Chitral
A year passed before I was able to save enough money and return to Pakistan to volunteer again with FM. I’d bought a condo, which had obliterated my savings account but had given me a real home, a place to always call my own. I needed that sense of security and belonging—I’d become an unintentional outsider, working per diem, my ears tuned only to the world news, my heart with the refugees, my focus on getting back to a place that needed me.
I arrived back in Pakistan as a seasoned aid worker. I carried a sturdy lipstick, scrubs for sleep, and what I felt was a wealth of experience. The team here now was entirely new; even Ella had left and joined another NGO based in Quetta along the southern border of Afghanistan and Pakistan. I was asked to go to Chitral to staff a small outpost clinic in the northern mountains. The village of Chitral was a small border town in the northeast corner of Pakistan, a lush green area nestled between several mountains with a small, muddy river snaking through the valley. The surrounding landscape was exquisite and tranquil, but the village, and nearby Garam Chesma, were the staging areas for freedom fighters and refugees returning to or coming out of Afghanistan. It was the first stop, too, for those who had left Afghanistan injured or ill and in need of medical care. Freedom Medicine ran the only clinic in the area, and I would work alongside an Afghan medic, Noori, whom I had trained on an earlier trip. It would be just the two of us providing whatever care we could.
Our small compound was primitive by any standard. Located just outside the village center, a small mud and plaster clinic building and a cluster of tents stood at the edge of a rickety old airport, the runway a collection of rocks and ridges, where, once every few days, a small, sleek plane would land, carrying UN supplies, locals who could afford the cost of the flight, and, inexplicably to me, the occasional tourist.
I shared the compound with the medic, several bodyguards, a cook, and occasionally some freedom fighters—all of whom treated me like a sister. I had a tent to myself; my only furniture was a cot, my only light my flashlight. I did have my own “bathroom,” a small plaster room that I shared with countless croaking, slimy frogs that slithered and jumped about endlessly as I tried to wash or squatted in this indoor latrine. I rose about 5:00 A.M., breakfasted on strong, black, instant coffee and smoked a cigarette, “my American breakfast,” I told them. The Afghan staff ate the traditional flat bread and drank green tea filled with sugar, and after a while they added my cigarettes to their daily fare. The scant two cartons I’d brought didn’t last long, and when I ran out, I went to the village bazaar and bought American cigarettes that the Afghans had hijacked from Russian supply trucks and then sold to help support the resistance. When the bazaar ran out, I was forced to smoke Chinese cigarettes. They tasted and burned as though they’d been dipped in gasoline. It wasn’t long before the Afghans lost interest in sharing my cigarettes.
Aside from my cigarette woes, my routine was simple. Since I washed at night and slept in my clothes (this time, it really did seem prissy and impractical to wear a nightgown), I had only to splash water on my face and I was ready for the day. My night routine consisted of washing my face, my feet, and my underarms. I would take off my socks, shake the dirt off, and turn them inside out. Once I put them back on, I felt clean and fresh again. There wasn’t enough water for more than a weekly bath, and there wasn’t much need. The mountain air was cool and refreshing here, not the sweat-inducing heat of the south.
Patients began arriving at the clinic early and were given numbers to mark their place in line. By 8:00 A.M., we were seeing our patients. The medic saw the men and I saw the women. I had picked up and remembered enough of the language to do most of the exam and history on my own. Those vital Dari words and phrases would stay with me, tucked away and hidden in the deep corners of my mind, and when, years later, I returned to Afghanistan, so did the easy feel of the language return to my tongue.
When I called “yak” for number one, the first patient or family of women and children shuffled into the clinic. The exam table was a small, canvas-covered army cot, a leftover from our very first clinic in Thal. The patients and I sat together on the edge of the cot and tried to sort out their problems. “Che taklif dori?” ‘What is your problem?’ I’d ask.
Just as in Thal, the complaints were varied—sore throats, earaches, minor skin infections, headaches. Equally common and familiar now were the complaints of tuberculosis (TB), malaria, intestinal parasites, dysentery, and, always, the terrible malnutrition that complicated all of their other problems.
The clinic was supplied with an abundance of medicines, chloroquine for malaria, Flagyl for the intestinal parasites, antibiotics for most other infections, including TB. Still impossible to treat was the malnutrition. Though there were refugees in Chitral, there were no UN camps, no way for them to register for rations from WFP. I could provide vitamins, but without a proper diet to guarantee absorption, they were useless. The refugees however, believed that vitamins, or any pill, would help, so I gladly handed them out.
Almost daily, we saw one or two patients in our emergency area. The war between the Soviets and Afghans, though reported to be winding down, in fact still raged on, and our small outpost clinic provided the first chance for medical care for many of the young fighters and refugees. But refugee life was hardest on the children, and for Noor, it would cost him his life.
He was tiny—maybe six years old and suffering from horrific second-and third-degree burns to both legs. His family had fled the brutal Soviet advance in Afghanistan and had settled deep in the mountains of northwest Pakistan, not far from Chitral. There, they eked out a living, working the fields and doing whatever odd jobs they could find to survive.
Every family member worked at something. It was Noor’s job to gather dung for fuel, to watch over sheep for local farmers, and to collect water from the streams. There was little time for anything else, but one afternoon in a cherished moment of childish abandon, Noor ran and shouted and played like the child that he was. While racing his friends through the village, he looked back to see if they were gaining on him, and at that moment, an open tandoor oven loomed. A tandoor oven is dug into the ground, a searing fire is always ablaze at the bottom, and a metal cover is fitted over the hole to maintain the high heat. But that day, there was no cover, and Noor’s eyes were on his friends. He never saw the danger until he fell into the blazing open oven.
His screams alerted the villagers, who quickly pulled him out, but the damage had been done. Third-degree burns covered both legs right to his hips. The fire had literally seared and torn the skin and muscle from his legs, but there was no medical care in the village and nowhere else to go. His family kept him at home, where his wounds festered and became infected. By the time a Medecins Sans Frontieres (MSF) nurse came upon Noor, he was septic and dying. His family was terrified of going to Peshawar for care; they were true rural dwellers and simply did not trust big-city medicine. They did agree to bring him to our clinic for dressings and medicines.
He was carried into our clinic by his father, who was accompanied by a harried French nurse from MSF. “You must see this boy. Understand?” Her French accent was heavy, her words rushed. Her head was uncovered, her hair a wild, unrestrained mop of black curls, her cheeks flushed from the crisp mountain air. When she pulled a cigarette from her pocket, lit it, and took a long, slow drag, the men watched her in wonder. Although I smoked, I kept my head covered and wore the traditional clothes of Afghanistan. The French nurse wore jeans and a long shirt. She seemed not to care what they thought.
Her eyes darted around the room until she rested her gaze on me. She gave me hasty instructions on Noor’s wound care as she pointed to his legs, both wrapped in heavy layers of gauze. He let out a screech when she pulled off one of his dressings to show me the raw flesh underneath. “The others are clean. Just re-dress this one today, and if you have any questions, you must send him to Peshawar. Understand? His father will not let him go, but you must insist.” She shook her head, her lips curling down as though she’d just eaten a sour fruit. And, with that, she was gone.
Noor pulled away when I approached. “Aacha,” I whispered. ‘It’s okay.’ I gently reapplied his dressing and sent him on his way, his father promising to return twice a week.
Days later, he reappeared, the heavy gauze sticky with drainage that had seeped through from his wounds. I took a deep breath. Pulling off the gauze would be agonizing for Noor. We tried everything to minimize the pain—we medicated him, soaked the dressings so that they would ease away from the tissue, but still his anguished screams pierced the air. I remember even now how excruciatingly sorrowful were those sounds, how I hesitated with each pull of the gauze, and how frightened his eyes were when he caught my gaze.
His dressings and wound care took hours, and every second was agony for him. This poor boy had suffered beyond anyone’s capacity to endure, and without skin grafts and advanced care, he would never recover. We tortured him every time he came to the clinic, and he came once or twice a week. His father held him tightly while we tended to the boy’s wounds, and he carried him away quickly when we were finally done. There was so little we could really do. I dreaded his visits as much as he likely did.
Though many patients had affected me, Noor was the first one to bring me to my knees with grief. I wanted to give in to my sadness and anger for this little boy. But I didn’t have that luxury. As an ER nurse, I knew I had to distance myself. Noor and so many others didn’t need my self-absorbed melancholy. They needed me to help, and to do that, I had to be fully present. I’d have time enough for sad reflection when I returned home.
When I hadn’t seen Noor for a few weeks, I knew that mercifully, his suffering was over. His one moment of joyful play had cost him his life, a lesson that the other boys in his village would surely long remember and I would never forget.
Just as in Thal, we also saw many others—babies, children, and adults—all suffering from severe malnutrition. One of these children was a tiny, malnourished girl named Laila, who was tenderly carried into our clinic by her equally malnourished father. Laila was about two years old but looked about one. With her big belly, loose skin, haunting eyes, and wispy hair, she reminded me of Mariam. When I examined her, she made none of the squeamish moves normal for a two-year-old; she had no reserves left, no more fight. It took all she had just to keep her eyes focused on me, and she watched me with the wary eyes of a child who had suffered plenty in her short life.
There was little we could offer—a small amount of food and a few rupees to purchase a little more. The terrible reality was that Laila was dying and there was little we could do. We had no nutrition program, though it was clear we needed one desperately. FM’s grants only allotted money for training freedom fighter medics, as well as our two small clinics in Thal and Chitral. There was no leeway in our spending.
Sadly, there were still hundreds of thousands of equally malnourished Lailas and Mariams in the refugee camps along the border. They were still the most difficult patients. We could not fill their bellies; the best we could do was to share our midday meal. Though many took us up on that offer, it was precious little to children who needed so much more, but perhaps to remember them even now and to keep them alive in stories honors their short, brave lives in some small measure.
Into all this sadness, a Chevy station wagon arrived at our compound late one afternoon. Two men emerged, clad in jeans, plaid shirts, and heavy boots, one carrying a paper bag under his arm. The Afghans watched in wonder. “Hey y’all,” one of the men said, “Mike told us to drop in and see how you were doing.”
I smiled. Mike had been the construction and all-around whatever-needed-doing guy in Thal, who’d always hinted at mysterious connections. These men were clearly CIA. Who else would drive around this border—dangerous not just for the explosives buried here but also for the roads, which were equally, or maybe even more, treacherous.
“Y’all gonna invite us in? We got something for ya.” He pointed to the bag he was cradling under his arm.
The Afghans’ eyes drifted from our visitors to me. It was imperative that I be seen as a good and honorable woman. Once these men left, there couldn’t be any rumors that might endanger me. I hesitated. “I . . .”
“Well, just show us your tent then,” one said, sensing my discomfort. “We got some good old American tea for you right here.” The Afghans nodded in understanding. Tea was okay; in fact, tea was good.
The men followed me to my tent, the Afghans drifting away but likely still watching. I left the flap open so there’d be no doubt that this was an innocent visit. We sat cross-legged on the floor and introduced ourselves, though they already knew who I was. Jack opened the bag, drew out three cans of beer, and passed one to Gary and one to me. “Open it,” Gary said.
“I don’t know.” I cradled the warm can in my hand. “I have to be careful. I can’t have any rumors getting to the local mullahs.”
“Well, just have a sip then. We’ll leave the rest for you.”
The offer was tempting, enormously so, but the risks were greater. These men would drive off shortly and I’d be left here to deny any wrongdoing. It seemed best just to avoid it altogether. I shook my head and slid the beer back. “I would love to drink this,” I said, “but I’ll just have to wait for the American Club. Maybe I’ll see you there?”
Gary and Jack finished their beers and stood to leave. “Y’all be careful up here, ya hear?” Jack said as they piled into their car. I stood and watched as they maneuvered that old Chevy back through our gate and along these rocky roads, hoping I’d get to really share a beer with them at the club.
Before I left for home, I flew to Quetta, in southwestern Pakistan, to see Ella. She was working there with another American NGO. Quetta was a squat and squalid city, dotted with colorless one-story buildings, the scene unbroken by grass or trees. It was also a deeply religious city and the city to which, we all later learned, Al-Qaeda funneled money for religious indoctrination and terrorist training in the late 1980s. Ella was working in a local hospital, teaching nursing. The hospital was a short distance from the house she shared with other members of her team. There were several religious schools, called madrassa, for boys, located between the team’s house and the hospital. I had noticed the schools along the road but had never given them much thought. I had become that confident, cocky ER nurse once again. I felt safe in one of the most dangerous places on earth, and that sense of safety made it all the more perilous for me.
One afternoon, as I walked alone from the hospital to the NGO house, I passed a school just as scores of young men and boys were being released for the day. I was dressed not in the full veil and covering I had worn in Chitral but in long, loose pants, a large long-sleeved shirt, and a lacey scarf to cover my hair. It was typical expat attire. I also had my sunglasses on as I walked in the heat of the midday sun. Although my clothes were respectable, it was clear that I was a foreigner, something I hadn’t even considered until the boys began to pour out of the gate. I stood in stark contrast to local women, who would have covered up under the full cloak of the burqa if they’d even dared to venture out alone.
The road home was long and isolated, no shops or cars or people about, just empty expanse. As the young men’s footfalls sounded behind me, I felt the first stirrings of fright. They began to laugh, and then moved closer, taunting me. The air crackled with tension. Finally, I felt the sting of a rock hit my back and I came to a full stop. The group was suddenly silent. The only sound was the frantic throbbing of my own heartbeat as it pounded in my ears. I couldn’t seem to catch my breath, and my skin felt clammy and cool even in this miserable heat. My thoughts raced in a confusing maze as I tried desperately to simply think. There was no hope of rescue; I was well and truly on my own. I knew my options were few. There were too many boys and I couldn’t risk inciting them further. I never turned to face them; instead I resumed my steps and gauged the distance to the NGO house.
And with those first steps, the rocks began to fly in earnest, many finding their mark on my back. As the distance to the NGO house closed in, I began to run. My fear gave me wings. I was a runner at home, and I knew I could make it. Breathless, I flew around the last corner and quickly opened the gate to the house and jumped in. I slammed the gate and hurried to lock it. As the bolt slid into place and I slid to the ground, I heard the crowd of thugs reach the gate. They shouted and threw their remaining rocks at the impenetrable walls. My tearful sobs were great gulps of empty silence as my tormenters milled about just feet away. They lingered for only a moment and then moved on, never aware that I hugged the other side of the gate, afraid to move, tears stinging my eyes.
I had learned what it was to be an outsider.
I shared my experience in Quetta with only Ella and her housemates. They at least would understand the situation. People at home never would. It just seemed best to keep that incident to myself. And, as I reminded myself, I’d survived to tell the story. It was best not to make a big deal of it.