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MESSAGE FROM THE CHAIRMAN JUNE 2006

Greetings to all our supporters!   We would like to thank you all for your generosity in the past and report our latest news.

Riots in Kabul
The past year has been largely successful and mainly trouble-free from our point of view.  Of course, the recent rioting in Kabul, although we were personally not affected, did nothing to improve overall confidence.  We remain, however, optimistic despite the continuing problems of insurgency, poverty and deprivation in Afghanistan.

Here is what our granddaughter Charlotte, 11, had to say about the riots in her e-mail from Kabul:

"Dear Micky,  (Michaela Gall, her aunt)

At school we were playing PE and then the PE teacher said to go inside the building because demonstrations were taking place and then we heard gunshots so we had to go upstairs and stay in the upstairs classrooms.  When the driver came to pick us up we went to our friends' house nearby and then Dad came to pick us up in a convoy from the French Embassy.  When we arrived at the Embassy we stayed there about 2 hours and we cooked our army rations on the Embassy verandah.  Then Dad decided to take us to the French ISAF base near the airport for the night.  We had to wear flak jackets and helmets and we rode in an APC.  When we got there we signed in and we ate some snacks and then went to bed in special mosquito net cots in a huge tent.  We had a really delicious breakfast with cereal, croissants, yoghurts and hot chocolate and the cooks gave us 3 chocolate Easter eggs.  Love Charlotte."

Record Number of Patients
We treated a record number of patients in 2005, many of them children suffering from a variety of diseases, particularly polio.  Perhaps our most heart-rending recent case is that of a teenage boy, Malik, yet another mine victim.  His story is, alas, still all too common.  On his first day working in a new, UN-sponsored bakery near his home in Kabul, he went outside into a nearby field and trod on a mine, seriously injuring a leg.  As he struggled to get up, he stepped on another mine and injured the other leg.  Two men, alerted by the explosions, threw him a long scarf with which they pulled him to safety.  Both Malik's legs had to be amputated above the knee.

Back to School
I happened to be in Kabul last September when he came in for treatment.  He now has a wheelchair and a pair of prostheses (artificial legs) and is determined to go back to school and complete his education, despite suffering a lot of pain.  SGAA is paying for a private tutor as he comes from a poor family and was the only one with a job.  His father, a former mujahid who fought against the Russians, was recently demobilised and is now unemployed. 

Moral Support from Ashmatullah
Malik has received advice and moral support from one of our best-known patients, Ashmatullah, whose picture is on the front of our brochure.   Ashmatullah is something of a role model since he is also a double amputee and works as a receptionist at the clinic Malik attends.  This enables him to support his mother and four sisters, his father having been killed in the mine accident in which he lost both his legs.

Merger with Swedish Committee
The most significant development of the year from SGAA's internal point of view, however, is a planned merger with the Swedish Committee for Afghanistan (SCA), an old-established and highly regarded charity funded partly by the Swedish Government.  Under the terms of the merger, planned to take effect this year, SGAA will continue to be responsible for funding the programme during 2006 while SCA gradually takes over the management.  Our name will be retained as RAD/SGAA (Rehabilitation of Afghan Disabled/Sandy Gall's Afghanistan Appeal).

Long-Term Goal
The merger will enable SGAA to carry on its activities under the umbrella of a larger, well-funded agency with the same long-term goal of improving the lives of the disabled in Afghanistan.  The Swedish Committee for their part, will inherit a well-trained, professional orthopaedic Afghan staff that have many years' experience of helping mine and polio victims. 

We hope that the services we have both worked so hard to create and expand over the past 20 years will eventually be absorbed by the Afghan Ministry of Public Health and local government services when the reconstruction of the country has been achieved.  This, however, is some way off and Afghanistan will continue to need expert advice and generous financial assistance for the foreseeable future.

Last September SGAA organised a second 'Up the Panjshir' walk with 18 sponsored walkers trekking up the Khawak and Anjuman Passes - see 'Up the Panjshir 2'  September 2005 item on this website.

Charity Golf Day at Rye
Our next fund-raising event is a charity day at Rye Golf Club on Wednesday, 26^th July, 2006.  We now have a full complement of 22 teams who will compete in a foursomes tournament for the best four-man team score, best individual pair, Nearest the Pin at the 5^th and 14^th and Longest Drive.  The eighty-eight competitors will then have an excellent Rye lunch with complimentary (any offers?) wine and auction, which will include one case of  excellent port, ditto claret, two lots of salmon fishing - on the Derwent and Spey -  a beautiful holiday house in Mallorca, tickets for the new Evita, a day for four at the International Show Jumping Championship of the Year at Hickstead, Dinner for four at Langans and a very fine Afghan rug.  A few more exciting raffle prizes would be hugely welcome!

We hope that everyone will have a really enjoyable day and that we will raise a lot of money for the disabled of Afghanistan who still need our help.

Sandy Gall

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'UP THE PANJSHER 2'

September 2005

Well, 'Up the Panjsher 2'! was a great success.  Lovely weather - in fact almost too hot at times - the Panjsher Valley in all its breathtaking beauty, snow-streaked mountain peaks soaring into the blue, the eponymous river's green, ice-melt water foaming and churning its way down irresistibly as it has done since the start of time.

But to start at the beginning.  The main party of 18 sturdy walkers, mostly women, left London Heathrow aboard PIA on Wednesday, August 24, 2005, arriving in Kabul the next day, one of them, Stina, minus the bag containing her walking boots. It never turned up but being a resourceful Yorkshire lady she made light of the problem, borrowed an old pair from my daughter Fiona, SGAA's consultant in Kabul, and got on with it, never grumbling once.

Another walker, Lorraine, from Manchester, whose late husband had watched my documentaries about the mujahideen war against the Russians, lost her telescopic walking stick but triumphed over this setback in true stiff upper lip style, and when the going got a bit rough later, happily mounted a donkey and then a horse, both for the first time.

We spent a couple of days in Kabul acclimatising and sightseeing, with Nancy Dupree, the omniscient and charming American scholar as our guide.  Thanks to Nancy we managed for the first time to get inside the Bala Hissar, the historic fortress with fabulous walls; from there we drove through the remains of the old city and ended up in Babur's Garden, the Light Garden of the Angel King, now being beautifully restored by an international team with a grant from the Aga Khan.   Next day Nancy took us to the Kabul Museum to see the near-miraculous work of restoration there,

above all of the famous statue of King Kanishka in the entrance hall.  Nancy stood on the steps beside it and described with anguished word and gesture how the Taliban Minister of Culture - an oxymoron if ever there was one - arrived one day with a sledgehammer and smashed the 3rd century masterpiece into what he no doubt imagined would be oblivion.  He failed.  It has been so lovingly and skilfully put back together again from hundreds of tiny pieces by the Museum's Afghan staff and experts from the Louvre that it is almost impossible to see the repairs.

We started, as we did on the first walk in 2003, by bus from Kabul across the vineyards of the Shomali Plain, a victim of Taliban scorched earth policy but now blooming again. Then via Charikar and Jebel Seraj to the entrance of the Panjsher Valley, where the road and river run through a narrow gorge which Masud blocked to stop the Taliban.  We stopped for a picnic among the trees at Pul-i-Feraj and then walked along the south bank of the river until we came to the riverside mansion of Dr Abdullah, the Foreign Minister and an old friend, at Dashtaq.  Our plans to stay there fell through and instead Colonel Muslim, our security adviser, arranged for us to camp in a beautiful spot overlooking the river beneath two enormous chenars [plane trees].  It was a good start to the walk and next day we continued along the south bank to Rokha where we crossed back to the north side and pressed on to the tomb of Ahmed Shah Masud, the famous guerrilla leader known as the Lion of the Panjsher, whom I first met and filmed in 1982.  Masud was assassinated by al-Qaeda in 2001, just before 9/ll. 

The tomb was being rebuilt and the once peaceful hilltop was like a building site, so my plan to give a talk there had to be shelved until the evening when we camped at nearby Jangalak, Masud’s village, on a wide shingly bend in the river.

Next morning we were entertained by the Governor of Panjsher, a large, friendly gentleman with an office in Paragh.  We all crowded into his office and drank tea while he paraded two of his disabled staff and complained about how little support the government was giving veterans of the Russian war.   Our destination that night was Astana, where the guesthouse proved as comfortable a stop as it was last time.  The bridge however had been partly washed away by the spring floods and replaced by two wires which had to be negotiated hand-over-hand as Michaela, Louis and several other intrepids demonstrated.  Victoria swam with the current down to a sandy spit which she said was wonderful.  

Next day we went up the Darra, the side valley by which my TV team and I entered the Panjsher in 1982 and had a delightful picnic under the mulberry trees near the uluswal, [district office].   I managed to track down Gul Bas, who escorted us from the Pakistan border, now a policeman.  I hoped we could have lunch together and reminisce, but he was busy paying his respects to a local worthy who had just died and was more concerned, I felt, about keeping in the good books of the wali [district chief] than reminiscing.  Gul Bas's picture is on the cover of Behind Russian Lines, an account of that first trip, and he's still wraith-like - no wonder, he lives up a steep side valley two hours walk from the uluswal - so he walks four hours a day to and from the office! 

 When I asked the wali what people were worrying about in the forthcoming election, he said: 'They are very angry about the Chinese guest houses', meaning the Chinese brothels masquerading as restaurants in Kabul.  They had in fact been closed down by the government but that did not seem to have lessened popular discontent.  As we walked back down the valley, Philippe and a couple of other walkers heard a local they passed say to his friends: 'I suppose these people have come here to set up a brothel'.

The idyllic rhythm of our progress was interrupted at our next stop, Safed Cher, a big village where two years before we had spent a pleasant night in the guest house [not Chinese] rented by Aide Medicale Internationale, a French NGO, but they had left and we had to find alternative accommodation at short notice.  The local mujahideen commander - yes, they still have muj commanders in the Panjsher - when consulted by Col. Muslim said 'Oh, no problem [which usually means there will be a problem], this place is good', pointing at the grassy banks of a rushing mill stream where there was just enough room to pitch the tents and unroll our sleeping bags.

Now, I should have known better than agree to camp in the middle of a village, but I had already turned down another meadow because it was being irrigated and soaking wet and I knew people were impatient to rest after their five-hour hike.  I also knew that Afghan villagers come top of the Guinness Book of Records for staring at strangers, particularly foreigners.  These boys, however, did more than stare.  They followed the ladies, like wasps round a honey pot, to our two long-drops in a corner of the meadow and even dared, as dusk fell, to indulge in the old Roman practice of goosing the more nubile walkers. 

Anxious to nip the revolt in the bud, I sought out our four local policemen, all armed with AK47s, to find them lying on their backs.  Luckily Muslim and the commander appeared at this point and managed to galvanise them into some sort of action.  Shortly after surmounting this crisis, I found myself on the carpet before our senior officer, Brigadier Bill who hollered:  'Things are going from bad to worse.  Someone's just thrown a broken light bulb into Catherine's tent'.  He held the offending object under my nose and, indeed, you wouldn't have wanted to step on it in bare feet.  Fortunately, Catherine, who had left the flap of her tent open to enjoy the evening breeze, was quite unfazed.

Eventually, as it grew darker, even the apparently insatiable curiosity of the men of Safed Cher, young and old, was satisfied - not a single local woman appeared to gawp, of course - and they drifted off to their respective khanas.  When I complained to Isobel, an experienced traveller in these parts, she said 'Sandy, you must remember there is nothing to do in these villages:  no telly, no cinema, no entertainment, nothing' and, she might have added, no pubs either.  As always we went to bed early and next morning, at 4.30, four brave ladies set off to ride five or six miles to Do Ab [Two Rivers] where we left the main valley to climb up to the 12,000-foot Khawak Pass.   I drove to Do Ab, where there is an extremely scruffy chaikhana [teahouse] which has been serving green tea in cracked cups for as long as I can remember.  It did not seem to have changed one iota, except for the posters of election candidates on the flyblown walls.

At Do Ab, I changed to horseback and joined the four ladies on the three-hour ride up to the delightful hamlet of Chowni.   We camped there and early next morning set off for the pass, but not early enough to avoid a great column of Kuchi nomads with hundreds of fat-tailed sheep and goats, their woolly Bactrian camels laden with their tents and all their worldly goods including chickens and even babies strapped on top of the other paraphernalia, as they came streaming down from the high pastures where they had spent the summer on their way to winter in the warm valleys of Jalalabad and even Pakistan.  These bi-annual migrations have taken place since time immemorial and certainly since the time of Alexander the Great, in whose 329 BC footsteps we were now following.  Unlike us, thank God, Alexander's Macedonians crossed the Khawak in winter, in deep snow, to catch Bessus on the hop, and nearly starved to death in the process, being forced to slaughter their pack animals and eat them raw, seasoned only with a few herbs from the mountain.  We, au contraire were regaled with roast partridge and green tea [alas, no Chablis] in Chowni where Catherine, not content with having walked all the way up from Do Ab, hired the local mine host to take her on a swift trot up the hill above the village.

When I first climbed the Khawak in 1986, our horsemen, scared of being bombed by the Russians if we were spotted in daylight, insisted on travelling at night.  They kept losing the way, sitting down and falling asleep to the fury of Andy Skrzypkowiak, one of my two cameramen, who assisted them up the pass with some well-judged kicks. We reached the top just as dawn was breaking - exactly what the horsemen had been trying to avoid, but luckily we saw no Russian jets that morning.  This time we found a Russian T52 tank, hauled to the top by Masud in about 1998 to block an attempted Taliban attack.  Masud had dug fortifications along the summit ridge and one of our guards who took part in the battle recalled how the great man ordered them to hold their fire until they saw the whites of the Taliban's eyes.  'We did and killed about 400 of them' he said, reliving the battle for us. After that the Taliban retreated, tails between their legs.

There remained only one great challenge left:  the Anjuman Pass, c. 14,700 feet.  This was the climax of our walk and Fiona and I wanted to get everyone to the top, on horseback, if necessary.   Breaking the rules, you may say, but I think legitimately because it is an exceptionally long although not particularly steep climb from the base camp beside another brawling stream.  It was a tough day.  Up at 4.30, breakfast [porridge and chai szabs] at 5, depart 5.30, with horses, if desired.  Late on parade was the horseman looking after one of our senior and pluckiest walkers, Jennifer, known affectionately as 'The Duchess'.  He arrived in characteristically Afghan cowboy style, his horse rearing and plunging and frothing at the bit.  Walking right up to the beast, which was still prancing dangerously, Jennifer grabbed the reins, commenting over her shoulder to me, a cautious pace or two behind: 'His bridle's over his eyes, that's why he's making such a fuss'.  Immediately she straightened the bridle, the horse calmed down.  Jennifer checked the stirrup leathers, made, as usual, of rope, not leather.  'They're too short,' she sniffed.  The horseman, young and bolshy, tried to argue but was firmly put down.  The stirrups were lengthened and Jennifer was in the saddle. 

As I watched her ride off across the stream, Susanna, about to follow, applauded: 'Isn't Jennifer great?  She really is the stuff of Empire'.  I stayed behind, having climbed the Anjuman two years before, to sketch and relax.  I had a wonderful day, washing my smalls in the ice-cold river, bird watching and sketching the view of the mountain from our camp, known as the Aylock, or bothy, where the shepherds camp with their flocks in the summer.  A large flock of Alpine choughs [or their Asian equivalent]  flew over at one point and later I was transfixed by the sight of a lammergeyer vulture, gepaetus barbatus, with its bright yellow chest and tufted beard, hence its Latin name, planing majestically down the valley on its eight-foot wings, king of the Hindu Kush. 

At our farewell party in Kabul, Mark Scrase-Dickins, a member of the Committee, won first prize, a small carpet, for raising most funds: £16,000.  And Ingrid, who 'could hardly walk to the shops two years ago', according to her husband Brigadier Bill, won Best Walker.  The British Ambassadress came to our farewell dinner at Gandamack Lodge, once the home of one of Osama bin Laden's wives.  Things have certainly changed for the better in Kabul. 

Let me finish with the bottom line.  Thanks to the generosity of all the donors who sponsored the sturdy walkers, including myself - although I was more of a rider - we have raised more than  £120,000 and still counting.  A terrific achievement!  Congratulations to all concerned.

Sandy Gall, Chairman SGAA

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What happened in 2004?

A historical review by Carlotta Gall.

2004 was the year that Afghanistan took firm control of its own political and constitutional future. Just two years after the American-led war against the Taliban regime, the transitional government under the leadership of Hamid Karzai, with the help of the United Nations, organised a grand assembly to draw up a new constitution in January, and hold Afghanistan's first ever presidential elections in October.

New Constitution - 500 delegates from all over the country gathered in the capital, Kabul, for a loya jirga, or grand assembly to approve the new constitution. After three weeks of sometimes intense debate, the assembly approved a constitution January 3, 2004, that introduced a new democratic system for Afghanistan, with an elected president, two houses of parliament and an independent judiciary. The country would be named the Islamic Republic of Afghanistan, and all laws would be in keeping with Islam, in recognition of the strong place Islam holds in the hearts of the people, but the assembly delegates, a mixture of tribal, regional and political leaders, and members of civil society, with good representation of women, unanimously approved a democratic system, where for the first time in its history Afghanistan's leaders would be directly elected.

Presidential Elections - The task of holding elections was daunting, and many argued the country was not ready for them. Eighty per cent of the people are illiterate, and live in remote mountainous regions, and six million people - more than a third of the population - still do not have enough to eat. Many of the militias and regional commanders remained active and armed and, it was feared, would exert control over the political process. The Taliban, ousted from power in 2001, were continuing a bloody insurgency in the south and east of the country, threatening and often killing people who supported the election process. Aid workers were also targeted and the year was a particularly black one for Afghan and international aid agencies, with killings and kidnappings. Yet despite the violence and the logistical delays, the elections passed off successfully on October 9, 2004, with an enthusiastic turnout across most of the country. The result was a solid victory for the leader of the last three years, Hamid Karzai, and a new five-year term as Afghanistan first ever elected president.

The problems facing Afghanistan remain enormous. Poverty after two decades of war is widespread, security remains poor in many regions, and reconstruction efforts are still inadequate. Much of the basic infrastructure still has to be rebuilt - roads, bridges, schools, hospitals, and government buildings -- and officials trained. The government is still struggling to establish itself as a functioning authority in the regions. In the coming months it has to disarm militias and prepare for local and parliamentary elections in 2005 and, under international pressure, has to start tackling opium cultivation and trafficking which has increased rapidly in recent years and endangers so much of what has been achieved. Most of the population in Afghanistan lives by agriculture and many farmers rely for survival on the poppy crop, which brings in more money than other crops. Intense efforts are needed to help them manage with alternative livelihoods, improved crops and access to markets to prevent them becoming even more impoverished.

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SGAA Activities in 2004

SGAA believes that the life of every disabled child can be improved in some way. A boy suffering from polio can be made a pair of callipers that will help him to walk to school. A girl with cerebral palsy can be made a wooden chair to help her sit up straighter and learn to feed herself. A boy with juvenile arthritis can be given physiotherapy treatment to reduce his pain and discomfort. Families of the disabled child can be counselled on what exercises to do at home. SGAA's health educators also work closely with children in schools to promote awareness of disability. If a child knows of someone who is disabled in his family or street he can suggest that they be taken to a doctor or a rehabilitation centre for a diagnosis. Often the parents think nothing can be done and leave their disabled child in a corner of the house. Early detection and treatment can help reduce the severity of many disabilities.

Orthotics and Prosthetics

Patient figures have continued to rise this year in both departments in the orthopaedic workshop in Jalalabad. Over 110 patients a month receive callipers, splints or spinal braces made for them by a team of 12 orthotic technicians.   The fabrication process has been speeded up with the arrival of a new plastics oven at the beginning of the year and extra workbenches for 5 trainee technicians. In addition over 40 patients a month come for a new artificial leg or a repair to their existing one, produced by our three prosthetic technicians who make up the prosthetic department.  There are also three artisans, two cobblers who make special shoes and leather buckles and a carpenter who makes special wooden chairs for children with cerebral palsy.  The workshop and storeroom remain very squashed and despite discussions with the hospital director, there seems little available space in the hospital to provide us with more storage space or a larger room for our carpenter. 

Component Workshop

The component workshop makes 30 - 35 wheelchairs a month and more than 500 other items such as crutches, rubber feet, walking frames and calliper joints.  This year the technicians have been testing different proto-types of a hand-propelled wheelchair, due to the many requests for this type of wheelchair from the disabled living in Jalalabad.  This has led to an exciting new project beginning in December 2004 in which SGAA provides 10 amputees every month with a hand-propelled wheelchair, the possibility of training and a loan to start their own business in the bazaar.  Each applicant has to come up with a plan of action which is vetted by a committee made up of local disabled businessmen and SGAA staff.  The project is sponsored by the generosity of the American NGO, Adopt a Landmine,  which works in many countries to raise awareness of the danger of landmines and the plight of mine-victims.  We hope to see some real success stories from this project in 2005.

A survey of the rubber feet made in the component workshop revealed that they are too heavy for some users and some of them break too quickly across the toes.  The problem of weight can be partly solved by finding a lighter wood for the keel  and SGAA staff have been scouring the bazaars in Afghanistan and Pakistan for the right kind of seasoned wood.  A different type of elastic has also been inserted inside the foot to reduce the risk of breakage across the toes.  It is difficult to produce a rubber foot that can stand up to the durability that Afghan amputees require.  Recently a young man of 23, a double amputee, came into the workshop to replace his artificial legs which he had been wearing since he was 17.  Since he walks 4-5 hours a day in the summer to collect firewood in the mountains near his home it is amazing they have lasted so long, although in the winter he works as a tailor.  He is married with 2 children and said that his disability did not impair his life at all.

Nazir Jalal is a double amputee who lost his legs fighting in the war.  He has been using an SGAA 3-wheel wheelchair for 5 years.  He recently had the opportunity to try out one of SGAA's handle-propelled wheelchairs.  This can go faster than a normal wheelchair and is thus highly coveted by local amputees in Jalalabad.  In the annual wheelchair race on Disability Day there is a special class for competitors using SGAA wheelchairs.

Physiotherapy Programme

The physiotherapists remained very busy in 2004.  As well as treating many different types of patient that come to the male and female clinics in Jalalabad the mobile teams continued to visit various clinics in the surrounding provinces.  A change came mid-year when four male physiotherapists, recently graduated from SGAA's two-year training programme, started working in 3 district hospitals in Nangrahar, Laghman and Kunar provinces as locally based employees.  This meant that the male mobile team from Jalalabad no longer needed to pay weekly visits to these hospitals, going only twice a month to supervise the new staff.  In October, motorbikes were bought for these junior physiotherapists so that they could start visiting local clinics round the district hospitals, thus widening access to patients.  Unfortunately, the women who graduated from the same course did not take up job offers in the district hospitals.  The main problem is that unless they have family in the area they cannot live there alone and SGAA does not have the means to provide daily transport to and from the hospitals.  This is a recurring problem in rural areas in Afghanistan where there are few educated women able to take up professional roles and educated urban women will not work in rural areas because of the lack of facilities. 

Training

In February 20 physiotherapists graduated from their two-year course run by SGAA at the Institute of Health Science in Jalalabad.  10 men and 10 women.  The course was taught by SGAA's physiotherapists and medical doctors using the curriculum approved by the Ministry of Health.  Paddie Chanmugam, SGAA's consultant physiotherapist had initially set up the course in 2002 and came out for the final exams in January 2004.  She was pleased with the standard of the students.  It is especially difficult to find women who have completed their secondary education (12^th grade) in many parts of the country because of the lack of schools for girls, especially during the Taliban era.  Even before the war very few girls completed high school as they were taken away from school by their parents at the age of puberty.  Tradition requires that women be treated by women in the health sector and girls be taught by women at school.  Today SGAA technicians remind many of the parents of disabled girls how important it is that they should attend school and have a basic education especially as they are less likely to marry because of their disability. 

Training seminars for our physiotherapists and orthopaedic technicians in May were held by SGAA's consultants John Fixsen (orthopaedic surgeon), John Lamb (orthotist) and Jeanne Hartley (physiotherapist) when they came on their annual monitoring visit.  This was the second time that Jeanne had come to visit our project and we were delighted that she accepted an invitation to join SGAA as a Committee member.  For the Afghan staff visits by our consultants are a valuable opportunity to find out about new techniques and ideas and bring their difficult cases for the "foreign experts" to examine.

Topekai is a trainee prosthetic and orthotic technician. She previously worked as a nurse and then a physiotherapy assistant in a government hospital in Kabul before starting a 2 year training at the Kabul Orthopaedic Centre (KOC) which SGAA supports.  So far Topekai has learnt how to take casts, rectify them to the correct shape and then drape the polypropolene plastic over the cast to make the appliance.  As a woman, Topekai will be able to look after the women and girls who come to KOC.

Health Education

The health education department increased its activities as a result of growing demand.  Initially all eight of the staff were part-time workers but during 2004 the supervisor and two others became full-time so that they can visit patients in their homes in the afternoons to see if they need help with their appliances and also to follow up their teaching programme in local schools.  The child-to-child programme in the schools is interactive and requires the children to identify causes of sickness and disability in the community.  These can include blocked drainage ditches which attract flies and contribute to diarrhoea or unexploded mines lying in the fields.  The health educators go with the children to help them activate the local community to solve its problems.

As well as many physically disabled there are also many Afghans suffering mental health problems.  Some of this is due to the war and bombing and the stress of losing family members and loved ones or simply the result of the harsh life of poverty.  SGAA's senior health educator followed a month's course in mental health run by a colleague NGO, HealthNet International, so that he can in turn teach SGAA's physiotherapists and health educators how to recognise symptoms of depression and anxiety in patients and what referral procedures should be followed. 

Kabul

The physiotherapy clinic in Khairkhana, a northern suburb of Kabul has had a good year.  The team of 4 women physiotherapists rotate between the clinic where they see women and children from the neighbourhood and a rural clinic in the Shomali Plain, north of Kabul.  Here there are many patients who cannot afford the bus fare to Kabul to seek treatment.  So successful has this clinic been that when SGAA planned to transfer it in October to the district capital, a delegation of community elders came to request that the clinic stay as their womenfolk had benefited so much from the treatment provided.

Four health educators also visit local schools and health clinics to talk about disability and hygiene in a programme similar to that in Jalalabad.  The clinic in Khairkhana has gained quite a reputation as there are few physiotherapy services available for women in Kabul and has featured on national television and radio.  Funding for this centre comes through the support of the Big Lottery (Community Fund UK) and when this funding finishes in February 2005 after 3 years SGAA will have to find alternative funds.

SGAA has been funding the Kabul Orthopaedic Centre (KOC) for the past 18 months.  During 2004 the quality of the work improved greatly. Three qualified women physiotherapists were hired to boost services for women and three orthopaedic technicians were sent on six-month upgrading courses to improve their knowledge.  More than 60 patients a month are now provided with orthoses and 50 patients a month with prostheses.  Six physiotherapists see on average a hundred patients a day in the busy summer season and 60 patients a day in the winter.  An outreach programme is planned for the beginning of 2005 to visit district hospitals and clinics to the east of Kabul where many poor communities live.

In 2004 the KOC was registered as an Afghan NGO (Kabul Orthopaedic Organisation) with the Ministry of Planning so that other donors could be approached to assist in supporting it.  SGAA's funding ended in December 2004 and other donors are being sought to help carry on the good work at there.

Monitoring

During the year several visits were paid by SGAA's consultants and committee members to Afghanistan to monitor progress.  Additional lectures and training were provided by  Mr John Lamb (Orthotist), Mr John Fixsen (Paediatric Orthopaedic surgeon) Mrs Paddie Chanmugam (Physiotherapist) and Mrs Jeanne Hartley (Physiotherapist).  In their reports they noted the severity of many of the disabilities they saw, due to lack of medical care and early detection.  They also noted what an important role the health education programme plays to raise awareness and prevent further disability amongst local communities. 

Funding

In the past two years a lot of money has been pledged to rebuild Afghanistan by the international community, but there are many competing priorities for this money: reconstruction of roads and cities, government reform, preparation for the elections, creation of a national army.  Programmes for the disabled do not rank high on the list.  This is why it is vital that SGAA continues to find new donors and to advocate improved services for the disabled.

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What happened in 2003?

Back to School and to Rebuilding - Afghans have been working hard this last year, rebuilding their homes, starting businesses, and sending their children back to school, or, for many, to school for the first time. Officials say nearly 5 million children will be back at school by the New Year, a third of them girls, which is a huge achievement in a country emerging from the draconian rule of the Taliban. Refugees continued voting with their feet, and another half a million refugees returned home from neighbouring countries this year, bringing the overall return since the fall of the Taliban in December 2001 to 2.5 million people. Another striking change was the spread of the mobile telephone network and internet connections linking cities and families across the country and the world.

Reconstruction - The United States put up most of the funding for a big road project to repair and repave the Kabul to Kandahar highway, one of the main arteries in the country, which had deteriorated into a rutted, bumpy and dusty track. Temporary suspension bridges have gone up on the road north of Kabul and engineers have been repairing the Salang tunnel, one of the highest tunnels in the world, which was blocked by explosions for years. Yet for many Afghans the reconstruction was painfully slow and for those in remote rural areas it seemed non-existent. Afghan and World Bank officials, who won $4.5 billion of pledges from donor countries in 2002, now said $30 billion would be needed over the next five years to rebuild Afghanistan to any normal standard. What is clear is that the task of bringing basic infrastructure, (roads, bridges, hospitals, law and order and education) to Afghanistan is much more enormous than anyone realised at first.

Security - One serious setback has been a resurgence of the Taliban in southern and eastern Afghanistan. Although roundly defeated by the American campaign of 2001, the Taliban made a comeback in 2003, launching guerrilla attacks, often by groups of militants from across the border in Pakistan. They have attacked and killed government officials and police, as well as international and Afghan aid workers in an evident attempt to scare away international assistance and diminish support for the government of President Hamid Karzai. There have also been attacks on international peace-keeping troops in Kabul, the United Nations and other international organisations in what appears to be a calculated terrorist campaign. The scale of violence is nothing like what we are seeing in Iraq, and many parts of Afghanistan are completely peaceful, but as the world starts to forget this far-off, poverty stricken country and turn to other problems, never have the Afghans needed foreign support, in continued humanitarian and development assistance, than now.

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SGAA Activities in 2003

Jalalabad
This year has been extremely busy in all of SGAA's clinics and centres. Patient figures are higher than ever in Jalalabad with an average of 600 new patients registered every month for physiotherapy treatment and 140 orthopaedic devices cast, moulded and fitted every month in the orthopaedic workshop cast. Among adults, 40% of physiotherapy patients have back and sciatic problems, among children the main category consists of those suffering cerebral palsy, followed by polio. The orthopaedic workshop primarily concentrates on making polypropolene plastic callipers for polio sufferers and prostheses for mine victims.

The component workshop which makes wheelchairs and mobility aids as well as orthopaedic components such as prosthetic feet has been very busy supplying not only the programme in Jalalabad but SGAA's two centres in Kabul and 3 Swedish Committee workshops in Taloquan, Mazari-Sharif and Ghazni. Over 30 wheelchairs a month are produced, 50 pairs of elbow crutches, 20 wooden trolleys and 20 walking sticks.

2 New Physiotherapy Centres
In January 2003 SGAA was given a grant by the British Embassy of Kabul to build 2 new physiotherapy centres in the compounds of 2 regional hospitals in Laghman Province and Kunar Province. This will mean that permanent physiotherapy services can be established in the hospitals for in-patients and out-patients. The construction and equipping of the clinics was completed by the end of the summer. The clinic in Chagerserai hospital Kunar was opened by the Governor of Kunar on 26th August and SGAA's phyisotherapy assistant, Mr Nabi started work there the next day. The clinic in Mehtarlam hospital, Laghman was opened on 28th September by the Deputy Governor of Laghman and the UK Director of SGAA, Mrs Eleanor Gall. This clinic is run by SGAA's mobile male and female physiotherapy team who travel every day from Jalalabad to hold physiotherapy clinics. In both clinics there are separate male and female treatment rooms and a room for the health educators to do health education training and disability awareness.

Training
Of the original 25 physiotherapy students who started a 2 year course in Jalalabad in February 2002, 19 are now in the final stages of their second year. Since September 2003 they have been working every day in the physiotherapy clinics to gain practical experience. They were also able to benefit from a one week course run in May by Mrs Karoline Munsch, an experienced Bobath trainer from Germany who volunteered to come and teach SGAA's physiotherapists in Jalalabad on the latest developments in this field of paediatric physiotherapy. SGAA physiotherapists see over 110 different types of cerebral palsy children a month and their objective is to help the parents improve the quality of life of their child at home by practising exercises with him or her and using appropriate aids. SGAA has a full-time carpenter who makes wooden CP chairs and seats fitted for each child. When the students graduate in February 2004, SGAA hopes to find them jobs in regional and district hospitals and community based programmes where they will have an important role in identifying disability as well as treating it.

In August 4 new bench technicians (one woman and three men) were employed in Jalalabad to strengthen the orthopaedic workshop which has long waiting lists. Three of the new technicians are amputees. They will be given an 18 month practical training in orthopaedic technology. Eventually SGAA would like to open a satellite orthopaedic workshop in Kunar which is difficult to reach from Jalalabad and where many requests have been made by local communities for additional services.

Health Education
This department has also increased its activities. Apart from giving health education sessions to over 2,000 people a month at SGAA's clinics and in local schools, the team also provide training sessions for other health workers in disability awareness, both in Kabul and in Jalalabad. Once a week the male health educators also go to local villages and visit SGAA's patients who have been issued callipers or mobility aids to see how they are coping in their homes. This feedback is useful not only for the physiotherapy and orthopaedic staff to know how their patients are progressing but also to identify other potential patients. Often families do not realise that help can be provided for a disabled member.

Kabul
SGAA services in Kabul have also been busy this year. SGAA runs a physiotherapy clinic for women and children in the northern suburb of Khairkhana. New premises for the project were found in June with more space for treating patients and easier access for wheelchair users. Over 950 treatment sessions are provided for patients every month by 1 full time physiotherapist and 2 part-time assistants. 4 health educators also visit local schools and health clinics to talk about disability and hygiene. This area serves the Shomali plain north of Kabul which saw some of the heaviest fighting during the Taliban period.

SGAA's second project in Kabul is the Kabul Orthopaedic Centre which it has been supporting with fellow agency Ashram International for the past year. The centre has treated 2298 physiotherapy patients in the last 12 months (Oct 02 to Sept 03) and fabricated 1165 orthopaedic appliances. SGAA has provided technical training for the staff and funds for local materials and salaries. The aim of this project has been to improve the quality of services and SGAA hopes that now the centre is working at a much improved level, other donors will step forward to support its vital services.

Monitoring
During the year several visits were paid by SGAA's consultants and committee members to Afghanistan to monitor progress. Additional lectures and training were provided by - Mr John Lamb (Orthotist), Mr John Fixsen (Paediatric Orthopaedic surgeon) Mrs Paddie Chanmugam (Physiotherapist) and Mrs Jeanne Hartley (Physiotherapist) . An evaluation of the project was also carried out in May for the European Commission and the recommendation was made that the European Commission should continue to support SGAA.

Funding
A lot of money has been poured into Afghanistan in the past 2 years and yet there are still enormous needs. Many Afghans are frustrated by the slow pace of reconstruction and the growing lack of security in many parts of the country. The government itself is concerned that international donors are losing interest in the country especially since the war in Iraq started.

SGAA itself faces a difficult future. Contracts with two major donors, the European Commission and The Diana, Princess of Wales Memorial Fund were completed at the end of September and SGAA has not been able to find new long-term donors to replace them. Disability at the moment is not a priority amongst donors who fund health services in Afghanistan. Fortunately SGAA has been able to generate additional funds by holding a sponsored walk (see below) and other events during the year. However 2005 may well see the charity reducing services in Afghanistan rather than expanding to meet the growing needs.

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Up The Panjsher!

In September 2003, SGAA organised a sponsored walk in Afghanistan to raise money for the charity and to celebrate it's 20th anniversary. 24 hardy walkers, plus five members of the Gall family and Diane Steer, a member of the committee, walked and rode up the 100-mile length of the Panjsher valley that lies north-east of Kabul, and leads to the Anjuman Pass. Each walker was asked to raise a minimum of £2,000 over and above their expenses. Many of them raised and continue to raise much more. So thank you to the many generous donors who supported the walkers and the Gall family. Below are accounts written by two of the walkers.

An account by Nigel Ryan, walker and ex-editor of ITN

Well, we did it. We had set out to cover ten miles a day in the Panjsher valley, camping out along the route used by successive conquerors from Alexander the Great to the Northern Alliance in their war against the Taliban two years before. And we had done it. Our walk has raised £130,000 for Sandy Gall's Afghanistan Appeal to provide artificial limbs for Afghan mine victims.

This time we were cossetted. With us was a cardiologist, a physiotherapist, a paramedic (consistently the sickest member of the group) and two surgeons (though no anaesthetist). Our camping equipment was leapfrogged ahead of us by jeep and we carried only what we needed for the day. Caterers kept up a non-stop supply of mutton broth and introduced into the Afghan food chain an inspiration in the shape of porridge.

Each night unseen hands dug two "long drop" throne loos: at times there was even hot water. Camping equipment has been transformed since my scouting days by lightweight sealed tents erected in five minutes with no gaps for insects, self-inflating mattresses; pretzel lamps that strap on to the forehead and free the hands, thermal sleeping bags, microlite walking sticks.

Last time I saw it the Panjsher was blackened by Soviet scorched earth policy and half deserted. Today it is getting back to its normal self, an enchanted 100 mile stretch of green locked 7,000 feet up in its mountain stronghold and watered by the Panjsher river. The people are returning, and with them traditional patrician hospitality. One minute we were slogging along a road of dust and loose rock, the next drinking tea sitting in a villager's little tree-lined patch of garden (its greenery sometimes deepened by a healthy clump of cannabis.) I ran into our horseman from twenty years ago who received me like a lord, with hugs and warmed cow's milk. Everywhere were posters of Ahmed Shah Massud, the Panjsheri hero assassinated by Al Qaeda suicide bombers, who changed the course of the twentieth century by showing the world that the Red Army was not invincible. Spookily we stayed in the guesthouse which had lodged his assassins; and in another in Kabul where one of Bin Laden's wives had lived.

Nobody knows how many million live mines are left in Afghanistan, ranging from Russian plastic devices that defy metal detectors to the stray unexploded US cluster bomb. Over 20 years SGAA, using a locally trained workforce of 80 men and - despite Taliban harassment - 20 women, has fitted 10,000 amputees with artificial limbs and thousands more with polio clubfoot and other endemic disabilities have been given orthopaedic appliances.

The Panjsher is said to be clear of mines; even so we kept an eye open for the red painted stones you find elsewhere

where you have to pass to one side (the trick being to know which). There were a few bad moments, such as walking on loose stones along terrifying precipices; and when we arrived at the foot of the Anjuman pass (nearly 15,000 feet and our final challenge) we learned that the jeeps had been held up by a river in spate. We spent a freezing hour in shirtsleeves watching the sun sink, taking our hearts with it. Then, looking like Rommel, Sandy Gall arrived with the blankets at the head of a column of vehicles, whereupon we instantly forgot we had ever been afraid.

Afghanistan is not yet quite ready for package tourism. Apart from mines and mayhem, the domestic airline flying you in has a few problems to sort out. Our party experienced two: three days' separation from our luggage and one emergency landing.

An account by John Elliott, Delhi correspondent

The only bad thing was flying clapped-out Ariana Afghan Airlines. When the rest of the group flew in via Dubai, their luggage was left behind by Ariana to make room for a trader's goods - thanks (according to well-informed Kabul gossip) to an "easily persuaded" Dubai cargo-handling agent! When they went home, the landing gear jammed on their Scariana (as it is known) Airbus 300. After circling for 90 minutes to burn surplus fuel, they returned to Kabul and a twisted front wheel slewed their Air India hand-me-down aircraft across the runway. And when I flew Ariana from Delhi to join the group last month, there was a tremendous juddering noise as we reached cruising height. Inexplicably, the pilot said he had lowered the undercarriage because it was too hot!

That apart, we encountered no danger - though there was of course violence in other parts of the country as the Taliban regroups, especially in the south, and old Mujahideen war lords battle for supremacy elsewhere. Some Danish-employed Afghan aid workers were killed just before we arrived. Bomb explosions blew up two houses near Bagram Airport (which we passed), and so on.

In Kabul it was peaceful, despite rather threatening US, Dutch and German ISAF security patrols, with the famous Chicken Street carpet and trinket shops all open for what looked like good business - including two shops selling snow leopard skins. We stayed in small rest house-hotels - mine, the Gandamak Lodge, run by a well-known and enterprising BBC cameraman, Peter Jouvenal, who's rented it from its Afghan owner, had comfortable rooms with elegant furniture, lots of carpets, a large garden and excellent (though expensive) food.

As we drove out through the northern outskirts of Kabul towards the Shamali Plains, the scene of many battles in the past, there was an enormous bustle of traders doing business and people building new small homes. In the Panjshir itself, the harvest (wheat and beans) was being taken in and, again, people were rebuilding their mud-brick homes. That's not of course typical of this war-ravaged country - which I guess is why we were rare tourists! (A journalist, Matthew Leeming, who's written on Afghanistan for The Spectator and others and is bringing out a guidebook next year, is planning to take groups on trips - www.matthewleeming.com - but there's little else at present).

We were a group of 24 paid-up walkers, aged from early 30s to mid-late 70s, Sandy and Eleanor Gall and two of their daughters; Fiona who is SGAA's consultant in Kabul, and the only paid ex-pat on the charity's books and Michaela, a professional painter who also helps voluntarily. There were about five or six SGAA staff to give general help and a similar number of cooks (and porters) who fed us superbly with Jan Mohammad, Masood's head of logistics and an old friend of Sandy's, in charge. Other Afghans included Haji Sufatmir, an elderly guide, who took one of the Rothschilds hunting Marco Polo sheep at the end of the 1970s. That made a total of 45 people or more. It's not surprising that the Independent's correspondent Phil Reeves, who interviewed Sandy in Kabul, started his story (it appeared on Sept 20) with the thought that American spy satellite watchers scouring the Afghan countryside for Osama bin Laden would surely be mystified by this straggling line of people moving up the Panjshir!

Our trek lasted ten days. We always tried to walk early to escape the midday sun and were generally away by 7am or so. At night we were in tents or rest houses - including Masood's main Defence Ministry rest house at Astana where I stayed when I interviewed him a month before he was assassinated in September 2001 (his two Arab suicide bombers also stayed there). We visited Masood's simple but striking tomb, sited dramatically on a hill in a bend of the river, and saw his house. In Kabul I met his elder brother, Yahya, and asked him how the assassins had managed to get past Masood's many security checks. He said it was because Masood had wanted to get his message across to Arab nations, the two came with good credentials and, most importantly, Afghanistan had never experienced suicide bombers, so they were not prepared for such an attack.

The valley is now peaceful, untouched by the violence elsewhere, after 20 years of being bombed and invaded by the Russians and then bombed by the Taliban. Rusting old Russian tanks and other equipment from the 1980s dot its dramatic landscape (along with some still-operational tanks, missiles and other military stores). The River Panjshir tumbles down past gaunt bare mountains - deforested by bombings and tree felling but green I'm told in the spring rains - and through well-cultivated green and yellow fields that are irrigated by mountain streams or long irrigation channels. Brown mud brick villages cluster in the base of the valley and sometimes climb up the mountainsides. Tank tracks and other parts add drama to grey stone walls where they are used as reinforcement.

The population of approaching 100,000 is being depleted as people drift to the towns for work because, with only one crop a year, this is not a rich valley. The people were almost universally friendly though women usually scurried behind their doors when they saw the men in our party.

Journalists rarely leave good behind when they move from one story to another but, for Sandy, now 75, the 1982 visit to find Masood triggered a mission to help disabled Afghans. He and Nigel Ryan both wrote books on the trip, and the pr lady for Sandy's publisher suggested that he offered to donate some of the proceeds to help the limbless. He had already been asked for help one of Masood's commanders, Abdul Wahid, who had lost a leg. This led to the creation in 1983 of the SGAA to care for victims of the Russian and (later) Taliban battles, plus children crippled by polio - and our walk marked the charity's 20th anniversary. As we walked up the Panjshir, the medical team - including two British doctors who are regular volunteer consultants - examined potential patients and told them about the clinics.

There were of course a few dramas and priceless remarks. A youngish banker lost his trendy sun specs down a deep drop loo when he lowered his head and bent too far to look down the hole! A lady architect tried to help by rolling a spare jeep wheel across a rough bridge and bowled it into the river - the driver waded in and saved it. Sandy memorably said in exasperation one day "What do people think this is - a holiday camp?"

I'm convinced the amount I've raised is money well spent. The SGAA is run with a minimum of administrative costs and is doing excellent work for people who certainly need help. 

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What happened in Afghanistan in 2002?

Return of Refugees - The most striking change in 2002 has been the return of almost 2 million Afghan refugees despite the dangers of continued fighting, landmines and drought in different regions. Endless streams of refugees were visible on the main road from Pakistan to Kabul in the spring and summer, returning after 20 years of exile in trucks piled high with household goods and roof poles. The newly arrived refugees had high expectations both of the new government of President Hamid Karzai and of the international community. But in a country ruined by decades of war rebuilding will take time as well as money. Some of the refugees have been disappointed. There is a tremendous housing shortage in the main cities; half of Kabul is still in ruins; and in villages near the Taliban front lines it is still dangerous to walk because of unexploded mines.

Back to School - Another positive change has been the daily sight of children with school bags and uniforms going to school - under the Taliban regime girls were not allowed to be educated. Some children have missed 6 years of school and it is a common sight to see a primary school class full of teenagers who are trying to catch up. The eagerness of these students despite the lack of basic facilities, books, chairs, desks and blackboards is impressive. Many children in the refugee camps had access to schools for the first time [Afghanistan has one of the highest illiteracy rates in the world] and Afghans learnt that education could improve the economic prosperity of the family. It is heartbreaking that many of the disabled children that SGAA helps cannot go to school because of the distance. In rural areas, it may be a five-mile walk to school and only the fittest children will be up to it - certainly not those with callipers or wheelchairs.

Security - Parts of Afghanistan continue to be unsafe due to rivalry between local mujahideen commanders. It is hard for people who have lived by the gun for 24 years to put them away. The government in Kabul has only limited control over these commanders as it is still training a national army and police force. So local communities and aid organizations working in other areas of Afghanistan do not have complete security, which makes rebuilding the country more difficult. Some Pushtuns in rural areas say it was safer under the Taliban. In one sense this may be true. But the Taliban murdered thousands of non-Pushtuns in the northern half of the country and are considered by President Karzai, himself a Pashtun, and many others to have failed disastrously as a government. President Karzai, however, is well aware of the danger from renegade Taliban and other dissidents and has repeatedly asked for increased international military support.

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SGAA Activities in 2002

Jalalabad Physiotherapy services - SGAA has continued its activities for the disabled throughout the year despite difficulties with the security situation. Local shooting matches between commanders, or threats to hijack aid agency vehicles, have led to the temporary suspension of our outreach programme on several occasions. The outreach programme sends male and female physios to health clinics in rural areas in Nangarhar and Laghman provinces to identify and treat the physically disabled, particularly women and children who have less chance of leaving their villages to seek help. The interruption of this programme has inevitably had a knock-on effect and patient figures were down in 2002 compared to 2001. Still SGAA's main centre in Jalalabad remains busy - it is heart-warming to see how many parents still bring their children for treatment despite the difficulties of distance and transport.

Orthopaedic workshop - Orthopaedic appliances and mobility aids have continued to improve in quality. Our Committee members, John Fixsen (orthopaedic surgeon) and John Lamb (orthotist) came out in March to review the project and were happy with improvements to all appliances, including our own prosthetic feet. John Fixsen worked with local surgeons and offered to arrange supplies of urgently-needed surgical instruments. SGAA appointed a new Afghan orthopaedic surgeon in Jalalabad and hopes to give him additional training in future. SGAA plans to invite Motivation, who designed the 3-wheel and 4-wheel wheelchairs made in the component workshop, to come out and evaluate production in 2003 and make recommendations for a hand-propelled wheelchair. SGAA wheelchair users have particularly requested this.

Training courses - Our new physiotherapy students started their two-year course in March 2002 and completed their first half-year exams in August; 13 men and 12 women passed the exams successfully. They will be sent on clinical placements at the end of their first year to local hospitals and clinics throughout the region. Our physiotherapy consultant and committee member, Mrs Paddie Chanmugam, spent 3 months at the beginning of the year preparing and starting the training course with the teachers - a team of Afghan doctors and physiotherapists. This is the first time that SGAA has successfully launched a training programme entirely taught by its Afghan staff members. Much of the credit for this is due to Paddie.

In addition 3 of our senior orthopaedic Afghan technicians have been busy completing a part-time course at the Pakistan Institute for Orthotics and Prosthetics [PIPOS] in Peshawar, Pakistan. This course has given them sufficient theoretical knowledge to enable them to teach other technicians and pass on their own skills.

Health Education - The health education programme has been boosted this year by the appointment of a supervisor, Dr Shah Wali. He has devised a training programme for all health educators based on his own child-to-child training course. The health educators not only teach patients at the clinics about prevention of disability in the home and outside, but they also visit local schools to teach the children, through role play, about the dangers of accidents in the homes and the importance of hygiene. In 2003 we hope to do a survey to see the effect of these classes on the local communities and whether disability is better understood as a result of this programme.

Women's Rights - There has been a huge professional improvement for all of SGAA's women staff this year since the departure of the Taliban. Now our female physiotherapists and orthotists can talk to their male colleagues without fear. Our senior woman physiotherapist is now able to attend internal SGAA management meetings [before she had to come to Pakistan to meet her colleagues!] and can also represent us at meetings with other organizations. While many conservative Afghans still have reservations about women working outside the home, particularly after marriage, there is no doubt that it is crucial that women be allowed to be educated and work as health professionals if the level of health care is to improve in Afghanistan.

Kabul Mother and Child Clinic - The mother and child physiotherapy clinic that SGAA set up in Kabul in June 2001 continues to be extremely busy. The clinic was transferred to the northern suburb of Khair Khana at the beginning of the year where it serves many people from the rural areas of the Shomali plain to the north of Kabul and is staffed by 1 full-time and 2 part-time female physiotherapists. Patients come for physiotherapy treatment to the clinic and are then referred to other hospitals or workshops as necessary. Four health educators are attached to the clinic and visit local schools and clinics to talk about what disability is and how it can be prevented.

Kabul Orthopaedic Centre - At the beginning of September 2002 SGAA signed a contract to provide support to the orthopaedic centre which it had equipped and sponsored between 1996 and 1998. The staff need refresher courses to improve their professional skills and the building needs repairs and repainting. SGAA were fortunate to find support from Ashram International in October 2002. Ashram agreed to pay part of the running costs of the centre for one year. This centre is ideally placed in the centre of Kabul to treat a variety of patients and has large rooms that provide ideal space for training students.

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