Dr Hakim Young's life took an extraordinary turn when he ventured into Afghanistan on a journey that expanded his world beyond borders. Initially drawn by medical humanitarian work, he found himself adapting to the pressing needs of the war-torn region. This transformation expanded his mindset, fostering deep bonds and connections that transcend the ordinary. In this interview, student correspondent Wong Shi Hui speaks with Dr Hakim about his story and reflections, which are a testament to the profound human connectivity that transcends geographical borders.
A life in Afghanistan
Tell us more about your extensive experience in Afghanistan.
During my 18 years in Afghanistan, the Afghan community became an extension of my own family. Before this chapter, my life was a typical urban existence which mirrored that of many in Singapore. But stepping into Afghanistan was like opening a door to a broader universe. I am humbled and I remain very grateful to have connected with the many wonderful Afghans and internationals who have enriched my human experience.
Initially drawn to Afghanistan for medical humanitarian work, I soon realised the severity of their lack in fundamental needs: basic essentials like safety, shelter, food and water were scarce compared to what we often take for granted in Singapore. This realisation spurred me to equip myself with a diverse skill set, venturing into disciplines like community development, agriculture, peacebuilding and education. These fields were not part of my medical training but were crucial for support in what was, 18 years ago and now, a kind of war-torn environment.
Could you share about your work in Afghanistan?
I ventured into remote Afghan villages to tackle basic public health education and training. These were communities deeply affected by infectious diseases, with diarrhoea as a leading cause of mortality.
Collaborating with the Ministry of Public Health there, I was involved in establishing a public health training centre. Working alongside the local provincial government and universities, we implemented various programmes and campaigns centred on enhancing public hygiene.
These initiatives spanned from months to years. The aim was not just immediate relief but fostering enduring shifts in the community's health practices. Continuous training and education were integral parts of these efforts, with the hope of instigating long term positive changes in the locals' health habits. Sustainability needs mindful attention, going deeper than greenwashing as we question why and whom we are being sustainable for.
What were the locals' concerns about?
In the context of the region I was serving in (which was considered a war zone), the pervasive sense of danger altered the dynamics of daily life. At the core of these concerns lay the fundamental human need to survive: to feel safe, and to neither be killed nor kill others. Moreover, basic necessities such as food and water were often scarce, further compounding the challenges.
Education, the ability to think creatively and critically, became crucial. The concept of "fight or flight" was not simply a choice. The sheer loss of millions of lives underscores the reality that fighting was not a wise resolution.
Peace-building initiatives were also significant. Rebuilding trust within communities involved creating safe spaces where people could come together, share their grievances and work towards reconciliation. It was truly disheartening to witness the loss of the simple yet profound skill of communication – to observe disagreements escalate into full-blown wars instead of being resolved through other means.
What were some interesting observations in Afghanistan that stood out to you?
Change has predominantly occurred in the physical or material realm, while behavioural shifts have been minimal.
Upon my arrival in a village in the heart of Afghanistan's province, there were neither phones nor electricity. Yet, phones soon permeated daily life, being sold in bustling bazaars. Though touted to connect people, when asked whether owning a phone allowed for more time with their peers, my Afghan friends responded with a resounding "no".
Owning a phone in Afghanistan is considered a luxury, for which you need to have savings beyond survival needs. An example of a persuasive advertising slogan is "Roshan Nazdik Shodan", which means "Roshan has come near to you" (Roshan being the main phone company in Afghanistan). Yet, phones remained a financial burden – not solely from the cost of the device's purchase but also from the need to maintain credits for its use.
I have a Nokia 3310, and when my Afghan friends want to call me or their friends, they would give the other party a missed call due to their limited credits. This altered the dynamics of relationships as conversations were hurried to conserve credits. Contrast this to the pre-phone era, where visiting a friend in the neighbouring villages fostered longer face-to-face interactions over tea, creating meaningful connections.
Phones undeniably serve as a blessing in emergencies, but in terms of nurturing social relationships, they fall short. This introspection led me to acknowledge that not all changes are inherently positive. It all boils down to the fundamental question: why pursue change? The true impact of change extends beyond material advancements and includes the complexities of societal evolution and the intricate web of human relationships.
Health beyond the physical
What are your future plans/activities?
I am fortunate to have the opportunity to redirect my energies to supporting refugees in Malaysia, a transit point for many awaiting asylum outcomes. I am currently working with the grassroots to conduct emotional health skills workshops for the refugees in Malaysia (most of whom come from Myanmar).
Even as my focus shifted to supporting refugees from various countries, that inherent connection to Afghanistan persisted. Conducting online classes with Afghan girls became a vital endeavour, particularly amid the upheavals following the 2021 government takeover. The transition proved especially challenging for females in Afghan society, demanding extra attention to their psychological well-being. Later this afternoon, I will give a talk about the fire lily, featured in the BBC documentary series The Green Planet, as an inspiration for Afghan girls, showcasing strength amid adversity.
Tell us more about the emotional health skills workshop you conduct.
The emotional health skills workshop aims to enhance our inherent emotional abilities, providing a structured framework rooted in cognitive neuroscience. Emotional health is vital for recovery amid stress, aiming to release, rewire and rebalance.
Historically, healthcare has focused mainly on the physical. The World Health Organization's biopsychosocial health framework emphasises a more comprehensive approach. Reflecting on my medical training, limited emphasis was placed on psychosocial learning, raising the need for skills ensuring holistic patient care. The alarming surge in suicide rates among refugees underscores the pressing need for proactive mental health care and highlights the dire manifestations of the mental health crisis.
Drawing from my personal experience where I was stressed in a war-zone – I thought I could do like before (in Singapore) and push aside my emotions. I thought, mistakenly, that endurance was the means of managing a whole spectrum of difficult emotions. I presumed that my feelings would sort themselves out, and this presumption applied as well to the refugees I was serving medically. This was a mistake I made.
Suppressing my emotional stress, I managed to function physically and appeared fine outwardly. However, that emotional stress was manifesting in ways unbeknown to me until my dentist pointed out cracks in my teeth. My sturdy teeth, among the hardest parts of my body, had succumbed to the strain of emotional stress, and that is how concrete our emotional health is. Fortunately for us today, cognitive neuroscience offers tools to enhance emotional health skills. This has redefined my approach in healthcare.
As medical practitioners, there is a need to delve beyond conventional inquiries when patients walk through our doors. In our social history-taking, there is a need to explore whether our patients can cope with the complex stresses in their lives and whether they feel chronically stressed. This additional question offers an opportunity for empathy and assistance, allowing us to aid patients in coping through emotional health skills if they respond positively.
Taking this holistic approach allows us to evolve as better doctors, going beyond physical care to encompass psychosocial healthcare. Focusing solely on physical health leaves us vulnerable to burnout. Addressing our emotional stresses before they manifest in the form of physical health problems is crucial.
How has the Afghan community come together in these challenging times?
It is the intrinsic nature of humans to support one another during challenging times. This preserved social fabric has been their saving grace, although all three aspects of biopsychosocial health remain significant challenges for Afghans, with an estimated 70% of the population facing psychological issues.
However, I am concerned that this social cohesion might diminish globally, particularly in cities like Singapore which are experiencing what some describe as a "lonely epidemic". We are striving to revive the community spirit, akin to the kampung spirit, although the physical kampung is no longer around. But our doors are closed, and people tend to stay within their individual units.
Recounting an incident in 2012, I was startled by reports that ranked Singapore as the least emotionally positive country globally. It struck me and my Afghan friends as paradoxical – a country so materially advanced yet struggling emotionally compared to our Afghan community entrenched in daily conflict.
Living in what feels like a physical paradise here in Singapore, the community and social fabric, rather than material wealth, are what buoy us through difficult times. Maintaining emotional and social health fosters adaptability as a community as well as emotional positivity. This is a valuable lesson we can glean from my Afghan friends who, despite enduring severe biopsychosocial stresses, exhibit remarkable resilience and slightly better social well-being due to their connectedness and mutual support.
Choices and paths
Do you have any regrets in the past 18 years?
No, I have no regrets.
Regret presumes that I could have made an alternative choice, but with every choice I have made, I did my very best to make a wise choice. As such, I would not have known if I could have made a wiser choice. Therefore, I do not have any regrets. This is different from remorse or learning from our mistakes, which I am still continuously learning from to do better.
I do not regret leaving private practice here in Singapore, and I do not regret making choices which some Singaporeans may perceive as being less progressive or successful.
If given the chance to rewind time, how would you have done things differently?
I would integrate emotional healthcare alongside biological healthcare, an aspect I might have overlooked in my previous approaches. This realisation has given me a profound sense of being alive. It is a balance between productivity and genuine human connection, recognising that we are not mere machines operating on automatic mode.
Reflecting on incidents, I have learnt invaluable lessons in adaptability and flexibility. Life is not always about clear-cut right or wrong choices. Our upbringing often conditions us to think in binary terms, but the reality is far more nuanced. My time in Afghanistan, dealing with intricate issues, taught me the importance of navigating the unknown and embracing complexity. We must feel comfortable amid uncertainty and wield a diverse set of skills to thive in dynamic situations.
In a war zone, determining the right course of action differs greatly from selecting answers in a controlled examination setting. The complexities involved defy any simplistic approach. In such environments, we learn to rely on each other, acknowledging and accepting the uncertainties that accompany such situations.
What are some pieces of advice you have for our readers?
To those embarking on similar paths, I offer encouragement to explore fearlessly. Often, unconscious pressure inhibits us from making mistakes or exploring new avenues, particularly in humanitarian work. Overcoming fears – be it the fear of death, the unknown or failure – is crucial. It is essential to confront these fears head-on, especially in conflict zones where the fear of death is tangible.
Personally, when facing death threats, I have learnt to visualise and emotionally prepare myself for potential outcomes, and this diminishes fear's paralysing effect. The fear of making mistakes or not achieving success often stems from how others might perceive us. However, success is an artificial construct, and dwelling on these fears can hinder our progress. By confronting our insecurities, we cultivate a sense of security and resilience, enabling us to navigate consequences, whether favourable or not.
The potential to contribute is boundless, and everyone can play a part in making a difference. Ultimately, working on ourselves is the foundation for resolving broader societal problems.
Attending to an Afghan child who had diarrhoea, a common challenge especially in the rural areas of Afghanistan
The painted signboards were installed across Bamiyan Province as part of a public health campaign I ran, to educate people to boil their water before drinking. Faces blurred for respect and privacy