Day 3: Kabul Medical University

Yousuf has arranged for us to go and meet the Chancellor of Kabul Medical University today, and we were planning to go this afternoon - but the Chancellor has to go to an urgent meeting at the Ministry of Health, so we have been asked to go at 0830. We wonder if the urgent meeting is anything to do with the yesterday's murder of Ahmad Wali Karzi, the President's brother.

Usual routine, bundle in the car, check doors and windows, gates open, off we go. It's about two miles down a single long road: noisy, bustling, chickens in cages, market stalls, people wandering everywhere (amidst the traffic too), swerving to overtake cars, buses, rickshaws, pedestrians, lorries, donkeys or horses and carts -  followed by immediate violent swerve to avoid being hit by an oncoming car or bus or rickshaw or pedestrian or pedestrian or lorry or donkey or horse or cart. You soon get used to it - I just assume that they are good at it by now as I've not seen any collisions yet, and even if we did it would only be at about 10 mph.

Obstacles in the road

We drove through the tree-filled park of the other university, where elegant faculty buildings stood in well kept gardens, and multitudes of students sat below the trees - talking, reading or just chilling out. And the rumour is that, even on the hottest day (its about 33C today, it can get a few degrees hotter) when you go and sit under a tree you'll get cold and need a jumper or scarf. Sadly, the security precautions don't allow us to try it out.

Kabul University Campus

There were two armed policemen at the gate to the Medical University, and they wanted to see our ID - but waved us straight through. Once inside, Yousuf seemed to know and be warmly greeted by every second person - and he was clearly transported back 30-odd years to his time there, at the time of the Russian invasion.

Memory Lane

The first impression was of a modern building teeming with students, inside and outside. Outside there were less trees that the non-medical university (which is a completely separate organisation), but very well laid-out gardens and a modern marble-floored square with plants and chairs and tables. Inside was much like any other hot country: wide corridors with all hard surfaces, floor-to-ceiling glass windows, then small, medium and huge lecture theatres - and an online computer room for a least 100 students. Every so often, though, the corridors would widen into seating areas with dozens, possibly even hundreds, of elaborately made large armchairs covered in what looked like hand-embroidered cushions. Their purpose was like the trees at the other university - for sitting, reading, thinking, chatting - and all the other things that go with learning. A pretty civilized environment, considering we're in a war zone, we thought.

Even more of an island oasis was the Chancellor's office: furnished with oriental carpets and voluminous heavy curtains, we went through two plush ante-chambers, the first with two assistants and the second with a very large and formal committee table, to arrive - almost like a Bond movie - at the command centre of a very powerful man. The desk was the size and style of a large luxury car; there were five very large and very soft ornate sofas  leading down each side of the room from the desk, with carved wood and glass tables low in front of them. The only item in English I saw on the vast desk was the spine of a book - "War Surgery - Working with Limited Resources in Armed Conflict: Volume 1". Oh yes, that, of course - which felt a million miles away from here. You certainly wouldn't have seen anything to indicate that was going on, at least from the moment we passed the armed guard and entered the gates of the university.

The Inner Sanctum

The Outer Anteroom

The Chancellor's place on the sofas was discreetly identified by the presence of his wireless bell-push, to call his assistants. We were gracefully ushered to our seats on the sofas, with the position of each, I think, reflecting our position and esteem in the social order - as a foreign guest, I was opposite him, with the Daimler-of-a-desk on one side and Yousuf on the other. And indeed, honoured I was - indeed somewhat over-awed and anxious to boot. We had about five minutes notice of his arrival, and were served green tea in octagonal glass cups while we were waiting.

Once he arrived, and had signed his way through a pile of papers which one of his assistants had brought in ('we will keep being interrupted by people if I do not do this first'), he welcomed us in English (by now including about about five other senior academics) and let Yousuf describe what we were there for, in Farsi. He was very receptive to our ideas for 'modernised psychiatry' integrated about three axes:

• throughout the biopsychosocial curriculum, 
• across the medical and non-medical disciplines, 
• througout the training pathway (undergraduate, postgraduate, continuing professional development and leadership training).

So the upshot was a lot of work for Yousuf in collaborating with various curriculum committees, support for including (or at least negotiating) with the other Kabul mental hospital (an academic neuropsychiatry clinic, where some of the senior staff have a particular aversion to Yousuf's plans for rigorous training and assessment), and willingness to include medical students in our forthcoming intensive psychosocial (living-learning) experiential courses over here, and my agreement to talk to somebody at IMH in Nottingham about possible exchange programmes, and help with designing, delivering and researching PTSD treatment programmes. He thought that the current friendly British Consul would be helpful with initiating things. Probably several other things too - as, by now, most of the talk was not in English, so impenetrable to my ear. The Chancellor gave his apologies, and disappeared to the Ministry. The rest of us carried on several impromptu conversations which broke out amidst the sofas, and we said our goodbyes a good while later - after the octagonal glass tea cups were taken away. Presumably a signal, and to ensure that Mission Control was ready for Mr Bond's next set of visitors, in his Inner Sanctum.

Yousuf treated myself and a psychologically-minded neurosurgeon, Dr Pirzad, to a walk down memory lane by showing us round the medical school - including the numbered seats in which they sat in lectures (and at which he has often subsequently lectured). The numbers are printed in a large size numeral, and on the seats at the top of the FRONT, not the back. This is so that the lecturers can make a note of all the empty seats - and woe betide those whose numbers are visible! A lovely low-tech way to opt out of lectures rather than opt in - and reduce paperwork in the bargain. Memory lane for all of us probably includes final exams, and we were treated to the interesting experience of finding our way through crowds of several hundred anxious young medics queuing up to get to the lecture halls (where the exams were held).

Waiting for the off

 It looked to me as if the genders were separated - but Yousuf assured me that was no longer true. They were however separated by punctuality: the first ones there got seats in the lecture theatres, and the last few had to sit on the floor in the corridor for their two hours of mental torture...

The swift or lucky ones got seats 

... while the rest did not

The final event of the visit was tea in Dr Pirzad's office, with him telling us interesting tales of meningiomas, and how do do neurosurgery with inexpensive ultrasound location rather than fabulously expensive scans. Clearly a man for mastery of gadgets and gizmos, I introduced him and Yousuf to the idea of using Prezi instead of Powerpoint - and we swopped notes on tricks with digital cameras and other boys' talk. I was also given a book in Farsi to examine - which is a bit of a non-starter for me anyway - but it was perhaps the largest ever book with the smallest number of words for its size. We decided the author (one of Dr Pirzad's acquaintances, who had given the book for his collection) had deliberately chosen a vast font size to win the biggest book in the library prize...

A heavy read (2005pp)

Then the two of them explained and discussed how they are going to revolutionise medical ethics in Afghanistan through regulation and registration of training. And I believe them!