Returning to Emergency Hospital

Before I arrived in Kabul, I had been planning to visit the Emergency Hospital. Other than my imagination, two short trips to the Panjshir, and a weekend in Mazar-i-Sharif, Emergency was Afghanistan to me. I made early contact with Hamed and Shukoor. Hamed took me for a drive and dinner; Shukoor invited me to Hedayat's wife's Takhtjami. After ten days at Wazir Akbar Khan Hospital I was quite anxious to visit to prove to myself that a little effort, a bit of organization, and a hospital with a focused purpose could deliver decent trauma care.

I have always thought of the Emergency Hospitals as being clean, far cleaner than the provincial hospitals. Much of this is due to its signature white walls, the yearly application of a fresh coat of paint, the meticulous ward cleaning schedule, the gardens, and a functional laundry for which bloody sheets and bed clothes are an empty excuse. Few hospitals in the developing world are as sterile as hospitals in the U.S.; I can work around this if the hospital appears clean.

When I entered the guard house at the gate to await approval of my visit, I found Koko Jalil asleep on the couch. His distinctive white-gray beard and the tan pakol, pushed back Massoud style, haven't changed in three years.

Beautiful, blond Susanna rescued me from the Afghan administrator, who hadn't a clue as to my identity, and introduced me to the all-Italian international staff. All new and all, except the general surgeon, appearing very young. Marco's hug was as solid and warm as I remember. Strange that I so readily hug the Italians, yet with Americans I've known for years, it seems a stilted and unnatural maneuver. I was happy to talk with him and happy he was back in Afghanistan. He treats both Hamed and Shukoor as colleagues. Unprompted, they both told me how much they appreciate that he is working for them, for the Afghans, not just for Emergency.

Marco asked if I wanted to tour the hospital. I wanted nothing more than to be told about every patient in every ward and to pore over every x-ray. It was all so familiar, the clean white walls, everything in order. Even the OPD with three newly arrived patients was a study in order--no rushing, no senseless scurrying. This feeling of order, almost of refuge, that I get in Emergency Hospitals, is an idea I don't seem to be able to readily get across to non-medical people. Yet I've seen the recognition of this light up the faces of doctors or surgeons who have worked in the third world, when they walk into an Emergency Hospital compound. Even the Italian tourists in Cambodia who come for a tour when on vacation to Angor Wat and want to see where their money goes are generally appreciative, but have little clue as to how truly different these hospitals are from the normal chaos and are neither surprised nor comforted.

I was surprised that so many people recognized me and remembered my name. The young x-ray technician, smiled so openly that I felt immensely welcomed. I know the Afghans appear happy to see anyone they know from before, even if they disliked them immensely, but I took their smiles and greetings personally.

I like Marco's style. He is not fazed by anything. Every surgical problem is just that, not a casino, something to be dealt with. He seems to be running the hospital such as he ran it in the past--with a firm hand and a sense of order of what the resources--human and otherwise--can offer. He and I agree on many things. For a while it seems Emergency was operating on its own, almost pretending it was like the Vatican, not part of the country of residence. Marco realizes that the hospital has to be part of Afghanistan's big health picture. Maybe the picture is out of place on its present wall, but, still the organization must deal with the reality.

Hamed walked over from his flat to pick me up--the weather had turned nasty--windy and cold, the dust was atrocious and I was glad for a scarf to cover my nose and mouth. Hamed's sister, Nazifa, was busy cooking a feast--mantu, aushak, meat, salad, qabli palao. The mantu and aushak, both dumplings or ravioli, were the most tasty ones I've ever eaten. She had worked all afternoon to make the food and I watched her in the kitchen preparing the last bits. Afghan culinary techniques are time consuming, based on old ways of doing things, not changing as new instruments enter the market, though she did have a hand-cranked pasta maker to make the dough for the dumplings. I liked watching her, liked the way she cut the watermelon in great uneven pieces, but with such gusto.