Day 5: food and drugs

When I was staying regularly with friends in Nottingham, we used to aspire to having three GIBBs (Great Ideas Before Breakfast) each day, to set us off to work with a spring in our steps. So after talking about expansive and grandiose ideas with Yousuf until late last night, then sleeping on them, I need to carry on the Nottingham tradition, here  in Kabul. So here are today’s GIBBs:

1. ‘Institute of Biopsychosocial Medicine’ – here in Kabul. Not for the traditional psychiatry of schizophrenia , mania and the organic psychoses – but mostly for PTSD and addictions.
2. Run on principles of greencare, sustainability and new economics. Small is beautiful, big society, cultural congruence, low-tech, supported from numerous directions.
3. With backing from David Cameron next time he comes over – as a British legacy to be left after the troops are all withdrawn.

Now I reckon that anybody is doing well if more than 1% of their GIBBs come to anything, so don’t hold your breath!

Back at home Sunday means Sunday Lunch is required – which is the one meal of the week that I always cook. Now we are in the unfortunate position here of having temporarily lost our cook – she got quite seriously burned when the pressure cooker exhaled its superheated steam all over her front a couple of weeks ago. So our cleaner is doing the cooking at the moment – which is fine and nutritious, but not very varied. Breakfast is local bread or UK cereals or eggs; lunch is basmati or pilau rice, fried chicken or casseroled lamb, and okri or spinach; dinner is the same as lunch. But today being Friday (meaning Sunday to us, see yesterday), there’s no food being prepared for us. But Yousuf has the answer up his sleeve – and after we had coffee (which I sprayed all over his day Sunday Best pajamas while trying to get the cafetiere working, in my craving for caffeine) – he went to a relative’s party and brought back two steaming bowls of Sunday lunch which had come from enormous party cauldrons, for feeding several hundred people.

Later in the afternoon, we decided to go and see the state addictions hospital, Jangalar, which is also part of the project. It is in a large building that used to be a car factory: about three quarters of it is used for NGO-run addiction programmes, and less than a quarter is run by the state for detoxification only. The NGO side is better endowed and has a wider range of therapeutic programmes, and the two are run entirely independently with no communication or cooperation.

Entering Jangalar Hospital

The state programme has 40 beds, but the usual number occupied is nearer to 30. Its premises are very dilapidated, although their refurbishment is part of the project. Nearly all the patients are heroin and opium addicts, and they are usually referred by their families. They first attend outpatient motivation groups run by psychologists at the Mental Health Hospital, during which time they reduce their drug use. Then they are admitted to the detox hospital, and prescribed a normal range of sedatives, anti-emetics, anti-diarrhoeals, and other required medication. It always includes ‘cold therapy’ on the prescription sheets, which means cold showers – in a rather unsanitary-looking shower room. They are regularly monitored for signs and symptoms of withdrawal, and when these have subsided (usually over about a week) they are moved to the next room  for up to about a month for rehabilitation, and therapy from the psychologists. One of the patients told me that what they need to wait for is for their families to be ready to take them back. As you might imagine in a poor country like Afghanistan, they are on their own once they are discharged from the hospital.

The Jangalar ward

The 'cold therapy' block (3 'showers')

However, despite the primitive surroundings, the staff seemed cheerful, professional and hopeful – and the patients welcomed us warmly. A facility like this is obviously barely scratching the surface of the country’s drug problem – and the chances of meaningful recovery must be poorer for the lack of any psychosocial follow-up. Another chance for a predominantly self-help model of greencare-based intensive long-term rehabilitation, I would hope: what most of the world knows as TCs. But what I would not hope for is that the research work, done here by overseas agencies, to introduce methadone maintenance regimes, demonstrates that they need to introduce non-abstinence programmes. Afghanistan has the clean slate I mentioned two days ago, and to commit itself to indefinite pharmacological treatment for vast numbers of people in the name of medical science seems to be a backward step to me. It would benefit the pharmaceutical companies, the doctors who prescribe it – and render the addicts lifelong emotional invalids, and spread the belief that the only way to treat addictions is with medicines. A biopsychosocial approach would seem much more culturally congruent, and sustainable way to go.

We asked our driver to take the scenic route home, so I could see a few different areas of Kabul. We made our usual hectic and collision-free way along the very dusty streets which sometimes looked like thick fog in the late afternoon hurly-burly, between the mountains dotted with ramshackle houses (glowing like a tableau of fairy-lights as dusk came upon us), and along the roadsides with all manner of stores selling everything from freshly-killed chickens to chrome car wheels – all illuminated by huge and unfeasibly bright multicoloured low-energy lightbulbs. The most striking places though were Las-Vegas-in-Kabul, and the Afghan version of Surrey-on-Thames.

Wedding halls are an iconic cultural phenomenon here: they are vast buildings, boring and grey by day, but illuminated with neon lights, electric trees and giant lit-up stars and moons at night. They also have lines of cars and hoards of people in their finery going in all directions, outside them. Inside, they host Afghan-size family parties and events – and as I said yesterday, ‘family’ here probably means hundreds, and quite possibly thousands of people. Thursday night is the busiest – but it was pretty hectic tonight too (Friday – like Sunday to us). Although at first it seems a bit unreal – ‘how can a country in this state waste all that money on electricity and parties?’ – I was really cheered up by the thought that they’re having a great time with their enormous families, despite the horrors going on all around.

The Afghan version of Surrey-on-Thames is where very rich people grab land (usually without buying it) and build ostentatious and extremely large houses on it (usually without permission). It was previously the location of disused military buildings like barracks, and is close to the city centre. We reckoned that there are too few people in the whole of Afghanistan who make that amount of money through legitimate business interests to fill these houses (and they would probably have better taste, anyway). So it doesn’t take much reckoning to work out that most are probably built with money from drugs and arms. ‘Why don’t the authorities just demand they are knocked down?’ I naively asked Yousuf; he didn’t quite use his usual ‘there are twenty reasons…’ answer, but top of the list was the fact that many extremely influential people live here, including some who are high in government. Tricky.

Time to go home for our evening meal. As we were stuck in traffic by the roadside stalls, Yousuf pointed out the local cheese (semi-solid, white, about the size and shape of a large squashed orange), as we’d talked about it a couple of days ago. When I said ‘let’s get some’, I was quite surprised at his John Macenroe-type reaction. But as his honoured (and very well-indulged) guest, he generously agreed to buy some. Then he seemed to get a bee in his bonnet, and went off to some other shops before coming back to the car with quite a collection of bags. This is going to be a very special Afghani traditional meal, he explained to me: we are going to eat like the poor people do, like the peasants: bread and cheese and raisins. He had also bought fresh melons and mangos. Well, if the peasants eat like this, I thought, I’m quite happy being a peasant (and often am at home, though it’s usually tomatoes instead of raisins). After an uncertain start, Yousuf decided that it tasted rather good after all – and I wondered if it was just something that he had never tried before. But he soon started reminiscing about how he used to eat it as a small child, and how it brought back the memories of those days – just a few streets away, here in Kabul.

A peasant's meal - not unlike a ploughman's lunch?

It is an Afghani saying that food tastes much better if you are hungry – and a peasant can enjoy his bread and cheese and raisins more than a king enjoys all his fabulous food. So indeed we did eat like kings – although he wasn’t sure he would be able to tell his wife about our ‘special meal’…