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

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.

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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.

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.

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!

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.

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.