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.