I work with an Afghan man who is very smart, in the "street-smart" sense of the word. He married a girl who was very young, and like a good Afghan wife, she soon became pregnant. She was 17 years old when she gave birth. The baby died of pneumonia at 6 months. I came into their lives about a year after their baby died, and met his wife for the first time when she was about 2 months pregnant with their second child. At this point, I guess that I should go back and explain how Afghan marriages work.
Most Afghans marry their cousin. Usually it is the groom's mother who negotiates the deal. Yes, it is a business transaction. The groom pays an amount according to what the woman can do. The standards are a bit different there than the west. For example, being able to read and write does not necessarily make you valuable. However, if you can cook and clean and sew and iron without complaining, you may fetch a very high price. When the wedding is over, the bride moves in with her husband and his parents, his brothers, their wives and any other unmarried siblings. There may even be grandparents if they are still alive. The poor girl, often a young teenager (though I have a friend that got married when she was 10) moves into a house with some very hostile in-laws. This was the case with Hassan's wife.
When her baby died, her mother-in-law blamed her, constantly berating her for the death of her baby. By the time the second one arrived, the poor girl was a nervous wreck. They came to me weekly with all sorts of imagined problems that the baby had. They were so afraid that something would go wrong and this one would die as well. No amount of assurance would calm their fears. They started to calm down a bit after the baby hit the 6 month mark, and survived, but they continued to worry.
One day, Hassan (his name is changed for his protection) came to me and said that the baby was very weak, and cried all of the time, and was very small. So, I went to see her. She was indeed very small and very weak. The temperature was over 100 F outside, but when I saw her, she was wrapped up in several layers of thick cloth. Her breathing was shallow and labored. I felt her little forehead and she was burning up. So I took off her clothes and cooled her down, then I asked to watch her eat. If you are in the medical field, you know how important it is to get an adequate history from a patient. I have found that very difficult with my Afghan patients. Sometimes you have to figure out what they mean. For example, when they say that someone is yellow, they don't mean jaundiced, they mean pale. Also, often they will say something different every time you ask, so I have to sort through, and sort-of take an average. Anyway, it took a while to sort through the complaints. Apparently Hassan's wife had stopped breastfeeding, because her mother-in-law told her her milk was bad and that is why her first baby died. Sigh...It wouldn't matter what I said, all those years of school and experience in maternity nursing mean nothing against the words of a mother-in-law.
They said that the baby ate formula well, but I knew from experience that I should observe and see what "eating well" meant to them. So they brought out a 4 ounce bottle and filled it with boiled water (water in Afghanistan is full of bacteria and parasites, so I was very proud of them for boiling it). They then put 1 scoop of powder in it. The baby sucked it down in and instant, then started crying. They said, see her stomach hurts. So, I picked up the can of formula and read the instructions. It was one scoop per ounce. She was getting mostly water. I explained to them that they needed to put 4 scoops into the bottle, but no matter what I did, they just wouldn't believe me. Also, in the meantime, they were convinced that the baby was going to die of pneumonia, because i had uncovered her, so they kept wrapping all of those hot layers back up around her. I realized at that point that I needed help. The next day, I asked my office mate (an Afghan man who translates my lessons into Dari) to help me explain the concept of concentration. Just because the baby was getting 4 ounces of liquid did not mean that she was getting 4 ounces of milk, and that she was crying, because she was hungry. I talked with him until I was blue in the face, and just couldn't get through. Suddenly, I realized that I was yelling at the poor man. I don't lose my temper often, but I just couldn't help myself, and the more I tried, the worse it got. So, I finally said (still yelling), "Hassan, I am not angry at you, and I am not yelling at you. I am just so angry with the pain and unfairness that made you first baby die, and is making you not able to see that you need to feed this baby better. I love your family, and I know that if you don't do what I say, she will die, and I don't want that to happen to you and your wife again!" I think that made him think. Then he told me that he couldn't afford to put 4 scoops into the bottle, because formula was so expensive. So, a generous man at our office anonymously donated a bunch of formula.
To address the issue of heat, I asked another American nurse to help me out. The Afghans respect "white hair", so since she is over 70, I though she could have a bit of an affect on them, and it worked. She was able to convince them that making the baby that hot all of the time was dehydrating her. The baby is now about a year and a half now. Though not completely out of danger, her chances of survival increase every day that she lives.
Wednesday, December 12, 2007
Monday, November 19, 2007
What I have seen
I began my sojourn in Afghanistan with a healthy dose of language learning. The two official languages o f the country are Dari (also known as Persian, pretty much the same language as Farsi and Tajik), and Pashtun. There are tons of other languages spoken, but these are the main business ones. I lived in a predominantly Dari area, so I opted for this one. (It is also easier.) I wanted to help women and children, and since most women are illiterate, they would certainly not know English.
As I was learning, I was also researching the needs of the people. 25% of Afghan children do not reach the age of five. Stop and think about that for a moment. Many ask me why Afghans have so many children. Well, it is simple pragmatism. They need their children to grow up and care for them in their old age. They know that 1/4 of them won't survive even to five years old, so they have between 8-15 to make up the difference (that statistic doesn't include infant mortality, or those that die after age 5.) The maternal mortality rate for the country is around 30%. In some provinces, it is higher than in the entire history of the statistic. (This is, remember 2007, how is that even possible?). In our city there were tons of programs addressing the illnesses that lead to these unnecessary deaths. There are tons of birth/life-saving skills classes for women, and classes on diarrhea prevention and pneumonia treatment and prevention. So I wanted to do something different.
This is what I saw:
When I walked down the road to our office every morning, I would see children standing in knee deep sewer ditches playing with discarded hypodermic and IV needles. I would watch as children climbed on top of roofs to get their kites in the air, then, as children are prone to do, look away from their feet and step right off the roof. {A brief aside here...if you have not read The Kite Runner, but desire to know about Afghanistan, it is a must read, and the movie is coming out on December 15. But, it is extremely graphic, not for the young or faint of heart}. I saw children fall out of the trunks of taxis, and children everywhere with horrific scars from burns they had received. I interviewed women who had lost their babies to completely preventable accidents. I then started asking about first aid practices. For the most part, there are none. When there are, they do more harm than good. If a baby is burned, they are then covered in oil, or mud. if a baby is choking, the mother sticks her finger into the baby's throat and pushes the food right on down...right into their little lungs. The more I heard, the more fire was lit under me. I decided to take on this 25% statistic and it was like taking on the devil himself.
I hired a couple of really swift Afghan women. One was a widow with 6 children who had managed to survive and keep her family intact through the Taliban years, an extremely difficult task. The other was a woman who had married her first cousin (extremely common practice in Afghanistan). She also had six children, three of whom were deaf. I designed safety and first aid lesson plans and a wonderful generous group of people donated 4 resusci baby dolls and two resusci juniors, and we went into local schools to teach the teachers, then into homes to teach women. Have you ever watch the nature shows where the salmon are not just swimming against the current, but they have to actually swim up a waterfall? Well, that seems awfully easy now.
More to come...
As I was learning, I was also researching the needs of the people. 25% of Afghan children do not reach the age of five. Stop and think about that for a moment. Many ask me why Afghans have so many children. Well, it is simple pragmatism. They need their children to grow up and care for them in their old age. They know that 1/4 of them won't survive even to five years old, so they have between 8-15 to make up the difference (that statistic doesn't include infant mortality, or those that die after age 5.) The maternal mortality rate for the country is around 30%. In some provinces, it is higher than in the entire history of the statistic. (This is, remember 2007, how is that even possible?). In our city there were tons of programs addressing the illnesses that lead to these unnecessary deaths. There are tons of birth/life-saving skills classes for women, and classes on diarrhea prevention and pneumonia treatment and prevention. So I wanted to do something different.
This is what I saw:
When I walked down the road to our office every morning, I would see children standing in knee deep sewer ditches playing with discarded hypodermic and IV needles. I would watch as children climbed on top of roofs to get their kites in the air, then, as children are prone to do, look away from their feet and step right off the roof. {A brief aside here...if you have not read The Kite Runner, but desire to know about Afghanistan, it is a must read, and the movie is coming out on December 15. But, it is extremely graphic, not for the young or faint of heart}. I saw children fall out of the trunks of taxis, and children everywhere with horrific scars from burns they had received. I interviewed women who had lost their babies to completely preventable accidents. I then started asking about first aid practices. For the most part, there are none. When there are, they do more harm than good. If a baby is burned, they are then covered in oil, or mud. if a baby is choking, the mother sticks her finger into the baby's throat and pushes the food right on down...right into their little lungs. The more I heard, the more fire was lit under me. I decided to take on this 25% statistic and it was like taking on the devil himself.
I hired a couple of really swift Afghan women. One was a widow with 6 children who had managed to survive and keep her family intact through the Taliban years, an extremely difficult task. The other was a woman who had married her first cousin (extremely common practice in Afghanistan). She also had six children, three of whom were deaf. I designed safety and first aid lesson plans and a wonderful generous group of people donated 4 resusci baby dolls and two resusci juniors, and we went into local schools to teach the teachers, then into homes to teach women. Have you ever watch the nature shows where the salmon are not just swimming against the current, but they have to actually swim up a waterfall? Well, that seems awfully easy now.
More to come...
Sunday, November 18, 2007
Initial thoughts
I have often thought that I should start blogging about my experiences in Afghanistan. They are usually amazing, though sometimes almost unbelievable. I have lived there for a bit over two years and have seen more in that time than in my whole life put together. When you speak to an Afghan, they speak a language of brokenness. They will say, "she is a broken woman" in reference to a prostitute, "the streets are broken", in reference to the fact that there are not many intact roads in the country. This type of talk will go on for a few minutes, listing everything that is wrong, not working, or painful, and it will finally end with a deep sigh and the words, "Afghanistan is broken". I think this is partly what draws me to this place. It is a country broken by poverty and years of ethnic violence and war. Afghanistan is broken.
A few years ago, our local newspaper in the states had a section that was dedicated to the reconstruction of Afghanistan. After pages and pages of the pain and brokenness and hopelessness, the conclusion was that we could work for years and years and never make any headway.
I RESPECTFULLY DISAGREE.
Yes, there is severe poverty. I have sat with an eight month old baby in my arms who was the size of a newborn and watched as her life began to ebb away because her parents couldn't afford to feed her and their 7 other children. She had been brought to me too late to help. Yes, there is hopelessness. I have escorted a man to a clinic as a last ditch effort to save his life, which was ravaged by homelessness, heroin abuse, and an intractable case of TB. Yes, there is brokenness. The women that I counsel have seen so much trauma (husbands being murdered in front of them, children killed by landmines, personal rape and betrayal), that they cannot even cry anymore. When they tell their stories, stories so horrific that Stephen King would cringe, they tell them with completely detached expressions, as if they are recounting a history of white bread.
But there is hope. How do I know this? Well, I know because I have seen it. I see a people ravaged by pain, who continue to get up every morning, make breakfast, send their kids to school, go to work, and continue to breathe, even when bombs are falling. I have seen the hope in the eyes of the shopkeeper in my favorite fabric store in the bazaar. He says that he had been in a Taliban prison until US soldiers came in and freed him. He is now free to provide for his family. I see hope in the women who have taken the initiative to go to literacy classes to set an example of education for their young girls. I see hope in the young medical resident in the pediatric ward of the local hospital who genuinely cares for his patients and is trying his best to provide good medical care for them. I see hope in the new born babies' eyes as they enter the world. Death cannot have the victory!
I should also mention that I am a nurse. Yes, life in Afghanistan is hard, but it is the biggest blessing in my life, and it is a joy and a privilege to be able to help and serve these wonderful, loving, passionate, frustrating, smart, foolish, warring, and peace-loving people.
A few years ago, our local newspaper in the states had a section that was dedicated to the reconstruction of Afghanistan. After pages and pages of the pain and brokenness and hopelessness, the conclusion was that we could work for years and years and never make any headway.
I RESPECTFULLY DISAGREE.
Yes, there is severe poverty. I have sat with an eight month old baby in my arms who was the size of a newborn and watched as her life began to ebb away because her parents couldn't afford to feed her and their 7 other children. She had been brought to me too late to help. Yes, there is hopelessness. I have escorted a man to a clinic as a last ditch effort to save his life, which was ravaged by homelessness, heroin abuse, and an intractable case of TB. Yes, there is brokenness. The women that I counsel have seen so much trauma (husbands being murdered in front of them, children killed by landmines, personal rape and betrayal), that they cannot even cry anymore. When they tell their stories, stories so horrific that Stephen King would cringe, they tell them with completely detached expressions, as if they are recounting a history of white bread.
But there is hope. How do I know this? Well, I know because I have seen it. I see a people ravaged by pain, who continue to get up every morning, make breakfast, send their kids to school, go to work, and continue to breathe, even when bombs are falling. I have seen the hope in the eyes of the shopkeeper in my favorite fabric store in the bazaar. He says that he had been in a Taliban prison until US soldiers came in and freed him. He is now free to provide for his family. I see hope in the women who have taken the initiative to go to literacy classes to set an example of education for their young girls. I see hope in the young medical resident in the pediatric ward of the local hospital who genuinely cares for his patients and is trying his best to provide good medical care for them. I see hope in the new born babies' eyes as they enter the world. Death cannot have the victory!
I should also mention that I am a nurse. Yes, life in Afghanistan is hard, but it is the biggest blessing in my life, and it is a joy and a privilege to be able to help and serve these wonderful, loving, passionate, frustrating, smart, foolish, warring, and peace-loving people.
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