Instead of helping Rabia Balkhi Hospital buy medical supplies needed to deliver 14,000 babies a year, the United States spent $1.3 million on computerized LeapFrog talking books.

The idea was to teach illiterate Afghan women about hygiene, prenatal care, immunizations and nutrition from talking picture books popular with U.S. children.

(ENLARGE)

2005: Two years after the gala reopening of Kabul's Rabia Balkhi Hospital with strong U.S. backing, doctors and nurses were using these buckets to sterilize instruments in the delivery room. Poor sanitation has been a persistent concern of Americans working at or visiting the hospital.

• Funds wasted on 'talking books' Photos • U.S. promise failed Documents • Thompson cites successes (PDF) • Embassy raises concerns (PDF) • Rumsfeld enthusiastic in 2002 (PDF) • Rumsfeld critical in 2004 (PDF) • CDC: 'Grim situation' (PDF) • CDC: Hospital 'horrible'

Never mind that rural Afghan people have never seen touch-screen technology. The U.S. Department of Health and Human Services gave LeapFrog a no-bid contract after an offhand comment by the daughter of a supporter of then-HHS Secretary Tommy Thompson, according to interviews and records obtained by The Atlanta Journal-Constitution.

It was more than a quarter of the money Congress gave HHS in 2004 to tackle maternal and child health issues in Afghanistan.

At the same time Rabia Balkhi in Kabul routinely lacked soap, hot water, proper operating room equipment and working incubators. HHS made a policy decision to focus only on training at Rabia Balkhi and refused to buy medical supplies.

In the past, the Afghan health ministry could only afford to supply its hospitals for about one week each month.

"After one week, we cannot buy gloves" or other supplies, Dr. Faizullah Kakar, the deputy health minister, said in February. Patients were being asked to bring their own.

In December 2004 Thompson announced the delivery of 20,000 LeapFrog books to Kabul. Then they sat in a warehouse for nearly two years until the Afghan government started distributing them. HHS officials said it took that long to field-test the books.

Meanwhile the devices' AAA batteries died; HHS spent another $9,800 to replace them last fall.

Thompson, in an interview last week, said he didn't think the books were purchased with funds from the congressional appropriation for Rabia Balkhi. "I still think it's a tremendous tool," he said.

HHS officials and Thompson defend the LeapFrog purchase and call the project innovative. But a $95,000 study commissioned by HHS found the books had dubious value.

Afghans who used the book learned from it, but fewer than 10 percent were willing to use it during a 2005 pilot project. Most found the device too complicated and preferred being taught by people.

"From a cultural perspective, it is not surprising," the report by the nonprofit group International Medical Corps concluded. "They have little or no experience with learning from books or electronic forms of media."

The study suggested the book might be most effective if used in conjunction with a live health educator.

How did HHS decide to buy LeapFrog books?

Kimberly Weiner Greene said she made an "off-the-cuff" comment to her dad, Jerry Weiner, a friend and supporter of Thompson's.

Weiner was attending an Afghanistan brainstorming meeting with Thompson. During a break, Greene said, her dad called to chat.

"Without thinking about what I was saying, I said: 'What a no-brainer. We should make LeapFrog books,' " said Greene, noting HHS was looking for a way to get information to women in rural areas without doctors.

Users could just tap a pen on pictures in the book, she noted, and hear an Afghan speaking in their language.

Greene said she never expected HHS would actually do it. Thompson called a few days later to say he loved the idea, she said.

Thompson's former HHS spokesman, Tony Jewell, said: "If there's a good idea, it doesn't matter where it came from. It was certainly vetted."

William Steiger, director of HHS' Office of Global Health Affairs, called the books' educational potential "extraordinary." He said they'll now be used alongside a live health educator.

Dr. Najiba Zamani, an Afghan-American consultant for LeapFrog, said she was shocked that the field study questioned the books' effectiveness. "In my opinion, those women, they need this book," she said.

Zamani said she's seen Afghan women cry when they learn what depression is from the book and that help is available.

And she said the book's ability to raise awareness about "birth spacing," by talking about how carrots planted too closely together become scrawny and weak, provides a culturally appropriate way of addressing a sensitive sexual issue.

Was the book the best use of limited U.S. funds?

Kakar said the books will be useful.

"But when it comes to priorities, we have donors. They do things according to what they think is right," he said. "Our priorities might be a little different."