Sylvia's Journal

I was ousted from my hotel room because the arrangements for extending my stay till airport departure time were made too late. So I spent about 8 hours hanging around the hotel lobby. This turned out to be fun.

There are many conversations to be overheard and interactions to be observed. I like people watching. I love airport arrival halls for the same reason.

I witnessed a few occasions where western ways of doing things bumping hard into Kenyan ways of doing things. There was little variation: one party responds with polite apologies. The other has a slight temper tantrum and fails to hide impatience, exasperation. Both parties retreat for a moment and then go over the same territory again. More apologies, more exasperation. If there were to be thought clouds over people’s heads each would say: “they just don’t get it.” But we usually don’t say what we think – especially when we are in such a cross cultural minefield.

It is a scenario I have seen (and at times been a participant in) that is played out over and over again as worlds collide, either forcibly put together or in well intended encounters on what looks like a level playing field. In the past we knew that these fields were not level, now we pretend they are. Worse, we fail to notice that the landmines that have been placed there over the centuries.

This is what makes my job so interesting. Being here only for a little while makes it easier to be the detached observer, something I wasn’t always able to do in Afghanistan.

We completed the vision for the Kenya Institute for Health Systems Management. It is as practical and complete as it could be given who was in the room. The final activity consisted of public commitments from key stakeholder groups on how they can and will support the fledgling new institute as it takes its first steps.

Several of the participants, in a series of self-revelatory statements, mentioned that Kenyans are very good about making big plans, conceptualizing stuff and then dropping the ball when it comes to implementation. I assured them this was not a unique Kenya quality and that it had something to do with either not owning the vision or plans, being too ambitious in scope, or finding the complexity of implementation, while none of their other work had disappeared, simply too much.

We’ll see in a few months. The group certainly had reached some momentum by the time we finished. The original ending time was 4:30 PM but we were done before lunch. The closing act took another 45 minutes and included a special African clap that is rather involved, a lengthy vote of thanks leaving no one out, an exhortation about change management that appeared to inspire everyone much like a minister inspires his or her flock on Sunday, and more claps.

Everyone left with a button, immediately pinned on. It should have been a lapel pin, stating that the wearer was a founding member of this new institute. The pin idea got sunk because there were too many logos that needed to be included. Since the elections some years ago that left Kenya in flames and with two dueling presidents there have been two ministries of health. Add to that MSH as the midwife of this institute and USAID as the financier, it was simply too much to squeeze on a lapel pin. No one seemed to think any less of a button.
It gave the wearers a special status. These buttons are of a limited edition, only for those who helped to build the vision from scratch. Maybe one day they will be collectors’ items on E-bay.

And then we drove back through the dense traffic that streams relentlessly in and out of Nairobi, all day long and into the evening. I was deposited at the hotel I left two days ago for my last night in Nairobi.

For dinner I took a taxi out to the house of a colleague. It still feels a bit funny that I can walk out of the hotel – I had to suppress a reflex to pull my scarf over my head – and take a taxi from the taxi stand, walking unaccompanied.

At the house I found dear old friends I had not seen in years, all of them having become moms (of boys) over the last four years. It was an evening of countless stories about everything, including about much reviled facebook which, nevertheless got us talking for at least an hour, engaging those who loathe facebook, those who love it, and those who claim they don’t ‘do’ facebook.

And now I have checked in for tomorrow’s flight and am preparing for the final deliverables.

The Africa I first visited, some 32 years ago, is different now in ways no one could have imagined. Of the 40 people or so in the room today, all are computer savvy, several have iPads or Samsung tablets, notebooks; many have two cellphones of which one a smart phone.

Wireless availability in the conference room requires my utmost effort to compete with the distractions of the entire world that can enter at any time through electronic portholes.

Many things didn’t quite go as indicated on the agenda which we used to our advantage. We skipped ahead to sessions planned for tomorrow. One speaker didn’t show up and another was shorter and more engaging than we had expected.

Although we haven’t quite gotten the partners that we wanted in the room, the ones who did show up are 200% engaged and fully supportive of what the Kenyan government is trying to do – the creation of an institute to ensure that, in the future, anyone graduating from medical school, or seeking a refresher course, will know how to manage a health facility or service – thus avoiding at least some of the costly mistakes and most of the painfully acquired lessons about good management.

Less than 10 years ago we did much of that preaching but now we are preaching to the choir. There is much energy for the task at hand, even right after lunch and deep into the afternoon. We got all the work done before it was time to leave, and more.

With a medical engineer, principal of one of the technical schools, I retraced the 5 km jogging trail around the golf course. With company the track seemed shorter but we walked one hour nevertheless. The monkeys had moved to another place. We spotted them grooming each other on the far end of the gold course, small moving black dots on pristine greens. The ants had completed their crossing and I didn’t see them again.

For dinner I avoided the formal and empty dining room downstairs. Instead I had a pizza, beer and lemon grass ice cream by the pool. I sat at the bar, the only place with enough light to read from my portable library on my Kindle-equipped smart phone. I am halfway through The Thousand Autumns of Jacob de Zoet, a historical page turner novel about my (our) next destination, Nagasaki.

We spent the morning finetuning the design of the workshop and meeting with counterparts. I ask about expectations, about challenges, traps and pitfalls I can expect. This is not just for me but an occasion to help people be realistic, let go of wishful thinking. “We don’t want to have politics interfere,” says one. But politics are always there.

I now have a co-facilitator and a flexible plan. I use the time to get my co-facilitator on board as an educational intervention. I explain my thinking and assumptions and test them. Heads are nodding when I describe situations we want to avoid: dominant people inserting agendas, hijackings, people not daring to speak out. More nodding, they have all be there and look relieved when I tell them there are ways that make all this more difficult for the hijackers or the monologuers or the grandstanders.

The first day of a workshop is always full of unknowns. I have padded activity times with extra half hours here and there in case we start late (likely) and speeches are longer than predicted.Padding the time allocations has the benefit that things can go faster. Sending people home early is never a problem.

In the four years since I was last here the case for better management and leadership training of health professionals has been made abundantly. I don’t have to advocate for it as I used to. I am surrounded by advocates –that baton has been successfully handed over and progress is visible.

I am moving out of my nice hotel to the place further out where the workshop will take place. I am taking advantage of my last few hours here by doing work that requires the internet, not knowing what awaits me.I traveled light so packing and unpacking twice on this trip is no problem.

It is warm and lush here. I had forgotten that it is not winter as I understand winter to be. it is hot and dry. It suits me fine.

I keep thinking I have to put a scarf on, that walking out of the hotel’s gate is not allowed, and marvel at the thinly clad women with their exposed legs and arms – Kabul routines are still deeply embedded in my head – I have to tell myself, I am in Kenya, not Afghanistan.

People say there are threats and attacks, from the Somalis. They consider security tight but to me it is not tight at all and probably rightly so – how can one preserve safety in a large city, teeming with people and cars? Life is risky, here too.

Later: I was driven to the Windsor Golf and Country Club – a fancy resort with, depending on one’s room, has a view over green with the city of Nairobi in the background or Mount Kenya and the Aberdare ranges on the other side. I have seen neither so far.

The magnificent 18 hole golf course has a 5 km path that meanders around it, through woods and open lands with an abundance of tropical trees and bougainvilleas in bright colors, their faded blossoms like a carpet on the ground. There are signs of wildlife. I spotted some Sykes monkeys overhead, paying no attention to me, and a column of ants, one inch wide, without beginning and end, that cut right across the path. I watched them for awhile and film them with my smart phone.

Two and a half years have passed since my last visit to Africa, a continent that I visited so often and for so long before I moved to Kabul.

I am starting my re-entry with Kenya, a more or less normal place after Afghanistan. I wrote to my old friends, colleagues, students in Kenya who I haven’t been in contact with for years. Not surprisingly many of the emails bounced, but some wrote back right away. I told them that my schedule was tight and my visit short but hoped we could at least talk on the phone, re-acquaint.

Some of the people I hope to see or will see weren’t parents, or not even married when I last saw them. Now they are parents to more than one child. There is much to catch up. Others were AIDS activists. I am not sure they are still alive. Some of those emails bounced.

I am going to do what I like to do: facilitating the conversations between key stakeholders that need to happen to establish buy in, create a shared vision, for an institution that is supposed to teach Kenyan health professionals how to be good managers and leaders in moving the health agenda forward.

I am only part of this during this one step. There have been many steps before and there will be more in the future. Accompanying such a process over time was the attraction of going to Kabul (an attraction few people understood). A structure with a similar mission (improve management and leadership skills of health professionals) now exists within the ministry of public health in Kabul; it is staffed and has a space, two enormous accomplishments that happened after I left. I helped with the planting and the watering, but am not sure I will ever get to see the harvest with my own eyes – of my four planned trips to Kabul not even one has been scheduled.

Arriving in Kenya was full of old and new; the smell of Africa, stepping out of the airplane, the airport (no change), the road into the city (just more businesses, more buildings) and the hotel (upgraded). I remembered my very first trip to Nairobi in 1979. When Axel and I left to return to Dakar, Sita, the size of a pinhead, traveled back with us. Much has changed, in the world, in airline travel, in Kenya and in our family, since then.