Boarding

The security agent at the Delta gate for the flight to Boston turned out to be American.  Not knowing this I replied to his questions in French. I think this may have annoyed him.

He asked where I was living (Boston) and where I came from (Abidjan). What had I done in Abidjan (I switch to English, understanding he is not a native French speaker. I work in public health). What does that mean? (me: I train doctors and nurses in management and leadership). What does that mean? I explain. He interrupts me, Madam you don’t have to answer my question but you wouldn’t be allowed on the plane (me: excuse me sir but I think I am answering your questions). So what does that mean, training in management? (I cite the 6 pillars of health systems work of the WHO). So then what happens? (me: we hope that the services improve). What services? (me, increasingly flummoxed, of health care). But they are doctors! Me: yes and many can’t manage themselves out of a paper bag, they never learned this in med school. He: and so then what happens?  I am even more flummoxed, feeling like I am speaking to a five year old. Me: Like when people who are sick need medicines, they are more likely to get the services and medicines they need.

He repeats, more agitated now, Madam, you don’t have to answer my questions and I will have to go over there (points to a bunch of uniformed people). I wonder, is his supervisor among them? That would be just fine as I am about to lodge a complaint. And then suddenly he closes my passport and waves me along.

I am immediately rewarded for my patience with the security man when the nice Delta employee who scans my boarding pass exchanges it for one with the seat number 1D. The universe is watching. Once comfortably seated in my seat 1D the pilot, through the PA system, apologizes to everyone on the plane for the security procedure. I was obviously not the only one. Whatever else happened to other people with other security personnel delayed our boarding. I ask for champagne and toast to the security man, wishing him to get better at securing our safety.

Almond-shapes

I spent three days with malaria experts from Africa and one team from Nepal, our own MSH advisors who brought along their government counterparts.  It was truly a united nations. United about the goal of eradicating malaria and about 20 different nations represented. In addition there were a few representatives from our competitors who, in this case, are also our collaborators. They will be taking the baton when our project that has provided the funding so far, ends in September. This is to make sure the transition doesn’t hurt the women and children who need to be treated or protected from malaria. It is an act of synergy and collaboration that is not all that frequent (outside partnering on a bid) in an otherwise very competitive field.

For three days we did not talk about malaria, or very little, but rather focused on the human harmony or disharmony that helps or hinders the work that needs to be done. This is of course entirely in line with the original founding philosophy of MSH, which was all about the unnecessary suffering and death as a result of poor management and leadership (and governance which was added later).

Our doctor experts, and their counterparts, are both causing and suffering the consequences of not understanding human dynamics. They know the theory and focus all of their attention on what others are doing wrong. It is a familiar refrain: the politicians, the senior leaders, the donors, the villagers, the healthcare providers…one or the other or all are doing things entirely wrong and so they need to be put on the right track. There is a lot of preaching and wagging fingers and doing it harder and louder when the hoped for result stay out.

For three days, in this coaching and communication workshop, I exposed them to everything I have learned over the past 7 months about the neuroscience of getting people to work better together, share, expand, appreciate, create a climate of trust, develop, celebrate and include. The term is to ‘up regulate’ those and down regulate the criticizing, the excluding, the judging, the withholding, limiting and dictating.

Although most of the people are doctors, they know little about the brain (little of the little we know about the brain), and so for a change I was the expert. Since the workshop was in English and French, with simultaneous translation, I switched between French and English in order to give one group and then other a break from the very uncomfortable headsets. On the third day I noticed some confused expressions on the faces of the French speakers. We had talked a lot about the limbic system and the amygdala. As I discovered, the word amygdala comes from the Greek word for almond, as the amygdala are almond shaped. But there is another part of the body that is also almond shaped, the tonsils which, in Dutch, German and French uses the same Greek derivative: amandelen, Mandeln and yes, indeed, amygdales.  And so, all the time I had been talking about the amygdala, they were wondering about tonsils. In my coaching course I have learned that ‘words means worlds.’ So very true. I was glad we had cleared that confusion up before everyone went home.

Psych roots

I believe I have closed a circle. I am reading (being read to) David Sapolsky’s   book ‘Behave’ which tracks behavior from the neurochemical processes that precede behaviors by milliseconds to what happens before that in minutes, months, years all the way back to childhood and what happens  in the womb. The chapter on early childhood development dragged out of my hippocampus (as I know now) all the theories and names that I learned 45 years ago. Some of the theories have been debunked but most have stood the test of time. The names of the researchers and their universities didn’t mean much to me at the time. Now they do.

I am dazzled by the complexities, multitude of agents, responsiveness to variation (environmental and endocrine), the improvisation, and learning and looping of brain processes. I am more surprised than ever that most of us, most of the people I know and work with, and those I meet around the world, behave more or less within the norms of the societies we were born into.

And although I know a lot more than a year ago about the brain, it is still one tiny bit of what there is to know. There are entire sections of the book that leave me perplexed and wondering, what did he just talk about? I go back 30 seconds or more and listen ago, still none the wiser. I am glad I took the Coursera course on the brain so I am a few steps ahead of Axel who is also reading the book and is even more perplexed. But in between the perplexities we are learning more about why we/others behave the way we/they do. And this is bringing me back to my initial professional discipline of psychology.

Normal

It will be 10 years since we fell out of the sky. I remember times when I thought things would never get to normal again. In some ways this has become true and in others it has not. We have become grandparents (normal), I continue to work and travel around the world (in economy class, normal), I ride my bike, the real Dutch one and the stationary one in my office at home (normal), I swim in the cove (normal in the summer only), we go out, watch Poirot or other cozy mysteries on our small TV screen on weekend evenings; we enjoy cooking and dining together, have friends over, and enjoy each other’s company (normal).

The things that didn’t go back to normal are mostly related to the shoulder and ankle injuries I sustained. I can no longer walk on uneven terrain and wake up with joint pain, especially in my damaged ankle. I have more or less intense prickles in my left foot (the aviator foot) and taking Gaba medicine to reduce the excitation of the nerves in that foot. Axel’s head injuries still show their effect albeit in subtle ways that only insiders can see.

When putting everything on scales of normal and not normal, the scales tip to the normal side. I believe we came out good if not better. Especially in that first year, 2007, we learned what ‘community ‘means in ways that most people take for granted. We learned the true meaning of gratefulness and altruism. And this is something we are now more tuned into, observing once again with Tessa’s illness that friends promote healing.

Summer has started at Lobster Cove. I swam across and around the cove twice this week. With my goggles on I am inspecting what’s below. At Tessa’s birthday party,  earlier this month when we were in Washington, many of the large oysters got picked and eaten, to my regret. I swam over the areas where we found a lot last year, including small ones that we left alone. I am looking for other areas like that. After the party, in addition to the large (empty) oyster shells we found at the beach, there were also large mussel shells, leaving us wondering whether the mussels are back or those came from a store. They were very large.  Maybe, like anything natural (bodies after a crash or entire ecosystems) restoration is possible and the cove will fill again with its normal inhabitants.

Present

Everything aeronautical went like clockwork from the moment I left the hotel in Lome until Axel picked me up 25 hours later at Reagan National Airport. I got to travel the last hour in style with the upgrade I had coveted all along, just for the JFK-DCA leg. It got me a drink while the people in the back did not because we were given a very low altitude to travel due to inclement weather in the region. The upside of this, according to the captain, was that we didn’t have to wait for hours on the JFK tarmac and that we got a good view at the scenery below; the downside that it was very bumpy and (for those traveling in economy) that the flight attendants were asked to stay put.

I was in time to join our friend Larry for a celebration of his 70th birthday party. I have never traveled that far to a party. I was able to enjoy the festivities till the very end when I pulled on Axel’s sleeve and told him I couldn’t keep my eyes open.

I had tried to nap in our DC hotel room where Axel was already well ensconced. But there were too many impressions, as there always are, from the 25 hour trip rummaging around in my brain; a combinations of movies (Avatar, CSI), reading (Sapiens), and (electronic) puzzle pieces. I just couldn’t silence my brain’s attempts to make sense of all these data bits that were pulsing through my head to allow me to fall asleep; but I did rest.

Rest (and digest) is one of the many things Jon Kabat-Zinn writes about in his delightful little book ‘Wherever you go, there you are.’ The reading is a logical extension of our reading of Brene Brown’s ‘Daring Greatly,’ which has led to many wonderful conversations during the many hours we spent together (first in Holland and then in the car while Tessa was in the hospital). I suppose Axel’s reaching 70 and me 65 has sharpened our focus on what we want to be rather than do.

Reading Kabat Zinn, Brown, Tessa’s illness and my coaching course with its intense exposure to what happens in our brains led me to start a daily meditation practice again. Some years ago I used to meditate 20 minutes before going to work but when it became another thing on my to do list and required me to get up  even earlier I dropped the habit as the the ‘have to’s’ canceled out the benefits of my meditation practice.

During this trip, and encouraged by Kabat-Zinn I realized I was ready to practice again, especially with my hyper travel schedule and the stressful last few months. I set myself a goal of 8 minutes. Combined with my ankle and hip exercises I am good for at least 10 per day minutes of living in the present. I have set my sights on increasing this here and now time, starting today.

While we are celebrating Tessa’s 32nd birthday from afar (her annual birthday bash at Lobster Cove has probably just ended on this Sunday morning), we are packing up to leave for Chadd’s Fort in Pennsylvania.  Axel has organized a trip to the Brandywine River Museum where, according to the NYT, there is a once in a lifetime exhibit of the works of one (or more?) of the Wyeths. This is how we are making our way slowly back home, and enjoying this mini vacation before my next trip to West Africa in two weeks.

Shifting gears

The Togo trip is nearly over. I am halfway home (in Paris now). I had wanted to buy an upgrade for the night flight from Lome but didn’t think it was worth the 500 euro Air France wanted. Instead I took a sleeping pill and I might as well have been in B-class. You can buy a lot of sleeping pills for 500 euro.

During this past week in Togo we, or rather ICRC, had brought together teams from rehab centers in Senegal, Mali, Niger, Togo and Madagascar. I knew some of them. Over the past three years we had organized these events but now we have passed the baton to ICRC which, in turn, is passing the baton to the management teams of those centers. In the process ICRC is also passing the baton of accompanying the process to its local (as opposed to expat) staff. This is how things should go. From being in charge I am now a hired hand.

We have worked together on this initiative with several Geneva- and field-based staff for the last several years. Now, after two last trainings (last week in Bangkok and this week in Togo), the teams will be coached rather than trained. They have their marching orders and have to show some pretty compelling results, starting in the next few months in terms of baseline data, and then over the next three years to show these data show improvements. No more easy money. Accountability it is!

We divided the coaching of the country teams over the next three years among our MSH colleagues. One will  coach the Cambodia and Myanmar teams, another the Pakistan teams, another the Togo and Madagascar teams and I get to travel to Mali and Niger in the fall (when the Harmattan blows in the Sahel). MSH is contracting with ICRC for my three trips to these countries and have monthly calls.  It won’t be enough to keep me gainfully employed but it will be interesting. I just have to find some other work in the side.

It was nice to have newcomers and old-timers to our management and leadership development program in the room together. The old-timers re-assured the newcomers that change was possible, that they should stop saying that they needed more money to do their work, and that they should start to change themselves rather than focusing on others to change. It was so very satisfying to have other people pass the message. This is experiential learning: experience first, then decide whether you like it or not. Having the old-timers in the room was very helpful.

I hardly left the hotel. One night I joined a small group to eat in a Chinese restaurant half a mile from the hotel.  A drunken motorbike taxi driver tried to recruit us to take a ride on his bike. He was ranting about how wonderful ‘les blancs’ were. We tried to ignore him but he ignored our silent treatment. At the Chinese we were the only guests, something that worried me but the food was good and freshly prepared. One of our ICRC colleagues has lived in China and dug up some Chinese words from his memory.

In front of the hotel is the beach which stretches all along the Bay of Benin for I don’t know how many miles. It is a beautiful wide beach with fine sands, the kind that would be any hotel’s dream in the US. But here it is, at least after dark, the territory of bad guys (‘brigands’). The hotel wouldn’t let us, two white women, walk the quarter mile or so to the water’s edge on our own even before it got dark.  And so a young hotel employee accompanied us and told us much about himself; when we arrived back at the hotel he wanted email addresses. This is all part of the dream of one day being sponsored to everyone’s dream – America. I let my younger colleague deal with this request. I get enough emails as it is from people desperate to leave the place they were born.

Landings

It has been two weeks since I last wrote.  It has been a bit of a rollercoaster ride. We finally landed and stepped out of the roller coaster when Tessa, Steve and Axel met with the neurologist. This was the top doc from Dartmouth who she had last seen two weeks earlier in the emergency room. As it turned out we had been given rather confusing, and at times scary, information. The last visit finally brought some clarity, which Tessa has described very well on the Mealtrain website so I will not repeat. Tessa may become a case for students to test their diagnostic skills one day.  She is recovering now, which may take a while. We are grateful that all the scary diseases have been ruled out.

After rushing back from Holland and then staying in a hotel in Manchester (NH) near the hospital, and several trips back and forth to the other Manchester, I finally returned home and to work.  I had just a little over a week before getting on a plane again. First to DC where I stood in for a colleague to moderate/facilitate a panel of disability activists, all formidable women, at a conference organized by Interaction, an umbrella organization representing both international development and humanitarian organizations. The session was about strategies for inclusion (who are we not reaching?), a complex topic. Some 30 people came to the session and engaged in spirited conversations that produced some very actionable ideas.

And then it was off to Africa again. I flew from DC, rather than returning first to Boston; besides it was convenient to return to DC on July 1st to celebrate our friend Larry’s 70th. Axel will drive down with a stop in NYC, and we will drive back up together on Tessa’s birthday (July 2).

I am glad I don’t usually fly out of DC (Dulles). The summer travel chaos reminded me what a great airport we have in Boston. The plane was so full that I couldn’t even bring my carry on. When I picked my seat the evening before I had one free seat beside me. But that was now taken by a 4 year old and his 6 year old brother. Dad wisely traded places with another family that wanted to sit together, and picked a window seat several rows away from his kids. Mom with daughter sat in the row in back of us.

All this meant that I had to take on dad’s job (I didn’t want to trade for a window seat), such as how the screens worked, and help with dinner. It also meant I had to worry constantly about sticky drinks being tipped over onto me.  Luckily this didn’t happen. However, the two boys, and their sister discovered a cart in the galley with unlimited coca cola. All through the 7 hours flight, while I was trying to sleep, they crawled over and under me, plastic cups with coca cola in their hands, and exclamations during movies that were not modulated by hearing their own voice. Sometimes all three kids sat next to me, and sometimes only one, squeezing back and forth between my knees and the chair in front of me. I should have bought the 145 Euro upgrade to the next class up which I had refused because I would have been in a middle seat.

And now I am in Paris, waiting to board the flight to Togo where I am joining colleagues from ICRC to get more rehab center staff ready to transform their centers.


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