One of the problems that Afghanistan faces is a devastating educational void. It is hard to overemphasize how pervasive this is. Three quarters of adults here are illiterate, according to "official estimates", which are essentially numbers plucked from thin air. BEFORE the Soviet invasion in 1979, 11% of adults surveyed were literate (18% of men and 3% of women). In some rural areas, female literacy approached zero. Now fast-forward through thirty years of war and disruption, and the estimates are not encouraging. Dr. Y, my Pashto tutor, has a phrase that is one of my favorites, "That is a good Pashto word...but nobody understands it." I can't say I'm a "surgeon"; I have to say I'm "a doctor who cuts", so the local (rural) population can understand. What would have been the outcome, do you think, had we invested a small fraction of the support we previously sent to the mujahedin to instead build schools and educational systems in Afghanistan after we used this country as our proxy battleground in the Cold War?

You see how important the work of those like Greg Mortensen is. Three Cups of Tea is a must-read. It's the best non-fiction book I've read this year. Read it and give it away. If you're looking for that perfect Christmas present for me, send the just-published sequel.

Many Afghans who have completed higher education have done so in Pakistan, the UK, or the USA. Most doctors here are on par with a pre-medical or medical student back home, and lack basic sterile supplies or modern textbooks. Pirated pharmaceuticals are plentiful in pharmacies, but the knowledge of how to use them is not as plentiful. Most dismal of all is the "get mine" attitude we see in the communities here. I think after thirty years of war, people cease to think in terms of community service, social capital, or whatever you choose to call that conscientious behavior that sees beyond the next dollar or afghan. "Get what you can now, because who knows what will happen tomorrow." When I ask if the provincial health clinic meets the health needs of the populace, I am told that most of the doctors see the free clinic as a means of recruiting patients to their "private clinics," where they will charge an exorbitant fee for their service. Predator or practitioner?

Thanks to the hard work of some of my predecessors, Dr. Fenton, Dr. Kam, and others, a stable "mini-residency" program in surgical care has been established and formalized here at the Salerno hospital. In six to twelve weeks, we try to impart some of the basics of surgical technique and patient care to our Afghan partners. We teach, we laugh, we prod, we sometimes scold. Of course, the raw recruits vary widely in educational level and motivation, and the hospital volume of local patients is erratic, but slow times are ripe opportunities for lectures and skills training. Injured coalition troops are an opportunity for them to observe us, their mentors, doing the things that we teach them about. Ill and injured local nationals provide an opportunity for them to put it all into practice under our supervision. Will they emerge from the mini-residency at the same level as my residents back home? By no means. But they will be better prepared than they were at the start. And hopefully, somewhere along the way, they will see that the calling to practice medicine is more than just a way to "get mine."