March 2011

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The dust is finally settling from last months  deployment defining experience with Saied.  We speak of him often.  Mainly to illustrate how some drops of good nectar can be drawn from a flower growing in refuse.  He continues to motivate and direct those of us who were lucky to have walked in life with him.

The picture above is of NMH.  It is a 420 bed facility.  This building was constructed in the 1960’s and retains its original flair!  This hospital is the Walter Reed of Afghanistan.  It serves to care for all soldiers, officers families, and anyone who has a permission slip from the Ministry of Defense.  Where does the enlisted family seek care?  When you have this figured out let me know.

Each of the rooms has a windowed door that connects to an outside corridor which connects all rooms on all floors.  On the far left of the above picture is the VIP section.  These are single rooms and have better furniture.

The nurses here come from different backgrounds.  Some are diploma nurses, some are certificate, some are University graduates.  Some are also dentists, physical therapists, biomedical engineers, and physician assistant drop outs.  Some cannot read or write.  Some want to  do a good job, others see this is a means to make money.  Their actions and thoughts are no different than those we appreciate back home.

Most of the house keeping staff is considered “Unreformed”, that is, they are employees and not members of the Afghan National Army.  They can expect a monthly salary of 3000 Afghani, $61.00 per month.

Care for friends and they will surely care for

I see all the gradations of work ethic here.  Some could care less, and always put forth their opinion they need more money, others say little and do a fantastic job.  I make it a point to find people doing a good job and praise them.

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I have concentrated my efforts on the 4th floor here at NMH recently as this floor is in need of the most help right now.  I routinely mentor both the nurses and physicians (when I can find them…). The soldiers on the 4th floor fall into three categories: septic (infected) wounds, burns, or septic (infected) thorax (chest). Some of the soldiers have not had a physicians progress note written in 2 weeks. What is the plan? I don’t know.

While I am working to figure out for myself how the Afghans view caring, I have stumbled on a few observations.  Husbands don’t hug their wives.  Mothers don’t hug their children.  This culture is reliant on showing they care by giving gifts and acts of service.  Of the five potential ways people can be loved, Afghans prefers the two least painful to loose (gifts and service).  The other three are:

Words of affirmation.  A c-section mother was screaming in pain during incision, the MD slapped her and said her husband had spoiled her.  She had a beautiful baby girl who was named by CDR Dianne Capri.  Her name is Arzu, we know it as Hope.

Quality time.  Men and women to do not spend time socially together.  After discussing this with our interpreters we found that men and women cannot be friends, ever.

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Physical touch.  Men and women don’t hold hands.  You will usually find the wife walking behind her husband.  Men hold hands with each other though.  I would like to believe we see this because of maternal mortality being around 20% and why get close to your wife if she has a good chance of dying?

From caring comes courage to support and protect those who are important to us.

We all need human connections, here they try to have ones that appear safe and unlikely to cause additional pain.  It is odd to us but, it is apparently effective for the men. I still question the effect this has on women.  How do women exhibit caring?  As men make decisions focused on their needs that further distance themselves from women emotionally, the divide widens and a perception of the expendability of women forms.  So we challenge them: If you want strong sons, you need strong mothers.

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