Posts Tagged 'Uganda'

Back home for a bit

A whole week has passed since I left Kampala. This means I can temporarily halt the taking of anti-malaria medicine.

My next assignment, hardly leaving me a chance to recover from the week in Uganda, was the facilitation of a worldwide technical summit organized by my pharmacists’ colleagues. We looked at the work that has been done over the last 4 years to improve pharmaceutical systems so that medicines are available in health facilities for those who need it. Colleagues from 17 countries joined headquarter staff to extract lessons learned and find out what they need to focus on in the last project year. I had been part of the organizing committee since the beginning of the year and getting the program designed had not been an easy task, but in the end everything came together nicely, the energy was right, we got the outcomes we had hoped for and we had fun in the process.

Axel had driven down to DC, stopping along the way to visit friends and family. He arrived in DC just when I landed from Kampala via Amsterdam and Boston and picked me up to deliver me to my DC hotel. It was like a brief spousal visit before I dove into the conference and he continued his visits with friends.

On Saturday morning we set out for our long drive north, after a good breakfast at the Red Fox deli on Connecticut. The whole day we drove in the rain; it was rather cold given that we are now officially in summer and it is nearly July. We interrupted our trip at Sita and Jim’s for tea before continuing to Manchester (still in the rain). They had just returned from a vacation on Lake Champlain with friends.

We arrived some 14 hours after we left DC to a wet and wild Lobster Cove, which continued to be wet and wild throughout Sunday – perfect for staying indoors and getting ourselves organized for next week which includes Tessa turning 30, the 4th of July and my return to Africa for another 3 week assignment, partially in Madagascar and partially in Togo.

Truth to power

We finished the four day Coaching & Communication workshop for managers, supervisors and coaches who are responsible for reproductive health or other health services. Eighteen participants joined us, coming from the Ukraine, Ghana, Kenya, Tanzania, the DRC and Uganda. We had revamped an older curriculum that was based on a modular approach spread out over a long period of time. It was a test and an opportunity for us to try something new.

As usual I kept exploring and reading until I landed in Kampala to see if there was something newer, something potential more impactful that we could add to the mix of inherited sessions. I revisited and re-read Kegan and Lahey’s book about competing commitments which I sensed was just the antidote for the usual New Year’s Resolutions that we see at the end of workshops (I will work on my listening skills, I will be a better human being, etc.)

We had reserved the last session for exploring of competing commitments and the concept of immunity to change because it required some level of trust and intimacy in the group. We felt we had reached that stage because of the constant practice sessions in trios. By Friday everyone was quite familiar with the daily life struggles and challenges of each other, and recognized how universal they were.

Everyone came with five challenges they had to deal with, related to relationships with peers, with bosses, with recalcitrant or non-performing staff. All of these they considered obstacles to both the quality and quantity of service delivery. This link to services was important because both our funders and their employers had agreed that this workshop would ultimately benefit the users or would-be users of those services. This was an assumption that we had to prove. We engaged everyone in this collective challenge by creating our theory of change which then informed the development of our monitoring and evaluation plan.

We had created several opportunities each day, usually in trios, to apply and practice the various concepts we covered: giving or receiving feedback, coaching, listening, inquiring versus advocating, facilitating learning, repairing relationships, exploring why we often cannot be honest when we have to have the hard talks, and re-writing the scripts of failed conversations.

One recurrent theme throughout the process was the inability to speak truth to power. We could see how, for them, as it is for us on the other side of the Atlantic, not being able to speak truth to power is the cause of many initiatives failing to deliver on promises (at best) or terribly gone awry (at worst) with sometimes catastrophic consequences for individuals or whole populations.

We used aIgnorance is bliss Calvin and Hobbes cartoon as teaching material. Despite Hobbes’ warning that they (Calvin and Hobbes) are heading for a cliff in their red radio flyer, the wild ride continues. Why worry about later when you are having fun now?. Hobbes is speaking truth to power (we are heading for the cliff), but is unable to stop the inevitable and unpleasant conclusion of the ride from happening.

We can all come up with examples of this in real life. The US’ misguided actions after 9/11, the arms race, dictatorial regimes, and, at a micro level, the sons of powerful persons who are never held accountable for raping or impregnating school girls.

Except for a few very brave souls (many of whom either stand to lose their freedom or live(lihood)), most of us reluctantly accept what happens so that we don’t have to fight with our demons or confront our deepest fears. In the immunity to change session some people did get a whiff of those fears. Although they could be real (when the stakes are high) in ordinary life many of our fears are imagined and never put to a test. If we did, and found out that they are unfounded, lots of things would stop to be problems, and many a ride towards a cliff would be diverted in time.

Back to work

I managed to stay away from my computer during most of my vacation week. This worked because there are some very capable people in the office who took over. I had no sleepless nights over this. In fact, I have slept better than ever in the last 6 months because my shoulder is no longer bothering me.

I continue to get high marks from my physical therapist for my progress. I have to watch out not to progress too much because the ‘no weight bearing’ remains in effect until July 27.

On Friday night I was back on a plane to Holland. This time with Tessa and Steve who joined me for my brother’s wedding – a second marriage for both – but celebrated as if it was a first. The only things that gave this away is that there were, between husband and wife, 9 (grown-up) children and no one was in white. We celebrated the melding of two families, or may be even four as the parents of one ex and one deceased spouse were also there. It was a joyous and warm celebration despite the nippy not-quite-summer-night weather. Tessa got to hang out with her cousins, a rare opportunity, and schemed to have everyone come to her wedding next year.

I left the party early to catch up on sleep and prepare for the next assignment, in Uganda, while Tessa and Steve partied on and left for the east of Holland with another brother and his wife, to explore lesser known parts of Holland by bike.

I got up when some had just gone to bed and most of Holland was still asleep to catch a train to Schiphol airport, boarded the plane to Kigali and Entebbe, and arrived at my hotel in Kampala at midnight. The quiet of the night allowed for a swift ride covering the 40 km from Entebbe to Kampala in less than an hour. Apart from the few drunken young men riding on giant Easy Rider type motorbikes, helmless, there was little traffic, a good thing. We let them pass and hoped to not see them again later by the side of the road. We didn’t.

One down, one to go

My co-facilitator has left after a day of debriefs, next steps and new assignments, two actually, falling into my lap which may require another trip to Uganda later this year. I am settling on the last trips for 2013: Pakistan and then Uganda.

We completed the retreat that produced a solid first draft of a strategic plan, with choices made and focus areas clarified. We looked for things that cost money and where the money could come from and things that can be attached to activities already funded. It was hard work, three days of hard work indeed.

We ended the retreat with everyone plastering everyone else with colored sticky notes indicating what everyone had appreciated about everyone else. We were quite a sight and parted on a high note.

Susan and I celebrated the completion of our assignment with our last Indian meal at the terrace looking out over Lake Victoria in the cool evening air, cleared by monsoon like rains during the day. We have been eating superb Indian food all week long and had pretty much exhausted the choices on the menu.

Today we finally made it out of the resort hotel and headed into Kampala proper. We had lunch with our client and then headed out to the MSH office to meet colleagues known only via Skype or email, shook hands with some of the 200+ office staff we have here in Kampala, met the chief and a colleague I have known for decades who is now one of the four project directors.

I packed my suitcase watching Ugandan TV and was surprised to see a special on vasectomy. That would not have been possible a decade ago I believe. A banner ran at the bottom of the screen stating that ‘experts target men as population spirals.’ I have been wondering ever since what that means.

Victoria views

We are lodged at the Speke Commonwealth Munyanyo Resort. It is a vast conference complex on the shore of Lake Victoria. “It is the biggest lake in Africa,” said the young man who was showing me my room, proudly.

My room looks out at the man-made Marina where a few fancy pleasure boats are moored plus a few canoes, upgraded versions of the traditional hollowed out tree trunks. We hired one yesterday for a spin around the section of the vast lake where the resort is located. There are birds everywhere: grebes, egrets, marabout vultures, kingfishers, and many I cannot name.

Breakfast is served on a wide porch that the British knew so well to construct in the buildings you can find all over the commonwealth. The main impetus behind this is, I believe, the sundowner as these terraces are always facing the setting sun. It is kind of a G&T place.

On my first breakfast I was just about the only woman on the enormous porch, surrounded by at least 50 men. I didn’t recognize their language, it sounded rather unfamiliar, and their skin color didn’t give much away, a generic pale coffee color. I asked and discovered they were don Turkey. I was able to greet them in their own language, to their great surprise.

A rest in between

The global meeting is now behind me, and so is Uganda. It is a strange sensation to know that, after nearly 9 months of planning, this big task is now completed. We said our goodbyes after a most festive closing dinner and talent show.

The talent show surpassed my expectations. My efforts to rope in people simply by putting them on the program worked. Everyone rose to the challenge, as confidence rose during the meeting and the energy level went up. I saw how high and positive energy makes people more willing to take risks.

We had dance demos (Salsa, Ethiopian, Afghan, Ukrainian, shimmy), magic tricks, we had skits poking fun at ourselves, and, I believe, the first MSH project I know of in 26 years that has both a rap and an anthem. The latter was an adaptation of Gloria Estefan’s Reach, focused on medicines – meds within reach, sung beautifully by one of our new staff members, a young woman from Mozambique with help from some other great voices; and then everyone got into the act.

Sprinkled between the performances were paper plate awards. We had one for best eater, PowerPoint with the fewest words, most energetic participant in anything, best reporter, best photographer, best hat maker, most portable trophy and more. I received the ‘best herder of cats’ award. The paper plates were beautifully decorated by the chair and only member of the awards committee. We all had a good laugh and then danced into the evening.herder_of-cars_award

It had been a moving last day, with the realization by many that the technical work of pharmaceutical management is incomplete without the self-reflection and self-awareness that have to produce the behaviors that make ownership and buy-in by local counterparts possible.

Saturday morning I joined many colleagues from Southern Africa. We left at 4 AM from the hotel to catch the 7:30 AM flight to Jo’burg. Four hours later we split into ever smaller groups: one went to Lesotho, another to Swaziland, a third to Mozambique, a fourth to Angola, a fifth to Namibia and a few of us by car to Pretoria.

I was dropped off at Katie and Josh for a braai with the participants of my new workshop, the one that starts tomorrow. But my mind was frazzled from not enough sleep and I did not retain any names. In the evening we went out to a wonderful restaurant (Kream) where we had ordered a series of exquisite starters that left me too full for the main dish and unable to even consider a dessert. I had steak tartare, crocodile Carpaccio, saffron scallops and more delicacies, accompanied by a wonderful wine of which I could only drink two small glasses before my eyes started to close spontaneously.

Pretoria winter weather is wonderful: blue skies, dry, clear air, cool at night and in the morning and evening and pleasantly warm during the day. Today Katie and Josh picked me up for a 90 minute Thai massage and pedicure, followed by a cappuccino in one of the many malls. The rest of the afternoon was for catching up on tasks that had been patiently waiting in my in box, and some writing.

And now onward to a workshop in which I have no organizing responsibilities – I am there as a participant, to listen and learn about how evaluators handle the challenges of measuring success in leadership and organizational development.

It’s about time

We are entering day 4 of the 5 day global meeting of my pharmaceutical management colleagues. The format of spending much time in small group work is new to many – the energy is high, mine and theirs. We are tackling challenges as they temporarily block us from our vision but mostly the path is clear. I am having great fun, trying out new things, improvising, and reconfirming that this is the work I love to do.

In the meantime the coaching work is continuing. This morning I got up at 3:30 to follow a teleclass that is done from the west coast, afternoon time. It was about coaching people on the issue of time. Time is coming up a lot in the meeting and so it was, indeed, perfect timing.

I am trying to practice my coaching skills, becoming more and more aware of my errors: asking closed questions, suggesting solutions. This awareness has taken the sting out of making mistakes – something I have struggled with for a long time.

Today’s meeting is all about planning, the logic and use of planning, the review of planning processes. I have, over the years, sat in countless meetings with staff trying to figure out how to do this right. I have yet to see a group that does it well. When I put my coaching hat on I can see why planning is so difficult; when I take it off and have, myself, to comply with someone’s planning process I get caught up in the negative energy that so often accompanies the annual planning ritual. It’s the difference between ‘have to’ and ‘want to.’

I am trying to rope people in to perform on our end of meeting celebration. There are some surprises in people stepping forward with a poem, a monologue or a song, and much reluctance among most others. I am coaxing a few groups, like the Afghans and the Ethiopians, to participate in the talent show. I am not sure I am going to be successful. Our early morning yoga group is going to put up a demo which we learned, called the flow of life.


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