Plastic Kabul. Photo: Ali Latifi
Plastic Kabul. Photo: Ali Latifi

Plastic Kabul

What the recent boom in the cosmetic industry means for the Afghan middle class.
Hamkar Plastic Surgery Hospital, Kabul.<br />Photo: Ali Latifi
Hamkar Plastic Surgery Hospital, Kabul.
Photo: Ali Latifi
Situated just next to a large roundabout, the Hamkar Plastic Surgery Hospital should be easy to find.
But this is Kabul, not an episode of Nip/Tuck.
In place of a sleek building that reflects the clean, simple standards of contemporary design is a metallic edifice still under construction where workers in hospital scrubs and surgical masks paint the walls and install light fixtures. Instead of electronic and new-age music, the sounds of saws and hammers are heard, as patients enter a bare lobby leading to a flight of stairs being mopped by nurses. The surrounding, evoking a sense of incompletion, may not be what one usually associates with an industry often seen to be indulging in a profligate exercise of turning out new tropes of 'perfection'. But it is very much in line with life in the new Kabul.
Nestled along the dirt road of the Char Rahi Sar Sabzi, Dr Aminullah Mohammad Ehsan Hamkar's eponymous private clinic is upstaged by the relative opulence of another of the Afghan capital's nouveau riche icons – wedding halls. With their multicoloured flashing lights and replicas of the Eiffel Tower, the wedding halls easily draw attention away from a clinic, which according to Hamkar, performs procedures that rival Western practices in their quality and precision.

My father doesn't know I'm here. He is against altering god's work.

What kind of plastic?
Hamkar, who began his PhD in Moscow just after the communist putsch and completed it before the end of the civil war in Afghanistan, hopes his practice will stand out not only from the garish saloon-e-aroosi, but also the many other cosmetic surgery practices that have sprung up around Kabul.
After completing his studies in Dushanbe and Moscow, Hamkar was startled to find people 'passing themselves off' as plastic surgeons in Kabul after having worked a month or two with foreign surgeons. At best, those who had earned certificates in neighbouring Pakistan would perform cosmetic procedures. Before Hamkar started his private reconstructive and plastic surgery practice more than ten years ago, doctors would ask him, "what kind of plastic do we use?" Questions like this alerted him to the dangers presented by the lack of proper regulations and oversight at multi-level surgical centres operating in broad daylight in the capital.
Hamkar hopes to change that and bring a renewed sense of professional competency to cosmetic and reconstructive surgery in Kabul. The fledgling cosmetic surgery industry he helped found has its share of critics. However, as he sees it, the economic realities of the nation are changing: "Afghanistan has a middle class now."
Despite the perceived economic advancements, the more conservative mores that have seeped into Kabul since the civil war of the 1990s remain largely unchanged.
Still recuperating from an eyelid tuck, 28-year-old Tahmena said it was frustration at people staring at her eyes that led her to seek the services of Hamkar and his associates. "I wanted to be beautiful," she tells me less than 24 hours after her surgery. Tahmena seems very pleased with the initial results. However, as she carefully holds her brightly-coloured floral print scarf to shield her face in an otherwise empty hospital room, Tahmena hopes the results are not too dramatic.
"My father doesn't know I'm here. He is against altering god's work," she said in a hushed tone. Without her father's support, Tahmena had to work to assuage the concerns of her mother. Aside from the objection that man should not alter what god created, Tahmena's mother was worried for her daughter's health. However her mother slowly came around to a hesitant acceptance. "She finally said 'If it makes you happy…'"
Religious objections to cosmetic procedures are nothing new. When confronted with statements about man's hands interfering with what god created, Hamkar, who also does plastic and reconstructive surgery at the Maiwand Teaching Hospital, says, "God also makes cleft palettes. If you touch one thing, why not another?" If the practical example of children unable to properly eat or drink due to a malformation does not suffice, Hamkar turns to a source few religious persons in Afghanistan are likely to dispute, Prophet Muhammad himself: "Allah is beautiful and He loves beauty."
Permission was only one of the obstacles Tahmena had to surmount before having her procedure. There was still the matter of payment. Though he too initially objected to an 'overpriced vanity', Tahmena's older brother fronted her the money for the procedure. Unwilling to provide an exact figure, Tahmena only told me the procedure cost "several hundred dollars".
Hamkar maintains that what his clinic charges for popular procedures – between USD 350 and USD 450 for rhinoplasty – is what "clinics [in other countries] charge for lab results". But even with a rising 'middle class', 20,000 Afghanis is no small sum for many people.
Reconstructive surgery
Only a day prior, while Tahmena was undergoing her procedure, the still empty halls of the lobby echoed with the sounds of an argument between an elderly man and hospital staff. "How long will the procedure take? How long is the post-op stay? The price will be very different if it's two days or five, I need to know in writing what it costs," the man who traveled to Kabul specifically for an unnamed procedure could be heard asking.
But it was a different question he asked that highlighted the contrast between cosmetic and reconstructive surgery in Afghanistan: "Do I need to pay for my own medicine and supplies?"
Though the hospital staff assured the man that any supplies or medication needed during the surgery would be provided by the hospital, his question was indicative of just how much access to medical care can be affected by finance in Afghanistan. Legally, public healthcare has always been free in Afghanistan. But with a GDP of around USD 20 billion and rampant corruption, Hamkar says, "all that is 'free' are these four walls."
Patients often have to supply everything from medicine to gauze before a procedure can be performed. Despite a lot of international aid spent on developing healthcare systems in Afghanistan, the Afghan health system lags behind even where it was 30 years ago. Prior to the wars and only a few months before Hamkar left for the Tajik capital to study, Afghan hospitals were fully capable of radiotherapy treatments. Today, the nation lacks the equipment for both radiotherapy and chemotherapy, and has to send a large number of patients suffering from all kinds of cancer to Pakistan for treatment.
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