So like no shit, there we were…

Today we went on the PRT (provin­cial recon­struc­tion team) base in Jalal­abad. Lou had arranged the meet­ing. A New York­er was run­ning it. He spoke fast (refresh­ing­ly so, as one’s mind atro­phies from a pre­dom­i­nance of inter­ac­tion with non-native speakers.)

He was excit­ed about a par­tic­u­lar new fund­ing stream from USAID that was meant for off­beat projects that are not being addressed by oth­er large funds. Lou had con­nect­ed a few dots and sug­gest­ed crick­et fields and now the ball is rolling.

Dur­ing the meet­ing I was drown­ing in acronyms. At some point, I request­ed a time out to deacronymi­fy. I think it was around the point that we were told that the pro­pos­al should, of course, address COIN (counter insur­gency) objectives.

Here are some notes from that time-out:  Feel free not to read them!

• PDC (Provin­cial Devel­op­ment Coun­cil) staffed by PC (Provin­cial Coun­cil) who are the vot­ing mem­bers, 19 of which 5 are female.
• ASOP — Afghan Social Out­reach Pro­gram, sub­set of IDLG
• DDA — Dis­trict Devel­op­ment Association
• These are all Shu­ra’s of appoint­ed peo­ples. But the best guys are the rung bel­low them, the CDC — com­mu­ni­ty devel­op­ment coun­cils — “They are like the small town PTA (Par­ent Teacher Asso­ci­a­tions) in Amer­i­ca that know what the local issues are, and they are elected!”
• TWG — tech­ni­cal work­ing group, usu­al­ly the TWG of some sub­ject under some oth­er acronym.
• IDLG — Inde­pen­dent Direc­torate Local Gov­ern­ments (a USAID gov­ern­ment part­ner). They appoint local gov­er­nors, and DDBs (Dis­trict Devel­op­ment Boards)
• ANDS — Afghan Nation­al Devel­op­ment Strategies
• StI­KA — Sta­bil­i­ty in Key Areas. It’s the new LGCD (Local Gov­ern­ment Com­mer­cial Development).
• NSP (Nation­al Sol­i­dar­i­ty Pro­gram) is under the NMRD? WTF?

They did not have a shop at the PRT, but we were able to get some hygien­ic prod­ucts at the MWR (Morale Wel­fare and Recre­ation) bunk.We had lunch at the DFAC. Over lunch, it was men­tioned that USAID is under­staffed in the region. I asked where the bot­tle­neck lies. It turns out that there are more USAID employ­ees hang­ing in Kabul/Bagram ~1200 than are active in the field. And the rea­son is quite an Amer­i­can one. In prac­tice, USAID employ­ees that are part of the PRT have to be phys­i­cal­ly fit to ride with full Army gear in MRAPS. (And that is the only way they are allowed to get around to get their work done.) It’s hot and heavy.

As an Amer­i­can com­pa­ny, USAID has to fol­low the Amer­i­can with Dis­abil­i­ties Act for Hir­ing, which means that they can­not exclude peo­ple based on their lev­el of fit­ness (some­times age or dis­abil­i­ty) for the task at hand. USAID has prob­lems recruit­ing peo­ple that are younger and can get clear­ance. So their pay­roll is full of old guys.

The net result is all the phys­i­cal­ly fit peo­ple (600 of them) are active in the field while Kab­ul is a “geri­atric ward” (1200).

“This is your government.”

***

When you live “out­side the wire”, going the DFAC (Din­ing Facil­i­ty) at the base is kind of like raid­ing your par­en­t’s pantry when you are a poor stu­dent. You fill your pock­ets with gum, soda, cook­ies, cliff bars, etc. Here was our score today:

We focused on gum.  Thanks Uncle Ben!

***

Dave was telling me that when he hung out with the Spe­cial Force guys, all of their sto­ries start­ed with, “So like no shit, there we were…”

So like no shit, there we were on an Amer­i­can base play­ing bas­ket­ball and trash talk­ing in Russ­ian with our Afghan driver/translator Najib, inside an emp­ty swim­ming pool, which was ini­tial­ly built by the Rus­sians when this was their Army base and then used by the Tal­iban as an exe­cu­tion ground. You could see the bul­let scars on ground, and the US sol­diers would cir­cle around us, doing their busi­ness, occa­sion­al­ly recov­er­ing our balls which had bounced out of the pool.

***

And to round out today’s ram­ble is a good one, but you have to click some links. It’s a TAL (This Amer­i­can Life) episode. In the first act you will meet JD (Japan­ese Dude) — aka Mohammed Jawed. He’s the one that took the pho­to of the sheep and boy on the bike (ear­li­er post). Well any­ways, lis­ten to this act, which is like the first 5 min­utes: http://www.thisamericanlife.org/radio-archives/episode/369/poultry-slam-2008

Measure Ma’an

Each be ruled by his own.

Here in Jalal­abad, wood is ruled by a ma’an (my spelling, try­ing to capu­ture the pro­nun­ci­a­tion. Else­where it is spelled mann.)

Most of the heat­ing and cook­ing ener­gy needs in Afghanistan are sup­plied by wood. Along the road you see plen­ty of shacks of the wood deal­ers.  Today we stopped by.  Typ­i­cal­ly kids are chop­ping wood while an old­er beard­ed pro­pri­a­tor (father/uncle) is sip­ping tea and wait­ing for customers.

I noticed our wood was being weighed on a scale, but instead of weights, it was coun­ter­bal­anced by cal­i­brat­ed rocks. The unit of mea­sure is a ma’an, which varies local­ly but approx­i­mates 7 kilos.

A ma’an is the pref­ered unit of mea­sure for wood, and is part of a com­pre­hen­sive unit scale:

Accord­ing to wikipedia the ety­mol­o­gy can be traced to the Hebrew word mana, as in mana from the desert. Every day the wan­der­ing tribe that exit­ed Egypt was allowed to col­lect one Omer of mana. On Fri­day, the col­lec­tion was dou­bled, to pro­vi­sion for Sat­ur­day, the Sab­bath day of rest. An omer is a dry weight of mea­sure, approx­i­mate­ly the vol­ume of 3.5 liters of water. On Fri­day there­fore, the col­lec­tion was 7 vol­u­met­ric liters, which would weigh 7 kg (if water).

To con­tin­ue reach­ing for more con­nec­tions, the ma’an weights were made of stone. An impe­r­i­al stone is 6.35kg, not that far off?!

None of this should be con­fused with a ma’an in Pak­istan. A Paki­ma’an is appar­ent­ly 7 times an Afghan ma’an.

Not every­thing is mea­sured using this scale. If for exam­ple you were buy­ing opi­um, then the stan­dard mea­sure is a “kar­tus” defined as the weight of a AK47 bul­let cas­ing, a sen­si­ble stan­dard from those at hand.

Shoes

Behold a typ­i­cal Afghan shoe.

It’s a dress shoe, because that’s the pre­ferred style. And it’s bent in the back because they wear them like slip ons. This is con­ve­nient. Afghans take them on and off so many times a day. They take them off to pray 5 times a day. They take them off when­ev­er they enter some­ones house for tea, etc. etc. And this is prob­a­bly true across most of Cen­tral Asia and many oth­er coun­tries in the “rug belt”.

What I don’t under­stand, is why no one has seized on this huge mar­ket oppor­tu­ni­ty of mak­ing a fan­cy dress shoe, with­out a back, a dress shoe nat­ur­al slip on? (Maybe some­one has, and this is your oppor­tu­ni­ty to mar­ket their wares in the comments.)

Anoth­er inter­est­ing con­se­quence of this, is that there is so much more work for shoe shin­ers. When you take off your shoes in the restau­rant, they walk up and make their offers.

This is a much more nat­ur­al way to do this than what I have seen in the West. I just could­n’t ever imag­ine myself sit­ting down to have some­one kneel in front of me to shine my shoes, while I made myself look busy with a news­pa­per. To bad, I have noth­ing to shine here. Can you guess why?

I got some army boots from the Bush Mar­ket the oth­er day, and while I smelled weed when we walked into the shop, I did­n’t expect the shop­keep­er to take a mini break to toke on a apple core bong in the process:

Guns and Welding

I was play­ing around with my stick weld­ing skills when I attract­ed the inter­est of one of our secu­ri­ty guards. He wan­dered up, try­ing to look non­cha­lant, to check out what I was doing that was mak­ing so many sparks.  I showed him the sec­tion of an ammo case lid where I had ground off the paint and was prac­tic­ing lay­ing welds.

When he saw I also had a 40mm bul­let cas­ing, then he got real­ly excit­ed. He pulled out a clip of live ammu­ni­tion from his cam­mo vest and took an AK round out to ask, through ges­tures and hand sig­nals if what I had was also a bul­let. I nod­ded in agree­ment and he was hooked. Unfor­tu­nate­ly, the bul­let cas­ing turned out to be alu­minum not steel, but I had acquired my first student.

Mean­while, dur­ing our bul­let exchange, Mustafa, the “house com­man­der” joined us. Not want­i­ng to be left out of the fun he picked up my angle grinder and ges­tured how he should use it, look­ing to me for a nod of assent. I showed him where the but­ton was and next thing I knew the two guards were grind­ing all the paint off of my ammo case, prep­ping it beau­ti­ful­ly for lots of weld­ing prac­tice. If we got those two guards into the Boxshop, all our FLG grind­ing prob­lems would be over. They worked the thing metic­u­lous­ly, get­ting at every scrap of green paint until the thing shone.

And that’s how I came to teach two Afghan men with very large guns who speak absolute­ly no Eng­lish how to stick weld. We’ve arranged for les­son two tomor­row, inshal­lah, as they say here.

Ladies Night…. Or Afternoon

The park in Jalal­abad is, like so many oth­er pub­lic venues, open to men only. How­ev­er, Wednes­day is spe­cial. Wednes­day is Ladies Day.

So Jenn, Kel­lie and I decid­ed to take a soc­cer ball and spend a few hours hang­ing out in the park with the Ladies of Jalal­abad. The park is sur­round by tall walls, shield­ing it from the views of passers­by and the entrance is guard­ed, per usu­al, by a young man in fatigues hold­ing an AK-47. He gave us a nod of approval and we slipped through the gate to the oth­er side.

Women on the streets of Jalal­abad move quick­ly and pur­pose­ful­ly from one des­ti­na­tion from the next, cov­ered in sky blue burqas. They don’t linger on the streets with the men. If lucky you may catch glimpses of red or pur­ple pants or a spark­ly dress under the burqa’s cloak, but women are large­ly anony­mous, cov­ered crea­tures in public.

How­ev­er, the park on Ladies day, safe from the eyes of men, is an out­let. An oppor­tu­ni­ty for girls and women to enjoy being out­side, uncov­ered, large­ly free. They sat in clus­ters and groups, burqas cast aside, dressed in bright col­ors with heavy lay­ers of kohl and lip­stick paint­ed on. I have no way of know­ing if they always are so done up or if the park was an excuse to real­ly dress up, but the gold­en fields of parched grass were cov­ered in the sat­u­rat­ed greens, pinks, reds and pur­ples of the tunics and head­scarves of these women.

While their moth­ers and old­er sis­ters sat in the grass, pic­nick­ing and drink­ing tea, hordes of chil­dren ran around, scream­ing, play­ing, and fight­ing with one anoth­er. When Kel­lie, Jenn and I start­ing kick­ing a soc­cer ball around and invit­ed some kids to join us we near­ly start­ed a riot as the clus­ter of kids raced after the ball.

The kids also love hav­ing their pho­tos tak­en. The boys espe­cial­ly will preen and strut in front of my lens, try­ing on dif­fer­ent pos­es and ham­ming it up. The girls bring for­ward their baby broth­ers for pho­to ops, their way of try­ing to get cap­tured on film. They’ve been taught they shouldn’t have their pho­to tak­en, but if it hap­pens that they are hold­ing a baby who is being pho­tographed and they make it into the shot…..

As we were obvi­ous­ly not Afghans, we gar­nered lots of atten­tion, not only for our soc­cer ball and cam­eras. Young women fre­quent­ly approached us, chat­ter­ing away in Pash­to, not car­ing that we had no clue what they were say­ing. They showed us their babies, offered us tea, and ges­tured emphat­i­cal­ly to get points across that were thor­ough­ly opaque to us. Smiles abound­ed and we nod­ded enthu­si­as­ti­cal­ly, not know­ing what we were agree­ing with.

A few men are allowed in the park- they run the food stalls and the pho­tog­ra­phy stu­dio in one cor­ner. For some rea­son this arrange­ment is under­stood as accept­able and the girls pose for pho­tographs and buy ice cream cones with their head­scarves down.

How­ev­er, the guard on duty with­in the walls was female as well- the first female Afghan secu­ri­ty per­son­al I’ve seen. She was a stocky woman in fatigues and black head­scarf who bran­dished her large knife men­ac­ing­ly at kids who appeared to be mis­be­hav­ing. Unlike every male in fatigues, she had no gun.

After a few hours of enjoy­ing the sun­shine we said our good­byes to new friends, promised to return next week, cov­ered up our hair once more, and passed back onto the street, back into the realm of men.

Coming to Terms

And there’s more where these came from…

Kabul to Jalalabad

The ride from Kab­ul to Jalal­abad was long and adventurous.

I saw a dog being killed in Kab­ul. They are con­sid­ered pests here.

Most of our dri­ve time was spent sit­ting in traf­fic on the windy seg­ment of the Kab­ul Riv­er Gorge (also called Tan­gi Gharu).

Part of the rea­son for the bad traf­fic is that peo­ple tend to dri­ve on both sides of the road in both direc­tions. At first it seems like a good idea, you get a lit­tle bit ahead of your neigh­bor. But local opti­miza­tion can some­times lead to glob­al cat­a­stro­phes. Such deci­sions cre­at­ed grid­locked jen­ga puz­zles on nar­row roads with pre­car­i­ous drop offs and small mar­gins for error. Each one took hours to resolve.

Had we left much ear­li­er in the morn­ing (say 6am) we would­n’t have expe­ri­enced this traf­fic. And so we sat in the car, or got our to stretch our legs, or to take pho­tographs of war debris from var­i­ous wars, such as this Russ­ian tank:

When­ev­er we’d show our faces, a crowd would appear. The younger ones talked to us. Some­times they asked for “ener­gy” = soft drinks.

I met a boy named Pamir who is studing law, on the right. He’s gonna be a bureau­crat some day. On his stu­dent card, you could see his blood type.

Jin­gle Trucks from Park­istan con­sti­tute a large frac­tion of the traffic:

Out of the gorge we were out in broad open val­ley swept by opaque dust storms, bend­ing trees horizontally.

The road had warn away in parts, and you have to be ready to stop abrupt­ly when you spot a pot hole. This caused our acci­dent. A truck in front of us stopped. We stopped right behind it, and many cars stopped on our bumper behind us… So far so good. But the truck in front start­ed back­ing up. We honked. It did­n’t care. It ate half our hood before it final­ly stopped.

Thank­ful­ly, its clear­ance was high enough that the dam­age was only cos­met­ic. Since there is no insur­ance and no pro­to­col for how to resolve acci­dents oth­er than by talk­ing. Our dri­ver (on the right) got out and start­ed a long nego­ti­a­tion direct­ly on the high­way. (Truck dri­ver is on the left.)

This is one of the main rea­sons why for­eign­ers are dis­cour­aged from dri­ving. All of the NGOs and even the secu­ri­ty com­pa­nies now hire local dri­vers. This is the kind of advice we get: if you hit some­one, get the hell out of there. If you stick around, you will get clubbed. (And if you see some­one dead/wounded, look out for boo­by traps. This one applies not only while driving.)

One amaz­ing thing about Afghanistan is the jusx­ta­po­si­tion of the past and the future, and how one caus­es the oth­er.  There is no postal ser­vice, for exam­ple.  You have to rely on email.

There will prob­a­bly nev­er be a wired tele­phone net­work here, but every­one has a cell­phone. Cell­phone tow­ers (when not pow­ered by gen­er­a­tors) are pow­ered by solar.

We did see con­struc­tion crews lay­ing fiber optics cable along the high­way. Sad­ly, I missed the pho­to op. Maybe Lou or Todd got it?

Much of the coun­try’s hydro­elec­tric facil­i­ties are locat­ed along this stretch of riv­er, so the fact that the Kab­ul riv­er is but a stream, presents a problem.

Approach­ing Jalal­abad, we pass the Darun­ta Dam and afte­wards is Nan­ga­har Uni­ver­si­ty whose ini­tial build­ings were used to house the Sovi­et engi­neers that built and oper­at­ed the Darun­ta Dam.

Right before you breach the perim­iter of Jalal­abad city prop­er, take a left down Awe­some Tod­d’s road (see Open Street Maps).

Wel­come to the Taj. This has become our home (Lang­ton Annex 😉 More about the Taj and its occu­pants in anoth­er post.

For now, a teaser:

This is part of the longer nar­ra­tive blog series, that start­ed with What is Nor­mal any­way? I will try to have this sub-series fol­low a lin­er nar­ra­tive, while the gen­er­al post stream will jump around.

Hardware Shopping

As it turns out, Jalal­abad has no Home Depot. Not even an ACE Hard­ware. So, when I want­ed to pur­chase an arc welder  to make fur­ni­ture and art out of old ammo cas­es and bul­let cas­ings, Mehrab took me and Peretz to the bazaar. More specif­i­cal­ly, to the hard­ware store sec­tion. Jam packed stalls nes­tled next to one anoth­er, crammed and over­flow­ing with jumper cables, machine belts, rusty bolts, and cheap Chi­nese screw dri­vers. Func­tion­ing as indi­vid­ual isles of the larg­er bazaar,  the coex­ist­ing shops all stock many tools while each spe­cial­iz­ing in a few. A cus­tomer starts a rela­tion­ship with one own­er, who then sends run­ners from their staff to oth­er shops along the way to grab any items not in stock. We choose a shop, out of acci­dent more than rea­son, and began the process of buy­ing tools.

First, we col­lect­ed assort­ed wrench­es, ham­mers, and screw­drivers, ges­tur­ing “bigger,” “smaller” or “heavier” to suit our needs. We perused the sin­gle aisle, avoid­ing the pair of chick­ens roost­ing under the ful­ly stacked shelves. Angle grinder. Leather gloves. Weld­ing gog­gles. Check. Our shop­keep­er showed us a file and told us it was “Good qual­i­ty. Made in India.” Even Afghans have dis­re­gard for cheap Chi­nese made tools, although the store was still full of them. The qual­i­ty prod­ucts they see come from India, hop­ping over Pak­istan to com­pete with infe­ri­or goods.

Then onto the rea­son we were there: a welder. The shop sold one option, a red met­al box with 5 thick screws pro­trud­ing, announc­ing the amps they would draw, and a ground­ing screw stick­ing out the side. Instead of a pow­er cord, two bare wires extend­ed, ready to be stuck direct­ly into a sock­et, as is the local pre­ferred method of “plugging in” an appli­ance. How­ev­er, for this com­pact met­al box to be use­ful as a welder we need­ed to piece togeth­er its attach­ments. The store sold us eight meters of heavy duty wire, cut off a large yel­low spool. Next, we debat­ed the mer­its of the two options for han­dles and set­tled on a heavy duty grip. But when I inquired about a ground­ing clamp, vital­ly need­ed to com­plete a weld­ing arc, our shop­keep­er seemed per­plexed. He sent one of the boys lin­ger­ing in the shop off to find one, while he encour­aged us to drink some chai. We perched on tanks of gas and sipped steam­ing hot cups of sweet­ened, car­damom fla­vored tea until the boy returned, with a pair of jumper cable clips. Not exact­ly what I had in mind, but it’d do.

The bits and bobs added up to most of what would be need­ed or use­ful for arc weld­ing and so, as we paid the shop­keep­er, our tools and sup­plies were loaded into a wheel­bar­row for trans­port. Next step: assem­bly and test­ing of the Mac­Gyver welder.

Nangahar Public Hospital

The first time we came to the hos­pi­tal, the staff apol­o­gized pro­fuse­ly for not being able to host us. They were deal­ing with the wound­ed of a sui­cide bomb­ing inci­dent in the dis­trict. There was one casu­al­ty. Five peo­ple were in the OR. And they were embar­rassed in front of us, that such things hap­pen in their coun­try. We left, and came back yesterday.

Nan­ga­har Pub­lic Hos­pi­tal (NPH) is a Region­al Post-Grad­u­ate Teach­ing Hos­pi­tal for the East­ern Region of Afghanistan. The East­ern Region cov­ers the provices of Kunar, Nan­ga­har, and Lagh­man. But in prac­tice it also cov­ers the provinces of Log­ar and Kapisa, and the dis­trict of Siro­bi (which tech­ni­cal­ly belongs to Kab­ul Region).

22 clin­ics from the East­ern Region trans­fer patients to NPH by ambu­lance. The hos­pi­tal does not have an Emer­gency Response Ambu­lance team. Three dis­trict hos­pi­tals of Kama, Ghani­ki and Khugiani also refer patients to the NPH.

Loca­tion. The hos­pi­tal is locat­ed in the city of Jalal­abad, halfway between Peshawar and Kab­ul, on the main high­way link­ing the two. This high­way is the main transport/supply line between Pak­istan and Afghanistan. The bor­der check­point, called Torkam Gate, is a half hour to the East and is the entrance to the Khy­ber Pass. The stretch of high­way west to Kab­ul is con­sid­ered the most dan­ger­ous road in the world by the NYT. It is dan­ger­ous because of acci­dents. And often, because of acci­dents, traf­fic on the nar­row road comes to a com­plete stop. NPH sees 600 patients from car acci­dents each month. Some patients pre­fer to be referred to NPH rather than hos­pi­tals in Kab­ul because, if the issue is suf­fi­cient­ly crit­i­cal, it is a much clos­er dri­ve to Peshawar, Pak­istan where there are hos­pi­tals bet­ter than any­thing in Afghanistan.

The hos­pi­tal has 10 depart­ments, which all train post-grad­u­ate spe­cial­ists: Inter­nal Med­i­cine (Med­ical Ward), TB, Infec­tious Dis­ease, Pedi­atric, Gen­er­al Surgery, Ortho­pe­dic, OBGYN, ENT (Ear, Nose and Throat), Opthamol­o­gy, Neu­ropsy­chi­atric (opened this year.)

A post grad­u­ate med­ical spe­cial­ist is some­one who has grad­u­at­ed a sev­en year med­ical pro­gram, CONQUER EXAMINATION, like SAT that deter­mines which Fac­ul­ty at which Uni­ver­si­ty you can attend: The order of RANK based admis­sion by fac­ul­ty fol­lows: Med­ical, Engi­neer­ing, Eco­nom­ics, Law, Agri­cul­ture, Com­put­er Sci­ence, Lit­er­a­ture, etc. So to get to med­ical school in the first place, they need­ed top marks. — Accord­ing to Ahmed “Zia” Ahme­di Here Afghan stu­dents vent about high­er edu­ca­tion on Face­book.served a 2 year prac­ti­cal at a region­al clin­ic, and received high marks at a cen­tral exam­i­na­tion in Kab­ul. Based on their grades and spe­cial­ty of inter­est, they are sent to post-grad­u­ate train­ing hos­pi­tals around the coun­try. Most spe­cial­ists train for 3 years, OBGYN is 4 years, and surgery is 5 years.

Accord­ing to Alhaj, Alhaj means that he has per­formed sev­er­al pil­grim­ages to Mec­ca.  If it were just one, he would be mere­ly Haji. Prof. Moham­mad Ismail “Alam”, Chief of Med­ical Ward, there are 30 spe­cial­ists being trained in the inter­nal med­i­cine depart­ment now, and 15 fac­ul­ty. (By con­trast, there are 3 trainees in the neu­ropsy­chi­atric depart­ment, hav­ing start­ed just this year.) The Med­ical Ward has 15 beds in the ICU/CCU. 8 for women and 7 for men. There are 12 nurs­es, 6 female and 6 male, and 1 head nurse. In the ICU and CCU both men and women take care of patients of both gen­ers. There are also spe­cial wards where female nurs­es take care of female patients.

Prof. Alam first stud­ied to be a doc­tor in the 1970s from an Amer­i­can NGO called CARE/Medico. CARE/Medico in Afghanistan — I can­not under­stand how a writer of Carl Edgar Law’s cal­i­bre could have pos­si­bly researched health care in Afghanistan and, more par­tic­u­lar­ly, med­ical teach­ing there over the past two decades (Can Med Assoc J 1983; 128: 186–190) with­out dis­cov­er­ing the work of the med­ical ser­vice arm of CARE known as CARE/Medico.From 1963 to its dis­so­lu­tion in 1979 CARE/Medico car­ried out a 3‑year res­i­den­cy pro­gram for recent­ly grad­u­at­ed Afghan doc­tors from the Uni­ver­si­ty of Kab­ul. This pro­gram’s nucle­us was a per­ma­nent team — includ­ing a Cana­di­anstaffed lab­o­ra­to­ry in Avi­cen­na Hos­pi­tal, Kab­ul — sup­ple­ment­ed month­ly by vol­un­teer spe­cial­ists from the West, main­ly Cana­da and the Unit­ed States. It was Afghanistan’s only con­tin­u­ous med­ical teach­ing link with the West­ern World.Dur­ing its 15-year exis­tence (ter­mi­nat­ed by the Russ­ian occu­pa­tion of the coun­try, like the Man­age­ment Sci­ences for Health pro­gram) this teach­ing course was, in effect, a high-grade res­i­den­cy pro­gram in med­i­cine, surgery and gyne­col­o­gy.Prob­a­bly more than 100 young Afghan doc­tors became pro­fi­cient in West­ern med­ical and sur­gi­cal teach­ing and tech­niques. There was also a nurse’s train­ing pro­gram. So thor­ough was it that short­ly after my return from Kab­ul in 1968 (hav­ing served in the CARE/Medico pro­gram there as a teacher) I met one of my stu­dents, who had just qual­i­fied as a sec­ond-year res­i­dent at St. Paul’s Hos­pi­tal, Saska­toon.This may not seem remark­able unless you remem­ber (as men­tioned in the CMAJ arti­cle) that the Uni­ver­si­ty of Kab­ul’s med­ical school taught “archa­ic” med­i­cine in French that was simul­ta­ne­ous­ly trans­lat­ed into a Far­si dialect, which is pret­ty well devoid of med­ical equiv­a­lents.I feel that Mr. Law’s arti­cle was infor­ma­tive — but only on a small seg­ment of the sub­ject. Canada’s con­tri­bu­tion in exper­tise and man­pow­er (doc­tors, nurs­es and lab­o­ra­to­ry tech­ni­cians) to this Afghanistan pro­gram was out­stand­ing and should be duly record­ed.FRANK MACINNIS, MD, FRCP©, FACP; Clin­i­cal direc­tor; Depart­ment of Psy­chogeri­atrics; Alber­ta Hos­pi­tal; Edmon­ton, Alta. (source: PubMed) He fond­ly remem­bers Dr. Mobri (first name and not sure about spelling) who taught him, and won­ders if he can get in touch with him now. The Amer­i­can staff left the CARE/MEDICO inter­nal med­i­cine train­ing clin­ic when the Rus­sians came, and Prof. Alam stayed there for 13 years (whole time of the Russ­ian occu­pa­tion) lead­ing the clin­ic. He said that the Rus­sians kicked out the Amer­i­cans and treat­ed the CARE/MEDICO trainees with scep­ti­cism, accus­ing “Alam” of being a CIA agent. “When the Rus­sians left and Mujuhadeen came to pow­er and there was unrest in Kab­ul (ear­ly 90s) I left on a fel­low­ship to India. And when I returned a few years lat­er to the Tal­iban, I trans­fered to Nan­ga­har Pub­lic Hos­pi­tal and have been here ever since.”

Most hos­pi­tal build­ings were ini­tial­ly built by Rus­sians. For a while, the Red Cross of New Zeland sup­port­ed the surgery depart­ments. Now the whole hos­pi­tal is man­aged by Health­NET TPO, an NGO based in Hol­land, and fund­ed by the Euro­pean Com­mis­sion. The hos­pi­tal is owned by the Gov­ern­ment, but Health­NET man­ages it and pays for all patient ser­vices as well as all 545 staff of the hos­pi­tal from Secu­ri­ty Guards (whose pay starts at 5000 Afs = 100$ per month) to Nurs­es (7.5–10k Afs=150–200$/month) to Doc­tors (12–20k Afs=220–400$/month) to Admin­is­tra­tors (~15k Afs = ~300$/month).

Ahmed “Zia” Ahme­di is the hos­pi­tal admin­is­tra­tor employed by Health­NET TPO. He is 28, ener­getic, and speaks almost per­fect Eng­lish, which he learnt in Pak­istan, where he spent the first 22 years of his life. He sports an iPhone 3GS which rings non-stop. He jokes, “I am like the tele­phone switch board.” He moved to Kab­ul six years ago to work for the UN, then switched to work for a US State Depart­ment Jus­tice Sup­port Ini­tia­tive, and then as an admin­is­tra­tor for the Inter­na­tion­al Med­ical Corps. But he likes his cur­rent job at the hos­pi­tal most, because he sees the peo­ple he helps.

Zia says that the biggest prob­lems with hos­pi­tal are social. Patients fight with doc­tors, neglect health codes, and barge into Oper­at­ing rooms dur­ing surgery. “They are unfa­mil­iar with hos­pi­tal conduct.”

Soccer with the Boys

The cook scored 3 goals. The mechan­ic Sadik stayed in goal. The guard Metin scored 7. I scored 9.