first few days in Kabul

26 April

Dr. Zirkle once told me that at SIGN conferences he concentrates on making only certain, limited points about the nail. I made some non-SIGN power point presentations to give to the doctors--flashy extravaganzas. They would work for the Filipinos and the East Africans--the Anglophone docs who have been using English since kindergarten. Here it isn't going to work, and in Mazar, it will be more difficult. I will have to change tactics.

Though there are problems with getting the older surgeons to think in terms of SIGN, the younger ones have been the engine behind its use at Wazir Akbar Khan Hospital. Dr. Ayyub said that with SIGN there are fewer non-unions and broken plates. The fact that Ayyub used this as criteria of success, made me realize he understands the goal. He also knows how to keep his cool.

One patient on the ward with a fractured femur had a carnelian bead on a string tied around his right wrist--to protect him from bad sounds and encourage healing. I wonder if it is like protection against the evil eye, but in this case, against evil sounds.
Hamed walked over from Emergency after work to visit with me. I had thought he had driven, but after searching in the parking area, found him at the front entrance of the hospital. One of the guards had commented on a small chain he was wearing on his pants and Hamed gave it to him. He laughed about this request for baksheesh. I guess when it is present at all times, it only makes sense that one learns to live with it. I find this sort of corruption quite disabling
He offered to take me out that evening and I took him up on his offer. A pleasure dive in Kabul is an oxymoron. The roads are only a pocked excuse, the traffic is aggressive, the thick pall of dust--especially at the end of the day--makes it impossible to see, and if I'm honest, there is nothing of beauty to see. But during 6 months with Emergency I went out so seldom, that the idea that I can get out now is rather exhilarating. We drove across town, up onto a hill with a mausoleum being built for Zahir Shah and his father. One existed before, but it was destroyed in the civil war. He took me past the Bala Hissar, but it was too dark to walk around the ruins.
When I asked Hamed about the hospital, he said it had been pretty quiet over winter, but now with the recent rains they are seeing more children with landmine and other ordnance injuries. They were also seeing more stab wounds. This, to him, was a positive sign of increasing stability. People are afraid to carry guns, and had reverted to a slightly less lethal form of expressing their frustration.
When we talked about general changes in the country he said 10 years ago, people were all poor, pretty much on the same level, but now there is a huge difference with the two ends of the spectrum increasingly further apart and far more people at the very poor end. He said the doctors are also a problem. There are too many of them, they order unnecessary medicines, perform unnecessary surgery. When they see a patient they look first in the pocket and then at the face. Patients view doctors not as people who help, but as predatory, criminal. The sorts of kudus that more well-to-do doctors get, taking care of wealthy patients don't belong to the doctors at Emergency, since the hospital takes only the poor. Hamed realizes that in the Emergency system doctors miss out on follow-up since the patients aren't theirs, (he put it in different, more Afghan terms, saying he does not have a chance to become famous.) People don't know his work, the patients don't know his name and so there is no recognition, which is most important here. The upside is that the poor receive proper care and there is no corruption.

Thursday evening during dinner out I met Christina, a woman who is in Kabul working with an NGO teaching skills to deaf women. Some of these skills are cosmetology. I asked if "the beauty school" was still functioning and she hesitated. It seems that after the Beauty School of Kabul was published, Deborah Rodriguez, the author, was banned from the country. Someone thought the book detrimental to Afghanistan's image.

The Norwegian woman who wrote The Bookseller of Kabul is also banned from the country. She portrayed a rather seedy situation that was quite damaging to the image of Afghan men among Westerners. The Afghan actors in The Kite Runner are also banned because of the portrayal of sodomy in the movie. I wonder if the author is also banned. He is an Afghan-American man and not a foreign woman. I find all this banning a backward and unproductive way to mold peoples' images of the country. Prohibition only heightens the appetite. It also shows fear of different ideas and a bullying mentality.

Tom Kraner, the general surgeon, agreed to walk up the hill/mountain west of the hospital Friday morning. There are so many things I never experienced when I was in Afghanistan before and now I have the freedom to do them. I wanted to go at 05:00. It is light then, the best light of the day. He would have sprung for that hour except he was worried that there might not be enough people. Security requires some people to be present, but not too many. It's a delicate balance, something one senses. There have been kidnappings in the past, but things are quiet now.

The path, which I can see from my apartment, used to be accessible from a back gate to the hospital, but this has been cemented shut, so one must walk about a km out side the hospital compound and around Indira Gandhi Children's Hospital to access it. Tom knew a short cut climbing up over the hospital's walls, walking along the top and jumping into a ditch, saving 20 minutes. It was like being a little kid and finally allowed to go out and play with the big ones. He's a tall, fit guy with long legs. I felt like a dashhound beside a great dane and that at 6000'.

The 360° view from the top was marred even at 06:15 by a low level brown haze. It will only get worse as the temperature rises. A Soviet-built swimming pool sits at the top. The talibs used to take people up here and shoot them; the bullet holes in the pool are now patched up. The snow mountains to the west were quite magnificent. On the east, below the hill is a newly laid out municipal public park--laid out in Persian fashion with square plots separated by rows of trees. I wonder if it is done like that so each family coming for a picnic has their own square. The west slopes and valley of the hill are covered with graves. Cemeteries are by rule free of landmines, a nice place for picnics.

A man walking with 3 children called out a greeting in English. He's a translator for the US military. I found out listening to Tom and the man, Fazli, that the US has a program in which certain people working for them, especially for the military, can apply for a US visa after 4 years of work. It's a protection program since many have dangerous jobs. Fazli complained about the Pakistanis coming into Afghanistan. He said "terrorist," but from the Afghans the word often sounds like "tourist." He said the Afghans needed a stronger government. Afghans respond to strength, they respect and appreciate it, even when it stops them from doing what they want to do. They respect the limits even when they are always working to destroy them.

We walked down the hill, passed a small neighborhood bakery, a "shop" about 2 meters wide. I wasn't hungry, but couldn't pass up the smell and the thought of hot fresh bread. I ate my "flap" as we walked along the non-descript dusty streets. I gave the remaining naan to Margaret for her breakfast.