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…

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

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.

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.