Ron Pavellas, Past President of Stockholm International Rotary Club, is on a field trip to Afganistan and during his weeks there will be sending us reports of his everyday observations and endeavours. Ron's trip is funded by Stockholm International Rotary Club, Kista Rotary Club, the Sweden-Afghanistan Committee and through contributions from idividual Rotarians. Thank you all for your support! Ron's email
Ron Pavellas, Past President för Stockholm International Rotaryklubb, befinner sig på en studierese för att granska sjukhusstandards och -behov i Afganistan, och kommer under resan förse oss med reserapporter om de han ser och möter. Rons resa bekostas genom bidrag från Stockholm International Rotaryklubb, Kista Rotaryklubb, Svenska Afgankommittén och enskilda rotarianer som genom egna bidrag stöder resans genomförande. Resans slutsatser kommer sedermera redovisas i en rapport. Ron tackar för allt stöd! Rons epost
I am not nervous at all, merely in a wait-and-see mode, ready for all new impressions.
On board. Took a nap and probably we will land in Frankfurt in around an hour.
12.45, Frankfurt airport.
In the waiting area for the flight to Dubai.
I am finally feeling in a new atmosphere. In the waiting area, without looking too hard or too long, I see and hear foreign, African and Asian faces and hear the sounds of female chatter in energetic choruses. The colors of the clothing are brilliant and shining. Some women wear the headdress and full covering, but with face free. There are many European faces, as well, mostly men -- on business I assume. There are some young women's faces that are of Europe. Frankfurt airport is shiny and clean, hard-surfaced, marble-like floors. In the Air from Frankfurt to Dubai, 15.35 Stockholm time: 17.35 Dubai time. I thought Dubai was 4 hours later than Stockholm, but it is 2 hours later. Afghanistan is one-half hour later than Dubai. So Kabul is 11.5 hours later than California and 2.5 hours later than in Sweden. I am in an aisle seat, on the left facing forward, in the center section. The two center seats to my right are empty. On the right aisle seat is a woman in chador (I don't know if this is correct terminology). She is fully covered, except for her face. She is in a bright dark blue upper garment, with a jean skirt over some sort of pants I can't fully see -- I try not to stare. She is now resting, eyes closed, but in the beginning of the flight she was reading a small book written in what I assume to be Arabic. She seems to purposefully not watch the TV screen in the overhead in front of us. The cabin attendants are German, except perhaps for one Germanic-looking woman (I thought she could have been a stocky male in drag) who speaks American. Two women in seats ahead of me are apparently African, and although theirs is also the kind of gown that covers, their lower arms will be bare upon them waving for conversational purposes. Their lower arms are covered with dark tattoos in the nature of script or designs that might be Arabic or related words -- I don't know. Neither can I tell whether these are temporary like henna, or permanent. The TV has shown a lot of stuff with Arabic (?) scripts and subtitles, including a rather sexy set of singers where a woman is quite revealing in her dress and movements -- much like a Spanish/Mexican video. The woman on my right does not watch. She is very dark-skinned, but not black and wears a turquoise headdress. The TV screen is now showing a Donald Duck cartoon. Now begins a Pluto cartoon.
21.45 Dubai airport.
Is this Las Vegas? Or does Las Vegas emulate Dubai Airport? Example: in the vast enclosed and air-conditioned area of the airport are tall palm trees, the bare trunks of which are ringed their full length by strings of lights. It is a bright mega-shopping mall, hurting my eyes. I will not sleep during my wait for the plane to Kabul at 06.00 the next day, 9 June. I will not regale you with the confusion about tickets and baggage collection and how to get to the other terminal on time. It eventually all came together, and I met several interesting people along the way:
- A South African woman, a nurse educator, teaching nursing students in Riyadh, Saudi Arabia. She was on her way home for a break from work. We promised to communicate by E-mail
- An American Rotarian from Encinitas (near San Diego) doing Rotary volunteer work in Jalalabad, Afghanistan.
- An Afghani Army Colonel, a military attaché in the London Embassy of Afghanistan. He has a Swedish Connection whose name and telephone he gave me. Perhaps she will speak to my Rotary Club in Stockholm?
- I slept the entire way to Kabul.
The first impression was of dusty mountains ringing the great bowl that contains Kabul. Dust seems to cover everything. The airport was crowded, noisy, confusing with various levels of security and crowds from various places arriving for various reasons. Much shouting of questions, comments and instructions between and among the uniformed officials and the arriving passengers, as far as I can infer. There was some grousing over the preferential treatment of UN workers in the customs line. I was met by SCA driver, Nadir. I tipped the baggage handler $2, not knowing what was correct. This turns out to be around 100 Afghani monetary units.
I went through traffic-maddened streets to the compound to unload and arrange my baggage in the guest house (among the semi-permanent residence in the surrounding apartments). Then to SCA offices 30-minutes away on the outskirts of town. I met many of the people there, and had a long conversation with the country director, a very impressive leader. I gathered a lot of reading material about the Ministry of Health and the work that SCA does for the Ministry, some of which I will be involved in.
I went to bed at 9PM and got up at 5AM, on Friday 10 June. Friday is the official "day of rest" for Afghanis, according to the religion. Many of our colleagues are out in the field and otherwise absent, so a few of us in the compound will socialize. I stay in a small apartment building of four apts -- the only person currently in it. My building contains the communal kitchen, dining and lounge, and the computer in which I am now typing. I made some fairly decent coffee from espresso grounds in a can. We drink water from bottles, plentifully provided. We had an excellent dinner last evening, five of us, and it cost me $6. This included a glass of wine, and a beer that one of the people gave me from her own stash. I will reciprocate when I find out how. I am consumed with learning the general and the special situations. The destruction here seems complete, yet the people continue. They are proud of what they had and seem still to see it under or beyond all the destruction. Armed police, including private guards, are everywhere. I live in a protected compound.
There can be no representative pictures, only narrow and selective glimpses. The destruction of a once grand country is nearly complete. Our driver, Nadir, points out with pride the destroyed palace that used to be. We visited the Intercontinental hotel, damaged but quite useful. The vegetable vendor is flanked by an open sewer. Security is everywhere, government and private.
Saturday 11 June.
Awaiting a meeting with a Dr. Ahmed, a physician, to continue my orientation. I will visit Wardak by automobile on Monday and leave for Kunduz by air on Tuesday
Circling this great bowl in which rests frantic Kabul
The high, dry ridges to the East
Reflect harshly the light of the setting sun
Those to the West are capped with snow
From the storms of the last two days
I feel I know these mountains
They are cousins to those I have known
In the high deserts of California and Nevada
They make me feel accepted in this new land
Exactly half-across the earth from the others more familiar to me
This land and its people will perhaps accept me also,
Inshallah
"Inshallah," God willing, I will survive these automobile trips to various places within and without Kabul. Of all the new things to deal with, the most difficult for me is to relax as the skilled driver weaves his way through the chaotic and often rutted roads. It amazes me to see people, including children, navigate fearlessly in the undisciplined streets and roads amid the trucks and cars and the occasional military tank. Bicyclists, motorcyclists, cart pushers, sometimes donkeys, sometimes goats or sheep all mingle, passing each other anywhere on the road, horns and brakes liberally used. As I mentioned earlier, one driver makes fun of me for pushing the non-existent brake with my right foot while in the passenger seat.
Today was my first trip out of Kabul, to a contiguous province to the west - Wardak. I visited the health center of the major town, Maidan Shahir. It was a nerve-wracking 45-minutes drive from the "Expat Compound" in Kabul, at least for me. The others were daily commuters who work in Wardak, all expats, two from Sweden, one from France. They seemed unconcerned as we experienced what seemed to me to be many near collision with bicyclists and pedestrians and other vehicles maneuvering in parallel and in series for position in the road. Some parts of the main roads in Kabul are under construction by Chinese companies and crews, making parallel detours inevitable.
Enough of this venting, however. After we left the outskirts of the city, and had mostly open fields and range and foothills near us, we had a relatively smooth ride as we gained altitude ultimately to 2260 meters, according to the GPS device of Dr. Phillipe. We were over a pass, but still in the drainage area of the Kabul River. (I had gotten a briefing the day before by SCA's Afghani public works engineer on the five drainage areas of AFG and its recent history of drought and its rivers an so on -- fascinating.)
We saw nomads returning to the city with their flocks of sheep and goats, sometimes accompanied by dromedary camels. Their dress was quite colorful and the women seem not to be as completely covered as the city, town and village dwellers. We saw much construction underway, everywhere, city and country, much of it reconstruction. The walled living areas newly constructed and in construction in the countryside are made so to keep eyes away from the women of the village or household compound. The soil is stony and rocky. Myriad piles of large, jagged stones are in cairns along the way, apparently waiting to be used as the main ingredient for walls and fences.
We passed two police or Army checkpoints, one at the border of the two provinces, Kabul and Wardak. We were waved through.
The rest of this narrative has to with my experience at the health center, its hospital and clinics. I am typing now on my portable, folding keyboard attached to my old PDA (Handspring). The computer and its link to the Internet of this apartment building I currently live in is used by others and I cannot have an uninterrupted time at it until quite late. And, the mood of the experience is quite different from I have so far written here. All I will say is that I had to exert effort at one point to maintain my composure and to keep from weeping
I will attempt this tomorrow morning when I am fresher and, I hope, in better physical shape I have had no exercise in a week, and I will do some calisthenics in my room, which is quite spacious.
Ron
PS: I will fly to Kunduz in the North on Wednesday, to stay for three weeks. After my time there, I will be driven back to Kabul in a vehicle over and through a tunnel in the Hindu Kush (mountain range), the highest paved road in the world. I will then return on a daily basis to Wardak for around three weeks to complete my work.
Tomorrow I will visit with an official of the Ministry of Public Health, visit a Kabul hospital and possibly have another tour of Kabul in the afternoon.
(Several kind comments on my mailings provide motivation to continue -- many thanks.)
It is simply a fact of life in this country that the sexes don't mix, except in controlled circumstances. Women do appear in public, but only if covered completely, except for Afghani women whose families are not as strict in this, and then at least the face will be seen. Foreign women are even more revealing, but will always have a shawl over their head or at least on their shoulders.
So, the hospital and the clinics in Wardak are segregated. There were women lined up to visit a male neurologist or neurosurgeon, but I believe their husbands or a male relative were present.
We approached the health centre by taking a frontage road off the two-lane highway. It was deeply rutted, rocky and dusty. We visited first the administrative offices in a set of small one-story buildings surrounded by a rock and cement wall. The corrugated iron door was guarded inside and out, and the passage to the inside was barely able to accommodate our Toyota SUV. In the car with me were the SCA Team Leader (a French Physician), the development worker and deputy administrator for logistics, finance and office management. (The latter two are Swedes who live in the compound, but in the longer-term residences. I stay in the building for those in transit, and I am the only one in the building of four apartments.)
I was greeting by several Afghani officials, one of whom I had already met in the headquarters offices in Kabul, Dr. Z. He is formally the "technical Deputy" to the Team Leader. Neither of these physicians currently works in clinical medicine.
I have been wearing sandals and no socks, as is common among men. I, along with all others, removed our foot coverings before entering any of the buildings in this compound. So, I experienced some cognitive dissonance in being barefoot in the administrative offices of a health centre.
Before entering I was shown where the outdoor privy is and where one washed one's hands (also outside) after using it, and before eating lunch. This building contained some of the administrative support offices, including finance, and also the main meeting room. It has no chairs, and is lined around the walls with cushions of about three inches thickness. We were later to eat lunch there, sitting cross-legged on the cushions. The central area was laid over and filled completely with a rubber mat on which the dishes of the day were laid. We used the traditional large bread slabs to pick up our food, although there were spoons in the yogurt (?) to place it into the main dish. Rice and a sort of mild stew were the main dishes, with a delicious Pakistani mango for desert.
I seem to be avoiding writing about the most poignant events of the day, but I believe I have to get all these details out of the way before I can. And now, I see the clock is defeating me.
It is now in the evening, and I have to prepare for my early morning flight on a UN plane to Kunduz. The rest of the above story will have to wait.
I spent today mostly touring, and I will send pictures via a link in Yahoo. I don't have time or energy to give a narrative for the pictures, but hope to later. Highlights were the dammed lake that holds Kabul's water, and the Kabul museum with the few things there that are left after some of the Majahadeen stole or broke the rest.
I also met with a high official of the Ministry of Public Health as a courtesy call, and he would like me to tell him what I have found in the hospitals I will evaluate. My SCA supervisor is delighted with this connection and invitation.
More, sometime later.
Ron
50 minutes to fly Kabul to Kunduz on a UN-owned aircraft. Here are take-off, and scenes from south of the Hindu Kush, over the Hindu Kush and into the fertile valley containing Kunduz, and deserts north and west of Kunduz City. 
My first private walk in Afghanistan through a bazaar. I bought sandals at the store of the older fellow, a high-school educated, articulate and ambitious young man who interrupted his education to flee the Mujahadin and Taliban -- by moving to Pakistan.
I see him as a future leader. He has strong ideas about what is good and not good for Afghanistan, and he highly praised the work of the Swedish Committee for Afghanistan. We had tea together and chatted a while, while boys gathered around to be part of the action and spectacle.
Kaduz, so far.
I have arrived Kunduz and, so far, I am reminded of when I worked in a rural county hospital in Central California, an agricultural center. But I defer any more words about my flight to and my further experiences in Kunduz until I complete transcribing from my notes of the Wardak visit.
At the health centre's offices, I was introduced to the hospital's chief operating officer (with a different title), a physician not in medical practice. He is an imposing man with clear, direct eyes, with a great black beard clipped square at the bottom. He wears a white pillbox hat, a common headdress. (I was later to earn this indicates, probably, a Muslim who tends toward strict observance, or "fundamentalism." The hat is Pakistani, not Afghani, according to one of the drivers.) He was dressed in white, the usual pants covered by a flowing smock with split sides.
We walked from the Health Centre to the hospital and clinics about 200 meters away. We traversed an untilled field that seemed to be occasionally washed by rain runoff that cascades from the nearby hills.
As we approached the guarded gate of the walled compound in which the hospital and clinics are contained, I noticed that a recent rain run-off had gone straight toward and under the wall of the compound, obviously having flooded the grounds and buildings inside. We stopped to discuss this and he acknowledged that this had recently happened and that it had been and remains a big problem, especially in that the run-off water headed right into the area where a new inpatient unit is being constructed. He talked a bit about how he is dealing with the various public ministries of the provincial government.
We then entered the compound, along with individuals and families seeking care, and various workers and visitors on business, some in vehicles. No part of the grounds is paved, although there are concrete walkways, mostly quite new, connecting some of the buildings. The ground is dusty, dust being a fact of life everywhere one goes, especially in the warmer months.
There is much detail I can relate about the physical setup, but I will save this for my official report. The salient, human issue is that whatever is in place is inadequate to meet the great need. Crowds of people, all ages and both sexes, crammed the outdoor and some indoor waiting areas for clinics and the pharmacy (a separate window for men and women, side by side,)
The inpatient wards are small, dark, not apparently clean.
My host told me of all the things he daily attends to get the physical plant improved, now and for the future, He seemed full of intelligent resolve and exuded the qualities of leadership, as far as I could tell from my limited understanding of his words. He spoke English well enough, but there was much noise and my hearing is not good for conversation in a noisy environment, especially with persons whose accents are unfamiliar to me.
As we toured the grounds and buildings, I focused intently, but briefly, on various people coming for care. There were colorfully children everywhere, most of them apparently accompanying ill mothers or siblings. Their faces were dirty, but no more so than any child who has been playing in a dirt field, such as where the hospital and clinics are placed. One old man harangued my host, with an eye toward me, an obvious foreigner, about the conditions for waiting for service (my host translated). I said I agreed with the man, with no demurrer from my host, and I acknowledged the man by placing my right hand over my heart while looking at him in the eye, a common gesture of greeting,
We toured all the clinics, lab and other areas, all of which are dark, in disrepair, not apparently clean, filled with people, The pharmacy is one big room, empty in the center, the walls lines neatly with drugs and dressings and all manner of medical supplies, but whatever systems were in place for inventory control and other management tools, were not evident. (My host later told me that he personally conducts weekly checks on the use and levels of drugs and supplies.) The patients are served at a window to the outside, as noted before. As I left this room ahead of my host to who stayed briefly to talk with the two people in the pharmacy, I found myself deeply saddened and moved by the lack of resources that these workers had in order to meet the need.
The hospital leaders and professionals continue to be hopeful. The grounds are dug for the foundation of the new inpatient unit. A new surgery building addition is almost finished. I toured it and noted that the two ORs had good but old surgical lights, probably adequate -- castoff gifts?
I have omitted description of much more. Despite the crowds, the unclean environment, the lack of adequate buildings, space and tools (and female physicians), my host has optimism and great energy. After all, things are better than they were.
Defunct Soviet tanks are always along any highway.
Myriad colorful banners are staked in the earth eveywhere to commemorate the deaths if Afghans during the wars of the last 25 years.
The building site
The three gents are: the engineer of the site, the chief engineer of this Province and the driver, left to right.
SAK Guest Residence (Formerly used by the KGB)
27 June 2005, 05.45
It is a cool 25 degrees Centigrade this morning. The recent days have been above 40. On some days fine dust from the surrounding desert quietly blankets the city like a light brown fog. Sometimes a brisk wind will push the dust throughout one’s living quarters.
Flying into Kunduz one sees a lush valley, verdant and well-tilled fields of rice, fruit trees, melon and more. The bazaar is filled with the produce of Kunduz, and beyond. Delicious mangos from Pakistan are irresistible.
The people travel the dusty, gravel streets on foot (sometimes pulling heavily-loaded carts), bicycles, motorcycles, on donkeys and donkey carts, in taxi carriages pulled by gaily tasseled horses, in motor vehicles of all sorts (including the occasional military convoy). On the side roads you will find cattle, sheep, goats, chickens. All these are competing for space, along with the vendors in and around the bazaar.
Many of the main roads are now in the process of being paved with asphalt by a German company, I believe. The street outside our living compound (two of us here at this time, always guarded) has been transformed in the last few days from a rough, dusty gravel road to a smooth street. To discourage speeding, each intersection has concrete obstacles to maneuver. The velocities of vehicles between these intersections reach dangerous levels (at least for my sensibilities). There are apparently no traffic laws. One drives on any side of the street at any time for any reason, but the default position is to veer to the right going forward.
Friday is the holy day, and Saturday is the expatriates’ additional weekend”day, for the most part. Sunday is like Monday in California and Stockholm, as far as going to work. I have access to the Internet only at the project offices, and never on Fridays. The connection is slow and not always reliable. Sometimes the city’s electrical power fails, although there are standby generators for the project offices.
There are three locations I drive to and from (Yes!) – the residence, the SAK/SAC (Swedish Committee) project headquarters and the Kunduz Provincial Hospital. These are all no more than a kilometer from each other.
I have walked the bazaar a few times with Kerstin, a master midwife educator from Sweden. She has worked in Africa and Southeast Asia as well. She calls herself Madam Kunduz. I feel safe with her. She has been here around two years and has confidence in her dealings with the merchants in the bazaar.
She is tall and elegant, a woman of not quite my years who draws stares from boys who are not used to seeing the bare face of a woman – and one whose skin is so pale. She wears a light scarf to show respect for the tradition of woman’s dress here.
Kerstin helped me find the place in the Bazaar where sandals are sold. We were drawn to a stall in the inner recesses of what I call a Ginza (from my memories of Japan in the late 50s). A clear male voice spoke in English, inviting to look at his sandals and other wares. He is a man in his late 20s -- handsome, smiling, confident. We chatted a bit, Kerstin and I identified ourselves with the Swedish Committee, and I bought some sandals. We were then invited to have tea and conversation, which we accepted. Ahmed has completed high school (gymnasium), but further education was interrupted by the wars and his family fled to Pakistan.
Young boys surrounded us, seemingly fascinated. Ahmed talked politics and we listened and responded without commitment. We talked about his business, the buying for which takes him to Pakistan and China. I told him, as we departed, that I expect he will be a community leader. He did not deny this possibility.
I was driven North to the town of Imam Sahib, across a desert, along with the project’s chief engineer. It took around 75 minutes. We looked the progress of a 50-bed hospital being built there as part of the Swedish Committee’s contract with the Ministry of Health. I had already looked at the drawings of the floor plans and had made what I hope will be helpful comments, which I tested, on this trip, against the reality of the actual building.
The desert was not barren, except for a few stretches. There seemed always to be enough ground cover (in June, at least) to offer something to nomadic herds. The road was paved but rough, and the Imam Sahib turn-off from the main road to Tajikistan was dirt, but in the process of being paved with gravel. It was not a comfortable trip.
I met Mr. Ghani, the site project engineer. Our Chief Engineer from the SAK office, “Sheik,” and Mr. Ghani had much conversation about the hospital project. I was treated quite courteously, which seems always the case when meeting people in Afghanistan. I toured the site, including the second floor with no roof yet built, asked my questions and then was invited to tea with Mr. Ghani in the project office. No chairs, just mats and pillows. Sheik continued his tour of the project while Mr. Ghani and I attempted some conversation, which was satisfactory enough despite my lack of Dari, a language found also in Tajikistan – the mountains of which were pointed out to me through the office window.
A few days later Kerstin and I were driven South to the SAK northern region office headquarters to spend two days with the regional director, Christer, my first contact with SAK in January. This was mostly a social visit to celebrate Midsommar together, but we did talk business. I took some pictures during the trip through a rich farmland with a great, rapid brown river originating in the Hindu Kush.
I am healthy and possibly losing some excess weight. Living strategies include washing and ironing one’s clothes every other day, a least, and moving slower than one would in a cooler climate. The afternoons seem to fry my brains and I do not do my best work then. I will be here for around another week, and then back to Kabul by car, to stay until 4 August. Until then, I will commute daily to the two hospitals in the contiguous province of Wardak to make my evaluations and recommendations regarding management structure and function. I am not evaluating people, just management systems. I hope I can help.
Ron
On my way to Pul-i-Khumri
29 June 2005
My borrowed laptop computer has been returned to the IT Department of the SCA offices in Kunduz. I am typing on my portable keyboard (hooked to my PDA) for later uploading to the computer in Kabul, where I will be tomorrow afternoon, Thursday.
Tomorrow morning at 0530 I will be collected at the guest residence by a driver who will take me to Pul-i-Khumri, the location of the northern regional offices of SCA where I visited last week for Midsommar. I sent pictures of that trip calling them "Trip to Baglan Province." From there I will take another vehicle that is leaving for Kabul with a few other expatriates, including one American I met briefly before I last left Pul-i-Khumri.
I have completed my interviews and observations here and will write my report over the weekend in Kabul (Friday-Saturday).
While typing this I am on the patio of the residence listening to the first western classical music I have heard since 8 June. We are connected to a TV satellite via a dish, and we (the expat residents) have a choice of BBC News (when it is in tune) and, always, EuroNews: endless repetition of politicians grinning at each other in large rooms or outside palaces they are about to enter the engage in talktalktalk.
How is it I am I listening to music? Within the myriad stations from near- and mid-eastern countries, and eastern and southern European countries, is a Greek station that broadcasts this wonderful music at various times. I just heard Beethoven's 5th symphony and them some Liszt Etudes. Right now a choral group is singing from Mahler's Symphony #3 -- new to me. I am outside on the patio where the temp is 37, and a very slight breeze. I have hung the clothes I just took from the washer in preparation for tomorrow's trip.
I haven't yet written in this journal about my experiences and impressions of Kunduz Regional Hospital, but will within the next few days, starting here. I am awaiting a visit by a local official of SCA who wants to debrief me and get pointers on management. It is around 6PM.
The hospital is designated 200 beds. I don't know if it could actually be staffed at this level because they are currently strained at 110 patients. There is a shortage of hospital space for clinical service and of hospital staff, including physicians and nurses.
The building was originally a hostel that has been converted, but still can't measure up to hospital standards of construction. All visitors, employees and emergency patients (male) enter through the same door, even if on a stretcher. The Emergency Department is a cramped room to the left, immediately beyond the hospital main entrance. Women enter at an entrance at the other end of the building on the same side. There are UN and other NGO (Non-Governmental Organizations) tents on the hospital grounds, pitched on the bare earth to house the nomads and others who must stay around for reasons unknown to me -- possibly family members of inpatients.
I am now listening to a keyboard Sonata by Domenico Scarlatti -- a great treat.
I will be the only person staying in the residence tonight -- Kerstin has flown to Kabul today on the first leg of a brief holiday at home in Sweden. She lives not far from Eva and me, and I have offered a general invitation for her to visit us for dinner upon her permanent return in October. As I may already have mentioned, she reminds me of my deceased aunt Angie, also a skilled and dedicated specialized nurse.
This is a rambling account, I know, but my excuse is the heat and the noisy street beyond the compound's walls, and my need to check the name of the music I am listening to from behind me inside the living room door -- and the interruption of the occasional pesky insect.
I miss my music greatly. If there is a next time I will bring my headphones, my portable CD player and lots of my favorite music, including jazz. I also miss the relative coolness, and the trees and other plants of Sweden in the summer -- a glorious time and season.
More Beethoven playing now.
The hospital is in bootstrap mode, and has come from nothing a few years ago to a credible something currently. There is hope, and there are, in my judgment, a sufficient number of native Kunduz people who have the will, supported by all their strength and spirit and skills, to make this hospital the best it can be for the people of the Province and beyond. It has a long way to go. After all, there was 25 years of war during which almost everything was destroyed. But, there were important gains and holding actions through the efforts of The Swedish Committee for Afghanistan and those Afghans who provided interim and local leadership. I am no expert in any of this, but these are my impressions.
I hear about the problems in the mental health of many people who lived through the horrors of human loss and their own injuries. There are still many mine fields not fully cleared. I heard several explosions in Pul-i-Khumri that my host Christer said were purposefully detonated mines. This part of Afghanistan has a lot of such fields, given that it is close to what used to be part of the Soviet Union -- and is now the independent state of Tajikistan. There are still Russian soldiers at the borders in Tajikistan, I hear, to help them deal with smuggling and infiltration of terrorists. I hear also that these soldiers will soon be withdrawn.
I am not sorry to leave Kunduz. But I am glad to have been here. I will welcome the quiet streets of home and, of course, the companionship of my family. But, I still have another month of work, to visit and comment upon the two small hospitals in Wardak Province which the Swedish Committee manages (along with all other direct health services) under contract to the Ministry of Health.
There is no tradition of management in the style found in western countries. This western style is sought, and people in health care management at all levels want to learn about it, difficult as it may be in altering cultural patterns in doing so. So, perhaps in my questions and reactions I am, willy-nilly, a bit of a change agent. Whatever recommendations for planned change I may make to the SCA will be evaluated by them for implementation whenever, and if, they deem it suitable. It's great to be a consultant now, instead of being responsible 24/7 for the operation of a hospital or medical organization.
I have taken pictures of the residence I have been staying in, and may later post a few for your viewing. It previously was occupied by Soviet KGB officers, I am told.
The man who prepares our evening meal has arrived and I have paid him for past services -- 100AF or $2 per meal.
This truly has been a ramble, and is enough for now, no doubt.
Ron
The next morning in Pul-i-Khumri,
10.20 AM, 30 June 2005.
I was driven from Kunduz starting 0540, first through the already thronged streets of downtown Kunduz (the bazaar), then over the now familiar road to where I now sit. The regional offices of SCA are on a pretty piece of property, between a small bazaar and a canal from the nearby lake and its dam. The property is, of course, completely walled from the traffic of the street and bazaar, and the canal offers a barrier on the other side of the property. The canal is no more than 10 meters wide next to where I sit at an unused guard station -- a desk in the open air with two chairs, under a small stand of shade trees. The water moves swiftly, as does the larger main stream that runs in parallel around 1 kilometer from here, from the dam which the road to here crosses over.
As we traveled here, the area I saw on the last trip that was flooded (one picture I sent showed a large truck mired up to the middle of its wheels) was now even more flooded, to the apparent dismay of the driver who spoke no English. The main road we were traveling could easily be flooded over if the water were to rise several inches more, and he will be returning this way after dropping me off.
The main road was, for around half the trip, recently and newly laid asphalt, and we overtook the road builders at a later point than we did last time we went in this direction. The remaining road is older asphalt and gravel patches where the road had deteriorated.
Throughout this region, speed bumps (fart hinders, in Swedish) will appear with no notice and the experienced driver will know how and where to spot them in time before a nasty jolt. Many "bumps" are old tank tracks laid over with earth and gravel.
It is a pleasant day, especially under these trees. The air here is less clouded with dust and one feels (or imagines) the beginning of the alpine nature of the land just to the south, toward Kabul.
I am in a holding pattern, waiting until 12.30 for lunch and them to ride with others on my second leg to Kabul. I arrived here 0730 and was immediately shown a small guest room to use. I laid on one of the two well furnished cots with the door open and was soon presented with a tray of tea and a few things to eat. (I just saw a small, gray praying mantis scurry across the desk on which this keyboard rests.)
I had a nice nap, with the daylight streaming through the open door and a floor fan providing some air movement. It was a delightful catch-up form the lost sleep of the previous night.
I have not yet seen my traveling companions. I assume they are staying at the residence of the regional director (Christer) who is on his way to Sweden to attend his son's wedding. It is not clear whether I will be driven to the residence or the others will come here to pick me up. It will all come together as it should, Inshallah.
I am ready to ascend the Hindu Kush and traverse the world's highest paved road tunnel. I have camera and binoculars at the ready.
Ron
10 July 2005
To my right: Dr. Mir Hosman, Chief officer of the two small hospitals in Wardak Province, and to my left the Administrator and the Chief Nurse of Shneez Hospital.
This area is to the West of Kabul by about 120 kilometers. I greatly admire Dr. Mir Hosman who was educated in the Punjab area of Pakistan (during the Afghan diaspora) and who has returned home to this verdant area in Wardak Province.
The final journal entry for my one-month stay in Afghanistan.
I returned to Stockholm 8 July.
Leaving Kul-i-Khumri in Baglan Province, we began our return to Kabul. The Toyota SUV contained the driver and three others, two Afghanis and one American. I was allowed to have the uncrowded front seat next to the driver as usual due, I suppose, to my great age.
The driver was the same who drove me and the chief engineer (”Sheikh”) to Imam Sahib’s hospital from Kunduz. He is a young, darkly handsome man, usually dressed casually in western style with jeans and a shirt. Today he is wearing his ”Sunday finest” (only, of course, the holy day is Friday here), a pearl grey overgarment under which are matching trousers and blouse. He has a favorite radio station which plays popular music of various regional ethnicities, including Indian. The station’s theme music used as a bridge between ads, annnouncements and the main music, is an abbreviated ”Fanfare for the Common Man” by the American Aaron Copland.
Our dusty, trusty vehicle climbed into the Hindu Kush over a good two-lane road through varied terrain, the dominant feature of which was the rushing water of the muddy river, and then a clearer tributary river as we started up the switchback road to the summit. The lower river was creating flooding in the farmland paralleling the road, and it sometimes threatened the road itself. It was a slow disaster for the affected farmers, and we wondered aloud how long the road would be passable.
As we changed from one river valley to the other, we passed by a great plain where the Soviets made their first major encampment in Afghanistan. We could see the remnants, slowly crumbling into the surrounding, rocky terrain.
As the road became steeper, the driver switched off the air-conditioning to prevent overheating of the engine. The opened windows provided a welcome breeze and fresh air. At lower elevations the air is visible (I have a friend in Southern California who says he doesn’t trust air he can’t see).
The surrounding, snow capped mountains began to reveal themselves and, as the switchbacks became steeper and more frequent, the passing hillsides were covered with large, beautiful flowering plants. On one long straightaway, we stopped at the site of a bee-keeper where Dunham (an ecucation consultant from the USA) bought some honey. The man-made bee hives were quite near the road, overlooking the clear, rapid river and its canyon. I imagine the elevation was around 3000-3500 meters at this point.
Before we reached the road’s summit, we went through many covered sections of the road which, at first I imagined, from a distance, was the tunnel. These covered areas (with openings on the downhill side that let in air and light) are very much like the covered tracks of the railroad traversing the Sierra Nevada in California – to keep the snow and ice from the tracks.
Finally we reached the summit and got out to enjoy it. There were some vendor stands offering refreshments and souvenirs. I bought a packet of pastachio nuts. I had my usual supply of pure water in a hiking bottle.
Salang Pass Tunnel is about 3880 meters or 12,720 ft above sea level. It looks merely like a large semicircular hole in the mountain, but there is an air of expectancy about it. Its history is filled with war and hard work, and it connects two great regions of the country.
The tunnel is around five miles long, by my imperfect estimate. It was not well lit and had many potholes filled with water. Often there would be a stopped vehicle around which we had to maneuver over the two lane road, with uncertainty about oncoming traffic. The light at the end of the tunnel was quite welcome. One could feel the difference in the nature between the region we had just left and this one. It seemed less dangerous somehow, perhaps more developed by man.
Our descent to the plain that holds Kabul at an elevation of 1800 meters (5900 feet) was more gradual than our ascent on the other side. Passing us toward the tunnel we had just traversed were many large buses and trucks carrying what appearde to be whole families and their goods. The Afghanis present told us these were, in fact, families returning from Pakistan and that they dfid not necessarily have their old home to return to. The pressure to leave Pakistan and other places was increasing – it is difficult for both the host country and the refugees if they remain for extended periods. And, now that there was more order and stability in Afghanistan, there is more reason to return.
The figure I remember is 70%; that is, 70% of the people returning are ”IDPs” – internally displaced persons. This will account for much of the building of new living coumpounds I have seen in rural areas, and the many UN-IDP tents in the urban areas.
The trip from the south side of the tunnel to Kabul City was around twice the length of the trip from Pul-i-Khumri to the tunnel entrance on the north side. The southern trip was quite tedious and not as interesting, except for the returning refugees..
As we neared the urban areas, traffic slowed for road repair and other causes. The traffic toward us was in much worse condition than that in our direction. We passed two wedding parties, each in a long and stalled train of autos. There were very few non-motorized vehicles in these traffic jams. I assume the animal and human-drawn vehicles (and herds of animals) found other routes, away from the dangerous congestion of the paved highway.
Before Dunham and I were delivered to the expat comound, the driver delivered the two Afghanis to their respective neighborhoods in Kabul. We arrived at 6:10 PM, with dinner set on the table. It was good to be ”home.”
The next few days I commuted to the hospitals in Wardak, a one-hour trip each way from the closest hospital. I saw much progress in the physical plant of the hospital I had first visited upon my arrival. The outdoor clinic patient waiting areas were soon to be sheltered from the extremes of weather and the conopies were strong enough not to collapses under the weight of accumulated snow. The new building containing two new operating theatres was complete and functioning.
I attended a management meeting in the SCA offices in Wardak that included the hospital director and the hospital administrator. Issues regarding community health, hospitals and health education were discussed, as SCA has interest and official duties in all these areas and more.
The other hospital in Wardak province is the only one of the three operated by SCA that was built to be a hospital. It lies around 100 kilometers to the west of the first hospital. One travels through a beautiful valley with lush farmlands to get there. My host, Dr. Mir Hosman, the director of the two hospitals, told me of his boyhood in this area and pointed out the grade school he went to. He and his family own property in the area. He told me also of his family’s displacement to Pakistan during the wars and of his medical education at the University of the Punjab there.
Dr. Mir Hosman was warmly greeted by many people at the Shneez Hospital, and we toured the entire campus. As we entered the women’s wards and clinics, the women quickly covered their faces. I, as usual, did not look directly at any woman but took the entire scene in at a glance. The atmosphere was congenial, but there were a lot people waiting to get service. There were two female physicians here.
I attended the weekly management meeting and enjoyed the proceedings that my host translated for me with quick asides. Present were Dr. Mir Hosman, the hospital administrator, the head nurse and three doctors, one female. The female doctor had her face uncovered.
I repeat here that whatever deficiencies are apparent to the western eye, trained and untrained, things in the hospitals are better now than they were two years ago when SCA started to operate them.
Back at the expat compund we received a written message from the Kabul Management Office (KMO – the headquarters) that all personnel, except a select few, were to leave Afghanistan during a period prior to and after the general elections in September.
I felt I had seen enough to make a final report to SCA, and I was feeling less secure in Kabul as an American and as someone who really didn’t know his way around.
I departed, driven by the same driver who originally welcomed me (Nadar) and was warmly seen off by him and a other Afghanis employed by the SCA. I will stay in contact with a few of them.
A final observation
Kabul seems to be a city state that lies within Afghanistan, the country. There is great energy and ambition and many dreams of progress in Kabul, but the rest of the country abides in its rural pace, not greatly affected, in the short term, by the pace of the capital city. The election of the national legislature in September will be watched with great hope and anticipation, and their subsequent work-to-do will also be great. How to bring the advantages of western ways to a country that has its own useful and traditional ways without harming the fabric of society? What a great challenge!
In one or two generations we will see a healthy, educated and economically vibrant Afghanistan, Inshallah.
/Ron