Amir and the Distant Clinics

Although there was misery here in Bamiyan Province, there was good news, too. We drove several days a week to distant villages to provide much-needed health care. In one of those clinics, in a village called Shaidan, a small boy of about ten pushed his way in and introduced himself. “Salaam aleikum, chetore asti, khoob asti, jonna jurast?” he greeted me. “I am Amir. I want to help,” he declared, a sparkle in his eye. Though dressed in rags, barefoot, and likely hungry, he carried himself with the distinction and self-satisfaction that only a young boy can muster.

“What do you want to do?” I asked. He’d apparently been watching, and he pointed to the growing crowd. “I’ll be your assistant, your chowkidor, a doorman.”

“Aacha, okay,” I said, still not sure exactly what he planned to do.

A heavy and tall wooden gate and mud wall surrounded this clinic, which consisted of a tent and small plaster building perched on a rocky ledge. The ledge was always crowded with people hoping to be seen. To help manage the crowds, I first triaged the group so that we might see the sickest first. Once that was done, we gave out numbers and tried to see people in some sort of order, women and children first, and then men. And that was where Amir took over. He kept track of the numbers called and happily shouted out the next number, granting entry to our patients only when it was their turn. He held out his hands and stamped his feet to keep people from crowding the door. Those waiting sometimes hurled angry insults his way, but he stood firm, guarding our door with an iron hand.

When I first met him, I wondered how he found the time to help us. UNICEF had opened a school in Shaidan, and Amir should have been there. “No, no,” he muttered when I asked. “How can I go to school? There is too much to do. Besides, I know my numbers. That’s all I need.” He told me that he had to work as a shepherd to help support his family and that his father did not want him to go to school. That was the tradition here in the distant hills of Afghanistan: everyone had to contribute to the household. Amir was one of six living children; two others had already died. His family suffered from a chronic lack of food, money, and hope, but the little that Amir earned in the fields really did help his destitute family.

The Taliban had never encouraged education here and had actually forbidden it for girls. The Taliban knew what vicious dictators around the world know—an uneducated population, unable to read, unable to understand the world around them, is much easier to control. But with the Taliban on the run, UNICEF was fighting back, opening schools around the country and encouraging all children to attend. Those who did could be seen scurrying over the dusty roads, happily carrying their plastic UNICEF bags filled with notebooks and pencils and the seeds of dreams. I wanted all of that for Amir, who, though working long hours in the fields, appeared faithfully at the clinic when I was there.

I couldn’t pay him. If word got out, there’d be trouble with the village elders, who’d want us to pay their own children. Instead, each week, I tried to bring him a small gift, something just for him. I asked the Afghan staff in Bamiyan to help me choose the gifts. At first, I asked them about toys. “Where can I buy toys?” I asked. “What do children here play with?”

The Afghans furrowed their brows and looked at one another. “Toys,” I said again, louder this time, mimicking throwing a ball or driving a small truck. The Afghans laughed. “There are no toys here,” they replied, and though they didn’t say it, I could see it in their eyes—that, for a foreign woman, I was likely stupider than they thought. It turned out that children here, as in so many places around the world, created their own playthings out of objects that they found, much like the oo-lak that my neighbor children had made.

Although I couldn’t give Amir toys, there was much that he needed. One week I got a sweater, then sandals, later a small world globe, and finally, a pen and paper, the last ones in hopes that he would someday go to school. No matter the gift, Amir was effusive in his thanks. “Besiar tashakore,” he said, repeating it over and over. A friend from Maine sent me a box of toys after I had written about Amir and my fruitless quest to find playthings here. The box included small action figures and plastic soldiers. I was sure that Amir would need some kind of toy orientation before playing with them, but as soon as his grimy little fingers pried open the box, he quietly drew in his breath, grinned widely, whispered “Tashakore,” and ran off before anyone could grab his treasures. He never returned to the clinic that day.

Amir and I often talked about his future; I told him that I hoped he would be president one day and to do that he had to go to school. “If you get an education, you can do anything,” I said.

He always shook his head and giggled at my hopes for him; his own dreams for the future were much smaller and more practical—enough food in his belly and a place to sleep at night. I struggled to instill in him bigger dreams and hopes. For the future that Amir envisioned and that his father envisioned for him, school was an unnecessary distraction. Why learn to read, for after all there is nothing to read here, no books, no magazines, no newspapers, no reason to learn. To count one’s sheep or goats at the end of a day in the fields, that was all that mattered to Amir and to millions like him around the world.

I pointed to a plane flying overhead one day. “You could fly that plane if you wanted,” I said. His eyes followed that plane until it faded into the blue of the distant sky.

“How?” he asked, as though I’d offered the impossible, and in a way, I had. “School,” I answered triumphantly, certain that he finally understood what I’d been saying all along. “You could even be president one day,” I added. Amir rolled his eyes. I’d broken the magic of the moment with that last thought.

I didn’t give up the struggle though, and when his father appeared at clinic to collect his son, as he sometimes did, I’d take him aside and ask him to reconsider school for Amir. He inevitably shook his head. “Nay,” he replied firmly each time I asked.

“Well, just think about it,” I pleaded, determined not to give up.

Amir missed clinic one day, and I assumed he’d been too busy in the fields, but at our next clinic, he arrived when we were just finishing up. “Salaam-aleikum,” he cried, raising his hand in greeting. In his hand was a UNICEF school notebook. He opened the pages and pointed to the Persian script, which he was learning to read and write. He was the first in his family to attend school, and to wonder if someday he might fly that plane, or maybe even be president. And, busy as he was, with school and work in the fields, he still did his best to get to my clinic, to manage the door and the patient flow. I felt as proud of him as if he’d been my own child.

When I left Afghanistan, we had a tearful good-bye, and he promised me that he would stay in school and study. I think about him often, and I hope that he has been able to do just that. For Amir, the reality is that he is probably back at work in the fields, tending sheep and helping to support his family.

Another of our regular outlying clinics was held weekly in a village called Garganatu, a three-hour drive, compared to Shaidan’s one hour. The roads were dustier, rockier, and more angular, curving through villages larger and smaller, but Garganatu was centrally located to several other villages, so it was there we set up our clinics in a crumbling but still serviceable one-room storehouse without windows and just one door-less entry that didn’t allow in much light. One Afghan physician and I usually made the trip, sometimes with another expat, though most often it was just the two of us.

The villagers trekked for miles and waited for hours to be seen, and when they saw the dust of our jeep coming through the village, they ran to crowd the doorway. They stood outside waiting noisily, each one more aggressive than the last to prove that he or she was sicker and should be seen right away. They knew already that we could not see all comers, since the ride back was long and we’d have to leave enough time to be sure we would be off the roads before dark. This meant that many would go home disappointed, which made them all the more anxious to be seen.

Compounding the problem was the high number of malnourished babies here in Garganatu. A large part of the weekly clinic was follow-up and distribution of nutritional supplements to the babies and mothers. There were several acutely malnourished babies in this village whom we had wanted to bring to Bamiyan for admission to the hospital. Without intensive monitoring, IV hydration, antibiotics, and supplemental feeding, it seemed certain that some of these babies would die. The hospital at least offered a chance for the sickest of these babies. Very few villagers agreed to come to Bamiyan; it was just too far away and they were afraid—of the distance, the hospital, our Western ways, and the strangeness of handing their babies to people they didn’t know for treatment they didn’t understand. All it took was one whispered rumor of a baby who had died in Bamiyan, and the villagers were steadfast in their refusal. Despite my promises and stories of success, they refused to leave their homes or give me their babies for care. I understood their reluctance, and though I never did learn the art of convincing them to do what I thought best, they did what they believed best. It wasn’t that they didn’t love their babies, for they surely did, but the fear of leaving their villages, their families, and their responsibilities was a more frightening prospect.

Aside from the malnourished babies, these villages were inhabited by many elderly, who came with the usual elderly complaints of body aches and fatigue. I guess if anyone in the world is entitled to those complaints, it is these elders, who’ve lived through so much. Still, for all their complaints of frailty, I admired the way they pushed and shoved and demanded to be seen, and seen early and often. Many came every week, and they hated to wait. They were a feisty and engaging crew, and we tried to see them all. I still made it a point to see the children first, then the women, and, last, the men, unless clearly someone was sick enough to be taken out of turn.

We had to work quickly, and there was never enough time to just sit and get to know these people and hear their stories. It inevitably seemed that we ran out of time before we ran out of patients. Those we hadn’t been able to see were promised that the next week, or maybe the week after, they’d be among the first to be seen, but promises are flimsy in Afghanistan, and more than one villager cast an angry glance our way.

We were holding a biweekly clinic now in the village of Acrobad, not quite as far as Garganatu but still another long drive from Bamiyan along winding, unpaved roads. In the village, we were given an old, dilapidated two-room house to set up. We used the first room as a waiting room for the women and children. That allowed the women time to socialize, lift their veils and share a laugh, a rare opportunity in their busy lives. Village women didn’t just raise the children, cook the food, and tend the animals; they worked the fields, gathered firewood, and literally kept the home fires burning.

Acrobad’s children were always covered in dirt and a fine layer of chalky dust that settled onto the dirt. It covered their skin and gave them a ghostlike appearance. I could never figure out where the white dust came from, and no else knew either, though one man thought it might be from the village’s grain thresher. These children appeared at the clinic each time we were there, just to watch us. They hung at my elbow, stared at the patients, rested their chins on their hands, and observed intently as I examined patients. Since none of the patients complained, I let them stay. They were not just a welcome diversion for me; they were also a great help. They would laugh out loud at some of my Dari pronunciations and eagerly correct my mistakes.

“Tashakore, tashakore.” One small boy almost rolled on the floor mimicking the faults in my accent. He held his belly and shook his head. “Khoob n’ast,” he declared loudly. “Tashakore,” he’d shout, encouraging me to try again, and though I always did try again, my Dari never quite met their standards. But they never gave up. As long as I showed up, they did, too, rolling their eyes and poking one another at my pronunciation of their language.

Despite the lack of regular health care, the villagers were really a hearty bunch. Aside from the chronic malnutrition, which affected most to one degree or another, very few villagers were really sick. The complaints were nothing out of the ordinary—a cough, diarrhea, skin rashes—but here the women seemed bolder, more outspoken. They didn’t hesitate to ask about women’s issues—fertility problems and possible solutions. They smiled and giggled when they asked, and though we couldn’t help with their fertility matters, they had some satisfaction in just asking.

As in all of the clinics that we ran, people invariably asked for soap, the little bars of magic which seemed to make their skin shine and glow if only for a day. We always brought plenty. It was such a small gesture, but by improving hygiene, the little bars of soap could literally save lives.

One woman came to our clinic, as so many did wherever I was, without any medical complaint; she only wanted some soap. Her name was Rasa-Begum, and though she guessed her age at about thirty-five years, her rheumy eyes and deeply lined face made her seem twenty years older. She was as thin and washed out as the clothes she wore. As with so many others, Rasa did not even have a place to call home. Acrobad was just a stop on the way to somewhere better, but that someplace was still out of reach.

In a slow, halting voice, with Aasif interpreting, she sat down and told me her story. “The Taliban have always hated the Hazara,” she said, folding her hands in her lap. “You must have heard the way they tormented us—the killings, the torture, the fires—they were the face of evil, but we fought back. All of us. We ignored their new laws; we laughed when we could, and allowed our children to play. And they took notice, and the whispers spread. They’d arrived in Bamiyan, it was said, and they meant to crush us and bend us to their will.” She paused, her eyes drifting beyond me, perhaps remembering.

“Aacha,” ‘It’s okay,’ I said, trying to soothe her. It wasn’t okay at all, but it had become my go-to phrase, the word I used to let people know I would listen and try to help. But I couldn’t help everyone, and Rasa seemed to sense that. Still, she continued.

“We lived out there,” she said, pointing to someplace just beyond Acrobad, a smile creeping slowly onto her face. “Begum, my second name, means ‘a lady of status,’ and I was. My husband had a small shop where he sold tea, flour, biscuits, even Coca-Cola. We were happy, but the Taliban didn’t want anyone in this country to be happy, and so they came.” She stopped and spun the plastic bangles on her wrist.

I forced myself to be quiet. Though I wanted to say something comforting, I knew this was her story and she had to tell it her way.

“It was cold last winter. The coldest winter I can remember,” she said, a sudden shiver rising to her shoulders.

“It’s true,” Aasif added. “In January and February, the temperature was below zero out here. Well below.”

Rasa nodded. “And that’s when they came, when they knew there’d be no escape for us because of the snow and the cold. We could only watch as they slaughtered our animals, and when they were done—they began to round up the men, and that night, as the snow flew and the cold clung to everything, we left. I think that everyone left. We wore our coats and just ran. We carried nothing, afraid of being slowed down.”

“Not even matches?” I asked, thinking that a fire would have kept them warm.

Rasa shook her head. “Why?” she asked, her eyes crinkling. “A fire, no matter how small, would have given us away, and we thought the Taliban would just leave, and we would be back in our homes within days. We ran into the nearby mountains and huddled together, the cold deeper than we’d imagined. The mountains offered no protection from the snow and the freeze in the air. And, I suppose I might have thought then that maybe a small fire would have worked, but the Taliban thought the same, and within hours, our village was filled with flames. They’d set fire to our homes and our fields, and all we could do was watch, and maybe pray that the heat would reach us. It never did, and my husband and I and our two girls curled together to sleep.”

“‘Tomorrow,’ my husband said. ‘Tomorrow, we’ll decide what to do.’”

“Where was everyone else?” I asked.

She shrugged. “In the mountains, we scattered. It was safer to be apart, or so we thought.” A lone tear tracked along her cheek. “The next morning, I woke to a quiet I’d never known. I pushed myself up and saw that all that remained in our village was rubble. Smoke still rose, but there was no sound, there was nothing left. I turned to my husband and called his name, but he was as still as the air, and when I moved closer to his face, I saw the icicles frozen there on his beard and even his eyelashes, his skin was already blue. I clamped my hand over my mouth. I couldn’t scream. I couldn’t attract attention. I woke my girls and we slipped back to the village, scrounging for whatever was left.”

I leaned toward her. It was late July. I asked how they’d survived, and if she’d been to Bamiyan to register with the UN office there so that she could get some assistance.

“Nay,” she said wearily. “We have no way to get there. We’re staying here until we can find a way to Bamiyan.”

I looked at Aasif and knew he was thinking exactly what I was thinking. Our jeep was always packed with staff and supplies when we went to Acrobad, but if she could get to Shaidan, we could give her small family a lift from there. Aasif asked her about our hastily devised plan.

“Inshallah,” ‘God willing,’ she said quietly. By August, Rasa and her children had made it to Bamiyan, where I saw her later. They were living in a tent and had acquired some small treasures—cooking equipment, clothes, and a washing bucket. Though her life was still a hardscrabble one, when she smiled, the color and life were back in her eyes.

These remote and distant villages, which were fast becoming accustomed to our clinics and our medicines, would be inaccessible in the winter months. Snow, ice, and freezing temperatures would make these roads impassable by January, but worry about that would have to wait. Our immediate concern, at the end of a long day in clinic, was to race the deepening shadows of dusk and make it home before darkness fell, before mines placed hastily in the road would become invisible to our drivers, before the bandits would appear from the shadows to rob or rape or kill us.

I never for a minute thought that anything bad would happen to me, to any of us there, but isn’t that the lament of every single person who’s run into just that kind of trouble? Still, for me, ignorance and that kind of deathly self-confidence were my own kind of bliss.