Sylvia's Journal

All morning we are hearing stories. Some made us happy, like the one from a ENT doctor who impressed the (German) funders of his clinic with the achievements that he accomplished after he went through our leadership program. He was even given a scholarship for a course in India.

But then the story, at least as told by him, turned sour. When the German organization discovered that he had a received a colleague of mine from the US who had interviewed him about his clinic’s success and highlighted the leadership program (we try to create leaders, and since this looked like one, we took some of the credit), his scholarship was withdrawn and he was asked to resign [I am sure we are missing some of the fine nuances].

Now he is deputy provincial director and leading there to his heart’s delight. This includes telling the governor about the Challenge Model while diagnosing his hearing problems.The ENT doc and his team proudly showed us all the initiatives they had taken which had resulted in an impressive array of public health achievements: number of patients showing up with dog bites at the clinic per month reduced from 40 to 0. For this dogs had to die – until the public is better informed, slaughterhouses removed to outside the city limits, losing fighting dogs not turned loose and pet dogs vaccinated. All this is part of their leadership project, for the long term.

They also increased vaccination of pregnant women to avoid tetanus, deliveries attended by skilled birth attendants, increased compliance with hospital infection prevention procedures and antenatal care. We all cheered; and not just for this team but for all the other teams that had produced similarly impressive results simply by changing their behavior.

A team from Balkh Province was invited to participate since they are our host. But Balkh is not a USAID-funded province and thus is not benefitting from our leadership programs. It is part of the arrangement between the European Union, the WorldBank and USAID: the 43 provinces were assigned (on what basis I don’t know) to the three funders. Balkh wants what the others get, and so we told them to talk with their chiefs and chief funder.

Each of us got some ‘easy’ (read ‘safe’), some difficult and some dangerous provinces, according to the conditions at the time of the agreement. That situation has changed a bit since then and the US is increasingly taking on provinces and health centers that were not in its initial portfolio. The EU and WB have not always taken kindly to these incursions. But, like the case of the Germans, one wonders, aren’t we all in this together to help Afghanistan?

The sad stories have mostly to do with security: friends killed by Taliban, death threats, not being able to wear a suit and a tie when travelling from one province to another, drugs being stolen and health personnel resigning to save their skins. We were also disappointed that a quick escapade that Alain and I had planned to the river further north that separates Afghanistan from Uzbekistan was nixed by our security people. They thought it too risky for us and, by extension, risky for our Afghan colleagues. And so we stayed in the basement all day, observing the workshop and our dynamite facilitator team.