A surprisingly simple way to lose weight

Let me be frank: I can stand to lose 25 lbs. That would drop my Body Mass Index below the obese range and lower my blood pressure a few points. I’m happy to report that I have lost some weight. (I’m five to seven pounds lighter, the operative variable being the number of chicken wings consumed the dinner prior to stepping on the scales.) Unfortunately, I doubt the weight loss is linked to healthy alterations in my lifestyle. I wrote last week about the sedative properties of my environment that have me sleeping 8+ hours nightly and prevent me most days from rising early for exercise before work. Late morning hunger and afternoon fatigue then rule out a gym visit later in the day. In addition, the dining facility here features every meal several entrees plus a buffet line of hamburgers, chicken tenders, french fries, onion rings and hot wings; and I’ve discovered that increased sleep unleashes a powerful appetite once consciousness takes over.

The only way I can explain my weight loss is this: I no longer stop at Carl’s Jr. on my way to work for a breakfast hamburger, hash brown nuggets and a Coke. The Breakfast Burger is a charbroiled all-beef patty, fried egg, crisp bacon, American cheese, hash brown nuggets and ketchup on a sesame seed bun. Living in San Diego County and frequenting the drive-thru at Carl’s Jr. most days of the week, I was always confused why the Breakfast Burger featured the hash brown nuggets smashed within the bun of the sandwich as the Value Meal comes with a side order of those crispy golden nickels. The burger certainly didn’t need the deep-fried potatoes for extra nutritional value: the sandwich provides 830 calories and 47 grams of fat.

Simple math illustrates my contention that I’m losing weight by simply eliminating the Carl’s Jr. Breakfast Burger from my diet. If I ate 300 of the burgers last year (a conservative estimate), then the sandwich accounted for 24,900 calories ingested. A pound of fat stores approximately 3500 calories. Therefore, eliminating the (delicious and addictive) Breakfast Burger from my diet equates to (24,900 ÷ 3500) dropping 71 pounds! And that doesn’t even include the calories I miss from forfeiting 300 side orders of hash brown nuggets. Realize I have to eat something first thing in the morning, but imagine that I consume a decent breakfast of 500 calories daily. Again, simple arithmetic shows that such a (surely boring and unappetizing) meal equates, over 300 days, to 43 pounds, or 28 fewer pounds than the (delightful) Breakfast Burger breakfast. I might meet my weight loss goal simply by avoiding Carl’s Jr., which thankfully has no franchising plans for Kabul.

Kabul Medical University students clamoring for ophthalmology lectures!

Beware owners of this breed, the Afghan hound: Your animal is predisposed to glaucoma and should have a complete eye exam from a veterinarian (not an ophthalmologist).


The efforts of the Navy medical mentoring team at the National Military Hospital are inspiring the medical students from Kabul Medical University who rotate through the medical center for clinical instruction. After a recent trauma care course presented by the Navy team, the several dozen medical students presented the course director with a list of topics they would like addressed in a lecture series. I was shocked to see that the twenty-three proposed lectures included two involving the eye: glaucoma and blindness. I’m accustomed to seeing lists of “essential” medical topics include well-worn issues such as sepsis, cardiac artery disease and gastroenterological dysfunction, but not eye problems.

My experience is that most medical students know very little and care even less about the eye, and that medical schools reinforce the negligence by giving scant instruction in ophthalmology during core courses. You would think that the phrase “life, limb and eyesight” would prompt a little more attention to vision. I cannot remember thinking much about the eye while I was in medical school, except for the day in the anatomy lab when we cut open cow eyes to peek inside. I can’t even recall a lecture on eye diseases and ophthalmic treatments. During our physical examination course I did learn the basic eye exam, although I didn’t really understand everything I was doing; and I remember an emergency medicine resident emphasizing to me that a patient’s visual acuity is measured separately for each eye at the Snellen chart (you know, the sheet of paper on the wall with the big black E).

I doubt most people could define optician vs. optometrist vs. ophthalmologist. Many patients of mine have commented that is must be wonderful to be able to do my work with only a bachelor’s degree. I’ve encountered nurse practitioners and even physicians who have no idea that ophthalmologists handle severe medical problems with the eye and perform surgery. What people presume about ophthalmologists these days is that we all spend our days performing LASIK surgery and making $1 million annually.

Even though the practice of ophthalmology in the US might suffer from the disinterest and confusion of the greater medical establishment, its status in no way compares to the lack of attention to eye maladies in Afghanistan. I attempted an internet search for information on glaucoma in Afghanistan, and found only two articles. I wasn’t investigating a rare disease such as kuru or Sanfilippo mucopolysaccaridosis. Glaucoma is the second leading cause of blindness worldwide. The two articles were simple surveys, valuable but limited in scope. In contrast, I was able to find dozens of internet resources for glaucoma in the Afghan hound, a beautiful long-haired animal that apparently is one of the more than forty canine breeds predisposed to developing glaucoma. I may write the American Kennel Club and try to shame it into a donation for ophthalmic research in the homeland of that distinctive champion dog.

You are in Afghanistan. You are feeling very, very sleepy...

A deployment to Afghanistan might be a treatment for anyone who suffers from insomnia. I usually sleep pretty well myself, no matter what my location or state of mind, but my slumber in Kabul challenges that of a medicated ICU patient. I could have napped for an hour that afternoon or quaffed a Coca Cola immediately before turning down the sheets, but I will still sleep through the night. Yesterday is exemplary: I had a headache and so went under the covers at 8 pm, thinking if I woke up very early the next morning I would simply role out of bed and meander to my office to watch the major league baseball games that the Armed Forces Network was televising live. The early morning line-up was the Padres-Dodgers game followed by the Yankees-Red Sox. But instead of watching baseball, I struggled to make breakfast after logging eleven hours unconscious.

Afghanistan is a major producer of opium, and I theorized soon after arriving here (and discovering that I could easily spend half of this deployment face down on a pillow) that perhaps a narcotic dust lingers in the Kabul air, providing me a gentle, constant sedation. The opium is grown in the southern part of the country, however, the area from which the Taliban emerged and currently the region with the most fighting between the Taliban and NATO forces. So instead of producing a population of listless Lotus eaters, the opium region here has bred just the opposite. The likelihood is that something other than a ubiquitous narcotic cloud explains my fatigue.

Boredom, I think, is the etiologic factor that best explains my impressive slumber. Although my base is one of the most developed American facilities in Afghanistan, there isn’t much to do here. The compound is a walled, heavily fortified and guarded three-square-block area in the Wazir Ahkbar Khan neighborhood of Kabul (famous as the setting for the novel The Kite Runner), but I am restricted from leaving the base unless I am on official business and part of an armored vehicle convoy. I do have several sites that I must visit regularly for projects, including the National Military Hospital and the Ministry of Public Health, but both of those buildings are a very short drive and the trips don’t allow me to see much of the city. Most of the day I spend on the base, which does offer a gym, a small coffee house, a pizza restaurant and a few shops. I have internet access in my room (although I pay myself for the service). Meals are provided for me, as is a laundry service. The “library” is an overheated basement room with shelves of Louis L’Amour and detective novels. (I spent an entire afternoon searching for a history of Afghanistan, which is how I discovered the library. I’ve yet to find the history tome.) So I have pretty much everything I need, but I don’t have much to truly enjoy. And when I don't have much to enjoy, I feel bored. And when I feel bored, I get tired. And when I get tired...

A few blocks away sits the International Security Assistance Force (ISAF) base, the headquarters for NATO troops in the country. Many different European countries have forces stationed there, and they play by different rules when they go to war. First, many Americans think that the Europeans avoid combat roles. I’m not sure if that is really true, but more than a few people have told me that the acronym ISAF is short for “I Sit, Americans Fight.” Also, the Euros are somehow are able to afford a superior food service. The only complaint I have with the American food contractor, Kellogg, Brown and Root (KBR), is that the food KBR provided in Kuwait was better than what’s served here. For example, KBR Afghanistan forgot to import the endless dessert bar featured in Kuwait. But the NATO force food comes from a company called Supreme, and supreme it is with a cheese bar, hearty bread selection, butter and espresso machine at every meal. I can eat at either base, and at least one day a week my colleagues and I make business for ourselves at the ISAF base somewhere near lunchtime so that we can enjoy the European fare.

The Euros also allow their soldiers alcohol (it’s a dry deployment for us Americans), and their base has a bar and beer garden that has faux field stone walls and a wooden fence that simulates Bavaria, I assume. Shops on the ISAF base sell Cuban cigars (which are contraband in the US) and nice European chocolates and candies. The PX on my base has Kit Kat bars and stale Pop Tarts.

Again, compared to the quarters of many if not most Americans currently stationed in Afghanistan, I am living in luxury. Recently I visited a small base just outside of Kabul and literally threw a stone the length of the compound. At the regional hospitals in some of the smaller Afghan cities, my colleagues live on the medical complex grounds and wander virtually nowhere else the entire 6-12 months they work there. Kabul itself is relatively quiet and no mortar or artillery fire disturbs the night. So I will continue to sleep long and peaceful hours, inshallah.

The Great Massoud: The Lion of Panjshir, Hero of Afghanistan

Photographs: The National Miltary Hospital in Kabul, yet another marvel of Soviet architecture. Clothing hangs out to dry on the Massoud Monument. Another view of Massoud Circle in Kabul. Massoud in the hat he made even more famous.



The National Military Hospital (NMH) of Afghanistan is a paragon of Eastern Block architecture built by the Soviet Union for Afghanistan in the mid-60s. The former USSR’s policies in that decade were more benevolent than in the seventies, when the then second super power decided to create its own Vietnam by invading Afghanistan in 1979 to support (i.e. control) the ruling Afghan communist party. Rumor in Kabul holds that the Soviets then used the basement of the NMH to torture select members of the local populace. A few years ago when US engineers inspected the facility, they reportedly found skeletons in the tunnels that run between NMH and other buildings on the hospital grounds. No one is sure if the remains are simply from a forgotten morgue, or the detritus of man’s indignity to man. I’m still waiting for a tour of these supposed catacombs, but every person I’ve asked to take me down there replies “It’s scary” and abruptly changes the topic.

The same engineers who assessed the building's functionality and soundness recommended that it be razed. The US has constructed new hospitals for the Afghan Army in four major cities around the country, and the NMH was judged to be so wanting for repairs and improvements that a replacement structure would be more economical than renovation. It’s the same argument that professional sports team owners use to coax (i.e. browbeat) municipalities to fund new stadiums, although in the case of NMH the paucity of luxury boxes was never an issue and it’s no stretch to claim that a new hospital might actually benefit the community that surrounds it. The Afghans, however, would have no part of NMH’s destruction, as it once was the operating base of the late Ahmed Shah Massoud, a National Hero of Afghanistan.

Massoud was an ethnic Tajik and one of the mujahedeen military commanders most responsible for the ouster of the Soviets from Afghanistan in 1989. He then joined with other commanders to form the Northern Alliance to fight the Taliban, who were vying for control of the country after 1994. His nickname was The Lion of Panjshir, as he hailed from the Panjshir Valley northeast of Kabul. (Panj is Dari for the number five, and shir means valley, so the moniker translates, literally, as the Lion of the Five Lions.)

So Massoud fought the Soviets, and he fought the Taliban; but history shows that a righteous military commander in Afghanistan always has at least one more warlord or lunatic group to subdue before total victory is his, and in 1993 Massoud found himself in a battle for Kabul with Gulbuddin Hekmatyar, a very nasty figure infamous for fickle allegiance and a well-deserved spot on the USA’s list of international terrorists after he tried to overthrow the current government of Afghanistan in 2003. Hekmatyar was also known for wantonly targeting citizens in his frequent bombardments of Kabul, and during the 1993 battle for the city Massoud led his troops and called for fire against Hekmatyar from the roof of the NMH.

Two days before America’s 9/11, on September 9, 2001, Massoud died when a pair of alleged al Quaeda operatives posing as Belgian journalists detonated a bomb during an interview with the commander. Most citizens of Kabul revere Massoud, and the current military reportedly rebuffed any suggestion that the NMH, Massoud’s former base, should be destroyed. Afghanistan has no registry of historic places, but if it did the NMH might be one of the earliest buildings with a bronze plaque. Or maybe something was lost in translation between the Americans and Afghans as they negotiated the fate of the NMH building, as at least two doctors there have told me that they favored a spanking new facility as long as a proper memorial were built in honor of Massoud. After all, they claimed, the Soviets built the NMH and they aren’t remembered fondly by the Afghans.

Massoud made even more famous the rolled wool hat that has long been an international symbol of Afghanistan and in the past has been called a pakol, or a Chitrali hat or Nuristani hat for the regions where the style evolved. Most Kabul citizens now call it a Massoud hat.

The traffic circle nearest the hospital boasts the name of and a monument to Massoud. The first time I saw it, a man was hanging wet laundry to dry on the wires circling the upper deck of the monument. The scene reminded me of the first time I visited the main temple of Angkor Wat and saw Cambodian cattle tied to the stone pillars and grazing on the grass surrounding the country’s most prized historic landmark. But Massoud was a man of the people, famous for retreating from Kabul to save its citizens from further torment of war, so I’m sure he wouldn’t begrudge that Afghan man a few pieces of dry laundry at his monument’s expense.

Trouble with weapons

Clear your weapon here: Although this sand-filled clearing barrel can stop an errant bullet, your weapon should be free of ammunition before you put the muzzle in and pull the trigger.

A principle of proper gunmanship is that, even with an unloaded weapon, you must at all times maintain “muzzle awareness.” A basic tenet of muzzle awareness holds that should you never point the barrel of your weapon at another person. It would seem easy to avoid such a scenario, but at times it requires quite a bit of attention and concentration to keep a muzzle directed safely away from everyone else, as when you have a rifle slung across your back and you are trying to move through a crowded dining room. Getting in and out of vehicles with weapons can also present a challenge, and I’ve been poked a few times in the leg and ribs by the business end of a colleague’s rifle as he struggled to get into a Humvee or armored truck while wearing fifty pounds of body armor.

Those incidents didn’t bother me much, as I know the improprieties were a consequence of the burdensome physical load the person was carrying. But what does annoy me is the “flashing” to which I’m subjected daily. If you are devoid of muzzle awareness and allow the barrel of your weapon to point directly at another person, you flashed him. During weapons training in the US and Kuwait, some people were notorious for flashing the rest of the platoon with both loaded and unloaded weapons. At one firing range exercise, another officer turned from the targets with her weapon still raised to ask the instructor behind her a question. Two dozen people behind her immediately fell to the ground as she flashed her loaded weapon at a line of people waiting to walk onto the range. The instructor flinched as well. On the base in Kabul, many people carry a pistol sheathed in a shoulder holster that should hold the gun under your armpit with the barrel facing groundward. Think Jimmy Smits as Detective Bobbie Simone on NYPD Blue. Yet every day I see several people walking with holsters that, because of comfort or misfit, maintain the pistol barrels parallel to the ground, thereby flashing everyone behind them.

When on base, we keep the ammunition magazine out of a weapon and the weapon’s status is termed “green.” If we leave the base, however, we are supposed to lock a magazine of bullets into our weapon, and with ammunition inserted the status of the weapon changes to “amber.” A weapon is considered “red” when a magazine is locked and a round of ammunition is loaded into the firing chamber, hence the phrase “locked and loaded.”

Even in amber status with the safety mechanism applied, a pistol can be dangerous when you are riding on the rough pocked roads of Afghanistan. A bullet can be chambered inadvertently, the safety switch can be jostled to fire, and suddenly you’ve got a weapon asking for an unintended victim. Which is why I became very nervous very quickly last week when a medical officer riding shotgun (but thankfully without one) in my vehicle had an amber weapon in his shoulder holster pointing not toward the floor but between the front two seats and directly at the head of another officer sitting next to me. We quickly pointed out his breach of muzzle etiquette, but his lackadaisical response was “Oh, that’s just the way my holster holds the pistol.” He made no attempt to adjust the pistol’s position. I politely proposed that the two of us in the back seat aim our pistols directly at his skull so that he could enjoy the same level of comfort we currently were feeling on the trip. He begrudgingly unholstered his gun and held it in a safe position for the remainder of the trip.

From what I’ve seen so far amongst the staff officers with whom I serve, I’m much more likely to take a bullet from someone I know in an inadvertent weapon discharge than to be shot by an insurgent. Personnel from my command carry rifles and pistols for self-defense, and I think we need them when we travel into some areas of Afghanistan; but the primary danger for anyone traveling in Kabul and environs, and maybe the whole of Afghanistan, is an encounter with an improvised explosive devise on the roadside or a suicide bomber on foot or in a vehicle. A personal firearm will do little to nothing to prevent or mitigate that type of attack. We routinely discuss the possibility of taking small arms fire during vehicle convoys, and the plan is always to drive through the attack if it happens. I certainly don’t plan to exit an armored, moving vehicle to search for a sniper if a few unwelcome bullets come my way.

My fellow staff officers and I are not combat arms specialists and we are not nearly as familiar with our weapons, and perhaps we are much more uncomfortable handling them, than is an infantryman or even an enlisted sailor. When we return to our base from a mission, base regulations require us to clear our weapons of any ammunition. The process is fairly straighforward: you first release the magazine of ammunition from your weapon; then you pull the slide or charging handle back to expose the firing barrel and to visually ensure that no bullet sits in the firing chamber; and finally you take your weapon off safe, point the muzzle into a large red clearing barrel and pull the trigger. You should only hear a click when you pull the trigger, as you have already emptied the weapon of ammunition and visually cleared the weapon’s firing chamber. Several times in the past year, however, officers here heard more than a click as they put a slug into the sand packed-barrel designed to smother such errant bullets. That’s called a negligent discharge, and it earns you a visit with the commanding general on base.

Recently only officers have been guilty of negligent weapon discharges on this base, a fact that delights most of the enlisted personnel. Thankfully, the clearing barrels have absorbed only a few bullets. The officers who thought that assaulting the barrels was appropriate may have felt rushed to clear their weapons or they may have been temporarily distracted, but they breached weapon protocol nonetheless.

Some of these officers might also have suffered the illusion that the clearing barrels serve as final barriers to any harm that might come from their inattentiveness. A colleague commented to me “What’s the big deal if you fire a round into the barrel? That’s what it’s designed for.” But that’s dangerous thinking: The barrels are there to ensure that a weapon is empty of ammunition even if the handler fails to clear it properly. Personally, I don’t want to be near a clearing barrel when it is occupied by someone looking for a close-quarters firing exercise; and I’ve seen inattentive people clear a weapon with the thing pointed somewhere toward the barrel but certainly not safely inside of it. In fact, when I heard of the negligent discharge at this base, I was momentarily impressed to learn that the bullets at least made it into the barrels instead of finding nearby metal and wood and flesh.

Afghan Star and the Afghan Paula Abdul

Photograph: I pose with Monisa, the Afghan Paula Abdul.



Hollywood studios might be the agencies best able to capture the hearts and minds of Afghans. Witness the recent success of the third season of Afghan Star, a television program modeled on American Idol. Afghanistan has a population of approximately thirty million people, most of whom live in impoverished rural areas with few luxuries; but an estimated ten million people watched the final episode of Afghan Star last month. I was impressed that one-third of the country’s population had access to a television. Small towns and villages across the country aired public broadcasts of the show that is the most popular television program in Afghanistan.

Saad Mohseni , founder of the television station that produces Afghan Star, thinks that his television show will bring about social change in the country. You might scoff at the idea that popular entertainment might foster anything but brain death, but consider Mohseni’s quotes: “… people voted, … they lined up in an orderly manner (outside the show) … the losers are gracious. No one is threatening violence. That’s a huge change.”

Afghanistan is a country without a history of democratic elections and where sectarian leaders have traditionally compensated for a political or military defeat by lobbing mortars at innocent civilians. I applaud any effort that models good sportsmanship. And any initiative that convinces a crowd of Afghans to organize themselve into an orderly formation should be carefully analyzed and studied for implementation in different social spheres. I’m thinking that Mohseni is correct, and perhaps the United States might want to modify our engagement strategy with the Afghans by providing every household a television set and wiring the country for digital cable access. We might also want to work a little harder to get urban areas like Kabul reliable electrical power to facilitate prime time viewing. And we shouldn’t forget that most Afghans still lack clean drinking water, proper schooling, medical care …

But back to Afghan Star. Like American Idol, Afghan Star employs a panel of judges to select the winner. The Paula Abdul equivalent is Monisa , a native Afghan woman who has lived for awhile in Germany studying music as an acedemic. She recently returned to Afghanistan and now is completing a clerkship in medicine at the National Military Hospital in Kabul, where I met her today. Like Beyonce or Madonna, she is popular enough to need only one name, and she’s the only woman I’ve seen in Afghanistan who does not cover her hair with a scarf in public. Thankfully, she has also avoided Abdulian displays of public disorientation and suspected intoxication. My Afghan interpreter identified her as the Afghan Star judge, after which I approached her and said “I saw you on tv and would like to take my picture with you.” Like every other Afghan I’ve met, Monisa was thrilled to pose for a photograph.

Baking na'an

Na’an is an unleavened flat bread and a staple of the Afghan diet. The Kabul Military Training Center has its own bakery on the premises as the demand for na’an is so great, and I visited the facility this week. The bakery building itself is rather nondescript and surrounded by discarded shipping containers, scrap metal and disorganized collections of firewood. If a single-wide mobile home sat there, you would swear you had stumbled upon a cyclone-ravaged disaster area. One my colleagues thought we had walked to the dump.

I’m not sure why the metal collection outside the building, but the firewood was waiting to feed the wood-burning ovens in the bakery. Firewood is a valuable commodity in Kabul as few trees grow in the dry terrain surrounding the city, and this wood reportedly came from the southern regions of the country. Oddly, none of it was stacked near the doors to the bakery. In fact, none of it was stacked at all but strewn as far as thirty yards from the sole entrance to the building. Already I have learned that the Afghan idea of organization often differs significantly from mine, and since the heat emanating from the bakery indicated that wood was indeed making its way indoors somehow, I gave no more thought to the disorder outside and ventured into the building.

The bakery had three rooms, each with a stone oven that resembled a hive with a large hole in the front. Underneath each oven was a raging fire. As it is now spring in Kabul, the heat was not crippling; but I wondered how high the temperature of those rooms will rise during >100 degree summer days. In each room one man worked at the oven, taking the fresh disks of flat dough and pressing them onto the stone ceiling. I was happy to see that for protection from the stone's heat all of these gentlemen wore gloves -- the only concession to occupational safety that I could identify in the entire place. After the disks had baked a few minutes in the oven, the bakers picked them off the stone with a long iron thongs and tossed them into a collection bin.

The other workers in the room were busy mixing by hand fifty pound bags of flour with water, then rolling the dough into balls before pressing it into disks. These other men also spent considerable time and energy imploring me to take photographs of them. Almost every Afghan I’ve met has been thrilled to pose for a photograph. If we really want to stop the Taliban, my recommendation is that we arm front-line soldiers with digital cameras and color printers, because if the Afghan insurgents are like their fellow countrymen they will interrupt any activity to pose for a snapshot; and they will wait to resume previous activity if you promise that a copy of the photograph is coming soon.

As a visitor and because I was taking photographs, the workers showered superfluous hospitality on me by baking a special sugar bread. It was simply a regular na’an loaf with sugar sprinkled on top, but I felt lucky as it was the Afghan equivalent to being in Krispy Kreme when the hot light is on and you get a fresh original glazed directly from the oven. The sugar loaf was delicious, as the exterior of the na’an had a crispy sweetness and covered a thin inner layer of warm dough. The flour tastes like a hybrid of white and wheat. If Afghanistan has an event similar to the Indiana State Fair, the sugar na’an likely holds the same status as an Elephant Ear or Funnel Cake.

Earlier I referred to the workers as men, but most looked to be teenagers – a few very young teenagers. A translator told me the daily wage there was less than $1, but you got all the na’an you could eat. One of the rooms also offered free Bollywood movies on a portable television with a small screen but surprisingly powerful speakers as that section of the bakery sounded like an Indian discotheque. I spotted a worker wearing a Cleveland Indians t-shirt complete with a large depiction of the arguably racist Chief Wahoo, mascot of the team. Dr. John Kim, a colleague of mine and a native of the metropolis formerly known as The Mistake by the Lake, rushed to get his photograph taken with this Afghan who was completely befuddled by our interest in his clothing. Western garments, especially those discarded, outdated, unwanted and mistakenly produced, make their way to developing countries and to people who see them simply as valuable wardrobe additions, usually with little knowledge of any graphic that might adorn the clothing. In Eldoret, Kenya I once saw an elderly native man walking through town with a shirt that had “F - - k You!” written across it. John and I are on the lookout for t-shirts proclaiming “New England Patriots, 2008 Super Bowl Champions. “