Containment

Yesterday we completed our sweep through one of the regions in the western part of Cote d’Ivoire. We sat in on the last session of this round of the workshops in the leadership program at the hospital of Bangolo. We were seated on brightly colored plastic chairs in a small standalone meeting room on the hospital grounds. Here too there were no tables, though some people used another chair for that purpose. This team, which included two women (unlike the previous group), was made up of the hospital director, someone from the ministry of sports and youth, an NGO leader, a midwife and a couple more hospital staff.

There is a way of applauding, all across Francophone West Africa, that starts with a shout ‘clap one,’ at which command people clap once, followed by a ‘clap two,’ and then ‘triplet’ (pronounced the French way). People clap three times in unison and with their hands send the last clap to the person who merits the applause. This person then accepts the clap by bringing his or her hands, full of the clap energy, to his or her heart. In the first group we attended on Wednesday, they even had assigned a focal point for these ‘triplets,’ who periodically shouted out the commands. The second group we observed had little of this and the third group did a triplet just about every five minutes. It can get a little bit stale after hearing dozens of triplets, but no one seems to mind.

I was quite pleased with what I observed the last three days. The facilitators were trained by the people I trained back in 2014, and most had entirely internalized the concepts and tools they were sharing. The three teams are working on the containment of infectious diseases outbreaks to keep them from becoming epidemics; it is small scale and small victory work right now but that is because they are practicing new ways of managing and leading as they go along. The hope is that after we are gone, they will have changed the way they lead and manage and can tackle larger problems.

The team in Guiglo focused on bringing deaths due to meningitis down to zero; the team in Duékoué was looking at neonatal tetanus and the team in Bangolo focused on rabies. I remembered a district in Afghanistan that had followed the same leadership development approach and also focused on rabies. They were able to bring the number of people coming into the hospital with rabies to zero by getting rid of the dogs that carried the virus. They did this by engaging multiple stakeholders to work together on this public health threat. I am sharing their Challenge Model with the group here – as they are not focusing on the dogs themselves, which they probably should. In Afghanistan it was the lack of environmental hygiene in the market and around slaughter houses that had led to the rabies outbreak

We had our last meal at the same place we have eaten every night – grilled carp and atieke and a salad with, every day, less and less tomatoes and more and more onions. We are now buddy-buddy with the waitress, Estelle, who was dressed in long white and gold trimmed gown, an outfit fit for the Oscars. Maybe because it was Friday night and payday just happened a few days ago? In her gown she dragged small tables and plastic chairs to accommodate our wish of not being too close to the disco that we assumed employed her. The playlist was fabulous but better at some distance. She served us our drinks with a smile and entertaining conversations. When we made moves to leave she kneeled before me and extended her arms, a respectful way of saying goodbye to an elder, which I am in this part of the world . She called me  ‘mamie’  (grandma), which I am also.

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