The Kite Runner

"A Hospital is no place to be sick."
-Samuel GoldwynUS (Polish-born) movie producer (1882 - 1974)

Today was an interesting day. Like I said before, the clinic has now become a hospital. When I first got to the hospital I decided to visit the inpatient ward. The beds are so close to each other that you can almost roll from one bed to another. Most of the injuries are war related. You see many fractures and leg amputations. Most of them are young guys too. I spoke with one of the patients for a while. He was telling me about how he was fighting the Taliban, alongside Americans, on the border when he received his injury. He said that they shot a rocket at him and that is how he got his leg injury. I felt sorry for him. They do not have the same luxury of disability or social security that we do in the states. They are paid a small lump sum for their injury and are left to get by the rest of their life without any additional compensation.

I headed down to the ER and I spoke with the doctor. He told me about 2 patients that were brought in last night. The police had arrested one man for robbery. When he was in custody the man's brother tried to rescue him and it resulted in both of them getting shot up pretty good. They ended up being Orthopedic patients so they were recuperating in the Otho ward. The funny part of it was that right next to the 2 criminals was a police officer that was recovering from a gunshot wound. He had shot himself while cleaning his gun. It is almost like the cops and the robbers decided to take a timeout and live in peace while they both healed. You would never see that in the states. I have been to hospitals that treat criminals and they have their own ward and the patients are usually hand cuffed to their beds. Take a look at an x-rays of one of the injuries. The fracture is pretty obvious.



I spoke with the man that was arrested and, believe it or not, he was a pretty nice guy. Of course, he said that he was set up and was wrongly accused. He was the first Afghan that I have seen with a tattoo. I thought that it was neat so I took a picture.



I went back downstairs and I went back to the ER and I saw a man with blood all over his shirt. I took a closer look and he appeared to have a big bump on his head. I asked the police officer what happened and he sort of smiled and laughed and said that the man was told to leave an area and he did not listen. They were cleaning up his head wound before they sewed it up. Another person came in with a pretty bad laceration to his chin.

I went back upstairs to visit with the OB doctor for a while. I tried really hard to teach her about fetal heart tracings. Fetal heart tracing is similar to an EKG. It is the information that the 2 monitors that are placed on pregnant ladies belly when they are in labor provide. The OB doctor told me that they do not have any monitors in all of Afghanistan (I did not independently verify this). I could tell that she was having a hard time at it so I kind of gave up because they probably will not be getting any fetal heart monitors anytime soon. One of the nurses that works in my office is a OB nurse and her husband is an OB/GYN doctor. They are mailing a bunch of OB related stuff like pregnancy wheels, paper measuring tape, and a few other OB related things. We have 6 weeks before the first baby is delivered so we are kind of under a little time pressure to get the room up and running to make the first delivery.

I had another big group of care packages waiting for me when I got back. I passed almost all of them out. I have a few more left in my room that I need to distribute. We went over to ISAF to celebrate one of our teammates birthday. It is always nice to eat somewhere different.

The movie The Kite Runner is coming out soon and I came across an article by the Author of the book, Khaled Hosseini, regarding his trip back to Kabul after many years of being away. It is such a great article that I thought that I would reprint it on my blog. It gives a really good example of what Kabul is like. So sit back, relax, and take your time reading it. Just a little warning there are some parts that are graphic so if you read this with your children then I would take caution.

Here is the link to the article

http://books.guardian.co.uk/review/story/0,,2227662,00.html

"The long road home Khaled Hosseini's bestselling novel, The Kite Runner, was set against the devastated landscape of his native Afghanistan. In the run-up to the story's release as a film, the author recounts the horrors and hopes of his first visit to Kabul since 1976 Saturday December 15, 2007The Guardian Ahmad Khan Mahmoodzada as Hassan and Zekiria Ebrahimi as Amir in Khaled Hosseini's The Kite Runner

"I once saw the Taliban beat a woman so badly, her mother's milk leaked out of her bones," an old shoemaker said to me in Kabul as the two of us sat by his shop front and watched traffic bolting by Haji Yaghoub mosque. In some ways, that sentence summarises my feelings about my trip back to Afghanistan after an absence of three decades: a marriage of the horrific and the poetic.

The horror was ubiquitous. It started the moment Kabul came into view from the window seat of the 727, a sprawling city the colour of mud and dust, bereft of the trees or blue waters I've always seen when flying over other cities. It continued when the Ariana aircraft touched ground at Kabul airport: strewn all around the runway were overturned trucks and carcasses of old airplanes, burnt fuselages, remains of wings gone to rust. Outside the terminal, amid Kalashnikov-toting military personnel, I was mobbed by beggars dressed in rags, all of them children. One of them - a frail boy of six or seven - got bullied by the others; his mud-caked hand lost its grip on the 5 afghani bill I was handing through the car window, and he let out a cry of such despair and sorrow it rang in my ears the rest of that first, terrible day.

Kabul has changed a great deal since I last saw it in 1976. The traffic is suffocating now, pedestrians, mule-drawn carts and bicycle riders weaving perilously through the clogged lanes of honking cars and taxi cabs, 3 million people roaming a 30 sq mile city designed for less than half that number. The air smells of diesel fumes and smoke from the trees people burn for firewood, and sometimes the wind-stirred dust is so thick you can't see the end of the block. The dust gets in your teeth, your eyes, your ears; everyone stops in their tracks and waits for the wind to die down. I was driven through Kabul on my second day there, a grand tour of what nearly a quarter-century of wars does to a city, to a people. As I gazed out the car window at the endless destruction blurring by, I realised that there is not a single block in Kabul that hasn't in some way been scarred by war. The so-called "posh" parts of town have dirty, unkempt homes with shattered windows, set along roads riddled with potholes big enough for a small child to lie in. The areas that bore the brunt of the mujahideen infighting - Karteh Seh, Karteh Char, Deh Mazang - have simply been flattened. They are little more than block after block of demolished homes, schools reduced to rubble, movie theatres, pharmacies and shops pulverised to piles of dirt and bricks. The crumbling Darul Aman, the old royal chateau built in the early 20th century by King Amanullah Khan, is pocked with holes from rocket attacks, standing at the end of dusty Darul Aman road like an abandoned, haunted mansion. I recall my father taking my brother and me there for picnics outside the chateau, but the flowers, trees and grass are long gone, too. Across the street, Kabul Museum is little more than a storage house for ancient artifacts that have been shattered by club-wielding Taliban.

The poverty and disarray in many areas is unspeakable. I saw an old woman wearing cracked bifocals picking slimy lettuce leaves from a fly-blown heap of trash. I saw a dead horse on the side of a crowded street and learned that it had been electrocuted when it had sipped from a rain puddle and a loose power line had touched the water. Passers-by hardly seemed to notice. One-legged war victims - some of them children - and maimed former mujahids walk the streets on canes, or just stand around leaning against walls and watching traffic, as if waiting for something. At the tomb of Ahmad Zahir, a famous Afghan singer, I stared at the bullet holes in the stone, put there by hateful Taliban who had fired with machine guns on the tomb of a man killed more than 20 years ago. "In Kabul, dying once is not enough," a young panjshiri man said to me at the grave site. As I walked away from the grave, I was mobbed again by burqa-clad women and barefoot children, their hair matted with dirt, faces oozing with sores, their teeth rotting already, begging for baksheesh. They took what I handed out and said, "May God give you plenty, Kaka! May God never make you unhappy!" The locals tell you the widows are to be pitied, but not to give money to the children, that it promotes a culture of begging. Maybe that's true, but some of these children, I learned from speaking to people, get beaten by their parents if they don't come home in the evening with a certain amount of money. On some of them, I saw the tell-tale bruises and burns. Desperation is an ugly thing. So is hunger. I don't know if handing out money to them was the right or wrong thing to do. I know only that turning from them required a strength that I simply did not find in me.

In the mountains that crown the city, children walk down winding dirt roads from up to 2,000ft to the city below to stand in line at the well and fill pails or antifreeze containers with water. They load them on their backs and carry them up to their homes - a process that takes hours every day. Then their mothers hand them dough, and the children walk down the mountains again to stand in line at the community oven to bake it. They wrap their bread in cloth and climb back up the mountains. There is a haggard, vacant look in the eyes of these children as you drive by them, as they disappear in the dust in your rear-view mirror. One man, a former police officer now working as a bodyguard, told me his son had failed mathematics and had to repeat third grade. "He is intelligent and he wants to be an architect and make buildings for Kabul," he said, smiling sadly, "but how can he study when he has to walk up and down the mountain all day?"

One policeman, who wanted to arrest me for videotaping him at a crowded intersection and ended up inviting me to his house for dinner (an offer which I politely declined), told me he made $40 a month to feed a family of 12: his wife, his four children, his dead brother's two wives and five children. He told me he hadn't been paid in three months and that he had borrowed money from every friend and relative he knew. He eyed the passing sleek black NGO Land Cruisers with disdain, a sentiment I found very common in Kabul, and complained that the government had given millions in aid money to the NGOs, which then spent it on fancy cars, fancy offices and fancy guesthouses. "What good are these NGOs? What have they done for us?" he said. "I have yet to see them put two bricks together." He told me the government had to find ways to put the aid money where it was most needed, in the pockets of average people. "We are thankful that the Taliban are gone and that we are safe walking the streets," he said, "but people are hungry now and they are getting desperate." He told me of a man he knew who had bought a loaf of bread, crumbled it to pieces, laced it with rat poison, and fed it to his eight children and himself. He told me of another man who, unable to feed his children any longer, had doused himself with gasoline and set himself on fire in the middle of the street. The policeman saw the shock on my face and nodded glumly. "It's true, my friend. It's all true. Tell this to the people in America."

I spoke to people on the street about life during the mujahideen infighting and Taliban rule. Mohammad Agha, a thin man with a haunted, weather-beaten face older than his stated 33 years of age, told me every home in his neighbourhood had been hit by rockets between 1992 and 1996. "My neighbour's home was hit one day, and I went into their basement. I saw a leg here, a breast there, meat everywhere." They had had to identify the victims by their clothing. His own house had been hit one day while he had been at work, and he had run home, expecting to have to dig his family's body parts out of the rubble. Instead he found his father sitting under their mulberry tree, clutching Mohammad Agha's children in his arms, all of them miraculously unharmed. "God is so great, words fail me," Mohammad Agha said to me. He told me that, one day, shortly after the mujahideen took over Kabul, he was walking by a house when he heard screaming. He knew the officer at the door from school and was able to get through. He found three young women in one room, their clothes torn off their bodies, and a mujahid soldier struggling with another woman in the living room. "He wore a ring on each finger, but there was one last ring he hadn't been able to pull off the woman's finger. So he had forced it into his mouth and he was yanking the ring off with his teeth, blood dripping from his mouth, tearing the meat off the woman's finger." He shook his head and told me that was one of the worst things he had ever seen in his life. "And I've seen people nailed in the head, cut in half with saws, their eyes gouged out with bare hands," he added. He told me how the mujahid forces in the mountains used people for target shooting: that they would bet 1,000 afghanis for a pedestrian, 2,000 for a bicycle rider, 3,000 for a car. 1,000 afghanis is $20. "You know the worst part?" he asked. "Some of those people are now working for the government, driving fancy cars." I spoke to my driver, Awdi Khan, a plump, kind-faced man in his late 40s. I told him that some people in America whisper that the reports of the atrocities committed by the Taliban are exaggerated. He scoffed at this. "Then they should have been here with us," he said. "There were executions every Friday or every other Friday; certainly hand-cutting every week. They would announce it on TV on Wednesdays: 'So-and-so, son of so-and-so, from so-and-so area, will be put to death for this or that crime.' The hands ... " he paused, " ... they would tie to a ring and parade them in front of the people at Ghazi Stadium." He told me how he sometimes had to pray midday namaz three or four times. "You would be walking down the street and some Talib would tell you to go to the mosque to pray. You would swear to him that you had just prayed, but he would hit you with a whip and call you a liar. You'd pray once more, then cross the street, and get stopped again."

But here is the most amazing thing of all: amid the despair, sickness and destitution, I saw beauty and kindness that brought me to my knees. And I saw what I had come to Afghanistan to see: signs of rebirth and hope, signs of a people allowing themselves to dream again. I saw men planting grapevines and trees on the hill that leads to Bagh-e-bala, King Abdur Rahman Khan's old palace, which overlooks the city. I chatted with a young shepherd playing the flute on that hill, the bells on his sheep jingling as they fed on grass. He thought his life was much better since the Taliban had been largely ousted - he could play his flute again. Children flew kites from rooftops and young men in pirhan-tumban played volleyball at the Shar- e-nau Park. People smiled and little schoolgirls sang songs as they skipped to school, holding hands. I saw people painting old homes, building new ones, digging gutters, going to the movies and playing Bollywood soundtrack songs and rubab music at street corners. Kebab-makers fanned skewered lamb on charcoal flames and, more than once, offered me free meals. Awdi Khan took me to a section of Kabul river that people had turned into a bazaar. "Afghan people make do with what they have been given," he said. The droughts had dried the river, so people had set up shops in its empty bed, selling carpets, clothes and cheap jewellery. "They call it Titanic City," he said. It rained for the first time in years while I was there, and within days the river was flowing once more. "No more Titanic City," Awdi Khan said, smiling, "but people are happy. We need water for the trees and the wells. We need Kabul to be green again." Kabulis love flowers once more. They buy them from stores and place them on the windowsills of their broken homes, sometimes planting them in the empty shells of old mujahid rockets - Rocket Flowers, they call them. They deck out their cars with pink flowers and white ribbons on wedding days, driving and honking through Chicken Street past muddy ISAF jeeps. Despite the squalor around them, Afghan dignity has managed to survive. I tried to hand a young boy money once at Koteh Sangi. He shook his head and said, "I am not a beggar, Kaka." Then he invited me over to tea at his house. The "house" turned out to be three and a half crumbling, roofless walls with a wrecking-ball-sized gaping hole in the middle of one.

I have returned to my own life now in America, a life whose even minor conveniences suddenly strike me as decadent. I have had a few days to reflect on my return to Afghanistan, as I drive around town, as I stand in line at the grocery store, as I lie in bed at night, my two children sleeping safely down the hallway. The enormity of what has happened in my homeland is overwhelming, but what comes back to me is not the poverty, the destruction, the aftermath of years of violence. Nor is it the nostalgic satisfaction of seeing once again my father's house in Wazi Akbar Khan where I grew up, or Istiqlal, my old school, or Cinema Park where my brother and I saw so many old westerns; all of these settings I used for my novel The Kite Runner. No. What I think of mostly is the people I met, their faces, their names, their smiles. I think of the stories they so generously shared with me, and how they have managed to survive in the face of what has happened in that land, how they have salvaged their dignity, their dreams and hopes. How they have stayed kind. I think of the strength of the Afghan people. I think of their humility. Their astonishing grace.

The author's latest novel, A Thousand Splendid Suns, is published by Bloomsbury (£16.99). The film of The Kite Runner will be released on December 26."

I look forward to seeing the movie.

Thanks for reading.

UV Light

"There is nothing new under the sun but there are lots of old things we don't know."
-Ambrose Bierce, The Devil's Dictionary US author & satirist (1842 - 1914)

"A man should never be ashamed to own he has been wrong, which is but saying, that he is wiser today than he was yesterday."
-Alexander PopeEnglish poet & satirist (1688 - 1744)

Today I spent some time discussing different medications that was in a shelf of a medicine cabinet in the ER. I held up a box of tetanus vaccine. I asked the ER doctor what were the indications for the vaccine and how long does the immunity last once the vaccine is administered. He knew when and how to use it but then he said that the vaccine only gives you 6 months of immunity against tetanus. I corrected him and I told him that it is actually good for 10 years. His reply was, "No, this vaccine is from China, it only lasts 6 months." We both laughed. He was still wrong.

I held up a bottle of Atropine and I asked him for what conditions does he use it. He said that he would use it to control severe nausea and gastrointestinal upset. I walked over to a Advanced Cardiac Life Support poster that we put up last week and I showed him where in the algorithm that it should be used. It did not strick me until tonight that Atropine could probably be very effective in controlling gastrointestinal over-activity because it works on the parasympathetic nervous system which effects gastrointestinal motility. We probably do not use it in the states for that reason because it is potentially very toxic. So he was not entirely wrong he is just behind the times I guess you could say.

Similarly, there were numerous vials of Aminophyline which was commonly used for asthma in the 1970s but is not commonly used anymore in the states because it has a lot of toxic side effects and it has to be monitored closely. Incidentaly, I have yet to see any asthma inhalers. I think that it may be a cost issue.

I held up a vial of Calcium Gluconate and I asked the same question. He said something about its use with diabetes. I told him that since they do not have a lab where they are able to calculate a patients calcium level then he probably should not be giving it to anyone.

I held up a vial of Vitamin K and I asked when does he use this. He answered that it would be used on someone that has a bleeding problem. In the states, Vit K would be used to reverse someone that is taking too much Coumadin. I have yet to meet anyone on Coumadin in Afghanistan and unless we are dealing with a Vit K deficiency, which is pretty rare, it probably does not have much use in an ER. He also had vials of Vitamin B6. In the states we use this only when we prescribe a common tuberculosis medicine called INH. I wonder if Vitamin K and B6 are needed because nutritional deficiencies are common in Afganistan.

We then went through about 5 different blood pressure medications. One of them was Digitalis. This is another medication that needs to be monitored by a lab and I know that they do not have that capability.

I went upstairs and I learned that they were going to have their first surgical case in the OR. I was very excited for them. I have been told that they have the nicest operating room in all of Afghanistan. Here is a picture.

I walked into one of the ORs and the surgeon was very hesitant to have me go in the room. He explained that the UV light was on. When I first learnt that they used UV light to sterilize their operating rooms I sort of smiled to myself thinking that they were misguided. Tonight I was a little curious to see if I was correct because it was not the first time that they have proven me wrong. I actually found that there was a lot of literature on the use of UV light for germicidal irradiation. It has been in use for over 100 years. In 1903 the Nobel Prize for Medicine was awarded to Niels Finsen for his use of UV against tuberculosis. Here is a link to an article.

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Here is another article that I found on the first operation under UV light.

"January 15, 1936 a Duke surgical team led by J. Deryl Hart, MD, performed the first operation under ultraviolet (UV) lights.

The early days of Duke Hospital saw rash of postoperative infections, some fatal, in patients with large, “clean” surgical wounds. Duke surgeons investigated this puzzling problem. Tests showed the cause of the infections to be staphylococcus aureus. They focused their investigation on how the bacteria got into the operating rooms, as all personnel followed prevailing aseptic procedures for themselves and the patient, as well as sterilization of all equipment used in operations. They found that surgical staff brought the bacteria into the operating room on body hair, particularly in the nose. The most careful scrubbing didn’t eliminate all the bacteria on a person’s body.

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To combat the problem, Hart’s team turned to ultraviolet lights. They determined the exact power needed in UV lights to kill the bacteria in the operating field with the least risk for operating room personnel. Surgical staff, because they frequently worked under UV lights, had to wear protective clothing with visors to shield their eyes. The patients were safe as they were in the operating room only once.

Results were seen immediately. Patients experienced less post-operative pain, and, most important, infections fell from 33 percent to 3.8 percent, with no fatalities. Other hospitals following Hart’s lead experienced the same results. The cost for this improvement was minimal: UV lights sold for less than $10 each from retail outlets.

This research garnered national attention for the new Duke Hospital."

I got to thinking a little bit more, and I was reminded that a year ago, before we moved into our new home, we hired someone to get rid of the tobacco smoke smell from inside the home and they used UV ozone. So here I was thinking that they were doing something that was futile and I did not even bother to research its validity or even realize that I used the same method to rid my home of tobacco smell a year ago. Talk about pie to my face. I am still going to emphasise the use of bleach and other common methods to reduce germs in the OR, but they can continue on with their UV light. Here is the light. It hurts my eyes just looking at the picture.

The VCR program did their weekly sorting tonight. A few of you might recognize some of the boxes.

Some kid is going to look very stylish with these snake skin boots.

Muslims will be celebrating another Eid soon. It is officially called Eid ul-Adha and it lasts four days, a day longer then the Eid that took place after Ramadan, hence the name, "The Greater Eid."

I included a small summary from Wikepedia if you would like to learn more about it. Here is a link to the entire article.

"Men, women, and children are expected to dress in their finest clothing to perform Eid prayer (Salatu'l-`id) in any mosque. Muslims who can afford to do so sacrifice their best domestic animals (usually sheep, but also camels, cows, and goats) as a symbol of Ibrahim's (Abraham's) sacrifice. The sacrificed animals, called "udhiya Arabic: أضحية" also known as "qurbani", have to meet certain age and quality standards or else the animal is considered an unacceptable sacrifice. Generally, these must be at least 4 years old, and weigh 26 st. At the time of sacrifice, Allah's name is recited along with the offering statement and a supplication as Muhammad said. According to the Quran a large portion of the meat has to be given towards the poor and hungry people so they can all join in the feast which is held on Eid-ul-Adha. The remainder is cooked for the family celebration meal in which relatives and friends are invited to share. The regular charitable practices of the Muslim community are demonstrated during Eid ul-Adha by the concerted effort to see that no impoverished Muslim is left without sacrificial food during these days. Eid ul-Adha is a concrete affirmation of what the Muslim community ethic means in practice. People in these days are expected to visit their relations, starting with their parents, then their families and friends."

Thanks for reading.

Chess Master

"Avoid the crowd. Do your own thinking independently. Be the chess player, not the chess piece."
-Ralph Charell

It is the Muslim holiday Eid for the next four days so we will be doing a lot of work in our office. It was a good opportunity to visit Camp Phoenix to get our HUMVEEs worked on. We needed new brakes and a bunch of other things fixed. A number of stars will be coming to visit the camp this week. You may recognize a few of the names, Kid Rock, Robin Williams, Lance Armstrong and the current Miss America. I watched them set up the stage. Hopefully I can get a few good pictures.

I was shopping in the px and I came across a Special Ops checkbook cover. I wondered what was so special about a Special Operations checkbook cover and why do they need to write checks anyways.

We had a Camp Eggers MWR Christmas party tonight. I included a chess quote at the top because I beat Adam at chess tonight. He put up a good fight but it just was not enough to beat the Chess Master. Maybe next time Adam.

The Air Force brass quintet played a bunch of Christmas Carols at the party. They were pretty good. After they were finished we enjoyed a wild game of bingo. We are a crazy bunch over here. We really know how to party.

Here is the Air Force brass quintet in action.



I loaded some new picasa photo books. Feel free to take a look.

Thanks for reading.

Ha Ha Ha

"You pile up enough tomorrows and you'll be left with nothing but a bunch of empty yesterdays. I don't know about you, but I'd like to make today worth remembering."

-Meredith Willson, The Music Man

It was actually a pretty productive day, unfortunately, most of it involved office work that is not very interesting so I will spare you the details.

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I received an iTunes gift card from my wife and I was able to download some new music. While I was on iTunes I also downloaded the latest episode of This American Life. When I was back home it was the highlight of my drive to listen to it on the way to work. They allow you to download a free podcast every week. You have to pay for older episodes. You can click on the logo to go to their website.

This weeks episode is a good example of how the show can make you both laugh and almost cry in the same episode. Take a listen. I promise you will be addicted. It is like nothing you have ever heard.

I received a whole box of Christmas stockings. I will bring them to the office party that will be happening soon.

A good friend of mine sent me a harmonica. It will be so fun to learn how to play.



I was also sent 2 new books. I think that I am the only person over here that has not yet read them. I plan to start with the Kite Runner first.

The wonderful kids from the Gaffney, South Carolina 8th grade class left me a great comment on yesterday's blog. I also received a bunch of letters and poems from them. I find it so funny that they are no longer able to say Ho, Ho, Ho and that it has been replaced by Ha, Ha, Ha.

It is so funny because I have a picture of the students and I bet that I could match their comments with their picture, especially !!!X!DREW!X!!! (")(-_-)("). He reminds me of myself when I was his age.

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Here is one of their poems.

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Here Comes Christmas

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Christmas is coming

and everybody wants a lot of gifts

but that is not what Christmas is about

Christmas is for the love of Christmas.

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It's just right around the corner

and no one can wait

it seems like Christmas is gonna be late

but the birth of Christ is not too late.

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I wish you a Merry Christmas

and the best of luck, never give up hope,

Ho, Ho, Ho, Merry Christmas

to you and all.

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Hope you have a wonderful Christmas.

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Thanks for reading

Hope and Freedom Tour

"Take a music bath once or twice a week for a few seasons, and you will find that it is to the soul what the water bath is to the body."
-Oliver Wendell HolmesUS author & physician (1809 - 1894)

"I think I should have no other mortal wants, if I could always have plenty of music. It seems to infuse strength into my limbs and ideas into my brain. Life seems to go on without effort, when I am filled with music."
-George Eliot



Today we were visited by some country music stars. Take a look.

Here I am with Darryl Worley

and Keni Thomas.

Their plane was supposed to get in a lot earlier and because we have been having a lot of bad weather lately they did not end up coming in until 11:00pm. The plane flight here is ridiculously long and the last thing that you want to do when you get here is take a bunch of pictures and sign autographs. They were real troopers. They all had great attitudes and seemed genuinely happy to be here.

While we were waiting around for them to come it was kind of fun because different people were doing karaoke and some folks were country dancing. It is always so strange and surreal to see seemly normal things like line dancing and then you look down at their leg and see a 9mm in the leg holster or an M16 on their back. It is a strange contrast seeing normal activities that are taking place in a very strange place.

Take care, it's bed time.

Shopping Intervention

"It is difficult to live in the present, ridiculous to live in the future, and impossible to live in the past. Nothing is as far away as one minute ago. "
-Jim Bishop

"I always say shopping is cheaper than a psychiatrist." Tammy Faye BakkerUS wife of Jim Bakker 1961

The snow really came down last night. Kabul is somewhat surrounded by very large mountains and for the first time they were all covered with snow. You have to really be careful walking around here because it is very slippery with all of the ice.

Last night a few stars came to visit Camp Phoenix. It is too bad that I missed it. A lot of people took pictures. I should have some more coming. Take a look. Maybe you can recognize a few of them.

Robbin Williams


Lance Armstong

Kid Rock

And that guy from the Daily Show. The Daily Show is one of my favorite shows back in the states. I would record it on a regular basis.

The Eid break was nice and now it is time to get out of the office and back to clinic work again. This next week will probably be the busiest of my entire deployment. I can’t go into any details yet but stay tuned. It should be interesting.

Tonight we had our team Christmas party. It was fun.

I am a little concerned about my friend Adam. I think that I might have to do a shopping intervention on him. We were joking with him tonight saying that he could probably open up his own shop with all of the stuff that he has bought. This is just a very small fraction of the things that he has bought and sent back home to his family.



When he opens his shop he will need to get the different standard phrases down that all of the vendors use. "Looking is free," and, "It's OK...just looking," or the so very believable, "Mister, I have not gotten any business all day. You are my first customer. I give good deal."

I was in the Coffee Bean having a Chai Latte with cinnamon with my good buddy Puff Daddy and I noticed this box with a sign on the front. It had a bunch of envelopes in it. The note in the card reads:

"Destiny began collecting and sending greeting cards to the troops in 2005 when she was only 10 years old. She read requests on anysoldier.com and found that most service men and women wanted cards and letters from home for the holiday." It goes on to say that she has sent out over 7,000 letters. I grabbed one and opened it expecting at most a signature, because after all there are about 100 cards there, it had about 12 different signatures on it. Wow.

I will send her a thank you and feature her on my community service site. Here she is.



Thanks for reading.

War Injuries

"I'm glad I didn't have to fight in any war. I'm glad I didn't have to pick up a gun. I'm glad I didn't get killed or kill somebody. I hope my kids enjoy the same lack of manhood."

-Tom HanksUS movie actor (1956 - )

Today when I got to the clinic not much was going on in the ER so I headed upstairs. I saw that the Orthopedist and was about to start his rounds so I decided to accompany him. I am not sure if the patients were just covered by sheets the entire time, but I never really had never appreciated how serious their wounds really were. Seeing all of their injuries today really took me by surprise. The hospital has only one Orthopedist and he has to manage patients that get sent from all throughout Afghanistan. The vast majority of the patients sustained war-type injuries. I do not mean be insensitive in any way, but it really felt like I was walking through a Hollywood movie set. The injuries that these people had were just horrific. The were the result of rockets, large caliber bullets, and large explosions. The patients were all very young too.

The first patient that we saw had an amputated foot and an external fixator over both legs to repair extensive fractures. The next patient had a deep gaping hole, the size of a grape fruit, over his right buttock. There was a smaller entrance wound over his right groin. The next patient and an extensive compound fractures over his right lower leg. When the Ortho doctor approached the patient he removed a small piece of gauze that covered his wound. A piece of bone fragment the size of a quarter could be seen protruding from the wound. He removed the piece of bone and discarded it in the trash and then his assistant covered it back up with gauze. The Ortho doc said that he did not have any more external fixators to repair his fracture. I asked why he did not have a cast on his leg and he said that he was still waiting for the edema (swelling) to go down. The next patient was completely missing his left arm and an eye. The next patient was partially paralyzed from a gun shot wound to his spinal cord. His foley catheter was lying on the floor. There was patient after another with similar injuries. I asked the Orthopedist how many of his patients were in the hospital and he replied, "18. "When I told him that it was a lot he smiled and replied, "That that is nothing, I had 120 patients in the old hospital."

As I was walking out of the room I saw a patient lying on a plastic mattress without a sheet. I asked the head nurse why he did not have a sheet. He told me that the patient had gone to the bathroom 3 times in his bed already and they were not going to give him any more sheets. I felt bad because the patient was incontinent from his injury which made him partially paralyzed. All I could do was just take it it all in.

I went back down to the ER for a little lighter atmosphere. The ER doctor and the PA were there. They are always in a good mood and we always joke with each other. I wish that I could play a recording of the PAs laugh. It is so funny. It sounds like a high pitch squeal. It is the kind of laugh that triggers laughter from others. The PA invited me to visit his apple orchard. He says that he owns 9 acres of land.

Look what they did to their medication dispenser. Each drawer has a different liquid in it- hydrogen peroxide, saline, betadine, and alcohol. I tried to explain to them that it probably is not the best idea, but what can you do.

I visited the lab and it was almost like going through a time warp. Take a look at some of these reagents. They do all of their labs by hand. I am not sure if you realize but in the states most clinics and hospitals used large automated machines to do their labs. It was like visiting a chemistry lab. They had all kinds of reagents: Thymol, Urea, Copper, Sulfuric Acid, Calcium Carbonate, probably every element in the periodic table. I am so curious what they do with Copper. I will just have to ask them next time I am there.

A friend of mine was sent a talking parrot. Take a look. It is the perfect pet. You never have to clean or feed it.

Take care.

Pine-sol

"We merely want to live in peace with all the world, to trade with them, to commune with them, to learn from their culture as they may learn from ours, so that the products of our toil may be used for our schools and our roads and our churches and not for guns and planes and tanks and ships of war."
-Dwight D. Eisenhower34th president of US 1953-1961 (1890 - 1969)

I loaded about 300 new pictures in the Dr. Massaud photo album. He takes amazing pictures. Loading them onto picasa was like cooking a turkey. I started it last night and it was not finished uploading until middle of the day. I already mentioned it on a previous post, he won the camera from a BBC contest. He said that he wanted to document the effects of 30 years of war so when his country gets rebuilt people will not forget how terrible it is to go through war.

Today at clinic I walked into the ER to see an older man in his mid 60s lying on the exam table. The ER doctor told me that he was a judge and he was just attacked by 4 Taliban members on his way to work. They had just shot him in the head. The bullet went from the back of his head and out his upper brow. His wife, who wore a burqa, was by his side holding his hand. There is not a lot we could do for him. I helped get him an x-ray. We did a neurologic exam and it was normal. The judge was admitted to the hospital and, ironically enough, they placed him in a bed located right next to a criminal.

I was somewhat disheartened standing amongst all of the patients in the ward. I am fairly disappointed with the level of care the patients are receiving. In the states any one of the patients admitted would probably be followed by 5 different specialists- Internal Medicine, Physical Therapy, Infectious Disease, Orthopedics, General Surgery, Social Worker, etc. Instead, the patients have their family members take care of them. I spoke with a father who said that he has followed his son from a distant province so he can help to care for his son at our this new facility. He has almost spent all of his savings. His son was with a group of other soldiers when they were ambushed by the Taliban. Everyone died except his son. He had numerous gunshot wounds to his abdomen. A large verticle post-surgical scar is visible over his mid abdomen with a couple of drains protruding from it. His father has had to purchase all of his medications, and even the colostomy bag that he has to use, from a local bazaar. There were no sheets on the mattress. The sheets that were there were filthy.

The interpreter that was with me (Dr.Massaud) was visibly upset. He said to me, "It is not right. This is a very brave man here. He stood out in the cold snow with his AK fighting very bravely for his country and this is the treatment that he gets."

I went to speak with the housekeeper about the sheets. He said that it is not his job to collect the sheets he only cleans them. I went to speak with the head nurse and he said that there is no one on the payroll to collect the sheets so the sheets are not being washed.

It have found that it is very difficult to get across the do more with less concept. In our military we just get by with what we have. We say mission first. You check your pride at the door and just get the job done for the sake of the mission. I tried to convoy the importance of patients' first to the head nurse but I do not think that he was very receptive to it. Before I finish this deployment there will be sheets on every bed and they will be cleaned everyday. I will make sure of it.

Speaking of cleaning, it is so funny how the house keepers always want to impress you whenever you are there. Yesterday we were in a small circle talking in the lobby and one of the housekeepers literally took a long vacuum and started vacuuming in the middle of our little circle. Today in the ER a few of them were in the ER with a mop cleaning all the floors, stools, and walls. I looked at the solution that they were using and it was pine-sol. I spoke with the head housekeeper and I asked him why he does not use a diluted bleach solution because pine-sol is not a very good disinfectant. He said that pine-sol was very good at disinfecting. We debated back-and-forth for 5 minutes. I think next visit I will focus on mop water and bed sheet washing. In all honesty, I think that it is actually more important then teaching medicine. If you can disinfect and have a semi clean environment for the patients then that is half of the battle. The healing part is easy, most of it is done by the patient.

Take a look at the Goat House DFAC (chow hall). They made this impressive display all by hand. I saw them carving the figurines. It must have taken 3 weeks. I am sure that it is not written in their contract. They just do it because they enjoy doing it.

Adam and I went to evening mass at the Italian Embassy. It was really nice. It always amazes me how consistent Catholic mass is where ever you go. Here we are in Kabul, Afghanistan, with a priest that is from Italy, and they are singing all of the same songs, saying the same prayers, and doing the same routines that go with a Catholic mass. There is something very comforting about it. Take a look at some of these beautiful paintings in the church.

Take care.

Italian Embassy

"A human being is part of a whole, called by us the Universe, a part limited in time and space. He experiences himself, his thoughts and feelings, as something separated from the rest--a kind of optical delusion of his consciousness. This delusion is a kind of prison for us, restricting us to our personal desires and to affection for a few persons nearest us. Our task must be to free ourselves from this prison by widening our circles of compassion to embrace all living creatures and the whole of nature in its beauty."
-Albert EinsteinUS (German-born) physicist (1879 - 1955)

"If there were in the world today any large number of people who desired their own happiness more than they desired the unhappiness of others, we could have paradise in a few years."
-Bertrand RussellBritish author, mathematician, & philosopher (1872 - 1970)

"Realize that true happiness lies within you. Waste no time and effort searching for peace and contentment and joy in the world outside. Remember that there is no happiness in having or in getting, but only in giving. Reach out. Share. Smile. Hug. Happiness is a perfume you cannot pour on others without getting a few drops on yourself."
-Og Mandino(1923 - 1996)

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Today we worked a half day and tomorrow we have the day off. The only good part of having a day off is I am able to sleep in. Other then that, I actually do not like them very much because the day tends to drag. It is not like I can spend the time with my family and escape this place. The days go by much faster when I am working at the clinic. I mentioned it a few days ago that I was going to have a very busy week. I was suppose to take a trip but it ended up getting canceled at the last minute.

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Adam and I went to the Italian Embassy for the midnight mass (it actually was at 9:00pm). There were a couple of news cameras there. I think because the Prime Minister is in town. At the end of the mass the priest asked everyone to say Merry Christmas in their native tongue. 15 people must have come up to the podium. They were from all different parts of the world. It was really fascinating to see and hear them all. At the end of the mass the priest announced that the Ambassador invited the entire congregation back to his home for pastries and chocolate milk. After he said this the congregation let out an, "Ahhh." Apparently, it is considered a big deal for the Ambassador to open up the doors of his home to guests. I felt very lucky that I was able to be a part of it. Take a look at some of the pictures.

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Here is the outside of the church.

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Here is the inside of the Embassy.

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I told Adam that I wanted to meet the Ambassador earlier in the night. A little latter we were standing by the large table full of pastries enjoying a cup of very thick chocolate milk (I should say chocolate pudding) and Adam asked, "Where is the Ambassador anyways?" I whispered into Adam's ear that he was standing right next to us. He immediately grabbed my camera and tapped the Ambassador on the shoulder and asked if he could take a picture with me. It was pretty funny. The Ambassador was very friendly. We had a short conversation and he asked if we had seen his plane. I said that I had not. He told us to make sure we take a look at it before we left. Here it is. I assume it is very old.

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We gave the priest a ride over to Camp Eggers because he had to give the real midnight mass over at Eggers.

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Thanks for reading.

Merry Christmas

"You must be the change you want to see in the world."
-Mahatma GandhiIndian political and spiritual leader (1869 - 1948)

Merry Christmas. People were especially friendly today. Random people wished me a Merry Christmas as I passed them by. Everyone seemed to be putting their best face forward even though we all know that we would rather be home with our families. I think that it is especially hard when you have young children. I really feel like I should be there for them during the holidays. I am looking at pictures that my wife has been sending and I think to myself that I can never get those moments back. I will just have to make up for lost time when I get back.

I uploaded pictures from the last VCR trip. I did not attend it so none of the pictures were taken by me. Someone that cares a lot about me does not want me going on anymore non-work related trips. So I will just have to help with the sorting for now on. I am sure that some of the toys that were sent from readers of this site were distributed to the children in the hospital. The hospital that they visited was a children's Orthopedic hospital. It is one of the main, may even be the only, place where artificial limbs are made in Kabul. We have a lot of police who are in need of prosthetic limbs so maybe we can try and establish a relationship with them.

Tonight we had 2 comedians perform for us. They were pretty funny.

It is almost 1:00 in the morning and I am editing and about to publish this post. As I am doing this I am watching my children open Christmas presents on my webcam. My wife is showing me the presents after they are opened. This will hopefully be the last Christmas that we spend apart.

Thanks for reading. Merry Christmas.

Turbulence

As you journey through life take a minute every now and then to give a thought for the other fellow. He could be plotting something.
-Hagar the Horrible

When we remember we are all mad, the mysteries disappear and life stands explained.
-Mark TwainUS humorist, novelist, short story author, & wit (1835 - 1910)

The only thing that makes life possible is permanent, intolerable uncertainty; not knowing what comes next.
-Ursula K. LeGuin

He's turned his life around. He used to be depressed and miserable. Now he's miserable and depressed.
-David Frost

Turbulence is life force. It is opportunity. Let's love turbulence and use it for change.
-Ramsay Clark

We must not allow the clock and the calendar to blind us to the fact that each moment of life is a miracle and mystery.
-H. G. WellsEnglish author, historian, & utopian (1866 - 1946)

This is a super sized post because you get extra videos and extra quotes today. The videos are from Dr. Mossaud. I love videos that show a little slice of Kabul. The first one is the long version of a Buzkashi game. I also included a shorter version on the video in case it takes too long to download. It is so funny because from my impression it looks like a ton of people are gathered around another big group of people riding horses all huddled in a circle. Someone grabs a dead decapitated goat in an attempt to bring it to the other end of a field. In the process, the group of men on horses charge towards the crowd that runs away like a matadors being chased by a bulls.

The other video a really young kid doing very hard work. I think he is pounding steel. Next to him are other people sharpening knives, etc. Of course no one is wearing eye or ear protection. The last video is a tour of bird alley. You see an old man making bird cages and you see all kinds of birds in this crowded alley.

Today I noticed a 360' difference in the quality of the patient care. I walked into the inpatient ward and every bed had sheets on them and they were all clean. The room did not smell. I asked the patients if they were satisfied with their care and they all unanimously said that they were very happy. I spoke with the head nurse and he said that everyone ended up pitching in to help out. You could tell that he was very proud of what they had achieved.

Brand new defibrillators came in the other day so I set one of them up in the ER. They were pretty user friendly. I went over the different cardiac life support algorithms and I showed the ER doctor how to use the machine. We placed electrodes on one of the assistant so we could view an actual EKG on the monitor. I was not sure how to print out a rhythm strip so I started to look through the user manual. The assistant immediately jumped off of the bed and joking said that he was through being a patient if I needed to read the manual.

A police officer was brought in by his fellow officers. He had just been dragged by a taxi that he had stopped and was trying to question. I was very impressed to see that the ER doctor actually filled out a standardized form requesting an x-ray. He also showed me an excel spreadsheet where he kept all kinds of patient statistics. Things have really started to come together.

I received a great Christmas present from my day care provider today. It was one of those gifts that you have to run back into your home to rescue when your house is on fire. It came with a dictated letter from my 4 year-old daughter. Here are parts of it:

Dear Daddy,

I love you. Happy Christmas! I goed to Bethany's birthday. I like when you are home. I know that you miss me. I miss you too. Goodbye. I love you.

Thanks for reading.

2 Apple Tree by 2 Apple Tree Length Vision

"People often write me and ask how I keep my wood floors so clean when I live with a child and a dog, and my answer is that I use a technique called Suffering From a Mental Illness."
Heather Armstrong, Dooce, 07-07-06

"Tomorrow is the most important thing in life. Comes into us at midnight very clean. It's perfect when it arrives and it puts itself in our hands. It hopes we've learned something from yesterday."
John WayneUS movie actor & director (1907 - 1979)

I love that title picture by Dr.Massaud. It is going to stay up for a few days.

Today I continued to see progress. It is progress that is small and subtle, but added together through time will equal big changes. Forinstance, the inpatient ward did not smell as bad as it normally does, doctors were doing wound care with gloves on, and nurses were changing bed sheets.

I visted with the Physical Therapist for a while today. I wanted to let him know that I considered him one of the most important people in the hospital. Most of the inpatients are Orthopedic patients that are recovering from amputated limbs and serious fractures. I told him that it is essential that he gets out of his 1st floor office and work with the inpatients upstairs. Despite having brand new equipment, such as treadmills and stationary bikes, he still insited that he needed new equipment. He pointed to his old cervical and lumbar traction devices. They look like mideval torture devices. I told him that this equipment is not important for the work that he needs to be doing. I informed him that in the states all a Physical Therapist that works in a hospital needs is a belt around their waist. I told him that the most important thing he should be doing is getting the patients up and moving. Here is the cervical traction machine.



Seeing pictures from the last VCR trip to the K.O.O. inspired me to try and get some artificial limbs for some of our patients with amputations. It turns out that we already have a contract in place with the K.O.O. and we were just not taking advantage of it. I would like to see at least one patients get a new prostetic device before the end of my deployment. I have arranged to have one of the patients seen this weekend. Ultimately, I would like to establish a regular scheduled visit to the K.O.O., like a shuttle service that runs there every 2 weeks. I will keep you posted.

I had a long debate/discussion with the ER doctor. He was giving an IV to a lady that was 12 weeks pregnant (by the way, just getting him to use an OB wheel to determine how far along she was was a challange in itself). He said that she came in with a note from an outside doctor that said she had abdominal pain which was the result of having kidney stones. I asked him if he did a urine test to check for a urinary tract infection. He answered, "No," because she was already diagnosed and that the doctor just ordered for her to get IV fluids. I tried to get across the concept of covering one's diarer. There are no malpractice attorneys in Kabul so doctors are not exactely concerned about getting sued. I tried to teach him that you should never trust what someone tells you. To always have a jaundiced eye to what others are telling you. Always verify for yourself just to be sure. I finally was able to convince him to get a urine study. The patient ended up not having a urinary tract infection but the ER doctor did say, "She has an abnormal lab! She had a hemoglobin of 8." Normal is >12. I said, "Good job. What did you do with her?" He replied, "I sent her to OB." That was not exactly the answer I was looking for.

We then had a 5 minute debate about how best to improve her anemia. He wanted to give her iron dextran which comes as a shot that you give in the arm. Aside from being very painful, it could also be very dangerous for the mom and the baby because you can potentially get a very serious reaction from it.

While I was in the ER I saw that they had 2 of the eye charts that I brought in the other day hanging on the wall. I asked the assistant if he knew how far away a patient had to stand to do a proper visual acuity check. He incorrectly answered 30 feet. I asked him how he planned to measure out the distance and he said that since he owns an apple orchard he is very good at judging distance. The distance will be the same distance between 2 apple trees. We both laughed. So I guess a patient should have 2 apple tree by 2 apple tree length vision. Works for me.

Thanks for reading.

Center of the World

"When the traveller from the south beholds Kabul, its ring of poplars, its mauve mountains where a fine layer of snow is smoking, and the kites that vibrate in the autumn sky above the bazaar, he flatters himself on that he has come to the end of the world. On the contrary, he has just reached its centre."- Nicolas Bouvier, L'Usage du Monde

Today was a down day so I did a lot of reading. I had to resort to living vicariously through the photos of LtCol Johnson who was invited to a lunch meeting that took place off base. He was able to drive to the top of a very tall mountain and take some beautiful pictures. The pictures allow you to see how large and beautiful Kabul really is. I included a little history of the different places that I researched off the web. Hope you enjoy.

Kabul City Walls, from Radio Afghanistan: "Around the emergence of Islam, the Kabul Shahan dynasty, a remnant of the small Kushanids, ruled ancient Kabul and its surrounding areas. King Ratbil Shah (or Zanbil Shah), a king of this line, was a very cruel tyrant. To stop attacks from abroad, the Shah decided to build a high wall around the city. He forced all the youth of the city to build the wall as soon as possible. So, the youngsters of the city were working very hard under the watchful eye of wardens supervising the construction of the wall. If anyone refused to work, he was buried alive in the walls. Thousands of youth fell victims to the tyranny of the evil king. The wall that still remains today on the Shirdarwaza and Aasmae mountains is a reminder of that dark era."

Habibia High School, from Google: "Afghanistan’s Who’s Who attended this important school in Kabul. Hamid Karzai, former King Zahir Shah and nearly 50% of the Afghan ministers graduated from this school, just to give an example. Though, the Taliban reduced Habibia to a bullet-ridden shell, it was reconstructed with international support and reopened with a modern and up-to-date look in 2005."

Here is a 3-D view.

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Pul-e Khishti Mosque, from Kabul Caravan: "Standing in the centre of old Kabul, the Pul-e Khishti Mosque was originally erected in the late 18th Century, but largely rebuilt under Zahir Shah in the late 1960s. Its can be picked out by its large blue dome but is otherwise architecturally indistinct, a mix of international modern style punctuated with traditional Afghan tiling."

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From Google: "Mosque in Kabul known under various names such as Masjid-e Pul-e Khishti or Pul-i-Khishti Masjid. Client for construction of this mosque of the Abdali period/style was Zaman Shah (1770 - 1844), the fifth son of Timur Shah."

Here is a 3-D view.

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Shah do Shamshira Mosque, from Google: "The large two-storied mosque across the river from Timur Shah's mausoleum stands on the site of a mosque originally dedicated in 1544. The present building was commissioned by King Amanullah's mother and constructed in the 1920s. Its name, meaning the Mosque of the King of Two Swords, relates to an early legend concerning the arrival of Islam in Kabul. "

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From Kabul Caravan: " Shah-Do-Shamshira Mosque Built in the 1920s on the site of a mosque dating back to the 16th Century, the Shah-Do-Shamshira Mosque is an architectural disaster. A two-storied structure in yellow, decorated with Italianate stucco, giving an effect that could be described as 'Afghan Baroque'. The name- the Mosque of the King of Two Swords- relates to the Arab conquest of Kabul, and the legendary death of a general fighting the Hindu defenders. Wielding two scimitars, the general led his troops to victory, despite having been beheaded in an earlier battle. The mosque sits on the north bank of the Kabul River facing the Mausoleum of Timur Shah."

That is pretty impressive that he was able to fight despite being beheaded in a previous battle!

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Here is a 3-D model of the mosque.

Thanks for reading.