Couple brings their Old English Sheepdog to Afghanistan

Couple return to Afghanistan
Doctor and nurse build infrastructure


By Margot Sanger-Katz
Monitor staff

December 21. 2006 8:00AM

Fred and Mare Hartman had lived and worked around the world. The doctor, Fred, and nurse, Mare, had set up hospitals in Honduras and Nepal and had built AIDS prevention programs in Uganda. In the past 15 years, they had built a thriving HIV and hepatitis practice in the Lakes Region. They had spent only a short time doing public health work in Afghanistan in the 1970s, before the Soviet invasion forced them out.

But as the country suffered through years of war, first with the Soviets, later between internal factions and now with the U.S.-led invasion, the Hartmans had always felt they had left business unfinished in Afghanistan.

When Fred Hartman received an offer to return in October 2003, he wasn't expecting it. In fact, he'd bought a new puppy for his wife a few weeks before he got the call.

"I never would have bought the puppy if we had known we would be going to Afghanistan," Fred Hartman said, as he watched the now-mature Old English Sheepdog play outside their New Hampton home. They had no choice, they said, than to bring Winston, the puppy, along.

Fred Hartman had been recruited to work with Management Sciences for Health, an organization hired by the U.S. government to develop a health infrastructure for the new Afghan government. He worked with Afghan health officials to build and renovate hospitals, bring in medicines and equipment and establish standards for training doctors and nurses.

His wife went with him without a clear job description, but she quickly found ways to make herself useful. She has training in nursing and education, so she at first worked as a teacher of English at a Kabul orphanage and later helped run a fledgling hospital in the capital, training medical residents and opening new inpatient wards one at a time.
Health conditions in Afghanistan were terrible when the Hartmans arrived. One of every seven women died in childbirth, the highest rate in the world. Because few women were trained in medicine under the Taliban, and Afghan cultural taboos prevented men from treating women, many died from easily prevented complications.

The mortality rate for children was also high: 25 percent did not live past the age of five. Many children died, Fred Hartman said, from diseases he never saw in the United States, including polio, which has spread in isolated parts of the country. The political history of the country had prevented the government from distributing childhood vaccines, allowing the spread of diseases like measles and whooping cough.

"That was the toughest thing,"

Mare Hartman said of the many deaths of children she witnessed at her hospital. It quickly opened maternity and pediatric wards to try improving care to the most needy groups.

But adults also suffered from infectious disease and malnutrition. Fred Hartman saw a 22-year-old teacher who died from advanced tuberculosis that could have been cured if treated sooner.

"Most of the problems we saw were treatable or even preventable," he said. "They'd come by the hundreds or thousands with problems you never even see here."

In their three years of work, both Hartmans said they saw much to be hopeful about. Fred Hartman supervised the opening of several hospitals, which expanded access to health care in isolated regions of the country.

Mare Hartman helped train young doctors and nurses in U.S. standards of practice, and she said that they were enthusiastic and eager to learn. Simple things like washing hands and sterilization techniques made a big difference, she said.

Fred, with the help of the country's health ministers, negotiated cease-fire days when workers could vaccinate children in rural areas.

The new Afghan constitution contains a provision guaranteeing health care to its citizens as a right. And the health department increased doctors' salaries to reduce corruption.

According to Fred Hartman, the country made strides in several health indicators over the past three years. Maternal death is down, childhood mortality is down, and vaccinations are up. The country has a long way to go, but considering its challenges - 23 years of war, harsh mountainous geography and poverty - Hartman said he's been impressed with the country's progress.

"It took a lot of effort to overcome the inertia of a destroyed system," he said. But he thinks the Afghans are determined to embrace peace and continue the pace of improvement.

"I remain optimistic and hopeful, but there remain some challenges to be addressed," he said.

Outside the boundaries of their public health work, the Hartmans said they were moved by the people they met in the country and made many friends. They found Afghan culture to be welcoming and were impressed by the stories of the people they met, many of whom had overcome terrible adversity. They worked with one doctor who traveled with a militia group, hundreds of whose members had died in a winter. And he met several people who described coming home to find their neighborhoods destroyed.

"I'm just in awe of the heroic people we lived and worked with every day," Fred Hartman said.

The Hartmans started their journal as a way of keeping track of their experiences and staying in touch with friends at home, but their e-mailed dispatches quickly developed a large following. The town of New Hampton, where they live, posted details about them on its website. As did Lakes Region General Hospital, which had owned the practice the couple ran in Laconia before they left. And, of course, their friends forwarded it to other readers.

It was only when they returned home that they realized how many people were reading their messages.

"People started giving that e-mail to other people," Mare Hartman said. "We'd run into people at the supermarket and they would say, 'I read your journal. You should do a book.' "

So they did. Last month, Window on Afghanistan was published by Trafford Press, a company that helps authors publish their own books. The book is available at Sundial Books in Gilford. It is on the Trafford website, and it will be distributed on Amazon and other online booksellers in a few months.

Back in New Hampshire, the Hartmans are moving on to new projects. Fred Hartman has decided to give up his practice and stay with the consulting group - and he's begun taking the lessons of Afghanistan to other countries in need of quick expansion of health resources. His work now centers on AIDS prevention in Africa and avian flu preparedness. Mare has found an opportunity that allows her to meld her teaching and nursing experiences. She will shortly begin training nursing assistants and nurse practitioners.

They have been enjoying the opportunity to rest, the comforts of home and the pets they left behind. Winston has returned home a full-grown dog whom the couple's older dogs hardly recognize. But they also have been reflecting on their experience in Afghanistan and suspect they will continue to do so for a long time.

"It was, above all, the peak experience of our entire careers. It was so - we were there," Mare said.