Sylvia's Journal

I don’t think I have ever heard a group of about 40 African men speak freely about their feelings in the company of their bosses and peers. But something got sparked over the last few days and the district teams were truly on fire last night after, they talked about saying ‘thank you’ more often (this is rather counter-cultural), reflecting on their own contributions to tensions and conflicts, turning complaints into requests and coaching their teams.

We completed the program with a lot of ‘feel good’ speeches but also exhortations to now stay the course. I am glad that I went, in spite of warnings from around me to stay in bed and recover fully. I am recovered fully now.

With Malalai getting the Nobel Peace Prize, the observations and contributions from the handful of women in our program and a recent blogpost on MSH’s website  (about a brave Nigerian woman who may have singlehandedly stopped the spread of Ebola in Nigeria, I am once again reminded what singularly important role women play in society and how men, who don’t let them develop or use their talents, are shooting themselves and the rest of us in the foot.

The entire morning, and part of the afternoon, the teams had a chance to shine in front of the DG. First each was given time to explain a poster they had put together and worked on all day yesterday: their challenge model, their action plan, a graph showing how they had progressed towards or beyond the target they had set back in May.

After the morning break each team was asked to tell us about some of the practices (or lack of practices) before they started this program, and then what they are doing different now. Although each filled in an elaborate chart covering many pages, they were asked to give the highlights, the most important new behaviors they have adopted, and, which presumably, made them successful in reaching or overshooting their targets.

The new behaviors concerned leadership practices (mobilizing others, focusing, understanding root causes, working effectively in teams, inspiring, aligning stakeholders not thought of before); management practices (monitoring not just once a year but monthly, looking at and using data for planning purposes, planning around challenges rather than doing the yearly cut-and-paste ritual) and good governance practices (being more inclusive, empowering women, using resources judiciously, and setting direction through a shared vision and a focus on goals, etc.).

After lunch we were treated to 11 stories about direct or indirect effects of this program on others. The facilitator team is keen on documentation, something that we don’t always pay enough attention to. Interestingly, several of the stories where not about our program but about people who work under or with our participants. They learned from our participants, second hand, and then, when given permission, used the new tools and understandings to make changes they had wanted to make all along. I think I am going to re-define leading as removing constraints that keep people from using their talents and do what they had wanted to do all along to make a difference in the lives of others.

Sometimes I don’t understand how things work here. We were invited to a restaurant (‘The Albatros’) by the local delegation in honor of the Director-General of the Ministry of Health who came all the way from Abidjan to hear the teams’ progress so far. His presence is very motivating to the participating teams because they have little contact with people that high up.

One of our facilitators, who is also a director of one of the health districts, showed up at the restaurant, when we were all seated, with lots baskets, pots and pans. They were unwrapped and unpacked on a table and revealed a copious meal with many different dishes and side dishes. How she managed to be with us all day and cook for some 25 people is a mystery – and not just a simple meal: we had rabbit, chicken cooked in various ways, sauces, tomato and onion salads and more.

What is also a mystery is why a restaurant would agree to host a party with all the cooking brought in from outside. Maybe they made all their money on the wine.

We were eating under the watchful eyes of Arnold Schwarzenegger or someone of his ilk on a giant plasma screen. He was doing dangerous things with cars, women and casinos. I have a hard time in restaurants with TV screens and try to seat myself so I can’t see them. But I was seated next to the D-G, in full view of the action movie. No one paid any attention to the flashing and exploding going on on the screen, interspersed with women who were in various states of undress. I had to muster all the discipline I have and keep my gaze focused on other things.

Once people started eating all conversation stopped and everyone concentrated on the food, which was accompanied by water and wine, countless bottles of each. The food was very spicy. I was glad I no longer had a sore throat or coughing fits.

When our plates were empty the Regional Director who is hosting us and the DG said their words of thanks and we were on our way home, back to our hard beds and my thimble of NyQuill.

We met all day on Tuesday to review where we are in the longer process of leadership development and prepare for the days to come. All of the facilitators were there, the same team I started with now five months ago, minus one, the most senior member of the team who is now advising the president which puts him, hierarchically, in the stratosphere and outside our reach.

The review of what happened since May was inspiring to say the least. The team has made this program their own, always being a few pages ahead of the participants. If they hardly knew what coaching was five months ago, they have been doing it since we had our first long coaching training over skype, me in Ulaanbataar, they in Abidjan, and taken to it with abandon.

Today was an extra day, inserted very wisely by the facilitation team as they realized that the district teams never have the time to reflect on their management and leadership practices, produce the required documentation to show links between leadership and management development and public health results, share their accomplishments and record their progress towards the targets they set back in May. So it was a quiet day for me and Alison. With our internet flash drive keys we were able to catch up on our email and other tasks, without losing any of the exciting stories.

After lunch, we watched the film Inside Story about a Kenyan soccer player, his vision, and the many obstacles on his way, not the least a few unprotected sexual encounters that got him HIV and which he passed on. It’s essentially a film about HIV, made in South Africa, with support from MSH. It illustrated beautifully what we are trying to do here. Of course a film about soccer would always be a hit, anywhere in Africa, but the HIV angle made it also a film about the teams’ work.

After the film the district teams shared with us some of the surprising side effects that this program has produced: increased prenatal visits and deliveries by skilled personnel, brought about not by the participants in our program but by people they told about the training and shared their learning with. All these surprising stories involved midwives and nurses who ran with the tools given to them, mobilized communities and other resources to move to newly minted visions and new freedoms given to them by their superieurs to do what they had wanted to do all along but never felt empowered to do. Something is rubbing off.  I just lit the match back in May.

We met at the MSH office yesterday, meeting new and old colleagues. We reviewed our program and then were on our way in northeastern direction to about 30 kilometers from the Ghanaian border. The trip took us nearly 5 hours over increasingly poor roads; at the very end the asphalt was in such poor shape that we drove mostly on the sides, skirting the biggest holes.

It is rainy season and the rain comes on suddenly and hard but doesn’t last long. We were driving a fairly new SUV and were comfortable inside. I managed to do a lot of knitting so that Faro’s cotton hoodie is hopeful done in time before the weather requires wool sweaters.

We met up with the rest of the team at our Abengourou hotel where we will hold the workshop. We are no longer greeting each other with the usual ‘bisous’ (kisses) three or four times, alternating cheeks. Now the greeting is a touching of elbows, where all skin is covered. Short-sleeved people need to put on something to cover the naked skin, something not quite respected by all; it is after all short sleeve weather here. At the entrances to hotles and offices you will now find large pails with soap and water. The simple act of hand washing may finally take root as a regular habit, something that has eluded health professionals for decades and is responsible, partially, for the rapid progression of Ebola across the region.

Some miscommunication about dinner landed us in a ‘maquis’ the kind of small local restaurant you find all over this part of West Africa, where you eat outdoors and there is no elaborate menu, just local dishes. Our Ivorian colleagues insisted on us eating fried yams (ignames) as it is the season. This was, surprisingly, not on the menu and required that someone go out and get the yams. As a result we had to wait more than an hour for our meals to arrive – but it was worth the wait.

The mattresses in our hotel are hard like a plank, and so is the pillow – you cannot fold it. I can do my early morning yoga and exercises right on the mattress without making a dent. I was considering this morning to send someone to the market to get me a piece of softer foam but then again, I slept very well for 9 hours thanks to my nightly thimble of NyQuill.