Douglas Grindle - How We Won and Lost the War in Afghanistan

In the faded photo a woman stands in bright sunlight in the middle of a poor Afghan village. She gazes confidently into the camera lens. She is in her twenties, with almond skin and black hair tied back. She wears a pleated skirt and a blazer, and she holds a sheaf of papers. Behind her is a mud house. She is a government employee charged with helping villagers stay healthy, and shes clearly proud of her position as a servant of Afghanistan.

The woman was a community health worker. The photo dates from the early 1970s, when she was sent into the villages to improve the health of the women. If she is still alive she would be about seventy. There is a good chance she died many years ago. The average life span for Afghan women is fifty-one years, and forty-eight years for men. More than a million people died during the Soviet war of the 1980s.

The Afghan government no longer sends neatly attired health workers into the villages. The picture is a relic of the past. The government does maintain community health teams inside villages. Often they are husband-and-wife teams. They receive limited training, and they usually keep a low profile to avoid attracting the attention of the Taliban, who would harass or kill them.

Thirty years later a man walks out of Mirwais Hospital in Kandahar City. He is tall, thin, and in his mid-forties. He is dressed neatly, with a worn blazer over his Afghan shalwar kameez clothing. But he wears a harried look, as if the day is too short and life too ephemeral to carry the many burdens he bears. He throws his leg over his motorcycle and starts the engine, roaring off.

The man is Dr. Mousa, a full-time physician employed at the government-run hospital. He also works as the governments director of health in Dand District, being responsible for its seventy-five thousand people. He splits his time between the district and the hospital. Because his pay at the hospital is low and he is not paid at all for his work in Dand, he works a third job at a private clinic. His daily pace is frenetic. Dr. Mousa has too many places to go and not enough time. Soon he will lose his job at the private clinic for not putting in enough hours. Dr. Mousa is constantly worried about earning enough money to feed his family.

Even though Dr. Mousa is the health officer for the district, he rarely visits the husband-and-wife teams in the villages. Security threats dont deter him. Unfortunately he cannot afford to go. The government does not pay him, nor does it provide a fuel allowance for his motorcycle. His hospital pay will either feed his family or fund his visits to the community health workers, but not both.

In 2011 Dr. Mousa worked in Dand for nine months without pay. He never received a fuel allowance. He never went to check on the village health teams. Eventually the health ministry shifted Dr. Mousa to another job that offered a salary.