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.