Trauma Center

ASFAKHAN, Afghanistan — Two weeks ago, police delivered several bodies loosely wrapped in cloth at the gate of Mazar Civil Hospital. Taliban fighters killed in battle, the officers explained to Abdul Hamid, the hospital gardener who was pulling a night shift as a guard. Take them to the hospital morgue, they said.

Then one of the shrouds slipped off. A man's ghastly head, decomposing and bloated after many hours in May heat, stared at Abdul Hamid from the stretcher. The ragged gash of an exit wound gaped blackly where the left temple once had been. Abdul Hamid passed out.
The next day, Abdul Hamid woke up without any feeling in the hands that had touched the grotesque cadaver. The morning after that, he woke up blind.
A five-day course of anti-inflammatory injections prescribed by an ophthalmologist had no effect. A textbook case of conversion disorder -- a common dimension of mental trauma -- a psychiatrist would have said, had Abdul Hamid seen a psychiatrist. But neither the gardener nor his family had ever heard of one. The culture of seeking cognitive therapy, like cognitive therapy itself, is almost nonexistent in Afghanistan. Its inchoate health-care system offers only 200 beds for mental-health patients in the entire country.
And so, eight days after Abdul Hamid's eyes refused to take in any more woe, a rickety zaranj moto-rickshaw carrying the 35-year-old man and his two weeping sisters joined the tumbledown procession of vans, trucks, taxis, and private jalopies that crawls steadily out of the sandbagged northern boundary of Mazar-e-Sharif, rattles past the lowland where the city dumps her refuse and human waste into black-rimmed lakes of stunning turquoise putrefaction, and jigs westward along a dirt track dead-ending at the Asfakhan Shrine.
The shrine's mud-brick beehive bell-jars the 830-year-old remains of a Muslim holy man named Mir Sangin. His tomb, a low adobe ziggurat painted pea green, is said to cure mental ailments. The men and women who pilgrim here in disturbed and desperate throngs are the truly forsaken in a land too busy fighting to care even for its healthiest people. The flotsam and jetsam of war hoping for a miracle.
By the most conservative estimates, two out of three people in Afghanistan suffer from post-traumatic stress disorder -- although the term's prefix seems inadequate in the land where trauma never ceases. Millennia of compounded war trauma have envenomed the country's population with mistrust, fear, and hypervigilance. When transcribed for the scale of a nation, experts who study conflicts believe, such symptoms, if unaddressed, impede reconciliation and help perpetuate war.
The signature injury of veterans of America's wars in Afghanistan and Iraq, "post-traumatic stress disorder" is a household expression in the United States. But in Afghanistan, where the noxious bouquet of depression, psychosomatic ailments, insomnia, rage, and panic attacks bleeds an entire society that for generations has been eking out an existence amid unending violence, it remains almost entirely unrecognized and untreated, says Dr. Mohammad Alemi, one of the country's leading psychiatrists who operates a 20-bed private psychiatric hospital in Mazar-e-Sharif. Most of the people suffering from the disorder come for comfort to shrines like the one in Asfakhan.
Each week, estimates Ishani Abdul Ahi, the shrine keeper, between 500 and 600 pilgrims journey to this eerie oasis in the sedimentary desert that yawns indifferently at the diaphanous Khorasan sky. Inside the sepulcher they claw at the walls and moan. They prostrate in prayer for hours on the carpet soaked with the urine of the incontinent. They weep silently beneath the swallow nests in the vaulted ceiling. They leave offerings of rice grains and money on the black cloth embossed with Quranic verses that drapes the tomb, and fasten their wishes to the tomb's pale railing with strips of cloth, tiny padlocks, and bits of thread.
"Miracles happen here," promises Ishani Abdul Ahi, whose ancestors have maintained the shrine for seven generations. "Crazy people come away cured." Several of his 20 grandsons, one of whom will inherit the esteemed position of shrine keeper from his grandfather, squat outside in the shaded arcade, selling trinkets, toy guns, and soft drinks cooled in buckets of murky stream water.
Last Wednesday, Abdul Hamid's sisters led the gardener into the shrine's putrid crepuscule and anchored him, teetering, on the floor near the northwest corner of the tomb. Next to him, a young man clasped the railing and shook. A few paces away, another man, recently paralyzed on his left side after a stroke, moaned a lament he alone could comprehend.
A woman ran fierce laps around the tomb, as she has done for 20 years, marking each footfall with a sharp, piercing shriek, as though her voice could scare away the destitution, horror, and war all around her. Then she collapsed on the floor in defeat.
Disoriented and frightened, Abdul Hamid wept.
The ammoniac reek of urine wafting from the floor of a place supposed to be holy, the cacophony of sounds -- the rattle of the metal railing, the woman's screams, the incoherent keening, the slapping of palms against adobe walls -- made no sense to him. His sudden blindness made no sense. "I am afraid," he whimpered, again and again, "I am so afraid."
He curled up against the corner of the tomb railing and tied, with his sisters' help, a plain white string to a metal post with long fingers he could not feel. His sightless eyes teared. He lay on the floor awhile. Unseen by him, swallows tumbled down elegantly out of their nests in the ceiling and dove through the shrine's open green door to somersault above the golden plains.