Sacked?

With great sadness, I have to report that I think all the dreams that Yousuf and I were having for really good biopsychosocial medicine, for the mentally wounded people of Kabul, might be turning to dust. And I just don't have any idea why - can't get hold of anybody to clarify the situation, and seem to be wanted over there no more. 

I had been a bit worried since the middle of August, as I knew Yousuf would have been back from his family holiday is Dubai - and had had no reply from him. In the time since my arrival back from Kabul, I had been recruiting potential trainers to go over with me for the next three planned visits - and there had been an excellent response from ex-service users from therapeutic community programmes who were willing to volunteer to come over as training assistants, and help explain the model of intensive 'user-partnership' and 'integrated psychosocial' therapy that we wanted to get going. As the intention was to use my personal fees from the project for their air fares and expenses, we could only stretch to two per visit, including the co-trainers.

In fact, many more than this came forward - and I was immediately set the task of selecting the 'best of a good bunch' for accompanying me to deliver the agreed training programme. And as I knew several of them personally or professionally, from our therapy and greencare in the Thames Valley, I did not want to be seen to be biased in choosing between people (all of whom seemed very well-motivated and capable). So I decided to ask each of them to write half a page on why they wanted to do this volunteering, and what they thought would make them good at it. From sitting on the panel in dozens of NHS interviews over the years, the questions weren't exactly hard to come up with!

So that I would get the choices made quickly, and be able to get the best value air-fares for the planned September visit, I asked for a very tight deadline. And everybody responded almost immediately - with some marvellous and inspiring pieces of prose. This was becoming an even more exciting project! And more so, because I had no trouble in also recruiting a journalist, business consultant and researcher to come on the future visits - some of whom would be able to find their own funding, and all of whom would be able to then do work that could sustain and develop the project beyond its current planned ending date. And another Kabul-trained psychiatrist working in Oxford wanted to discuss whether he could help too. This lot will really help the project, I was thinking  - about a dozen highly experienced volunteers more than they were expecting!

So I assembled all the applications into a spreadsheet and sent it off to Yousuf, with a few demographic variables, asking him to rank the applicants so that I could get back to them and make all the practical arrangements (which would have been quite complicated - including visas, insurance, induction, preparation, accommodation and security arrangements) in good time.

One week - no reply. Oh well, he's still on holiday maybe. Two weeks: probably got a backlog of emails to sort out. I'll send a reminder email. I think that was also the week the British Council over there was attacked - so a bit of non-specific worry about the security situation: I wonder if they are stopping all but absolutely essential movements. Three weeks: he's probably just very busy with all the work going on in Kabul, but I'll send a note to the London office just to check all's well. Four weeks: no reply from London or Yousuf - starting to get concerned now. Nothing relevant I could find on the web. Send a 'worried' and supportive email to Yousuf. A colleague over here, who knows Afghanistan quite well, though it would just be normal delay and bureaucracy - so I sat tight for a bit longer.

Then, a few days ago now, I received an odd communication by email from the US offices of the NGO. It was an email asking me to acknowledge receipt of a letter from the impressive manager who had started as Country Director for the NGO just before my July visit - and who seemed to be really invigorating the project with determined leadership (which, from stories I heard, had been in rather short supply on the managerial side, until then). The letter a blurred monochrome pdf which was all of two sentences long, on their headed notepaper, saying my services were no longer needed after a budget realignment. Not even a 'thank you'!

I acknowledged it - with a rather intemperate 'what the hell is going on'-type email to the California office, which got a very speedy receipt and thanks (thanks for your acknowledgement, that is). But no more explanation of what was going on. I informed all the volunteers that it looked like we weren't wanted over there any more, and got some heartwarming messages back. The colleague who knows a bit about Afghanistan and NGOs wasn't at all surprised, and said this sort of thing happens all the time -and really shows what a self-serving shower some of the NGOs are.

So that's where we are at the moment. Although obviously disappointed, I am hopeful that the energy and commitment people felt in coming forward will still be used - though maybe not through this NGO or this project. And it may need a lot of work to get back to where were were.

I have some dark thoughts about NGOs in general, as well as the sort of rumours, mischief and anti-group process that might have been marshalled - but I had better not air them here until I have found out more about what is actually happening. I feel very sorry for Yousuf - I imagine that he is very unhappy that the project has been scaled back in this way, and has probably been asked not to get in contact with me. I think back to how proudly he introduced me to his Kabul colleagues as one of his own teachers - and how honoured I felt by that. And, then, how humiliating it must feel to be unable to even be allowed to explain it to me. But these are my mere fantasies, at this stage. But oh, how we are told that people enjoy such freedom in corporate America, indeed!

In the next week, I shall send friendly individual emails to all the people I know in the organisation, and report my progress here in the blog. I shall also ask why I haven't been paid yet! Watch this space - the story is not over yet...

Media Land

Since my last entry here, life has returned to normal: valuable times with service users, grim times with NHS managers, busy times with a family growing up and leaving home, and a little bit of green time with a brilliant holiday read called "Sustainable Energy - without the hot air" and down at the yurt. Which, although randomly overgrown with everything from thistles to orchids, is looking wonderfully rustic in the midst of a town-of-ugly-repute - and producing great runner beans, courgettes and soft fruit. It reminds me of a couple of greencare principles: a weed is just a plant in the wrong place, and there's no such thing as bad weather, just wrong clothing. Which reminds me of my summer holidays, in a very beautiful part of England where the Pennines start, but for which I very definitely had the wrong clothing (though it was warm and sunny when we left Berkshire, honestly!).

In a town of ugly repute...

My dear employers, Berkshire Healthcare Foundation Trust (who now deliver all mental health and community services right across 'The Royal County'), had been beavering away on my behalf while I had been away on my hols. At Yousuf's suggestion, I had let them know that this blog was 'out there'. Their diligent PR department had done good work, and alerted BBC Radio Berkshire to the fact. So on my return, I had a few emails asking me to contact their newsroom. Could it really be that so little of interest is happening in Berkshire that they want to talk to a random psychiatrist about helping a foreign colleague? Well yes, they were interested in my tale - and the first phone call to them left me feeling quite excited that this was interesting stuff. And - though it would be touch-and-go whether I'd get to my groups in time, they provisionally booked me into the Andrew Peach Breakfast Show for Tuesday. I'd heard Andrew Peach a few times, quite liked his style, and thought it would be nice to meet him - but my excitement was squashed when I later got an email saying 'sorry, we can't fit you in. We might get back to you'. Don't call us we'll call you. Oh well, maybe somebody in Chapel Row has a new insight about Kate before she knew you-know-who.

But then they did get back to me - and a wonderfully engaging young media type, called Tom, phoned me and asked if he could ask me a couple of test questions and record them for the show. Wow - so this is what fame was like! I then spoke to somebody very helpful who explained that they wanted me to do TWO spots on the Wednesday morning breakfast show - a quick one, like a taster, at 0820, then a longer chat at 0915. I tried to get out of it by saying that I wasn't media-friendly and I'm not very good at this sort of thing - but then I thought of Yousuf and all he's doing for his devastated home town, and how he had asked me to get all the publicity for the project that I could once I got back home. They promised me that it wouldn't be at all like a grilling from J Paxman, so I said yes. They emailed me a map of where to go and asked me to be there for 0810 so I had 'time to relax' before I was on air (as if!).

The family were not impressed with the fact I'd need the car - as a few boyfriend/girlfriend/sleepover arrangements would need changing - and I set my alarm for quite a lot earlier than I needed. So when it went off I sat up in bed for a few minutes and wondered what on earth I had to say that was worth saying, then made myself a strong coffee. In the car, I decided to write myself a list of  three essential points that I wanted to get across. I did one per red traffic light, and I got to eight by the time I was in Caversham, near BBC Berkshire. Forgoing my usual fix of James Naughtie, I tuned into 104FM to hear all about the lastest advice against having caesarian sections, and listener's responses. Now why on earth would those listeners want to hear anything at all about sorts of therapy that none of them have ever heard about in far away bits of the world that none of them would ever be likely to go to?

The directions were odd, and had a space warp included - I know Caversham fairly well, but have never really known how to get into the enormous and palatial BBC estate there (most of which I understood is their main British listening station for all overseas broadcasting). I tried about three wrong turnings before finding the right one - after asking a local, who seemed surreal in her friendly coolness. Security was impressive - enormous folding road ramps that were only lowered when they had checked you on the list, and then a long drive between well-manicured lawns to a visitors car park. As I parked I thought "I expect they need this sort of thing in Tripoli at the moment, but why CAVERSHAM???".

The BBC's palace in Caversham (the nice side of the river from Reading)

The laid back receptionist pointed me to the seats in the waiting area - it was about 0800, and fairly quiet. But the whole area was what you would expect of a rather distinguished and long-established private mega-multinational, not the dear old Aunty BBC - public servant that she is. With a high-ceiling, classical columns, graceful arches, whole wall screens of News24, extremely funky computer hot-desks, nests of comfy chairs and emotionally intelligent management advice on the notice boards - this was very different from the NHS (or indeed Kabul MH Hospital).

Tom came to find me at 0810, as planned - and I found out that Tom is a first year journalism student at Cardiff who is there on a week's work experience. He enthusiastically told me that they had used a short sound clip from the phone interview (that he did with me the day before) at 0710 to trail my interview. Even more wow - this is really what it's like to be a star! And what a great work experience for him, we agreed (OK, maybe I was getting a bit carried away by now...). But he certainly had that 'put you at ease' thing, and we chatted quite easily while sitting on the producers' room sofa watching the studio through the one-way mirror - just like a good family therapy set up, I thought. The producer was soon to go on maternity leave, and not entirely comfortable with all the chat about why people had emergency C-sections. But the screens relentlessly showed progress of the show - and as it edged towards my time I was led into the studio, sat with two multicoloured microphones across a table from the presenter - James Cannon - who was standing in for the day for Andrew Peach. But I was impressed with the smoothness and flow of the whole thing, and particularly how James was so natural with it all - but I suppose that's his job. I think he's probably what I'd call a 'butch and hunky' DJ rather than a 'warm and fluffy' one - but that is in no way to detract from his professionalism.

Warm and fluffy?

Butch and hunky?

Just before my slot, he turned off the speakers and was talking normally - until I realised it was to thousands and thousands of people out there, and he was starting to talk to me.

I forget the rest, but don't think I said anything too bad.

When I checked my list, I think I'd covered two of my eight points, and I was going back in for more in about three quarters of an hour. So I was given a cup of BBC coffee and did some work in the canteen. Which was well-populated and rather plush; some of its patrons spoke in american accents and I could quite imagine them with those curly wires going from their ears under their collars. Spooks? Who knows, I certainly don't - but then I reckoned it could explain why the BBC needs such exquisite surroundings for their international listening station, and how they can afford to live in a palace!

Round two felt a bit more under control, and started straight after Diana Ross, on the dot of 0915, though I got the feeling that I went off into long chatty rambles that were rather off the point. But James seemed perfectly cool with it, asked good questions to keep me in my comfort zone, and rounded off nicely when our time was up. I had managed to squeeze in six out of my eight points.

Now I wanted more!

A very friendly and helpful editor from the newsroom took me out, and said that they may be interested in doing more on this 'story'. She wondered if one of their journalists might be able to come with me on my next trip: it could make great radio, she said. I enthused about how much Yousuf would appreciate that, and how it might help the long-term future an sustainability of the project. Yet more wow. I left with a spring in my step, and drove back into the normal world of Reading's late rush hour traffic jams.

Day 8: Escaping from Heathrow

It’s funny how sometimes you only talk to people in planes in the last few minutes. On the flight to Bahrain, I was next to a Danish NGO worker who was working with a women’s mental health project in Kabul. So I gave her Yousuf’s email. And just landing in Heathrow I made acquaintance with an electronics teacher from Norfolk , who has been doing it for 17 years. Life sounds a bit different there: the King keeps giving his people bonusues and pay rises, and the students aren’t too bothered about learning electronics because the country can pay other people to do it. At least our gang of psychologists and psychiatrists in Kabul are motivated and keen: guess who I’d rather be teaching!

Heathrow is obviously a different world – but a bit like Kabul, it is difficult to esacpe from. I had three plans up my sleeve: taxi, bus and family. Taxi - £xx to Slough, about 5 miles away. Too expensive; next option please. Bus: transfer to Terminal 5, then to Slough Bus Station, then transfer to local hospital bus. Too much luggage for that; next please. Family: all asleep and grumpy, not really possible; back to taxi.

Oh the joys of being home!

Day 7: getting out

Last day

Goodbyes all round, today – I’m quite sad to be leaving and looking forward to the next trip in September, though a lot of organising is going to be needed if it is all going to happen as planned. Lots of warn handshakes, a few hugs and smiles all round.

So not a long entry today, but a few travel tips from my experienced globetrotter colleague:

1.       Luggage weight.

Take it to the local butchers where they weigh the lambs and goats. Only a small tip is required (though if you’re not a local you may be asked for a large one. But resist.) The problem was that my big case was just under 30kg (with my secret purchase) and my borrowed case was nearly 20kg. And the baggage allowance is 35kg. And they charge about $25 per kilogram for excess. And if you can’t pay (probably in used cash plus easements), you have to ditch your stuff or miss the flight. Because at Kabul, nobody else is allowed in to see you off – so they couldn’t take it away for you. But in fact dear Yousuf DID manage to charm his way in, having correctly advised me on item 2, next.

2.       Hand baggage and laptops.
Put all the heavy stuff in your hand baggage (I expect you know that already) – and IN WITH YOUR LAPTOP. A separate laptop bag is always allowed – so use it! I was fortunate in having a large and floppy expandable laptop bag with me. So I ended up with one main bag checked in (34.8kg!), one small wheelie borrowed suitcase (about 12kg with all my clothes mercilessly stuffed in) and my ‘laptop bag’ (about 15kg and fit to burst). Luckily they didn’t spot me before I got away from the check-in desk. Apparently, they can even send you back from the gate to have them weighed (meant to be a maximum of 10kg, and they can charge ‘first class excess’ on anything over) – but they were too preoccupied with other things here, I think. Carting them round the airport was quite a pain, but less so than a whopping excess baggage charge. So far, so good.

3.       Travelling from Kabul airport.
Expect it to be quite a novel process, and look at it like you would an interesting cryptic puzzle. You know that you’re going to be on that plane in the end, so enjoy the struggle of getting there. And cherish the creative new ways they have found to put extra stages and steps into the process of getting on a plane. Keep smiling. I lost count after about seven, there of which happened before we even got the car parked. They did save the best one till last, though. You think it’s like one of those computer  games, as you keep getting onto the next level and thinking you’re winning – and surely you have finally got to safety when you find you’re in the departure lounge with all the planes visible out of the window? Well, no, not here.

In a strange airport where none of the officials speak English, how do you make sure where and when to get your plane? By checking the monitors, maybe? Well, normally yes. But they were all showing that ‘Windows isn’t working’ screen we’ve all seen. And even non-English speaking staff were nowhere to be found: they came and opened the glass doors for each flight, were completely busy with getting everybody through, then disappeared into thin air. But the answer to this level six challenge was the first class lounge, just tucked in behind the man with the prayer mats – where they had a large plasma screen display that you could see from just inside the entrance. Luckily, I soon discovered that the flight was an hour late, so didn’t need to fret while wondering if I’d missed the plane. And was that it? Well, no. There was the small matter of the corridor leading nowhere with no plane in sight and a broken lift. But when you found the staircase tucked away round the corner, it was like winning the jackpot. But when you got to the bottom of the stairs with two ridiculously heavy items of hand luggage, the bus doors were shutting… (to be continued)

Day 6: Group Therapy Afghan-style

Back to work after the weekend – on Saturday-which-feels-like-Monday : it’s going to be a long week as I’m going to have another Monday, starting as soon as I’m back. A very upbeat team meeting – starting just after 0800. The CD (=NGO's country director) is coming every day to hold the reins until a new CoP (=Chief of Party, what an odd expression) arrives to lead and manage the whole mental health project here. There has been a lot of chatter and worry about whether the project is up to scratch, or at least there is for the visible bits of it like whether walls have been painted or electric switches fitted or getting the water turned on when somebody turned it off.  The less tangible products – like better staff attitudes and less grumpy patients at Jangalar – for which I think I have seen and heard  convincing evidence, seem to be to nebulous to be registered clearly on the project tick boxes, though I know we have to try to do just that before we finish.

I don’t have any other experience to compare it with, so I have no idea whether it is a realistic worry or not, but I would think it was quite a morale problem if everybody in the team thought they weren’t doing good enough. With the pervasive paranoia that must be inevitable for anybody living in a war zone, this could surely be enough to break the camel’s back. But what was noticeable was the energetic and infectious enthusiasm of the new CD: she was on top of everything that needed doing, and even willing to start an addictions therapy group herself to get the idea of ‘self-counselling’ off the ground (using expertise from a previous life). So although it lasted till well after 0900, it felt like time together well spent. And with a bit of gentle prompting from Yousuf and I, they even warmed to the idea of possible team awaydays, and relational skills training.

I went straight from this into being an observer in the ‘day hospital’. Now if ‘day hospital’ conjures up images of people sitting around and gently convalescing, in spacious therapeutic surroundings, forget it! This was a slightly shabby room about 15 feet square, with a circle of about 12 chairs. People came into the group once weekly (there were different ones each day) either when they were still in-patients, or in the 12 weeks since they left; there were different groups taking place on each weekday. There were six women and two men in it today, which is less than usual as some of the hospital beds are shut for the refurbishment. Although I had good interpretation of what was being said in Farsi, for most of what was happening,  I didn’t need to know the content. To a strictly trained group analyst, here are the less-than-perfect things that were observable without the language:

• ·         The conductor (a psychologist) spoke to one person at a time, nobody else spoke until it was the next person’s turn.
• ·         Nearly all the conversation seemed to be questions (from him) and answers (from the group member)
• ·         People wandered in and out
• ·         There were several interruptions for administrative matters
• ·         A referral was made and accepted while another patient was speaking - a man was brought in with a referral note and sat down
• ·         During his turn to be asked questions, the man who was admitted to the group during it became rather animated with what he was saying, and hitting his head. Others looked worried and looked to the conductor, and he seemed to indicate that he shouldn’t have been there. In fact he quite soon walked out.
• ·         Each person was given just over five minutes.
• ·         When one of them started getting upset, the subject seemed to change and he moved onto the next person.
• ·         I don’t know if there was a starting time, but there wasn’t a set finishing time and most of them just drifted away when everybody had ‘had their turn’.
• ·         The two who seemed most troubled by the new man came over to Yousuf and seemed to be imploring him to do something.
• ·         After that, somebody else from the group came in and had a long, and what looked like quite intense, conversation.

But, oddly enough for somebody who is even obsessional about how far away his group therapy chairs are from each other, and how perfect the circle is, I was strangely encouraged by it. So I wondered why, and came up with this list:

• ·         It was a group, and a therapy group, and it was happening here in Kabul
• ·         They were all sat on chairs, in a circle, and talking.
• ·         There were empty chairs for absent members (though this may have been accidental).
• ·         It seemed to be valued by the organisation, and its members
• ·         Not counting myself and yousuf, it had the ‘perfect number’ for an analytic small group – eight members plus the conductor
• ·         The mix of members’ problems seemed to be very reasonable: one woman talking of domestic violence, another with difficult family rivalries, a man with crippling self-doubt, an agoraphobic woman who was now managing to come in from some distance away after being an inpatient, a woman who appeared very resistant to speaking and would only utter single syllables when questioned by the conductor, and two who had had their turns before we came in. Even the man who was hitting his head appeared more angry and upset than psychotic, so may well have been a suitable member for a longer-term group.
• ·         It was a mixed group – gender, age and socioeconomic status (one member implied being quite wealthy).
• ·         It had a clear slow-open format, with members staying for (I think) twelve sessions after discharge from hospital.
• ·         There was at least a level of trust that enabled the four women wearing bhurkas to show their faces and express emotion in them.
• ·         The conductor is one of the psychologists who was in the Tuesday morning psychotherapy teaching sessions, and wants to learn more.
• ·         The room, although not in any way comfortable or well-furnished by our UK standards, was still good enough for conducting group therapy.
• ·         It happens every week.
• ·         There are different groups on the other mornings, conducted by different psychologists.
• ·         It felt like the basic structure for establishing a group therapy culture is in place.
• ·         I always enjoy groups!

Next, a brief discussion with Yousuf about the training course plans, which had been quietly germinating for a few days. With a couple of rough old diagrams, they sprouted into two courses delivered in six 3-day events. One course will be for 80 people and be called ‘Biopsychosocial Medicine: Awareness Level’, and the other will be a more intensive course, hopefully for training 20 future trainers, called ‘Biopsychosocial Medicine: Foundation Level’. As the 14 psychologists were all assembled in the library for something unrelated, we thought we would try out the idea on them when they finished their meeting. And they liked it, a fact probably not unrelated to the expectation that they will all be expected to do the ‘Foundation’ level, and form the backbone of the new way of doing things. So germination led to sprouting, which seemed to get the warm sunshine it needed – let’s just hope that everything blossoms by next spring!

Bolstered with enthusiasm at this, I resolved to do a quick report for the NGO to gather all this together straight after lunch.  I started about 1.30pm, expecting to finish by about 2.30. In the way of these things, it was finished and emailed off almost exactly 12 hours after I started it: 1.30am. But it is an evidence-based analysis of what needs I have unearthed during the week, and a detailed plan for setting up these two levels of ‘biopsychosocial’ training in the three future visits (late September, late January and April). The details are too much for this blog, but they are uploaded as a pdf resource.

But it wasn’t all work and no play, as a certain downtown trip happened, and what a trip it was. In order to not compromise security, I can only portray it by photographs in which the location is not discernable, and the captions are somewhat cryptic…

Just what we need in Slough

$50,000?