Thursday, October 2, 2008

Pharma

U.S. Medics Reach Out In Afghanistan - Matt Mientka

Army Medic Stacey Osterhoubt
Army Medic Stacey Osterhoubt
KABUL, AFGANISTAN-Though the Department of Defense's (DoD) Central Command in Tampa, Fla., continues to prepare for a possible war with Iraq, American civil affairs officials here said they are staying for the long haul to help rebuild the country and inoculate the population against terrorism.

The United States began a dual military and humanitarian mission last year in which combat medical support teams began to conduct medical and dental outreaches into the local populations. This year, reserve civil affairs teams began to replace the combat medical providers to help rebuild the country's medical infrastructure and to conduct outreaches far into the Afghani countryside, away from the relatively sophisticated medical infrastructure of Kabul.

Currently, the U.S. deploys approximately 300 medical and non-medical civil affairs personnel-a higher number than at any other time during the war. These so-called Coalition of Joint Civil Military Operations Task Force teams include physicians, nurses, medics and other non-medical specialists, some of whom coordinate work with the many non-governmental organizations (NGO), such as the International Red Cross and Doctors Without Borders, that operate here. The vast majority of the task force members are reservists.

Away from the greater Kabul area and the U.S. base in Bagram, seven medical teams composed of various specialists live in safe houses in the countryside, from which they launch medical outreaches to remote villages, providing clinics and meeting with village elders to assess medical needs. The teams also build water wells and restore schools.

Col. Elizabeth Steadman, NC, USA, told U.S. MEDICINE last month that DoD continues to play a leading role in rebuilding the country, assessing needs and coordinating the inflow of equipment and supplies from governmental and non-governmental donors. "The [Afghanis] have good plans," she said. "It's just really a matter of getting the resources to work with and the U.S. has helped significantly with that."

Col. Steadman said she has worked with the new Afghani minister of health, a female surgeon and retired four-star general, to plan Afghanistan's medical infrastructure. "Their focus now is on primary care and preventive status," she said.

Medical Infrastructure
Most hospitals in Afghanistan have not had the money to purchase new equipment and refurbish their buildings for the better part of two decades, Col. Steadman advised. "So most of the equipment is 20-30 years old in many cases and they don't have the high-tech things that we have in the U.S.-there are no CT scanners in Afghanistan, except one at the Army hospital," she said.

Officials interviewed by U.S. MEDICINE agreed that, although medicine is practiced in a Spartan, low-tech environment, the country has a wealth of talented, dedicated physicians who often work without pay. In contrast to a report from the American Forces Press Service that Afghani physicians treat everything with "egg yolk and spit," Col. Steadman advised that the primary difference between urban Afghanistan and U.S. medical care is technology.

"At Kabul, the treatment is basically the same as in the U.S. but without the high technology," Col. Steadman said. "They have the same medications that we do and they treat with [virtually] the same antibiotics that we have. Basically, if they had the supplies and equipment the treatment would be the same," she said, noting that a lack of radiology and other equipment precludes physicians from performing certain procedures.

Col. Steadman, who was at the tail-end of a nine-month tour last month, said she had traveled a few times from Kabul to Bagram and other points in the country but had worked primarily in Kabul. Among other tasks, she worked with officials from the Kabul Medical Institute, a medical school that, like the two sole pharmaceutical plants in the country, was ravaged by the civil war and the Taliban.

"After the Taliban left, there were no medical books in the library" at the medical school, Col. Steadman said. Since then, American personnel have obtained approximately 16,000 medical, dental, veterinary and nursing textbooks, as well as monetary donations for the school. "We rebuilt the library at Kabul Medical as well as the dental school and we've also sent a lot of [textbooks] out to some of the remote areas and villages to the physicians there," she said.

The Kabul Medical Institute was reopened in late October with U.S. and coalition help, according to DoD.

Currently, the task force is working to restore Afghanistan's pharmaceutical production capacity, which was greatly slowed when warring factions during the civil war stole scarce machine motors from the only two plants in the country. While one plant once employed 702 pharmacists, it is now down to 80 total employees manufacturing only two or three drugs. Col. Steadman said the task force is hopeful they will soon procure machinery to restore the pharmaceutical output to 25 per cent of its former capacity, allowing the country to reduce its import dependence on Pakistan.

Afghanis Receive American Personnel
Though American civil affairs teams have been well received in Afghanistan, military personnel continue to exercise caution because Taliban and al Qaeda sympathizers remain in the area. "There's a level of danger. Going out, we're always armed, we are always in uniform," said Col. Steadman. "I don't feel threatened, but I'm very cautious because we are still considered to be in a war zone."

Upon arriving in Afghanistan, Col. Steadman said she had doubts about how she would be perceived by the local male physicians because of her sex. "I have to say there has not been the first issue," she said. "They've been incredibly gracious and it's just amazing how wonderful they are and how much they appreciate us."

Working in Kabul, Col. Steadman said she has seen the "good parts" of Afghani society and has observed that, in just the last three months, fewer women are covering themselves with burkas. "It seems to be their choice now," she said. Currently, women are returning to school across the country, including the nursing school in Kabul, where there are now 25 female students among the 325 students. The task force is also refurbishing a women's surgical hospital that had long been neglected.

A Medic Teaches Afghanis
Likwise, Staff Sgt. Stacey Osterhoubt, USA, a medic, told U.S. MEDICINE last month that she and her colleagues have been well received in Afghanistan. "They're very curious about us, as we are about them, and I'd say that [medical outreach] has been very welcome."

Sgt. Osterhoubt, who is a nurse in the civilian world, said she and her colleagues commonly treat patients that suffer from the common cold. "They're very prone to [colds] as well as stunted growth simply because of malnutrition," she said. "So a lot of what we're trying to do is work with volunteer groups, furnishing vitamins in the area, doing teaching in schools to help along the way."

Although infectious diseases such as tuberculosis are common here because of poor sanitation and medical infrastructure, the most common ailments stem from malnutrition, and obesity is equally rare. "What we've done is go to villages outside of the city and spend a few days with them, treat them," said Sgt. Osterhoubt.

In a remote village far from Kabul, the hub of Afghani medicine, she once spent the day with a local midwife to reinforce the teachings she had done with the local women there. Sgt. Osterhoubt said she believes, as military leaders have been saying, that civil affairs forces will remain in Afghanistan for the near future to get the job done.

Last month, assistant secretary of defense for public affairs Torie Clark outlined the recent actions of civil affairs personnel over the course of "just a few days." Among their accomplishments, they provided medical care for 1,400 civilians-half of them children-in Kandahar. In northeastern Afghanistan, they treated 900 civilians for minor medical conditions and provided veterinary care for 700 area sheep.

Afghan Sexy girl

Prostitution Thrives in Afghanistan

Prostitution Thrives in Afghanistan
The oldest profession is alive and well in carefully-concealed brothels and on the streets.

By Sayed Yaqub Ibrahimi in Mazar-e-Sharif

“I do not enjoy being with men. I hate them. But to keep them as loyal customers, I pretend,” said the young Afghan woman.

Dressed in jeans and a tee-shirt, with shoulder-length black hair and wearing no makeup, 21-year-old Saida (not her real name) looked ordinary enough. But in this highly conservative society, she has sex with men for money, sometimes several times a night.

Saida’s father and older brother were killed in the civil war of the Nineties, and she lives with her mother and younger siblings in the northern city of Mazar-e-Sharif.
an ill-fated Afghan women who have been pushed into prostitution
RAWA Interview with some prostitutes

She has been a prostitute for six years, since the day her mother made a deal with a local pimp.

“One day an old woman came to our house,” Saida recalled. “She talked to my mother, and then took me to a house. A man almost 30 years old was waiting for me. He attacked me right away. It was horrible. I knew nothing; I felt only pain.”

According to Saida, she was left alone with the man for half a day before being brought home.

She told her mother what had happened, but she got no response.

“I now know she must have agreed because she was desperate,” said Saida. “I was in pain for a week. The old woman came again ten days later and took me back to that house. After that I started going on my own and getting money from rich people.”

Saida is now quite familiar with the world of prostitution, and accepts it as her lot in life.

“Having sex with men of any age or appearance is quite normal for me,” she said. “I don’t care who I spend the night with as long as I make a little money.”

She said she sometimes services five customers in one night, and has some regular clients, although she prefers to have a steady stream of new ones.

“My regular clients pay me less,” she explained. “The new ones give me a lot of money.”

Saida said that she charges from 1,000 to 2,500 afghani per night, between 20 and 50 US dollars.

“All men are the same to me,” she said. “At first I really hated fat men, or those whose bodies smelled bad, but now I don’t care.

She broadens her client base through referrals, and does not have a madam or pimp.

“Men give my telephone number to their friends, and that way I find new customers,” she said.
Afghanistan is a source, transit, and destination country for men, women, and children trafficked for the purposes of commercial sexual exploitation and involuntary servitude.
US State Department Trafficking Report, June 12, 2007

Afghanistan’s sex industry is booming, according to both private and official sources. Statistics are scattered, and few solid figures exist. But since the fall of the Taleban regime in late 2001, prostitution has become, if not more widespread, at least more open.

A police official in the northern province of Jowzjan, speaking on condition of anonymity, said that according to official figures, 2,000 families in his province alone had resorted to prostitution over the past 10 years. The true figure is likely much higher.

“The main factor is the lack of employment opportunities,” he said.

In many cases, prostitution becomes a hereditary trade, passed on from mother to daughter.

The Taleban strictly controlled sexual activity, meting out harsh punishments for extra-marital relations and adultery. Married women who had sex outside marriage were stoned to death; others were publicly flogged.

Sex outside marriage remains illegal in post-Taleban Afghanistan, and the prisons are full of women who have been convicted of “fornication”, a charge that carries a penalty of from five to 15 years in jail.

But this has not stopped women like Dilbar (not her real name), a 40-year-old madam who keeps a brothel in Mazar-e-Sharif.

Dilbar is a professional. She worked as a prostitute for many years, and has passed the trade on to her daughter, who helps her run the brothel. She no longer takes on clients herself.

“I am too old now,” she laughed. “I have children. But I help other girls to become prostitutes. I provide the means to make young men happy for a short time.”

Her customers call her “Khala” - “Auntie” - as a sign of respect.

Dilbar has ten girls who operate out of her brothel as well as making house calls on request. She requires a constant supply of new blood for her clientele, who are always seeking fresher delights.

“When I find a new girl I ask her to bring a friend,” she explained. “That way I get more and more girls. So I can get rid of those who become too old, or who get used up.”

Since prostitution is illegal, Dilbar has to be careful. She does not often allow customers to spend the night, to avoid attracting her neighbours’ attention.

“Most customers just spend a few hours during the day,” she said. She charges from 1,000 to 2,000 afghani, depending on the girl. “The younger, fresher ones get more,” she explained. She shares the proceeds with the girls, but did not divulge her percentage.

The business end of things has been made much easier by the mobile phone. Dilbar moves house frequently so as to avoid detection. With a mobile phone, she can alert her regular customers to her new location.

“Before we had mobile phones, I had to spend a longer period in each house,” she said. “Then when I moved, I would have to go personally to my customers to tell them where we were. These mobile phones are a great help.”

The capital Kabul, too, has its bordellos. In addition to a number of Chinese “restaurants”, which employ imported prostitutes and cater to an international clientele, the city sports several venues such as the house run by Kaka Faiz (again, not his real name).

The charges are steeper in the capital, with Kaka Faiz charging up to 100 dollars for a night with one of his girls.

“We address the needs of young men,” he said. “They exist, so we exist.”

Most of Faiz’s girls are under 25, and he has a well-heeled clientele.

“The men who come to my house work in NGOs [non-government organisations], and some of the city’s wealthiest people also come,” he boasted. “I have placed this entire house at their service, and they can feel quite safe and secure.”

Azita, 19, is one of Faiz’s girls.

“I do not want to do this,” she said, tears rolling down her face. “But I only have eight years of schooling. I wanted to become a doctor, but I couldn’t complete my studies. This is the only job open to me.”
While prostitution existed both before and during the Taliban, Afghan women's rights groups believe the number of sex workers in the country is increasing at a greater rate than before because the country has reached an unprecedented level of economic hardship and lawlessness.
South China Morning Post, April 9, 2006

While unhappy with her fate, she does not blame Faiz, who offered her assistance when she needed it.

“I did not know any boys, and they did not know me or my address,” she explained. “So I meet them in Faiz’s house. He is a good man. Even when there were no customers, he gave me some money. Otherwise, our family of six would die of hunger.”

Organised brothels may offer the girls some protection from the tougher customers.

Latifa, 25, who operates independently, complains that many of her clients are swindlers who refuse to pay after sex.

“Some men try to make us smoke or drink,” she said. “One night two men invited me to their house and said they would pay me 2,000 afghani. They offered me a drink, but I said no. Then they demanded that I have anal sex with them. When I refused they threw me out of the house at midnight, without paying me anything.”

But it’s not all bad, she added.

“There are a few good men who honour their agreement and pay in advance,” she said.

Street prostitutes have a difficult time.

Roya (not her real name), is 25 and comes from Pul-e-Khumri, but now lives in Mazar-e-Sharif, about two hours away.

She is a full-time beggar, and also performs sexual services for money. She goes into shops and offers to have sex with the owner for the equivalent of four dollars.

“Otherwise I have to stand out on a busy street for hours to make one afghani,” she complained. “I have been begging since I was a child. But when I got to be an adolescent, men would humiliate me and try to touch me. So I started having sex for money.”

Taxi drivers are a rich source of information on prostitution, since they interact with so many different types of people.

“I know an old man who came from a foreign country,” said a cabbie in Mazar-e-Sharif. “He didn’t know the city so he asked me for help. He likes young girls. So I took him to a few places. Now we both go once a week. He meets one young girl, and I get another one. He pays for us both, and then he gives me six times the usual taxi fare.”

One young man in Balkh province was unapologetic about visiting prostitutes.

“It’s entertainment - what else are we supposed to do?” he said. “I have relations with a lot of girls; they come to my shop and I pay them. It is good for both sides – I am not married, and they make money.”

The market was completely unregulated, he added.

“We pay from 100 to 5,000 afghani [two to 100 dollars] depending on age and beauty,” he said. “Half the population is involved in this type of activity.”

With so much underground sexual activity, the risk of disease is high.

Doctor Khalid, who runs the AIDS Public Awareness section of a Mazar-e-Sharif clinic, said the Afghan public is woefully ignorant of the risks of HIV infection.

“There are many factors in the transmission of [HIV/] AIDS,” he said. “But the main one is illegal and unhealthy sexual relations.”

When a prostitute has sex with many clients, there is scope for passing on not only the HIV virus which causes AIDS, but also other diseases such as syphilis and certain strains of hepatitis, the doctor explained.

“The campaign for public awareness is not satisfactory,” he complained. “Most people are not aware of the dangers.”

Exact figures are unreliable, but the Afghan health ministry listed 75 recorded cases of HIV in August 2007, representing a fourfold increase in just six months. The actual figure is likely to be exponentially higher.

If Dilbar’s views are any indication, Doctor Khaled is right to be worried.

“AIDS, shmaids!” laughed the brothel owner. “AIDS doesn’t exist in Afghanistan. I’ve never heard of anyone getting infected with AIDS. Here a girl will have sex with three men in a day without using a condom. These condoms are some kind of foreign thing. Myself, I’ve never used one.”
A police official in the northern province of Jowzjan, speaking on condition of anonymity, said that according to official figures, 2,000 families in his province alone had resorted to prostitution over the past 10 years. The true figure is likely much higher.
IWPR, Jan.16, 2008

The police say they are clamping down on prostitution.

“We are quite serious about eliminating these centres of prostitution,” said General Sardar Mohammad Sultani, the police chief in Balkh province, of which Mazar-e-Sharif is the main town. “Now no one dares to do this openly. If there are such centres, they are hidden, and those who use them are so skilled that the police do not know they are there.”

But one young man who had been arrested for having had unlawful sexual relations told IWPR that many prostitutes operate in collusion with the police.

“I once had an appointment with a girl at her house,” he said. “Ten minutes after I got there, the police showed up and took me to jail.”

He explained that this happened because he had not yet figured out how the system worked.

“Last year, I was taking a woman home. She was wearing a burqa, but the police stopped us and said they recognised her as a prostitute. She had a good laugh with the police, who demanded money. I gave them 100 dollars and they let me go.”

Police chief Sultani denies that his men are complicit in prostitution.

“If anyone has any evidence, they should come to us,” he said. “If we do not take action, then people can hold us responsible.”

Dilbar, the wily madam, just laughed when asked about police corruption.

“We have always existed, under each and every government. So have the police,” she said. “Somehow we find a way to do our job and keep everyone happy.”

Sayed Yaqub Ibrahimi is an IWPR staff reporter in Mazar-e-Sharif.