Healthcare Reform - Afghan Style

The following was taken directly from the website of the Afghan Health and Development Services 2008 Annual Report.  It tells a chilling story of the actual events going on in Afghanistan, including kidnappings, beatings, and killing of Afghan health care workers by insurgents.   

 Kandahar and Urozgan provinces were very unstable in this year. Traveling back and forth between places was very dangerous.  Although maintaining current activities were not easy, expansion became very difficult. The sufferings were very slow expansion compared to what was planned, late implementation, high turnover of staff and less frequent supervisions.

 

Incidents with direct effect during 2008:

• Temporary closure of Hadeera CHC, Khas Urozgan CHC and Babur BHC due to heavy fighting
  Nahr-i-Robat BHC staff were kidnapped (health facility in charge, vaccinator, CHS and driver) and the vehicle was robbed.
  Rockets fired partially crushed Chora CHC and Khas urozgan CHC buildings few times 
  
• Temporary closure of Hadeera CHC as local police occupied the building
  
• Insurgents attacked House-e-Madad BHC and killed the midwife; Mrs. Zarghona
• Gunmen robbed mobile phones of the night duty staff and burned the ambulance
  
• Insurgents threatened Maywand, Zheray, Khakriz staff to stop working for government and NGO
• The female staff of Zheray, Maywand and Senziri facilities resigned due to insecurity
  
• Maywand CHC and 26 health posts in Zheray were closed after verbal and written warning from insurgents
  
• Insurgents kidnapped a CHW of Chora for 2 days and CHS of Oshey 3 days (both released by community members’ intervention)
  
• Insurgents fired on supervision team in Panjwaie District, EPI supervisor was injured and the vehicle heavily damaged
  
• Gunmen attacked on vaccination outreach team in Arghandab; the rental vehicle was stolen and the vaccinator and driver were released after being in hostage for five hours
  
• Three month medical supply of Chenartoo BHC was looted on the way by insurgents
  
• Doctor and guard of CHC were badly beaten by insurgents on the way to Khas-Urozgan 
  
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Who is your "Expert"

There are now hundreds of experts on my little country to the East, they claim to know my people, my culture and my world.  I don't believe it.  I live this culture, eat this food, talk this language and I barely understand it.  How is it possible that people go to Kabul, stay in western hotels and eat in restaurants you can only get into with a non-afghan passport, and come back as experts?  Since when do we expect so little from the people we allow to guide us in important decisions (aside from the Sarah Palin phenomenon)?  Who are these experts?  Who are your experts?  I know the people I listened to when deciding on what I thought about the surge, who shaped your impression and opinion on Obama's policy?  I'm curious to know.

Gender Equity Begins at Home

I spent yesterday at the Jamestown Foundation's Annual Terrorism Conference.  (Get your jokes in now, yes we have a membership card, no you don't have to have a beard and turban, no there was no metal detector at the door. Hahaha.)  There were 16 speakers on four different panels.  About 240 people atteneded this conference and I estimate 35-40 percent of the attendees were women.

There was not a single woman on any panel, not as a speaker and not as a moderator.  During the Q&A, not a single woman raised her hand to ask a question, not even me.

Towards the end of the day I wanted to ask a question.  I wanted to speak up, but I didn't.  I stayed quiet.  If you know me, this is unusual.  I am not shy.  I am not normally intimidated.  But I was.  As intimidated as I am when all the men in my family gather in the living room talking politics.  I sit quietly, I listen.  I disagree.  I wonder.  The questions form in my mind, as they did yesterday, but my voice is unwelcome.  They don't say "Zary, don't speak", but I feel it and I know it.  I pass through to the space where I really belong, with the women in the other room.

I've been to other talks and normally there is at least one panelist who is a woman - Brookings, Mideast Institue, CSIS, USIP.  The conversation is vibrant and full.  I wondered,  yesterday, as I sat in silence with my question bubbling inside me, if all of the other women felt it too.  Was our silence our acknowledgment that this was a mens club, and we should just pass through?  We should listen but not participate?  I have not been a part of any studies on the topic, but the clear impact of neglecting women's voices on the podium was to silence women's voices on the ground.



We send people to Afghanistan to teach gender equity.  Maybe we should keep some of those experts here to teach it at home.

My first foray into the Afghan 'space'

Development people have their own language, like lawyers and philosophers and anyone else who wants to make certain that not just anyone gets an invite to their party (it isn't the White House, after all).  I'm learning some of the lingo as I go along, and one of the development junkies favorite terms is 'space'.  Back on September 28, 2009, when I went to my very first talk at the Center for Strategic and International Studies, I called it a talk about Afghanistan.  Now I call it a talk about the Afghan space.

On that day Mark Ward of UNAMA made a bold statement; he claimed that there had not yet been an economic scandal in Afghanistan.  My eyebrows raised, having heard that Afghanistan and corruption were joined at the hip.  I was pleased that my countries were being scrupulous in the handling of their financial  affairs, but doubted the complete veracity of that statement.  I don't think Mr. Ward lied, because, it turns out, you can have coruption that doesn't involve scandal, as long as no one knows about it.  Despite the scandal-less travesties that take place every day in Afghanistan, the lives of many, many, many Afghans has improved dramatically since 2001. Afghanistan now has bridges, roads and schools.  We have a constiution.  Twenty-eight percent of parliamentary seats are reserved for women.  People are allowed to LAUGH.  Girls play soccer and hold jobs.  It's not the same country as it was, and that's good.  The problem now is that it IS the same country as it was. . . . in 2003.

I invite you to listen to Mark Ward's talk.  It's an excellent primer on in country conditions in Afghanistan and he paints a picture of a lively and bustling Kabul.  While reporting on his whole talk would be fun for me, and amusing (maybe) for you, I think hearing it from the expert himself will let you draw your own conclusions about the Afghan space.

Obama's Speech

I was asked by several people to give my thoughts on last night's Presidential speech at West Point.  Here is something I sent to an old friend.  We can call it an Open Letter on Obama's Speech by an Afghan American:

First and foremost, Afghanistan needs security in order to function fully. Security means troops and flushing out the bad guys.  Obama sending 30,000 more troops, in my humble opinion, is a good thing if its done right.  Done right is the key.  The biggest concern is the continuation of the status quo - money going into Kabul to NGO's, etc. with no oversight or accountability which ultimately leads to corruption (who can help it with all that money?).  Also, there is a great concern for civilian casualties, of course.  I worry that if the timeframe is so short, we might be more willing to sacrifice a few women, children and innocent bystanders in order to complete the mission post haste.

I think that the spelling out the 2011 deadline was a mistake.  I understand why he said it (to make those Dems and others who believe we've really been 'fighting' this war for 8 years feel better) but it undermines the
confidence the Afghan people will have about the US's committment to the mission.  A while back I read an article where an Army commander asked a village elder "What do you want from us"  and the elder said "Build a building. Let us know you are staying.  When you stay in a tent we know you aren't staying long.  We can't help you if you are going to leave because they will kill us for helping you."  It is impossible to
hand over security to an army when less than 30% of them can read or write their own name, much less do it in 18 months. 

I think the increase in troops is good.  It's good if it goes to Kandahar and Helmand and if they are truly going to train and build capacity.  I think it is good if we can teach our men (by our now I mean U.S.) and women cultural sensitivity, to build long term relationships.  I think its good if we can have local buy-in on reconstruction projects, roads, electricity and  education.  I think its good if our soldiers sit and have tea with the villagers and get to know them so that there is trust, then the villagers might be willing to tell them "there are taliban in that house".  I think its good if we keep our killing to the true enemy and not to the people who have done nothing but live in Afghanistan, and live where Taliban are part of the fabric of their day to day existence.

I am disturbed by people who claim that this war has gone on too long. We started fighting this war in October 2001 and ended in 2003.  Since then we've let our soldiers carry on with limited support and supplies. It's about time we gave them the tools they need to complete their mission and to come home safely after their job is done.

Then its probably off to Yemen and Somalia - sigh.

Welcome

When I talk about Afghanistan and the U.S. involvement there I use the first person regardless of the country I'm talking about.  I say "we need to send more troops" and I say "we need to make sure our people have clean water" When you (me) are Afghan and you (me) are American, your heart beats twice as fast when there is an IED that explodes, a hotel is bombed, or a village is destroyed. I know people who fight here and people who fight there - for the same cause: To make their nation safe and to make sure their children don't experience the tragedies they, we - me - lived through.

My country is more than a nation of sex-crazed men, bikini clad women and disobedient children. My country is more than a nation of child brides, men in turbans and shrouded women. My countries have a rich history that cannot be summed up in soundbites, you will not know them by watching the evening news or a single documentary. Come with me beyond the burqa. Let's lift the veil on my nations and see who is underneath.