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.

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