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.

On the way to Kabul

24 April 2009

Dubai Airport terminal 2 is only marginally better than when I last experienced it in the fall of 2005. It remains the quarantine terminal. The preponderance of men--both westerners, primarily engineers and security types, and Central Asians in shiny suits with unhealthy paunches, and common stubble-- give it an unbalanced energy. The Western men are largish, independent-types, well off, but not flashy, the type who venture out to grab the iffy, but lucrative deal or the hundred other "things" obtainable only far from home. The Central Asians seem weighted in a fateful destiny and the debilitating effects of tobacco and ill living.

Considering the shiny, glassbling of the new Terminal 3, the quarantine terminal is a very poor cousin. The most incongruent aspect is that as soon as one passes from the general entrance into the restricted ticketing counters, one must negotiate a quarter mile of movable, gated switchbacks traversing the entire area of the otherwise huge, empty hall before reaching the luggage scanners. The snaking path could easily accommodate 600 people with baggage. But there is no one in the line, and no one has bothered to move the gates to accommodate this wasteful expenditure of energy. The same sort of maze confronts the traveler approaching passport control. Though not exactly the same humbling procession as the supplicant approaching the gates of Nineveh, it seems to operate on the same level of intimidation.

The accomodating Filipino at the Kam Airlines counter gave me seat 9A--the most perfect seat available for an economy ticket. Positioned before the wing and facing NW, away from the sun, and toward the mountains, I again had the sense of coming into the country with oriental fairy tale suspense and anticipation.

Clouds covered the interior of the Hindu Kush, heaped up against the valley walls, mixed in whiteness with the snow. West of Kabul, we dove into the clouds, circled to the north and completed our final approached to the west. Much is green in the undisturbed villages around the city laid out in rigid squares. Nomad tents and brown and black goats. Puddles from an early morning rain glaze the runway; glossy blue-black magpies hop around on the grass. While taxiing, Afghan men walk around the plane, the female attendant is ignored. It is a land of men, not laws.

Our flight has been enlivened by the addition of the Afghan Cricket Team, returning from their recent series of international games in South Africa. They did not win the championship, but neither did they disgrace themselves. The game is new to the country, having been added to the national sports lineup after refugees learned it in Pakistan. (So I assume most are Pashtun). They were honored back as quite the heroes, representing Afghanistan to the world in their green blazers with embroidered pocket patches.

Waiting at the luggage carousel I chanced on another world-classifying scheme: the number of suitcases passing on the conveyer reinforced with rope. Third world airports cater to fewer passengers traveling with cardboard boxes, but not all have graduated to complete reliance on manufactured zippers and nylon straps, allowing them to discard the security of tidy equator-defining wrappings of rope. I don't remember ever seeing rope in Billings; Dubai was pretty unroped, yet Kabul remains rope heaven.

My apartment at the Loma Linda University compound attached to Wazir Akbar Khan Hospital (WAKH) is simple, clean, and the sort of place I like. The IT technician has actually made the wireless connection my computer work. The people sharing the compound are very agreeable and all work at the hospital.

WAKH is typical of public health hospitals in the developing world, with different odors, huge numbers of people milling. I was given a quick tour and some counsel by Dr. Tom, the general surgeon who has been working here for a few years.

Viewing the Pierre Bonnard exhibit at the Metropolitan Museum I felt as if I was being offered a chair at a simple European repast. Fruit of the most luscious texture filled the tables, sometimes accompanied by a basket of bread, a bottle of wine, or a pot of tea. This was fruit that begged to be eaten, the intense colors promising flavor no Dutch still life perfection could deliver. I did not know all the fruits' names; some of the colors were unrecognizable. Was papaya available in France in 1929? Bonnard painted the illusion of fruit in all its old testament desirability. Even the shallow bowl of brilliant red sour cherries looked to be brimming with sweetness.

The second course of the artistic feast took place in the museum's ancient Middle East exhibit. The unfolding of each successive empire, each ruler, and each set of all-powerful gods gave meaning to the reality of impermanency. A fitting prelude to Afghanistan.