Archive for November, 2010



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I moved all our belonging from one side of Dubai to another before returning to Axel’s hospital. But he wasn’t quite discharged yet and so I continued without him to my pre-surgery appointments in the competing hospital.

The architect of the American Hospital must have had a mental imagine of a hospital as a shush-shush kind of place. In sharp contrast, the architect of City Hospital had something more lively in mind. It has places to sit and interact with each other and the world, rather than the sit-quietly places and rather subdued atmosphere of the American hospital.

Now it was Axel’s turn to pick me up. We walked across the street to a very fancy mall, for the merely rich and the very wealthy where they also had a modestly priced bento box lunch place. The only redeeming part of the mall was the underground souk representing various parts of the Middle East and Arab world: Egyptian, Turkish, Moroccan, and Syrian that sold the most exquisite wares from the region. We drooled over Kashmir shawls, hand embroidered by very patient people, and didn’t even bother to ask for the price.

The mall and the restaurants were as empty as the American Hospital. This is supposed to be High Holiday time: Eid, cool evenings, and pleasant days, but where was everyone? Could it be that Dubai is no longer the place where the very wealthy congregate?

We took naps until it was time to go to the movies (Eat, Pray, Love) and then did our initial shopping for basic supplies for our remaining 9 days here. And now it is my turn to fast.

Being patient

I spent hours today sitting by the window of Axel’s 5th floor hospital room, first while he was in surgery and then during his recovery. The private patient room could as well have been in a luxury hotel; medical tourism indeed. It has an enormous plasma TV screen, a couch that can become a queen size bed in case I want to spend the night here. The headboard of the hospital bed has all the bells and whistles that an Afghan nurse can’t even imagine in his or her wildest dreams.

Seeing Axel lying on a hospital bed in his johnny flooded me with memories from a little over three years ago; a not very pleasant sensation. With a heavy heart I handed him over, early in the morning, to a cheerful multi-national crew. They went to great lengths to put me at ease.

It appears that only those at the top of the pecking order are allowed to individualize their hospital uniform caps – the OR nurse with a colorful geometric pattern and the anesthesiologist with a football (soccer) motif. The Bangladeshi orderlies were all dressed the same, with disposable rather than cotton caps. The Lebanese surgeon wore a disposable paper hairnet which made him hard to recognize.

Just when I was about to start worrying, two and a half hours after I left him in the pre-surgery bay, he was wheeled back in the room, dazed and sore and with an oxygen mask. The nurse handed me a biohazard bag with a small container with what looked like mung beans in soy sauce. They were the offending gall stones in bile.

I took a picture (just in case anyone wanted to see them) and then threw them out in the biohazard waste container. It was pretty gross. Two hours later I fed him cherry jello, apple juice and lukewarm bouillon and myself a lovely zatar (wild thyme), tomato and beet salad with hummus on the side.

At about 4 PM I left him in the care of the Philippina nurse and went to see my surgeon who confirmed that I have indeed a tear in the cartelage of my right knee. As a general surgeon he will fix both my left wrist and my right knee – the reverse of the two operations I have undergone earlier in the last 5 years. I will be on crutches for 10 days which means I will return with them to Afghanistan.

Axel will stay overnight on the suggestion of the physician (but maybe also on the suggestion of the hospital administrator – the place looked decidedly underutilized). After a romantic hospital diner a deux I returned to our apartment to say goodbye to Anne and Chuck and pack up.

Tomorrow we have to change apartments in between Axel’s release from the hospital and my chat with the anesthesiologist, blood work and other surgery prep. Then I will be the patient.

Indulgence

My three travel companions took a water taxi from the Dubai Marina all the way to the Dubai Creek, with a stop at the Atlantis Hotel at the top end of the Jumeira Palm. It took an hour and a half – twice as long as a traffic-jammed taxi.

The Atlantis hotel looks like a Disney land hotel from the outside and inside you might as well be in Florida too. The stop was unplanned, due to motor failure. I warned Axel to beware of a motor-less boat drifting off to the Iranian coast.

The crew of the little boat that looks like a pod from the Body Snatchers, consisted of toothless Indonesians. They managed to avoid the Iranian coast and delivered everyone safely at the Gold Souk water taxi stop.

I missed the boat ride because of an MRI of my right knee, to determine whether a cortisone shot will do or I need an arthroscopic intervention.

While everyone my companions were still on the high seas someplace between Dubai and Iran, I went apartment hunting, walking in the hot midday sun from apartment complex to apartment complex until I found Mr. Shah from Mumbai who promised us a studio for a reasonable amount of money for our remaining 10 days. We will move to his apartment hotel on Wednesday morning.

In the afternoon Axel had his appointment with the anesthesiologist and other hospital staff to prepare for tomorrow’s surgery. We were warned that it is quite common here for surgeons to order an overnight stay at the hospital. I will go through a similar routine tomorrow afternoon.

On our way back from the hospital we stopped at the Dubai Mall to get me a new bathing suit. The one I had brought from Afghanistan had been blown away from our 33rd floor balcony where it was drying after a swim on the day of my arrival. When you live in a forest of skyscrapers there are canon winds that can be quite powerful.

We couldn’t resist the chocolate confections at one of the many coffee & pastry places at the mall (one that even took pride in training the next generation in indulgences) but instantly regretted our indulgence, that cost as much as dinner for two last night, after we had licked our plates clean.

A day before sick leave

As medical tourists we are exquisitely taken care of by Caroline and her colleague Asia from SOS International. We are one of their projects for this and next week but you’d think we are their only project. They schedule our appointments, tell us about the procedures, what to expect, not to do.

For years I have carried the SOS International card with me and MSH paid its fees. I never had to use it. Now I am learning what they are really about, service, awesome service.

Today was the one day this week that we did not have any medical appointments and so we set out to explore more of the city and its thin history.

We took the spotless metro into town enjoying the high ride across what is called refrigerator alley – the Sheik Zayed multi-laned highway that goes from Dubai to Abu Dhabi and that is lined with the weirdest looking skyscrapers.

We picked up the Red Bus at one of the shopping centers that make you think you are in New York and descended at the restored Maktoub palace at the edge of the Creek.

The before and after pictures reminded me of the Murad Khani restorations in Kabul – here someone also saw beauty in what was utterly decayed. The spectacularly restored palace with its summer and winter rooms, its wind towers for natural airco was filled with pictures of the olden days.

Old is not very old here – going back at most two generations. In fact, some pictures were from the 70s when I was in Yemen. The Dubai from then was very much like North Yemen in the 70s. The transformation that happened here is phenomenal (whether you approve or disapprove) and it left me wondering, what happened here and what did not happen in Yemen?

We are starting to ask taxi drivers that question. The answers are very consistent: leadership, or maybe more specifically, enlightened leadership; leadership without greed or coming from a small ego, insecurity, a bully complex or what not. It appears to be leadership from someone with wealth, status and the weight of a power dynasty behind him; no need for games.

I noticed that females were entirely missing from the pictures – except for the room that was called ‘socio-cultural.’ It contained young girls dressed up to the nines after the celebration of their graduation from Quran school. All the others contained only pictures of the ruling elite, from young eager boys handling their falcons to old wizened rulers with their hands on their djambiyas, the crooked dagger that they carry right below their bellies, just as in Yemen.

Axel and I went apartment hunting. The day after his operation, and the day before mine, our current apartment lease ends and we need a new place to stay. We walked round Bur Dubai looking for short stay apartment rentals. Young Philippina or Pakistani clerks, eager to sign us on, showed us around.

We are staying in tonight, having food brought up (Peking Duck, seafood noodles), and watch a movie that Tessa sent along with Anne and Chuck in a care package. But when Anne and I came back up from the apartment complex’ sauna and jacuzzi we went straight to bed. Only the men watched the film. Today was vacation. Tomorrow we are on sick leave.

Medical journeys

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Last night we had a late and outrageously expensive dinner (mostly because of the wheat- and grape-based beverages but also because the restaurant’s location) at the Dubai Mall overlooking the famous dancing fountains. The mall closed at midnight and was still full of small children who appeared more awake than we were.

This morning was my day of medical tourism. We took a taxi to a part of Dubai that is called Dubai Health Care City. The place is chock-a-bloc hospitals, specialized clinics, group practices and pharmacies. My appointment was in building 55, which made me wonder whether there were at least 54 other buildings.

I was swiftly diagnosed by Dr. Ali, a young surgeon from Pakistan (I think) who trained in Toronto and at Brigham and Women’s in Boston. He has scheduled me for carpal tunnel surgery on the 11th. He also ordered an X-Ray (done) and an MRI (Monday) to find out what is wrong with my painful knee. If there is something to be fixed in the knee he will do it right after the carpal tunnel surgery on Thursday. And so, this medical visit to Dubai is as much mine as it is Axel’s.

My new orthopod works in a medical group practice that made me reflect on care in Afghanistan. This place has everything Afghanistan doesn’t have: for starters, a large number of well educated nurses. All of them have been trained by the government of The Philippines, after which they left for greener pastures. The education of nurses has thus become a significant subsidy by the Philippine government to the UAE. It really should be the other way around.

And then of course there is the infrastructure of this place – uninterrupted water, electricity, salaries paid on time, internet at lightspeed, integrated machines that check your temperature, blood pressure and god knows what else with one push of a button. All the while I am thinking, why? Is this only about money or is there something else?

After our doctor’s visit we played tourists. We took a bus tour, a dhow trip along the creek and then a meal at one of my favorite restaurants with its cantilevered deck overlooking the Creek.

Returning at our apartment complex I marveled how we could just walk in from the street. No sandbags, no razor wire, no sign that says ‘No Guns,’ no metal detector. Things used to be like that in most places of the world – now this may be the only place left where the assumption of innocence and goodwill is assumed and trusted.

Fantasyland

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I am back in fantasy land. After a very fast and smooth exit from Afghanistan and similarly fast and smooth entry into the UAE (even though ‘the systems were down’), I found Axel in shorts and T-shirt waiting for me at the foot of the Dubai Marina Heights Tower. We are lodged at the 33rd floor in a ‘vacation-rental-by-owner’ apartment, together with our friends Chuck and Anne.

The apartment complex is surrounded by others, each with their own peculiar architectural markings, a spa and sport complex at the 5th floor, inside, and two pools (wading and lap) on the outside. I felt very exposed in my very decent black bathing suit that was quite a contrast to the barely clad young women sunning themselves in on lounges.

Across the marina is a half-completed skyscraper that looks like the crooked house of the crooked woman on crooked lane. We are deeply into fantasy land, or, as someone explained it, architectural practicum 101.

We were invited to join our friends at a birthday party for Chuck’s sister in law who lives here with her husband/his brother at the top of the rotating Hyatt Regency. In about one hour our views had circled the city and we were back where we started except for our full, very full, bellies. I usually don’t go for seconds but the buffet was too elaborate to limit to a single visit.

Everyone is taking a nap now, recovering from lunch. It is dark and Dubai and Sharjah are flickering near and far. When the temperature falls below 25 everyone comes out and celebrates the good life. I suspect that it is here that the taste for money, a lot of money, is acquired because there is much to spend it on and there is never enough. I wonder how much of the real estate we are seeing is owned by Afghan warlords and poppy growers, and how much of that are my tax dollars at work.

Between two worlds

I wrote my entry for today in the plane, high above Iran, going from one world to another. I had much time to read.

After some 300 pages in Obama’s Wars the president still hasn’t made the speech to the American people about the troop commitment to Afghanistan of about a year ago. He is still meeting for hours, and watching military powerpoints. It is fascinating, though utterly confusing, to read about the discussions in the American military-political stratosphere, high above the clouds for someone who is living far below the clouds, with everything above my head opaque.

Over the last year we have been summoned more than once to the embassy compound to hear then this then that strategy, with all the new vocabulary that goes with it. It was always communicated to us, by civilians. With Woodward’s revelations about the skirmishes between the military brass and the Obama entourage I realize that the opaqueness was effective – little did we know.

One sign that the consensus was fragile at best were the frequent changes of what was important. Were we trying to eliminate the Al Qaeda leadership? Defeating or disturbing the Taliban? Which Taliban? There was COIN (Counter Insurgency) combined or not with nation building (no-nos for Obama because it can’t be done anytime fast), then Quick Impact, to be realized according to a sequence of commands: clear, hold, build, transfer.’ I think there was a fifth command but we didn’t have time to learn the words by heart. All I remember was that our part in this strategy concerned the building and transferring.

Sometime in March and April we were all ordered to look at some 80 districts along the ‘ring around Afghanistan’ in an attempt to promote the free movements of goods and help the economy by liberating and securing the districts along this road.

For us that meant assisting the district health officers wherever they existed to better manage health care delivery so that the population would notice that the government cared – a tall order that turned out to be misguided since the government is not only perceived to be corrupt, large parts of it are.

In the end we never got the exact numbers of where to put our efforts and now the districts are out of focus again and many so unsafe we couldn’t even go there if we wanted. Still, a district health assessment, considered urgent some 9 months ago, is close to being commissioned. We are always a running a little behind what Washington orders.

With each new strategy or tactic new words were introduced which made everyone scurry back to their computers to make new powerpoints and present the reality, perceived or for real, using the new words and trying to make them real, precise and practical using new diagrams and new flow charts. Luckily reality is entirely malleable and luckily we have powerpoint and armies of translators (many of them doctors who make better salaries that way) to come up with the right Dari and Pashto words.

Loose ends

The tying up of loose ends today got pushed to the back of the stove as new urgencies showed up on the front. In a truly collaborative and collegial effort we responded to one of our stakeholders’ rather complex request and produced desired plans and then discussed them. It took most of the day and past daylight. I was proud of the team effort.

I cleaned up my office, turned off the lights and left a Ugandan proverb on my desk about vision, for when I return.

I sorted out our pick-up tomorrow morning early to make sure all for four adults and one kid plus various suitcases will fit. Back home I handed out Eid gifts to our guesthouse staff, passed all untouched food to the guards who are having a banquet tonight, finished the mango ice cream myself and now it is time to pack and turning in early. The alarm is set for 4 AM, wheels up scheduled for 7:45. Dubai and my honey, here I come.

Home alone

Axel’s has left for Dubai and his doctor’s appointment. When else did we have to travel that far to see a doctor?

I had my longest day ever, with too many meetings and too many hours in traffic. For desserts a cocktail party at the Dutch embassy where I saw new and old friends, including the head of the police training team, a founding father of the Dutch Afghanistan Committee, a friend of my friend Miho all the while enjoying the luxury of a few glasses of South African wine.

It is amazing how bad the image is of the Americans in the conversations with my compatriots. There is hardly a positive word uttered (arrogant, unilateral). I take it with a grain of salt, as Dutch people tend consider themselves better than the Americans and most anybody else in the world but still, being a half American, it hurts a little bit and I wonder, does it have to be this way? Can this stereotype not be changed?

And now I am watching the depressing news coming through from the US about the elections. There are no surprises. Still, no matter the outcome, the US election process is a few hairs better than the one over here where the losers are bad losers and take to the streets protesting the the process that did not elect them. At least our president is graceful about the new reality.

Risky business

I spent most of the day at the ministry. Only one of the three meetings I had planned to attend actually materialized. So much for getting things clarified, straightened out and organized before I go off for a fortnight. Still, it is good to hang out at the ministry because you meet people and hear things one would not back at our office.

In the morning I attended a presentation by the private sector (for profit) office that has sketched out a plan for bringing them on board to work alongside the ministry towards better health services and products for Afghans.

It is a complicated undertaking because (1) there is a general mistrust of the private-for-profit sector’s motives (perceived as ‘make as much money as you can, no matter what the quality of the product or service is’), and (2) the for profit health sector is not organized making it hard to invite ‘representatives’ to the table.

The plan was a heroic attempt to bring some order in all this, and a strategy for action. Yet how this is going to be funded is unclear. This was also true for the next presentation about Afghanistan’s mental health strategy; maybe an even more complex and more costly undertaking.

Everyone agrees there is a huge problem but the boundaries of what constitute ‘illness’ and what is the result of cultural practices that some of us would call domestic abuse are fluid.

The strategy development process was long and arduous and full of disagreements and conflict. The proponents of the need for action fought many battles and lost often to primary health care advocates. All sides claimed that their investments pay off. But the investments will have to come from outside as the government cannot pull this cart on its own. Someone is calculating the cost. It will stun people no doubt.

That women are anxious, throw themselves in wells, burn themselves or are seriously depressed is not because they are mentally ill (although one could argue they become that way – ill from worry). Afghanistan, especially the rural areas, is not a healthy place for women.

One of today’s ANSO reports (the organization that reports faithfully on the multiple ‘security incidents’ each day) illustrates this all too well: the bodies of two women were brought to the capital city of Helmand province this morning. They were, allegedly, members of a women’s tailoring cooperative – funded through the US government which made them, in the eyes of the insurgents, ‘collaborators,’ a death sentence that was swiftly executed. Or may be it was simply a family feud – such reckoning goes mostly unpunished.

There are safe houses for women who escape, but they are well hidden and thus not easy to find. The women who make it there need psycho social support yet there are few professionals who are trained to provide this and no government services or legal recourse to help them. The mental health strategy tries to insert some services so that women who come to the health center can find an attentive ear rather than a man to escort them back to their tormentors (husbands, brothers, uncles as well as mothers-in-law).

One of the people who spent much energy on this mental health strategy is Inge Missmahl. She attended the meeting as one of the architects of the strategy. She and her ministry counterpart must have been very happy to hear the words ‘strategy accepted,’ at the conclusion of the meeting, coming out of the mouth of a senior government official.

My friend Charles had sent this link that shows Inge speaking on TED. I felt privileged to meet her in person.


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