Sylvia's Journal

We had a long day full of heated discussions about what quality of services means in the context of the two rehab centers. We divided the group in 3: one group had to list what quality looks like from the client’s perspective, another from the provider perspective and the third group from a management perspective. The last two were easy since we had both managers and providers in the room. The first one was more difficult, to put oneself in the shoes of someone who needs the service but may not be educated as to what to expect. Imagine someone who had her leg amputated after having been given an injected with a dirty needle, then an untreated infection, then gangrene leading to the only remaining response to save her life: an amputation. Imagine the trauma of all that, and then to travel 600 kilometers in public transport (what if you have to pee?) arrive at the entrance of a crowded hospital with no indications of where to go and who to address. It would be traumatizing for a man, but even more so for a woman. 

After the lists were completed each group moved over to one of the others and indicated with a (+) or (-) sign whether the listed aspects of quality were being honored/present or not. Because of time constraints (we have very slow and soft starts every day) we could not have another round; good enough for now. 

The review of the lists and the plusses and minuses was heated, especially the minuses but surfaced some important issues. The culture card was played frequently, it’s a card that implies that one has very little control over things. This is true of course, there is so much here that people have no influence over whatsoever; interestingly, the one thing they do have control over, their attitudes and mentality, is something they seem reluctant to do- and this was one of the things that got in the way of quality.

The habits of talking over each other is common in meetings. By setting norms at the beginning there is always the hope that these will impose order. But they never do, unless a higher authority is created. Sometimes they look at me, as the higher authority, to maintain the rules but I always decline. I usually give a little speech about everyone being responsible. But that never works either. In Francophone West Africa a Village Chief is often proposed. I usually push back against that because it complicates my work when have to report to a Village Chief who knows nothing about process facilitation and my methodology. But this time I decided to go along. After a while I got the hang of asking permission to the chief to speak, and I realize we can meld two approaches together. He was, more or less, able to handle the competing voices when we chanced on a hot topic. Most of the time I remembered to ask his permission (like ‘OK, can we move on now?’), and when I forgot he was forgiving, we exchanged smiles. It costs me nothing and it honors a tradition.

At the very end, an actual higher authority (the Deputy General Director of the hospital, AKA Monsieur le DGA) came in to listen to the results of our meeting. But our Village Chief had disappeared. This was a problem as he was the obvious person to welcome the DGA, everyone said so; second in line was the (real) chief of the rehab center. But he had left the room as well to look for the Village Chief and now both were gone. 

We hadn’t discussed the process of the formal closing, after all the hard work of structuring processes I forgot to pay attention to this last process – a process probably no one considered a process. I asked who welcomes, who introduces, who closes, etc. no one had thought about it and so it was rather disjointed, especially with the two Chiefs gone. In the end it all worked out although it was not the exciting and seamless culmination of the week’s work to the DGA with the presentation of the teams’ commitments. The food also came half an hour late, so the celebratory dinner was more like a feeding frenzy with everyone helping himself and herself to as much as the food as possible. And it felt hardly celebratory. By the time I got to the feeding station most of the food had gone – I got two brochettes and a Madeleine  cookie. I missed the little pizzas and some other ‘mouth teasers,’ that were piled high on people’s plates, then covered with a napkin to take home. This is about living in a place of scarcity – get what you can get before it is gone; even though all the people in the room have a salary that can sustain them. It wasn’t a leadership course so I kept my observations to myself.

Yesterday morning I had the extraordinary experience of sitting in a meeting in Ghaziabad (in Uttar Pradesh) while also sitting in my hotel room in Niamey. A century ago this would have been considered magic, or at least impossible. But thanks to WhatsApp it was possible.

My Indian colleagues are on an exploratory mission, while visiting their family in Uttar Pradesh for Diwali. The exploration is about better understanding what the municipalities are struggling with so that we can finetune our proposed design to the Department of Urban Development. I am very grateful for my Indian team mates – they find out things I could not possibly have learned from a distance. It’s humbling to realize how little I know about what is going on nearly halfway around the world. 

I learned from our graphic designer member of the team that the Dutch are very involved in waste removal and clean water in Uttar Pradesh – he was scribing a meeting and made a fabulous graphic about it. Of course, the Dutch would be involved in waste and water management, coming from a country that is partially below sea level. It has led to extraordinary creativity and a very specialized expertise.

We still don’t have the contract in India and it may not come anytime soon as our proposal has been winding its way through the bureaucratic maze while we are busy learning directly from stakeholders about the complexity of the urban renewal work – it is not just about aligning the departments within the municipal government, but also aligning and mobilizing the multiple actors outside the municipal confines 

So far, our design is just focusing on the internal alignment, which we assumed is a start (which will be confirmed or disconfirmed by my team mates once the interviews are completed). Our initial design is based on the premise that there is much collective learning that needs to be engineered, between departments in one municipality and between municipalities to learn from each other (among other things on how to deal with all these outside forces, especially the ones that create troubles for them). We’ll see what happens, it has been a wonderful experience so far and the relationship with my Indian team mates is priceless, no matter what the final outcome will be. Win or lose, there will not be failure.