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!