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…

"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.

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.