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Sick

On the day before our departure I got sick: a sore throat, cold shivers and a bad cough. Halfway through the day, after having made many mistakes (a wrong bank transfer, a wrong accusation, a wrong turn) I accepted defeat and went home to try to sleep off whatever this is. My boss prescribed something to gargle and relieve my sore throat.

All through the winter I have been taking an ayurvedic immunity booster and stopped it last week thinking I could do without. All through the winter I have stayed healthy which is not easy in Kabul. A coincidence?

We checked the internet for the temperatures in our three destinations: Darjeeling (warm), Pemayangtse in West Sikkim (cold) and Gangtok in East Sikkim (in between).

We heard from Tessa that two of her old schoolmates will be teaching at the Gangtok school that is modeled after their secondary school in Beverly MA (and headed by one of Sita’s classmates). Now that Axel is in education (and has been offered the impressive sounding title of headmaster) our visit to the Gangtok is more than a nostalgia trip.

Good dips

Never in my 30 plus year career in international health have I seen such a direct effect of what we do on the saving of lives, especially the lives of babies and small children. It is actually the mission of MSH to do so but so far in my career the contributions are indirect and difficult to measure.

It is not because of clinical skills applied directly to individuals (that too of course) but because of a triage system that we have been helping to set up – a triage system that moves seriously ill kids to the front of the line, straight to the resuscitation room – a system for managing the material supplies and human skills that combine into timely and appropriate care of very sick children.

With the help of a many experts in emergency pediatric care, some of them colleagues from Malawi, WHO treatment guidelines, with pharmaceuticals, supplies and equipment provided through our project by the people of the United States, the emergency triage, assessment and treatment is operating reasonably well. Every week we have a meeting with the hospital director, the chiefs of the outpatient department, the emergency ward, the hospital pharmacy, the chief anesthesiologist plus the chief of the department in the ministry responsible for child health.

I try to attend these meetings as often as I can because, unlike many other meetings that depress me, these lift my spirits. The meeting always starts with stories about the children that didn’t die because they received prompt attention in a manner they would not have even a month ago.

We had arrived a little early and got to witness the triage in action. During a brief lull in his work the nurse, a new nurse, excitedly told us about how his triage work saved lives. There were more stories like that, all told in Dari so I only got the rough idea.

In all cases the essence was that at the end of the day the hospital did not have to send some parents home in great grief. Of course children still die and we are awaiting with great impatience the first chart that shows whether there was actually a dip in the 24-hour mortality statistics. I expect and hope for a dip, however small, as the dipping will probably be self-reinforcing

In the dark forest of ‘hard and difficult and messy’ it’s nice to have a few points of light.

Show and tell

The first day of our COO’s visit went without a hitch. The huge circus size tent stood on our volleyball field and had inside it tables covered with all the stuff our various projects had produced: slideshows, public education announcements, guidelines, pictorial guides for illiterate people, guide books, policies, training manuals, and promotional materials used on national awareness days such as TB Day, HIV/AIDS Day, etc.

Each project had their 10 minutes with the big chief while the rest of the people were busy taking pictures of one another, then in front of this table, then in back of that table. I clicked away myself as I know our 50th anniversary is 10 years away and by that time these old pictures will be priceless.

The current slideshow on which I have been working at least 15 hours was a success and worth all the time I spent on it simply by looking at the faces of those who have been with MSH for a long time. My intent was to make people smile and reminisce, and they did.

All the guesthouse cooks had been drummed up to prepare lunch for all the staff, a cast of over one hundred. The lawn not covered by the tent was covered with chairs and tables. It was a very festive scene.

Multilingual conversations

We celebrated New Year’s Day with an Afghan family. The invitation had come from one of my colleagues. We found ourselves in a small nuclear family, not what one would expect when thinking of Afghan families; two girls, one boy (all young adults) and educated parents, a mother who had studied in Germany and a father who had studied in the USSR.

When we first arrived we sat in the formal salon, sipping tea, eating various New Year’s delicacies and getting to know each other. The mother and I spoke in broken German, the children, except S whose English is quite good, spoke broken English with us and we spoke broken Dari with the father.

I could understand the mother’s German reasonably well but speaking was another thing altogether. The neural connections between the parts in my brain that know German and that are learning Dari intersected so much that I found myself searching frantically for German words and getting Dari replies instead.

The father and son are in politics and with Axel, trained as a Political Scientist, the threesome had a great time together talking about Afghanistan’s parliament. We came to the same conclusions as we always do: progress will be slow but less slow if education of the population becomes a priority, a massive investment in higher education here and abroad, jobs and career opportunities for young people so they want to come back home from study abroad and the strengthening of the judicial system so that consequences are attached to bad behavior. And of course there are the women, but that, everyone agreed, goes without saying.

We had a tour of the house which contained one large formal salon with western furniture, four rooms with tushaks (carpet covered mattresses) and balish (hard back pillows), and some miscellaneous rooms where various possessions were stored.
One major way in which Afghan houses are different from ours is that neither parents nor kids have their own bedroom. According to S at night everyone plops down on one of the tushaks in (I imagine the warmest) room and sleeps. Having a house with young people and none of the privacies our young people have (and expect) is hard to imagine.

We met the house kawk (fighting partridge) which was a mean bird, as one would expect, going after dad’s toes. He was quickly put back in his cage, not a petting kind of bird. Then we admired the hybrid roses which had just started to leaf out. We have to come back to see the result of dad’s green thumbs.

In the back of the house was a separate rental unit, a lovely three story house with a roof terrace that looked out on the narrow and exceedingly dirty Kabul River. In the distance S pointed out the bridge after which the area is called where junkies live.

While Axel played chess on a tiny chess board with S’s dad (and lost) I got to see the family photo albums, just like at M’s house some months ago. I marvel at pictures of these Afghan families, with parents our age, how they dressed and lived in the 70s. It was actually not that different from how we dressed and lived – no chadoors, exposed arms, necks and legs. Looking at these pictures one can see the extent of Afghanistan’s backslide, at least for the middle class. Watching the women now I can’t imagine how this is possible and I am reminded of Margaret Atwood’s ‘The Handmaiden,’ which is, hopefully, a fantasy, about such a backslide in the US.

What amazes me most is that the people who were young adults in the 70s and the parents of many of my colleagues now, have still not be able to regain their and their children’s (especially girls’) freedom from oppressive cultural, social and gender norms despite the fact that the Taliban have long gone.

Aside from the political discussions we also talked about the Holy Qu’ran, the Books of Psalms, the Torah and the Bible, all holy books and all, supposedly, required reading for good Muslims. All books were available in the house, including the King James Bible in English. This led to further conversations about the differences between the various holy books that I found very illuminating as it explained the Moslems low regard for the bible which, they claim, had probably strayed very far from the original stories and texts over the centuries with much lost or added in translation, something that cannot be said of the Holy Qu’ran which remains in its original Arabic.

After a simple but delicious lunch I found myself explaining Quaker traditions before we were treated to a fashion show by the two girls. We think we started the new year in the best possible way.

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New Year’s Eve Afghan style

I am sitting here writing on the last day of the Afghan year with three and a half kilo of dried fruits and nuts next to me. The order was delivered in the early evening by the woman who runs the Afghan Pride Association. She hand delivered the traditional new year’s delicacy called Seven Fruits (hafta meyva) in seven 500 gram bags. We learned how to process the delicacy from Razia jan who brought us the finished product at just about the same time.

The traditional dish is made from a combination of fruits and nuts: pistachio, almonds, walnuts, dark and golden raisins, tiny dried apricots and something that looks like a different kind of apricot. The ingredients are skinned, washed and then submerged in boiling water to soak overnight. It’s the removing of the skins from the nuts that’s most tedious Razia told me.

M. explained to me that the traditions around the Afghan New Year date back to pre-Islamic time and came from the Zoroastrians in Persia. The celebrations are not universal in this country. There is a divide more or less along ethnic and north-south lines: there are those who welcome the new year with great abundance and those who see it as a heathen practice. The more conservative mullahs are preaching against the exuberant start of the Afghan New Year. The most exuberant of all the action is in Mazar in the north. People are streaming there from all parts of Afghanistan.

We are all told to stay home because there will be crowds everywhere and the rule is, stay away from crowds. We are not as constrained as the people in the US compound who are in lock down since today and until Tuesday evening. At least we can move around a little bit and were allowed to accept an invitation to celebrate the start of the Afghan New Year with S’s family tomorrow. Unfortunately we were not allowed to join the family later to one of the popular outdoor places like Lake Qargha or Babur Gardens where crowds are expected.

Working for the republic

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.

Eating out

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.

High and windy

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.

Memories

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.

Stucks

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.


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