The Path that Dr. Nakamura Left to the Afghans: The Water that Saved 600,000 People - Discuss Japan
Discuss Japan > Back Number > No.57 > The Path that Dr. Nakamura Left to the Afghans: The Water that Saved 600,000 People   
No.57, Diplomacy  Mar. 31, 2020

The Path that Dr. Nakamura Left to the Afghans: The Water that Saved 600,000 People   

Dr. Nakamura delivered a speech at the ceremony for the completion of Sheiwa Intake and Canal on March 15, 2008.
Courtesy of PMS (Peace Japan Medical Services) & Peshawar-kai


Dr. Nakamura Tetsu passed away at the age of 73.


On the morning of December 4th, he lost his life in an attack by an armed militant group while he was on his way to an irrigation work site.


Dr. Nakamura was born in Fukuoka Prefecture in 1946, the year after the end of World War II. From 1984 onwards, he gave his life towards providing medical support to refugees in Pakistan and Afghanistan. He was not only a doctor, however; he also strove to support the people of Afghanistan by digging wells and helping construct irrigation canals, based on his belief that “one irrigation canal will do more good than 100 doctors.” His many years of service were recognized in 2003, when he received the Ramon Magsaysay Award, a commendation known as “Asia’s Nobel Prize.”

Ms. Sawachi had long supported the good doctor’s work from the sidelines, having written and published his memoir in 2010 (Hito wa aisuru ni tari, magokoro wa shinzuru ni taru: Afghan to no yakusoku [People Deserve Love, and Hearts Deserve Trust: A Promise with the Afghans]). In this special feature, Ms. Sawachi shares some of her memories of Dr. Nakamura.


Sawachi Hisae, nonfiction writer
© Bungeishunju

I had no idea the human body could shake like mine did that day.

I first learned of Dr. Nakamura’s passing when I received a call from a journalist at the Asahi shimbun. He said that Dr. Nakamura had been attacked by some kind of group in Afghanistan and had sustained injuries. Although he said it wasn’t life-threatening, his tone suddenly changed during the call, seemingly having received a memo or note from one of his colleagues.

“I’m sorry. Dr. Nakamura has passed away.”

I instantly felt a violent quake beginning in my toes and spreading all over my body. This was my first time seeing just how the body reacts when faced with such shocking news.

My first proper meeting with Dr. Nakamura was in 1997. I was attending Stanford University when Yamaichi Securities went bankrupt. Japan was still basking in the afterglow of the bubble economy, and we Japanese continued to act like we ruled the roost. I remember when the broadcast went up of the Yamaichi Securities president bawling his eyes out during the press conference, every single one of my classmates in the United States started laughing.

I had seen just how Japan is viewed from abroad, and I wanted to change the perception of Japan from the outside. It was at this time that I saw a report on Dr. Nakamura’s work. He was risking his life to help people living in a conflict zone. I had no idea there were Japanese people like this.

It was over a decade later that I was finally able to meet him, in August 2008. He was shorter than I imagined, and I was struck by how slowly he spoke. I met and talked with him several times after that, backstage when he would return to Japan to give a lecture or before other appearances.

Born into the World of the Dock Worker

Dr. Nakamura originally came from the rough and tumble world of the dock worker. His grandfather was Tamai Kingoro, head of the Tamai-gumi Group. This group was in charge of all the stevedores working at Wakamatsu Port (currently Kitakyushu Port). Mr. Tamai was also the father of author Hino Ashihei. Ashihei’s book Hana to ryu (Flower and Dragon) details stevedore labor disputes and functions as a biographical novel for the Tamai family, with his parents serving as protagonists.

Dr. Nakamura thought very fondly of his uncle Ashihei, whose literary career supported the Tamai family. Since Ashihei had to take on a lot of odd jobs to support this huge family, he reportedly would call up his editor and dictate the manuscript’s continuation while carrying on conversations with the rest of the family. In other words, he was creating his novel as he spoke. This left a big impression on Dr. Nakamura. “The part of his brain he uses to write is different from the one he uses to converse. That’s incredible talent.”

Ashihei’s good friend Tsutomu was Dr. Nakamura’s father. It’s said that he was incarcerated once for labor rights activism prior to the war, under the Maintenance of the Public Order Act. Dr. Nakamura’s mother was Ashihei’s younger sister, and she met Tsutomu through labor activism. They both loved to drink and would supposedly finish two 1.8 liter bottles of sake a night. Dr. Nakamura never drank a drop, saying that he had “seen enough of what drinking can do to you.”

As a child, Dr. Nakamura dreamed of living in the Japanese countryside while he studied insects like Jean-Henri Fabre.

But his father would often say, “You need to make a difference to this world of ours. That’s why you were born.” Although being an entomologist was his dream, he knew that his father would never approve. This led Dr. Nakamura to enter Kyushu University’s School of Medicine. He initially held on to his dream of transferring into the Department of Entomology at some point. However, when he learned how his father had taken a loan to finance his costly medical textbooks, he resolved to become a doctor.

Taking his Family to Pakistan

With a recommendation from his parents, Dr. Nakamura attended a mission school for his junior high education, and he was baptized there. This would eventually lead him to the Middle East. While working at a hospital in Fukuoka Prefecture in 1982, Dr. Nakamura received a request from the Japan Overseas Christian Medical Cooperative Service (JOCS), asking for someone to fill a position in Peshawar, Pakistan.

At the time, Dr. Nakamura’s eldest daughter and son were still in their infancy, but he was enamored with the idea of working in a place with absolutely no medical system. He finally decided to go after his wife agreed to go with him. Indeed, she must have demonstrated unparalleled bravery in taking her young children along to a place like Peshawar.

I once asked him, “Didn’t you thank your wife?” He replied half-jokingly, “If I did that, she would have had me committed.” You can take the lad out of Kyushu, but you can’t take Kyushu out of the lad. Even if he was thankful, he wasn’t able to express it.

The family of four arrived in Peshawar in 1984. Dr. Nakamura spared no effort trying to immerse himself in the local culture. He started by growing his hair out and wearing a Chitrali cap, a kind of traditional Pakistani headwear also known as a pakol. While it is true that Dr. Nakamura would have looked very strange in Pakistan without the long hair and pakol, they would later became Dr. Nakamura’s trademark in Japan.

He also began to attend a local language school to learn the official languages of Urdu and Pashto. “I’ll never get anywhere without understanding what people want to say to me.”

Initially, he was assigned to treat Hansen’s disease, but the areas hardest-hit by Hansen’s disease were hotbeds for infectious diseases like tuberculosis and malaria. This meant that Dr. Nakamura had to treat a wide array of diseases.

Moreover, Afghanistan and Pakistan are covered with massive 3,000-meter-tall mountains. Visiting the secluded villages in these highland areas, Dr. Nakamura found no other doctors. When he went to treat a village, surrounding villages would hear of his success, and he would be inundated with days upon days of requests for treatment. One day, when he ran out of medicine and told them he would have to return home, he saw an old man drop his shoulders in dismay and turn away. Dr. Nakamura said the image of that man’s back was burned into his memory that day.

The year before Dr. Nakamura was dispatched to Pakistan, his close friends established an NGO called “Peshawar-kai” to support his activities, with the NGO later setting up an office in Afghanistan as well. [Editor’s note: Dr. Nakamura had provided medical services in Pakistan and Afghanistan as the representative of the Peshawar-kai and the Executive Director, Peace Japan Medical Services (PMS) in Afghanistan.]

First, They Need Water

Digging canal, December, 2000. A scene from the Marwarid Irrigation Canal Construction Project.
Courtesy of PMS (Peace Japan Medical Services) & Peshawar-kai


Just as Dr. Nakamura’s medical work started to take off, the year 2000 bought him face to face with a crisis that tested the limits of medical treatment.

It started with a severe drought in Afghanistan that year. Experts predicted 4 million people would be affected by famine, with potentially 1 million starving to death. Forced to drink dirty water, cases of dysentery and typhoid fever also ran rampant. Countless children were losing their lives to diarrhea. They couldn’t be saved, regardless of efforts to combat dehydration intravenously. At the end of the day, people need water to live.

“We can treat you later. For now, you just need to survive.”

This was all Dr. Nakamura could say.

Afghanistan originally had abundant agricultural resources. Walking through old farmland scarred by the flames of civil war, Dr. Nakamura was convinced that the community could revitalize the farmland so long as they could divert water to the area. This was when he set out to construct wells and irrigation canals.

However, there were no civil engineers in Afghanistan capable of constructing such irrigation canals. Dr. Nakamura took it upon himself to study, eventually reaching the point where he could draw up construction plans. It was through this study that he learned about irrigation techniques used in ancient Japan. Every trip back to Japan, he would survey irrigation trenches and weirs across Kyushu, learn about engineering techniques used in the Edo period, and search for those techniques best suited for Afghanistan.

One of those is called jakago (or “gabion” in English). These are wire baskets stuffed with stones. Although canal walls are usually built with concrete, Dr. Nakamura was able to create irrigational canals by stacking countless jakago. He used materials which were easy to procure in Afghanistan and simplified the construction process so that in any case, the Afghan people could maintain and manage the canals themselves.


A scene of the same place on April, 2014 where people were digging (see the photo above).
Courtesy of PMS (Peace Japan Medical Services) & Peshawar-kai


Sometimes Dr. Nakamura would visit the construction site and operate the shovel excavator himself. Dr. Nakamura’s work ethos was all about just getting it done.

He said, “People would express their sympathy for my struggles, but being on-site like that put me at ease. I would wake with the sun and spend all day slaving away until nightfall. I felt truly happy knowing I’d once again given my all that day.”

Even so, Dr. Nakamura admitted there was one time when he thought about giving up. He was traversing a mountainous area more than 3,000m above sea level on horseback. He fell from the horse with his leg still caught in the stirrup, dangling upside-down. As the horse continued to run, Dr. Nakamura thought that he would die with his head dragged along the ground. It was then he thought, “Ah, finally, I can rest.”

It was around this time that more and more young Japanese people began to arrive in Afghanistan, having learned about Dr. Nakamura’s activities and wanting to work in the country. But in reality, most were just feigning big-brained concern for global trends. Dr. Nakamura would start by having them do physical labor—digging with a shovel—all the while listening incredulously to their stories. It was only after they had done the hard labor and gradually become covered in dirt from head to toe that they would come to truly respect the work being done.

In 2007, they completed the first phase of construction on an irrigation canal to divert water from the Kunar River, the biggest river in Afghanistan. The water flowing through the canal brought crops back to the former farmland, and thousands of displaced people, barely getting by, returned to the area.

Dr. Nakamura granted the people’s greatest wish—a wish for peace, for family, for three meals a day. Children played in the irrigation canals, reducing infection rates for skin diseases. Shops sprung up which caught fish living in the irrigation ponds. Dr. Nakamura looked so happy as he described the changes to me. It was after this that the “Green Ground Project” took off.

Rebuilding “the Spiritual Pillar of the Community”

I published Hito wa aisuru ni tari, magokoro wa shinzuru ni taru: Afghan to no yakusoku (People Deserve Love, and Hearts Deserve Trust: A Promise with the Afghans) together with Dr. Nakamura after only three interviews. This was motivated by my desire to provide Dr. Nakamura with royalties to support his activities in Afghanistan. I gave everything I had to make sure the book sold, and I think between the 1st and 18th printings, we sold 40,000 copies. The 20th printing happened after Dr. Nakamura had already passed. However, there are roughly thirty pages regarding his family which were cut from the final galley proof, as neither he nor his wife would talk much about their relationship.

One year, I received a huge shipment of molasses (the sugary byproduct of stewing sugar beets and other juices) from the Peshawar-kai in Fukuoka City. I think this was a token of Dr. Nakamura’s appreciation. He was, in a sense, reporting the results of his work in Afghanistan—he struggled to dig out these canals, he revived the farmland, and now, they can even make molasses there.

Dr. Nakamura had said that rebuilding ruined madrasas was “just as important as the canals.” Madrasas are both educational institutions and religious centers, and they serve as an office for regional government where elders from across the region convene. They are the spiritual pillar of the Afghan community.

Dr. Nakamura said that at one ground-breaking ceremony for a madrasa, the gathered elders in attendance shouted, “With this, we are free!” in voices even louder than at a canal’s completion ceremony. While humans certainly need water to live, spiritual support is essential for them to live like people. Afghans decide everything at meetings of their elder council. Dr. Nakamura understood that well.

Afghanistan changed dramatically in the aftermath of the September 11 attacks in 2001. US troops began to bomb the country believing that Afghanistan’s Taliban Administration was sheltering Osama bin Laden, the mastermind behind the attacks.

Dr. Nakamura and the staff of the Peace Japan Medical Services (PMS) were forced to continue their activities while under attack by these bombers, and it became a common occurrence to see US helicopters flying in formation right next to irrigation canal construction sites. Dr. Nakamura was faced with life-threatening danger more than once or twice.

On one occasion, a stray bullet hit him in the leg. When I heard that the bullet had grazed the surface of the bone, I said to him, “Surely you were hospitalized?” “No, because I’m a doctor.” He explained that he had to sew up the wound himself, without anesthetic. I said jokingly, “Did you forgo the anesthetic because you hate needles?” He started by outright refusing, but as I prodded him and asked again, he admitted, laughing, “I mean, it hurts to get an injection, so.” Thinking about him now, I seem to only recall memories of the fun banter we had.

Soothed by Classical Music and Insects

After the September 11 attacks, the Maritime Self-Defense Forces (MSDF) were dispatched to the Indian Ocean. Before their dispatch, Dr. Nakamura was called into the meeting of the Japanese Diet as an advisor. He expressed strong disagreement with the decision to dispatch the MSDF, saying that it would “do more harm than good.”

Japan’s pacifist constitution is well known even in Afghanistan. If armed forces know that you are Japanese, they will not attack you. That’s why the car in which Dr. Nakamura rode had the Japanese flag and “JAPAN” in all caps emblazoned on the side.

However, this dispatching of Japan’s self-defense force to the Indian Ocean bred fear in the Afghan people… a fear of Japan as an ally of the United States. Dr. Nakamura was forced to remove the Japanese rising sun and “JAPAN” from the car in order to protect himself.

After the simultaneous attacks on the United States, the Taliban were viewed as an enemy. Although the word “taliban” originally meant “students,” this idea of the “Taliban” had no clear definition. Where there were the militant Taliban, there were also the unarmed Taliban who oversaw the country’s agricultural industry. Dr. Nakamura said jokingly, “It wouldn’t be wrong to call me a Taliban leader. Most of the Taliban members were simply old folks living in rural communities like me.” He said with clear anger in his voice, “They were wrong to conflate the Taliban with terrorism.”

With all the difficulties he faced, Dr. Nakamura found respite in classical music. He especially loved Mozart, and he brought excellent audio equipment with him from Japan, trying to get the best sound quality. When bringing the equipment through customs, one of the local workers vouched hard for him, misunderstanding the equipment to be necessary for the canal construction. Dr. Nakamura apologized sincerely afterwards.

Since there’s no plumbing or electricity in Afghanistan, Dr. Nakamura could only use his personal generator to power the audio equipment for a few hours at a time. He enjoyed his music to the fullest during this limited time.

He had always been passionate about insects, having been fascinated by Fabre’s Insect Adventures as a child. He loved scarabs in particular. They do not live in Japan, but he was able to spot them countless times in Afghanistan.

Butterflies only eat specific plants. I had never heard of it, but Dr. Nakamura said that if you see the butterfly Pieris rapae, you can imagine that a cruciferous plant like rape seed or cabbage is growing nearby. He would go find it. “It was one of my secret pleasures.”

I also heard from him that lizards the size of cats live amongst the people there. Dr. Nakamura seemed to really be enjoying himself as he told me about the Old World porcupines as well, and although he hadn’t seen one, the tigers living on the tallest mountains.

“We Only Die Once”

As the local Peshawar-kai representative, Dr. Nakamura was responsible for protecting those he worked with. He always regretted an incident in 2008, when Mr. Ito Kazuya, working on-site in Afghanistan, was murdered.

The Afghan people were facing another severe drought that year, and those fears had begun to erode the public order. There were twenty-four Japanese volunteers working with Dr. Nakamura in Afghanistan at that time, and the good doctor intended to send all of them back to Japan while he would remain. Mr. Ito lost his life just before that.

Dr. Nakamura had already lost his second-born son, Takeshi. I won’t talk much about his family here, but Dr. Nakamura had five children. Takeshi was the youngest child. The year after the Afghan bombings began, he died of a brain tumor, at only 10 years old. When his condition worsened in December 2002, Takeshi said to his family, “We only die once.” Dr. Nakamura said they found solace in this.

Dr. Nakamura told me that Takeshi had a mischievous side. When Dr. Nakamura was setting up his e-mail address, Takeshi gave him one that started with “tecchan,” a diminutive nickname for Tetsu. I’ll never forget the happy look on Dr. Nakamura’s face as he told me this story.

After the death of young Takeshi, Dr. Nakamura immersed himself in his work on the canal, as if to strike back at the absurdity of the situation. The pain of losing Takeshi was inescapable. But no matter how hard and solid the earth had become, Dr. Nakamura would bring water back to these areas which were once farmland. No doubt the death of his beloved son fueled his resolve. I think his returning Afghanistan’s agriculture to the point where they can even make molasses stands as a testament to that.

What is “the Best Memento to Posterity”?

The last time I saw Dr. Nakamura was in September 2019. It was a lecture he gave in Kawasaki City, Kanagawa Prefecture. Looking at his face from the audience, I felt he had lost a lot of weight and grown considerably older. I would usually say hello back in the waiting room, but I didn’t feel like it that day for some reason. Now it is much too late. I regret not speaking to him then.

Even though Dr. Nakamura is gone, the project which he worked so hard to build will go on. The irrigation canals he constructed continue to support the lives of more than 600,000 people living in the irrigation zones.

One of Dr. Nakamura’s favorite books was Uchimura Kanzo’s Kosei e no saidai ibutsu (The Best Memento to Posterity) (1897). In the book, Uchimura explains the importance of leaving behind a legacy. With regards to civic projects, he writes that they “leave behind eternal joy and prosperity for future generations.” Dr. Nakamura brought several copies of this book with him from Japan and recommended that young volunteers in Afghanistan read it. Although Dr. Nakamura is no longer here, his wells, canals, and madrasas remain to support the livelihoods of the Afghan people.

Once, Dr. Nakamura said:

“People’s names are forgotten. But the canals will remain… I don’t know if you would call it “god” or “heaven” or what have you, but my secret conviction is that no act of the divine can compel people to act beyond their own ability. All I can say is that, ‘I’ve done what I can; I hope I’ve earned your grace.’ I think that’s okay.”

The canals will remain. Dr. Nakamura believed that even if the people who worked on the canals are forgotten, the people of Afghanistan will help maintain them. That is the “best memento to posterity” and a message to future generations.

Translated by The Japan Journal, Ltd. The article first appeared in the “Nakamura Tetsu-san ga Afugan ni nokoshita ‘michi’: ‘Mizu’ wo hiite 60 mannin wo sukutta (The Path that Dr. Nakamura Left to the Afghans: The Water that Saved 600,000 People),” Bungeishunju, February 2020, pp. 174–181. Discuss Japan reprint with the permission of both the author and the publisher, Bungeishunju, Ltd. [March 2020]


  • Sawachi Hisae
  • Dr. Nakamura Tetsu
  • Afghanistan
  • Pakistan
  • Japan Overseas Christian Medical Cooperative Service
  • Peshawar-kai
  • water
  • Ramon Magsaysay Award
  • Afghan to no yakusoku
  • drought
  • famine
  • irrigation
  • madrasa
  • Uchimura Kanzo
  • Best Memento to Posterity