Spring is in the Air…

March 2009     Kabul, Afghanistan

Most times a backyard BBQ does not include skull fractures, amputations and calling the boss a “fucking wombat,” but this is Kabul.

Friday is the one-day weekend, and I scored an invite to an afternoon grill-out in a walled garden with a houseful of South Africans and others. The local food is oily and bland, so I jumped at a meaty feast on our first warm Spring day. I hailed Shafiq to pick up some warm beers from the black-market corner store and drop me off at their house. This day marked the end of a long winter, punctuated by frozen mud streets and burst pipes in our house, a weak electrical supply from Kyrgyzstan, feeble heaters and dim lights.

The location was downtown; walled, razor-wired and guarded in the usual manner, and I picked up my Italian friend Simona along the way. She has lived in this country for four years in a comfortable house with her French boyfriend, usually intending to leave for an NGO job in a less broken place, but always falling into a better newer gig at the end of her rotations, so the common story here goes. She tells upbeat stories about living in the remote Northern countryside early on, and foreboding tales of watching a country clawing its way back up towards the light, then sliding backwards into the rot and violence again.

I had met one of the house residents before, Peiter, he was manning the grill and the stove today, serving up an array of imported goods (sausage and wine!) requisitioned from the exorbitantly priced international market.  He is also the ER doctor at the international charity hospital across the street from the house, and I vaguely assumed that several of the other dozen people present worked there, too. The hospital staff do not just live here – they are locked in, on duty 6 days of the week, and on-call Friday. They serve only poor Afghans, as I learned to my frustration much later that day. To everyone’s misfortune, much of their “mass-casualty” work comes early on Fridays, the  Muslim Holy Day, which the fundamentalists honor by blowing themselves up in crowds of Afghans gathered on their day off.  They usually do this early in the day in the hope of being buried before sunset, in accordance with custom.

As usual I was the only American around, and we were having a good time cracking on each other in a corrupt shared language, when a radio crackled loudly from under Pieter’s apron. “Control to Nighthawk One. Nighthawk One, stand by….mass casualties…airstrike in Paktia…ETA 20 minutes…unknown number.” I looked on with some amazement as the music cut off, everyone put down their wine and produced white hospital coats and started muttering about things that did not need translation. It was like a scene from M*A*S*H, including a lovely blonde Finnish nurse.

Simona and I stood there about as useful as a pair of left shoes, until it occurred to me that they might be short-handed, so maybe I could help out. Just as much, I wanted to see what a misguided US airstrike looked like in person, having read about such events for years. Civilian casualties are very much a part of why this war is increasingly unpopular with the Afghans, despite great and costly efforts to minimize that outcome. Rarely does any media cover when and how airstrikes and ground missions are called off because of the risk to civilians, and how many Taliban survive to fight another day because of these restrictions.

We hustled off through the gate, on what struck me as a rare occasion, walking in public here. Simona stressed about forgetting to wear a head-scarf while the local men stared at her and traffic honked and sped by. We prepped the empty ER for a few minutes until the ambulances and pickup trucks arrived with the wounded: an older man with a closed head injury, no blood, but a massively distorted forehead and deeply unconscious. A young guy on an old broken stretcher, with entry and exit wounds to the abdomen. Two men shot through the legs, bandaged but still bleeding onto unclean sheets from a clinic in Paktia, a small town two hours southeast by road. Were these men Taliban? I sure hoped so. While viewing the CT scan of the head injury (maybe a dozen fractures,) and the x-rays of the shattered lower legs, it occurred to me: these are obviously not bomb injuries. No burns, collapsed lungs or missing limbs, and these are not bullet wounds from an attack jet – people vaporize when hit with that size cannon.

The real story emerged, or part of a story anyway: there had been a US raid the night before to capture a Taliban leader, and public protests about it later. This turned violent when the Afghan National Police showed up to disperse the crowds who threatened to overrun a government building. The first patient had been hit with what must have been a big rock; the other three were hit when the Afghan police machine-gunned the crowd. There may have been more patients en route, or else they stopped for treatment at roadside clinics along the way. We wheeled two of the patients into the OR, knowing that the older man would soon die in place due to lack of necessary equipment and facilities. Despite the efforts of the staff and consideration for surgery, he did just that within 30 minutes, and might have died almost as quickly in a first-rate hospital. He was too far gone by the time he arrived.

As for the other leg injury, a piece of bone must have been out on the street, because there was a three-inch gap in his lower skeleton, and Pieter planned to amputate. First he had to argue with the family member who refused to sign the consent form and did not want a foreign doctor to operate on his cousin. Pieter has worked here for years, and has dealt with this before. He got squarely in the man’s face and shouted in English, with an interpreter beside them, “What is wrong with you? I am not the enemy! I am not here to kill this man! You want an Afghan doctor? Go find one! I am not here to argue over this man like a carpet in the bazaar!” He turned and walked out in what seemed like a well-played script, as the man sheepishly signed on the line which was dotted.

Pieter is surely aware that if this man (or any patient) later goes home and dies of infection or the family believes he is at fault for taking this man’s leg, they could turn on the doctor and target him in the name of the family honor. That is unlikely because even unclean Christian doctors are respected, but revenge equals justice in this culture. Years ago a lunatic Afghan climbed into the lion’s pen at the Kabul zoo to fight him. The lion ate him. The next day, the dead man’s brother successfully avenged  his death by tossing a hand grenade into the cage, blinding the lion in one eye.

There was no shortage of staff, no more patients arrived, and the mass-casualty tents remained sealed, so I went home.  Around midnight we got a call for a drunk Australian a few streets away who fell and hit his head. It seems he was exceptionally thirsty after his rugby team lost a big match. We arrived to find him face-up in tighty-whiteys on a floor swamped with blood, fighting the four men tasked with restraining his arms and legs. He was hurling choice words at each of them, including his boss:  “Piss off, ya clackers!  Ya fooking coonts!…Wombat!” They held him down for the half-hour it took us to clean the six-inch long spurting gash trenched across his forehead, and re-unite his scalp with 34 staples. Zipperhead.

He calmed down enough for us to get him into the ambulance for a CT scan at a nearby private hospital, but it was still Friday the Holy Day and the CT tech was off duty. I called two other hospitals and got the same story. I didn’t mind – it actually amazes me that there are any of the $1,000,000 machines on this side of Pakistan. I did mind when I called the charity hospital from earlier that day and the European medical worker informed me that they only treat Afghans.

I lost my cool and shouted for awhile into the phone about them refusing to treat an insured white guy with money to pay for the service which would clear him to get back to work building a powerplant to provide electricity to this f-ed up country and the hospital in which you work. He would not budge on the rules.  Idealism turned on its ear.  He was a zipperhead too.

Today I found a news item about the US raid and the police shootout. It understates the injured:   http://www.afghanistannewscenter.com/news/2009/march/mar152009.html#6

Winter in Kabul, 20 photos:http://www1.snapfish.com/share/p=390101263162430056/l=4372557017/g=6193089/otsc=SYE/otsi=SALB

Yes the glorious painting above is another masterpiece from America’s national treasure, “The Painter of Light,” Thomas Kinkaide.


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