Gratitude

Space! I barely even realised how much I had been craving it until I got some and felt such an incredible rush of happiness. From the moment the plane took off I felt as though I had been set free from a kind of prison. Space! As we flew over the plains of Herat and then up over the mountains of Ghor, I had this huge, silly grin on my face and my spirit felt lighter than it has in weeks. This week I was grateful for space and the freedom to move through it. Cheghcharan, the provincial capital of Ghor is a small, poor town. I spent some time this week in the bazaar, trying to buy decent clothes and shoes for the orphanage, because I hadn't brought enough with me from Herat for the number of kids that I found when I got there. Here are some images from the market. This week I was grateful for my income and what it enables me to do. Most of these children are not orphans, although many would come from women-headed households. Some even have fathers, but their families are too poor to care for them. On my first visit the Director explained all this to me, and shocked me with his announcement that they had between 250 and 300 children in the orphanage (I suspect some of the children come and go from their family homes, hence the approximate number). I realised that I couldn't possibly give enough for all the children on this visit, so I suggested that most of the clothes and shoes I had brought would fit the youngest children. Next time I visit I'll take something for the older children, probably books and pens, I think. So we agreed that the Director would sort the clothes into approximate sizes and I would return on Thursday morning so we could distribute them together to the smallest children. When I arrived on Thursday it was snowing. The Director brought me into the yard of the orphanage and as I stood there, not quite sure what was going on, all the children filed out of the buildings and stood around the yard, in the snow, looking expectantly at me. I desparately tried to tell the Director that I didn't have enough clothes for all the children, and that in any case they shouldn't be standing out in the snow. Just as I was beginning to feel completely overwhelmed by the terrible situation I had created in my clumsiness a car pulled up and my fabulous colleague/assistant got out, he had finished his meeting with the Governor and decided to come and see how I was doing. As he stepped out of the car I burst into tears, explaining that I had got myself into this horrible situation and begging his help to fix it! He was great, we explained to the Director that it was too cold for the children to wait outside and he explained to the children that this time we only had clothes for the littlest children. He helped me organise for all the children to go inside and then come out in small groups so that we could fit the clothes and shoes properly. My other colleagues arrived - Muna and Harry - and they were fantastic. I watched Muna gently trying to fit the tiny, cold feet and arms into our second-hand boots and jackets. Meanwhile Harry was slipping polar fleece hats onto cold little heads and checking which children didn't have socks so that we could make sure they got the best we had. This week I was grateful for my colleagues, good hearted and hard working people on whom I can rely and with whom I can have fun. This little girl was being helped by an older boy. From what I could make out he was not her brother, but he was beautifully gentle with her and a very good advocate for her, making sure she got everything he could find that would fit her. The little boy on the left has his new hat, boots, jacket and fleecy shirt and pants on as well. In the end, things became a little chaotic again, as the older children all made their way out into the yard and wanted to get somethings for themselves. I had bought six footballs and so we told the teachers to let the children play with them, we also found a box of clothes donated by someone from the Lithuanian PRT which had not been distributed so we were able to give some of the older children clothes, hats, gloves and shoes from that box. This week I was grateful for the chance to give and most of all for the fabulous Commander, whose idea this was in the first place and whose generosity and kind-heartedness help me keep my faith in the good. Another highlight of this mission was my visit to a community-based girls' school in Dowlatyar. The girls were studying mathematics, chemistry and physics when I arrived. When I asked them how many wanted to be doctors, teachers, lawyers and engineers respectively, most of them said they wanted to be doctors. Which means they are aiming to get the highest grades possible in their exams. I told them about Maria Bashir, the women who was recently appointed to be the Provincial Chief Prosecutor in Herat and said I wondered whether the next Director of Public Health for Ghor province was in the room. Perhaps this beautiful girl? This week I was grateful for my education and everything it has brought me, including the chance to work here. And finally, just to prove I was there, here is a photo of me with my fabulous colleague Reza (on the right) without whom I wouldn't be able to do anything useful at all, and our counterpart from the Afghan Independent Human Rights Commission, Mr Hakak. This week, as always, I was grateful for Reza! We stopped for a photo op on our way to Dowlatyar, and I felt free as a bird after these weeks of restricted movement in Herat. I also got to walk from one village to the next through the snow in Dowlatyar - much to the astonishment of the locals who seemed to expect a foreigner like myself to collapse in a heap of helplessness as soon as I stepped away from the 4x4! This week I was grateful that I can walk with ease. One final set of photos - the rest are on flickr if you want to see more. These men bring the wood in from the country-side to Cheghcharan town every morning to sell it for fuel. Their donkeys are piled high with dried scrub and wood. I worry about the environmental impact of this practice, but have no better option to offer them right now so I am grateful for the warmth given off by the wood stoves that I found in every office I visited, and (thank goodness) in every prison cell as well. This week I was grateful for bukhari (stoves) There are some strange loud noises going on this morning, it sounds like explosions somewhere in the city. More often than not these are controlled explosions, getting rid of unexploded ordinanaces found by the demining teams, but it reminds me that I'm back in Herat and won't be able to go out walking as I please until I go home to New Zealand in February or when I return to Ghor, whichever comes first. This week I am grateful for being able to travel.

Afghan women saving mothers' lives

Last night I was having an after dinner drink with some colleagues and visitors from Kabul and we got onto the topic of midwife projects here in Afghanistan. I raised the subject because of a very cool Icelandic woman who is based up in Chegcharan in Ghor who is a development advisor to the PRT and who has been putting lots of energy into getting midwife training happening up there. This story was in the news yesterday. I found it both disturbing and somewhat encouraging. Nothing really seems very encouraging in this country, but here is a little step that might make a big difference to some women and babies. Afghan women saving mothers' lives Dec 17 - (AFP) In a white coat and with a dark scarf covering her hair, newly graduated midwife Fatema, 20, is just months on the job and still a little nervous. But the determined young woman has no doubts about the importance of her work in a small clinic in rural northern Afghanistan, a country with one of the world's highest maternal mortality rates. Fatema's elder sister bled to death in childbirth when she was 16, having been married at 15. Her baby's shoulder became stuck in her small pelvis and two traditional birth attendants broke its neck trying to pull it out. It was a complicated breech delivery, with the child positioned bottom first, and the untrained birth attendants -- who help 80 percent of Afghan women have their babies -- did not know how else to handle the problem. "Look, if someone had known something at that time, we could have referred them to go to hospital," says Fatema, which is not her real name because like many Afghan women interviewed for this story she did not want her name to be used. Lack of knowledge and superstition amongst the rural community in Takhar province spawned rumours afterwards that the dead teenager must have been "bad" to deserve such a fate. When the British medical charity Merlin came to Takhar in 2004 to look for women to train as midwives, Fatema jumped at the chance. In February she and 20 other women became the first graduates from a USAID-funded 18-month course at the Community Midwife Education centre in the provincial capital Taloqan, returning to their districts with internationally recognised diplomas to improve the chances of women surviving birth. War-shattered Afghanistan is behind only Sierra Leone for the highest number of women to die in childbirth. The maternal mortality rate here is around 1,600 out of 100,000 live births, according to a recent UNICEF survey. This means that one in six women between the ages of 15 and 49 die giving birth. This compares with a rate of about 13 out of 100,000 in Britain, where one in 3,800 women die in childbirth, according to 2000 UN statistics. There are many grim stories to illustrate the problem in Afghanistan: of traditional birth attendants, called dayee, cutting a baby's limbs off with a kitchen knife in a desperate attempt to save a woman's life when something went wrong in delivery; of pregnant women bleeding to death on a days-long donkey ride to find help at a far-away health facility; of husbands beating their pregnant wives' bellies because they can't afford another child. "It is the worst I have ever seen," says Addie Koster, who heads the Taloqan centre and has worked in Afghanistan for the past five years after stints in Africa, Asia and Central America. There are many reasons so many women die, says Koster, most linking back to the 25 years of war that destroyed the country's infrastructure and entrenched a social system that denied women basic rights. Often mothers' pelvises are too small for birth, she says. This can be because they are young -- with nearly two-thirds of girls married before age 16, according to statistics cited by the United Nations -- or malnourished as about two-thirds of pregnant Afghan women are. When complications arise, the difficult terrain and lack of infrastructure can mean clinics are days away although some women are too poor to even afford the donkey ride. Dayees sometimes rely on folklorish techniques -- such has biting on hair to dislodge the placenta -- that may appear to work in simple births but are of little use when things go wrong. More dangerously, they make liberal use of oxytocin -- an injectable hormone that can be bought in the smallest bazaar without a prescription -- to induce labour even when the baby just cannot fit through the pelvis. In a custom entrenched during the 1996-2001 rule of the ultra-conservative Taliban who forced women under the all-covering burqa that most still wear, some men still refuse to allow their wives to go to clinics where only a male nurse or doctor is present. Taloqan's Community Midwife Education centre is a key part of a strategy taking on all these problems. One of its main aims is to boost the number of women in the province giving birth with the help of a skilled attendant from the current eight percent. Province-wide clinics are being built -- although in one case staff operated out of tents for two months before being able to move into a newly constructed building. Female staff are being trained and recruited from other provinces, even other countries; community meetings are explaining the benefits of pre- and ante-natal check-up, having a baby with a trained midwife, and breast feeding. Another of the centre's fresh graduates, 22-year-old Lailuma, is installed in a clinic far from the provincial capital. Since arriving in April, she has helped with 15 deliveries -- up from zero before she arrived because women would not see the then male-only staff. "The area where I live is very remote. There were no midwives," the stylish woman says softly, a black scarf framing her face. "I wanted to become a midwife because I wanted to do something for women." Twenty-two new students have been in place since April, learning to suture on chunks of raw meat and delivering the same dummy baby over and over again before getting down to the real thing. They are not shy about describing the difficulties facing Afghan women. "There are no cars, no road, no transport. And security is not good," says one explaining why most rural women give birth at home. "The dayees know nothing. After 20 years of war, no one knows anything. We have been left behind because of the war," says another. "During the Taliban it was worse," adds one more, recalling the government that refused to let women work which meant there were few female doctors for them to see. The situation is improving in provinces like Takhar which see little of the current Taliban insurgency, which is focussed on the south and east of the country. When the hardline regime fell, Takhar had only five female medical staff, says provincial health chief Hakim Aziz. Today the number is well on the way to the goal of putting at least two women into each of its 52 clinics. And whereas a community health clinic once saw on average five deliveries a month, there are now about 25, Aziz says. The new students at Merlin's centre were selected by their communities for the program and are obliged to return after graduation to work for at least five years. They will go a long way towards filling the 32 vacancies for midwives in Takhar, says Nezamuddin Jalil from the Social and Health Development Program. The group runs nine of the province's clinics including Fatema's at Bangi, a community of about 30,000 people 30 kilometres (19 miles) from Taloqan and dotted with green flags marking some of the fiercest battles of the US-led offensive that dislodged the backward-looking Taliban. "We started from zero," the doctor says. "There was no staff, no access. Now we have enough health facilities and enough equipment. But there is a lack of female staff." Despite the challenges, "day by day it will be ok," he says.

Through the fog of peace?

Last night I was drinking tea with three journalists from The New York Times, The Times (UK) and Associated Press, respectively. Between the three of them they have years of experience in Afghanistan (as well as Iraq, Chechnya and all the other fun places), but each of them has been out of Afghanistan for some time and had recently arrived back. So I was listening carefully to their assessments of the current situation and their prognosis for the future. The outlook was not cheery; they had been taken aback by the level of disappointment, anger and resentment amongst the population here, apparently a dramatic shift from recent years. They felt that defeat of the Taleban insurgency would require a long term (i.e. 15 year) commitment of thousands of troops. Another day I will write more about the ensuing discussion about military strategies for fighting insurgencies – first I need to find and read a book they were referring to which apparently sets out recommended rules of engagement for such situations. But for now, I was left reflecting on this anger amongst the Afghan population. My question to them was whether this was a general disappointment and anger at lack of progress in making basic improvements in their lives, or whether it was a more specific set of complaints against this Government (are they perceived as corrupt, as selling out Afghan values to the Americans and the other foreigners?). They told me what I’ve heard before many times, people are furious at what they see as the massive waste in the implementation of development assistance. People believe that a lot of aid money disappears through embezzlement and corruption, and they accuse not only the Government and the big contractors, they also accuse NGOs and their implementing partners of this corruption. People also criticize the mutli-layered structure through which much development is delivered. Delivery of development assistance here is complicated. Firstly there is the question of how the money comes into the country. Some money comes (or is supposed to come) to the Government through commitments under the Afghan Compact. The Afghan Compact is the multi-lateral donor agreement with the Government of Afghanistan which provides for the government’s, very modest, operating budget and some even more modest funds for implementing development and infrastructure projects). Other funds come to the Government through bilateral assistance from the big donors. But in some cases donors insist on maintaining management of the implementation of their development assistance, so that USAID directly manages much of the USA’s development assistance in Afghanistan. But neither the Government of Afghanistan nor the big donor government development assistance agencies are actually able to implement all the projects – so the next layer comes into the picture. The GoA, for example, contracts with implementing partners, private companies and NGOs. In some cases the projects are so big (like the National Solidarity Programme) that one large implementing agency is contracted to coordinate implementation through another layer of direct implementing partners. The same is true for the large projects funded and managed by USAID and others. At each layer of this structure you have a mix of organizations. Some are extremely efficient and effective with minimal overhead costs and great track records on delivery, monitoring and evaluation. Others are less efficient, and carry heavy overhead costs which obviously eat into the funds available. One significant factor that affects overheads in development and infrastructure projects here is the cost of security. Again there is a huge variety of approaches taken to security. Some NGOs like ActionAid adopt a strategy of low visibility to protect the security of their staff, beneficiaries and projects. Recently here in the west World Vision has decided to shift to a lower visibility approach after four of their staff were killed in past months. At the other end of the spectrum projects directly implemented by the US Department of State, like the Justice Sector Support Programme, adopt a very different approach with armoured vehicles and armed close protection agents for even the civilian staff (one came to our office with some JSSP team members recently and completely freaked out our staff – his resemblance to Rambo was striking). Construction projects also utilize very different approaches to security, some rely on the Afghan National Police and Army (ANP and ANA) for protection, and others employ expensive private security companies. Consulting firms and private construction companies also employ huge numbers of private security guards for their guesthouses. Most NGOs, on the other hand, employ local guards who are not armed, or rely on the ANA and ANP. The UN has a policy of working with national security forces to provide security for missions such as UNAMA, so we also work with the ANA and the ANP. But with all these different layers, and the expense of security arrangements, you can start to see why people here use the image of a snow ball being passed through many hands to describe the way that development assistance makes its way to communities in Afghanistan. I don’t know how much actual embezzlement or corruption goes on, although I hear constant reports and rumours, but I can see that even without dishonest being involved it is reasonable for Afghan people to feel they are not getting the full benefit of the aid dollar. The debate about implementation of humanitarian aid and development assistance in Afghanistan has many other facets. While citizens complain that private companies cost too much money, the Government continues to sub-contract its large education, health and infrastructure projects because it doesn’t yet have the capacity within its own structures to implement such large scale projects (and don’t governments in other developed and developing countries also sub-contract out major infrastructure projects?). Meanwhile NGOs argue that the involvement of the International Security Assistance Forces in humanitarian aid and development assistance (through the PRTs – Provincial Reconstruction Teams) is blurring the lines between military and humanitarian intervention, confusing the population and increasing the security risk for humanitarian workers (who offer much ‘softer’ targets than the soldiers), some PRTs respond that if there were some NGOs present in the areas in which they operate then they would be more than happy to leave the humanitarian work to them, but since there are not they figure someone has to do something. Of course, the response to this is that the confusion of military and humanitarian action is making it too dangerous for NGOs to return to some of those areas so the cycle is self-perpetuating. The question is whether it could be done better. This is the question that the journalist from The New York Times asked me. He wanted to write a story about the critical role of development in determining success or failure in Afghanistan. After long discussion about the military strategy and the prognosis for its success (it seems these guys think that a definition of what will actually constitute success would be a good start) they wanted to hear from me about the other major strategy – development. He wanted to know what was being researched, written or talked about in development ‘circles’ as offering a better alternative. Are there any models out there that have worked to provide effective development at low cost? I thought about the community-based participatory approaches taken by organizations like ActionAid and the efforts made to build those elements into the National Solidarity Programme here. But I want to hear from my friends who know more about current research on development assistance in post conflict settings (Amanda and Immy, I’m pointing at you in particular). I would argue that alongside what is conventionally thought of as development assistance (building bridges, roads, water and sewerage systems, dams, schools and hospitals, training teachers, midwives and engineers) there is a need to emphasize human rights in any strategy to stabilize this or any other post-conflict country. When I talk about human rights I’m thinking of everything from the traditional sphere of civil and political rights (strengthening the justice system and rule of law) to the need to integrate a human rights approach into all economic and social development projects. It sounds like a mantra, like a rhetorical flourish that I’ve practiced and repeated through years of working in human rights organizations. But whenever I really sit and think about what went wrong with an intervention, or what could have been done differently, I find myself thinking of barriers that constitute barriers to full enjoyment of human rights. Conversely when I try to creatively imagine where the opportunities lie for leveraging meaningful changes with small interventions, I find that I am imagining opportunities that translate into steps towards better realization of human rights. At least I know that I’m working in the right field – the question still remains whether I’ve worked out how best to apply myself to the field. But that seems like a life-long question. So I won’t try to answer it today.