Posts Tagged 'Man'

Victims

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.

Questioning

In my profession it helps to be an extrovert. Usually I am energized  by people who are learning, or eager to work together for a common goal.  But today, during the break, I went upstairs to my room and made my own cup of Nescafe rather than standing in line for exactly the same thing, and since I am not eating any of the stuff that is served at break time (all contains processed sugar) why bother?  Maybe it is because I am tired of having one event after another and being surrounded by people all the time. Or maybe it is because I am getting to be more introverted as I am getting older. Tomorrow I will be a little older.

At lunch time we had a heated discussions – I have heard the arguments over and over. They go something like this:

Me: “Why are there no women in any of your teams?” At first they joked. “We did this express.” When I took their response serious, they became more serious: “Women don’t want to work in this part of the country.” “Why,” I asked. “Because of the crisis (=the contested presidential elections four years ago that dragged Cote d’Ivoire into a nasty civil war). “But that was many years ago,” I said.

We went a little deeper. “They don’t have the right credentials.” “Why,” I asked (why is a great word in my work).  “Because they are nurses and midwives (at least in the health sector).” Me: “There are no women doctors?” At our table is a female departmental director (a doctor). She and a representative of an international NGO contest what the men are saying. We ended up with this: “This is how things are ‘chez nous’.”

Me: “You are willing to put a doctor at the head of a structure? Especially if this person (usually a man in most countries) knows nothing about management or leadership, or for that matter good governance? And, therefore does a lousy job such as depressing morale, being a poor planner, not understanding teamwork or delegation at best or being toxic  at worst? Someone who wastes resources (including such highly valuable resources as human energy and goodwill)? You prefer doing that (failure nearly guaranteed) rather than considering putting someone in charge who has demonstrated her management and leadership capacities but who isn’t a doctor?” “Yes” they say, “because a nurse or midwife could not possibly supervise a doctor!” There you have it. Checkmate!

One of my favorite sayings these days is that we tend to generate most of our own problems. Sometimes people get very angry when I say that, but I ask them to consider the practical consequences of accepting this thesis: if you agree then you can do something about your problems. If you don’t accept it there is not much you can do, and you will have to live with all these problems of today and all those in the future. The latter are the complainers – I have met too many of them.

What our leadership development program does is reduce that number quite a bit – our current facilitators are proof. They have started to question a lot more than they did before and in doing so they become change agents. We are working on a critical mass of questioners and critical thinkers, though this will probably not happen in my lifetime.

Managing

The passport has surfaced and I should have it in my hands when I board the flight for Addis. Miracles happen and DHL sometimes messes up.

Today we distributed the tasks for the three day workshop that starts tomorrow. I will do very little as I have handed over the baton to the team from Cote d’Ivoire, a mix of MSH staff and ministry of health staff. That was my job and it is nearly done. There were some misaligned expectations of the local staff, our rookie facilitators who inquired about per diem and facilitation fees, a manifestation of the disease we have created called ‘perdiemitis.’ I invoked good governance by saying if there were written rules about that on government letterhead we would gladly pay. Of course no one can produce such a document.

We wrestled with French translations of several words that were invented in Anglophone cultures. Every country and every French speaker seem to have his or her ideas about which French word best represents these essentially untranslatable concepts. We use Leadership and Management instead of Direction and Gestion – there are nuances that get lost in translation. Try to translate stewardship!  We are having endless conversations about this.

The whole notion of andragogy is still alien to people. They have received a classic French education that starts with definitions. One of my new trainees was wondering why we are asking all the questions to participants, like this one “think of a time when you worked in a great and productive team? What made it great?” Luckily one of the people I trained a year and a half ago, the cohort that is now taking my place, explained patiently that it is all about discovery of what knowledge we already have inside us. Yeah!

In the meantime I am counting the days to leave this hotel, have a good massage and a pedicure. This will happen in Addis. I looked up the hotel we will stay in and it has a picture of two Ethiopian beauties smiling in their white towels in the hotel spa. Here, the closed I come to spa is the wrapping on the tiny guest soaps “Spa, les fleurs du coton.”

The hotel owner is apparently some sort of priest or evangelical on Sundays. He showed up in flowing white robes when we settled into our conference room last Sunday. Seeing him in his flowing robes reminded me of the chapter in the brilliant Congo book about ‘la bière et la prière. On Monday he was dressed in ordinary clothes with a ladies handbag crossed over his chest like a conductor, except conductors don’t have ladies handbags. In it is a calculator and probably money. He spends a lot of time calculating.

He doesn’t seem to take his management duties very serious. This morning he sat down in the restaurant watching TV while the curtain rail (including curtains) on one side of room had collapsed onto a couch but he didn’t seem to notice. He doesn’t seem to be in the least concerned about his surly staff, the state of the kitchen, the lax security (regarding personal possessions, not terrorists) and the quality of the breakfast.’

Missing in action

The prefect who came to open our alignment meeting told me it was his third opening of the day. I asked him what else was going on in town. There was a UNICEF meeting to teach the gendarmerie who to deal with kids that had committed (presumably petty) crimes. I was glad to hear. Apparently they treat these kids now in a way that isn’t very nice.

The second workshop he opened was about gender. He told me that men beat their wives and this was a bad thing (I agreed). A research study conducted in the surrounding countryside had revealed that some 42% of the men interviewed (he didn’t know the sample size) beat their wives regularly. “Why, I asked?” “It’s cultural,” was his response. To my astonishment he then added that 48% of the women wanted to be beaten by the husbands. “Why?” I asked again. “It’s cultural.” The percentages indicate that 6% of the women want to be beaten but aren’t. I would love to see this study.

In between my work I am chasing my second passport that, according to the DHL tracker, arrived at its destination (our Abidjan office) last Monday. Proof of this, also available on the internet is that a certain Mariama Coulibaly signed for it, even though the package wasn’t addressed to her. As it turns out there is no Mariama Coulibaly in our office and so we are wondering where my passport went and who this mysterious Mariama is. It is not a minor thing, losing one’s passport, as there is a thriving trade in American passports. On top of that, it contains my entry visa for my next stop, Addis, as the visa in the passport I traveled on sofar expired last Monday – the same day my second passport landed in Abidjan.

Serious play

I have missed the entire month of November in the US. When I left there were still leaves on the trees and it was decidedly not winter. There had been no serious frost and we were still harvesting. I understand all that is now over.

Saffi has added this month that I missed to her life and is now 4 months old. She can now do things she could not do when I last saw her, such as pushing up on her arms.

I am nearing the end of my third assignment, the longest of them all. When I leave on Friday the team will be on its own. I have no worries or doubts about that. Today they ran the senior alignment meeting with great skill and confidence, with me coaching from the sidelines except for the two sessions that are most difficult to facilitate, especially with debate-happy French speakers (la francophonie). I have learned over the years how to handle this and actually get quite a kick out of it, but, unprepared novices can easily drown in the cacophony of voices and opinions and lose the thread and much time.

I repeated the exercise we did last week, asking what their secret was about keeping Ebola out. This time we had a much more mixed audience, some doctors but also several men in uniform (gendarmerie, the army), veterinarians, the prefect which is the highest representative of the government (somewhat like a governor), members of the regional council, the mayor’s office, animal husbandry people and the regional reference hospital, including the focal point for Ebola. Yet, they came up with exactly the same reasons as the 30 health folks did last week, giving the data some more oomph. I daresay I now know what allowed them to keep Ebola outside their borders: political will, mass education and mobilization, logistical, technical and financial support that allowed them to put all the required equipment in place, training and supervision of the various actors in health and other sectors, including health providers at the community level, coordination mechanisms that actually work and surveillance.

I had the group create a shared vision after a guided imagery followed by drawings. After the initial indignant outcry (‘we can’t do this!’) they all set too work with great vigor and under loud laughter. It was serious play because Ebola is nothing to joke about.

I did notice that everyone shakes hands again – old habits die hard. When I elbowed the prefect he told me bare elbows was still not good enough and we rubbed our covered shoulders.

Everyone thought Ebola had disappeared. The new alert from Liberia (and the ongoing alerts from Guinea) means they have to reconsider such behaviors like shaking hands again. A sick person from Guinea was just returned at the border. The threat is real and nearby; half the population has relatives across the border.

The hunting and eating of bush meat is still being enforced and those who made their living doing the hunting and selling have been given a new trade, charcoal, thanks to the quick action of one of the ministries that had figured out that forbidding a trade and not replacing it so people can continue to feed their families will only lead to cheating. People have been put in jail for ignoring orders from up high. It is a matter of life and death and so they take everything quite serious.

After hours, at 5PM every Monday, the coordination committee meets for exactly one and a half hours. It starts exactly on time when the prefect enters. The actions from last week are read and everyone present is held accountable. Only a very good excuse is acceptable I am told. During the height of the outbreak next door, these meetings took place daily.

Bleak

I was the first for breakfast this morning, testing how well prepared the kitchen was for having some 30 people show up every morning this week.  As there was no one in the restaurant I ventured into the kitchen. What I saw there was rather disgusting, and once again I am amazed they were able to keep Ebola out. The place was filthy with plates from last night’s dinner heaped up and general chaos. I swore not to eat anything that was cooked in there and this morning I declined the omelet. It is going to be a week of limp baguettes and tea. The luxury will be the small Vache Qui Rit triangles that I will buy myself. It is a bleak prospect but it will all be over by Friday.

What is also bleak is the news on France 24 with all these images of serpentine wire, guns, explosions, blood and crying women. And then there are the documentaries about climate refugees; this morning was about villagers in Bangladesh whose livelihood has been wiped out and who are now squatting in the slums of Bangladesh. I watch more TV during my trips than at home and it is a sapping experience.

Bleak is also the large mirrored bar cabinet in the restaurant that doubles as bar at night. It could hold 40 bottles but there are only three, whisky, gin  and something else, that speaks of loneliness and its consequences.

I am utterly aware of the catabolic energy that pervades just about everything and I am determined to turn it around, at least with the people I can influence this week.

Escapade and cascade

This morning we went to the Cascades de Man. It is the touristic attraction of the region. People go here just for the waterfalls. It is the end of the dry season and so the waterfalls were not as spectacular as they are during the rainy season, but nice enough. The road there and the waterfall ‘amenagements’ as the French call it have added an element of ugliness to what is otherwise beautiful mother nature. The road to the entrance, where the ticket man sits, is hardly navigable in the current dry season. I can imagine that during mud season only 4×4 can get there, and not easily.

Once in the area of the waterfalls the tourists are helped by a steep set of uneven steps and a railing. That was helpful. Once down in the waterfall valley large slabs of concrete and preformed benches and platforms have been put in place willy-nilly without any sense of esthetics. They are practical as you don’t have to jump across rocks but also an eyesore. A small mildewed pavilion puts the finishing touches on the “amenagement.” It is run down, fungus on the walls, garbage – it will be fixed the guide told us. He is not paid by the ministry of tourism and lives on tips. I wondered whether the man who collected our entry fee (200 CFA which is less than 50 cents) is an employee or also a volunteer, and if the latter, whether he can keep the change.

There is a bridge made from vines that the villagers made in order to cross the cascades. It is in rather poor repair and fortified with man-made ropes. Our guide showed off, walking a few meters onto the bridge, saying that we probably couldn’t do it but he was and experienced guide. “Huh,” I puffed, “I can do this,” and we were all allowed to take a few steps on the wobbly rope bridge. Clearly, there are no lawyers here who make the rules. It is not that difficult when one has no baggage but I was wondering about women having kids on their backs and wares on their heads when a deadly force races by several meters below.

We returned to the concrete slabs and made our way to the big cascade. A large pool in front served as a self-cleaning swimming pool. Two small boys in their underwear were having a great time. Higher up the cascade formed a series of plateaus, nooks and crannies which enticed many adults to partially disrobe and take a shower while posing for their friends.

There is a steep path to the top of the cascade which we declined to take – our shoes were the wrong footwear and it was too hot. We also declined the two hour walk up to the ‘dents de Man,’ two large boulders that could have been the teeth of a giant.

On our return we went back to La Paille, the Senegalese restaurant where we are taking all our meals outside work hours. Today the waitress was rather sullen, eating a banana in a rather seductive way while taking orders. It looked as if taking an order was a tremendous effort on her part, as if she’d rather had the customers go away.  But she had an amazing hairdo and I was allowed to take a picture. It is the only smile she gave us.

I ordered again a Cieboudien (also affectionately called a Tjep), Senegal’s famous rice and fish dish, but with chicken. That was a mistakes as the chicken must have been of the elderly kind – little meat and sinewy.

Back in the hotel we went to check out the conference room and found the trainers of a workshop that had just finished. The topic, according to the banner with logos of the International Rescue Committee, the French, the EU and the Ministry of Health indicated that the workshop had been on the “Renforcement du système de santé.”  Interesting, I though, we are doing the same, but we are doing it with American money; and as I have learned along the way, usually the French and American development aid groups work in parallel without much contact and sometimes even in direct competition.

Here we are, working on intersectoral coordination when coordination within the health sector is hardly happening.  We ended up chatting with the organizers and discovered that they had been training midwives in safe motherhood and delivery practices. That too counts as health systems strengthening (everything counts as health systems strengthening – abbreviated as HSS- these days). The representative of the International rescue Committee mentioned she was not invited to our event so we quickly extended an invitation as she is clearly another critical player in the HSS dance.


May 2017
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