Sylvia's Journal

Today I spent the entire day at the ministry. We all traipsed out from our quiet Karte Seh across town in one of our minibuses. They are referred to as the Flying Coaches, which, when pronounced fast by a Dari speaker sounds kind of Dari (flakatsch). This to distinguish them from the more comfortable Toyota Landcruisers. I do prefer the flying coaches because they take more people. This invariably means more stories, more jokes and much more practice of my Dari.

The Results Conference has been in the making for many months. Although the preparations were a bit wobbly, the first day of this long awaited event was beyond our wildest dreams: excellent presentations, excellent people, excellent food and a sense of camaraderie around the common goal of improving health care for Afghans that made us all proud and feeling warm and fuzzy inside.

Most of the presentations were of international conference quality – a far cry from what was the norm only 8 years ago: clumsy, bad English, low confidence, poor logic and data. Now we saw confident people presenting interesting and sometimes very compelling data and ideas, asking and answering questions with great confidence and ease. The capacity building that has happened here and in Australia, Japan, India, Pakistan, US and UK has paid off. In fact there are other countries that want to learn from Afghanistan. If you can accomplish some spectacular health improvements here, there is no excuse not to, elsewhere!

One of the more memorable presentations was by an engineer from the Ministry of Mines who spoke to us about the findings from a survey of the air quality in Kabul. We knew it was bad but not how bad. The stuff that is burned here: plastic, wood, motor oil, rubber tires, diesel fuel is pumping high concentrations of NOXs and VOCs (essentially toxic and proven carcinogenic gasses) into the air and thus our lungs without any discrimination.

These gasses, the high altitude, the presence of nearly year round sun and the fact that Kabul lies in a bowl produces high concentrations of ozone which is the stuff, he explained, that makes the mountains around Kabul disappear on a beautiful summer day at the end of the morning. It decomposes rubber bands and tires in no time so it can’t be good for our lungs. There were some choking sounds in the room as he went from one scary slide to another. This is what the danger pay is really for: a lung fund to rent a retirement flat in a sanatorium in the Alps.

He quoted liberally from US and Canadian environmental health policies and ended his show with a list of short term and long term strategies that have worked in the US in places with similar geographic qualities, like Denver. One of his bullets was ‘stop smoking vehicles.’ I imagined the illustration Sita would have made hearing this recommendation; it made me chuckle. Unfortunately any progress on his recommendations is unlikely in the short run due to the inability to enforce anything and the opportunities that are offered to (and allegedly often embraced by) those tasked with enforcement to making some quick and big money on the side.

In between presentations we had meetings with the deputy ministers about strengthening leadership at the top. After some quick and effective interventions from our main donor, I found myself with a new assignment: to shadow the acting minister for a while until we can figure out how I, with all of MSH behind me, can best support her. It is a dream come true after all my years of preparing for this moment. I am supposed to report to Her Excellency’s office tomorrow at 8:30. At noontime I will return to the MSH office and Steve takes my place for the afternoon to help with things of a public health and technical nature I know little about. I will be focusing on the management, leadership and organizational processes at the top levels of the ministry. Imagine that!