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Good intentions

Published June 12, 2016 On the road Leave a Comment
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Saturday was another workday, our last, but it kept us busy in meetings until it was time to go to the airport to catch my flight to Johannesburg. I kept telling myself that once I landed I would have time to finish my notes, turning my scribbles in the training handbooks into notes usable for the session authors. But once there I realized that transcribing scribbles into notes is tedious and detail work I didn’t have the energy for. I postponed the task once more with the intention of finishing the job in Madagascar before my next assignment would start on Monday.

The flight from Johannesburg to Antananarivo is only a short 3 hours but between getting up at 7:30AM and arriving at 6PM at my hotel in Tana (5PM South African time), I took me an entire day.

The quiet Sunday afternoon I had imagined myself sitting on a terrace with a cup of tea, finishing my work, didn’t materialize because a glitch in Kenya Airways baggage handling left me waiting for a colleague for two hours. I took the taxi I could have taken 2 hours earlier and arrived in the dark.

To my great surprise I arrived at the same time as two ICRC staff members with whom I have shared many weeks of training in Addis, Lomé, Bangkok and Dar es Salaam. Quelle coincidence! We had a nice dinner together, longer than if I would have eaten alone, and thus the final slug to complete my assignments from Capetown made for yet another late night, hopefully my last.

All in a name

Published June 10, 2016 On the road Leave a Comment
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In parts of Anglophone Africa, a generation ago, there were many parents who liked English so much that they picked interesting or random English words to name their babies. I have come across a lady named Address in Rwanda. When asked how she got that name she told me her father picked the word from a piece of paper written in English. Not knowing English and understanding what Address means, he thought it sounded nice and it became his daughter’s name.

There are many men with the first name of Kennedy in East Africa (I haven’t met a Nixon yet), among those born in the 60s. I am sure there are a few little Obamas in east African primary schools right now and someday there may be a lot of Hillaries.

One of our trainees has a last name on her badge that required explanation. If I remember well it was spelled ‘Magnififayi.’ I asked her where that came from, and once again, it was a parent (dad) who loved the English language so much that he called his daughters Magnify, Modify, Specify and Glorify. The man at the place of birth and deaths registration was probably as perplexed as I was. In an attempt to Africanize the name he added the ‘fayi’ part.

I love to ask people when I start a training to explain where their names come from as it helps me to remember them. These stories are so interesting and wonderful because in most cultures first names have a meaning. They could be the names of prophets or characters from the bible, names of Gods or Goddesses, names of the days of the week the child was born on, or names of saints on the calendar. I was told there are children in Francophone Africa who are called Fetnat – which was picked from a French calendar that indicated that the birthday had taken place on the day of a Fete Nationale, abbreviated on the calendar as Fetnat. But the ‘fy’ sisters are the best ones yet.

Testing – round 2

Published June 9, 2016 On the road Leave a Comment
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I joined the rest of my team in sunny Stellenbosch on Sunday morning and reviewed the materials for the second pilot of the training of trainers of the WHO Wheelchair Service Training packages.  Participants began to trickle in from Tanzania, Kenya, Zimbabwe, Malawi, Burkina, Jordan, Canada and the US; twelve participants to learn how to train managers of rehabilitation services to either start, improve and/or expand wheelchair services.  Another group of nine learned to become trainers of intermediate wheelchair services (those that are for people whose bodies need to be supported in a wheelchair).

I joined my co-observer, the same as in Nairobi a few months ago, to see whether the improvements we had made after the first pilot, some months ago, were indeed improvements. We had two new trainers to deliver the package as per our instructions and it was them we were observing; one trainer from South Africa and another from Zimbabwe. It was a fabulous team of trainers and, by and large, of participants.

The training took place at the Western Cape Rehabilitation Centre, requiring a daily 45 minute shuttle between Stellenbosch and the center. Since it is located at the edge of Capetown in an area where one should not drive after dark, we were under considerable pressure to end the packed days in time so that we could debrief with the trainers and observers and share our learnings. We never managed to get out before dark.

As a result our days were very long, often arriving back at the hotel at 8PM or sometimes even later, having left the hotel in the morning at 7AM . After the two days of core training participants were given assignments to try out sessions from the management training to get a taste for the material and demonstrate the concepts taught the first two days.

They were quite anxious about the practice sessions. We offered to be available after hours, which sometimes meant till 10:30PM. Then there was the requirement, for us observers, to write our daily observation notes about each of the sessions every evening. I was always too tired, pushing the task ahead of me. And so the intense and long days from the previous week continued. When I filled in my timesheet for the two weeks (New York and Capetown) I had clocked 170 hours in a two week period that demands only 80 hours.

Characters and principles

Published June 5, 2016 On the road Leave a Comment
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It was a quick turnaround. The time between trips (originating in the US) has never been this short. I had only a few hours to take care of corporate requirements that relate to the annual performance review process, login glitches, emails waiting to be responded to and packing.

The packing was a little more complicated than usual because in South Africa it is winter, in Madagascar it is a little warmer though still cool in the morning and evening and in Holland it should be nice summer weather if it is not raining. I decided to travel with a suitcase rather than hand luggage, to spare shoulder and wrists joints.

The plane to Amsterdam was full but not full enough to push me forward for free. I had a good seat and decided to medicate myself for a short night sleep, and did so.

In Amsterdam I found out that there was a business class seat available on my connecting flight, requiring a payment of 150 euro and 35000 miles. It was a great investment for an 11 hour flight. Aside from catching up on Dutch movies, KLM has a new food service with an on-demand menu of wonderful small dishes after the initial meal. That meal included a delicious ‘rijsttafel’ option. There was even a supply of licorice, available at all times.

My seat mate came from Vancouver for her bi-annual artificial insemination treatment. It seemed a long trip for something that could be done in the US or Canada but she insisted that there was something about the quality of the donors and, besides, her wife was from Capetown and had connections. It was also an expensive trip as she had bought a business class ticket for about 6500 dollars. When I told her that, without using miles my upgrade would have cost 800 euros she thought that was cheap. I suppose it was, compared to 6500 dollars.

Across the aisle were two (older?) ladies from California, one of them drinking one Heineken after another, stating loudly to the steward how light Dutch beer was compared to what she was used to back home. Just before we landed one of the crew remarked to her she was not a frequently flyer and would she like to join? She declined saying she could not be bothered by that. The world is so full of characters whose stories I would love to know.

While transiting in Amsterdam I learned that Mohammed Ali had died at the age of 74. I had traveled to Kabul in 2002 on the UNHAS flight and he was on it too, visiting Afghanistan as a kind of peace ambassador. One of the NYTimes articles includes a picture of him with a small school girl in Karte Sei.  It was a small plane and we all got to shake hands and have our picture taken with him. He was already in a far advanced state of Parkinsons. I had not realized that at that time he was only 60. He looked old and needed several handlers to take care of him. Parkinsons is a horrible disease.

Reading the statements from Obama and Trump about his death, I am amazed how united people with such radically different outlooks are about what made this man so great. Who could have imagined that back in the 60s and 70s? It seems that, in the final tally, we all do value people whose behavior is guided by principles, even if we don’t agree with them or with each other.

Distilling actions

Published June 3, 2016 On the road Leave a Comment
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The months and weeks leading up to the NY consultation included many skype calls and iterations of the agenda – we were retrofitting activities into a solid design. It was just-in-time, with the finally pieces falling in place just hours before the end.

We nearly always called each other from different continents – often late at night or early morning for at least one of us. Some of these late night skype calls took place during my vacation in Thailand and Vietnam. There were times I regretted to have accepted the assignment.

It’s hard to join a design team in midstream, especially with people whose comfort zone is with the traditional format of individual presenting alone or on panels followed by Q and A’s or when the organizers feel not entirely in charge.

The traditional format (powerpoints followed by individual questions and then answers from the presenter), especially with 80 people in the room can be deadly. Individual agendas can easily hijack the usually few remaining minutes in a session. Everyone has experienced this more than once. And yet, unfamiliar with alternatives, most public health experts I know repeat the pattern of the old format over and over. It is what they known and what keeps them in their comfort zone, even though such a format is hardly engaging. When I ask about such experiences they sigh, as if this is an inevitable course to follow.

I love to show alternatives, what is possible, and how to get to the action – which is what people always say they want. But unreflected action is worse than no action. There has to be a process for meaning making and culling and vetting. This is why we need structures for meaningful interaction. And just as with physical structures, conversation structures also needs architects.When we select speakers and let their activities design the event we are putting the cart before the horse. And when we attach ourselves too much to narrowly described pre-set outcomes that may not be shared by all those invited, we are also unlikely to get value for money.

I am always struck about how much fear there is that ‘things will get out of control, that dominant people will hijack the meeting or minorities don’t feel safe to voice their opinions.’ The irony is that without structure, this is eactly what will happen.

There is always wisdom in the room but that this wisdom is either unrecognized or unfiltered. The process of coming to shared insights is a distillation process, with lots of impure stuff being heated (talked about with passion), then run through a cold water pipe (the realities, conditions on the ground) until the really good stuff comes out in small drops. And that is finally what we did. I was really happy after all to help make that happen.

We celebrated the end of the event at a small tapas place next to Central Station after which we all went our ways. I walked to Penn Station which was way too frantic for me and must be very intimidating for innocent tourists. I couldn’t wait to get into the train, have my dinner and a beer. Four and a half hours later I tumbled exhausted into bed.

Community and presence

Published June 2, 2016 On the road , Uncategorized Leave a Comment
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I enjoy working with people who don’t know that you can get a lot done with 80 people in two days. One woman from Uganda said, after we collectively defined what integration meant in about 20 minutes, that this exercise would have taken them days or maybe even weeks back home.

When people express wonder, amazement and appreciation for the facilitation, they don’t realize that they are commenting on the design. Facilitation is very easy if the design is solid, even for newbie facilitators (maybe not easy but doable). Facilitation is very difficult if there is no design, even for experienced facilitators.

I believe the appreciation comes from having one’s voice heard or seeing that space is created for the quiet voices.  Those whose voices are always heard, and often too much, don’t usually express such appreciation. They sometimes bristle at the structure that I impose.

“Everyone participated!” say the ones who want to hear everyone’s voice, as if they can’t quite believe it.

For me this is simple and never a surprise; people participate because there is no way not to participate. The only people not participating are those who are doing something else on their phone, tablet or computer, or are taking calls outside the room. To reduce these absences, I periodically sweep through the room and close computers or turn over smartphones that are being used for some other purpose than the meeting. I do this with a smile. Some people thank me for it, some get defensive (“I was looking something up!”) and some get a bit prickly. people learn fast. When they see me coming they put their phone down so I don’t have to do it for them. I am acting like an old fashioned teacher, people recognize that quickly. It works.

In the development world I work in, I often hear people say ‘value for money.’ It is also one of MSH’s strategic priorities. Yet we are surprisingly tolerant of meetings where half the people are not present, even though the limited development resources that we always complain about, have been paid to physically bring them in. I think I know why we tolerate this kind of behavior: we are uncomfortable confronting people, especially those higher in the pecking order. Under the guise of being polite, we actually collude with people who are not polite. If we are saying we want to do something together, then shouldn’t we all be present together? I sent those who cannot be present out of the room.

Despite all the kudos and raves, I didn’t even feel that this meeting was as good as it could have been – there were a few disconnects, speakers who came in for their session, unaware of what the group has already discussed and defined; the schedule was rather full leaving little time, too little time, for serious discussions and reporting back.  Because of that, running late from the get go, unrealistic expectations were not examined and thus, there were disappointments at the end. Some critical voices were missing and there were too many wishes and wants resting on different agendas that had not been sufficiently confronted. Hierarchy and seniority always gets in the way, here and everywhere else.

Still, I was pleased with the productivity, the expansion of the community of activists and the good energy in the room. Things could have been improved with more time for dialogue, more focus, scribing and music. I hope there is a follow up where we can do this.

A brief trip to NYC

Published June 1, 2016 On the road Leave a Comment
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Some months ago I had agreed to facilitate a consultative meeting in New York City, just days before my planned trip to South Africa. It would mean arriving back home at midnight the day before my departure to South Africa. I accepted because I love such assignments, even though it was a bit of a sacrifice and there were moments I regretted my ‘yes.’

It was a consultation about getting childhood tuberculosis considered as part of a broader package of maternal and child health interventions as the local level. This may sound simple but it is far from simple. Local level ultimately means the community level. This is the level where, in many developing countries, the usually unpaid community health workers are fulfilling the most basic tasks of prevention, diagnosis and treatment of illness. These people often have little education and sometimes aren’t even literate.

They are trained to fulfill their various tasks through vertical programs: the malaria people provide materials, pictorial algorithms and instructions, training sessions and reporting forms. And so do the health education people, the maternal and child health experts, the HIV people, the TB people, the nutrition people, the vaccination people, and so forth. A participant from Uganda told us that she has seen community health volunteers who have to fill in 11 registers to show their task masters what they did each day or week or month or quarter.

The purpose of the consultation, led by UNICEF and the TB Alliance, was to learn from other experiences of integration and consider the upstream implications of integration at the base: the health system functions, the financing, the evidence and identify the research agenda that would give guidance on how to proceed and avoid mistakes of the past

I took the train to NYC, having calculated that plane or Acela train would take about the same time and cost about the same as well. Sometimes we hear about Amtrak trains derailing because some system was poorly maintained or the conductor was driving too fast. These things happen and make a big splash, but they are rare. I boarded the train hoping all systems were maintained and the conductor had had a good night sleep and followed the rules. I arrived safely at Penn Station, though the trip took a bit longer due to a few glitches that were annoying rather than deadly.

I arrived at UNICEF just when the place emptied out for the day. I finally got to meet my team mates in the flesh (though one I had met nearly 20 years ago in South Africa). We did the finishing touches on the design and flow of day 1 and identified what still needed work for day 2. Since all my team mates were lodging in places far apart I was on my own for dinner and too tired to visit anyone. I consulted Trip Advisor and found an authentic Japanese/Korean restaurant across the street. It was full of Japanese and Koreans, which confirmed the rave review, and I was greeted by all staff the way I remember from Japan. I also discovered a Japanese convenience store a few blocks away and stocked up on some delicacies to nibble on later, while watching TV in my tiny ‘central location’ hotel room.

I watched an amazing PBS program in which Stephen Hawkins turns theoretical constructs into a series of ingenuous experiential exercises for teams of three young scientists. The take away message: we are infinitesimal small in the greater scheme of things. It was another reminder about keeping perspective.

Transitioning home

Published May 15, 2016 On the road Leave a Comment
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I arrived in Holland where it was still cold but the sun was shining and all the trees were green. I stayed in a hotel, just blocks from my friend’s house (that has no guest room), very convenient. It caters to young travelers. There were little things that gave this away: one had to pay for internet, 4 euros per device for 24 hours; there was a kettle and cups for making tea or coffee but the packets/tea bags were to be requested at the front desk, which required exiting one building with very steep stone steps, and entering another,  with ditto.  The beds were made for skinny people, 80 cm wide or made be even 70 cm.

We made a trip to the local supermarket to get me my favorite foods for dinner, had a glass of wine, toasted to turning 65 and then I returned to my hotel.  The next morning IU checked out, walked in a completely deserted Amsterdam (it was Ascension Day) to have my breakfast and prepare my lunch for in the plane. We drove in no time at all to Schiphol. The roads were as empty as I have ever seen them. All Holland was still asleep. I kind of like Holland that way.

Back in the US, one month makes a big difference in spring time. Everything was green, trees flowering and an occasional tulip still going strong.  It was nice to be home.

Cooking with Koong

Published May 14, 2016 On the road , vacation Leave a Comment
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For my last full day, solo, in Bangkok I took the train to the weekend market early in the morning to see if I could find the lady who had sold me one wonderful top I wanted more of. It is an easy ride on the train, no stops, less than a dollar. Surprisingly I was able to found her again amidst the 7000 stalls. I wandered around a bit more, a strong ice coffee in a little plastic carrying back to keep me awake and hydrated, until I couldn’t stand the heat anymore.

Returning to the train I walked against a stream of thousands, no tens of thousands of people on the way to the market. My timing had been perfect.

For the afternoon I had signed up for a cooking class. After our private cooking class in Changmai last year, this was a very different experience. I counted some 25 people waiting at the assembly point. We were swiftly formed into three groups each with an instructor. We walked a few hundred meters to the mostly deserted vegetable market. We were each given a cute little basket to create the illusion of shopping for the food we were going to prepare though most was already purchased in the morning, when the market was a bit more alive and the produce fresh.

Our instructor gave us a brief intro to Thai herbs as greens are called, sniffed and smelled a few and then, from a pre-arranged pile, we each took some stuff and put it in our basket and headed back to the school.

Three classrooms on three floors were filled for the afternoon session. The morning session was already full and the evening session was too late for me. Our instructor was a peppy young Thai lady who had learned a smattering of Dutch (ik hou can jou, lekker, eet smakelijk), German, Chinese and other languages from her students. My fellow students were two Filipina sisters (one living in Japan, the other in Vienna), a Brit living in Malaysia with his Malaysian wife, two young German men trekking on a low budget through Southeast Asia, and a couple from Singapore.

We donned our aprons and then had our class sitting on the ground, like cooking is done traditionally in most of the world. We each had a sharp knife, a cutting board and, outside the room, our own gas stove and wok. We learned how to make coconut cream and milk (not entirely from scratch), tom yum soup, fresh spring rolls, pad thai, green curry and mango sticky rice. It was more or less the same menu we had in Chiang Mai, except here two helpers did a lot of the prep work, so our cutting and squeezing and pounding was mostly giving us a feel for what it takes to get ready for the actual cooking. Only the wok part we got to do entirely on our own – a row of 9 people standing in front of stoves and the teacher on the other side giving us instructions and doling out the ingredients we had played with, plus more fillers and protein.

After each menu item that we had prepared we returned to the dining area where we sat at tables and consumed the fruit of our, not so very hard, labor. It was an enjoyable experience although I was not very impressed with the green curry. My table mate also pushed it away; too salty, too much fish sauce.

On my way home I had one last foot massage, splurging with the whole hour one for 8 dollars. How I will miss these. Back at the hotel I followed Axel in his plane across the Chinese Sea and then the Pacific and then the great American planes, using the Flightradar24 app which even shows the land (or water) gliding by underneath the plane. When he landed at JFK I was asleep.

I had one more work call for my next assignment, one of only very few work incursions into my vacation, and then packed my bags.

Off he goes

Published May 14, 2016 On the road , Uncategorized , vacation Leave a Comment
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It is really too hot these days to do any visits to places that are not air conditioned. Still, we went to visit the Wat Pho temple complex which is worth a good sweat. And best of all, it has a massage school which was founded to make sure the Thai art of massage and ancient healing would not get lost to the tablet and smart phone generation. Part of the temple is dedicated to the art of healing massage with ancient stone tablets explaining which touch heals which body part. I had expected a large waiting time to get a massage but I was wrong, some 40 or so masseuses (presumably in training, though we couldn’t tell), in white dentist uniforms stood at the ready. The prices are a little more than at our local massage place but still little and still worth every baht. I was glad to contribute this way to the upkeep of the magnificent temple complex and the ancient art of massage-healing. We received an expert treatment and our feet, having been massaged so much in these last two weeks, are starting to limber up. I didn’t hear Axel whimper one bit.

We collected ourselves at Starbucks which will forever be associated with respite from the great heat, and less so with free wifi which requires putting in your passport data and more complicated stuff when you are a foreigner.

On the way home we stopped at the massage place and had a Thai massage. The last Thai massage Axel had was in Kabul when the Thai lady walking over his body broek (we think) a rib. I remember Axel letting out a fierce cry. It ahs taken more than 5 years for him to try again. It was a good experience, no ribs broken and much tightness released.

At night we found another mall (all have foodcourts and airco) for dinner and had our first and one and only sushi dinner of this vacation. It was our farewell meal.

A few hours later I helped Axel drag his overstuffed duffle bag (no wheels!) to the train for the airport. He left at 2:30 on China Eastern Airlines, going East to JFK via Shanghai. We whatsapped when he got there and then he settled in for his 14 hour flight and I went to sleep.

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