Sylvia's Journal

I like to believe that there are more people working for the good of this republic, trying to get it into the 21st century and taking care of its citizens than those trying to cripple, destroy, destabilize it for their own benefit or some higher ideal that is at cross purposes of the former group. I was reminded of that this morning while being a fly on the on the wall at a meeting of one of the institutions of higher learning that prepares allied medical professionals (not doctors) for future jobs in health care.

The entire meeting was in Dari, including the agenda and I was grateful for my colleague who came along and helped me understand what was going on.

This observing of her bi-weekly meeting with her senior faculty is a first step in, what we hope, will be a longer process. We had been invited to assist the director in building a strong team that would be able to stand together and withstand the pressures from people with power and connections who are trying to circumvent the rules that apply to most other people. We don’t get many of such invitations and so it was worth sacrificing part of our day off for this purpose.

The director is a graduate from our leadership program, many years ago. It is refreshing to work with someone like that, someone who knows that leading and managing is not an automatic skill set that comes along with a promotion.

It occurred to me while listening to discussions about some of the faculty team’s challenges that in this country many good people are spending enormous amounts of mental and physical energy to counter attempts at circumventing transparent processes. There are so many places where interference happens: there is enrollment which is supposed to be only for students who qualify. There are the diplomas that should be only for people who pass the necessary tests, not for those who think they can buy them either from the professor or in the market.

The US and other government clamor for transparency all the time, rightly so, but I don’t think that people who are not directly involved in this ‘work for the republic’ have any idea what it takes, what courage, what sacrifice, to implement transparency. Like so many other things here it is easier said than done.

This morning, side by side, Axel and I completed the 45 minute beginners’ yoga routine that we have on DVD. During weekdays I alternate this with half an hour on the elliptical and hope that between these two routines I will maintain some flexibility and stamina.

Axel picked me up after my usual Friday massage for lunch in the Bistro restaurant – a place around the corner from Chicken Street that used to serve wine but no longer does. It was a lovely sunny and warm spring day, just the kind of weather that demands a cool glass of white wine to accompany one’s lunch. We fondly remembered our vacation, exactly one year ago, in Lebanon where we had such fantasy lunches every day.

Instead we sipped our fresh fruit juices while watching Liz from the BBC at a table nearby looking at a map of Afghanistan and doing take after take of some background story that was, for once, not about angry Arab youth. We had gotten used to see her nightly on TV, then in Tunisia, then in Cairo and then in Libya, against the backdrop of Arab foment– seeing her in this lovely garden setting made Afghanistan look very peaceful and quiet.

Back home I spent another three hours on the photo memories of 40 years of MSH in Afghanistan, a job that will never be finished. I will ask Axel to print one copy to show to my colleagues. It may be a nice present for our founder who has Afghanistan close to his heart.

We had dinner in front of the TV, watching an old movie, The Thin Man. Since tomorrow is a work day for me I had to do my homework for language class which made me not pay as much attention to the movie as I should have in order to understand the unraveling of the mystery.

The mildewed plastic has been taken off the windows. As a result we have a clear view of our garden again. The outdoor table and chair set has been brought out, and cleaned. It is nice to have a guard who does this for us. We are ready for lunches and dinners outside.

Many people were busy all day preparing for the visit next week from our Chief Operating Officer from HQ. It is a huge deal. Carpenters are putting up tables and cases to display the products of various units: posters, printed materials, photos, etc. Other people are collecting documents, making appointments, cleaning the gardens and me, I am still working on the slide show that we will show next week.

The large display boards in the main building, with their old and tired pictures and posters that have not been changed since I arrived here have been cleaned off and dusted. They have been spiffed up with new photos. One entire board has been dedicated to guards and security personnel, our very Special Forces. It has pictures of a training they received on how to disarm and tackle a person with bad intentions. I am so impressed.

The first tree blossoms are out, the almond trees, the cherry trees and some others I can’t name; the fragile pale pink, hot pink and white petals stand in sharp contrast with the otherwise grey and colorless backdrop of the landscape.

And then, in the middle of the morning the infamous dust storm came rolling in, the khak bad as it is called. It is a bit like the Harmattan or the Zephir, but not hot (at least not now). Everything slammed, rattled and was covered with dust in no time. Next week we plan to have our project display under a tent in the garden. If such a storm rolls in then we will have a big problem.

One of my colleagues said that these storms come to open the blossoms – it’s a nice image of nature working together with nature to speed up the reproductive processes. If this is true we ought to be expecting a visit from large swarms of bees next.

Yesterday I had arrived back from the ministry at 1 PM and found the cooking pots in the kitchen empty. I noticed that people are having lunch earlier and earlier (at 11:45 I already see people leaving the canteen with trays of food) and so today I joined the early crowd to make sure I wouldn’t miss lunch again. I made up for the missed lunch by scissoring off a chunk of the ‘farmer’s sausage’ that Paul had left me when his trip ended earlier than he thought. Paul lives in France, amidst many such sausages I imagine.

Back home today I finished the sausage off with another of Paul’s gifts, his last Kriek beer while Axel was trying to sleep off of some pulmonary affliction that will probably be aggravated by today’s dust storm. This is not a good place for people with lung problems.

Today was SOLA day again. The class was more than full, with two new girls who are quite a bit behind. I have no idea how much they got from the lesson. Suddenly even the weakest English speakers and readers seemed strong in comparison. I noticed how the presence of these new girls boosted everyone’s confidence (through probably not the confidence of the newcomers). I had given the girls as homework to slow down in their reading and scan the entire sentence before reading out loud. They had all practiced this and the difference was noticeable. It shows what sponges they are!

And now it is weekend, a short one because I have to work on Saturday. We are now only one week away from our trip to Sikkim. This is very encouraging and lifts our spirits.

I have been working for at least 10 hours now on a slide show to celebrate MSH’s 40th birthday during a visit from our chief operating officer. I have sent emails around the world for photo memories and must have a folder now that contains close to a 1000 pictures. This is both a good thing and a bad thing about digital pictures. Everyone has so many of them from the last 10 years or so, it is like an unstoppable flood.

Photos from the first three decades here are a little more sketchy. I have to content myself with the occasional grainy scanned image. Early pictures require searching, scanning and minimizing. This is more work for my colleagues who were here in the 70s and who actually made pictures. As I am finding out most didn’t.

While I am working on organizing the pictures around themes (MSH Special Forces, Kitchen Crew, Wheels, At Work, At Play, In The Presence of Power, Teams, etc.) I curse my small screen laptop but it will have to do. I know it is going to make people smile and dig up good memories of past times – good past times amidst many bad times. I have dedicated the slide show to our fallen colleagues. There have been a few.

Here is what I learned today about the pharmaceuticals that our project brings into the country for distribution to all (US and Afghan) government supported health facilities in the country. The process from manufacturer to the final dispensing into the hands of Afghan patients is a carefully controlled and monitored process that is also of an unimaginable complexity. Some people would call it a nightmare. But my program manager in charge of making all this happen is the coolest person on earth. Why his hairs have not turned gray is a mystery.

For example, one 20 ft container with amoxicylin is stuck at the Pakistan-Afghan border because someone put the wrong border crossing on a piece of paper. Appeals to the US consulate in Pakistan have not solved a problem. This is ‘stuck #1.’

Stuck #2 are seven 40 ft containers filled with medicine for Afghanistan. These are stuck in the Karachi custom doldrums with thousands of other containers awaiting the rescinding of an order from the (Pakistani) government that only certain containers be cleared. We are not among these. Many letters and petitions are being sent everywhere.

Another batch of 40 ft containers are somewhere on the Indian Ocean and then there are some in the ports of Mumbai and Shanghai, awaiting further transit shipping. I just hope that the Somali pirates don’t get to the ones on the open seas right now.

Other ‘stucks’ have to do with waivers and exemptions but these I cannot even explain, they boggle the mind.

Never in my wildest dream did I imagine the complexity of providing medicine to the poorest of the poor. Development aid is, for a large part, procurement of goods and services. Little did I know when I arrived in Kabul.

On the ‘unstuck’ side we have moved swiftly from winter into summer. The last of the snow has melted and we removed the heating pads from underneath our mattress covers. We are extinguishing our diesel heaters. I am ready for a fan to put by our exercise machine – the jump in temperature has been rather large. All the coats are put away. We went from heavy winter coats to no coats at all.

We still have the plastic on our windows which looks gross with black mildew spots and the traces of dried up rain and snow drops. We are looking forward to its removal so we can look out of our windows again.

All morning we discussed the support functions of our common operations management unit, things like procurement, HR, finance, security, transport, housing, etc. Two people have come from HQ to see what is going well and what needs to be improved. It was a chance for them to hear directly from those being served and those serving. We are after Management Sciences, so this is a matter of pride, of good stewardship and of security, among others.

The afternoon program was a visit and meeting to the children’s hospital. We were early and had a chance to check out how the triage is working. The changes in three short weeks were phenomenal. The resuscitation room is now working so well that the dreaded assignment to the emergency ward (‘too much work’) has now become a desirable assignment (‘a place where much can be learned’). The various chiefs told stories about kids now saved because of the quick action and the functional resuscitation room.

On the down side, every up appears to come with a down, we are having a hard time getting some of those who ought to be doing the monitoring and checking to do so in our stead. It is the same old problem, encountered in nearly all our counterpart offices that are thinly staffed and with not enough of the technical skills that are needed, to avoid having the blind (or one-eyed) leading the blind.

There are other problems that have to do with the private practices most doctors have in the afternoon – to supplement their meager government salaries. This makes it hard to get people to travel along to the provinces.

While we were in the emergency ward I watched one bloodied and screaming kid after another enter the place, carried by an anxious parent. When we saw one of the guards leading the kid to the resuscitation room we knew that the training had taken; a victory. The guards at the entrance of the hospital have learned who should go straight to the emergency ward (and where) and who can stay in queue. The queue was the place where, until their training, everyone went, even those whose lives were in jeopardy.

Most kids brought in were victims of traffic accidents. In my year and a half here I haven’t witnessed any kid getting hurt in a traffic accident but being at the emergency ward for half an hour made me realize they do happen all the time which is actually not a surprise.

Back at the office, after an uncomfortably hot car ride back, I put the finishing touches on our proposal for a one year extension for review by Boston where the day had just started.

And now I am working on a slide show of 40 years of MSH in Afghanistan. I have solicited pictures from people who were here at different periods during those 40 years. I received many positive responses to my request – getting pictures with people on them who I don’t know. It is both fun and a lot of work.

This morning we met with US and Afghan government officials to discuss what the ministry wants to do with our US tax dollars to improve health. It was an interesting negotiation process to observe – I had not been directly involved until now.

Much of the shift in US policy requires behavior change from all parties. I observed how easily we all slide back into default behaviors – doing things for people who have gotten used to it; expecting more than advice.

There is a lot of hurry to complete the negotiations, get things formalized, write and sign a memorandum of understanding between the governmental parties and start spending the money.

When someone suggested we move slowly and try a ‘pilot’ to see how this momentous transition from assistance agencies like MSH to the Afghan government will work, the reply was a tense and terse, ‘we have no time to learn.’ I don’t think the person who uttered those words realized what such a message conveyed. It is worrisome. We are all in for a bumpy ride.

Today was another balmy spring day. The heap of snow in the corner of our garden is melting rapidly and will be gone tomorrow – exactly when the first tree blossom will burst open.

In contrast to the hurry of governments we had a leisurely evening with some of my pharmaceutical colleagues, the ones we affectionally call ‘the druggies.’ For the first time in months we sat outside on our terrace drinking Kriek and GTs, compliments of Paul and Andy, while finishing the last of the Italian anchovies antipasto which was bought some months ago in the bombed Finest supermarket – a treat no longer available.

We finally made it to Sadiq the woolman’s factory. We met Sadiq last fall at the agricultural fair. I have been buying wool from him and trying to sell the woolen hats made by the women who card, spin, knit and knot for him. Since last December we have been trying to visit him and finally we did this morning, on a beautiful spring day.

The ‘factory is located in a bare-bones house with concrete floor and bare brick walls. No heat, plastic on holes in the walls that serve as windows. Today several of the women were sitting outside in the warm sun. The whirring of spinning wheels and the sight of these ladies reminded me of the scenes described in Grimm’s fairy tales where princesses sit in bare rooms spinning flax into gold. These very destitute ladies did not look at all like princesses.

In one room two women were knitting hats on four small needles. I gave them Alison’s package of needles which she had brought from the US. It included needles of all sizes and length. It took a while for them to realize that these needles were for them.

Outside two women were cleaning out heaps of dirty wool and pulling the knotted clumps apart. The result of their work then went to the spinners. One was spinning by hand, a tedious job that required giving a ball of wool a big whirl while feeding the wool to the whirling ball. Upstairs more women were spinning, using simple wooden spinning wheels, turning the rough goat wool into skeins for the carpet workers in yet another room.

Five carpets were under construction. One young boy was working on a carpet from a picture of someone. Sadiq suggested I bring a picture of myself next time and they will make a carpet of me. A boy and a girl were working on a carpet with the Chelsea Football Club logo. The patterns look just like my cross-stitching patterns grid. Two of the carpets were more to our liking. It will take another month or so before they will be finished.

As we drove back through this dense and enormous shia part of Kabul, where most of the Hazaras live one of our drivers was making politically incorrect remarks about what he called ‘these Chinese people,’ while commenting on life size posters of now dead men who, revered by the Hazaras, were certainly not revered by our guard and driver. If I didn’t know it, this country, even without the Taliban, is still much divided.

Little Assefa with all of her 21 years is managing the massage place while Lisa is in her native Philippines. This includes confirming appointments with clients, getting the room ready, doing the massage, serving tea or coffee and writing receipts for services rendered. Here is one skill set that has been successfully transferred to an Afghan – she may not be quite at Lisa’s level but 15 years from now she surely will if things don’t fall apart here and the foreigners she practices on don’t leave.

Today it was clear that winter was over. Unlike in Massachusetts there is no regressing once this threshold has passed. Spring starts very near the 21st of March, give or take a week. From one day to the other bucharis can we turned off, gloves, hats and winter coats put away.

Fazel showed up with the sapphire earrings and rings that I commissioned last week. I am very happy with the result. Sita and Tessa will have to wait a few months before they get them. He also brought samples of the finest embroidery imaginable, made by his 45 year old mom. She must have very keen eyesight. Compared with that my cross stitching is of the crudest kind.

After lunch we went to Babur Gardens, partially to be outside in the balmy weather but also to see a photo exhibit from 6 accomplished photographers. Four of them Afghan, one contemporary foreigner, and one long since dead, John Burke, an Irish photographer who was the first to capture Kabul on his cumbersome glass plates.
In the evening we joined a mostly World Wildlife crew for an early St. Pats party.

Before we knew it the men were standing outside around a fire pit while the women sat inside – we have taken on the habits of our host country. Axel was happy for once to be with guys who are not doctors and who are not working on USAID projects. He was surrounded by rugged outdoorsy types who, evidently, like fires and strong adult beverages, large slabs of meat and who come from commonwealth countries. They got so carried away that they started to burn the garden furniture. That’s just about when we left.

Back home we watched in disbelief the images of Japan’s earthquake and tsunami and then more Libya scenes to which we are becoming inured.

I am trying to use my teaching skills in-house but I keep walking into walls. There is no time for the things I want to teach about organizational dynamics, teambuilding, leadership, emotional intelligence, dealing with conflict – I can’t seem to get anything going, neither in the ministry nor in our own project. Despite all the expressed wishes about training and development, when I think I have something organized it gets cancelled, or when I propose a session it takes months to actually happen, if at all. The paradox is that this is why I came out here in the first place.

And so I get my jollies reading Three Cups of Tea with the SOLA girls. Connie brought back no less than 10 copies of the young reader version of this book. We tried it out today after most of the girls got stumped by the rather difficult original version. It was a big hit; the glossary at the end of the book is particularly appreciated.

Axel is stepping up his (volunteer) teaching after we have come to the conclusion that the paying jobs that are out there won’t quite give him the satisfaction the teaching is giving him. I think this is good for his soul, aside from being a good thing for the SOLA kids.

He went to the market to buy some flipcharts for his teaching. What he got represents the most creative translation of flipcharts in local (transliterated) language.