Kabul’s Dark Nights and the Dream of a New Silk Route

This article was published by Global South Development Magazine

Kabul’s Dark Nights and the Dream of a New Silk Route

The electricity pylons that transmit electricity from Tajikistan and Uzbekistan to light major regions of Afghanistan were blown up by extremists who operate in the northern region. The darkness in Kabul continued until the Afghan National Forces battled the insurgent group for more than 20 days to recapture the area and restore the electricity pylons.

On top of the electricity problem there is another challenge the residents of Kabul have to grapple with: disruption in access to the Internet due to fiber cable breakdown of Insta Telecom- a major internet service provider in Kabul.

Call it a new warfare technique/strategy or deterrence instrument, the extremists do not cease to exploit the disadvantages/or vulnerabilities of the government to enrage the National Unity Government team & inflict social and economic costs to the Afghan society. According to a startling report by AFP, the Taliban have demanded a “protection tax” in return for no-damage to telecom companies present in Taliban stronghold areas. The demanded “protection tax” equals to 10 % tax collected by the government. The telecom companies should pay 10 % of protection tax in order to keep their service running in areas controlled by the Taliban.

Extending their reach and targeting private companies to finance their war puts a serious question mark on their intentions for the much expected peace talks. These harsh realities therefore pose the imminent question: can the government ensure the security of mega investment projects such as the TAPI gas pipeline?

Construction on the TAPI project started in Turkmenistan on 13 December 2015.

With the deterioration of security situation in Afghanistan how feasible the Turkmenistan, Afghanistan Pakistan and India (TAPI) gas pipeline project will be?

The project, named after countries Turkmenistan, Afghanistan, Pakistan and India, TAPI will play a vital role in revitalising Afghanistan’s prominence in the region, but only if the project gets completed. The pipeline will be designed to carry 33 billion cubic meters (bcm) of Turkmen gas annually. Both Pakistan and India through state-owned companies would purchase 42 % of that volume (13.8 bcm) each. In the meantime, Afghanistan would purchase 16 % of the gas amounting to 5.11 bcm. In addition, Afghanistan will be entitled to receive a transit fee 400 million for the use of its territory from each of the other TAPI buyers.TAPI-proposed-route

According to the Afghan Ministry of Mines and Petroleum the pipeline is expected to be 56 inches in diameter and will have a working pressure of 100 standard atmospheres (10,000 kPa). The initial annual capacity will be 27 billion cubic meters (bcm) of natural gas. Thereafter the capacity will be increased to 33 bcm. The pipeline would run for nearly 1,735 km, including 735 km across Afghanistan and another 800 km through Pakistan. Gas will be drawn from the Dauletabad gas field, the pipeline will enter Afghanistan to pass through Herat, Farah, Nimroz, Helmand and Kandahar and the Pakistani cities of Quetta and Multan, before reaching India at Fazilka in the northern Punjab province.

In a recently published booklet by the office of president of Afghanistan the two projects TAPI and CASA 1000, are considered as sources of “Transformation of Afghanistan” expected to boost the national economy and create jobs. These two projects are at the top agenda of Unity Government for the country’s economic self-reliance.

On the day of the signing ceremony and days after people held celebratory rallies and welcomed the project across the country, pictures of some rallies which were shared on social media, one could see from the dressing that the rallies were organized by the government to show public support.

On the day the Multi-billion gas project was being signed where it met with public rallies and tremendous threading on social media the Taliban affiliated account on twitter, on 13 December, posted Sabiq Jihadmal ‏@Sabiq_JL  “#TAPIProject was signed 17 years ago between Islamic Emirate and Turkmenistan Govt, that was the starting not today.” And in second tweet he wrote: “90% of TAPI will pass in (through) territory under control of the Islamic Emirate, I don’t know from which address insane Ashraf Ghani is there”.

It’s true that the Taliban never opposed the TAPI project and during the 1990s, their involvement to negotiate with the US company Yonical, to provide security guarantees for a similar pipeline is a historical fact. The Afghan Government is indeed convinced that the Afghan Taliban does not oppose the TAPI project, as it is important for the financial stability of Afghanistan and, therefore, none of the groups intend to hamper the project. But it’s questionable under what conditions the Taliban will ensure the pipeline’s security?

Afghanistan’s Worsening Security Situation

Afghanistan’s more than a decade long experience with development reveals that infrastructure projects, such as roads and bridges, in volatile regions were not immune to devastating attacks by the insurgents. Exploiting the weak negotiating position of the past and present government, and the ensuing coordination failures within the state institutions, the armed groups have extorted government money in exchange for the release of project and government workers. In some instances, the insurgent forces also killed many kidnapped workers. 

The past 13 years of experience of development projects highlights one thing for sure: whenever there are development projects specially in volatile areas, they have faced dire consequence of paying extortion money to armed groups to set free their workers. And still a number of engineers, NGO and aid workers have been kidnapped and killed.

Leaders from Afghanistan, India and Pakistan converged in Turkmenistan to launch the 1,814km TAPI. Photo AP.
Leaders from Afghanistan, India and Pakistan converged in Turkmenistan to launch the 1,814km TAPI. Photo AP.

The Long War Journal which has been tracking the Taliban’s attempts to gain control of territory since NATO ended its military mission in Afghanistan in June 2014 claimed, in a report on 5 October 2015, that out of 398 districts in 34 provinces, 29 districts are under Taliban control in Afghanistan. And another 36 districts are contested while 335 districts are either under government control, or their status cannot be determined. Some of the districts under control of the Taliban are located in the three southern provinces of Afghanistan, Helmand, Kandahar and Farah. Recently a government official in the Helmand province raised deep concerns over the worsening security situation. Head of Helmand’s provincial council Karim Atal told Tolo News that the “situation is very bad in the Greshk district, and the government is weaker in the area, therefore a solution must be found otherwise TAPI cannot be Implemented in Greshk”.

This comes at a time when the Helmand deputy governor pleaded via social network to Ashraf Ghani to save Helmand. “Your Excellency, Facebook is not the right forum for speaking with you, but as my voice hasn’t been heard by you I don’t know what else to do. Please save Helmand from tragedy. Ignore those liars who are telling you that Helmand is secure, in the past few days about 90 Afghan forces have died.” But despite the plea, there was no immediate reaction from Ghani’s office. The defence ministry also rejected the troop death claims and denied that Helmand was at risk of falling to the Taliban.

Recently the Taliban claimed that one of the provinces where they are continuously taking over territory in this freezing cold is Helmand. They have managed to completely control Musa Kala and Nawzad districts of Helmand. Earlier they had also overrun the district of Khani Sheen along with its administration centre and military bases. The inability of the Afghan Forces was confirmed by the deputy governor of Helmand (Rasoulyar) who pleaded to President Ashraf Ghani in an open letter through a social media post that if immediate action were not undertaken the entire province of Helmand would be lost. He also admitted that over the past 24 hours over 90 army and police personnel had been killed and dozens wounded in the clashes raging in Gerishk and Sangin districts. On 23 December 2015 the district of Sangin in southern Helmand province also fell to the Taliban for the first time in 14 years.

TAPI’s Bleak Future?

As Kabul is going through its period of darkness due to blowing up of the electricity pylons in Baghlan province, with the increasing demand for gas in India and Pakistan will they endure to remain in a period of uncertainty? If the pipeline is blown up, will they wait till Afghan Forces secure the area so the pipeline could be restored? Although last month, Daud Shah Saba, the Afghan Minister for Mines and Petroleum, told Upper House in Kabul that a 7,000-member security force will be raised to guard the gas pipeline project. Will the 7000 security forces be able to patrol the 700 km of pipeline through one of the most unsecure and dangerous parts of Afghanistan?

TAPI is not the only way to fulfil Pakistan and India’s hunger for Energy. On one hand, Iran, Pakistan, India gas pipeline has not been forgotten. Whereas, on the other hand, with the relaxation of economic sanctions on Iran, India is hopeful about the $4.5 billion project to pump Iranian natural gas to India, envisioning the export of 31.5 million cubic meters of natural gas per day via an undersea pipeline originating from Chabahar Port in south-eastern Iran, traveling through the Sea of Oman to Ras al-Jafan on the Omani coast, and after traversing the Arabian Sea, ending at Porbandar in South Gujarat in India. The project, known as the Middle East to India Deep water Pipeline (MEIDP), is scheduled to be completed by 2022.

Subodh Kumar Jain, Director of South Asia Gas Enterprise Pvt. Ltd., which came up with the idea of the 1,200- to 1,300-kilometer underwater pipeline project, says that that’s the best energy option for India.

Again, TAPI’s future depends on the overall security situation in Afghanistan and whether it deteriorates in the future.

UNAMA, in a recently published report, documented the highest civilian casualties in 2015 exceeding the previous recorded level of casualties in 2014.The United Nations also says that 2015 may have been the worst year for conflict-induced displacement in Afghanistan since 2002. U.S. forces-Afghanistan (USFOR-A) and Resolute Support (RS) commander General John F. Campbell says, “if we do not make deliberate, measured adjustments, 2016 is at risk of being no better, and possibly worse than 2015.”

The awfully precarious situation of the Afghan National Security Forces (ANSF) in Helmand province in southern Afghanistan is another worrying development. Along with the Taliban marching up attacks this winter, long after the period in which fighting has typically declined, other groups, such as Islamic State of Iraq and the Levant-Khorasan Province (ISIL-K) have also expanded their presence in Afghanistan.

The biggest of all this will be the future of the TAPI project, as the pipeline project passes through the heart of the Taliban area, a place where warring parties are known to hold up businesses for payoff to fund their war.

In the pipeline world this usually involves “insurance” payoffs like the Taliban has already asked the telecom companies in the form of a 10% protection tax. And once the militant groups take the proposed pipeline as a hostage, the ransom they ask is not going to be an easy one.

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Medical tourism in India: The price of ignorance

Socrates asks his pragmatic young debater Thrasymachus (Book I, Republic):

“But tell me, your physician in the precise sense of whom you were just speaking, is he a money maker, an earner of fees or a healer of the sick? And remember to speak of the physician who really is such…”  (Plato, Republic)

Although Thrasymachus, argues that the idea of justice is nothing but the advantage of the stronger, responds by stating that physicians are healers first.

If the question was to be asked in today’s medical environment, Thrasymachus’ answer would be very different. Today’s physicians seem to be predominantly purveyors of a commodity and not the healers Plato had imagined.

With the exceptionally high cost of medical services aboard and long waiting lists. People from the developed countries often to come to less developed countries for treatment as costs are relatively less and treatment can be a lot more efficient. However, people from the under developed countries often turn to their neighbours for medical treatment, due to a shortage of medical facilities and underdeveloped medical technology.

Here I will focus on the medical travellers of Afghanistan who seek medical treatment abroad in India, and explores how ethnical medical professionals and interpreters are when dealing with Afghan patients in India.

The Medical Market in Afghanistan

Certainly there has been a huge change, the physicians are no longer mere healers of the ill, and they are using the medical profession as a way of increasing their income and making more profit. This has been the case since the exponential growth of private medical hospitals as well as private clinics since the fall of the Taliban regime.

The private sector has become really dominant in Afghanistan, there is a great demand for their services, not only for self-employed medics but hospitals and diagnostic centres. Despite the high fees charged, and the increased price of medicine, patients continue to seek primary care from private rather than public care providers.

One may assume that the popularity of the medical sector is due to a success rates and public feedback, but this is not the case.  Doctors are working in unethically for profit at the expense of the poor and vulnerable.  When patients visit private hospitals they are prescribed several tests, including scans, blood tests, etc. Most of the time, these tests are irrelevant to patient’s sickness, but as the patient is unaware of their illness they hardly question the doctors.  After being seen, the patients leave the hospital with several packages of medicine, some of which have side effects and may even be harmful to patients liver and kidneys, cause further illnesses and therefore bringing them back to the doctor for further treatment at a later stage in life.

In Afghanistan the health sector is a blooming business for many, it is seen as a lucrative business and a way of earning cash by taking advantage of the corruption and lack of health regulations in Afghanistan government.

The Ministry of Health has taken several measures to curb unethical practices in the health sector. However, all of these steps have been ineffective in controlling the greedy and unscrupulous people who earn huge profits by exploiting people in different ways.  There should be procedures that monitor the fees that are charged for medical consultations, tests and treatment, and strict action should be taken against those practitioners who prescribe unnecessary tests and medicine to generate profit.

If such laws were enforced, these businessmen would not dare to enter the health sector attempting to make a profit with their unethical business practices. The problem does not stop here, another very important problem in Afghanistan, is the lack of genuine Pharmaceuticals. Hundreds of pharmaceutical companies import medicines from neighbouring countries without proper regulations. All these unethical and malpractices in private medical sector in Afghanistan opens the door for more people to seek medical care abroad and loose trust in the sector.

In the past very few people could afford to travel to India for treatment, as they had to arrange travel documents, purchase tickets for travel, arrange living costs while there, and more importantly have money for treatment. However as people are very critical of the medical practises inside Afghanistan most people arrange the expenses by whatever means, either way borrowing, selling or leasing the land, or receiving remittance from abroad to receive better medical treatment in India.  However their miseries do not end by just leaving to India.

In India:

The problem starts from the moment they get out of the airport, especially those going for the first time, and are not familiar with either Hindi or English languages. Upon my recent visit to Delhi I found ground breaking facts about the way Afghan medical tourists are being robbed.

Serious illness tends to change the sick individual’s perception of himself, and forces him to confront the fragility of his own existence. If he wishes to be treated, he is required to seek help regardless of whether his illness is serious or not, he puts his live in the hands of utterly strange people trusting their humanity. The only thing the sick person asks for is the restoration of his health. However the people, upon whom the patients trust their lives with, eventually betray them for their own material greed, very similar to those medics within Afghanistan.

The patients become victims of a competitive medical market in India. From hospitals to medical stores, they all have their own policies of attracting patients, with the ultimate price being paid by the patients.

The process starts when the patients approach the interpreters. So who are these interpreters? The interpreters are the people from Afghanistan who have refugee status in India and almost all of them are employed in the medical tourism business in Delhi, from interpretation, arranging accommodation, restaurants, broker to fill the FRRO forms and medical stores. Each interpreter has developed his/her own network with hospital and chemist shops. Despite their daily charges from patients the interpreters are earning from the hospitals as well as the chemist shops. Upon taking patients to hospitals the interpreter receive money called as “referral fee” ranging from 10 % to 25% on the final bills; some hospitals even have the flexibility of increasing the final bills so that the extra many goes to the interpreter.

This explains why some patients with very minor health problems have had to undergo surgery?  It’s because the interpreters reap the most benefit if the patients undergo surgery and it’s only when the hospitals pay the “referral fee”, the interpreters play major role in convincing the patients to undergo surgery.

It’s not all the interpreter will settle for, in 2007 when I was in India the interpreter took a patient to complete some check-ups, he collected the money from the patient. The patients are quite often illiterate, and have not come across some of the technology available in India. The interpreter took him to the elevator, the elevator was new to the patient, and the interpreter took advantage of this, so he went as far as charging him for using the elevator in order to complete a medical check-up. Then they take the patients to chemist store, who they talk to as the patient cannot communicate with the pharmacist, this is in their interested as they can talk about how they can also take a share of the money they charge for the prescription

The chemist’s shops are usually owned by Sikhs from Afghanistan, who have their own policy of how to attract Afghan customers, through deceiving means.  They usually write in Persian which is not comprehendible to Indians, having the luxury of writing in Persian gives the more tools to attract patients. I was awestruck to see boards written in Persian and few of them caught my eyes reading stating “Government of India foreign exchange and Government of India pharmacy”. I was really eager to know why they used the phrase “Government of India”, and came to the conclusion that it was to gain legitimacy through being seen as a government body.  This idea was working very well for them and the chemist shops which used this phrase were really crowded by Afghan customers.

ئثییئثی

I was curious to find out about the about the legality of writing such a phrase:  “Government of India”. So I asked a person involved in medicine business,   who requested to remain anonymous told me that “there is nothing such as governmental or public chemist shop in India, and the reason the chemist shops write it in Persian is to avoid legal prosecution while at the same time attracting Afghan costumers.” As, in India the government run chemist shops are located only in public run Hospitals.

گردشگری طبی در هند و بهای نادانی

(سقراط از مناظره گر عملگرای جوانش، تراسماخوس می پرسد (کتاب ۱، جمهوریت/جمهوری
اما برایم از طبیب ات بگو در قالب شعور همان کسی که همین حالا از او سخن گفتی، که آیا براستی او پیداگر پول است، یا دریافت کننده فیس و یا اینکه تداوی کننده بیمار؟ و به یاد داشته باش که از طبیبی سخن بگویی که او واقعا همان   است… (افلاطون، جمهوریت
هرچند تراسماخوس در اینکه مفهوم عدالت چیزی غیر از نفع قویتر نیست، مجادله می نماید، اما در پاسخ می گوید که طبیبان نخست از همه  تداوی کننده گانند
اگر این سوال قرار بود در محیط طبابت امروزی پرسیده شود، پاسخ تراسماخوس بسیار متفاوت می بود. طبیبان امروز به نظر می رسد عمدتا عرضه کننده ادویه جات هستند و نه تداوی کننده قسمیکه افلاطون تصور می کرد
با هزینه فوق العاده بالای خدمات طبی در خارج و لیست های انتظارطولانی، مردم از کشورهای توسعه یافته معمولا به کشورهای کمتر توسعه یافته به منظور معالجه می آیند چراکه هزینه ها نسبتا پایین بوده و معالجه می تواند به مراتب موثرتر باشد. این درحالیست که به دلیل کمبود سهولت ها، تجهیزات و تکنالوژی طبی توسعه نیافته، مردم از کشورهای توسعه نیافته به منظور تداوی معمولا به کشورهای همسایه می روند
این راپور پیرامون موضوع مسافرین افغان که به منظور معالجه به هندوستان می روند تمرکز داشته و خاصتا مطالعه می کند که متخصصین طبی و مترجمین در هندوستان تا چه اندازه با مریضان و مراجعین افغان، مطابق اصول اخلاق برخورد می نمایند
بازار طبی در افغانستان
بدون شک یک تغییر عظیم رخ داده که در نتیجه آن طبیبان دیگر تنها تداوی کننده گان بیماران نبوده بلکه مسلک طبابت را منحیث یک راه بلند بردن عاید و به دست آوردن مفاد بیشتر استفاده می کنند. این روند از زمان رشد تصاعدی شفاخانه های شخصی و همچنین کلینیک های شخصی بعد از سقوط رژیم طالبان به همین شکل بوده است
سکتور خصوصی در افغانستان واقعا برجسته و غالب بوده و تقاضا برای دریافت خدمات این سکتورنه تنها در حصه داکتران شخصی بلکه شفاخانه ها و مراکز تشخیصیه بسیار بالا بوده است. علی رغم هزینه بالا، و قیمت افزایش یافته دوا، بیماران همچنان خواهان دریافت حتی اندک ترین تداوی از خدمات طبی خصوصی هستند تا دولتی
ممکن است چنین پنداشته شود که عمومیت یافتن سکتور طبابت نتیجه میزان موفقیت و عکس العمل عمومی به آن است درحالیکه چنین نیست. داکتران به شکل غیراخلاقی، به منظور دریافت مفاد از مصارف فقرا و قشر آسیب پذیر عمل می کنند. وقتی بیماران به شفاخانه های شخصی مراجعه می کنند، تحت معاینات متعدد به شمول سکن، معاینات خون و غیره قرار می گیرند. بیشتر اوقات این معاینات به مریضی مراجعه کننده ربط ندارد اما از آنجایکه بیماران از آن بی اطلاع می باشند، بسیار به ندرت از داکتر دراین باره می پرسند. بعد از دیدار داکتر و انجام معاینات، مریضان با بسته های متعدد دوا شفاخانه را ترک می کنند درحالیکه  بعضی از این دواها عوارض جانبی داشته و حتی به جگر و کلیه های مصرف کننده مضر می باشند که موجب مریضی های دیگر شده و به این ترتیب باعث بازگشت دوباره بیمار در آینده به شفاخانه به منظور تداوی می شوند
سکتور طبابت در افغانستان به مثابه یک حرفه درآمدزا است که به عنوان یک تجارت پرمنفعت و راه به دست آوردن پول به آن نگریسته می شود که از فساد اداری و همچنین نبود قوانین صحی در دولت افغانستان نفع می برد
وزارت صحت به منظور ممانعت و محدود کردن عرف و اعمال خلاف اخلاق رواج یافته در سکتور طبی تدابیر مختلفی را روی دست گرفته است. با این حال، این تدابیر به منظور کنترول و نظارت افراد حریص و بی پروا که به مقصد کسب مفاد بزرگ از مردم به شیوه های مختلف بهره جویی می کنند، بی فایده بوده است. باید شیوه های سنجیده شود که توسط آن، فیس دریافتی برای مشاوره طبی، معاینات و معالجه تحت نظر قرار بگیرد و همچنان اقدامات قاطع علیه متخصصین که به منظور کسب مفاد، معاینات و دوای غیرضروری تجویز می کنند، روی دست گرفته شود
اگر چنین قوانین عملی می شدند، این تجارت پیشه گان جرأت نمی کردند با اقدامات منفعت جویانه غیراخلاقی شان برای کسب مفاد به سکتور صحت روی بیاورند. مشکل به همین جا ختم نمی شود، مشکل عمده دیگر در افغانستان، فقدان داروسازی اصلی است. صدها شرکت دارویی دوا را از کشورهای همسایه بدون قواعد مشخص به کشور وارد می کنند. تمام این معالجات اشتباه و اقدامات غلط و غیراخلاقی در سکتور خصوصی صحت در افغانستان درها را به روی مردم که به دنبال مراقبت طبی در خارج هستند باز می کنند و باعث سستی اعتبار به این سکتور می شوند
در گذشته تعداد کمی از مردم قادر به سفر به هندوستان به مقصد معالجه بودند چراکه آن ها مجبور به تهیه مدارک سفر، خرید تیکت، فراهم نمودن هزینه بودو باش در آنجا و از همه مهمتر، داشتن پول کافی برای تداوی بودند. با این حال از آنجایکه نگاه مردم به مراقبت و تداوی طبی در داخل افغانستان بسیار انتقادی و بحرانی است، بیشتر آن ها از هر طریق ممکن به شمول گرفتن قرض، اجاره دادن دارایی و زمین، یا دریافت پول ارسالی از خارج اقدام به فراهم آوری مصارف لازمه می کنند تا تداوی و معالجه بهتری را در هندوستان به دست آورند. با این وجود سرگردانی و بدبختی آن ها با ترک هندوستان به پایان نمی رسد
:در هندوستان
مشکلات درست زمانیکه از میدان هوایی خارج می شوند، شروع می شود مخصوصا برای آنهایکه اولین سفرشان به هندوستان بوده و آشنایی به هیچ یک از زبان های هندی و انگلیسی ندارند. در آخرین سفرم به دهلی متوجه حقایق جدیدی در مورد غارت و چپاول شدن مسافرین طبی افغان در هندوستان شدم
بیماری وخیم باعث می شود تا برداشت بیمار از خودش تغییر کند و این وخامت او را وادار می سازد تا با شکنندگی وجودش مقابله کند. اگر او خواهان معالجه باشد، پس مجبور می شود بدون درنظرداشت اینکه بیماریش جدی است یا نه، از دیگران کمک بخواهد، و خود را به دست مردم کاملا بیگانه بسپارد درحالیکه خوش بین به وجود حس انسانیت است. تنها چیزی که بیمار به دنبال آن است، صحت یابی است. درحالیکه مردم که، بیمار زندگی اش را با اعتماد به آن ها سپرده است همانند همان داکتران افغانستان، نهایتاّ به دلیل حرص مادی شان به او خیانت می کنند
بیماران قربانی بازار رقابتی طبابت در هندوستان می شوند. از شفاخانه ها گرفته تا فروشگاه های طبی، هرکدام دارای پالیسی های خود به منظور جلب بیماران هستند و این بیماران هستند که قیمت نهایی را می پردازند
پروسه از زمانی شروع می شود که بیماران با مترجمین به تماس می شوند. این مترجمین کی ها هستند؟ مترجمین به زبان ساده همان افغان هایی هستند که در هندوستان مهاجر شده اند که تقریبا همه شان در تجارت گردشگری طبی با وظایف مختلف از جمله مترجمی، فراهم آوری مکان بود وباش، معرفی رستورانت، دلال خانه پوری فورم FRRO و فروشگاه های طبابتی مشغول به کار هستند. هر مترجم روابط و شبکه خود را با شفاخانه و دواخانه ها به وجود آورده و توسعه داده است. علاوه بر پولی که مترجمین از بیماران روزانه به دست می آورند، مقدار دیگری نیز از شفاخانه و دواخانه دریافت می کنند. به محض رساندن بیمار به شفاخانه، مترجم از بیمار پول دریافت می کند که به نام «فیس مراجعه» یاد شده و معادل ۱۰٪ الی ۲۵٪ هزینه نهایی تداوی بیمار می باشد؛ بعضی شفاخانه ها حتی حاضرند هزینه نهایی تداوی بیمار را بلندتر ببرند تا از این طریق مترجم پول بیشتری به دست بیاورد
حالا می پردازیم به اینکه چرا بعضی بیماران با مشکلات کوچک صحی تحت عملیات طبی قرار می گیرند؟ به این دلیل که اگر بیماران تحت عملیات قرار بگیرند، مترجمین می توانند مفاد بیشتری حاصل کنند و این زمانی است که شفاخانه ها «فیس مراجعه» بپردازند که در این صورت مترجمین در متقاعد ساختن بیماران برای قبول انجام عملیات  نقش بیشتری بازی می کنند
اما این همه چیزی نیست که مترجمین به آن قناعت کنند، در سال ۲۰۰۷ زمانی که من در هندوستان بودم، یک مترجم بیمار را برای تکمیل معاینات همراهی می کرد،. این مراجعه کننده یا بیمار بی سواد بود و با بعضی تکنالوژی در هندوستان آشنایی نداشت. مترجم بیمار را به آسانسور/لیفت برد، لیفت برای بیمار ناآشنا بود، و مترجم از این ناآشنایی سود می برد، بنابراین مترجم در جریان تکمیل معاینات در بدل استفاده از لیفت برای بیمار از او پول می گرفت. بعدا اینگونه مترجمین بیمار را به فروشگاه های طبی می برند جایکه مترجمین خودشان صحبت می کنند چراکه بیمار نمی تواند به زبان داروساز در آنجا افهام و تفهیم کند و این هم به نفع آن ها است چراکه به راحتی می توانند بین خود توافق کنند که چه مقدار پول اضافی برای فروش دارو از بیمار گرفته و بین خود تقسیم کنند
صاحبان فروشگاه های طبابتی در جاییکه بشترین افغانها در دهلی نو مسکن میشوند معمولا سیک های افغانستان هستند که پالیسی های مختلف خود را به مقصد جلب مشتریان افغان دارند. اکثر اوقات اگر به هوشیار نبودن مراجعه کننده در حالت خریداری دارو پی ببرند، بجای دارو سه ماه دارو یک ماه را میدهند و پول از سه ماه را اخذ مینماییند. که متآسفانه چنین اتفاق با من هم رخ داده بود. دارو فروشان سک معمولا  به فارسی می نویسند که قابل درک برای هندی ها نیست، و این نوشتن مبالغه آمیز به فارسی باعث جلب بیشتر بیماران می شود. من از دیدن بعضی لوحه ها حیران زده شدم که به فارسی نوشته شده بودند که بعضی از آن ها نگاه من را به خود جلب کردند که عباراتی مثل «صرافی معتبر دولتی هند یا داروخانه معتبر دولتی هند» برآن ها نوشته شده بود. من بسیار مشتاق شدم بدانم که چرا عبارت «دولت هند» در آن لوحه ها استفاده شده بود و به این نتیجه رسیدم که این کار باعث اعتبار کار آن ها شده و چنین به نظر می رسد که آن ها مرتبط به دولت هند هستند. این چال بسیار برایشان مفید بوده و دیده می شود فروشگاه های طبی که این چال را به کار برده اند با شمار زیاد مشتریان افغان روبرو شده اند
من مشتاق بودم درمورد قانونی بودن نوشتن همچون عبارات مثل «دولت هند» بدانم. بناء از شخصی که در پشه دارو سازی فعالیت داشت در این مورد جویا شدم که خواست هویتش مخفی بماند. او به من گفت که «چیزی به نام فروشگاه طبی دولتی یا عامه در هند وجود ندارد و دلیل اینکه این عبارات به فارسی نوشته می شوند این است که هم خطر پیگرد قانونی رفع شده و هم در عین زمان مشتریان افغان بیشتری جذب شوند.» چنانچه در هندوستان تنها فروشگاه های طبی مربوط به دولت در خود شفاخانه های دولتی موقعیت دارند.