JALALABAD, Afghanistan — When Capt. Brian Weber came to eastern Afghanistan to run an Army medical clinic, he took on a challenging patient: The ailing, aging health care system.

Weber, a physician’s assistant and Texas Army National Guardsman who runs the Jalalabad Provincial Reconstruction Team clinic, has spearheaded several small-scale initiatives in Nangarhar province aimed at improving medical services for Afghans. Medicines alone aren’t the cure, he said.

Instead, Weber sticks to a more basic prescription: good sanitation, better medical education and practices, and plain old bricks and mortar. Projects range from $50,000 worth of toilets to new equipment for a neonatal intensive care unit.

Years of running his own clinic in tiny Commerce, Texas, have prepared him well for the experience, he said.

“I come from a rural community, so I’m used to infrastructure problems,” he said. “The same type of problems we face in rural America, they have here.”

The struggle, he said, is often to convince Afghan health care providers that their two most-requested items — medicines and new equipment — will only provide a quick fix for their ailments.

“The problem with equipment is they don’t know how to use it,” Weber said.

The long-term cure, he said, is “better education. That would raise the level of care quite a bit.”

Much of his efforts involve talking to local doctors and overseeing basic infrastructure products — many of them related to sewage and sanitation — at local hospitals. Better sanitation, he said, will greatly assist in alleviating the nation’s top three pediatric maladies: diarrhea, pneumonia and malaria.

At Nangarhar University Teaching Hospital in Jalalabad, where the air is filled with an indefinable, indescribable sour smell caused by desperation, crowding and not enough of anything, “there was raw sewage on the operating room floors,” Weber said.

It’s not just the facilities — several of which were built by aid groups and donor nations in the 1950s and 1960s and appear not to have been touched since — that are antiquated. Education, Weber said, is also a little behind the times.

“On (the medical school library’s) current periodical rack — the current one — is a 1972 edition of the New England Journal of Medicine,” he said, shaking his head.

He’s tried to bring educational materials and foster partnerships with American medical schools.

Local officials say that the reconstruction team’s efforts have made a great difference in patient care.

“This is good,” said Nangarhar University Teaching Hospital director Dr. Nasir Kammawal.

Regarding the hospital’s top priorities he said, “The most important thing is medicines. And the second, an incinerator.”

“There are a lot of things here we don’t have,” said Dr. Obaidi Rahman, a pediatrician at Jalalabad’s main hospital, who asked for concentrated oxygen and nebulizers.

Despite the request, Rahman, who graduated from the province’s medical school two years ago, agreed that the American-led reconstruction of the health care system is moving at a satisfactory pace.

“It’s happening in the right order,” he said, through a translator.

Other officials agreed.

“When I first came here,” said Dr. Amanullah Hamidzai, chancellor of Nangarhar University, indicating the neonatal intensive care ward, “there was water all up and down this hallway. If Capt. Weber was not here, probably we would not have half of what we have in this hospital.”

Hamidzai, an American citizen who recently returned to the university where he taught during the 1960s and 70s as a young doctor, said the Afghan health care system during that time was “completely like Europe. It was very good.”

When asked how long it would take to restore the nation’s healthcare system to modern standards, he paused and contemplated.

“Maybe ... forever,” he said with a wistful smile. “No, maybe four years. Four to five years.”

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