Posts Tagged 'Tanzania'

Learning halfway around the world

Today (Friday) our Learning Summit with ICRC ended in Dar es Salaam, but I was already gone and spent the day in Amsterdam while Axel made his way westwards across the Pacific and then China to meet me in Kuala Lumpur. He should be there by now while I still have a 12 hour night flight ahead of me.

After a 10 hour not so restful night flight from Dar es Salaam to Amsterdam I decided to treat myself to an upgrade and managed to get the last seat for 40.000 miles and 250 Euros.  I have just this one night to get ready for the next assignment which will last from Sunday afternoon till Thursday next week. During that time Axel will wander around KL, find us nice places to eat at night and prepare our trip to Vietnam.

My assignment in Dar es Salaam was short, just three days. We had some 40 people from Asia and Africa and Europe participate in a “Learning Summit” – with the learning aiming at a better understanding of how ICRC program managers and their partners, rehab center managers, can better manage and lead the services for people with mobility challenges, and mobilize the disability sector to push ahead with the implementation of the United Nations Convention on the Rights of People with Disabilities. With four colleagues from MSH it was light work for me. I left the group in good hands. This may well be the last of a whole series of event with ICRC. We have made good friends and everyone has learned something about the others’ trade. It has been a wonderful ride.

Now I am getting ready for more wheelchair related work, a management training for rehab center managers and a stakeholder meeting to bring together Malaysian stakeholders who are critical to make services available and accessible to people who need them. It has been among the more rewarding assignments in my long MSH career.

In between Africa and Asia, in between ICRC and wheelchairs I enjoyed a day with my friend Annette who lives in the heart of Amsterdam. She bought me my favorite foods, raisin rolls with old cheese and osseworst (raw beef) on dark bread. We walked up and down the colorful Albert Cuyp market, had herring, a freshly made, still warm stroopwafel, with syrup dripping down my hands. We drunk coffee in a hip place (not a coffee house) and strolled along lovely shops as if we had all the time in the world. We did. Amsterdam can be so bewitching in spring (and any other time when it is not bone chilling cold and/or raining).

Calls and cuts

Our two days and a half of hard work, calling something into being that doesn’t exist yet, came to an end at lunch time yesterday. We accomplished what we set out to do, and more, the latter to the surprise of a few doubting Thomases, who admitted their delight in our closing reflection.

We went from divergent to convergent thinking, from the weeds to the clouds and back, and ended up with a good foundation of the house we are building as the faint outlines of the vision began to emerge: a space and a place where people involved in health education can connect, learn, scheme, assess, experiment, etc. At times there was some hesitation – could we pull this off, ever? – but when we closed everyone has recognized that, with enough hands on deck and good steering, we could do it. We were swirling in images, weeds, clouds, foundations, steep staircases, decks, breezy rooftop hang outs, winding dark alleys, dead ends, open spaces, etc.

Some of the imagery came from our last dinner together on the roof of an old house, located in the middle of narrow winding alleyways that could barely accommodate the tuk-tuk that took me there. It appeared to have been made for giants – steep stairs with threads double the size of what I’d call normal – and furniture larger than life. At the rooftop restaurant however, the place was for little people: tiny tables, pillows, a mufraj of sorts, with large swaths of textiles flapping in the wind over our heads, and the muezzin calling from everywhere around the island, not quite in synchrony.

Facilitating for three whole days and the intense humidity had not been kind to my ankle. An unexpected long walk to Freddy Mercury’s restaurant on Wednesday evening reminded me that the surgery had only been 2 weeks ago. I started icing my ankle again and keep my foot elevated – seated facilitation became possible because of many helping hands from a solicitous team.

The cutting of the internet cable in Egypt didn’t just affect the Middle/Near East and India, as reported, but also a good chunk of the east side of Africa. Checking in for our puddle jumper to cross back to the mainland was rather chaotic with the internet down.’ This was not a local event, as we had assumed, but something much bigger – an Achilles heel exposed.

We received hand written boarding passes after showing a print out with a ticket number. The part of the system that did not require an internet connection (dedicated workers) trumped all and showed that there are still memories here of LBI (life before the internet). We took off and landed exactly at the appointed hour. Quite amazing!

I had myself dropped off at the Hyatt where a colleague was just finishing her trip, heading out to Amsterdam. We were able to squeeze in a beer and some bar food before checking into my hotel in another part, a pricey deal for a very short night: convocation at the airport at 3:00 AM. And that is where I am right now: off to Nairobi and then crossing the continent for Abidjan.

Changing behavior

Ten of us have converged on Zanzibar from a few corners of the world. There are two Ashoka fellows, one from Delhi and the other from Dhaka. They are the kind of people who get showcased on the Stream, Al Jazeera’s must see program about what Millenials are up to. I only watch the Stream when I am on the road. I marvel about the intensity of their social activism and the cleverness of their inventions, often combined into a successful venture. I bet there is a relatively large proportion of social entrepreneurs in this age group. One of our two fellows, I turned out, was indeed featured on the Stream, some years ago.

We started the day with introductions, questions about ‘What does your name mean and/or who were you named after?’ ‘Who are your people and what values did they instill in you?’ and ‘What is one novel and refreshing idea you have heard recently?’ The stories made us laugh and inspired us.

I am the insider/outsider in this group – insider because I am a member of the project team and outsider because I am only facilitating the work of this group of people (I am not a member of this nascent Advisory Council). But also because the world of behavior change (for health) communication is a parallel world to the one I inhibit that features management and leadership. Of course, when you think of it, we are all engaged in behavior change, our own. That is particularly true for me as I am learning to be a coach.

The work of the group is to form itself into a Council that will advise the formation of a Marketplace for organizations and people involved in ‘communication for health.’ We mindmapped the accomplishments and challenges in the field and looked at examples of effective communities of practice. Today we will put these together as we sketch a first vision of what this ‘thing’ we are calling into being might look like. We worked long and hard – beyond the planned ending time – because we had run into a challenging set of questions. The group wrestled with these for a bit until we got some traction and then we called it a day.

We had our dinner last night at Freddy Mercury’s restaurant. I had to be reminded that Freddy was a member of the band Queen. He was born on this island, destined for musical greatness according to the intro on the menu. There were pictures everywhere of Freddy and his band and the women’s bathroom was labeled Queen (men’s was Kings of course). Despite our multiple requests for Bohemian Rhapsody we were fed Brittney Spears and the likes alongside our meal. The food wasn’t quite in the same league. Sitting next to the ocean you cannot go all that wrong with skewered prawns, but I counted more heads than tails.

The restaurant offered cocktails with names designed to get foreigners to buy overpriced drinks that are in the ‘meh’ category – who could decline a ‘Romney’ or an ‘Obama,’ There were adjectives attached to those but I can’t remember. I stuck to South African white wine.

The restaurant was a 30 minute (slow) walk from the hotel and did little for my ankle. Before the operation I could not have walked both ways. Now I had trouble with the return trip only – only a small comfort. The icepack I brought, which in the hospital seemed reusable, doesn’t want to close anymore. I will have to fumble with plastic bags with ice cubes again. The operation does not appear to have improved the situation as much as I had hoped. My ankle (tibia/talus) joint has gotten stuck a few times again and the pain radiates out into my ankle bones. But right now I don’t want to think about what next as such thoughts are even more painful.

Memories calling

I am back in the land of Islam. The vast majority of Zanzibari are Muslim. And so I listen to the call of the muezzin and it transports me back to Afghanistan. There is something very soothing about that call – a permanence amidst chaos.

I do miss being in Afghanistan, strange as that may sound. The place has an addictive quality to it that is hard to explain to anyone who only knows Afghanistan from the media. But anyone who has ever been there (really there, not in military garb) understands, instantly. We are all bitten by the same bug.

And so now I am in Zanzibar and only barely present to the town. I made one quick outing into the old city which was sleepy and quiet after lunch. It s good to do nothing as it is very hot and humid, and any effort is met with lots of perspiration.
Today the last of the people arrive for our meeting. We reviewed the program and are mostly set. The sun is setting, the sundowners consumed and I am looking forward to another great seafood meal, meeting people I have never met before. What fun!

Lala salama

A peaceful night I had indeed, under my mosquito netting canopy. Nothing disturbed me except a dream about physical decrepitude, a body that ached all over. I woke up stiff and followed the wise instructions of my DVD yoga instructor to loosen up. The post breakfast massage finished the job.

I met a few of my team mates last night for dinner at the beit-el-chai restaurant across the hotel. We drunk a cool South African Chenin Blanc, sampled variations on Bouilabaise and exchanged stories.

Today is reserved for reviewing several documents that are under construction and dot the ‘i’s and cross the ‘t’s in my facilitation notes for the meeting that starts tomorrow. This will keep me busy for the rest of the week.

I tried to conduct my weekly coaching session by phone, then Skype and had to give up. The Internet connection is OK for mail and surfing but it doesn’t quite support voice.It will set me back a bit but in the greater scheme of things, I decided, it is not important enough to worry about. next week I will try again from Abidjan.

Ups and Downs

I am at Schiphol airport waiting for a connecting flight to Boston. I have decided to not let anyone know I am here so I can finish my reports; the next trip is very soon and I don’t want to work this weekend.

I am out of Africa. It is a traditional call I make to Axel, announcing my new position on the map. I do this early in the morning while he is still up the night before. This time I got Sita on the phone as well. These are some of our small rituals.

I left Tanzania somewhat deflated, without an ounce of energy left. The road trip back to Dar es Salaam took a lot out of me; more than I at first cared to admit. I emerged from the car in pain and stiff as a plank and then my mood began to change; from the high spirits of having accomplished what I set out to do to feeling hopelessly inadequate in the face of overwhelming odds.

Each time I leave Africa I am more confused. The more I learn, the more I know. And the more I know the more I know what I don’t know. And in times like these, when my mood is low, I wonder how I can be of any help. Everything appears to be related to everything else. It feels a bit like untangling miles and miles of hopelessly tangled up yarn. You look for a beginning or an end, to start untangling. And then, not being able to find either one, you take a pair of scissors and create a beginning and an end. From then on it is slow going. Sometimes you feel you are just making things worse; instead of one gigantic tangle, you create a whole bunch of slightly smaller tangles, all as daunting as that first big one. The worst part is that seemingly well-meaning efforts at untangling actually mess things up. I am referring to the hundreds of models, tools and approaches that are being offered by helping hands, some incompatible yet offered to the same people. It is a bit of a lose-lose proposition when I begin to think like this: I am either adding to the tangle – so why continue? Or if I think I am not, I can fool myself by using reasoning that is self-serving, also called arrogance. Of course I have to remind myself that these words and sentences come out of a particular mood. I don’t always think like this; I would not have lasted this long.

Yesterday morning, Isaac and William had asked me to say a few words at the opening of their leadership program, now in its third day, “people would like it.” Participants don’t often see the folks who developed the materials they study. I asked the participants what has changed for them as a result of this program. It was hard to get volunteers so I called on people by giving them the microphone. It is always a struggle, anywhere in the world, to get concrete examples; people tend to use words that are titles of workshop sessions. Up front only one member of a team sits at an otherwise empty table. I asked her what happened to the rest of her team. She explains that one is in the internet café checking up on a letter and the other she doesn’t know about. Getting participants to apply what they learn about being pro-active directly in class is hard; I challenge her to be more active and get her team complete by taking action now. My exhortation clashes with the polite attention that is given to foreigners. Nothing will happen until I leave, if then.

I checked out and paid my bill and then went to the other hotel where the AIDS meeting was held. I arrived in the middle of a morning discussion and I could sense that the meeting had heated up from yesterday. Some agencies had not delivered on promises according to the government representative from one region. Another demands that these discussions are frank and honest, rather than the usual Tanzanian mode of exchanging pleasantries. I so wish I could follow Kiswahili. The session is conducted in the way that Mandela describes how his father held court in the Eastern Cape. The Chief (Chairman) sits in front facing the people who are seated in semi-circular rows facing him. What is billed as ‘plenary discussion’ is actually a very disciplined and choreographed process allowing people to speak, one by one. Their words are addressed to the chief, but everyone listens attentively. There are few non-verbal cues for me to gauge whether they agree or not with the speaker. Sometimes there are a few smiles or hmmms. This is not dialogue but serial monologue. Occasionally I get a translation. I am learning that the reporting process does not accomplish its purpose. Reports are missing; they appear to describe inputs and outputs, or maybe process, but say little about what is different as a result of their work; they also appear hard to read. Imagine nearly a hundred of those. It is no wonder that there is no feedback loop.

I am trying to figure what is at stake for the different groups in this meeting. It appears to have something to do with the modalities by which the national secretariat reaches civil society. The creation of new, temporary structures that consists of NGOs or consortia for the implementation of the project is supposed to help ‘push the money down’ where the government does not have the capacity to do this on their own. The temporary structures have two main purposes: building the government’s capacity at the regional, district and local level and managing the grants given to civil society organizations to produce a string of small victories in the battle against HIV/AIDS. It seems that these two are not always meshed together as they should, but implemented in parallel. Some government people are indicating that the capacity building has not happened and that they don’t know what is going on. Of course in all this the enormous amount of money involved muddles everything. Someone remarks, “If you have a lot of money you don’t need to involve anyone, you can just go it alone.” As an American citizen who contributes her tax dollars to help foot this bill, this is of course not what we intended.

bushclothfull.jpgOne of the women wears a dress made out of US-Tanzania friendship cloth. If there was an archive of bushfacecloth.jpgspecial occasion cloth you could trace the visits of important people across Africa. This includes presidents as well as religious leaders. When we break for tea I take a picture of her, with a separate zoom into Bush’s face. It’s the kind of picture you see in obituaries – depicting a much younger Bush. I wonder about the design and production process of the cloth. Was there an official request, an official picture provided by the embassy? I can just imagine Laura and George sitting with a photo album on their knees, and Laura saying, “George, I think this picture would look fabulous on the belly, bosom and back of a lady in Tanzania!”

At tea break I sit with three women from local government. I ask them how the process of working with the facilitating agencies has been for them. At first they are cautious in their responses but soon they loosen up. They complain about something that I hear around the world. It is a complaint that is wrapped in communication language but that I have come to see as a symptom of something else, maybe a deep-seated fear of inadequacy? It is constantly fueled by the absence of acknowledgments and appreciation for work well done, or by the carelessness with which people communicate (or forget to) with one another; the sense of inadequacy or incompetence is thus reinforced; self protection then leads to resentment of the higher ups, since they are causing this feeling after all. If you belong to a minority group, like the handful of women in this meeting, the resentment is doubled. Instead of spirited engagement we get resentful entitlement. Money has to come to the rescue to ‘motivate’ or ‘facilitate,’ a pervasive belief. This is how I believe we mismanage the most precious of human resources we have: the energy to invest one’s time and creativity in doing a good job. I am re-reading Elliott Jaques about Executive Leadership. He states something that I know to be true from personal experience but also from watching others: “People are spontaneously energetic with respect to the things that interest them.” Could we possibly try this notion on others?


The meeting I am attending helps me understand better the context and realities of this country’s response to the AIDS crisis. The meeting has only one other white person in it, a German who just started living here. The meeting’s language is primarily Kiswahili. Although the German looks like he understands Kiswahili, he confides to me that he doesn’t. Once in awhile I recognize an English word such as ‘bureaucracy,’ or ‘sustainability.’ Periodically I ask for translation but I am mostly watching people. Occasionally my neighbor makes a remark that gives me some clues about the issues she is thinking about and that need her attention. Sometimes these are commentaries on what other people say, or on statistics; and sometimes they are topics that only women will understand.

I made a trip to the tiny internet café of the hotel where the meeting is being held to discover that the computer runs on very old software. A message showed up that the system is no longer protected from viruses because the software has not been updated. By then I had already picked up the Trojan Horse and the Rungbu virus on my pen drive. I spent the rest of the morning scanning my computer to make sure no other viruses crossed over.

At lunch I sit with a retired professor of Muhimbili School of Public Health. He is a sociologist and talks to me about the early years of the AIDS epidemic when he was a lone voice crying in the wilderness. There was and still is much stigma attached to being HIV positive and he has lost many colleagues, educated people, who even on their deathbed were not able to acknowledge the disease they were dying of.

From the presentations and side conversations I learn much about the ripples and unintended side effects of the huge amounts of money that stream into the country in the battle against the disease, especially how it affects the lowest layers of organized civil society, the community-based organizations. They are trying to implement activities at the village, ward and household levels. There are expectations that money will solve all problems yet spending the funds has repeatedly been problematic, suggesting that something other than money is needed. [Bunny, the main character in Upton Sinclair’s Oil! remarked on page 490 that “he had learned this much from his father, that money by itself is nothing, to accomplish anything takes money plus management”]. As it happens, this is also one of the main messages of our Leadership & Management Program.

Another side effect is that the care of orphans and those affected by the disease is beginning to discriminate against those who are not HIV-positive. As the wife of the President of a neighboring country commented, “why, you are making people want to be positive!” Apparently in some schools there are more AIDS orphans than non orphans (one indicator programs are being evaluated on). This of course creates much resentment among those who have managed to stay healthy, but poor nevertheless; their schoolfees are not being paid. And finally, it appears that the implementation of care and mitigation activities, two of the three major strategies, are beginning to overshadow the strategy of prevention. As long as prevention is not effective, the other two will require increasing amounts of money to sustain an ever growing pool of people affected by the disease.

One PowerPoint presentation follows another. There are close to twenty. It becomes increasingly difficult to see the forest through the trees. This is too bad because I know there are other ways to structure such meetings that would help create more of a dialogue and keep the forest visible through the countless presentations describing a multitude of trees, some the same and some different from one another. Simple mind-mapping would already have helped; not on the wall though. Hotel management has posted a sign that nothing can be put on the walls. But I could have done it on my computer, quietly in the back, if only I would understand Kiswahili. So I am struggling with how to stay awake, making to-do-lists and writing in my journal; and when that is done I play solitaire. I am sitting in the back row and so I can see that I am not the only one; but, thanks to my Calvinist roots, I appear to be the only one who is self-conscious about it.

I also break the monotony of presentations I cannot follow by taking bathroom breaks. Outside the room are large framed portraits of participants, taken in the morning, developed and printed on large glossy paper and framed in cheap plastic frames. This is a gamble that the photographers take – there is no guarantee that people will buy their pictures; and if many don’t, it will be a significant monetary loss. Apparently they know their market – they are selling well and it must make it worthwhile. They also must have learned over the years not to take pictures of the white folks because they don’t buy. That is correct and I am grateful there is no portrait of me in the gallery.

On Wednesday night, after a work session, I have dinner with William and Isaac. I came back to the hotel too late to meet their participants. This will happen on Thursday morning.

At night I pack while watching a Nigerian movie about a bad church leader. There are many fat men in it with sunglasses and sticks and skinny young women who whimper a lot. I can’t understand what they say but I don’t need to. The story is obvious. The announcement for the next episode promises that things will end badly for the church leader. That is good.

The next morning I watch another Nigerian movie. Once again there is the fat man, also with a stick, but this time also a little fat and obnoxious boy. They are bad and because of that I know they will come to a bad end. There are also several skinny, poorly dressed men who act like children in the fat man’s presence. They too whimper a lot. Witchcraft, in the shape of eggs and wax dolls play a prominent role in both movies. I soon learn why. When the movie is over the credits say ‘Thank you Jesus, you are my inspiration!’ This is Nollywood, with a religious twist.

May 2018
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