Paying in Parasites

German Diagnostic Clinic – 30 August, 10:19.
Kabul, Afghanistan

On a recent weekend trip to visit some current and potential communities for local governance and small infrastructure projects, I was once again showered with Afghan hospitality. From the onset there was food and drink presented me in the very respectful Afghan manner. From fresh figs that stem from the heavily fruited trees that provided shade overhead, to piles of rice hiding hunks of meat – a sure sign of respect and honor, for not everyone in the group received meat – I was practically expected to eat everything I was presented, often a portion of the very little that a family had available.

The mentioned trip is arguably what brings me to the German Diagnostic Clinic in the neighborhood of Shar e-Naw in Kabul today. The small clinic has operated here for a number of years eversince the co-founders founded a clinic at the police academy. Their brochure states "The center is open to anyone without discrimination". The staff include a very blonde German male nurse and a short, also blonde, fifty-something German doctor named Maria who shuttles patients in and out of her examination room. In a place where “capacity building” is a buzzword easily used at least twenty times a day, I am always amazed at the efficiency and professionalism of the Afghan staff in the clinic, many of whom I have noticed, speaks fluent German. As a kind of a one-stop shop for vaccinations, medication, x-rays and blood and other sample work, I have come to much appreciate the service and the clean environment that they keep. So what brings me here today? To check up on my four friends, of course. I have completed seventeen days of antibiotics and am here with a lot of hope that at least some of them have subsided.

Yes, of course I know all the tricks of eating in the developing world, after all, I had survived reasonably unscathed in Zululand, Morocco, Egypt, Turkey, Iraq and some other creative cuisine locales in between. Always peel or boil (preferably both) any fresh fruit or vegetables; boil or buy water; don’t use the ice; avoid meat as much as possible; and since coming to Afghanistan, I have added a new rule: CAUTION – Yogurt ahead. That being said and known, there are times when certain practices are simply not acceptable and potentially downright rude.

Afghanistan may be a land of rather less than more, but for lack of ritual, honor and custom, it can not be accused. The dining experience is an excellent example, and quick lesson in etiquette and Afghan culture. In the many dinners and lunches I have shared with colleagues and friends, I have come to understand some of the customary rituals that I perform well-rehearsed whenever I encounter such a social gathering. Allow me to elaborate on a typical dining ritual, as I have come to know it.

The guest arrives at the home, shoes join the dozens of dusty pairs already assembled outside the door, and is led into the home where he or she is thoroughly introduced to each of the fellow-guests with mutterings of “Salam Aleikum, Khuba stid, Jura stid, Bagerai Stid, Tjorora Stid” (How are you? How is your health? Are you well?.....and a whole host of others) while placing one’s right hand over the heart, then, depending on the situation either extending it to shake hands with the male host and the guests, or in the instance of women, kissing.

When I dine with men, I am usually the only woman. No wives or daughters are ever seen in the company of men outside the family. Theses gatherings are usually with professional affiliations, in which case, as a senior expatriate female manager – am welcomed and respected to participate. This prompted a feeling recently that in Afghanistan, there are essentially three genders: male, female, and then expat female - which is somewhere between a man and a bad woman. In the presence of males, I tend to follow the lead of my host or translator to decide whether or not to shake hands with the men when I step into the home. For the most part, I have been welcomed and with very few exceptions accepted into the group.

Most of my staff are extremely protective and take a lot of pride in introducing me at gatherings. When I am invited to a family gathering, women will be present provided that all the males are family. In this instance, women usually kiss each other on the cheeks, three times – sometimes the third kiss involves a series of kisses trailing off in one’s ear, a sign of endearment I have come to realize.

Once inside the room where the food will be served, the guest is lead to the middle seat on the far side and his or her comfort is ensured by additional pillows being offered. Almost on cue, and always silently, a servant or young male family member appears with tjai. While there is a strong affinity for the press-on-top urns of hot tea in offices, in the communities the silver tea flasks are always used for guest-purposes. The ritual involves pouring about two sips of tea in the bottom of a one-eared, all-glass mug (there must have been a shipment of millions of these to Afghanistan at some point over the last ten years, because it is the only mug or glass I have come across so far), swirled around a few times, and then carefully poured into a shallow bowl that always accompanies the tea presentation. The first glass of tea is always presented to the guest of honor, alongside it a bowl of chocolates (usually a type of toffee, or milk-like chewy candy – disappointingly no actual chocolate involved). Repeat the rinsing for all the guests.

During tea everyone catches up and asks about family and work. As silently as before the bearer of the tea returns to remove the remnants. Follows the customary meal preparation. The food is preceded by a long plastic tarp rolled out in the middle of the squared arrangement. The young male then returns with another silver water jug and big silver catchment bowl, and starting with the guest of honor, pours water for each of the guests to wash their hands. Sometimes there is soap, other times not. A basket of folded towels is passed around.

The food is brought out in a particular order and placed in specific positions on the tarp. First the bread. Depending on the situation, there will be one round flat bread for each guest, or one between every two. The guest of honor is always served first and I have now learned, gets one of each of the dishes to him or herself, while the other guests will sit two to three to a setting. The customary bowl of fried rice with mutton and sultanas, known as qaboli palaw, for one, will always hide a prized piece of meat, and there may even be an additional dish not presented anyone else. In addition to the palaw, dishes include, yogurt, tomato and onion salad, sometimes a very oily soup that you break flat bread into until it soaks up all the soup and you can eat it with your hands by squeezing small pieces between your fingers, and if you are very lucky, one of my favorites manto (a dumpling-like pastry stuffed with minced meat, topped with some tomato-like sauce and sour yogurt).

The whole meal is eaten with one’s hands – often using bread to aid in the process. It is customary to share food with each other, though the guest is always discouraged from doing this and insisted upon to eat all the food, an impossible feat of course. Since certain delicacies, specifically meat, is distributed based on status, any left-over desirables not eaten by the senior members of the party, will be passed down to the far end of the group. Meal times are accompanied by lively chatter and large gesturing, frequently food in hand. I discover I am the only one spilling food as I guiltily notice the trail of rice kernels leading from my bowl to my lap. I clumsily try to improve my rice-with-hands skill but find it a bit awkward. I deny the spoon offered me though. Following the meal there is the customary mound of melon, a refreshing finish to a heavy meal – frequently water melon, but also one or more of a myriad of sweet green melons I am not familiar with.

As quickly as it appeared, the food is removed by the young servant. First the bits of bread is stacked and carried off, often to appear again at breakfast; next the bowls are piled high and removed on large silver trays. The tarp in the middle is used as a make-shift plate and hold-em all for discarded food such as bones and other discards. This is now rolled into the tarp and then carried off.

After eating, there is a small gesture of thanks by all holding their hands at chest level, palms facing upward, head tilted up, followed by a movement that looks like something is being poured over their heads. Depending on the situation, hand washing may be repeated.

The waiting room of the German clinic is very far removed from my fond memories of the communities I visited, and smells of disinfectant. A small girl in a pink outfit leads her mom around the floor, constantly being shined by a cleaner in a green lab coat. There are about twelve people waiting. An African male, an Indian with a woman of Asian descent with a bad blonde dye. Another attractive couple changes seats to escape the vigorous blow of the wall-mounted A/C. The rest of the patients are Afghans. Men in shawa khamis and a women peeking out under her blue burqa escorting a much older woman around to complete samples. An old man with a limp speaks too loudly with his neighbor, presumably he has a mild hearing problem.

We wait patiently as they call our numbers. The doctor recognizes me and in five minutes has drawn blood and instructed me to come back in an hour to see if we’ve killed any of the buggers. She has a very friendly face behind wire-rimmed glasses that rests on the tip of her small nose. She is efficient, friendly, and has a great sense of humor.

Blood work in, stool sample submitted, I pay and wait in the garden for the results. In the small courtyard with its orange pine tables adorned with tacky plastic flower-and rock center pieces, bright red and orange striped canopy shielding a tea and water station, and my favorite – the two garden gnomes, it is hard to believe I am in the middle of dusty, noisy, Kabul. Hopefully the extended antibiotics helped, as I ponder paying in parasites for the need to participate and acclimate. Sometimes a necessary price to pay, I have learned.