Healing the broken

about boycotting

2011-12-08T03:40:00.001-08:00

I realize that there are worthy causes everywhere, and if we boycotted everything that had something unethical about it, we would sit in a cave and starve to death. Sometimes though we need to stand up and be heard. Boycotting Nestle covers many areas. It seems that no matter what your pet issue is, Nestle has crossed it. And for me, the lives of babies and children and the mental health of poor uneducated women who find out that their children did not have to die is worth giving up my make up, instant coffee, and hot chocolate. There are alternatives. Is a baby's life worth putting in a little extra effort to find a different brand? Perhaps to you, it seems far away and theoretical, but to that mother whose baby is not in the grave, it is very real, and very worth it!Oh, and if you are giving something up, let those companies know that you are doing it and why. Be respectful, but let them know!

Nestle boycott

2011-12-08T03:29:00.001-08:00

So, don't think that boycotting Nestle is easy for me. I love Maybelline mascara. When I wear it, I look as though I am wearing false eyelashes. In a word, beautiful. However will we choose beauty over the lives of babies? Also, Nestle has a huge share of the market on all Western products in Afghanistan. Will really have to do homework on what products are theirs, and either finding alternatives, or going without... PTL for Hersheys!

Nestle products

2011-12-07T11:37:00.000-08:00

Here is a list of different products that you may not konw are Nestle. Of course, anything labeled Nestle, but I was surprised at some. I have taken off the international brands, as most of my readers are Americans:

Cereals

Cinnamon Toast Crunch
Cheerios (outside US, Canada and Australia)
Cini Minis
Honey Nut Cheerios (outside US, Canada and Australia)
Oat Cheerios
Cookie Crisp
Crunch (Cereal)
Fitnesse
Force Flakes
Chocapic
Gold Flakes
Golden Nuggets
Golden Grahams
Honey Stars
Koko Krunch
Milo Cereals
Nestlé Corn Flakes
Nesquik
Shreddies
Shredded Wheat
Clusters
Trix

Yogurt

Fruit Selection Yogurt (Philippines)
Longa Vida (Portugal)
Munch Bunch
Ski

Coffee

International Roast
Nescafé
Sunrise (India)
Nespresso
Partner's Blend
Taster's Choice

Water

Aberfoyle
Aquapod
Arrowhead
Buxton
Contrex

Deer Park
Deep Spring
Hépar
Ice Mountain
Henniez
Nestlé Aquarel
Nestlé Vera
Ozarka
Perrier
Poland Spring
Powwow
Pure Life
San Pellegrino
San Bernardo
Viladrau
Vittel
Zephyrhills

Other drinks

Nestea (Joint-Venture with Coca-Cola, Beverage Partners Worldwide)
Enviga (Joint-Venture with Coca-Cola, Beverage Partners Worldwide)
Milo
Carnation
Caro
Nesquik
Libby’s
Growers Direct Organic Fruit Juices
Good Host
Juicy Juice
Ski up and go (Yogurt and Cerial drink)

Shelf stable

Bear Brand
Carnation
Christie
Coffee-Mate
Dancow
Gloria
Klim
Milkmaid
Molico (now Svelty)
Nespray
Nestlé
Nesvita
Nestlé Omega Plus
Nido
Ninho
Svelty
Emswiss
Milo

Chilled

Moça (Brazil)
Chandelle (Brazil, Chile)
LC1 (Switzerland)
Molico (Brazil now Svelty)
Nestlé
Ski
Sollys (Brazil)
Sveltesse (France)
Svelty (Mexico)
Yoco
Munch Bunch (UK)
Le Viennois (France, Belgium, Switzerland)
Nesvita (Philippines, India)
Ninho (Brazil)

Ice cream

Dreyer's
Edy's
Häagen-Dazs (North America and the United Kingdom)
Mövenpick (Switzerland)
Nestlé
Nestlé Drumstick - The Original Sundae Cone
Nestlé Princessa (Poland)
Oreo (Canada)
Peters (Australia)
Push-Up
Skinny Cow

Infant foods

Cérélac

Gerber
Good Start

Lactogen
Nan
NAN HA
NanSoy
Neslac
Nestlé
Nestogen

Nido
Piltti (Finland)
PreNan

Performance nutrition

Nesvita
PowerBar
Pria
Supligen

Healthcare nutrition

Boost
Carnation Instant Breakfast
Nutren
Peptamen
Glytrol
Crucial
Impact
Isosource
Fibersource
Diabetisource
Compleat
Optifast
Resource

Seasonings

Buitoni
Maggi
Carpathia
CHEF
Haoji
Thomy
Totole
Winiary

Frozen foods

Maggi (INDIA)
Stouffer’s
Lean Cuisine
Buitoni
Hot Pockets
Lean Pockets
Papa Guiseppi
Findus (Sweden)
La Cocinera (Spain)
Tombstone Pizza
Jack's Pizza
DiGiorno Pizza
California Pizza Kitchen Frozen

Refrigerated products

Buitoni
Herta
Nestlé
Toll House

Chocolate, confectionery and baked goods

100 Grand Bar
Aero
After Eight
Allens
Animal Bar
Baby Ruth
Bertie Beetle (Australia)
Big Turk (Canada)
Black Magic
Blue Riband
Breakaway
Butterfinger
Butterfinger BB's
Butterfinger Crisp
Cailler
Caramac
Carlos V (candy bar)
Chips Ahoy! (Canada)
Chocolate Surpresa (Brazil)
Coffee Crisp (Canada)
Chunky
Drifter
Fizzfindle
Frigor
Galak/Milkybar
Goobers
Heaven
Hercules Bars (Disney)
Icebreakers
Kit Kat (except in the United States, where it is a Hershey's product)
Lion
Matchmakers
Milky Bar
Minties (Australia)
Mirage
Joff
Munchies
Nestlé Alpine White
Nestlé with Almonds
Nestlé Crunch
Nestlé Crunch Crisp
Nestlé Crunch with Caramel
Nestlé Crunch with Peanuts (Limited Edition)
Nestlé Crunch Pieces
Nestlé Crunch White
Nestlé Milk Chocolate
Nestlé Princessa
Nestlé Wonder Ball
Nestlé Yes (Germany)
Nips
Nuts (Europe)
Oh Henry (except United States)
Peppermint Crisp
Perugina Baci
Polo
Prestígio (Chile, Brazil)
Princessa (Poland)
Quality Street
Raisinets
Rolo (except the United States where Hershey makes it)
Rowntrees
Fruit Pastilles
Jelly Tots
Pick & Mix
Randoms
Fruit Gums
Tooty Frooties
Juicy Jellies
Snowcaps
Smarties
Texan Bar
Toffee Crisp
Toll House cookies
Walnut Whip
Violet Crumble
Yorkie
Munch (only in India)
XXX mints
Milky Bar (India)

Wonka confectionery brands
Nestlé made Wonka Bars to promote the 2005 film adaptation of Charlie and the Chocolate Factory by Roald Dahl.
Bottle Caps
Donutz
Fizzy Jerks
FruiTart Chews
Fun Dip
Gobstoppers
Laffy Taffy
Lik-M-Aid
Nerds
Nerds Gumballs
Nerds Rope
Oompas
Pixy Stix
Rainbow Nerds
Runts
SweeTarts
SweeTarts Rope
SweeTarts Shockers
Tart 'n' Tinys
Thrills
Wonka Bars
Wonka Xploders

[edit]Foodservice products

Chef-Mate
Davigel
Minor's
Santa Rica

[edit]Petcare

Alpo
Beneful
Cat Chow
Dog Chow
Fancy Feast
Felix
Friskies
Go Cat
Butchers
Bakers
Winalot
Gourmet
Mighty Dog
Mon Petit
ONE
Pro Plan
Purina
Tidy Cats

[edit]Related with other companies

Nestlé owns 30% of the world's largest cosmetics and beauty company L'Oréal and its brands including Garnier, Maybelline, and Lancôme as well as The Body Shop stores.
Nestlé owned 100% of Alcon. In 2008 Nestlé sold 24.8% of Alcon shares to the Swiss pharmaceutical giant Novartis. In 2010 Nestlé sold another 52% of Alcon to Novartis. Novartis paid a total of 39.1 bn US$.

boycot Nestle

2011-12-07T06:09:00.000-08:00

*A caveat on this blog. I am trying my best to express myself clearly, but I am recovering from back surgery. Please forgive any ramblings.

I try my best not to do anything political on my blog. But I have been encouraged by my roomie's boycott of Nestle to do some research on the company, so I think my next few blogs will be about Nestle. I am nearly speechless by what Nestle does which is causing the deaths of millions of children in the third world yearly! How are they still in business?! Why isn't someone in jail over this?!

Here is the deal: If you are an American or a European, I am not railing about your choice to breastfeed or not. That really sin't any of my business. My business is the thousands of Afghan children who I am trying to save every year. In developing countries, breastfeeding isn't a choice, it is a necessity. I cannot tell you how many children that I have seen who are dead or dying due to the fact that their mothers didn't breastfeed. For these women, it wasn't their choice, they were tricked into giving their children formulas.

One child I wrote about earlier in my blog. Her parents did not understand that for every ounce of water they put into the bottle, they needed a scoop of formula. She was starving because they weren't feeding her enough. For another child, his mother was using well water to fill the bottle. The well water was contaminated by all sorts of bacteria and parasites. She could not afford to use the gas it takes to heat the water to boil it to kill the bacteria before adding it to the formula. I held this little 1.5 year old boy who MEASURED THE SIZE OF A 1 MONTH OLD! Thankfully he is doing better now, but it was touch and go for a while.

Nestle gives out milk in third world hospitals to women who do not know the dangers of giving formula to their children. Once the woman gets out of the hospital, their breastmilk having already dried up, the free milk dries up and they then have to buy it, and realize they cannot afford it. So besides what I mentioned above, the dirty conditions and diluting the milk too much, I have seen women giving their children watered-down sweetened condensed milk, as well as tea with sugar.

Other problems such as RSV and pneumonia show up, because these babies have not received the "inoculations" that their mother's breastmilk would normally provide to newborns.

No matter what side of the breast-feeding issue you fall on in the west, there is no question that in the third world, there is simply no other alternative for childhood nutrition (unless the mother is HIV positive, a problem that is not addressed in this blog) Please research Nestle (you can google Nestle boyott, or get on youtube and do a Nestle boycott search), and if you agree that their practices are unethical (and actually criminal) please join me in this boycott.

And, do some research on which companies that Nestle owns. Many companies have a different name, but are owned by Nestle.

Not on FB update

2011-10-26T15:27:00.001-07:00

Made it safely to Dubai, heading home in about an hour.

Not on f

2011-10-26T15:25:00.000-07:00

Definition of NOT FUN: saying goodbye to the sweet Afghan boy who you introduced to moving sidewalks, escalators, Western toilets, and America... My heart is broken in two.

Not on FB update

2011-10-25T04:10:00.000-07:00

I tucked cutie pie into bed last night, and he cried. He keeps telling me not to leave. So sad...

Not on FB uodate

2011-10-24T18:30:00.000-07:00

Weird... I just saw my house in Afghanistan, my car in my mom's office parking lot, my house in Greenbrier, my house in Mesa, and my dad's truck in the driveway, all on google earth... So weird!

Not on FB update

2011-10-23T17:21:00.000-07:00

Today, cutie pie got on his scooter, and I got on the bike and we went about a mile and a half up to the sonic and had burgers, fries, onion rings, and a cherry limeade! Later on, we went to a carnival, and we both went up a climbing wall. He looked like spiderman! He practically ran up the wall! I went half way up nd almost gave up, but just before I went up, cutie pie said I couldn't do it... That is one way to get me to do something! So, I went all the way up, I really didn't think I could do it. When I got down, my arms and legs were shaking and I couldnt get the harness off. But, I did it!

Urologist visit

2011-10-21T19:28:00.000-07:00

So, we took little Mr. Precious to the urologist today. At first, the doc wasn't very encouraging, due to the lack of available follow up in Afghanistan. But after he examined him, he seemed a bt more hopeful. He will have x rays, and MRI next week, then a laproscopic surgery so that the surgeon can se what is going on and what he has to work with. Again, he charmed all of the nurses. After 5 minutes with this kid,you just fall in love.

Not on FB update

2011-10-21T02:24:00.000-07:00

So, yesterday, the chiropractor asked me if I ever feel stressed... Um... Was he kidding?

Oof

2011-10-20T13:30:00.000-07:00

I think I need to adopt... I am in love with this precious boy! So are all of the nurses. He is so precious!

Not on FB update

2011-10-20T13:27:00.000-07:00

Went bike riding for the first time in over 10 years!

Not on fb update

2011-10-20T13:25:00.000-07:00

Went fishing for the first time in 30 years yesterday, and caught a bass!

Not on FB update

2011-10-18T10:31:00.000-07:00

Hello kitty at wal mart! Who is the happy girl!?

Not on FB update

2011-10-18T10:29:00.000-07:00

Kam air is the way forward in airplane food! Gourmet! Tandoori chicken, falafel, dinner rolls, salad, it was great!

Not on FB update

2011-10-18T09:59:00.000-07:00

So, why would an airline serve lentils at the beginning of a 16 hour flight? P!U!

Not on FB update

2011-10-15T09:50:00.001-07:00

Definition of fun? Taking an afghan kid on a moving sidewalk!

Hiking

2011-10-10T02:53:00.000-07:00

Went hiking the other day and ran into a few UXOs. What is a UXO you ask? UneXploded Ordinances. That means they are rounds of ammunition that got shot, but never detonated. Scary! We stacked rocks around them so that no one would treat on them.

Bullies

2011-10-06T00:57:00.000-07:00

http://www.blogher.com/are-you-ready-talk-about-it-i-am-i-was-bullied

This is a great link, and I wish I had time to read all of the comments. I was also bullied as a child. Most of the time it was verbal, but there were a few physical abuses along the way. I am not sure why me, I think that it is because everyone knew it would make me cry. I have an extremely painful memory from when I was in the 5th grade that was brought up last week. I was too young to have to deal with an adult situation.

Some things I have mulled over as an adult. Some of that bullying has made me what I am today and though it still doesn't take much to make me cry, I am tough enough to stay in Afghanistan against all of the odds. Does that mean I would go through it all again. No! The world is not as it was meant to be and bullying is part of its fallenness. Looking back, I realize that no one who bullied me had a healthy home life. That doesn't excuse them, it is just an observation. Also, I didn't have a healthy view of who I was. Had I had that, it probably wouldn't have bothered me much, and they wouldn't have had fun doing it.

All of that being said, there are things parents can do. First give your kids instruction! Don't allow them to bully others! And if your kid is bullied, get them out of the situation. I would have loved to move schools. I was too ashamed to tell my mom what had been going on. (Though she knows just about everything now. It wasn't her fault at all.) But there are signs. If your kid comes home from school every day and cries, or often fakes illnesses... ask! Give them a healthy, safe place to talk, and don't judge. Don't give them advice. It doesn't help. Telling a kid not to cry when people are yelling abuses at them constantly does not help! Let them know how valuable as a person that they are. Let them know that they are so valuable in God's eyes, that He humbled Himself, took the form of a man, was bullied and beaten Himself, and died, because He loved them so much. Thankfully, He overcame death, and was raised again, so that we can have a new life.

I still struggle with the after effects of being bullied. I would rather call it abuse, because that is exactly what it is. But His mercies are new every morning, and He is still forming me into the beautiful vessel that He wants me to be.

Oh, here is a funny thing, I went to my 20 year high school reunion a few years back, and everyone, even some who had been abusive to me, had fond memories of me... go figure.

NOT ON FB UPATE

2011-10-05T00:19:00.001-07:00

Really, really bad case of giardia...

NOT ON FB UPATE

2011-10-03T00:13:00.000-07:00

Ok, don't know what happened, but the pain is back and I am sick as a dog. I woke up at 4am today and it was unbearable. So, giving in and going to the doctor today. :P

NOT ON FB UPATE

2011-09-28T00:19:00.000-07:00

I have always been over limber, as a matter of fact, when I first started physical therapy for my back in 2000, I was forbidden to do some of the stretches, because I was too limber, and my joints would slide in and out of position! I am now still quite the noodle, and have to modify the stretches in some exercise videos, because they don't stretch me at all the way they are...

Here is the funny thing, I have been stretching out my hamstrings a lot due to my back pain the past few weeks, and now... i really am not kidding, this 42.5 year old chubby woman can do the splits! Not the side to side mind you, but front to back both directions... I think that is pretty cool! ;)

Not ON FB UPATE

2011-09-28T00:16:00.000-07:00

I made a decision last week that seems to have been a good one. I decided to pretend that my back didn't hurt, and just exercise as if I were well. Of course I was careful with some moves, as I do the FIRM series workouts, and they can be pretty intense. But I am doing much better. It isn't completely well, but I am able to move about much more freely! PTL!

NOT ON FB UPATE

2011-09-27T03:09:00.000-07:00

Woo hoo! mary is responding to a new drug I put her on, and this morning when I arrived at her house, the whole yard was swept clean, the toilet had been at least rinsed out, and there were sandals on the feet of her children! Victory!!!!

NOT ON FB UPATE

2011-09-26T03:11:00.000-07:00

bleh... I ate juSh the other day. Think breakfast gravy but made with goat fat, and lots of it... I haven't spent much time out of the bathroom since them... maybe it was the yogurt... or the almonds from the bra, or perhaps the dust storm kicking up the amount of fecal material in the air... hmm

artillery fire

2011-09-24T22:57:00.000-07:00

so, in honor of the former president of Afghanistan who died last week, on Friday, there was artillery fire. Very disconcerting when you live in a war zone, even when you know it was planned!

NOT ON FB UPATE

2011-09-24T22:52:00.000-07:00

So, what would you do if a woman you were chatting with suddenly put her hand into her bra and after fishing around a bit, brought out a handfull of small almonds and handed them to you and insisted that you eat them? WELCOME TO MY LIFE!

NOT ON FB UPATE

2011-09-21T00:07:00.000-07:00

This is the second time I am writing this... for some reason, the last didn't publish! Grr...

I have two suggestions for ending the nastiness and squalor that Mary and Wanda's family live in. They are poor, but they have access to water, and there isn't really an excuse for them to live like they do.

The two suggestions are at opposite ends of the spectrum, but I have been thinking of putting them together.... Any wisdom would be greatly appreciated!

The first suggestion is that we go out there with buckets and bleach and roll up our sleeves and clean it from top to bottom to show that it can be done and how to do it.

The second suggestion is to tell thme I won't come back, or that I won't treat their illnesses if they don't stop living the way they do (an incentive to change)

My idea is to go out there, help them clean so they understand that it really can be done, and then tell them, yes children get sick, no matter how clean the environment is, but they do get sick a lot more and are more apt to die from the dirty conditions. So, once we help them get things cleaned up, it is their responsibility to keep it that way. If they don't, I will assume that they don't care for the health of their children, and I will stop treating their illnesses, but if I see positive changes and that they are trying, I will continue to help with their healthcare.

Wisdom???????????

NOT ON FB UPDATE

2011-09-20T03:24:00.000-07:00

So, my friend, Mary, is in the hospital with dysentery. I have been trying for two years to get them to keep things clean at their house but they just haven't. I am starting to get angry. One or more of the children is always sick. (One man with two wives and a total of 7 children plus guests). Their bathroom is outside and is just a hole in the ground. The children do not go in the hole though, they go all over the place.

After I got back from the hospital I had it out with the women. All of the children were running around without shoes, and going in and out of that nasty bathroom. I went into the yard and threw open the door to the toilet and made the other wife come and look. There were puddles of diarrhea all over the ground. Then I showed her all of the flies that were all over the yard and inside their house. I told her that the flies walk all over the poop (I didn't pull any punches this time!), then they walk all over their food and cushions, so that when they ear they are eating poop, and when they lay their head down to sleep at night, they are putting their faces on poop. I told them to buy a bottle of bleach (very cheap) and just poor it all over the bathroom to kill all of the germs. And I made the children all go put plastic sandals on their feet. Wanda (the other wife) said that she couldn't make them all wear sandals they take them off and put them down the toilet hole. I said, "You are their mother, and you have authority given to you by God to take care of them! This is your responsibility!" I was so mad!

I told them that the medication we give for diarrhea (usually metronidazole aka flagyl) is bad for their livers and if they keep getting sick and taking medicine, their livers would die, and then they would die. It is far better to not get sick than to take medicine.

I then went in and treated some mal nourished children. Poor little babies.

fun link

2011-09-20T02:51:00.000-07:00

ok, this has nothing to do with me what-so-ever, but I read it today and thought about all the kids out there playing video games... perhaps it isn't so bad after all! http://www.foxnews.com/health/2011/09/19/us-gamers-crack-puzzle-in-aids-research-that-stumped-scientists-for-years/?test=latestnews

GRRR.....

2011-09-18T01:54:00.000-07:00

Seriously, what is the point of the WFP and UNICEF if they aren't going to help someone. I guess once the kids starve to death they may help with funeral costs!

NOT ON FB UPDATE

2011-09-18T01:47:00.000-07:00

I finally decided I couldn't take the pain anymore and called a doctor. He put me on Hydrocodone for a few days to get past the excruciating pain and be able to sleep a bit. Starting to feel a little more human again.

NOT ON FB UPDATE

2011-09-18T01:44:00.001-07:00

I cooked some lentils last night for today, but they are really dry, so I am making soup... When life gives you dry lentils... ;)

NOT ON FB UPDATE

2011-09-18T01:42:00.001-07:00

Had Lizzie Lou over for dinner last night. So sad she is leaving. Yummy Cajun fish!

NOT ON FB UPDATE

2011-09-18T01:41:00.001-07:00

Still haven't found plumpy nut, but am calling the WFP (World Food Program) this afternoon to try to track some down.

NOT ON FB UPDATE

2011-09-18T01:34:00.000-07:00

Ok, just a little caveat before I write this. I love all of you my married friends, and most of you don't do this. Those of you who do will have something to think about.

Why is it that when a single woman says she desires to be married, every one says that she needs to make sure she is content as a single before she can get married, but a married woman can complain constantly about having a husband and children and doesn't get told that she needs to be content? I am really tired of the double standard.

Partly, I don't think we are meant to ever be fully content in this life. That verse about being content in all situations, Paul is talking about money, he is content rich or poor, it isn't about marriage at all...

Marriage is a mandate passed down before the fall of man, it was not good for man to be alone, even when man was in perfect relationship with his creator!!!!! So stop judging me for wanting to get married. It isn't good for me to be alone!

great site

2011-09-14T00:43:00.000-07:00

http://www.michaelyon-online.com/afghan-faces.htm

NOT ON FB UPDATE

2011-09-14T00:33:00.001-07:00

Am just finishing up re-reading Eric Metaxes's biography on Dietrich Bonhoeffer. I think everyone who calls themselves a believer in Christ should read it!

NOT ON FB UPDATE

2011-09-14T00:25:00.000-07:00

Whew! That was a close one!

NOT ON FB UPDATE

2011-09-13T01:51:00.000-07:00

I am having severe back problems... on a brighter note, most of the babies I am treating are getting a little bit better. Gonna find some "plumpy nut" for them! (google it!)

NOT ON FB UPDATE

2011-09-10T04:52:00.000-07:00

So, I have always had trouble sleeping at night. But it is now to the ridiculous stage. It is HOT. I mean still really hot. My swamp cooler burned out back in late June, and now, it is just hot. I have a fan and when it blows directly onto me, it cools me off enough to sleep, but it drives my nerves crazy, like Chinese water torture. It is loud, even on low with earplugs, and I feel like someone is gently slapping me all night long. I just can't win. But, I desperately need to sleep!

NOT ON FB UPDATE

2011-09-07T00:03:00.000-07:00

Definition of gaudy: An Afghan wedding.

NOT ON FB UPDATE

2011-09-05T02:45:00.000-07:00

Ok, I am ANGRY! So angry! Babies here are dying needlessly of malnutrition. Most of it is ignorance. Pure ignorance. But when we teach them, they don't learn because it goes against cultural norms... GET READY MALNUTRITION! THIS MEANS WAR!

NOT ON FB UPDATE

2011-08-31T06:21:00.000-07:00

So, we went visiting for the holiday today, and I was talking to a mountain woman about my desire to get married. She said, well, you reall need to hurry. Every day, you are getting older, weaker and more broken down... Sigh...

NOT ON FB UPDATE

2011-08-28T23:42:00.001-07:00

I have been thinking about all of this travel security nonsense. The liquids, really? Only 3 oz bottles? But a whole bag of them... I can get about 8 of those little bottles into a quart sized ziplock bag, so that would be what, 24 oz? So why is it bad to just have one 24 ounce bottle? Also, I have been through Heathrow airport 3 times the past month. I honestly forgot all three times that I had my inhaler in my purse, a little aerosol can. Now, even in Afghanistan I have been stopped in security for that. It was not noticed at all by the Brits. I realize that they would have let it through, but they didn't even ask... did they even notice? Begs the question.

So, I have decided, since it usually costs to check a bag nowadays, and even for little trips, I have so many little bottles that it is too much for my carry-on (shampoo, conditioner, straightening gel, straightening spray, eye make-up remover, facial cleansing stuff, moisturizer, mascara, body lotion, body spray, shower gel... you girls know what I'm talking about!), I will no longer carry the regular stuff. On arrival I will go to Boots, or wal-mart, or where ever may have little sample bottles and just carry my face stuff that I can't get there. Such a pain!

Ok that was a bit more than FB, but not really a blog...

NOT ON FB UPDATE

2011-08-28T23:33:00.000-07:00

Trying to get 500 emails answered! Oh dear!

NOT ON FB UPDATE

2011-08-20T00:51:00.000-07:00

I'm leavin' on a jet plane, don't know when I'll be back again...

NOT ON FB UPDATE

2011-08-19T00:39:00.001-07:00

Yes, I saw what happened this morning, yes, all of my peeps are ok, yes, I am going back. :)

Sweet moment, funny moment

2011-08-17T14:08:00.000-07:00

For those of you who know me, you know that I can't really get through an entire day without having some sort of weird adventure. Yesterday it was a trip to the ER.

Today, I went hiking and we found a great spot in the woods to have quiet times. It was so beautiful. K. went a couple of hundred yards away and we both did our individual things. I read, and listened to P&W music (Psalms from The Sons of Korah) and then slept a bit. At one point I heard some scuffling and woke up and looked around to see if K. had come to eat lunch. What I saw was a beautiful baby deer about 12 feet away from me, and another behind it. he just stared at me and let me take his picture. So sweet. He hung around for a little while then went off and played around with the other one. What a nice little moment of grace.

After K. and I had lunch, I decided to go hide in the trees and do the necessary thing. I started to walk away and then stopped and got my camera. I told K. that it would be funny if a pack of wild boars (proliferate in those woods) came running up while I was "busy" I would have to take a picture of it so people would believe me. So, after I was done hiding, I walked about two steps, when... I AM NOT KIDDING! This pack of wild board went running through and stopped right where I had been!!!!!!! I HAVE A WITNESS!

I have to say I am very thankful that I was done, but isn't that just WEIRD?!

NOT ON FB UPDATE

2011-08-17T12:12:00.000-07:00

Went hiking today. Pain is a lot better, but still there when I don't take the metamizol. What is that you say? It is a great anti-inflammatory, the one I took after my appendix ruptured, when they thought I had typhoid. It is illegal in the States, but thankfully I am not there.

NOT ON FB UPDATE

2011-08-16T05:07:00.000-07:00

Well, I have seen the inside of another foreign hospital as a patient. I woke up this morning in terrible pain. Turns out it is a UTI. I didn't know they could hurt that bad! I thought it had to be a kidney stone, but they didn't see anything on the scan. Anyway, I'm now on antibiotics and pain medicine, but still feeling pretty rotten.

2011-08-15T13:54:00.000-07:00

I was lord of all Catan for 24 hours, but just lost my power in a very sad game of Cities and Knights.

NOT ON FB UPDATE

2011-08-14T00:18:00.001-07:00

I am not sure why, but I had really out there crazy dreams all night last night, and I just remembered one of them. I had a cat that only had one eye. Not like one eye was missing on a side, but it was like a cyclops with a big eye right in the middle! How weird is that?

NOT ON FB UPDATE

2011-08-14T00:05:00.001-07:00

Last night, I watched the movie, Limitless. I really pondered afterward why it left me so cold. I decided there really wasn't a redeemed ending, mostly even bad movies have some sort of redeeming ending. This ending was just a continuation of extremely selfish motives that prevailed throughout the whole movie. But, my friend reminded me this morning that it is a GREAT conversation starter. What would you do if you had limitless potential to recall everything you had ever seen or learned, and were limitless in what you could learn. What would you do with that power?

NOT ON FB UPDATE

2011-08-13T08:58:00.000-07:00

Since I can't be on FB anymore, anyone who feels like putting int he effort can read frequent updates here on my blog, as well as longer blog entries. Welcome one and all! Feel free to comment.

Moving house

2011-07-04T08:56:00.000-07:00

So, I started my big house move today. I have lost count of all of the times I have moved the past 10 years. Not as much as some, but, more than most. I should always remember that things take longer here than at home, but I seem to always forget. Actually things that may take an hour or so at home take days and days here.

So, I went tot he house today with the realtor (yes, they exist here, usually referred to the "paraperty dealer"). I wanted to do a once over to make sure everything worked before signing the contract. I don't know what happened on the last couple of days of the previous tenant's contract, but it seems that every foreign restaurant in town threw up on the floor. I have never seen such nastiness. I nearly cried. I had to quickly change all the days plans to clean. I mean it took hours just to sweep all of the trash out. Then we began to clean!

It took me, a teammate, and a local housekeeper all day just to clean the flat I am moving into. (There are two other flats in the building that we will start on tomorrow.) WE hired a truck and they made two trips and will make another tomorrow. SO most of our stuff is actually in the building but I think ti will take days before the house is really livable.

Oh, and someone left the basement window open and the screen is torn, so since the place is so nasty, guess what came in for a visit? Oh yeah... cock roaches. I nearly lost my mind. But I really believe that this time it is not a house structural issue. I think it is simply a nastiness issue that can be resolved with a few roach motels, boric acid, and bleach! I love bleach! What a great invention! What is that called? Something hypochloride or was it an hypochlorate I get the ides and ates confused? Oh well, chemistry was over 20 years ago. I guess I am allowed to forget a bit.

I am so thankful for my teammate, K, who helped me. If she hadn't been there I think I would have lost my mind. And, the availability of Dettol products (the British version of Lysol) is one of the huge blessings of life here. I go to the foreign shop and I stand in the cleaning products isle and bask in the glow of antiseptic/antibacterial products! Now, i am not a germa-phobe... perhaps I should be as much as I get sick here. But I love to clean! And, I think there is enough antibacterial products available here that if we poured them all into the sewer, perhaps children would stop getting so sick from their drinking water! But I digress...

Back to the house. It really is a nice place and there are very few repairs that need to be made, thankfully. But the amount of cleaning that needs to be done pretty much negates the time saved by few repairs. I am not sure that easy should even be in the vocab here.

So, tomorrow we go to buy carpets. I think I shall put linoleum in my room so that... yes, it will be easier to clean. So much dust here. If we could package the dust and sell it for something, the financial woes of this country would fade into the sunset. But again, I digress. I am really tired and have a hard time staying on task when I am this tired.

I don't need a big fancy place, but I need to have some beauty. I need a place that is "mine" where I can retreat to and rest. When I sit with a dying child, I need to go home and let down. I am excited about this house. I think it has the potential to be beautiful and homey. I just need to unpack and get settled in... Oh and the great thing? The contract is for two years! If we actually make it that long, it will be the longest I have been anywhere in recent memory! :)

Who am I?

2011-07-01T09:12:00.001-07:00

I have been told that I am too dramatic about my life here, that I am attention seeking.

Hmm...I have a friend here who says she really struggles because of the stories that women tell her. The stories they tell... they really are horrific... I don't hear the stories. Why? Because I live them...

I don't hear about the woman whose brother beat her for talking to a man on the phone. I treat her wounds from the beating.

I don't hear about the woman whose baby is starving to death, and whose husband won't let her seek treatment for it. I hold it and pray over it that it may die quickly so it doesn't suffer.

I don't hear about the woman who wants or tries to commit suicide. I hold her down as she is screaming and trying to escape to get the gas can and the matches.

I don't hear about the sixteen year old girl who is newly engaged and just beginning her life, but dying because she had no access to healthcare. I fight for her and and watch as she turns from a beautiful young woman to scarcely a waif and fades off into eternity. I hold her sisters hand. I keep her mother standing as she wants to throw herself onto the floor. I sit at the funeral numb wishing I could have done, wondering if I could have done... more.

I don't hear about the twin babies who are starving to death. I sit with their mom as she cries because they are refugees and have hardly enough money to eat every day.

I don't hear about the pain. I live it.

A random thought

2011-07-01T09:06:00.000-07:00

I was just thinking today about how people comment on things they know nothing about. I read news stories about Afghanistan (usually full of very incorrect and exaggerated information) and then I read comments from the readers. I am quite shocked when I read things like, "the US should just carpet bomb the whole place and get out of there!" First of all, I think what people clearly don't understand is that we are NOT at war with Afghanistan or the Afghans. We are at war with the Taliban and terrorists. Most of the bad guys who are here are insurgents. That means they are Foreign to Afghanistan! Would you carpet bomb innocent women and children because THEY are being invaded? Just a thought...

follow-up

2011-01-03T06:43:00.000-08:00

I went to work this morning, and Hadassah, my coworker, told me that when she handed the "reward" money to the woman, she said, "You should be giving me $100 instead of Af 100!" Hadassah is sure she is the one who stole my purse, thinking to get a very large reward for returning it!

Turning the other cheek

2011-01-02T03:02:00.000-08:00

Turn the other cheek… what if you don’t have time before the next slap comes? Sometimes life feels like that. You keep taking hits and before you can turn the other cheek another one comes. Today it happened literally.

I have been taking care of a woman from the mountains who is probably about 17 years old, had a (about) two year old little girl, has been widowed and remarried, is pregnant, and dropped a huge stone on her legs and broke both of them. After a painful 3 day trek down the mountains to a province called “laghman”, where she had two surgeries. One of which was an “ex-fix”. Meaning she had an external rod with screws in her leg.

Yesterday, I went to her house to check on her (this is an endeavor in and of itself that takes over an hour, just to get there). She is staying at one of the poorest places I have ever seen. There are four families living in the “yard” which is more like a compound. Each family has a room all of which open to the outdoors. Two of the rooms have no doors or windows. This is Kabul, which is very high (in the mountains) and very cold.

She didn’t know where to go to get the ex-fix removed, so I agreed to take her to a local hospital here that is good at orthopedics. WE arrived into chaos, which is the case in just about every hospital in Afghanistan. Her mother and her friend were with her, as well as my coworker and I. We took her to the female emergency room and sat to wait for the doctor. There is a woman in the er who is kind of like an information giver. She was pretty well dressed, which usually means at least partly educated. She seemed fascinated with us, which happens when I show up with a group of women. It took a while, and the others were kicked out because we were too many people for a small place.

The doctor came and looked at her and ordered an x-ray to make sure there was no infection in the bone. So, I took her down to the x-ray department in a wheelchair (the chair leaving a little bit to be desired). We got there, and got her x-ray and then sat outside to wait for it to be developed. As we waited, I realized that I needed to pay for the x-ray. I reached to my shoulder to get my purse, and it wasn’t there. I frantically looked around me and looked in my back pack (had my computer with me too.) But, it wasn’t there. I felt very panicky. In the meantime the man at the door of the x-ray room who lets people in and out kept following me around asking for “Shirni” which means candy. In this case it meant a bribe. Ugh!

I told my coworker, Hadassah, and she went back to the ER to look. She didn’t see it, so this man, Wahid, came with me to look for it. We looked on and under every bed, and behind every curtain. It was nowhere to be seen. I started to have a very sinking feeling in my heart as the truth sank in. Someone had stolen my purse. Then I started thinking of all that was in it. $600, my credit cards, insurance card, nursing license, all of my keys, glasses, well, really like most women, my purse is a treasure trove… I kept praying and trying to remember that I will have what I need, but it was hard to stay focused. I went into the x-ray room to look, and they said the x-ray was ready, but wouldn’t give it to me until I gave them Af100. Wahid was there and told them that someone had stolen my purse, and they guy just shrugged and said that he wouldn’t give it to me without the Af100. Wahid rolled his eyes and gave her the money.

We then went out to fetch the lady and go back ot the ER. Wahid then handed me Af 500 (about $9.5) That is a lot for a man who only makes $100 a month. He said that he was ashamed of his country that would steal from me when I was trying to help.

While we were waiting for the doctor to come and take the screws out, I was standing in the hall with the other ladies talking. They were really sad and angry about my purse. Suddenly, the well-dressed woman form the ER came out with my purse! I hollered and hugged her and kissed her, then she started asking for “shirni”. I told her that it was enough that she had done a good thing before the eyes of God, and the other women told her that the “shirni” I was giving was helping the poor in Afghanistan. She then slapped my face! And before I could react, she slapped me again. Then I started to say something and she slapped me again! I was so angry, and then she walked away. (Actually I think she ended up slapping me about 4-5 times, but I lost count).

That shook me up, but I was distracted by the women telling me to make sure that all of my money was there. They shielded me while I crouched in a corner to look and it was all there. I took out 500 and a100 to repay Wahid. They all saw the 100 and told me to give it to that woman, so I gave it to Hadassah to give to her, which she did.

The doctor finally came in, and began to take out the screws. I protested that they hadn’t given her anything for pain, and he said that he couldn’t because she was pregnant. I convinced him to get a local, and that woman came in while we were waiting, and grabbed my cheek (the same one she had slapped) and pinched hard and pulled it away from my face. She said what is Af100? It isn’t anything! I pulled away from her and said, everyone here wants money form me. I am trying to help this woman and everyone just wants something from me! Then she laughed and said she was only joking. At that point I was near to tears. Then the doctor and Wahid started to unscrew the ex-fix, and I told them to stop until she had the local and they just laughed and said that it doesn’t hurt, even though the woman was obviously in terrible pain. I told them she was in pain and they shouldn’t think it is funny. Finally, they got all of the bolts undone and gave her a local anesthesia to take out the first screw. But they didn’t wait for it to take effect. They gave the shot then unscrewed it from her bone! I just kept holding and kissing her hands and praying for strength for her and myself.

It was finally over. They put a hard cast on her and we helped her to the car, where 4 new blankets, huge bags of flour, rice, beans, oil and washing powder awaited her/and her family. The car took her home while Hadassah and I waited for some other friends who just happened to be at the same hospital at the same time.

It was a rather trying day, full of good things, yet, my heart has once again been slammed by accusations of being rich and not caring, and having my face smacked by someone who I had only been nice to… So, I came home and ate chocolate.

I am pretty sure that the woman had stolen my purse and had thought she could get a big amount of money to give it back. If she had known that I was only going to give her Af100 (about $2.25) She wouldn’t have given it back. Sigh…

2010-11-19T00:08:00.000-08:00

Sometimes, I think that I am a bit wimpy, or that I am just seeking attention when I feel sad. I often have to be reminded and assured that I really have been through some rough times, and it is ok to grieve and mourn. I have seen a lot of death the past few years. I have even experienced it myself once, and nearly a second time last month. Everyone in the world goes through cycles of loss and grief, the richest, the poorest, the most religious and the atheist. This is a fallen world, so no one is immune to pain. But Afghanistan seems like a constant season of loss… It never ends.

This entry will be about the last month. I still need to blog about my evacuation and all that happened in India, but that will have to wait for another day.

I woke up on October the 4^th about 2:30 in the morning in terrible pain. I had been working with the Kuchis (a nomadic Pashtun people of Afghanistan and Pakistan), helping them with a sewing project, and as we celebrated the end of the project the week before, I had eaten a rather large bowl of homemade yogurt… they use whatever water they can get for mixing the yogurt, and of course the milk is not pasteurized, so I just thought I had picked up some nasty bug that would take a couple of days to get over. I began taking Xifaxin (an antibiotic that works on in the intestines) and some anti spasmodic medications for pain. Neither really helped, the pain just continued to worsen, and my temperature began to go up and my body began to hurt so badly I didn’t want to move… the pain very much resembled the pain I had just before I became septic two years ago, so I decided I would go to the doctor the next morning. There is a really nice German clinic here, very expensive, but clean and well stocked with a laboratory and different diagnostic machines.

I finally got in to see the doctor, who was a very sweet German lady. She did an abdominal exam and took blood and got a stool sample. When she did the abdominal exam, she said that she feared I probably had appendicitis, but wasn’t sure. I sat in the waiting room for the results and when they came, she said that the blood test didn’t indicate appendicitis, so she wrote a prescription for anti-parasites (which I had tested positive for), and told me to come back the next day to get the results of the test for Typhoid. That evening, I called my friend Dr. Jerry, and he said to not take pain medication just in case my appendix ruptured anyway, so that it wouldn’t mask any symptoms. That was hard. The pain was so bad, that it felt like I had surgery with no pain medication. I couldn’t even touch my side.

The next morning, we got a security alert that the German clinic was being watched, and that the threat was specifically against Americans going to the clinic. We all got together to figure out what to do, and we decided I would go in disguise. I put on a burka, and one of my local drivers from my office got a taxi and pretended to be my brother. We, of course, got lost on the way to the clinic, so we ended up driving for an hour over terrible roads that resembled the moon more than a real road. In the clinic, the doctor took me in right away and told me I had Typhoid and that I should go straight home and sleep, but that I couldn’t start taking the antibiotics until I had finished the parasite medicine (10 days later). (In hindsight, I am so glad that I started right away, or I may have died of infection.) I asked her about the pain in my side and could she please give me something for it, so she gave me an anti-inflammatory. I called Dr. Jerry again that night and he said that he didn’t think I had typhoid… I thought he meant I wasn’t sick enough… what he really meant was that I was too sick… He also told me it was ok to go ahead and start taking the antibiotics, so I did. After a few days, I started to feel a bit better, but still as weak as a kitten.

In the middle of the treatment, we had to move house… very difficult to do on your best day in Afghanistan. Some sweet women from my NGO came and helped me pack up my kitchen and a few other cabinets around the house that I hadn’t gotten to. We got to the new house, and I began to unpack, lifting heavy boxes, trying to get things in order, all the time I still had this pain in my side and was very weak. I would unpack one thing and then have to take a nap. I was starting to feel pretty discouraged and useless, but since I wasn’t as bad as before, I just figured it would take a long time to get over the infection.

People kept telling me I was looking better, I finished the medicine and kept thinking that I must be better, and just still weak. But everytime I looked in the mirror, I saw a weird looking pasty white thing. Finally, one day (two weeks after it had all started) I called Dr. Jerry again and told him I was still just worn out, and still had a terrible pain in my side. So, he said I should come to Cure hospital and get an ultrasound to see what may be going on. I said I would think about it, and maybe go the next day. Because of the moving and having been sick for two weeks, I was really behind and trying to get caught up at work.

At the office that morning, my local coworker kept telling me the pain was just left over because I had been sick for so long, etc… finally one of my foreign coworkers said that she would go to Cure with me that afternoon, and decided she would get herself checked out at the same time. So, we got into the car and took the hour long surface of the Moon road to Cure. By the time we arrived, I was in so much pain that I wanted to just lie down in the road and sleep forever.

I saw the doctor and for the first time, I felt that someone actually realized I was sick. I had a high fever (I didn’t even realize it!), and he had felt a mass in my abdomen. I went through all of the tests again… blood, stool, etc… but this time, I had an ultrasound. My appendix had ruptured, probably two weeks before when I had first felt the pain. The lab guy came out with an amazed look on his face and said “you are really sick, you must have diarrhea. You have SO much bacteria!” Yeah, no kidding…

So the surgeon saw me and said I needed to be admitted right away for IV antibiotics and surgery the next morning. It was a bit overwhelming. I have been in a third world hospital before and I didn’t want to repeat the experience. I talked with Dr. Jerry who told me the American surgeon was out of the country so the Afghan would have to operate on me. It was all so fast, I didn’t know what to do. I sat down and called my mom and all of my bosses from my Ngo and in the States. Then there was this sudden flurry of phone calls about insurance and evacuation and I was hooked up to antibiotics which were making me feel really sick, and I was given a pillow that smelled like the bathroom (which smelled so bad, that I retched every time I went in). It was just a bunch of fiberfill stuffed into a pillowcase. I wish I wasn’t so fastidious, but every time I moved and smelled the pillow, I could only imagine the ick that may be on it, and I retched. I finally asked for someone to bring my pillow from home. Dr. Jerry kept coming in to check on me, and he called another doctor who had seen the Afghan surgeon actually do surgery and said that he was the best in Afghanistan. That wasn’t really that comforting to me, since I had seen so many bad doctors here, it seemed that to be the best here really didn’t take that much effort.

On one side, if I were evacuated, the abscess that held the infection in one place may have ruptured on the plane on the way. On the other hand if something happened after surgery, it would have been much more difficult to move me… I finally gave in and told them all to just make the decision for me.

As soon as I was admitted, my friend, Lizzie, jumped into the car and came to spend the night with me in the hospital. That was such a blessing. I was told this week that I am stoic. I find that funny because I feel so emotional, but I think that I keep it buried sometimes, and I guess I did that with the fear. I was terrified, but I was afraid to tell anyone. I’ve had so many terrible labels put on me in my life and the past few years, it seems the one that stuck was weak and needy. I don’t think that I am either of those, but I was so afraid to appear that way. You know, emergency surgery is just that, you are NOT expecting it, so I had nothing with me, and I was dirty. Thankfully, Lizzie brought me some soap so I was able to take a quick shower that night.

I didn’t sleep much that night. I was still really sick, and in pain, so I mostly just tossed and turned. But since I had gotten sick a couple of weeks before, somehow every night had been full of terribly freaky dreams. That night was no different. The few minutes that I actually did sleep were filled with crazy dreams. It could have been either the fever or the metronidazole (one of the drugs).

The next morning, the surgeon came in and told me he was ready. But the insurance company was still trying to decide on whether to evac me or not, and they needed to talk with him first. It was crazy. Finally I was wheeled out to the OR. Lizzie came as far as they allowed her. I had Dr. Jerrry’s promise that I would be given pain medicine after the surgery, so that helped me face it. But as I saw the OR, my heart froze… It looked, well, not like an American OR. I laid down on the table and the anesthesiologist asked if I had any problems with anesthesia before. I told him nausea and he asked what he should do about that. I told him to give me some phenergan (great for nausea, but also helps pain medication work better). He said he wouldn’t give that to me… I wondered why he even asked… I asked him if he would give me pain medicine when it was over and he said he would give me tramadol, to which I replied that I was allergic, and he said then we will just give you diclofenac (an anti-inflammatory like ibuprofen). As they got me ready, I asked if I could keep my knees bent until they started, because my back hurt, and though he said yes, a nurse came by and grabbed my foot and yanked it out from under me with no warning, which not just hurt my back, but my poor stomach was wrenched as well. The doctor told him to stop so I was able to put my foot back. About that time, Lizzie snuck in and told me that there were two men in the waiting room waiting to put me on a plane to evacuate me as soon as surgery was over. I thought that was crazy and if they were gonna do that, they should just go ahead and take me before the surgery! I am glad that she told me because if I had woken up on a plane, I would have really freaked out!

Finally, the anesthesiologist started giving me sleepy drugs. I have always found surgery to be a bit weird. Suddenly everything is black, then suddenly as if no time had passed, you are awake and in pain. I was in terrible pain! And, I couldn’t breathe. I felt like my throat was swollen and I was in so much pain I couldn’t cough or even try to clear my throat. I felt panicked, and I couldn’t do anything. I tried to tell the doctor and he said I was ok. But I didn’t feel ok. He finally gave me a shot of diclofenac. I don’t know how long I lay there. It felt like an eternity. I was so afraid I would die and it was so painful. When I had sepsis two years before, though I was in a lot of pain and it took a lot of effort to breathe, it wasn’t so scary. I felt like I was just slipping into the arms of God. This time though, I was struggling to breathe and it was so painful. I didn’t know how long it would last, and when I would finally just quit.

At some point, they finally began to wheel me back to my room. Lizzie was right outside of the OR, and she grabbed my hand as soon as she could. All I could do was keep saying, “Jesus help me!” I asked for pain meds, but the anes just said, well you are allergic to Tramadol. I said give me something else, and he said I gave you diclofenac (can I say that is like taking a half a Tylenol for a migraine). When we got to my room, Dr. Jerry was there. I was still struggling to breathe, and he told them to give me some morphine. The Anes said that I didn’t need it because I had already had diclofenac. Jerry said, “she is in pain, give it to her” “She is fine” said the anes, “give her morphine and don’t wait” said Jerry with his arms folded, and as I heard later, with the look of murder on his face. Finally I was given 5 mg. Also the ward doctor told the nurses to give me more anytime I asked for it. I didn’t ask a lot, because… obviously… I have a pretty high pain tolerance. But every time I asked, I had to fight for it. The nurses kept telling me I would get addicted, and I argued that I was a nurse and knew the research, and how most people recover more quickly if their pain is controlled, and that if you are really in pain, you don’t get addicted, etc… finally I stopped arguing and just said that I didn’t care if I got addicted, just give it to me!

Lizzie gave me a washcloth soaked in clean water to breathe through and finally it became a little easier to breathe. Over the next few days, people from all over the NGO community came to stay with me. Though the nurses were all professional, they were all Pashtun men and it was obvious that they liked to touch my soft white skin. They also seems to love giving me shots in my hip… Thankfully, I was never left alone with any of them. I had a huge hole in my right side, with a tube hanging out, and I kept retching and vomiting, but everyone just kept with me! I have been told that people who are receiving chemo therapy get so nauseated that they begin to vomit when they just see the nurse bringing in the IV bag. That is how I became every time the nurse brought in the metronidazole bottle. I would just see it and begin to retch. I ended up taking metronidazole for 25 days in October. I am not sure I will ever be able to take it again. Even when I got home from the hospital, in a mix of our bathroom smelling so bad, taking the metronidazole, and the nasty drainage from my wound, I continued to retch and vomit for about a week. If you have ever had open abdominal surgery, you know how painful that is.

I am now much better, besides a bought of kidney stones last week, my side feels a lot better, though I still have a rash and itchiness from a tape allergy. Also, every place I had a shot of diclofenac, both hips and my left thigh still hurt and all around the sites is numb, I wonder if that will every go away, and my IV sites are still really sore.

But I wonder… just before I went into septic shock, though I had had chills and fever the day before (something you can’t really fake), the head nurse on duty had ordered the other nurses not to check on me. She thought I was crazy and faking… I would have died if a teammate hadn’t come to visit and found me unconscious with a 107 degree fever. This time, I walked around for two weeks white as a sheet, weak as a kitten and in terrible pain, and no one really noticed how bad it was… Am I really that stoic, or do I complain so much that people think I am crying wolf?

Also, last time death seemed so easy, this time it was painful and scary… I don’t think I can do this again…

If I had known how bad it would be waking up, and how hard that first night would be, I would have chosen evacuation. Such wonderful things have happened because I didn’t evacuate, and many of my relationships with local people have grown deeper, because I experienced a little of what they experience. I would like to say that it is so worth it, and that I would do it all over again. But maybe I really am weak and needy. If you told me I would have to do it again… even knowing the good outcomes, I think I would still choose to evacuate.

I’m so sorry.

Treating traumatic wounds: two stories

2010-08-22T13:51:00.001-07:00

Warning! This is a bit bloody, so if you have a weak constitution skip this post...

One day one of our Mountain friends came to me and said that a man who was staying with them had cut his hand, would I look at it? I asked if he had been seen at a hospital, and he said yes, but he needed surgery and the hospital wouldn’t do it because he didn’t have enough money. I agreed to see him because it sounded a bit serious. I was so unprepared for what I saw.

Apparently he had been in a fight in Iran, and had been cut in the fight. That was about 6 days before I saw him. He came to our office and I rather nonchalantly removed the bandage from his wrist/hand (I am used to Afghans exaggerating their wounds for either money or attention)... then I nearly fainted.

These mountain people are EXTREMELY thick. They aren’t fat at all. They can't be, there isn’t enough food for them to be fat, and walking up and down mountains makes you fit. But they have huge hands and feet and their wrists and legs are thick. I would estimate his writs was about three times bigger than mine. The cut into his wrist was at least half way through. If it had been my wrist, it would have completely severed my hand from my arm. Thankfully, as I mentioned he was thick.

I cleansed the wound, covered in triple antibiotic cream, re-bandaged it, and gave him $60 from the blessing fund to go to Cure hospital and have surgery to reattach it. He got sewn back together, and thankfully no infection set in, and as far as I know he is living his life back up in the mountains...

A few weeks later, my language teacher brought her daughter to our lesson to have me look at her hand. She is an active three year old, and had climbed up onto the roof and fallen off. (This is such a common occurrence here, so many children die of falling off roofs.) Thankfully she didn’t hit her head. What she did do though, is grab a skewer to slow her fall, and ripped her hand to pieces.

I saw her three days later, and again, my first question was did you go to the doctor? I want them to learn how to navigate the medical system, because I don’t know how long I will be here and if they are dependent on me, what will they do when I am gone? I would love to stay in Afghanistan forever, but I was evacuated before for medical reasons, and security is not so good right now, who knows what will happen from day to day?

They said that they had taken her, but that the doctor didn’t do anything except bandage it. I agreed to look at it, and was appalled! her hand was completely shredded! She had needed a really good cleaning, debridement, and stitches. Sadly, none of that had been done. He had just bandaged it.

What I did next was what you would expect. I took her into the house, took some soap and a scrub brush to clean the back of her hand and all around that was not injured, then cleansed the wound with soap and water. I took her back outside and poured betadine all over the wound, put triple antibiotic all over it and bandaged it with a clean dressing.

Normal stuff...

What wasn’t normal was her reaction... Did I mention she was three? When I took her inside, she whimpered a bit, but not from what I was about to do, but because she was going into the house. I scrubbed her, cleaned her poured alcohol and betadine on her, and bandaged her up, all without a single tear... These children are tough beyond their years.

Oh, I found out later that they had NOT taken her to a doctor. They had taken her to a pharmacist. By the time I saw her, I couldn't put in stitches, because she was at such a high risk for infection.

I saw her several weeks later though, and her hand was healing well, and I think it may not even scar! Oh the healing power for children. We truly are fearfully and wonderfully made!

Nan recipes

2010-08-21T00:19:00.001-07:00

This blog is for those of you who live in countries that have nan, or naan. (that would be the name for bread in about half of the world's languages) If you can go down to your local baker, and get some of the dough before it is baked, you can make practically anything! So wonderful.

I love to cook and bake, but time is very limited and I can't wait all day for different breads to rise, so I use nan dough for nearly everything.

I thought I'd share a few of the things that I have made.

We'll start with savory breads...

My favorite is soft pretzels. You take a chunk of nan dough, roll it into a long stick, then twist it into a knot. Then dip it into melted butter, and sprinkle really whatever you want onto it. I usually sprinkle garlic salt and sesame seeds onto it. then bake until brown. YUM! (If you don't twist it, they are called breadsticks, which are also yummy!)

You can also make cinnamon pretzels using the same method... or just a bit of sugar, and when done dip them in Nutella... Yes, we can get Nutella in Afghanistan. It is one of the advantages of living in a war zone. You can get lots of yummy food from the different countries involved. Reeses from the States, Nutella from Germany, Tim Tams from Australia... you can even get kimchee...

One of the easier recipes is pizza. Simply roll out the dough to the desired thickness (actually it is very difficult to roll it out very thin), bake it a few minutes, and then add whatever toppings you want and bake.

You can also make calzones. Just take the dough, roll it out as thin as you can without breaking it, and fill up half of it, and fold the other half over the first half, pinch together with a bit of water and bake...

My absolute favorite thing to make with nan dough is bagels; unbelievably easy, yet impressively tasty!

Simply boil water with salt, roll nan-dough into balls, then poke a hole in the middle. Make the hole as big as possible, because it tends to bounce back into just a little depression. Then drop the bagel into the boiling water. When it floats to the top, flip it over, then take it out. Drop IMMEDIATELY into whatever topping that you choose... whether savory or sweet, while it is still wet, so that it sticks. Then put it on a pan and bake until hard and brown on the outside, but soft and done on the inside.

Toppings for bagel:

My favorite is sesame seeds. They make it really taste like a bagel. But you can use fried onions, poppy seeds, garlic, butter (you can NEVER go wrong with butter), cinnamon and sugar... really your imagination is the only limitation.

I have noticed that if I buy a ready made nan, I eat a lot more than if I buy dough and make a little at a time. One of my favorite things to do is grab a little chunk of dough, flatten it out and fry it in a bit of butter and salt (also sometimes adding sesame seeds... notice a pattern here?) It makes a wonderful addition to any meal...

If I am having people over for a meal, I take nan dough and divide it into 3 balls and put all three into a loaf pan. I then take a knife and put a cross into each ball and pour melted butter with garlic all over them and bake. Best garlic bread you will ever have!

If it is summer, let the dough sit out on your counter for a couple of days. It will ferment and when you bake it, it will taste like sourdough!

Another easy, fun thing is pigs in a blanket (though we call it cows in a blanket, as we are not allowed to eat pork...)

Sweet stuff:

Sometimes, I take nan dough, roll it out into a cookie sheet, bake it for a while, then spread cream cheese mixed with whatever flavor jam I happen to have in the house, and bake... voila instant cheese cake!

You can also roll into tiny balls, dip in butter and cinnamon sugar, and put three at once into a cupcake or muffin tin. HOT CROSS BUNS!!! :)

hmm... I am out of ideas for the moment. Sitting in a living room in Austria, it is easy to forget what you do when you have a limited repertoire. But never fear, when I come up with new things, I will be sure to add them! If you think of any ideas, please share in the comments. I love to try new things!

what am I doing here aka buying socks for the poor

2010-01-17T02:14:00.000-08:00

Sometimes I wonder what the point is. Deep down, I always know, but there are these moments. I feel like every Afghan is trying to suck everything I have out of me. These first 4 months back have been filled with people sucking all of the money they can from me, and I am so easily manipulated, because my heart hurts for them. I went to get my work permit renewed, and they wouldn't renew it until I produced the old one. I was evacuated in an emergency situation... I have no earthly idea where that thing is. So, I got a copy from my old NGO. That wasn't good enough, so I had to pay for the government to put my information out on public radio to ask if anyone had seen or stolen my work permit. As if that weren't enough, when I got it, it was only good for a month, because they made it retroactive for the past year, though I hadn't been there. They said it was because I hadn't cancelled the old one when I left... again... emergency. I just feel like they think money is created in America and there will never be an end to it. When our office administrator told me these things, I said that I just didn't have that much money to be paying again, and he literally said, "you are an american, you are rich". Now granted, I have more money than the average Afghan, but I am not rich even my their standards, and many of them make tons more a month than I do.

So, I leave the office to buy some milk, and on the way, I see a guy selling warm winter socks. I know a family with more kids than I can count, so I stop to buy some for them. I am trying to bargain with the guy, he was asking for like 10 afs each, and a lady tells me to stop bargaining, because I am an American and I should be paying $10 for them. I have to confess I wanted to hit her. I nearly started crying. I am giving my life for them, and I try to do something nice, and that is what I get. I realize that I am not here for their recognition, but sometimes they just make it hard for me to want to be here. I ended up telling her that she was rude, because I was buying the socks for poor Afghan children and not myself and she should just mind her own business. Sigh... sometimes the best does not come out of me.

War and Rebellion

2009-11-07T22:48:00.000-08:00

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

2009-10-27T00:14:00.000-07:00

***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

2009-09-29T22:56:00.000-07:00

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

2009-09-29T22:47:00.000-07:00

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

2009-09-13T09:53:00.000-07:00

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.

food distribution

2008-09-22T18:15:00.000-07:00

In early June, four guys from my home town came to Afghanistan to make a documentary. One of the first things that we did was a food distribution in Balkh city (about 45 minutes from Mazar). My friend, F. who runs a kindergarten heard that there were many extremely poor people there. One of her teachers, S. had come to her to ask if we could help.

After the horrible winter that we had, food prices soared (though this was not just in Afghanistan, it was a global price increase). Some children in the States raised $2000 so that we could do a larger distribution. We reckoned that with that amount of money, we could buy enough food to feed 30 families for a week.

food for a family for a week

We had heard many horror stories about food distributions. People are so desperate to feed their families, that they become violent and people who are not part of the distribution begin to crawl over walls and riots start. So, a friend who had done this before gave us a very detailed plan to keep things organized, but we also had an escape plan if things got crazy.

S. had met with the kalontar (like an elder) of the village and made a list of families with the biggest needs. We then made a date and headed out.

Well, the plan went flawlessly. It went so quietly and smoothly, it was almost boring (though the joy of helping these families was very exciting)

My film guys and some local Afghan men lined up all of the food on a raised porch-like area. Each family was to receive a big bag of flour, a bag of rice, a bottle of oil, and a "goody" bag with beans, salt, soap, and matches. The women were all lined up against a wall, and their men were on the other side of the courtyard. We organized it so that when we called a name, the family had to come and get their food, and they had to be totally gone before we called another name. It worked really well.

While we were handing out the food, S. whispered the families' stories to me. Some were incredibly sad. Widows, men that are too weak to work, men that want to work, but nothing can be found because of the economic conditions. Older sons who would usually work for their family died in accidents or of illnesses. One of the most common though, was that the old (I mean like 70 year old) men were still producing babies, though they were too old to work, so these poor younger women (sometimes teenagers) are married off (actually sold) as second or third wives, have no way to feed their children.

This is a huge problem in Afghanistan. The society itself has social rules about helping widows, but if the husband is still alive, they won't help, no matter how old, weak, or sick. So many of the younger women pray every day that their husbands will die so they can get on the dole. This is the plight of women in Afghanistan.

When we were finished, we had enough money left over, so F. went with A. two weeks later and gave out food to 10 more families. That was the day before I went into the hospital.

Last day of clinicals

2008-09-20T18:17:00.000-07:00

You never know what life will bring you tomorrow. When I went to work at the hospital on June 24th, I had no idea it would be my last day.

We went back to the neuro/psych ward so we could follow up on the patients we had the day before. We were surprised to see the patients smile at us. Though their problems are far from over, I think that just showing a bit of kindness to them lifted their hearts a bit. We spent that day much the same as the day before, doing PT with the stroke patients and holding hands with the depressed patients.

At the end of the day, I took my students into a room to have a post conference with them and talk about what they had learned. After the conference, as my students were walking out the door, I said something that made one of them laugh out loud. About 30 seconds later, and armed guard came running into the room looking for the woman who had laughed out loud. Apparently that is still illegal to some. I couldn't believe it. Thankfully the woman had already slipped out of the room, and I could honestly say I didn't know where she was. It turns out that the governor of our province was touring the hospital and heard the woman laugh and sent his guard to arrest her. I still sit shaking my head when I think of it.

After I extricated myself from that situation, I went into the nursing lounge to change my head-covering so I could leave, and I was accosted by the head nurse. SHe started yelling at me about the behavior of two of my students. She said that it was completely inappropriate for the one to have laughed and the hospital had lost face, because the governor was there. Then she said that two of them had been in the hall flirting with male med students the whole time we were there. She said that they even winked and made kissing faces and sounds toward them.

She said that she knew things were different in my country, but that these students just can't act like that and I need to control them. After about 10 minutes of her yelling at me, I finally got a word in edgewise. I said, that this sort of behavior was also not appropriate in my country (not the laughing, but flirting in the hall during clinicals is not acceptable). I also said that I have 10 students, and when I am working with them on a patient, I can't see all of the others, and that they were old enough to govern themselves, and that I would talk to the head of the nursing school about them. She finally calmed down.

I went to the head of the nursing school that afternoon (who I must say dresses like Elvis Costello). I told him that I was having trouble with a couple of my girls flirting with boys and before I even said their names, he knew who they were, and said that he would take care of it. That made me feel better. Apparently I am not the only one who has had trouble with them.

As I said, you never know what the next day will bring. If I had known it was the last day I would spend with my students, I would have said goodbye or given them all hugs, etc...As it was, I just left them hanging.

the psych ward

2008-09-20T17:27:00.000-07:00

The week before I got sick, our clinical rotated through the neuro/psych ward. They don't have enough rooms to separate the two, so they are all in one big room. One one side of the room are older women who have had strokes. They are pretty sad, most are poor, and one in particular touched my heart. It was just she and her husband subsistence farming. She was so worried about what was going to happen to her and her husband now that she couldn't work. I worked extra hard with her teaching her some physical therapy exercises. My heart broke for her, but it was all I could do.

On the other side of the room, there were four women who were as the Afghan doctor said "psychotically depressed". That means they were so depressed that they were having breaks with reality. I didn't really see that. I think that the doctors were just tired of hearing them cry and they made up that diagnosis as an excuse to give them antipsychotic medication to put them to sleep.

The first girl was about 16-17 years old. Her mother was with her and obviously cared deeply for her, as a mother should. I sat on the bed with her, and accepted a warm, sweet cup of milk that her mother offered me and asked what was going on. The mom told me most of the story. She said that a year before, the girl had gone to a wedding and some men had come to the wedding and threatened to kidnap the girls. Since then, this young woman had not stopped crying.

Afghans are notoriously emotional, but this seemed way over the top, to be frightened, and then to cry for a whole year. I had a sense that there was more to it. In Afghanistan, if a woman is raped, it is considered her fault. As I watched this young woman and her interactions with people, and the fact that we couldn't get her to tell her story, but just let her mom speak for her, I felt that she had probably been raped at that wedding, and perhaps even gang raped. My heart burned for her. I knew that if she told her parents, it may mean death for her. I took the nursing student assigned to her (this is the same student that I took out to help me with Roqia [the little girl with abdominal TB]) out into the hall and told her my thoughts. I asked her to just sit with the girl all day, hold her hand, and listen to her. I told her to make sure that this girl knew that no matter what happened that day, it wasn't her fault. I also sat with her off and on all day that day, and told her over and over that if anything else had happened to her, that it wasn't her fault, but it was shame on the men who did it.

Another lady, near the end of the row was so depressed that she was starving herself. She was literally just skin and bones, and she was completely catatonic from the antipsychotic medication that she had received. She had several small children one of which would come and sit with her every day. It broke my heart to watch these little children watching their mother starving herself to death. I sat and held her hand as well, and cried with her (as I did with every patient that day). I also snuck her a little money before I left that day to help her buy her medicines.

While I was sitting with her, another lady was brought in and put in the bed beside her. She then began screaming a blood curdling scream and shouting that she will pour gasoline all over herself and light herself on fire.

At the end of the row, in a bed beside the window, there was another young married woman. I don't think she could have been more than 19, but already had several children. She was also labeled "psychotically depressed". As I was holding her hand, she looked at me with tears streaming down her face and said, "God has left me. God has left Afghanistan."

That was one of the most difficult days for me in Afghanistan. But my students learned a lot about caring for more than just a body part. They learned to care for people. The next day, when we walked through the door for clinicals, all of the patients that we had cared for the day before smiled. Their problems are far from over, but a little kindness went a long way.

A few more notable things happened this day. A man in the ward next to ours died. He had a heart attack. His family began wailing, which if you have never heard you are fortunate. Then armed guards came running down the hall with their kalashnikovs at the ready. When a patient dies, guards always come to make sure that the family members do not kill the doctors or nursing staff.

Did you ever see the movie "Blood Diamond?", They keep shrugging their shoulders and saying TIA (meaning "this is Africa"). The Afghans have the same phrase. WHen you ask why something is the way it is, they shrug their shoulders and say, "Afghanistan as dega" (This is Afghanistan).

A terrible burn

2008-09-07T17:18:00.000-07:00

Sometime near the end of April, my driver showed up with his little nine month old boy, who had been severely burned three days before, because he pulled over a pot of boiling water onto himself. I was pretty upset with him for several reasons. First of all, he had taken my first aid class, and had been taught how to prevent this, and to immediately put cold water on a burn, and to never spread mud on it. Well, he had ignored all of those things, and when I saw the baby, he was covered in mud. The second thing was that he had waited three days to come to me. I asked him why, and here was his answer...

About 2 years ago, he came running to me, like there was a dire emergency, and asked me to come see his mother, because she was sick. I asked what was wrong with her, and he said she has diabetes. I said, well when did she find out (as he was so excited, I thought it must have been a new diagnosis, and the family was scared). Turns out she had it for 20 years. I asked if she was having any new problems with it and he said no. From previous blogs, it is clear that I am over busy, and usually, when people have problems, I will drop everything to help them. But at that time I was extremely busy, and it put me over the edge that he would try to manipulate me like that (he did this quite often. When I did get to go see his mom, he tricked me into coming on a day when every woman in his family was there and I ended up having over 30 women clamoring for me to examine them). So I reacted rather badly and told him to never do that to me again.

The second reason that he waited so long was because of an incident that happened about 2 weeks before his baby was burned. He showed up at my front gate on a day when I was running late and did not have a guard working, and he rang my bells for over 10 minutes. I finally went out, and talked with him through our tiny little window that we have cut out of our gate. He said that his mother needed eye surgery at the eye hospital and since I know the administrator there, would I ple

ase call and ask how much it would cost. I said yes.

So, I made the call and of course there are different prices for all different surgeries and I had no idea which surgery she needed. Later on, when I got to the office, I told him there were different prices and that she needed to go there and be examined to find out how much it would be. He said that she had gone and they said it would be about $100. I asked, "then why did you show up at my house and ask me to call?" He laughed and said he thought I could get a lower price. I talked with his boss that day, and told him that it was inappropriate for a man to show up at my house asking to talk to me, and to tell him to never do it again. If he has a problem, he can call or see me at the office.

So, he didn't bring his son to me until he was dying. At first I felt bad, but I know that I had made it clear that if there was a real need I would be there for him, so I gave up the guilt.

Back to the story. He, his wife and their son showed up in front of K.'s house (she is the nurse that I work with) and another foreign woman happened to see them there and called me. K. and I exam

ined him, and at first, because of all the mud, I thought that he was covered in third degree burns. It was really bad. He also had a fever.

We took him into the bathroom and began to scrub his wounds. It was horrific to hear his screams, but very necessary. WE finally got the mud cleaned off,and the dead skin. His whole left arm and leg were burned, along with a spot on his scalp and small spots on his right hand and foot. We covered the wounds in silvadene cream, Vaseline gauze and wrapped him all up. We then made a plan to debride (scrub) the wound and change the dressing every three days. We also gave him some antibiotics and tylenol for infection and pain. Thankfully, I had some narcotics with me,

and we began to give him some pain medicine about 30 minutes before we started. After a couple of weeks though, he equated the me

dicine with what was to come, and he began to throw up the medicine as soon as we gave it. So, we had to do with Tylenol suppositories.

The going was slow, as a matter of fact, I never got to see him completely well, because I got sick. But I did get to see his leg heal, and his arm was healing well, though we feel that part of his arm was indeed a third degree burn. It took 3 months to heal.

This picture was taken after about two months, when his leg was already better, but his arm still had a long way to go!

TB

2008-09-07T15:38:00.000-07:00

Sometime back in late March/early April, we used our blessing fund to send a 12 year old girl, Roqia, to Kabul to have abdominal surgery.

This little girl was born with multiple birth defects. She had a cleft palate, and her face was malformed, making her eyes protrude. She is also very small for her age, but that is pretty common among the poor in Afghanistan. She had originally gone to the doctor to be examined for cleft palate surgery, but something else showed up.

She had a very swollen stomach, which was either going to be diagnosed as liver cancer (this would have been a death sentence for her), or tuberculosis. It turns out that she had abdominal tuberculosis. They did surgery to clean out the abdomen and to do a biopsy. She was then sent back to Mazar with her family.

That's when I came in. They had left her abdomen open so that the TB drainage could drain out of it. But, apparently during the surgery, they put a small hole in her bowel, so it wasn't just TB drainage coming out, but bowel contents as well. In Kabul, they had placed a colostomy bag over the wound to catch the drainage, but since she didn't have a protruding colostomy, the bag wouldn't catch the drainage.

I went to her house (they are very poor, so their house isn't the nicest or the cleanest on the block). She was in a great deal of pain, and the drainage was unbelievable. It was (if you have a weak stomach, please don't read this part) part white cheesy TB drainage mixed with bowel contents (diarrhea). I washed my hands, and put on gloves and took off the bag. She had a big X shaped hole in her belly, and gunk (the official medical term) was pouring out of it. I cleaned her up, and tried to put a new bag on, but so much stuff was oozing out, that I couldn't get the bag to stay. It was a different sort of bag than we have in the states. There wasn't any adhesive on it. Instead, there was a strap that wrapped around your body to hold it in place. It was also very heavy, so that no matter how tight I wrapped it, if she sat or stood up, it would slide down and the edge would sit on top of her wound giving her excruciating pain.

Speaking of pain, in the midst of all this, she was recovering from surgery, and pain medicine is not usually prescribed after surgery in Afghanistan. I examined her,and found that her stomach was very distended (swollen with air), so I called a pediatrician friend in Kabul, who had been following her case (Dr. J), and he felt that she should have an enema. He said that after her surgery, the swelling was down, the drainage was minimal, and her pain was under control. So, it was a bit disconcerting that she was doing so badly.

I didn't have access to an enema that day, so I taught her mother how to keep the wound clean, then went home. That night, my roommate gave me a great idea. She told me to get a nursing student to come help me with Roqia. She said it would be a great way to mentor a student in nursing care.

I went out the next day and bought an enema, then went to the nursing school to find a student. The head of the department thought it was a great idea as well, and went to a classroom with me to find someone. There, he gave a long speech about how whoever went with me would need to behave and they couldn't look at the drainage and faint or throw up or react in any way what-so-ever. This speech had to be made, as they needed to know this wasn't about prestige and getting in good with the foreigner. It was about taking care of a sick child.

I was hoping to get a student of the same ethnic group, as this family's ethnic group is the most persecuted ethnic group in Afghanistan. Well, the girl that volunteered was not just of the same ethnic group, she had also spent most of her life as a refugee in Iran (as had this family). So, she could relate to them very well, and would treat them with respect.

I was very impressed with this girl. She washed her hands before and after and wore gloves. She also was very patient and did a lot of teaching with the family. Later on, I was to have this girl in my clinical group, just before I got sick, and she indeed will be a good nurse.

Back to Roqia. She felt much better after the enema and the drainage slowed down considerably. I visited her several days later, though and all of her symptoms had returned. I talked with Dr. J again and he said to give her another enema then start her on some medicine that should keep things moving along better. When I gave the enema this time, (warning, again, don't read this part if you are squeamish) I looked in the pan afterwards, and a long white worm had come out. So I added some worm medication to her treatment.

Thankfully, after that she began to make steady progress to get better. She was due to have her cleft palate repaired in September, but since I got sick and had to come home, someone else is following up on her care.

An aside about the family. They love this child. They are however, a typical Afghan family and don't know much about hygiene. Roqia's mom did her best to keep the wound clean, but in the process, not much else stayed clean. She had a box where she kept the rags that she was cleaning Roqia's wound with (both clean and dirty were in the same box, along with her TB medication). One day, she served me tea. When an Afghan serves tea, they must serve some sort of candy (sweets they call it). After she served me the tea, I saw her reach into the box and dig around finding all of the candy that had spilled out into the bottom of it, then she served it to me. Though I am usually not very careful with what I eat at Afghan's houses, I had to draw the line there. As a matter of fact, it almost made me retch when I saw her do that. I had to finagle around to find an excuse to not eat the candy, but I managed to get out of it.

Trip to theouterlands part 3

2008-09-06T07:55:00.000-07:00

When we left for the mountains, we decided as a group, that I would be anonymous, meaning that we would not tell anyone that I was a nurse, for fear of me being overwhelmed with work. I did not bring any of my diagnosis books or assessment tools (not even a stethoscope). But, the woman who runs the CP clinic did not get that memo, and she mentioned to all of the patients families that a nurse was coming. Oh dear...

One day while we were on our trip, an employee at the CP clinic asked me to go look at his daughter who had been sick for a while. So, we went out to his village and it turns out that his daughter has malaria. She had already been diagnosed, and was taking medicine, but I didn't have my drug book with me, so I called a friend back in Mazar to get the right dosages. She was not taking enough, so I corrected the dose for her. About a month later, I found out that all Afghan malaria was drug resistant, and that what the doctors prescribe is useless there. Ugh...well it is a lesson learned. During our surveys on this trip, we found out that in the mountains, most people get malaria every summer. So, they desperately need some prevention measures, like mosquito nets, and getting rid of standing water etc...

After we finished with the little girl, one of the women in the house said that she was suffering severely with gall stones. She had lost so much weight, that she was a stick and her shoulder blades were sticking out. She said that the doctor told her she needed surgery, she couldn't afford it...again the public hospital is supposed to be free, but the docs and nurses want bribes to treat you. Thankfully there is a Turkish run wing of the hospital and we had made some contacts there, so we got her into see someone. It is s frustrating to deal with the apathy of the medical community there!

As we left the house, people started coming out of houses and streets all over the village, asking for me to come and examine their sick loved ones. This is my biggest struggle in Afghanistan. The need is so incredibly great, and the resources are so few. I long to help everyone in need, but I am only one person, and sometimes I work until I have nothing left and I get so sick that I can't go on for a while. (more about that in a later blog) I did something that day that I don't do very often, but for my sanity I am having to learn. I walked away.

The next day, at the clinic, a baby was brought to me who had pneumonia. Since I didn't have anything with me, I couldn't treat him, and once again, I had to walk away (though I did tell the mom to get the baby to the hospital). I really struggled that night with what I should do, and I finally came to the conclusion that I wouldn't travel without my medical things again. The basic things do not take up much space, and it will be worth it. Second, though I can't go into a village and treat every single person I see, when individuals come to me (like the baby with pneumonia), I need to be ready to treat them.

Trip to the outerlands part 2

2008-09-05T18:26:00.000-07:00

It has been a REALLY long time since I blogged, and tons has happened. I'll try to write in order. At the last blog, I was traveling in the outer lands. I will pick up from where I left off.

While F. and I were working in the CP clinic, A girl of about 12 was brought in. She didn't have use of her legs, and they were stiff with contractures. Her mom said that she had CP. The problem was, that she had an open sore on her foot, and the clinic cannot treat children until they are otherwise healthy. I asked the mom to take the bandage off of her foot so I could examine it. It was completely gangrenous. All of her toes, through the middle of her foot was black. Then there was a diagonal split that was entirely open flesh. It was one of the worst wounds I have ever seen.

I asked her mom if she had been to the hospital, and she said they had, but the doctors wouldn't treat her, because she was handicapped. F. and I bundled her up and took her back to the hospital. We went into the ER with her, and the ER doc recognized her. He said it didn't matter, because she didn't understand what was going on. He said that she had polio and shrugged. We told him that she was a little girl in pain and that she needed treatment. He said that they had treated her, but that the parent's had taken her out before treatment was finished.

Honestly, I didn't know who to believe. It was quite possible that they didn't do anything for her, because of her mental and physical state, or that they were expecting bribes to treat her, even though it is a free hospital. But, it could be that they were treating her, and the illiterate parents took her out, because they didn't understand the length of the treatment.

One thing was for sure, the doctor didn't think her worthy of treatment. We dug our heels in, so the doctor came and cleaned the wound and started and IV. Then, F. and I stayed with her until she was admitted to a ward. We made sure she was scheduled for surgery (for amputation of her foot above the ankle), and that she was getting antibiotics.

We then sat and talked with her and her mom, and though there were some obvious problems, it was clear that the little girl had a good intelligence level, and that she understood what we were saying to her.

We went back two days later to make sure everything was going well, and she was scheduled for surgery the next morning. We loved on her and her mom and then had to leave. They wept hard, as we were probably the only people who had ever shown compassion to them.

trip to the outerlands

2008-04-22T01:53:00.000-07:00

Back at the beginning of March, four of us ladies made a trip to a more rural province. Each one of us has a goal of getting to a more isolated area to work, so we went on this survey trip to see how it may be. We had several goals. One was to see if that particular place was where we wanted to go. Two was to see what type of work was going on in that area. Three was to see..well, can we hack it?

All of us came away changed, but I will just tell my story. It was a more difficult place. We had an outdoor toilet, which would be fine except for the frequent diarrhea that is so common in Afghanistan. Trips out there at 4:30 in the morning aren't the best fun.

In Mazar, we are used to walking around anywhere and wearing a head covering that leaves our face bare (or naked as they say here). But, there we wore a hijab. (a veil that covers everything but your eyes). In this area, most of the foreign women have chosen to never walk alone, so we were somewhat of a disturbance to our guards. Every time we left, they would say, are you sure? I'll go with you. We finally convinced them that we would be ok.

So, F. and I went a walking one day, and as we came to an intersection, we saw a little Toyota truck full of police. We thought nothing of it, as it is such a common site. but suddenly we saw a riot of men following the police. Neither of us said a word, but both of us at the exact same time flipped around and started walking the other direction. We had no idea what was going on, but we knew it was something we didn't want to walk into. We found out later it was a demonstration in protest of Denmark, which had decided to republish some offensive cartoons regarding the prophet Mohammad. Glad we got the heck out of Dodge!

F.'s mother has cerebral palsy (CP), so her heart is drawn to children who have physical challenges. There is a CP clinic in the town we were in, so she and I worked in it for a few days. She had a lot of ideas, and had sent some toys and materials ahead that we could work with. The children were amazing, and the work that the clinic was doing was equally amazing. A physical therapist had come out and taught some local Afghan women how to stretch and exercise the children, and they had learned well. One little boy had even learned how to walk.

We have all seen some pretty horrific things here regarding how parents treat their children, and because of this, we were really worried about how they would treat a child who was less than physically perfect. We were very surprised. The mothers doted on these children. One mother even said that her husband was so good to their little girl with CP, that their other children didn't think he liked them at all!

I learned a lot about CP that week. I had thought it just happened at birth, but it can occur up to 2 years after as well. It can happen as a result of severe dehydration after a bought of diarrhea (which is a common cause of death here as well). It can happen after a high fever. (Also common here, because as soon as they see a runny nose, they start piling clothes and blankets onto a baby even in the severe summer heat thinking that they will prevent pneumonia. Instead, they cook their babies). I can't tell you the number of mothers who told me that their baby was fine until a bought of diarrhea, and suddenly they were limp or stiff. The same with the fever.

The saddest, though is that it can also be caused by shaken baby syndrome. Most kids here are severely abused. It is a part of life that they grow up with. The problem is that some of it is not meant at all as abuse. Kids are just thrown around like they are rag dolls when they are little. They have multiple siblings who pick them up and carry them, toss them around, and drop them (I have seen two year olds carrying around their 6 month old sibling who is almost the same size as they are). When a mom wants to put a baby to sleep, she puts it on her legs and rocks hard, it until it is completely rattled. They have no idea. Also, they shake them when they are choking. My heart freezes every time I visit friends with children, because I see danger at every turn!

While we were there, I evaluated a child new to the program, and I am fairly certain that she has shaken baby syndrome. Her head was huge indicating hydrocephalus (water on the brain), and she had gone blind. She also screamed a hideous scream, the kind you hear from crack babies. It was blood curdling and made you want to run away. It was so sad. She is scheduled soon to go to Kabul to have surgery to receive a shunt that will remove the water. So sad.

That was just the beginning of the trip...more to come...

beggars

2008-04-21T09:44:00.000-07:00

What do you do with beggars in a country where it is a profession? According to the laws of Islam, you have to give to beggars to get to heaven. If that is true, then you have to have beggars to give to. I struggled for a long time about what to do with them. Some are truly poor and desperate, some are not. Some of the children aren't beggars at all, but see a foreign woman with a nice face, and act like a beggar to see if they can get anything from me.

In the past, I sort of picked and chose according to the moment. There are times in the bazaar that if I give to a beggar, tons of them will crowd around me, and it becomes a mob scene with women and children pulling my clothes off. I hate that.

Lately though, because of the wretched winter they had here and now the drought we are in, prices have doubled for staples like flour, oil, and rice, so I give to nearly everyone I see. When I shop, I ask for small change so I have something to give.

I have been looking for other ways to give as well though. My roommate loads little draw string bags to give out. She packs it full of sample bottles of shampoos and soaps or first aid supplies and a 50 afghani note (one dollar...a lot for a beggar). I used to buy cookies when I went in to a shop to give to the children, but being the nurse that I am, I have wanted to do something a bit more nutritious. So, today, I walked home from "du sad bestar" (the hospital I am working in). It is about a three mile journey, so I usually run into a lot of beggars. Last week, I ran into about 5 in a 5 minute period, so I thought this week that I would be more prepared. So, I stopped at a little store and bought 4 little boxes of Mango juice, thinking it would add some vitamin C and beta carotenes to their diet. So I walked and walked, and no beggars. I couldn't believe it. There just weren't any out today! Perhaps they were hanging out at wedding halls, as it is wedding season. Or, perhaps the police came through and cleared them all out. That is possible. I saw a big truck full of Kalashnikov armed men drive by as I was leaving the hospital...who really knows?

I was a bit disappointed, as I was very tired from the day at the hospital, and I had loaded myself down with all these juices. But, as I got to the back side of the bazaar, where all of the used clothing is, I saw a little old woman bent completely in half shuffling along with her little bag of bread looking into a shop to see if the man would give her a bit of change. I looked to make sure she was a beggar (though I really didn't have a doubt). Then, I turned around and bent over to talk with her and gave her the juice and told her it would be good for her. At this point, usually the beggar will say "God bless you", because to give to beggars gains favor with God. I don't believe this. I give, because I know that God loves these poor distressed people. I said, "God bless you khAlla (auntie)". Then she grabbed me and hugged me around the waist because she couldn't stand strait, and burst into tears. I bent down to hug her back and cried with her.

What else could I do?

du sad bestar

2008-04-16T05:47:00.000-07:00

Du Sad Bestar That is the name of the hospital that I am assigned to. It means 200 beds. I take that to mean that they can have two hundred patients. If you haven't been in Afghanistan for a long period of time, the first thing you may notice as you walk in the door is a guard with a Kalashnikov (old Russian type automatic machine gun) at his side. Not your every day occurrence in the USA. Though, I think we do have armed guards in most ERs nowadays. I have actually gotten used to seeing Kalashnikovs. I actually don't really notice them anymore unless I am trying to remember what it was like to be new here. I noticed this time, because I was wondering what in the world I would blog about. Life has gotten so "normal" for me here, that I forget what things are really NOT normal in the west.

I actually haven't blogged in a while, because I was over a half a month without electricity, and my computer battery is so bad now, that by the time I used it for a 45 minute exercise routine, it was finished. I guess our frequent, long lasting power outages are also not "normal".

There are two of us "foreign" nurses who are to be supervising the clinical instructors. Clinicals are on Monday and Tuesday, though the original schedule had them on Tuesday and Wednesdays...ok, how can I begin to explain why we had to completely change the 18 week schedule that had been set for months....March 21 was the Afghan New Year. It is celebrated by people from all over Afghanistan making a pilgrimage to Mazar (my town) to the blue mosque/shrine of Ali (you can Google that one...it may be under Shi'ite traditions). Then, every Wednesday, for 40 days (which equals like 5 Wednesdays or so), the women of the city gather at the shrine for a picnic lunch. Police guard the perimeter so that men can't get in, and women dress up in their finest shiny dresses and it becomes the social event of the year. We had to change our schedule that had been set for months, so that the female instructors could go on a picnic.

We also have a short meeting on Sunday to go over what the instructors are to be teaching during the clinicals. The plan was that we would rotate around all of the clinical sites to see how the teachers were doing. Unfortunately, the teacher at du sad bester has a habit of not showing up for clinicals. So, I am there on a permanent basis. All of the other instructors go to the school to sign in that they are present, then they go to the clinical site, then back to the school at the end of the day to sign out. This particular teacher was told to not even go to the school, but just show up at the clinical site, because otherwise, he would sign in, then disappear and reappear to sign out at the end of the day, having never stepped foot in the hospital. Sigh...

Our first week was technically last week. We started at the nursing school on Monday with a meeting for the students to explain the rules to them. Mostly "normal" stuff... you must have a uniform, your ID badge, a watch with a second hand, stethoscope...Boy did they ever balk at that! One guy got up and said, "you can't lay your American rules on us. We are poor Afghans!" We actually didn't make any rules. We just read to them the rules that the nursing school has always had, and told them that they would be enforced.

So, the next day was practice day. They were to show up at their clinical site, in uniform, on time. That was all. we had 7 of 10 show up. All were late. One didn't have his uniform, several, a couple didn't have ID cards, a couple didn't have a pen or paper. None had stethoscopes. On the bright side, the instructor showed up on time.

We finally got started this week. Only three students showed up the first day. My coworker, K, made this great plan to build up their knowledge every week. So, this week they were to take a history and get vital signs. Next week, they will do the same, but also do a head to toe assessment, the next week, we add procedures like IV starts, etc... We let them go into a ward to choose their patients, get their history and take the vital signs. Here I must put in another aside. A ward is not like a ward in the States. It is a room full of beds. Also, in the States behind hospital beds is equipment, like oxygen, suction, ambu bags (the bags used in respiratory resuscitation) . There is no such thing here. Just beds.

About 15 minutes later we went to check on them, and take the vital signs ourselves, so that we could see if the students were right or not. It turns out they hadn't really done anything. So I observed. It was obvious that they had never done that before. So, I gathered them together and took them to an empty room and taught them how to take a temperature, blood pressure, pulse and respirations, and then made them practice on each other until I knew that they could at least put the cuff on right side up.

Another thing we did was buy bags of supplies for each of the clinical sites. We included things like a BP cuff, alcohol swabs, thermometers (you would be hard pressed to find a thermometer in a hospital here. the nurses just touch your forehead and make a guess as to what the temperature is.) My big contribution was a bottle of alcohol so that the students can wash their hands between patients. They thought I was obsessed, as I followed them around with this bottle. Everytime I got near one of them, I was pouring alcohol on them! Yet another aside. They don't have isopropyl alcohol here. That is the rubbing alcohol that we use in the States. They have ethanol. It smells like a bottle of rum, and I have to confess, the past two days of clinicals have tempted me to upend that bottle into my mouth!

So this particular clinical group, which I will have for several weeks is all boys, so all of the patients are male. As this is Afghanistan, before I can touch a patient who is a man, I must ask his permission. So far, I haven't had anyone refuse, though I have had some very smiley men, who really creeped me out.

I will continue this blog tomorrow, as I am now exhausted just recalling the past two days!

nursing seminar

2008-03-01T06:58:00.000-08:00

I teamed up with two other nurses this week, "K" and "M" to hold a 3 day seminar to teach nursing instructors what they need for their nursing students in their clinicals. It was quite the eye opener! "K" started by giving an introduction to the expectations. They have to show up for their clinicals, or they will be out of a job. Period. Sounds silly to have to say? Well, several of the instructors never show up, so the students drink a bit of tea, then leave. They then graduate and start working in the hospital with no clue of what to do. We would like to stop this practice, so she also gave some expectations for the students. If they don't meet those expectations, they don't graduate!

I then gave a lesson on "Comfort measures". These range from fluffing pillows (yes, some nurses still do that) to getting the patient to do deep breathing , coughing, and leg exercises to prevent pneumonia and blood clots. They had no idea that patients on bedrest were at risk for these things. I also said that a patient should get up and walk ASAP after surgery, and they thought I was crazy (they still think you need to wait 24 hours...a practice that is not long ago in our past). So they couldn't believe that I had surgery this summer, and walked out of the hospital less than two hours later!

The next day, I gave a lesson on assessment (many new things there!), and "M" gave a lesson on medication math. The assessment went well, and I had found this great program on "lung sounds" on the internet, and because I am an aid worker, they gave me a 30% discount! So we got to hear a lot of crazy sounds. They were upset that I didn't have any heart sounds to listen to. I told them, that they had enough new and important stuff to learn, and that if they heard anything different than lub-dub, they should tell the doctor.

Here is where it went crazy. "M" introduced them to medication math. What the doctor orders is not necessarily how the drug is supplied, so you have to do some calculations to figure out the correct dose. For example, the doctor may order 15 mg of something, but it comes in a bottle labeled 30mg/ml. So, you have to give 1/2 ml. That is an easy one. They aren't always that easy. These nursing instructors are the creme of the crop, some with 20 years experience, and they had never calculated a dose! They draw medicine up into a syringe and just give it without knowing how much of the drug is actually in it! Oh dear.

Then, we went on to drip rates for IVs. That was even worse. They just eyeball it and give a little or a lot (no kidding). That is dangerous for an adult, it is lethal for children. In the States, though we learn how to do a drip rate, we have machines now that do it for you. here they have nothing mechanical at all, so it is up to the nurse. When a patient gets up to go to the bathroom, they shut their own IV, then open it back up when they get back to bed, and usually, they open it all the way up and get flooded with fluid! So crazy.

So, we have decided to have another "mini" seminar just for medication math for these poor instructors.

The instructors were eager to learn though, and that was very heartening. The students come back to school jsut after New Year (which is March 21 here!) So, we will have our work cut out for us!

a light at the end of the tunnel

2008-02-19T06:17:00.000-08:00

Well, I can still see my breath in my house, but it is no longer painful! Spring looks like it may come early this year, but you never know what is around the corner. The BBC is still calling for snow. We shall see. In the meantime, over 1000 people have died as a result of the coldest winter on record in Afghanistan, and over 300,000 livestock have died, with as of yet unknown repercussions. Here are a couple of links to download video of this Afghan winter.

http://edition.cnn.com/video/#/video/world/2008/02/16/guillermo.afghanistan.weather.cnn?iref=videosearch

http://edition.cnn.com/video/#/video/weather/2008/02/10/vo.afghanistan.deadly.cold.ap?iref=videosearch

Last week, a friend, "F", who runs a kindergarten here called and asked me to see a couple of siblings of one of her students (ages 3 and 1.5). She said that their hands and feet were black and swollen from frostbite and one had a blister that was open. My heart froze, and the chill ran through my entire body as I thought of having to take small children to the hospital to have their fingers and toes cut off. I gathered all I thought I would need to try to thaw them out, along with some ibuprofen and codeine for the pain. As soon as I walked into the room, I could tell it was an extremely poor family. They had next to nothing. And there is a certain smell that a room picks up with the family is poor. I can't describe it. I call it the smell of poverty. It is the same smell that was in the orphanage I worked in in China. It is a smell that I am becoming more and more familiar with.

F brought them some cushions to sleep on and a blanket and some coal for heat. I brought a thermos of warm water to thaw out the children (it takes fuel to heat water and I was afraid that they wouldn't even have that.)

I looked at their little hands and feet. They were black, and they were icy, but they didn't seem as bad as they had been described. F said that they weren't as bad as when she had seen them earlier. So, I gave them both some medicine, and placed their hands and feet int he warm water. I also took out a bar of soap to wash them (some of the black was simply dirt). As we waited for them to thaw, I passed out gummy bears to all of the children (lost count when the whole family was in the room), and we sang children's songs to them in both English and Dari, and told stories. When the two that I was treating started to cry, I went to plan B and brought out the beanie babies I had brought them. They really enjoyed that too.

It takes a long time to thaw frozen body parts, so as we continued to wait, I went around the room to feel everyone else's toes and fingers...There were at least 6 children and 4 adults in the room (the size of an American bathroom!), and not a single one of them had a pair of socks...need i remind you that the average temperature during the day in the month of January did not get above the teens? It was too late to address that issue, but the next day, we sent them all socks and gloves. We also reinforced that once the children's fingers and toes were thawed, they had to keep them warm, or it would be even worse, and they would lose them.

In the Afghan culture you are not supposed to say anything bad may or will happen. They think it will cause it to happen, and if they do say it, they preface it with KhudA nakuna (God forbid!) But I have found that they simply will not follow my instructions unless I scare them into it. So, I told them that if their hands froze again, they could get infected and would lose them and if they weren't cut off in time, they could die. Harsh, but true. I can only hope they listened. When we left, the little fingers and toes were warm and pink. God was smiling on those children that night. I have no other explanation.

Today, as I was walking to the office, I GOT HOT! I couldn't believe it! The sun was shining and I got hot! There is hope.

Winter part three-the never ending story

2008-01-26T06:23:00.000-08:00

Yesterday, I was sitting on cushions, with two heaters on, and I could still see my breath. There was no electricity, and our water had finally frozen. I hit rock bottom. I can't imagine how it must be for the Afghans who can never get warm. Our guard came in with a blow torch and heated our pipes for about 30 minutes, seemingly to no avail, but a couple of hours later, we suddenly had water again! Today we had running water and electricity the whole day! A blessing without precedent!

How do you walk with the poor when you are not one of them? This is the question I have been asking myself the past week, as things have gone from bad to worse. The Afghan people have made great strides in trying to move forward after generations of wars and tribal conflict. But, they hang by a precarious thread. They have a little now for basic survival, but there is still nothing in reserve. Any disaster can take them down, and that is what we are seeing now.

What does poor mean in this society? My friend and I went looking for the poor the other day. We have a fund set up in America to use to buy food, medical care, blankets and heating fuel for the poorest of the poor. There are many poor here, but there are some who are simply desperate. We asked local Afghans to introduce us to the people that they think are poor.

My friend's house helper picked out two families. We went to the first and saw a weird scene. It was almost like it had been set up. (Yes, there are people here who would scam a foreigner to get whatever they can). It was a concrete house (you really want to live in a mud house here, warmer in the winter and cooler in the summer). There was no heat what-so-ever. It was absolutely frigid! It was a widow, with nine other people in her house, including two healthy working age sons. Now, at the moment, it is difficult to get a job, but if you are desperate to eat, there are some things you can do. We asked what they needed, and they said everything, and the quantities that they asked for were huge. We looked around though, and there were two chickens in the yard, two bicycles, and a small generator. That doesn't sound like much from a western standpoint, but there are people now who are tearing up every scrap of wood they can find to heat their house, and their children are starving. This family was not that desperate. If they were, they could sell the generator, the bicycles, and they could eat the chickens.

We went to the next house. This family was different. There were two families living in two rooms of a house. In one room, there was a woman, her husband, who was disabled from kidney problems, and two children. The other room housed a widow, her daughter and several children. This is the room in which we sat. Two of the children sat in the coldest corner. One slept while the other looked at us with big haunted eyes. As we spoke with the woman, she said that she peels chickpeas for 20 afghanis a bag (40 cents). This will buy bread for her family, but not much else. Suddenly, a metallic cough rang out from the little girl, which went right through my bones, then the tell tale whoop during the intake of air, which indicates whooping cough. Yes, this family was hard up. We made a list of things to bring them, including antibiotics for the children.

The third family we visited was recommended to us by my house helper. There was an older woman, her son, his wife and their 1 1/2 year old daughter. The man was out, presumably looking for work. They lived in the basement of their landlord. It was about 14 feet by 7 feet. They owned nothing but a teapot and the clothes on their back. Their neighbors had loaned them a little gas bottle to cook on, and a carpet to keep the cold from seeping in through the dirt floor. They had just moved here from Bamian (the city with the ancient Buddha statues that the Taliban destroyed in 2001). We asked why they moved away from their qaom (relatives...all Afghans live in a neighborhood surrounded by family). They said they heard that it would be better in the city. I don't know what drove them to think this, but it was so strong, that they hitched a ride on a potato truck and sat on bags of frozen potatoes for probably two days of driving. They were desperately poor. We also made a list of things to bring them, including cushions for the floor, so they are not sleeping on the bare cold floor, one more blanket (two had already been donated), and some basic food necessities to get them through a few weeks. (Usually this includes flour, rice, kidney beans, and oil). We also ask neighbors to pitch in with what they can, a cooked meal, a bag of potatoes, an extra floor cushion... We cannot save Afghanistan, but if we work with the Afghans and show them that they can help their own country, it is a step forward. Hopefully in the process, we are alleviating some of the suffering.

Nursing clinicals

2008-01-21T23:13:00.000-08:00

When I took this new job helping the nursing students with their clinicals, I knew it would be a challenge...yesterday, I got a reality check.

Definition: clinicals are when a nursing student goes into the hospital and puts the theories they have learned in the classroom and the lab into practice. The instruction that the students receive here is pretty equivalent to what they receive in the states, and they have a good lab in which to practice...but clinicals. I hardly know where to begin.

First, we are supposed to be supervising the instructors who are teaching clinicals. This is difficult to do when the instructor never shows up. So the poor students are unleashed into the hospital setting with no goals, and no supervision. So, mostly they just stand around for a while, then drink a cup of tea and leave. These students are in their last year of school. In a few weeks they will graduate and get a job as a nurse, having never once even touched a patient!

So, we are teaching the clinicals. We arrived at 8 am and I got a tour of the hospital...please lay aside your expectations of what a hospital in the west looks like, and step back several hundred years. Now, the students who were meant to show up at 8:30 started trickling in about 9:15. Oh dear. I assigned one patient to every two nursing students, instructed them to go over their chart, examine the patient, and see what medications they were on, and I would come and see what they had done. (we were in the "ICU" where there were about 5 patients in the room). I stood back and watched for about 10 minutes as they looked at the charts, then they just stood there staring. So, I went to the first pair and asked what they had found out. They said that she was there for Nafas tangi. (literally tight breath). That is a generic diagnosis given to anyone having trouble breathing. Could be asthma, emphysema, bronchitis, anxiety, heart failure, etc... I looked at the chart though, and she was on all sorts of heart medications. The problem is, that the drug names are all written in English...the nursing students don't know English. Sigh...

So, I asked if they had done a physical assessment (examination). No. Ok, first take the vital signs. No blood pressure cuff or stethoscope to be found. Well, you can at least take pulse and respirations. Those are important if the patient is having trouble breathing and has heart problems and is on heart medications. So, one student put her hand on the patient's wrist to count the pulse. I asked her if she had a watch. Oh, no...well, how do you know how many beats per minute? Oh, I have a cell phone she said. Does it have seconds? no. Ok, here is my watch. So, she counted on one wrist, while I counted on the other. she got 60. I got 144. Granted it was an extraordinarily weak pulse that was very difficult to count but the extreme difference told me she had no idea what she was feeling for. So, we worked on that for a while. In the meantime, all 7 of the students had crowded around me and the patient and were leaning on me trying to see and here everything. I think they were nervous and just didn't know what else to do!

After we got the pulse down, I told them it was important to look at the whole body, especially the feet. The woman was 70, and had been in the hospital for 9 days. She was at an extreme risk for a blood clot. there are no PTs here to come and walk with the patient. So, we went to check her feet, and they had 2+ pitting edema (very swollen). Even so, her little legs were about the size of my wrist!

When we finally got through with that patient, I wanted to make sure that I set a good example, so we set out to wash our hands. We finally found THE ONE sink in the hospital...I though I might be sick in it. It was so gross, that I felt it may be better to not wash after all. Turns out that we couldn't anyway, because the pipes are all frozen, and there was no soap to be had. We finally found a pitcher with warm water and we poured it over our hands and rubbed hard. (hopefully the friction removed a few germs...sigh again).

We went on to the next patient, and it went much as before. The chart was nearly unreadable, it was half English and half Dari, and the students hadn't done any kind of exam.

At the end of the day, I had a post conference with them. You know, for what they had available to them, they had actually done ok. Here are the instructions that I gave them.

1. Your patient is a person, not a thing or a body part. When you go up to them, talk to them. They are sick and scared. They don't know who or what you are (doctor, nurse, student, weirdo off the street), and they don't know what you are doing to them. Tell them who you are and what you are going to do. Treat them like a person.

2. You must take vital signs. This is important. Who has a watch? All raised their hand. Bring it to the hospital every time you come! If you don't have a BP cuff, at least get the pulse and respirations, and we will come up with a stethoscope so that you can listen to lungs.

3. To examine a patient, you must touch them. You cannot do a physical exam without touching the patient. (this is a public hospital which means that the patients are very poor. Though you don't have to pay to go to nursing school, you do have to have some sort of money to pay for food and lodging while you go to school, so typically the students are of a higher class than the patients, so they disdain them, and don't want to touch them).

4. Wash your hands. I know that sometimes there simply is no way, as there is no soap or water, but try your best to find some and when you can, wash.

5. Many of these patients have been here for days/weeks. They are at high risk for pneumonia and blood clots, as they just sit and lay around all day. Go to them every hour and have them pedal their feet and take deep breaths and cough. Even that may save a life.

I came to a quick realization that this hospital will never be UAMS or Good Sam, and we will not be able to get the nursing students up to the level of a Western trained nurse. But if I can just get one to wash her hands, we will have saved a life. If I can get one to treat a patient like a human, we will have given someone dignity. If we can make one step forward, lives will be changed, and then we can prepare to take the next step.

A few more notes about the hospital. It is a big, cold concrete building with concrete floors that are caked with mud. When we arrived, someone was mopping, and it was so slick that I thought if I can just keep from falling down today, I will have accomplished something big. The wards are full of flat beds, and patients just sit in them all day. There are no food trays to be passed. Families must provide sustenance for the patients. The patients are dirty, with no place to wash. They must go to a bathroom down the hall, that I would go into kidney failure to avoid.

The doctors come in, treat the patient as an inconvenience, and never touch them (I say again, how can you examine a patient without touching them?) The charts are just a bunch of papers stapled together, with instructions written in English, and no orders are ever discontinued, so when it says Dopamine (an IV medication used to treat extremely low blood pressure), but your patient doesn't have an IV, you wonder what is going on. On the next line, you see Enalapril (used to treat high blood pressure), and you realized that someone lost their mind. But, everything is extreme here. Someone has low pressure, so they give dopamine is such a large quantity that the pressure spikes and they give a medication to bring it back down.

On several of the charts the blood pressures on admission were written as 65/0 or close to it. Then, though they were on dopamine their pressures were not monitored. Now, in the States, with that kind of blood pressure you probably won't survive, though you may. Here, there is no way... NO WAY! I think the pressures are made up by people who cannot here on the low grade stethoscopes they have here. Sigh...

One of our patients had been admitted because she had not urinated in several days. She had been in the hospital for a number of days, but there was no clear diagnoses to be found on her chart. As we started our exam, the doctor came in with her son (you must quickly get out of the way when a doc comes in, as they view themselves as gods, and nurses as roaches). The son had a handful of x-rays with him, showing that his mother had TB and had been treated for only one month, then quit treatment. Treatment for TB is 6-9 months, and antibiotic resistant TB is so rampant here, that if you miss one dose, there is nearly no hope. This woman had been laying in a crowded room for days coughing and exposing every other patient, doctor, nurse, student and visitor to resistant TB. Big Sigh... At least the students recognized that she needed to be wearing a mask.

While we were there, a lady was admitted and the women with her sat beside her and sobbed. I put my arm around her and said, Auntie (a proper form of address for an older woman whom you do not know), is this your mother? She said yes. I asked what was wrong. She said, her blood pressure is 0. I looked at the woman MOVING AROUND IN THE BED AND OBVIOUSLY BREATHING, and sighed yet again.

Winter part two

2008-01-21T22:27:00.000-08:00

I cannot describe the pain that winter has caused here. Last week, a building in our bazaar caught fire, it spread, consuming two of the biggest retail buildings in our city, and damaging 7 others. ISAF (the international security assistance force) came to help put out the blaze, but it was too far gone to save the two buildings. As a result, 500 people were directly put out of business, and tons of others were affected (for example the people who make the clothing that is sold in those stores, and the people who sell the fabric to make the clothing, etc...on down the line). If you would like to see pictures and hear news of this fire, paste this link into your browser: http://the-rumi.blogspot.com/2008/01/balkh-city-on-fire.html It has really devastated the city. When you drive or walk past, it looks like two burned skeletons and the shattered dreams of people who are just trying to make life better here.

There are all sorts of rumors that go around here when something like this happens. Some say it is the wrath and judgment of God against materialism. Others say it is certainly Al Qaeda or the Taliban. I think someone just got careless with their open flame gas heaters and poof the building went up in flames. There are no building or fire codes here, so of course there were no sprinklers or fire hydrants.

It sounds terrible that the laws haven't caught up here yet, but less than 100 years ago, The US was in the same boat. It took tragedies of children dying in factories to get child labor laws passed. Many people died in clothing factories and tenement fires before building and fire codes were passed into laws. These are Afghanistan's growing pains. Hopefully this suffering will not be in vain.

In the meantime, the cold seems to be unrelenting. We have managed to get a bit of a handle on it. Last night we hung parachute fabric on the inside of our door. You can still see your breath in our hall, but now, there isn't such and arctic blast coming in.

The cold managed to get me first though, and I am down with bronchitis and a sinus infection. So, since I can't smell, I didn't notice the gas leak in my room until my guard came in to change the gas bottle. He said, dear, I am very worried about you. The smell is bad. So, I called my two friends in and sure enough, it was bad. So I had to open up my room to the arctic and air it out. We didn't have electricity, but a dear friend had given me a battery operated fan for the summer, and it happened to be charged up and working! So, my room is now filled with fresh air, albeit cold.

They say that 14,000 sheep have died in the mountains. Simply froze. Also 200 people have died. In the States the sheep wouldn't be that big of a problem, because the government would come in and subsidize. But here, that means the shepherds are out of business, and thousands of people will not have meat to eat in the spring.

As you go through your day, let me encourage you to count your blessings. Toilets that flush. Water that comes out of the faucet, furnaces that come on with the touch of a button, buildings with fire codes and sprinkler systems, and smoke detectors. Fire hydrants that actually have water and firemen who show up and sacrifice themselves to save others. Electricity that is powerful enough to run your refrigerator, hot water heater, electric blankets, computers, stoves, ovens and microwaves. Police who are upright and enforce the laws, instead of breaking them, the freedom of women to get into a car and drive anywhere at will. Grocery stores that are full of food, and jobs that provide enough to eat with. We truly are blessed.

Winter

2008-01-19T05:05:00.000-08:00

This is the coldest winter in Afghanistan in at least 10 years. It has even snowed in Herat and Kandahar, where there is usually no snow at all int he winter. They say that 60 people have died in Herat due to their roofs falling in from the heavy snow.

There is no such thing as central heat in Afghanistan. Most Afghans use something called a 'sandalee" to keep warm.

There are various forms of the sandalee. Traditionally, there is a small hole dug into the middle of the floor (easy to do when your floor is dirt). Hot coals are placed into the hole, then a table is placed over the hole and thick heavy blankets are placed over the table and overlap the cushions the people sit on. You sit on the cushions and put your body under the heavy blankets. It is a very quick way to get warm, but you can imagine the dangers. Almost every family has a story of a child rolling down into the coals and burning to death. Other children have suffocated under the heavy blankets, others have been the victim of CO poisoning.

Nowadays in the city, there are more sophisticated forms of the sandalee. The heat source may be put into a big metal bowl, so that children don't roll into the hole. Others use electric heat sources (though electricity is often scarce here). The problem is, that you cook and clean in an unheated room. Imagine washing dishes in water that is straight snow runoff and the temperature in the room is 25 F.

There are other forms of heat. There are old-timey type wood burning stoves like your great grandmother used, but for the most part, there is no wood in Afghanistan. There are diesel drip heaters. Basically diesel is in a can on the side, with a spigot. You turn the spigot on, diesel drips down a tube into a small barrel type container and you drop a match into it, and it slowly burns. I know many people who have had fires in their houses due to this type of heater. And, diesel in expensive. In the two weeks since I arrived, my roommate and I have spent over $60 in diesel. I have a German made diesel heater. It is basically the same principle, but a bit safer and more controlled. I also have a gas heater in my room. I have had fun dancing with the two heaters trying to make my room bearable. I get it to where I can function as long as I am wearing a lot of layers.

A few people have sawdust heaters. They tend to keep the room comfortable as long as they are burning properly.

All this to say. Winter is hard on the Afghans. Their hands and feet are always bright red and swollen with the cold. They spend most of their time being cold and only get warm when they have time to get under the sandalee.

I wonder if there is ever a time when Afghans are not suffering...

Ashura

2008-01-19T04:40:00.000-08:00

Today is the tenth day of Muharram. This is the day that Shii'ite Muslims mourn the passing of Hussein Ali. You can get more of its history at Wikipedia. My goal is to give you a picture of how they mourn.
Again, for Afghanistan, I need to go back a bit and explain ethnicity here. There are many ethnic groups in Afghanistan. This is part of the reason it is so difficult to unite them. There are Pashtuns (the Taliban was made up of Pashtuns), Tajiks, Hazaras, Uzbeks, and a myriad of other groups.
Most people in Afghanistan are Sunni Muslims. The Hazara people, who are the people that I happen to have a lot of contact with are Shi'ite (also known as Shia). They look more Mongolian that typical Afghan, and because they are Shias, they tend to be persecuted, especially by the Pashtu.
In the city that I live in, there was a massacre of Hazaras during the Taliban. I have a friend who literally ran with her husband and two small children to the mountains when the Taliban invaded this area. She was still hemorrhaging from the birth of her second child.
So, today is the day for the Hazaras to mourn their hero. They do this by flagellating themselves with chains into a bloody mess. It is one of the most difficult holidays here. The calls to prayer from the local Shia mosque are mournful to begin with, but the singing that lasts all night for Ashura is dark and frightening. It reminds me of the phrase from Lord of The Rings that says, "there is a fell (deadly) voice in the wind." I have to sleep with ear plugs to block out the heartbreaking pain of the voice.
When they work themselves up into such a frenzy, there is no telling what will happen, so needless to say we expats don't leave our house on Ashura for safety sake.

In addition to the sadness of people beating themselves to the point of sometimes having to be hospitalized, this is the coldest winter that many can remember. It gets down to 8-11 F every night, and there is no central heat here.

Hassan's story

2007-12-12T19:24:00.000-08:00

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.

What I have seen

2007-11-19T15:36:00.000-08:00

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...

Initial thoughts

2007-11-18T15:33:00.000-08:00

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.