Archive for March, 2012

No bite: public versus private health up close

As we were settling down in our seats at gate E5 at Schiphol yesterday, an elderly Indian couple sat down in back of me. As soon as the woman sat down she started coughing, a rough deep cough not like one that comes with a cold. “TB,” flashed through my mind, not that I know what a TB cough sounds like, but my mind had put India and coughing together.

The woman occupying the seat next to her asked to be reseated and indicated her concern about having a serious cougher in a plane that would be circulating air for the next 7 hours. Other people in the neighborhood agreed with nodding heads. A purser was dispatched and he asked the woman how she was feeling. Fine, she indicated, and her husband confirmed. The purser asked her to put her hand in front of her mouth as she coughed. The couple agreed.

But no one sitting around the couple felt comforted by this attempt at containment.  The head flight attendant was called in. She listened patiently to the complaints, walked up to the couple and said in the sweetest voice, “I hear you are not feeling well.” This was of course instantly denied.

A woman next to me, who was studying Stata, a statistical software package used among others by epidemiologists told me the woman should be taken off the plane as she was a public health risk. And just as she was saying this I was reading the chapter about American public health systems losing their bite sometime in the second half of the 1900s in Laurie Garrett’s book ‘Betrayal of Trust.’

In the end the Indian woman was given a painter’s mask and told to keep it on during the entire trip (she didn’t really) and the crisis was, at least for the duration of the trip, averted. I saw the ‘no bite’ approach of public health in America, demonstrated right before my eyes, along with the terrible dilemma of public versus personal health.

Up north again

Although I slept about half the flight time from Johannesburg to Amsterdam, that still left about five hours of not sleeping in a completely full plane. Knowing that I was not continuing to Boston, another 7 plus hours, helped to see me through the waking hours. I don’t do this enough, this breaking of the trip in Amsterdam – something I am entitled to as per our travel policy. On my way out, breaking the trip in Europe means leaving home a day earlier, and so I don’t. But now the break was very welcome.

I stayed at my adopted Dutch home, near the airport which has a lot to look forward to: a friendship that dates back to the 60s, a long walk with one or two dogs, unlimited great coffee from a machine that never tires of making good coffee, freshly laid eggs and always a good glass wine.

We went to the shopping street of my childhood, a melancholy experience filled with memories of riding there on my bike, or going shopping for the Saturday meal with my father. He would go to the ‘traiteur’ and stocked up on French cheeses and French bread, good wines. He would not think about buying staples, that was my mom’s job. Our French Saturday meals were more memorable than all the other weekly ones my working mom or the help prepared. He would also take us on Sundays to museums around Holland, also memorable, while my mother rested from doing three jobs at once. Life’s not fair for working moms.

I stocked up on Dutch goodies (cheese and licorice) and helped S. pick out a baby shower gift for Sita and Jim in a wonderful toy store that reminded me of Newburyport’s Dragon’s Nest, a place where Tessa lost her ‘lapje,’ a tiny dirty and smelly strip of a crib sheet that served as her safety blankie. The drama ended with picking the piece of cloth out of the garbage can of the toy store a few tense hours later.

After our shopping we went to see S’s 94 year old mom who still lives by herself in the house I remember from the 60s, entirely unchanged. We sat in the kitchen with its (old Dutch) tiled kitchen table and the antlers from various members of the deer family hanging on the old wood paneling. We drank tea and ate thin slivers of New York cheese cake while talking about ‘koetjes and kalfjes’ (cows and calves). I would like to be as sharp when I am 94. Nearly a decade ago we had hosted her and her late husband at Lobster Cove and ate, of course, lobster, an experience she remembered fondly. She asked about Axel’s lobster traps, and she asked about the girls who she first met when they were the same age I was when I first met her all these years ago.

The rest of my time was a blur as my tiredness was setting in. I remember the meal, the first glass of wonderful wine, but hardly the second. I woke up in the middle of the night, wondering where I was, where the doors I was seeing led to, entirely disoriented. Maybe that is not so surprisingly after sleeping in so many different rooms for the last 6 weeks.

And now I am home again, and re-acquaint with my hubby, sitting by the fire because it is still winter in the northern hemisphere, even though high temperatures, in the US and in Holland, fooled everyone, including the flowering trees.

Reporting time

I had the luxury of one full day to finish my trip reports (there were four different ones), sorting through six weeks of small pieces of paper to accompany my expense report and other tedious chores that kick in towards the end of a trip.

The staff had organized a small goodbye party, including three cakes and a speech, very touching.

I signed for the bumper scratches on my shiny red rental car and handed in the keys. It was the only blemish on an otherwise perfect 6 weeks. I was told that it was nothing. The insurance will pay. Still.

I made the rounds for goodbye hugs at 5 PM when the office empties. Driver Charles drove me back to the apartment where I dined on the last leftovers in the fridge: yogurt with muesli, a small chunk of cheese and a few small sate sticks while watching Private Benjamin, the only program I seem to be able to get on the complicated TV and dish arrangement (too late to learn now).

The suitcase is packed and the sleeping pills are handy for the 11 hour flight to Amsterdam and to Sietske. Goodbye to South Africa, for now.

Community

I found my way to an informal Quaker worship group in Pretoria, not that far from where I live. It was at a private residence – the official Meeting House is in Johannesburg, some 55 km away. To avoid long drives every Sunday the Pretoria group meets at people’s homes every two weeks.

The house was lovely, old, with tin ceilings and old doors, the ones with the top and bottom part opening separately – a feature you find in old Dutch homes – so you can hang over the bottom and chat with your neighbor without opening you house. Unlike the area where I live, with its high walls, electric fencing and people inside being tightly shut out from the outside, where security companies making fortunes from fear, this house was in a neighborhood that appeared to be without fear: gates were missing or open, doors to the street were open, no electric wires nor placards posted in the grass on or in the walls that indicated which security company was in charge. It was in a place where one could imagine the existence of a community.

Inside was also neat. It was refreshing to be in a house without electronics, no sign of TVs, computers, iPads and such. There were two comfortable couches, a table made from a traditional African resting bed with several unmatched vases filled with garden flowers that were picked by kids I imagined.  It was a joyous and happy place.

I was warmly welcomed by a small group – maybe there were 15 in all, five of them kids. There were other visitors, a retired couple, from Concord Friends Meeting in New Hampshire, on a two year Peace Corps stint as teachers in a primary and secondary school in a village some distance away.

A young African woman, who accompanied her partner to the silent meeting from time to time, had noticed, as I had, that there were lots of grey hairs in the room. I also noticed quite a few Birkenstocks or look-alikes, very few painted toenails (mine and the hostess), and mostly white folks in comfortable and sensible rather than fashionable dress.

It was mostly a silent meeting and I liked it; not quite the feeling of weightlessness of yesterday in the salty spa pool, but a feeling of being in tune with the universe. A few people spoke but I didn’t get the messages the words behind the words and so I let them pass like riverboats coming into sight and then disappearing from sight, without a trace.

I commented on the excellent coffee we were served afterwards, with real speculaas cookies, and was promptly given a bag of coffee to take back to my apartment that doesn’t have coffee making equipment. I protested to no avail.

Two people had Dutch roots, one had left Friesland with her family when she was nine – going on a four week journey to the other part of the world in 1954. I told her I used to read books, when I was about that age, about kids emigrating and how jealous I was, living in the house and town of my grandparents, something I found very boring. One book I remember as if I read it yesterday, ‘the boot vertrekt zonder Claartje’ (the boat leaves without Clara) about a family moving to Canada.  The funny thing is that this 9 year old is now a very root-bound pensionada  (‘retired spare part’ she called herself) who hasn’t moved much since long ago while I, feeling so root-bound in my youth, are travelling around the world as if there is no tomorrow.

Afloat

I slept terribly last night, from hour to hour, an interminable night. I gave up at 5 AM and watched the sun come up over the valley. The day was full of promises.

I worked for a while on my next assignment and then joined the well-heeled folks of Waterkloof Heights/Ridge for a latte at the little shopping center down the street. It was the perfect spot, in the warm fall sun, to review resumes for my co-facilitator in Bangladesh and meeting up for a final debrief with the project director. We talked about the project and when I would come back. I indicated that the project is first in line after the grandbaby is born and my grand-maternity leave has expired.

The afternoon was dedicated to a final soak and massage at the spa. It was twofer day and Katie and I got the ‘flotation therapy’ for free – a half hour in a kind of Dead Sea bath – a weightless float in a dark room – it was delicious and would have been totally relaxing if I hadn’t had to watch out for floating into Katie – suspended at the other side of the small round and shallow pool. I was thinking a lot about the grand-baby, being similarly suspended, in a much smaller space, making summersaults – I had an urge to do the same, feeling what that would be like.

We followed the flotation treatment with a Swedish massage which was followed by a sushi feast. It was good that Katie drove us back as my massage brain was hardly dependable, what with traffic going in the wrong direction

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All done

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I drove to the last day of my last assignment trying out a different route. I am getting quite comfortable driving with a stick shift on the wrong side of the road. I do still occasionally activate the windshield wipers when I want to indicate that I am turning left or right but I am mostly getting it right. Except for my backing out of the apartment’s parking lot – Jabu, who looks after the place was gesticulating frantically but the scrape with a brick wall had already left its mark on the red lacquer of my rental. It is one of the few ugly marks on an otherwise unblemished 6 weeks in Southern Africa.

And so I am basking in that feeling of having completed all assignments to the client’s satisfaction. The (re)treat is over – two intense days of learning and talking about things that are important for a team. In a way there was too much to absorb – the awareness of styles and how we would like to be approached when we get irritated about people not acting we would like them to act. It was a lot to absorb and will need a lot of reminding, supporting, and some gentle confronting.

The team made a commitment that it is up to the task and headed out into the weekend. But not before a bottle of champagne was popped open and there was much thanking and toasting and clinking of filled champagne glasses. At every twist and turn one is reminded of being in a wine-producing country.

I returned home exhausted, unpacked my facilitator bags and collapsed in front of the TV watching a famous South African soap opera, an episode with much sadness. From the previews I could tell that the next episode will star another emotion, anger.

I went out for dinner with two colleagues who had been in the (re)treat. We agreed we would not talk about the retreat, let is simmer for a bit.  We talked about the joy of flying in small planes, a hobby we shared, and that is popular in South Africa. I realized I haven’t flown since last November when Bill’s plane went into the shop for a makeover.

Today’s program consists of a talk with the chief about future work here, a half hour of ‘flotation therapy’ at the Soulstice Spa, followed by an hour massage, and finished off with a shushi dinner with friends.  Life’s good.

Treat

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I spent all of Human Rights Day, a holiday here, preparing for my last assignment, a teambuilding with the senior staff of one of our regional projects that is based here in South Africa. It is the crowning moment of 6 weeks of learning about the team, and doing a few other things on the side.

In the evening I was invited to a couple that likes to cook – and has a kitchen a whole lot more equipped than the one in my apartment. We were four of us, four different cultures: South African Indian, expat Indian, American and me Dutch American. I made for a wonderful meal and conversations that richoted from Romney, American politics, to the Seventh Day Adventists, and life in Durban. The dinner was a reward for a long day of hard work.

Today we had the first of our two days retreat. It was actually a treat rather than a retreat as we were pampered in a palace, hidden away on a small street, between trees and houses. It must at one point have been a large estate with the owners selling of pieces of land until the surrounding land and the building were no longer in the right proportion to each other.

The place is run by a woman of Dutch descent, her father came to South Africa during the second world war – an escape of sorts I imagine. And so we speak Dutch with each other. The staff is busy pampering us with everything we could possibly wish for – dainties for our tea and coffee breaks and for lunch a wonderful spread, including an enormous cold salmon, shrimp, pate, French cheeses, small chunks of lamb on rosemary sprigs and more.

There is a family of ducks that has the run of the place. Loud quacking they traverse the mahogany parquet in the central hall to get to their bath in the courtyard. After their bath they traipse back to the garden to resume their search for grubs. Their presence emphasize the lining up of ducks that the team has to do.

Today we were in the Louis XV (or XIV) part of the palace and dreamed about the project’s legacy after which we descended down to earth to look the team’s current situation straight into the eye – sobering at first. We looked at the gap between espoused theories and theories in use to see it is often wider than we think. We talked about Chris Argyris Model I and Model II – how bad we all want to subscribe to Model II but it is so difficult! Exercises that brought out the competitive element surprised some parts of self that were expected to be more altruistic.

All in all it was a heavy meal, the real meal but also the mental one, new concepts and frames to hold the current reality so that it can be made discussable – the learning of a new language with all the discomforts that come along with learning important things.

Tomorrow we move to the Chinese Imperial suite, a little further down the estate, between the first and the second swimming pool, hidden behind much shrubbery, as if it isn’t there. The walk down to the room feels like a walk into the Secret Garden.

Sticky

I managed to hit the holiday traffic back on the N1 to Pretoria which meant being stuck in stop and go traffic for some time – I thought my ride back from Jo’burg would be a cinch, as I wouldn’t get lost this time but it took me once again nearly two hours for what should be a 45 minute ride.

I am driving a stick shift car, requiring my left ankle to be very active at an odd angle for the 30 minutes of driving in stop and go first gear traffic; this after two days in a resort where every path was excruciatingly painful to navigate because of the uneven bricks and steep inclines. Luckily I had an ice pack that has been sitting unused in the freezer.

We finished the workshop early; I think this is going to be my signature – about half an hour before the stated ending time. Most people like it except those flying home and having to wait even longer at the airport.

I learned a few things about the very complex (South African) world of pharmaceutical products and services – I thought I knew a little from Afghanistan, but here it is complex in another way – there are so many more stakeholders.

And now I am back in the apartment for the home stretch: one more team building workshop on Thursday and Friday, another massage on Sunday and then a midnight departure to Amsterdam on Monday. It’s time to go home.

Jungled

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I had looked up the hotel on googlemaps. There were many variations on the name and address of the hotel but there were at least several variables that were the same. I had asked for a picture of my destination and was shown a small roundabout in a very poor neighborhood with a fenced in yard that had some kids clinging to the bars.  I assumed it was a mix up and thought little more.

I programmed my smart phone gps to get me to the hotel, some 45 kms away. I found the freeways easy to navigate and was very pleased with myself. But then I took a wrong turn and got lost. I didn’t master the smartphone gps as well as I should, I realized and ended up asking directions a few times, each more convoluted than the next one. Eventually I started to recognize names of streets and made the required left and right turns, and then, when the phone indicated I had arrived, I was right at that little roundabout in the poor men’s neighborhood – I recognized it right away – it was no swanky hotel and I had been driving all along to this place that someone – a joke? – had given the same name as the resort.

I called the hotel but they didn’t know where I was. I asked a nice gentleman at the petrol station to talk with the hotel on the phone and figure out how lost I was. As it turned out I was entirely on the wrong side of Johannesburg, west instead of east or the other way around, and that I was about 35 kms away from the resort, nearly the distance I started from, hours ago.

The helpful gentleman knew the place and gave me a long list of directions which I frantically scribbled down. I reprogrammed my gps and this time a voice came on which made the trip so much easier than if I had only had the directions from the man at the petrol station. After two hours of driving on countless freeways in all directions I finally arrived, to be further lost even at the entrance and inside the complex, which is rather large.

I checked out the room where we will meet for two days, the Lion Room. It is nicer than I thought. A young waiter helped me set up the flipchart stands and distribute the name tents on the tables. I asked him whether he could help me make the table setting gender-balanced since I couldn’t tell from the names whether they belonged to a man or a woman. As it turned out he couldn’t tell either since he was from Malawi. Like me he could recognize the anglo names, and the one Malawian name (which meant ‘thinking person’) but it could be used for a man or a woman so that was no help.

Since the conference rooms are locked up at 5, and the young man was in no condition to break the rule, I had two hours to spare for dinner. I checked into my own room where I found an enormous fruit and cheese platter waiting for me.  I went on a scouting expedition around the complex. There was much to explore: a pool (an indoor and an outdoor one), a spa with its secluded nude sunbathing section, the children’s medieval castle, the orchid greenhouse, the game room, and the sun roof. from where you have a stunning view of the Magalies hills. Aside from a few employees I didn’t encounter any guests, as if I was the only one here. It must be low season since anything with doors was locked.

Along the meandering path, made from old (unmatched and therefore tricky to walk on) bricks, sculptures from a local artist were placed strategically, in front, behind or next to the countless little pools and waterfalls – I am supposed to imagine myself in a jungle, like Mowgli – and the sculpted animals and water nymphs were everywhere.

Most of the rooms are brick and thatched huts, quaint and rustic and very well appointed to the taste of holiday makers. There are a few imperial suites. These are named after the kings who ordered their warriors to annex, or, if resisted, kill, rape and plunder, the tribes that stood in their way in the early 1800s.  There are also some restaurants though I haven’t found the one we are to have dinner in, one had a large two-room bar. I had wanted to sit down for a pint after my driving ordeal but it was one of those bars with giant TV screens that showed one or another sports game. No matter where you would sit down there was no way to avoid the screens – and given that I was the only person around, I dropped the idea of a pint.

Spa-ed

There are more spas per square inch in the suburbs of Pretoria than any other place I know of. Katie took me to the Soulstice spa – a place on the edge of town, where you can take a sauna or steam bath while looking out at farm fields. It was as if I had walked into a copy of Architectural Digest.

After two hours of pampering we had a light lunch, as one should. The masseuses would probably not have approved of the glass of white wine but we felt that the healthy salad compensated for any unwanted toxins.

Next week I am tempted to go into the Amethyst Rasul Chamber. According to the brochure it is based on the traditional Turkish bath and involves exfoliating and cleansing rituals with mud, followed by a tropical rain shower – and you can do it with a friend or partner.  And then there is the flotation treatment, which is described as going back into the womb. One of the masseuses has done it but she said she got bored very quickly. I thought about our grandson to be – he is doing somersaults, out of boredom I wonder?

The days and night of rain are harbingers of winter I was told. Winters here are nothing like winters in Massachusetts but it does get nippy. I learned there is under-floor heating in the apartment; I am checking out the bathroom floor heat tonight, just to enhance the bath taking experience.


March 2012
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