In northeastern Afghanistan, there is a province called Badakhshan. In Badakhshan, there is a capital city called Fayzabad. In Fayzabad, there is a provincial hospital. In that hospital, there are dozens of women who came from far away to have their babies. They are Pamiri women and women from the Wakhan corridor. They are women from everywhere in between.
In 2011, I took my very best shot at helping out. I was 27 years old and I moved from Ottawa, Canada to Kabul, Afghanistan for a job with a well-known and well-respected global non-profit. I thought I would do some good. I thought I would learn a lot.
In my first week, with my boss - an indescribably kind and smart Afghan doctor - and some of the expatriate staff from other departments, we loaded eight of us into a small kodiak plane and flew from Kabul over the high Hindu Kush to Fayzabad. I was a health program staff member.
My job was to try my best to capture what was happening on the ground - in cities like Fayzabad and many smaller communities far afield - and explain that to our funders, our directors and our higher ups in Geneva and Paris. I worked as a Western intermediary between the people who actually made the hospitals run, staffed the clinics, led the programs on the ground and really got stuff done and the donors - many of whom were not typically allowed to visit anywhere outside of Kabul as national staff of Germany, France, the UK and Canada.
My skill set - a degree in global public health, fast learning and native English - was enough for that much. But it wasn’t enough for this: My first trip to Labour and Delivery.
A small fire in a circular stove - a bukhari - was centred in the ward to warm the patients. Beds lined the walls. A few windows looked out onto the courtyard and the riverbed on which the hospital sits. It was a bright, sunny day.
The obstetrician - a Tajik female doctor offering her services to her neighbouring country because she speaks the language, knows the culture and jobs can be hard to come by - welcomed me and introduced me to some of her patients.
One woman was seated in a bed near the window. She was relaxing and seated upright. All the other women had little bundles of blankets at the foot of their bed or beside them holding their new babies. Not her. I learned from the obstetrician that this woman was in her 40s but I could never tell because the women of the mountains are weathered and sinewy. She lost her baby on the way to the hospital. Riding a donkey through the mountains. For days and days and days. She smiled at us.
As a resident doctor now in Canada, when I hear that a patient has suffered a loss like this, there are a few things I know: She probably got extraordinary prenatal care. She probably got the best ultrasounds at the correct intervals. She was probably taking her vitamins and eating as best she could. She could take a pregnancy leave if things were just too much to manage or if she was feeling unwell. When a baby is lost late into the pregnancy, there are a few things that get investigated according to the expertise of an obstetrician and whichever other team members they bring on board. Often, we don’t know why there was a pregnancy loss but we know they happen less and less often than they did 40 years ago.
For this women from the mountains in the Fayzabad Provincial Hospital, I knew nothing. Not only did I know nothing about her experience of home, family, marriage, work or school, I didn’t have the skills to access that information. And for what, I thought? How could our many millions - even billions if you include military investments - of dollars from governments around the world heal this fractured nation? What were we doing then? What are we doing now? I know we can point to United Nations development indices to show that there are some actual, tangible improvements in communities across Afghanistan but these are regressing with each unstable day. And Afghanistan certainly never asked for us to come in and dress things up only to leave in under 15 years. And what is Afghanistan, anyway? It’s a collection of cultures, languages, militias, regions, terrains and neighbours. It was always an uncomfortable fit for a place called ‘country.’
I am getting sidetracked. This post isn’t about the development industry, nor is it about Afghanistan’s history or culture because I know just slivers of both.
It’s about how I thought I could fix something. I am a born do-er and I can’t rest until I’ve solved something or cleared something off the list. This is why I travelled all over the world in my 20s. I just booked tickets and went places, usually on scholarship or loan. This travelling showed me - really, deeply - how destroyed some places are. How hard people have to fight to live. How some people actually have no simple pleasures. The sun shining is darkened by life as a woman where women are valueless except as reproductive vessels. The song of a bird sullied by constant toiling for two pennies to make last longer than I can bear. All of it even more painful when you consider the enormous wealth of the political and corporate elite, usually within the same block.
And it makes me furious. And it makes me sad. And it hurts. And it makes me complicit, as one who has so much.
So of course my instinct was to “go there” and “do something” with all that pain. Alleviate my own suffering by ogling and fumbling around with theirs.
I know many people who I think are making a real difference. Most of them are actually from their own country and still working there. Some could leave, but don’t. Some can’t leave, but wouldn’t if they could. And I know expatriates who stay in communities for a really long time and work really hard. I have an journalist acquaintance who moved to Kabul just after I did, and she is still there, still writing, still making things known. And I have good friends who have devoted their entire careers to management of crises around the world. This is important.
But right now, that’s not me. My efforts to make it all better haven't landed.
But I don't accept that the alternative is to do nothing. I don't accept that there is nothing I can do even if my little sphere of influence is among the already privileged and fortunate.
Which brings me to the US election. There are now five candidates remaining and some of them are idiots. Some of them are not idiots but I can’t tell if they’re serious about making life better for Americans and the rest of the world. Clinton and Sanders spent last night at labour union rallies in New York City, demonstrating that the labour movement is a persistently relevant force in modern politics. Corporations are not beholden to their workers nor to the environment unless we make it so.
Saving the world looks like paying attention to the political process - in all sorts of different countries - and voting every chance I get.
And that is it. That’s the one true thing that I have. I don’t have that for the US election because I am Canadian but I am following along as other people exercise their suffrage week after week in the US.
I don’t think medicine has a monopoly on direct action against the scourge of economic inequality. It’s not about your job.
It’s not about the number of countries you’ve visited or the number of schools you’ve built with your untrained hands. That work has devastating consequences locally, and I’ve seen it first hand when trying to assess bids of skilled labourers to work in Northeast Afghanistan. I can’t imagine the struggles they face in Central America where legions of Western Tweens travel to get all their feels at the behest of the slick sales team of one of our nation’s most well-known non-profits. For the price of many thousands of dollars, you too can warm your heart by witnessing someone else’s distress and putting a local out of a job.
I don’t even know if it is about any one kind of formal activism - the most change I have been able to demonstrate is through conversations in my daily life. When I have a patient spewing Islamaphobia while I check their patellar reflexes, I stop him. I tell him that I don’t happen to agree with him and that I think Islam is a poor target for his hate and fear. I think the world has let him down in other ways and his retreat to radicalism is the very thing that he thinks he hates about what he believes Islam to be.
I don’t know what kinds of change I have brought forth as a board member, an analyst, a research coordinator. I think it’s really all about daily conduct.
Be kind and supportive. Everyone around you is probably trying their best. A lesson I re-learn every week or so.
But the vote. Always the vote.
The vote you get with democracy is one important vote. Then there is the vote you get with your dollars - the majority of which is stacked against the interests of equity and in favour of mass income inequality. If you have no money, it is easy to feel disenfranchised. Amartya Sen describes the definition of poverty as the absence of opportunity. And when money talks, the lack of it strips people of agency. The agency to choose to support the company that buys wholesale from local farmers versus the one that stacks our shelves with Mexican produce, ripened on a dark truck somewhere in Illinois.
So vote. If you have money, vote with that. If you don’t, it really sucks. Vote with your ballot. And wait while those that do figure out the best kind of world is the one where we all get to play in the sandbox.