Heroes of humanity

30 SEP 2014

As I settle back into my life in Charlotte, I am amazed at both how easy it is to reintegrate and how quickly the palpable tension from the Middle East fades. And, yet it still surrounds us, this fear and uncertainty.  I will write a little more on risk later (I had an interesting conversation with British Ambassador Peter Millet about risk just prior to jumping off a 30 foot waterfall).

The news coming out of the Middle East would seem to suggest that humanity is dead.  Daesh is truly a nihilistic group of murders who are less “Islamic” than my dog Sam.   And, still we must not forget that this is not some obscure, distant, and faceless war.  The victims are women and children- mothers, sisters, grandparents, babies.  The violence and disruption is unimaginable.  But, there are heroes as well.  This video was sent to me by a friend who works at the USAID Office of Transition Initiatives.  It is worth the 3 minutes.

On a tangentially related note, I wanted to return to the vitriolic, partisan lashing that the press gave President Obama for his earlier statement regarding the lack of a US policy to address ISIL.  Now, I will admit “We don’t have a strategy”, though refreshingly honest for some, is not what you want to hear from your President.  It does not instill confidence domestically and echoes of weakness internationally.

That said, Politico outlined some of the complex domestic “political” challenges in crafting a coherent strategy.  Clearly, domestic concerns are critical.  However, this is not even half of the story.  Any efforts require a political solution and must address AT LEAST:

1.  Creation of a  strong and unified Iraq with control of the sectarian violence and establishment of stronger governance practices.  Note this is strongly opposed by Iran, moderately opposed by the Kurds who are essentially independent, and not supported by the Sunnis who have been subjected to nearly a decade of retribution for Saddam’s rule.

2.  Addressing the subterfuge of the Saudis and the Iranians.  Challenging since we are economically tied (read dependent on) to Saudi oil and hyperfocused on preventing an Iranian nuclear program.
3.  Working with the increasingly totalitarian Turkish state and acknowledging their concerns vis-a vis an independent Kurdish republic.  They just took 200,000 refugees in a week, hard to complain about them, though there is ample evidence of their complicity with ISIL.4. Controlling or containing the impact of the smaller Gulf states on the escalation of violence through funding of Salafist extremists (see a recent Foreign Policy article details some of the support for my comments about Qatar in my ISIL/ISIS diatribe).5.  Some semblance of understanding of the divided opposition forces (None or which are “moderate” any longer- 3 years of conflict has a way of driving the moderation from ones belief system).6.  An understanding of the global economic implications of intervention or lack of action.7. A massive commitment of diplomatic and development forces to augment the military forces currently attempting to halt the ISIL advance.  Think of it like chemotherapy treatment- extreme violence is required to halt the advance of this malignant cancer.  But, in doing so we will destroy a great deal of surrounding healthy tissue (e.g. infrastructure, education, moral, ethics, crops, etc.).  Unless we combine the destruction with an aggressive rehab program (i.e. political and economic support), the ideology will survive.

If this were a senior comprehensive exercise for a political science master’s degree, it would be viewed as a seemingly unsolvable problem that the faculty put together to “test the student’s thinking”.  That said, with people like Ambassador Wells (Jordan) and Stuart Jones (Iraq) working with local leaders, I have hope.  I have to; the alternative is surrender to evil.

A good overview on Syria from 10 months ago.

Storms in Jordan

28 SEP 2014

20100202 EF LogoMy last day in Jordan. 1 day and a wake up as we used to say when deployed.

A climactic “depression” has swept over Amman, dropping the barometric pressure, bringing clouds and cooler weather. An appropriate start to Fall- beginning tomorrow as I depart. If I was more intelligent, or a more creative writer, I would inject some nifty segue and transition to a discussion on the current state of public opinion and the regional instability. Or, I might hint at my own souring mood as my Fellowship “comes to an end”. But, honestly, more on my mind is my daughter who is inconsolably crying right now thousands of miles away and my beautiful wife who, with only a few hours of sleep, is trying to sooth her. I felt impotent watching my child in scream through the pixelated screen of a Skype call.

A chest- tightening sense of guilt turned my self-pity into an indescribably heavy feeling as thoughts of the Syrian children I met this morning invaded my conscience: Rajah an 11 year old triple amputee, Abdullah a slightly older boy giving his “new” left leg a first spin today, and a host of others, some orphans, others dropped off at the “rehab apartment” by parents who could not care for them. I struggled to separate sympathy and empathy. How can someone demonstrate empathy for people who have lost so much, who have experienced nearly unbelievable horrors?

How can someone, hell, how can I reconcile my rage, sadness, senses of fortune, vulnerability, power and responsibility with their desire just to have a “normal” childhood? I am not sure. I didn’t ask about their wounds. I threw out a little bad Arabic combined with a few fist bumps (“Gotas” as my pal Rye Barcott says they are called in Swahili) got a bunch of laughs in return. Abdullah showed me his prosthetic unsolicited with what looked like a smirk of pride; he was mobile again. Man, these kids are tough. It was kind of them to humor the big American. For me, it was another reminder of the human face of war that we too often forget or choose to ignore.

The Jordanians, Syrians, Iranians, Brits and Americans who are working to provide comprehensive rehab to these kids are an impressive group- some working other jobs in Amman and volunteering at the apartment to provide services. Others are working with the Innovation and Planning Agency to see if 3D printing of prosthetics will offer a cost effective solution for some of the amputee needs. All have huge hearts. All seemed to be there out of a sense of duty to their communities and to broader humanity.

I am preparing for my final meeting of the Fellowship. It should be a good one. I promise the next post will be more uplifting- the past 48 hours have brought an amazing series of meetings,

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collaborations and potential opportunities to drive change. Thanks to all for the support.








The last several days have highlighted the amazing people and networks connected to the Eisenhower Fellowship.

What do you do when you are the boss? Ask Andrew Harper at UNHCR

25 SEP 2014

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Sometimes, the Gods speak to you.

I was driving to my meeting with the Representative to Jordan & UN Humanitarian Coordinator (a Prior interview gives some background) Andrew Harper, when amongst the morning mental haze, Amman smog and traffic, I had a vision of our first encounter:

A stone faced Brit sitting across the table from me uttering a simple, “So, what do you want.”

I shook out of my daze and chuckled. I have been following Andrew Harper on Twitter since before my first trip to Jordan. He is omnipresent; in Amman, at ribbon cuttings for the opening of Azraq, meeting foreign donors, cajoling local partners and rolling through the social media landscape. I am not sure what it was, the terse but polite email exchanges leading up to the meeting or perhaps just the assumption that in order to lead this type of response, you must have a general intolerance for people who waste your time.

I vaulted up the three flights of stairs to his executive office, shook hands, slid into a chair at the conference table, handed over my obligatory gift of a CHS pen set and realized how off base I really was: he is an Aussie.

“So. Go”

Alright, game on.

I liked him immediately and had flash backs to my mentor in medical school; Jack Delahay. A guy whose presence demanded respect and who could with a smile on his face make you realize that you better not waste his F*ng time. So I went into my pitch, offset only a little when he rolled his eyes as I slipped local “resilience” into the conversation. I tried to explain the unique aspect of the Eisenhower Fellowship- I am not here to write a report or do research. I am here to learn, build networks, contribute ideas and solutions, and set the stage for future collaborations. That got a “sounds cool” out of him.

I had a series of questions as the framework for our conversation, but the discussion rolled from by the Mafraq solar farm (which he supported) got canned, to ideas surrounding modular refugee camps and deconstruction/ resettlement plans. I got a brief glimpse of the politics as we discussed his interactions with donors who would randomly refuse to pay for items after they were purchased and would deny their existence despite pretty good technical accountability for the material. We also talked a bit about how strengthening the Jordan communities, government and systems is critical to the medium term stability of the country and the success of the UNHCR mission.

I never really got clarity on his views about managing complex operations while fostering innovative solutions. He said, “We work in crisis. We just do it. It comes out of this office and we make it happen”. Perhaps that simplicity was enough. An example we discussed revolved around the use of biometrics for cash dispersals. The technology uses IrisGuard (Incidentally, the Chairman of the Board is Karim Kawar, Eisenhower Fellow and former Jordanian Ambassador to the US) linked to ATMs. The banks take a 2% commission, but otherwise there is no other operating cost and automatic reporting allows for very clear accounting. Despite my general discomfort with agencies using biometrics to track us, for the Syrians who are used to Assad’s regime of hard surveillance and repression, this was a piece of cake.

A couple of other cool things with IrisGuard as it transitions to the health community: no physical contact which reduces potential disease spread and allows for registering of conservative Muslim

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women more effectively, the Iris technology can register young children (apparently fingerprints are not reliable until age 13-14), and it allows for greater accountability in terms of tracking populations/ resource utilization.


IrisGuard Tech in health center
IrisGuard Tech in health center

Innovation in Crisis Response

26 SEP 2014

David Callaway, MD
Eisenhower Fellow 2014
Twitter: @CallawayMD

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So it is always nice to get a shout out from Joe Klein at TIME. But in the spirit or transparency (I am going to try to use all of my favorite buzzwords in this blog, see if you can find them- answer key will be at the end), I am not building refugee camps, just working with the different stakeholders to see if I can help make the entire process more efficient, innovative and effective.


During my last visit, I met Kilian Kleinschmidt, popularly known as the “Mayor of Za’atari”. Kilian is an interesting guy- full of ideas, demanding in their execution and, from what I can tell relentless in his pursuits. Save your chuckles people, I get it. We are having dinner tomorrow night to catch up and see where he will head on his next adventure.

From the 2013 NYT article:

“What makes Kilian tick is the same thing that makes him difficult,” said Pilar Robledo, who worked closely with Mr. Kleinschmidt for four years in Pakistan and now serves as a consultant to a project here run by the United States Agency for International Development. “He is a man who thrives when mired in chaos, and seems like a different person when an emergency situation has normalized.”

When Kilian and I last met, we talked large scale solar plants that could jointly power Za’atari and Mafraq (the closest major city). I proposed it. He told me how he had already walked through the stages to final approval- then rejection. Damn, I guess I am not that smart. But, we bonded over the idea. He told me of his newly formed “innovation teams”; though at the time, the mission, structure and execution of the teams was a bit hazy. But, the idea was enough to get me to shift the second half of my Eisenhower Fellowship from Turkey to return to Jordan.

This week, I met with Reihaneh Mozafarri who is part of a small start- up innovation team seeking to fulfil Kilian’s vision. Reihaneh is an intelligent and articulate Iranian women who works for the Innovation and Planning Agency (IPA) which is currently hosted under More Than Shelters a UK- based NGO. Her husband works for ICRC in Baghdad; the modern power couple!

David Callaway and Reihaneh Mozafarri from the Innovation and Planning Agency
David Callaway and Reihaneh Mozafarri from the Innovation and Planning Agency


We met outside of the UNCHR caravan and after a quick catch up with Brendan Dineen (a public health stud from UNHCR who is battling the waste water problem in Za’atari and Mafraq) we did a quick hand shake and headed to a Youth Task Force meeting. Always wary of “Task Forces”, “Clusters”, and “Committees”, I grabbed a spot in the corner and tried to be as inconspicuous as a new, tall white guy with a Red Sox hat can be at a refugee camp in Northern Jordan.

It took all of 2 minutes for Emma, a tall freckled Irish woman from the Norwegian Refugee Committee, who was running the Task Force to pause and ask me to introduce myself, where I was from, what I brought to the table. Since they were discussing youth and adult futbol leagues to offset tensions and provide daily activities, I mentioned to them the awesome work being done in Kenya by Carolinas For Kibera. Based on the CFK model, I made the suggestion that they should consider mixed teams of NGO, Syrians, and Jordanians rather than NGO team, refugee team, and guard teams. I know, this is a violation of Alan Jone’s advice to “shut up until you have been in the job for a while.” But, as I had 6 hours and not 6 months, I rolled the dice.

This was concluded with a “Welcome. Please get with Dr. Callaway after the meeting for any bilateral discussions or conversations.” And, then back to coordinating business. Frankly, it was one of the better run meetings I had sat through in a while. After the meeting, I complimented Emma on her managerial style. Her reply was that it was easy since their job was to “run the Task Force, not be a primary stakeholder in the programs.” This reminded me of the various OMI missions run in Haiti after the 2010 earthquake. A cool model; empower the experts to accomplish their missions by basically helping them to not get in their own way.

Turns out, this was Reihaneh’s introductory meeting, an opportunity to brief the IPA. She gave a short general overview of the organization and then met with the NRC and ACTED people to discuss the IPA’s ability to help bring in some agricultural experts to augment a local youth garden project. The conversation was interesting, but it was still a little unclear to me the role of the IPA. There were a couple of eye rolls every time the word “innovation” was uttered. I grabbed one guy and asked why.

“The UN doesn’t know about innovation. And, they don’t know what needs to be done in the streets of the camp. They’re caught up in the compound or in Amman.” Frankly, I haven’t spent enough time in Za’atari to validate this sentiment. There is probably some truth to it (Lord knows I am prone to rail against bureaucracies and especially aid organizations), but I suspect it more reflects the ongoing challenges of communication, tasking and lateral coordination in complex response. But, I think this is both a common refrain about “innovation teams” and about the UN. I will

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also say one of the biggest challenges that we try to overcome is to help large organizations link tactics, operations and strategy. The other comment that I heard (and hear often) is that “innovation” doesn’t just mean technology. Absolutely.

Eager to get a “look under the hood” and see if the IPA represented a valuable operational tool or just another dusting from the “Good Idea Fairy”, I steered us outside, we grabbed a dusty bench in the shady courtyard of the UNHCR caravan compound and got down to brass tacks.

The mission of the IPA is broadly to link networks and facilitate innovation in the camps. They seem to be hoping to be facilitators and coordinators across different sectors. The anchor project right now revolves around facilitating a project to bring 3D Printers to the Camps and begin producing prosthesis. IPA has partnered with Handicap International (HI), Ultimaker (the 3D printer producer), and a local Jordanian company (whose name they did not know). As a side note: I reached out to the Jordanian Eisenhower community and within 18 hours was meeting with the young founders of a startup named 3DMENA (MENA is Middle East and North Africa). It turns out, these guys are the “local partner” and I was able to get hands on look at the prosthetics.

3d Printer Entrepreneurs
3d Printer Entrepreneurs


The 3D printing option has only been utilized in South Sudan but if done correctly, this prototype could offer a dramatic reduction in cost of prosthetics, and massive increase in return on investment for donors to HI, and ultimately a more rapid return to function for trauma victims.

Things got a little more challenging as we dove deeper into the specifics of how to build an effective “innovation team”. This is where the teams I think are working hard to build their system. In my opinion, key components for success include:

  1. Effective idea capture: This is anchored in the CFK philosophy of “participatory development”. Not all good ideas will come from the community, but they are essential for identifying critical gaps and potential solutions. Likewise, it is critical to have a mechanism in place that examines solutions from other, unrelated sectors and evaluates application in your scenario.
  2. Effective idea vetting: Again, the “Good idea fairy”. 3D printed prosthetics may be a cool idea, but the devil is in the details: how many amputees are
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    there, what are the unmet needs, what are the programmatic costs in terms of time, manpower, money, training, etc. What is the scalability of the project.

  3. Local/ end user participation in idea generation, maturation and execution: Some of the early home solar projects in Za’atari fell victim to this. Power was already free, so when PV panels were placed on the caravans, the Syrians took them down and sold them for parts.
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    Is solar a bad idea? No. And, now that the camp is moving to install substations and charge for electricity, there will be a market for the panels.

  4. Mechanisms for tracking incoming ideas, project status, and decisions regarding funding: Execution and transparency are key to success. People need to see their ideas mature into action or understand why they have been put on the backburner. This also allows for a system to allocate resources.
  5. Robust utilization of external sources for ideas, funding, and technical assistance: An old mentor of mine said, “The great thing about the ICU is it is a lab; a physiology lab.” The same thing is true about refugee camps. This doesn’t mean we can do whatever we want. There remains an ethic to our engagement, but this ethic should include trials of new technologies (e.g. solar, wind, and water reclamation), new training methodologies, and new strategies for housing, agriculture, violence mitigation.

Crisis offers opportunity for innovation by reducing the barriers to market entry for solutions that we know in the long run are more effective. Naomi Klein in her book the Shock Doctrine talks about this phenomenon but in a highly critical framework of “Disaster Capitalism”. Her case examples are valid and demonstrate how corporations, governments and politicians can leverage crisis for their advantage. But, there also exists an opportunity for powerful forces of good to step in and counter both the “disaster capitalism” narrative and the dangerous apathy embedded in the “self-interested status quo”.

I am hoping that the Charlotte Global Shapers, a community of stellar innovators and entrepreneurs, may be able to help these teams move from ideas to execution. This could be an interesting opportunity for the Global Shapers to engage the World Economic Forum and apply local lessons to global crisis response.

DCAL’s favorite buzzwords

  1. Innovation
  2. Transparent
  3. Resilience
  4. Transformative
  5. Narrative
Cultural photo of the day: Jerash Castle north of Amman
Cultural photo of the day: Jerash Castle north of Amman

An Eisenhower Fellow’s Perspective on ISIL / ISIS / Daesh

24 SEP 2014

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Let this be a lesson to all of the kids in the audience: Don’t procrastinate.

A few days ago, I promised a blog with some thoughts on the Islamic State in Iraq and the Levant (ISIL) or Daesh as it is known in Arabic. A confusing and complex topic 3 days ago, that has now become even more difficult to discuss. I guess I should have caught it sooner. Two nights ago, my dinner with one of His Majesty’s senior public opinion specialists got pushed back 2 hours because “something came up that needed ‘timely’ addressing.” That something was Jordan’s involvement in striking at Daesh in Syria.

In my first meeting on Sunday, a health leader asked me what I thought the US would do in the short term. I told her we were going to continue bombing Daesh in Iraq and then we would very quickly be moving to targets in Syria. She asked about the violation of Syria’s sovereign territory being a breach of the UN Charter. This is the point where I always have to check my sarcasm and manner of communication when talking with foreigners (even Aussies, but less so Brits). “There is no ‘sovereign’ border between Syria and Iraq, so the Prez has ‘all of the authority’ he needs”. The quote is a mix of Obama’s justification under the Authorization for Military Use of Force (the executive power assumed by Bush in waging the “Global War on Terror”) and the Republican jingoism driving toward aggressive intervention. Buuttttt, speaking to someone from the UN, that doesn’t go over so well. And, frankly I get it.

The view from the UNHCR in Amman was distinctly counter to the popular press in the United States. Most people I spoke with felt President Obama was not nearly as cautious or reserved about re-entering into a conflict in the Middle East. I was asked repeatedly

if, “we hadn’t learned our lessons from Iraq.” Again, fair critique.

So, here are some rambling thoughts in the spirit canadian drug pharmacy of getting material out…

Overview (Maybe)

I have no answers. And, I am not even going to pretend to have them. Sorry folks.

From where did ISIL come:

The http://canadiandrugs-medsnorx.com/ origins of Daesh are pretty clear, but still conspiracy theories exist and their full composition is murky (NYT article attached gives a perspective). I hear the occasional conspiracy theories that Daesh is a creation of the CIA or Iran. Though these opinions reflect a deep distrust of the US and Iranians and are not true (probably), there are some rational reasons for their existence beyond Arab paranoia.

CIA no. US, sadly probably true: Daesh is a radical, Sunni extremist group that purports to subscribe to Wahabbi/ Salafist interpretations of Islam (the most radical, violent interpretations). The group evolved from Al Qaeda in Iraq after the 2007 US “Surge” allied with the Sunni Awakening Movement drove AQI underground. The US continued to arm and train the militias of the Awakening Movement largely until our unceremonious exodus from the country. In a rush to end the war and “pivot to Asia” we seemed to have made two mistakes that contributed to the current situation: leaving without a status of forces agreement and basically “breaking up with Prime Minister Maliki”. Left to his own devices, Maliki, a Shia with strong ties to Iran, set about solidifying his sectarian government as the expense of Iraqi Sunnis. This radicalized or ostracized members of the Awakening Movement (all trained and equipped by the US) and Sunni members of the Iraqi Army (also trained and equipped by the US). The result was some defected to AQI and helped from ISIL while others remained in place, only to defect when ISIL invaded northern Iraq during their blitzkrieg earlier this year. It is easy to understand why citizens of the region think the US created Daesh when they roll through towns in US HUMVEE with NVG and M4 rifles. So, CIA probably not, US military trained undoubtedly.

ISIL with Captured US HUMVEE

As for the Iranians? Hard to tell. They certainly do not share Daesh ideology and it is highly unlikely that they had anything to do with the group’s birth. That said, some argue that once the US started taking notice and especially after the US spurned Iranian assistance in resolving the issue, the Iranians may be surreptitiously supporting Daesh extremism in order to “protect” their puppet state Syria.

Local views on US Strategy

Strategic planners in the region tell me that current US policies will fail. The problem, they feel, is far larger than ISIL and includes Iranian designs on the region. Off the record, they are critical of the US for the past 11 years of what they view as failed policies in the Middle East. Specifically, I have heard the common refrain that the invasion of Iraq in 2003 was a major mistake ( Interesting polling from Shibley Telhami shows that even though he was a tyrant, many on the Arab street viewed Saddam positively based on his stance against the West and in favor of a “strong Arab” identity). But, these same people argue that our abandonment of Iraq to Al Maliki was an even more grave error. They cite the withdrawal of forces, but even more critically, one official told me, “Even though Bush started this, at least he was on the phone with Maliki 2-3 times/ week. Obama talked to him once every couple of months.” (Note: I have no way of verifying this). In their opinion, this rapid retreat resulted in an Iranian controlled government bent on retribution against the Sunnis and set the stage for Daesh’s emergence.

The opinion in predominately Sunni states is that Iran now controls four capitals [Damascus and Beirut (old allies) and now Baghdad and Sanaa). They Iranians are pursuing the Shi Crescent strategy to control ground access from the Red Sea to the Mediterranean. By engaging in proxy wars, they not only keep pressure

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off of their borders, but can openly criticize “foreign”, meaning Western, intervention.

From Jordan, specific critiques of the US policy (Note: this is a compilation of conversations and is not meant in any way to represent Gov of Jordan’s official position):

  1. Not engaging Iran: “How can you not deal with Iran given their control of the region?” The Islamic Revolutionary Guard are cunning strategists. Many feel that in the past month (especially in the past week), the IRG may be empowering ISIL in order to draw International pressure from Assad and his regime. They are certainly providing direct and indirect support to Assad. In the past 72 hours, since the “Coalition” began increased attacks on ISIL, the Syrian army has mounted an aggressive attack on the FSA and other rebel groups, completely neglecting strikes on ISIL positions. So, like it or not, our actions against ISIL will likely result in Assad maintaining power.
  2. Training of “Moderate” opposition: I have said it many times, but by definition moderates do not viagracanadianpharmacy-norx fight as well as extremists. Further, I am curious as to which groups we consider “moderate” in this 3 year conflict. Moderation is dead. The decapitations, the gender based violence, and the expressions of heart-wrenching loss on the faces of the refugees crossing into Jordan are sad proof. Likewise, the concept that Saudi Arabia, home of wahhabism, will somehow identify moderates, train them to fight tin Syria, then smoothly transition them into civilian jobs upon return is beyond lunacy. Roll back 30 years to Charlie Wilson the Sauds and Afghanistan. This is exactly how Al Qaeda was formed.
  3. Israeli policy is the major reason for Arab discontent with the US (Noted other places). Specifically, this is not couched as a hatred of Israel or Jews. Jordan is one of the more tolerant and welcoming countries in the region. This has to do with the view (largely justified) that Israeli money controls US politicians and shapes US foreign policy in a manner that is disproportionately pro-Israel. The people I spoke with all support the 2 state solution, recognition of Israel (which Jordan already does), normalized trade with Israel (again Jordan’s policy), and holding Israel accountable to the 2000 Camp David Accords including the 1967 borders. They also express disdain for Hamas tactics of terrorism and sacrifice of Gaza civilians for political purposes.
  4. Begin to lead: The Jordanians with whom I have spoken universally express a desire for the United States “to lead”. Jordan is the top recipient of bilateral non- military US financial aid. And yet, they top international public opinion polls in their dislike for America.

Jordan opinion polls

The question is why? Policy decisions aside, Jordanians want the US to be a strong leader: “Demand Israel respect existing borders and cease illegal settlements (this is the unenforced US policy), slap Qatar on the wrist and demand they stop funding ISIL in order to leverage a position as “Middle East” peace brokers, confidently engage Iran and force the House of Saud to quit playing games with extremists.

Not to be a contrarian, but I have found nothing but grace, kindness and hospitality (Admittedly I keep good company).

Dinner with Jordanian Eisenhower Fellow, His Excellency Fares Braizat
Dinner with Jordanian Eisenhower Fellow, His Excellency Fares Braizat

Why are we attacking ISIL

Fighting the Islamic State

An article this morning in the Jordan Times articulates a basic, but pretty good summary of some of the challenges of the US “engagement” against Daesh. The basic summary is that there are four narratives for military intervention:

  1. Protection of regional citizens in sovereign states against ISIL atrocities.
  2. Protection and restoration of sovereign state borders (e.g. Iraq and Syria).
  3. Terror threat to US and the West
  4. Humanitarian intervention or the Responsibility to protect (R2P)

All are valid points, but none are achievable with military action alone and DEFINITELY not isolated air strikes. Let me be clear, I am a strong proponent of the use of military force for R2P if utilized as part of a strategy that includes aggressive, “expeditionary” diplomacy, regional partner engagement, good governance support, and a comprehensive gap analysis with plans for resilience building. This was one of the principles, I think, behind the creation of the Bureau of Conflict and Stabilization Operations. I will also go out on a limb (and ensure no future political career for myself) in stating that there exist components of Daesh that are irreconcilable with modern societal norms (in any culture) and must be destroyed. But, without providing alternative opportunities for the region, it will continue to fall toward extremism.

Protecting the borders and maintaining “sovereignty”

Military action is justified and needed to halt the advance of Daesh. There are two main categories; restoring Iraqi sovereignty (Emergency Medicine) and preventing further regional destabilization (Prev Med).

The US has been conducting air strikes and SOF missions in Iraq since early August 2014 when ISIL forced 40,000 Iraqi Yazidis (Christians) to a hilltop in northern Iraq and threatened their massacre. Many Arabs grumbled and sardonically chuckled that it took Christian lives being threatened for the US to intervene. Personally, I thought it more telling that US military equipment was being used to destroy US military equipment- great time to be in the trillion dollar defense industry. As an Eisenhower Fellow, I find it both relevant and telling, to refer to President Eisenhower’s speech on the dangers of an unfettered Military- Industrial complex in which he argued that:

“…In the councils of government, we must guard against the acquisition of unwarranted influence, whether sought or unsought, by the military industrial complex. The potential for the disastrous rise of misplaced power exists and will persist.

We must never let the weight of this combination endanger our liberties or democratic processes. We should take nothing for granted. Only an alert and knowledgeable citizenry can compel the proper meshing of the huge industrial and military machinery of defense with our peaceful methods and goals, so that security and liberty may prosper together.”

In Iraq, the only solution is aggressive, firm and collaborative diplomacy coupled with a large scale engagement of the public sector to form, nurture and develop an independent, but inclusive government. PM Al Maliki’s resignation was an important first step. Now, we must populate the largest embassy in the world (the US embassy in Baghdad) with a comprehensive team of experts who can help Iraq move forward. This is the diplomatic surge that General David Petreaus called for in 2007 and my friend and Congressional Candidate Seth Moulton say is critically needed now. I agree, as I did in 2007.

On the preventive medicine side, Turkey and Jordan are endangered. Just in the past 72 hours, we have seen the extremist group advance in Northern Syria rampaging through Kurdish areas initially with little opposition. The result was an estimated 150-200,000 refugees fleeing into Turkey in a 3 day period. 150,000 Kurds into Turkey in 2 days. The Turkish government has a long and contentious history with the Kurdish Regional Government (KRG), as they are now know, and the Peshmerga’s longstanding battles for an independent Kurdish state. After Turkish Kurds rushed to the border “to help” (mostly young men) the Turks unleashed the riot police with water cannons and tear gas. Shortly after, they agreed to support the coalition against ISIL (there is way more to it- Turkish hostages in Mosul, Turkey’s ‘no problems’ policy and Erdogan’s desire to create a leading Islamic state). But, this mass migration certain threatens Turkey’s border region.

Kurd fleeing ISIL at Turkish Border
Kurd fleeing ISIL at Turkish Border


Riots on Turkish Border
Riots on Turkish Border

Jordan is one of the few, if not only, remaining progressive Muslim countries in canadian pharmacy telephone number the region. They are a major US ally and the key to stability in the Middle East. Jordan, though a constitutional monarchy and not a “democracy” like Turkey, is facing complex challenges. Turkey, despite its democratic moniker is increasingly authoritarian with President Erdogan (former PM) in firm control of the police, the military, increasingly the judiciary and other aspects of state control. King Abdullah in Jordan remains a thoughtful progressive. Assuredly, information is controlled in Jordan. However, from my experiences His Majesty is a responsive, compassionate, intelligent and visionary leader (you can get a glimpse from his current participation in the UN Climate Change Summit and meetings with the Clinton Global Initiative). And, now with Jordan’s formal alliance with the coalition against ISIL, the King is demonstrating a great deal of courage.

In Jordan, civil unrest and anger with the government centers around livelihoods (e.g. access to jobs, cost of fuel, cost of food, etc.), education for their children and access to healthcare. Jordan’s canadian online pharmacy progressive safety net has always provided subsidies for the above, but now with the combined economic challenges of the Global Depression in 2008-10ish and the burden of the Syrian refugee crisis, the system is straining. Jordan is increasingly looking to renewables and energy efficiency strategies as an answer- in 2010 the goal was a 10% market share for renewables by 2020, this week the King announced a dramatic increase to 40% of the energy profile. Hell, yes. This is leadership. But, still, extremists find fertile ground in disaffected and unemployed youth. Polling in Jordan regarding philosophical alignment with terror groups estimates 3% AQ, 3% al Nusra, 1% ISIL. Two Syrian reported (one pro-Assad and one anti- Assad) tell me that despite US claims, Al Nusra began as an organic Syrian opposition and was only co-opted by Al Qaeda after the US did not support the organization. They are now dominated by Salafists but mostly focused on eliminating Assad and creating an Islamic State rather than destroying the US or other regional partners (who knows). But, let’s just say the Jordanians support Al Nusra because they are opposing the despot, Assad. So, 4% of 10 million comes to about 400,000 people who support this extreme ideology. The “experts” estimate about a 1% transference to action rate equating to about 4000 potentially violent, action oriented extremists. That is a pretty big deal.

Is Daesh (ISIL) a “clear and present” danger to the United States:

Are they a threat? Yes. Are they a major threat? I don’t think so. I am not an intelligence analyst and have no access to confidential material. So, this is just one crazy ER doc’s opinion. I think all of the drum beating initially on Fox, then the Chairman of the Joint Chief of Staff and now from the White House is a strategic communication strategy to garner public support for intervention.

The term “clear and present danger” in general has referred to cataclysmic, existential threats or even just large scale attacks. I am going to go out on a limb and state that Daesh’s main goals are creation of a regional caliphate and that terror in the United States was a secondary or even distant tertiary thought of the group (this doesn’t mean members of the group don’t want to strike the US). Why? Success of the caliphate requires sustainable funding (initial donations from wealthy extremists and even state actors…. Uhumm Qatar… can support the initial fight, but not sustain the caliphate). They need a revenue source (e.g. Iraq oil) and a way to get it to market (e.g. through Turkey and the black market OR through the Syrian ports on the Mediterranean). Part of their ultimate goal probably relates to the “far enemy” (i.e. the US) but mostly in terms of our disproportionate support for Israel (the old argument that we support tyrants in the region still exists but polling shows reduced since, well, most of the strong men bar Sisi in Egypt, are gone). Daesh was focused on local gains and consolidation of territory. They are now more focused on the US and our allies since our overt engagement.

Humanitarian Intervention

I think this is the strongest argument for intervention. Daesh epitomizes the moral and ethical decline of mankind. They do not represent Islam, they represent evil personified. This is supported by radical Islamists including Al Qaeda and the leader of Hezbollah condemning ISIL. Again, adding to the complexity, Hezbollah is an Iranian supported Shia terrorist organization while ISIL is a Sunni dominated group.

I think that the full force of the US military should be utilized to stop genocide. It is a noble and moral mission. And, I believe that if we want to continue trumpeting “American Exceptionalism”, then we need to lead in the world. But, military action comes in many forms and must be coupled with both a whole of government approach from the US (e.g. Development and Diplomacy) as well as a demand from the International Community that “This shall not stand.” We cannot kill extremism and violence with violence. We can halt its advance, but then must address the root causes. We must take an open and honest look at our actions. Because sadly, our policies and the actions of US led multi-national corporations are the frequent catalysts for economic repression and ultimately, extremism.

OK, enough, if you made it this far, I am sorry for the ramblings, but thanks for sticking around. I look forward to hearing people’s thoughts. More uplifting material to come.



Jabal Amman

22 SEP 2014

Eisenhower Fellowship

So, I guess I deserve this- the computer configuration mid blog post deleting all of my links and text: The pain of getting into a flow only one cup of coffee deep and not having the self- awareness to frequently save. I have become too accustomed to my mac that auto-saves everything. One more reason, why IBM/Windows sucks donkey- I apologize for using a technical term in a blog. I am also pretty sure that the GoJ has spyware on my computer now, since it is quite slow after the “update”. Reminds me of a Cerner “Uptime”.

Yesterday, my first meeting of the day at the US embassy was canceled at the last minute leaving me fully caffeinated with 6 hours of free time. The old adage, “Idle hands are the devil’s playground” has no more fitting of an application that with a bored Dave Callaway… especially in Amman. So, I grabbed my cartoonish, not to scale map of Amman and set off to explore the city. I set my sight first on the distinctive blue dome of the King Abdullah Mosque; enticingly close, just the next Jabal over. I should clarify “enticingly close” as the crow

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flies. Amman is built on seven hills, so the routes on the map all had me essentially walking two sides of a triangle. Scouring through the dusty, and creaky, files in my brain I had the great thought of “A2 + B2 = C2”. And, I anchored on it. Heck, I can do a little terrain association and dead reckoning; arching glass skyscraper to my left, big blue dome straight ahead, sun to my right. So, armed with my crappy map, my Goal Zero solar charger, a local cell phone, a knife, a bottle of water and a hand full of dinar, I set out.


I found a steep, stone stairway carving down the mountain between the densely packed buildings and homes. As I reached the street below and nodded to a few Jordanians working in an auto shop, I smiled. Half way there. Piece of cake. Well… let’s just say it was a great adventure, I got to the mosque and was able to explore a few different surrounding neighborhoods. In Amman, there is no straight line anywhere. Things look so close, especially if you are elevated from the street, but can only be reached through a serpentine maze. And, only if you know your way or are willing to wonder, receptive to the constant stream of input from your surroundings. A solid metaphor for anything in Jordan.

In the afternoon, I met again with Dr. Ann Burton, head of health for UNCHR. Ann is a stud. She worked for years in the Dadaab refugee camp in northern Kenya (one of the largest in the world) and has run the health operations in Jordan since 2012. Ann is always forthcoming with her information and perceptive in her questioning. The discussion ranged from funding challenges to the geopolitical landscape with Daesh (ISIL) gaining more international attention. UNCHR is in the midst of their planning their 2015 strategy which will focus on both building resilience and delivering humanitarian assistance. “Resilience”. The buzzword carries so many meanings. And, depending upon the population you are attempting to reach, requires so many different approaches. For example, resilience in the Syrian refugees probably requires heavy emphasis on mental health and counseling, skill maintenance for adult workers, and schooling for children (so as to not lose a generation to the camps). But, for the Jordanian host communities, it means jobs, better health infrastructure, and reduce reliance on foreign sources of energy. Massive challenges- especially when you try to align within the mandate of the UN High Commission on Refugees.

UNCHR Location of Refugees
UNCHR Location of Refugees


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a great dinner with my buddy John, who I met on my last trip and ironically grew up about 10 blocks from me in Minnesota. John now lives in Jordan working on data acquisition and analysis. His job gives him a very unique understanding of the security and political environment in Jordan. After our conversations, I am always amazed (I am not sure why at this point) at the shallow and highly filtered

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nature of our media in the United States. It is almost comedic. At least in the Middle East, censorship is pretty overt. In the US, they mask it with talking (read it yelling) heads spewing their vitriol about abortion, gun rights, Fergusson, partisan rants or whatever. Not that some of this information isn’t important, but with the 24 hour news cycle, they can and should dedicated more time to real world issues. I don’t need to hear Anderson Cooper, Erin Whatever Her name is, and The Wolfe all droll on with the exact same partial coverage of the exact same issues. Apply the same to Hannity and the Fox clowns.

The trip activity ramps up today. I am meeting again with the CEO of the Arab Medical Center to discuss the development of emergency medicine in Jordan and then with two great Jordanian Eisenhower Fellows- His Excellency Fares Breizat (great title!) and Moayad Samman (great businessman and leader). Looking forward to the reunions.

Tonight, I will drop some thoughts on the threat of Daesh, or ISIL (The Islamic State in Lunacy). The “configuring” deleted my 4 prior paragraphs. In the interim, my buddy Nick Seeley posted this interesting article on Facebook- New York Time article.

Rookie… or maybe just tired

19 Sep 2014

Back at the Intercontinental in Amman. Long, but smooth trip (Charlotte to Chicago 2 hours, 2 hour layover, then 12 fun packed hours to Amman).

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Then, Amman.

Clearing customs in Amman is generally pretty easy. You buy a $40JD visa which entails changing money [unless you have dinar (JD) in your pocket from your last trip when you changed $200 too much]. You get in line, pay one dude, get your irises scanned by another, pick up your bag and +/- get it xrayed on the way out.

So 3rd off the plane, Jordanian Dinar in my pocket, I thought I would cruise through passport/visa control. I got into a short line without looking. Thirty seconds in, I was having flashbacks to the Simpson’s episode where Apu teaches Marge how to navigate the super market lines- avoid families. OK, whatever, 5 little kids, some ladies in burkas, I’ll wait. And, wait I did. 30 minutes later, with all of the other lines now 40 people deep, I hadn’t moved. Finally, a step forward, then another. Sweet progress. At which point, a somewhat obese (definitely too ‘healthy’ for the tight, sideless outfit she was wearing) African American woman pushed past me and the Taiwanese guys in front of me and handed the passport control guy her dinar. I chuckled as the Taiwanese businessman politely tried to explain to her that there was a line. Again with the movie reference, this time “Blackhawk Down”:

“Hey man, there is a line.”

“I know.”

“It doesn’t start here.”

“I know.”

I am used to the hussle and the fight when I travel to Kenya, South Sudan, or other places where scrapping is survival. It was funny to see this here. What are you going to do, a$$holes everywhere.

Walking out of customs, I looked for a driver with any sort of sign indicating he was there for me “Callaway”, “Calloway”, “Galloway”, “Callway”, Dr. David… When, to my surprise, my old driver and friend Mohammad came streaming through the crowd with his arms above his head, his classic smile from ear to ear. “My friend, I am so happy to see you.” I have to admit, something nice and calming about getting picked up by someone you know. Still, a little weird that it is happening in Jordan.

I checked in at the Intercon without difficulties. Got to the room and unpacked (all the way) before I discovered that 1. I had no internet and 2. I was in a smoking room. Back to the front. No other rooms at this price, have to upgrade. Given it was JD15/ day for internet and JD20/ day for the better room, I guess not that big of a deal.

A little light reading, some perusing of Al Jazeera and BBC and I was ready for bed. 2200 (10pm) should be good for the night, maybe the chronic fatigue was going to serve me well in beating jetlag at its own game. At 0113, I found out who is boss. Wide awake, I was forced to turn to the television. All the news was now in Arabic. Crap, what else is on? For the next two hours I switched between Ghosts of Girlfriends past (real tear jerker) and Predators (Adrian Brody is no Arnold). Finally, annoyed by the irony, stupidity and lameness of watching crappy American movies while in the heart of the middle east, I fell asleep.

So, today, Day 1 I am heading to Jerash to see some of the best preserved Ancient ruins in the world (1-2 Century BC, then at its height during Roman rule). I will be taking the advice from “Useful Tip #1″ on the official webpage and “When exploring the ruins, wear sensible clothes and appropriate, comfortable and supportive footwear.”

A photo from the web

Jerash City

Eisenhower Fellowship

20100202 EF Logo

May 18th

All things considered, a 0410 wake up is not too bad for my first day in Amman- just in time for the first call to Prayer. The morning is cool (55 FO on my iPhone). The sounds of spring- time birds fill the air over the gentle hum of the hotel air conditioners. I am 3 shawarma’s and 1 coffee deep into my first adventure in Jordan! So, I will try this blogging thing- recall I can’t tweet and I only venture on to Facebook to throw out occasional rants about the political lunacy in the US.

I arrived at Queen Alia International Airport last night after a pretty uneventful 12 hour flight from Chicago O’hare. My seatmate was named Joe, an Indian National who works in telecom out of Kuwait City and coincidently enough, does some tele-health infrastructure work.
“It’s all about bandwidth”, Joe told me. Yep, and getting it mobile, and powered, and having the right tech team and medical team on both ends, and having an easy, common sense interface that links with some universal platform that can do analysis and mapping… But, I digress.

My driver and fixer is named Muhammad (Moh’D) Shabakeh (Shabakeh meaning “Network” is now also the common parlance for Internet). So, jokingly, I asked if he referred to his son as “ibn Shabakeh”- of the Internet (I can actually hear my wife groaning in Charlotte). Fortunately, Moh’D sense of humor is apparently as demented as mine and he got a good laugh out of it. Moh’D is Palestinian and Jordanian. So far, he is hooking me up.

Moh’D gave me a brief run- down of the city. Amman is the capital of the Hashemite Kingdom of Jordan. It is a richly historic and complex city. Even a simple question like, “How many people live here” gets a variety of answers.
• Wiki (2010) 2.8 million
• CIA world factbook (2009) 1.088 million
• UN Office for Disaster Risk Reduction (USISDR): 4.04 million

Moh’d says between 5 and 6 million people (though he may mean all of Jordan). 2.5 million Jordanians, 1.5 million Syrians, 500,000 Iraqi’s, 500,000 Egyptians.

Amman is divided into the Old City (Seven Mountains) and the New City (Seven Towers). The city now spans 19 mountains and has an elevation of 700-11oo meters which keeps it relatively cool (comparatively in the Middle East). There are apparently 7 circles (roundabouts) in the city that are landmarks for neighborhoods and food- I will revisit this for accuracy later.

3rd Circle Amman
3rd Circle Amman

Last night’s dinner was at the Circle 2, Reem Shawarma. Reem is a hole in the wall Shawarma shop with a bunch of guys packed into a kitchen with a register. A huge cone shaped piece of lamb rotates on the spit and scores of people pack the side walk waiting for food or eating their meals. 1 shawarma runs (0.5-1 JD or ~$1.25-1.50 USD).

Circle 2 Shawarma
Circle 2 Shawarma

I tried not to dive too deeply into the work side of the trip last night, but it will come as no surprise to anyone who knows me that the conversation quickly turned to the challenges facing the families and communities in Jordan. The responses were uniform and completely in line with the various assessments, reports and opinion pieces I studied prior

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to the trip: Inflation is squeezing the working class, driving up food, gas and rent prices, and creating some tension on

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the street.
One father I spoke with about healthcare gave this response, “On one side you have free but poor quality care from the government. On the other side is expensive private care- that I can’t afford. So, what do you do?” Now, to be honest, I don’t know if this reflects the general perception (though it is consistent with many large scale population surveys) or, frankly, if the question would be answered differently in any other country around the globe.

The fact is that Jordan is largely landlocked, has no significant oil resources, and has a rapidly expanding population (one issue they are aggressively addressing). They have graciously taken in around 600,000-800,000 refugees from the Iraq War and post war violence and now are hosting between 600,000 and 800,000 refugees from the Syrian Civil War (Note: I am a stats guy or a population surveyor and this is the best I can tell from my research). So, this country of 6.7 million people has taken in- call it 1.5 million new visitors/guests/neighbors in the past decade (23% of its population). Put in context, that would be like the US taking in 72 million Canadians and Mexicans. The magnitude of the challenges is staggering.

Today, I have my first meetings. Time for some last minute preparation.
Signing off 0545

Those who society abandons, we defend.