BERMEL, Afghanistan — Down a dirt alley a half-mile from Forward Operating Base Boris, a no-frills bastion that houses several hundred U.S. and Afghan troops behind 10-foot-high, sand-filled walls with a pair of 145 mm mortars at the center, American soldiers slinked like cats on the prowl.
Each was separated from the next by 30 feet to avoid suicide attacks while Maj. Yince Loh, 36, a brain surgeon from Los Angeles, searched for the home of an Afghan midwife.
A local pharmacist had given Loh her name. Both men hoped that the woman could help them open a small clinic to help address the health care needs in Paktika, one of the poorest and most dangerous of Afghanistan's eastern provinces.
Their task is made more difficult because a barren tribal region spans the mountainous border into Pakistan, where Taliban insurgents, backed by al Qaida paymasters, plot to destroy U.S. forces' good deeds and outreach efforts.
Sign Up and Save
Get six months of free digital access to the Bradenton Herald
"Frequently the distance between home and a health care center is a two- to ten-hour walk," said Kathrin Lauer, a medical administration expert with the U.S. Agency for International Development in Afghanistan. "Midwives with good training are critical if you want to reduce the maternal and neonatal mortality rates. This is one way to help win the war."
Some U.S. officers in Afghanistan, however, think it may take a decade of hard work, at great risk to American soldiers, to achieve their goals of providing hope and security for residents.
Loh, who's worked with U.S. special forces fighting Islamic extremists in the Philippines, wants to introduce basic medical and nutritional development projects to Bermel's district center, which has open sewers and no electricity or running water.
"Right now, we can't help the Afghan government come in here and build a big Afghan clinic," Loh said. "But we have some options and we are still looking for midwives to help.
"Our goals are incremental: to improve infant mortality step by step. That will certainly help improve perceptions of the government."
Senior U.S. officers in Paktika said that the Taliban and al Qaida operated in the province, using the mountain passes as transit routes for a raging insurgency focused on major population centers farther within the country's interior.
"We've had several instances where we believe suicide bombers have been waiting near the bazaar to launch an attack on U.S. forces," said Capt. Bill Waddell, 29, of Stillwater, N.J., an embedded military trainer who's working with Afghan forces at FOB Boris. "But the Taliban is sometimes reluctant to attack these days in population centers, as they prefer to catch U.S. forces alone."
"We are now working under a counterinsurgency strategy that separates the enemy from the people and improves the way of life of the population," said Brig. Gen. James C. McConville, 50, of Quincy, Mass., the Army's chief of supplies and development for eastern Afghanistan.
In the Waziristan region, however, which extends into Paktika province, the enemy openly mingles day and night with the local population. Health workers seen or thought to be siding with U.S. or Afghan security forces become targets of the Taliban's wrath. Last year, militants kidnapped one midwife and shot another dead.
A firefight between the Taliban and U.S. special forces just to the south echoed in the distance as Loh and soldiers from the 3rd Battalion, 509th Infantry Regiment (Airborne), part of the 4th Brigade of the 25th Infantry Division out of Fort Richardson, Alaska, stepped inside the small wooden clinic of a midwife named Shamshad.
They peered into a barren back room with a dirt floor, where Shamshad, who like many Afghans uses only one name, sometimes delivers five babies in a day.
Wearing a brown silk sari, Shamshad, 45, sat with her male cousin on a bed, nervous and afraid. The Taliban recently abducted her and forced her to walk for two weeks in the frigid mountains as punishment for providing a bandage to a wounded Afghan government soldier.
She's one of two midwives in Bermel's district center, where she's been working from her small clinic for a dozen years, even when the Taliban were the "official power" in town before the U.S.-led invasion in 2001.
Many of Bermel's ethnic Pashtun residents don't even consider themselves Afghans. They prefer to be known as Waziris, a tribal grouping that resides primarily in western Pakistan, in an insurgent sanctuary that has firm al Qaida backing. The British Raj divided Waziristan between Afghanistan and Pakistan with the "Durand Line," a border that's largely meaningless to Waziris.
Shamshad was visiting relatives on the Pakistani side of the border when she was abducted by the Taliban, who've created a mini-state in Waziristan that enforces strict Islamic law, among other things with regular public executions.
"Please help me, but don't bring me anything yourself; send it at night through someone else," Shamshad pleaded as the Americans greeted her.
Sgt. Eric Pollock, a National Guardsman from San Diego, asked Shamshad whether she could work at an Afghan medical clinic, but she said she couldn't.
"If I work in an official clinic, they (the Taliban) will behead me," she said, demurring from having her photo taken out of fear that the Taliban might see it.
"I've been interested in medicine for a long time," said Shamshad, who wasn't covering her hair as Afghan and many other Muslim women traditionally do. "My husband would not let me work in a government clinic, so I opened my own clinic here. But when I was arrested in Pakistan by the Taliban and fell ill, thieves ransacked the clinic and took everything, including my stethoscope, hot water heater and blankets."
Loh said he'd think about how he might help Shamshad as he emptied his medical supplies onto the counter for her and prepared to return to base.
Afghan civilians interviewed who didn't wish to be named for fear of the Taliban said that U.S. forces faced a stiff challenge as they tried to strengthen the virtually nonexistent Afghan government's hand in Paktika province.
They said that the Taliban's propaganda efforts often succeeded because of rampant Afghan government corruption and the incompetence of Afghanistan's security forces.
"The Taliban is gaining power, and people see this and some are happy about it," one Afghan man said. "If the government is incompetent, the Taliban only has to present itself as a reasonable alternative."
While the Taliban and al Qaida have what's arguably their strongest and strictest militant sanctuary on the Pakistani side of the ill-defined Waziristan border, their rule is less secure on the Afghan side.
The Taliban fire aging, inaccurate Russian rockets into FOB Boris several times a week. American troops dutifully scramble to return fire before ducking into bomb shelters.
Most clashes occur outside the fortress, when members of a U.S. company commanded by Army Capt. Harland McKinney, 30, of San Diego venture out in jeeps or on foot.
On at least 10 occasions in the past three years, American forces on foot patrols into town less than a mile away have been attacked. Pollock, 41, an Army civil-affairs team leader, is still investigating the death of Sgt. Federico Borjas, a fellow San Diego police officer whom an Afghan National Police officer assassinated last November while Borjas was on patrol in Bermel. He was shot in the back of the head, one indication that the Taliban either have infiltrated or intimidated the Afghan police in Bermel.
In the town market, where the tension is thick, the American soldiers have launched a "hearts and minds" campaign of their own in conjunction with their Afghan colleagues.
Although Pollock worked alongside the murdered Borjas for more than a decade, he said that he harbored "no real anger towards the Taliban," and added that he's experienced genuine warmth and hospitality in Bermel. At every stop on his patrols, he tries to sit and drink tea with the locals, who've embraced him warmly.
"Federico's death hasn't really hit me yet," he said. "I know when I go home and walk past his empty locker, it will."
CHILDBIRTH IN AFGHANISTAN:
Afghanistan suffers from appalling health deficiencies and has an average life span of less than 45 years. An Afghan woman has a one in eight chance of dying in labor. High mortality rates for women and children stem from ignorance of basic health care and a lack of proper birthing facilities.
In keeping with tradition, only female doctors and midwives deliver babies in Afghanistan, and most husbands prefer that their wives don't give birth in hospitals. Health care workers assist with just 14 percent of births. A 2002 UNICEF survey of maternal mortality in Afghanistan found that in many remote regions, some 2,000 to 4,000 women die for every 100,000 live births.
Several nonprofit organizations, including the U.S. Agency for International Development-supported Alternative Development Program in eastern Afghanistan, are attempting to identify young Afghan women as possible midwives and take them to hospitals for training.
(Smucker is a McClatchy special correspondent.)
MORE FROM MCCLATCHY