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!
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