I-Witness
An alumna in Afghanistan
Created to feature personal alumnae perspectives on breaking news around the world, this month’s “I-Witness” features an article by Chrysanthe A. Courniotes ’04, project manager for an Afghanistan medical reconstruction project at the Center for Disaster and Humanitarian Assistance Medicine (CDHAM) in Bethesda, Maryland.
Courniotes holds a Masters in Science in international health management, economics, and policy from the Scuola di Direzione Aziendale (SDA) Bucconi in Milan, Italy. Her story begins in Kabul in March 2007, when she traveled to the war-zone of Afghanistan as the only female on a two-week medical site survey team.
As we were landing in Kabul on a clear crisp day, the sight of the snow-covered mountain ranges made me feel as though we were landing in a ski resort area and not in a country devastated by more than 30 years of war. Walking away from the runway into the “airport,” I was brought back to reality when I saw a sign that read “Welcome to Kabul” in English and Dari. The arrival area of the airport was a bombed-out shell and the scene was pure chaos. In one corner of the room, an Afghan police officer attempted to stamp visas; in the other corner Afghan citizens, U.S. contractors, and citizens from other countries formed three haphazard lines to get their passports stamped and documented by the Afghan National Police. After having our luggage thrown into piles, we exited the airport to find the U.S. military convoys waiting to escort us to the military base where we would be living for the next two weeks.
“You have to wear your armor and helmet,” a lieutenant instructed me as I was about to enter the vehicle. At that moment I realized that my vision of immersing myself into Afghanistan’s culture and truly connecting with the people in the streets was lost. Why was I given the choice to wear this protection while the children playing in the mud on the side were not? I did not want to be a victim of circumstance, but I felt like a hypocrite as I wore my helmet.
The drive to the nearby military base should have been short, but the number of cars on the roads and the circular design of the roadways made the trip a longer adventure, complete with a “shooter” holding a weapon in the event of an attack (a standard feature in every U.S. military vehicle). This was not the scenario I envisioned when thinking about my first fieldwork experience. After we arrived and settled into our quarters, we were briefed on our agenda, which involved meeting with several Afghan government leaders and their deputies; touring the National Military Hospital in Kabul and a Provincial Military Hospital in Gardez, the National Police Hospital in Kabul, and five of fifteen civilian health facilities in Kabul and one civilian facility in Gardez; and coordinating with both U.S. government (USG) civilian agencies and non-government organizations (NGOs) who are in Afghanistan. When I went to bed that night, I was anxious to get started on our assignment and see for myself what foreign aid projects in Afghanistan have accomplished and what remains to be done.
My morning routine was similar to that of military personnel. I woke up at 5 am to shower, dress, and brought my armor to the cafeteria to eat breakfast with my team. We were then transported by the Command Surgeon’s staff to our various meetings and site visits in Kabul and we also went on a trip to the provincial capital Gardez. In Kabul, we met with Dr. Mohammad Amin Fatimie, Afghan’s Minister of Public Health, who believes that “poverty is the cause and the symptom of disease and instability.” Driving through the poverty-stricken streets of Afghanistan, I found his statement telling, so much so that I wanted to jump out of the car and reach out to the citizens, wanting desperately to assist them in rebuilding a country with so much promise yet such daunting challenges.
As we toured both the civilian and military hospitals, the difference between them was quite evident. In my opinion, due to the Department of Defense’s limited ability to date to fund civilian sector development, the National Military Hospital (NMH) had inadvertently become the gold standard of hospitals in Kabul, while the civilian facilities we toured ranged from bearable to heartbreaking. An image remains in my mind of the Indira Ghandi Children’s Hospital: six malnourished toddlers in the same bed, barely breathing, in a room filled with at least 30 women and their ailing children. The tour of this particular hospital affected me the most. As we passed by the intensive care units filled with children dying from illnesses or burns that were preventable, it made me realize that in my life I had nothing to complain about. These citizens were truly helpless. I was motivated to ensure that our project would make a difference for those children—I did not want to leave them behind without a promise of hope.
With every day that passed, I became more and more concerned at what I was seeing. Indeed, five years after the U.S. entered Afghanistan, Kabul still has frequent electric power outages; no centralized water, sewage, and heating systems; and no centralized oxygen , waste, and air circulation systems in the hospitals. On the other hand, the U.S. military bases and U.S. government compounds have an overabundance of food and never seem to experience a power outage. I tried to keep in mind though that humanitarian assistance efforts can take time to have comprehensive results and that the guilt I was experiencing of being able to return to comfort at the end of the day was normal but I still did not feel right about the differences between being outside of the military base gate versus being on the inside.
Despite the difficulties, however, I was enjoying our trip, and I met very kind and motivated Afghan government and civilian workers. In particular, my preconceived idea of a military base and how it functions was proven wrong. Every day the Command Surgeon’s staff mentored and assisted the Afghan officials who are the key to Afghanistan’s future.
The relationships a humanitarian assistance worker forms in Afghanistan are the key to gaining credibility and legitimacy with the citizens. For example, before my trip I had met two female nurse managers in the Afghan army when they came for a site visit in the U.S. When, in turn, I went to their country and toured their National Military Hospital, they hugged me and said, “Thank you for keeping your promise and coming to see our country.” Those moments were very gratifying and I wanted to re-live them over and over again. From the beginning, I knew that the fourteen days allotted for our trip would pass by either very slowly or too quickly. As my cough worsened from the poor air quality, the days seemed to pass by slowly, but when I was talking with my friends in the hospitals I did not want the days to end.
I am a realist. I know that our project will assist the U.S. Government to coordinate their efforts with NGOs and the international community, but our project alone will not help the Afghan citizens gain the lives they deserve. The amount of money invested in a country does not solve the problems of that country if that funding is not used to enable the citizens to fulfill their immediate needs. Choosing to purchase high-tech equipment for a hospital instead of dealing with provision of more basic healthcare needs is not using money wisely, especially when the equipment remains wrapped in plastic because neither the physicians, nurses, nor allied health workers know how to use them. There is a lot of work to do to improve Afghanistan’s healthcare systems, and sometimes it feels overwhelming. At these moments, I close my eyes and think of those children, and I know in my heart that this is the right thing to do. There is no other job I would rather have at this time in my life.
Many of my friends have asked me, “Why don’t you focus your attention on the U.S. healthcare system?” My answer is that the U.S. healthcare system may not be functioning at full speed but Afghanistan’s healthcare system is barely functioning. Once I play a small role in addressing the pressing need for better health care in Afghanistan, I will have the skills to work on similar and other issues facing the U.S. system. You have to take small steps in fulfilling your dreams, and this project is one of those steps that has changed my life for the better.
