MarySmith’sPlace -Back in the saddle, bribery and injections Afghanistan adventures#42

Lal-sar-Jangal, Hazaristan – early winter 1989

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Next day, Slowcoach had obviously decided to accept her fate and make the best of a bad job.  She kept moving, if somewhat reluctantly, until we reached the home of Qurban’s patient, Nasir – after four hours.

After we had eaten, Nasir produced some apples. They were so very small and bruised I, at first, assumed they were for the horses. But they were for us. Other than Khudadad’s gift of a melon, they were the first fruit, I’d seen since arriving in Lal. In the summer months, melons are available, brought from Bamiyan, but bananas, oranges, tomatoes are never seen. When Bashir had shown me his English ABC book I’d pointed to the picture of an orange, asking him the Dari word for it. He shook his head, ‘It has no word in Dari,’ he replied. I said there must be, but he insisted there was not. When asked, Qurban explained Bashir had never seen an orange in his life, and assumed there was only an English name for it.

Lal’s climate was certainly not suitable for growing much in the way of fruit. It is only warm three months in the year, the soil is poor, and few farmers have enough land to grow sufficient wheat for their needs, so even vegetables are rarely grown – a few potatoes and turnips. It was hardly surprising so many children in Lal suffered from a variety of health problems caused by poor nutrition. Feeling guilty about even thinking of giving Slowcoach my precious apple, I bit into it as though it was the most delicious thing I’d ever tasted.

Nasir brought his wife and children into the room to meet me. With the exception of the smallest baby – only a few weeks old – all the children had running noses and skin infections, head-lice and, possibly, scabies.

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 The healthiest child in the family.

I held the baby, the healthiest person by far in the family while Nasir, with Qurban translating rapidly, gave a prepared speech of welcome. This included a great many flowery sentiments about friendship, followed by references to his poor house, his poor family – ending with an outright appeal for money, for a job. He handed over a written application, setting out his case and asking for financial assistance.

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The dinner and the apples had clearly been an investment. Leprosy patients were able to apply to the social care budget for help if their economic situation, and any disability caused by the disease, warranted it. Nasir, however, owned land and was fit enough to work. Mumbling something about discussing the matter with the committee, I pushed the letter into my bag. I wished he had just asked me outright for a loan when we had met at the clinic, without the charade of the lunch party and overtures of friendship.

The following year, Nasir was given a substantial loan with which to buy supplies, in Kabul, to enable him to open a small shop in his village. He returned from Kabul wearing a very smart new suit, very little stock for his shop and the rest of the money had disappeared. A few months after this he put in yet another loan application – despite not having repaid any of the first one – this time it was refused.

Next morning, we left early to return to the clinic and, wonder of wonders, Slowcoach was quite amenable to a getting up a bit of speed, a sort of half jog. Just when I thought I was improving my riding skills, Qurban dashed my hopes by informing me the only reason the horse was prepared to go faster was because she was going home. By the time we reached the clinic I’d decided I never wanted to sit on a horse again – dreams painfully shattered by reality. I was horrified when reminded of Haboly’s invitation for the following weekend, another four hours of torture each way and, worst of all, I learned for the first time, that the journey to Waras would take two days on horseback – each way.

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In the meantime I carried on with the work I’d to do, including taking stock of medicines and equipment, a task often interrupted by the women who wanted to talk to me. Although I met dozens of women every day no friendships were formed between us as they were in Jaghoray.  Having always subscribed to the feminist principle that all women are sisters, I was appalled to discover I harboured extremely un-sisterly feelings regarding the women of Lal. Every conversation centred entirely round their determination to get medicines or money from me.  I felt guilty about my reaction to their constant whining and complaining, their shameless demands, and their dirty smell.

It wasn’t their fault I’d tell myself. I looked at every excuse I could think of – the relentless, grinding poverty, the annual pregnancies, the death of almost half of all infants before the age of five, the lack of education – but still I could not prevent the feelings of frustration, even disgust, as a woman clutched at my clothing, whining for a pejkari, an injection, for her sickly baby. I’d spend time trying to explain her child needed foods such as potatoes, green vegetables (though where she’d find them I didn’t know), yoghurt, eggs. The endlessly patient Rahimy helped to translate, but the woman would close her ears, continuing to demand an injection. Then, realising this mother desperately wanted her child to live I’d force myself to try again.

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I don’t remember where this was taken but it reminded me of when there was no worries about  lockdown hair!

MarySmith’sPlace – Afghanistan adventures#40

Lad-sar-Jangal Winter 1989

Qurban’s wife, Masooma, had taken their two daughters to Pakistan to visit her parents, who had not yet seen their grandchildren. She was expected to return with Jon when he came to collect me. In the evenings I sometimes joined Qurban in his room where we talked late into the night catching up on news.

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Qurban had spent much of his life in Karachi and was eager for news of friends there, and to reminisce about his days at the leprosy training centre and hospital. Although I had known Qurban quite well during his student days he had never talked much about his early childhood in Afghanistan. During one of our late night sessions he told the story of the horrors of those days when, at the age of about seven he contracted leprosy.

He had known of the disease as his paternal uncle had leprosy. In those days, people were terrified of leprosy, believing it to be incurable. As no-one understood its cause all kinds of misconceptions and myths surrounded the illness: it was a curse of God, a punishment for sin.  Qurban’s uncle must have done something dreadful to be punished in this way, a bad person, to be avoided. He had been ostracised by the community, forced to build his house far away from the village. He wasn’t allowed to pray in the mosque.

One day as Qurban was returning from the village school he and some friends had stopped to play in the river. A friend pointed to a light coloured skin patch on Qurban’s leg, asking what had caused it. Qurban hadn’t noticed the patch before. When his friend poked it with a sharp stick he felt no pain. In that instant he understood. His uncle had several similar patches with no feeling on his body. Qurban went home but said nothing to his family – hoping the patch might disappear as mysteriously as it had come.

Eventually he showed the patch to his father. ‘It was the first time I had ever seen my father cry. I didn’t know grown up men could cry. His tears frightened me more than anything.’   His father warned him to say nothing to anyone. They began a round of visits to doctors, healers, mullahs, wise women – anyone who might have the means of making the patch disappear. Nothing – not the ointments, pills nor injections, made the slightest difference.   Prayers, visits to nearby shrines and tawiz (a few lines of the Quran stitched into a cloth bag and worn as an amulet) were all equally ineffective.

Despite the misery and fear he felt while his parents searched desperately for a cure, Qurban was still a child, with a child’s resilience and enjoyment of life, delighting in leading his friends in mischief. One day he boasted that he could stick pins in his leg and feel no pain.  For a few minutes he had basked in the admiration of his friends at this strange and wonderful feat. Next day his world collapsed.

‘At first I didn’t understand what had happened. No-one at school would talk to me but I knew they were whispering things about me. After school, for the first time in my life, no-one would walk home with me. But a crowd of boys was following me. I wanted to run, but I kept walking normally. Suddenly a stone hit my back, then another and another and the boys were shouting “Leper, leper!”  Then I ran.’

Qurban’s school days were over, his childhood had ended.

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Band-i-Amir – one of the most beautiful places in Afghanistan

One day Qurban’s father took him to the shrine at Band-i-Amir. This chain of five lakes, or dams, is said to have been created by Ali, son-in-law of Muhammad (PBUH). The waters are reputed to have healing powers. Qurban was excited about travelling so far, convinced that this time, surely, he would be cured.

Wondering whether he was to drink the magic water or wash the patch in it, he heard a splash. Turning, he saw threshing arms and legs churning the water. A young girl, a rope tied about her waist, had been thrown into the lake. He watched, horrified, as she was finally hauled, gasping and spluttering back onto the bank. She lay vomiting onto the shore while the people surrounding her murmured prayers.

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Taking to the curative waters. This photo was taken in 2006 when I returned to Afghanistan

Convinced he would die Qurban became hysterical, begging his father not to throw him in the water. His father agreed that they should go first to pray at the shrine before Qurban underwent the “treatment”.  The child’s sobs attracted the attention of a stranger who paused and peered at the patch on his leg. ‘That is leprosy,’ he announced. ‘You will never cure it like that – better go to Pakistan. They have medicine for this. My wife’s cousin was cured there.’

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The shrine at Band-i-Amir I think that might be my son standing in the foreground!

Qurban had wanted to go immediately.  Not realising that Pakistan was another country, he couldn’t understand why his father, although excited by the news, did not seem particularly anxious to set off on another journey to buy the medicine. ‘He struggled for months to raise enough money for the trip,’ he explained. ‘And he had to make arrangements for someone to care for my mother and the land. All this time I hated my father because I thought he had decided not to go.’ Qurban paused, blinking back sudden tears, before continuing: ‘I was seven years old, quite a big boy, but all the way to Pakistan, I complained about being too tired to walk. My father carried me on his shoulders most of the way.’

Even when they reached Quetta their troubles were far from over. Many Hazaras had already settled in the city and they soon made contact with people from their own area – but no one had heard of a cure for leprosy. Soon they were caught up once more in a round of visits to doctors, whose prescriptions were useless and expensive. His savings soon vanished and Qurban’s father had to find work. Not far from Quetta he found a job as a coal miner; back breaking work digging for coal in a series of open cast mines and tunnels running deep into the side of the mountain.

One day their luck changed. They met a doctor who not only recognised Qurban had leprosy, but knew of the hospital in Karachi where it could be treated.  He wrote a letter of referral to a doctor there. Within days, Qurban and his father had made the journey to Karachi and Qurban had been admitted for treatment in the large Manghopir hospital on the outskirts of the huge city. His father left him almost immediately to return to Lal.

Qurban grinned, ‘The rest you know – school, training, marriage and back to Afghanistan.’   I realised, however, there was a great deal about Qurban I really didn’t know at all. Although completely cured of leprosy, the memory of those stones thrown by his school friends so long ago had marked him deeply. Those little boys, grown up now, had welcomed Qurban back into the community – showing him acceptance and respect. But Qurban’ feelings of insecurity and lack of confidence made him question what the community really thought of him.

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Qurban in dark glasses even with his family.

Convinced everyone who looked at him saw immediately, in his loss of eyebrows, the stigma of leprosy, he had affected the habit of wearing dark glasses at all times, even indoors. He suffered periods of moody introspection, which could last for days, during which he would talk to no one, followed by a sudden cheerful gregariousness. His sudden mood swings left everyone confused. Qurban admitted he could do nothing to fight off the black clouds of depression which descended on him without warning.

MarySmith’sPlace – #RussianJeep #Leprosy #AfghanAdventures 16

As the clinic was soon to have a vehicle, a driver, Jawad, was appointed. When, through his network of cousins and uncles he heard of a jeep coming on the market in Angoori bazaar he and Hussain went off one morning to check it out.

The noise of an engine signalled their return late in the afternoon and we rushed out to greet the arrival of a beaming Hussain and his magnificent ‘Model Konah’ Russian jeep. On the threshold I stopped, stunned into silence at the sheer frightfulness of the vehicle.

The windscreen was so adorned by garlands of plastic flowers and other shrubbery, the driver’s visibility was reduced to almost nil. The floral theme was continued by chintzy curtains at the side windows while, suspended from the front bumper, was a collection of chains and medallions, chiming and chinking in the breeze. When Jawad put the vehicle into reverse a female voice with an American twang proceeded to warn, ‘Attention Please, this car is backing up. Attention Please this car is backing up.’

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The jeep which became Hussain’s pride and joy

The enthusiastic spectators who had gathered welcomed the jeep, as they would a bride to her new home, by bombarding it with sweets.

Hussain so loved the chintzy curtains he at first refused to remove the side windows – they did not open, having to be completely removed – but when his passengers all became faint and nauseous from the terrific heat inside he did reluctantly allow the windows to be taken out.

Now he had transport, Hussain was eager to try to find a leprosy patient he’d received news of. By now he had registered two, previously untreated, patients who had come to the clinic but this man apparently lived in a village some distance away. We set off one morning to find him, with only the vaguest of addresses and directions.

At a fork in the road, Jawad stopped. The road on the right curved around the side of a mountain.  ‘That’s the road to take,’ said Ismail. ‘It’s a short cut which joins this road again on the other side of the mountain.’

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The road round the mountain.

‘Are you sure?’ asked Jawad. ‘It doesn’t look very wide.’

‘Oh, yes, even big trucks use that road,’ Ismail replied with great authority so Jawad turned onto the mountain track. Half an hour later, increasingly concerned at how narrow the road had become, he stopped, insisting Ismail accompany him on foot to investigate further ahead.

A shame faced Ismail re-appeared to break the news the track simply disappeared about a quarter of a mile further on. There was nothing for it but to go back the way we’d come.  Except the road was already too narrow to allow Jawad to turn the vehicle so we had an agonizing thirty minutes of American accented ‘Attention please, this car is backing up’. My suggestion of pulling out a wire produced such a look of horror on Hussain’s face the idea was quickly dropped. I nursed a slight hope the mechanism might self-destruct under the strain of overuse but the nasal tones rang out with what seemed to be an increasingly persistent warning. Finally Jawad decided that it might be better to risk falling down the mountain in the middle of a three point (well, probably six) turn, rather than witness his passengers have nervous breakdowns.

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Ismail assured us the road was wide enough for big trucks

Hussain asked everyone we met on the road, and in a village shop but no one knew of our patient. One man thought he knew of a person with leprosy and gave directions to a farm. The way was obstructed by a small river whose muddy banks were too soft to bear the weight of the jeep so Hussain and Ismail continued on foot to the farm, returning after almost an hour looking thoroughly fed up. Eventually Hussain had to admit defeat and abandon the fruitless search.

A whole day wasted, leaving us tired and with a guilty niggle that perhaps we had not done enough to find the missing patient. Perhaps he was afraid his neighbours would ostracise him if it was known he had leprosy and he didn’t want to be found. To cheer everyone up I introduced the game of ‘I Went to Market and Bought’ which, played in English, soon had everyone laughing as they struggled to remember the ever lengthening alphabetical shopping list.

A second outing, to the home of one of the newly registered leprosy patients was more successful. The family were obviously very poor and the room in which we sat, although spotlessly clean, had nothing more than one threadbare gilim on the floor and a bright red geranium in a pot on the windowsill. The patient, Moosa, had been referred to Hussain by a doctor in Angoori bazaar – one of the few doctors in Afghanistan who knew anything about leprosy. Moosa had long been suspicious the tell-tale anaesthetic patches indicated the dreaded disease. Like many others, he had tried to hide the signs, afraid once it was known he had leprosy, he would be forced by the community to live as a social outcast. The doctor assured him the disease could be cured and sent him to Hussain.

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The jeep in all its glory!

At the clinic Hussain had explained how easy it was to cure the disease if Moosa took his medication regularly, and promised if he followed advice he need never suffer from the deformities which have made leprosy a disease feared throughout history. During the house visit Ismail began to teach the patient how to protect and care for his feet, showing him how to rub off the hard skin with a stone, how to soak and oil his feet each day to prevent cracks in the skin which, if left untended could cause ulcers.

While all this was going on I examined the women and girls in the family. This caused great hilarity, especially when one little girl ran away, screaming hysterically, convinced I was about to give her an injection. She was brought back and tearfully submitted to the examination after which she joined in the general laughter.

The family invited us to stay for lunch. None of us felt we should burden this poor family with the cost of feeding us but Moosa was insistent. Hussain whispered to me we should accept in case he thought we were refusing to eat with him because he had leprosy. There were many apologies for the humbleness of the meal but, served with simple dignity, the large bowl of yoghurt, crisp spring onions, fresh, warm bread and salt became a banquet.

MarySmith’sPlace – Afghan adventures (8)

The morning of the clinic opening Ali Baba had to lock the door to prevent eager patients from disrupting breakfast.

Too nervous to eat, Hussain checked for the hundredth time that all was ready. He’d asked me to sit with him in the clinic, write the prescriptions and make notes of things which needed to be changed. It would also be a good way to improve my Dari.

Hussain gave the signal for Ali Baba to open the door. Immediately, half a dozen men pushed and shoved each other into the consulting room, all talking at once. Using some pretty persuasive shoving himself Ali Baba eventually succeeded in evicting five of them and the victorious winner sat on the floor, beaming happily.

Hussain urged him to sit on the folding metal chair provided for patients. He, himself, was ensconced in a chair more appropriate to his exalted position.  It was a monstrous wooden armchair of peculiar design and proportions, “crafted” by the village carpenter to Hussain’s specifications. In fact, he very quickly realised it was totally out of place in the clinic and swapped it for a folding chair, which must have been less intimidating for patients.

The examining couch was of equally generous size, and so high that patients required the help of a chair to enable them to reach it. It became a useful diagnostic aid and Hussain often had to hide a smile as a patient who had been complaining of dreadful, incapacitating pains and weakness all over his body would suddenly leap with remarkable agility onto the examining couch.

An average of between forty and fifty patients arrived each day during the first week. This left little time for other work – accounts, reports, supervising the building work at the new clinic. As yet Hussain did not have any leprosy patients on his register but that would soon change.  He would inherit all patients living in Jaghoray who, until now, had been receiving treatment from the leprosy clinic in neighbouring Malestan.

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Hussain at work in his clinic

Many of the patients who came in the first weeks came mostly out of curiosity, wanting to see the foreign “doctor”. I tried in vain to persuade people to stop calling me doctor. Others came because, at last, they had a health service on their doorstep – one which dispensed free medicine. The clinic’s primary aim was to control leprosy in the area but because of the stigma attached to the disease we knew the people would not be happy about a clinic opening only for leprosy patients. We needed to keep people on our side if we were to be able to trace and treat everyone who had leprosy and could do that by prescribing medication they needed.

One major problem was that many of the patients, who showed up in the early weeks, had an obsession for medicines.  Injections were number one on the list of preferred treatments, considered to be the most effective (if it hurts it must be doing some good?), next in favour were syrups followed by multi-coloured capsules. Antibiotics in the form of plain white tablets such as Penicillin V were not thought to be of much use and aspirin or paracetamol were not even considered to be medicinal.

Hussain valiantly resisted prescribing unnecessary medicines but he was going to have to fight hard to win that battle. His entire reputation as a “good” doctor rested, not on effective health care, but on the amount of drugs he prescribed. In such a close-knit community, holding on to such principles in the face of plummeting popularity was going to be tough – especially for someone like Hussain, whose ego needed constant boosting. Occasionally patients became angry and abusive if not given a prescription, as though Hussain was denying them something that was rightfully theirs.

The days slid by quickly. I no longer reached automatically reaching for a light switch when dusk fell. I’d stopped trying to flush the latrine. I did wish it was possible to flush if only to hide my embarrassing pink poo. Some months before, while working in Karachi, I contracted tuberculosis and had been taking treatment (including Rifampicin, responsible for the pretty poo) ever since. I kind of knew that after nine months of regular treatment – and I was very good at “eating my medicine” every day – it was safe for me to stop. However, I also knew I should wait until I could have bloods checked in a laboratory so I was waiting until that could happen.

Unfortunately, I’d found I was sharing my room with things that went bite in the night. These proved to be tiny mites which lived in the mud walls. Ali Baba sprayed my room thoroughly with an insecticide lethal to all insects – and, presumably mankind, as it had long been banned in the west. Even by bedtime fumes still lingered but I did get a good night’s sleep. After two nights, though, the invaders returned in force to feast on foreign flesh and only if the room was sprayed every other day did we prevent the little horrors from enjoying me for their midnight snacks.

A constant battle also had to be fought against the horrendous flies which swarmed in the moment a window was opened. Baqul would organise fly eviction crusades. Everyone used their patou – the large shawl worn or carried by all the men, required for keeping warm, carrying shopping, wiping noses and a hundred other uses including fly evictions. Each member of staff charged around the room flapping their patou wildly at the flies until, unsettled and giddy, the flies would eventually find their way out of the windows.

The alternative, rather gruesome, method was to add some black Baygon powder to a saucer of water.  The flies found this concoction delicious and would swoop down to gorge, only to be seen moments later struggling in their final death throes. A saucer full of a couple of dozen dead or dying flies floating in black slime was a revolting, but horribly fascinating, sight.

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Threshing wheat – a timeless image and much nicer than flies in their death throes!