Afghan Doctor

Doctor can be a very deceptive title in Afghanistan. When most people in the US speak of a doctor, they are speaking about a Medical professional with a doctorate degree in Medicine who has a license to practice medicine. Here, as with many things, the lines of differentiation blur to the point of becoming a continuum of gray space. I have been introduced to many Afghans who refer to themselves as a doctor. In truth most are acting in the capacity of a physician, but they usually do not have training in medicine. The term Doctor is used for both Medics and Medical Doctors(MD). It can be very confusing for all involved including the patients.

To be fair, the Afghan Medical Education system has had some hard knocks in the past few decades. Under the Taliban learning of most types was frowned upon and women were strictly prohibited from studying medicine. Now there are at least 4 internationally recognized medical schools in Afghanistan and several others that are not recongnized. Most schools subscribe to the European model 7 year training program. The bachelors and doctorate degree are combined into one program. Overall the system is lecture heavy and light on interactions with actual patients. Out of the 7 years, only one is spent in hospitals and clinics observing or assisting with patient care. This system produces doctors who know the lecture type details and pathophysiology of disease, but may lack the experience in practical application to patients. The most prestigious and well respected institution of medicine is Kabul Medical University. With as many as 400 students a year going through clinic rotations at Kabul hospitals, it is difficult to imagine they get the same level of involvment in patient care that we experience in the US as students.

Specialty training is also very different in Afghanistan. Specialty training is more like an apprenticeship than a program of structured learning. There is no set time to complete the training. Doctors work under a specialist (surgeon, internal medicine, anesthesiologist) until their preceptor determines they know enough to be on their own. There is no board certification testing or validation to a governing body. While this seems to work well for some specialties (surgeons in particular are widely accepted as being very well skilled) others not so much. For instance, I have seen ENT specialists who do not seem to know how to use an otoscope to check the ear canal and tympanic membranes. While this apprenticeship style of post graduate training is very different for us to accept, it works most of the time for the Afghan people. What is more it is the only system they have for right now.

Are you confused yet? If so I have adequately explained what is meant by the term Afghan doctor.

Combined ANP/US Range and Golf

Weeks ago when we were talking and having chai with our ANP counterparts the topic of weapons came up. Our counterparts relayed to us that they had not been trained on their pistols and were not very comfortable with their use. Since they do carry these weapons and rely on them for their personal safety, we decided to arrange some time together on the range to practice. After a basic range safety lecture through my interpreter, we began.

I was expecting their pistols to be old WWII era soviet style weapons. I was quite suprised to find that they carry new Smith and Wesson 9mm pistols. Their pistols did not have a safety, but were light weight and handled well. One of the weapons misfired a few times, but I suspect that more oil was needed. They did fine and improved with only a little practice. We also let them shoot our pistols, which are much older in design comparitively. We ended the shooting with a familiarization fire of the M-4 which was orderly as well.

After the shooting Steve took out the golf clubs. All of the Afghans universally said it was much harder to hit a golf ball than watching TV might suggest. I was worried that some of the clubs would be literally broken in half due to the hatchet like swing of some of the new golf initiates. There were quite a few laughs and a good time was had by all. It was a good safe time. I suspect this was the last mentoring type activity I will perform in this country. There is a new member of the team here now, so very soon it will be time for me to move on.

New Clinic Open

For those of you who have been following all along you may remember my post from 17 August. In that post I showed you an ANP clinic which was still under construction. Well, yesterday we visited the same clinic and it is now open and operational. Our Afghan counterparts were very creative in furnishing and outfitting the clinic until a package of goods arrives from Kabul to fully equip and stock it.

There are still a few minor issues to be resolved, but this clinic is a significant step up in facilities for them. It is new. It has running water. It has a continuous power source. It has heat and air conditioning. The staff who will be running the clinic were kind enough to pose outside of it. I am almost shocked that it only took four months to get this clinic completed and operational. While this may seem like slow progress by our standards, it is light speed for Afghanistan.

Time has a different quality here. In this land, Alexander the Great came into town 'sometime yesterday'. There is a common saying here; "You may have watches, but we have Time". Many Americans will interpret this as laziness, but it is more a cultural acceptance of the limits of time. I am just glad that I could actually see one more milestone achieved during my time here.

This was probably my last mission "Outside the Wire". My replacement is here and the team will have to press forward with our many other projects without me.

Rumi------ Jalāl ad-Dīn Muḥammad Balkhī جلال الدین محمد بلخى

Local boy becomes world class poet.

That would be the headlines if there were any when Rumi (1300's) was alive. He was born only a few miles away from where I sit right now and is still revered as one of the most eloquent poets of all time on the subject of Love in mystical ways. His family fled the Mongol hordes as they invaded this area and fled west. It was in the Sultanate of Rum in modern day Turkey that he came to pre-eminence as a spiritual philosopher and most notably as a poet. This gave him his "nickname" of Rumi, although Afghans still refer to him as Balkhi- coming from Balkh.


Translations of his Farsi/Dari poems still ring our ears today. He gives such a different perspective on issues. His poetry is unique.

Just a few excerpts translated:



Looking at my life
I see that only Love
Has been my soul’s companion
From deep inside
My soul cries out:
Do not wait, surrender
For the sake of Love.

You know what love is?
It is all kindness, generosity.
Disharmony prevails when
You confuse lust with love, while
The distance between the two
Is endless.

I read that Rumi was the last documented person to have people of five different faiths carry his funeral bier. He even has some poems about Jesus. The Mawlawī Sufi order or order of Whirling Dervishes was founded in 1273 by Rumi's followers after his death. His son Sultan Walad was installed as grand master of the order. The leadership of the order has been kept within Rumi's family in Konya uninterruptedly since that time.

I encourage you to investigate some of Rumi's works. You may be suprised what Afghanistan has contributed to the culture of the world.

Chistmas Day

Christmas was a wonderful but busy day. We had three services within 24 hours, with lots of good singing. I had the opportunity to watch a flock of goats for several hours on guard duty. Finally we had a good ole time at the First Annual 5k Jingle Bell run around Camp Spann. If there was a category I am sure I would have won 'Best hat made out of office supplies'. The meals were very good and ample as well. I had some good calls back to my family to find out how my gifts went over. It was quite a Birthday Celebration. I hope you had a fun and meaningful Christmas too.

And a Special Thank you to those who sent boxes, presents, decorations, or greetings. They were all much appreciated. Merry Christmas!

Shab e Yalda شب یلدا

In the western world we think of the 21st of December as the Winter solstice. The night of the 21st is the longest of the year for the northern hemisphere.

In Iranian and to some degree Afghan culture the night of the 21st of December is Shab-e Yalda شب یلدا .

It is an Iranian festival whose origins go all the way back to Babylonian and Zoroastrian religious rights. It has been adopted over time and is still celebrated as a winter feast, when families will sit up all night around a fire telling stories and eating melons, pomegranate, and nuts.

Because Shab-e Yalda is the longest and darkest night, it has come to symbolise many things in Persian poetry; separation from a loved one, loneliness and waiting. After Shab-e Yalda a transformation takes place - the waiting is over, light shines and goodness prevails.

Shab-e Yalda is also a very special day to someone very close to me. Someone I hope to see soon. And while it may not be fast enough, sometime after Shab-e Yalda the waiting will be over. Light and goodness will prevail.