Monday, March 31, 2008

Boot Camp Afghan Style

Double-click images for larger photos Left – New recruits in an Afghan military formation. Center – Colonel Bahomodeen takes issue with the fat content of the recruits’ lunch. Right – I give a little ophthalmic instruction to the physicians.

A Day at the Afghan Army Recruit Processing Center

Today I went to the recruit processing center for the Afghan Army. The physicians there had requested an ophthalmologist visit the facility as they had some concerns about the vision screening done at the center, and I gladly went with several senior officers from the Army public health division who had other areas of the facility that they wanted to inspect.

The Afghan general practice physicians who work at the center were very professional and spoke excellent English. They had good equipment to work with, including an auto-refractor that scans the eye and quickly determines a prescription for glasses; and a phoropter for determining the prescription manually. (You know the drill: "Is it better at one or two? Three or four? ...") The physicians knew how to operate both pieces of equipment, more than what most non-ophthalmologists in the US can do. They even had questions about the use of positive or negative cylinder when determining a patient's refractive error. If you have no idea what that means, don't feel alone as typically only ophthalmologists and optometrists get trained on such issues. But the fact that these two general practitioners were facile with the concept impressed me tremendously.

They recounted for me that it was not unusual for them to prescribe glasses for a recruit only to have the patient complain that the spectacles did not give them crisp vision. The percentage of recruits that need glasses at all is low: They estimated that only five percent got prescriptions when they arrived for processing. They weren't sure what they are doing incorrectly. The likelihood is that they are not doing anything incorrectly, but instead that these recruits have other ocular conditions such as cataracts, tear film abnormalities, strabismus, corneal pathology or retinal disease that reduces their visual acuity. The clinic had no slit lamp for proper evaluation of the eye, so our plan is to procure that equipment for the clinic then conduct a short course in eye disease and examination skills given by Ronald Willy, M.D.

I also postulated that some recruits might be rethinking the whole join-the-new-Afghan-Army-and-fight-the-Taliban plan that sounded so appealing when they were back in their villages dreaming of what they would do with the $40 monthly salary plus room and board offered recruits. Upon hearing this theory, my colleagues laughed and agreed that they thought “soldier’s remorse” was a significant factor. I explained that it was not uncommon for a US military recruit to discover he was suddenly blind in one eye after two weeks of boot camp.

Recruits are crafty creatures, no matter what their ethnicity and culture; and when it comes to factitious illness they often are difficult to treat as you cannot simply play Mr. Goodwrench and hook these guys up to a diagnostic device that determines “legitimate knee pain” or “retinal degeneration leading to poor vision.” Physicians at the Afghan Army National Medical Center recently recounted for me how newly trained soldiers took advantage of the decrepit conditions at a local barracks and blamed their physical environment for inducing illnesses that left them unable to perform their duties. Not surprisingly, every soldier who suddenly took sick was slated for transport to an isolated duty station somewhere in the Afghan hinterlands. The soldiers awaiting duty in Kabul itself reportedly were in fine fettle.

Recruits arrive at the processing center regularly. Many come from the provinces, have lived in rural areas their entire lives, and are in the "big city" of Kabul for the first time. The clothing they are wearing when they arrive is usually their sole possession. We visited a barracks building and found beds nicely made but lockers completely empty as this group of recruits had arrived the previous day and had not yet been issued any Army clothing or their "hygiene packs" with soap, shampoo and other toiletries. The barracks had nicely tiled bathrooms and shower facilities, which are foreign to many of the recruits who must be taught how to use a modern faucet.

Like most Afghans I have encountered so far, these recruits LOVED posing for photographs. Well, they didn't really pose as they were sitting in a quasi-military formation and had officers watching them; but they clearly enjoyed our attention and my statement that if they were joining the American Army, they would be getting their heads shaved bald like mine (at which point I removed my hat). I got several photographs of the platoon and found myself fascinated by their traditional Afghan dress and differing facial features. Most of the men -- and they were all men -- were in their 20s and surely had seen considerable suffering and violence their entire lives as the past few decades have been devastating for Afghanistan.

Afghan society is very hierarchical, and when the colonels from my group got to these recruits they immediately began to remove their hats to check their hair (for lice and other disease, I suppose) and pull back their outer garments to check the cleanliness of their underwear. Understand that the colonels all are educated, from influential families, and wealthy by Afghan standards, so the recruits and other officers raised no objections to this impromptu inspection. In fact, the recruits seemed to enjoy the attention and clearly understood that the colonels were yelling about the need for clean new clothing for the entire group (which, along with three square meals daily, was probably a prime motivating factor for these guys to enlist.)

The colonels also raised hell in the kitchen when they saw floating in two large tubs of water the wedges of meat and fat destined to be lunch for the recruits. Colonel Bahomodeen, a veterinarian and a kindly older gentleman who was dressed in a suit and tie, reached into the vat and pulled out pieces of frank fat and began yelling that you cannot feed such product to soldiers and expect them to be happy and healthy. The kitchen staff seemed to get the message, as about ten of them started fighting each other to get to their hands into the tubs to remove the fat. Colonel Bahomodeen did concede that some fat should be left in the mix for “flavoring.”

As we left the recruits, I noticed many were staring at my female colleague, Dr. Illy Dominitz. I doubt they had ever seen a woman in public without her head covered. Illy was standing before them with head bare, in a military uniform, carrying a pistol. I’m sure some of them were thinking “The stories we heard about the strange things in Kabul really are true.”

Saturday, March 29, 2008

My kind of people

Photograph - Lt. Col. Mohammad is the gentleman on the far left. His image is blurry as, even with my shutter speed at the fastest setting, I couldn't capture a clear photograph of him due to the speed and vigor with which he attacked his lunch.

The Afghans Come for Lunch

Shortly after I arrived in Afghanistan I heard from reliable sources that food is of significant importance to most people here. Not surprising, I thought, as both the Afghan economy and farmland are poor. But I soon learned that the Afghans are like the Chinese in that they really don't place much value on clothing or housing or any other suspected personal artifice, but they insist on eating good food -- and a lot of it -- no matter what their financial state. History and genealogy would confirm this common bond with the Chinese, as a significant percentage of Afghans carry the genes of Genghis Khan; and one minority group, the Hazara, have facial features you'd expect on a world table tennis champion, not a Shi'ite Muslim from Kabul.

Today I lunched with six top officials from the Afghan Army's public health office, and I was astounded by the sheer quantity of food they consumed. I heard before they arrived that they relished any opportunity to eat at the dining facility on our base, and it was clear they understood the logistics of dining here and the variety of food available to them because they worked the buffets as if they had already run reconnaissance on the place. They seemed to know exactly how many pounds of food the rather flimsy paper trays could hold as they loaded on lunches that included grilled chicken breasts, fried chicken tenders, roast beef, chicken wings, deli meat, enchiladas, egg rolls, taco beef, turkey wings, macaroni, french fries, salad and several selections of fruit and potato chips.

In the past I have worked extensively with Cambodians and Indonesians who, to a person, were hesitant to eat anything unfamiliar and who usually subsisted outside their countries on rice and simple grilled chicken. The Afghans I dined with today showed no hesitation in consuming entrees unknown to them. I don't think enchiladas are an Afghan staple, but when my guests learned that beef resided inside the corn tortilla, they nearly lifted the entire tray from the steam table. I fashion myself a pretty big eater, but I felt a post-prandial fatigue coming on just watching these guys dish themselves 6-7 entrees apiece.

For the first time, I felt a solidarity with the Afghans. They are my kind of people. The lunch also gave me renewed hope for the development of Afghanistan because if these men are able to marshal to their advantage the vast mineral wealth found in this country as competently as they mined and consumed the myriad offerings at the dining hall, Afghanistan will be a first-world country before I fulfill my Naval commitment.

Never believe that Afghans lack creativity or ingenuity. I saw at lunch roast beef in a peanut butter sauce, french fries on a bun, chocolate chip cookie-crusted chicken, broccoli-infused enchilada casserole and cranberry Coca Cola. Two men ate sour cream straight up, with no chaser. I lived in Japan for year and thought the Japanese took extensive liberties when preparing American cuisine, but the Afghans brought together disparate elements that would have sent any reasonable Japanese diner back to the sushi bar. And the Afghans consumed enough to shame eating champion Kobayashi.

I was charged with procuring and delivering desserts at the end of the meal, and I wanted to test the resolve of my guests so I brought each one of them two desserts, a bowl of ice cream and a large piece cake, in addition to a selection of cookies for the group. I was lucky to snare the last peanut butter cookie as every treat seemed to vaporize before I could reseat myself.

A coworker asked if perhaps these men ate so voraciously because they seldom enjoyed such a large and varied selection of food. I doubt that is the case. Anyone used to eating light would NEVER have been able to wolf down one-quarter of the lunch these men devoured, and most well-nourished people would be risking nitrogen poisoning from an overdose of protein had they been going tamale-for-tamale with them. I say again, the Afghans are my kind of people.

I wish our encounter had ended in the dining hall, but these dignitaries had a secondary agenda that included the promotion of public health in Afghanistan, so we retired to a meeting room to endure a presentation detailing ... the rancid conditions of most slaughterhouses in Afghanistan. My stomach is pretty strong, but I might go vegetarian for awhile after seeing photographs of a butchering facility located very near our base, and I don't recommend anyone else sit for such a presentation just after a meal. Upton Sinclair would have been too ill to write The Jungle had he visited this place. A cat served as rodent control, and that was the most progressive element of the facility. I'm not going to post any of the photos as too many people would be disturbed by them and a few images might risk categorization as pornography, but the lowlights include blood stains five feet up the walls, men with slaughtering knives in their mouths as they struggle with animals, and a line of dead goats bleeding out into an open trough.

I'm a physician and I've seen quite a bit of human gore, but those photographs really made me queasy; and I realized half-way through the presentation that I was so unnerved because what I was viewing could be my food. My Afghan colleagues, though concerned with the conditions they reviewed, did not seem viscerally disturbed: As they commented on strategies to clean up the slaughterhouses, they munched on M&Ms and Skittles and small chocolate Easter eggs. As I've said, these Afghans are my kind of people.

Wednesday, March 26, 2008

Rebuilding means something used to be there

I've been in Afghanistan for two weeks and only now am I beginning to get an idea of what my job will be. Unlike most people who arrived with me, I was not a direct replacement for a departing officer. That means I had no turnover brief or orientation to my job responsibilities or clear explanation of exactly what I'm supposed to complete or supervise or promote for the next twelve months. I'm new and my position is new, and that can be advantageous, or disastrous. As an example, as a staff officer, I am considered available to fill space on any "advisory board" or "working group" on base that needs representation from medical personnel. My military experience such groups has been that they advise very little and work even less. It's hard to maintain consciousness when your day is enveloped by their meetings, and the incessant dozing they induce plays havoc with my ability to sleep through the night. So I'm trying to create a few specific duties and projects for myself that might keep me occupied and focused during the day. I might even be able to assist the Afghan Army in the development of its medical system.

The US Navy has teams of physicians, nurses, hospital administrators and other health professionals "embedded" at different Afghan Army and Police hospitals and clinics throughout the country. These teams typically live on the grounds of these facilities, and they can probably count on one hand how many times they leave the premises during their 6-12 month deployment. In Kabul, at a base small by American standards but pretty large relative to the hospital grounds in Mazir-e-Sharif or Herat, sit me and other administrative and leadership staff who work to direct and support the embedded teams. "Direct" might mean that we implement through the embedded teams a trauma care plan devised by the Surgeon General of the Afghan Army. "Support" might mean that we procure a means of refrigeration for vaccine doses spoiling in the heat of Kandahar.

My first task has been to formulate a monthly reporting scheme for the embedded teams in order to better track their progress in mentoring the Afghans to provide better care for soldiers and their families. So far, reports from the regional hospitals have varied from "emergency room here is really coming into its own and better caring for patients" to "staff still loathe to wash hands before entering the operating room" and "surgeons no longer using the same set of instruments on two different cases simultaneously." Much of the mentoring here is very basic. The facilities are called hospitals, but an American would hardly recognize the organization and services provided within. A significant percentage of any hospital staff is likely illiterate, and that makes record-keeping a bit difficult. Many of the nurses have had no formal education. A physician may or may not have attended medical school classes or passed any formal licensing or certification exam.

They're not dishonest. For the past several decades, Afghanistan has not been able to offer most citizens the opportunity for a good primary and secondary school education, let alone quality medical training. No uniform, objective training standards seem to exist for these positions. An Afghan ophthalmologist told me that after his medical school training, he passed both the internal medicine and surgical exams, and he decided to practice ophthalmology. I'll admit that a language barrier was present, but I could not elicit from him any recount of focused ophthalmic training he received. It appears that local surgeons simply select the specialty that interests them most. A colleague told me of meeting the Chief of Surgery at a provincial hospital who pleaded for a different professional post as he trained in internal medicine, and had not even attended a surgical case as a medical student.

US military medical professionals are working for improvements in Afghan military healthcare as our efforts are part of a larger strategy to improve Afghanistan's internal security by reinforcing and expanding the national army and police force. American medical personnel are engaging the Afghan healthcare system at the clinic and hospital level. Progress is often elusive and usually precarious. If an Afghan hospital represents the pinnacle of healthcare here, the illustrious apex of a pyramid, then any embellishments to its facade stand in danger of collapsing groundward as the elements of a solid structural base necessary for a society to sustain advanced care -- a high literacy rate, adequate economic resources, sustained electricity -- are usually lacking. Afghanistan is a development project at every level. Few geographic and societal sectors in Afghanistan are being "rebuilt" as they have never existed. Progress should be measured in small increments as the task is monumental.

There are professional assets here: Afghanistan has dedicated, intelligent and sometimes well-trained medical professionals, although not nearly as many as needed. The US is attempting to mentor some of these people in hope that a partnership will result in better care for all Afghans, a necessary element for the country if Afghanistan is to be a stable country that doesn't pose a threat to America. That's the US military's goal for Afghanistan, our current "end-point." With respect to Afghan medical care, the project will be decades long. The medical education tract begins with a basic education and then continues as prospective healthcare professionals progress through a training sequence that takes many years. The US has been in Afghanistan intermittently for only seven.

Sunday, March 23, 2008

Strategy 101: Why not join a legitimate protest?

You would be understating the situation if you claimed that Afghanistan operates idiosyncratically. As an example, the country's time zone is not Greenwhich Mean Time plus four hours, or Greenwhich plus five, but Greenwhich plus four and one-half hours. No one here has been able to provide me a compelling argument for the advantage of a country keeping its hours unsynchronized with those of its neighbors and most the rest of the world. The official Afghan calendar differs not only from the Gregorian calendar of the West, but from the standard calendar of Islam. Most Muslims worldwide celebrated the beginning of the 1429th year of Islam on January 10, 2008, the new year according to the lunar calendar; but Afghans adhere to a Persian solar calendar and just last week welcomed in year 1387.
The actual date of the Prophet Mohammed's birthday is not known, so Muslims typically celebrate his birthday in the third month of the new year. We infidels in Kabul were confused by the national holiday last week that accompanied the arrival of the solar new year, as we were three months into the Islamic lunar calendar and we didn't know if it was simply a celebration of the new year, or the new year plus the Prophet's birthday; and if they both deserved celebration, which one took priority; or if Afghans celebrate the Prophet's birthday in the third month of their solar calendar year, should we prepare for birthday festivities three months from now.

I'm not surprised that progress comes slowly here, as many people working in the country cannot answer with any certainty the questions "What year is it?" and "What time do you have?"

I was hoping that holidays in Kabul bring the sight of kites in the air, kite runners in the streets, and lamb kabobs on the grill. I saw and smelled none of that. Security experts here warned that some angry Afghans might be using the holiday to promulgate mayhem in the streets of Kabul by hunting down Westerners, so I spent the time restricted to the base. The holiday itself was not responsible for promoting native anger, but instead American officials feared a backlash against anyone European in appearance due to the February republication in several Danish newspapers of the infamous 2005 cartoon depicting Mohammed with a turban fashioned as a bomb; and the supposed upcoming release by a Dutch politician and filmmaker of a documentary that equates Mohammed with Hitler and the Koran with Mein Kampf.

The holiday incorporated a Friday, the Islamic weekly holy day when Muslims attend mosque. The rumors were that a number Afghans, angry with the Prophet's treatment in Europe and free from labor the afternoon subsequent to services, would break from the mosques primed by their imams' fire-and-brimstone damnation of all things European and proceed to stalk the streets of Kabul with AK 47s and hand grenades as they made their way to the Dutch Embassy to let Holland, Denmark and the rest of the world know, with the sound of gunfire and the smell of cordite, that they took great umbrage to this depiction of Islam and its founder.

Understand that guns and other weapons of battle are not uncommon finds in Afghanistan, a country that some argue remains the domain of sectoral war lords. If you swept a few square blocks of Kabul at any time of any day you would likely would a find a disturbing percentage of the population with weapons that the NRA would have trouble justifying as noble possessions. To claim that an Afghan street demonstration might feature guns is akin to claiming that New York City's Puerto Rican Day Parade might be short of Port-a-Johns.
But the typical American reaction to such a prediction is a flurry of expletives followed by preparations to hunker down in a secure building with soft drinks, potato chips and a TV to wait out the violence.
This theory and practice of "bunkering" to me seems counter-productive to the overall US goal which is to win the "hearts and minds" of all people Afghan and Islamic. I think this past holiday in Kabul, we Americans missed a chance at solidarity with and understanding of Afghans and Muslims. Instead of sheltering ourselves in our fortified compounds to wait out the anger and feared violence, we should have joined the angered Muslims in their protest. We should have met them, as they surged from the mosques, with sandwich boards in Dari reading "Follow me to the Dutch Embassy" and "Burn Danish newspapers, not Kabul." We should have changed the placards on the rear of our Humvees from "Stay 100 meters back or you will be shot" to "Honk if you read the Koran today." We should have patrolled the streets with loudspeakers suggesting that we protest vociferously for awhile before retiring together for a pleasant evening of tea and kabobs.

The Dutch film deserves protest, as it reportedly lambasts the founder and the book of a religion that has produced great learning and liberal thoughts. Islam was a repository of ancient knowledge and writing while the priests and rulers in the West were burning books along with anyone thought heretical during the Middle Ages. Islam helped the West revive itself after a very dark period. Not exactly the stuff of Mein Kampf. Take a look at the photo above of the Dutchman, Geert Wilders, responsible for the film. The man dyes his hair platinum blonde to to call attention to himself. If his art and analysis are as plastic, superficial and comical as his appearance, then he should be shunned.

Protests and demonstrations in the US are seen as expressions of freedom; they are considered spectacles of a thriving democracy. But the prospect of a protest against us, especially when conducted in a foreign land, seems to trigger only fear and trepidation and ruminations on impending danger. Part of my job and the responsibility of countless other military personnel here is to mentor the Afghans as they build their country and transform their society. We missed a good opportunity last week to model for them the preferred protocol in liberal democracies for public protest and the expression of collective anger and grievance.

There were protests in Kabul over the holiday, and the news agencies reported that the participants, whose numbers ranged from a few hundred to several thousand depending on the source, were calling for the departure of the Danes and Dutch from Afghanistan. They also burned various flags and chanted "Death to America." I'm not sure how we got linked with the Europeans on this issue, but I do know that it might have been different had we joined with the protestors, not hid from them.

Friday, March 21, 2008

The Taliban cannot stop March Madness! And something called Buzkashi

Modern warfare has become very user friendly as, at most US military bases, the internet and cable television are readily available. Therefore a ceasefire need not be called for March Madness, the NCAA basketball tournament. (Yes, Helen Cheng, this is the BASKETBALL tournament. The Kansas game we watched in January was football.) I am so happy with the tournament coverage here that I even look forward to Dick Vitale and his shameless ACC apologetics.

My beloved Marquette Hilltoppers/Golden Avalanche/Warriors/Golden Eagles (our mascot changes every 20 years) punked Kentucky for a first-round victory, and next we face Leland Standford, Junior College. Let's hope the damn tree that somehow serves as Stanford's mascot doesn't get too close to Marquette's players and handicap them by inducing corneal abrasions with its branches. Let's hope as well that Stanford's band is NOT present at the game as it is likely to charge the floor before the game is over.

The game telecasts in Afghanistan start late in the evening and proceed overnight, so the tournament has not been good for productivity in the office. With pre-game prognostications and post-game analyses, then the games themselves, my colleagues and I are spending 10-12 hours daily following the tournament and our personal brackets. That doesn't mean we aren't in the office. Very few people have televisions in their rooms on this base, but the offices have sets and access to AFN, the Armed Forces Network, which has devoted two channels, AFN Sports and AFN Extra, to the tournament. So although we are not exactly working, we can claim to be in the office all night long. The dining facility always serves a midnight meal as people work around the clock here, and the "mid rats" (midnight rations) are welcome as I adjust to a nocturnal life for the next few weeks.

Most NCAA tournament devotees know that much of the event's excitement comes from entering the office pool and testing your bracket of winners against that of your coworkers. Usually there is an entrance fee. As gambling is haram, or forbidden by the Koran; and since gambling is illegal on US military bases, we cannot and would never consider having an entrance fee for such a pool here in Kabul. Therefore, we play for "jellybeans." It's twenty "jellybeans" to enter the pool, and you take home more "jellybeans" if you win. "Jellybeans" also come in handy here when playing poker and rolling dice.

I don't think the Afghans really appreciate the enormity of March Madness. So I have to say that a University of Georgia hoopster was overstating things just a bit when he stated that the Bulldogs "shocked the world" the night they unexpectedly won an NCAA berth by taking the SEC post-season title. Basketball from any league is not a passion among the Kabul locals. Sami, one of our office custodians, has heard of Michael Jordan but could not tell me what sport His Airness played, although he did mention "the Bulls of the Chicago."

Afghans reportedly are more fond of flying kites (although I have yet to see one in the skies over Kabul) and a traditional sport called buzkashi. I would classify buzkashi as a variation of polo, as men play on horseback; but I doubt Prince Charles could be persuaded to suit up for a sport where the object is to carry a dead, disemboweled, decapitated calf the length of a field while other riders use any means possible to thwart you and take possession of the carcass. (See photo above.) Cricket must have influenced the evolution of buzkashi, as a match can last several days. To toughen the skin of the calf for such an extended contest, the carcass is soaked in cold water for 24 hours before the competition. A goat can be used if a calf is unavailable or too expensive, although aficionados claim the goat carcass tends to disintegrate before the end of the match.

Wednesday, March 19, 2008

Afghan Women Part I: Encounter with the burka

Although not the most beautiful of Afghanistan's cities, Kabul is by far the most cosmopolitan: the social and cultural Afghan equivalent of New York, Los Angeles and Washington, D.C. melded into one metropolis. And although Kabul boasts very little in the way of glamour, investment capital and strong governance, you can find here educated female professionals who wear Western garb (although always with a head scarf) and compete successfully with the menfolk. Yet the streets of Kabul also provide reminders that most Afghans live by a familial and social code much different from what is acceptable to an urbane Westerner. Perhaps this cultural divide is best exemplified by the burka worn by many women here.

My most unnerving moment so far in Afghanistan was when I passed within a foot of a woman wearing a burka who was walking the direction opposite of mine. I know that I am not supposed to stare at these women, and I didn't; but I felt myself transfixed as I had difficulty believing that what I saw coming toward me was an actual person. That's exactly the response the burka is supposed to elicit in a man, I suppose. I would not be acting properly if I acknowledged her in any way, as she is someone else's property and not considered an individual at all. The burka was effective in negating her as a person as I passed.
Other women comport themselves in public completely covered except for their upper faces, but I don't find that garb at all disarming as you can see the woman's eyes and they acknowledge, even if they don't look at you, that a human being exists under the robes. Not so with the burka. You cannot see through the mesh covering the woman's face. With their feet hidden and the sheets of the burka loose and flowing, these women are blue apparitions coming toward you. Sometimes you can see bony hands and fingers jutting from under the burka, but that only adds a grotesque, skeletal component to an otherwise sad and somewhat frightening scene.

This week I attended a lecture at the Afghanistan Ministry of Public Health. Outside the ministry building sits Massoud Circle, a major intersection in Kabul. I stared through a second-story window as I waited for the lecture to begin, watching Afghans as they walked, biked and drove around the circle. Several women I saw wore burkas, but two women held my attention more than the others. They were both in burkas, accompanied by one man, and sitting together several feet off the circle. The three looked as if they were awaiting transportation; and even though already fully covered, the two women faced away from the busy circle toward a stone wall. (See photo above.) They spoke to one another, but their clothing and position made it impossible for them to interact at all with the people around them. They took every measure available to hide their existence from the other people scurrying about near them.

The physician giving the lecture was a female Afghan physician who worked with the aid organization CARE to improve maternal-fetal health in Kabul. She explained how community educators, themselves literate local Afghan widows, tried to reach and educate expectant mothers. Many females in Afghanistan marry older men soon after the women (girls, really) reach ten years of age, even though the legal age for matrimony is sixteen. In order to educate a pregnant woman on nutrition, pre- and post-natal care, and the local medical services available, the community workers first gain the sanction of the local mullah, the Islamic leader, and then the woman's mother-in-law. (Often, an entire community of older women will meet as a shoura, an estrogen-soaked community council, to decide if they will accept the educators into their homes to speak with the younger pregnant women.) Usually, if his mother decides that an educator should speak to his pregnant wife, the husband will consent to an intervention in his home. But the husband alone determines if his wife will leave the house to visit a hospital or physician.

The social pressure for conformity and the engrained traditions found here can even overpower parents who want their daughters to educate and liberate themselves. I know a physician who helped sponsor a very bright young provincial woman so she could study law in Kabul. She was a stellar student. Her parents, who were quite proud of her learning and accomplishments, shocked everyone when they announced recently that they would be marrying the woman, who is twenty, to a man more than twice her age. They explained that they truly did not want to give their daughter away and force her to abandon her studies, but the pressure from their extended families was so great that they had no choice but to agree to the betrothel. The marriage will ensure that the aspiring lawyer returns to her village to spend the rest of her life as a virtual recluse.

Monday, March 17, 2008

In the beginning, there is disbelief

A healthy percentage of people coming from developed countries to work in Afghanistan quickly find themselves in disbelief at the living standards facing the typical Afghan, even in an urban area such as Kabul. A report from the Rand Corporation entitled "Documenting Health" states that what data experts can gather on the country "clearly place Afghanistan at or near the bottom of every socioeconomic indicator used to measure human and economic progress." The social stagnation permeates every sector of both private and public life: most people suffer horrible sanitation and lack clean drinking water; women, especially the young females, are usually looked upon as chattel; the government often seems lacking, incapable or corrupt; good schooling is a luxury; most people could not even tell you what decent healthcare should provide; the country's infrastructure remains crumbled and crumbling due to war and neglect.

The country needs a continued infusion of donor intellect, money, and expertise to partner with the Afghan people and resources that are available and capable of transforming their society on virtually every front. The changes have to be accepted and ultimately directed by Afghans. But this partnering is difficult. Afghans have a culture and history quite distinct from most of the foreign nationals here to assist them, and Afghan priorities and decisions are sometimes befuddling. Progress comes very, very slowly here, even when Afghans and foreign development workers are working well together.

After the initial feelings of disbelief fade, frustration often sets in. Many of my coworkers have been here for six months or more (a relatively short time when you talk about nation-building projects), and they can spew endless tales of education and development projects sidetracked by forces beyond their control. Two senior corpsmen in my office are charged with implementing a combat medic course for the Afghan Army. One lesson focused on the placement of a tourniquet to prevent exsanguination if a limb is amputated. They demonstrated the tourniquet's facility in the classroom by placing it on a leg. In a subsequent practical exercise, the hypothetical victim suffered an amputated arm; but instead of addressing the severed limb, the Afghan soldiers placed the tourniquet on the victim's leg, as they had learned in class. Clearly, these soldiers had no working knowledge of basic physiology. Many of them were illiterate. How could they possibly know about the flow of blood through the body's vascular channels if no one had ever taught them? Western medical experts really didn't understand the basics of the circulatory system until the late 1800s. The Afghans' failure to place the tourniquet properly illustrates the cruel result of youth denied a fundamental education. And the frustrated corpsmen are struggling to overcome this educational deficit as they try to teach basic first aid.

I spent my pre-deployment training with an engineer who went this week to inspect a new building constructed for the Ministry of Interior. He was dumbfounded by some of what he saw. A few of the toilets were clogged or broken as Afghans, after defecating in them, used rocks to clean themselves and then flushed the stones along with their waste. They weren't vandalizing: many of them probably had never seen toilet paper before (or the paper dispener next to the commode was empty) and they routinely used rocks for such ablution. The new, industrial-sized kitchen in the facility was still spotless, which led my engineer friend to inquire if any cooking was being done there. "Oh, no. We cook out here," some Afghans told him as they led him through a back door to a yard where pots hung over improvised wood fire pits. I wonder if anyone had bothered to show these Afghans how to work a modern stove.

Hearing these stories, it is easy to conclude that Afghans are stupid and uninterested in changing. But the knowledge and technological savvy that Westerners possess are the result of learning -- we've been instructed on how to function in the modern world since we were toddlers. Our sophistication is not innate. We were taught to use a modern commode (although many of us rebelled against that instruction). Safe driving, operating kitchen appliances, the fundamentals of democracy such as voting and responsible political representation, the value of good hygiene -- all of these things, and many more, we learned because we grew up privileged. And we not only learned the lessons, but we learned that by applying the lessons in our everyday lives, we were much more physically comfortable and oftentimes emotionally better pff. The Afghans will learn these lessons, just as we did, but it will take time. You cannot expect to compress several generations of education and experience into a decade of development work.

Today I imagined myself in 1984, at age 18, sitting down to a computer with a Microsoft Windows operating system and internet connectivity equivalent to today's standards. I would have looked pretty stupid trying to operate the thing.

Saturday, March 15, 2008

Afghan food, Afghan pride

An Afghan general recently told my boss that an Afghan values three things above all else: food, sleep and gossip. (From my limited reading on Afghan culture, I thought that Islam, personal pride and revenge also were highly prized, but I'm from Indiana so I won't countermand the general.) I was glad to hear that food is a priority, as an abundance of good vittles ranks near the top of my own pyramid of needs. If I were free to roam off our secure base to explore the local cuisine, I might be able to comment more on the Afghan fare; but currently I'm pretty much restricted to Kellog, Brown and Root's American food in the dining hall as I checked with the security folks here and they quickly denied my request to organize a convoy for a tour of Kabul's kabob shops. But the value of food to the typical Afghan does help explain my first encounter with Tajib, the custodian at my office.

As I have no opportunity for formal language training here, I have taken to asking the guards and housekeepers, who are available pretty much 24/7, to teach me a few phrases in Dari. To a man, they have become quite excited when I, an American, express interest in something other than ESPN and the number of days remaining on my tour. In fact, most of them begin spouting phrases that I "must know, sir" so quickly that I don't have time to write them down. Usually there is an order to the vocabulary they toss me, but when I asked Tajib for the Dari equivalent of "How are you?" he quickly replied "chatur hastee, but sir you must also know of the health of man and for food. Sir, you must know carrot, zardak, and milk, shir. Milk!"

I didn't want to tell Tajib that I am over forty years old and what I need to be able to communicate is "Please direct me to the high fiber cereal," as I did not want to hurt his feelings or insult his personal pride; and I know he now considers me an ally as now every time he passes by me in the office, which is about 50-75 times daily, he utters with a smile "Mr. Ron!"

And even though the general didn't list pride among his top three Afghan values, I know it is important to men here; and I fear I may have inadvertently challenged the pride of my groundskeeper, Khirlal. I happened upon him my first full morning in Kabul when I was roaming outside and looking for the person designated as laundry man for my building. That position is quite an entitlement, from my perspective, as the going rate for washing and ironing a standard American military uniform is $3; and by my calculations a man would only have to wash and iron a dozen or so uniforms each week to earn an income exponentially greater than that of most other Afghans. However, the idea of washing and ironing must not strike Khirlal as work suitable for himself, as when I asked if he was my laundry person he gave me a glare that would have been appropriate had it been 1980 and I an invading Soviet infidel. But he did direct me to Suninal, who gladly took my uniform (that held about three pounds of Kuwaiti sand) and my money. As I departed I asked Khirlal, whose English is decent, to teach me the Dari equivalent of "thank you" and "good day" which he did with a smile but at such a pace that I didn't comprehend that Khirlal was not part of a phrase but his actual name (as to that point I had not learned what he calls himself).

I didn't have a problem that morning as I thanked Khirlal for his instruction and made my way to the office, but I was taken aback the next day when he approached me as I left my building and asked me directly, "Do you remember my name?" A quick smile will get you out of a jam most places on this planet, but apparently not in Kabul, as when I continued to smile and said nothing Khirlal gave me another glare, and this one would have been appropriate had it been 1980 and I an invading Soviet infidel who had recently torched his village.

Then -- and it stunned me for a moment until I clearly recalled that I had introduced myself the previous day -- I caught him looking at my nametape! I was in uniform, so my surname was embroidered above my right chest pocket and he had to read it before he said solemnly, "Willy, my name is Khirlal."

Well, I have pride as well, so I continued to smile and said "You cheated!" as I pointed to my name and then left him with "Salaam, Khirlal!" He looked at the end a bit nonplussed by my brazen retort. I like to think that now we both have a better understanding of each other.

Thursday, March 13, 2008

I guess he really didn't like me

Every day I walk a thirty-meter stretch of Kabul street heading to and from the military compound. By regulation I travel wearing body armor and helmet with my pistol loaded. My first day in Kabul I traversed this path a few times as I had several boxes and a few duffel bags to transport to my temporary living quarters. During one afternoon trip a slight Afghan man approached holding me while holding the hand of another male, a common sight here. What was uncommon, hopefully, was the movement of his free hand as he pointed to me and said firmly as he passed, "Sir, I hate you!"

Now I have walked the streets in many countries and on a few continents and I have heard many non-native speakers attempt a statement or two in English that failed to express the true feelings of the aspiring interlocutor. In fact, the evening after this incident I dined with an international group that included a French NATO colonel who approached us at dusk and bellowed "Good morning to you!" So I stand ready for liberal interpretation of the English of foreign nationals; but I think this particular Afghan expressed his feelings for me quite precisely.

I immediately thought of several reasons why he might experience acute displeasure upon sight of me. I was a foreign Naval officer walking along Afghan municipal streets in full battle uniform carrying a loaded weapon, and I was coming from a secure compound where international military forces enjoy an existence that is positively royal relative to the lives of most Afghans. While I conduct my business confident that appropriate financial remuneration awaits me at the month's end, most Afghans struggle to earn a few dollars each day. His government spends $1 per year on his health care, while mine provides me universal coverage.

He might have also thought, quite correctly, that if freed from my current military and environmental constrictions, I would be more than happy to drink and gamble and woo women as long as my stamina and wallet hold. These wanton pursuits are likely haram, or forbidden, by his religion. To me, they are the critical elements of a rejuvenating vacation.

If I spoke a bit of his language, at least as much as he knows of mine, I could have stopped him to ask more about his abject dismissal of me. But I was perspiring from the load I was carrying while sheathed in armor plates and I was tired from an overnight flight from Kuwait, so I didn't break stride when he addressed me; but I did mutter in Dari, the Afghan national tongue, the only phrase I know: tashak kur, or thank you.

Wednesday, March 12, 2008

Kuwait Part II: Faster Pussycat -- Jessica, Jessica!

In this second and final installment covering my time in Kuwait, I was prepared to expound on many interesting and curious things both military and Kuwaiti. I was prepared to tell you about one training range, essentially a shooting facility and driving course carved out of sand dunes, where the temperature last year beat anything ever measured in Death Valley, CA, making it the hottest place on earth. (Thankfully I spent time there during the relatively cool Kuwaiti "spring.") I was prepared to tell you about the USO installation here where you are required to remove your boots to enter, leaving the Navy folk to dread the arrival of any new Marine battalion as that ensured the facility would produce the funk of 1000 soiled sweat socks.

I wanted to comment on the Bollywood Laundry run by third-country nationals blasting Indian pop; and the two-day sandstorm that delayed our training and had my colleagues agonizing over the consequent delay in shipping them to the war zone called Baghdad. I wanted to write about the innumerable, odd concrete structures that I discovered, on my own, to be mortar shelters; and the thousands and thousands of Jersey barriers that barricade and direct and restrict and cordon the movement of Humvees and trucks and people.

But I'm in a foul mood and not eager to address any of those topics as I had to depart for Afghanistan and missed my chance to attend the most exciting event to hit Kuwait since Sadam's invasion: the Jessica Simpson and Pussycat Dolls concert, sponsored by My Space. Jessica and the girls took the stage in "Kuwait Rock City" March 10, one day after I left the country. I've been unable to find much news on the event (perhaps Google Afghanistan blocks searches for such debauchery) as the popular press seems to have given it little attention and, ironically, the military restricts access to the MySpace website.

I did read that Jessica actually planned to sleep in a military tent, eat military meals, and spend only as much time as absolutely necessary with her traveling hairstylist. The Pussycat Dolls themselves, in a pre-concert interview, warned "the desert's about to get a lot hotter." Damn my luck!

The MySpace Kuwait Rock City event also featured comedian Carlos Mencia and a hip-hop singer and a couple of rock bands, but you didn't sense much excitement on base for these side acts. Everyone was anticipating the arrival of Jessica and the Dolls in-country

Wednesday, March 5, 2008

On base in Kuwait: Part I

To ensure the operational security of US forces, I cannot reveal exactly where I am in Kuwait. But any US military member in Kuwait finds him or herself essentially in the same place: the desert. Regardless of what actual base you occupy. The sand that blows around and violates the exterior of all animate and inanimate objects is not the fine sugar found on Florida beaches, but a heavier composite that feels like fine dirt and is light brown in color. And everything that it touches -- concrete, metal, skin -- takes on a brown hue after repeated exposure.

The sand also tastes like dirt, and when the winds whip, as they have been doing the past two days, the air tastes like soil. You can cover your mouth with a scarf or balaclava, but after awhile the sand begins to overwhelm the fabric and you realize that the faint taste of Indiana farmfield lingers on your tongue.

As we are not here long, my group is in temporary housing that consists of groups of 8-10 person tents that resemble a desert tenement slum. Perhaps because they are old, or perhaps because they have been battered by winds and sand for a few years, the tents give the impression that they were erected during a British expedition sometime in the late 1800s. I know they are slightly more contemporary as they boast concrete floors, fluorescent lights and air conditioners (although we have not used them as the temperature is pleasant now in Kuwait).

The tents are stocked with bunks and lockers rumored to have been obtained from the hold of a charred delivery truck found burning on the "Highway of Death" shortly after the first Gulf War began: the bunks have varied frames and mattress sizes and most of our lockers are missing doors.

One of the most appealing features of this base is the food. Kellog, Brown and Root, now known as KBR Services and a subsidiary of Halliburton, provides our meals, and the variety and quality is very good. The reported daily price to the US taxpayer for an individual's meals is $71. Unfortunately, I find that I am only able to eat approximately $50 worth of food most days, thus preserving KBR's profit margin.

I wanted to take photographs of the dining facility, but was told such actions could somehow breach base security. Specifically, I wanted a shot of the dessert case. The sign overhanging that section reads "desert," but the offerings include fruit cheesecake, chocolate cheesecake, pies, tarts, cookies and brownies at every meal. There's also Baskin Robbins ice cream, ice cream sandwiches, and soft serve ice cream with nuts, whipped cream and fruit toppings available. No Nutty Buddies in the freezer, so Elvis would be upset, but otherwise anything you need frozen or sweet to keep you overweight and happy.

Tuesday, March 4, 2008

Army Training: Hurry Up and Wait

Boredom and monotony bedevil the life of every enlisted soldier. So much of your existence consists of waiting for nothing to happen. Everyone jokes about the urgency to "hurry up and wait." Below is a typical daily itinerary for my last three weeks training with the Army at Fort Jackson, SC. You'll notice that most of the day calls for waiting. I'll employ the Naval euphemism: to standby.

05:15 Wake up and personal hygiene time
05:45 Gather by platoon for personnel and weapons count, then standby
05:50 Ensure complete platoon formation, then standby
06:00 Company formation for announcements
06:05 Breakfast
06:25 Platoon formation anticipating company formation, then standby
06:30 Company formation to announce schedule changes from thirty minutes prior
06:35 Break for first training exercise, then standby
06:45 Training schedule revision announced, instructions given to standby
06:55 Announcement that training schedule revision rescinded
07:00 Announcement that training exercise to begin soon, then standby
07:15 Announcement that training exercise to begin soon, then standby
07:25 Exercise instructor arrives
07:30 Projection equipment found to be malfunctioning, instructions to standby
07:40 Projection equipment repaired
07:45 Training exercise begins
08:30 Training exercise concludes
08:35 Bathroom and smoking break
08:45 Reconvene for second training exercise, then standby
08:50 Announcement given that presenter in route, standby
09:10 Second training session begins
10:00 Bathroom and smoking break
10:10 Reconvene to complete training exercise
10:20 Training exercise complete
10:25 Bathroom and smoking break
10:40 Reconvene for final morning training exercise, then standby
10:50 Announcement to standby for training schedule revision
11:00 Announcement to standby for training schedule revision
11:15 Bathroom and smoking break
11:30 Reconvene for final morning training exercise, then standby
11:40 Announcement to standby for revision to training schedule
12:00 Break for lunch
12:35 Platoon formation in anticipation of initial afternoon company formation, then standby
12:45 Company formation to announce no revisions to afternoon training schedule
12:50 Break for first afternoon training exercise
13:00 First afternoon training exercise begins
13:45 Bathroom and smoking break
14:00 First afternoon training exercise reconvenes
14:15 First afternoon training exercise concludes
14:20 Bathroom and smoking break
14:30 Reconvene for second afternoon training exercise, then standby
14:45 Second afternoon training exercise begins
14:50 Exercise interrupted, all personnel ordered to medical for screening
15:00 Formation at medical building for screening, then standby
15:15 Majority of personnel excused from medical without screening
15:20 Announcement to standby for further instructions for afternoon
15:30 Announcement to standby for further instructions for afternoon
15:45 Personnel excused for afternoon
15:55 Messenger to barracks to announce immediate formation
16:00 Company formation to announce revision to afternoon training schedule
16:05 Company dismissed for additional afternoon training exercise
16:15 Personnel convene for additional afternoon training exercise, then standby
16:25 Announcement that additional afternoon training exercise to begin soon, then standby
16:30 Announcement that additional afternoon training exercise to begin soon, then standby
16:45 Announcement that additional afternoon training exercise cancelled, then standby
16:50 Announcement to standby for further information
17:05 Personnel dismissed for the day

This typical itinerary helps to explain why so many military personnel smoke and drink.

Monday, March 3, 2008

Kuwait = Sand

My training group landed in Kuwait late Friday. Everyone was happy, as the Department of Defense allots bonuses and benefits to military personnel who serve in a designated combat zone each month, and to qualify for the extras you need be present in a combat zone only one day of the month. All Navy personnel seem know at least one person who was aboard a ship near the Persian Gulf when the captain decided, late in the month, to move into “combat waters” and remain there until the new month arrived. Thus, two months of benefits. To have arrived even one day later would have cost me considerably.

We flew a charter plane from Columbia, SC to Kuwait. The flight was quite comfortable, and unlike the service on typical US routes, the flight attendants peppered us with food, including full meals. I got tired of eating, which is very unusual for me. Apparently past charter services have been skimpy with the grub, so we ate a final meal at Fort Jackson early in the evening, then received a carry-on meal as we boarded buses for the airport just a short time later. Once airborne and on our way to JFK in New York for fuel, the airline served us another meal consisting of hamburgers, potato chips and apple pie. There may have been a salad included as well, but I was fighting a food coma after my third evening meal of the day, and my memories of that leg of the flight are faint.

The flight staff was very nice and reportedly enjoyed the military charter flights as, with no booze to be had, we are peaceful and appreciative relative to other transcontinental passengers. They had the plane decorated with American flags and red, white and blue streamers and stars. (See photo) A large map of the USA hung near my chair featured a cartoon every state depicting a renowned product or resource for the area. Northern Indiana had a group of ripe tomatoes, which I thought appropriate. I was confused, however, by the stack of pancakes in central Texas.

We left the plane at JFK Airport in New York as it took on more fuel. Since we had little time and no tickets or boarding passes for the flight, we were restricted to the terminal. This being the military, many people wanted to smoke; so the staff gave people permission to light up in the terminal near our gate. This caused quite a stir with passengers arriving at nearby gates. I watched as dozens entered the terminal, immediately lifted their noses in disgust and glared at the two dozen sailors in desert fatigue uniforms happily inhaling carcinogens. Other passengers, though, went to their pockets for smokes and had a look of glee as they imagined, I presume, that during their flights all smoking restriction laws had been lifted unexpectedly.

I slept for most of our trans-Atlantic leg, but awoke ninety minutes before touchdown in Germany and had breakfast before we deplaned for a two-hour break while the plane refueled and a new crew came aboard. We shuttled into a reception center that not only allowed smoking indoors, but also had a gift shop with edible sexual toys. I am not sure how many of these “novelties” joined the flight to Kuwait (where they would be considered contraband), but it was the time to buy as the shop attendant had little change and gave a simple exchange rate of $1 = 1 Euro. The center also sold beer, and since I was in Germany and the time was nearly noon, I decided that I deserved a couple of beers before touching ground in Kuwait where consumption of alcohol, we were told, is illegal. Certainly no alcohol would be available on the US military base there.

While in South Carolina, I adopted a motivated young sailor, Petty Officer Bagsic, as my personnel security detail after I witnessed first-hand how well he handled firearms. He also acknowledges the genius of my wit. Bagsic is heading to Afghanistan and has assured my safety. He got a bit of training (see photo) during the Germany layover when he recognized the dangerous situation I might create by drinking a third beer, and he took it upon himself to assume control of that superfluous beverage even though he already was saddled with a bottle.

We deplaned in Kuwait in the dark and directly from the tarmac to waiting buses. The weather was encouraging: high 60s with a gentle warm breeze. For a moment I thought we had landed in San Diego, until I noticed that my eyes stung a bit, my lips felt somewhat gritty, and a faint taste of soil was emerging from the back of my tongue. I also realized that the beams from nearby floodlights illuminated the thin mesh of sand that lingers everywhere in desert kingdom of Kuwait.