Saturday, July 26, 2008

Kandahar Police: Prosthetic limbs and eye makeup

Photograph: Policemen and police recruits display
a short-lived semblance of order and discipline.

My recent trip to Kandahar in southern Afghanistan was to serve as the medical monitor for an Afghan police recruitment and training initiative. A few hundred policemen and new police recruits arrived at a training center where they would first be administratively processed into the Afghan police force (if necessary), medically cleared for service (no double-amputees or opium addicts, please), then trained by teams of Americans and Afghans on proper policing. Some of the men already had served on the Afghan police force for a year or longer but had never undergone basic police training: Upon joining the force, they simply received a uniform, a weapon, and a duty post. Several of these gentlemen displayed for me wounds already sustained in battles with the Taliban, and a dozen or so took my hand and rubbed my fingers over palpable schrapnel lodged in their legs, arms and scalps.

The medical evaluation included a urine screening for drug use, a brief medical history and a cursory physical exam. Hash and marijuana use are so prevalent in Afghanistan, especially in Kandahar where tons of marijuana are grown, that a positive test for THC (the active ingredient in pot and hash) does not disqualify one for police service. In fact, if recent hash or marijuana use did disqualify recruits, it would be impossible to field a sizeable police force as typically up to half of the new police officers test positive for THC. Opium use is a different story. Desperate as the police force may be for new members, an opium addict is not likely to respond well to a regimented and physically demanding police training camp.

Most of the policemen and recruits were young and healthy, and easily passed the physical examination. I had to fail a few who I thought might kill themselves while running and marching and otherwise exerting themselves physically during the upcoming training. The failures included a gentlemen taking the blood anti-coagulant Coumadin after heart valve replacement, and another current policemen in atrial fibrillation medicated with digoxin. (His bottle of pills had a label with “Poison” written in bold letters under the name of the medication.) A surprising pass was a middle-aged officer with a left lower leg amputation who was determined to remain on the police force and who, at my request, could easily hop on his nicely constructed prosthetic limb. At least two of the policemen had lost a single eye in previous trauma (including one who claimed he was shot by an American soldier), but I passed them as they assured me they could shoot using their remaining good eyes.

My biggest problem with the screening was not determining what medical problems and physical complaints where problematic for police service, but maintaining order among the free-ranging Pashtuns (the predominate tribal group in Kandahar comprising the vast majority of the police there) who often seemed oblivious to requests for straight lines and an orderly procedure through the stations of the medical evaluation process. Most of them were shocked, and then amused to the point of distraction, that they were expected to collect and then give to a stranger a sampling of their urine. As soon as some of them learned I was a physician, they left whatever stage of processing in which they found themselves to tell me (in unintelligible Pashtu) about their stomach pain, or headache, or immediate need for a vitamin injection (a very popular therapy in Afghanistan) or intravenous fluids.

A serious architectural design flaw, which added to the overall confusion, had the base store and barber shop located along the same hallway as the medical clinic. The screening process began with a line for the urinalysis station outside the building, as the Afghans went to outdoor portable toilets to collect their specimen; but often during the day I had wayward trainees who had left their respective groups elsewhere on the compound for a trip to the store or barber (neither of which kept discernible business hours), thus mixing themselves with the class I was trying to move from urinalysis to the clinic proper for an exam. I found myself yelling in PashtuDookahn bundee! Dookahn bundee!” (“The store is closed!”) at dozens of Afghans attempting to destroy the little order I could maintain by pushing their way through the hallways to the store entrance. (Luckily very few of the policemen wanted haircuts.)

Many Pashtun males darken their eyelashes with a black ash that leaves them looking as if they have applied mascara. American military males, often homophobic and quick to chafe at customs that they perceive to be emasculating, sometimes interpret the custom as simple beautification by one male to attract another. Homosexual practices, while not discussed openly, certainly are prevalent among Afghan males; but the Pashtuns darken their eyelashes in belief that the practice strengthens their eyesight. Or improves already weak vision. The darkened eye adnexa might decrease the glare bombarding the eye, especially in an environment like southern Afghanistan where the sunlight and glare bound toward your face from every direction. So the practice is no different from a baseball outfielder applying a thick stripe of black greasepaint underneath his eyes before a game. The difference is that a Pashtun male maintains his darkened eyes no matter what he is wearing, even if he is sporting a police uniform.

I learned during my brief time in Kandahar that the Pashtuns, at least the men willing to join the police force, love to entertain and to be entertained. They laughed when I attempted to speak Pashtu to them (“Stan am Najibullah dee?” – “Your name is Najibullah?”) and shadow-boxed with the three police named Mohammed Ali (although I don’t think any of them were familiar with The Greatest of All Time). They joined me in preemptively shouting “Dookahn bundee!” to anyone approaching the building who presumably was heading for the (usually shuttered) store. They laughed with me as we watched one of their colleagues drink five bottles of water before he was able to urinate. (Dehydration was the norm amongst the Afghans there.) You never would have guessed, observing what I did during the process, that the Pashtuns are the ethnic group from which the Taliban sprung.

Thursday, July 24, 2008

Kandahar: Desert heat and the Taliban nearby

Photograph: Main Avenue. Actually, the compound's only avenue.

The 1965 movie “The Hill” depicts a British prison constructed in the sands of the Libyan Desert to house deserters and other miscreants whom the Brits believed had disrespected their royal army. The hill, for which the movie is named, is a manmade construction in the middle of the brig that the prisoners climb as punishment for infractions or lax discipline. What was most memorable for me about the film, however, was the cinematography that captured the white heat and merciless sun of the desert: rarely did a scene show shade, the Brits were forever drenched in perspiration, the walls of every building were a bleached white, the sand and rock covering the ground looked like hot blanched charcoal … as I watched the film, on television, I instinctively reached for my sunglasses as I felt my retinas might be simmering.

Kandahar, Afghanistan, where I have been the past week, could provide the setting for a sequel to “The Hill” should the Afghan government ever decide to promote movie production as a revenue source for the country. The days here begin temperate at 75-80 degrees, but the pleasantness ends at about 06:00 when the southern Afghan sun burns through any lingering haze and begins to bake the earth below it. The temperature most days has reached 110 degrees, sometimes 115. Many people comment that “it’s a dry heat,” something akin to a “clean gunshot wound.” Adding to the comfort is the flame-resistant uniform issued to us that seems to bestow protection by keeping your skin so warm that any additional heat and fire results in a relatively minimal and painless aggradation in temperature.

The base where I temporarily am working is a relatively small (150 x 200 meters) collection of faded tan sheet metal buildings and plywood shacks the color of newsprint completely bleached by the sun. An asphalt driveway runs the perimeter of the base, but a few inches of loosely packed gravel cover the rest of the ground. Your steps produce a crunch and pop as you ambulate around the grounds, fooling your ears into thinking that they are inches from a very large bowl of Rice Krispies with new milk added. Shower trailers are available, although they now have no electricity as last week a guard from a private security firm died after electrocuting himself while bathing in a stall with improper wiring. Such a small base offers few amenities, but for what it lacks in comfort it compensates with excitement.

The first night featured parachute-slung flares dropped within 500 meters of the compound’s walls to illuminate the surrounding fields for special forces units hunting the Taliban fighters who use the area to launch rockets at a large nearby airfield. My compound hasn’t been targeted directly, and soldiers here pass the story that a local warlord owns the property on which the base sits and put out word that his land, for which Americans supposedly are paying an outrageous rental fee, will be left unscathed. Although I have no doubts that warlords continue to exercise considerable power throughout Afghanistan, I find it difficult to believe that the Taliban would be so cooperative. The insurgents come very close to the compound and induce reactionary measures from coalition forces nearby, threatening damage in the warlord’s neighborhood. Also, the land on which this compound sits is an expanse of sand and rock, which had little to no development until Americans built a base. The supposed warlord/landlord has no infrastructure upgrades he needs to preserve.

My belief is that the rockets the Taliban typically fire at our bases are not exactly laser-guided missiles; and the insurgents are happy if they can place the ordnance anywhere within the wall of a compound. As this base is extremely small, especially when compared to the nearby airfield, the Taliban chooses to ignore it as one of their rockets, if at all wayward, would likely miss the compound altogether.

The excitement continued the next morning as I awoke at 05:45 to two explosions followed by machine-gun fire from one of the compound’s guard towers. I had planned to jog around the base perimeter at 06:00 or so, but delayed the run as the gunfire from the tower continued intermittently for the next 30-45 minutes. No alarm sounded on the base, and there was no assault on the walls, so I went to breakfast and chuckled when I saw that “Natural Born Killers” was playing on the large screen TV ubiquitous throughout US military dining facilities and seemingly preprogrammed to play, at high volume, only action films that feature gunfire and gore.

As I exited the dining facility I saw three Chinook helicopters descending as they flew over the base, and several people standing on a platform peering over the compound wall. I scurried up to the platform in time to see the helos disgorge soldiers in the mud-brick village only 500-750 meters from the compound, in the direction of the explosions I heard earlier that morning. The aircraft lifted off after a short time, and I couldn’t discern any more activity in the distance. Only then did I take notice of a terrible stench pervading the air around me; and, after looking more closely at my “platform,” discovered that I was standing atop a sewage collection tank, and next to a venting pipe open to the waste below and emitting miasmic vapors.

Photograph: Me atop OP Septic Tank.

I spent the remainder of my first full day on the compound wondering just how hot the place can possibly get, and was not surprised at nightfall to see more parachute flares. But the night and the next day waere quiet, until another loud explosion in the near distance sounded in the early afternoon. I learned later that a suicide bomber started to approach a convoy of vehicles from this compound when an Afghan policeman recognized the danger and shot him, but not before the bomber detonated his explosives. He was too far from the American vehicles and soldiers to cause them any damage or injury, but a local Afghan woman and a child reportedly died in the blast.

I’ve heard soldiers deployed to Kandahar and nearby Helmund, the heart of the Pashtun ethnic group and a stronghold of the Taliban, openly mock the relative safety and luxuries of “cosmopolitan” Kabul, as if those of us in the nation’s capital are enjoying the Afghan equivalent of a Sedona spa while they remain in the south of the country fighting the real war. Their vision of Kabul doesn’t correspond to reality, but I cannot blame them for overestimating the comfort and safety of their comrades to the north as I have been in Kandahar only one week, and I can report first-hand that it’s not pretty down here, and too often frightening as well.

Sunday, July 20, 2008

Military Air Travel Part II: Tactical landings and other joys of the journey

As a military aircraft approaches an airstrip in a combat zone, the pilot takes the plane through maneuvers collectively categorized as a “tactical landing.” The purpose of the intermittent acceleration and deceleration, sudden banking and very quick descent onto the runway is to minimize an enemy’s ability to lock onto the plane’s path and speed should the foe be planning anti-aircraft fire near the airport where the planes are low and vulnerable. The experience equates to landing in Denver from over the mountains in the west with a pilot who forgets he is no longer a stunt flier but instead is carrying a DC-10 full of paying passengers.

I recently withstood a tactical landing at Bagram Air Field in a C-130 packed with 70 other passengers, including an Air Force band whose extra pallet of musical equipment delayed our departure from Qatar while the bandmaster debated with the plane’s loadmaster over the ability to squeeze the horns and drums and amplifiers into plane’s cargo hold. While those two talked, we passengers stood in Qatari desert sun on a tarmac where the temperature was easily 135 degrees. (Instead of moving us back into the air-conditioned terminal to wait out the fate of the flutes and saxophones, the flight crew brought water to us as we huddled for shade under the wings of the aircraft. I poured my bottle over my head, and counted as the water evaporated from my skin, (sparse) hair and uniform in 3-4 minutes.)

The C-130 is designed to carry passengers, but it is not designed to carry passengers comfortably. The hull of the plane features four columns of heavy web seating, with paired columns facing each other. The space between the seating columns is so narrow that you have to alternately load passengers into the paired columns, and you end up with your legs intertwined with the passenger across from you. Also, the seating, like that of most military aircraft, seems designed to restrict blood circulation to the lower limbs. The air conditioning in the C-130 in Qatar didn’t begin operation until the plane had gained a considerable altitude, which left me wishing I had another bottle of water with which to douse myself -- until plane cooled so much that my perspiration-soaked uniform began to feel like a restrictive cool compress.

The C-130 features dismal airspeed (it is a propeller aircraft) and the flight path from Qatar to Afghanistan must skirt south significantly to avoid Iranian airspace. I’m tempted to write the Red Cross/Red Crescent to detail the discomfort military personnel experience on this route in hope that the relief organization might coax from Iran an humanitarian gesture permitting personnel transport planes to enter its airspace, and thus cutting significant time from the 5 ½ hour flight I endured.

The C-130 has a toilet located in the rear of the plane next to pallets of cargo, but it is a very simple commode with only a curtain for privacy. I’m not sure the best way to access the toilet if you are seated in the middle of a column of seating physically enmeshed with your fellow passengers, and I didn’t see anyone make for the toilet on this flight. Should you reach the C-130’s commode, you need not worry about anyone hearing you go about your business as the noise level in the passenger bay is significant enough to warrant ear protection.

After such a pleasant flight, a tactical landing serves to bring your travel to a memorable conclusion. The C-130 features several windows, portals really, situated five feet about the heads of seated passengers on both sides of the aircraft. During my recent landing at Bagram, our pilot several times banked the plane a complete 90 degrees, so that I could see the wing opposite me perpendicular to the (rapidly approaching) ground. The plane rocks and rolls enough that you cling to webbing (i.e. your seat) to keep upright. Once on the ground, the air conditioning usually cuts out well before you are able to depart the plane, thus coupling heat with any lingering nausea from the landing.

Of course, to burden yourself with the comforts of the C-130 is rewarding in that, de facto, you have actually boarded a military aircraft and are (hopefully) heading to your desired destination. For my recent flight out of Bagram en route to Qatar I left my base at 05:00 to make an 08:00 boarding brief at the airport, only to learn that my scheduled 09:00 flight had been delayed until 22:00. I felt fortunate that my flight, while later than expected, was at least leaving the same day. The final leg of my return journey to Kabul was originally scheduled to be a short flight from Bagram, but when I reported to the terminal at 04:00 I noticed that my flight remained on the departure board, but had been diverted to another city in Afghanistan. The diversion resulted in me staying at Bagram for two days waiting for an armored personnel carrier to drive me the thirty miles to Kabul. My transient billeting at Bagram was a lower bunk in a hanger that also housed temporarily an Army infantry battalion.

Military airports in combat zones always feature at least one large structure where passengers are often deceptively shunted to suffer under the illusion that they are about to board their aircraft. The military component of the Qatar airport has such a structure that I saw several times during transit to and from that desert Kingdom. It is a white building, roughly twenty feet wide and sixty feet long, with a dirty concrete foundation and a semi-permanent skin of a polymer material suitable for graffiti which restless passengers have filled from the floor to seven feet above with drawings of pin-up girls in skimpy Navy outfits, professional edicts (“Be polite, be professional, but be prepared to kill everyone you meet”), homophobic macho declarations (“I’m on a gunship, you’re a homo”), and descriptive stickers (“Kandahar rocks. There are many.”)

I “staged” in this building for six hours waiting for a flight from Qatar to Afghanistan. Several times I heard announcements that updated information on our flight would be passed in twenty minutes, only to hear sixty minutes later that no update was currently available. Once the ground crew marched us to the tarmac where we stood for thirty minutes staring at a large expanse of concrete devoid of airplanes before returning to the shelter to once again peruse the graffiti. Twice the ground crew dismissed us to the nearby flight kitchen that provides bag meals for travelers. Crew members typically expect passengers to wait together for hours enduring considerable discomfort in order that everyone on the flight manifest be ready to spring and seize the supposed three minute window allotted for boarding a plane after several hours of unexplained and ill-informed delay, so the fact that the crew released us from the staging area TWICE to gaggle over to the flight kitchen for sustenance assured me that no plane ready to transport us was anywhere near Qatari airspace.

The concrete floor of the building held what looked to be the collective filter catch of several hundred local vacuum cleaners, but I was lucky enough to find a piece of cardboard half my height and I slept on that for two hours before I heard, at 02:00, that my flight was cancelled (allegedly due to two successive mechanical failures) and that all passengers should return to the terminal for assignments to transient housing on the adjacent American base. After a bit of early morning travail with a terminal staff who seemed surprised that any passengers remained at the airport, and absolutely shocked that those same delayed passengers would request a bunk rather than bed down on the unimproved terminal floor, the other passengers and I boarded a bus and shortly found ourselves deposited at Quonset hut with a small staff who administered the temporary housing for the base … and who gave us the words you never want to hear at 03:00: “Everyone sign in here and then gather next door for your brief.”

All I wanted at that early hour (or so I thought at the time) was a bed of any type, as I was looking for a few hours of sleep before I returned to the airport at 08:30 (which was only 5 ½ hours away). I didn’t want the standard lodging brief, but instead a building number and a bunk assignment. I would take sheets and a pillow only if readily available. So, initially, I wasn’t too welcoming to the pleasant young woman who, after only a few minutes, entered the briefing room and asked, “Who here needs an alcohol ration card?”

Fatigue and dismay dissipated from the room as nearly all of us jumped from our chairs and bum-rushed that understandably stunned woman. Realize that in Afghanistan I am not allowed alcohol. During the R&R break I had just enjoyed, I was allotted three drinks daily. None of us expected an extended three-drink binge from the flight delay. We learned that the base bar closed at 04:00, forty-five minutes away, so we went from the briefing room (I’m not sure if I even stayed for the brief, or if I simply got my ration card and ran) to the linen office next door, then to our bunkhouse where we threw our bags and sheets before we scurried 200 years to the bar.

A friendly airman was tending the bar, and she informed us that we could buy only two drinks initially, but after a few minutes we could return for our third and final drink. Moreover, even though the bar closed at 04:00, we were welcome to take our accumulated cocktails and beer bottles outside to enjoy the sultry desert night at the seats and tables set under a huge, white, permanent awning that resembled an expansive, double-spired circus tent without side flaps and that is called, quite appropriately, The Bra.

Those drinks were refreshing. The early morning was beautiful. I drank and talked with friends as the desert sun rose and the base personnel starting to wake up and ambulate around us, unaware of how happy we were at that moment underneath The Bra.

Saturday, July 19, 2008

Military Air Travel Part I: Sad and unusual cargo, and me, on the C-17

Photograph: The C-17 Globemaster III aircraft. It might be loaded with Abrams tanks, 105 paratroopers, or 107,900 pounds of bottled water.

Military air travel within a theatre of combat is similar in several ways to civilian air travel undertaken anywhere else. To begin your journey, you report to an airport terminal replete with uncomfortable seats. You encounter restrictive baggage regulations. You are given flight numbers and departure times that have scant relevance to the eventual aircraft that, perhaps sometime in the future, will lift off the ground with you as passenger.

Military air transportation also offers two additional variables not typically encountered by civilians: You rarely know in advance on what type of aircraft you will be flying, nor do you know with what you will be traveling. I offer my recent flight from Afghanistan to Qatar as evidence. I reported to Bagram Air Field 30 miles north of my base in Kabul at 08:00 for my pre-flight brief to learn that my scheduled 09:00 departure had been delayed until 22:00. That night, I waited with a group of thirty other military personnel, headed with me on a four-day R&R pass to Qatar, until 23:30 to fill the jump seats on C-17 Globemaster III airplane already loaded with several 7000-pound spools of sheet metal, a single giant propeller twelve-feet in diameter, and the body of a Polish soldier killed the previous day in southern Afghanistan -- his remains now in a casket draped with the Polish flag, secured to the deck of the C-17, and on their way back to his family and his native land.

Photograph: Inner bay of the C-17. Notice the flag-draped casket of the Polish soldier in front of what surely must be one of the world's largest propellers.

The casket sat at the front of the C-17’s huge bay, between the passengers in the jump seats, and was the first thing I saw as I boarded the aircraft. The other passengers and I knew we would be traveling with the remains of the Polish soldier, as a gate attendant informed us before boarding that the casket would be on the flight along with a Polish escort. I give the US Air Force courtesy points for early notification that the accompanying cargo on this C-17 would include something different from the spare engine parts and tires which typically keep you company when aboard that aircraft. The attendant also asked us to please show respect t to the casket during the flight, a request I don’t think we required but certainly not inappropriate. You couldn’t forget about the dead soldier during the flight due to the casket’s position in the plane and the fact that you had to pass it to enter and exit the aircraft, and to get to the bathroom while aloft for five hours.

I had seen the casket before the flight. Bagram is the main airfield in Afghanistan, where many of the military killed in combat are loaded onto planes for flights back to their homes. When the bodies arrive at Bagram from elsewhere in Afghanistan, they proceed in open vehicles through a Fallen Comrade Ceremony, where ALL military personnel on base line the streets and salute the trucks carrying the caskets holding the dead. Even if a body arrives in the middle of the night, announcements over the loudspeakers rouse the sleeping military masses at the airfield and everyone puts on a uniform and lines the street. Bagram has a long runway, at least 1 ½ miles in length, and the base itself runs alongside this strip. During a Fallen Comrade Ceremony, the procession passes by 1-2 miles of military solemnly saluting from both sides of the street. I stood for the ceremony as I was waiting for my own flight, but was surprised to see a Polish honor guard and then a casket covered with a Polish flag drive by as I assumed the dead would be American. The announcement for this particular ceremony did not mention the nationality of the deceased, and it wouldn’t have mattered anyway as everyone participates for any coalition KIA; even though the overwhelming majority of military stationed at Bagram are Americans.

A little more information about the C-17 aircraft may help illuminate why it’s not really unexpected that, during travel to an R&R break away from a combat zone, military personnel might find themselves seated next to the remains of a KIA. The C-17 is a transport aircraft and its primary purpose is to carry cargo, not people. It’s huge, and can fly a 70-ton Abrams M1 tank in its belly. In fact, it can fly with up to 170,900 lbs of equipment. Along the long frame of the immense cargo bay run several dozen fold-down seats for passengers, who are usually passengers of opportunity, meaning that they get those seats and fly only if the cargo load and weight does not prohibit them from overloading the plane.

You also realize very quickly once inside the C-17 that the aircraft is not designed for human comfort. It does have a bathroom, but the jump seats seem designed to compress a passenger’s sciatic nerve. There are no windows in the plane, so you deduce the plane’s movement and speed by the sound and feel of the wheels rumbling and groaning under tremendous weight below you, and the sudden cut in speed felt thirty minutes or so before the plane lands. A crew of two airmen, typically, does announce overhead when the plane is about to depart for the runway, and sometimes they give you the projected duration of the flight; but otherwise you hear only a constant rush of empty air that, if you close your eyes, would lead you to swear you were housed inside an enormous vacuum cleaner.

A nice feature of the C-17 is the ability to leave your jump seat once at cruising altitude to stretch out on the metal floor of the plane. You can spot veteran C-17 passengers as they have blankets and pillows ready for the opportunity. Of course, that opportunity is often limited, as it was on my most recent flight, when several lengths of chain securing the 7000-pound spools of sheet metal ran from the middle of the plane to the base of my feet; and I almost tripped over them and fell into the giant propeller mid-way through the flight when the plane was dark, it was 02:00 on my personal diurnal clock, and I was half-asleep and trying to get to the bathroom.

Tuesday, July 15, 2008

An unusual week, even for Kabul

The National Security Department (NSD) is the Afghan equivalent of a merger of the CIA, the Secret Service and Department of Homeland Security. The NSD has 14,000 Afghan employees, and has its own hospital in Kabul to provide them medical care. Most Americans, myself included, may wonder why a federal government department, even a major department such as the NSD, would be in the business of providing direct medical services to its employees. The answer, I’ve learned, is two-fold. First, the care provided by Afghan’s public hospital system is subpar to non-existent. Therefore, federal department ministers insist on clinics and hospitals devoted to the care of their own employees. Secondly, these same ministers wield enormous prestige and power by controlling their ministries’ medical treatment facilities.

Many Afghans report that this system is part of the “Russian Model” (a common phrase usually uttered by Afghans with unconcealed contempt and disgust) of leadership and government imported during the 80’s when the Soviet Union occupied the country. And the spectre of that cruel decade continues to haunt Afghanistan today: even though the Soviets physically departed in 1989, their nefarious influence lingers in the corruption, bureaucracy and mistrust that continues to keep the country crippled.

But back to the medical care issue. You may be asking yourself: Wouldn’t this proliferation of an essentially private ministerially controlled hospital system create a healthcare delivery model in Afghanistan that is two-tiered, with those connected to government ministries enjoying care much better than those Afghans (the powerless majority) dependent on the underfunded, understaffed, poorly equipped, dirty and decrepit public hospitals? And you would be asking the correct question, and the answer to your question would be: Yes, that’s exactly what’s happening in Afghanistan.

I began last week with a visit to the NSD Hospital in Kabul, and I saw what was by far the nicest Afghan government medical center I have toured since arriving here four months ago. Our guides informed us that the Turkish government built and equipped this hospital for the NSD. I’m not sure why the Turks took on this ministerial hospital as a project. Perhaps because it was a relatively small and defined initiative whereas propping up the Ministry of Public Health, which is responsible for the healthcare of the majority of Afghans, would be a more complicated, frustrating and expensive project. And I must admit that the Turks did a good job: the facility was spacious and clean, with modern equipment for surgery, child-birth, laboratory testing, radiology, physical rehabilitation .. it even boasts a contemporary dentistry and dental surgery suite.

The provision of advanced medical care in this facility with such modern, sophisticated equipment unfortunately is limited by the Afghan medical personnel’s unfamiliarity with most of the machinery. The laboratory has automated analyzers still in plastic, many of the computers have never been booted, the ultrasound machines simply stand sentry in the radiology suite … The Afghan physicians at the hospital invited a group of American medical professionals for a tour and to request that we assist in mentoring the staff on the use of all the high-tech equipment that suddenly surrounds them -- and most of which is completely foreign to their professional experience.

No sane person would begrudge Afghan medical professionals the equipment common to any American community hospital, but foreign donors who foot the bill for MRI machines, electronic patient databases and advanced laboratory capabilities (of what value is PCR in Afghanistan today?) not only ignore the basic medical needs of the typical Afghan – immunizations, prenatal care, midwifery services, childhood nutrition – but they further enable the more privileged and positioned Afghans to sequester the best care for their tiny fraction of the population. And, as mentioned above, much of this foreign investment in the latest technology is foolish: Few Afghan medical professionals are familiar with an automated blood pressure cuff, but some of the well-funded hospitals here have internal automated defibrillators sitting (unused) on the shelves.

Two days after I visited the NSD hospital, it served as the primary triage center for the hundreds of Afghans wounded in a bombing outside of the Indian Embassy which sits just a short distance from the medical center. The blast devastated an entire Kabul block. I was at my desk five blocks from the site when I heard the explosion and saw the windows of my building shake. Press accounts reported approximately forty people dead, most of them Afghans. Some citizens of Kabul claim many more died. A local television broadcast carried footage of an Afghan man as he recounted how he left his wife and two children on the street while he entered the Indian Embassy to secure visas. He survived the bombing, but back on the street he could find no trace of the rest of this family. They were, quite literally, obliterated by the blast.

So many people were killed and injured that the Taliban claimed it had nothing to do with the devastation, although few people believe those insurgents are innocent. When their attacks claim far more innocent lives than they anticipated, the Taliban has a habit of disclaiming any responsibility for the carnage. Afghan officials quickly accused Pakistani intelligence, long associated with the Taliban, of supporting the attack, which was directed at Indian diplomats. Already Afghan leaders are simmering over the safe haven given to Taliban fighters in the Northwest Territories of Pakistan, where they train and then stage incursions across the border into Afghanistan. I’m wondering if the incident will fuel greater tension or even war between Afghanistan and its purported enemies in northwest Pakistan; or even between Pakistan and India, two rivals who historically have needed little encouragement to begin shooting at each other.

The bombing so close to our base left most of us a little tense. The blast was a reminder that travel anywhere in this city and country is dangerous, but as we are on a reconstruction and development mission almost everyone at my command regularly drives around Kabul and environs to attend to our projects. So we were lucky at week’s end to host some visitors who would provide a necessary distraction from the ugly events of war: Roger Goodell, the NFL commissioner, and two Dallas Cowboy Cheerleaders.

The USO group that visited my base also included Osi Umenyiora, defensive end for the New York Football Giants and one of the players primarily responsible for the Giants Super Bowl victory in January. Big Osi was wearing his Super Bowl ring, which is the size of an anvil, and gladly offered the ring to Giants fans so they could take a photograph with him while wearing the championship jewelry. Drew Brees, a graduate of Purdue University and current quarterback for the New Orleans Saints joined Umenyiora, as did Milo Ventimiglia, the lead actor in the television show “Heroes.” I have never seen “Heroes,” and in fact when I saw Ventimiglia strolling around base the afternoon of the visit I thought he was one of the many Afghan interpreters who work here. Even a few of my Afghan friends agreed that he looked like he could be Dawood Najool from Kandahar.

The line for photographs with the group was very long, and I was already late for my weekly poker game, so I didn’t get to chat or pose with any of the celebrities. I need to apologize publicly to my mother for not getting a photograph with Brees, as she is a rabid Purdue University fan. Also, I missed the opportunity to thank Umenyiora for taking out the Patriots in the Super Bowl, thus ruining the loathsome Pats’ quest for a perfect season and thereby earning the gratitude of the majority of the US population living west of Waterbury, CT.

Finally, I regret not getting a few moments alone with the NFL commissioner, Roger Goodell, as I really wanted to ask him why he allows Patriots’ coach Bill Belichick to roam the sidelines looking like an indigent in a hoodie sweatshirt with tattered sleeves.

Photograph: A soldier poses with the USO group. He's wearing the Super Bowl ring of Osi Umenyiora, who stands behind him.