Friday, July 31, 2009

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?

Thursday, July 30, 2009

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.

Wednesday, July 29, 2009

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.

Tuesday, July 28, 2009

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!

Monday, July 27, 2009

White Hats


Monday, July 27th

Kabul, Afghanistan

Taliban turban. Need I say more?

Sunday, July 26, 2009

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.

Wednesday, July 22, 2009

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!!

Tuesday, July 21, 2009

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.

Thursday, July 16, 2009

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.

Tuesday, July 14, 2009

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!

Saturday, July 11, 2009

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 ..."

Sunday, July 5, 2009

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.

Friday, July 3, 2009

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.

Thursday, July 2, 2009

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.