Sylvia's Journal

I have missed the entire month of November in the US. When I left there were still leaves on the trees and it was decidedly not winter. There had been no serious frost and we were still harvesting. I understand all that is now over.

Saffi has added this month that I missed to her life and is now 4 months old. She can now do things she could not do when I last saw her, such as pushing up on her arms.

I am nearing the end of my third assignment, the longest of them all. When I leave on Friday the team will be on its own. I have no worries or doubts about that. Today they ran the senior alignment meeting with great skill and confidence, with me coaching from the sidelines except for the two sessions that are most difficult to facilitate, especially with debate-happy French speakers (la francophonie). I have learned over the years how to handle this and actually get quite a kick out of it, but, unprepared novices can easily drown in the cacophony of voices and opinions and lose the thread and much time.

I repeated the exercise we did last week, asking what their secret was about keeping Ebola out. This time we had a much more mixed audience, some doctors but also several men in uniform (gendarmerie, the army), veterinarians, the prefect which is the highest representative of the government (somewhat like a governor), members of the regional council, the mayor’s office, animal husbandry people and the regional reference hospital, including the focal point for Ebola. Yet, they came up with exactly the same reasons as the 30 health folks did last week, giving the data some more oomph. I daresay I now know what allowed them to keep Ebola outside their borders: political will, mass education and mobilization, logistical, technical and financial support that allowed them to put all the required equipment in place, training and supervision of the various actors in health and other sectors, including health providers at the community level, coordination mechanisms that actually work and surveillance.

I had the group create a shared vision after a guided imagery followed by drawings. After the initial indignant outcry (‘we can’t do this!’) they all set too work with great vigor and under loud laughter. It was serious play because Ebola is nothing to joke about.

I did notice that everyone shakes hands again – old habits die hard. When I elbowed the prefect he told me bare elbows was still not good enough and we rubbed our covered shoulders.

Everyone thought Ebola had disappeared. The new alert from Liberia (and the ongoing alerts from Guinea) means they have to reconsider such behaviors like shaking hands again. A sick person from Guinea was just returned at the border. The threat is real and nearby; half the population has relatives across the border.

The hunting and eating of bush meat is still being enforced and those who made their living doing the hunting and selling have been given a new trade, charcoal, thanks to the quick action of one of the ministries that had figured out that forbidding a trade and not replacing it so people can continue to feed their families will only lead to cheating. People have been put in jail for ignoring orders from up high. It is a matter of life and death and so they take everything quite serious.

After hours, at 5PM every Monday, the coordination committee meets for exactly one and a half hours. It starts exactly on time when the prefect enters. The actions from last week are read and everyone present is held accountable. Only a very good excuse is acceptable I am told. During the height of the outbreak next door, these meetings took place daily.

I was the first for breakfast this morning, testing how well prepared the kitchen was for having some 30 people show up every morning this week.  As there was no one in the restaurant I ventured into the kitchen. What I saw there was rather disgusting, and once again I am amazed they were able to keep Ebola out. The place was filthy with plates from last night’s dinner heaped up and general chaos. I swore not to eat anything that was cooked in there and this morning I declined the omelet. It is going to be a week of limp baguettes and tea. The luxury will be the small Vache Qui Rit triangles that I will buy myself. It is a bleak prospect but it will all be over by Friday.

What is also bleak is the news on France 24 with all these images of serpentine wire, guns, explosions, blood and crying women. And then there are the documentaries about climate refugees; this morning was about villagers in Bangladesh whose livelihood has been wiped out and who are now squatting in the slums of Bangladesh. I watch more TV during my trips than at home and it is a sapping experience.

Bleak is also the large mirrored bar cabinet in the restaurant that doubles as bar at night. It could hold 40 bottles but there are only three, whisky, gin  and something else, that speaks of loneliness and its consequences.

I am utterly aware of the catabolic energy that pervades just about everything and I am determined to turn it around, at least with the people I can influence this week.

This morning we went to the Cascades de Man. It is the touristic attraction of the region. People go here just for the waterfalls. It is the end of the dry season and so the waterfalls were not as spectacular as they are during the rainy season, but nice enough. The road there and the waterfall ‘amenagements’ as the French call it have added an element of ugliness to what is otherwise beautiful mother nature. The road to the entrance, where the ticket man sits, is hardly navigable in the current dry season. I can imagine that during mud season only 4×4 can get there, and not easily.

Once in the area of the waterfalls the tourists are helped by a steep set of uneven steps and a railing. That was helpful. Once down in the waterfall valley large slabs of concrete and preformed benches and platforms have been put in place willy-nilly without any sense of esthetics. They are practical as you don’t have to jump across rocks but also an eyesore. A small mildewed pavilion puts the finishing touches on the “amenagement.” It is run down, fungus on the walls, garbage – it will be fixed the guide told us. He is not paid by the ministry of tourism and lives on tips. I wondered whether the man who collected our entry fee (200 CFA which is less than 50 cents) is an employee or also a volunteer, and if the latter, whether he can keep the change.

There is a bridge made from vines that the villagers made in order to cross the cascades. It is in rather poor repair and fortified with man-made ropes. Our guide showed off, walking a few meters onto the bridge, saying that we probably couldn’t do it but he was and experienced guide. “Huh,” I puffed, “I can do this,” and we were all allowed to take a few steps on the wobbly rope bridge. Clearly, there are no lawyers here who make the rules. It is not that difficult when one has no baggage but I was wondering about women having kids on their backs and wares on their heads when a deadly force races by several meters below.

We returned to the concrete slabs and made our way to the big cascade. A large pool in front served as a self-cleaning swimming pool. Two small boys in their underwear were having a great time. Higher up the cascade formed a series of plateaus, nooks and crannies which enticed many adults to partially disrobe and take a shower while posing for their friends.

There is a steep path to the top of the cascade which we declined to take – our shoes were the wrong footwear and it was too hot. We also declined the two hour walk up to the ‘dents de Man,’ two large boulders that could have been the teeth of a giant.

On our return we went back to La Paille, the Senegalese restaurant where we are taking all our meals outside work hours. Today the waitress was rather sullen, eating a banana in a rather seductive way while taking orders. It looked as if taking an order was a tremendous effort on her part, as if she’d rather had the customers go away.  But she had an amazing hairdo and I was allowed to take a picture. It is the only smile she gave us.

I ordered again a Cieboudien (also affectionately called a Tjep), Senegal’s famous rice and fish dish, but with chicken. That was a mistakes as the chicken must have been of the elderly kind – little meat and sinewy.

Back in the hotel we went to check out the conference room and found the trainers of a workshop that had just finished. The topic, according to the banner with logos of the International Rescue Committee, the French, the EU and the Ministry of Health indicated that the workshop had been on the “Renforcement du système de santé.”  Interesting, I though, we are doing the same, but we are doing it with American money; and as I have learned along the way, usually the French and American development aid groups work in parallel without much contact and sometimes even in direct competition.

Here we are, working on intersectoral coordination when coordination within the health sector is hardly happening.  We ended up chatting with the organizers and discovered that they had been training midwives in safe motherhood and delivery practices. That too counts as health systems strengthening (everything counts as health systems strengthening – abbreviated as HSS- these days). The representative of the International rescue Committee mentioned she was not invited to our event so we quickly extended an invitation as she is clearly another critical player in the HSS dance.

Two things are abundant here: prostitutes and insecticide.  The former are recognizable by their very (very) tight and very (very) short dresses that leave nothing to the imagination and the latter by the constant affront to the senses and (it works!) the dead bugs in the shower. I don’t think anyone reads the labels in order to understand that these two practices are not good for anyone’s health. On the other hand, I am heartened to hear (on TV France) all the climate-related inventions made by young and not so young people around the world and in particular in developing countries to make everyone’s life better, humans, fauna and flora.

The hotel we stay in now is a little simpler than the previous one. If that one was half a star, this one is zero star. Some things are better, others worse: the airco makes less noise, the room is larger, the bed is larger, the door lock is hardly secure, the shower works until my neighbor starts to shower, and the water supply is on and off, as is the internet connection.

Breakfast this morning was rather chaotic and of the basic kind: a section from a limp baguette, an omelette and a Lipton teabag dipped in water that boiled awhile ago. In the other hotel we had a luxury breakfast: juice, croissants or pain au chocolat (both rather limp and a bit too sweet for my taste), jam, butter and a vache qui rit wedge in addition to the bread and omelette.  The fruits we added ourselves (papaya, watermelon, pineapple). When out in the country in most developing countries we stay in hotels that usually don’t cater to foreigners with expense accounts and so the lodgings are rather basic and payment straightforward: in cash.

I left the previous hotel without paying my bill because, contrary to what they told me on check-in, they don’t take credit cards. They would take Euros but I had none. “We don’t take dollars!” said the receptionist and her helper who was dressed in a lacy Victorian dress. “Why not?” I asked. “Because the Euro doesn’t fluctuate but the dollar does.” I offered them a really advantageous exchange rate but that didn’t work. In the end our accountant picked up the bill while I was cruising around town looking for an ATM.

What I had not counted on was that it was the end of the month. Everyone who receives money in the bank at the end of the month, not just from Man but from wide and far had come to Man, some spending their last 300 CFA on a taxi ride. People sleep in front of the ATM. When we made a tour of the city around 8:30 AM the lines were at least 100 meters; the ATMs without lines were already empty. A kind of monthly black Friday. We checked out all the ATMs in Man to no avail.

Last night we tried again and found the lines short, about 15 people waiting in a more or less orderly line, all men. The first 7 were crammed into the air-conditioned portal of the machine itself, and the rest waiting outside. An man in police uniform bypassed us all saying he had urgent business. I hassled him so much that he made mistakes with his password, exiting mumbling ‘zero, zero,’ (everyone laughed). He came back in again through the exit door, once again bypassing everyone. No one seemed to mind very much – they are used to abuse of authority according to my colleague F. My hassling distracted him (guilty conscience no doubt) and it took three tries before he had his money (and very little of it, about 15 dollars worth of CFA). It was a (very small) taste of obnoxious behavior of people in uniforms.

Of course it is nothing compared to what I read in the Congo book that I have now nearly finished. There I wouldn’t have dared to contradict a person in uniform as those folks are dangerous, even if they don’t wear a uniform. I am learning about despicable behavior of Heineken in the DRC that makes we not ever want to drink a Heineken again.

We finished our training and split up in three teams, one staying here (with me), one going north, close to the Malian border and one going south – all three regions bordering either Liberia, Guinea or both. Each team consists of staff from the central ministry of health, from MSH/Abidjan, from our staff in the region and local health officials.

This morning they practiced sessions they will be doing next week and everyone gave feedback and everyone learned a few tricks of the trade or something about themselves. There was even talk of leaving one’s ego home – not raised by me, though I often think this. Many of the participants are doctors in senior positions and being vulnerable is not something they are used to – but most people took this challenge in stride. I saw a few people transform in front of my eyes.

Tomorrow we will move to another hotel since UNDP reserved all the rooms many months ago. It will probably be one star less (which means 0 stars) and I have to pack my suitcase for the 6^th time in 4 weeks.

For our last night together the two women I have been dining with at the hotel each night, took me out to eat “poisson braisé”. The fish we had at our hotel all week was OK, though not exceptional. The street fish we got tonight was exceptional.

The driver took us through the streets of Man to a main drag where all the women lined up with their fish. The hotel had cooked sweet potatoes for us and gave us a plate to take to wherever we were going. I can’t quite get over this: my colleagues buy food and then give it to the hotel to cook and they serve us and don’t charge a penny. My colleagues are not in the last shy about this. “Why not?” they ask, “it’s cheaper when you buy the food outside the hotel.” Well of course, I think, but that’s how hotels work. But the restaurant manager happily takes the pineapple, the papayas, the sweet potatoes and cooks or cuts them and serves them to us without giving us a bill. It appears completely OK.

Maybe this is the same surprise that Africans have when they come to the US and see us waiting for a red stoplight when there is no other car in sight. Or when we get a ticket mailed to our home and we obediently put a check in an envelope and pay our fine. Many Africans find this bizarre.

We ordered our fish and then waited for it to be served for an hour which gave me plenty of time to observe the scene around me.

A kiosk across the street read “verywhere you go,” which I thought would be a good title for a book. There were kids the size of Faro (probably older), shoeless and unsupervised, and kids the size of Saffi riding on their mother’s back; there were young girls waiting for something to happen, just standing there and older boys hanging out. There were “salariés” as employees are called here, eating with colleagues, probably because their wives or mothers live far away and so they fend for themselves and eat out for a few dollars. There were “vendeuses” and little boys selling stuff, going from table to table. The boy sold packs of paper napkins – a captive audience that eats with its hands the greasy fish and sauces. The vendeuse sold deodorant. She was young and beautiful and at every table with only men she was asked for a demonstration and everyone got to smell the pink or white or yellow sticks, made jokes, with an occasional buyer. Her charm got her to show her wares. I saw a great deal of poverty and the desperate jobs that come with it.

The salaried people (including us) all had at least one if not more cellphones. Many have them in their hands – few clothes have pockets. Everyone who was sitting at a table was focused on their device. Even couples, the one next to us ordering a large coco cola and a bottle wine sat silently side by side looking at their phones. My table mates, during the long waiting time, spent a good chunk of that time playing games or talking on their phones. This cellphone disease that has cut out conversation has spread around the world, wherever I go.

Although participating in the Thanksgiving celebration on Skype doesn’t satisfy all the senses (smell, taste and touch), it did satisfy some (sound and sight). I connected three times during the day, following the various preparations from early morning (nothing on the stove at all) to mid-day (giant turkey in oven), to ‘nearly there.’ We remembered last year when the electricity went out and we huddled around the stove melting the snow for tea, coffee and other liquids. This time things were easier.

I got to show my face to Saffi who doesn’t quite understand the concept of ‘Oma,’ and see Faro being a bit too helpful in bringing in an egg from the chicken coop, egg dripping on his hand. An information session on the fragility of eggs is clearly in order.

I learned more about the various creative endeavours of the members of my family: Sita has already made ceramic mugs, Tessa showed the ring she has made and Axel is making art on silk. Sita asked me what I wanted to learn to do, other than knitting and embroidery. I had to think a bit. Woodworking I finally said, something I did two decades ago at the local vocational school, but now I travel to much to take scheduled courses. I made a coat rack, fixed a set of drawers, made a clothes valet for Axel and saw horses – all in good use still. More than 5 decades ago I learned woodworking in France during a summer camp. I made a small stool, turned a salad bowl and egg cups. I love the feel of wood and see a rough piece of wood transformed into something of beauty. Actually, I like transformations, period. Even here, in five days I saw some transformations, good ones.

I can’t wait to be back now and am counting the days – 14 days to be exact, and two more assignments remaining. It’s been a great trip so far but I don’t think I am going to make it a habit to be away for 6 weeks, unless Axel comes along.

Every day it is getting a bit hotter – we are moving into the rainy season here in the mountains and the humidity is mounting by the day. Air-conditioning is a great invention.

We have completed three of the five days of our training of trainers. The design I adapted from the previous TOT is working fairly well thanks to my foresight to make comments about what worked and what didn’t work. Still I am making adjustments as we go because this time our focus is a little less defined and this requires that we explore things in more depth. Last time our focus was given: increase the retention rate of people on antiretroviral therapy – a problem that has created sleepless night and much head ache at the top of the ‘pyramide sanitaire.’ In our previous program it was a tangible problem that was addressed successully.

Now the focus is intersectoral coordination with regard to Ebola and other epidemics – prevent, detect and treat, or “préparation et riposte” as they call it here. Coordination is a lot less tangible than HIV patient retention rates; some people think it is simply meetings but everyone knows that bodies around a table doesn’t necessarily make for good coordination. But something was done right here as Ebola never entered Cote d’Ivoire even at the height of the tragedy next door. I am trying to figure out what that ‘something right’ was.Today we are going to find out what good coordination means to the three regional teams that are represented here, and hope we can tap into that experience.

The team of experienced trainers is stepping up to the challenge as we bring on board a new cohort, with a few hiccups here and there. One hiccup that startled me was when the participants received their facilitator guide materials: 500 pages, a two hole puncher and a four hole binder. It was quite a sight seeing all these doctors punching all these pages with those punchers. It took 45 unplanned minutes. I have learned over the years to put plenty of padding in my time budget and so we could absorb this hiccup as well as those related to ‘la francophonie.’

The participants are slowly molding into teams – they’d better as they have a big job to do next week when we go ‘live,’ and start on Monday with three simultaneous alignment meeting in three frontier regions with Liberia and/or Guinea.

We will divide in three facilitation teams, consisting of a few experienced facilitators – the ones that already completed a successful leadership program in the eastern part of the country – and then the ones we are training right now.

As usual, since the training is experiential, there were countless ‘anxiety’ questions when we started on Monday. That mist is slowly lifting, and those not very engaged (what? another training?) are starting to get engaged. I am doing few sessions myself and coaching mostly from the sidelines. I am proud of the team that is so passionate about the work of leadership development.

My colleague R was correct; we arrived exactly at 6 PM at the hotel in Man. The roads were pretty good except for some 20 km where the driver was zigzagging across the road trying to avoid holes in the tarmac. Luckily there was not much traffic on the road and the zigzagging was possible. These roads are not wide and large trucks can take up more than half.

We had lunch in Yamoussoukrou in a maquis, a small roadside restaurant serving traditional fare for very little money. Yamoussoukrou is famous for its enormous basilica that is visible from far and stands in sharp contrast to its simple and chaotic surroundings. Nearby is the family compound of the former president Houphouet. It is enormous and reminds me of the palaces of Chinese emperors; surrounded by 4 meter high walls that are interrupted on each side by enormous gates, it looks unassailable.

The whole team that I trained more than a year ago is now assembled to continue its cascade training. Enthusiasm is high and everyone is very confident. They are going to run the show – my contribution is the design and serving as a coach on the sidelines. It is now entirely their game.

Man is located in a beautiful hilly part of the country that could be like the foothills in Switzerland. We drove past hills that look like enormous boulders sprinkled across the otherwise flat land. The hotel is located on a hill and every room has great views. Everything is clean but the black spores of mildew are everywhere. My cough, though never completely gone, returned during the night and my voice is affected again. The octave test showed I am regressing.

There is no internet in the rooms and the dangle I was giving is from the wrong company, one that doesn’t work here. This may be a problem. On the one hand being out of reach of emails is appealing; on the other hand there is work to be done after hours that requires an internet connection. Thanks to a mysterious little box that my colleague  R has I can leach off her internet connection and post this while it is still hot.

I watched the news and wished I could connect to my sister in Brussels to find out what it is like to wait for nothing to happen. It seems a big dilemma – you want something to happen so you can stop waiting while you don’t want something to happen because people will get hurt. How long can one close down a whole city?