Hot pants

It seemed that I was wearing the Afghan equivalent of hot pants today. I discovered this when I alighted from the car in front of the ministry of health, after my colleague made a comment about women and pants. It took a while to sink in and then I suddenly felt very naked in my mid-calf length dress.

Women were casting fleeting glances at my bare half calf and exposed ankle and men were looking, smiling and then looking away. Unfortunately there was no turning back as I was heading in for a meeting. I tried to bend my knees a bit to bring the hem of my skirts at least an inch or so lower.

This transgression was far from my mind when I put on the dress in the morning. Next time I will have to wear it with some leg covering underneath. I am not sure leggings will be acceptable, so maybe it is back to pants. This is how I had to dress as a little girl in 2nd grade in the middle of the winter: a skirt or dress with pants underneath. I hated it because I thought I looked stupid. I am less interested in looking fashionable now and I am slightly intrigued that my bare ankles and calves might be objects of desire.

The mountains around Kabul were crisp and clear all day today after a night of rain in the city and snow higher up. They looked beautiful and made me want to go for a hike. Of course hiking is out of the question. Between threats of kidnappings and mines, the most beautiful places will remain out of reach for now.

We are continuing to complete our new house with requests for small things like toilet brushes and salt and pepper shakers. Unlike back at home, we can’t just get into a car and drive to the shopping center to take care of everything once and for all. Axel made a trip out of the house with the cook, armed with a dictionary, since they can’t speak each other’s language. They are learning the names for food items and vegetables in each others’ language while filling up our refrigerator.

Our first houseguest will arrive on Wednesday and so we are trying to get his room ready with good lights, extension cords and heat while preserving our own privacy with some last minute purchases that will keep us warm without having to open our door to the diesel-heated hallway and adjacent rooms.

In the meantime at work I am trying to stay at the 30.000 foot level while juggling immediate needs of my own staff, our counterparts in the government and those who pay the bills at the 10 cm level. I am thoroughly enchanted by that challenge as I think it can be managed. This is the stretchy part of my assignment here as I get to put in practice all the coaching advice I have been delivering to senior managers around the world. It’s both a test and a confirmation of what it takes to get off the dance floor and stay on the balcony, as Ron Heifetz suggests to those in senior positions.

For the first time in my life I am looking down from the balcony to the action down below and am resisting the urge to head down there myself. It is not only a natural urge on my side, there is also a pulling that is going on, please come down! In the meantime I have been looking around me and notice that all the light switches are up here, not down below. How’s that for mixing metaphors!

Grappling

On the way back from our weekly meeting at the US gated community I noticed several SUVs with ski racks. That struck me as odd. But when I asked my Afghan colleagues it turned out that people used to ski in Afghanistan, at the Salang Pass. In fact, when my housemate Steve got married here in 1977, MSH gave the couple skis as a wedding present. Skiing now would be a bit risky because of all the mines. So, no skiing this winter, unless of course we choose to go to Dubai and ski on the ski slope in the shopping center.

The consultant floodgates have opened and I now watch the stream from the other side of the table. Consultants want to meet, and should meet of course. Between counterparts, funders and consultants, most of my office hours seem now to be spent in meetings, some short and sweet, others long, at times arduous and occasionally difficult. There is much more ‘grappling’ at this level with complex issues that have no simple solutions and have consequences for many more people. This is the reality of being in a senior leadership position. Although I always knew this intellectually, living it is something else. The flipside is that I have staff who can do things for me, a luxury I enjoy.

The entire day we ran our meetings past their ending time. Time boundaries here are very elastic, more than the rigid time keeper that I am is used too. But everyone is very accommodating, partially because there is always the excuse of the traffic jam. Here traffic jams are the same as everywhere else in the world and then a little worse because of shifting military or police presences. Whenever high level people with their enormous security contingents move around town everyone stands still. Sometimes whole roads are blocked off because of a conference or meetings. On some streets our green car plates give us special privileges that ordinary white number-plated cars don’t have. Still, I sometimes wished that I could take taxis and explore the city streets on my own, stopping whenever and wherever I wanted.

I use the time I spent in traffic to learn Dari or practice the names of drivers when I am the only passenger. When I travel with a bunch of Afghan colleagues I learn about the jokes that Afghans from one province make about another province, like Wardakis about Konaris. These are very much like the jokes that the Dutch make about the Belgians or vice versa. That alone would be a good reason to learn the local language. There is much joy in those moments.

Habit

At 6 AM the car park outside my window is teeming with people carrying small and big bundles. Taxis and small buses stand ready to take people wherever they want to go. It is Saturday morning and time to travel. I am told that much of this travel is to relatives far and wide to attend funerals and weddings, events for which people are spending more than they can afford and go deeply into debt.  William has told me about this disastrous social trend that drags middle class people below the poverty line. Apparently it is the Christians more than the Muslims who engage in this Ghanaian version of keeping up with the Joneses.

Like any gathering of people, it is also a good place to sell stuff or to preach; both are happening in a cacophony of voices, colors and sounds: it’s pure eye candy. I try to capture it on my small low performing camera. Where are my daughters with their equipment and skills when I need them?

William drove us back to Accra after the completion of the retreat, more or less on schedule. The HR director and the DG joined us at mid morning, something we had hoped but did not want to believe until we actually saw them. They arrived just when the participants, in self selected teams, had made commitments to take a small bite out of a series of huge challenges, observed during the visits we made earlier, in cross functional teams: one group took a bite out of the human resource challenge, another out of the resource management challenge, another sat down to tackle infrastructure challenges, a fourth team took on quality assurance and the fifth team decided to get their own house in order to improve the functioning of the national health insurance scheme. All challenges are enormous and represent nearly intractable tangles of interests, agendas, stakeholders, schemes, models, languages, and a history of piecemeal and failed attempts.

We call these leadership projects that give senior leaders a chance to rehabilitate themselves in the eyes of those working at the operational level and improve their management and leadership skills. It is opportunity to show that they can make a difference for the levels below that keep pointing fingers at them. There is a tendency to want to take on everything at once and cover the entire country, in the process making the task so difficult that everyone gets paralyzed or feels so impotent that any action feels risky. This, I believe, is the cause of much of the inertia that we see and that people complain about.

I also believe that the inertia comes from not seeing it; everyone else does the same. I provoked the participants a few times on their passivity when their team members did not show up at agreed upon times. No one took action; no one called his or her team mates, even after dropping a few hints. People want to be congratulated on being on time themselves; when I told them it doesn’t count until their teams are complete there was this vacant look on their faces. It made me want to wave a large flag in front of them, shouting, ‘anybody home?’

They all say they want to change this habit they consider dysfunctional. But it is lodged deep in their cells.  It will take an enormous and sustained effort to dislodge it. As Mark Twain observes: “Habit is habit, and not to be flung out of the window by any man, but coaxed downstairs, a step at the time.” We did a lot of coaxing these last few days.

Many of my observations about senior leaders were confirmed by my friend Seth who is now high up in the ministry of education. He happened to be in the neighborhood of our hotel yesterday and we met in the hotel bar and talked about his new role and his past history with the regime that is in power again. Seth and I met at a conference in Zanzibar some 3 years ago and have stayed in touch. He will be one of my sounding boards for my theories about senior leaders, since he is one himself.

I am disobeying doctor’s orders and slept the entire night without my sling. I can’t stand it any longer. The physician’s assistant had told me some weeks ago that he usually lets patients take the sling off at night after four weeks. In two days it will be four weeks. I let my body guide me: the discomfort is less without the sling than with it.  I can move my shoulders in several directions without any pain.  I assume this means it is not frozen, something I was worried about.

Make-do/can-do

The chaos of getting 22 people off in 7 cars to 7 different destinations as close to 8 AM as possible did not materialize. Our Ghanaian colleague Philip had been fretting over getting this right, not an easy task, and then everything was right. At lunch time everyone returned and the field visits had been completed without a hitch, with spirits high. There had also been some bonding across organizational divides; there is nothing like sitting together in a car going over bumpy roads. It reminded me of a field visit I made with a bunch of family planning professionals from all over Francophone Africa in Benin. We travelled over bad roads for 700 km, from early morning to deep into the night. We sang songs for hours, told jokes, changed tires and pushed the car out of mud; we became friends for life!

I accompanied two gentlemen from the ministry of health and we were  expertly chauffeured by driver Valentine over roads that had lost their hard top here and there. Although our destination was not far, it took us exactly an hour to get to our destination. We were warmly welcomed by the midwife in charge, just outside the Labour Ward where some hard work was being done by two women who had reached their term. No husbands were present – labor, even with an extra ‘u’ is women’s work.

Over the next couple of hours we chatted with various employees and explored the buildings and rooms that were part of the health center. The senior leaders were told to present themselves as students, counter cultural for sure. There had been much concern before the visit about whether this was possible and shouldn’t we surprise people. But none of these fears came to pass, as I knew from experiences elsewhere.

The health center consisted of the main block with wards and consultation rooms, a block of dilapidated staff quarters, an incinerator, two containers that houses the generator and the ambulance, a block of rooms for specialized services and something that was referred to as the ‘new’ building, a large unfinished structure in a corner of the compound. Work had started some 8 years ago but they had run out of benefactors or the benefactors had run out of money.  Inside it did not look like a new building anymore.

A matron who had been taken out of retirement had settled into one corner of the building overseeing a makeshift recovery ward. The ward has two beds, one covered with two crib mattresses instead of an adult mattress, a bench and a crib. ‘It’s not enough,’ she said. Sometimes she has to ask the least sick person to move over to the hard bench. We were all inspired by her commitment, passion for her work, concern for the community and can-do attitude. She surely was able to make something out of nothing. Asked about her retirement, she answered that she was too good and too strong for that and that she plans to continue working under contract as long as she can.

Throughout our tour the accountant accompanied us, pointing out the places where resources would make a difference and places where they themselves had made a difference in the absence of a response from their own employer, the government of Ghana.

At the family planning clinic we found the nurse talking with one of the outreach workers, a young man who does vaccinations as well as HIV/AIDS outreach. We asked the nurse to teach our driver how to put on a condom. He was a good sport and demonstrated at the end of the lecture that he had understood everything well, from hand washing to opening the package and rolling the condom down on a wooden model; all this done with great care and clarity and a good dose of humor.

On our way back to the hotel we stopped at a tiny community health center staffed by community nurses. We learned much about the reluctance of the (very poor) local people to be referred to the next level health center and how this has led to true telemedicine: the nurse in charge calls the physician assistant, who is the person in charge of the referral health center  (the one we had just visited ) who coaches her trough his cell phone on how to give care that he would have given. It is not ideal but she learns from this and the patients benefits; another form of can-do/make-do.

I interviewed three young community nurses who are entering their second year after 3 weeks of practical work. They had just returned from their community outreach rounds, checking up on the vaccinations of babies and mothers. Their eyes sparkled and their uniforms were spotless but brown; the coveted white uniforms are not for them until they pass next year’s exams.

After lunch we compared notes among the seven teams, using appreciative inquiry as our approach: what had they seen that was inspiring, touching, surprising (in the positive sense) and life-giving (literally and figuratively). What we heard stood in sharp contrast to the supposed incompetence, low morale, mediocre care, inertia, drug supply problems and poor management that we are usually being told about by the top people in the ministry, people like the ones  we had in the room.

We were encouraged by the interest and enthusiasm from our participants; there is no more coming and going and, aside from things like punctuality, everyone is fully participating and deeply involved in the program.  I provoked them around the punctuality issue. There is much denial about their own behavior and they are rarely confronted, except by their bosses, who probably don’t manage themselves very well either. There is also much inertia and little sense of collective responsibility. A few individuals are proud, and want recognition for being on time and ‘sticking to the norms.’ Yet there is no action to make sure their whole team is present, even after several hints. Although Americans are culturally considered individualists, and Africans collectivists, when you look closely you see that the educated elite has drifted far afield from the collective sense of duty and responsibility, may be not in their words, but surely in their actions.

We ended the day with two exercises, one called the Helium Rod, which we fabricated out of flipchart paper, and the other about shared vision, using a gadget that we also constructed out of material found locally. Experiential exercises are still a novelty here. It is one place where we can put a mirror in front of the participants and show them what they actually do, as opposed to what they say they should be doing. In a place where senior people don’t ever get direct and honest feedback about what they should be doing differently, this is the only way to confront people so they can see what they need to work on. Intellectually they buy this, but there is a sense of impotence when it comes to action.

Today the rubber will hit the road. In a reflection about the effect of the appreciative inquiry many expressed concern about it being a bit artificial and not contributing to the solution of problems. The problem-focused approach to work and life is so deeply entrenched, and so pervasive that it has become embedded in their very cells and doing anything else feels wrong. We told them we will get to these problems later but first wanted to establish a solid foundation of knowing what is going well so that this can be supported, enhanced and extended.

Today we will focus on their challenges. We will put them to work, in teams, on analyzing how they can remove obstacles they observed in the field. I have a premonition that they will find ways to push the responsibility for solving these problems further up the chain, thus reinforcing the practices that firmly keep in place the roadblocks that everyone can list in their sleep and that have been identified in countless reports for as long as I remember but that no one feels empowered to tackle.

Frogs to start with

An ADRA driver picked us up and took us up to Dodowa, in principle a ride of one hour that took us closer to 2 hours. We kept turning right, and then right again, and again, and again. I expected to find ourselves back at where we started. I find the layout of Accra and its outer roads very confusing and disorienting. There are some cities, like New York City or Washington, where I can quickly orient myself, even without a map. Accra is the opposite, together with Conakry, two places I never figured out despite multiple visits.

The start of the retreat was as tentative as the 9 months of stop and go preparation. Of the 30+ invitees only 4 were present at the appointed (lunch) time, 11 people showed up an hour later, still working on their lunch when we were supposed to have started. More people straggled in over the next few hours. Nevertheless, by dinner time we had caught up with our planned program and everyone was deeply involved reflecting about leadership, their own and others’.

After dinner we lost people as fast as we had gained them. Some went home even though we already paid for their hotel room. We are apparently still too close to Accra. Still, many are intrigued with the methodology and the approach we are taking and fourteen people showed up for the after dinner session on work climate. Our lead facilitator was stuck in the rush hour traffic leaving Accra for hours and Diane, bless her heart, jumped in with only seconds notice and ran a good session in his stead.

We are staying in a hotel that was designed, I think, by a builder who doesn’t believe in architects and who cheaped out on materials. It is a veritable accident waiting to happen with shiny tiled stairs that could kill you in the rain and levels up and down everywhere, gratuitous steps without a purpose other than to trip you. Tripping would be a disaster for me as I cannot catch myself with two arms. Thus I walk slowly and very mindfully through the long death trap hallways, up and down levels that are hardly noticeable because the tiles fool you into believing all is level.

When I went to check out the hotel on Monday, straight off the plane, a gathering of traditional rulers was in session. Each ruler was decked out in magnificent cloth, loosely draped over one shoulder, with spectacular staffs, thick gold necklaces and head bands with fur from powerful wild animals. It was a photographer’s dream but I was too timid to snatch the opportunity until invited to pose with two of them. I was promptly addressed as ‘wife’ by one – apparently spouses can be acquired easily by a traditional ruler. I smiled and then we parted ways – divorce being just as easy.

At the end of the day I retreated to my enormous, gaudy pink and gold room. Outside the hotel, thousands of noisy bullfrogs, who live in the blue-tiled moat that traverses the grounds, make any conversation impossible. They make such a racket that neither the airco nor music could drown them out. It is a deafening cacophony of ribbits and croaks that went on all through the night. According to my faithful medicine cards, the frog stands for cleansing, new beginnings, or maybe simply a good start.

Teams

The trip I hoped to make to Kabul with Axel, in just over a week, seems more and more unlikely and the limbo continues. I try not to get too upset about this, although I am disappointed. I have stopped to look too far ahead (since there is nothing to see) and instead am focusing on the work of now. It makes me forget the disappointment as it connects me to exciting projects and wonderful people around the world.

I received the most encouraging news from my team in Cambodia which has managed to get government health facilities to make special efforts to reach out to youth, with a focus on reproductive health. The 26 or so government officials who are the first to participate in the leadership program were rather skeptical at first. Others were also skeptical about them and had their doubts that anything would change. The health facility managers set what seemed fairly un-ambitious goals for their teams – but it seems they have been surprising everyone, including themselves, and surpassed these goals.

The senior leadership work in Ghana that appeared to be stuck for the longest time in the initial planning phase has come unstuck. Now it requires the alignment of schedules and a dates. And that’s where I bump into my uncertain future.

Another piece of work like it, concerning senior professionals as well, is in the planning stages for Central America. I am helping my colleague Diane design a process for getting senior leaders focused, moving and more confident in their ability to function well as a team and fulfill their oversight role for major investments in health programs. She will do the actual facilitation since I am not a fluent Spanish speaker, but we fantasize about doing it together. Given all the scheduling challenges, this is highly unlikely.

Last night we attended the annual meeting of the Manchester Historical Society. The average age of its members is probably about 65. Although on the young side of the median, with enough grey hair, we blend in nicely. There is always wine and an impressive buffet of finger food before we start with business. This helps with the socializing although I always manage to introduce myself to someone with a mouth full.

The business of the Society is conducted in no time adhering to the letter rather than the spirit of parliamentary procedures. This makes the business meeting a breeze. The last piece of business is always a motion to ratify any errors and omissions of the executive board, which we gladly did.

The highlight of the annual meeting is always a speaker with something interesting to tell us about the place we live. This year it was a gentleman who had written a book about Cape Ann. He told us many great stories, accompanied by slides, of the famous people who resided here, their houses, their houseguests and friends, and their writings about and paintings of Manchester, Essex, Rockport or Gloucester.

Conversations

Senior official are very busy here. Yet they will spend hours each week sitting around conference tables waiting for their peers or bosses to arrive. They use the time for small talk, maybe some coordinating and communicating, and I am sure some complaining but I would have to speak a lot better Dari to confirm that. No one checks their watches as we westerners would have done.

I use the waiting time to learn a few more words and try out my Dari on one of the non-English speaking office staff. When I ask for tea and it doesn’t come, I know I need to work on my pronunciation. When it finally comes it is like I passed the orals (with a tangible reward for it).

One of the department heads indicates that he is too busy to attend this meeting and should have sent his deputy. I tell him that I would like him to stay at least for the visioning part. He says that he already has a vision. We spend the next three hours in conversation about the challenges and dilemmas for people at the top. We have a long discussion about power and then they draw their vision, a few under protest. The vision drawings, when put next to each other, produce a fairly complete picture of what the directorate is striving to accomplish. People smile. It is more compelling that the very abstract and boring language that they started with.

The morning serves as a diagnostic for me and as a mirror for the the chief and his department heads. The people who said they would leave because they were too busy for this meeting stayed. I consider this a victory. We don’t get the entire agenda finished and I am not clear how and when to continue our conversation since my departure is in sight. It is now abundantly clear that I cannot do this work if I zip in and out for two weeks every six months.

I ask if I can sit in on the team’s next staff meeting on Sunday. This would provide me with another opportunity to see how they work together and possibly continue our conversation of today. Now that the group has a vision, the next step will be to find out what blocks them from this vision or keeps them stuck in a place they want to leave.

In the afternoon I facilitate another conversation with the technical advisors from the project who will soon leave their comfortable offices at the MSH office and move in with their counterparts in the ministry. It’s a complex undertaking with many unresolved issues, dilemmas, worries and fears. None of their bosses are around, intentionally. The discussions are earnest and frank. It is clear that much needs to be ironed out before the move can actually take place.

When most people have left, Steve and MP congregate in my temporary office. We talk about what we did today in between yawns. It is time to go home, the weekend has started. Only Dr. Ali stays behind to participate in the  worldwide staff meeting in Cambridge where it is 9 in the morning. I had hoped to follow it from the guesthouse but never get the audio right and while messing around with it miss the entire presentation from my colleagues back home I had looked forward to.

Dinner is another slow and wonderful affair with many stories and Janneke’s home cooked nasi goring to complement all the other dishes made by the cook today and yesterday’s leftovers. We have food aplenty.

It’s now the equivalent of Saturday night and so we plan to watch a movie but can’t figure out the video, so we watch the news about Pakistan and Western Afghanistan. As the crow flies these two places that are near but I look at the news as if I am in the US.

Cowpaths, cola and cleanliness

The weather has turned back towards winter again. It has been raining for the last few days and the warm summer weather has disappeared. I am turning my airco back into a heater. I am told that Afghanistan advertises itself as the country with 300 days of sun. Under other circumstances this might have attracted tourists.  I think at least half of the sun-less days have been used up already over the last month. the only thing that tells us spring is here are the rose buds that are popping and the tiny grape bunches already visible on the vines, growing bigger each day.

The challenge of coaching my Afghan colleagues in using a very well calibrated and researched set of facilitator notes is that I cannot improvise – as much as I like to do that, and often have to do this. This is the contradiction that I experience wherever I go. It’s much like learning to dance. You first have to learn the steps and why the steps go in this order and not that order. Only when you have internalized the steps, so they become automatic and don’t require conscious thought, can you start to improvise and embroider on the material. This is difficult for me because I have to model sticking to the notes yet I know them so well that I tend to do a lot of embroidery in response to the particular needs and realities of the team. So I end up asking people to ‘do as I say’ rather than ‘do as I do.’

We follow a cow path this morning in our session. There is some logic to it since it leads to a desired endpoint but otherwise it winds this way and that. Dr. Ali, bless his heart, keeps bringing in the young women trainers. It is like a kind of inoculation against women power – if you put women up front enough the men get used to it and the sharp edges wear off.

They teach, among other things, Steven Covey’s circle of influence. It’s a popular exercise all over the world and especially here. In our notes we end with a quote that is, allegedly, from Reinhard Niebuhr about knowing the difference between the things you can do something about and those you cannot. In the middle of the exercise someone stands up and invokes (in Dari) the name of God. What follows after that sounds like a recitation from the Holy Koran. I am puzzled and a translator is sent my way. I was right. The verse translates, loosely, like this: when a problem is too big, something you can neither control nor influence, then you can leave it to God. I am trying to reconcile Covey, Niebuhr and God but have a hard time getting my head around these three.

We end the teambuilding retreat with the usual take-out lunch, always with too much bread and too much meat and/or chicken. We are served cans of Kuka Kula. I sit next to the health promotion director and he tells me that the Kuka Kula people take nice Afghan spring water and turn it into unhealthy soft drinks eagerly consumed by people  used to drinking water or tea.

He has a tough job: supporting some good old habits (tea drinking) and unlearning some bad ones (spitting) and teaching the discipline of hand washing and personal hygiene aside from the nutrition, child health and maternal health behavior change communications. We, that is the women in the room, have recruited him, our first male, to be part of a coalition that has just developed its vision for a more healthy ministry of health (clean, smoke free) and a measurable result: 4 clean female toilets in the main MOPH building by December 2009.

I challenge the two young women trainers to take the lead on this initiative. At first they say it cannot be done and I question them about stopping before they have even started. Everyone gets very busy telling me why it is ludicrous to even try. It’s a perfect set up for talking about leadership. People do want to be leaders but they don’t want to change things, or don’t think they can. We use the challenge model tool that we are teaching to everyone here.

Today was the last day of the various retreats in the basement of the ministry of health. One more piece of work that is externally focused happens on Thursday and after that my focus will shift to capacity strengthening in management and leadership within the project.

Men retreat, women advance

We are meeting with the public health institute. After yesterday’s all male policy and planning team we now have at least one woman (a deputy director) at the table, and two younger women as observers. The latter are here to observe and they get to teach bits and pieces. The institute is smaller than the other directorates and convening the direct reports to the DG is easier, despite the fact that one of the directors is responsible for coordinating Afghanistan’s influenza A response – he’s a busy man these days.

There is a good atmosphere in the room and the group is a congenial one. When the two young women stand up front and do their teaching I notice a subtle shift in energy in the room as if the men become more boisterous; the noise level certainly goes up. I seem to be the only one noticing it. I share my observations; people laugh. They don’t think anything has changed. There is much hilarity in the room. Still at some point my co-facilitator, a senior male doctor, has to step in to refocus and bring the energy down to manageable levels.

We conduct the same diagnostic that we did with the policy and planning team. We move faster in some areas and slower in other. This directorate has a beautiful brochure that looks like a glossy magazine, with its mandate, vision, staffing chart and pictures of senior health officials at official occasions in addition to staff sitting at their desks and in action in the field. There are also picturesque Afghan landscape scenes (and some that don’t look very Afghan to me).

When we ask whether they have a shared vision, some say yes, some say no. I step in to explore whether they have the same understanding of the construct of a vision. Some of the directors have a very sharp and compelling vision for their own teams while others don’t – it’s a little uneven. The women trainers return to the back of the room, and sit next to me. They are giggling and telling me about all the mistakes they made. They discover more mistakes in the Dari flipcharts they prepared and giggle some more. I admire their resilience – they are pioneers for their sex. I ask a male colleague who has been observing with me, and occasionally translating, how big a barrier these women are trying to break through. He tells me proudly that having younger women teach older and senior males is OK in his department. It is quite an accomplishment considering that only a decade ago this would have been unthinkable.

I postpone going to the bathroom as long as I can because it is such a hassle. I am told that, in the entire central ministry of health, there are only a few bathrooms for women; one of them is across the hall from our basement training room but it is permanently occupied by women cooking on little stoves and men eating. One floor up are two stalls but these appear to be permanently locked. If you are lucky someone will find the key. It is attached to a rather yucky looking rag that is probably full of interesting bacteria. This time I find a bathroom on the third floor. It’s a very long walk across the building and three floors up. “This is our big problem,” say the young women who serve as my guide. Men don’t seem to need clean bathrooms, but we women do. There is clearly not yet a large enough constituency to demand such a change.

A good day

Our morning starts with a visit to the chief of health services. He greets me enthusiastically and I can now ask him in Dari how his family is and how is travels were. He travels a lot to the provinces and because of that has a good idea of what is happening at the basis of the pyramid. He wants to organize quarterly meetings and rotate them in the provinces and have his staff travel there instead of provincial staff travelling to the capital city.

He talks about good provincial teams and bad provincial teams. Where they are bad, he says, ‘the staff is crying.’ But he cannot do anything about it because some of the provincial bosses are well connected and powerful. This is the impotence of senior leaders that is much more rampant than people at the bottom of the societal pyramid think – the paradox of powerful people feeling powerless. This doesn’t necessarily mean that they acknowledge this and ask for help. But this very senior doctor does.

We talk for awhile so that I can understand his predicaments better and offer ways in which we can assist him. He agrees to bring his senior managers together again, the team building that derailed a bit last week. We will meet on the day that I was supposed to have left and we will give it another try. But this time I extract a promise from him: if he is called away by his superiors, he will say no to them. I realize this is not easy, and may not even be possible. We agree that if he cannot say no, we will cancel the meeting.

On our way out of the ministry we run into a man who is the son of a famous Afghan poet, and the brother of another, both named Mushda. We ask him about a poem that we can use in the sessions with the senior leaders that will help raise spirits and speak of unity and collaboration. He immediately starts to pen, in beautiful handwriting, in Ali’s diary, a poem that his father wrote 50 years ago about unity between Sunni and Shiites, between Pasthuns and Hazaras. As we walk out of the heavily barricaded ministry compound onto the street I ponder this extraordinary encounter with poetry right in the middle of the ministry’s flowering courtyard.

In the afternoon we help the policy and planning people create a shared vision and talk about their hopes and dreams – something they have never done before. The turnout of these very busy people is good. We spend a long time talking about what a vision does, rather than what it is. I do an exercise with the kind of elastic that is used in men’s underpants, cut lengthwise into two rounds of about 4 meters. With it I demonstrate the constructs of structural conflict and creative tension, the kind that a vision generates. It gets the message across but, as I find out later, is a little too risqué for my Afghan colleague when I ask him whether he wants to do the exercise tomorrow. Foreigners get away with much countercultural mischief.

After work we drop our colleague off at her apartment that is close to the airport. She invites us in for tea. I say yes right away and then realize I should have refused at least 3 times before accepting. This leads to a discussion about cross cultural disasters when people invite you and you say the wrong thing. I am assured that it was an honest invitation and that my immediate yes was appropriate.

Zelaikha lives in a high rise complex that is visible for miles – several multistory apartments with a bright red roof on top amidst colorless one story mud brick hovels built by people coming in to the city from the rural areas. Eventually these mud brick dwellings will be demolished and the people pushed further out onto the slopes of surrounding mountains, to make place for more of the high rises.

Zelaikha and her family own their flat. She lives there with her mom, sister and brother. Other siblings live higher or lower in the tower. Some of the buildings are 2 years old, others 4 but they all look like they have been there for 20 years: cracks in the wall, run down and people trying to live like they’d would in a village – with part of the contents of their apartment moved into the public hallways and stairwells, laundry draped over gallery banisters; toys and kids everywhere. When the bad weather moves in the wind howls around the canyons created by the high rises and the electricity goes out. Her mom and sister join us but don’t partake in the juice and tea.

The mother has raised seven very successful children: four of the five girls are doctors and the rest are engineers. I ask her if she is proud and my question gets lost in translation because she shakes her head and smiles. I smile back. They lived in Iran and Pakistan during the Taliban years – with all these well educated girls there was no room for them in Afghanistan. Most of them are back and happy to be home again.

It takes us forever to return to the guesthouse, all the way on the other side of town. We drive under grey skies and through dust storms that reduce visibility to about 2 meters while I listen to the conversation in Dari between the two people in the front seats. I am beginning to recognize a word here and there. My vocabulary is increasing rapidly – there’s nothing like total immersion.

At home I find our new house mate has arrived; Janneke from Holland. There is clearly a Dutch theme to my stay this time. We discover quickly that we have several friends in common and she worked at a place where I applied for a position some 17 years ago. Obviously I did not get it and that turned out to have been a good thing. She may actually have interviewed me all these years ago but we did not recognize each other.