In my travels, I ask most every Muslim I meet about Islam and the Quran. In every case, I am told that Islam is a religion of peace, often with great passion. I approach those answers skeptically, as public relations for the religion. And then you meet men like Dr. Saber Perdes, CEO of Kabul’s Jumhuriat Hospital, a short walk from Chicken Street and my adopted Shar-e-Naw neighborhood. Being in the presence of a man like Saber, I think, if this man exemplifies what Islam is about, sign me up.
The historiography of how I ended up in his office goes like this: Afterparty project backer and old friend Forrest Wright introduces me to his sister Leslie for my research on the Kosovo war who then introduces me to Shqipe Malushi, who spent years running workshops on issues like women’s rights in Afghanistan. An Albanian American, she is beloved by Afghans. If you assume to know Shaira, her honorific Afghan name ( “The Poetess”) people drop everything and make themselves available.
I walk to the hospital, where I am kindly and efficiently treated by Saber’s staff. He welcomes me to his office and apologizes for the short delay. And then schools me on Afghan public health, the real power behind the Taliban and how Islam informs his work as a medical professional. He begins with his extraordinary personal history.
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I’m a physician by training, but I am not practicing medicine right now. I studied primary school and then high school, and most of my faculty of medicine in Pakistan as a refugee.
Why were you a refugee?
Because of the war. First, we were displaced from Kabul to another province in 1985. Then in 1988, we moved to Pakistan. We lived in a refugee camp where there were no facilities, where life was so hard and most of the people were living in poverty. I can recall the days when I went to the English language classes. I took four classes of English language obtaining the first or second position, but I couldn’t continue due to financial problems. My father was keeping a farm of honey bees and we had a lot of honey at home, but we couldn’t’t sell it. So, it was a hard life. I didn’t give up and my family supported me.
Was there something about your experience in the camp, seeing the suffering there, that motivated you to want to get into medicine?
In fact, at that time, the situation got difficult in Afghanistan because there was the civil war in the early 1990s and then later on there was Taliban and we didn’t have a specific future to look to. The only two fields that were bringing in money were engineering and medicine as everyone needed that, even Taliban needed a doctor to be employed. Since my elder brother was a doctor and I had worked with him at a clinic as an assistant for some time, I was motivated to study medicine. In Afghanistan, when you obtain the highest marks in the university entry test (Kankor), then you go to the school of medicine. So mostly it’s the cream of the crop. Until 2001, I understood Basic English, but I couldn’t’t talk for more than a minute. Then, when I was in the final class of my medical courses, I decided to continue studying the English language. I went to a very famous center, it was called ELP. The International Rescue Committee had established the center in 1985. I got admission and they told me that the new class would start in 45 days. I said that’s fine, I just want to pay my money so that I will come and I will make sure that I take that class. Before that, I had procrastinated for a long time saying that I will do it this year, next year…
As a medical professional, is English important for understanding research?
At that time, it wasn’t important since all of our classes were in local languages and the professors tried to prepare notes for us. We had very few reference books, but the professors were not asking for them. They would give us a reference like, “If you want to study more, you can read this book.” It was not a required reading. It was just recommended reading. But I thought that if I studied English, it would make me stand out among my classmates. And when I completed my classes in July of 2002, not only did I get the first position, but also I made a record score for that center, which was 98% in Advanced Level 2. And it motivated me a lot. At that time, there was the collapse of the Taliban’s government and I came to Afghanistan. I started teaching English and I did my residency at different hospitals in Kabul. Still, the financial status of the family was not good. I was receiving some money from my brother while I was teaching English and doing little works of translation services. So I started to translate one of the articles for a kids’ magazine called Parwaz which means fright. And when I translated that article, I think they paid me ten bucks. And they were translating one article every two months, so ten bucks in two months. It was pocket money for me. And I was traveling mostly on my bike to different areas of Kabul. It was not crowded like this. There were very few cars and I could ride my bike even in front of the US embassy as the roads were open. Now, they are all closed to the public. By teaching English and doing some translations, I improved my English language capacity. In 2003, I got a chance to do interpretations in a workshop, which was about the constitution in Afghanistan.
I think it was March or April 2003. An organization called FNST was administering the workshop. They tried their best to find two interpreters, but they found only one. They couldn’t’t find another one, and finally they picked me up because they just wanted to fill the second slot. They didn’t believe in my skills. Although one of the bosses of that organization was a close friend, he had never given me a chance before that. So, there were two interpreters at the workshop. The other interpreter had worked with international organizations and he had spent some time in Australia. When I heard about him, I prayed a lot to Allah, I said, “I don’t want to be ashamed in front of an audience of sixty people.” The German facilitator was a very kind person, but he was very strict, he was to the point, and he was speaking outstanding English. His name was Mark Killer. So he was really a killer. (Laughter) During the workshop, we were taking sessions. And I clearly remember that during one of the sessions, Mark asked the audience a question and the audience responded in a very different way than he had expected. And then Mark told the respondent that if I ask you, “What are dogs?” you respond to me that, “Hens lay eggs!” They are totally irrelevant. The other interpreter couldn’t pick the words for “lay eggs”. Maybe he didn’t know the specific expression. He said, “Pardon?” And Mark told him again and then he translated that into something wrong. And among the audience, there were people who knew English and they laughed. Mark asked, “why are you laughing?” They said, “the translation was not accurate.” When the workshop finished, he tapped me on the back and told his people, “whenever I come to Afghanistan, this person should be my interpreter.” It was a great moment of boosting self-confidence, and also a great moment of appreciating what I had learned. Since then, I have served as an interpreter at different events. I had the pleasure of doing simultaneous interpretations at very high level meetings where the vice president and other high level people from different ministries and the parliament were present. Shaira was one of the facilitators who came to Kabul and GTZ hired me as a part time interpreter. I remember that when I was hired, there was another interpreter as well. So I was their standby interpreter. And when I did interpretations, they liked me and after some time, she kicked out the other interpreter and I worked with her for a long time.
To come to the point, I see that the English language and computer skills have helped me a lot during my career. In 2009, I got a Fulbright Scholarship and I studied Masters of Public Health at St. Louis University in Missouri. My concentration was health policy. I finished with a GPA of 3.9 and distinction at comprehensive exams.
Can I ask you a question about the Taliban? It’s an odd question. You mentioned that of course everyone, including the Taliban, needed healthcare. What was the attitude and the quality of administration of healthcare in the country during the time of the Taliban? Besides being a bit severe in their theology, were they good administrators or was the country basically in a state of collapse and chaos during those years?
As I’ve heard from people who have worked with them, they were not good administrators. When they needed something, they were just giving orders. Like, “We need this in a very short time!” They were respecting doctors because of the profession. That’s what people say about them.
Did you consider, I’m sure you would have had no problem with a visa, did you consider not coming back?
No. Even though I was told several times, “If you stay here, it will be good for you”, I preferred to come back home. There is no doubt that the quality of life is better there, but my people need me. Life is very short. We should be in service of those who need us the most.
How long have you worked at the Ministry of Public Health? And in what capacities?
I joined the Health Promotion Department of the Ministry of Public Health in late 2006 and I worked there until I left for US in Aug 2009. When I came back to Afghanistan, I joined the Health Economics and Financing Directorate (HEFD) as an intern in Jan 2011.
During my first week of internship, I was offered a full time job and I accepted the offer. After working for six months as a Health Economics Advisor, I got promoted to the position of Health Economics Unit Head. I worked for three and half years at HEFD and then I was selected as a Director/Chief Executive Officer (CEO) of this hospital through an open competition. I joined Jumhuriat Hospital in mid-September 2014.
This money was for the Health Policy Project (HPP). And it was up to the government how they wanted to spend it. We had a say in managing that fund, or I would say in at least prioritizing the areas where it should be spent. One of the areas was to support nine of our staff members who were full time based at MoPH. I was happy that I was receiving a competitive salary which met my needs. However, I never acted as a USAID official. I have always stood out as a Health Economics Unit Head because I had a governmental position there. I had a P2 form, which means that I was a civil servant, but only the salary came from the Health Policy Project. I was not reporting to the health policy project. I was only sending them my monthly attendance sheet for the reimbursements. You’re right that there are mixed feelings in some cases with the money that comes from other donors. If I worked for a bank, I would definitely have that kind of a feeling as I don’t want to take money that comes from interest.
For religious reasons or political reasons?
For religious reasons! I don’t like to be paid from interest because I believe that interest is not allowed in Islam. But if anyone donates to the health sector, we should happily accept it and then try to use it in the best possible way.
Because the need is so great.
Yeah, the need is so great and the health sector hasn’t received a lot of money. I believe that expenditures in the health sector should be considered investments. When I considered coming to the hospital, I was told that, “you don’t know about hospital management and you do not have experience from hospital management, how would you run such a large hospital?” I told them that I would try to use the knowledge that I have, combine it with the experiences of other hospitals, consider what’s not working well, and be a role model. I would not be micro-managing things, but I would be running the hospital as a leader. s I have a vision for this hospital, I believe that this hospital will be very different in five years from now. In the past thirteen years, there have been significant investments in the health sector and expansion of services, but mostly those services were expanded to rural areas and provinces under the Essential Package of Hospital Services (EPHS) and the Basic Package of Health Services (BPHS). BPHS is primary care and EPHS is secondary/tertiary care. However, national hospitals have always been ignored. We have a saying that if you are very close to someone, you could be hidden under his beard. Since I have joined the hospital, I have always tried to communicate to stakeholders at different levels and to give them reasons why this hospital needs more attention and why we need to bring in reform.
If I can ask, what’s this hospital’s position in Afghanistan and Kabul, what unique role does it play?
It is a specialty hospital and it should be serving as a tertiary care center. Although we have services that are not available in most provinces, my vision for this hospital is that we should have subspecialties. Soon, we will be inaugurating plastic surgery ward mainly for reconstruction of cleft lip, cleft palate, burns, and other issues. We have also planned gastroenterology in our proposed organogram for the next year. We will be doing trainings for our staff to do the different procedures that are required for being a specialist of gastroenterology. Research shows that majority of our patients who go to Pakistan and India, suffer from gastroenterology problems. If we have those services in Kabul, we will stop them from going there. We have also planned an organ transplant center, but that will not be operated within the next year even if it is approved by the MoPH.
Are those gastro issues caused in some ways by Afghan life, by diet or pollution or stress?
That’s a very good question. There are multiple reasons for that. Since I haven’t done a research in this area, this is my guess and also what I have heard from other people. Diet and stress could be two major causes. Patients have heartburn, hyperacidity or some other issues, but their causes are different. Most of our people like spicy food and we know that spices play a crucial role in gastric disease. Stress could also be a major cause, but there is need for research to approve or reject this hypothesis. Evidence from other countries might be available on the internet, but I haven’t searched it.
Is there research or personal perspective that you have about what are the effects on the body of decades of conflict? Even when you’re not a mujaheddin and you’re going about your daily life, does that have some long-term traumatic effect across the population? Or is that just hard to measure?
I haven’t read a research paper on this topic, but I think that there are effects of war and we can see them everywhere. Most health workers are not behaving well with their clients and with their colleagues. They’re harsh and their attitude is not good. If you reason with them for a couple of minutes, it could escalate to a very hot issue and it may end up in physical clash.
Very interesting.
I have seen people who have gotten engaged in physical fights with physicians inside the health facilities. If you go to a shop and you ask for prices of three or four things and you don’t buy them, they will probably tell you that, “Okay, you’re not buying them. Get lost.” But in other countries, if you ask them for ten items and you don’t buy them, at the end they will give you a business card while wearing a smile. So that’s a difference we can see. The first day when I came back from US, I took a taxi from the airport. I noticed that this person was not driving well, he was not obeying the lines, he was not turning on his signals when he was changing lanes. He didn’t even care for the red light. He just crossed it. I said, “Oh my God, this person is crazy. This is not appropriate.” But after some time, I got used to it. Now when I drive, sometimes I may disobey some of the traffic rules and regulations. Behavior is contagious. It is well explained in (Malcolm Gladwell’s) Tipping Point, the book. So when someone does something wrong, the others also either get encouraged to do that or they get it without any intention. And they practice that behavior for a long time. That’s something that I have noticed from the effects of war.
So it’s not an Afghan culture thing, it’s the effects of war.
It’s the effect of war. It’s not the culture. Our culture is very rich and according to our culture, if someone comes to our home, for example let’s say you are my guest and someone comes and tries to snatch you out of my home, I can fight for you until the last drop of my blood is spilled because you are my guest. You are my honor. The effects of war can be seen in the younger generation more than the older one, because they have grown up in war.
Besides all the deaths, there must have been so many lifelong injuries through the eras of the Taliban, the Soviets and the mujaheddin. How do you and your colleagues nationwide deal with that large of a population of people who were so badly hurt over so many years?
I think people get desensitized to that. As we get insensitive to the suicide attacks and a lot of bad things that are happening. Like when I was in the US, one of my classmates invited me to a dinner party. Many other Americans were there. During our conversations, they asked me about my life in Afghanistan. I told them about how I lived my childhood. What I told you just at a glance; I told them in details. One of my classmates exclaimed “I can’t believe that you are still alive.”
And sane.
Yeah. When we hear in the Western world about gunfire in a school, everyone is shocked. That is considered one of the worst things that could happen in a community. But here, a lot of bad things happen. Like, a suicide attack happened over there in the Kabul Security Department. I could see it from this chair (he points out the window to a large building nearby). And when I heard the sound of the explosion, I said, “Oh my God, it’s in the Security Department.” But I didn’t even move out of my room because I think we are desensitized to that. We somehow get used to that. We say that this is the reality of life and just accept it. Whenever something bad happens, I receive a call from my parents, they ask me, “Are you safe?” and I say, “Yeah, I’m safe.” It has happened several times that I have crossed a square and after fifteen minutes or so, there was an explosion in the same area. My parents ask “Where are you?” And I say, “I just crossed the area where there was explosion, but I am fine.”
So it’s almost like you have to hold two thoughts in your head at the same time. One, to know how to be careful and alert and to be safe. But also not to be obsessed with that and to go about your business and not live a life driven by fear.
Yeah.
Before the elections, I had met President Ghani twice. Once, we had a Fulbright conference and he was there for a full day with us. And then he invited a bunch of Fulbright Scholars, including me, to his home. Since he is also a Fulbright Scholar, he knew that we were a little bit different than others in terms of the way we think; the way we analyze things and see things from a different perspective. At that time, he had not been elected. We asked him if he would run for presidential elections. He replied, “I’m thinking about this. Our goal would be to reduce corruption by 60% within the next five years and then the rest of the 40% would be enough for the big sharks to move around.’” When President Ghani won the elections, I was very hopeful and I thought that he would bring a lot of changes. But I think US didn’t play the role that was expected from them. When there is democracy, if someone wins by only one vote, he is the winner. That’s democracy and US should have backed that principle.
Abdullah.
Abdullah is a great person; he is also a doctor. But I think a car with two steering wheels will never get to its destiny. Right now, everything is going in an ambiguous direction, we don’t know what will happen. But at least I believe that if President Ghani and Abdullah are serving the country within the next five years, there will be many positive changes because both of them are determined people, they don’t give up. On the other hand, President Ghani holds others accountable. Like if we are talking with him, he will say, “what can you do?” And when we give him a word, he will take notes and then after a while, he will ask us “Why didn’t you do this?” That’s something that makes him different. He also thinks critically. The critical thinking is something that’s absent among most of our politicians. Thus, I am very much hopeful that we will have a peaceful Afghanistan after the western troops leave.
How worried are you about the Taliban can take over Afghanistan again?
It depends on their supporters. How much do they support them? I know the Taliban’s game. A game played in Afghanistan supported by neighboring countries and they didn’t even want the whole of Afghanistan to be conquered by the Taliban. If their funds are cut now, I’m sure that they cannot survive more than a month
Really, more than a month?
Yeah. As we saw in 2001, they collapsed in two weeks. No one could imagine ever that the Taliban would collapse in two weeks, and they did. Just two weeks. Now, they have funding and they are highly supported.
At that time, Pakistan, Saudi Arabia, and some others thought, “We better do what the United States is asking of us after we’ve supported these groups that were responsible for Al Qaeda’s attack on 9/11.” But then years passed, maybe Pakistan became emboldened to support the Taliban again. As I understand it, there were some Pakistani Taliban that were attacking Pakistani troops and that were causing problems for Pakistan as well. What do you make of that?
I pray that their numbers increase, so that they can feel it on their skin. Because Pakistani religious scholars are giving statements such as “go for jihad to Afghanistan.” But they have red light districts in Lahore and many other cities. They have a worse situation in Pakistan. No one is calling for jihad there. They are brainwashing youths and sending them to Afghanistan for jihad. If there is jihad, first they should do it in Pakistan.
The 16-year-old at the Lycée the other day blew himself up, Do you think he Pakistani or Afghan?
I don’t know about his identity. People say that he was arrested a couple of years back, but he was forgiven by (then President) Karzai. And then he planned to blow himself up this year.
Terrible. Some people in the west think that there’s something in Islam that encourages that kind of behavior. As with any holy book, there are certain phrases that people can take and say, “Here is proof that it’s a war-like religion.” Or, “They’re encouraging violence.” What, if I may ask, is your experience with Islam? How does it affect your role, your behavior as a medical professional and as a man of faith, which you apparently are, how do you look at these people who, in the name of Islam, are doing these extreme things?
I believe that Islam is not the Islam that is portrayed by extremists. Islam is always encouraging people to do good things. For every good thing that we do, we get rewarded ten times. And there is a verse in the Holy Quran that if you spend your money just for the sake of Allah, to get Allah’s blessings, you could be rewarded up to 700 times or more. This concept is explained as if you have one wheat and you cultivate it, it has seven stalks and every stalk has one hundred wheat grains. So you get 700, or more than that. On the other hand, if our neighbor is suffering from something and we do not help them, or if we eat something good and we do not share it with them, we will be held accountable by Allah. “Why didn’t you do that? Your neighbor was suffering from, I would say, hunger and you were eating a lot of good stuff.” If we cross a street and we go on the right side, we will be rewarded for that as that’s something good. Go on the right side. The routes are already set.
There are principles in Islam, for example, Tawhid. Like if someone says “La Elaha Ellalah o Mohammad ur Rasoollullah (speaks in Arabic),” it means, “We believe in only one Allah, one God and that Mohammad is the prophet of Allah” he/she is a Muslim. After that, being a good or bad Muslim depends on their good and bad actions. Calling Mohammad the prophet of Allah doesn’t mean that we deny other prophets. In fact, we as Muslims believe that Mohammad Peace Be Upon Him (PBUH) is the last prophet of Allah and we believe in about 124,000 prophets including Jesus, Noah and David.
That’s a lot of prophets.
I believe that Islam never encourages killing innocent people. There are verses in Quran which are about fighting others and they are translated as, if someone attacks you, you should defend yourself. At that time, I think there were people opposing Mohammad because they had done the worship of statues for hundreds of years and Mohammad introduced in the new religion. They felt ashamed of that and they didn’t want Islam to grow up. So the followers of other religions wanted to kill Muslims. There was the verse, if they want to kill you, you’re also allowed to kill them. That was self-defense! But some extremists are taking that verse as when you see a person from another religion, just kill them. I believe that it is just the personal interpretation of those people. Islam never encourages violence.
In Islam, there are rules set for everything and respect of elders is always encouraged. Some verses address only Muslims, others address the general humanity. In humanity, Hindu, Muslim, Buddhist… everyone is included. When I talk to my people and I give speeches, I sometimes recite a verse that is about saving one’s life. I believe there is a similar verse in the book of Judaism, as well. Its interpretation is like this: “if you save one life, you have saved the whole humanity.”
Yes, that’s right.
It’s a clear verse from the holy Quran. It doesn’t say if you save the life of one Muslim, you have saved the lives of the whole Muslim community. Rather, it is about humanity, so everyone is included. The interpretation of verses from Quran makes a difference for Muslims around the world.
In the professional and medical circles that you travel in, if I can ask, what’s the attitude toward the United States’ thirteen years in Afghanistan and the decision to cut back most of the troops but keep about 13,000? Is there gratitude, is there hatred, is there a sense that it’s time to go, are there mixed feelings, is there criticism about strategy, it could have been done differently? What is the general feeling that you get about this thirteen years of American presence in Afghanistan?
I think the US didn’t want to have a very strong government in Afghanistan right from the beginning. That’s my personal opinion and I can link it to Karzai. Because Karzai had worked at very low level positions before becoming a president. Everyone knows that managing a small business or a restaurant is very different from running a country.
(Laughs.) Yeah, that’s fair.
I believe that Karzai is a good leader and an outstanding tribal person for his people, but when someone becomes a leader of a country, they should be visionary people who can think about ten years from now or fifteen years from now. For example, Karzai has always talked about fighting corruption and deploying the right people in the right places. He just talked the talk, but he didn’t walk the walk. And it was just a lip service. He didn’t have a vision for Afghanistan. I have never heard him saying that “In 2015, Afghanistan will have this, this, and that.” If I were Karzai in 2002, and I had the international assistance in different areas, I would say that, “Okay, I have these priorities for Afghanistan, who wants to support this?” Like in this hospital, if someone tells me now “what support do you need?” I tell them that I want to establish an organ transplant center; a gastroenterology ward, an allergy center; train ten of my staff members, need machinery for imaging and their maintenance; ….. etc. Each donor may pick one or two areas that are in line with their strategic plans and the hospital services will be improved before long. While the donors are supporting the hospital, I can do supervision. The same could happen to Afghanistan. He could have thought about the traffic jams, about a subway, about having our own power …. etc. We don’t have our power. We are importing energy from Tajikistan and other countries. We are losing a lot of the energy throughout the way and also we are losing the money that goes out of the country. He could have thought about encouraging the local production in Afghanistan. Right now whatever is produced, that’s not standardized. He could have thought about having a health sector that’s meeting the needs of people. I can say that he was just trying to be there or maybe he was under external pressures. Who knows!?
Is there some suspicion or disparagement of the United States, that perhaps he was intentionally their guy who could be controlled? And all this talk about democracy for much of the thirteen years is really undermined by the fact that this western power, protected by their military, decided who was going to be leading in Afghanistan?
He looked like a puppet.
So what’s the answer for your country? Is it negotiating with the Taliban? Is it taming Pakistan, as you were talking about before? Is it patience and faith? Is it more US troops? What’s the answer, do you think, for Afghanistan?
If you look at the war, it is mostly in the areas where there are Pashtuns. From the south to the east. Helmand, Kandahar, Zabul, Ghazni, Logar, Nangarhar, Kunar …etc. Majority of their population is Pashtuns and they are near the border of Pakistan. I also think that the Northern Alliance, have convinced the US military and US officials that Pashtun is Talib and Talib is Pashtun, which is not correct.
Yeah, there is that impression.
Yeah, that impression is incorrect. Because of that, we have suffered the war in these areas. Some people become Talib because either they lose their family or they don’t have any other things to do. Or they get very angry at the current government due to the high levels of corruption and bureaucracy and they say “it’s better to be against the government.” Some others get brainwashed. But when we are trying to, let’s say, fight cockroaches in a building, we cannot fight them one by one unless we find their source, where they come from. When we track them, we can find that these cockroaches lead to a specific area. We go there and we see that there is a big hole and thousands of cockroaches come out of that hole. So we have to spray something there, make sure that no single cockroach comes out of that hole again. And then try to track the rest of them everywhere. Wherever we find them, we kill them. Then it will be safe. I, as a civilian, know that there are bases of Taliban in different areas of our neighboring countries. How wouldn’t US officials know about that? Although Osama was captured and killed in Pakistan, and many other high-level Taliban might be living there. I would like to say that Pakistan is playing a double-faced game right now. They tell the US, “We are trying to fight the terrorism.” And then they are supporting terrorists “Okay, go to Afghanistan, do the jihad, they are Americans, they are infidels, kill them, and when you kill them you will be rewarded several times.” That’s it.
I like that cockroach analogy. Finally, I’m just curious about your experience in the United States. What was that like and what were your impressions of America?
I spent just under 400 days in the US in total. It was a great time, I learned a lot from my professors, classmates, and friends. It was not only learning about public health, but also I tried to serve as a cultural ambassador of Afghanistan. I attended different social events and gatherings and I delivered speeches at events where I was requested to do so. I talked to them about the differences and similarities in our cultures. Some of them had never seen an Afghan in person before. I remember that at one social event, I talked to a bunch of Americans and answered their questions. One of them said “you are just like us!” I made a lot of great friends. I had host families whom I am still in contact with. What I want to say is that there are good and bad people everywhere. Most of the people I met in US were very kind, honest and friendly.
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Thanks to Afterparty project intern Kayley Ingalls for transcribing the interview and providing background research.