Afghans face arduous mountain journeys for coronavirus tests

Poor access to hospitals is hampering Afghanistan's ability to track the spread of Covid-19

In rural Afghanistan, donkeys are both used to carry goods and luggage and as transportation. Stefanie Glinski for The National

Villagers near Khaja Gulrang in Afghanistan's Badakhshan province return home, walking through an empty river bed. Stefanie Glinski for The National

Shakira Nuddin, 30, sits in her house in Khaja Gulrang village, Badakhshan, holding her youngest son. Stefanie Glinski for The National

In rural Afghanistan, donkeys are used to carry goods and luggage and as well as for transportation. Stefanie Glinski for The National

Travelling by donkey in rural Afghanistan. Stefanie Glinski for The National

Khair Mohammed, 48, in Arashakh Poen village, Takhar province.

A man suspected of being infected with the coronavirus gets tested at Taloqan's coronavirus hospital. Stefanie Glinski for The National

Khaja Gulrang village in Badakhshan, Afghanistan, a far-flung community, hours away from the nearest hospital. Stefanie Glinski for The National

Arashakh Poen village in Afghanistan's Takhar province is cut off from the main road both by mountains and a river. Stefanie Glinski for The National

The view from Arashakh Poen village in Afghanistan's Takhar province. Stefanie Glinski for The National

Villagers in Arashakh Poen first heard about the coronavirus in March when dozens of men returned from Iran – residents of the community who had been working in the neighbouring country, now trying to escape the newly declared pandemic.

What they didn’t know – and dreaded – was that they had possibly brought the virus home to their remote village in northern Afghanistan’s Takhar province, cut off from main roads by mountains and a river.

That’s why when Khair Mohammed, 48, first developed symptoms that quickly grew worse, he faced a tough choice: staying at his house, hoping to recover, or braving the journey to Taloqan city – with the only Covid-19 testing facility in the province – about a three-hour donkey ride through the mountains, followed by a bus trip.

Too weak to travel, he opted to stay put.

His gamble worked out and he recovered, but Mr Mohammed is just one of millions of Afghans living in far-flung mountain villages, hours from roads and hospitals.

Afghanistan’s official Covid-19 infections have just passed 20,000, but with a test-positive rate at 40 per cent, actual figures are deemed much higher. With only 11 testing laboratories across the country, the capacity of Afghan authorities to track the spread of the disease remains low.

Khaja Gulrang village in Badakhshan, Afghanistan, a far-flung community, hours away from the nearest hopsital.

“We’re in the process of setting up 20 more testing facilities, but even these will remain in the provincial capitals,” said Dr Qadir Qadir, general director at the Ministry of Public Health. Even if testing was increased, little would change for far-away communities, he said.

At present, about 2,000 tests are evaluated in the country each day, but with up to 20,000 daily samples taken, laboratory staff are lagging behind, with result waiting times often as long as two weeks.

Mr Mohammed’s village has a lot to offer: a small coal mine up the hill keeps houses warm in winter; a salt mine provides work for some of the villagers and a nearby river irrigates crops and farmland. Arashakh Poen’s mountain views are spectacular, but villagers have long decried its remoteness: neither roads nor a clinic are nearby, limiting travel options to long hikes or uncomfortable donkey rides in summer, while heavy snowfall in winter forces the community to stay put for months at a time, disease or not.

Several villagers have made the journey; some of them remaining in hospital to wait for test results, while others returned home, but even after several weeks there were no updates on their infection status.

Dr Abdul Jamil Frutan, who runs Taloqan’s coronavirus hospital, says patients who test positive are contacted and no one is forced to stay at the clinic.

“Even those people who made the trip to the city didn’t quarantine in their houses upon their return,” Mr Mohammed admitted. “We’re farmers and animal keepers. In rural Afghanistan, you can’t just take a break. We work to survive.”

This resonates with other, equally remote communities.

In neighbouring Badakhshan province, Shakira Nuddin, 30, has only left her village Khaja Gulrang for medical reasons, including to test for Covid-19 last month, when she joined her brother and other villagers on a shopping trip to the city ahead of the Eid Al Fitr holiday.

“If they hadn’t travelled already, there would have been no chance for me to leave,” she said.  In her village, women don't travel unaccompanied. The journey – several hours on a donkey through an empty river bed followed by a taxi ride, is exhausting.

From the main road, Badakhshan’s provincial capital Faizabad and Takhar’s capital Taloqan are almost at equal distance – Ms Nuddin’s family usually opts for Taloqan, a slightly bigger market city.

After taking the test, Ms Nuddin never heard back from the clinic. “Getting tested was an exception,” the mother of four admitted, explaining that she previously hadn’t even left for childbirth. “We are born in the village, and many of us die here,” she said.

While the community had been informed about the virus and its dangers – by men returning from working in Iran, as well as by non-profit organisations working in the province – the arrival of the pandemic has been neither a shock nor a surprise.
"We've been through diseases and war here. We had our houses washed away by flash floods and we endure cold winters with few resources. A new virus is barely seen as a threat," she said.

“In our village, we assume that many have already passed the virus,” Khair Mohammed said. “But living far from any testing centres, most of us will never know.”