ARZAN QIMAT, Afghanistan -- Dr. Mohammad Azam hurries out of the cool, dank waiting room filled with women and their sick children and steps into the bright sunshine.
Dressed in a white lab coat, a stethoscope slung around his neck, the doctor lights a cigarette and chats with the guard posted outside the community's lone health clinic.
It's at least his second cigarette break this morning.
Three years ago, the government had to force Dr. Azam to work in this desolate place, dubbed "New Kabul" by the former Communist government. It was supposed to be a suburb within easy commuting distance to Kabul. Today, Arzan Qimat appears a dust bowl on the edge of nowhere.
A pediatrician, Dr. Azam volunteers to work in the clinic because of the enormous need. He sees dozens of children a day in an office with only an examination table, a metal desk and a guidebook of medical terms. He uses the book less frequently now. The ailments of his patients have become familiar.
Casually, Dr. Azam reviews aloud his diagnoses for the week. Tonsillitis. Malnutrition. Renal bleeding. Tuberculosis. Bacterial meningitis. The problems vary in severity, but they all have a common cause:
"Poverty," says Dr. Azam. "People cannot take care of themselves under these conditions."
After the Taliban fell in November, the village started to fill with refugees, returning from Pakistan, Iran and Mazar-i-Sharif in northern Afghanistan. Unable to afford the rents in Kabul, they squat in the abandoned buildings here. Judging from his records, Dr. Azam says the population has jumped from 2,000 to 6,000 in the past few months.
Much of the well water is "salty," as the locals say. Dr. Azam says it's polluted with sodium and hydrogen chloride, which causes ulcers and gastrointestinal problems.
Stiff winds whip dust through the empty streets like a scene from the Wild West. This dust carries a hidden danger: human waste that had been dumped on the streets and dried in the sun because there are no sewers or septic systems.
Dr. Azam stamps out his cigarette, walks through the crowded waiting room to his office, and calls for his next patient.
ARZAN QIMAT is about 10 miles from Kabul. But it takes Dr. Azam nearly an hour to reach the clinic each day.
Just outside Kabul, the paved road gives way to dirt and rocks, running along green rice paddies brimming with water. The landscape becomes barren, and the road resembles a mogul course. Cars heave and lurch over every ditch. The Afghan government encouraged people to settle in this suburb, but it never built a road to get here.
It used to take Dr. Azam and the other doctors and nurses about an hour and 45 minutes to travel the 10-mile route by bus. Today, they ride in a white jeep provided by Médecins Sans Frontieres, the French arm of the nonprofit Doctors Without Borders, which runs the clinic.
Along the road, there are clusters of brick kilns, like giant beehives, belching thick black smoke into the air. The brick makers say they chose Arzan Qimat, not because of the quality of mud, but because there's plenty of room. No one else wants to work here, they say.
High tension towers run through the village, connecting Kabul with Lowgar in the south. But none of that electricity goes to Arzan Qimat, and there are no plans to install it anytime soon.
When Dr. Azam arrives at the clinic at 7 a.m., there's already a line of patients. Between 150 and 250 people, mostly women in burqas and children, visit the clinic each day.
As a male doctor, Dr. Azam used to fear the Taliban would punish him for speaking with women, as he treated their children. There was a female gynecologist and a midwife at the clinic, but Dr. Azam was the only pediatrician. He had no choice but to treat them. "I was waiting for their whip to hit my back," he says.
The Taliban may have left town, but the health problems remain. Refugees, traveling from Pakistan and Iran, are not acclimated to the weather and succumb easily to illness. They come to the clinic without records of vaccinations or doctors' visits -- if there were any.
Nomads, known as Kochi, who pass through the village on their way to greener pastures in the west, stop at the clinic for a checkup. After living outside with their sheep and goats for the past two months, they have colds, bronchial infections and stomach ailments.
IN ONE MORNING, Dr. Azam treats a stream of sick children -- all of them suffering from diarrhea and weight loss.
Mina Gul brought her two-month-old son to the clinic. He was asleep and swaddled in a white blanket. Even as the doctor poked and prodded at his skin, the baby would wake for only moments at a time. Dr. Azam told his mother, a Pakistani refugee, to keep giving her son fluids.
His next patient, Mirwas Janasar, 2, raised more concern. The little boy had diarrhea with traces of blood.
Afghanistan has one of the highest infant and child mortality rates in the world. According to Physicians for Human Rights, a Boston-based health research and advocacy group, diarrheal diseases cause many of those deaths, killing 85,000 Afghan children every year.
Dr. Azam tries not to become discouraged, but the problems seem overwhelming and the solutions out of his control. He compares himself to a farmer planting crops that won't grow.
When a farmer seeds the ground, he wants the land to give him something in return, Dr. Azam says. "If the land doesn't give him anything, he gets sad."
But never sad enough to give up.
The four doctors at the clinic say they have adequate medicine to treat their patients. Water has to be transported to the clinic by car. But clinic workers are digging a deeper well, which they hope will provide suitable drinking water. Médecins Sans Frontieres workers are looking to install a solar panel on the roof to generate electricity.
But the clinic still cannot handle emergencies so patients have to travel on their own to the hospitals in Kabul, a journey that can be both time-consuming and treacherous.
Dr. Azam and his colleagues recently pooled their change to transport a boy to the hospital in a taxi. By the time he left, the boy's hands were clenched and his head reared back, as meningitis racked his body.
The boy survived the long trip.
Dr. Azam spends the afternoons working in Kabul at a private clinic with paying patients. It's more lucrative and closer to his home. But he still comes here every morning, where a line of women and sick children wait for him.
"I am a doctor," he says. "This is my job."
