Compared to the birthday breakfast I would have had at home, this one here in Man was a bit below the grade, a quarter limp baguette, a vache qui rit triangle and a Lipton teabag dipped in warm water served by a surly waitress. But a week from now I will make up, no doubt, with a spectacular replay.

On the second day of the workshop the group struggled to formulate a measurable result related to better coordination. Not surprisingly, people came up with more meetings and more people at meetings. We pushed for better and more creative results, such as setting up local structures to improve emergency preparedness, but the general attitude is one of victim – we are low on the country’s political and economic ladder and we never get enough money.

People don’t like it when I push them to be more creative and become agent rather victim – this is after all a leadership development program. There is some comfort in being able to decline responsibility and blame others for problems.

This may all seem very theoretical from a distance but yesterday a young woman, secretary of the regional health director whose district director is with us, died in the region’s referral hospital after childbirth. She leaves behind her newborn and two small children. Everyone is very upset about this (though they also remark this happens a lot – as one could see in the maternal mortality statistics).  It seems that the handovers were not done well. When people act as individual professionals and are looking only at their own responsibilities when their task is done, this is what happens. Although lack of trained personnel is sometimes a cause for such tragedies, at this hospital there were enough trained personnel. Heartbreaking, over and over again.

I sometimes think that working in teams, taking on a collective responsibility for outcomes, and willingness to shoulder blame is the biggest challenge in countries where people either have lived in constant fear of getting lost in the crowd of anonymous poverty or are still close enough to be worried. It’s puzzling as I am dealing generally with the educated upper middle classes.

When I challenge the constant coming and going of people holding their telephone in front of them as if it pulls them out of the room, I am told these are urgencies. I count. “You had 10 urgencies today?” (this is not a doctor on duty). “Oui, it is my boss asking for information.” “Can’t you ask your boss to leave a message and you will call back during break time?” They look at me in shock. What, ‘contredire le chef?” Culture and poverty…it is going to be a long journey.

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December 2015
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