Sylvia's Journal

We were driving around the center of town to pick up a colleague when one pointed out a large dust cloud. I would have assumed it was a dust cloud but he knew better than that. I watched the reaction of my Afghan colleagues to the explosion while the radio crackled to life and our security man communicated with all his drivers, scattered across the city about the target.

Everyone got on the phone to call relatives or friends who work or live in the area where the cloud originated. There was such a sense of despair – will this ever end? But then, very quickly, after ascertaining that no friends or relatives were injured, life resumed and we pursued our trip to the airport.

We talked about stress again, the constant high alert people are on, with increased levels of adrenaline a perpetual physical state. It reminded me of living in Beirut in the late 70s; it was like that there too. You forget that you are always on high alert but your body knows it. It shows up as high blood pressure, and, I am sure, a constant state of low depression, with spikes every time a bomb goes off. Healthy people of average weight don’t understand their high blood pressure, but my doctor colleagues do.

It is nice travelling with my new colleagues because you learn much about them as persons rather than as co-workers, employees or bosses. I have always preferred that over travelling alone. During the flight to Hirat we talk about things we have never time for in the office.

This field trip is a new experience for me. We drove to the UN terminal for our domestic flight. Outside the terminal is a square box with a small hole at the top. A sign above it urges people to empty their weapons in the box. I didn’t see anyone do it but I would have imagined if they did I shouldn’t be looking, as if this was a very private thing, like peeing in a paper cup at the doctor’s office.

In the waiting room we watched Al Jazeera’s presenting one depressing piece of news about the world after another: a typhoon in Japan, floods in India, three earthquakes in the Pacific and a bomb in Kabul, the one that we had just seen from a distance.

In between all the pcitures of distress we saw Obama with his cabinet discussing troop deployment in Afghanistan. I asked my boss what he thinks about that. He is convinced that this is not how you win minds and hearts. Many others share this opinion. The military live in a bubble. When they come into the ministry of health (any ministry I suppose) they enter in groups with their fire arms visible. It is a frightening sight. How can we possibly expect Afghans to warm to them?

One of our consultants had dinner last night with a military surgeon at one of the bases. He reported that the entire experience was surreal. There was no sense of the ordinary reality of Afghan people, Afghan hospitals and what’s possible in hospitals here. The doctors live at the base, eating imported cafeteria foods and having access to near unlimited amounts of money for their projects. I recognize a very deep-seated American assumption that anything can be bought. But it doesn’t work here. You cannot buy hearts and minds, you have to earn being let in.

The way to wiggle your way into the hearts of Afghans is to learn their language, respect their culture, ask to be taught about things you don’t understand. But much of what we do here as Americans is cooked up in these bubbles. Foreigners who are here on their own talk pejoratively about this and I assume they consider me a bubble person as well. It is true that we expats at MSH cannot mingle freely with Afghans on the street. But I can mingle freely with Afghans at work and at their homes; this is something US government officials and military cannot do. I feel sorry for them as they miss out on that one thing that makes this place so special.

Today was more varied than yesterday and did not give me a headache. We now have every morning a touch base as the senior leadership team. It is helpful and short. After that I make the rounds of my staff to let them know what they have to do. This is an interesting new reality to me – making sure others do their job rather than me doing it. I kinda like it.

After I informed every one of urgent tasks I tried to sort out what my work was. In the frenzy of last minute requests from higher ups (from our funder and our government client) this is not obvious. Any message to be communicated to these higher ups needs to be very carefully thought through: what’s the medium (phone, in person, email) and I always have to image the possibility of the receiver receiving my message in a bad mood. It’s a good discipline for communicating. To be on the safe side, since I don’t know the personalities yet, I ask my boss for advice. So far I haven’t made any faux pas I believe.

From the high and complex to the banal and simple, Akram took me to select carpeting and carpets for the new house. For carpeting I picked beige rather than purple or dark green; for the carpets I asked if they can give me the money and I go to Chicken street and select my own but that is not according to the rules. I will get machine-manufactured carpets. We went to see what they look like in Guesthouse 32. They are not bad for industrial carpets (forgot to take a picture).

I did decline the monstrous furniture and asked if I could have the traditional Afghan ‘furniture’ that consists of mattress-like cushions on the floor with cushions in the back. That is how we had arranged our house in Lebanon 30 years ago. I can already picture myself lounging on those.

Back in the office I made my acquaintance with the office cat. When people keep a dog here they give it a name but not to cats; they are simply called peshak, the Dari word for cat. That is just like my first cat which was called Poes, the Dutch word for cat. I have baptized the cat, daftari-peshak , or office cat in Dari.

In between work related crises I have to make sure I have all my paper work in order. One such thing is my foreigner registration card that requires a visit to the ministry of interior. Everyone is searched upon entry to the ministry compound. My male colleagues are searched at the entrance. I am let in to a tiny shack where female employees do a cursory search or none at all. They are mostly curious about foreigners like me, sometimes asking for make up (I have to disappoint them).

This morning, when I asked them in Dari how well they were and answered their return question with a praise-the-lord, one of the ladies got up and planted a big kiss on my cheek. I think this is why people fall in love with this place. You simply can’t help it.

The office where the registration cards are manufactured (handwritten, a passport picture first cut to size and then stapled and then a stamp) is occupied by a person that I thought a woman but Steve told me was a man, since a woman would have worn a scarf, and he didn’t. He is a dwarf who is also dwarfed (anyone would be) by the gigantic registers that are piled up on his table.

Baskets full of cancelled registration cards are placed willy-nilly on the floor. The purpose of the registration process is not entirely clear but it keeps at least one Afghan busy and on salary. Signs are posted to say that it is a free service of the Afghan government; so no salary supplements for the little man. But the upstairs official who adds one other stamp did ask for donations to replace his old furniture and office equipment. A thinly veiled request for bribes, I asked Khalid? No, not at all; it’s a very poor ministry and they need help. That is obvious.

I asked what happened to all the registers and cancelled cards when the book or basket is full. Khalid, our logistics man told me that from time to time these places catch fire and that takes care of the archiving.

We had our weekly phone call with Boston which is tedious, partially because it is after work hours, because at least one of us is called on another cellphone and the quality of the connection is often bad and requires several re-calls.

I can now be disturbed twice as often since I am now in the possession, like many of my colleagues, of 2 cellphones and 2 numbers. One is pre-paid (using scratch cards) and one is post-paid. The latter is for calls to Boston that would exhaust multiple scratch cards. For that phone we get a bill monthly. I am now a two-fisted cellphoner.

We create most of our own stresses. Here, in this country, these self-made stresses are put on top of stresses that others created: social, financial, political, technical, etc. I got a taste of the self-made ones today and it gave me a headache so big that I am ready to go to bed at 7 PM.

We met with the minister to discuss two urgent issues. There are doomsday scenarios if the issues don’t get resolved quickly. I have questions about the accuracy of the doomsday scenarios but was in no position to challenge or ask questions, given the set up.

Anyone who has an audience with the minister, of lower status than his excellency, first waits in a large but windowless ante-room, populated entirely by middle-aged men, some in suits, others in local attire. Then one is ushered into his inner sanctum.

Two rows of matching couches and arm chairs, facing each other, with low tables in between lead to a small table with an Aeron chair behind it and a small contraption that I later discovered is a bell that rings in the ante-room and immediately produces a younger man who serves tea and cake, brings paper or ushers in other people.

Whoever sits in the chairs closest to the minister gets to have his ear while those further back wait for their turn. Then as one is finished and gets up the people in the back move towards the front. It’s a clever system that moves people fast. We got exactly half an hour. No chit-chat. The military, 3 men and one woman, took our places near the front. I was curious about their agenda but we had to leave. They got to hear our discussions.

The big event in Herat is coming into focus and the enormous detail that the US contingent needs, probably because of security and not wanting any surprises, has kept us busy all day to the point of a big headache.

I discover in person what I have learned from the literature: the higher you go the less need there is for technical knowledge about public health. Technical considerations in the decision making processes called for today were consistently trumped by political considerations. As a senior person you need some good technicians on your staff or in your pool of consultants, but that is not the skill set that is asked of me here and now. Yet there is the illusion that technical skills are the most critical, even, or especially at the highest levels. I don’t think so.

I finally had my first long conversation with my new boss, an Afghan doctor who has worked with MSH since the 80s. Our talk was interrupted several times by calls from this then that person at USAID who wanted more details or (re)direct our attention (which it did). Eventually we completed my agenda, with a new set of marching orders for me.

I escaped to my office, a small square room that is wedged in between the Security office where there is much coming and going and the provincial capacity building advisor, one of my staff. It is a bright sunny office that looks out into the garden, and sits on the outer perimeter of our compound. I have my new Chinese bookcases, unpacked my book shipments, I got a slightly larger Chinese desk than the dinky one I had before, a fancy (also Chinese) contraption to hang my scarf and coats on, a printer, a landline phone and two cellphone numbers, one pre-paid, the other post-paid (subscription). Like many Afghans, I am now a two-fisted cellphoner.

Even though my spot is a bit noisy I like it because I feel more out in the world (as much as one can in a compound that looks like a prison from the outside). When I walk out of my door I am outside rather than in another office or hallway. And the grapes are all around me, that is probably the most joyful part right now.

Things are speeding up and slowing down at the same time. Something interfered with our internet connection and I was told it has something to do with the weather in Hong Kong. Somehow our computers at the office think we are in Hong Kong (our Google homepage is in Chinese) while our computers when plugged in at home think they are in Germany. There is something to this notion of butterflies flapping their wings in one place of the world and storms raging in another.

Thus, the internet problems are slowing us down, albeit it only for awhile. As soon as the internet was repaired, at the end of the day, we were all inundated by a tsunami of emails. Things are coming over the transom so fast that I am having to abandon my discipline of ending the day with an empty inbox. The price for this is working at my computer until far into the evening.

The pace is picking up for an official event in Hirat. I am spelling the name of the city and province with the letter ‘i’ since the computer otherwise keeps changing the spelling to Heart; very annoying. A whole slew of very high level notables will open a new provincial health office in that city, a photo-op/ribbon cutting event that takes lots of time of many very senior people to organize. Since provincial health is part of my portfolio, Steve happily ceded his place to me for this outing.

There is an immutable core to the event, the official opening, which is highly orchestrated and requires endless briefing papers from us. Despite the internet problems all these have been delivered, except for one which I need to chase after tomorrow. Steve and I had to go to one of the guesthouses to send all these documents to the people who requested them.

In the meantime there is also a pedagogical event planned before and after the ceremonies that I have chosen to design, in order to stave off the ubiquitous power point presentation. I want to develop a cadre of people who can design events in more imaginative ways. I have my work cut out.

Greg, our hospital consultant who also knows about building houses that are save to live in (i.e, no electrical outlets in the shower stall, etc.) offered to do a safety audit of my new house. We visited the house and I noticed much progress on the rehabilitation. The grass has been cut, the rose bushes are in, the safe haven installed and a transparent film placed on all the windows in case they shatter. Greg pointed out things that need to be checked (like the septic system!), replacement of water heaters and the ungrounded electrical work. The latter cannot be changed because that is how all of Kabul is wired.

I have an active dream life, which should not be so surprising in a period of such intense transition. Last night I had a series of dreams that were all about transformation; all images were about one state turning into another. There are many attempts at transformation going on here, from individual habits to the systems that keep this country from being the normal democracy that most people want so badly.

My dreams are rudely interrupted every morning between 4 and 5 AM when the muezzin calls the faithful to prayer. The call in my neighborhood is made with an echo. I can just imagine the preacher going to the loudspeaker store and being shown his options. He must have really liked the machine that produced the echo, hearing his voice multiple times, repeating first and then trailing off into the distance.

My morning (and evening) routine still includes shoulder exercises and since I have decided that the home-visit-physical therapist wasn’t adding anything worth 40 dollars a visit, I am my own physical therapist for now, and thus harsh with myself about sticking to my exercise regime. I have the schedule of exercises (new ones, and which to drop), week by week, taped to the inside of my door. Tomorrow it will be 9 weeks post-op and I am ready to move into strength training. I am scouting around the guest house for something weighing about 1 pound.

I made contact with the only female physical therapist I know of in Kabul, who practices out of the military hospital in Wazir Akbar Khan. I am going to ask her to check up on my exercise regime from time to time to make sure I am not getting into bad habits that work the wrong muscle groups.

I spent most of the day in meetings which are not boring yet because I am still learning and trying to understand what this project is all about. I am starting to get used to being the only female; I think it gives me an edge as I can say things no one else does, like verbalizing the mood or feelings of a group. Clearly that is woman’s work. I hope some of it rubs off.

I am seeing a side of the project that remains fairly well hidden when you swing by from time to time as a consultant: the constant demands from this or that stakeholder group for information (needed right now!), requests to provide logistical and administrative support for highly visible visits by senior functionaries from Afghanistan and the US (with all their protocol requirements), and funding of this or that activity, not quite part of our mandate, but an easy way to channel US funds into gestures of goodwill. I am still mostly fascinated by all this but I can see how it distracts from what’s in the work plan; yet in terms of effort from senior staff, it is a big part of the job.

Two of my expat colleagues have gone off to India for their quarterly R&R (rest and recuperation). It is an important benefit to be let out of the country from time to time and wander around freely in another place. They both needed it badly. This leaves Steve and me on post, surrounded by a steadily increasing pool of consultants who are flying in after a two month ‘no fly’ period because of the elections. Guesthouse zero is filling up rapidly with Steve and Greg from the US, Ankie and me from Holland and Haran from India. As always, it is a wonderful mix of stories when we meet at night around the dining room table.