Are We There Yet?
The NOOR Project in Afghanistan
By Connie Frisbee Houde

Are we there yet? What does this simple phrase uttered by a bored child on a road trip have to do with Afghanistan? An Afghan would chuckle because the idea of a quick trip to the countryside is viewed as a joke, and yet road trips to the outlying countryside are often a necessity. In many cases, plans to travel outside of the major Afghan cities are made a month in advance to make sure the vehicle is in proper condition to make the trip on the rutted, and in some areas, virtually non-existent roads. Four-wheel drive is a definite necessity and extra petrol, oil, and spare parts need to be taken along. Once on the road, travelers rely on locals for information about the conditions of the roads. As if that weren't enough, the few maps that can be found are seldom reliable.

When I traveled to Afghanistan for the first time in 2003, these facts were unknown to me. That initial trip consisted of a 10-day "reality tour" taken mainly of the capital city of Kabul. While there I became reacquainted with a high school classmate, Libby Little, and her husband, Tom, both of whom had been living and working in Afghanistan for the past 30 years. Tom is currently the program coordinator for the National Organization of Ophthalmic Rehabilitation [NOOR], the only eye care program in Afghanistan. Started in 1966, NOOR has operated almost continuously through the countless wars and upheavals the country has faced. Sitting in their small kitchen, huddled around the kerosene stove-the only heat source in their home despite it being the dead of winter-it was impossible not to be moved by their tales of raising a family while living and working in Afghanistan. With a great deal of humor, the Little's recounted tale after tale of inspiring life and death incidents. How during the Russian occupation they had to flee Herat with their three small children to avoid capture or being "disappeared" by the Russians; or how in the early '90s, they spent months living in the basement of their house and driving two hours around the outskirts of the city to avoid the factional fighting at the front lines so they could continue to provide eye care to the needy.

With a limited volunteer staff, NOOR has worked to train Afghans to become eye doctors and ophthalmic professionals who now run facilities under the supervision of NOOR, which supplies and manufactures the materials needed to keep the eye care program working. Having developed hospitals in the cities of Kabul, Herat, and Mazar-i-Sharif, NOOR is currently building hospitals in Kandahar and Jalalabad. They have three small clinics in smaller cities, each of which are run by individuals trained by the program. Provincial traveling eye teams consisting of at least one doctor, a number of technicians and other support personal, often including a cook and a driver, complete another phase of their work-which is to bring eye care to the outlying and more remote areas in Afghanistan. Where roads are adequate, the team travels in a bus built over the frame of a Russian-made Kamas truck. To reach the more remote areas, the eye teams use one or two of NOOR's four Land Rovers that were driven from England in 2004. The teams carry all their equipment and set up shop-where possible-either in a local medical clinic, school, or if need be, in tents. With 85 Afghan eye doctors to treat the 25 million people living in Afghanistan, in 2004, a total of 246,411 outpatients were seen and 15,812 sight-saving surgeries were performed in 20 different provinces.

All the information I received about Afghanistan on that first visit indicated that its rural areas were strikingly different from the cities. The adventurer in me wanted to visit these places and thought what better way to travel to rural regions by taking a "road trip" with one of the NOOR provincial eye teams. I returned to Afghanistan in 2004 and spent a month traveling with NOOR eye teams observing, photographing, and interviewing patients. Besides enormous travel difficulties, the only hitch encountered was overnight sleeping accommodations, which do not present any difficulties for the usual all-male eye teams since team members either sleep in tents, their travel vehicles, or the clinic or school in which they are working. But in Afghan culture, where there are strict separations between males and females-especially as far as sleeping arrangements-there is no appropriate place for a woman under such conditions. When I accompanied an eye team to the northern city Kunduz in 2004, we were lucky to find a German-run guesthouse, where a foreign woman like myself could stay. If this had not been available, as the only woman, I would have been given the hospital room the male members of the team shared and the men would have had to sleep in the bus-a major inconvenience to the team and their work.

Since my initial visit, I have seen some substantial differences in the types and rates of development between the cities and the countryside. Electricity is now more prevalent and consistent in Kabul, and smaller cities often rely on generators for electricity for a few hours in the evening, while people in remote villages still rely on candles and fires, and go to bed when it's dark and rise with the sunlight. In Kabul, a visitor can choose between hotels and guesthouses. These are non-existent outside of the major cities unless there are non-governmental organizations present who are willing to provide a room for foreigners working for their program. In the major cities there are TVs, restaurants, and markets where you can purchase a wide variety of items-just about anything one might desire. In the rural areas the availability of goods is scarce. Women's attire highlights another area of difference between city and country life. In Kabul women wear a small chador, only covering the head, rather than the large chador that is required among some ethnic groups to cover much of a woman's body, or the all-encompassing burqa prevalent among the more conservative women living in rural areas.

An Afghan policeman sits under a column adorned with posters of candidates for the recent parliamentary elections in Afghanistan, September 13. The campaign featured relatively few violent incidents and a lack of acrimony among the thousands of candidates vying for seats in parliament.[/image]This year there were four members to our team: a male Afghan driver trained to give the basic eye chart test, a male Afghan optometrist, a female German optometrist teacher, and myself headed to the remote village of Anjuman high in the mountains at the end of the Panshir Valley northeast of Kabul. Because we traveled into a very conservative area of the country, it was necessary to have at least two women on the trip to respect the local customs and to be accepted by the villagers NOOR wishes to serve. Our plan was to survey Anjuman, a village of 250 houses, and the impoverished area surrounding it, to determine what type of eye care was needed.

The major roads leading directly out of Kabul are paved and each year improvements to the road see the paving stretch a bit further into the countryside. On a good day, with everything going in one's favor, the journey to Anjuman, can be made in 10 to 12 hours. A few weeks earlier another team was stranded on this route when a bridge high in the valley had washed out due to high water from snowmelt. This was both good and bad news. Good because the heavy winter snowfall signaled the end of a seven-year drought that had forced many farmers to relocate with their families to the cities where overcrowding taxed the already meager infrastructure and caused those making a marginal living to sink even further into poverty. It was bad news because snowmelt continuing late into July and August had made the rivers in remote mountainous areas very treacherous, overflowing their banks and washing away the roads. In remote areas villagers make repairs to the roads and bridges if they have the skills and we needed to find out if such repairs had been made.

After a couple more hours riding through a ready-to-harvest, wheat-filled valley, we found ourselves on a fairly good narrow dirt road following alongside the river. We stopped a passing UN vehicle going the opposite direction and learned that the road was still washed out. Turning around, we retraced our steps and continued north across the Hindu Kush Mountains and through the Solang tunnel to Kunduz. This same journey had taken 14 hours in 2004 because of horrible road conditions; we had trailed behind rows of overloaded trucks on an extremely rutted, slick mud road covered in rivulets of water from a snow the previous night. This year we saw the road had been recently paved and bridges were in the process of being repaired. The road even had white painted lines down the center! At the outskirts of town we drove past a new hospital that had been built in a year to replace the shabby, outdated facility the eye team used the previous year. Drive time between Kabul and Kunduz was literally cut in half from the previous year so we had time to continue to the east to Talacon, where NOOR operates a clinic and we could spend the night before we continued.

Maps are invaluable to understand where one is traveling but they are virtually impossible to come by in Afghanistan. According to the map I had brought with me-printed in 2002 and purchased in a local Albany bookstore-it was possible to get to Anjuman by driving through the mountains south of Talacon. After consulting with locals who traveled from village to village in this region we learned that there were no roads our Land Rover could take that went to the south. Our final plan was to take a two-day journey through the most amazing and breathtakingly beautiful countryside on bone jarring roads filled with ruts, cavernous potholes, and boulders. We drove through swollen streams along narrow barely one-lane wide roads carved into the rocky mountainside. Our map turned out to be inaccurate-not a surprise, but each time it was unfolded the locals would pour over it talking animatedly and pointing at places they recognized. As the day wore on and the sun became warmer, water flowing down from snow melting high up in the mountains made our path more precarious. Finally arriving in Skazar, a small village of 140 houses, we discovered that the road to Anjuman had been washed out as well. Despite three days travel time to reach our goal and all the preplanning, we never made it to Anjuman.

For the Afghans who depend upon these roads for their survival, "are we there yet" takes on a life or death meaning. In a recent e-mail from Tom, who had just returned from a trek to Anjuman and back, he recounted the story of a young man who had been suffering from appendicitis. For two days his family had carried him on a donkey over a snow covered mountain pass to the closest clinic. He died along the way. Even if they had reached the clinic Tom doubted that there would be a doctor who could have helped him. The remote rural areas also have one of the highest infant mortality rates in the world. Simple complications easily treated in the West are life threatening in these places because there are no easily accessible medical facilities. Until more roads are built and reconstruction efforts reach into the rural areas, the divide between city and country will only widen. The phrase, "Are we there yet?" will continue to a call to improve the lives of the Afghan people that is beyond the minimum needed for basic survival.

Connie Frisbee Houde has been photographing remote areas of the world since 1990, beginning with work as a textile specialist on an archeological expedition to the south coast of Peru. Houde has traveled to Afghanistan for the past three years, combining her concern for social justice with her love for adventure.

Copyright © 2005 Luminary Publishing, Inc. All rights reserved.