My Last Day in Kabul

August 18, 2009

Kabul

We submitted our report yesterday and are just now working with the minor changes. So as we listened to another day of IED explosions, suicide bombings and RPG's Dr. Hamidi and I sat in the compound garden and talked about the real challenges in the Afghanistan health picture. This man is the most heroic person I have ever met. Every Thursday he puts on his turban and drives to Helmond to work in a womens' clinic. He get's paid $200 a month for his work and never complains.

As much as I am proud of the work of USAID, The US Human Terrain System, ISAF and the American technical advisors, I am humbled by the non-stop determination of Afghan doctors.

I'm too tired to write anymore tonight and I need to go to bed now - to prepare for a wild ride the the airport. But suffice it to say, I am almost in tears when I think about the grace and dignity of the Afghan people. We must continue helping them.

Amy, Carmen & Christi ... you did not die in vane. The Afghans will always remember you. So will I.

So Why DOES Social Marketing Always Look Like S*#t?

August 16, 2009
Kabul

After six weeks of reviewing the basic package of health services, the emergency package of health services. the management structure of The Ministry of Public Health, The Pharmaceutical procurement process. the financing mechanisms, the service delivery gaps and the strategies for communicating with the Afghan people about healthy behavior I have come away with these thoughts.

1. There are too many dis-connected health projects in Afghanistan.
2. There are too many pissy, strident consultants rolling out bizarre ideas that are not sustainable and render no results.
3. The Ministry of Health is over-burdened with the management of all these projects and ex-pats.

How the Ministry of Public Health manages to deal with 34 country programs and three major donors is a miracle. My strong suggestion is that all health communications, be it product-driven social marketing or behavior change public health communications, should fall under one roof - with one advisor. Full stop.

As I listened to an annoying World Bank advisor describe their dumb-ass idea of disseminating micro-nutrient "Sprinkles" (crushed-up vitamins) and UNICEF cookies to combat malnutrition I wanted to pound my head on the table. Mercifully the Minster of Health spoke up and said, "Uh ... that's a clever idea, but Afghanistan cannot be eating UNICEF cookies for eternity, could we please think about somehthing more sustainable..?"

And today we are finalizing our report. We have intentionally kept our project design to 30 pages. The other team members are writing 200 page documents ... 200 hundred fucking pages??!! My team of Afghan doctors have spent the day laughing our heads off about how public health professionals are miserable communicators. But it's all been great fun. And this afternoon I submitted my team reports - with a one-page summary of all 430 pages. In exchange the Minister of Public Health presented me with a beautiful hand-made traditional Kuchi dress. I'll take photos tomorrow. Tonight I need to get some sleep.

Kindness and Love

Saturday, August 15th
Kabul

Today my bedroom windows were blown out by an enormous car bomb that blew up near our compound. Two people are injured, but mercifully nobody was killed here.

After the initial blast, we began cleaning our rooms. It was very, very quiet.

My colleague Dr. Hamidi brought is adorable little 4-year old daughter Shigufa with him today. Shigufal is suffering from congenital heart disease and we are all trying to get her to Omaha to get much-needed open heart surgery. So in the aftermath of this horrible bomb, we just relaxed with her. My beloved friend Poya said, "Please ... get us out of here ... I am sick of all these bombs ... let's just have love..." I think these pictures say it all -that and the sound of little Shigufa taking a nap in my room while Beauty & The Beast is playing on my television.

As I think about this perverted Taliban ... I can't imagine how or why they are here. They are not Afghan.

When the going gets tough ... the tough go Shopping

Friday, August 14th
Kabul


I woke up at 4:30 am to the sound of another missile flying overhead and then a giant KA-BLAM! It sounded like it was across the street. In fact the Taliban blew up their own stupid out-post on the other side of town. But within minutes there were F-16's flying over head and roar of helicopters whizzing by. It sounded like Armageddon. Yeesh ... I rolled over and went back to sleep.

Fridays are our day off. So I had a good lie-in. I woke up late and wandered into the other building to make toast and fight with the coffee machine. Finally Delip Sen wandered inside. He is the Indian Special Forces guy who is generally in charge of all security. He's the most peaceful person in the world. But I've also seen him draw a knife so fast it made my head spin ... so I know he's on his mark all the time. But this morning was very hot ... like 110 degrees hot. We are all bored shit less with this lock-down. So Delip said, "Sir" (He always calls me Sir) ... I think I need to take you sir to the shops at ISAF ... I think you had better get out of here ..." I almost kissed him on the lips.

So off we went to go shopping again. Me and Delip and his knife and three armed guards - a lead car and a follow-up car. I love shopping. But as we flew around check points at 90 miles an hour I realized I've crossed some kind of sanity line when it comes to shopping. As I bobbled around in the middle of the back seat with two battle-rattle guys flanking me I sort of thought ... "what the hell ... I always told people to bury me in a Neiman Marcus bag. So if I go down, I'm going down shopping.

Anyway, Delip bought his wife a beautiful necklace and took a photo of me. Then we went for ice cream ... While the marines were inside the ice cream place ordering the most delicious grape ice cream I've ever eaten, I took this photo of Delip.

Funny How the Brain Works ...

Tuesday, August 11th
Kabul


Today we heard non-stop gunfire and fighter jets flying overhead all day. It isn't Taliban shooting. It's ISAF and Afghan police in target practice next door - preparing for the election next week. Still the sound of nonstop gunfire has a numbing effect. This kind of stress causes adrenaline highs and a survival instinct to shut down and sleep. My team is on a critical path to finalize our design documents. But the stress is outrageous. It's a funny thing how the brain works in this kind of situation. We all want to sleep ... all the time.

I'm trying to get my own work done right now so that if shit really does hit the fan next week and I am wigged out with adrenaline and fatigue at least I don't need to work on my report at the same time. I find myself doing the weirdest things when this nervous energy takes over ... like going to the roof and looking at the sky or taking photos of myself in the mirror. Yeesh ... I need to continue with my report.

Easter Burkas

Monday, August 10th
KABUL

Today was another interesting day.

I am conducting repeat meetings with The Ministries of Public Heath to corroborate my recommendations. So this afternoon I met with a brilliant man named Dr. Tawab Kawa Saljuqi. He is a medical doctor and the Director of The Health Behavior Unit. His unit is responsible for determining what the public health issues "are" - and then figuring out how to develop campaigns. But, by his own admission, the capacity in Afghanistan for doing good social marketing or health behavior campaigns is week. Adding to his challenges, he has to manage consultants from The U.S, The U.K.. Australia, Holland, Poland and Canada. All of these short-term ad visors storm in with wildly different ideas. So today I suggested we strip his office of the responsibility for rolling out campaigns and focus it on managing health behavior data and research - and then form an in-ministry "agency" that will develop campaigns with the assistance of qualified international experts. He practically kissed my feet.

After the meeting my team and I went out to do a bit of handi-craft shopping in the yard. Because security is so tight, the shop-keepers set up a kind of bazaar in our yard. They brought amazing items - including brightly colored burkas for the "American Market." So my team of medical doctors got a bit punchy and decided to dress up in traditional garb. We laughed our heads off. Our chief epidemiologist is wearing the pink burka in this photo. The most heroic doctor I've ever met (Dr. Hamidi) is wearing the turban. Dr. Nazir Asif is dressed like Shah Massoud and my dear friend Khan Mohammed Poya is wearing the Hamid Karzai hat. I'm standing in the middle with my beloved Burka over my head.

I've come to love this team. They are the most intelligent, well-mannered, heroic people I know. I adore them and I adored today. It was so much fun to laugh and dress-up and let loose a bit. I will miss them.

Human Terrain System

Saturday, August 8th
Kabul

I am really wiped out today - from a long, arduous weekend of field work and assessments. One of the biggest challenges here is determining how to incorporate a counterinsurgency (COIN) strategy into social marketing and behavior change communications for health. USAID and the Military are not speaking - at high levels. But those of us on the ground are compelled to do something. We're also contractually obligated to do something to work together.

I've been working with the US Army Human Terrain System - it's a controversial pilot project that embeds social scientists and aid workers in with the troops - to train them on community development and to sensitize the troops to cultural issues. The initiative is led by Steve Fondacaro (on the left). Like me, Steve is driven to continue his work because, like me, he lost three beloved colleagues here. He wears their name bands on a his wrist at all times. By stark contrast, Management Sciences for Health has taken down the photos of my three colleagues. When I made a visit to their office and asked where their photos were, they shrugged their shoulders and said, "..somebody probably has their photo in a box somewhere ..."

Steve wants to carry on the legacy of his colleague Paula Lloyd, Ph.D. - who was passionate about women's rights in Afghanistan. Dr. Lloyd lost her life last January after she had been doused with gasoline and set on fire by the Taliban. Steve is determined never to have that happen again. So he keeps a vigilant eye on me. He left the compound today for his home leave. But the big guy on the right - Mac is staying across the hall from me. Funny how underneath all the battle rattle these are super nice guys. God be with Dr. Paula Lloyd. And in spite of Management Sciences for Health atrocious dismissal of Christi Gadeu, Carmen Urduneta and Amy Neibling - they have not been forgotten either.

Social Marketing - Literally

Wednesday, August 5th

Kabul, Afghanistan

Today we were liberated from lock-down. Half my team went to USAID to make their initial presentations. But my colleague, Dr. Asif Nazir and I stayed behind to review our final report on social marketing. I noticed he was a bit quiet. Finally he said, "Susan, I got in a big argument with my wife last night and I need to fix it before I can do any work." When I asked what we could do he smiled at me and said "SOCIAL MARKETING"

So Dr. Asif, Farhid the IT guy and a bodyguard jumped into the jeep and headed back to Ganjina. Farhid has a crush on the designer who is making my jacket and Dr. Asif wanted to buy something for his wife. So Farhid was dressed in a very handsome suit. He was determined to get this designers' telephone number. While I was being fitted for my jacket Dr. Asif was looking through the racks for his wife and chuckling about how we need to leave Farhid in the designer salon - under the false pretense of representing my need to get the jacket done quickly. So after my fitting we faffed around the rest of the shop while Farhid set his sites on Wajda, the incredibly beautiful fashion designer. After about an hour Dr. Asif whispered to me "God, I wonder if he is proposing marriage to her in there ..." Even the body guard was laughing. So I poked my head in designer salon and found Farhid being fitted for a jacket. You've never seen a happier IT guy in your life.

And personally, this was the most enjoyable social marketing experience of my life. I didn't want to spoil it by taking any pictures of Farhid and Wajda just now. So I can just show you what I'm having made ... and stay tuned for the photos of Farhid in his suit.

42% of the Afghan Parliment is Illiterate

August 4th, 2009

Kabul, Afghanistan

Today we dodged eleven in-coming Taliban missiles. Nine of them were directed toward the airport. One was at the U.S. Embassy and one went right over our compound and smashed into the building across the street. I cannot even think about this - so I'm re-directing my thoughts toward the big development picture.

The Afghanistan governing operations budget relies on over 75% of it's resources from international donors. The World Bank, The EC and USAID are the biggest funders. But there are over 34 separate countries offering money as well. This means the Afghans don't really own their own government. It belongs to an international community of donors. But the Afghans are all uber-trained and trying to run their own country. Even today, they cannot fight the Taliban themselves. The International Special Forces are in charge.

As the United States uses Afghanistan for it's political football the Afghans suffer. For example, USAID poured almost $1 Billion Dollars into a massive rule of law project. This project balanced tribal/informal with formal, centralized justice systems. USAID built courtrooms, courthouses and provided massive technical assistance in legal systems. But now Holbrook wants to re-direct all US funding to the Eastern & Western conflict areas and to focus on strengthening tribal justice systems. Ambassador Eikenberry wants to focus our efforts only on a formal system. So the entire project has shut down. No court system is in place now. You don't need much of an imagination to think about the consequences ... particularly right now with vicious warlords and Taliban fighters shooting in the streets.

But the US is actually the most organized and strategic partner for Afghanistan. The French have a wheat seed give-away program. They offer French wheat seeds all over the world. So while the U.S. is working on a complex alternative crop program to find ways of offering an alternative to Poppy production, the French are dumping wheat seeds all over Afghanistan. This French wheat has sterilized the indigenous Afghan wheat and other crops such as saffron crocus. So we are working at cross-purposes. But try telling that to the French. The British government is funding technical assistance to the Ministry of Finance. They are working very hard to provide assistance to the Afghans in managing the donor funds and generating return-to project funds. Then there is the World Bank. Don't get me started here. The World Bank strategy is to offer loans to governments. Big loans. These loans go directly to the government. We hope. Most of the time they pay for Land Rovers and houses for corrupt government officials. But try telling that to The World Bank. They become very strident and arrogant about what they refer to as a 'humane' way to create SWaP (A System Wide Approach for donor funding). Their incredibly high priced consultants fly into countires (first class of course) ... and stay for about a day ... long enough to swan around the people they've just given money to and to show how cool they are ... and then the fly back to Washington D.C. - by way of Geneva or Prague or some place where they can give a big speech about development in Afghanistan.

To top it all off, 42% of the Afghan Parliment is illiterate. While this International Theater of the Absurd is swishing around Kabul, the poor Afghans have to deal with basic issues like knowing how to read. As ironies abound, the young generation of twenty something Afghans have surfaced and are running the country. They are the translators, the writers, the teachers, the assistants and the diplomats, the journalists, the economists and ... they should run the country.

Look at These Afgans ... and Stop Worrying About Your Feet!

Kabul

I had a frustrating day. My feet are cracked and dry and permanently dirty. No matter how many showers I take I am always filthy. Kabul has no clean sewage system. So the best we can do is add chlorine in our water tanks. But the fecal content of the water is outrageous. So even when I turn on the shower it smells like poop.

Meeting with my American colleague today didn't help. They are in analysis paralysis and have begun snarling at each other. Their 'debates' have taken on a nasty tone. A funny thing happens to ex-pat consultants in the field - particularly in war zones. At about the third week everyone starts snapping. The slightest thing triggers an argument. I know for me, I've suddenly become pissed off about the weird crown molding in my room. The fact that I'm hot-flashing every fifteen minutes, I have had diarreah since I arrived, my feet hurt, I'm dressed like a sack of potatoes every day and am followed by heavily armed guards doesn't help. But really, I feel a bit off today.

By stark contrast, the Afghans here continue on like gracious, articulate, gentle, humanitarians. We must seem like the Keystone Cops to them. I mean look at these guys! Poya and Omer continue coming up with creative ideas for how to end domestic violence. They translate all our meetings, write our Power-Point presentations, schedule our meetings and basically do everything. And they get paid peanuts. Yet they remain positive hopeful and professional. Every time I think about my stinky feet and the poopy water I need think about these lovely young Afghans. They show up clean, calm and well mannered every day and they go through immense challenges every day here. I hope tomorrow brings a new perspective.

A New Generation of Afghans

August 2 - 2009
Kabul

The three young Afghans in this Photo - Poya, Fadima and Omer have dedicated themselves to re-building Afghanistan. They have formed a non-profit organization called Kind Hands Strong Village which is dedicated to ending domestic violence and violence towards women in Afghanistan. The following is their mission statement.


KIND HANDS – STRONG VILLAGE

OUR MISSION:
To publicly honor women and girls of Afghanistan, to train boys and young men in gender equity, to end domestic violence in Afghanistan and to foster leadership in a new generation of empowered, tolerant, productive Afghan citizens.

WHO WE ARE & WHAT WE BELIEVE IN:
We are Afghan men and women who were born in the mid-1980’s – into a country at war. We have seen the atrocities of Russian occupation followed by the devastation of Taliban rule – which perverted Islam into a crushing blow against basic human rights. We survived in tact. But many of our friends, family members, countrymen and women did not. The emotional fall-out from years of abuse toward women has left a physiological scar on our country.

While we are re-building the infrastructure for providing a basic package of health services to everyone in our country – social norms still dictate that many women cannot receive healthcare from a man. In fact most Afghan women don’t seek healthcare at all. And while it is now legal for girls to go to school, many don’t because they are afraid. In rural areas of Afghanistan many girls and women don’t even know they have basic human rights. They’ve simply given up. Suicide is pervasive amongst girls and women who feel they have no way out of abuse. We want to change this.

While we support organizations that ‘empower’ women, we believe there will be little positive impact until men make a public stand of support for girls and women. We respect the teachings of the Holy Koran – and we know Islam is a tolerant religion based on dignity. We reject the teachings of violence in any manner. We dream of a country where girls and boys, women and men can live with freedom and dignity.

We are committed to personal growth, education and peace for everyone. We want to re-claim our heritage, re-claim our culture and help re-build the dignity of our girls and women to their rightful place.

I've Worn Some Crazy Things In My Life ...

August 1, 2009 - KABUL


Oh... I have a Burka now. It's a crazy kind of hat really.

Chicken Street

August 1st, 2009
Kabul, Afghanistan

My draft design is completed and I'm waiting for comments from State and USAID. The rest of my team seemed to be in a bit of a funk today - arguing with themselves and banging away at their computers. After about an hour of offering help and faffing around my Afghan colleague, Dr. Arslan and the chief security guard (and former Indian Special Forces Officer) named Delip and a body guard and I took off for "Chicken Street" in downtown Kabul.

Chicken Street and Flower Street were named by former Peace Corp volunteers in the early 1960's for their colorful displays of .. what else .. chickens and flowers. But over the years these two streets grew into a sort of souq/bazaar - full of antiquities shops. Today you can find opulent silks, sparkling Afghan rubies, Persian and Afghan carpets, fur hats and coats and loads of Pashmina from the Kashmiri dealers.

Delip and I had a blast going in and out of the shops. I speak Farsi fairly well, so it's always a surprise to the locals. This afternoon an adorable kid was trying to sell me a polyester scarf for forty dollars. He was shocked when I asked him in Farsi why he was selling plastic shawls at that price. But he rallied back into form and pulled out a selection of luscious Pashmina. In the end, I didn't buy anything. But Delip went back in the shop to buy the scarf for his wife.

We returned to the compound to find the entire team asleep in the blistering sun. Poya told me they had gotten into a huge argument and then collapsed with their coca-colas. Poya says this kind of thing happens all the time with ex-pats. So while the team snoozed we looked at the little purchases from Chicken street and continued talking about the program to end domestic violence in Afghanistan. Stay tuned for more details on this!

In the mean time let me know if anyone wants a Pashmina shawl!

Sent for Carpets ...

Friday, July 31st

Kabul, Afghanistan

For security reasons, we are stuck here on the compound. So I asked the guards to drive to Ganjina and pick up the two carpets I had on hold. What do you think?

I'll Take These Guys

Thursday, July 30th

Kabul, Afghanistan

As the only woman on my project team I had sort of expected, perhaps delusionally, that my colleagues might be looking out for me here. I sort of imagined a kind of chivalry from them. They are an extremely nice bunch. But whenever we have a meeting in downtown Kabul my Brooks Brothers suit-clad colleagues dash out of the jeep faster than you can count to three. They form a sort of impenetrable clump while scurrying into the building - leaving me out on the street struggling with my head covering and holding all the documents. The Afghan bodyguards are also usually scratching their heads when they see the blur of gabardine dash away from the jeep. I mean how weird is this? Here we are rolling out programs to empower Afghan women, provide healthcare to Afghan women ... and basically inferring that most Afghan men are animals. And here I am shoved in the back seat of a jeep with my bodyguard while all my male colleagues ignore me. I imagine they are probably nervous - trying to act like this entire life of machine guns, bodyguards & burkas is somehow normal. My Afghan guard, Zia treats me like a friend and a lady. So when the colleagues flee the jeep I always have Zia. But still, it's weird.

Today we are on high alert for suicide bombers. Our compound Security Manager, Mike is a drunk. He sent me a cryptic email saying I should be on high alert for a " Female BBIED". Huh?? What on earth is that? Babe-in-a-Burka? He refused to tell me. Mike just snarls at me or sits like a totem pole when I ask him anything. On my last day here I intend to call him a jack-ass. But for now I need to figure out how to survive this fool. Mercifully I also have a new detail of ISAF (International Special Forces) and a friend in Washington D.C. who calmly explained BBIED means body born improvised explosive devise. Lovely.

Well at least I have a clear explanation. These three ISAF guys: Steve, Mack & Mike are very nice and very big. Huge in fact. But despite their hulking physique - they are absolute gentlemen. They treat me and Zia with respect. God only knows what they think of our security manager.

Meanwhile the Brooks Brothers brigade is figuring out how to go to the mens'-only golf course in Kabul tomorrow. Mike the security manager made up some bullshit briefing about how the western part of the city was off limits - except the Kabul golf course - and ordered me to stay on the compound and cook. If you hear of an American casualty from a frying pan to the head injury don't be surprised.

I remain impressed and humbled with how the U.S. troops are always so professional and respectful. If the Beltway Bandits had a fraction of the professional commitment of the U.S. military we'd be making headway. I personally think most Afghan men are nice. I think they like to see officers and gentlemen. But then again, it's late on Thursday night and I'm pooped and I have to figure out what to cook. Pigs- In- A- Blanket I think.

Today at Ganjina

Wednesday, July 28th

Kabul, Afghanistan

Today I am at the halfway point in my project. I finished my draft, submitted it to USAID and then went off to meet with someone at The World Bank. It was liberating to go off in a small, un-armored car with just a driver and a body guard ... and not a caravan of guns. I pulled into the World bank compound, which is beautifully manicured, and for the first time in three weeks, was able to stand outside in the warm summer sun ... feeling the breeze on my hair and listening to birds. I felt like a liberated hostage. I didn't want to leave.

Instead of returning back to the compound after my meeting I asked my driver to take me to Ganjina.

Ganjina is a beautiful craft center tucked away in Kabul. We drove to the gate - went through the usual check for bombs under the car and were ushered into a magnificent garden ... roses, fish ponds, canaries, pine trees and a wonderful grapevine orchard - all leading into a 200 year old building that serves as a showroom for wonderful handmade fashions and crafts. I went inside and tried on sumptuous silk clothes. My bodyguard tagged along ... and seemed to be enjoying himself. He's quite the fashionista. Honestly, he helped me pick out fabric for a wonderful jacket ...and then I selected the silk for embroidery. We left the driver snoozing under the grapes ... with my camera. He took this photo.

It was nice to feel normal today.

KIND HANDS - STRONG VILLAGE

Tuesday, July 28th
Kabul, Afghanistan

... In life there is male and female. You need both to make a balanced world. If the right hand is man and the left hand is women - then Afghanistan has had it's left hand tied behind it's back. The right hand can't do everything. It thinks it can - but it can't. It can't even wash itself. In fact without allowing the left and right hands to swing freely the whole body is off balance. So the left hand needs to come out and be whole and free - to let the broken right hand repair itself ...

My young colleague Khan Mohammed Poya approached me the other day with an idea for forming a non-profit organization dedicated to ending domestic violence and promoting respect toward women. He feels as an Afghan man, that unless young men are taught to respect women - that all the 'gender' projects in the world will be meaningless. He wants to have a camp where boys between the age of 8-14 (an impressionable age in any culture) will come together to learn about tolerance, respect and leadership. He loves the "SEEDS OF PEACE" program and wants to so something like to promote respect towards girls and women. So he asked for my help.

I drafted a Delphic outline for what a not-for-profit organization might do ... with a mission statement. But then I asked my sister to think of a good name. She and Poya have been communicating on-line for the last three days. The finally agreed on the name KIND HANDS - STRONG VILLAGE.

Poya and his friend Omer are thrilled about this. They went out today and registered the company as an NGO and have created a board of directors and are organizing meetings with medical doctors, teachers and other stakeholders. I am so impressed with them. Thank you Poya ... for getting your idea out!

Let's make this happen!

White Hats

Monday, July 27th

Kabul, Afghanistan

Taliban turban. Need I say more?

Malnutrition Means Many Things

July 26, 2009

Kabul, Afghanistan

In Afghanistan today one out of every four children dies before they reach five years of age. These are the worst health indicators ever recorded. Most mothers are malnourished and therefor cannot produce breast milk. Salt is not iodized. There is very little access to fresh fruits and vegetables in most of the country. To roll out a vaccination program here requires three times the normal dosage of vaccines because nobody has a strong immune system.

Yet strangely childhood obesity is on the rise. Obese children are still usually malnourished here. However there is a program through Save the Children-USA and various NGO's - to educate children on healthy eating and hygiene. A little magazine called PARVAS is disseminated to children throughout the country. These children take the magazine home and read it to their parents - and together they are all learning to read.

How strange that Childhood Obesity is happening everywhere in the world.

Figuring Out Who the Bad Guy Is.

Thursday, July 23rd

Kabul, Afghanistan

Meeting with the coordinator of the provisional reconstruction teams for USAID today was a bit disheartening. The rift between the U.S. Military and USAID is so thick you can cut it with a knife. As metaphors prevail, it turns out there is a quiet little Afghan organization trying to get the message out to villages about how not to be afraid of U.S. and Afghan military. The little brochure they produced is simply called "COMMANDOS." It is a low-literacy brochure that describes how to work with military to root out the Taliban.

I wish there were a little brochure designed for USAID and The U.S. Military to figure out how to get along.

A Courageous Young Leader in the Fight to Improve the Quality of Life

Wednesday, July 22nd
Kabul, Afghanistan

We convened a round table discussion today with a number of non-governmental organizations (NGO's). Organizations such as Save the Children, The Agha Khan Foundation and Marie Stopes International were at the table. It was a lively debate about what's needed to improve health care in Afghanistan.

The more I am here the more impressed I am with the Afghans who are working tirelessly to improve their lives. The program director for Marie Stopes International, Mr. Farhad Javid was absolutely passionate about getting quality reproductive health care and contraceptive supplies to Afghans. He was equally passionate about working to end violence toward women. As I listened to this articulate, organized, courageous young man describe how they are working with all social (and anti-social) sectors of Afghanistan I was inspired. He has managed to get reproductive health and family planning information into schools, mosques, beauty salons, pharmacies, jails etc. etc. He is also determined to match the distribution of contraceptive supplies with a campaign to promote gender equality. His charisma was infectious. Everyone in the room was engaged.

This is good!!

Systems are Inadequate to Judge Human Contact

Tuesday, July 21st
Kabul, Afghanistan

In spite of angry street protests from women and men in Afghanistan last winter, the Afghan constitution still includes a Sharia law that forces a women to succumb to sex on the demand of her husband or a family elder. At the dismay of many international observers, myself included - President Hamid Karzai supported this insane law.

So as we work through the re-design of a national health system - and evaluate the basic package of health services as well as the social marketing and behavior change communications strategies, I am struck by the fact that we can get no where if the constitution essentially makes rape legal.

As the only female member of my design team, I am also struck by how insensitive my American colleagues are to this issue. When I mention this enormous obstacle in the context of our enormous goal of improving maternal-child health I am met with a wall of cynicism and smug laughter about how this is a cultural issue. When did I miss the memo? I thought literature, music, architecture and art were cultural issues. I've always thought rape was a crime. If we development professionals continue turning a blind eye to the basic human rights of women we won't get anywhere - particularly when it comes to improving the health of women.

There is a functioning Ministry of Public Health in Afghanistan. It has received over $34 Billion dollars in assistance since 2001. It has a functioning health information office, an office of pharmaceutical management, and office of healthy behavior, an office of community health, an office of monitoring and evaluation, an office of infectious disease control and many other offices. But nowhere in the entire infrastructure of the Ministry of Public Health is there an office to deal with domestic violence. It is not documented - therefor it does not officially exist.

Three days ago my translator, a young intellectual man named Khan-Poya invited me to meet with the director of health at the Ministry of Women's Affairs. It was a compelling meeting. First of all, this health director is a female medical doctor - rare in Afghanistan. Secondly, she has managed to get herself on the public-private sector coordinating office advisory committee of the Ministry of Public Health. She believes the only way to role out a campaign to deal with violence against women is through the private sector. I have promised her my help.

The third compelling component to the meeting was that my translator feels so passionately about this issue that he wants to form an organization to raise awareness and funding to support gender equality. As the health director and I talked about the disturbing case-load of injured women she sees every day in her practice, I noticed Khan-Poya had tears in his eyes. He clearly finds this situation intolerable. I don't blame him.

Today I am taking a break from my team and all the field visits. I need to sit and write and think about this issue. I am reminded of a saying that an old college English professor had - " ... systems are inadequate to judge human contact ... "

Never has that expression been more meaningful than here in Afghanistan. We can push forward all the health systems in the world, but until we deal with human contact -- how people treat each other -- we will get nowhere.

What's right for Afghanistan - Should be defined by Afghanistan

July 16th, 2009
Kabul, Afghanistan

Answering the question of why international social marketing so often looks like s--t - as my former assistant so delicately put it, would require a universally understood definition of the term. In the United States the term 'social marketing' is often used to refer to any campaign that promotes a positive social message. For example, Ogilvy Public Relations uses the term 'social marketing' to describe the RED DRESS campaign which promotes heart health awareness. This campaign has inspired and educated millions of people - and generated millions of dollars for research. Another "Truth" campaign that disseminates the facts of smoking is also called social marketing.

Here in Afghanistan the term 'social marketing' has a very, very narrow definition - driven in large part by the specific service offerings of an American contractor who has the largest social marketing project in the country. They define social marketing as a commercial market strategy for aggressively selling condoms, contraceptive products & oral re-hydration salts - and for strengthening the private sector. By this measure it is hard to determine actual behavior change. The focus is almost entirely on sales - which infers use. But again, the focus is on selling products not on changing behavior per se.

We are tasked with reviewing the entire USAID health portfolio and designing a new five year strategy. So we're trying very hard to be objective and to think outside the box. But we have our biases. We are a good team of specialists in health financing, pharmaceutical management, governance, systems and social marketing - defined broadly and narrowly. I think we need to focus on getting out dynamic messages about healthy behavior. My colleague thinks we need to focus on selling products, pumping up a private sector - and not worry about training. But that's just the banter between a group of ex-pats trapped on a project compound.

By stark contrast, the Afghans at the Ministry of Public Health who have been the recipients of over $34 billion dollars in AID over the last seven year have a much broader world view and are more interested in tailoring a holistic behavior change communications and social marketing strategy that works for Afghanistan. They receive funding and assistance from over thirty donor agencies and have many creative ideas for how to influence behavior in their own country. But USAID is the biggest donor and the firm with the social marketing contract is determined to force private-sector strategies into the Ministry of Public health - allegedly to create competition in the market and to diversify funding sources for health communications. In many ways this is smart because the international community is not going to be able to sustain the current level of aid to Afghanistan indefinitely.

But the Afghanistan constitution states that all health services are free - including contraceptive services. So forcing a private sector model into Ministry of Public Health is creating problems. These problems are not just with the Afghans at the Ministry of Public Health - who are burdened with managing many international donor programs. But the 'market' (if you can call it that) is confused about why some products are free and others cost money.

As big USAID government contracting firms jockey for new USAID contracts the debate about best strategies for sustainability becomes even more ferocious. I personally hope the Afghans win. But this means they need to step forward and tell us specifically what they want and how they will manage it.

Hopefully there will be some new, fresh talent at the table for the next round of behavior change and social marketing contracts. I worry that too much of this important work in re-building Afghanistan is driven by the cut-throat strategies of competing government contracting firms. It isn't easy to roll out a project in Afghanistan, but it isn't impossible either. The cronyism amongst USAID contractors is disturbing to me. Afghanistan has a new generation of determined, courageous young people who are re-building their country. America is a great partner. America also has, arguably, the most talented pool of advertising, public relations, communications and marketing professionals in the world. In spite of the negative side effects of consumerism, Americans can sell anything. So why keep this industry out of the picture in Afghanistan? - where the need for smart, creative, professionals is crucial.

Chopped Up Provinces - Little Lessons

July 14 - 2009

So I'm in a meeting today with the Ministry of Health in downtown Kabul. His Excellency is telling us that the most valuable thing we can offer them as a project that covers the entire country - vs. the way things are now.

To my shock (and I don't know why I should be so shocked given the bizarre revelations each day) the country of Afghanistan has been chopped up into quadrants of coverage by donors. There are 34 countries and over twenty international donors offering help with health in Afghanistan. For example USAID covers thirteen provinces and has the largest portfolio. The World Bank covers X provinces and the EC covers X provinces. None of the donors are coordinating efforts. How in the world is this poor Ministry of Health supposed to develop a basic package of health services and products when so many ad visors are giving different directions? On my team alone there are two Australian economists, One Scottish public health specialist, a Sri Lankan monitoring & evaluation specialist, a Dutch behavior change specialist and three Americans who specialize in maternal child health, pharmaceutical management and social marketing. Even our team has it's divisions on how to solve things.

So what to do.

I think the best thing I can do now is to facilitate dialogue between team members and reach out to the donors on a coordination effort.

The social marketing efforts here so far have been excellent. But there is so much more to do.

Our team has grown to 10 ex-pats. Three women arrived last night. They seem to have some turf issues - that are a bit of a side show. Today they insisted we all wait for the driver outside the compound of the Ministry of Health - in the middle of rush hour traffic ... all of them un-covered and laughing about how dangerous it was to be out there. I'm learning an interesting thing about myself - which is to trust my instincts. This kind of behavior is very dangerous and I have nothing to prove now. I don't want to make a statement about anything. I just want to do this work safely. So I will simply wait for my bodyguard and a car and let these women do their own thing. If they want to wear sexy clothes and stand in the streets of Kabul - fine. I just want to do this work in a manner that is respectful to the cultural norms, doesn't put the body guards, the drivers, the translators and the colleagues at risk - and I want to feel calm. So in a strange way, these little challenges all day long are a learning experience.

Oh .. also I am taking a kind of yoga calisthenics class each morning. Our security manager is a former general in the Indian Special Forces. Each morning he does a 1 hour class. It has done wonders for me. Now my clothes are all too loose!

Competing Objectives? .. Or Just a New Paradigm

Sunday, July 11 - 6:05 am

Counter Insurgency vs. Sustainable Health Outcomes

is this the way to think about our goals here? Or are the provisional reconstruction teams who have so much money, who work fast and are looking for immediate results offering something valuable to the effort at getting a sustainable health system.

The Afghanistan health picture is a challenge. It is a wicked problem with more than one cause and more than one solution. Not only is there a rift between Afghan tribes, but the donor community is divisive. The Military community is divisive and everyone agrees there is a need to coordinate efforts - but they don't. Add to it the rogue charity groups who don't want to coordinate with anyone - who simply want to roll out their own plans ... and what does Afghanistan have?

If we can think creatively about what is good for Afghanistan - and who is good at what -- there is hope. Well, there is always hope. God knows the Afghans are the definition of hope.

But perhaps there is hope for a new paradigm - a way of working together. Today I am setting out to meet with other projects. other donors and other stake holders. Wish me luck.

Starting our Work - Remembering my Colleagues

July 11, 2009 - 1:20pm / Kabul, Afghanistan

After a restless night of non-sleep I managed to get myself to the fitness room in the other building of the compound. If I can get a routine going it will be great. There is an Indian guy here who leads a yoga session every night at 6:00pm. I think I'll go.

Today we had our planning meeting with USAID. It went extremely well. They are asking us to be smart and creative in our recommendations and project design. I'm so excited about this. The Afghans on our team are amazing. We have three doctors on the project who are smart, strategic, organized and visionary. They have great ideas and are committed to finding ways to get immediate help to those who need it - and are determined to an approach that will be sustainable.

I spoke with our Afghan USAID contact about my late colleagues. He took me to a special room where their photos are hanging. We both stood silently - but I finally couldn't hold back the tears. I told him about how I recruited Amy Neibling from my home town and how I had met her mother. He wants to write a note and asked me to deliver it to Amy's mother in Omaha. We both kept looking at their photos and then we were both in tears.

He kept saying "... We will always love these beautiful women who came here to help us ..."

Lavendar Keeps the Scorpians Away

Sunday, July 6th 8:20pm


Funny how the mind works. For the last two days I have had a frantic, empty feeling about everything. Ramin is away at his fathers funeral in Tehran and most of my friends and neighbors are away for the holidays. And I finally signed my contract on Friday for this Afghanistan assignment. So I need to get ready.

What to pack?? My mind is a blur.

All I can think about is how to dress professionally, whilst looking like a sack of potatos - and worrying about scorpians. I remember loads of scorpians from my last trip there. They were everywhere. So this afternoon I went to the garden and picked about a pound of lavendar and then sewed thrity one sachets. (I heard scorpians hate lavendar) Last night after the fireworks I made lavendar room spray and this morning I ironed all my clothes with lavendar water. Then I started thinking " ...wait a minute, I'm not supposed to lure anyone with my feminine odor ... maybe I should just smell like a pig for forty two days... " I need clothes ... but I'm dressing for whom? The Taliban?!

Finally at 1:30 I met my dear friend brunch. Gina immediately suggested we order a bottle of champagne and think through the clothing scenario. Thank God for Gina and the champagne. I now have my sack-of-potatos-don't-look-at-me Kabul clothing that I can leave in Afghanistan. When I depart Kabul in late August I am flying to Dubai for a much-needed two-day spa retreat en route home. Since Gina knew I didn't want to arrive in a 7-star Dubai spa resort looking and smelling like a road warrior - she made the sensible fashion suggestion that I visit the nearby Eileen Fisher boutique. So after three hours of laughter and a lovely brunch I took my champagne-filled head to Eileen Fisher and bought a lovely white linen top coat that will carry me from the Kabul compound to the gates of the Park-Hyatt in Dubai ... and everything will be smelling of lavendar.

Community Health Workers

Friday, July 3rd, 10:15 am

In the northern part of Afghanistan - near the site of the 1,700 year Buddhas', there is a heroic community of mountain people who have been providing health care to their neighbors for decades. Back in 2004, I met two women in this region who were trained community health workers. They walked me up and down the mountain side until I almost passed out. They deliver babies, medicine and health information. They walk for six to twelve miles a day through rocky, snow covered paths to serve their community. The day we spent together we were visiting the family of a young woman who had tried to kill herself by setting herself on fire. When I asked these two health workers if they believed the young woman had really done it to herself - they told me depression and suicide are common problems in Afghanistan. I wonder if things have improved.

Poetry in Afghanistan

July 2nd, 2009 - 6:20am

I wake up each morning listening to Garrison Keillors' 'Writers Almanac" on the radio. It's a lovely way to start the day. But by the time I get out of bed, take a shower and have breakfast I can't remember the poem I heard that morning. By stark contrast, Afghans can recite poetry all day. Most Afghans can't read so they don't take the radio for granted.

In fact, I remember talking with a group of people in southern Afghanistan about how they got information and they all said, "...we love the BBC!" Back then, I was trying to figure out how to roll ut a campaign with health information -- over the radio. But Taliban were often storming into the raidio stations and in turn our troops were bombing the radio transmitors. A bit surreal. So one little kid started to make a poem out of the health messages we were trying to disseminate - then he handed me a rose.

Keeping Promises

Tuesday, June 30th, 10:51 am

When I first went to Afghanistan in 2003, I was asked to develop a social marketing strategy that would improve women's health. Afghanstan has one of the highest infant/maternal mortality rates in the world. One out of four women dies in childbirth and many children in Afghanistan don't live past the age of four. Those are the worst health indicators in the world.

With cultural challenges everywhere it was important to get a base-line on what was happening. An entire generation of women had not been out of the house. So it was really difficult to figure out how or if women were getting health services. It was even difficult to determine what was a clinic and what wasn't. The literacy rate was about 1% and men were still terrified to touch a woman - even to administer health services. So we travelled around the country conducting meetings about what was needed. In every clinic, in every village, in every community there were only male (men) community health workers. Many of the men were in tears trying to explain that they wanted to help the women in their villages. We all knew the answer was to train a new generation of female community health workers.

In one of the outreach sessions I asked the men to raise their hands if they would agree to go home and encourage their sisters, mothers and wives to become health workers. They all raised their hands. I wonder where they are now. I wonder if women are health workers now. I wonder if we made any impact at all.

A Happy Boy

June 29th, 2009 6:00pm
I am remembering a little boy I watched in Kabul several years ago. He was the housekeeper's son. He played joyeously in the courtyard while his mother cleaned the rooms. He had no toys, no music, no video games ... just his imagination. He danced through the trees and the rose bushes. He seemed to be the image of hope and laughter and love. I wonder where he is now. I hope he is still happy.

Thoughts about the up-coming trip

Sunday Morning, June 28th - 11:20am

... My first thought is about my last trip to Afghanistan in 2004. It was a stressful trip that ended in a spectactularly strange manner. But it paled in comparison to the events that unfolded six months later when my entire staff was killed outside of Herat as they were completing the work I had started. Since those days I have been grief-stricken, angry, confused, determined, hopeful, desparaging, proud, ashamed, anxious and calm. I've thought about the magnificent mountain views and the lavish picnics we took on our field outings. I've thought about the lovely Afghan people, the honorable community health workers, the savory food, the wild green eyes of children, the sidewalks made with cement and crushed lapiz ... and how after it rains in Kabul the sidewalks are glistening blue ...

But my memories are clouded by a feeling of guilt about the deaths of my colleagues. One of the young women was from my home town. I recruited her. Why I survived and she didn't will haunt me forever. I've also never understood how the firm that sent us all to Afghanistan five years ago could look at itself in the mirror ... much less use the deaths of these three young women to promote their business. It's been appalling to me. But that's their business now. I've moved on.

I am heading out to Kabul next week to work through a larger strategy for developing social marketing programs. This is an area where I know I can add value. I have more experience, a different team and time to reflect on lessons learned.

Today though, I need to figure out how to break the news to my mother that I am going back to Afghanistan.