Monday, February 16, 2009

Lessons in Cultural Differences

Chance Wayne: We’ve come back to the sea.

Princess: What sea?

Chance: The Gulf.

Princess: The Gulf?

Chance: The Gulf of misunderstanding between me and you …

                              Tennessee Williams, Sweet Bird of Youth

A group of Afghan Army medics recently quizzed a colleague of mine by asking him to give priority to the following vehicle processions: a wedding party, a funeral convoy, the presidential escort team, and an ambulance traveling with a casualty. The Afghans wanted to know who the American thought was most important and most deserved the right of way should they be encountered on the road. My colleague responded quickly that the ambulance was the first priority, with the presidential vehicle likely second, the funeral procession third, and the wedding party least important.

The Afghans were aghast. They argued that a wedding is the most important event of a person’s life, and that it was only right and correct and fitting that the wedding procession deserved priority over all other groups. The vehicles carrying the dead and the deceased’s relatives would be the second priority, as the funeral signifies that a person is going to meet Allah (apparently the most important moment in a person’s death). The Afghans rated the presidential convoy as the third most important since they carried the leader of the nation. The ambulance, they insisted, was certainly the least important of the processions. The person inside was injured already, they argued. The victim’s fate was more in the hands of God than those of the paramedics and the physicians the casualty might see if newlyweds and dead people didn’t completely block access to local medical care. The Afghans seemed to believe that clearing a path to the nearest hospital would do little to improve the injured person’s chance of survival.

After I heard this story, I began to think strategically on how we could improve emergency medical care in Afghanistan. My first thought was that we should paint and decorate all ambulances to resemble a bride’s vehicle. And maybe we could add edifices to the Afghan hospitals so they would have the outward appearance of one of the ornate wedding halls that are omnipresent and very popular here for nuptials celebrations. A longer term goal would be to ease the sexual repression and frustration that add so much social (and physical) imperative to the wedding (and the wedding night).

All of my thoughts, however, and all of my strategy might very well prove foreign to the many Afghans. After all, we would not agree that even a blushing bride should wait out a rushing ambulance if they arrived simultaneously at an intersection. The Afghans would likely be stunned to hear that I have devout Catholic friends who no doubt would call a halt to a wedding reception to recite a short prayer for the injured should they even hear a distant siren wailing. The difference in how Americans and Afghans think sometimes is quite startling. Hypothetical scenarios such as the aforementioned vividly illustrate the contrast.

I think Americans and our Afghan colleagues can bridge differences as we work together to improve the lot of the average person here, but contrasting sociocultural attitudes, beliefs and priorities often makes the work difficult. Recently a group of Afghan Army colonels were discussing with their American colleagues a proposed system of casualty evacuation from a battle site. The Americans assumed that serious casualties would be transported for care first, followed by the less seriously wounded, and then the dead.

The Afghans colonels were silent at the beginning of the discussion, and very polite to consider the American plan; but then they abruptly inserted themselves into dialogue when, from their perspective, the American proposal proved itself to be prima facie ridiculous. The wounded, they stated, are important. But the dead, they insisted, are more important. Of course the dead soldiers would be evacuated first from the battle site, the Afghans insisted, and returned to their homes or another appropriate location for the quick ceremony and burial that the Islamic tradition dictates.

I’m not sure how you argue against the Afghan colonels on this point. It’s not easy to argue against what someone else accepts as faith, as faith is not always beholden to intellectual reason. I probably could not convince a proponent of intelligent design that there is nothing notable at all in the construction of the human pharynx where our food and air can mix; and that either element can create a disturbance quite easily by taking the inappropriate route further south into our bodies. Or that a woman’s canals for defecating and birthing are perilously close together. There’s nothing objectively intelligent at all in these and other anatomical “designs” of the human body.

Biological evolution can certainly explain their current construction. But to the intelligent designer who refuses to believe the theory of evolution, faith is more important than objective fact. In fact, faith itself often sets the framework for what can and cannot be accepted as fact.

Motivating the Afghans to create what we, the Americans, feel is an appropriate healthcare system will remain a frustrating endeavor until we accept the fact that the Afghans don’t always believe and value what we believe and value; nor are many of them especially eager to adopt our cultural attitudes and ways. The American expectations here might be the major source of confusion and frustration, even though we often consider the response of our Afghan colleagues as the most challenging issue.

I’m no expert in cross-cultural dialogue and learning, but I’ve seen enough during my year in Afghanistan to realize that this place is different – very different – from what I regard as normal and functional. We need to recognize and address these differences if we expect our work to be successful.

But back to the wounded Afghan soldier who sees a dead buddy evacuated before he gets transport for treatment of his internal bleeding: My advice to him is to feign death to ensure quicker evacuation.

Wednesday, February 11, 2009

Latest Taliban Atrocity: Coordinated Murderous Attacks in Kabul

At 09:45 yesterday I had just completed the routine safety checks we perform on our armored vehicles before we leave base when I heard the unmistakable sound of gunfire fire nearby. My colleague Phil and I waited a moment in silence, but we heard nothing in addition to the initial few short bursts. We got into our vehicle, left the base and drove two miles to the National Military Hospital where we had work to do. We did not know that the gunfire I heard came from the Afghan Ministry of Justice building which was under attack by Taliban insurgents.

We were diverted from our usual route to the hospital when a secure road that runs from my base to the entrance of the Presidential Palace was closed. Afghan guards at the security control point were placing steel barriers in the road as we drove up expecting to drive through after showing our identification cards. Instead, the guards motioned for us to turn around. I assumed that President Karzai was leaving the Palace, as the route typically is closed when he travels. I did not know that the Ministry of Justice lay on the other side of the Palace grounds, and the guards at the checkpoint were securing the area in response to the nearby attacks.

At the National Military Hospital we parked near the emergency room entrance, where a small crowd of hospital staff had gathered outside. This was unusual. An American nurse mentor told us that the hospital had planned a mass casualty exercise and that they must be executing the drill this morning. A few seconds later, a disheveled four-door sedan rolled around the corner of the building toward the emergency room entrance. Every one of its windows, including the windshield, was shattered, and the front bumper was hanging askew. The paint on the car looked like it had been sand-blasted. I told my colleagues “I don’t think this is a drill” a few seconds before the hospital staff pulled a limp body from the back seat of the sedan.

Several soldiers jumped into a few of the army ambulances parked nearby and sped off. One of our interpreters got a call from his father, who was walking near the Ministry of Justice building when the attack began, with the news that a suicide bomber had detonated himself and his explosives at the ministry before several armed insurgents stormed the building. The Afghan media initially reported that six government buildings had been attacked by militants. Later I learned that insurgents had bombed and laid siege to two national ministry buildings in addition to the department of corrections building.

Yesterday morning, shortly after the attacks began, no one knew exactly who had been struck or what site, if any, would be next. In that tense atmosphere of anticipation and dread, I recalled my emotion on September 11, 2001 when I watched the second of the World Trade Center towers fall, and learned that an airplane had flown into the Pentagon. I remembered feeling flat and helpless that day, when all I could do was watch CNN as the newscasters tried to make some order of the events unfolding.

I didn’t stay at the military hospital very long. My commanding officer called me and ordered all US military medical mentors to leave the hospital immediately and report to the safe US compound adjacent to the hospital grounds. The military hospital is a prominent institution in Kabul and a likely site for attack. US military personnel throughout Kabul were ordered off the streets and onto secure bases, presumably until the scope of the attacks became known. Even though three sites in Kabul already had been assaulted, Taliban spokesmen were telling media sources that several other suicide bombers were roaming the streets of Kabul looking for targets. Most of Kabul went indoors.

Just before I left the hospital an ambulance returned, and the medical staff lifted from the rear a stretcher carrying the limp body of a boy no older than ten. His clothes were tattered and his exposed skin was burnt. He didn’t move. When the medics transferred him to a gurney his body gave no resistance. He simply rolled like a sack of potatoes responding to gravity. He displayed none of the reflex and muscular rigor we expect from a young human being. The Afghans rushed him into the hospital. I’m certain he was already dead.

I have not been completely dead to my emotions while in Afghanistan, but you witness so much poverty and desperation and cruelty here that these scenes become routine. You expect to encounter them most of the days you venture around the country, and the expectation and unfortunate familiarity keep your emotions in check. The scenes can still impact you, but more subtly as you arrive upon them again and again.

For some reason, however, I had a more visceral reaction when I saw that burned, dead boy. I’m a physician and have contacted dozens of human bodies traumatically amputated and gouged and scorched and bleeding. The sight of bodily trauma, no matter how severe, doesn’t bother me. My medical training leads me to approach such patients clinically in order to determine what needs to be done for treatment and intervention. But when I saw that innocent young Afghan boy after Taliban insurgents had murdered him, I felt both anger and an immense sadness welling up within me.

My sadness is for the Afghan people, who must endure the violence perpetrated by madmen, self-proclaimed liberators, who have no qualms killing the very same Afghans and Muslim they are fighting to “free.” It’s no surprise that the Taliban attacked the buildings housing the ministries of Justice and Education yesterday, as the insurgents have no sane concept of or need for the ideals espoused by those agencies. The intellectually and spiritually barren mindset of the Taliban is something to despise. The actions of these men should provoke outrage in anyone possessing even the thinnest veneer of human decency.

I turned to Phil as we walked away from the hospital and said “The people who did this are animals.” They must be stopped.

Saturday, January 31, 2009

Afghan Ronny in the Social Justice Press

Almost twenty years ago, when Afghan Ronny was in his early twenties, he maintained a lifestyle more attuned to his social and political ideals. At the time, he also was unafraid of personal poverty. Three of those years he spent with the Jesuit Volunteer Corps: East, a Catholic service organization whose work is defined by four tenets: social justice, simple living, community life and spirituality. During his tenure with the JVC, Afghan Ronny never envisioned himself as a physician, and certainly not a military officer. Luckily, the JVC community has not ostracized him for moving into the financially lucrative field of medicine, or joining the armed forces. (The Jesuit volunteer community is populated by scores of lovable peaceniks who abhor any kind of violence.) In fact, the organization recently requested an article for JVC: East periodical, Journeys. Below is the submission, included here without the minor editing needed for publication. (Afghan Ronny is never short of words.)

Prayer in a Time of War

Recently a coworker, whom I will call Susan, recounted for me how a young soldier she knew, whom I will call Kevin, always visibly prayed for the safety of himself and his fellow soldiers before they departed their base in Kabul, Afghanistan for convoy operations. The major threats to the American military in Kabul are roadside explosives and suicide bombers that might be waiting to attack your vehicle as you traverse the congested city. We travel in armored vehicles with heavy personal protective gear and loaded weapons every time we leave our bases. Kevin’s fellow soldiers certainly recognized the dangers of every convoy they undertook, but apparently delighted in mercilessly teasing him for his overt spirituality.

Susan, a devout Christian, continued to tell me how Kevin’s comrades hit a bomb the first day Kevin was away on leave, when no prayer preceded the convoy vehicles’ departure from their relatively safe, fortified compound onto the Kabul streets. I saw a wry smile on Susan’s face as she told the story, and sensed her true message: Don’t underestimate the protective power of God toward those who pay the Lord homage.

I had a visceral and much different reaction to the story. If God is merciful, I asked myself, why would Kevin’s fellow soldiers be more at risk without Kevin and his prayers? Because Kevin prayed openly for safe passage, did he serve as something of a protective totem for the convoy group? Is the intervention of God into the world today that simple? I doubt it.

You don’t have to look to Afghanistan for evidence that God’s mercy, love and justice manifest themselves in this world much differently than what we might expect or even understand. Today I read of the death of Nequiel Fowler, a ten-year old from the southside of Chicago killed in the crossfire between two rival gangs at war at 4:30 in the afternoon on the block where she lived. Her younger sister Valerie, blind from eye cancer, was with her but unharmed. Did Nequiel forget to say her prayers the night before? Did her family neglect to petition God for safety? Was Valerie a “better little girl” and therefore able, by the grace of God, to dodge the bullets?

Such questions are rhetorical at best, and possibly even cruel. Nequiel was an innocent girl trapped in a brutal world where parents often are afraid to allow their children out of the house to play as armed drug dealers and dangerous gangs infest the streets. She was not responsible, by acts of commission or omission, for her own death, just as her sister is not responsible for the cellular chaos that produced the neoplasms that disrupted her vision. Nequiel’s predicament and ultimate death are disturbing testimony to the injustice human beings will inflict on one another. And although the overt social abuse Nequiel withstood came compliments of her thuggish neighbors, as a society we are responsible for marginalizing entire populations into decaying, oppressive sectors of our cities and countryside where crime, abuse and injustice grow inextirpatable roots.

In Afghanistan, when suicide bombers and other insurgents attack foreign forces in the country, local citizens often suffer most for the brutality of the event. Recent bombings in Kabul have killed and maimed many more Afghan children and adults than foreign soldiers. The Afghans killed and wounded were the victims of a war, a conflict they likely found necessary to tolerate but not support. They simply were walking to school or work or to the market at an inauspicious time. No prayer before the blast would have saved them from their suffering, because a deranged human being, not God, decided they were insignificant and expendable.

Every time I travel through Kabul and the outskirts of the city, I see thousands of large families living in small mud huts. They don’t enjoy even minimal medical care. Many suffer from malnutrition. For every woman covering herself with a burka in public, another young wife is restricted from even leaving her home. Children play in the same foul water that they drink and use for bathing. Local markets recently began selling bread scraps as the price of food has risen astronomically. Trucks dump raw sewage into a rank field near the center of the city. And I am describing Kabul, the most urbane, developed metropolis in Afghanistan.

My job in Afghanistan is to assist the Afghan Army in developing a medical system able to provide adequate treatment for soldiers and their families. The goal of US military personnel working as mentors with the Afghan Army is a competent, self-sustaining military institution that can ensure the security Afghanistan needs in order for the nation to develop, prosper and protect its citizens.

I play a small role in an ambitious project that Afghans and foreign advisors have undertaken: The creation of a unified Afghanistan free from internal strife and external oppression. Such an Afghanistan has never before existed. Dedicated people, the vast majority of them Afghans, are addressing social ills that threaten to stifle this new Afghanistan: corruption, poverty, hunger, ignorance, misogyny, indifference, exploitation. These scourges, all too common here, threaten most Afghans much more than do bullets or bombs.

I’m not sure what place prayer has in a land like Afghanistan, and in the conflict that surrounds me. Do you pray for protection for yourself when you know that a child living a few blocks from you endangers himself every time he walks into the street? Do you pray for safe passage out of Afghanistan after a tour of duty is complete, knowing full well some woman you may have passed on the street could have been killed by her husband for showing her face to a stranger? Is such prayer too selfish, too smug, and too foolish?

Do you recognize that the fight in Afghanistan is a war with injustice, not simply a battle with the Taliban? Do you dare pray for protection and peace in the midst of yet another war that has nothing to do with God, but everything to do with us?

Article first published in Journeys, the periodical of the Jesuit Volunteer Corps: East, Vol 32, No.1, Fall 2008.

Saturday, January 24, 2009

Afghan Ronny on the Radio

I first encountered Indiana Secretary of State Todd Rokita in September of last year at breakfast in the dining facility at Camp Eggers, Kabul. He was a man in civilian clothing whom I had never seen before, and he was reaching for a breakfast burrito on the steam table. “My advice,” I told Rokita, almost reflexively, “is that you skip the burrito.” Most of the breakfast fare here is decent, but not the breakfast burrito. It features what appears to be a soft, flour tortilla shell; but that casing, upon handling, actually feels like the stiff cylinder of cardboard that makes for the centerpiece of a toilet paper roll. Within the shell is a concoction with the consistency of tapioca pudding, the color of aged egg yolk, and the taste of an exotic, spiced chalk.

Rokita took a burrito anyway, a choice he later regretted; but when he turned to me, surely wondering who the hell was I to have the audacity to tell him what to eat, I noticed he was wearing a baseball cap with the name of my home state, Indiana, stenciled on the front. “Are you from Indiana?” I asked. Rokita looked surprised. I suppose he was waiting for me to tell him that his hash browns were inedible. Instead, he said, “Yes, I am. Are you?” And at that we started small talk, as native Hoosiers are wont to do, and sat down to chat some more while we ate.

Rokita was visiting US military bases in both Iraq and Afghanistan with a few other state secretaries to investigate if military personnel had adequate access to absentee ballots for the upcoming election. He was delighted to hear that I not only had received my ballot from the Howard County Clerk in Kokomo, Indiana, but that I had mailed it the previous day. I was impressed with Rokita’s professionalism as he made no mention of the candidates on the ballot, or what I thought of the players in the upcoming election. All that interested him was the ease with which I was able to obtain an absentee ballot while deployed in a war zone.

I met with Rokita later in the day as at breakfast, shortly after he confessed that he should have taken my advice on the burrito, he told me that he would like to meet any other personnel at Eggers from Indiana, as he had gifts of state flags that he would like to distribute. I found a Navy petty officer I know who resides in South Bend, and we joined with Rokita to receive our flags and run them up the flag pole for a photo op shortly before he left the base. As he was departing, Rokita asked me if there was anything his office in Indianapolis could do for or send to the military personnel at Eggers.

The situation at Camp Eggers

Although Camp Eggers is a base situated in the capital city of a country at war, and although IED strikes and rocket attacks are not nearly as common here as in other more restive areas of the country, danger still exists. Just last week, a suicide bomber with a carload of explosives detonated himself and his load along the perimeter wall of Eggers, inflicting many Afghan casualties in addition to killing one US soldier and severely wounding another. It was the biggest blast so close to home since Eggers was settled as a military base several years ago. Personnel from Eggers cannot leave base unless we are on a trip essential to our work, which means we are restricted to base for much of our time here. I live in Kabul, but I feel that I know only those parts of the city I regularly drive past, and I know those areas only by sight.

Although personnel at Camp Eggers are for the most part isolated from the rest of Kabul, our existence is not one of discomfort. We have hot meals, usually enjoy hot showers, and can exercise in a well-equipped gym. I must share a room with another officer; but I can buy internet access for my personal use, and a small military exchange here has most of the toiletries I need, along with snacks that I should do without. We even have a Thai restaurant on base, with an authentic Thai staff that looks to be suffering in extremis from the winter cold; as well as a small pizza restaurant. We are comfortable, especially when compared to the military personnel forward deployed to more austere bases found in remote Afghanistan. And even those forward deployed personnel are living pretty comfortably relative to the millions of poor Afghans who regularly go without food, proper clothing, and decent shelter.

A few times every month military personnel from Eggers embark on a humanitarian mission and visit a needy area of Kabul where we distribute donations of clothing, food and toys sent to us from people in the US. Oftentimes we are lacking toys, so I suggested to Rokita, when he asked what he could do for us, that he recommend his office staff collect toys and send them here so that we would have gifts to distribute to Afghan children. Rokita was obviously touched that I requested toys for the local children instead of comfort items for myself and the other Americans. I can only assume that he didn’t notice the availability of Thai cuisine on base and the stack of Snickers bars on my desk. Regardless, in emails subsequent to his visit, I coordinated with Rokita and his staff the logistics to get toys collected by his office in Indiana to the children of Kabul. I distributed most of the holiday stock his office sent to a refugee camp filled with Afghan families recently returned from Pakistan who were living in the most squalid conditions I have seen since I left the house I shared with six other male friends my senior year at Marquette University. I photographed several of the children with their toys, and sent them to Rokita’s office where they are now posted on the Indiana Secretary of State website at the link below.

A short statement on official visitors to places like Afghanistan

The title of this article speaks of a recent appearance by Afghan Ronny on the radio, an episode I will address shortly. First, though, I would like to give an opinion on the propensity of public officials and military leaders to travel long distances in order to ascertain exactly what is happening in places such as Iraq and Afghanistan where American military personnel are fighting wars. These trips can be categorized as fact-finding missions, or junkets, or boondoggles, depending on your point of view. As a deployed Naval officer who has met, while in theater, his congressman, his home’s secretary of state, and several Admirals with collars full of stars, I support most of these visits. These people are responsible for the policy decisions that eventually determined my deployment to Afghanistan, and they are responsible for supporting me and the overall mission of the US military while I am here. I am not sure what these visits cost the American taxpayer. I’m not even sure if all the visitors I have met traveled on the government dime. But whatever the cost, and to whomever, I applaud the travel.

You simply cannot fully appreciate the situation here from a chair in the United States. Additionally, a minority of senior public officials these days have military experience. They, along with the senior military officers based in the US, need to see first-hand what a war entails, and how a war progresses. They need to hear stories directly from the personnel who enact the executive and legislative decisions of the country. They need to see how a conflict and US policy decisions affect the local populations that absorb the brunt of any war’s violence. And since these dignitaries all have to fly into the theatre of war on military airplanes, most are able to experience the joy of travel in Air Force C-130s and C-17s.

Now about the radio appearance

But about my radio spot. A few weeks ago, a staffer from Secretary Rokita’s office contacted me and invited me to participate in a radio show Rokita would host on AM 1430 in Indianapolis. Rokita wanted me to talk about the toy donation program for Afghan children that his office supported, and also to speak about my situation in Kabul. Those who know me are aware that the only thing I enjoy more than hearing myself talk is to hear myself talk to the media. I quickly sought and received authorization from my commanding colonel to participate on the condition that I mention his name and excellent leadership while on the air. I also alerted family in Indianapolis and Kokomo, Indiana to tune into and tape the segment that I was sure would serve as the platform from which I would launch my own media career after broadcasters recognized my eloquence and brilliance. My sister Therese assured me that procuring a tape of my “performance” would be simple, as her husband, my brother-in-law Steve, is the sales director for the station.

When I called into the show on January 21st and spoke to Rokita during the newsbreak before my segment, he asked if I would mind responding to callers while on the air. No problem, I said, thinking to myself that it was an excellent way to start bonding with my future loyal audience. But I will admit that I also wondered if anyone listening would have questions for me. It’s not like I am a celebrity. Not yet, anyway. But my first few minutes went well. I cannot remember all of what I said, only that I did most of the talking; and when I finally shut my mouth Rokita went immediately to a commercial break.

I could hear the station staff over the phone during the break, and someone announce that one and then two callers were on hold. Unbelievable, I thought. The residents of central Indiana so quickly have recognized my genius and affability, and are calling to speak with me after only a few minutes on the air. I braced for the first caller, wondering what I might be asked. I rehearsed answers to possible questions about my educational background, my motivation, my idyllic childhood and adolescent years in Kokomo. Then Rokita introduced the caller: Therese, my sister. And she didn’t ask me anything at all, but proceeded to tell the listening audience what a nice and service-minded guy I am. She judges me short on brilliance, but high on benevolence. Not bad, I suppose, and I was thankful for her comments; but I wondered how this use of precious airtime was going to further my budding media career.

I was able to ramble on myself once more shortly after Therese hung up. Again, I cannot remember exactly what I was saying, only that I was doing all the talking and Rokita, bless him, did not interrupt me. But then, after another monologue of several minutes, I heard a dial tone and realized that my precious connection to AM 1430 was no longer patent. I have no idea when the phone line disconnected, nor what of my disquisition my audience had missed. I furiously dialed to reconnect with the station. I reached Rokita again, and he laughed off the disconnection and told me not to worry about the interruption as he was going to commercial break at about the time I suddenly dropped from the airwaves. I knew I couldn’t let the severed broadcast disrupt my focus and concentration, as my second caller now awaited a conversation with me. Rokita chuckled as he introduced her, saying something like “I think you know this caller as well.” It was my mother.

Most mothers, having not seen a son for twelve months and surely worrying about him that entire time since he was deployed to a war zone, would probably spend the first few moments of a phone call, even one conducted in public over the radio airwaves, inquiring about her son’s well-being. Not my mom. At least not during this call. She and select friends of hers also had been sending me toys for Afghan children; and, after the briefest of salutations to me, she used her airtime to let central Indiana know what items where appropriate and inappropriate for delivery to Afghanistan. After a minute or so, Rokita managed to verbally muscle both my mother and I into a moment of silence, something that had been nearly impossible for him to accomplish with my family up to that point in the show. He slyly asked my mother if there was anything she wanted to tell the audience about me, perhaps a story of my childhood or teenage years. I quickly interjected at that point, insisting that my mother was to say nothing even remotely controversial. I am a physician and I have a professional reputation to uphold, and my mother maintains a reservoir of facts about me that, if revealed, would cause a congressional confirmation committee to collectively gasp and ask for a recess. Thankfully, another commercial break then intervened.

I felt obliged to end my segment of the show by thanking Rokita for allowing my family to turn his radio program into a verbal Willy reunion. I also assumed that my brother-in-law at 1430 AM had arranged for my sister and mother to be the only callers on the show. Not so, my sister told me. She did not even know that I would be taking callers until Rokita announced the open phone lines when my segment began. My sister then called my mother, who reportedly was driving around Kokomo with my father as they could get the broadcast in their car but not in their home, and told her to call the station. Both reported that they had no problem getting through to speak to me. I guess I wasn’t drawing as much of the attention of central Indiana as I had hoped.

Monday, January 12, 2009

Viagra apparently NOT a silver bullet for intelligence agents

The headline in the Washington Post was sure to draw attention:

Little Blue Pills Among the Ways the CIA Wins Friends in Afghanistan*

The article reported that CIA field operatives in Afghanistan were distributing Viagra to select elders and chieftains in order to win their favor, and hopefully gain intelligence on insurgent activities and other critical knowledge of the Afghan leaders’ territory. You’ve heard of the effort to win hearts and minds. With this strategy, US intelligence seemed to be moving in a direction that would secure our nation the allegiance of other Afghan organs.

The story relies on unnamed intelligence officers to corroborate that Viagra is just one of many gifts that an intelligence operative might use to win over an aging yet still influential Afghan. The problem with the report, as several of my own reputable sources tell me, is that it simply isn’t true.

Of course the CIA itself won’t comment one way or the other on the story. That isn’t surprising, as the Agency’s policy is that it never comments openly on methods used in clandestine intelligence operations. So that fact the Langley says nothing means nothing.

The striking thing about the article itself, which troubled me when I first read it and assumed its veracity, were the internal inconsistencies. Those alone should have prompted my skepticism over the truthfulness of the story. The reporter quotes a “senior U.S. intelligence official familiar with the Agency’s work in Afghanistan” as saying that operatives use tactics “consistent with the laws of [the US].” Viagra is still a prescription drug in the US, and I doubt if intelligence teams harboring any ideas of dispensing Viagra were prepared to drag a physician around Afghanistan with them; so the quote from this official, which was more extensive and supported the ingenuity of the operatives for thinking “out of the box” and doing “what’s necessary to get the job done” (apparently by stocking up on blue pills for field ops) was itself internally inconsistent.

This mysterious intelligence official seemed to want it both ways: To both assure compliance with US laws, and yet insure that CIA operatives were free to distribute pharmaceuticals without a license, and likely with little familiarity the drugs as well.

The official quoted also applauded intelligence agents who “take risks.” If the agents were in fact distributing Viagra to impotent and elderly and likely dehydrated Afghans, then they did enjoy risk, including the risk that the Viagra would suddenly drop the blood pressure of the intelligence source they were attempting to court and leave him on the ground dead due to drastically reduced cardiac output. In Afghanistan, like most other places, the people are more likely to admire you and cooperate with you if you assist them by improving and prolonging their lives instead of killing them. An intelligence operative likely would garner scant information from a village should he return the next day and discover that the local elder died shortly after munching the blue pill left by the American.

The article quotes a supposed retired operative as saying that the Viagra was not given until the prospective Afghan recipient’s health could be “established.” I am not sure what “established” means here, but I doubt it means the intelligence operative performed a full physical examination on the man and verified blood pressure and other vital signs in addition to reviewing current physical complaints and the Afghan’s past medical history. In other words, I doubt any intelligence agent would have the knowledge or inclination to complete the sort of medical evaluation necessary and expected in the United States before a physician would prescribe Viagra. I don’t know what this former operative is doing for retirement work. I can only hope he didn’t begin a second career in medicine.

I also hope he doesn’t provide any type of marriage counseling, as this same retired operative states that older Afghan men, often maxed out at four wives as is the Islamic custom in Afghanistan, consider Viagra a tool that can put them back into “an authoritative position” in their marriages. It is not uncommon for rural Afghan men to have wives of different ages. As an Afghan man ages, he often will marry successively younger wives. If a man is hovering around sixty, and sexually not the dynamo he was once when he had only one or two wives and a raging libido, he probably is pleasing his older wives by simply leaving them alone at night. And the younger of his betrothed, I would guess, are happy that a man who resembles their grandfathers is not cuddling next to them with an erection. It seems to me that, from an Afghan female perspective, the miracle of Viagra might be utilized by a husband to introduce not authority into his marriages, but instead punishment. Maybe US intelligence and counterintelligence efforts alike should consider focusing on the Afghan women a bit more, so we don’t lose the females to the insurgents as we ponder ways to (figuratively) stroke their men’s egos and sexual appendages.

One final thought for any intelligence operative considering the use of Viagra for currying favor with elderly Afghan men: The effects of the Viagra itself are fleeting, as will be the loyalty of any Afghan recipient. The Taliban can procure Viagra from the Kabul bazaars and distribute it around the countryside more easily and with greater effect, perhaps, than can US intelligence agents. The Taliban have a tougher time building roads, dams and electrical plants; and digging wells and instituting agricultural programs for poor rural Afghans. The Taliban’s expertise with such projects is their ability and willingness to destroy them at the expense of the livelihood of other Afghans. I think these initiatives, instituted for the greater good of the community, might be where any US operative wants to spend his time, energy and money. They are the endeavors that will promote peace and security and a favorable view of the US. We need to keep the focus on long-term investment instead of a short-term erection.

*Washington Post article, December 26, 2008

Saturday, January 3, 2009

It Cannot Get Much More Desperate Than This

You’ve seen the footage on CNN of the refugee camps in places like the Sudan and other war-torn nations. The reports usually feature shots of hundreds of skinny children with dirty faces and tattered clothing; of makeshift shelters constructed of flimsy wood and rope and UNHCR-embossed tarpaulins; of an aid worker at a vat of gruel dishing meals to camp residents; and possibly a medical tent with a red cross on the side with a line of patients waiting, exposed to the elements. The refugee camp I visited recently in Kabul featured the first two: plenty of dirty kids, many of them shoeless, in light clothing even though winter snow has arrived; and housing constructed from scrap sheets of plastic, mud and blankets. Unfortunately, I didn’t see much in the way of food or medical care.

This camp is a settlement of fifty families displaced by war or poverty. Or both, since both ravage Afghanistan and hundreds of thousands of people continually move to Kabul in hope of finding work and food. I’m not sure if the Afghan government provided the land for this camp – a 200 x 200 yard expanse of dirt near the middle of the city – or if the people here are squatters. It doesn’t really matter much, as many, if not most, of the residents of Kabul are quite poor, and they live on land to which they have no legal claim. They settle on plots of land relished by no one.

Such as the hillsides. The city of Kabul rests in a valley surrounded by mountains and impressive hills. If this were Hollywood, expensive homes would occupy the highlands, providing fabulous views of the metropolis. In Kabul, the higher you live in the hills, the poorer you must be. No roads climb up the hills. There are no water wells up there. My Afghan coworkers find it unbelievable that wealthy people would even consider a residence in the hills in the United States. When they see a house high on a hill, they think about the daily circuit those residents must make down and the back up the hill simply to fetch fresh water.

The refugee camp was on flat ground, but it had no well that I saw. The sector of the city surrounding the camp seemed sparsely populated, possibly because the land is so unfit for human occupation. The camp “latrine” was a corner of the settlement designated for waste. I saw no fire wood, only dung balls, rolled from the excrement of the few head of cattle in the camp that the refugees burn as fuel for their fires. For comical juxtaposition, an elaborate wedding banquet hall stood a few hundred meters away, and across the street was a building billed as the “Afghan Economical and Social Development Exhibition.”

I went to the settlement with two dozen other military personnel from my base to distribute cooking oil, blankets, clothing and toys to the camp residents. Oftentimes these trips can be raucous, as the desperate people, both children and adults, will swarm you and try desperately to grab hold of anything you might be able to offer them. In fact, I left my wallet and keys in my office for this trip, as kids oftentimes will search your pockets for goods while you are engulfed in a crowd of fifty of their friends. Thankfully, though, this group was relatively orderly. The elders from the camp did a nice job of keeping order, mostly by swatting children back from the supply truck as we tried to unload it.

This place was without question the most wretched human settlement I have ever encountered. I’m not Angelina Jolie, but I’ve seen some pretty desperate communities both permanent and temporary on a few different continents. Yet no place I have ever visited before embodied the perfect storm of malnutrition, disease and foul weather that marked this camp. A few infants in their mothers’ arms appeared obtunded. Every child looked malnourished. Congenital malformations, lazy eyes, and dermatologic maladies were the norm among the children, who played among cows and goats and the droppings that accompanied those animals. A good number of the men had limbs either twisted from untreated trauma, or missing altogether. No one appeared to have bathed in a long time. No one wore clothing proper for an Afghan winter, and if they had shoes they likely were sandals. Everyone bore a rather thick film of dirt on their skin.

Several families lived in hovels carved from the side of a hill, sometimes featuring a mud brick wall. Those were the prime pieces of real estate. The majority of people lived in tents or shelters made of nothing more than plastic sheeting. None of these residences provided much protection from the cold. None of them had functioning doors. And the temperatures in Kabul have dropped precipitously the past few weeks, with snow arriving just a few days ago. Maybe the cold was what led me to think, as I stood and looked around the camp, that it doesn’t get any worse than this. It couldn’t get worse, because any worse and you simply could not survive.

We distributed toys to the children and supplies to the adults, but I noticed that I didn’t see much of what we provided shortly after we handed it out. A few boys kicked soccer balls that we brought them, but otherwise you were challenged to see a stuffed animal or any other toy we had provided. I learned from an interpreter that both the children and adults quickly take their new possessions and hide them, probably in their shelters, either to protect them from theft or to preserve them for the future. Most of these people possess little more than what they wear and carry with them each day, and they want to preserve anything new or novel that they acquire.

Even though I had trouble finding many kids with their new toys, I had no problem finding residents who wanted to pose for photographs. I have written before that most Afghans are proud to pose for photographs, no matter what their socioeconomic or physical condition. The rarely seem to consider an avid photographer a voyeur. In fact, they can get surly and indignant if you don’t photograph them. The only exception to this is that many Afghan women, for purposes of modesty, will shy away from the camera. In this settlement, however, almost everyone waived for me to photograph them. One stately, elderly gentleman held a pose for several minutes while the Americans flocked around him like paparazzi. A father kept herding his children back to the front of their mud hut so that we could get shots of the entire family, including the wife. It was difficult to photograph a solitary child you might find especially cute, because a virtual swarm of other children would enter the frame when they saw you had a camera.

The snow fell heavier this morning, the day after I visited the camp. I walked to breakfast with a colleague who had organized the trip, and I told him as we entered the dining facility that I was wondering how those poor children in the camp were doing today. He said he was thinking the same thing.

Note: The internet speed here rivals dial-up velocity circa 1992.  I cannot upload photographs of the refugee camp today.  I will try again another day, as a few of the photographs will tell the tale of this camp much better than I am able to describe it. 

Thursday, January 1, 2009

A Visit to the Slaughterhouse

WARNING: If you are a vegetarian, easily disturbed by descriptions of the slaughtering of animals for human consumption, or averse to tales of mammalian blood loss (my friend Joe Gaylord come to mind), I recommend you discontinue reading this post now.

I agreed immediately to accompany the preventive medicine officer on his inspection trip to the local Afghan Army slaughterhouse. Several months ago I had seen photographs of slaughterhouses here depicting men with bloody butcher knives in their mouths, cats serving as the rodent eradication force, and sickly animals nonetheless passed as safe for butchering and eventual human consumption. I also eat in the Afghan Army dining facilities occasionally, and the beef, lamb and goat from this particular facility stocks all the army kitchens in Kabul; so I was curious as to the origin of my lunch meat.

We first visited the holding yard where all newly acquired animals spend a minimum of twenty-four hours to ensure that they are robust enough to at least eat and ambulate. The cows, sheep and goats in the yard enjoying their last few hours of life when we visited were certainly able to scurry away whenever we ventured close to them for a photograph. The Afghans giving us the tour thought it funny that we would want our pictures taken with a herd of goats, but I’m sure it was just the latest of American behaviors incomprehensible to them.

The stockyard smelled like any other stockyard. In other words, it smelled like an animal pen from a Midwest farm, so I rather enjoyed the earthy scent as it elicited pleasant childhood memories of my family visits to the Gethsemane monastery in Kentucky where Uncle Ronny, my namesake, lived as a Trappist monk and worked with the other brothers a very large dairy farm. The farm featured a pen with a bull, and my brother Dave and I would sit on the fence and take in the smell of hay and manure as we waved a red shirt at the beast in an attempt to get him animated. I was rather cautious of the cattle in the Afghan stockyard, as I know from personal experience that taunting can get them agitated; and I was happy to note that they were leashed.

The Afghans informed us that they segregate all the animals by sex when they arrive. Afghan culture dictates that men and women rarely socialize with anyone of the opposite sex outside of their own families, so I thought this routine might be an extension of that custom. I also thought it rather cruel to separate the male and female beasts, thus negating the possibility of one last night of carnal pleasure before they were sacrificed for the nutrition of the Afghan Army and its American mentors. Through an interpreter, I suggested to my Afghan colleagues that perhaps they should do something nice for the animals here and allow the males and females to consort together on their last night of life.

Attempting to amuse another person through an interpreter is a rather dicey initiative. Oftentimes the interpreter himself will not understand your joke, or perhaps the languages differ so much in vocabulary and contextual imperatives that an extremely witty line in one tongue becomes simply a befuddling phrase when translated into the other. The interlude necessary for the translation of your words is painful enough with regular conversation; but when you’ve told a joke, and are anticipating some display of mirth from your interlocutors, the period during which you wait while your colleagues hear your words in their own language can be excruciating. You begin to fear that what you said was not funny at all to them; or worse yet, offensive. Thankfully, at the slaughterhouse, I had with me a very fine interpreter who immediately laughed when I proposed cohabitation for all animals awaiting slaughter, and every one of the Afghans surrounding me roared with laughter after they heard the translation.

What I like about most Afghans with whom I work – good Muslims all of them – is that they like to eat and they love to laugh, even if the humor is a bit bawdy. It’s my kind of Islam.

From the holding yard, we went to the cattle slaughtering room. It was easy to find, as approximately fifteen severed cow heads were piled outside the door. The eyes I could see had a rather stunned look, as if the animals were shocked that this was the end. Inside the slaughtering room, men worked at several carcasses of beef, stripping away the skin and fur, pulling out the innards, and sectioning the meat with axes. In fact, the slaughtermen did all of the work with their hands or with a hand ax. I was impressed with the men sectioning the meat, as they obviously were quite skilled and practiced at slicing the carcasses with a simple ax, and they were able to partition the meat nicely.

The room itself was cleaner than I had expected it to be. Some of the butchering was done directly on the floor, which itself was not exactly a sterile surface. The USDA inspectors would not have liked that practice, but Upton Sinclair probably would never have bothered writing The Jungle had this been the only slaughterhouse he saw. I remember a neighboring farmer in Indiana who would annually butcher a cow by killing it then hoisting the animal by its hind legs with the front lift forks of his tractor before he disemboweled it. The work in the Afghan slaughterhouse seemed at least as clean and sanitary as that farmer’s, and I remember the fresh beef our neighbor delivered to my mother as tasting delicious.

I asked the supervisor how they actually killed an animal, as we entered the room when the cattle had already become simply large sides of beef, and he told me they first tie the legs and then quickly slit the animal’s throat. He then became excited, and told me that he would go fetch a cow and kill it so I could witness the procedure myself. I really had no interest in watching that process, nor did my colleagues who just uttered “Oh my god” after our interpreter told us the supervisor’s intent. I grabbed our interpreter and, luckily, we caught supervisor just as he was making his way to the stockyard. I explained that I really didn’t want to interrupt the routine of the facility, and that although I appreciated his willingness to down one more head of cattle for our edification, the additional slaughter really wasn’t necessary. He understood, thankfully, and then suggested that we move on to the room where they dealt with the sheep and goats. I told him that was just fine with me.

As we continued the tour, I joked with my colleague Dr. B-, one of the Afghan army officers who was accompanying us, that the sight of all the fresh meat was making me hungry for lunch. Dr. B- laughed, and as we entered the next room we encountered three freshly slaughtered sheep hanging on a hook, one of which was obviously a male (until recently) as its inordinately large testicles hung down over the abdomen of the inverted carcass. Dr. B- pointed to the testicles, smiled and told me “We will prepare these for you for lunch as you are very hungry!”

Dr. B- and I have become friends over the past few months. I was impressed when I learned that he has fathered twelve children, and I always make mention of his virility whenever we meet. After he suggested the testicles for my lunch, I took his hand (an appropriate gesture of friendship between men in Afghanistan) and told him that I would eat them if the meal rendered me as fertile as he is. Dr. B- laughed at my retort, and told me that when this inspection tour was over we must take tea together. He’s my kind of Muslim.

There was very little activity in the sheep and goat section of the facility. The workers slaughter a specified number of animals each day, and that morning they had already killed, skinned and sectioned the allotted number of sheep and goats. The supervisor decided, however, that since we were not able to see how they killed the cattle, that he would bring in two sheep so that we could witness the slaughtering process from start to finish. We couldn’t stop him this time. When we learned of his intentions through our interpreter, he already was heading back from the stockyard literally dragging and carrying a bucking sheep that acted as if it knew precisely the consequences of the very near future.

I hope, when my time comes, to die a peaceful death, and pass from this world during a night of deep sleep. If I have to die by the knife, however, I want one of the Afghan slaughtermen I met to take me out, because they went about their work as quickly, professionally and humanely as you get when you are killing an animal with a sharp instrument. One man grasped the hind legs of the sheep, and another secured the front legs and upper body of the sheep before he took what was certainly a very sharp knife and, in one smooth motion, slit through the animal’s neck so deeply that the head looked as if was swinging back on a hinge.

As he killed the animal, the slaughterman recited in Arabic a prayer which translates roughly as “God is great and he provides for his children.” His voice was deep and rich and resonated throughout the room, and all the other workers paused and attended to his words. The prayer surprised me, so much so that for a moment I forgot what was taking place in front of me, and I stared somewhat transfixed at the slaughterman instead of the sheep dying in his arms. The prayer and the sincerity of the men transformed a simple, ugly slaughter into a religious sacrifice. Of course, that’s my view on what transpired. I’m sure the sheep interpret the act differently.

The slaughterman sliced the sheep’s neck over a drainage trough that caught the animal’s blood. The animal exsanguinated and died quickly, but for a couple of minutes the sheep’s muscles continued to twitch and exhibit reflexive movement. The slaughtermen kept the animal secure with their arms until it finally settled still. They then completely removed the head and injected air under the skin that ballooned the animal so much that they could use the sides of their knives to play the belly of the animal like a drum. The air allowed them to slice through the skin without cutting open any of the internal organs of the sheep, and once they had removed most of the skin they hung the animal on a hook and continued on with the butchering.

The temperatures were in the mid-40s the day I toured the slaughterhouse. I’m glad I went during the winter, as I do not want to imagine the smell and heat of the place during a Kabul summer. The only temperature control for the slaughter rooms seemed to be windows, which were open, partially closed, or completely shut.

The clothing of the men working there was soaking wet, with what I will not describe. I never saw showers anywhere in the facility. I hope they are located somewhere we didn’t tour, although I expect the most that might be available for the men is cold water from a hose. Most Afghans have no running water in their homes. Even my interpreters, who make comfortable wages by Afghan standards, typically hire someone to bring water to their houses, and then they heat what they need in a pot on their stoves. The men at the slaughterhouse likely were paid enough to enable them to survive. Nothing more than that. They certainly need bathing and laundry services at the end of their working days, but how they manage that I do not know. Theirs is yet another trade in Afghanistan that I’m glad I won’t ever have to undertake in order to support myself.