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.”