Posts Tagged 'New York'

Distilling actions

The months and weeks leading up to the NY consultation included many skype calls and iterations of the agenda – we were retrofitting activities into a solid design. It was just-in-time, with the finally pieces falling in place just hours before the end.

We nearly always called each other from different continents – often late at night or early morning for at least one of us. Some of these late night skype calls took place during my vacation in Thailand and Vietnam. There were times I regretted to have accepted the assignment.

It’s hard to join a design team in midstream, especially with people whose comfort zone is with the traditional format of individual presenting alone or on panels followed by Q and A’s or when the organizers feel not entirely in charge.

The traditional format (powerpoints followed by individual questions and then answers from the presenter), especially with 80 people in the room can be deadly. Individual agendas can easily hijack the usually few remaining minutes in a session. Everyone has experienced this more than once. And yet, unfamiliar with alternatives, most public health experts I know repeat the pattern of the old format over and over. It is what they known and what keeps them in their comfort zone, even though such a format is hardly engaging. When I ask about such experiences they sigh, as if this is an inevitable course to follow.

I love to show alternatives, what is possible, and how to get to the action – which is what people always say they want. But unreflected action is worse than no action. There has to be a process for meaning making and culling and vetting. This is why we need structures for meaningful interaction. And just as with physical structures, conversation structures also needs architects.When we select speakers and let their activities design the event we are putting the cart before the horse. And when we attach ourselves too much to narrowly described pre-set outcomes that may not be shared by all those invited, we are also unlikely to get value for money.

I am always struck about how much fear there is that ‘things will get out of control, that dominant people will hijack the meeting or minorities don’t feel safe to voice their opinions.’ The irony is that without structure, this is eactly what will happen.

There is always wisdom in the room but that this wisdom is either unrecognized or unfiltered. The process of coming to shared insights is a distillation process, with lots of impure stuff being heated (talked about with passion), then run through a cold water pipe (the realities, conditions on the ground) until the really good stuff comes out in small drops. And that is finally what we did. I was really happy after all to help make that happen.

We celebrated the end of the event at a small tapas place next to Central Station after which we all went our ways. I walked to Penn Station which was way too frantic for me and must be very intimidating for innocent tourists. I couldn’t wait to get into the train, have my dinner and a beer. Four and a half hours later I tumbled exhausted into bed.

Community and presence

I enjoy working with people who don’t know that you can get a lot done with 80 people in two days. One woman from Uganda said, after we collectively defined what integration meant in about 20 minutes, that this exercise would have taken them days or maybe even weeks back home.

When people express wonder, amazement and appreciation for the facilitation, they don’t realize that they are commenting on the design. Facilitation is very easy if the design is solid, even for newbie facilitators (maybe not easy but doable). Facilitation is very difficult if there is no design, even for experienced facilitators.

I believe the appreciation comes from having one’s voice heard or seeing that space is created for the quiet voices.  Those whose voices are always heard, and often too much, don’t usually express such appreciation. They sometimes bristle at the structure that I impose.

“Everyone participated!” say the ones who want to hear everyone’s voice, as if they can’t quite believe it.

For me this is simple and never a surprise; people participate because there is no way not to participate. The only people not participating are those who are doing something else on their phone, tablet or computer, or are taking calls outside the room. To reduce these absences, I periodically sweep through the room and close computers or turn over smartphones that are being used for some other purpose than the meeting. I do this with a smile. Some people thank me for it, some get defensive (“I was looking something up!”) and some get a bit prickly. people learn fast. When they see me coming they put their phone down so I don’t have to do it for them. I am acting like an old fashioned teacher, people recognize that quickly. It works.

In the development world I work in, I often hear people say ‘value for money.’ It is also one of MSH’s strategic priorities. Yet we are surprisingly tolerant of meetings where half the people are not present, even though the limited development resources that we always complain about, have been paid to physically bring them in. I think I know why we tolerate this kind of behavior: we are uncomfortable confronting people, especially those higher in the pecking order. Under the guise of being polite, we actually collude with people who are not polite. If we are saying we want to do something together, then shouldn’t we all be present together? I sent those who cannot be present out of the room.

Despite all the kudos and raves, I didn’t even feel that this meeting was as good as it could have been – there were a few disconnects, speakers who came in for their session, unaware of what the group has already discussed and defined; the schedule was rather full leaving little time, too little time, for serious discussions and reporting back.  Because of that, running late from the get go, unrealistic expectations were not examined and thus, there were disappointments at the end. Some critical voices were missing and there were too many wishes and wants resting on different agendas that had not been sufficiently confronted. Hierarchy and seniority always gets in the way, here and everywhere else.

Still, I was pleased with the productivity, the expansion of the community of activists and the good energy in the room. Things could have been improved with more time for dialogue, more focus, scribing and music. I hope there is a follow up where we can do this.

A brief trip to NYC

Some months ago I had agreed to facilitate a consultative meeting in New York City, just days before my planned trip to South Africa. It would mean arriving back home at midnight the day before my departure to South Africa. I accepted because I love such assignments, even though it was a bit of a sacrifice and there were moments I regretted my ‘yes.’

It was a consultation about getting childhood tuberculosis considered as part of a broader package of maternal and child health interventions as the local level. This may sound simple but it is far from simple. Local level ultimately means the community level. This is the level where, in many developing countries, the usually unpaid community health workers are fulfilling the most basic tasks of prevention, diagnosis and treatment of illness. These people often have little education and sometimes aren’t even literate.

They are trained to fulfill their various tasks through vertical programs: the malaria people provide materials, pictorial algorithms and instructions, training sessions and reporting forms. And so do the health education people, the maternal and child health experts, the HIV people, the TB people, the nutrition people, the vaccination people, and so forth. A participant from Uganda told us that she has seen community health volunteers who have to fill in 11 registers to show their task masters what they did each day or week or month or quarter.

The purpose of the consultation, led by UNICEF and the TB Alliance, was to learn from other experiences of integration and consider the upstream implications of integration at the base: the health system functions, the financing, the evidence and identify the research agenda that would give guidance on how to proceed and avoid mistakes of the past

I took the train to NYC, having calculated that plane or Acela train would take about the same time and cost about the same as well. Sometimes we hear about Amtrak trains derailing because some system was poorly maintained or the conductor was driving too fast. These things happen and make a big splash, but they are rare. I boarded the train hoping all systems were maintained and the conductor had had a good night sleep and followed the rules. I arrived safely at Penn Station, though the trip took a bit longer due to a few glitches that were annoying rather than deadly.

I arrived at UNICEF just when the place emptied out for the day. I finally got to meet my team mates in the flesh (though one I had met nearly 20 years ago in South Africa). We did the finishing touches on the design and flow of day 1 and identified what still needed work for day 2. Since all my team mates were lodging in places far apart I was on my own for dinner and too tired to visit anyone. I consulted Trip Advisor and found an authentic Japanese/Korean restaurant across the street. It was full of Japanese and Koreans, which confirmed the rave review, and I was greeted by all staff the way I remember from Japan. I also discovered a Japanese convenience store a few blocks away and stocked up on some delicacies to nibble on later, while watching TV in my tiny ‘central location’ hotel room.

I watched an amazing PBS program in which Stephen Hawkins turns theoretical constructs into a series of ingenuous experiential exercises for teams of three young scientists. The take away message: we are infinitesimal small in the greater scheme of things. It was another reminder about keeping perspective.

July 2017
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