Dispatches from abroad: laughter amid the land mines
====================================================

* Maureen Mayhew

*Badghis province, Afghanistan* — After 4 plane trips and a 2-day drive, I arrived to join the only 3 foreigners in Bala Morghab, my home for the next 9 months. During the drive up to Bala Morghab, and despite the gutted Russian army tanks dotting the countryside, I felt like I had entered biblical times. Many nomads were on their usual migratory path to the mountains, travelling from oasis to oasis. They cross the desolate, dusty landscape, men on foot leading bright green-, pink-, red- and purple-clad women and children on camel trains decorated with brightly coloured blankets, pompoms and sequins. Thousands of sheep and goats dot the landscape, guided by shepherds. Donkey drivers sit with their feet at hip height sticking out parallel to the ground. Black-cloaked women and bearded men in turbans walk several days to their destinations, dog stick in hand. Everyone stared at me, the foreigner, their crystal clear blue eyes boring into my thoughts.

After 14 hours of driving in which we covered 250 km, the white-washed clinic came into view — the only white building in a town of dusty brown mud huts. It used to be a hospital, but was destroyed by bombs 4 years ago. MSF reconstructed part of the building but the rest remains derelict, a remnant of war like the conglomeration of Russian tanks rusting beside it.

In addition to managing an existing clinic and providing medical backup for the Afghan physician, I train all clinic staff. I am also extending the outreach immunization program, training health workers in villages about disease recognition and public health, and responding to emergencies and epidemics. Finally, I teach land-mine awareness to a people whose lands are surrounded by the highest concentration of mines in the world.

The wonderful people in the clinic were hard working but the clinic's imperfections were immediately obvious — and overwhelming. The waiting area was chaotic. The women, 95% of whom are illiterate, had never had to wait in line before and did not understand how or why they should do so. The clinic manager seemed unmotivated. The health care workers prescribed too many antibiotics. Even the pharmacy was running out of medication.

After 4 months of teaching and brainstorming with the Afghan staff, things looked much better. The final segregation between the male and female sides of the clinic were completed. In a land where Islamic law enforces gender segregation, it was amusing to note that we had to construct physical barriers to prevent women from milling with men. The clinic manager was collecting statistics, writing reports, managing his staff and effectively organizing clinic activities. Fewer medications were being used, and the Afghan doctor had begun a weekly training program for the health workers. A cholera epidemic had been very effectively managed. The worst drought in 17 years was continuing and aid organizations that distribute food were slowly responding to our drought survey.

Being a foreign woman in Afghanistan has many advantages, not the least of which is being free to work. Despite Taliban law, I walk alone from compound to clinic — a 10-minute walk — every day dressed in a light cotton shalwar kameeze and chador. I speak with local people along the way. I socialize with both men and women and am often invited to homes. Having spent many evenings lounging on cushions conversing with our night guards, Abdulla and Abdulkhadir, my Farsi has improved, enabling me to visit homes of those women who have never received foreign visitors. Occasionally we visit nomads in their tents. Despite the requirement of a male escort for longer walks and trips, I am freer than my male counterparts. Because it is culturally unacceptable, foreign men do not have the experience of visiting people in their homes, drinking tea with families, laughing with the women and playing with the children. The houses are the domain of the women. After the age of 14, men and women are completely segregated, with the exception of family members and foreign women.

The Afghans I have met are wonderful, welcoming, honest people. Their ways are heavily criticized by the Western world, but having worked with them and visited their homes, I have gained respect for the Afghan way and the difficult circumstances in which they live. The solutions for them are not simple. Many believe that the Taliban, despite their rules, provide a more peaceful existence than in previous times. For the villagers of Bala Morghab, religious belief gives them strength and hope for the future. 

![Figure1](http://www.cmaj.ca/https://www.cmaj.ca/content/cmaj/163/12/1601/F1.medium.gif)

[Figure1](http://www.cmaj.ca/content/163/12/1601/F1)

Figure. Maureen Mayhew