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.
07 May 2009
04 May 2009
A Short walk in the Hindu Kush
Seven of us ex-pats working at Wazir Akbar Khan left the hospital early last Thursday afternoon for Istalif to spend the night in the mountains at The Lodge, (www.remotehydrolight.com).
The exuberant, spring-green of the Shomali Plain north of Kabul was surrounded by mountains of cold, pure white lofty peaks. Having only passed through this area in the fall and winter when the landscape was a contracted dry monochrome, I was surprised at the inviting lushness, the expansive openness. But spring is fleeting in Afghanistan, and all will soon desiccate and melt into shades of brown.
About 40 kms north of Kabul we turned west toward the mountains, traveling a rutted dirt road alongside walled fields; walled living compounds, some looking quite prosperous with a fresh, outer layer of mud, dung, and straw; and walled vineyards. Many of the walls had been damaged during the Taliban wars and remain unrepaired. Others have fallen under the weight of weather and time. Walls define Afghanistan's cultural architecture; falling from walls and collapsing walls define common Afghan orthopaedic injuries.
Besides green, the fields and walls were dotted with the orange of single poppies and the blue-purple of a 6 petaled delicate, open-cupped flower. Young boys wantonly pull them up from the fields to sell along the road to Afghan tourists.
The road followed the plain for about 4 kms then climbed into the mountains, through picturesque villages of huddled mud houses, reminiscent of Italian hill towns in appearance and raison d'être. Orchards of blossoming apricot and almond, interspersed with groves of willowy poplars, balanced the horizontal green of terraced fields. Redbud, in thick bushy form, with branches lavishly covered in pink-red buds, lined the road and dotted the hillsides. Yellow gorse-like shrubs complemented this exquisite medieval pastoral picture.
The track through the villages or hamlets was flanked on both sides by the high, windowless walls of fortified houses or the shorter walls of terraced fields and meticulously tended small groves of mature walnut and mulberry trees in various stages of early leafing. Each switchback we traversed, skirted a stream of rushing water or an irrigation canal, opening to a clearing where people and animals could rest in the cool shade. Magnificent spreading chenars (oriental sycamores) graced shadowed glades. A short alley of deodars in one picnic area gave an idea of the more abundant beauty that in the past lured the wealthy of Kabul to Istalif as a summer refuge.
We stopped at the village at the end of the road, Mazar-e-Mitalam, 6 km from Istalif Bazaar to began the 2 km walk to the lodge. While parking the vehicle an official approached the members of the group requesting a clinic. The nearest medical clinic is a long walk and gives limited care. We had not advertised ourselves as other than ex-pats on a weekend outing, yet it was assumed we had the power to DO something.
The sound of water was the background music to the walk, but my thoughts were crowded with the most wonderful realization that I was walking unescorted, among Afghans who were going about their daily work. I was part of the picture, walking with a purpose to a destination. Though we all have different ideas of Afghanistan, the one of mud and rock architecture perched on the side of mountains, a rushing river below, intense blue sky supported by snow-white peaks, and red-cheeked children herding baby goats, is, I believe, universal. I was finally in the "real" Afghanistan--rooted in a distant Kiplingesque past, traversed on foot, interpreted in free-form. I never thought I would have the chance for such an unfettered short walk in the Hindu Kush.
It was a glorious walk along the chaotic Istalif River, the mica and pyrite of the wet rock glistening in the sun. A chenar at a bend in the river fluttered with strips of glittery cloth in supplication. For what? I assume the usual: fertility, protection from the vicissitudes of poverty, maybe a medical clinic.
After an hour and half dawdling walk with no photo-op left untaken, we entered the small garden of the unpretentious lodge. Two large sleeping rooms strewn with thin mattresses and bolsters around their periphery occupied the top floor with a small kitchen between. Three unisex hot-water shower; seated, flush toilet; and sink enclosures satisfied all other needs on the first floor. I sat on the roof listening to the river, absorbing the view of mountains, snow, green terraced fields tucked into every crevice high above, when the smell of sautéing garlic rose from the kitchen, followed by fragrant cinnamon and the yeasty smell of bread fresh from the oven. What a welcome!
The seven of us polished off the chicken, rice, and bread about sunset then some of us watched the stars from the roof and talked. Light from the quarter moon obscured the stellar display, so I woke at 02:30 to view the Milky Way and was rewarded with the head of Scorpio rising over the southeast mountains--the first sighting of my favorite summer constellation. I rose to sunshine at 05:30 and did a full workout of tai chi on the roof as the morning warmed.
Oatmeal, eggs, toast, and tea prepared us for an 8:00 hiking departure. My idea was a nice ramble in the hills, an alpine frolic. I soon realized I was in for a much different outing. After crossing the river we worked our way up through a green, irrigated valley plaited with water channels among terraced fields and groves of poplars. Tom led the way, picking our path over boulders, up and down, along scree and dirt, and around huge overhanging outcrops. Up we climbed, past the running water into a landscape of brittle dryness.
Wild mint and penny royal grew along the streams and when crushed underfoot gave off a heady fragrance. I found a small patch of tiny-flowered ground orchids. At the high, drier elevations, small yellow tulips, fritillaries, ranunculus, yellow "star lilies," the furry basal rosettes of mullein, and the red, phallic shoots of a spurge emerging from a bulbous root grew among the rocks. Bordering a boggy rivulet at snow line, a profusion of 3" high pink primulas grew in a patch of mossy grass, looking like a Persian carpet. Each stage of the climb brought us better views of the mountains, a greater expanse of snow, and best: the feeling of solitary achievement.
After a snowball fight we descended an adjacent canyon, gingerly picking our way on the steep slope to the stream that led us back to the river and the lodge. Seven hours of very unexpected climbing and worse--descending--had extracted all my energy.
I had not conquered any peaks, made no daring ice field traverses, or braved avalanches. I was scratched, pricked with thorns, sunburned, and exhausted. Yet walking out of the valley I felt a sense of belonging, as if I had earned my temporary presence in this strange and beguiling country, simply by walking in it.
The exuberant, spring-green of the Shomali Plain north of Kabul was surrounded by mountains of cold, pure white lofty peaks. Having only passed through this area in the fall and winter when the landscape was a contracted dry monochrome, I was surprised at the inviting lushness, the expansive openness. But spring is fleeting in Afghanistan, and all will soon desiccate and melt into shades of brown.
About 40 kms north of Kabul we turned west toward the mountains, traveling a rutted dirt road alongside walled fields; walled living compounds, some looking quite prosperous with a fresh, outer layer of mud, dung, and straw; and walled vineyards. Many of the walls had been damaged during the Taliban wars and remain unrepaired. Others have fallen under the weight of weather and time. Walls define Afghanistan's cultural architecture; falling from walls and collapsing walls define common Afghan orthopaedic injuries.
Besides green, the fields and walls were dotted with the orange of single poppies and the blue-purple of a 6 petaled delicate, open-cupped flower. Young boys wantonly pull them up from the fields to sell along the road to Afghan tourists.
The road followed the plain for about 4 kms then climbed into the mountains, through picturesque villages of huddled mud houses, reminiscent of Italian hill towns in appearance and raison d'être. Orchards of blossoming apricot and almond, interspersed with groves of willowy poplars, balanced the horizontal green of terraced fields. Redbud, in thick bushy form, with branches lavishly covered in pink-red buds, lined the road and dotted the hillsides. Yellow gorse-like shrubs complemented this exquisite medieval pastoral picture.
The track through the villages or hamlets was flanked on both sides by the high, windowless walls of fortified houses or the shorter walls of terraced fields and meticulously tended small groves of mature walnut and mulberry trees in various stages of early leafing. Each switchback we traversed, skirted a stream of rushing water or an irrigation canal, opening to a clearing where people and animals could rest in the cool shade. Magnificent spreading chenars (oriental sycamores) graced shadowed glades. A short alley of deodars in one picnic area gave an idea of the more abundant beauty that in the past lured the wealthy of Kabul to Istalif as a summer refuge.
We stopped at the village at the end of the road, Mazar-e-Mitalam, 6 km from Istalif Bazaar to began the 2 km walk to the lodge. While parking the vehicle an official approached the members of the group requesting a clinic. The nearest medical clinic is a long walk and gives limited care. We had not advertised ourselves as other than ex-pats on a weekend outing, yet it was assumed we had the power to DO something.
The sound of water was the background music to the walk, but my thoughts were crowded with the most wonderful realization that I was walking unescorted, among Afghans who were going about their daily work. I was part of the picture, walking with a purpose to a destination. Though we all have different ideas of Afghanistan, the one of mud and rock architecture perched on the side of mountains, a rushing river below, intense blue sky supported by snow-white peaks, and red-cheeked children herding baby goats, is, I believe, universal. I was finally in the "real" Afghanistan--rooted in a distant Kiplingesque past, traversed on foot, interpreted in free-form. I never thought I would have the chance for such an unfettered short walk in the Hindu Kush.
It was a glorious walk along the chaotic Istalif River, the mica and pyrite of the wet rock glistening in the sun. A chenar at a bend in the river fluttered with strips of glittery cloth in supplication. For what? I assume the usual: fertility, protection from the vicissitudes of poverty, maybe a medical clinic.
After an hour and half dawdling walk with no photo-op left untaken, we entered the small garden of the unpretentious lodge. Two large sleeping rooms strewn with thin mattresses and bolsters around their periphery occupied the top floor with a small kitchen between. Three unisex hot-water shower; seated, flush toilet; and sink enclosures satisfied all other needs on the first floor. I sat on the roof listening to the river, absorbing the view of mountains, snow, green terraced fields tucked into every crevice high above, when the smell of sautéing garlic rose from the kitchen, followed by fragrant cinnamon and the yeasty smell of bread fresh from the oven. What a welcome!
The seven of us polished off the chicken, rice, and bread about sunset then some of us watched the stars from the roof and talked. Light from the quarter moon obscured the stellar display, so I woke at 02:30 to view the Milky Way and was rewarded with the head of Scorpio rising over the southeast mountains--the first sighting of my favorite summer constellation. I rose to sunshine at 05:30 and did a full workout of tai chi on the roof as the morning warmed.
Oatmeal, eggs, toast, and tea prepared us for an 8:00 hiking departure. My idea was a nice ramble in the hills, an alpine frolic. I soon realized I was in for a much different outing. After crossing the river we worked our way up through a green, irrigated valley plaited with water channels among terraced fields and groves of poplars. Tom led the way, picking our path over boulders, up and down, along scree and dirt, and around huge overhanging outcrops. Up we climbed, past the running water into a landscape of brittle dryness.
Wild mint and penny royal grew along the streams and when crushed underfoot gave off a heady fragrance. I found a small patch of tiny-flowered ground orchids. At the high, drier elevations, small yellow tulips, fritillaries, ranunculus, yellow "star lilies," the furry basal rosettes of mullein, and the red, phallic shoots of a spurge emerging from a bulbous root grew among the rocks. Bordering a boggy rivulet at snow line, a profusion of 3" high pink primulas grew in a patch of mossy grass, looking like a Persian carpet. Each stage of the climb brought us better views of the mountains, a greater expanse of snow, and best: the feeling of solitary achievement.
After a snowball fight we descended an adjacent canyon, gingerly picking our way on the steep slope to the stream that led us back to the river and the lodge. Seven hours of very unexpected climbing and worse--descending--had extracted all my energy.
I had not conquered any peaks, made no daring ice field traverses, or braved avalanches. I was scratched, pricked with thorns, sunburned, and exhausted. Yet walking out of the valley I felt a sense of belonging, as if I had earned my temporary presence in this strange and beguiling country, simply by walking in it.
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