Sylvia's Journal

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.

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.

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.

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.

This morning at about 7:20 AM my colleague Dr. H and I walked into a parallel universe – the universe of ISAF, just east of the Kabul airport. It had been hard to get instructions on how to get there because the military either don’t leave the base or they don’t drive through Kabul, or both. As a result, they couldn’t explain how to get there. I was told to ‘take highway 7 east and then go to Abbey gate.’ No ordinary Kabuli would know where that is as no one uses these terms. It is military-map-speak. There was also no Dari speaker anywhere near to explain to the driver where the hell the place was. But we found it.

The entrance to the base is a process, not a door or gate. We worked our way along meter-high blast walls that looked they could withstand an earthquake, wires and endless check posts, eyes cans, whole body scans and long lines of Afghan workers showing up for duty. Along the way I spotted a truck from Feenstra Vleesgroep BV from Dokkum (Friesland) – what was it doing there and how had it gotten there?

On the narrow path, paved with large chunks of stone (no high heels allowed), we encountered men wrapped up in so much gear that they looked and walked like zombies. I think they could easily walk through active warzones with all that protection and come out unscathed.

Once we passed all the checks, following the young female German lieutenant, she pointed us to an old Volkswagen truck. She apologized. The back was filled with old newspapers and the front was full of gear. She had to climb in through the passenger side because, as she had already said, it was old, from the time the Germans had populated this base by themselves.

We drove over beautifully paved roads with white stripes in the middle, like one would in Europe, and everywhere signs of the Germans. On the other side of the wires and walls we saw orchards and maize fields and Afghans living in mud brick houses; no asphalt roads with white stripes on that side; no roads at all. I wondered what it would be like to live so close to America (or
Germany) and yet have no access.

The base, which houses all the operational units (the planning people are closer to town) is home to several thousand people, a veritable city on the edge of Kabul. Many people never find out about Afghanistan, or even Kabul. It is self contained. There is the Marouf store and gemstone center – a glassy storefront that would be right at home in a tourist center. We learned there was a Thai restaurant (a three-course meal for 17.50 Euro, with tropical drinks without alcohol), a bazaar, a Moneygram store and a travel service and streets with exotic names, and then the barracks. And everywhere, as far as they eye could see containers and generators.

People were lounging outside in the sun, most in uniform, sitting at picnic tables in front of their two-story barracks. I got to check out the bathroom in the French hospital, now taken over by the Americans which was obvious because of the Haloween display, a hunched over person in camouflage with hospital gloves and a facemask.

The conference was interesting mostly because we were the only people who are actually living in Afghanistan, the other universe that most attendants don’t know. The presentation was well received though with few questions. I imagined that our picture of life outside the wire will take some digesting.

Of the 100 or so people in the room only 6 or 7 were civilians, including us. There were probably about 10 women. I still have a hard time looking at women who wear camouflage jackets and holsters and guns – call me old fashioned but to me fighting wars is something that men do. I did notice one woman sitting in a back row thumbing through a stack of family pictures as if they were baseball cards – I noticed the wistful expression on her face. It confirmed to me that women have no business here.

I learned today that each country has its own formulation of what camouflage looks like. The US, the Croates, the New Zealanders and the Afghans have pixalated camouflage clothes (some with large and some with small pixels); the French, Brits and Australians have organic blobs, like amoebes, splashed on their jackets. The colors are grey, tan, and dark green in various combinations. Only the Afghan military has the color of bright green, the happy color of new life, in their camouflage. I liked that. But they also have the accented red of the Afghan flag which contrasts with the bright green – it’s a Christmas contrast but also the juxtaposition of life and death in this bloody place.

The organizer liked the distinction we made between needs and wants (the army wants everything and has the resources to satisfy them) and the notion of creating feedback loops between the various actors. This included of course a feedback loop with the foreign and national armies, hence our presence.

By way of thank you for our efforts we received a medal and an engraved pen and pencil set. I imagine my great grand children looking at the medal (‘Outstanding Health Support in Difficult Places’) and making up stories about what great grandma did to get it and missing the real reason (a powerpoint!).

We left just when the smells of fried chicken and the fumes of frying fat from the adjacent cafeteria became unbearable. I stuffed myself with Dunkin Donuts type (giant) croissants and brownies to make up for the missed lunch.

On the way back we were escorted by two Croates. During the ten minute ride we discussed the origin of the necktie (cravat, from Croate) and what it had been like to live in Yugoslavia when it exploded. They are in Afghanistan to repay their debt to the international community and my Afghan colleague Dr. H. thanked them.

Even though it was my day off the workday wasn’t over. We rushed back to the ministry and met with the minister to present the areas where we can’t move without her support. She re-iterated the priorities of the ministry for the next five years which match our organization’s strengths quite nicely.

From there I barely made it in time to my Dari class. I finished the Iranian story about the lady of the thousand stories and then we talked using all the new words I had learned.

As if the day wasn’t long enough, in the evening we rallied to Restore Sanity. The Kabul rally didn’t quite match the Washington rally but it is the thought that counts. It was also nice to feel part of something big. Some twenty of us Dems Abroad came together in the basement bar of a Chinese restaurant. By night the streets of Kabul are too cold and too dangerous for such a show of support for our embattled president. Blindfolded we pinned American teabags on pictures of the Tea Party leadership. I won a bag of pork rinds, contraband in this place.

Janneke had the top of her middle toe sliced by the not so very experienced pedicurist at the spa. Luckily it was after the massage so she was very relaxed and had at least had one good experience. But I think it was the last pedicure we will have there. I had been a little concerned about the razor gizmo that was used to remove calluses – luckily I had the more experienced member of the staff and emerged intact.

It was messy because the blood kept squirting out and the stupefied girl was clueless as how to stop it. Everyone got involved and soon there were wads of bloody cotton balls, gauze and what not; until Lisa came upstairs and took over. We drove off to the clinic where she got a proper bandage and a tetanus shot. All is well again.

I left her with Lisa at the clinic and had a drawn out lunch with our boss from Headquarters who is visiting us for a week. We had our lunch at the Galleria so that he could squeeze in some quality shopping time while we waited for the car to come and get us.

Back home I used up all our fresh milk to try to make mozzarella. It was like one of these fairy tales where something good gets exchanged for something less good all the way to nothing. Out of one gallon of the most delicious creamy milk I created a piece of cheese that had the size and taste of an eraser.

M. showed up for another knitting lesson. The 2 meter long scarf for her boyfriend was completed and I helped her put on the final touches and got her started on a matching hat. The wool is so authentic that it is a little scratchy but we hope that the Woolite will help soften it a bit and take the sheep smell out.

And now it is time to finish my preparations for the military conference tomorrow. I still don’t know where I am supposed to show up. The lieutenant commander wrote me, in answer to my query, “Ma’am, unfortunately I do not have a map that would point you into the right direction [he will ask someone else].We will be prepared to meet you at the gate at 07:30.” I am halfway through Obama’s Wars and so was not too surprised about this answer. I guess we will ask around when we get closer to the base, to find out at which of the many gates the gentleman will be waiting for us.