training day 1

So last night I slept from 11-3. Have you ever been so tired that you felt sad and emotionally fragile and vaguely nauseous? Well, I have. Getting snappish from undersleep is one thing but I bypassed that state today and went straight into actual distress. Luckily, we were ahead of schedule on our agenda for day 1 of the training.

We'd thought to have at least a day or two to prepare after our arrival but no such luck, so we sucked it up, spent all yesterday afternoon and (in my case) a couple of hours this morning preparing, and powered through (1) Intro to USAID, given by Caryn; (2) Intro to the Project, given by Karim N.; (3) Intro to 22 CFR 226, given by me, with many questions from the 13 other participants; and (4) review of the compliance checklist, tag-teamed by me and Caryn.

Then, at 3, jet lag hit with the force of a thousand milligrams of benadryl. (Diphenhydramine hydrochloride. Fun name. Diphenhydramine.) I excused myself around 3:40, spent 30 minutes waiting to get my weekly pass for the Serena business complex so I won't have to check in every morning from now on, came back to the hotel, and slept for an hour and a half. That's probably too long but thirty minutes was just not going to cut it.

That level of exhaustion was a new or at least unremembered feeling for me. And I've finally gotten to the thrust of Awakenings, the chapter after all the patient descriptions in which Sacks lays out his case for the treatment of sick patients as people, giving equal weight to the "objective" facts of their disease (the parts that make their "case" a case -- same word as used in law, as he points out with stunning insight) and to the metaphysical questions around their state. "How are you?" Sacks says, is a metaphysical question, one not answerable factually but only by example and allegory. Those examples, those allegories, are central to understanding patients and their response to disease. And modern neurology, and modern medicine in general (in 1972, when he was initially writing, and presumably still in 1990, when my edition came out) has largely abandoned those vital elements in favor of the brutally quantifiable. Post-encephalitic Parkinsonian patients and their reactions to L-DOPA, the description of which fill most of the book, provide unusually rich territory for exploring the necessity of treating patients as whole people.

I'm just going to quote him at length, because, well, POWER.

There is nothing alive which is not individual: our health is ours; our diseases are ours; our reactions are ours -- no less than our minds or our faces. Our health, diseases, and reactions cannot be understood in vitro, in themselves; they can only be understood with reference to us, as expressions of our nature, our living, our being-here (da-sein) in the world. Yet modern medicine, increasingly, dismisses our existence, either reducing us to identical replicas reacting to fixed 'stimuli' in equally fixed ways, or seeing our diseases as purely alien and bad, without organic relation to the person who is ill. The therapeutic correlate of such notions, of course, is the idea that one must attack the disease with all the weapons one has, and that one can launch the attach with total impunity, without a thought for the person who is ill. Such notions, which increasingly dominate the entire landscape of medicine, are as mystical and Manichean as they are mechanical and inhuman, and are the more pernicious because they are not explicitly realized, declared, and avowed.

I thought about that today as I realized that my ailing state earlier today was clearly shaped as much by my own reactions to exhaustion in the context -- determination to finish the day's work, unwillingness to appear weak until I actually couldn't fake it anymore, and so on -- as by the fact of my not having slept very much for days and the upset that caused to my body's chemistry.

Now I'm awake and sort of ready to face the rest of the day. I actually feel alright now. Going to visit the tailor down on the first floor and maybe go to the pool for a bit. It's oppressively hot, but I think that would be okay as long as part of the time outside is spent underwater.

To conclude on a somewhat related note, here are a couple of songs I've been listening to a lot the last couple of weeks. The first one requires a hat tip to Gabby, the second I found just stumbling around YouTube and subsequently bought the album it's on.

Ambassadeurs - "M.O.P.E."

Ryo Fukui - "Early Summer"

dawn

Dawn is the newspaper founded by Mohammed Ali Jinnah, who also founded Pakistan. When I filled out my little entry form last night, that's what I checked for my morning complementary paper. Glad I did, 'cause there's a bombshell of a top headline this morning: "Dr Afridi jailed for helping Khyber militants."

Shakil Afridi is the physician accused of helping the CIA run a fake hepatitis vaccine campaign in Abbottabad to try to figure out whether bin Laden was staying in the house where he was, in fact, found. The government arrested him, much to the ire of US diplomats and officials. All indications were that he'd been arrested for, essentially, treason ("anti state activities"). Helping a foreign military carry out an attack on your home soil qualifies, I think.

But now court documents have revealed that, "The four-member tribal court did not entertain evidence relating to Dr Shakil Afridi's involvement with the CIA, citing lack of jurisdiction as the main reason and recommended that he be produced before the relevant court for further proceedings under the law... However, he was sentenced...on the charge of having links with Manal Bagh." That is, he was involved with Lashkar-i-Islam, a militant group based in Khyber Pakhtunkhwa province. The court left open the option of trying him for treason but his trial and sentencing to date have had nothing to do with bin Laden or the CIA.

This is apparently as big a surprise to the Pakistani media as to anyone. It'll be interesting to see what people think today.

pakistan: an easy country

Just got to the Serena after a rather smooth journey. There was a caterwauling baby the seat in front of me on the IAD-DXB flight that provoked some images I'm not ashamed of.* But otherwise it was fine. Watched "Drive" and "The Talented Mr. Ripley," neither of which I'd seen and both of which were very enjoyable. DXB was its normal weird self, although because our connecting flight was on Emirates Caryn and I ended up in the special terminal. And when we got there, around 5 PM local time, there was nobody there except staff. A bit strange.

The DXB-ISB flight was great: I had practically an entire row to myself and Emirates planes are nice. Anyway, blah blah blah, now I'm in the Serena and wiped out, which is entirely appropriate because it's 2:30 in the morning. Time for bed, more tomorrow.

Edit: Hope this post answers the comment on the previous post.

pakistan: a hard country

Well, it took me a month but I finally finished Anatol Lieven's Pakistan: A Hard Country. It takes the form of a survey of contemporary Pakistani politics and social structures and the ways these are influenced by geography, history, religion, and traditional cultures.

First, Lieven provides a brief primer on Pakistani history and a more in-depth look at the main structures making up the country: religion, politics (i.e., political "parties"), the justice system (such as it is, and it ain't much), and the military. Then the book breaks down Pakistan's ethno-regional blocks: Sindh, Punjab, Balochistan and Khyber Pakhtunkhwa each get a chapter. Finally, he addresses the history and issues around the Pakistani Taliban, and makes some suggestions directly to US policy makers.

A major theme running throughout the book is the role of patronage. The most powerful social ties in Pakistan are still familial and tribal, and at a national level political parties are mostly not parties at all, but organs of patronage dominated by family dynasties from a particular place. The Pakistan People's Party is run by the Bhuttos and is predominantly Sindhi. The Sharifs dominate the Pakistan Muslim League, which is mostly Punjabi. And so on. At a sub-national level, extended families and tribes switch party allegiances often, or even As a result, Pakistani politics is overwhelmingly, probably incorrigibly corrupt.

Lieven presents his observations and conclusions mostly without judgment, which is rather refreshing. Usually, when I hear talk of Pakistani corruption at another (knock wood) NGO or contractor, it's from the point of view of a Westerner, who was responsible for or knew the people responsible for the management of that money in the way that Westerners think money should be managed. To have corruption in Pakistan placed in a - ahem - Pakistani context is helpful to say the least.

One last point, although I could go on for a long time about this book: The picture of Pakistan that's painted for me at work, and that I help paint, obviously places a large emphasis on the role of my employer. So it's good, very much in line with the perspective-and-humility kick that I've been on for the past year or so, to read a nearly 500-page long book about Pakistan and note that certain groups receive barely a mention. Pakistan is large, complex and very populous. Down in the weeds, it's sometimes hard to remember that.

Outstanding introduction to contemporary Pakistan.