Background Briefing

Returning to Kabul, four years after Patch Adams led a clown doctor mission there, Australian clown Jean-Paul Bell and reporter Gerald Tooth are struggling. They return with their own aid to find a nation at once resentful of and utterly dependent on international assistance. Can a drop in the ocean make any difference? Reporter, Gerald Tooth.

Transcript

This transcript was typed from a recording of the program. The ABC cannot guarantee its complete accuracy because of the possibility of mishearing and occasional difficulty in identifying speakers.

THEME

Gerald Tooth: Hello, I'm Gerald Tooth, and this week on Background Briefing we're taking you on a very personal journey about delivering aid to Afghanistan.

Back in 2002, just a couple of months after the fall of the Taliban regime, I travelled to the still shell-shocked Kabul for Background Briefing with 21 clown doctors who'd come from all over the world.

It was an almost surreal journey four years ago, through a city still reeling from 30 years of conflict. Patch Adams led the disparate troupe, who tried to apply their laughter-is-the-best-medicine philosophy in hospitals and schools. They had some successes and some failures. The bickering amongst themselves didn't help things.

The one Australian clown on that trip was Jean-Paul Bell, who heads up the Australian Clown Doctor Association. We formed a friendship and deeply affected by what we saw, resolved to do something to help some Afghan children.

This then is the story of what happened when we went back to Afghanistan recently. It is a story about hopeful endeavours smacking up against cold, and hard-to-swallow realities. And it is a story of confronting the very difficult question of whether well-intentioned amateurs can actually make any difference in a country where the fundamental problems are so profound that they have cracked the very bedrock of Afghan society.

AIRPORT ATMOSPHERE

Gerald Tooth: Well Jean-Paul, it's been four years. Here we go again. What is it about Afghanistan that you just can't get out of your system?

Jean-Paul Bell: Being in that emotional group of clowns, walking into the Indira Gandhi Hospital and the incredible effect it had on us about how pathetic the environment was we had to try and raise a laugh out of, and how in quite a few ways we failed. And I really believe the impact it had on us, I still carry it with me, and so I was determined to do something about it, and now I've got the opportunity to do that.

Gerald Tooth: This tale about the politics of personally giving aid begins at Delhi International Airport, as we wait to fly back into Kabul.

Jean-Paul Bell: I've managed through the great number of hospital connections that I've got, to collect four humidicribs from across Australia, from as far as Western Australia, and New South Wales.

Gerald Tooth: Do you hope that people will remember the original clown doctor mission, and do you think that that mission would have made any difference in any way?

Jean-Paul Bell: No, I don't think so. And the hospital is dealing with horror on a day to day basis, and we're just part of the passing parade so to speak, of assistance.

Gerald Tooth: As you will hear, Jean-Paul's words about being part of the passing parade of assistance are to prove prophetic.

There are just five in our little group, boarding this hopeful flight: myself, Jean-Paul and his wife of just three months, Maggie Haertsch, and a two-man documentary film crew.

As we set out I find myself as a journalist in the unfamiliar position of knowing I have crossed the border from observer to participant in this story. And then as the trip goes on I sometimes feel caught in the no man's land between the two.

For now though, any nervousness is because we're all about to fly into a city that was rocked by a major riot that killed 13 people, just a week ago.

By October, Australia will have sent over 500 troops back into the country that many still see as the cradle of global jihad. And it is the Australian Defence Force that has made this micro-aid mission possible. Jean-Paul and his wife Maggie have convinced the Army to fly in their cargo of medical equipment packaged up in four large crates.

My contribution was to organise a fund-raising exhibition of photos I had taken during the 2002 clown doctor trip. Some time ago the money was sent to a girls' school in Kabul for them to use how they wanted.

At the airport in Kabul, we're met by Walid Tamim, a 27-year-old medical student who was our guide and interpreter when we were last here.

GREETINGS

Gerald Tooth: He takes us to a newly built hotel in Kabul's most genteel suburb. It looks like an Arabian fort and has a team of guards armed with machine guns.

Later we head to the Indira Gandhi Institute of Child Health, the 350-bed hospital of horrors that so shocked everyone on the last trip. It is to here that Jean-Paul and Maggie are sending the humidicribs.

The memories of the squalor and suffering in that institution are vivid. Toilets were overflowing into hallways through which feral cats roamed. Each bed was crowded with two, sometimes three children, and a lack of medicines and equipment gave it the feeling of a place of suffering, not healing.

Four years on, the first impression is one of transformation. The whole place seems cleaner, brighter and more hopeful. There are even roses growing in the garden. Inside there is only one child in most beds.

We are ushered into the office of the hospital's Director, Professor Abdul Jalali. It's a large, well-appointed room with a big conference table and comfortable lounges. A formal portrait of President Hamid Karzai is on the wall behind his expansive desk.

Cups of tea and plates of biscuits appear, and the Professor makes a polite welcoming speech.

Abdul Jalali: I'm very glad to see you here. We've been acquainted with each other by email. We haven't seen each other. I appreciate and am so grateful to you, I am very thankful to you, I express my gratitude for taking so much interest with the Indira Gandhi Institute of Child Health. That means that since we admit patients from all over the country here, we take care of all children from every corner of the country here, and that means that you are interested in the health of all children of Afghanistan, and that's something that's a very, very appreciated.

Gerald Tooth: Almost immediately, he's called away to his second job as Director-General of Human Resources in the Ministry of Health.

Professor Jalali leaves us with the hospital's Head of Paediatrics, Professor Abdul Mayar.

Jean-Paul and Maggie are keen to find out as much as they can about the hospital. For Professor Mayar though, this is obviously just another group of foreigners with a film crew in tow, saying they are going to do good.

Abdul Mayar: Some of the foreigners, they come here, they take the pictures and they go "we will help", then go. And untilnow I not see them again..

Gerald Tooth: He says he has seen many foreigners come and take pictures, promise to help and not be heard of again. The point is made that Jean-Paul and Maggie are bringing all sorts of medical equipment as well as cameras.

However, Professor Mayar says the sort of help he'd like to see is a doctor exchange program with hospitals overseas that would better train his staff. He says some Indian doctors are already doing that, but it needs to happen more often.

The Indian government in fact, built this hospital, which as opened in 1972. India still provides the bulk of the funding for what remains the only public children's hospital in all of Afghanistan. It has a staff of 650 of which only 170 are doctors, and 175 are nurses.

Professor Mayar's list of problems goes on as he adds low ages for doctors. He tells us most of those in this hospital only earn about $60 [$35-45 US] a month.

And they work hard for that money. Sometimes a crushing 300 outpatients a day are seen, presenting with a long list of illnesses, such as gastro-enteritis and septicaemia. Usually more than 50 are admitted.

In their efforts to know more about how the place operates, and to get some idea of how the humidi-cribs will be used, Jean-Paul and Maggie ask to go on a short tour.

Professor Mayar takes us straight to the Neonatal Intensive Care Unit, known as NICU.

BABY CRYING

Gerald Tooth: The first thing we see is a baby, sharing a bed with another, that is violently convulsing. No-one in the crowded room is taking notice until the Professor steps in.

So there is no doctor in the ICU?

Woman: No.

Abdul Mayar: I told you some of the doctors, they have deficit of the salary, they have to find money from the private clinic, no? For example ...

Gerald Tooth: Professor Mayar explains that because of their low wages, many doctors leave the hospital at 3 o'clock to go and work in one of the growing number of private clinics in the city. Many of these clinics have been set up by foreign governments. There is a French clinic, an Italian clinic and a German clinic, among others. They pay doctors far more than they can earn in the public system, and charge more than most Afghans can afford.

The end result in this hospital though is, as we have just witnessed, a neo-natal ICU without a single doctor in the middle of the afternoon.

Maggie Haertsch: We'll stop the tour now, but come tomorrow?

Abdul Mayar: Tomorrow, yes. Tomorrow you want to see ...

Gerald Tooth: We leave the hospital, pile into the van and begin the first of many on the-the-road debriefs. Jean-Paul reflects on what has changed since the last visit and is reassured that the humidi-cribs he has brought are still very much needed.

Jean-Paul Bell: So really, in terms of equipment, nothing's really changed, I think the place definitely has brightened up, but we'll see more tomorrow. Would you agree, Gerald?

Gerald Tooth: It's moved on from being absolutely squalid with feral cats and stuff running around in the hallways, it's cleaned up and brighter, but it's still very confronting seeing the treatment that those children are getting, or the lack of medicines and the lack of equipment, and it's just astounding to go into an Intensive Care Unit, and there be no doctor on duty, and the consequence of that being a small child going into convulsions and nobody's doing anything about that because there's no doctor there to even notice that something's happening.

Back at the hotel, Jean-Paul agrees that there has been little real progress at the children's hospital.

Jean-Paul Bell: It's true. It really is suffering, and when you realise that it is the only children's hospital for the entire country and they actually get people to come from all corners of Afghanistan to that hospital, and you really have to ask yourself for what reason.

Gerald Tooth: Already the seeds of doubt have been sown for Jean-Paul and his wife, about whether they have chosen the right target to try and help.

In their room a little later Jean-Paul and Maggie pack baby clothes into plastic bags to give away at the hospital.

Maggie Haertsch: Why don't we take everything out of this bag, and we put it all into there, so just dump all that there.

Gerald Tooth: They were donated by the people in their home town of Newcastle.

Maggie is a registered nurse and midwife with a Doctorate in Behavioural Science in Medicine. Her thesis looked at antenatal care in New South Wales in the early '90s.

She now runs her own business selling a workplace training system she has developed. Big institutions such as hospitals are her main clients. As she folds baby clothes, Maggie explains her motivation for coming on this trip.

Maggie Haertsch: I think we lead very selfish lives, very focused around our own careers and ambitions, and I like to have a bit of balance, I mean I'm quite an ambitious person I think, and quite career-minded, but I've also got a lot to give and I think this is extremely - it provides a lot more balance to your life. And it's really important to realise that you're coming and visiting a place like this, just gives you so much more perspective around life. You know, and just how other people live, and just being extremely grateful for what you do have. But I don't know, I don't really think about it that much, just think it's just a thing that I really like to do.

Gerald Tooth: Our second day in Kabul begins with the short trip back to the Indira Gandhi Hospital. Today is the day that the Australian Defence Force has said the humidi-cribs should arrive.

As we wait in the van to leave, conversation again turns to the baby that was convulsing in ICU. Our interpreter, Walid Tamim, who is a fifth year medical student specialising in paediatric surgery, talks of his frustration with the Afghan medical system.

Walid Tamim: I pray and say Oh God, don't make sick anybody of my family, because I know there's nothing I can do for them.

Gerald Tooth: Your fear is that anyone in your family has to use the medical system here?

Walid Tamim: You know what, if somebody gets sick, I really lost my hands and feet; it's an expression in my language means I really lost control, what to do. If I really find out that somebody has a heart problem in my family, I feel really, really bad. I say, there's nothing I can help my family member. So I should think of sending her somewhere to India or Pakistan. I don't rely on any hospital at all.

Gerald Tooth: Walid has been talking about a small Afghan-run surgical clinic for children that is in need of help, and suggested to the couple that they think about what they could do there.

Meanwhile Jean-Paul's concerns are growing about just where he has sent the medical equipment from Australia.

Jean-Paul Bell: Yes, it's amazing, really out of this whole process is we want to know how we can have the best effect, and out of this conversation, we're finding out is the Indira Gandhi Hospital the one we should concentrate on, or should we choose the smaller hospital to do the most?

Walid Tamim: That's why if you want to have a quick result, and see something really affects the life in the hospital; it's a huge hospital, only a big country can support it fully. But when I talked about that small surgical part of the hospital, there you can see the results in a couple of weeks. If you bring those machines, with a few surgical equipments, you see what you did, and you see the changes.

Jean-Paul Bell: Yes, whereas at the Indira Gandhi it's a drop in the ocean.

Walid Tamim: It's a drop in the ocean.

Gerald Tooth: We return to Professor Jalali's office and he gives another speech about the hospital's Indian-backed building program. He paints a vivid picture of the massive assistance they are already getting, which is measured in millions. Whether intentionally or not, Professor Jalali makes four second-hand humidi-cribs sound like a very small offering.

Abdul Jalali: We will have an MRI machine. It's bought by Indian friends, and it cost about 1-million,1700-thousand Euros, and a CTC scan, similarly 1-million-300-thousand Euros. And other equipment like electrocardiography machine and electro-encephalography machine, and other laboratory machinery and x-ray, digital x-ray, they are all bought by the government of India, and it soon will be installed in the new Poly-clinic.

Gerald Tooth: Yet in the next breath, Professor Jalali says the hospital doesn't have some of the basics they need to function.

Abdul Jalali: Regarding the equipment and surgical instruments and consumable items, for instance in the operating theatre, like stitching material, surgical gloves, surgical blades and all these, are really short in our hospital, and we have to get it from somewhere.

Gerald Tooth: It just so happens that the donated humidi-cribs have been packed full of these such things.

He then laments the whole country's dependence on foreign aid.

Abdul Jalali: On the whole our budget is very limited, and the whole budget of the country, about I think 60% comes from the international community, it's not enough for the whole system, and our share is very less.

Gerald Tooth: Then we go to the hospital's Malnutrition Ward. Professor Jalali tells us that in Afghanistan two out of every five children die before the age of five. Mothers having babies also die at an alarming rate.

In the Malnutrition Ward the statistics are made real. The chronically underweight babies have the wizened faces of old men. They have lipless gaping mouths that suck at the air. They lie in their cots, abject and listless with unfocussing dry eyes, while their mothers sit beside them.

Maggie asks Professor Jalali about what's behind the extraordinarily high infant mortality rate. Becoming a little frustrated, he points out that bringing the rate down is a priority for the Ministry of Health, indeed the whole Afghan government.

Abdul Jalali: The whole country concentrating in this area.

Maggie Haertsch: Is it primarily obstructive labour, or post-partum haemorrhage, or both, or - ?

Abdul Jalali: Well it's poverty in general. It's poverty, lack of medical institutions in the villages and the provinces, lack of trained personnel, lack of medical health education, and lack of habits and the tradition, lack of transportation, the lack of communication and these are all involved in this high mortality rate.

Gerald Tooth: Behind these problems contributing to high infant mortality is Afghanistan's violent history over the last 30 years.

Abdul Jalali: We are just recovering from three decades of conflict, war, and struggle, something like that, and that means that we are still struggling there in the post-war syndromes, post fighting syndrome, and that affected our whole system, economic systems, agriculture system, irrigation system, social system and health factors, all to be considered.

Gerald Tooth: There's been a significant change in the attitude to foreign aid since we were last here. Then, everything was welcome, now there's what you would call aid fatigue. With an economy that would simply collapse without foreign assistance, there's an underlying resentment tied to wounded pride and the frustration of having outsiders meddling in their domestic affairs. At the same time there's the weary attitude that it is an utterly necessary evil as the country rebuilds.

And then Professor Jalali leaves again for the Ministry.

JEAN-PAUL SINGING.

Abdul Jalali: OK, if you will just permit me.

Gerald Tooth: Amongst the misery of the Malnutrition Ward, Jean-Paul performs his brown paper bag trick, a trick that spreads like a rumour across the city during our stay.

It's a sight gag where he throws an imaginary ball in the air and then catches it in the paper bag, accompanied by a finger snap that really does make it look like a ball has fallen into the bag. He then gets the child, or often adult, to join in by throwing the imaginary ball to him. Finally he reveals how the trick is performed, and coaches his audience before leaving them with bags of their own.

He's brought 800 brown paper bags along with him, and most times when we leave a building a quick look back reveals dozens of people laughing as they try to master the simple trick.

With the departure of Professor Jalali our new guide is Dr Noorulhaq Yousufzai, the Assistant Director of Paediatrics. He stuns Maggie when he reveals that the four humidi-cribs arrived yesterday, without making any connection between the equipment and those that sent it.

Along with the cribs they've also sent three endoscopes and a bronchoscope and Dr Yousufzai takes Maggie to see where they have been stored.

Maggie Haertsch: Yes, that's us, that's from us.

Noorulhaq Yousufzai: Yes, they sent these boxes, because I think it's not complete.

Gerald Tooth: The four humidi-cribs are in fact on the other side of the hospital, locked behind doors that no-one can find the key to, today. Dr Yousufzai says this particular donation is badly needed.

Noorulhaq Yousufzai: Specially we need for incubators in our hospital. We had plenty of incubators but they were not in function condition. So when we got these four incubators it helped us, specially in the management of the sick young infants. And also they send us three endoscopes. I think it's so necessary for us, especially for diagnosis of some case, in -

Gerald Tooth: Gastro-enteritis?

Noorulhaq Yousufzai: Yes, yes.

Gerald Tooth: He explains that all the humidi-cribs they did have were rendered useless by power surges from their erratic electricity supply.

When we can't get to the locked away Australian humidi-cribs the doctor shows us around the soon to be opened maternity wing. It's just been rebuilt after being destroyed by rocket fire in the civil war 15 years ago.

Jean-Paul raises another concern about how the hospital is run, that is undermining his crumbling faith in the institution. What's troubling him is an abject lack of infection control.

Jean-Paul Bell: I have not seen one disinfectant-type device in the entire hospital. Even things like alcohol gel which you just squirt on your hand before you deal with anybody. If you look at the toilet in the closest point to NICU -

Gerald Tooth: NICU being the [Neo]Natal Intensive Care Unit.

Jean-Paul Bell: That's intensive care, just the bacteria there would kill a normal human being without touching a thing. It makes you question that no matter how much medical equipment, how much medical staff you have, if you don't have the basic infection control, then it's pre-Louis Pasteur, isn't it.

Gerald Tooth: When we've left the hospital the hygiene conversation continues over lunch. The point of reference is of course hospitals in Australia where both Jean-Paul and Maggie have worked. As they talk about what they've seen in the children's hospital in Kabul, anxiety and anger begin to rise in equal measure.

Maggie Haertsch: It's like 1950s childbirth. 1950s stuff.

Jean-Paul Bell: And they're not washing their hands either....

Maggie Haertsch: I mean infection's just a big, big, problem. That place is oozing with it.

Gerald Tooth: Jean-Paul is also frustrated and says to Walid that they've spent a lot of money to come to Afghanistan, and they want to have maximum impact but, he says, you feel like you've delivered this stuff but all you've done is push it off the edge of a precipice into a bloody great hole.

At the end of the day Jean-Paul is a little dismayed at the way in which they found out their cargo had arrived.

Jean-Paul Bell: No, that made you feel rather small and insignificant. Like I've got a feeling quite a bit of medical equipment sort of drops in out of the blue like that, with nothing connected for it. So on one hand, they kind of feel a little bit annoyed about people just giving them stuff like donating quite offends their pride. There seems to be almost a representation of what the country's like. It's like mini war-lords within the hospital. Everybody's got their own little department and their own agenda, and there's no-one actually co-ordinating all of that into one positive outcome. There's no real management plan.

JEAN-PAUL singing 'Don't Fence Me In'

Gerald Tooth: The next day begins with some early morning ukulele practice.

And then, for the third day in a row we pack into our van to return to the hospital.

We go to Professor Jalali's office and Maggie and Jean-Paul are keen to actually see the humidi-cribs. There is, however, a shock in store.

While the humidi-cribs are all there, the medical equipment and materials that were in the packing crates with them are strewn all over the floor like rubbish. And the floor in this yet-to-be-opened wing of the Indira Gandhi Hospital is grimy with talcum-like dust.

After checking to make sure everything is there and explaining what some of the things are to the doctors, Maggie asks if the medical supplies can be picked up off the floor, and gets a surprising response.

Maggie Haertsch: We should probably put it back in boxes and keep it off the floor.

Noorulhaq Yousufzai: No, no, ...

Gerald Tooth: Maggie, quite frustrated, then points out a sticker on one of the humidi-cribs. It's a red hand that says 'Stop, think smart. Have you washed your hands?' and was part of an infection control campaign run in Australian hospitals.

Maggie Haertsch: Right, are we ready? Can I point this out, I think this is very important about washing your hands before you touch a baby, and I just think that there's a lot of work I think that needs to happen in this area.

Abdul Jalali: Yes, we have an infection protection program, and we instruct them that whenever you touch a baby, you wash your hands with the soap and water, and this is essential for us. Even we put to them a detergent there, some, for instance, a Dettol solution.

Maggie Haertsch: But it's a hard thing, hospitals in the UK have a big problem with this, every hospital has a big problem with this, and it's something that everyone must just remember so much, right down the line.

Abdul Jalali: We have this problem, sometimes they don't await instruction.

Maggie Haertsch: That's right. And they don't remember. They're busy, they go from one to the other and don't remember. But having little signs like this to -

Abdul Jalali: That's a reminder, which is very good.

Maggie Haertsch: And I've got four of these, one for each of the humidi-cribs so you can plug them in. You know they're all in good working order, and you can set the temperatures.

Gerald Tooth: Professor Jalali's assertions are at odds with what we've seen in the hospital. The rooms do not have sinks with running water and there are no facilities for hand-washing. Yet it is obvious that while there is a long way to go, things have improved from what they were like four years ago.

It's here though that naturally high western expectations have crashed headlong into unavoidable third world realities, with pride on both sides injured in the collision.

Then in the hallway strewn with medical supplies there's a formal little ceremony that everyone feels obliged to go through with.

Jean-Paul Bell: On behalf of the Australian people, and the parliament of Australia, we present this flag to the Indira Gandhi Hospital ...

Gerald Tooth: Maggie and Jean-Paul's Federal MP who helped to get the Australian Defence Force involved in their project, has given them an Australian flag and a certificate, and asked for the couple to present them to the hospital.

Jean-Paul Bell: ...the humidi-cribs behind us, and all the medical equipment that has been sent by the Australian Defence Force. We thank you for the opportunity to help your hospital.

Abdul Jalali: Thank you very much, this is a great honour and privilege for me and for the Indira Gandhi Institute...

Gerald Tooth: Afterwards, Jean-Paul stands alone with his arm draped over one of the cribs and speaks to the camera.

Jean-Paul Bell: I just want to say I started my life in one of these, I owe my life to one of these, and it's with great emotion that I bring these over here to continue to improve the health of Afghan babies, and may they live long and strong, just like me. I bounced back. Yes, my older brother didn't make this journey because he didn't have one, and I spent my first three months in one of these. Every time I see one I feel very emotional. I think that's why I love caravans, to me it's a tragedy, and we have to help, we have to do as much as we can because they are beautiful people, and they need every possible assistance. There's much to do here, there's a lot of politics involved in helping. We talk about getting the most expensive equipment, but really, what they need is soap and water. If you look around here, and the way some of the stuff that we've already delivered has just been dropped on the floor, there's a lot of lessons to learn about looking after equipment ...

Gerald Tooth: Then it's back to the Malnutrition Ward where Maggie hands out the donated baby clothes.

Jean-Paul plays the ukulele while Maggie hands out things, eagerly accepted by the mothers, who line up for their share. And as this is going on, he gets the answer to a question we've been trying to get to the bottom of since we arrived, and that is, does anyone remember the clown visit from 2002?

And there's a twist here too. The doctors only remember the antics of Beach Clown with whom Jean-Paul clashed on the original trip. She took over his performance at the hospital by putting a red nose on the Director, Dr Hosmari, and dancing with him.

Jean-Paul Bell: What do you remember about the clowns visiting your hospital, can you remember?

Answer: When they came to the hospital, they make a joke and the Director -

Gerald Tooth: Oh, Beach Clown. That argument that you had with her about interrupting your performance, they all just remember her.

Jean-Paul Bell: Exactly. I'll scratch her eyes out when I see her.

Gerald Tooth: And then with the baby clothes have been handed out, Jean-Paul expresses some discomfort. He's worried that the gift giving may have appeared patronising.

Jean-Paul Bell: You know, the sort of Great White Gods have come across from the ocean bearing gifts.

Gerald Tooth: It can look that way, can't it?

Jean-Paul Bell: Yes. But we've also brought some very useful medical equipment, so - and the feeling you want is from one community to another.

Gerald Tooth: None of those mothers in there look ungrateful.

Jean-Paul Bell: No, that's true.

Gerald Tooth: Later, as we are again debriefing in the van, Maggie is also uncomfortable about the handing out of gifts.

Maggie Haertsch: That was really weird, like it just feels so weird to be doling out things, I've never done that before, I don't want to really ever do that again. I mean it was lovely to be able to do that, and the gesture and for people to know that their clothes have gone to some very sick children, but no, reminds me of those images of Princess Diana and like I'm so far from that.

Gerald Tooth: The day ends with a visit to the prominent female Member of Parliament, Malalai Joya.

A democratic parliament was elected in September 2005 with women taking 68 of the 249 seats in the Lower House. The Taliban responded by putting a price on all their heads, offering a $33,000 [$25 000 US] reward for the body of any MP.

At 28 years of Age Malalai Joya, who represents the Northern province of Farah, is one of the new generation of Afghans challenging the old ways of her country. She is furious about the continuing influence of the warlords whose destructive violence is the cause of many of Afghanistan's problems, not the least, the deaths of tens of thousands of people.

Since the fall of the Taliban, many of these men have been elevated to positions of power within the US designed democracy. President Hamid Kazai has even appointed some as members of the Council of Elders. She claims up to 60% of the new parliament is aligned with warlords.

On 7th May this year, the tiny and fine-featured Malalai Joya fearlessly stood in the national parliament and told then they were murderers, with blood on their hands, and they should be jailed.

The insulted members replied with shouts of 'Rape her!'. Later assassination attempts have forced her to live amidst heavy securing, changing house every day. We pass through a solid steel gate and are searched by her guards before entering today's house.

Maggie and Jean-Paul have more baby clothes they want to distribute. Walid, our Afghan interpreter, has decided to send them to Malalai Joya because Maggie has expressed particular interest in being put in touch with a women's group from the MP's social activist past.

This evening's meeting is to show her a sample of the clothing and organise that connection at which the clothes will be handed out.

Maggie Haertsch: I'm not sure what will be best, because I'm conscious that we don't have a lot, and people need a lot of things. There's a lot of people who would appreciate having them, but there's a lot of people back in Australia, a lot of women, back in Australia who would love to be able to continue to provide, so this is a way of us finding out how we can create more support.

Jean-Paul Bell: As a grassroots....

Maggie Haertsch: We probably would have maybe enough for ten mothers.

Malalai Joya: Yes, Jean-[Paul] told me that then you document ...

Gerald Tooth: A meeting is organised for later in the week.

UKELELE/JEAN-PAUL

Gerald Tooth: It's Thursday, and at breakfast, Jean-Paul talks about the day ahead which is a return to a girls' school we visited in 2002.

Jean-Paul Bell: We're off to school today. Yes, it's going to be fantastic going back to this particular school because it really was I suppose the joy in the visit, after suffering through Indira Gandhi, it was great to get to the school and just be in a roomful of that amazing girl-power that was there, you know. And they of course were really excited about us turning up, and they were just excited about being at school. And obviously this is going to be a different generation of girls we'll probably be seeing. We won't I expect be seeing the original girls that we performed for, but that won't matter.

Gerald Tooth: The Makta-e-Panjsad Famili School for girls is the place that drew me in and got me involved.

After our visit in 2002 I staged a fund-raising exhibition of photos I had taken of the original clown doctor mission. The proceeds, $US5,000, were sent to Walid to use at the girls' school. In consultation with the school he set up a fully-equipped science laboratory.

We arrive, and are ushered into the Principal's office.

The Principal tells us about what's changed since we were last here. The school has more than doubled in size, to now have 9-1/2-thousand students. They range in age from six years to 24, with the few older students being those trying to make up for the years lost under the Taliban.

Walid explains just how the money was spent.

Walid Tamin: I thought about a laboratory. I just added 500 of my own, and 300 from my brother, so 800 more plus 5,000 of yours. So with that money, that money you sent, we cleaned up the room, we built a beautiful laboratory and now like around 5,000 children especially girls, from the 7th grade up to 12th grade, they're using the laboratory. And it's got three sections: Physics, Biology, and Chemisty.

Gerald Tooth: It is filled with typical high school science paraphernalia, Bunsen burners, cupboards full of chemicals, and anatomically correct posters of garishly fleshless people with their muscles and organs exposed.

The girls in their austere black smock uniforms and white head-scarves are sitting crowded around one of the high benches, earnestly answering questions.

Their teacher is taking the year 5 class of 12 and 13 years olds through the finer points of mixing various liquids with different solid compounds.

As the lesson comes to an end I am unexpectedly asked to say something to the class and awkwardly do so.

I just want to say how wonderful it is to see all of these girls doing so well. (TRANSLATION) The thing that I think is going to make Afghanistan strong in the future is the education of girls, they are the heart and soul of the country. (TRANSLATION)

The chemistry teacher is Nassima Nagib. She has been a teacher for 20 years and during the time of the Taliban secretly taught girls in her home. She says the advent of the properly equipped laboratory has made her excited about teaching again, and opened the world of science to the girls in a way unadorned book-taught lessons could not.

We leave the science room and go to the school's creche, where children are crowding in to see Jean-Paul perform.

After three long days in the utterly depressing Indira Gandhi Hospital, this one-man, comic mime show, in front of healthy, happy children, is a welcome mood changer.

The brown paper bag trick has an outing, as does Mr Pinky, the wind-up elephant who won't do as he's told. Then Jean-Paul puts a surgical glove over his head and blows it up until it explodes. Everyone in the room joins in the joyous response.

After the show we all return to the Principal's office where I ask her about the re-emergence of the Taliban in Southern Afghanistan. As a result there have been numerous school burnings and the murder of teachers as part of a very effective campaign to prevent girls gaining an education.

However Zahra Kohistani says she doesn't believe the Taliban will come back. She says emphatically, 'This is not going to happen again. Never again'.

Then comes an awkward moment. Zahra Kohistani asks that each of the five of us donate $US100 cash right there and then so the school can buy its first computer. It's clear our guide Walid has told her she should ask. Caught rather off-guard, we dissemble and decline, but promise to form an ongoing relationship with the school. Everyone is a little uncomfortable.

While the rest of the group returns to the hotel I go off with Walid for lunch.

His mobile rings, and it is Malalai Joya, the female MP from yesterday. She wants to know exactly what Maggie and Jean-Paul are offering.

When she is again told it is just a suitcase full of baby clothes, she becomes furious. Over a short series of calls during which both ends of the conversation hang up on one another, Maklalai Joya abuses Walid and asks him 'What sort of Afghan are you to bring these people to me?' She also says, 'I have a whole province of poor people depending upon me; I can't waste my time on such small things. Tell these people we are not such beggars that we need what they offer.'

She cancels the planned meeting.

Walid is both stunned and angered.

When we return to the hotel he tells Maggie and Jean-Paul what has happened.

What they've come smack bang up against is the expectation that as aid givers they are representatives of a nation, Australia, and not just two individuals trying to do the best they can with the support of a community and not a country.

Maggie is particularly disappointed.

Maggie Haertsch: You know, I suppose I'm surprised. She's a very passionate woman, she's very prominent, she's quite an activist and she's got a lot on her mind, and I don't think she understood now, well we know, she didn't understand the quantity. And she accepted that, and was also quite gracious about that, and we said, 'It's only a small gesture, we know you need much more'. So the fact that she's reacted this way to Walid, she's just not understood. And I think that that's really disappointing. Really disappointing because well for a start, it was my first contact with women in Afghanistan. To this point I haven't actually really had a lot to do with women, and she's very much involved in women's issues, and I was hoping that I would be able to establish some sort of relationship with the organisation that she was an activist in which was the one we were going to be meeting tomorrow, and now that's not going to happen. So I am disappointed. I certainly understand it; this doesn't compare to what she's got to do, absolutely nothing. So if that how she feels no problem, we'll just find someone else who can take it. I know it'll go to someone who'll appreciate it, but yes, I am disappointed, but that's OK.

Gerald Tooth: For a couple, you're doing quite a lot, but it seems that at an official level it might not be appreciated?

Maggie Haertsch: Yes, I think there's a difference between people understanding that we're just a couple of individuals just spending our own money, and using the generosity of our community and bringing that here, as opposed to being seen as some sort of Australian government representatives. I think there's really quite a big difference.

Gerald Tooth: Overnight, Maggie and Jean-Paul have decided to take the rejected suitcase full of baby clothes to the small government-funded surgical clinic that Walid has told them about.

They head there, first thing on Friday morning.

From the outset, the visit is in stark contrast to their experiences at the Indira Gandhi hospital.

It's called the Maiwand Children's Surgery Hospital and is located in what looks like a converted house in the grounds of a larger public hospital.

Afghan surgeon Dr Said Meer Jan is the Director, and he takes Maggie and Jean-Paul through the building, explaining the procedures they perform. The 14-bed facility is used only for child surgery and opened just 10 weeks ago. It is also used for doctor training.

It is a model of cleanliness, efficiency and, as it emerges, surgical innovation.

As the surgeon explains, they are also in desperate need of support with funds so short that the three doctors who work there sometimes pay out of their own pockets for the cost of operations. And it seems that there is no limit to what they will undertake, from chest and abdominal surgery to minor brain surgery.

They are hampered by the fact that they have only been able to acquire adult sized operating instruments.

The director tells the Australian visitors that on one occasion he was forced to use a pair of scissors to relieve pressure inside a child's skull brought on by encephalitis.

Jean-Paul is interested in helping.

Jean-Paul Bell: What would be good is if he could email to you what is needed for equipment, and if you could then email Maggie and put what his requests are in English, then we'll see what we can do.

Gerald Tooth: They're also very impressed with the infection control processes in place in the clinic. There is a sink with running water in every room.

After all this is explained the baby clothes are handed over, and gratefully accepted.

And enthused with what they've seen, they make a decision about where their future support should go.

Jean-Paul Bell: I think this is the place to support, personally.

Maggie Haertsch: Personally, I do too, especially because of its teaching line.

Gerald Tooth: Jean-Paul is convinced that the Indira Gandhi Hospital is not the place for them to be assisting in the future.

Jean-Paul Bell: I think for people such as we are, where we're very grassroots, in order to do something for the Indira Gandhi we would have to convince the Australian government to get behind that hospital. That's a very big thing. I think realistically, with our resources, we would be better off supporting sick children in that clinic. We could make a major impact on that, just simply by fishing around back in Australia, through the various hospitals we both have connections with, in finding equipment like a paediatric operating theatre suite really.

Gerald Tooth: On our last evening, we talk about what has and hasn't been achieved, and I asked Jean-Paul if he'd do all this again.

Jean-Paul Bell: Definitely. This does not deter us in one way at all. In fact we're very committed to continue to support the High School here, the girls' High School, and also the Primary School. And we've been given certain directions in what they need, and it'll be up to us to get that together, with your help of course, because we're all involved in this together.

Background Briefing's Co-ordinating Producer is Linda McGinness.

Technical operator, Leila Schunner.

Website, Anna Whitfeld.

Executive Producer, Kirsten Garrett.

And thank you to documentary film makers Ian Hamilton and Jamie Lewis for their help in making this program.

I'm Gerald Tooth and you're listening to ABC Radio National.

THEME

Further Information

Clowning in Kabul is an account of the trip to Afghanistan in 2002