Saturday, August 28, 2010

Would you like some cancer with your giardia?

Me: Good news, Dr. Shakur! I have diagnosed the issue with your Ob/Gyn ultrasound, and it's a much easier fix than I thought. Only the probe needs to be replaced. The CPU and monitor work fine.

Dr. Shakur (Medical Director, Jalalabad Public Health Hospital): That is excellent news! Would you like to take a look at the X-ray machine now? Also it is broken.

Me: Uh...

Dr. Shakur: We have about thirty, forty machines in the hospital that are not working.

Me: ................ok. Let's take a look.

Tuesday, August 24, 2010

Womb with a view!

Fary is an action hero. In the time I've been here, I think she's visited 12 schools. I am still shaking off jet lag, puttering around the guest house, and she is shaking hands and kissing babies, literally.

It's nice to meet native students, and Jenn has championed right alongside her for every outing. but I'm reserving my energy for an actual class I might teach, or that Jenn and I might teach together. There is great interest here in learning how to find scholarships, how to apply to study abroad, and how to improve one's study skills generally. I don't feel qualified to teach about these matters in the way I feel qualified to teach, say, algebra. But if there's sufficient interest and I can be of some help in elucidating matters I'll do my best.

I also learned that UCSD offers a credential program in exactly the course I had planned to teach a workshop in - english for medicine and science. And many of the students and teachers I have met so far have already received their certificate! So, bonus points for accurately identifying a need in the community. Demerits for coming late to the party.

In the meantime, I have been troubleshooting the portable ultrasound device here in the comm room, left by MedWeb. This has been a fun project - I finally feel like my BME education is paying off. I wish I'd discovered earlier in life how much I like computers. At any rate, I was able to diagnose and patch a software issue in Windows XP, and now I'm up and running with the field sonogram... except the resolution is not so good. Meeting planned with the MedWeb honchos for sometime tomorrow, hopefully we'll get this sorted, maybe even in time to loan it out to the Ob/Gyn dept at the National Hospital.

We visited the day before yesterday. One of the ironies round these parts is that healthcare is paradoxically more available in Afghanistan than in the USA. Anyone in Afghanistan can walk into the National Hospital and expect to be treated. No insurance necessary. That is why I actually received my first prenatal exam from the distinguished faculty here.

We started with a quick tour of the sonography department in the main hospital. Two broken machines (old, dusty) which I photographed, kicked the tires, so forth. The main hospital also has one newer machine, a Honda, that works. And a full schedule. I did not wish to embarrass the doctor by asking pressing questions about diagnostics, but Fary has mentioned that her goal is to train a suitable technician.

I wish I could have taken more pictures of the hospital. People gathered outside to wait on the grass in the courtyard, sometimes hanging IV bags from trees. The interior of the buildings are not air conditioned, and reek of bodies and disease. At home, I find hospitals a little unsettling in their sterility - the bracing, chemical aroma of disinfectants, the threat of the superbugs left after the 99.99% kill rate advertised on their bottles. The opposite is true here. Nothing about this hospital seems even remotely sterile. It is not scary in the abstract - it is concretely the stuff of nightmares. Yes, it's free to visit, but if you end up here the feeling is that it may be your last visit anywhere. I actually wish I had worn the burqa, it might have been possible to stealth some more photos. In my alien western garb, it would have been poor form to just start snapping pics randomly.

Making our way into the Ob/Gyn building was a relief. It didnt smell so bad. Women and children only.

We spoke first with two lady doctors who gave us a sense of their load - 1400 patients per month. They took us to see the dedicated Ob/Gyn ultrasound - broken. Recently. Power here is unreliable, and surges. It's possible this machine was fried.

They took us to meet the department head, a sweet middle aged lady whom her students proudly proclaim to be the best doctor in all of Nangarhar. And the rest of the entire department! About ten doctors, all young women, all married save a single widow. Everyone crowded into one room, tried some english on us, told us about their studies. I sprawled on the exam table as the department head gave me an abdominal exam - the first time a doctor has laid hands on me during this entire process.

"Congratulations," she says. "16 weeks." She prodded me further, checked my eyeballs, and wrote me a presecription for iron and folic acid. And told me to eat. Thank god, she also told me I was completely normal.

This is an enormous relief. I have been haunted by stories of women who show up to their 16 week checkup, only to find a dead 12 week old floater in there. But everything is the right size and all I have to do is make sure I don't become anemic. Excellent! After 4 months it's such a relief to have a doctor look at me and say, "you and your baby are fine"


Fary asked the department head some questions about working during Taliban rule. They were in charge for 12 years, and in that time, she said, it was possible for women to work in medicine, but not to train.

They asked us if we would be able to fix the sonogram - I think it more likely to be replaced than repaired. But no promises. Inshallah.

It was truly an honor to have met and interacted with these women - for sure the smartest in Nangarhar and doubtless among the hardest working. They deserve technology that works. I would like very much to help in any way.

We then visited the school of midwifery, which is where I had assumed I would receive my checkup. This is an amazing progam - young women in rural villages are selected by tribal elders to come to the city and participate in a 4 year midwifery program, promising to return home when their training is complete. This is a very beautiful building, and it even has a kindergarten attached for the girls who have babies of their own.

I am touched and inspired by the professionals I'm meeting here, their dedication and their bravery, men and women alike. The feeling of helplessness is still there.

And I'm anxious to get this portable ultrasound working. How fun, to have one here in my bedroom... a womb with a view!

Sunday, August 22, 2010

Storytime

When I was a little girl, among my favorite books were The Hitchhiker's Guide to the Galaxy trilogy. In my visits to Afghanistan, I recall The Restaurant at the End of the Universe, wherein Ford Prefect and Arthur Dent end up stranded on prehistoric Earth with a shipful of exiled middle-management from the planet Golgafrincham. It's not really fair to analogize the proud and storied Afghan people with Adams' pre-lingual native hominids. However, the US occupiers bear more than a passing resemblance to the bureaucratic, preening, incompetent, process-obsessed, blustering Golgafrinchans. The kind of people who will hold a series of meetings about how and when to discover the wheel. Who declare leaves to be currency, then decide to burn down forests to prevent inflation. And then make documentaries about it.
I'm also reminded of another favorite childhood fable - Mark Twain's A Connecticut Yankee at King Arthur's Court. A late 19th century engineer bumps himself on the head, awakens in Camelot, and quickly puts his superior knowledge to work becoming the most powerful man in the country save only the king. Appalled by the (literally) medieval conditions, he makes it his mission to introduce technology and modernize England. His chief opposition? The Church of course. The intersection of ancient and modern is frustrating on both ends. Ultimately, the Yankee ("The Boss" as he is known) is put to sleep by the King's old tutor Merlin - whose magic The Boss mocked, but which is nevertheless the native and reigning technology.
And then, of course, there's Kipling's The Man who Would be King. He wrote about this part of the world a hundred years ago, and even then it was the graveyard of empires. I loved Kim and Just-So Stories as a Tot, but I didn't read this until after my first visit here. There's no satire. Just straightforward, brutal allegory.
So many people live here, have lived here, have passed through on their way somewhere else. And by that token, so many have attempted to conquer, or passed through on their way to conquer somewhere else. The natives routinely dispatch all comers, without even the benefit of shoes. Since the time of Alexander the Great, the world's most ambitious warriors have cut across Afghanistan on their way from Europe to Asia (or vice versa), depositing their genes along the way. These are the toughest people on the planet.
As for our current venture: what will serve to distinguish us from those who have come before? Our president has declared a 2011 pull-out date. I listen to Fary and Dave complaining about the intractability of the government, and I think, good. Let them get out of the way. The ones who remain to do the work of reconstruction will be the private organizations who are truly interested and motivated - not pencil pushers or empire-builders. Ah, but Dave says, if there is no security private groups will not come here. And security is costly.
The president (the Afghan president) has made a declaration that all private security companies should be disbanded in Afghanistan. And this is quite something, because a large percentage of our presence here is contracted out.

What will be our legacy? I have seen entire parking lots of abandoned earth movers, left to rust by the Russians who bailed twenty years ago. Our CIA effectively hand-picked the extremist psychopaths who comprise our chief complaint against the nation, our reason for coming. How much of the current situation is our fault? How much can we fix? Is it any of our business?

Ours as much as any other empire, I guess. There is a long tradition of diversity here. Many nations, many tribes have made this land their home, have left their art and their culture. It is a beautiful city, Jalalabad. It was once a jewel. Best oranges in the world, some say. And gardens built by kings. Buddhists used to run the show here, did you know? The shameful thing is, you can tell where americans have been by the trail of destruction. Not, say, by the trail of clean water and reliable power. We can be such jerks.

I suppose my personal goal is the same here as it is at home: help people, especially young people, to obtain knowledge for themselves. Support people in their endeavor to live healthy and safe lives. To do whatever I can to reinforce the twin values of creativity and curiosity.
These are just rambling thoughts, really. Today was a big day and it will take a minute to organize it all for consumption. And I have a bit of homework, too. I am still feeling the effects of jet lag, barely.

Maybe tomorrow I will swim in the scintillating pool...

Ladies and gentlemen:

May I direct your attention to my colleage, Jenn Gold? She and I are on this bus together, and you'll find her coverage quite complete. Good write up of the trip we took to the College of Education and Medical School yesterday: Fall Break 2010

Friday, August 20, 2010

The medical situation...

Is pretty abysmal and awful here.

I had a hard time writing about it last year, mostly because of the glut of information. but also because I was in the company of actual doctors and people working with companies bringing actual telemedicine technology out here (MedWEB). I didnt feel like I had much to add to the conversation, other than a needling sense of injustice. And confusion. And helplessness.

There's the corruption factor: people who are not qualified for jobs are given expensive government grants (your tax dollars hard at work) to accomplish reconstruction that never happens.

There's the "ick" factor: jobs aren't completed properly, and there is no oversight, and so sewage systems arent built properly and babies end up playing in untreated bloody, needle-filled runoff from hospitals

There's the brain drain factor: anyone who obtains enough training to bring up more people behind him/her is almost certainly too smart NOT to bail

There's the technology factor: So many modern machines are donated, without the donors understanding that the limiting factor is f*cking electricity

There's the "reach-back" factor: Even when machines are usable, there is often insufficient training to use them properly - let alone fix them when they break.

Here's a horror story for you: Fary told me about a time she visited the teaching hospital, after the Rotarians/Sister Cities had made some equipment available to the medical students. Including, as it happens, an autoclave. Neither faculty nor students were able to operate the (totally functional, undamaged) autoclave, and so sterilized their surgical tools in boiling water. Next to the unplugged autoclave.

...

...

...

Medieval.

More horror: Mehrab's son came down with a condition. Kid wasn't feeling too hot. So he takes the boy to a specialist here in Jalalabad. The doctor listens, palpates, strokes his beard. Then he tells Mehrab that his son has a deadly serious lung infection, and will require surgery.

"Whoa. Easy there, distinguished sir." Says Mehrab, and hightails it across the border to obtain a second opinion in Pakistan (several hours journey, on deadly roads, through a border that's tighter than a hymennorrhaphy). The doctor they visit (a lady, Mehrab doesn't hesitate to interject), orders things like an X ray and blood work because this is Pakistan and they can do that here. She is pleased to inform him that his son has Pneumonia only, that it can be cured with antibiotics and rest, and no surgical intervention will be required. "If I could not visit her, my son would be dead." He is certain of this, the way only a father can be.

So... the ultrasound. What I thought was going to be a technological fix (i.e., it's not working, see if we can make it work) is actually a more subtle problem. Fary, who is a nurse, claims she jumped the "is it working" hurdle last time - in part by removing sensors from their original pacakging and firing the thing up for the first time after it had been there for godknows how long. A year? Two years? The thing works. The challenge will be to find someone suitable to train in its use.

Again, there are many programs in place bringing up new young doctors who would be willing to put in the time investment necessary to become proficient in this sort of diagnostic tech. And I have a few ideas up my sleeve.

Tomorrow, we visit a school. And a hospital. Not sure which ones. I'll keep you posted.

This aint no party. This aint no disco.

Basically, I got here in time to tag out Dr. Dave and Todd on their way to the playa. They are taking the trip I wanted to take - arrive in Afghanistan mid-july, depart around this time for Reno, have someone waiting for me in BRC with my stuff. Like a rockstar.

Fortunately, I found gainful employment (in the nick of time, truly) at one of my favorite institutions in the world, and I am very fortunate that I could even be here, that my PI is so very flexible. Jbad-to-playa-to-first-day-of-work would have been kind of hard on the brain and bod, even without a passenger. Perhaps it is good fortune that my flights of folly were not so entertained. Still. BRC. Home...

"I can't believe you guys are leaving for the Burn. I'm so jealous."

"I'm jealous you get to STAY."

"Bullshit."

I am really going to miss these guys. Not only for their good company, but for their experience and their tentacles in the social network here. With Todd and Dave gone, it's like half of my network going dark.

I awaken this morning to sounds of rain, and flashes of thunderstorms. Its lovely, and I'm tempted to kill the fan to get the full audio-visual suite of effects - the wind and patter and lightshow and booms. But I decide against it. It's still hotter than hell and my windows dont open.

Within a few hours, Todd is knocking to say his goodbyes. I offer to make a pot of coffee from my Peet's stash to see them off, and to check out my new digs. We have an agreement - that when Todd bugs out I get the comm room.

It's upstairs next to the leaseholder's suite - directly beneath the satellites and home to the sat modem and routers - basically the nerve center of the Taj. It's where Ken the IT Genius stays when he is here, and was Todd the Supernerd's in his absence. Now that the Synergy Strike Force fulltimers are playa bound, the comm room is mine. Reason being, in the remaining company of rotarians, USAID treehuggers, their security, afghan houskeepers, and National Guardswoman, I may be the one best qualified to troubleshoot if the internet shits the bed. This is not a comforting thought. At all.

Mehrab, the manager, is surprised that I am moving to this room voluntarily. "The noise!" he says.

I am heartened to find, upon arriving upstairs, that Dave and Todd are migrating the modest Taj arsenal from the leaseholders suite to the comm room. Yes. Yes yes yes. The amount of radiation in to which we are exposed in here might not be great for the baby, but hey. If there is actually anything resembling a real problem, having a closet full of AKs will be AWESOME for the baby, I'll tell you what.

I can't wait for Tim, our security specialist, to get here.

Maybe I'll go for a swim in the scintillating pool downstairs. Possibly the cleanest water for miles. Not potable with all that chlorine but germ free, you betcha.

Thursday, August 19, 2010

The real danger is the bread.

Do I edit down the details of my trip? Downplay the danger to provide comfort to family members who think I'm batshit insane for undertaking these voages in any condition? Or do I tell the truth? That the situation on the ground here is worse than it has been in four years, according to my esteemed mentor and employer, Dave Warner MD, PhD? That if Fary the Super-Rotarian were not here to provide her considerable social sway and 7 years of in-country expertise, that I would not have been hired to come? Lo siento, mi familia. If you want candy-coated optimism about the sitation here, I'm sure our president can provide you with plenty. It is not my job to provide you with this.


In a certain sense, Dr. Warner explained, Fary and will be insulated from danger specifically because we are women. Anybody (anybody) could fall prey to an IED or a suicide bomber. But only the men in our company might be targeted for any kind of violence. Women will be left alone. The doctors who got plugged out in the sticks? Well, first of all - they were out in the sticks. Second - their execution (that's really what it was) is considered an atrocity even by the most conservative of locals. And the women? Well, they died because they were with the men.


We're not anywhere close to there. And our objective will not be to head out into remote villages and make new friends, or even to provide (nearby, relatively stable) villages we know with the medical care and technology they sorely need. Instead, our plan for the rest of the year will be to shore up existing networks (the hospitals, the university, local officials), and stand shoulder to shoulder with the local people who are the first victims of the Taliban, and of creeping bereaucratic incompetence.


More later - I'm going to be out of the field for at least another day. Right now the biggest threat to my person is not militant islamic extremism - it's the food and waterborne pathogens that got me within 24 hours. What I like to call the "Jalalabad Fire Drill" - total GI evacuation. Everybody out of the pool. Motherfucker. I was really careful not to eat the uncooked produce at dinnertime. I think it might have been the naan - it's purchased in town and carried here. Probably on the back of a motorcycle. This isn't as bad as last time though, and The Bean has raised no complaints at all.


Tonight is Thursday, the night before the Sabbath, and I'm hoping to be well enough to tend bar.

Tuesday, August 17, 2010

Dubai.

Apparently, the winds reverse directions with the seasons because in the summertime it only take 14.5 hours LA to Dubai, whereas in the winter it takes over 16.I am traveling with a Rotarian who has visited Afghanistan 13 times previously - she averages about 2 trips per year. More about Fary and the Magical Jalalabad-San Diego Sister Cities organization forthcoming, but it will be sufficient to say for the moment that traveling in her company is easy, fun, efficient, and drama-free. Even though one member of our company was delayed in Atlanta, Fary deftly manouevered a flight plan change across three airlines in three different countries for our stranded friend, as well as an overnight stay in a Kabul guest house and a driver - in less than 15 minutes on a cell phone in the airport. She didn't even break a sweat. She is a nurse, Persian by way of England, (so both her accents are lovely), gracious, worldly, well tailored, trim and cheerful. When I am "of a certain age", I want to be just like her.


New projects on the horizon. Seems the ultrasound machine is still not operating in the National Teaching Hospital. New Objective: get the damn ultrasound machine operating and train a technician - preferably a recent medical school graduate. Someone with enough training, who is young and excited to make a difference and not too old to be allergic to learning. This is not an entirely selfless project. If I can get this beheamoth functioning, I (and by extension, you) will be rewarded for my efforts with baby pictures.


It is 100 degrees here at night in Dubai. Stepping outside is like stepping into a sauna. Exactly the kind of weather I would love if being mostly naked wouldn't result in immediate arrest and deportation. The airport is gigantic - frightening, opeulent, electric. Designed to awe and intimidate. If you have ever been to the most grandiose hotels in vegas you have a sense of the total fealty to commerce and luxury that permeates this space. Only these are designed to accomodate an order of magnitude more people, the massive halls echo instead of ring, and no booze is available. It's Ramadan.


We were reminded of this as we took a seat in the nearby La Meridian Hotel. "It's a pity," Fary said. "They make the BEST martini here!"


We were ushered to our oasis by a Lady Cab. Because we are two women unescorted, we were directed to a line of pink taxis driven by matronly, hijabed, pink-smocked lady drivers. This detail of local flavor totally escaped me last time, as I was in the company of Dr. Dave. We listened to "Radio Virgin" - a top - 40 club hits station, cranking Kesha's TICK TOCK. Which frankly startled me.


Dubai is a city of extremes and excesses and basically embodies everything I find indefensible and unsustainable about the human species. It scares the living shit out of me. Which is good, because I am a smartmouthed, uppity bitch and fear, genuine fear, is one of the few things guaranteed to keep my hippie ass in line and out of trouble. This is NOT a free country. Please purchase Gucci bikinis to wear on the novelty palm-tree shaped man-made islands, but understand that if you hold hands on one of their startlingly white beaches you will be arrested. I will have 24 hours here (and a hotel room - thanks Fary!) on the return trip. Fary recommends that I take the desert Safari, but I think I will just haunt La Meridian, go to the spa, and sleep in my frosty, air conditioned room until its time to go.


At least in Afghanistan, there is no pretense about how fucking medieval it can all be. It's part of the charm, really. What You See Is What You Get. As opposed to Dubai, where What You See Has Been Engineered To Be The Most Expensive In The World And Is Polished To A Mirror Shine By Imported Slave Labor.


Next up, Kabul. I can't wait to get to the Taj!


Monday, August 16, 2010

Guest Lecturer

I've recieved an invitation to teach at Jalalabad University! I am humbled and honored by the request. The invitation came from my friend Wahida, who is part of the English faculty. I am thinking that a weeklong intensive in English for Biology/Science might be good. I met many aspiring doctors and engineers last year. My Pashto is poor, but with a translator I am sure I can convey a lot.

I depart tomorrow at 4 pm. LA to Dubai, Dubai to Kabul, Kabul to Jalalabad. Praise be to Allah, I will not change planes in America.

I'm also planning to have my first prenatal checkup at the School of Midwifery at the National Hospital in Jalalabad. Afghanistan has one of the highest infant mortality rates in the world, and so a new women's healthcare education facility was built - i visited last year. Ironic that I should have an opportunity halfway across the world to obtain health care that I would have to wait for in America (my insurance will kick in sometime in September). It will be interesting to see what services are available, what information is prioritized.

Wednesday, August 11, 2010

Back again, soon enough:

I'll be returning to Jalalabad and the Taj Mahal guest house on Monday. It's an interesting time. More could be said about how interesting, but if you care enough to read this you've likely been submerged in reports of the Taliban's creeping influence, the butchery of medical volunteers, the malaise of the Afghan people, and the general incompetence of our government.

I'll keep you posted as I travel.