In addition to meetings and surveys and project analysis and set-up, we’ve also had quite a few adventures in the past 24 hours. Politics have stalled the bridge building process across the Kabul River to the Kuchi village that Sister City/Rotary/Mindtel have been assisting for the past few years, and so makeshift rafts (inner tubes with rope and some wood) are still the way to get across. The plan was to donate some rubber rafts to replace these and then head over for a visit. Reality, on the other hand… presented quite a different experience…
First, we got hung up on a rock in our SUV in the middle of the river. After 10 minutes of attempting to get the car off the rock, and realizing it wasn’t going to happen anytime soon, Dave decided to inflate the raft – on the roof of the car through the sunroof using the foot pump with his hands. Part of the crowd gathered on the near shore of the river came out to assist and try to push us off again – no luck so we got into the raft. (I have to say chivalry is not dead as Meggin and I were the first in, and we were oh-so-carefully handed into the raft – actually quite charming and we were grateful as the water temperature is near freezing.) With Dave and I paddling and Meggin carefully photo documenting we pushed ourselves off and over the rocks and through the rapids – trying to maintain some semblance of control and not tip over. I can only imagine what the picture of this looked like to the villagers! Thankfully, they are friends, and were just excited to have us make it over rather than laughing at us – although I REALLY need to learn Pashto because there was quite a lot of smiling and pointing as we climbed out of the raft – particularly by the boys. (They did, however, immediately jump into the raft (way more than it should really hold) and started paddling around. Albeit, one boy asked Dave – why’d you bring us this cheap thing? We need a wood bottom one. LOL. Point taken and sorry was the best luggage would allow!)
Due to the elapsed time and the pure spectacle we created, there was now quite a crowd gathered to welcome us. The kids know one word in English – “Picture”. With multiple cameras and willing “shooters” – they were in absolute heaven. They’ve become quite the little posers, I must say. Finally we had to begin the hike up to the village, and we did so to the chant of “Picture, Picture” the entire way. The kids are endearing and the parade up the hill with all their brightly colored clothes and beautiful, dirty faces was full of laughter.
Upon arrival at the village there were more pictures (naturally), and then Dave went to go talk to the elders about the situation with the wells. Meggin and I were surrounded as the women came out to talk to us (again, gotta learn Pashto…) and we were invited into one of the huts. While we sat on their carpet, we were surrounded by more than 30 women in children in a semi-circle around us (in a not large space I might add) they asked for our socks. After handing them over, however, a fight broke out among some of the children over the INDIVIDUAL socks, so the eldest woman gestured for us to take them back. So, now we are of course on a sock mission – among other things… For starters, the village has never seen a doctor or dentist. There seems to be some sort of spreading fungus on the kids and lice were literally jumping off their heads.
As we rejoined Dave and the men, and were invited in for chai, we learned that due to flooding they had lost their access to fresh water several months ago. As I drank my second cup of tea, not wanting to be rude as they generously gave us the only gift they had to offer – sugar, I was gently reminded by others in our party that the water we were drinking was the contaminated, barely filtered river water. I needed a stronger immune system anyway… As for them, it is just unacceptable and a complete travesty that they don’t have access to clean water. We found out that it is $500 to put in a new bore hole and give them access. Needless to say this WILL happen in the next couple of days.
This morning, our adventures continued as we made our way to the Public Health Hospital to add a more reliable relay for the sat comms hosted at the Taj and providing access to the hospital. Ryan is of course our comms/sat/tech guru (who is my hero as well after fixing my computer twice in as many days), but no way us non-techies (e.g. Meggin and I) were going to be left behind as we climbed to the top of the water tower. After admiring the FabFi antennas (Google it) at the top that have been providing the link to date, we stopped to look out at the view from this incredible vantage point – snow capped mountains surrounding the valley, bustling activity on the streets below… Tomorrow morning Pete and Ryan will return to complete the last step to get the antenna up and running. For now, as I sit at the Taj writing this, I am just thankful beyond words to be back here, for our friends new and old, for all we have accomplished, and simply for the day.
Saturday, November 14, 2009
"Never doubt that a small group of thoughtful committed citizens can change the world. Indeed, it is the only thing that ever has." ~ Margaret Mead
We arrived in Jalalabad three days ago and have managed to visit the three primary hospitals we had on our agenda. The Teaching Hospital (see entry below with the IV bags hanging from trees, etc.) was our first stop. I’m sad to say that not much (if anything) has changed in 6 months. The smells are still rancid and basic supplies (clean water, soap) are in short supply. As promised many months ago we had planned to fix their “broken” anesthesia machine. Turns out, that the machine had never been taken off the pallet (bolts rusted on) and by simply plugging it in – it worked. However, no one is trained to use it, so instead it sits there while they use a bag-valve mask (BVM) to administer anesthesia – which we might add is not constant and patients frequently wake up in the middle of surgery. In so many ways everything comes back to training and dedicated PEOPLE to make it happen – the technology and equipment pieces are the easy pieces. The human factor is the imperative as Dr. Dave Warner likes to say.
It’s so true. We have the potential resources and ability to install a large telemedicine network here, but there are basic training elements that are lacking and must be met first. So we draw up plans, revise them, and revise them again and again – trying to find a solution that can be sustainable in the long term even if we are not involved. Initially we’ll focus on training because there is such a vital need by establishing a Telemedicine and Medical Distance Education Center. We have a site, excitement about the idea, and it looks like the funding to make it happen within the next 6 months.
At the Jalalabad Public Hospital today, too, we saw a “friend” (no names) from our last trip here who recently was almost prey to a suicide bomber attack. We see a slight resignation in him now versus the near boundless energy from before the attack, the elections and political wrangling and change of the past several months, yet there still remains hope and a light in his eyes and a determined resolve to help his people.
All the kids tug at our hearts everyday as we see them in the halls of the hospitals and the banks of the river, but there was something equally powerful and moving sitting across the conference table today looking at this powerful man oh so humbly and graciously—with no pretension—express his appreciation for the fact that we came back, ask us to not leave and help him to help his people. We are humbled to be around such incredible people who do so much for little more than love. It is a lesson also in resilience – quitting is not on option…
It’s so true. We have the potential resources and ability to install a large telemedicine network here, but there are basic training elements that are lacking and must be met first. So we draw up plans, revise them, and revise them again and again – trying to find a solution that can be sustainable in the long term even if we are not involved. Initially we’ll focus on training because there is such a vital need by establishing a Telemedicine and Medical Distance Education Center. We have a site, excitement about the idea, and it looks like the funding to make it happen within the next 6 months.
At the Jalalabad Public Hospital today, too, we saw a “friend” (no names) from our last trip here who recently was almost prey to a suicide bomber attack. We see a slight resignation in him now versus the near boundless energy from before the attack, the elections and political wrangling and change of the past several months, yet there still remains hope and a light in his eyes and a determined resolve to help his people.
All the kids tug at our hearts everyday as we see them in the halls of the hospitals and the banks of the river, but there was something equally powerful and moving sitting across the conference table today looking at this powerful man oh so humbly and graciously—with no pretension—express his appreciation for the fact that we came back, ask us to not leave and help him to help his people. We are humbled to be around such incredible people who do so much for little more than love. It is a lesson also in resilience – quitting is not on option…
Friday, November 13, 2009
Afghanistan Return - Fall 2009
Compared with our last trip here to Afghanistan in March, which can only be described as a whirlwind, this trip, which began on November 6, has been at a totally different pace—Slower and quieter, but still powerful. A lot has changed in six months, and certainly the media has done a “great” job of sensationalizing some of the security and political issues, but there is still an amazing hope and energy that is palpable, and I would be sadly remiss if I didn’t mention it and try to convince others to feel it and care about it, too.
We spent several days in Kabul on this trip due to travel issues, but everything happens for a reason and I’m so happy we did. Having not spent much time in Kabul previously, it was a whole new adventure – from the tranquil serenity of our guest house to the bustling and crazy traffic that rivals anything LA or New York can throw at it – just add some donkey carts, bicycles and lanes that aren’t really lanes so much as “guidelines” – to the French restaurant tucked away off dirt side streets with good friends. At one point, we set out to pick up our air tickets from the UN travel office thinking it would be 45 minutes max roundtrip and over 3 hours later we had success. Little bit of lost driver time in there, too, but the upside was that we (Meggin & I) got to see parts of Kabul we’d never seen before. Also, got to ride in the back of the car (trunk really), as in true Afghan style, we crammed 8 people into a car meant for 5. All part of the adventure.
That’s kind of been the flow of this whole trip – start with a plan, have it change, redirect, etc. and go with it – which is often far better than the original plan. We were able to meet again with Afshar Hospital, which is now open and functioning – great to see the changes and the use of the facility. Our meeting was delayed by a couple of days as they prepared for and then conducted their first outreach clinic on the outskirts of town along the Jalalabad-Kabul road. They saw over 200 patients (men, women, children) in the space of 4 hours – impressive to say the least. We brought along a 3.5 MHz portable USB ultrasound, which we donated and they will use for their upcoming clinic this weekend and in the weeks that follow. While we were there, their IT Tech was able to load it onto one of their laptops (after first conducting a virus check of our ultrasound AND the laptop!), so it is ready to go and they were excited to use it. There is just such a great feeling about being able to give something that you KNOW will be put to good use and immediately.
Our next stop was the privately funded and run Acomet Hospital – associated with Kabul Medical University. Another great facility – and completely dedicated to a qualitative standard of care. They offer no patronage, rather services are provided on a first come-first serve (or urgent need) basis – period. The two brothers that run it are incredible. We’ve now had the good fortune to meet both, and their dedication (which includes living at the hospital), energy, and commitment to forward progress and quality are truly inspiring. As but one small example, in a couple of weeks the 64-slice CT (impressive technology) they ordered will arrive at the hospital. We were able to donate a Medweb server and get it up and running for their Radiology Department. After our return from Jalalabad, we’ll head back to the hospital and Meggin and Ryan will provide some additional training and ensure they know where to go for support.
As I sit here in the sun in Jalalabad reflecting back on the week, I just can’t help but smile. It’s REALLY good to be back here in Afghanistan.
Up next… Our Jalalabad adventures… including today’s planned excursion in a couple of hours which involves rafting across the Kabul River to visit the Kuchi village…
We spent several days in Kabul on this trip due to travel issues, but everything happens for a reason and I’m so happy we did. Having not spent much time in Kabul previously, it was a whole new adventure – from the tranquil serenity of our guest house to the bustling and crazy traffic that rivals anything LA or New York can throw at it – just add some donkey carts, bicycles and lanes that aren’t really lanes so much as “guidelines” – to the French restaurant tucked away off dirt side streets with good friends. At one point, we set out to pick up our air tickets from the UN travel office thinking it would be 45 minutes max roundtrip and over 3 hours later we had success. Little bit of lost driver time in there, too, but the upside was that we (Meggin & I) got to see parts of Kabul we’d never seen before. Also, got to ride in the back of the car (trunk really), as in true Afghan style, we crammed 8 people into a car meant for 5. All part of the adventure.
That’s kind of been the flow of this whole trip – start with a plan, have it change, redirect, etc. and go with it – which is often far better than the original plan. We were able to meet again with Afshar Hospital, which is now open and functioning – great to see the changes and the use of the facility. Our meeting was delayed by a couple of days as they prepared for and then conducted their first outreach clinic on the outskirts of town along the Jalalabad-Kabul road. They saw over 200 patients (men, women, children) in the space of 4 hours – impressive to say the least. We brought along a 3.5 MHz portable USB ultrasound, which we donated and they will use for their upcoming clinic this weekend and in the weeks that follow. While we were there, their IT Tech was able to load it onto one of their laptops (after first conducting a virus check of our ultrasound AND the laptop!), so it is ready to go and they were excited to use it. There is just such a great feeling about being able to give something that you KNOW will be put to good use and immediately.
Our next stop was the privately funded and run Acomet Hospital – associated with Kabul Medical University. Another great facility – and completely dedicated to a qualitative standard of care. They offer no patronage, rather services are provided on a first come-first serve (or urgent need) basis – period. The two brothers that run it are incredible. We’ve now had the good fortune to meet both, and their dedication (which includes living at the hospital), energy, and commitment to forward progress and quality are truly inspiring. As but one small example, in a couple of weeks the 64-slice CT (impressive technology) they ordered will arrive at the hospital. We were able to donate a Medweb server and get it up and running for their Radiology Department. After our return from Jalalabad, we’ll head back to the hospital and Meggin and Ryan will provide some additional training and ensure they know where to go for support.
As I sit here in the sun in Jalalabad reflecting back on the week, I just can’t help but smile. It’s REALLY good to be back here in Afghanistan.
Up next… Our Jalalabad adventures… including today’s planned excursion in a couple of hours which involves rafting across the Kabul River to visit the Kuchi village…
Friday, April 10, 2009
Pens for Peace
Been awhile since I’ve been able to write an update, but now back in the U.S. – despite the strong desire to stay in Afghanistan longer. Looking forward to the return trips! I’m going to commit the next few weeks… maybe longer, because it will really take that long to document some of the great efforts and projects we saw in our short time in Afghanistan. We were only on the ground for 8 whirlwind days, but it’s incredible how many amazing people we met dedicated to making a positive difference in Afghanistan and beyond – and how exportable some of these ideas and projects are to other areas.
First up, I have to begin to tell the story of the Pens for Peace effort. We randomly got involved after some of the logistics got a little challenging… not that we’re a logistics company (at all), but you get a reputation for tenacity and getting it done, and add that “philanthropy” piece – and sometimes it catches up to you. So how did the program start? It started when Chris Corsten (at the time, a Captain in the US Army) first came through the streets of Nangarhar Province in 2005. Kids would line the streets and use a form of sign language to “sign” that they wanted the troops to give them pens and paper – they’d realized that the incoming forces had these “precious commodities” and a heart for the kids (who seriously couldn’t?). Chris happened to mention this to his mom back in his small hometown in Wisconsin. Before he knew it, his mom was shipping boxes of pens for Chris and other members of the military to distribute that she’d managed to pull together with her friends and others she engaged.
That continued for some time, and then a call from Chris to Bill McCready in Reno, NV following Chris’ participation in one of Bill’s online investment trainings took the “program” to the next level. One thing led to another in the conversation, and it turned out that Bill was also a veteran of the U.S. military, having done several tours in Vietnam. Bill, enroute to a Rotary meeting, mentioned “well if there is anything I/we can do…” (aha! Famous words – right?!) – And in that moment, Pens for Peace was born as Bill and the Reno Rotary Club kept a steady supply of pens flowing to Chris in Afghanistan.
Chris soon became known to the local children as “Captain Kalam”… meaning “Captain Pen” in Pashto, and as he would walk into his office or to the villages he would visit, they would hold out their hands and call out to him. Having witnessed the “entourage” that one can get as you walk through villages, I can only imagine the following he had and how each cry of Captain Kalam must’ve brought a smile to his face, as well as tugged at the heart strings.
About 9 months ago the program got a boost by the donation of two massive PALLETS of pens (equates to about 100,000 pens) in Reno, NV. As you can imagine, the financial costs and international shipping logistics of getting these into Afghanistan - and to Nangarhar in particular - were major challenges… not to mention the fact that it is generally always preferable to “buy in country” (or in affected areas) – money helps stimulate the local economy which can help spur additional development. After numerous dead-ends, the challenge was thrown out to us during a late night email exchange with Dave Warner, MD PhD (Mindtel, LLC) that went something like “Kim meet Chris, Ken and Bill… they have pens for kids… trouble getting them here… need in time for spring surge… do what you can… synergize at will.” This was of course following these news stories… As you can see, we had no choice:
ABC News Newsbroadcast (Video): http://www.youtube.com/watch?v=nGdk9JwZWzY;
ABC News Story (Text/Photos): http://abcnews.go.com/WN/popup?id=6639064
So we synergized : ) And after a few more dead ends, and visits to the High Sierra Industries Warehouse in Reno where the pens were (great organization as well that employees adults with disabilities… google it), and thanks to a donation from the Woodard Family Foundation in Eugene, OR (you really gotta love the Gamma Phi sorority connections and lifelong friends always willing to support your latest adventures and undertakings)… the pens are making their way into Afghanistan in a steady stream of 5 large APO (Army Post Office) boxes every few days (we figure they'll all be there by early May - there's 675 boxes total). I also managed to fit about 1,500+ pens into a bag as part of my checked luggage; of which we dropped ~700 of them at the La Jolla School for the girls there. The rest of that bag will likely end up in the hands of the kids at the villages by the Kabul River. All told, the pens averaged out to a very reasonable $.02/pen and are high quality that the kids love – which is the core mission. Photos to come soon.
One person, seeing a need, engaging others and making a positive impact. To some, pens may seem a small thing and something we take for granted, but sometimes it’s the smallest gestures that can make the biggest difference.
First up, I have to begin to tell the story of the Pens for Peace effort. We randomly got involved after some of the logistics got a little challenging… not that we’re a logistics company (at all), but you get a reputation for tenacity and getting it done, and add that “philanthropy” piece – and sometimes it catches up to you. So how did the program start? It started when Chris Corsten (at the time, a Captain in the US Army) first came through the streets of Nangarhar Province in 2005. Kids would line the streets and use a form of sign language to “sign” that they wanted the troops to give them pens and paper – they’d realized that the incoming forces had these “precious commodities” and a heart for the kids (who seriously couldn’t?). Chris happened to mention this to his mom back in his small hometown in Wisconsin. Before he knew it, his mom was shipping boxes of pens for Chris and other members of the military to distribute that she’d managed to pull together with her friends and others she engaged.
That continued for some time, and then a call from Chris to Bill McCready in Reno, NV following Chris’ participation in one of Bill’s online investment trainings took the “program” to the next level. One thing led to another in the conversation, and it turned out that Bill was also a veteran of the U.S. military, having done several tours in Vietnam. Bill, enroute to a Rotary meeting, mentioned “well if there is anything I/we can do…” (aha! Famous words – right?!) – And in that moment, Pens for Peace was born as Bill and the Reno Rotary Club kept a steady supply of pens flowing to Chris in Afghanistan.
Chris soon became known to the local children as “Captain Kalam”… meaning “Captain Pen” in Pashto, and as he would walk into his office or to the villages he would visit, they would hold out their hands and call out to him. Having witnessed the “entourage” that one can get as you walk through villages, I can only imagine the following he had and how each cry of Captain Kalam must’ve brought a smile to his face, as well as tugged at the heart strings.
About 9 months ago the program got a boost by the donation of two massive PALLETS of pens (equates to about 100,000 pens) in Reno, NV. As you can imagine, the financial costs and international shipping logistics of getting these into Afghanistan - and to Nangarhar in particular - were major challenges… not to mention the fact that it is generally always preferable to “buy in country” (or in affected areas) – money helps stimulate the local economy which can help spur additional development. After numerous dead-ends, the challenge was thrown out to us during a late night email exchange with Dave Warner, MD PhD (Mindtel, LLC) that went something like “Kim meet Chris, Ken and Bill… they have pens for kids… trouble getting them here… need in time for spring surge… do what you can… synergize at will.” This was of course following these news stories… As you can see, we had no choice:
ABC News Newsbroadcast (Video): http://www.youtube.com/watch?v=nGdk9JwZWzY;
ABC News Story (Text/Photos): http://abcnews.go.com/WN/popup?id=6639064
So we synergized : ) And after a few more dead ends, and visits to the High Sierra Industries Warehouse in Reno where the pens were (great organization as well that employees adults with disabilities… google it), and thanks to a donation from the Woodard Family Foundation in Eugene, OR (you really gotta love the Gamma Phi sorority connections and lifelong friends always willing to support your latest adventures and undertakings)… the pens are making their way into Afghanistan in a steady stream of 5 large APO (Army Post Office) boxes every few days (we figure they'll all be there by early May - there's 675 boxes total). I also managed to fit about 1,500+ pens into a bag as part of my checked luggage; of which we dropped ~700 of them at the La Jolla School for the girls there. The rest of that bag will likely end up in the hands of the kids at the villages by the Kabul River. All told, the pens averaged out to a very reasonable $.02/pen and are high quality that the kids love – which is the core mission. Photos to come soon.
One person, seeing a need, engaging others and making a positive impact. To some, pens may seem a small thing and something we take for granted, but sometimes it’s the smallest gestures that can make the biggest difference.
Friday, April 3, 2009
"Progress"
Today we went to the Teaching Hospital associated with Nangarhar University – operated by the Ministry of Education (versus the Ministry of Health, as is the Public Hospital). Words cannot express the great tragedy of this place… this is not a rural hospital or clinic located in an unsecured area, where maybe you could understand and offer SOME explanation of the condition (of the TEACHING hospital no less); but instead it is located in the middle of Jalalabad, so there are no excuses in my humble opinion. We’ve seen some bad places in our travels, and this is by far one of the saddest stories. There were points at which I would have been hard pressed to speak, and Pete pushed us to get out of a few rooms a little more quickly for the same reason.
The 240-bed hospital sees more than 400-500 outpatients per day and handles 50-60 new admissions each day. I’m not sure if that includes the people sitting outside the hospital with IV bags hung from trees?
Each wing has a name plate that denotes the NGO or governmental agency (from all over the world) that have donated, and then later left the hospital, and its director, to try to continue to keep it funded and running… which is difficult to put it mildly and explains in a lot of ways the lack of affect we saw in his face – good people all over trying to make a difference and beaten down by a system that has failed them. The doctors and staff were recently (again) not paid for months and only just started to see some of their salary and pay come through… hence the tendency for all the private clinics.
There is no money for even cleaning supplies. As we walked into the pediatric ward, there was a pool of blood on the floor of the waiting room swarming with flies. 30 minutes later as we walked out someone was using a squeegee and bucket, of what we’ll at least hope was clean water, to wash it into the drain located in the middle of the ward entrance hallway, where a burqa-clad woman holding onto the hand of her barefoot toddler happened to be walking through at the same time.
I have to wonder (among so many other things) what message and “teaching” is really being done here – or can be done here at this time? We’ve certainly seen the possibilities elsewhere, and how a little can go a long way. Now it’s time to cut through the bureaucracy and make it happen. Lives are at stake in more ways than one.
Unbeknownst to us prior to our tour, this was the same hospital that was visited in 2006 by Dr. Dave Warner… I had seen the pictures and saw the piece aired on CBS News… you tell me, which pictures are from today and which are from 2006…. http://projects.mindtel.com/2006/0506.jbad-06/nu-hospital/
Like I said earlier, the children get me every time.
The 240-bed hospital sees more than 400-500 outpatients per day and handles 50-60 new admissions each day. I’m not sure if that includes the people sitting outside the hospital with IV bags hung from trees?
Each wing has a name plate that denotes the NGO or governmental agency (from all over the world) that have donated, and then later left the hospital, and its director, to try to continue to keep it funded and running… which is difficult to put it mildly and explains in a lot of ways the lack of affect we saw in his face – good people all over trying to make a difference and beaten down by a system that has failed them. The doctors and staff were recently (again) not paid for months and only just started to see some of their salary and pay come through… hence the tendency for all the private clinics.
There is no money for even cleaning supplies. As we walked into the pediatric ward, there was a pool of blood on the floor of the waiting room swarming with flies. 30 minutes later as we walked out someone was using a squeegee and bucket, of what we’ll at least hope was clean water, to wash it into the drain located in the middle of the ward entrance hallway, where a burqa-clad woman holding onto the hand of her barefoot toddler happened to be walking through at the same time.
I have to wonder (among so many other things) what message and “teaching” is really being done here – or can be done here at this time? We’ve certainly seen the possibilities elsewhere, and how a little can go a long way. Now it’s time to cut through the bureaucracy and make it happen. Lives are at stake in more ways than one.
Unbeknownst to us prior to our tour, this was the same hospital that was visited in 2006 by Dr. Dave Warner… I had seen the pictures and saw the piece aired on CBS News… you tell me, which pictures are from today and which are from 2006…. http://projects.mindtel.com/2006/0506.jbad-06/nu-hospital/
Like I said earlier, the children get me every time.
April 2, 2009
So we’ve officially been on the road for a short 7 days now, yet it feels both as if a lifetime has gone by and also that it has flashed by in second, too – a mad whirlwind of meetings/site visits, chai (tea), equipment testing, new friends and new experiences. Today we visited the PRT (Provincial Reconstruction Team) to continue connecting all the dots. As we walked in, Sabaghul (age 3) and her father were talking with a local very talented doctor/cultural specialist Dr. X (not putting names in writing) and Capt. Millis, in charge of medical for the U.S. Army at the PRT. What a story this was, and I know we only got half of it… turns out that as Capt. Millis rotated in, he was asked to find this little 3 year-old girl with a heart defect (transposition of great vessels) that the previous rotation had encountered, but lost track of due to the movement of the family.
Well, they found her and were able to link her with the Gift of Life program out of New York, which is paying for her to have another surgery in the coming weeks in Peshawar. Not the original surgery as planned given that she is exceptionally small for her age (she looks to be the size of a 1-year old), but should grant her more time to get stronger. Post-surgical care will be done by the PRT-U.S. Army medical team. Yet another perfect example of how telemedicine can be used effectively to improve overall care and reduce complications, given that everyone would have the same records and information; however, this case will likely just need to stand as an example of the need and potential value, versus an actual case due to some of the political considerations.
After Sabaghul and her father left, we were able to get some additional ground truth on the healthcare system here, and it still keeps coming back to the same things no matter who we hear it from – the great need for additional training and education to build the local capability and capacity – especially in the rural areas where power is available for 1-2 hours/day. The tendency for “drop and run” as I’m going to call it, and no lasting support, REAL education and plan for sustainability on all the “donations of X,Y,Z”, is just staggering.
After that, it was back to the Fab Lab/Taj for Pete to set up the fixed satellite, which finally made it here from Kabul. Happy to report it is now installed, and getting great bandwidth that we can use to dedicate for medical comms. While he did that, I tagged along with Steve and Fary to the La Jolla School (named because of the Sister-City Sponsorship through Rotary) just on the outskirts of city proper. I’ve heard about the school for over 7 years and was excited to finally see it. Nearly 5,000 students grace the steps in 2 shifts – older boys in the morning; girls and younger boys in the afternoon. It does need some repairs following the October 2008 earthquake in Pakistan, which Steve and Fary carefully documented for action. We got to look in on some of the classes, and after a while again, the kids warmed up to us and expected us to go to each classroom. The vast majority of older girls still hurriedly pull their headscarves around themselves to shield themselves from the men as they enter the room. A smile and wave from Fary and I and they do seem to relax a bit – but only just. When it was just Fary and I in the computer lab with the girls, however, they were remarkably freer (but still reserved). Standing back and observing, I did notice that as Fary walked around to each workstation to see the work they were doing, and offered high praise, the next girls down the line, strove to do the same thing and elicit the same praise.
Well, they found her and were able to link her with the Gift of Life program out of New York, which is paying for her to have another surgery in the coming weeks in Peshawar. Not the original surgery as planned given that she is exceptionally small for her age (she looks to be the size of a 1-year old), but should grant her more time to get stronger. Post-surgical care will be done by the PRT-U.S. Army medical team. Yet another perfect example of how telemedicine can be used effectively to improve overall care and reduce complications, given that everyone would have the same records and information; however, this case will likely just need to stand as an example of the need and potential value, versus an actual case due to some of the political considerations.
After Sabaghul and her father left, we were able to get some additional ground truth on the healthcare system here, and it still keeps coming back to the same things no matter who we hear it from – the great need for additional training and education to build the local capability and capacity – especially in the rural areas where power is available for 1-2 hours/day. The tendency for “drop and run” as I’m going to call it, and no lasting support, REAL education and plan for sustainability on all the “donations of X,Y,Z”, is just staggering.
After that, it was back to the Fab Lab/Taj for Pete to set up the fixed satellite, which finally made it here from Kabul. Happy to report it is now installed, and getting great bandwidth that we can use to dedicate for medical comms. While he did that, I tagged along with Steve and Fary to the La Jolla School (named because of the Sister-City Sponsorship through Rotary) just on the outskirts of city proper. I’ve heard about the school for over 7 years and was excited to finally see it. Nearly 5,000 students grace the steps in 2 shifts – older boys in the morning; girls and younger boys in the afternoon. It does need some repairs following the October 2008 earthquake in Pakistan, which Steve and Fary carefully documented for action. We got to look in on some of the classes, and after a while again, the kids warmed up to us and expected us to go to each classroom. The vast majority of older girls still hurriedly pull their headscarves around themselves to shield themselves from the men as they enter the room. A smile and wave from Fary and I and they do seem to relax a bit – but only just. When it was just Fary and I in the computer lab with the girls, however, they were remarkably freer (but still reserved). Standing back and observing, I did notice that as Fary walked around to each workstation to see the work they were doing, and offered high praise, the next girls down the line, strove to do the same thing and elicit the same praise.
Wednesday, April 1, 2009
Jalalabad Adventures Continued... Ultrasound Training & Visit to the Kabul River
So much for the “established program”!… day instead of great spontaneity, starting with an early call to Pete from Dr. Pardes, the Public Health Director for Nangarhar Province, asking that he come back to the Public Hospital by 10AM to demo the 3.5MhZ portable USB ultrasound that we brought along to a group of 20-30 doctors/staff. While there, they actually used the ultrasound to do a demo exam on a child who had been admitted for abdominal pain. Perhaps the greatest take-away though is the hunger and thirst for knowledge and training. That’s the lesson we’ve certainly learned in the past and want to repeat here in Afghanistan… LOCAL sustainability matters, and that boils down in so many ways to training and education.
Following the demo, a crew from the Taj/Fab Lab/Rotary/Synergy Strike Force “surged” to the local Kuchi village down by the Kabul River, where the building of a bridge across the river is in the works… project led and guided by the Jalalabad-San Diego Sister City program out of the La Jolla Golden Triangle Rotary Club (google it). It may be an engineering feat, but it’s a bridge of another sort too…
While the “adults” discussed the bridge and the opportunities/issues, the “kids” got to play… and play we did. Having had this project, among others in the area, in the works for a number of years, the kids are real camera hams – once they warm up. No girls down by the river, but a crowd of boys. It took a bit for them to warm up to Adriana (George Mason U. grad student in Stability Ops) and I, but once they did… wow. We were surrounded with requests for pictures with us, without us, and always, always… to show them the pictures. So much fun and we were laughing a lot. One little boy very much wanted me to take his picture with the notepad I was carrying… and he was adamant that the picture be just him (no small feat because the camera draws an instant crowd of posers). Again… a hunger and thirst for knowledge that we would do well to feed. Maybe medical school and career in telemedicine is in his future?
For a 30 second video from the Kabul River go to: http://www.youtube.com/watch?v=yDxBAlXSKGA
Tuesday, March 31, 2009
Free Rangin...
Today was truly our first “Free Range” opportunity and what a day it was! We went to a brand new CHC (Comprehensive Healthcare Clinic) in the Kama District (VERY impressive 40 bed hospital built for $200,000 – WITH equipment), and a BHC (Basic Healthcare Clinic – no beds, almost “urgent care” like). Hard to describe in words both what we saw, heard, smelled – and the possibilities to truly make a difference. Could have done without riding in the UN ambulance (low profile unmarked Toyotas are really good), but all was safe and good and it did handle the crazy dirt roads to the BHC pretty effortlessly.
Then it was off to the market with Mahrab – total pro at negotiating the colorful busy streets packed with artisan crafts, shoes, food, men, women (most burqa clad), and children – you name it… pretty much there, as we shopped and made arrangements to have new shalwar kamiz’s made. It was so much fun… and almost exactly how I’d imagined it – only better and brighter.
We’re also starting to slowly, but surely (as much as you can in a few days at least), piece together the healthcare “puzzle” here. One of our key theories established prior to our trip was that it would be far better to link Jalalabad with Islamabad/Pindi in Pakistan than to Kabul (both are primarily Pashtun, whereas Kabul is predominantly Dari; many Afghans also seek care in Islamabad; and of course the relationships we established there over the past year as a result of our comms/telemed work there). Theory = PROVED – based on all our meetings and conversations over the past few days.
Over the next couple of days we’ll seek to make the introductions between our new Afghan friends and Dr. Zafar, Dr. Sadia and the rest of the team in Pakistan. Also hoping that we can help to orchestrate reciprocal trips between Jalalabad-Rawalpindi so that a) an operational highly successful telemedicine program can be witnessed by the teams of doctors here, and b) that leveraging the true expertise of Dr. Zafar and Dr. Sadia, a successful regional model can be established. I have a feeling that if all of these incredible people are able to meet, that magic will happen – especially if we can keep the bureaucrats out of it.
Up next… figuring out the best location for the telemed equipment… as of COB today, we are thinking the Fab Lab may be best location until we can arrange a return trip and do a little more training and support. There’s a whole lotta equipment (eagerly accepted) just sitting in boxes, in the basement, etc. of the hospitals here because the support and training infrastructure was not there before well-meaning (blank space - insert name) NGO, government agency, etc. left it. We don’t like repeating the mistakes of others (or our own for that matter)! We also just can’t pack it up now though… as we catalogued everything today on the pool table, we generated more than a little bit of excitement. Beginning to look like that in addition to a spontaneous school, that the Fab Lab may become the next clinic in JBad.
Tomorrow it’s back to the more “established” program, but really hoping not too established, because today was a really great day.
Sunday, March 29, 2009
Kabul Happenings - Day 1
A lot can really happen in 24 hours…so far in addition to surviving Kabul traffic (no small feat in of itself) due to local expertise and TRUE driving skill (us Southern Californians can learn a thing or two here!) … we narrowly missed children, bicycles, goats, sheep, and numerous other obstacles on our way around town, we’ve attended meetings and tours of hospitals and a local Rotary meeting...and have successfully made it to our home away from home for the next week in Jalalabad – and ALL our gear made it. But first about Kabul… what an experience in so many ways (broken down cab story upon request). While picking up some satellite gear purchased from Kabul Net, I was left in the car while Ishaq and Pete went to pay, and was immediately surrounded by children. They say they are professional beggars, so I shouldn’t cave and give, but professional or not I can only take so much of “Please Madam, Please Madam, Please” while I type on a blackberry worth more than most of these kids will see in a year. There’s the one precious little boy who kept throwing the Kleenex he was selling through the open window, the one who tapped on the window for a solid 5 minutes then started imitating a chicken and I just couldn’t help laughing, and the two little girls who chased after our car… I guess I’m just going to add that to the budget. Pete’s actually not much better, although his breaking point is the mothers holding their babies in the middle of the road.
Back to the purpose of our trip … get some “ground truth” on the healthcare “system” in Afghanistan and look for opportunities where telemedicine capabilities can be applied and leveraged. After visits to the soon-to-open privately funded Afshar Hospital and Acomet Hospital (affiliated with Kabul University) … the possibilities are endless – they are committed to healthcare, technology, education and building local capability and capacity, and have movers and shakers at the helm to put it mildly. Lot of synergy here and information to report.
Tomorrow, we’re off to meetings in Jalalabad… although on no particular schedule, because that’s the way it works.
Tomorrow, we’re off to meetings in Jalalabad… although on no particular schedule, because that’s the way it works.
One last quick bit… we were most honored on Saturday night to attend the Kabul Rotary Club meeting, where Dost Mohammad won the prestigious Rotary International Paul Harris Award for his dedicated leadership. More on Rotary and the work they’ve been doing here later (we owe all the smooth trip and connections to them for a start). If you’re interested in joining or providing support to the Kabul Rotary Club, contact Dost at domohammad@mtn.com.af.
Pictures: Picking up the sat dish; @ Acomet Hospital with Kathleen Rafiq and Dr. Goforth; @ Afshar Hospital with Dr. Goforth, Dr. Tim Fader and Dr. Nayeem.
Thursday, March 26, 2009
What is Telemedicine & Next Up on the "Tour"?
Telemedicine is broadly defined as the use of technology to support the delivery of medical care over geographic distance. The increasing availability of Internet connectivity and portable, low-cost laptops and medical devices make it possible for the developing world to benefit significantly from telemedicine, where it has the potential to increase access to healthcare in rural and remote areas; provide care to mobile or evacuated populations; and increase the efficiency of physicians in urban areas.
In the most common practice model, physicians (or other healthcare providers) carry a compact tele-clinic with them. When they encounter a patient who would benefit from a consultation with remotely located senior or specialist physicians, the tele-clinic equipment is used to collect and transmit relevant clinical information. The foundation of the tele-clinic is a laptop computer; medical devices that may be included in a tele-clinic include EKG, respirometers, and digital cameras equipped for a variety of uses, including ENT and dermatology photographs. Data collected from these devices is automatically included in a referral request, while clear, Web-based interfaces guide physicians in the collection and reporting of other clinical information, such as history and symptoms.
Next stop: Exploring Telemedicine Possibilities in Afghanistan... Estimated date of Arrival - March 28, 2009 (Kabul), March 29 (Jalalabad)...
In the most common practice model, physicians (or other healthcare providers) carry a compact tele-clinic with them. When they encounter a patient who would benefit from a consultation with remotely located senior or specialist physicians, the tele-clinic equipment is used to collect and transmit relevant clinical information. The foundation of the tele-clinic is a laptop computer; medical devices that may be included in a tele-clinic include EKG, respirometers, and digital cameras equipped for a variety of uses, including ENT and dermatology photographs. Data collected from these devices is automatically included in a referral request, while clear, Web-based interfaces guide physicians in the collection and reporting of other clinical information, such as history and symptoms.
Next stop: Exploring Telemedicine Possibilities in Afghanistan... Estimated date of Arrival - March 28, 2009 (Kabul), March 29 (Jalalabad)...
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