HEALTHCARE IN AFGHANISTAN

Baltimore

Naomi Klein’s May 2 “Lookout” column contains a mind-blowing statement: “In Afghanistan, where the World Bank also administers the country’s aid through a trust fund, it has already managed to privatize healthcare by refusing to give funds to the Ministry of Health to build hospitals. Instead it funnels money directly to nongovernmental organizations, which are running their own private health clinics on three-year contracts.” Klein obviously thinks building hospitals would be preferable to providing primary healthcare. Building hospitals to serve the urban elite rather than primary healthcare facilities to serve the rural poor was an early fault of the World Bank and other aid agencies. Now that the bank is finally addressing needs of the rural poor, Klein wants to see money diverted to hospitals to serve the rich and powerful. This casts doubt on the validity of her entire column.

TIMOTHY D. BAKER
Professor, international health, Johns Hopkins University


KLEIN REPLIES

Toronto

The question of how Afghanistan spends its national healthcare budget should not be up to Timothy Baker, me or any other foreigner; it should be up to a sovereign and accountable Afghan government. Instead, the government of Hamid Karzai–already heavily shaped and influenced by foreign forces–is virtually shut out of all major reconstruction decisions. The Financial Times reports that two-thirds of the national budget goes directly from foreign donors into the hands of NGOs and private contractors, bypassing the Afghan government entirely. The real question is not whether aid dollars will be spent on rural clinics or urban hospitals; it is whether any healthcare system will be left behind when the contracts are up and the private contractors leave Afghanistan. The NGOs themselves admit that the current situation is one of total dependence: Acbar, a group presenting eighty large NGOs in Afghanistan, recently said that if foreign contractors were shut out of government reconstruction contracts “all national development programs, including those that focus on health and education, would collapse.” Which raises the question: Is Afghanistan really being reconstructed, or is it just a place for foreigners to collect lucrative short-term contracts? The great fear, as articulated by President Karzai’s spokesman, Jawed Ludin, is that the billions spent on aid will be “like an iceberg that melts away and leaves nothing.”

NAOMI KLEIN


GUNBOAT DIPLOMACY CA. 2005

Hempstead, NY

As a military historian, I was fascinated by Michael T. Klare’s April 25 “Imperial Reach,” about future US basing schemes. The same profound arrogance and ignorance that went into dismissing General Shinseki’s warnings about the number of troops needed to hold down Iraq is revealed in spades. These forward bases are extremely vulnerable to pre-emption by local groups or revolutionary governments (imagine one of these depots in Pakistan or Venezuela being gobbled up and helping to arm the rebels), and these Stryker Brigades (which an officer friend of mine said the Army is pushing like a new religion) are too small to take on a real adversary (Iran, North Korea) yet too big and bulky to be used in antiterrorist or counterinsurgency contexts.

What these clowns fail to comprehend is that sending in troops is not the equivalent of the British sending a gunboat 100 years ago. Gunboats were a warning not to mess with the international order or threaten foreign nationals or foreign property. Sending in troops means taking over a society and getting stuck running it. America is using the tools of direct colonial rule to impose what it would like to be an informal empire. This just won’t work, but Rumsfeld, Cheney and Bush are too ignorant and haughty to get the point. Soon, they will run out of cheap victories, just as they are running out of cheap oil. They will send US troops in over their heads, and the resulting use of massive bombing and perhaps nuclear weapons to bail them out will be as shattering to the international order as it is bloody.

JAMES LEVY


Lakeview, Ore.

Recently my son in the Navy Seabees reported he might be going to Mali to help set up a base. I confirmed that Mali has no oil, nothing of interest. But west and south lie countries with oil, and just enough strife and “terrorists” to send our military in to “protect” oil interests. OK, that explains Mali.

Michael Klare’s article brought even more light to what’s going on. As a Vietnam veteran, I was interested when Conoco announced that its highest-producing well, ever, was merrily functioning off the coast of Vietnam. We “lost” in Vietnam thirty years ago, promising democracy, but today, capitalism is winning.

Now we plan to set up troops around the world, invade countries pre-emptively as we wish, and any who challenge us are to be called “terrorists.” We again promise people “democracy.” The real motive is again capitalism at the point of a gun. Capitalism does not equal freedom.

DOUG TROUTMAN


SILENT MAJORITY

Sequim, Wash.

I am one of the readers who, as you said, nodded quietly in agreement [“Letters,” May 9] with the poignant rendition of Terri Schiavo on your April 18 cover. As a nurse for almost twenty-five years, I have thought about and interacted with death quite a bit. Developmental psychologists have pointed out that those who have the most trouble allowing loved ones to die are those who feel a sense of dissatisfaction with their own lives and relationships. I have often attributed this on a larger scale to religionists who believe in life after death and antiabortionists who can’t allow others to make personal choices about their destiny. I think these people have something in common: an inability to accept the fact that death is simply a part of life. Thank you for the bravery you demonstrated in publishing that cover art.

LAURA SHOWERS, RN



ROOTIN’ TOOTIN’ SHOOTIN’ DEMS

Omak, Wash.

Many thanks for Sasha Abramsky’s “Democrat Killer?” [April 18]. The sooner those urban Democrats recognize how counterproductive is their shrill diatribe against guns, the better. It detracts from the real issues upon which we should be concentrating and “triggers” a negative response from us rural types–and it plays into the hands of the neocons.

By the way, that’s a mighty fine Colt Peacemaker displayed on the title page.

JACK HOLDEN


Portland, Ore.

Absolutely right: The left should drop guns as an issue. We will never get anywhere with it, and we lose voters who would vote for us on most other issues. Leave gun matters to the states, and ask the NRA and other groups that favor guns for their input on increasing gun safety.

JUDY MELLOW


Havelock, NC

Sasha Abramsky was on target concerning the importance of the gun issue to rural swing voters but missed the mark on what Democratic policies are alienating gun owners so badly. The expired assault weapons ban did not cover automatic weapons or military firearms; rather, it restricted the manufacture of new firearms holding more than ten rounds (like the pistol in your local police officer’s holster) for the civilian market, as well as civilian rifles, shotguns and handguns with two or more features that gun-haters particularly dislike (such as a rifle stock with a protruding hand grip). Pre-1994 guns and magazines were exempt.

It is the Feinstein ban–not concerns over hunting firearms or background checks–that has driven the gun-owner backlash against Democrats since 1994. Four out of five gun owners are nonhunters, and if Democrats don’t stop fighting for bans on every class of civilian guns the prohibitionists tag with a scary label, the backlash at the polls will undoubtedly continue.

SHANNON PARKER


Alexandria, Va.

Whatever difficulty Democrats encounter these days as proponents of gun control cannot be corrected until they do what the gun-control movement has failed to do, namely, correct the misleading impression that they are anti-gun. Since “anti-gun” implies opposition to private possession of guns, it can hardly be surprising that countless devotees of private gun ownership fear that even minimally stricter controls are incremental steps toward what they imagine is the ultimate aim of gun-control advocacy–the banning of private gun ownership.

Effective advocacy of stricter gun control should include rules that are responsive to the imperatives of public safety and respectful of the rights and needs of skilled, law-abiding, responsible gun owners. Minimum national standards for lawful, responsible access to guns should be subject to additional requirements that states and localities may consider essential. In addition, politicians supporting gun control can stress more than conventional public safety: Strict gun control is indispensable in the “war on terror.”

In addition, a well-designed gun-control campaign should do what the private gun owners have failed to do: Make gun ownership a respected source of personal pride. Since guns are as easy to get as hammers and screwdrivers, there is no more pride in owning a firearm than in owning a hammer or screwdriver. Law-abiding, responsible gun owners, obeying strict controls, should welcome a distinction they’d deserve.

DAVID J. STEINBERG
Director, 1968-89, National Council for a Responsible Firearms Policy