To Balkh and Beyond

Seljuk minaret


A week ago Friday, (yes, I am behind) Homayun picked me up in his car for an outing. His children and wife were at her family's village about 40 kms north of Balkh and we planned to arrive there for lunch. But first, we had unfinished business in Balkh.

When I was in Mazar-i-Sharif in early 2006 I wanted to visit the oldest extant mosque in Afghanistan, the 9th century C.E. Noh Gumbad, or Nine-Domed Mosque, at the shrine of Haji Piyada just outside Balkh. I'd read about it in The Road to Balkh, an outdated guide, but valuable historical document I had picked up in Kabul. Homayun had never heard of this mosque and because of car trouble and the afternoon buzkashi game, we never made it.

The mosque is in quite a ruinous state. All the domes, for which it is named, are missing; the one remaining, cracked arch is supported by metal scaffolding. UNESCO has built an ugly but functional metal and plastic structure to protect the site. A new mud wall surrounds the large compound of low scrub and a small grove of chenars (oriental planes) and mulberry trees offer deep shade over a nearby narrow irrigation channel. Swallows, mynahs, and sparrows chatter and whistle in the rafters and the trees; mud dabbers use the ruins as a palace.

The ruins are the remains of baked brick and mud stucco heaped on a mound of mud. The major architectural elements left standing are short double columns, whose capitals are carved stucco in a modified paisley pattern. The undersurface of the remaining bits of arches are decorated with various braided floral and foliage motifs. It looks distinctly unique in its squatness, design and size, but I do not know enough to make architectural or historical sense of the structure. The monotony of dull mud-color, the static, repetitive decoration, and the short, fat columns give the ruins a heavy feeling that is not immediately attractive. For the uninitiated amateur it is easy to find beauty in the pure colors of fine tile work, the majesty of iwans (lofty semicircular vault, generally closed on one side and open on the other, characteristic of Persian architecture.), or the soaring grace of a 16th C. Ottoman minaret. This place is not quite so easy. But why do I think a religious building must be beautiful? The importance of its mud and brick is that it has outlasted the depredations of Genghis Khan, time, and many earthquakes.

Many tinseled horse-drawn gharries ply Balkh's wide tree-lined streets. It would be a pleasant small town except that the Taliban still holds some sway and the atmosphere for outsiders, let alone farangis (Europeans) is not at all friendly. Homayun was not all that interested in stopping, but I wanted to see again the green domed mosque and shrine to Khoja Parsa, in its shady garden. The mid-15th century ribbed dome looks significantly more dilapidated than when I saw it 3 years ago. Grass grows in the spaces between the missing tiles giving the dome a hazy aura and, along with the dust, dulling the original brilliant turquoise-green. All is faded and sad.

When we first entered the shady garden of the shrine we passed a half dozen thin, dark, fine-featured women selling sparkly, plastic wrist spangles from pieces of material laid on the ground. They wore simple loose scarves, and were quite forward in their attempts to interest us in their cheap wares. Not at all like typical Afghan women. My first thought was, "gypsies." When I asked, Homayun said they were "Jugui" (pronounced jeu-gee)--typically dark-skinned, semi-nomadic people who hustle to make a living and are known as dangerous. Lurid myths exist about their indiscriminate sex lives and taste for the flesh of children. Funny how these common accusations are so easily branded on outsiders, indiscriminately repeated, just as I'm repeating them now, without authentification.

We drove north from Balkh to Daulatabad along a flat plain on a fine paved road, past wheat fields and large walled compounds whose buldings are often domed. The walls of the houses are a meter thick and the gardens are filled with shade and fruit trees. It is a world of small hamlets or villages composed of relatives farming and herding together. The landscape includes many one-humped camels grazing and hauling as well as herds of sheep and goats, often tended by children and dogs. The shimmer of sunlight off the sequined and glittered dresses worn by the little girls as they tend the animals looks most incongruous. Winter and spring moisture was generous this year and the wheat is almost ready for harvest.

On the outskirts of Daulatabad Homayun parked the car and led me into a maze between 10-12' high mud walls into a warren of interconnected living compounds. The featureless walls, the twisting and turning through shadowless midday sun, and the blind alleys all gave me the disorienting sense that this was not a place welcome to outsiders. No windows, no hint of color indicated that we were following the right path until the walls opened up to a small pond (more cesspool) shaded by a few trees where the children were playing. We were taken through another series of doors and walls into an open compound and a long room ringed with pillows and thin mattresses along the walls. A cool room, wonderfully dark compared to the sun glare outside. Safe and welcoming

The children ran in happy to see their father, received their hugs, and ran out again to play in the water and race along the walls and over the roofs shouting and screaming with their cousins. I was introduced to Homayun's in-laws not by name, but by title, "This is my mother-in-law, this is my mother-in-law's sister." For another, he said, "I don't think you have name in English, but she is the second wife of my aunt's husband." People came and went, happy to see Homayun, curious about me. After tea and a short nap, the large plastic cloth was laid on the floor and we were served aushauk, one of my favorite dishes, a type of vegetable tortellini, and raison and carrot studded fragrant qabli pillao (rice).

The evening before this outing, I had seen on the map that near Daulatabad were the ruins of a Seljuk Minaret, I asked if we might see it. Ten of us piled in the Toyota sedan on a hot dusty, slow 40 minute drive to the village of Zodyan. I felt sorry for Homayun, being stuck with a person like myself, with unnatural desires to see all the strange things. I said he must look at me as igniting a spark of interest in his children to be archeologists, something the country needs (along with the enforceable laws to protect the sites). There is no country so in need of a viable archeological program and no country so under-explored.

The Seljuk minaret sits in a small oasis just outside the large village of Zodyan on a flat plain. The map indicated only Seljuk, and I'm guessing it was built during the time of Sultan Sinjar--in the mid 12th C. I also assume this was the site of a large city to have had a mosque with such a grand minaret. Two-three story high segments of brick and mud wall ruins stand outside the village, but I couldn’t make heads or tails (or tales) out of them. The whole of northern Afghanistan is covered with tepes, round archeological mounds. Few have been explored and the locals know nothing of the history. All the more reason one of Homayun's children should become an archeologist.

The minaret, whose top has been lopped off, stands now about 50-60 meters. It is made of well baked brick formed into monotone repetitive decorative patterns including one 2 meter high row circling the monument in majestic Arabic script. A steep circular staircase winds up the dark interior and opens suddenly without the protection of railing or wall. I sat well away from the edge and enjoyed the bird's eye view of the village in the middle of the vast plain.

The village is populated by Turkmen--a vaguely mongoloid people with wind and sun-reddened faces, I quite liked their appearance and their unconcealed timid curiosity. A shrine was also present at the minaret. For whom, I do not know and I suspect the name or the story is lost in time. Sharifa took all the children into the shrine, touched the posts and the green, velvet covering, prayed and all the children knelt quietly for two minutes in this dark cool place. Other worshippers, all women and children came and went, kissing parts of the shrine, praying.

Before we left Daulatabad, I saw a flash of blue, a largish bird flying from a wire into a garden. It was the turquoise blue of a kingfisher. It was a most wonderful sighting, but even better, I saw another dozen in our drive to the minaret and back to Mazar.

Dealing with patients the Afghan way

A doctor in a poor, crowded, public, Central Asian hospital is like an oriental potentate. People petition you as to weave your way through the crowds blocking the entrance and plead with you to see them, thrusting their rolled-up x-rays in your face. They all have an injury, pain, or deformity, but know only the loudest, most persistent, or the one who has cultivated a powerful interlocutor will be seen. These are not always the most severe cases or those that if treated will produce good results. It looks like chaos to me, but it is a system, as systems go, based on patronage, power, and persistence.

I had forgotten how difficult it is to extract a medical history from the Afghans. When I first wrote the chapter about Afghanistan for A Leg to Stand On my experience in the country was still fresh in my mind but the frustrations of working in this ahistorical medical fashion had left a conflict that I had a difficult time putting into words that people familiar to a Western system could understand. I did not do a very good job of explaining that the history is the most important aspect of evaluating a patient for further treatment. I was taught that at the end of a good history I should have in my mind a working diagnosis, which my exam and clinical tests narrow in number or confirm. This is one of the beauties of clinical medicine and is also one way to cement the doctor-patient relationship, by talking with the patient.

Looking at the x-ray without a history is also, to my mind, a form of "cheating." A good orthopaedic surgeon should be able to make a reasonable differential diagnosis based on history and physical. And not only is a first look at the x-ray unfair, it is a spurious goad into forgetting about the rest of the patient. It can lead one down a blind alley of shadows that look quite out of the ordinary, but in fact have nothing to do with the problem at hand. One must first establish the problem; x-rays are not problems.

Orty was very impatient with me when he edited this part of my story a long time ago; he did not believe that patients would lie, the word I used to describe their answers to my questions. "Why would or should they?" He asked. Perhaps lying was the wrong verb, though I felt that many of the patients blatantly used my naïve ignorance to counter their own needs. They thought their lies would qualify them for care, or better care, or even admission to a hospital whose admission criteria they knew they did not fit. My husband's insistent red marks, indicating that all my words trying to sort out this incongruity were boring and no doubt a figment of my overly-intrusive nature, caused me to change the thrust of that part of the chapter. But I never felt that I adequately examined this need of patients to dissemble, either with frank lying or selected, resolute silence.

The Afghan doctors at the Emergency Hospital in Kabul and here at Balkh Civilian Hospital in Mazar make no bones that the patients' histories are suspect and not to be trusted. This, I think is one reason they have systematically skipped this whole segment in the diagnostic process. They go straight to the x-ray. To them it is cutting straight to the chase without the back story.This black and white film is the petition necessary to gain recognition, physical evidence that something is wrong, the shadowed reality of all that ails the patient. The x-ray becomes the validation of the pain or the disability.

When I brush aside the x-ray and ask what exactly the problem is, the x-ray is trust into my face again. The picture of an offset fracture or the irregularity of a joint is more real to the family and patient than the fact that the patient has no pain and uses the extremity with full function. When I ask the patient to roll up his sleeves, ask again that both be rolled up, and look first at the uninvolved side for a normal comparison, I'm immediately taken for an idiot while the patient, or all his male relatives, point to the deformity on the other side. I nod, but continue my exam. I ask why, 8 months later, they have now brought the patient to the hospital. What exactly is the problem. I'm handed the x-ray and told they thought the crookedness would straighten out. That is what the shakastabund, the traditional bone setter, said.

Yesterday the "problem of the shakastabund" was made more clear on two separate occasions by two different orthopaedic surgeons. When the patient with a fracture goes to a trained medical doctor, the doctor usually tells the family that they should go to the bone setter. The primary doctors have no high opinion of the local orthopaedic surgeons and do not refer to them. This non-referral may have to do with petty grudges, the vagaries of this culture of hanging onto power at all costs, or just plain pettiness. The bone setter does what he has been taught to do, which is bandage the limb with a tight bandage and splint it with cloth hardened with egg or other stiffening materials and bits of wood slivers. Some of the shakastabunds have an understanding of what they are doing. I have a picture of the most beautifully immobilized leg wrappped in precise overlapping layers of cloth as skillfully as the royal embalmer would wrap a pharoh for mummification. I still have the decorative patterned slats of wood that I was told are typically used by the bone setters. But I've also seen some rather crude and physiologically untenable splinting that have led to severe problems. "Presents from the shakastabund," I call these swollen, blistered extremities, some of which are dead from inappropriate treatment and have to be amputated.

Is it harder to get a history in Afghanistan than Africa? I think so, but maybe this is just my problem with language. I have only worked in Anglophone Africa, where I understand both the patients and doctors better. In any culture traditional healers have little need for a medical history and the patients are not asked such intrusive questions as we are taught to do. Sometimes I think they resent our asking. Taking a history supposes that an order can be sorted out when all the pieces of the puzzle are in place. The "order" in a traditional system--the reasons for disease or injury--have little to with the mechanisms we are trained to consider important. Things just happen, and insha'allah you deal with what lies in front of you. Maybe the history is only something thrown in to confuse us.

Walking in Mazar

The ubiquitous Afghan cleaners and tea-wallahs in public places seem to be a generic type of short, bandy-legged, bent, old-before-their-time men. Their shalwar (draw-string trousers) reach mid calf, their clothes are not dirty with only today's dirt, but are discolored with old, old filth washed many times. Inevitably they have straggly beards, and wear a skull cap or a ratty turban. They are in the back ground, waiting for a handout, will clean the OR floors, but only if asked or they will bring you bitter tea with no sugar. No one asks their opinion about the world.

Badrang--cucumbers. They are one of the main items vendors are presently selling from carts in the city. Beautiful, firm, fat cucumbers, sweet as melons. The vendor will peel one for you right there and you can eat it while you walk down the street, but I rarely see Afghans walking down the street eating. However, I saw a lady slip an ice cream cone under the front of her burka. How does one eat an ice cream cone while wearing a burka?

Orthopaedics is truly a social disease in the developing world. The non-trauma orthopaedic patients arrive with some horrendous deformity caused by some inexplicable condition that was or is so severe and has gone on for so long that the bones, joints and the patients have grown into their deformity. The time is past when a solution is possible, or the problem is beyond the capacity of this hospital, beyond the capacity of the patients to follow through with the long drawn out treatment that would be necessary to perhaps help them. Most times I'm not sure that even fixing them into a more normal appearing physical shape will improve their state. The intellectual poverty of the patients is a barrier I cannot overcome.

A man with TB of the spine was admitted to the ward a few evenings ago. He had been on anti-TB drugs, but decided, along with the blessings of the local mullah that he didn't really need them. So, he stopped taking them. Only when he developed lower extremity weakness and couldn’t walk did he rethink his condition and come to the hospital. His paraspinal TB abscess was drained of 800 cc of pus. Now he is back to near normal, oblivious to the severity of his situation and how he aggravated it. It's not that he doesn't care about his health; he is just plain ignorant and has little trust in western medicine. Everyone has an underlying social problem that makes the treatment of their orthopaedic problem difficult and likely to fail. For chronic problems like mechanical low back pain, degenerative joint disease, diabetes, and hypertension, the situation is much worse than for trauma. At least we can fix a certain amount of the trauma. Surgery bypasses some of the social impediments. But not always and never in a completely satisfactory way.

At the hospital I am called "madam-sir." A convenient title that covers all possibilities.

Rahimullah has been very patient with me, giving me the names of the streets we commonly travel on our ride from the IAM guest house to the hospital. It is an easy route and had I paid more attention and kept the shrine in my sights, along with my compass, I could have figured it out, though without the names. Last Friday I was to meet Kristin and some Afghans who had come up from Kabul to see the north. I gave them the name of Marmal Street, the paved road near the guest house and told them to follow it south from Tashqurgan Road, (which is now called Massoud Street just to confuse everyone). Rahimullah told me the name of the nearby school--Sultan Razia. I gave all this information to my friends and told them I'd meet them on the corner at a vegetable/grocery. We actually met up! I was quite proud of this little maneuver in a city neither of us actually knew, whose average citizens don't know the name of the street they live on, and who have no inner map in their head with which to process directions.
Our trip started with a drive north from Mazar to see the Amu Darya. We drove through sparse pasture land of green tussocky grass interspersed with red poppies and small yellow flowers. This turned into sand dunes, which intrigued the Kabuli women who apparently had never seen, walked on, or felt sand. The Amu Darya or Oxus and its other named riverine beginnings form an extensive portion of the northern border of Afghanistan between Uzbekistan, Tajikistan, and Turkmenistan. Historically it is important either as an obstacle or conduit for transport, trade, and war. Today it is a brown, fecal-smelling swift body of uninviting water with little to recommend it for further viewing. I preferred what I knew of it as history than what I saw on Friday. Unfortunately, much of the rest of the world remains preferable in an historical mode than in real life.

Returning to Mazar we stopped to visit the shrine. Walking with Afghan women is a slow ordeal. There is no consensus and no communication of where we are going, no one can quite make of her mind, just a purposeless slow meandering. Walking with a woman who is wearing a burka is worse, especially one with high heels. I've never seen a woman in a burka wearing sensible shoes. After the defeat of the Taliban and their rules forbidding high heels because of the distracting sound such shoes made, keeping men from thinking about god, Afghan women are taking their revenge by wearing the most garishly fancy, uncomfortable, silly looking footwear. Neither Nike nor Adidas fall into this category. So we meandered in the gardens. Beautiful with roses, but far too crowded.

Kristin and I went off by ourselves to walk inside the grounds of the shrine, I believe we were the only infidels of any sex doing so. We were covered, following the rules of Islamic modesty, but the suspicious attention we generated was most amazing. Even the burkas turned around to stare at us. The last time I visited the shrine was with Homayun in the middle of winter on a non-Friday. It was a much more pleasant experience. At that time I felt none of the xenophobic suspicion I felt with Kristin. I was hoping to see someone trip because they were staring at us and not watching their step. Experiencing this, I can only say that Afghanistan is light years away in its preparation for entering a century in which the rest of the world at least gives lip service to gender equality. Though Kristin and I walked around the shrine with only stares and whispers following us, and encountered no physical aggression and no words spoken against us to our faces, I will return with my newly tailored clothes, including a generous chardor and black plastic sandals. I will carry no back pack (a bit of a give away) and will see if it makes any difference.

Kristin has taken the role of dressing for the culture to what I would call perfection. She has stylish tunics of appropriate length, with color coordinated well-made pants and chardor of fine material. She wears them all naturally. She has incorporated some Western ideas into her fashion--I can't say what they are exactly, perhaps it is the color patterns--less dark than the morbid colors worn openly in Kabul, though not as flamboyant as the normal wedding culture sequins and glitter commonly worn every day under burkas. I am covered, but more in the spirit, if not the letter of the law and certainly without the flare that Kristin manages. Still she is stared at. And it isn't just her sensible shoes. I think no matter how one does it, our ideas of dress will always have some element of individuality that is not Afghan. And if the clothes and lack of make-up don't do it, something about our manner will bubble to the surface that shouts out, "foreigner."

Mazar-i-Sharif

I had planned on traveling from Kabul to Mazar-i-Sharif by land. The Salang Tunnel and the northern slopes of the Hindu Kush in full green were especially alluring. My requisite, Afghan escorts did not finish their duty with the ministry of health and the $39 one way ticket on Safi Air seemed a good price, cheaper than hiring a taxi. The security hassle to fly out of Kabul--the repetitive searching through my belongings by bored women who were more interested in the ongoing TV soap in their hot, stuffy cubicles, the unsubtle gestures requesting bribes, the dirty fingers patting me down for weapons, the superficial, slap-dash irrelevance of it all--is simply a two hour tax on a one hour journey.

Many things in Afghanistan are done by rules and procedures that make little sense to me, but are simply the way things are done in this country. For example, the large plane was only half full of passengers, but they were seated all scrunched together in the front half of the plane, with the back completely empty. I would think for comfort and balance passengers would be best spaced accordingly. But no, this is the way it is done in Afghanistan.

The mountains were partly obscured with cloud, but the short flight in bright late afternoon sunshine was calm and I had a fine dose of mountain and snow and green. A non-military contract manager from Mississippi sitting beside me asked if I believed humans were the cause of global warming. He asked this in the same way evangelicals, whom one has just met, ask if you have taken Jesus as your savior. He immediately told me his position--that man, in God's great scheme, was too insignificant to cause such wide atmospheric changes and the scientists were spinning statistics because they had nothing better to do. Had I pursued the argument, I'm sure he would have introduced the improbability of evolution in the second round. I was reminded that not all people receive the same message from the accumulated data, or some get their data from the same sources.

Mazar city is dustier than I expected. Dr. Rahimullah said that many of the smaller streets are unpaved and after rain, the cars pick up mud and deposit it on the paved roads. He dropped me off at the International Assistance Mission (IAM) guesthouse compound where a room was waiting--clean, with a big comfortable bed, common kitchen and bathroom--the basic unadorned mission-type guesthouse I expected. It was quite full the first night, but has since housed only one or two others. It seems this will be the pattern during my month here.

The small garden surrounding the guesthouse is well tended with grapevines trellised to shade the walkway along one wall, two fig trees with small fruits, and a flowering pomegranate tree. I do taichi beside a profusion of fragrant rose bushes and parterres of salad greens mixed with petunias and stock. The first floor of the house is an English-as-a-second language school, with one American man living here for 5 months to learn Dari. From first light at 04:30 until 20:00, noisy sparrows and soft wooing, (not cooing) doves seem always present. The latter remind me of the ubiquitous presence of doves that I think of as typically South African. A matted, thickly furred brindled mastiff with cropped ears and tail lives in the parking-garage part of the compound. Zambul's (bee in Dari) deep barks set off the nightly neighborhood canine chorus.

I believe this is a typical Afghan urban residential neighborhood. From street level is it all mud. Nothing but perhaps the color of the door, the metal work on the gate, or the shape of windows distinguish one family's compound from another. I suspect that for someone used to mud walls, there are distinguishing features to give one hints, but these I do not know. Time and a conscious effort to put a child's face with a doorway, a frequently seen car, or repeated greetings from the inhabitants would let me classify each compound into my own order. At this point I know I live on the second street from Marmul Street, past a guard house and at the last compound on the right. And after a rain the street becomes thick adherent gumbo.

I am intrigued by these compounds behind mud walls. They mask the gardens. All that is important is hidden, unknown to the casual person passing by. In the US one knows something about the people living in a house or apartment building; we readily display how we live for all to see. From the outside I would have never guessed this house had such a pleasant and well-tended garden, a house with expats, a rough-barking dog, a refuge from dust and noise.

And I would have never expected a bowl of strawberries in Mazar. One of the longer-term residents of the guest house runs an NGO that helps local Afghan farmers establish new cash crops. Besides a lucrative seed oil project, he has some farmers growing strawberries, tut farengi--or in translation--European mulberries. Two nights ago he received a large bag of the berries and offered me a bowl. These were not the "industrial" berries, picked a week before and woody enough to withstand the abuse of a thousand mile journey to market. These were strawberries with a flavor I remember from the past, soft succulent, sweet fruits.

The full moon has just risen over the mountains to the southeast, the little boy flying his kite from the neighboring roof has disappeared inside, and the light just went out in the daily Afgahn ritual of electrical outage during the busiest time of the evening. Inshall'allah it will come back on in a couple hours.

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.

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.

Spring unfolding

Spring unfolds in Montana in a most painful, start-stop fickle manner over many months. I am sure the reality is no different in Afghanistan, though perhaps commencing a bit earlier and holding back its glories less petulantly. Since I arrived about ten days ago spring has been most generous. The grass in our personal and the hospital compounds has visibly greened and I can measure the new red-growth of the rose bushes. A type of lilac with single pale lavender blossoms throws out great plumy spikes from eight-foot tall bushes lining the short walk between the house and the hospital. The leaves are not the typical spade-shape, and the lilac fragrance is over-laid with a clove scent. Coming and going I cannot help the Foltz tendency for stealing flowers. Every morning a handful go to the hospital's office and every afternoon a handful return with me to my rooms.

A bush of salt-cedar, or tamarisk, is in tight blossom. I'm sure its cousins along the Yellowstone have yet to make a showing. Honeysuckle spirals in confusion over some make-shift trellises. In a few weeks they will thrum with insects.

I have said little about the place I'm living. The rooms of the apartment are laid out single file, along a short entrance hall: bedroom, kitchen, bathroom and study. All windows face west, but from 04:45 first light until sunset, all the rooms except the bathroom are flooded with light. The best word to describe it is comfortable, though I'm not sure others would use that the defining characteristic. It gives me what I want and more than what I need. I rearranged the furniture in the study so that I have a long "runway" to do tai chi, all the while looking at the snow-topped mountains--a most magnificent sight, the heights close at hand, just beyond the dusty bowl of the city.

From the study and while I write, I have a good view of the hill Tom and I climbed last Friday morning. There are always people walking its paths and usually a car creeping along the narrow bumpy road. Sometimes I see strings of runners/joggers. The best for me are the ones walking or playing along the crest. Their silhouettes are more stark than the forms trudging along the hillside. It is a hill where people live and use at their own; a part of their lives, not an obstruction.