It isn't easy to shock Masahiro Morikawa, assistant professor of family medicine and director of the department's International Health Program at CWRU and University Hospitals of Cleveland.

As an international health practitioner, Morikawa has been doing relief work for the past 15 years. He was at the Thai/Cambodian border during the refugee crisis in 1983 and 1984. Also in the early 1980s, he was at the Thai/Burmese border, and then in Northern Ethiopia during the 1985 famine. In the 1990s, he did disaster relief following the earthquake in Japan. And recently, he's traveled back and forth between his home in Cleveland and Kosovo, both before and after the war there in the late 1990s.

It's safe to say that Morikawa has stared disaster in the face for the last 15 years. He's seen it all. Or so he thought.

And then the last three weeks in December 2002 brought Morikawa to Afghanistan, where, he said, "It was a very different experience from many of the other crises I've worked with, because Afghanistan has been in war now for over 20 years."

Morikawa's time in the recently liberated country was spent evaluating the emergency medical program for mothers and children in various clinics in Kabul province, Afghanistan. The program is operated by Kinderberg International, an organization that is supported by the German Ministry of Foreign Affairs whose purpose is to provide emergency pediatric and maternal care in the

Kabul and Musayi districts of Afghanistan.

While evaluating the clinics, Morikawa observed the surrounding culture and found it bursting with confusion and chaos.

"I was struck by the chaos. People have absolutely nothing at all. There are no infrastructures, nothing," he said, describing the people who fled to Pakistan and returned just three years ago, now poor and without any resources. "You'd be struck by it."

In addition, Morikawa said that many also desperately worry about the impending war with Iraq.

The disarray extends beyond health care, according to Morikawa, and into many other aspects of the culture such as leadership positions, for example.

Adding to the chaos, Morikawa said, is the alarming number of NGOs, or non-governmental organizations.

"They have over 300 NGOs, with offices in Kabul that no one knows about," he said. "They go where the money is. I see much confusion and chaos created by many of these short-sighted programs conducted by NGOs."

Morikawa said he worries about the non-governmental organizations because he knows that many of them will be gone when another war or crisis comes and moves attention away from Afghanistan. There is much difficulty in making any substantial changes for the Afghans in such a short amount of time, but Morikawa is optimistic.

"I hope this time, many NGOs will provide long-term supports for Afghan people," he said.

Morikawa wants all medical students to know that "the world really needs them," and that they, too, can be international health practitioners. When asked where he plans or hopes to go next, Morikawa said he doesn't have any plans at the moment.

"I will go wherever I can help," he said.

Perhaps even seeing it all won't stop him.