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Harvesting Dreams : An Afghan Story
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This is a story of war and misery, spirit and dreams, and of how a band of strangers half a world apart was able to make some of those dreams come true. Most of all, it is a story about how determination and perseverance can change lives.

Much of the story takes place in afghanistan beginning in October 2001, when the eyes of the world were focused on the invasion of afghanistan and the events that propelled it to the forefront of international news.

Like millions of americans, I knew little about afghanistan. Given its sudden importance, however, I began searching for more information by browsing the Internet, reading newspapers and by discussing afghanistan with members of several international discussion forums.

What I learned was, that except for its major cities, afghanistan could easily pass for pages torn from the Old Testament

Fig. 1: Afghan camel herder
Fig. 2: Father and son going to market

Roughly the size of Texas, afghanistan is a land of great contrasts: from cloud-piercing mountains to vast uninhabited and arid regions; from teeming cities that once offered a cosmopolitan way of life, to tent cities erected to replace villages still littered with the unexploded ordinance from decades of tribal fighting and the Russian invasion.

Famed for its great hospitality, art and poets, afghanistan also is home to marauding mujahideen warlords and bitter tribal feuding. Much of the country’s income was confiscated by warlords after the Russian retreat, creating a dangerous gap between rich and poor, cities and countryside. Devastated by two wars, years-long drought and more than 35 years of dictatorships, it was easy to see why afghanistan ranked among the poorest countries in the world.

It was through Medical Imaging, an Internet forum for imaging professionals that I first became aware of Dr. M. Hashim Wahaaj. In addition to performing and interpreting radiology and ultrasound studies, this afghan physician also taught ultrasound to local doctors. as the sole afghan member in our group, Wahaaj , as he preferred to be called, was barraged with questions about his opinions on everything from the war and his medical practice, to the current state of life in his home city of Kabul.

When Wahaaj was asked how he felt about the prospect of invasion, he simply replied that history has shown that every invader – alexander the Great, Genghis Khan, the British and most recently the Russians - were all super powers before invading afghanistan. In the end, however, they all lost not only their super power status, but saw the decline and division of their countries. One could only wonder if the same fate awaited the americans.

In October 2001, the U. S., joined by the United Kingdom and supported by a coalition of other countries, initiated military action against the afghan Taliban for their refusal to produce Osama Bin Ladin, the reputed al Queda leader. High-altitude air strikes focused on the cities of Kabul, Kandahar and Jalalabad, quickly destroying the Taliban air defense and severely damaging many al-Qaeda training sites. The Northern alliances, composed primarily of tribal warlords and their armies and assisted by american and British military advisors, constituted the ground forces. While news of the bombardments were being broadcast, our questions and comments faded as we tried to grasp the reality of what Wahaaj, his family, his patients and his students were living through.

The passing days had an almost surreal quality to them. Mornings were spent reading forum messages from Wahaaj. Evenings were spent viewing broadcasts of what Wahaaj had earlier described. Seen through his eyes, the hardships, the lack of reliable power and water, food shortages and widespread damage became more than TV news bulletins or words on a newspaper page.

Fig. 3: Typical example of a bomb-damaged home.
Fig. 5: Damaged hillside homes. Only in the evening after electric power was restored, was it apparent how very many of the houses were inhabited.
Fig. 7: Rooftop city view of bomb damage.
Fig. 4: The ruined mosque that served as the burial place for the Royal Family. The underground has been restored, however, the top remains untouched, a reminder of the consequences of war.
Fig. 6: Bombed-out public building
Fig. 8: Afghan women washing at community spigot.

In early November, air strikes, including cruise missiles concentrated on interrupting Taliban communications within the major cities and Taliban morale began to fall. However, the rebels fighting the Northern alliance forces held fast, causing the alliance leaders to demand more bombing of the front and prompting Wahaaj to establish a mobile emergency aid station in the region. In response to our concerns for his safety, he replied,

“My in-laws are from the North, and although my wife was murdered by some of her relatives for her beliefs, her work and her possessions, I still have very good relations and connections in the North, especially in Mazar-eSharif. Do not worry, I will be fine.”

After a fierce ground battle, the strategic city of Mazar-eSharif fell and the Taliban regime began unraveling. By November 12, Taliban forces abandoned the city of Kabul under cover of darkness and fled to the south and east to make a stand in Kandahar and in their mountain strongholds. Only a handful of foreign al-Qaeda fighters were left to defend the city and after a brief gun battle, Kabul fell. The new afghan transitional administration took control of the city several weeks later.

Although intense battles continued in the mountains, the major cities were now under the control of the Coalition Forces. In response, the Taliban began using guerilla tactics. They began forming small cells of terrorists to carry out car bomb attacks in the cities, ambushes of ground forces on the highways and roads, kidnapping of humanitarian aid workers, and RpG (Rocket propelled Grenade) attacks on the newly established Coalition military bases.

For several days, we heard nothing from Wahaaj and concern for his safety and that of his family was increasing. To our relief, he finally communicated from his clinic in peshawar, pakistan that all were safe.

Fierce ground fighting continued throughout December and January as several thousand foreign Taliban and al Qaeda recruits infiltrated the area from neighboring pakistan. The alliance ground troops were forced to call for more frequent Coalition air support. Carpet and pinpoint bombing missions laid siege to the area. Because the insurgents frequently hid among innocent villagers, civilian causalities rose. Bombing blunders and possibly skewed intelligence resulted in the bombing of mosques, schools, Red Cross warehouses and hospitals. Word from the outlying provinces was that the Northern alliance forces were executing Taliban, al Qaeda and civilians, alike. The Coalition forces were unwittingly being tricked into fighting the blood feuds of the alliance leaders.

It was in early January 2002 that Wahaaj wrote, describing how a dear friend, an innocent noncombatant, had been killed in the recent bombing. The bitterness and sorrow of his words were almost palpable. How do you comfort someone who is grieving – especially in the midst of a war started by your own country? How do you try to explain the unexplainable? Two things can happen with grief. You can close up shop and stay depressed, or you can channel your emotions into empathy for other people and do something to help. Wahaaj would choose the latter.

We traded many messages, each of us discussing and trying to defend our governments’ decisions and actions and discrediting propaganda, until finally realizing that it was futile. It was then that I came to realize that the first casualty of war is truth. Wahaaj said it best,

We can talk and talk about who did what and never be finished. Now is the time to think about rebuilding afghanistan.

I do not know how much you know about the Taliban. First, let me say that I am not a Talib. I am an afghan doctor. I actively participated in the afghan jihad following the Russian invasion and went to the warfront to give medical aid. For more than fifteen years we were at war with the Russians.

After the Russians left, the Mujahideen government came to power. We were expecting a lot from them, but they did the worst. While they were in power nothing and nobody was safe.

I can give you examples: When I traveled from peshawar to Kabul I had to be careful of how I dressed. There were more than fifty checkpoints on that road and every one of them used to take travelers’ money, watches, and would arrest them to get more money for their release. Within the city, I was unable to drive my car because the supporters of that government took private cars. Beautiful girls were forced into marriage with them, against their will. No one could do anything to stop them. This situation brought about the Taliban movement. The people were fed up with the Mujahideen government and its atrocities.

In the beginning, the Taliban were good for the country. However, they too started to make life difficult for the people. Despite this, they were better than the former government because they at least restored peace, unity, law and order.

Now the Taliban government has gone. I hate politics. I am a doctor. I established six clinics during the time of the Taliban. Regardless of who comes to power, I will run my clinics and do my job day to day. I am the only ultrasound teacher for the entire country and the only available ultrasound equipment in my country is a simple, convex probe unit – no Doppler. We have only simple x-ray machines and they are old. There is not one CT scanner in all of afghanistan.”

He wrote often during frequent travels between his clinics, seeing his patients and teaching his students. after so many years of war, the afghan medical and educational systems had deteriorated badly resulting in miserable medical and educational standards. a recurring theme in Wahaaj’s communications was his frustration at the lack of educational material for his doctor-students.

Having recently retired and trying to pare down my library, I asked him if he would have any use for my old textbooks, journals and tapes.

“Anything you send would be of value – regardless of age. Your offer means that you love teaching. By teaching, one gets inner satisfaction. Our students are (the) lights that will illuminate our world after our deaths.”

I put out a call for educational materials on several sonography-related Internet forums. While waiting for replies, I mailed a package of books and journals to Wahaaj, unsure of how long it would take (if ever) to reach him.

Among the many problems confronting Wahaaj was the lack of communications between his clinics. The war had left only one afghan Internet service provider functioning. as a solution, he formulated a plan to establish a courier service within afghanistan and its neighboring countries. Only one month later, despite continued fighting in the mountains and rural areas, the courier system, with offices in ten afghan cities and two foreign countries, was up and running.

Kismet, Luck, Magic or Dreams
February 2002 was only a few days old when, for the first time, Wahaaj wrote to ask for a favor. He needed help in finding someone to donate a CT scanner for afghanistan, and I agreed to try to help. after extensive networking among the commercial and ultrasound medical imaging communities, I struck out. all efforts failed to produce any CT scanner leads...but they did produce a letter from Barry Goldberg, M.D. at Jefferson University in philadelphia. Dr. Goldberg extended an invitation to Wahaaj to study – tuition free- at the Jefferson Ultrasound Research and Educational Institute (JUREI). When I relayed the offer to Wahaaj, to my surprise, I learned that Thomas Jefferson was where he had first studied ultrasound a decade earlier!

“I learned a lot at Jefferson and saw them exert every effort to help others. a world map was displayed in the ultrasound department, upon which each student stuck coloured pins into the area representing their country. When I found afghanistan on that map, there was no pin on it, so, I put on two

During the month I was at JUREI I worked hard studying all of the teaching files. There were 40,000 of them, and I made more than 5000 slides from them to begin my teaching files. When Dr.Goldberg learned how many slides I had made he asked to see them and had about 600 of them copied for his own ultrasound department. I was the first afghan to study at Jefferson and now, ten years later we are rejoined!”

Reconnecting with his former mentor eventually led to an affiliation between JUREI and The Wahaaj Institute of Ultrasound Imaging and the promise of educational assistance and teaching aids. as a result of the affiliation, Wahaaj received government permission to create and register The afghanistan Ultrasound and Diagnostic Imaging Society as a non-governmental organization (NGO). Through this Society, he hoped to eventually offer lectures, seminars and conferences for local physicians. More importantly, he hoped to acquire medical equipment with which to begin rebuilding the antiquated afghan medical facilities and to bring hope to the physicians who had been working for so many years without modern medical resources.

A matter of days after forming the society. Wahaaj mentioned the idea of hosting an international medical and ultrasound conference in Kabul – in august, less than six months away! at first I was stunned, then skeptical. anyone who has worked conferences of any size knows the amount of work and the difficulties associated with such a project in a modern city -- let alone in war-torn Kabul!

Playing the devil’s advocate, I pointed out the risks of such a venture during wartime in a city devoid of essentials such as reliable electricity, housing and basic modern conveniences. Nevertheless, Wahaaj would not be deterred. He was confident that he could take care of everything. He just needed... ”a little help and direction ”. We both embarked on letter-writing campaigns to american and European medical and commercial ultrasound companies. The response was quick and positive, with many responders promising to promote the meeting in various journals, newsletters and web sites. Finding speakers to make the lengthy and expensive trip to afghanistan proved more difficult, especially since only food and lodging could be funded. an additional problem for americans, travel to afghanistan was the U.S. State Department's advisory that travel was not advised. Several Indian and pakistani members or our Medical Imaging forum volunteered to speak at the conference. By a stroke of luck, I learned that Nashville sonologist, Dr. philippe Jeanty was scheduled to lecture in Iran around the date of the afghan conference. When contacted, Dr. Jeanty graciously agreed to lecture at the afghanistan conference for as long as he was needed.

Barry Goldberg, who was one of the first speakers to be invited, was unable to attend the conference in person, but offered to provide a video presentation for the event. Included in his acceptance message was the promising news that he hoped to find a new ultrasound unit - complete with color Doppler capabilities – for the Wahaaj Institute. Looking back, I realize that it was at this point that events began to unfold, as if by magic.

The Conference
Conference plans were in high gear and by May Wahaaj received endorsement for the conference from the afghan Minister of Health.

“It is decided that we will arrange a three day international conference of ultrasound and diagnostic imaging, to take place in Kabul on the 28th through the 30th of august, 2002. The conference will be organized by the afghanistan Ultrasound and Diagnostic Imaging Society, with the collaboration of the government of afghanistan and the Wahaaj Institute of Ultrasound Imaging, Kabul.

The Ministry of Common Health has promised to extend its assistance and cooperation and will ask other ministries to cooperate, especially the Ministry of Foreign affairs, for providing visas and other facilities to the participants of this conference.”

The speed with which the project was coming together was incredible. Limited funding arrived from the World Health Organization (WHO) along with donations in response to the conference announcements here and abroad. Brochures were quickly printed and distributed. Commercial booth space was being rented and meeting registrations began arriving. The conference took place on august 28th, the culmination of Wahaaj’s investment of energy, courage and unflagging determination.

The primary speakers presented multiple lectures: Drs. Latha Natarajan, and T. S. Natarajan (India), Dr. Murad (pakistan) and Dr. philippe Jeanty (USa). an ocean away, I tried to imagine what was happening, and anxiously waited to learn how the lectures and the meeting events were received. I didn’t have to wait long. The very next day, Wahaaj replied:

“The first Ultrasound and Medical Conference was a great success. More than 250 doctors from all over afghanistan attended the conference. It was the first conference of its kind in the history of afghanistan.

Dr. Jeanty was the hero of the conference. In his speech he said,

‘You afghans have only one picture of the United States as a country that sends bombs and tanks. However, today I am here from the United States to bring you knowledge’. The tireless Dr. Jeanty gave us six lectures a day for every day of the conference.

I want to tell you why I organized this conference on the 28th of august. It was the first anniversary of the killing of my wife, Dr. Kareema Mubeen (pakeeza Wahaaj). It was her soul that guided me in this venture. I will try to organize the next conference, which again will be held on the 28th of august.”

Only later did I learn from Dr. Jeanty, that the conference had been moved from the Intercontinental Hotel to another site, because the hotel was bombed only days before the conference was scheduled to open.

Even today, as we look ahead to the fourth annual conference in Kabul, I scratch my head in wonder at what sheer willpower can accomplish.

So Near, and Yet So Far.
During the summer of 2002, General Electric Medical Systems (GE) announced its intention to donate 200 new diagnostic ultrasound systems, transducers and accessories to improve healthcare in developing countries. The selection and distribution of the $6.5 million dollar donation would be handled by assist International (aI) a humanitarian organization, along with several partnering groups. GE also announced that Dr. Goldberg’s JUREI program had been chosen to provide training to the recipients of the equipment.

Quickly, I contacted aI’s executive director, Tim Reynolds to tell him of the desperate need for ultrasound units in afghanistan – as well as any CT scanners that might by “lying around”. To my delight, he said he was already in contact with Dr. Goldberg and he promised that Wahaaj would be receiving several new ultrasound units.

That was the good news. The "not so good" news was that nothing could be shipped to afghanistan until aadequate funding was secured and someone in Kabul agreed to act as a consignee.

Confident that Wahaaj would agree to accept that duty, I was just about to volunteer his services, when Tim mentioned that the five ultrasound units destined for Kabul were only a very small part of a much larger shipment. There would be several very large shipping containers filled with food, blankets, medical and educational supplies and even a diesel ambulance! When I explained the situation to Wahaaj, he not only agreed to act as consignee but to handle all of the custom’s declarations and necessary certificates.

Summer gave way to autumn and the search for affordable shipping was almost at a standstill. Over-land shipping was ill advised because of the fighting and widespread incidents of robbery. Shipping by air seemed the best, but, at an estimated $100,000, that option was clearly out of reach. Letters of appeal for services and/or funding were sent to UpS Inc., Rotary International, The United Nations, The World Health Organization and many other philanthropic organizations.

I suggested asking the U.S. air Force for help, as they must be flying supply missions to Bagram airbase near Kabul, on a daily basis. One of my networking colleagues also suggested contacting the Denton Cargo Shipment program that permits military aircraft to carry qualified cargo for humanitarian missions. I learned that aI had already contacted both the Denton project officials as well as the United Nations, only to learn that all non-military air shipments had been suspended due to the war. Nevertheless, aI representatives were heading to Washington to plead their case.

We received the news in January (2003) that the Washington lobbying had been successful. The Department of Defense agreed to soon ship all of the containers. Soon , turned out to be almost six months later, but our frustrations faded away when Ray Schmidt, aI’s Director of Operations, announced that U.S. air Force delivery of the entire shipment would be accomplished before the end of June.

Tim Reynolds planned to arrive in Kabul late in June. Together, he and Wahaaj would deliver the ultrasound units. Two of the units were slated for Wahaaj’s clinics and three were intended for selected area hospitals. aI was hopeful that Wahaaj would provide training to all three hospital staffs.

An Incredible Journey Begins
The waiting was almost over, but for the folks at aI the fieldwork was just beginning. Marshalling the supplies and delivering them to travis air Force Base in Northern California was one of their last stateside duties. In the warehouse, the five ultrasound units were dwarfed by boxes of wheelchairs, medical equipment and supplies, sacks of rice, new shoes and clothes, baby bundles, school supplies, blankets and much, much more.

Fig. 9: a sampling of the medical equipment (including stretchers, defibrillators, and wheelchairs) bound for Kabul.
Fig. 10: Boxes of wheelchairs donated by the Wheelchair Foundation.

On the day the shipment was scheduled to leave many of the aI volunteers who had played major roles in securing the precious cargo, were on hand to celebrate. Two C-130 transport planes would carry the entire shipment (including the ambulance) to Bagram airbase, about 20 miles outside of Kabul. The aI volunteers would reach Baghdad via commercial aircraft and would be met by Wahaaj.

Fig. 11: Cargo packed and ready to go!
Fig. 12: Tim Reynolds, aI Executive Director, also ready to go!
Fig. 13: C-130 crew members waiting for cargo to be loaded and the aircraft readied for take off.

Tim Reynolds graciously promised to share his journey with me by photographing everything of interest. Enroute to Bagram, he began his photographic journal by snapping pictures of the rugged mountains separating afghanistan from pakistan.

Fig. 14 Flying over snow covered mountains.
Fig. 15: aerial view of the Khyber pass separating afghanistan and pakistan. It was the site of many tough battles.

Tim, Wahaaj and a small band of aI volunteers made the trip to Bagram air Base to accept delivery of the shipment. Then, U. S. air Force personnel escorted the group across the Shimali plains, to Kabul. after months of e-mail communications, the long-awaited ultrasound units would soon be delivered. The first stop was at the Wahaaj Ultrasound and X-ray Clinic, where everyone pitched in to see that Wahaaj’s two new units were safely installed. Then, it was off to deliver the other three units to the Ministry of Health for training purposes and eventual redistribution to three Kabul hospitals.

Fig. 16: Wahaaj and Tim in front of the Wahaaj Ultrasound and X-ray Clinic. Note the sign, written in persian, announcing the X-ray clinic.
Fig. 17: Tim and Wahaaj supervise the unloading of the first ultrasound unit. was the site of many tough battles.
Fig. 18: a jubilant Wahaaj with his new scanner.
Fig. 19: an ultrasound unit for the Ministry of Health is unloaded at the De Solay Daywa, an NGO operated by Mrs. Karima Jan (of the Kabul chapter of the Rotary Club.

Once the ultrasound units were safely delivered, the plan was to visit various local orphanages, where Wahaaj’s presence as an interpreter was very much appreciated. For Tim, this would be a return visit to one orphanage that aI had “adopted” on a previous visit. For two years, every month, they sent $2000 to support this center. Orphans are very close to the heart of the aI mission, and none more so than the children of afghanistan. Children who are without any of the basic necessities for a happy childhood, and whose situation promises a bleak future for those who survive.

An entire generation of afghan children have known nothing but war. It was this sobering fact that prompted an afghan engineer to sell his home in 1995, to finance the building of a school. Joined in the venture by a Swiss humanitarian organization (Terres Hommes), that school would grow into today’s ashiana project, one of the most successful and well-known humanitarian endeavors in afghanistan.

Approximately eight ashiana centers now provide a safe haven where Kabul’s children can rest, play games and learn new skills to help them escape grinding poverty and the often dangerous situations associated with their only alternative, street begging.

An estimated 2000 children, and their families, who struggle to scrape out an existence for themselves now are provided with a productive enterprise. Instead of selling water, cigarettes and newspapers, or washing cars and hailing taxis for the equivalent of less than two cents, they are learning trades and skills.

Ashiana schools and centers provide two meals a day and basic medical care for the children and their families. They are offered academic and vocational training along with bomb-awareness classes. Workshops teach them carpentry, engineering, painting, electrical repair, calligraphy, sewing and other practical crafts so that they can generate an income. Only a small portion of that income is used to replenish the supplies they use and the rest goes home with them to support their families.Incredibly, ashiana fights to survive on a meager budget of only $4 per child, per month.

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Fig. 20: Tim and Wahaaj get ready to unload supplies with the help of teachers and students.
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Fig. 22: Tim, Mohammad Yousef, Director of ashiana, and Wahaaj visit students in the engineering training room.
Fig. 24: afghan girls show off their school supplies.
Fig. 21: Engineer, M. Yousef, Wahaaj and Tim (behind sewing machine) take part in an ashiana sewing class.
Fig. 23: an injured boy studies art at an aschiana center, hoping to sell this painting to support his family.
Fig. 25: Older girls in class. Under Taliban rule, women and girls were prohibited from attending school. as a result, today, 75% of afghan women are illiterate.

Also on the day’s schedule was a stop at the allaudin Orphanage in Kabul. Here, there are so many orphans that the children sleep in crowded quarters of 20 to 30 beds per room, making it is necessary to crawl over some of the beds in front, in order to get to those in the back. Yet, life at allaudin is better than anything else available.

The donations that make this work possible come from a broad and diverse group of people. For example, one young British girl, living on Saipan – a tiny island in a large ocean – began raising money at her high school. Her efforts netted $1500 U.S. dollars - money that was used to provide blankets and school supplies for the needy children of afghanistan.

Fig. 26: Morning inspection time for young boys.
Fig. 28: Tim makes a “special delivery” of blankets at the orphanage.
Fig. 27: Bedtime for older boys in crowded dormitory.
Fig. 29: Smiling orphans display one of the blankets.

An important part of humanitarian work is that of diplomacy and observing protocol. During his brief stay in Kabul, Tim met with the vice president of afghanistan and many directors of the various NGOs that would be receiving the supplies, food, money and equipment that aI had brought.

Fig. 30: Tim Reynolds, amin arsalan (Vice president to Hamid Karzai), Mrs. Karima (Rotary International) and alam Nooristani, social activist- politician.
Fig. 31:The two women hugging have just received money for a local orphanages. Tim is required to provide photographic proof whenever delivering cash, equipment or supplies.

At mid-day, following these meetings, the group was treated to lunch at a mountain picnic ground located at Istalif, outside of Kabul. The afghan-style picnic involved reclining on persian rugs and eating goat meat while armed men (accompanying Mr. Nooristani) stood guard.

Fig. 32: alam Nooristan, Tim Reynolds, another host and Wahaaj relaxing at Istaliff.
Fig. 33: Jim Stunkel, and Wahaaj enjoying their al fresco lunch.

At last, the time had come to deliver the ambulance. Taking delivery, on behalf of the first Rotary Club in afghanistan, was its president, Mrs. Karima. The fledgling Kabul Rotary Club was born through the collaboration of two american groups: the afghan Centric Club in Hayward and Rotary International, District 5170 of Fremont, California. Each group played a major role in gathering and distributing much of the donated goods and plan to continue supporting the Kabul Rotary Club.

Accompanying Tim at the presentation, was Jim Stunkel, a Battalion Chief in the San Jose, California Fire Department. Jim had played an essential role in getting the american Medical Response Company to donate the ambulance. That donation could not have been more timely, during their stay in Kabul they observed unconscious accident victims being delivered by taxi cabs to a local hospital.

Fig. 34: Mrs. Karima accepts the new ambulance
Fig. 35: Unidentified hospital in Kabul where the aI contingent saw unconscious accident victims delivered to the Emergency Room in taxicabs.

The following days were filled with visits to many additional institutions, among them a women’s organization supported by the Fremont afghan Coalition. at one stop they delivered computers; at another women’s center they brought funds for distribution to the center’s clients.

Fig. 36: Delivering computers to a local women’s’ center.
Fig. 37: afghan women waiting for money at a relief agency.

Eventually, the time for departure came, but only when the last school supplies, the last bags of rice, and the last cartons of medical equipment had been delivered. The memories created during the whirlwind visit were undoubtedly replayed many times over during their long flight home.

As I viewed the hundreds of pictures provided by Tim Reynolds, I began to realize the scope of the incredible journey he had completed. a plea for a used CT scanner resulted in introducing me to incredible people and events beyond my imagination. What was accomplished in a matter of 18 months is tangible proof that people who have never met can work together and do great things, if they respect each other, listen to each other and are willing to learn from each other. The small part I played in this experience made me realize we are defined not by our differences from people in other cultures and countries, but by our similarities.

It is difficult to say who felt more gratified because of this project: the givers or the receivers. a thread of caring, that cannot be seen or touched, linked all of us together. It was a rare privilege to be a part of this effort. However, the joy of accomplishment pales with the realization of how much more remains to be done.

Afghanistan Today
Afghanistan has made remarkable strides in the few years since the Taliban regime was ousted: a new constitution, successful presidential and legislative elections; more than one million girls enrolled in schools; progress in de-mining the countryside; major strides in defense; justice and financial reforms and the reintegration of over 3 million refugees. Nevertheless, you are unlikely to hear or read enough from your local print and electronic media about the remaining challenges this country faces,

The ravages of decades of war have devastated afghanistan’s infrastructure, torn people away from their homes and each other and created countless numbers of widows and orphans. Some afghan families “live” in the shells of bombed out buildings, paying exorbitant rents. This fact clearly illustrates the critical need to build low-income homes. Not one facet of normal living exists that does not have to be created or rebuilt. It will require economic development as well as government subsidies to rebuild this country’s infrastructure.

The afghan educational system is in a state of virtual collapse with needs for everything from pencils to computers. When the topic of education comes up we tend to focus on children’s education, but adult education is just as important, as so many refugees have chosen to remain in the cities rather than return to their rural homes and farms. adult courses, in everything from literacy to vocational skills are the key to these people ever earning a decent living. If the afghan people are ever to live and function normally, everything -- homes, schools, hospitals and libraries must be built.

In almost every respect, afghanistan is one of the poorest nations in the world. Nowhere is this more apparent than in their health care system. In afghanistan, the average life expectancy is <50 years. Half of the children under 5 are moderately to severely underweight and one fourth of all afghan children die before reaching the age of five. Most illnesses and deaths are due to preventable communicable disease, for which a few low-cost interventions could rewrite those statistics. Maternity services are still primitive in many outlying areas: no anesthesia, no epidurals, no surgeons available for emergency C-sections, and often no lights, hot water or even bandages.

Fig. 38: a father comforts his injured child, burned by boiling water pulled from a stovetop.
Fig. 39: What will the future hold without corrective surgery?

Seldom mentioned, is the need for mental health programs to treat both adults and children for the emotional trauma of living through years of war. It is painfully obvious that the entire public health care system in this country needs to be revived and rebuilt.

Humanitarian missions, such as assist International try to answer the desperate need for everything from food on the table to advanced medical care; but they alone are not enough. Until the events following September 11, 2001, afghanistan was an orphan conflict that the world had largely forgotten. With the overthrow of the Taliban, however, it became the focus of world attention and was expected to be in the news far into the future. The war in Iraq has changed that by eclipsing much of our focus and resulting in the delay or abandonment of early promises of help. Three years later, many early pledges of aid and support have dissolved into talk by the yard and action by the inch.

Coalition forces still remain in afghanistan and will for some time to come. Each day brings new challenges and threats as the insurgents continue to fight from their mountain strongholds as well as employing guerilla-style attacks on our military bases and soliciting martyrs to carry out suicide bombings.

In the two years that have passed since Wahaaj received his ultrasound units he remains busy at his clinics and school as well as consulting at the hospitals where the other units were donated. He also serves as a medical consultant to the afghan Ministry of Health and only a few months ago took delivery of that long awaited CT scanner.

He is busily preparing for the Third International Ultrasound and Medical Conference next month and is thinking of writing a book about his beloved wife, pakeeza. as he said to me:

“Love feeds your spirit, body and mind!”

Wahaaj also shared with me their long held dream of establishing a hospital devoted entirely to women. It is a noble dream in a country with the highest maternal death rates in the world, and one in which men and boys are given precedence in health care. pakeeza, a successful obstetrician-gynecologist, longed to provide the best for her patients. It is Wahaaj’s long term goal to build this hospital in her name to honor her memory.

Most recently, Dr. Wahaaj was asked by his tribe to represent them by becoming a candidate for elected office. as I write, he has embarked on a new project – that of campaigning. If elected, he will become a Minister of parliament and serve a term of five years. Such an event could open new options for the future by improving the medical infrastructure and medical care for the entire afghan population. It also may be the catalyst that allows him to make the pakeeza Maternity Hospital a reality.

The delivery of five ultrasound units to a medically impoverished country may be only a ripple in the large lake of need that is afghanistan today; but, it brought some of the fruits of modern medicine to the people who need it most.

What stimulated this event was a doctor who believed that he could take on projects bigger than his own interests and change his world by helping to relieve suffering and bringing constructive change to his people.

He reached out, unabashedly to everyone he could think of, whom he thought might be willing to help him solve some very big problems. In addition to the positive results achieved by Dr. Wahaaj, there is an important lesson to be learned: Despite our many differences, we people of Earth share one important commonality – our humanity. We each have within us the power to change the world. We just have to open our hearts to harvest our dreams.

-Marveen Craig

A CALL TO ACTION
What You Can Do
If you are moved by the suffering of people without adequate food, shelter or health care, and have the knowledge and tools to assist those in struggling situations, there are many ways to help. There is a great need for medically trained professionals around the globe. people with almost any skill can find meaningful assignments. The medical personnel most in demand include surgeons, pediatricians, obstetrician-gynecologists, family practitioners, nurses, pharmacists, laboratory technicians and medical educators. With only a little research, people with almost any medical or medical support skill can find productive and rewarding assignments.

For direct, short-term involvement in afghanistan (and most other overseas locations), you would need to take a     minimum of 2-4 weeks away from your family and work responsibilities, and in many cases, you would need to fund your own travel expenses. Many volunteers find sponsors to help with the expenses of volunteering. These may be colleagues at work, religious or civic groups or family members. Volunteers interested in afghanistan are reminded that afghanistan continues to be a conflict zone, thus subject to security concerns.

Listed below are a few samples of the many organizations looking for medically trained volunteers. This is only the tip of the iceberg. In addition to the needs in afghanistan there are needs in many more developing countries. Simply using your favorite search engine and exploring volunteer opportunities in the country of your choice (including your own) will yield many possibilities.

Medical Volunteer Opportunities (Overseas)

American Red Cross:http://www.redcross.org
International Federation of Red Cross and Red Crescent Societies:http://www.ifrc.org
Cure International:http://www.cureinternational.org/locations.jsp
Doctors of the World: www.doctorsoftheworld.org
Health Volunteers Overseas: http://www.hvousa.org
International Medical Corps: http://www.imcworldwide.org/index.shtml
International Medical Volunteers association: http://www.imva.org
International Health Volunteers: http://internationalhealthvolunteers.org
Loma Linda University International programs: http://www.llu.edu
Mercy Corps: http://www.mercycorps.org/
Oxfam: http://www.oxfam.org
UN Volunteers: http://www.unv.org/volunteers/options/abroad/index.htm
USaID: http://www.usaid.gov/locations/asia_near_east/afghanistan

U.S Department of Health and Human Services (HHS): HHS is involved in several activities within afghanistan. One of them is the Rabia Balkhi Hospital (RBH) training project. HHS has established a maternal and child health teaching program at RBH to provide focused short-term training to a range of healthcare professionals. The objective of the short-term curriculum is to retrain the hospital’s existing attending physicians in the fundamentals of clinical medicine. activities at the RBH facility include:

  1. Development of neonatal assessment and triage
  2. Re-establishment of emergency room services
  3. Training and promoting the use of infection-control measures
  4. Establishing medical records and health care surveillance systems for maternal and child health
  5. Introducing quality-assurance principles, and
  6. Supporting the informatics functions of the project.

HHS is currently developing a Request for applications (RFa) to establish a residency-training program in Obstetrics and Gynecology at RBH, which will serve as an OB/GYN Centre of Excellence in afghanistan. Contact: http:// www.globalhealth.gov

Organizations that Facilitate Volunteering
International Healthcare Opportunities Clearinghouse (IHOC) is another excellent resource.
Sponsored by the Lamar Soutter Library at the University of Massachusetts Medical School, the Clearinghouse is a searchable database of over 100 service and educational opportunities in international healthcare: http://www.library.umassmed.edu/ihoc

The practice Opportunity Line is a 24-hour toll-free automated telephone service that allows you to search anonymously many international and domestic opportunities. The system prompts you to enter your specialty and geographic preferences and then, lists detailed profiles of available opportunities. Contact: 1-800-233-9330.

Medical Equipment Donations
Donated supplies and equipment are critical to many relief operations. The key, however, is to collect only needed items, since the costs of transportation are very high.
Supplies : Some organizations develop wish lists. In general, bandages, medicines (that are not outdated), multi-use items (i.e., glass syringes, feeding tubes, etc.), needles, sutures, surgical gloves, surgical tape and urine/blood test sticks top those lists.

Worthwhile equipment (both low and high tech) should be durable, repairable and in good conditions. Some items frequently requested include: autoclaves (basic models), centrifuges (hand operated or basic electric models), durable blood pressure equipment, electrical generators, glass thermometers, laundering equipment, microscopes (good quality), personal items such as stethoscopes, eyeware, face masks, etc, reusable surgical or dental equipment (in good condition), X-ray machines (basic models) and ultrasound machines. Contact one of the sites below and find out not only what to collect but how and when shipments are best handled:

American International Health alliance: http://www.aiha.org
American Support For afghanistan: http://www.asanonprofit.org/index.php
Assist International: assistinternational.org
aFaF australian Foundation for the peoples of asia and the pacific:
http://www.afap.org/support.html
Carelift International: http://www.carelift.org
Direct Relief International: http://wwwdirectrelief.org
Global links: http://www.imva.org/pages/volufrm.htm
Global Watch Group: http://www.globalwatchgroup.org
International Medical Equipment Collaborative: http://www.imecamerica.org
Map International: http://www.map.org
Medical Bridges Inc.: http://www.medicalbridges.org
Medisend International: http://www.medisend.org
Medshare International: http://www.medshare.org
project Cure: http://www.projectcure.org
Recycling of Unused Medical Supplies (Intervol): http://www.intervol.org/medicalsupplies.htm
Remedy: http://www.remedying.org
Suture Donation: http://www.globallinks.org/sutureprogram.htm
Samaritan’s purse (World Medical Mission): www.samaritanspurse.org

Medical Text Donations
appropriate educational material and textbooks can be very useful to medical projects. Unfortunately, most medical books focus on healthcare issues in developed countries. Much of the material needed in undeveloped countries is published in Europe. Knowing which items to send usually requires direct communication with the receiving organization.

Listed below are organizations that specialize in collecting, transporting and disseminating books:
Asia Foundation’s Books for asia: http://www.asiafoundation.org/Books/overview.html
Book aid International: http://www.bookaid.org
Bridge to asia: http://www.bridge.org
Brother’s Brother Foundation - Education program: http://www.brothersbrother.org/bookpolicy.htm
SaBRE Foundation: http://www.sabre.org
Sudan-american Foundation for Education, Inc. (SaFE): http://www.sudan.com/safe/about.htm

Non-Medical Volunteer Opportunities
Some of you may consider volunteering as a team with colleagues or even with family members. There are many non-medical opportunities that might fit family members without medical background. Here are just a few of hundreds of organizations committed to improving the basic requirements and many facets of every day life for those in dire need.

Help afghan School Children (HaSCO): This non-profit, non-political organization’s goal is helping afghan children catch up after many years of lost schooling. Headquartered in Vienna (austria) HaSCO uses an active group of online volunteers in different countries. Contact: http://www.help-afghan-school-children.org/

Idealist – action Without Borders: a non-profit volunteering resource center using information from over 35,000 organization in 165 countries. Founded (1995) to build a network of neighborhood Contact Centers, it is the one-stop shop for volunteer opportunities and nonprofit services in communities around the world. Contact: http://www.idealist.org

Virtual Volunteering
If you have limited time and funds, Virtual Volunteering, may be a way for you to share your talents. Some organizations now offer the opportunity to do volunteer work via the computer. Those with regular/reliable computer access and the skills and experience that would be valuable to a volunteer organization, may find this to be the answer to their situation. Becoming an online volunteer might involve any of the following:

performing translations; data analysis; proposal writing; editing articles; answering the organization’s e-mail; online mentoring; web design; publication design; typing grant applications; typing a college term paper for a person with a disability; assisting with fund raising promotions; doing necessary research; keeping in contact with a shut-in who has e-mail; or other services that can be done through computer networks.

VirtualVolunteering is not meant as a replacement for face-to-face volunteering, or to take away paid positions at an organization. It is meant to help build the capacity of staff at an organization, as well as those that the organization serves. Virtual Volunteering offers motivated people a convenient way to make a difference.

One organization that you may wish to research for more on this subject is: Online Volunteering: http://www.onlinevolunteering.org

Background Information on afghanistan
For a deeper understanding of afghanistan, its traditions, culture, econmy, languages, politics, history, and a greater awareness of the many challenges facing the afghan people, we suggest the following independent web site: afghanistan Online: http://www.afghan-web.com/history

In addition, the best selling novel The Kite Runner by Khaled Hosseini, vividly depicts afghanistan in its happier days, the changes brought on by war, the perilous journey and the difficulties afghan immigrants had to overcome to assimilate into the afghan communities of Fremont and Hayward, California.