This is the third and final article illustrating several of the challenges encountered in building a functioning healthcare system in Afghanistan.
Hopefully your village has a medical clinic, and hopefully the clinic is more than just a white building
When you visit a medical clinic in the United States, you direct yourself to a building in which various medical services are provided. In Afghanistan, the local medical clinic might be a physical structure devoted to healthcare, but within its walls very few services are likely provided. Your local “clinic” might even be the home of the government-appointed healthcare agent for your village. Your clinic might have a physician on duty, but most times you will only see there a poorly trained nurse or, even more likely, a local citizen with very minimal medical education who nonetheless is contracted by the Ministry of Public Health to provide the little healthcare he or she is able to offer the community.
I’m not implying the services always are poor, but they are certainly scarce. In fact, the Basic Package of Health Services for Afghans promoted by the Ministry of Public Health calls for little more than comprehensive vaccinations, pre- and post-natal care, treatment and control of malaria and tuberculosis, and nutritional supplementation. The ministry has not yet been able to provide for the entire population even this rudimentary package as resources – both human and financial – are lacking. The providers available often are not well-educated or trained, but they are committed. When you look at the scant stock of pharmaceuticals, vaccines and essential supplies available to these workers, you realize that even a US-trained physician would have trouble addressing the medical needs of the Afghan communities.
The construction of a proper clinic building is a source of great pride and hope for Afghan communities. It serves both practical and symbolic purposes. Practically, a clinic building serves as node where community medical treatment can be consolidated and then enhanced. In many remote places, providers dispense government-funded medical care in their personal residences as no dedicated local clinic structure exists. A clinic building also symbolizes that a community not only possesses cache and prestige, but that improved medical services might soon be available. The building itself therefore becomes a sign of hope, prosperity and advancement.
You must be cautious when constructing medical clinics (in addition to other government facilities such as schools and police stations) in Afghanistan as well-meaning donors and development personnel often have made the mistake of raising a building only to learn that the Afghan government lacks the resources to staff, equip and administer the facility. Then, your medical clinic becomes simply an empty white building with a red crescent painted on its wall.
How much is that pacemaker in the window?
Consider this scenario: You are a patient in an Afghan hospital, and your physician presents you with a prescription for an intravenous pharmaceutical he feels necessary for you to recover from your illness. He doesn’t write an order for the drug to be given by the nursing staff, because the hospital pharmacy doesn’t have the drug in stock. In fact, he probably doesn’t even give the prescription to you, as you are ill and bed-ridden. He probably gives the prescription to a relative of yours in the hospital with you who is there to attend to your needs such as food, laundry and bathing, as the hospital provides none of those services.
If the relative is able to afford the pharmaceutical, he or she proceeds to a local bazaar where a wide array of drugs can be bought with or without a prescription, even though the quality of the drugs is often suspect, especially those manufactured in Pakistan, China and India. (Afghanistan has made considerable advances in medical care the past several years, but the country is still far from developing a drug enforcement agency.) Medical devices are usually available at these markets as well.
The situation in Afghanistan is similar to that of many developing countries. The American surgeon Atul Gawande writes of the shortage of medical supplies in public Indian hospitals that has created such a demand for the goods that the hospitals are now surrounded by “rows of ramshackle stands with vendors selling everything from medications to pacemakers.” * In Kenya, I witnessed family members returning from local pharmacies with morphine, hypodermic needles and an assortment of IV fluids.
If you or your family cannot afford the required drug or device, you simply hope for the best. In these cases, the hospital wards merely serve as holding facilities or inhospitable hospice rooms.
Because Afghan physicians make very little money working in public hospitals, they do not always give their patients in those facilities proper attention. In fact, sometimes patients languish in those hospitals with no physician care whatsoever. Recently a colleague recounted for me how he found a surgical patient, recently transferred from another hospital with drainage tubes still protruding from his abdomen, wandering the halls of a Kabul hospital with his medications in hand, looking for someone to care for him. The patient claimed he had been in the hospital three days since his transfer, but had not yet spoken to anyone – physician, nurse or technician – on the medical staff.
Until some sort of plan for proper hospital services is drafted and funded, most of the Afghan medical centers will offer very little to the population. And until then, most hospitalized Afghans will, unfortunately, be wondering the same thing as much of the ambulatory patient population: “Is there any treatment available for me?”
*Atul Gawande, Better: A Surgeon’s Notes on Performance, p. 241.
Friday, October 31, 2008
Thursday, October 23, 2008
Critically Ill: Afghanistan's Healthcare System (Part Two)
This is the second article illustrating the challenges encountered in building a functioning Afghan healthcare system.
There is No System Here: The Example of Medical Waste Disposal
A few months ago my office began getting regular emails from American engineering teams scattered around Afghanistan who were alarmed that they were encountering medical waste improperly disposed in fields, ditches and trash dumps. The emails included photographs of used syringes and hypodermic needles, empty IV bags and soiled gauze sheets strewn on open ground. The engineers were shocked, and the subtext of their messages was “What are you medical folks going to do about this?” The answer, which for diplomatic purposes wasn’t included so bluntly in our replies, was “We aren’t going to do anything about it right now.”
Just as Afghanistan has no sound system for providing medical care, it has no infrastructure or service for disposing of medical waste. If you practice medicine in the United States, you take for granted that red plastic boxes designed for safe needle disposal are available in the clinic, and that when they are halfway filled they will be carted, along with larger red bags of other assorted medical waste, to a container where they will wait until the medical waste disposal truck comes to collect the garbage. Later, in places that I hope I never see, community-sized piles of medical will wait for incineration, with non-burning waste subsequently carted away for another type of disposal such as burial in land or disposal at sea.
The only concern I have with this system is the behavior of mob-infiltrated waste disposal companies that often cut corners, and thus increase profit, in their treatment of the waste, as evidenced on the New Jersey shoreline in the 80s when used needles, dumped from a trash freighter not yet far enough out to sea, washed ashore.
Afghanistan has no system yet to dispose of human waste, let alone medical waste. Kabul, the largest and most metropolitan of Afghan cities, has no public sewer system. The minority of the homes that have plumbing rely on trucks to empty their individual septic tanks, and the waste is then spread onto nearby fields, one of which is located just a few minutes drive from the center of the city. Outhouses are the most common lavatory in Kabul.
If an Afghan medical clinic has proper needle disposal containers and designated medical waste garbage bags, an unlikely proposition, then the personnel have no avenue to properly dispose of those receptacles once they are full. The Afghans have two choices: Let the waste sit in the clinic, or heave it onto the closest patch of barren earth or into the nearest open ditch.
At a few of the major Kabul clinics and hospitals, American development personnel have installed incinerators to ensure more hygienic medical waste disposal. The incinerators have solved some waste problems for hospitals, such as the question of how to dispose of flesh surgically removed from patients. Before, at a major Kabul medical center, amputated limbs and other choice bits of the human body that were not going home with the patients simply were buried on the hospital grounds. The only challenge was to inter the pieces deep enough so that local dogs couldn’t smell and unearth them.
But the incinerators brought new problems as well. Electricity often is unreliable in Kabul, and the incinerators don’t burn much without power. The incinerators are imported, rather exotic machines here. If one malfunctions, you cannot simply thumb through the Kabul Yellow Pages and pick the medical equipment repair specialist of your choice. The companies who sell the incinerators and other medical equipment typically have, at most, only a few service representatives for the entire country; and Afghanistan is about the size of Texas, with a transporation infrastructure that rivals that within countries such Mali and Papua New Guinea.
The hierarchical, bureacratic nature of Afghan medical facilities has also worked to subvert the use of what incinerators are in place. In one hospital, a specific employee is charged with collecting the building’s waste and the depositing it in a storage room. However, that employee does not possess the key to the storage room. The key to the storage room door is the possession of another hospital employee, who must coordinate with the waste collection agent to ensure that needle boxes and red garbage bags can pass through an open disposal room door to await incineration. The employee responsible for transporting the waste from the storage room to the incinerator, another actor in this tableau, also depends on the availability and good will of the waste disposal room keymaster so that the waste can transit from the hospital building to the incinerator itself. Thankfully, the door to the incinerator has no lock, so the transportation agent, if motivated, can deposit waste directly into the unit. However, the transportation agent has not trained to actually fire up the incinerator. The process of burning medical waste is the responsibility of another employee, qualified and facile in incinerator operation. Of course, the incinerator mechanic is helpless unless the machine has electrical power, which comes from a nearby outlet through an extension cord. The keeper of the extension cord is yet another hospital employee, hopefully collegial with the incinerator mechanic and willing to produce the cord so that the medical waste can burn.
Even if medical waste is burned properly in the incinerators, the Afghans have nowhere to dispose of the (hopefully sterilized) metal needles and ash. I don’t know where they deposit this stuff. My guess is that it somehow makes its way to field or ditch where American engineers, aghast at the sight of it, avidly photograph the scene and rush the images to us medical personnel. I contend that improperly disposed waste is an encouraging symbol as it represents the fact that Afghans somewhere were actually receiving some sort of medical care. I’m more concerned that most Afghan medical clinics still lack the supplies to even generate medical garbage.
There is No System Here: The Example of Medical Waste Disposal
A few months ago my office began getting regular emails from American engineering teams scattered around Afghanistan who were alarmed that they were encountering medical waste improperly disposed in fields, ditches and trash dumps. The emails included photographs of used syringes and hypodermic needles, empty IV bags and soiled gauze sheets strewn on open ground. The engineers were shocked, and the subtext of their messages was “What are you medical folks going to do about this?” The answer, which for diplomatic purposes wasn’t included so bluntly in our replies, was “We aren’t going to do anything about it right now.”
Just as Afghanistan has no sound system for providing medical care, it has no infrastructure or service for disposing of medical waste. If you practice medicine in the United States, you take for granted that red plastic boxes designed for safe needle disposal are available in the clinic, and that when they are halfway filled they will be carted, along with larger red bags of other assorted medical waste, to a container where they will wait until the medical waste disposal truck comes to collect the garbage. Later, in places that I hope I never see, community-sized piles of medical will wait for incineration, with non-burning waste subsequently carted away for another type of disposal such as burial in land or disposal at sea.
The only concern I have with this system is the behavior of mob-infiltrated waste disposal companies that often cut corners, and thus increase profit, in their treatment of the waste, as evidenced on the New Jersey shoreline in the 80s when used needles, dumped from a trash freighter not yet far enough out to sea, washed ashore.
Afghanistan has no system yet to dispose of human waste, let alone medical waste. Kabul, the largest and most metropolitan of Afghan cities, has no public sewer system. The minority of the homes that have plumbing rely on trucks to empty their individual septic tanks, and the waste is then spread onto nearby fields, one of which is located just a few minutes drive from the center of the city. Outhouses are the most common lavatory in Kabul.
If an Afghan medical clinic has proper needle disposal containers and designated medical waste garbage bags, an unlikely proposition, then the personnel have no avenue to properly dispose of those receptacles once they are full. The Afghans have two choices: Let the waste sit in the clinic, or heave it onto the closest patch of barren earth or into the nearest open ditch.
At a few of the major Kabul clinics and hospitals, American development personnel have installed incinerators to ensure more hygienic medical waste disposal. The incinerators have solved some waste problems for hospitals, such as the question of how to dispose of flesh surgically removed from patients. Before, at a major Kabul medical center, amputated limbs and other choice bits of the human body that were not going home with the patients simply were buried on the hospital grounds. The only challenge was to inter the pieces deep enough so that local dogs couldn’t smell and unearth them.
But the incinerators brought new problems as well. Electricity often is unreliable in Kabul, and the incinerators don’t burn much without power. The incinerators are imported, rather exotic machines here. If one malfunctions, you cannot simply thumb through the Kabul Yellow Pages and pick the medical equipment repair specialist of your choice. The companies who sell the incinerators and other medical equipment typically have, at most, only a few service representatives for the entire country; and Afghanistan is about the size of Texas, with a transporation infrastructure that rivals that within countries such Mali and Papua New Guinea.
The hierarchical, bureacratic nature of Afghan medical facilities has also worked to subvert the use of what incinerators are in place. In one hospital, a specific employee is charged with collecting the building’s waste and the depositing it in a storage room. However, that employee does not possess the key to the storage room. The key to the storage room door is the possession of another hospital employee, who must coordinate with the waste collection agent to ensure that needle boxes and red garbage bags can pass through an open disposal room door to await incineration. The employee responsible for transporting the waste from the storage room to the incinerator, another actor in this tableau, also depends on the availability and good will of the waste disposal room keymaster so that the waste can transit from the hospital building to the incinerator itself. Thankfully, the door to the incinerator has no lock, so the transportation agent, if motivated, can deposit waste directly into the unit. However, the transportation agent has not trained to actually fire up the incinerator. The process of burning medical waste is the responsibility of another employee, qualified and facile in incinerator operation. Of course, the incinerator mechanic is helpless unless the machine has electrical power, which comes from a nearby outlet through an extension cord. The keeper of the extension cord is yet another hospital employee, hopefully collegial with the incinerator mechanic and willing to produce the cord so that the medical waste can burn.
Even if medical waste is burned properly in the incinerators, the Afghans have nowhere to dispose of the (hopefully sterilized) metal needles and ash. I don’t know where they deposit this stuff. My guess is that it somehow makes its way to field or ditch where American engineers, aghast at the sight of it, avidly photograph the scene and rush the images to us medical personnel. I contend that improperly disposed waste is an encouraging symbol as it represents the fact that Afghans somewhere were actually receiving some sort of medical care. I’m more concerned that most Afghan medical clinics still lack the supplies to even generate medical garbage.
Wednesday, October 15, 2008
Critically Ill: Afghanistan's Healthcare System (Part One)
Most medical professionals, when they first arrive in Afghanistan, are pretty shocked when they recognize the poor quality of medical care available in this country. The average Afghan probably has little to no access to healthcare at all, but what is available publically might be less than what an American can supply at home from the family medicine cabinet. Decades of war, corruption, destructive cultural biases and international indifference have devastated Afghan society, including the education system and national medical institutions. The healthcare system in Afghanistan today, where the government’s per capita expenditure is less than $3, is a dissheveled, ailing patient on its back and in need of resuscitation. I’m not able to dissect the entire system, examine its components, and then propose a plan to improve its functioning; but I can produce several vignettes which I hope illustrate the problems. Consider it a short primer, in two parts, on the state of Afghan healthcare today.
“Physician” is More a Title Than an Academic Degree
Until very recently, you didn’t have to do much to graduate from medical school in Afghanistan. Admission standards were extrememly lax, with several hundred students matriculating each year to the most prestigious medical school, Kabul Medical University (KMU). Once enrolled as a student at KMU, you didn’t have to attend class to graduate. Attention to the seven-year medical school curriculum was optional: No student failed, and students did not know the nuisance of medical competency and licensing exams. At the end of the seven year program, which essentially was a protracted lecture series, all students graduated with an M.D. degree and simply chose what field of medicine best suited them. Although some students entered residency programs at Afghan hospitals, such advanced training certainly was not required. You want to be a surgeon? Go ahead and cut. You’re a medical doctor.
Many US medical school mercifully utilize the pass-fail grading system, but students must then pass a series of national licensing exams before continuing on to further medical training and autonomous practice. The Afghan system was, unfortunately, pass-pass.
The system is slowly changing. Selection for a seat in a medical school class is now much more competitive, a fact that angers many influential Afghans who have grown accustomed to easily “enrolling” their kin in medical school. Tuition at the schools is free, so wealthy and connected Afghans often considered the academic excursion as nothing more than a seven-year shopping sojourn for their children. Additional rigor has evolved as at the end of the medical school curriculum as well, as graduating students must pass an exam in either medicine or surgery in order to practice.
These changes in medical education should produce more competent physicians in the years to come, but unfortunately the quality of physicians already practicing in Afghanstan varies tremendously. Many physicians possess an understanding of human biology not quite as extensive as that of a bright American high school student. Some physicians who have received advanced training in medicine or surgery nevertheless still lack a basic understanding of the fundamentals of medical intervention. An American orthopedic surgeon here recently considered it a victory that he persuaded the Afghan surgeons to stop sharing one set of operative instruments for the two surgical cases taking place in the same operating room.
Afghanistan does boast some very good and talented physicans and surgeons. Often these people have trained in the former Soviet Union, Pakistan or Turkey. Others are simply very dedicated, intelligent, and driven to provide the best possible care under the circumstances. Unfortunately, there are too few of these folks around, and it will be years before medical education reforms and training initiatives serve to stock the Afghan healthcare system with a preponderance of competent physicians.
If You Paid Me Like an Interpreter, I Would Practice as a Doctor
The monthly salary for a physician working at a public hospital for the Ministry of Public Health is about $50. Physicians working for the Afghan Army earn more, but still only $200-300 per month. An Afghan interpreter working in Afghanistan for the United States, another government, a foreign business, or one of the numerous non-governmental organizations (NGOs) here averages $600-800 as a monthly salary. Medical students in Afghanistan, as a population, have much better facility in English than most other groups of people. The quality medical texts available here are often written only in English, and the medical school curriculum (that is a seven-year program modeled on the British system) includes English language instruction. Therefore, a shocking number of medical school graduates in Afghanistan have no intention of using their degress to provide medical care to their countrymen. Instead, they graduate from medical school and immediately find employment as interpreters.
Many physicians who do work at the public and military hospitals are strictly morning employees. They cannot afford to support their families on their government salaries, so they practice at the government institution until about 13:00, then they depart to their private clinics where they attend to patients who are able to pay cash for their services. Some brazen physicians even utilize the government clinic buildings and equipment to conduct private clinics. Security at the military hospitals is often compromised as some physicians instruct their private patients to see them at the military installation, even though entry to those facilities is supposed to be restricted. At another government hospital, an advising American intensivist was shocked to find the Afghan ICU attending physician absent from the critical care ward every afternoon, but using internationally donated equipment and supplies on the ground floor of the hospital to conduct his profitable private practice.
The consequence of the pitiful salaries and short working hours of Afghan physicians charged to provide medical care to the overwhelming majority of Afghans is that the wealthy have the opportunity to pay for decent care, while the poor often have trouble even finding a physician they can afford to visit. The physicians themselves are stuck in a system that offers no financial security if you treat the needy. Moreover, many Afghan physicians who might look forward to a relatively lucrative private medical practice simply look to emigrate from Afghanistan. I know personally several well-trained doctors who chose to forfeit any opportunity to practice medicine as they secured visas and moved to the United States, where they will be lucky to live a middle-class existence after their arrival. No institution in the US will recognize their Afghan medical credentials, and they will more likely be driving a taxi cab than ever seeing clinic patients in any capacity. Their country misses them.
“Physician” is More a Title Than an Academic Degree
Until very recently, you didn’t have to do much to graduate from medical school in Afghanistan. Admission standards were extrememly lax, with several hundred students matriculating each year to the most prestigious medical school, Kabul Medical University (KMU). Once enrolled as a student at KMU, you didn’t have to attend class to graduate. Attention to the seven-year medical school curriculum was optional: No student failed, and students did not know the nuisance of medical competency and licensing exams. At the end of the seven year program, which essentially was a protracted lecture series, all students graduated with an M.D. degree and simply chose what field of medicine best suited them. Although some students entered residency programs at Afghan hospitals, such advanced training certainly was not required. You want to be a surgeon? Go ahead and cut. You’re a medical doctor.
Many US medical school mercifully utilize the pass-fail grading system, but students must then pass a series of national licensing exams before continuing on to further medical training and autonomous practice. The Afghan system was, unfortunately, pass-pass.
The system is slowly changing. Selection for a seat in a medical school class is now much more competitive, a fact that angers many influential Afghans who have grown accustomed to easily “enrolling” their kin in medical school. Tuition at the schools is free, so wealthy and connected Afghans often considered the academic excursion as nothing more than a seven-year shopping sojourn for their children. Additional rigor has evolved as at the end of the medical school curriculum as well, as graduating students must pass an exam in either medicine or surgery in order to practice.
These changes in medical education should produce more competent physicians in the years to come, but unfortunately the quality of physicians already practicing in Afghanstan varies tremendously. Many physicians possess an understanding of human biology not quite as extensive as that of a bright American high school student. Some physicians who have received advanced training in medicine or surgery nevertheless still lack a basic understanding of the fundamentals of medical intervention. An American orthopedic surgeon here recently considered it a victory that he persuaded the Afghan surgeons to stop sharing one set of operative instruments for the two surgical cases taking place in the same operating room.
Afghanistan does boast some very good and talented physicans and surgeons. Often these people have trained in the former Soviet Union, Pakistan or Turkey. Others are simply very dedicated, intelligent, and driven to provide the best possible care under the circumstances. Unfortunately, there are too few of these folks around, and it will be years before medical education reforms and training initiatives serve to stock the Afghan healthcare system with a preponderance of competent physicians.
If You Paid Me Like an Interpreter, I Would Practice as a Doctor
The monthly salary for a physician working at a public hospital for the Ministry of Public Health is about $50. Physicians working for the Afghan Army earn more, but still only $200-300 per month. An Afghan interpreter working in Afghanistan for the United States, another government, a foreign business, or one of the numerous non-governmental organizations (NGOs) here averages $600-800 as a monthly salary. Medical students in Afghanistan, as a population, have much better facility in English than most other groups of people. The quality medical texts available here are often written only in English, and the medical school curriculum (that is a seven-year program modeled on the British system) includes English language instruction. Therefore, a shocking number of medical school graduates in Afghanistan have no intention of using their degress to provide medical care to their countrymen. Instead, they graduate from medical school and immediately find employment as interpreters.
Many physicians who do work at the public and military hospitals are strictly morning employees. They cannot afford to support their families on their government salaries, so they practice at the government institution until about 13:00, then they depart to their private clinics where they attend to patients who are able to pay cash for their services. Some brazen physicians even utilize the government clinic buildings and equipment to conduct private clinics. Security at the military hospitals is often compromised as some physicians instruct their private patients to see them at the military installation, even though entry to those facilities is supposed to be restricted. At another government hospital, an advising American intensivist was shocked to find the Afghan ICU attending physician absent from the critical care ward every afternoon, but using internationally donated equipment and supplies on the ground floor of the hospital to conduct his profitable private practice.
The consequence of the pitiful salaries and short working hours of Afghan physicians charged to provide medical care to the overwhelming majority of Afghans is that the wealthy have the opportunity to pay for decent care, while the poor often have trouble even finding a physician they can afford to visit. The physicians themselves are stuck in a system that offers no financial security if you treat the needy. Moreover, many Afghan physicians who might look forward to a relatively lucrative private medical practice simply look to emigrate from Afghanistan. I know personally several well-trained doctors who chose to forfeit any opportunity to practice medicine as they secured visas and moved to the United States, where they will be lucky to live a middle-class existence after their arrival. No institution in the US will recognize their Afghan medical credentials, and they will more likely be driving a taxi cab than ever seeing clinic patients in any capacity. Their country misses them.
Sunday, September 21, 2008
COIN for the Realm: Novel Approaches to Counter-Insurgency Operations in Afghanistan (Part Two)
(This is the second article in a two-part series. See the previous post for part one.)
Operation Frigid Air
The warm weather months in Afghanistan long have been considered the prime fighting season. In winter, it’s just too cold to fight. Key roads and passes also become too difficult to travel with all the snow and ice. But I also believe that the considerable heat of the oppressive Afghan summer months brews irritability and anger in the breasts of many Afghans, who must leave their homes that have been transformed into literal mud-brick ovens by the summer sun. It is no coincidence to me that southern Afghanistan, the traditional home to the Pashtuns who comprise the majority of the Taliban, is also the hottest region of the country. Unable to stand the heat of their homes, many Pashtun men must loiter out-of-doors enveloped in a surly, violent funk, which makes them easy recruits for the Taliban who can promise immediate relief with a cooling, windy ride in the bed of a white Toyota pick-up truck. After a brief respite from the heat, the new recruits are more likely to take up with the Taliban and look for women to whip, books to burn, and children to chastise for such unGodly activities such as kite flying and marble shooting.
I theorize that an air conditioner in the home of every Afghan would keep most males inside during the summer fighting season, and render impotent the aforementioned Taliban recruiting strategy. At my base in Kabul, we make great use of the Chigo brand of air conditioner, manufactured in China and readily available in Afghanistan. Many Afghans have an aversion to Chinese goods, which the natives here think inferior even to Pakistani products. But I don’t think any Afghan would reject a free air conditioner, no matter what the brand.
The cost to install in every Afghan home a Chigo air conditioner would be substantial. At a unit price of $300 and an estimated five million homes to cool, Operation Frigid Air would generate a bill of $1.5 billion. Consider, though, that the US already has spent $172 billion in Afghanistan since 2001. At less than $2 billion, we could pacify a country for less than it costs to rescue a major US bank. Consistent, clean electricity for all the units would be problematic, but with potential Talibani indoors luxuriating in their pleasant 70⁰ F environs, the countryside and cities would be quiet. Development teams would then have the opportunity to build the utility infrastructure the country lacks, without the danger of insurgents destroying power lines and applying dynamite to hydroelectric projects.
Perpetual Star Strategy
One of the most popular television shows in Afghanistan is Afghan Star, a glorified talent show modeled on American Idol. The founder of Tolo TV, which produces Afghan Star, estimates that 11 million Afghans, or nearly one-third of the population, are avid viewers. You have to be a little suspicious of a viewing audience estimate from a television producer who surely will overestimate his production’s popularity, much like a D.C. protest march organizer’s participant estimate will usually quadruple the National Park Service’s figure. But I work with Afghans, and I will testify that they were all talking about the final episode of Afghan Star in March. One interpreter told me that it not only was his grandmother’s favorite television show, but the only program she watched.
The United States should assist in producing a continuous run of Afghan Star, perhaps even creating regional shows in the native languages that send their winners to a national competition. Afghans and Americans are alike in many ways, but especially similar in our avidity for televised camp. Entire villages gathered on common ground to watch the final episode of Afghan Star on the single small television available in their locale. The Afghans who did not watch the last season of Afghan Star likely missed the show only because they had no access to a television. Several thousand large-screen television sets distributed throughout the country and a perpetual dose of Afghan Star would leave the vast majority of the country too mesmerized by the national singing talent to ponder subversive activity. The interest in Afghan Star is so intense here that any noise or disturbance promulgated by the Taliban during an episode would draw swift vigilante justice by offended locals who would then scurry back to catch the remainder of the televised entertainment.
A Professional Approach to Finding Osama bin Laden
Although recent reports claim that he does not control the day-to-day operations of Al Qaeda any longer, and efforts to locate and capture him are not truly counter-insurgency operations, Osama bin Laden remains a fugitive that many Americans would like captured. Military experts and diplomats argue that the forbidding, tribally controlled terrain of northwest Pakistan, where bin Laden most likely hides, foils attempts to locate him. However, the difficulty in determining bin Laden’s whereabouts does not stem from the mountainous, rugged geography that engulfs him, but from the fact that the United States has not utilized available experts to pinpoint his whereabouts.
bin Laden’s full name, estimated wealth and last known location should be forwarded to an aggressive university development office with the additional misinformation that Osama is an alumnus known to distribute his wealth liberally to initiatives dear to him. If the Cornell University alumni donation experts were given the incentive to track down bin Laden, they would likely have a viable address for him in 2-3 weeks. I have attended three major universities, and I cannot shake free from any of them no matter how often I move. Sometimes I think that the schools each surreptitiously placed a LoJack beacon somewhere under my skin before I left the institution. The US military and our intelligence agencies are capable of amazing feats; but to find Osama, they should move over and let university development personnel, the true bloodhounds when it comes to this sort of work, take over the mission.
Operation Frigid Air
The warm weather months in Afghanistan long have been considered the prime fighting season. In winter, it’s just too cold to fight. Key roads and passes also become too difficult to travel with all the snow and ice. But I also believe that the considerable heat of the oppressive Afghan summer months brews irritability and anger in the breasts of many Afghans, who must leave their homes that have been transformed into literal mud-brick ovens by the summer sun. It is no coincidence to me that southern Afghanistan, the traditional home to the Pashtuns who comprise the majority of the Taliban, is also the hottest region of the country. Unable to stand the heat of their homes, many Pashtun men must loiter out-of-doors enveloped in a surly, violent funk, which makes them easy recruits for the Taliban who can promise immediate relief with a cooling, windy ride in the bed of a white Toyota pick-up truck. After a brief respite from the heat, the new recruits are more likely to take up with the Taliban and look for women to whip, books to burn, and children to chastise for such unGodly activities such as kite flying and marble shooting.
I theorize that an air conditioner in the home of every Afghan would keep most males inside during the summer fighting season, and render impotent the aforementioned Taliban recruiting strategy. At my base in Kabul, we make great use of the Chigo brand of air conditioner, manufactured in China and readily available in Afghanistan. Many Afghans have an aversion to Chinese goods, which the natives here think inferior even to Pakistani products. But I don’t think any Afghan would reject a free air conditioner, no matter what the brand.
The cost to install in every Afghan home a Chigo air conditioner would be substantial. At a unit price of $300 and an estimated five million homes to cool, Operation Frigid Air would generate a bill of $1.5 billion. Consider, though, that the US already has spent $172 billion in Afghanistan since 2001. At less than $2 billion, we could pacify a country for less than it costs to rescue a major US bank. Consistent, clean electricity for all the units would be problematic, but with potential Talibani indoors luxuriating in their pleasant 70⁰ F environs, the countryside and cities would be quiet. Development teams would then have the opportunity to build the utility infrastructure the country lacks, without the danger of insurgents destroying power lines and applying dynamite to hydroelectric projects.
Perpetual Star Strategy
One of the most popular television shows in Afghanistan is Afghan Star, a glorified talent show modeled on American Idol. The founder of Tolo TV, which produces Afghan Star, estimates that 11 million Afghans, or nearly one-third of the population, are avid viewers. You have to be a little suspicious of a viewing audience estimate from a television producer who surely will overestimate his production’s popularity, much like a D.C. protest march organizer’s participant estimate will usually quadruple the National Park Service’s figure. But I work with Afghans, and I will testify that they were all talking about the final episode of Afghan Star in March. One interpreter told me that it not only was his grandmother’s favorite television show, but the only program she watched.
The United States should assist in producing a continuous run of Afghan Star, perhaps even creating regional shows in the native languages that send their winners to a national competition. Afghans and Americans are alike in many ways, but especially similar in our avidity for televised camp. Entire villages gathered on common ground to watch the final episode of Afghan Star on the single small television available in their locale. The Afghans who did not watch the last season of Afghan Star likely missed the show only because they had no access to a television. Several thousand large-screen television sets distributed throughout the country and a perpetual dose of Afghan Star would leave the vast majority of the country too mesmerized by the national singing talent to ponder subversive activity. The interest in Afghan Star is so intense here that any noise or disturbance promulgated by the Taliban during an episode would draw swift vigilante justice by offended locals who would then scurry back to catch the remainder of the televised entertainment.
A Professional Approach to Finding Osama bin Laden
Although recent reports claim that he does not control the day-to-day operations of Al Qaeda any longer, and efforts to locate and capture him are not truly counter-insurgency operations, Osama bin Laden remains a fugitive that many Americans would like captured. Military experts and diplomats argue that the forbidding, tribally controlled terrain of northwest Pakistan, where bin Laden most likely hides, foils attempts to locate him. However, the difficulty in determining bin Laden’s whereabouts does not stem from the mountainous, rugged geography that engulfs him, but from the fact that the United States has not utilized available experts to pinpoint his whereabouts.
bin Laden’s full name, estimated wealth and last known location should be forwarded to an aggressive university development office with the additional misinformation that Osama is an alumnus known to distribute his wealth liberally to initiatives dear to him. If the Cornell University alumni donation experts were given the incentive to track down bin Laden, they would likely have a viable address for him in 2-3 weeks. I have attended three major universities, and I cannot shake free from any of them no matter how often I move. Sometimes I think that the schools each surreptitiously placed a LoJack beacon somewhere under my skin before I left the institution. The US military and our intelligence agencies are capable of amazing feats; but to find Osama, they should move over and let university development personnel, the true bloodhounds when it comes to this sort of work, take over the mission.
Friday, September 19, 2008
COIN for the Realm: Novel Approaches to Counter-Insurgency Operations in Afghanistan (Part One)
Photographs: I asked none of these Afghans to pose for snapshots. I simply found them stationary and waiting for me to photograph them when they saw I had a camera.
In his latest book on the Bush administration, Bob Woodward attributes much of the reduction in violence in Iraq to a new military and intelligence strategy that has proven as revolutionary as it is effective. Somehow, and Woodward gives no details on exactly how, the United States has developed a widely successful approach to locating and eliminating insurgents in Iraq. Information on the actual techniques currently is classified information. I’m not sure if the military plans to incorporate similar operations in Afghanistan. I can offer, however, a few novel techniques that policy and strategy experts in D.C. might not have considered. These suggestions are in no way classified, but I believe them to be imminently applicable to the conflict in Afghanistan, so I encourage and welcome their incorporation into any other operations the United States military might be planning for securing peace in Afghanistan.
The Polaroid Lure
The strength of this technique is rooted in a simple cultural fact: Every Afghan loves to get his or her photograph taken. I think we have all encountered, both within the United States and elsewhere, people shy toward the camera. Especially in developing countries, many people are loathe to be part of any type of photodocumentation that might be perceived as evidence of their supposed backward, funny ways to curious foreigners. In Vietnam, I saw crippled, kyphotic elderly women stand and run when I raised my camera near them. In Cambodia, I witnessed a man fishing in a river with his bare hands who managed to duck under water and hold his breath for a period of time that would have impressed Houdini, thereby negating my opportunity for a snapshot. But in six months, I have not met a single Afghan unwilling to pose for a photograph.
At the Afghan National Military Hospital recently, I was walking the grounds photographing the new fountain and landscaping (all done at the expense of the ICU renovation) when I noticed that many people I was passing had stopped and posed, expecting me to photograph them. A few seemed quite irritated that I didn’t include them in shots of the nearby water and trees. You don’t need to ask explicitly for permission to photograph an Afghan. All you need to do is hold up your camera, and all activity in front of you will stop until you signal that you’ve taken all the photographs you need.
Military success in Afghanistan depends on the successful implementation of COIN: counter-insurgency strategy. The Polaroid Lure technique is a manifestation of COIN strategy in a most simple and elegant form. Let me reiterate the last sentence from the previous paragraph: All you need to do is hold up your camera, and all activity in front of you will stop until you signal that you’ve taken all the photographs you need. The Taliban are Afghans, mostly, and we’ve all seen pictures of them riding around Afghanistan in their white Toyota pickup trucks looking for women to whip, books to burn, and children to admonish for such unGodly activities such as kite flying and marble shooting. I theorize here that the joy you see in the faces of these Taliban is NOT simply a display of religious zeal and a devotion to a misguided revolution, but the reflexive exuberance of any Afghan to the placement of a functioning camera in front of him.
Most Afghans are even more than excited, in fact overwhelmed, if you are able to offer them a copy of their photographs. Such a gift creates an immediate and deep bond of friendship and gratitude. Personal photographs are treasured mementos here, and not simply because most Afghans cannot afford cameras. The gift of a photograph is considered a token of hospitality and appreciation, both extremely important values in Afghan culture; and especially in the culture of Pashtuns, who form the predominate ethnic group in Afghanistan and the majority of the Taliban.
The United States should issue every soldier, sailor, airman and Marine coming to Afghanistan a Polaroid One Step camera and several cases of film, with orders to provide an instant photograph for every Afghan met. Battle reports detail that, in combat, US forces typically encounter Taliban fighters at a distance of 700—1000 meters, close enough that the insurgents would be able to detect cameras in the hands of US military personnel. Let me reiterate the last sentence from the penultimate paragraph: All you need to do is hold up your camera, and all activity in front of you will stop until you signal that you’ve taken all the photographs you need. My theory holds that not only would the Taliban halt any military assault and graciously pose for a photograph, but after the benighted rascals received a personal snapshot of themselves, they would lose any urge to fight and consider us infidels quite good folk after all. The hearts and minds of the 99.99% of the Afghans who want nothing more than an end to conflict here also would be ours.
The cost of such an operation would be minimal, especially when contrasted with the cost of US military efforts in Afghanistan since 1991, a figure the Congressional Research Service estimates to be $172 billion as of July 2008. Even if the US military ordered at the list price of $75 from Amazon.com enough Polaroid One Step cameras for all NATO and US military personnel in Afghanistan, with an additional order of enough film for one snapshot each of the estimated 35 million Afghans (at approximately $1.50 per sheet of film), the total cost of operation Polaroid Lure would be under $57.5 million. The total cost would be even less with a bulk order from Polaroid if the federal government bucks tradition and decides that a contract price for goods bought in large quantities from manufacturers should be less than what the typical suburban consumer would pay when buying the item singly. Additionally, the bulk Polaroid purchase would finally provide solid evidence that military spending creates the vaunted economic spinoff that Congressional hawks like to tout as rationale for every tax dollar spent on expensive military procurement packages.
(Next blog post: COIN (Part Two, including Operations Summer Freeze and Afghan Star, and a strategy to find Osama bin Laden.)
Tuesday, September 16, 2008
Mazir-e-Sharif: A Trial with Wind, Dirt and a Troublesome Prostate
Whoever first pronounced that “forty is the new thirty” likely was not a male suddenly unable, at age forty-one if my case is exemplary, to sleep through the night without waking at least once to urinate. Typically this disrupted sleep is due to a prostate gland that, after four previous decades of relative dormancy, is now blossoming like a desert lily at daybreak; and which delights in tickling a bladder that subsequently demands evacuation no matter what the present volume. I certainly did not have this problem at age thirty. Now, in my early forties, I can rarely escape the nightly interruption, even if I attempt to dehydrate myself before getting supine for slumber. In fact, I could blood let myself to a near death before sleep but still find myself in the bathroom at 02:00.
I don’t mind the interruption if I am home, or even at my base in Kabul as the toilet is only several yards from my bed, and usually I can take care of business and be back asleep within a few minutes. But during my recent trip to Mazir-e-Sharif in northern Afghanistan, where I slept in quarters without bathroom facilities, I found the nightly physiologic intrusion more burdensome. There, on a US military base that simply is a collection of plywood shacks and large shipping container boxes sitting on packed gravel and fenced by stacked barricades, I awoke each night to the famed Afghan 100 Days of Wind – extended in Mazir-Sharif through the moonlit hours and accompanied by the ample airborne dirt and silt from the surrounding desert. Every night, I awoke and trekked in the dark thirty or so yards to the toilet trailer with my head down as the dirty air stung my eyes; but I did notice one night that young, thin trees planted by the camp’s headquarters, virtually stripped of leaves either by the wind or a local goat, bent at nearly ninety degree angles in the gusts.
Every night, before I even began another quest for uninterrupted sleep, I took notice of the wind. In fact, the first time I lay in my bunk I thought that an active loading dock sat behind my quarters, as I heard the intermittent percussion of wood and metal colliding. The following morning, I discovered that the sounds were from the corrugated sheet metal, used as roofing on the buildings and shelters surrounding me, lifting in the wind and then crashing together or into the wooden beams that were supposed to hold them firmly in place.
The dirt raised by the wind permeated everything, even the interior of the buildings themselves. The nearby Afghan military hospital, where I spent two days, had a film of dirt everywhere: on the floors, on the patient’s blankets, on the operating room equipment. The dirt simply overwhelms the new hospital’s air filtering system. I went to inspect the ophthalmology equipment at the facility and instruct the staff, which is devoid of an eye surgeon, on its use. The room marked “Eye Clinic” had been locked for months, and when we opened the door I felt as if I were Howard Carter as he peered through the hole he had drilled into sealed door of Tutankhamen’s tomb, for I saw everything inside the clinic perfectly preserved under a soft, quiet layer of silt.
The weather in Mazir-e-Sharif remains very warm, and I was grateful for the sultry climate in the middle of the night when I walked to the bathroom in shorts and a t-shirt. I also appreciated the air conditioners that cooled most of the buildings. The recirculated air may have been dirty, with thin clouds of dust visibly emanating from the air conditioners’ vents, but at least the buildings remained a pleasant temperature. I tried to focus on the comforting cool every night as I returned from the bathroom and climbed back into my sleeping bag, comfortable again below the waist but tasting on my tongue the ancient soil that permeates the air in Mazir-e-Sharif.
I don’t mind the interruption if I am home, or even at my base in Kabul as the toilet is only several yards from my bed, and usually I can take care of business and be back asleep within a few minutes. But during my recent trip to Mazir-e-Sharif in northern Afghanistan, where I slept in quarters without bathroom facilities, I found the nightly physiologic intrusion more burdensome. There, on a US military base that simply is a collection of plywood shacks and large shipping container boxes sitting on packed gravel and fenced by stacked barricades, I awoke each night to the famed Afghan 100 Days of Wind – extended in Mazir-Sharif through the moonlit hours and accompanied by the ample airborne dirt and silt from the surrounding desert. Every night, I awoke and trekked in the dark thirty or so yards to the toilet trailer with my head down as the dirty air stung my eyes; but I did notice one night that young, thin trees planted by the camp’s headquarters, virtually stripped of leaves either by the wind or a local goat, bent at nearly ninety degree angles in the gusts.
Every night, before I even began another quest for uninterrupted sleep, I took notice of the wind. In fact, the first time I lay in my bunk I thought that an active loading dock sat behind my quarters, as I heard the intermittent percussion of wood and metal colliding. The following morning, I discovered that the sounds were from the corrugated sheet metal, used as roofing on the buildings and shelters surrounding me, lifting in the wind and then crashing together or into the wooden beams that were supposed to hold them firmly in place.
The dirt raised by the wind permeated everything, even the interior of the buildings themselves. The nearby Afghan military hospital, where I spent two days, had a film of dirt everywhere: on the floors, on the patient’s blankets, on the operating room equipment. The dirt simply overwhelms the new hospital’s air filtering system. I went to inspect the ophthalmology equipment at the facility and instruct the staff, which is devoid of an eye surgeon, on its use. The room marked “Eye Clinic” had been locked for months, and when we opened the door I felt as if I were Howard Carter as he peered through the hole he had drilled into sealed door of Tutankhamen’s tomb, for I saw everything inside the clinic perfectly preserved under a soft, quiet layer of silt.
The weather in Mazir-e-Sharif remains very warm, and I was grateful for the sultry climate in the middle of the night when I walked to the bathroom in shorts and a t-shirt. I also appreciated the air conditioners that cooled most of the buildings. The recirculated air may have been dirty, with thin clouds of dust visibly emanating from the air conditioners’ vents, but at least the buildings remained a pleasant temperature. I tried to focus on the comforting cool every night as I returned from the bathroom and climbed back into my sleeping bag, comfortable again below the waist but tasting on my tongue the ancient soil that permeates the air in Mazir-e-Sharif.
Tuesday, September 9, 2008
Earthquake!
I lived in southern California for eight years and learned a few things about protecting myself during an earthquake. I know that you are supposed to take cover under a protective object if a quake begins, or better yet leave a building that is shaking in a temblor. Recent events lead me to conclude that the typical Afghan training for earthquake safety is a bit different, as a few days ago when I felt the floor beneath me suddenly begin to sway, the Afghan military officers who surrounded me made no movement to duck underneath the heavy table in front of us; nor did they break for the door. Instead, they looked at me with effusive smiles, and the officers who spoke English simply said “Earthquake!” with faces full of excitement and anticipation such that I haven’t seen since the last time I was on a rollercoaster with my young nephew Davey Boy.
The Afghan officers’ response was in keeping with the cultural notion of inshallah, which means God-willing and attests to the Muslim belief here that your individual fate is truly in the hands of God; and marks as foolish any personal attempts to evade the will of God. I’m not sure what the Almighty had planned for me during the earthquake, but I was pretty confident that as soon as the ground began rocking, I received a direct message from God instructing me to promptly get my ass out of the building. But a friendly Afghan colonel next to me put his hand on my shoulder to indicate that I should stay seated; so I was forced to subscribe to inshallah myself for a few minutes.
I had encountered the concept of inshallah before in another predominately Muslim country: Turkey. Just a few days before I arrived on a visit to an uncle working in the city of Izmir on a highway construction project, a Turkish laborer had fallen into a pool of water that unknowingly was charged with electricity due to a faultily wired pump working to drain the liquid. An American supervisor found the Turk not breathing and with a poor pulse, so he disconnected the pump, pulled the victim from the water and began administering CPR. To the amazement of all the Americans nearby, the Turk responded: He regained consciousness, and was pronounced healthy and fit after an extensive evaluation and short stay at a local hospital. The other Turks, however, were not impressed with the CPR performance or their countryman’s recovery. “Inshallah,” they claimed, indicating that God simply willed the recovery; and why was this American-construction-supervisor-turned-paramedic so proud of himself?
I never heard a comment from the Turk who survived due to the CPR. Apparently God instructed him to find employment elsewhere, as he never returned to the construction site.
The building that I felt rock during the quake here is a model of Eastern Bloc architecture and engineering, built in the 70s by the Soviet Union. Once the earthquake began, I remember thinking “This shack is coming down and fast!” but such a reactionary conclusion failed to acknowledge the sturdy Afghan construction found throughout the country. It’s not unusual to encounter remnants of a wall that would still be completely intact had not Genghis Khan’s mob assaulted it with the Mongolian equivalent of a Stinger missile sometime around the year 1250. Many buildings here are the products of masons who were absolute masters of their craft. Even the mud brick homes that look as if they will simply melt away in the near future are quite stout. The medical office building in which I withstood the earthquake had been upright more than thirty years, a testament to its structural integrity as it surely has withstood several earthquakes yet remains standing. In fact, the rule in Afghanistan is that, in the event of an earthquake, it’s much better to be in an older, tested building than a new structure that may not have had its girders rocked before.
The earthquake announced itself a bit differently from the few I have felt in southern California. I first noticed slow, smooth undulations of the earth. Then a brief pause interceded before the ground shook more violently for 10-15 seconds. After the initial action, I could swear I felt a series of delayed tremors, but then I realized that I was sitting in a rickety chair barely able to hold my girth; and what I thought were after-shocks were actually my own anxiety-induced spasmodic gyrations that had converted my contorting seat into nauseating carnival ride akin to the Spinning Teacup I rode as a kid whenever Drago Amusements came to the Kokomo Mall parking lot.
News reports gave the earthquake a 5.6 rating on the Richter scale, although it’s difficult to ascertain the magnitude of a quake in Afghanistan as the country has no agency to monitor the events. The epicenter was located approximately 100 miles northeast of Kabul, but thankfully no serious injuries or damage occurred. The earthquake reminded me that the geotectonic plates beneath me continue to move and ram each other, creating not only earthquakes but the grandeur of the nearby Hindu Kush mountains, the Korakoram range in Pakistan, and the remainder of the Himalayas beyond. I’m hoping the plates don’t engage in any more aggressive jostling for position during my remaining time here, inshallah.
The Afghan officers’ response was in keeping with the cultural notion of inshallah, which means God-willing and attests to the Muslim belief here that your individual fate is truly in the hands of God; and marks as foolish any personal attempts to evade the will of God. I’m not sure what the Almighty had planned for me during the earthquake, but I was pretty confident that as soon as the ground began rocking, I received a direct message from God instructing me to promptly get my ass out of the building. But a friendly Afghan colonel next to me put his hand on my shoulder to indicate that I should stay seated; so I was forced to subscribe to inshallah myself for a few minutes.
I had encountered the concept of inshallah before in another predominately Muslim country: Turkey. Just a few days before I arrived on a visit to an uncle working in the city of Izmir on a highway construction project, a Turkish laborer had fallen into a pool of water that unknowingly was charged with electricity due to a faultily wired pump working to drain the liquid. An American supervisor found the Turk not breathing and with a poor pulse, so he disconnected the pump, pulled the victim from the water and began administering CPR. To the amazement of all the Americans nearby, the Turk responded: He regained consciousness, and was pronounced healthy and fit after an extensive evaluation and short stay at a local hospital. The other Turks, however, were not impressed with the CPR performance or their countryman’s recovery. “Inshallah,” they claimed, indicating that God simply willed the recovery; and why was this American-construction-supervisor-turned-paramedic so proud of himself?
I never heard a comment from the Turk who survived due to the CPR. Apparently God instructed him to find employment elsewhere, as he never returned to the construction site.
The building that I felt rock during the quake here is a model of Eastern Bloc architecture and engineering, built in the 70s by the Soviet Union. Once the earthquake began, I remember thinking “This shack is coming down and fast!” but such a reactionary conclusion failed to acknowledge the sturdy Afghan construction found throughout the country. It’s not unusual to encounter remnants of a wall that would still be completely intact had not Genghis Khan’s mob assaulted it with the Mongolian equivalent of a Stinger missile sometime around the year 1250. Many buildings here are the products of masons who were absolute masters of their craft. Even the mud brick homes that look as if they will simply melt away in the near future are quite stout. The medical office building in which I withstood the earthquake had been upright more than thirty years, a testament to its structural integrity as it surely has withstood several earthquakes yet remains standing. In fact, the rule in Afghanistan is that, in the event of an earthquake, it’s much better to be in an older, tested building than a new structure that may not have had its girders rocked before.
The earthquake announced itself a bit differently from the few I have felt in southern California. I first noticed slow, smooth undulations of the earth. Then a brief pause interceded before the ground shook more violently for 10-15 seconds. After the initial action, I could swear I felt a series of delayed tremors, but then I realized that I was sitting in a rickety chair barely able to hold my girth; and what I thought were after-shocks were actually my own anxiety-induced spasmodic gyrations that had converted my contorting seat into nauseating carnival ride akin to the Spinning Teacup I rode as a kid whenever Drago Amusements came to the Kokomo Mall parking lot.
News reports gave the earthquake a 5.6 rating on the Richter scale, although it’s difficult to ascertain the magnitude of a quake in Afghanistan as the country has no agency to monitor the events. The epicenter was located approximately 100 miles northeast of Kabul, but thankfully no serious injuries or damage occurred. The earthquake reminded me that the geotectonic plates beneath me continue to move and ram each other, creating not only earthquakes but the grandeur of the nearby Hindu Kush mountains, the Korakoram range in Pakistan, and the remainder of the Himalayas beyond. I’m hoping the plates don’t engage in any more aggressive jostling for position during my remaining time here, inshallah.
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