Sylvia's Journal

On Monday morning we were ready to receive our team of would-be ministry of health coaches at 9 AM. Two hours later only one had arrived. I am usually pretty good in my guesses at when we can really start but this time I was wrong by two hours. It turned out we all had missed some important information about local traditions.

There is a Monday morning ritual at the ministry at 8 AM that is called ‘monter les travaux.’ It involves raising the flag and receiving instructions from the minister. You cannot show up at the ministry and skip this event. How long these things last is anyone’s guess, least of all mine.

And then of course there is the 30 km that separates us from Cotonou. How long that takes on a Monday morning is another guess. My experience of yesterday, 30 km in one and a half hours on a Sunday in the middle of the day may give us a clue. At 11 AM we had finally a quorum and started, as such things always start, a little stiff, a little haltingly, no one quite knowing what to expect.

By the afternoon we had started to demystify some key concepts, especially leadership – all too often associated with politicians and people at the very top (in other words, ‘not us.’) And then we started to dive into the substance of our collective challenge that will keep the local teams busy for months to come: how do we want the improved leadership, management and governance skills to show up in relation to the priorities of the ministry of health?

Last night after our two local colleagues had joined us in Porto Novo I learned one of them was quite sick in his bed and didn’t think he could join us the next day. Although he is a doctor himself, my co-facilitator, who is a physician from Guinea, took his pulse and decided we needed to get to a pharmacy.

And so we learned something about private pharmacies in the second largest city of Benin that we had not learned last week when we were surrounded by the owners of these pharmacies.

We drove for more than 30 minutes from one extreme of the city to the other without finding any pharmacy open. We finally went to the hospital pharmacy. They didn’t have exactly what the doctor had prescribed. My colleague wasn’t entirely sure the affliction was malaria or typhoid fever, or maybe something else because of the high fever and other symptoms. We are after all in a hot and humid place, ideal for small organisms that can create havoc in our system and interfere with longevity.

And so I got to experience what it is like to need a pill and not being able to find it. We settled for a second choice of pills. That required going from one small opening in a wall to find out which medicine was available; then to another opening, entirely covered by a curtain which required bending over and peering through a small slit at the bottom to listen to the instructions of the woman behind the cash register (name, pill, pay). A noisy dot matrix printer provided the receipt that could be exchanged for the pills by going back to the pharmacy where a new line had formed in the meantime. It took a long time, even during the quiet hours of the evening, to get what we had come for. These kinds of experiences make me count my blessings and realize what we take for granted back home.

Having accomplished our task we decided to take a quick meal in a local eating establishment which would be so much faster than in the hotel, cheaper and of better quality. With an orchestra playing loudly the kind of dance music West Africa is known for, we tried to get our order across a glass partition behind which several stern women were stirring multiple giant pots and signaling them to remove the covers so we could see the contents.

The women were not very kind; they seemed impatient, as if we were holding up the routine, even if there was no qeue. I was flummoxed. I had no idea what to order, and there was no point in asking questions because they couldn’t be heard, nor could the answers, given the volume of the music. I pointed at the only thing I recognized, something with a head and a tail, swimming in a red sauce.

I turned out to be the kind of fish I don’t care much about, a cousin of the mackerel or bluefish, oily and dark, but the sauce was good. With a plate of rice to soak up the spicy sauce and with a local beer it was not a bad meal.

We ate without talking, and watched the people dance, which was quite entertainin. Although it was late, more and more people streamed in, starting to dance before they even ordered.

Having eaten our meal in record time, 10 minutes at most from order to finish, we drove back to the hotel where the doctor delivered the medicine to his confrere. I know it worked because the patient showed up in good shape at next morning’s breakfast. All is well again.

We moved to Porto Novo, a little further east, closer to Nigeria. It’s only 30 kilometers but in the pouring rain on a narrow road it took nearly one and a half hours. Everything turns to mud on a day like this. Talking about mud, as we did on Friday, in a figurative way is one thing, the real stuff is something else.

Several of the rooms in our hotel have names rather than numbers. I am in ‘longevity.’ Next to my room is ‘royalty,’ across is ‘sensuality,’ next to that is ‘satisfaction’ and at the end of the hall is ‘enthusiasm.’
The room is comfortable, climatisé, with one star less than the previous hotel, and quite a bit cheaper. I have a tiny refrigerator, the kind that college students have in their dorms. It is not stocked, as my previous refrigerator, with ‘sucreries’ (sodas) and local beer.

A stream of tiny ants has been climbing up the legs of the table that I use as my desk. They found my computer across their path (which is only to the wall at which point I assume they will go down another leg again).

Unperturbed they traversed my keyboard and climbed up the screen, then descended again on the backside of the screen. I hope none of the little fellows fell in between the keys as I imagine they can mess things up. I discouraged them from their chosen path, creating havoc in the ranks. They went elsewhere. I remembered that ants symbolize patience, which goes well with longevity I reckon. I have taken note – it is also a message I get in my coaching training.

I watched the old king of the Belgians abdicate, and then the new king ascend the throne in three languages, multi-tasking while reading the comments from the participants in last week’s workshop. Pomp, pageantry and the practice of the new.

The most cited learning from our participants, the pharmacists in last week’s workshop, and their good intentions for practice related to listening, the kind of listening that makes us better leaders, better followers, better parents, better employees, better citizens, and better kings.

It is the simplest of all leadership practices because we don’t have to teach it – people know how to listen. And it is the most difficult of all leadership practices because we forget about it as we insert our own opinions, thoughts, needs, agendas into conversations as if nothing else counts.

As a coach-in-training I am immersing myself in the discipline of listening. Yesterday I spent hours listening to recorded classes, catching up on content not quite assimilated, tips and techniques missed during earlier midnight teleclasses.

And then, during the required hour of coaching a peer, on Skype, I listen again, leave space, try not to interrupt, not to assume, not to judge the other. You’d think I’d be good at it now, having been on this path since February. But what I am learning is that good listening requires constant vigilance, self-awareness and the ability to kick that pesky ego back to its proper station.

And now I am listening to the new king, making his promises for his new reign. It is a new chapter for him and Belgium. For me it is only a new paragraph as I prepare my move to Porto Novo, a new hotel, a new group to work with this coming week.

I am missing the second unpleasant hot weather spell at home. Here in Benin we appear to be stuck in a stationary front that covers the city and coast under thick heavy clouds. I haven’t seen the sun in days. It is overcast and humid. From time to time the humidity is 100% and it rains. It is just as well that I don’t have anything else to do than concentrate on work and catching up on piles of reading, in my comfortably air-conditioned hotel room.

I am catching up on reading about networks and neural networks, about risk, ambiguity and the different parts of the brain that kick into action when our emotions are triggered. I surfed the web and hopped along trails that revealed findings from the neuro-sciences. I realize that I was very prescient when I started my psychology specialization, nearly 40 years ago, with neuro-psychology. It is all coming back and, more importantly, it is both hot and cool these days, looking at why people behave the way they do in groups and organizations.

We completed the first of the two leadership development launches this week. A small group of members of the national association of pharmacists of Benin was initiated into the not-so-secrets of leadership, good management and good governance. They embarked on this path with great enthusiasm, concentration and perseverance.

We talked a lot about getting out of one’s comfort zone, about listening, about knowing where one is heading (if you don’t want to end up elsewhere) and separating facts from fictions.

This morning we dipped down into the hard labor of figuring out what a good result would look like, what data we can use for monitoring and which indicators will tell us whether we are bound for success or trying to do something undoable. There were groans, aha’s and there was much solidarity as four teams banded together to tackle some of Benin’s persistent and complex pharmaceutical challenges.

They experienced a trip through the kind of mud, something I am quite familiar with. I have learned over the years that mud is full of nutrients and serves us well, despite being hard to wade through. I have made this mud trip with people in many different countries and know to expect it. But for people new to our approach (an alternative to simple and one-sided solutions that treat symptoms only) it was frustrating. They greeted my assurances of normalcy with relief.

Our local team will continue the process during the next 8 months, now that the train has moved out of the station. I have no doubts about their ability to do so enthusiastically and competently.

At the breakfast restaurant there is a small Nespresso machine, prominently displayed, the one that makes one cup at a time and that you can get at drugstores in the US. It can be activated by buying the small capsules for 3.50 dollars apiece – it is an alternative to the Nescafe powder which is available as part of the breakfast buffet. I have chosen to be a tea drinker this week as that is the only thing that is brewed.

The main dining hall is actually an enormous terrace. It overlooks the lake, part of the city, the bridge and, across from the sandbar, the Bay of Benin. Hovering in the distance are towering oil tankers, menacing silhouettes, against a dark sky. It’s hard to imagine that the skinny Somalis frighten these behemoths on the other side of the continent.

Tonight the terrace was off limits for us guests. It was reserved for Iftar, Ramadan’s breaking of the fast, for the Lebanese who make Cotonou their home. It made for good entertainment as I ate my lonely dinner, watching from an adjacent section where guests were allowed.

A stream of men made its way to the terrace, kissing and hugging and handshaking a welcoming committee. The Lebanese appear to fare well here, judging from the protruding bellies and double chins. They are the business men of West Africa, much like the Indians play that role on the other coast.

We are not quite halfway through the four events for which I was summoned. I am biting my way through the challenges that come from sorting out a hybrid process for leadership development. We are using the parts that are very robust and can stand on their own – sorting out the right French translations from the not so right phrases that transmit a different message than the one intended. But it works in a context where andragogy is a novelty. Leadership made palpable.

More challenges have already appeared on next week’s horizon when we are working with the ministry. An important event has been called in the capital that will certainly draw attendance down but there is not much we can do. I look at it from the positive side, less people, more depth.

Those who were new to the methodology only two days ago are now treated as knowledgeable coaches and showing increased confidence. It’s a bit of a contrast with the very intensive coaching training I am in, which required being on the phone from 1:30 till 3:00 AM very early this morning, and again after midnight tomorrow at the same time. I have alarms set on my smartphone for at least 4 coaching related activities this week, all at odd hours, all outside the regular 12 our workday – a side show.

Except for my very short trip to Ivory Coast earlier this year, I haven’t been much in French West Africa for nearly a decade. The arrival at Cotonou airport reminded me of arriving in Mali decades ago, or in Haiti before the new terminal was built.

The French have many great words to describe the chaos: pagaille, anarchie, brouillamini, cafouillage, désordre, gâchis. Maybe it is the poet it in me that likes these words that are so full of the noises they describe. You can practical hear the luggage carts bumping into each other, grinding to a massive gridlocked halt; the enormous boxes wrapped in plastic film containing luxuries from France, dwarfing the men in dusters below them; the big mamas with their oversized boubous and large gauzy scarves; the babies, finally asleep and the husbands busy greetings friends and relatives.

There was no way I could see, let alone extract, my suitcase from the fast moving baggage belt through the throngs of people and carts that separated me from my case. Being tired and resigned rather than assertive I was slowly but steadily pushed into the walls of the tiny arrival hall. I think the hall was designed a long time ago when planes were DC6s and small boys carried one’s possessions past sleepy douaniers.  

Some people, maybe those from the diaspora, dressed in western clothes rolled their eyes at me as if to distantiate themselves from the disorder of their homeland.  

I thanked my lucky stars I had only one suitcase and nothing else.  I had offered to bring a Xerox box full of books – but that offer was made to late, for which I was most grateful. I surrendered until the suitcase would appear, and settled in for a long wait. Eventually it did appear and all was well.

This is what surprises me about this part of the world: the total acceptance, or maybe tolerance, of what seems such an easy problem to solve. Why not get rid of these bulky baggage carts and engage more of the skinny porters?

My sparring partner here, who hails from another part of West Africa, has a pair of glasses with one of the sides of the frame entirely bent out of shape. He doesn’t seem to notice or mind. Last time I saw him he still had the small sticker with the strength of the lenses (2+) attached to them. I wonder whether it is the same frame, now without the sticker. I think that frame was bent too.

I carry with me a small notebook and write down the things that I see that I find inexplicable. Sometimes these things make me smile, sometimes they make me wonder and once in a while they get me very irritated. I ponder all this while stuck in traffic and occasionally I have a brilliant thought, like this one: It occurred to me that the people here live very much in the present, unlike us in the US who live either in the past or in the future.

For example, even though it may rain heavily (the weather site for Benin tells me so, and, presumably farmers know about this), no one carries an umbrella. And then, when it rains, surprise, everyone gets soaked. Maybe that is the point – it’s refreshing while it rains, but afterwards?  [And of course, there are few Senegalese here, the guys who are selling umbrellas in New York, it’s more lucrative.] I, on the other hand, even though I never actually use an umbrella, always have one handy, just in case.

The people who live here could benefit to live a little more in the future whereas we could benefit from living a little more in the here and now. In that respect my co-facilitator and I make a good pair, me fretting about things that may or may not happen, anticipating alternative scenarios, and my partner looking happily through his crooked glasses at what is right in front of his nose. We have been making good leadership workshops together since back in the previous century.

My doctor told me I should eat more garlic to counter the hot flashes, whether caused by a malfunctioning thyroid or because I am of a certain age. This requirement is more than fulfilled by the restaurant of Hotel du Lac which sprinkles all its dishes with enormous amounts of garlic that leave me gasping for fresh air.

We completed our first day preparing members of the ‘Order of Pharmacists’ of this country for their leadership role in realizing their mission of promoting ethical and independent behavior and honoring the pharmaceutical profession as a critical actor in promoting and maintaining good health.

After a hesitant start that made our careful planning of yesterday irrelevant from the start, we ended up with five people in the room, plus two of our colleagues. This will be the team of coaches, to oversee the leadership program that is for the rank and file who will join us on Wednesday.

Compared with facilitating a meeting of 120 people on my own only 2 weeks ago, this ratio is rather luxurious, 7 people with 2 facilitators and tomorrow only 3 participants per facilitator. Only on Wednesday will the ratio be more reasonable: 24 for the two of us.

We are retrofitting an approach painstakingly developed over the last 10 years to a situation that doesn’t quite fit the design – but it is robust enough that the general principles are relevant even to this small group. The challenges of the pharmacists lend themselves well to the Challenge Model, a visual image with embedded questions to get from mission to ‘what next tomorrow?’

We tackled questions of ethics as well as support for a profession that suffers from unregulated sellers of both legal and potentially ineffective, counterfeit or smuggled drugs – cheap prices for drugs of unknown origin and dubious effect. But with a sizable illiterate and superstitious population, such practices go easily unnoticed. The bonafide pharmacists are being asked to comply with ISO standards and engage in a lengthy, costly and rigorous certification exercise. The prize for such compliance is a promise of better earnings at a later time but many are not yet convinced. There are only a handful of early adopters (some in the room with us). The challenge is how to get more of them. That was one of our discussions today, to be continued tomorrow.