The other time she participated in a humanitarian mission in Afghanistan, in 2013, Brazilian nurse Ana Lúcia Bueno treated Taliban fighters in prisons. Now that the fundamentalist group has emerged from illegality and returned to government, she sits with them at negotiating tables to discuss the direction of the Afghan healthcare system.
The coordinator of medical operations for the International Committee of the Red Cross (ICRC) in the country, Bueno, 41, is responsible for 33 hospitals with a total of 10,000 health professionals, in addition to 46 primary care posts. She uses the knowledge she has gained during 15 years of working in conflict zones in places such as Yemen, South Sudan, Somalia and the Gaza Strip.
The ICRC took over the costs and management of Afghan hospitals after the regime change, when international funds stopped coming in and there were no more government resources to pay for them.
“Our role is to keep the system running. The population is not responsible for who is governing. Life goes on, women continue to have children, children continue to get sick and need a vaccine”, says Bueno, who arrived in the country in January and should stay until June 2023.
“Making the machine run in dysfunctional contexts”, as she defines it, requires negotiation — to gain access to hospitals, to convince authorities to place people with a technical and non-religious profile in positions of trust, so that women are not excluded. “It takes time, dialogue, diplomacy.”
According to Bueno, Afghan health professionals continue to work — the Taliban have tried to present a more moderate image than when they ruled the country 20 years ago, maintaining some women’s rights, although withholding several others.
“In every dialogue with them [os talibãs] we reinforce that there should be no discrimination. In some more conservative provinces, they need an escort from a male family member to get to work, but this is not so common anymore. In Kabul we hardly ever see that anymore,” he says. “What they report is that they feel uncomfortable with disapproving looks. There’s a whole generation that has gained some freedom in those 20 years and now it’s having to tread carefully, testing the limits.”
Women make up 32% of the workforce in ICRC-run hospitals in Afghanistan. Most work in nursing, gynecology and obstetrics or general practice. The sites have separate wards for female patients, and they need to bring a family member to see a male specialist — but that was before the Taliban.
Bueno, who in the country wears a veil, pants and a long shirt covering her arms, is often the only woman at official meetings with health officials.
“Up until now I have been respected as a professional. They know that the dialogue has to be with me, that I am the one who makes the decisions”, she says, and then tells an episode she lived the day before, in Kandahar (the Taliban’s spiritual capital). “A colleague who is a hospital manager approached me and said, ‘Can I ask a question? Why are most of the heads of the Red Cross women?’ I replied that it must be because we are competent. He broke into a smile.”
If on the one hand there was a drastic reduction in the number of wounded after the group took full power and the end of direct fighting, today the pediatric wards are crowded with cases of malnutrition. According to Bueno, one of the explanations is the economic crisis that came with the departure of most international organizations from the country, leaving many people who had a source of income directly or indirectly linked to this system without a job.
“The banking system has collapsed and so far has not returned. The poor have more mechanisms to deal with a situation like this, but in recent years a new middle class has emerged that does not have the same skills.”
Bueno also observes another phenomenon: the population of villages that were previously isolated because they were in Taliban territory are now able to access the health system. With this, the increase in the registration of some diseases may have to do with the fact that these patients have only now entered the radar.
“We are experiencing a measles epidemic, for example, and we don’t know if it is because of this phenomenon or a reflection of the lack of vaccination. We are still trying to see the size of the damage and what it will mean in the coming years.”
A specialist in public health and pulmonology, Bueno is from Rio Grande do Sul and began his humanitarian career in 2007, part of the first Doctors Without Borders team in Brazil. She was 26 years old and took private English lessons after work and on weekends to learn the language in four months, in time for the selection. Her first assignment was to Somalia, where she worked in a tuberculosis program.
Four months before the trip, she got married. Her husband, who is an airline pilot, lives in São Paulo and was never able to go with her on missions: of the 21 missions he has been on, 20 were in war zones, where it was not possible to take escorts. Even in the exception, in Mexico, where Bueno spent a year working on migration and urban violence in five countries in the region, he was working and could not go.
Every two and a half months, on average, she has two weeks free to see her family in Brazil. “It’s a career that in the first year you either like it and stay forever or you already know you won’t want to continue. Many people enter with the illusion that it’s going to be an adventure, but you can’t romanticize it. It’s a life commitment”, she says.
In Afghanistan, she says that she works at least 12 hours a day, including on weekends, and that she always has to be on her cell phone. When she spoke to Sheeton the 20th, had been a particularly stressful week as one of the ICRC-supported hospitals had treated the wounded in an attack on a boys’ school in Kabul.
Bueno herself was the victim of an attack in the country in 2013, when a Red Cross office was raided in Jalalabad, in an attack that lasted two hours. A guard died and there were injuries.
“The risk exists and I am living proof of that. It was traumatizing, I don’t even talk about it much. I needed some time to recover”, he says. “We have a risk assessment scheme that has to be taken very seriously. The moment a person relaxes into small things, security can be compromised.”
She also polices herself so as not to lose empathy in the face of the violence she witnesses. “The moment we start to normalize the absurdities that war creates, we stop meeting the demands of the population. You have to remain strong in times of crisis, but you cannot lose humanity. This is an exercise that takes years old.”
For Bueno, one of the most interesting aspects of his work is getting to know each country where he works in depth. “We are not a visitor, we become part of the system. This allows us to get to know the country with its regional and cultural nuances, in a way that a tourist never can. It’s fascinating.”
