Lal October 1989
After the excitement of arriving in Lal I experienced a sense of desolation when Khudadad left next day. Although we’d been travelling companions for barely two weeks, not only had I come to depend on him for so much – from ensuring I was well fed to finding a bed for the night – but I’d truly enjoyed his company. As the truck pulled away I stood forlornly clutching the huge melon he had given me as a farewell gift, waving until he was out of sight.
Stocktaking and updating the record cards of leprosy patients seemed such mundane chores compared to the excitement of travelling, never quite knowing what might happen or where we would end up. Having to begin all over again getting to know a new group of people none of whom, apart from Qurban, I had ever met before was daunting.
The clinic was a depressing place with dark, poky little rooms whose tiny windows allowed in hardly any light – a common design feature in houses throughout the area, to insulate them from the bitter chill in winter, when temperatures drop to -40C. Qurban had done his best to improve the appearance of my room, which was the size of a cupboard, by lining the crumbling walls with orange cloth. When I was in bed, a colony of mice staged athletics events behind the cloth, occasionally venturing out to scamper across the pillow. Qurban was negotiating over the price of a piece of land on which to build a new clinic, something I hoped he could accomplish quickly.
I began to sort out who was who amongst the staff. Ibrahim was in charge of the dressings and injection room where he did the soaking, trimming and dressing of leprosy patients’ ulcers, as well as attending to other wounds and injuries. As two of his nephews had both been my English students in Karachi where they were trainee leprosy technicians, I happily accepted Ibrahim’s invitation to visit his home in Waras sometime, as I had promised the boys I would try to deliver their letters personally to their families.
I’d already been invited by Qurban to visit his family’s village and Haboly, the general medical assistant, was insistent that I must also visit his. Invitations quickly followed from Aziz and Rahimy and my social calendar was soon completely filled for all foreseeable weekends.
Rahimy had been a mujahid but retired from their service, cheerfully returning his Kalashnikov, to work in the clinic as a field assistant where he was paid a regular salary and was less likely to be shot at. Wounded in a skirmish, the injury had left him with a permanent disability in one hand. He was such a quiet, gentle person, demonstrating a genuine concern for the patients, it was difficult to visualise him in his former role of gun toting freedom fighter. Rahimy was to come with us to Pakistan to attend a laboratory technician course over the winter. The second field assistant, Juma, would then, the following summer, begin his training in Karachi as a leprosy technician.
Every morning patients gathered early outside the gates of the compound. Many travelled for hours by foot, or by donkey – by horse, if they were better off. Some took two days or more to make the journey from remote villages and, most days, around fifty patients arrived to consult Qurban and Haboly. They arrived well prepared for a long wait, bringing with them kettles and dry tea and nan, along with fodder for the horses and donkeys. Children found new playmates with whom to pass the time, chasing each other amongst the groups of adults and around the tethered animals. The scene resembled a country fair and in fact, in the days following the clinic’s initial opening, one enterprising man had opened a temporary chaikhana to cater for the crowds.
In addition to these “general” patients Qurban had a case load of around two hundred leprosy patients scattered across his extensive control area. He had an almost equal number of registered tuberculosis cases. It was too much for one leprosy technician to cope with so Qurban was keen for Juma to start his training as soon as possible to lighten the load.
Tuberculosis patients caused the greatest concern because of the rate of absenteeism, and lack of personnel to follow up missing patients. The effectiveness of the tuberculosis drugs in some ways works against controlling the disease in Afghanistan – and other developing countries – because soon after a patient begins his treatment he feels well. Believing he is cured, he discontinues the medication. If he is being prescribed drugs by a private doctor the cost for the full course of treatment is prohibitively expensive and, understandably, the impoverished patient has other uses for his money. The biggest danger, when a patient stops taking his medicine before all the bacteria has been destroyed, is the remaining bacteria mutate into a new strain, resistant to those particular drugs.
When news spread a foreign doctor had arrived the numbers of patients, especially women, increased. Despite Qurban’s cajoling I refused to play at being a doctor. ‘In my country a person would be sent to jail if caught pretending to be a doctor. It’s too easy to make a wrong diagnosis or prescribe the wrong drugs. I’m happy to check female leprosy patients and talk to mothers about nutrition and family planning but I’m not going to pretend I can do anything more than that.’
Qurban laughed, ‘You are not in your country now. The people here are desperate for medical care. Anyway, everyone in this clinic is a doctor, even the cook!’ I’d heard the cook being called Dr Aziz but had assumed it was simply a term of respect. I hadn’t considered the possibility that he might actually prescribe medicines for people and was only slightly reassured to discover he confined his prescribing to aspirin and vitamins.
We finally agreed I would do the stock taking, write my reports and carry out leprosy examinations on female patients. I’d be available to talk to women about nutrition for their children and for themselves in pregnancy, to explain how contraceptive pills should be taken or to teach a woman how to work out her fertile days. The dwindling number of female patients soon made it clear the women were not interested in hearing a foreigner talk about mashed potatoes and greens for their children, and had no magic drugs to make their babies strong and healthy.