Amid endless Afghan tragedy,doctor won't quit
For 25 years,Tetsu Nakamura has been helping Afghans learn to help themselves.

By Daisuke Furuta/April 10, 2010

▲Tetsu Nakamura,center,examines sick people an
Afghan refugee camp in northwestern Pakistan.
On an unforgiving landscape covered with jagged rocks and sand,fields of green have appeared, offering a sanctuary and hope in a country wracked by decades of war, poverty and death.
This agricultural region about an hour's drive north of Jalalabad in eastern Afghanistan is the latest accomplishment of Tetsu Nakamura, a Japanese doctor who has risked his life and seen endless tragedy in his close to quarter-century of helping the people of Afghanistan.

The group he heads, the Peshawar-kai,provides everything from medical support to agricultural assistance in war-ravaged parts of Afghanistan.
About 600 children study in a brick madrasah the group built next to a mosque.
While madrasahs are normally considered religious schools,Nakamura,63,said his group's school was more like a traditional Japanese terakoya,"where children can learn how to read, write and do simple calculations."

After the Taliban regime was ousted in 2001, the United Nations and nongovernmental organizations from the West set up schools throughout Afghanistan.But many have been forced to close because of threats or open attacks due to local anti-West sentiment.
To avoid a similar fate, Peshawar-kai decided to call its school a madrasah, in line with Muslim tradition.
"When one calls it a religious school, people immediately consider it a hotbed for radicals, but the reality is different," Nakamura said."Radicals are not created by madrasah, but through hatred of the United States and poverty."

On Feb.8, a ceremony commemorated the completion of not only the madrasahs and mosque, but also irrigation canals.
The canals began operations over their entire 24-kilometer length last August after six years and five months of construction. The canals have rejuvenated farmland that had gone fallow due to drought.
In addition to the traditional wheat crops in the region, local residents now also harvest potatoes and watermelons that were introduced on an experimental basis by the Peshawar-kai.
Under the group's plan,the irrigation canals will provide water for 14,000 hectares of farmland, providing food for about 600,000 people.
Farmers who fled as refugees have returned to their homeland and created communities along the irrigation canals.
The madrasah was constructed so local children can learn, while the mosque was built as a place of prayer and gathering for the farmers.
Such a peaceful landscape full of promise and production is a rarity in Afghanistan.

UNICEF statistics show that about one in four Afghan children die before reaching the age of 5, the worst mortality rate in the world. Average life expectancy is 42, much lower than that of neighboring nations.
According to the United Nations Assistance Mission in Afghanistan, 2,412 civilians were killed by explosions, combat or terrorist acts in 2009, up from the 2,118 fatalities in 2008, which had been the deadliest year since the fall of the Taliban.
Since 2001, 2009 has also been the worst year for fatalities among foreign military personnel in Afghanistan, at 520, according to a private-sector group.

Nakamura blamed such figures on a "cycle of violence."
"When foreign militaries enter the nation to suppress falling law and order, fighting breaks out, leading to a worsening of conditions," Nakamura said."If civilians die, family members vow revenge."
"In terms of fighting and drought , the situation is now the worst in the 25 years that we have continued with our activities."
A similar situation can be found in neighboring Pakistan.
Peshawar, in the northwestern part of Pakistan, was where Nakamura's group got its name. It was also the group's original base of operarions until Japanese members working at a core hospital there were forced to evacuate in November 2008.

Footwear woes lead to philosophy
A Christian, Nakamura was introduced to Muslim regions through his mountain climbing hobby.
In June 1978, he accompanied a Fukuoka Prefecture group on a climbing trip to Pakistan as medical staff.
Stunned by the enormous difference in medical care available in Japan, Nakamura decided to live and work in those regions as a doctor.
He joined a group of medical professionals caring for leprosy patients and moved to Peshawar in May 1984.

Nakamura soon realized that many patients in Pakistan were unable to walk because they had developed holes in their feet caused by poorly made sandals assembled using nails. No matter how many times he provided care, Nakamura could not keep up with the number of cases he saw.
He took a different approach to easing the patient's pain by opening a shoe shop within the hospital.
He came up with an idea for a sandal made of soft leather and rubber sponge- and no nails. The patients themselves made the sandals, which sold for 200 yen($2.10) a pair.The patients were paid for their labor with the sales money.

The experience helped to shape the philosophy for Nakamura's assistance projects.
If no doctors are in a region, Nakamura made a point of going himself.If local residents did not have good footwear, they should be able to make their own.
"I want to achieve what local residents wanted by working together with those people and opening up a path for their independence," Nakamura said.

Refugees return to Dara-e-Noor
In Feburuary 1989, the Soviet Union completed its withdrawal from Afghanistan, ending a war that had lasted close to a decade and resulted in 1 million dead and 3 million refugees.
Afghan refugees who had evacuated to Peshawar slowly returned home, but what awaited them was a land ravaged by war.
Their plight led to Nakamura's decision to build a new medical clinic in Afghanistan.
The site chosen was Dara-e-Noor, a region in eastern Afghanistan on the border with Pakistan.
To get from Peshawar to Dara-e-Noor involved a 10-hour drive followed by a three-day walk.

Nakamura departed for the region in November 1991 with four staff members.
Even after Soviet troops withdrew, fighting continued between Afghan government troops and resistance fighters.
After crossing the border, Nakamura's group walked over a snow-covered mountain pass.They repeatedly encountered guerrillas armed with rifles but passed them without problem after exchanging greetings.
They crossed the Kunar River by raft and hitchhiked a ride on a jeep. Along the way, they found villages and irrigation canals damaged by fighting and idle farmland.
Even after arriving at Dara-e-Noor, Nakamura's group could still hear artillery fire. They were welcomed as guests by residents who followed Muslim teachings. They treated the group well and allowed the mwmbers to stay at their homes.

Some of the Afghan members complained about the isolated location, but Nakamura decided that Dara-e-Noor was where he wanted to build his clinic.
"We are not needed where anyone can go. We have to go because no one else will,"he explained to the group.
Patients who came to the Dara-e-Noor clinic were not only leprosy sufferers. In 1992 alone, the clinic had 36,000 visitors. Combined with the clinic in Pakistan, 100,000 people used the clincs of the Peshawar-kai.

As the group's activeties expanded so did the organization that had its headquarters in Fukuoka city.
When Peshawar-kai started in 1983, it had about 620 members, but by 1997,it had 3,189 individual and group members.
When Peshawar-kai constructed its first clinic in Peshawar in April 1998, total construction costs of about 50 million yen were coverd entirely by donations.

Digging in to save lives
Nakamura realized something was not right in June 2000.
He went to the Dara-e-Noor clinic to oversee a rebuilding project and found it was overwhelmed with dysentery patients. The cause of the epidemic was drought-stricken people drinking waste water. Even during rice-planting season, the land was parched.
In a report at that time, the World Health Organization said 12 million Afghans would be affected by drought and that 4 million faced famine.
Nakamura immediately put together a plan to dig wells in various locations.
He said his thinking then was:"Without water, the people will not be able to live.Diseases can always be treated later."

With the help of experts, the 20 wells that were in use in August became close to 300 by October. The number of local workers hired also increased rapidly to about 650.
However, no matter how many wells were dug, they would eventually dry out without rain. More farmers returned to being refugees after abandoning farmland that could no longer grow food.
At about the same time, the U.N. began taking a tougher stance against the Taliban fundamentalists who had gained control of the Afghan government and were suspected of providing protection to al-Qaida terrorists.
With rumors spreading that the start of war was near, an increasing number of foreign assistance groups began leaving the capital of Kabul.
Sticking to his philosophy of going where no one else goes, Nakamura constructed five temporary medical clinics in Kabul.

The situation deteriotated rapidly.
Following the Sept.11, 2001, terrorist attacks on the United States, everyone thought an U.S.-led attack on Afghanistan was imminent.
Nakamura, who was in Jalalabad at the time along with his staff, was forced to evacuate under Japanese Embassy orders.
At a meeting, Nakamura told the Afghan staff workers:" We shall return. We will not abandon you."
While the United States was celebrating the liberation of Afghanistan from the oppressive Taliban government, drought continued in the country.
During that time, Nakamura's group dug about 660 wells, but they had almost no effect.
In early 2002, Nakamura put together a new plan to create green land involving irrigation canals from the Kuar River in eastern Afghanistan to rejuvenate the land around the Dara-e-Noor region.
The project began in March 2003.
Nakamura himself operated heavy equipment to dig the canals and used his hands to pile up rocks to reinforce the canal banks.
To allow local residents to use the irrigation canals semi-permanently, a decision was made to use traditional construction methods so local residents could themselves make any repairs when the canals were damaged.
As the length of the irrigation canals increased, more farmland was rejuvenated.
Nakamura began a farm to experiment with produce that could withstand dry conditions.

Then tragedy stuck. Kazuya Ito, 31, a Peshawar-kai staff member who worked at the farm and was popular among the Afghans, was kidnapped in August 2008 and murdered by his captors as police tried to rescue him.
The Peshawar-kai's policy for securing safety is different from other nongovernmental organizations.
It maintains a distance from all political forces, including the Japanese government and the United Nations.
In that way, it can gain the trust of local residents.
The local residents are in a sense the "bodyguards" for Peshawar-kai staff workers.
However, safety conditions had dereriorated due mainly to fighting between U.S. troops and armed resistance forces.
Ito was killed at a time when Japanese staff members were preparing to return to Japan for a temporary evacuation.
After bringing Ito's body back to Japan and holding his funeral, Nakamura returned to Afghanistan alone.
"If the irrigation canals are completed, we will be able to save the lives of hundreds of thousands of people," Nakamura said. "We cannot abandon this project."
It would take another year to complete the canal project.

Nakamura turns 64 this year, and he is not thinking about a new project for Afghanistan.
 He is placing his hopes on private-sector support from Japan. The Democratic Party of Japan-led government has announced a support package of $5 billion, a figure about 2,000 times the annual operating budget for Peshawar-kai.
"If the money is used from the standpoint of the general public, it should help save many people," Nakamura said.

At the Feb.8 ceremony to celebrate the completion of the irrigation canals, the madrasah and mosque, Nakamura gave a speech in Pashto.
"While support came from Japan in terms of finance and technology, the mosque and irrigation canals were constructed by the Afghan people with their own hands and the sweat of their labor," Nakamura said."That is what is so great about this project."