For those of you anxious to hear about my experiences in Kabul, Afghanistan, you have had a long wait. But it’s time to let you know what I have been up to.
I came here in September to serve as the first Regional Medical Officer (RMO) assigned to U.S. Embassy in Kabul. I work here together with two mid-level providers who have extensive experience and have become good friends and excellent colleagues. I do not travel from this post at present, but will travel to two regional cities, Herat and Mazar-i-Sharif, in the coming months when new consulates open there.
I can think of several core questions you might be wondering about. What is life on compound like? Is it safe here? What kind of medical work am I doing and for whom?
Unlike most other world-wide embassies,we all live on the embassy compound in Kabul. It is a site of approximately 20 acres containing several office-type buildings, three apartment buildings, a dining hall/recreation/health unit facility, and over 300 containerized buildings that are termed “hooches”. These are corrugated steel shipping containers into which are punched a door, a window, an air conditioner/heater, electrical and data hookups, and basic plumbing. When done, the offices are functional but spartan. The living quarters are similar to ½ of a Super-8 type motel room, approximately 10X17 feet. Most of the married couples that work here together and the senior-ranking Foreign Service folks rate a one-bedroom apartment and all others live in a hooch. Overall it is rather like living on a small college campus in terms of lifestyle. We all work long hours and in the spare time that arises we exercise, find hobbies to share, watch DVDs or communicate with friends and family over the internet or phone. Due to safety concerns we are not permitted off compound except when our jobs demand it, so there is no real opportunity to sample the culture and meet the people of Kabul other than the local employees that serve at the embassy. This is another difference from most posts. We do have the chance to visit nearby NATO Camp Eggers on weekends for a change of scenery and some shopping at a local bazaar set up there.
Although there have been over a dozen car or suicide bombings in Kabul in 2009, they are isolated events and have not threatened the embassy itself. When on compound we feel and are quite safe. Not so true when out in the city. I was on the road on the way to a local hospital a month ago when there was a car bomb near the Indian Embassy and we could all hear the gunshots during the recent siege of a nearby UN-rented guesthouse. These events are sobering and cause us all to take all precautions seriously. We travel only in armored vehicles and wear body armor when in the traffic. Feeling our buildings rock and roll with two small earthquakes that occurred in October was another highlight of the Kabul experience.
As part of the clearly stated goals of the U.S. presence here of “Defense, Democracy and Development”, there is a big push to increase the civilian presence in Afghanistan by our current administration. We are being given plenty of resources and the most important of them is personnel. A year ago there were a little over 200 American government civilians in country, and that number will be nearly 1000 in January 2010 with another 300 arriving by May 2010. About half of those will be stationed throughout the country with Provincial Reconstruction Teams (PRTs) and the remainder in Kabul. The embassy management staff has worked miracles managing the logistics for this massive increase when it comes to protected housing, office space, transportation needs and security. The job of all these people is to promote development projects, help in the locally sponsored development of democratic local and regional government, and help Afghans develop tools to fight the huge challenges of corruption and drug-related crime.
In the health unit my first priority was to gear up the clinic management systems to handle a big increase in patient load. Those efforts have paid off as our daily visits have occasionally surpassed 100-150 visits a day during cold/flu season and while giving out over 800 seasonal flu vaccines followed several weeks later by another 600+ H1N1 vaccines. We had only one Afghan staff receptionist when I arrived, but have now added two local physicians and a local nurse to our staff. They have helped us run the lab and pharmacy as well as help us care for the American and Afghan employee patients in the clinic. Most of the cases are routine primary care, but we have had a flurry of people with tooth fractures, broken crowns, etc. Unfortunately there is no American quality dental care available here, so even those problems need to travel to New Delhi, India for repair work. We have also managed two challenging cardiac cases, including a young man who suffered cardiac arrest while out running one morning. Thanks to a great joint effort of local guard medics that started CPR outdoors and the ready availability of the defibrillator and the health unit team, he was successfully resuscitated and is now mending up back in the U.S. The military medical evacuation system assisted us several weeks ago with a patient whose coronary stents had re-clogged and needed urgent repeat angioplasty. There are no local civilian hospitals that we can use in Kabul so any hospital patients must be stabilized in local military field hospitals and then evacuated to Germany, London, or Washington, D.C. With the lack of local facilities you can imagine that we are appreciated by the people stationed at the Kabul embassy.
Our health unit staff in October. We have added two additional staff, with two more coming in December.
I just had a particularly interesting and busy week with the visit of Secretary of State Hillary Clinton who came for the inauguration of President Hamid Karzai. I was asked to accompany the traveling party throughout the visit as the always-nearby medical support person. Careful planning was in order as I carried a medic backpack with supplies and meds for many possible scenarios, and also a duffle bag with portable oxygen, airway management supplies and an automatic defibrillator. I am pleased to report that I only needed to treat a few minor illnesses of traveling staff members. It was fascinating to attend the three 2-hour countdown meetings to assure that every detail was planned to the minute. This was followed by a whirlwind 27-hour visit involving over a hundred support personnel, carefully orchestrated motorcade movements, extensive security arrangements and dealing with the ever-present press corps.
Life around the compound has been very busy, but pleasant. I put in treadmill time most mornings, play tennis on Fridays (day of prayer and rest in Afghanistan), have started up a fun bridge club for old-timers and newcomers and enjoy private time on the electronic keyboard I brought along. Food service is provided in the cafeteria. The food is varied, healthy (if you get the salads and veggies and don’t overdo the ice cream….) and safe. In a closed community it has been easy to get acquainted and make interesting friends. I have enjoyed meeting many civilian and military leaders and learn about the role they are playing in Afghanistan.
Laura is keeping busy in Minneapolis this year. Among other new challenges she is studying university-level Spanish and volunteering, teaching English as a second language at a Latino community center. This is great preparation for our upcoming tour to Santiago, Chile beginning October, 2010. I am looking forward to seeing all the family for Christmas, and Laura and I will meet in Spain in March for a St. Olaf adult study-travel tour. We touch base every few days on Skype, which is a godsend to all of us Americans overseas.
A big reason I joined the Foreign Service was to continue to experience new things, to learn and to grow. I am continually challenged to do that here in Kabul. The time is passing quickly and I am pleased to provide support to those doing such important work here.
