Sunday, August 3, 2008

Afghan Army Physician Recruitment Strategy: A War with Pakistan

The roomful of Afghan medical students disagreed amongst themselves on many topics. The group argued over the theory that the Americans, and moreso the British, secretly support the Taliban while publically posing as opponents to the insurgents. They argued over the salaries they might command upon graduation from medical school from the various non-governmental organizations (NGOs) and coalition forces seeking interpreters, jobs that offer more than the average monthly salary of a government or military physician (which range from $50-$250), but not the $1000-$2000 a few students proclaimed they would earn. (One of my interpreters, he a recent medical school graduate, informed me that the students expecting a monthly salary anywhere close to three digits after graduation were “dreaming.”) The students also debated the virtues of employment with the Afghan Army, the topic I truly wanted to cover at the meeting as one of my projects is a physician recruiting campaign for the army; and I was using these students, most of whom were civilians but a few of whom were already committed to military service, as a focus group to determine why so few medical students consider the army, which suffers an acute shortage of physicians, as a career path.

Of course, I knew already why most of the students had no interest in military service. Many of them consider the military salary laughable. Also, they anticipate that once committed to military service, shortly after graduation they will be assigned to a combat zone far from their homes. Most of these students live in Kabul, the most cosmopolitan of Afghan cities, and sending them anywhere outside the capital would elicit the emotional response of a typical New Yorker after he learned of an impending transfer to Arkansas. In restive provinces such as Kandahar, Helmund and Khost, they would risk danger not only from conventional battles, but from societal elements hostile to the army and the central government in Kabul. (Afghan military personnel often wear civilian clothes when traveling to and from their jobs – or even while on the job – as they fear they will be attacked by insurgents if identified as military.)

But even the students most stridently opposed to military service assured me that they would voluntarily join the army if the government of Afghanistan declared war on neighboring Pakistan.

I have encountered almost daily a pervasive Afghan resentment for Pakistan. Afghans believe, correctly, that much of the terror perpetrated on their country is the result of insurgent training and organization in the tribally controlled Northwest Territories of Pakistan. The area is heavily populated by Pashtuns, the dominate ethnic group in Afghanistan and a people separated by an international border dictated by the infamous Durand Line (drawn by Great Britain in 1893 and another troublesome vestige of that bygone empire). Afghan mujahedeen who fought the Soviet invasion of Afghanistan organized there, and the Taliban now utilize the area to train and launch attacks across the border into Afghanistan. Many Afghans interpret the unwillingness of US forces to cross over the border to eradicate the Taliban from that thumb of Pakistan as tacit American support of the insurgents. These Afghans reason that the US routed the Taliban from Afghanistan in a couple of months, and that we would do the same if we invaded Pakistan’s Northwest Territories – if we really wanted the Taliban gone.

The recent bombing of the Indian Embassy in Kabul has done nothing to improve Pakistan’s reputation in Afghanistan. At least forty Afghans died in the blast, and hundreds of others injured. The bomb damaged much of entire city block. Immediately after the blast, Afghan authorities accused the Pakistan intelligence service of assisting the insurgents who detonated the explosive targeting Indian diplomats. Pakistan denies the allegation, but historically Afghanistan has been a land where rumors, intrigue and duplicity serve as political currency; and it’s difficult to convince most Afghans that its neighbor was not involved in that terrorist act given Pakistan’s past tutelage of the Taliban and its enmity of India.

A prevailing belief in Afghanistan, perhaps justifiable, holds that Pakistan desires an unstable western neighbor. Pakistan and India remain just a few bullets shy of an all-out war, and many Afghans believe that Pakistan fears a united Afghanistan would mean trouble on the Pakistan’s western border in the Northwest Territories where the Pashtun population sits split by the Durand Line. Historically, the Pakistani Pashtuns (and Baluchis farther south) associate with their Afghan brethren, not the dominant Pakistani Punjabis. The Pakistani government exercises little influence now over these lands, as they are the domain of tribal leaders devoted to custom (and their people on the other side of the Durand Line) instead of an affiliation with Islamabad. If the United Nations were the NCAA, and Pakistan a major Division I university fielding the Northwest Territories as a football team, the UN would sanction Pakistan for loss of institutional control.

Afghans I have met also claim that Pakistan wants to keep Afghanistan poor and underdeveloped in order to save a market for cheap, second-rate Pakistani goods that flood the market here. The adjective “Pakistani” is used as a pejorative to describe inferior products, such as “this Pakistani air conditioner lasted only six months” or “that damn Pakistani medication only gave me a stomach ache.” No other country’s exports invoke consumer antipathy more than those of Pakistani. The Chinese are rumored to unload inferior and most likely dangerous goods unto unsuspecting Afghans, but not since Genghis Khan has China loomed as a martial threat to Afghanistan and I haven’t heard anyone in Kabul clamoring for military action against the Red Giant.

I wouldn’t want to be in Kabul should Afghanistan and Pakistan come to blows, even if that conflict would bolster my army physician recruiting efforts. I think it would be suicidal for the Afgham Army to strike at the Northwest Territories at any time in the near future. And I don’t think the US, which still bolsters, trains and maintains the Afghan Army, is ready to commit forces to combat in a third country. Just as unlikely: That a significant number of newly graduated medical students soon will commit to serve in the Afghan Army. A more sobering reality is that many of the new physicians will not even serve their countrymen as clinicians, but will scatter to jobs as interpreters and NGO employees, thereby leveraging their English skills and educations for decent salaries instead of laboring in a national healthcare system whose employee benefits by comparison leave US Medicare physician reimbursement offerings looking like the gifts of a cornucopian horn.

3 comments:

Anonymous said...

Hey Dr. Willy!

I posted your blog on mine. Check it out!

Erwin

Erwin said...

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gloria said...

Is it bad that my knowledge of current events over there comes from your blog? I can't imagine riding the planes over there. You've got a tough stomach!