War and Rebellion

The combat (or recon, I guess I should catch up on these things) helicopters fly low over our house. Sometimes I think I can reach up and touch them. There are men with big automatic guns sitting at the side of them sweeping their gaze back and forth looking for enemies. The birds who have camped in our tree are all scared and fly quickly up and then back down so they don't get caught up in the rotors. They come in threes, these helicopters, and they are so loud that conversation automatically stops, the ground shakes and your body vibrates. Then, they are gone. The birds automatically nestle back into the trees and continue their singing and preening, as if nothing had happened.

A big boom is heard, our house shakes, the windows rattle. A couple of hours later we hear there was a rocket attack, and many Italian soldiers are dead. Husbands and sons who will not return home. But the kittens outside on the balcony continue to roll around and tumble and cry for milk.

A bomb (IED if you are technical) goes off, though foreigners are targeted, many civilians are killed. Yet, the sun continues to rise. The birds continue to sing, kittens continue to arch and purr, and children go out and play soccer.

God's creation is rebelling against war and pain. The sun will continue to rise every morning to remind us of the light that is there, and the HOPE that will never ever end.

Birth Stories

***Warning*** some of this information may be a bit graphic for men or children.

I recently attended a “birth-life-saving-skills (BLISS)” training for Afghan women. I had been considering this as a project for some refugees that have fled the fighting in the mountains. I am no longer just considering, I have decided. It is a great course. I attended the training with another foreign doctor, some Afghan doctors, some educated Afghan women, and some Afghan women who are completely illiterate. I think that many of the illiterate women had seen more births than any of us “educated” people had. The course teaches very simple things that one can do to prevent death during the birth process. For example, cutting the cord after it has been tied off in two places, and cutting between the tied areas. Also, cutting with a knife or scissors that are not full of dirt and mud or blood from previous births (i.e. clean), rubbing the baby vigorously after birth so that it will start to breathe. Often, if the baby doesn’t breathe, they just give up, when something as simple is a rubbing it, flicking its feet, or cleaning out its mouth and nose are enough.

The course also tells the danger signs that indicate the woman or baby needs to be transported to the hospital, and what first aid to render in the mean time. For example, if a woman is hemorrhaging, she should drink a lot of salty water (there are no ambulances here to provide IV fluids on the way to the hospital).

Anyway, this blog is meant to be about the stories we heard the women telling. Sometimes, there are things that are so horrific, that you wonder how people survive having seen it.

Story 1:

There was a woman in a rural village who was hemorrhaging. The description sounded like placenta previa, when the placenta is blocking the birth canal. A baby cannot be born vaginally with placenta previa. She must be born by c-section. The lady who was attending her birth (whether it was a local midwife, or an old woman from the village who is trusted to deliver babies by the sheer number of which she has seen, is not clear), decided to give her pitocin to make the baby come more quickly. (Pitocin, or oxytocin is the hormone our body creates that sends women into labor. Sometimes it is given under controlled conditions in the states to speed up a slow labor, or stop a hemorrhage AFTER birth… in any case it should never ever be given to a woman in a remote village. One of the risks is that her uterus will rupture) When it was clear that her hemorrhage was not going to stop (using pitocin in this case I think ensured that it would get worse). The poor woman travelled 2 hours by car when she couldn’t go further because of the lack of roads. She then got on a horse to carry her the rest of the way (1/2 hour). She and the baby both died on arriving to the hospital.

Story 2:

One woman was having trouble due to a prolonged labor. She was very tired and in a lot of pain. So, the people of the village put her on a blanket and shook her to make the baby come quicker. Then, a dog was brought in to bark and make noise to chase away the Jinn (evil spirits). She eventually hemorrhaged and died.

Story 3:

One woman had three children who were blind. (this often happens here because of inbreeding after generations of women marrying their first cousins) Her husband told her it was because God was punishing her, so he made her fast during Ramadan. (Ramadan is 30 days where Muslims fast in order to gain favor with God. Pregnant women, sick people, travelers, and children are exempt from fasting and women with there monthly cycles are not allowed to fast) The woman became very weak. I cannot remember if she lived or not.

Story 4:

This story is more personal, as the woman was my employee, Nan. She has 6 children, 3 of whom are deaf. She is a very educated woman, who knows this is due to marrying her first cousin. However, when her 7^th was born, her mother-in-law told her it was because her breast milk was bad and that she shouldn’t breast feed anymore. The baby was very sickly, and eventually died. She is convinced it is because he didn’t have the immunity that her breast milk normally gives a child. So, she lives in guilt and shame over her 3 deaf children, and over her dead child, because she was trying to prevent his deafness. No matter how much I hugged her after she told me her story, she refused to be comforted. She cannot be convinced that the death was not her fault!

Story 5:

Warning This story is very graphic!

There was a woman who had a very prolonged labor, and for some reason the baby got stuck (it is not clear if the head was too big, or if there was shoulder dystocia). After days of labor, it was clear that the baby could not get out, so someone stuck something sharp into her and cut the baby to small pieces and pulled it out piece by piece.

I don’t write these things for their shock value. I write them to get them out of my head. This is why I am here, so no more women have to go through these things.

Drinking tea with the Kuchis

There is a nomadic people group in Afghanistan called "Kuchi".  They are really Pashtuns who travel back and forth across the land following the heat.  They farm in warm Laghman province in the winter, but travel south during the summer to keep away from the intense heat of Laghman.  

I have seen them numerous times along the road, women dressed in colorful clothing with many children, some walking some riding donkeys or camels.  They carry their entire livelyhood on the backs of their camels.  They always seemed so mysterious and exotic.  I always wondered what they would be like up close.

Yesterday, I had the chance to meet them.  I went out to one of their camps, as a literacy class, and a women's birth life saving skills was going on.  I was mostly there to observe the classes, but I was able to see into lives that have not changed for over 2,000 years.  

At first, I felt as though I had stepped into a scene from the Bible.  There were little tents scattered around, and small thatched shelters where sheep, goats and chickens found shade from the unrelenting Afghan sun.  A family of 13 (wife, husband, and 11 children) would live in a tent the size of one that a small family in the states might go camping in. It sounds simple and romantic, but then, you get to know them a bit better.  One woman came to me and told me that she was a widow and had only one son, and one daughter.  Something happened to the son two years ago, and would I please go and look at him?  I went and saw what I feared most.  He was brain damaged.  He looked to be about 14-15 years old, but looked and behaved just like a child with CP, only CP doesn't start at 12.  His mother said that he came in one day, had blood dripping from his nose, and drooled, and had been lame ever since.  She denied any accidents, but I don't know how else to explain it.  He didn't have a high fever, which rules out meningitis and polio.  It was so sad.  She is completely unable to support herself.  

Before I went to see him, I sat in a tent with about 5 other women from the village and drank tea.  They pulled out all of the snacks that they had, including a few raisins, a few hard candies, and some tiny dry chickpeas.  Flies were so thick on the candies that you could barely even see them.  As we sat there, I wondered what I could do to help them.  Suddenly I thought I could take the opportunity to teach them a bit about burn safety.  

I actually had a lead in, so it was an easy transition.  the tent was very small, we had to sit hunched over to fit.  So I asked where they did the cooking.  They said they put the propane tank with a small burner on top right in the middle of the tent.  HELLO!!!!  That screams danger to me.  So I told them to try to keep their children away from it.  But if they do get burned, just to pour cold water on it, no oil or butter.  They they asked, what about toothpaste?  That is what they put on it here, I don't know why, except that it is minty and probably feels cool to the skin.  I said no, just cold water, and if it turns black, to please please please go to the doctor.  Actually I did not really see anyone with burn scars there the way I usually do.  I don't know if it is because they don't get burned as often, or that if they do, they die.  That would be worth investigating.  

Then, I told the children that they needed to remember, if their clothes ever catch on fire they should not run, but drop and roll.  One of my goals is that every child in Afghanistan would learn that mantra... "stop, drop and roll!".

Oh, by the way, they only speak Pashtu, and I only speak Dari, so all of this passed through a translator.  Unfortunately, I am too busy to get involved with t e Kuchis, but hopefully something I said sank in.  

I had been discouraged about my previous work here.  Things change so slowly.  But a friend told me a couple of weeks ago.  There are two children that are not in the grave today because of your lessons.  That may seem like very little to you, but it is very great to the parents of those two children.  Hopefully my simple words yesterday will keep other children from the grave as well.

thoughts on the war

Have you ever felt an explosion?  I have... plenty. I live in Afghanistan.  I used to live in the North, and somehow, the suicide bombers there was always very inept.  They managed to always kill themselves, but didn't seem to ever get their targets.  I have now moved to Kabul where they are better trained.  Sadly... I felt a bomb about a week and a half ago.  It was very quick, just a boom that shook the building and made the windows rattle.  Actually, It sounded like someone had thrown a brick into our window.  Then it was gone.  I didn't think much about it, until two hours later when I heard that 20 people had been killed by it.  Several Italian soldiers, and many Afghan civilians.  My heart broke.  It broke for the poor Afghans who were just going about their daily lives.  It also broke for the Italian ISAF troops who are trying so hard to bring peace to this place.  After spending a month in the ISAF hospital last year, I have a very soft spot for those young soldiers.  They don't want to hurt people, they just want to bring peace.  I don't know the personal motivations of the leaders involved in running this war, but I do know that Afghanistan needs some peace and some guidance to that peace.  They have never known peace, so I am not sure they know how to operate without violence.  There is no easy answer.  But, if we all pull our troops out, the whole country will fall again, and we can't do that to the people here again.

The Journey

This is just a bunch of deep random thoughts about the past year...

How can you explain something that has happened to you, when you don't understand it yourself?  The past year, I have been fighting tooth and nail to reclaim my life.  It all started with a little tummy ache, and ended with me on death's door and being evacuated from two different countries. In the middle though, I was taken care of by some of the most precious Germans I have ever met.  I was loved by people I didn't even know.  I was held together by friendships that I couldn't imagine ever having.  

When the major saga ended, the journey back was just starting.  I arrived in America and spent 4 more days in the hospital.  When I got out, the dramatic physical illness began to finally wane (after 7 weeks), and the emotional one descended.  I really thought I had lost my mind.  Some people from my organization came to debrief me, and one mentioned that I may have some brain damage from the 107 F fever that I had, and the other mentioned that I was at risk for substance abuse due to the post trauma stress... so... I would be a brain damaged addict before it was all over?  I really didn't want to go down that road.  But I have to say, drowning my sorrows did cross my mind a time or two, better to drown my sorrows than for me to drown in them...

I have always dreamed of friends that would stick by me when everything else was gone.  But this time it wasn't a dream.  I would call, cry and they would just listen... no condemnation, no judging, and best of all, no one tried to "fix" me.  They just let me be me.  There were days that I really didn't think I would make it to the end of the day.  Yes, there were a few that said, "why are you still crying, you should be over this by now"  Mostly, I said that to myself.  But I think there are people who haven't grieved over living in a fallen world, and they couldn't understand.  So, there is grace for them.  

I lost a lot.  The biggest loss were my two cats.  One was a little kitten that I saved just before I got sick, the other was My little Pip Squeak, whom I had for 2.5 years.  She was such a sweet joy to me.  One of my leaders wrote me an email when I had been here about 3 months, and told me I needed to get a cat, because they comfort me so.  But the pain of losing them is nearly too much to bear.  Then again... 

When I was in the German Army Field hospital, I had some really precious nurses taking care of me.  In the past 3 weeks, I have seen three of them and my doctor.  I knew when I got to the hospital, that the Germans would be good and efficient.  I never dreamed how kind they would be.  There was on in particular that was just a joy to be with.  He cried when I left, and so did I.  

Saying goodbye to people who have effected my life in such a big way in such a short time is really weird.  Do you stay in touch?  Do you say goodbye forever?  What do you do?  What is appropriate.  I should know these things, because I am a nurse.

  I had a special  patient one time in the recovery room.  He had been in a car accident, and we fought all day long on July 4th to keep him alive.  Twice we brought his family back to say goodbye... he lived.  He had multiple surgeries over the next few months, and I recovered him on a number of occasions.  I remember his name, but I am sure he doesn't remember me.  I wonder sometimes when I am in the states, if I will run into him at Wal mart.  

I had another patient who had a tracheostomy and had multiple out patient surgeries to keep it patent (open).  Somehow, I always ended up being her nurse.  The last time that I recovered her, as she left, she put her arms around my neck and told me that she loved me.  

When I saw Chris (my German Medic), I told him I loved him, because I do.  I love hard, but it hurts, because somehow there is always a goodbye involved.  I wonder sometimes if I will ever get to stay with those I love.  I know I will in eternity, and though that seemed very close a year ago, it seems very far away right now.  

My two best friends here are now far away.  One left for England for more schooling, and the other will stay in Mazar, as I move to work in Kabul.  Another goodbye.  But I am so very thankful that I have such a precious friend to say goodbye to.  It means I have loved and been loved well.  I wouldn't trade anything for that.