Kabul International Airport - Day 12

I awoke this morning about 20 minutes before my alarm with a Charlie horse in my right calf. God I hate those things! I blame the alcohol, altitude and dry air here. I really didn't drink enough water yesterday.

We got moving to the airport about 6am, to beat the city traffic. We made it without a problem and started the crazy check in process.

Before our vehicle could even enter the airport grounds, all the males had to step out and get patted down. The driver just got a pat down, and Art had to go walk through a security line with an extremely friendly officer. An officer also inspected the front compartments of the car. Kim and I sat in the back and weren't bothered. We got the all clear, and proceeded past checkpoint #1.

About 100 yards down the road was checkpoint #2. First the males got out, and then the officers knocked on the windows for us females to get out too. I had some trouble with the lock, which made the officer knock again and again. Finally, I got out of the car and proceeded to what looked like a shipping crate. Here Kim and I were patted down the sides, quickly. Our purses were with us and inspected. We had some trouble opening the back door to leave, but finally made it outside again. We walked back around to the front of the building to unload our bags from the car. They were passed through an X-ray machine, and we loaded them back into the car.

We parked the car outside of the new terminal and unloaded our bags. Here we said goodbye to the driver, as he could not come any closer to the airport without a ticket. We showed proof of our ticket to the guard and passed through the gate onto the terminal grounds. Checkpoint #3 clear.

Before we could enter the terminal, we had to go through checkpoint #4. The females were escorted through one set of doors and the males another. I received a pretty thorough pat down this time - front, back, sides, axilla. It's reassuring that when they finally check the women for a bomb, they are already inside the terminal. Our bags passed through another x-ray.

At this point it was about 6:45am. Our flight was scheduled for 9am. We spent a while waiting to check in at a real desk, as they don't even open until 1.5 hours before the flight. We got our boarding pass, which had information on it besides a stamp with the flight number. Not even passenger information. Luckily we had our confirmation email with our names on it. We also checked our bags.

Next stop, checkpoint #5, ie. the traditional airport security line. On the way to Kabul through Dubai, I had a full water bottle in my bag and didn't realize it. So this time I filled my nalgene bottle with water to try to ward off more Charlie horses. Well, things are changing in Afghanistan. I couldn't bring my water through the line!! Unlike being in the US, the security agent was kind enough to go dump out my water so I didn't have to chug it. We also had to take off our shoes, and separate out the laptop. Toiletries didn't seem to be a concern. It's very nice that they are trying to be more secure. I was also chosen for an extra search. I went to a private room, had to remove my scarf, and was thoroughly patted down again.

In the waiting area, there were plenty of seats, decent bathrooms, and a duty free shop!!! This whole terminal and comfortable experience is new to Art & Kim - they say I'm missing out on the "real Afghanistan." It is evidence of progress though, which is hopeful!

We boarded our Kam Air flight almost on time, and now I am writing this at 20,000ft over Iran. We should be getting to Dubai shortly, as we have been flying for almost 2 hours now.

I've gotta say, I am impressed with this airline as well as the terminal. It's nothing like what I was promised and prepped for by Art. The seats are roomy, the plane is ¾ empty so you can sit anywhere, and they served a pretty damn good lunch of chicken/beef kabob, veggies and apple/pomegranate/pear salad. I got to see more beautiful snowcapped mountains too!!

Back to the Capital City - Day 11

This morning we said goodbye to our security force, our friends at the guesthouse, and the puppies. We headed over to the military base to catch a USAID flight to Kabul. The highlight of the drive over was when the Army guard at the gate looked at our security guard's ID and said "What the fuck is this?" Ah to interact with frustrated military personnel.

We flew on a small turbo prop plane, with 7 passenger seats and 2 seats in the cockpit. Once we took off and got up above the haze/dust/smog, I was finally able to see the snow covered mountains! These include the Hindu Kush and Tora Bora mountains. It was beautiful, especially seeing lush green Jalalabad from the air. It was also really cool to be able to see the view out of the front window! The flight lasted about 20 minutes, and we landed safely on the military side of Kabul airport.

Once we finally found our vehicle, we made it back to the guesthouse in about 30-45 minutes. We had a delicious lunch, met with Art's son Brandon who has just recently returned to Afghanistan to work for another 6 months, and had a few meetings about new potential projects.

The smog cleared up a bit late in the afternoon and some snow covered mountains were visible from the upper floors of the guesthouse. The clear sky didn't last very long though. I have never experienced somewhere with such poor air quality. According to a close friend, Kabul has the highest ppm of human fecal matter in the air in the world. I was only informed of this AFTER I returned. Otherwise, I would have worn my scarf on my mouth the entire time we were there. Luckily our GH was on the edge of the city and I couldn't stand being outside for more than 5-10 minutes....

Tomorrow we fly to Dubai, then have about 36 hours to recoup before our 14 hour flight back to DC. I will be spending about 24 hours in DC on Saturday and returning to San Diego on Sunday. Then it's off to work on Monday….

Lots more pictures to come once I'm stateside!

*Pictures!

Last day in Jalalabad - Day 10

Today is most likely our final day in Jalalabad. Tomorrow we fly to Kabul, but we don't know what time yet.

We started out going to the hospital for about an hour, to turn on the cryostat and install a program called VSee, which is similar to Skype. It's a low bandwith video conferencing program that will allow us to remotely train the pathologist and technician. The quality is excellent! I have been skyping from Afghanistan, but my video camera won't work. I can get video, but I haven't been able to send it. I didn't spend a ton of time trying to figure out whether it was my computer or the connection.

At 10am, Art & I went over to the Medical Faculty at Nangarhar University medical school. I presented a basic lecture on cardiac anatomy for the students. There were about 25 males in the first session, and 7 females in the second session. They were mostly first year students, who have not had systemic anatomy yet. They all seemed very interested and asked a lot of good questions. The boys opened up about about 10 minutes, when Art started asking them questions during the lecture to make sure they understood. He was a great resource when my slide of fetal circulation sparked questions about Rh and blood type concerns. It's a topic I have learned and am familiar with, but I haven't reviewed it recently. Neonatal and women's pathology is Art's area of expertise, so I let him take the reins on that and refreshed my knowledge.

The girls were shy and quiet at first, but then the men (Art, our guard Sabor, and Abdul the organizer) left the room, and they opened up more. It's amazing how the mere presence of males affects the women here. They asked many good questions, and when a few girls came in late, I did a refresher of the basic anatomy part of the lecture. At the end of the lectures, both Art and I were presented with flowers by Abdul and a female medical student. It was a great picture opportunity, and the females kept taking pictures with me on their cell phones!

Unfortunately, we had to rush off to our next appointment. On the way, Art explained the education system to me. High school students are tested, and the top students go to medical school, regardless of desire. This is why most of the people we meet are "doctors." Most of them go for the education, and don't end up practicing. Our security guard is a "doctor" but he doesn't know medicine. The doctors who do practice remain in general practice. There are no specialists in the in country so many conditions often go undiagnosed or misdiagnosed.

We picked up Kim who was next door at the boys high school, then headed over to one of the girls' schools, Bibi Zianab. They have 5800 students, split into two sessions (morning and afternoon). The school building is a square with an inner open courtyard. Of course, there is not enough building space so they hold some classes in the courtyard, complete with desks. The outdoor classes are cancelled when it is too hot, cold, or wet.

We met with the GCEP girls again in their computer lab. Leena and her sisters were there again, and very excited to see us! We discussed possible projects that the students would like to do, in addition to building a library of books to read. The tricky thing with books is that they need to be culturally acceptable, so we have to be selective about content and also illustrations. We encourage the students to raise money to books, which will be matched by rotary fundraising - maybe $50 to every $10. They also came up with ideas about drawing contests in each grade, and a science laboratory.

After visiting with the girls, we headed back to MKH. We turned on the cryostat again and it FINALLY got down to -22oC. Took about 1.5 hours, but that is an improvement. We got a "fresh" tissue sample from the heel of a gentleman with an ulcer, and finally got to do a real frozen section. We also got a specimen from the ear of a second patient, but this one had been in formalin for a little while. We did the best we could - it was easy to cut and stayed on the slide pretty good. Dr. Azim seems to have a pretty good handle on doing frozen sections. We got back from a meeting one day to find him practicing on his own. He is definitely motivated to learn. We are still using the quick stain because the Hematoxylin is over oxidized and bad.

The additional reagents never arrived from Pakistan in time, so we were unable to use the processor and embedding station. They work though - we plugged them in and turned them on. I did my best to excplain to Dr. Azim what each machine did and how to use it. It was a little challenging to do without being able to show him. So I found a few videos on Youtube, which showed the embedding process and cutting with a microtome. While I was donig this, Kim was training the doctors how to use VSee and gmail.

We finally left when Aisake came to pick us up. We made him wait a little while, which was unnerving - Ben was in the car and we didn't know it. Its pretty much against protocol to sit in a vehcile somewhere too long. We bent a lot of rules this trip...many thanks for Aisake for putting up with us!

While still dressed in our traditional Afghani outfits, we put on our body armor vests, got an AK-47 & a 9mm, and re-enacted the "mouse in the couch" situation. Don't worry, the guns weren't loaded!

After our last dinner we did hear some popping sounds, which could have been gunfire or firecrackers. Our head security guy went out to investigate with the guards and came back and said it was just firecrackers. We spent the evening up on the roof, looking at the stars and drones. I got my google sky map to work without GPS which was pretty cool! Saw at least 4 shooting stars....

I have to say I will miss Jalalabad. We met a lot of great people here. The expats are all really intelligent, motivated people, who remind me a lot of my WM friends. The locals we met were all very appreciative of our efforts and eager to learn. Honestly, the locals are generally good natured towards the Americans. They want change for their country. It is the taliban and extremists that are making it impossible to roam safely in the country.

I felt oddly calm in Jalalabad. Granted, we had a quiet uneventful week. Regardless of the situation, you always have to keep your guard up and your head down.

*It is now almost two weeks after we left Jalalabad for Kabul/home, and things have picked up again in the town. The base has been attacked, though there have been no direct attacks or threats on the house or office. If that had happened while we were there, we most likely would have been locked down in the guest house. We only had 8 precious days anyway, it would have been tough to lose another day. Thankfully, that didn't occur!

Grand Opening! Day 8

Today is the grand opening of Mughul Khan's histopathology lab, located at the Spinghar hotel around the corner from the hospital and our office. Kim and I wore our new outfits from Dr. Mirwais, while Art dressed in the western fashion. He was giving a presentation, because the big draw to the lab is an American doctor from San Diego. We were told that there were about 150-200 people invited, which freaked me and our security out a bit.

We arrived at the hotel about 1.5 hours before the scheduled start time to set up. Afghani's are generally late, so our start time of 10 was more realistically 11, even though Dr. Mirwais assured us everyone was informed that they needed to be on time. Our DAI friends said that this meant people would only be an hour late instead of two.

Watching the guys from the hospital hang banners was entertaining. They stood on a very stable looking ladder...

We started about 11am, with a reading for the Quran. They sang for about 10 minutes. I wish we had had an earpiece with a translator speaking into it. Everything except Art's presentation was in Pashtu, so I didnt understand much of it.

There were many introductions and it was finally Art's turn to speak. He had to stop after eveyry line for translation, and It was interesting to hear how much longer the translations were sometimes. At the beginning of his presentation, Art quoted 8 word from Shakespear and the translator went on for about 2 minutes in Pashtu....but apparently he was explaining something else.

Art's presentation was well received and generated many questions. At one point, there was a heated discussion because a surgeon had done a modified radical mastectomy without a tissue diagnosis. The formalin fixed grossly positive lymph node was sent to us and frozen, confirming a diagnosis of invasive carcinoma. Even though we are in a third world country, the same issues in healthcare present themselves. Except in the US, you could lose your license for that kind of behavior.

After the opening was finished, we had a large lunch for all the participants. Local food, some kind of rice with veggies, chicken, beef, and yogurt with jello topping. Art always has said - don't eat the yogurt. Its not refrigerated. But we all tried a little bit. I liked it - it was coconutty.

We headed back to the hospital for a little while. On Saturday, we finally got a new resistor in the cryostat and froze our first specimen! The axillary lymph node was positive for poorly differentiated carcinoma. It was not the best slide, due to fixation and the fact that our Hematoxylin ended up being brown (ie. oxidized and bad), but it was readable enough. We were able to use all of this information during the grand opening. It was good that we finally got a slide made - it's something really small and easy to do at work in the US, but it was a giant step forward for us in Afghanistan!!

We then went back to the guesthouse to work on reports and presentations. I sat outside at a table with the puppies for a while. Kim donated a pair of socks to them so we could play tug of war. They had a lot of fun with it. I just hope we didn't inspire them to steal laundry off the line.

Dinner was a delicious stew with very large veggies. The cook does a very good job making American dishes, he just doesn't chop veggies very small. For dessert there was a really good fruit salad!

Frustrating Day - Day 9

Today was a tough day. Yesterday after the opening, we had given the doctors at MKH a list of all the reagents that we needed more of. The quantities we got at the Bazaar Tuesday are not enough for the processor. They said no problem, we will have it tomorrow. Well, tomorrow is here and the reagents are not. We might get things tomorrow if we are lucky, but I won't hold my breath. So, no processing or embedding going to happen today!

Also the internet was down at the hospital, and the microscope wasn't working for a while. We spent a lot of time tinkering with the router, computer and plugs trying to make things work. Finally we got the microscope up and running. The internet was down at the source, so there wasn't much we could do. We had been making fairly good progress the last few days, so it was very frustrating to have a day where we couldn't get much of anything done.

After the opening, surgeons started sending us specimens. We had requested that if they wanted a frozen section the tissue should be kept fresh in the fridge. This morning we got a specimen from a surgeon's 6 year old son. It was a lymph node in formalin, whih was frozen in the freezer. We also got a breast biopsy in formalin. We did our best to freeze a piece of each, because it was the only available option, but the cryostat was not cooperating today. It took a few hours to get down to -13 and we tried to cut th tissue but it was way too soft. Even thick sections didn't work. The slides came out crappy, as did the stain with old Hematoxylin. Eventually it got down to -16 so we tried again. Not much luck. It was getting dark, and the room we are in doesn't have sufficient lighting. We turned off the machine and gave up for the day.

I spent most of the night working on my presentation for tomorrow. I am keeping it pretty basic with lots of pictures. I have found a lot of useful cardiac pictures thanks to google, since I was not prepared at all for this! When I was done, I watched a few minutes of Bollywood movies before bed. Great dancing, not so great acting!

We have satellite TV in the guesthouse, so we get mostly channels from India, ESPN, CNN, BCC and a few other channels. One night we were watching the Simpsons, so Fox must be in there somewhere. There are lots of movies too, most purchased from the military base.

It's the weekend! Day 6

Friday is the Sabbath here in Afghanastan, so everyone has the day off. It was pretty glorious to sleep in today. There was a BBQ planned for the afternoon, so it was a nice casual day. Everyone has been walking around the compound in American clothing, and the females don’t need to wear head scarves. So, I put on a banana republic shirt short sleeve shirt because it was sunny and I wanted to get some vitamin D and not sweat like I have been the rest of the week. (long sleeves, head scarf and any temperature over 72 = too hot).

After about two-three hours of sitting around out on the patio reading, one of the women here (who I saw at breakfast) says to me “You know, your outfit is totally inappropriate for here.” I thought she meant the city of Jalalabad, which is very conservative compared to the capital of Kabul. I was aware I wouldn’t be able to wear the shirt outside the compound. But she actually meant for INSIDE the compound. She said that she never ever wears short sleeves (except she was today), and always has a shirt that covers her behind.

It didn’t even occur to me that I might offend someone, or that the guards were staring at me.In the evenings other females sometimes wear gym t-shirts with short sleeves, but when I thought about it, they didn’t go outside to get to the dining room. I did. I felt bad about it and made sure I changed my shirt into something more appropriate. I guess I figured since we didn’t have to wear the headscarf, then we didn’t have to worry about what we wore as much. Oops.

As I said before, Jalalabad is more conservative than most of the rest of the country. All the women here wear a burqa outside. Some of the older female children even wear them, but it seems most do not. The only skin that is visible is the face. The neck and ears are usually covered by the head scarf, and the rest of the body by clothing. Occasionally the girls wear sandals and show their feet. In Kabul, there were women out on the street without the burqa.Not many, but some. In Jalalabad there are zero.

The BBQ was a delicious feast of beef, pork, chicken, baked beans, corn, pomegranate seeds, hash, salad and eggplant garlic dip. There were also pomegranate margaritas! We had a few visitors from other guesthouses, who we met last night. This included the two guys who are riding their motorcycles from Turkey through Iraq and Afghanistan.

After lunch, we sat around and talked the afternoon away. I tried to teach the pups to fetch. At first they seemed to get it and be excited, but then they were distracted by a game of Bocce. It was getting pretty dark, like it was going to rain, and the wind was picking up. In a place that is generally dusty, you can imagine it was pretty bad. We went inside before there was sand coming out of our ears, and set up the projector to watch Charlie Wilson’s War. It was kind of gross to see just how much dust was floating past us in the light.

I realized a little into the movie that I have in fact seen it before. Don’t know when or where, but if not it was pretty bad déjà vu. The movie is more interesting this time around because one of our local friends here (Ishaq) was actually a Mujahedeen, Afghan fighter, at this time. He lived this movie, met Charlie Wilson and Ronald Reagan, and helped to defeat the Russians. He wasn’t watching with us, but had given us a play by play history lesson on Wednesday at the hospital.

It was also interesting watching the movie in country, with a bunch of expats who have been here a while. For those who haven’t seen it, the point is that Charlie pushed for this covert war to help the Afghans fight the Russians. It worked and they won. But afterwards, Charlie pushed to spend a little bit more money on building schools and roads. Instead, America pulled out and the country turned into what it is today. History is getting ready to repeat itself, if security contractors end up having to leave the country. Many US workers will be forced to leave, and not only will 30,000 local jobs be lost but many unfinished projects will remain just that – unfinished.

It’s really a shame because so many of the locals we interact with really do love Americans and the work we are doing to help their country. They are very gracious and appreciative, and feel safe with us here.

One of our fears about our project is that we will set it up and show them what to do, but they will not take the initiative to sustain it. That seems to be a common problem encountered here.We have to be careful to share the responsibility with the locals. We don’t want to just come in with everything and set it up. We need them to find supplies so that they will make a connection in town for stocking up. We can’t just do a book drive in the US and send the books over. Some fundraising needs to occur locally, to teach responsibility and hard work.

Speaking of work, maybe we will get to do some tomorrow. If we get the resistor, that is. The grand opening of the lab is on Sunday. Hopefully we will have a functional lab by then!

First day in Jalalabad - Day 3

Today was our first full day in Jalalabad. We went to Mughal Khan hospital to start setting up the equipment and gathering what supplies we didn't have. Everything except for the processor had been moved from the 4th floor office to the lab room on the second floor. Art started to unwrap the processor, and I stood up to help him.

Dr. Mirwais put out his hand and signaled for me to stop. "Please, sit, women here don't work." First culture clash. Since it was the first day, Kim and I obliged to just sit while Art did all the work. It wasn't half bad, though he kept giving us dirty looks. Seriously though, I didn't want to offend anyone on the first day. We finally went down to the lab room and I was able to tell Art why I wasn't helping. He then proceeded to talk up how well educated Kim and I were.

So we finally unwrapped the cryostat and decided we should go to the Bazaar to get tables, reagents and tools. We had requested alcohol, formalin, paraffin and xylene before we left the USA. They are fairly common reagents in industry, so Art didn't think it would be an issue to get.

On past trips, Art and Kim have both been able to just get up and go wherever needed, whenever. This time we have rules about security, so we had to call for permission and ask them to scout the location first. Then our car came to pick us up. This took about 45 minutes.

We finally got to the edge of the Bazaar, and went to a shopping plaza with medical supplies. Kids came up to the car and tried to look inside as we were parking. Our guard Sabor was with us, and accompanied us inside the store. He was pretty awesome. The store we went to was interesting - there were all kinds of drugs on the shelves, buckets of medical tools, old microscopes on shelves, even a large model of a heart! They gave us a can of the Afghan version of Red Bull while we were there, with a piece of gauze as a napkin. It tasted the same but I didn't drink much of it, for fear of having too much caffeine. We got forceps without teeth (they took ones with teeth, cut them off and polished them), a small amount of formalin, xylene, alcohol and slide sized coverslips. The paraffin, sodium bicarbonate, hematoxylin and eosin had to be obtained elsewhere in the city or in Pakistan somewhere. Ok, so no processing or staining going to happen today.

We also went to another store to pick out desks to put the equipment on, until they can get permanent lab tables put in. We saw an area with lots of Afghan rugs, then went to a paint store to get some brushes for frozen sections.

When we returned to the hospital, we had lunch and then plugged in the equipment to make sure it worked. Everything was going well until we plugged in the cryostat. Something happened and it made a popping sound. After some investigation, we determined that a resistor had been fried and needed to be replaced! The electrician went to the Bazaar to look for one. Unfortunately, there were none in town and the part had to be obtained from Pakistan. Ok, no frozen sections going to happen today.

We finished unwrapping and placing the rest of the equipment on the desks. Originally, we got 2, but decided we needed a third, which was brought to us almost immediately. Dr. Mirwais doesn't waste time. If we need something, he makes someone go get it RIGHT THEN. He seems like a very powerful person.

While we were in town, Dr. Mirwais wanted to have a grand opening for the lab. We were told that Afghani's LOVE openings and closings. Some places will have a 3rd grand opening....Well today was Tuesday, and he wanted to see if we could do it Wednesday. As in, TOMORROW. We finally talked him into Thursday, stating we hadn't actually gotten to make a slide yet. So we drove around the corner to the Spinghar hotel to reserve the hall. Fortunately, it was booked Thursday and not available until Sunday. So we set the date for our "grand opening." His family lives in Kabul so he decided to return home that night until Saturday.

When we returned to the hospital at the end of the day, a tailor was there to measure Kim & I for local outfits. We couldn't go to the Bazaar so he brought the tailor to us. He showed us some different shirt designs, then asked us about colors. I picked green and blue, she picked blue and magenta.

Then we headed back home to the guesthouse to recoup.

Thelma & Louise

I would just like to say that I love these dogs. Seriously. They are so freaking cute and sweet. Found on the streets of Afghanistan around the age of one month, these girls were taken in and raised at the guesthouse. What kind of dog are they? "Afghanistan mutt."

Thelma

Louise

Thelma is the lighter one, and she's the alpha. Louise is such a sweetheart, but can be a little shy. She loves to hide in the bushes.

Naptime

Both enjoy having their bellies and necks rubbed. Today we enjoyed some tug of war with old gym socks.

Kabul to Jalalabad Road - Day 2

Monday we traveled east from the capital city to Jalalabad city in Nagarhar province. Generally, the mode of travel is a USAID flight. Unfortunately, all flights were grounded for a few days due to an incoming US dignitary. This meant the only way for us to get to Jalalabad was by road mission.

I’ve heard about and seen pictures of the “Jalalabad Road.” Every time Art visits, he drives the road to J’bad. He has never flown. It is one of the most beautiful drives in the world, and also one of the most dangerous. The road winds through the mountains, with one side against the mountain and one side against a steep drop into the gorge. It’s a good solid paved road, but people drive without rules here. The river running through could be a world class whitewater destination, if you didn’t have to worry about being shot out of the water.

The road starts with a military checkpoint. When we arrived, there was a nice traffic jam. No one was moving, due to an accident that had happened overnight. A large truck, probably stacked twice as high as the crate, had crashed into another truck and tipped over. Everyone was out of their cars, standing around. It was a great picture opportunity, except our windows were not tinted so everyone was staring in at us. I felt uncomfortable being too obvious with my picture taking, though I did take a few. Once all of the cars coming towards Kabul had passed, we were pushed to the front of the line and followed a military vehicle onto the road. After leaving the guesthouse around 8:30, we were finally on the road at 10am.

Unfortunately, my camera battery had started flashing red while we were at the checkpoint. I had charged it in Dubai and for a few hours in Kabul, so I was puzzled as to why it was already dying. I must have fried the charger somehow. I was pretty upset because 1) it's a beautiful drive, 2) it's a beautiful drive we weren't even supposed to do, 3) I love taking pictures. So I would scope out pictures, turn on the camera, take the picture and turn it back off. I did this the entire ride, and the battery actually lasted until Jalalabad. I didn't take quite as many pictures as I would have on the drive, but this forced me to scout out the pictures more.

We started out making good time. Trucks lined the side of the highway in our direction, but we were not moving. There were a few oncoming cars and trucks we literally had to squeeze between, but we survived. Traffic headed to Kabul was very bad and didn’t seem to be moving at all. The views from the road were beautiful. There is no snow on the mountains yet, but the whole thing reminded me of driving through western Colorado in the Glenwood Canyon.

Once we were out of the mountains, (about an hour) we rendezvoused with a car from Jalalabad to take us the rest of the way. Our guards were out in full force while we switched cars. This one has tinted windows so I can take pictures unnoticed. It was another 2 hours to Jalalabad.

Trucks line the highway

The road hugs the cliff

Cliff hugging

Overturned truck blocking traffic

Patroling guard before the switch

Beautiful landscape, drier this year than in the past

Raging rapids

Many people travel on top of carts

Kabul river is extremely dry

Local lunch at the office - cilantro yogurt and beans

We arrived in Jalalabad and went straight to the office. They were kind enough to fix a late lunch for us, and we were shown were we can work while we are in town. Then we had a security briefing before heading over to the Mughul Khan hospital, to meet Dr. Mirwais Shegiwal. He is the one who owns the hospital and will be helping us set up the lab. He is quite the business man, let me tell ya. We toured the 4 story hospital with an awkward design, and saw the room which will be the new lab. They told us it would be cleaned out by tomorrow.

Finally, we made it to the guesthouse. There are 12 people staying at the compound, including the 3 of us. We each have private rooms, laundry service Sun-Thurs, two awesome dogs, internet access, a flat screen TV and a cook. The place is protected by armed guards, 24/7. There was some mention of body armor during the brief, but that never happened. There are three buildings, and I live in the safe room for my building.

I was feeling pretty tired and still a little sick by this time. I managed to make it to dinner, which was more American than local. Then I excused myself and passed out for a good night’s sleep. I only woke up one time when I heard a distant far off boom. No worries though, I'm already in the safe room.

Welcome to the Capital City - Day 1

So these posts are a little out of order, but I’m going to try to catch up.

We first arrived in Afghanistan on Sunday, October 24, 2010.

Kabul city on the way in

We arrived in Afghanistan at 7am on Sunday, about 30 hours after we left San Diego. Our flight was on Sofie airlines, which is almost a real airline. Our three hour flight included a pretty decent breakfast (way better than the one of united). It was most international people - nothing like the flight Art first took into the coutry which was full of men in turbans.

The weather was sunny and cool, since Kabul is up in the mountains at about 5900ft. We got off on a jetway (a new addition apparently) and went into a new terminal. Around the baggage claim were a bunch of pushy locals with carts, so we allowed one to help us. Going through customs was interesting. They require you to hand over your luggage tags but they don't really check to make sure you have those bags. No problems with our host gifts even though there is a supposed ban on the stuff. The local baggae cart man appeared again to push our bags to the car.

We finally found our ride, an armored land rover, out in the parking lot. We piled all of our bags in, and set out for the guesthouse.

Let me tell you how thankful I am that I don’t have to drive in this country. It is pretty ridiculous. In Kabul, the roads are mostly paved but they aren’t I nthe best condition. There are no stoplights or stop signs, or even marked lanes for that matter. Cars go anywhere and everywhere. It is very common to have a car coming right at you, and swerve away at the last second. Not only are there cars on the road, but there are a bunch of bicycles, motorbikes, donkey carts, open taxis and people walking along and across the street. We probably rarely drive faster than 15mph in the city, because it’s near impossible. There is so much traffic. In a traffic circle, there might be 7 cars facing each other trying to pass. I give props to these drivers because they stop on a dime when someone walks out in front of the vehicle, or when the corolla in front of us filled with 10 men suddenly stops. Every time we get in the car it’s a new adventure.

The benefit of driving so slow is that I am able to get pretty good pictures out of the untinted window. The bad part is that everyone stares at the Land Rover as we go by, and everyone can see inside it. It’s very important to keep my head covered here.

We finally made it to the guesthouse in one piece. After they checked the car for IEDs with a large mirror on a pole, we got out and went to have breakfast. Corn flakes, milk and bananas. Yum! Staying in an International guesthouse, you get many of the comforts of home. We have internet, AC, a gym, a TV room, a pool table, water heaters that give enough hot water for 2 long showers, and international food. We received a security brief once we were settled, and were shown to our rooms. Kim & I were sharing a bathroom and joined rooms. It smelled a little funny, like curry, but you got used to it after 10 minutes.

Now this is the first time Art & Kim have been “inside the wire” with required security detail. They are used to making plans and going. We can no longer do that – first we must have security check out the site, then pick us up in the armored car and send an escort with us. Personally, I don’t mind it. It does slow us down a little bit, but I feel safer this way.

We made an appointment to go to the CURE hospital, where there is already a pathology lab in operation. It is the only one in the country, and they do about 50 blocks per day 3 days a week. There is one pathologist, who was trained in Jalalabad, and two female technicians. An older, retired pathologist from Canada had just arrived for a 2 month stay to train the local guy. Unfortunately, when we were searched before going in, the woman took away my camera and said I had to leave it in the car. All I could understand was the word journalist, to which I said “No ma’am.” But I don’t want to piss anyone off, so I left the camera. Art, however, didn’t have to give his up!

The lab is pretty basic and reminds me a tiny bit of the Medical Museum I toured in Indianapolis last month. They have two rotary processors like the one we are going to be setting up, a microtome, an embedding station and a stainer rack. They get most of their supplies from Pakistan, or the USA. Our doctor from Jalalabad was supposed to come meet us at the hospital so he can talk about suppliers and see a working lab, but he didn’t make it in time. We watched the technician do an FNA on a woman with enlarged cervical lymph nodes. When we looked at the slides, there was a lot of blood and it was not really enough to make a diagnosis. The local pathologist wanted a repeat FNA, but we all pushed for a core biopsy. It is very interesting to hear their thought process.

After the tour of the hospital, we went to meet the doctor from Jalalabad at Babur gardens. He convinced us to take a shortcut through the neighborhoods, on some lovely narrow bumpy roads. It was quite the adventure. We drove by what looked like a landfill, but may have just been a field filled with trash. Eventually there was a small drainage ditch in the middle of the road that we had to straddle. Once again our driver was amazing and got us there safely. We did have to stop a bunch of times to ask the locals which way to go.

Our shortcut road

The gardens were reconstructed in 2004. It’s a terraced setup, with a marble tomb and mosque at the top. There are great views of Kabul from the top, although they are partially blocked by trees in some areas. Art has a picture of the place from his first trip and it looks so different because all of the plants are small. Near the entrance are a bunch of shops. We went in one and saw some male carpet weavers in training. The room next door had females inside, so Kim and I were allowed to go in. It takes them about 4 months to make one rug. It’s no wonder they are so expensive!! We went into a little shop which had vases & bowls of blue glass from Herat, and some pretty wooden pieces. I didn’t have money on me right then, otherwise I would have bought something. Hopefully we can go back when we are in Kabul.

View of Kabul from Babur Gardens

Afghan carpet weaving

We took the “long” way back to the guesthouse and it took us about 2 minutes to get back to the start of the “shortcut.” Weird. We had some leftover lunch, and relaxed until dinner. I was starting to feel pretty tired, because I hadn’t slept more than 2 hours at a time in about 48 hours. It was only 4pm though, so I pushed through to dinner.

We went to a Lebanese restaurant in the city and met with some people Kim knew, James & his friend Fred. It was interesting because the outside of the restaurant looks like nothing. Just a guy sitting out front. You go inside, check your weapon, and go down a long hallway to a fancy door. Then you step into the restaurant. They had some giant hookah apparatus there. I was only a little hungry, so we ordered hummus for all and I got falafel. Well, the waiter brought us chicken soup, a bunch of appetizers, and dessert on the house. There was so much food for 5 people that it was impossible to eat it all. I felt bad wasting it, but I just wasn’t hungry enough.

When we got back to the GH, people were hanging out drinking at the bar. It was only about 8:30 but I couldn’t take it any longer. We had such a long day that it felt like 2 days. I had to go to sleep. I took half a sleeping pill, set my alarm for 6am (had to convert the time from EST first) and went to bed. I woke up once and my clock said 3:30. I figured that was 6.5 hours of sleep, not too shabby, and I didn’t have enough time left to take any more sleeping pills. Well I forgot the time was EST. It really was only midnight. I still had about 6.5 hours to go! Another night of crappy sleep.

Moonset over Kabul

Why am I in Afghanistan, anyway??

This is a really good question, posed by McV and many others.

For me, it all started in January of this year. I walked into our frozen section room to help out on a day when Dr. Art Mendoza was on frozen duty. As I walked into the middle of a conversation, he said “I bet Heather would go. Do you like to travel?” I replied’ “Sure, I love to travel. Can I take pictures there?” “ Absolutely.” “ Travel, pictures and time off….I’m in. By the way, where are you going?” “Afghanistan.”

At this point, he expected me to change my mind. He has been asking everyone else in the lab to come for years. He first visited Afghanistan in 2004, and this is his 6th trip. I said I might actually be seriously interested, and asked to know more about what he does over there.

During this trip, the major project is to set up a pathology laboratory in the city of Jalalabad, in Nangarhar province. The idea came about during his first trip here, when he was staying with a local surgeon. He met with many doctors at Nangarhar University during his stay, including the Chief “pathologist”. I put it in quotations because the doctor is not really a diagnostician. He teaches pathology but has never used a microscope to make a single diagnosis. Back in 2004, there were no pathology services available in the entire country. At this time, there are two labs in Kabul – one at the CURE International hospital* and one at a private lab which is not currently operational. Currently in Jalalabad, all biopsies are sent to Pakistan for processing. This is expensive and takes 2 to 3 weeks. The goal is to provide a local service, which will be cheaper & faster, and will eventually provide jobs in the community once the lab expands. It is also valuable to the local surgeons to be able to do frozen sections during their surgery, instead of waiting weeks to find out any diagnosis.

USAID, via DAI, provided a grant to purchase the equipment needed to run a routine lab, as well as perform frozen sections. This includes a cryostat, microtome, processor, embedding station, water bath and staining rack. The local hospital is to provide a pathologist and technician to be trained, both by us and in working labs.

So after hearing story, I did a little research about was really happening in Afghanistan. I’m very lucky to have a bunch of really smart friends who are interested in international relations. I talked to lots of people to get their opinions, and I was surprised to find that most of them were positive and supportive. I really expected people to tell me I was absolutely crazy, but they kept that to themselves.

Initially we were going to go in the spring of this year. However, the equipment was in the US and had to be shipped overseas first. Art knows from experience that shipping can be unreliable and take up to a month. So we waited to book our trip until the equipment was actually in Jalalabad, which ended up being the very end of May. We could have traveled in June or July, but the climate of Jalalabad is similar to Palm Springs. During the summer here, it is well over 100 degrees. All females must be covered except for the face – long sleeves, long pants and head scarf. Summer would be miserable and unproductive. So we planned our trip for the fall, and here we are.

*Recognizing the enormous need—and seizing on a tremendous opportunity—CURE International accepted an invitation from the Afghan Ministry of Public Health to assume control of both a partially restored hospital and a nearby outpatient clinic in Kabul in January 2005. By the end of that first year, both facilities were fully operational and serving more than 8,000 patients each month. In addition to providing top quality care, the hospital also offers training programs for doctors and nurses to further elevate the level of care provided in the future. Programs include obstetrics and gynecology, pathology, orthopedic surgery, general surgery, plastic surgery and general practice.

Rotary processor and embedding station

Microtome and stainer

Finally got the microscope and camera working

Outside of Mughul Khan hospital

Our first specimen

The Afghanistan way - Day 5

Today, day 5, we went to MK hospital again, to find that our supplies have still not arrived. As I have been told, such is Afghanistan. There is not much else we can do until the cryostat is fixed. There are also a few electrical issues. We need voltage converters and long power strips that will support our American plugs. We did finally get the stains & paraffin wax.

Happy to have supplies

We have a breast biopsy in formalin from the public hospital on standby, though judging by the history it sounds like we might even be able to make the diagnosis based on gross appearance, or by examining the patient. If we can’t get things working soon, they will need to ship it to Pakistan.

In the meantime, we had some delicious chai latte and chocolate cookies while we met with Almas. He invited us to go to the Education Faculty this afternoon to participate in a GCEP skype conference call.

We returned to the office for lunch since there wasn’t much to do at the hospital. Kim & I once again ate with the females. One is 27 and “engaged” to be married soon. Technically, they are already married, for visa purposes. Her husband is Afghan, but lives in the UK. Once her visa goes through, he will come here and they will have a traditional Afghan wedding. Then she will move to the UK with him. It was not an arranged marriage – she met him through a coworker. She is quite a remarkable woman. She speaks five languages: very good English, Dari, Pashtu, Arabic & Persian. She has an MBA from Pakistan and is extremely excited to leave here and start a new life.

It was an amazing opportunity to get some cultural exposure. Her story is very typical. Her father has two wives, so she has two mothers and many siblings. The men in her family, including her only brother , did not support her about getting an education. Her brother used to beat her, but she still says she loves him. The family bond here is amazing.

The food was very good too.

After lunch we literally drove across the street in our armored car to the Education Faculty. There were clusters of children, sitting out in the yard learning. There were desks and chairs on top of the school buildings. It was just like described in the books.

We walked into the building, and there were about 20 high school girls and IT trainers sitting in a computer lab. The lab was started by the La Jolla rotary club as part of the Global Community Exchange Program (GCEP). It allows high school students in Afghanistan to connect with students in the USA. They also have weekly Skype conferences. This week they were talking with two female soldiers & a woman from the State Department from a nearby military base.

Before the conference, the lead IT trainer - a woman getting her BBA at the local university – had us introduce ourselves to the girls. We were sitting on the side of the room. As I spoke, all of the girls turned their heads to stare with a smile on their face. The genuine enthusiasm and excitement I could feel radiating from them was amazing. They sort of gasped in awe when I said I had a master’s degree and worked as a Pathologists’ Assistant. We asked them what projects they would like to become involved in, if they had any ideas. They were kind of shy at first, but eventually spoke up that they would like real English classes in their schools. Many children are not allowed to take private lessons, especially girls, so they have to learn any way they can. They understand English “is an economic language,” and are so eager to better their conversational skills. Honestly, I am in awe of them, because I only speak one language, and have a hard enough time with Spanish let alone Dari or Pashtu.

One of the girls passed us a notebook and asked if we could write her a note, including something about ourselves. “I just love Americans!” It was so cute. They were very appreciative that we came to talk with them, even though we mostly sat and watched them answer questions asked by the military women.

Another of the girls, when asked by us what she wanted to be, told us she liked economics and would like to do business. However, her family said she must be a doctor or they will not pay for her education. She does not like patients. After the conference, I took her aside and suggested she look into pathology if she has to study medicine. We'll see where that goes.

A few women from a local radio station also attended the conference call. They arrived gracefully in their burqas, it was quite a treat to see them. The radio station is for women, by women, which is an amazing thing in this country of men. Their part of the interview was in Pashtu, and I didn't understand much of it at all.

The afternoon really was the saving grace of the day. It was a wonderful experience to interact with some female students. Later in the week I will hopefully be doing a short lecture at the medical school. Better get working on that...

School at Education Faculty

Skype conference call with State Dept & military personnel


GCEP girls and trainers

For dinner, we went to another DAI guesthouse, dubbed the "opium mansion." It was big & ornate, with a bit of a disco feel. We met a bunch of new (to me) people who have been here for a few weeks or a few years. There are some really intelligent people over here. At times I have a little W&M deja-vu. After dinner, we went over to the famous Taj guesthouse and met many more intelligent, inspiring people. Unlike the dinner guesthouse, and the one I'm staying at, the Taj is "outside the wire." Most of the people staying here have the ability and freedom to go into more dangerous areas & more places within the city.

Art was a little worried that it would be disappointing, but the Taj lived up to it's hype. I enjoyed hearing about what projects everyone is involved with, and also how people came to Afghanistan in the first place. And then a really wise woman told me: Sometimes, the question "what is my job here?" is best answered "You're another beating heart on the ground here".

A new adventure

So it's been almost a year since my last post. Shame on me for not keeping up....

I have embarked on a new adventure, halfway across the globe, so I feel this is an appropriate time to pick up where I left off.

Last Friday, I hopped a plane to DC, hiked from terminal D to C in a stuffy terminal, then caught a plane to Dubai. Surprisingly, the 12 hour flight wasn't that bad. We were in Economy Plus, so a little more room. I had an aisle seat, and a personal screen with movies, TV and a map of where we were! Dinner was lasagna, and I watched Toy Story 3 again. After that, I was ready to try to sleep.

And try I did. But those plane seats just aren't comfortable. Why can't someone redesign them to be ergonomic? Start with providing a little lumbar support, and stop jamming your chin into your chest. Even with my travel pillow around my neck, there was not enough room to really get comfortable enough to sleep. I was a little afraid to knock myself out on the plane, so I didn't, and only got a few hours here and there. I even had an eye mask so light wouldn't bother me like it did on the way to Paris.

Finally we reached Dubai, cleared customs and stepped out into a 90 degree, humid night. It was stifling then, but man I would LOVE some humidity right now. We stayed at the Holiday Inn Express near the airport, which was pretty nice and so cheap! Even though we only had about 6 hours there, it was great to get out of the airport, shower and nap.

We were back at Dubai airport at 1:45am, all ready for our 3:30am flight to Kabul. Why it leaves in the middle of the night, no one knows. We stocked up on bottles of host gifts, and boarded the plane.

We got to see the sunrise over Afghanistan, which was beautiful. I saw a few snow dusted mountaintops, but the weather is still really warm and it was a very very dry winter.

Finally we landed at Kabul airport in Afghanistan, where my new adventure begins....pictures to follow soon!