Karen Hays, certified nurse midwife working with JHPEIGO, left her home in Seattle to help train physicians and midwives as part of Management Sciences for Health's USAID-funded REACH program in Afghanistan, with which JHPIEGO is a sub-contractor. On her first visit to the country, Hays was excited to have the opportunity to work with International Medical Corp's (IMC) Midwifery Training School in Jalalabad and support continuing education at Jalalabad's University Hospital. Soon after her arrival in the Southern Afghan city, however, all of her plans changed when, sparked by the Newsweek Magazine report that soldiers had flushed a copy of the Koran down the toilet at Guantanamo Bay, enraged citizens stormed the streets, targeting foreigners and international aid organization workers.

Hays, who arrived in Jalalabad a day before the shooting began, was hard at work in the Jalalabad University Hospital's labor and delivery room when rioters surrounded the hospital. "We heard gunfire and people were running around. I really didn't know why," Hays remembers.

Meanwhile, the fully dilated patient Hays was tending to, who was about to have her first baby, was terrified.

As the bursts of gunfire grew louder, hospital staff fled the labor ward. Women grabbed their burqas and screamed in Dari. A Jalalabad University doctor demanded that Hays leave her patient's side and take refuge among the other hospital staff gathered in a nearby room. The doctor ordered Hays to sit in a chair blocked from the view of the window.

But Hays' urge to understand the chaos surrounding her led her to a nearby window. The scene outside was unreal. Police crisscrossed the hospital grounds firing off shots. Civilians were running in every direction in an attempt to escape the chaos and gunfire. Hays commented that she felt like she was in a "parallel universe," as that was the only way she could explain all that was happening around her.

Amazingly, Hays' instincts called her back to work and thoughts of her pregnant patient outweighed her fear of being shot. "I saw what she had ahead of her and thought: if they're going to shoot me, they'll shoot me. I have to stay with her. Accepting my fate gave me a sense of peace. I got in the comfort zone of my work and the chaos was just going to have to happen around me."

Hays headed back to her patient's room, bringing the patient's mother with her so she could comfort her daughter. Despite repeated distractions of gunfire, the delivery was successful. The courage and assistance offered by Hays' and the other doctors who returned to the delivery room paid off. The young woman gave birth to a baby girl.

As the day wore on, it became apparent to Hays that it was too dangerous for her to remain in the hospital. The wounded were being brought to the nearby surgical ward and many of the injured were also embittered protesters. Remaining in the hospital increased Hays' risk of being attacked. "I was unsafe with my western face," commented Hays.

However, the surgery unit was located between the maternity ward and the IMC training center, where Hays had left her passport, money, cell phone and radio. Without these items, Hays would have a difficult time informing the REACH team in Kabul that she was unharmed and she would not be able to leave Jalalabad and Afghanistan as planned. After Hays learned that it was unsafe for IMC to send a car to pick her up, she approached the director of the maternity ward for instructions on how to get back to the IMC Training Center.

The strategy that was devised in the following moments would reunite Hays with her valuables. A burqa was thrown over her body and a stream of women surrounded Hays to accompany her to the training center. The plan was on the verge of being executed when a fair skinned, blue eyed Afghan hurried over, warning Hays of the dangers of posing as an Afghan. She herself was walking past a group of men when, assuming she was a foreigner because of her coloring, they yelled, "Let's get her." She responded to them in Pushto, thus saving herself. She urged Hays not to go outside wearing the burqa as doing so would undoubtedly draw suspicion.

Unable to retrieve her belongings, and three hours after the shooting started, Hays knew she needed to inform someone of her whereabouts. A female doctor feeling sorry for Hays, told her to sit and gave her some rice and meat, exclaiming, "It may be awhile before you get another meal."

In the meantime, one of the doctors in the OB ward braved the chaos outside and snuck to the IMC Training Center to retrieve Hays' cell phone and radio. Upon receiving these items, Hays used her phone to reach her REACH supervisor, Jeff Smith, in Kabul. She exclaimed to him that she needed to get out of the hospital, "I feel like I'm in the middle of a burner. It's getting hot and any time now, flames will pop up."

Smith's response to Hays: "Follow your instinct."

All hope seemed lost when the miraculous happened. Hays was informed that a guard from IMC had arrived and was waiting outside the hospital to pick her up. Hays saw the white IMC vehicle and was flooded with relief. She approached the car door and was about to enter the vehicle when she stopped dead in her tracks. Hays knew most, if not all, IMC staff by face. However, she had never seen the man sitting at the wheel of the car before.

Fear started to overcome Hays. She needed to make a split second decision. She could run from the driver of the vehicle, who could be a gunman posing as IMC staff. By fleeing, however, Hays would increase her chance of being shot by the unruly mob in the streets. Or Hays could trust that the driver was an IMC staff member she simply didn't recognize. Hays was about to make a decision when her eyes fell upon the man's picture identification card. He was an IMC staff member after all. Hays jumped in the car and they sped off to the training center.

At the training center, Hays learned that UN and foreign aid agencies had started pulling all non-essential staff out of the city; therefore, Hays would leave Jalalabad that evening, and much earlier than planned. Hays hopped in an IMC vehicle and security staff drove her to the airport just in time to catch the last plane for Kabul.

Hays left behind a day's worth of work and ten times that in experience. When asked who she first contacted after she arrived safe and sound in her guesthouse in Kabul, Hays exclaimed, "I emailed my mom."

Throughout the course of the day, Hays comments that the hospitality of the Afghans she encountered shone through. "Doctors at the hospital offered to bring me to their homes, but I declined because I didn't want to put their families in danger," as anti-foreigner sentiment put those associated with helping non-Afghans at risk of being targeted. Additionally, the IMC security staff, drivers and the doctor who obtained Hays' belongings all risked their lives to ensure Hays' safety.

Hays summarized her experience by saying, "I don't know if I had an angel looking over my shoulder but for sure I had the right amount of support from the Afghans I was with."

Just as inspiring as her gratitude for such a hospitable group of people is the compassion Hays has for Afghans. Commenting on her Afghanistan experience, Hays states that Afghans have had "25 years of such experience. I've suffered .01% of the stress, grief and horror they've suffered."

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