Archive for the 'On the road' Category



Back home for a bit

A whole week has passed since I left Kampala. This means I can temporarily halt the taking of anti-malaria medicine.

My next assignment, hardly leaving me a chance to recover from the week in Uganda, was the facilitation of a worldwide technical summit organized by my pharmacists’ colleagues. We looked at the work that has been done over the last 4 years to improve pharmaceutical systems so that medicines are available in health facilities for those who need it. Colleagues from 17 countries joined headquarter staff to extract lessons learned and find out what they need to focus on in the last project year. I had been part of the organizing committee since the beginning of the year and getting the program designed had not been an easy task, but in the end everything came together nicely, the energy was right, we got the outcomes we had hoped for and we had fun in the process.

Axel had driven down to DC, stopping along the way to visit friends and family. He arrived in DC just when I landed from Kampala via Amsterdam and Boston and picked me up to deliver me to my DC hotel. It was like a brief spousal visit before I dove into the conference and he continued his visits with friends.

On Saturday morning we set out for our long drive north, after a good breakfast at the Red Fox deli on Connecticut. The whole day we drove in the rain; it was rather cold given that we are now officially in summer and it is nearly July. We interrupted our trip at Sita and Jim’s for tea before continuing to Manchester (still in the rain). They had just returned from a vacation on Lake Champlain with friends.

We arrived some 14 hours after we left DC to a wet and wild Lobster Cove, which continued to be wet and wild throughout Sunday – perfect for staying indoors and getting ourselves organized for next week which includes Tessa turning 30, the 4th of July and my return to Africa for another 3 week assignment, partially in Madagascar and partially in Togo.

Truth to power

We finished the four day Coaching & Communication workshop for managers, supervisors and coaches who are responsible for reproductive health or other health services. Eighteen participants joined us, coming from the Ukraine, Ghana, Kenya, Tanzania, the DRC and Uganda. We had revamped an older curriculum that was based on a modular approach spread out over a long period of time. It was a test and an opportunity for us to try something new.

As usual I kept exploring and reading until I landed in Kampala to see if there was something newer, something potential more impactful that we could add to the mix of inherited sessions. I revisited and re-read Kegan and Lahey’s book about competing commitments which I sensed was just the antidote for the usual New Year’s Resolutions that we see at the end of workshops (I will work on my listening skills, I will be a better human being, etc.)

We had reserved the last session for exploring of competing commitments and the concept of immunity to change because it required some level of trust and intimacy in the group. We felt we had reached that stage because of the constant practice sessions in trios. By Friday everyone was quite familiar with the daily life struggles and challenges of each other, and recognized how universal they were.

Everyone came with five challenges they had to deal with, related to relationships with peers, with bosses, with recalcitrant or non-performing staff. All of these they considered obstacles to both the quality and quantity of service delivery. This link to services was important because both our funders and their employers had agreed that this workshop would ultimately benefit the users or would-be users of those services. This was an assumption that we had to prove. We engaged everyone in this collective challenge by creating our theory of change which then informed the development of our monitoring and evaluation plan.

We had created several opportunities each day, usually in trios, to apply and practice the various concepts we covered: giving or receiving feedback, coaching, listening, inquiring versus advocating, facilitating learning, repairing relationships, exploring why we often cannot be honest when we have to have the hard talks, and re-writing the scripts of failed conversations.

One recurrent theme throughout the process was the inability to speak truth to power. We could see how, for them, as it is for us on the other side of the Atlantic, not being able to speak truth to power is the cause of many initiatives failing to deliver on promises (at best) or terribly gone awry (at worst) with sometimes catastrophic consequences for individuals or whole populations.

We used aIgnorance is bliss Calvin and Hobbes cartoon as teaching material. Despite Hobbes’ warning that they (Calvin and Hobbes) are heading for a cliff in their red radio flyer, the wild ride continues. Why worry about later when you are having fun now?. Hobbes is speaking truth to power (we are heading for the cliff), but is unable to stop the inevitable and unpleasant conclusion of the ride from happening.

We can all come up with examples of this in real life. The US’ misguided actions after 9/11, the arms race, dictatorial regimes, and, at a micro level, the sons of powerful persons who are never held accountable for raping or impregnating school girls.

Except for a few very brave souls (many of whom either stand to lose their freedom or live(lihood)), most of us reluctantly accept what happens so that we don’t have to fight with our demons or confront our deepest fears. In the immunity to change session some people did get a whiff of those fears. Although they could be real (when the stakes are high) in ordinary life many of our fears are imagined and never put to a test. If we did, and found out that they are unfounded, lots of things would stop to be problems, and many a ride towards a cliff would be diverted in time.

Back to work

I managed to stay away from my computer during most of my vacation week. This worked because there are some very capable people in the office who took over. I had no sleepless nights over this. In fact, I have slept better than ever in the last 6 months because my shoulder is no longer bothering me.

I continue to get high marks from my physical therapist for my progress. I have to watch out not to progress too much because the ‘no weight bearing’ remains in effect until July 27.

On Friday night I was back on a plane to Holland. This time with Tessa and Steve who joined me for my brother’s wedding – a second marriage for both – but celebrated as if it was a first. The only things that gave this away is that there were, between husband and wife, 9 (grown-up) children and no one was in white. We celebrated the melding of two families, or may be even four as the parents of one ex and one deceased spouse were also there. It was a joyous and warm celebration despite the nippy not-quite-summer-night weather. Tessa got to hang out with her cousins, a rare opportunity, and schemed to have everyone come to her wedding next year.

I left the party early to catch up on sleep and prepare for the next assignment, in Uganda, while Tessa and Steve partied on and left for the east of Holland with another brother and his wife, to explore lesser known parts of Holland by bike.

I got up when some had just gone to bed and most of Holland was still asleep to catch a train to Schiphol airport, boarded the plane to Kigali and Entebbe, and arrived at my hotel in Kampala at midnight. The quiet of the night allowed for a swift ride covering the 40 km from Entebbe to Kampala in less than an hour. Apart from the few drunken young men riding on giant Easy Rider type motorbikes, helmless, there was little traffic, a good thing. We let them pass and hoped to not see them again later by the side of the road. We didn’t.

Death and life

Sita hired Axel for a four day job at Google in Cambridge this week. It’s nice when that happens. Google put them up in a hotel next to their office complex. My office isn’t that far. My commute that evening was easy though not inexpensive: a 15 minute trip and a 40 dollar parking bill. We had dinner together, the three of us, amidst the skyscrapers of biotech and computer sciences. The place has a good energy; the energy of inquisitive minds and youth and the smell of money.  Later Axel and I walked to Central Square which is an entirely different biome in the people’s republic of Cambridge with its frantic rhythm of African drumming and dancing coming out of the windows of the dance school, the cheap stores, the crazy people, and a less glamorous view on life.

On Wednesday morning we had breakfast in one of the countless coffee and small meal places. The whole neighborhood appears to be fueled by coffee. From there I headed up to Medford and then home in the early afternoon for my PT session. I am progressing at the right speed, according to my physical therapist. I can nearly stretch my arms over my head and touch the ground when lying down on the ground – a few more inches and I can start what is called ‘the lawn chair’ progression, working more and more against gravity as I increase the incline from the ground. It’s the other (good) shoulder that is now giving me problems, probably due to over use. It is also the shoulder that never quite recovered from the crash and a slip on the ice, respectively 8 and 6 years ago. That rotator cuff is held in place by only three tendons, not four.

From the PT I rushed to DC for the second time in 2 weeks. No hotels were available, it is Graduation time everywhere in the US, and so I stayed with my Dutch friend O. in the suburbs. We caught up on years of not seeing each other. Part of that was an account of his recent visit to my ex-husband, one of his very good friends, who has been diagnosed with cancer and given a prognosis that is frightful. I plan to see him on my next visit to Holland, a month from now. Will I make it in time, I wonder.

After an energy filled day at our DC office with colleagues from various part of the organizations, doing some deep thinking and strategizing, I returned home to an empty house, full of thoughts about cancer and dying when I heard the news that another Taliban attack had happened at a Kabul guesthouse that I knew so well and where many people I knew lodged when in Kabul. And this time I knew the one American that was killed. Axel found me in a deep funk and edgy – there had been no one all day with whom to talk, other than a post on FB which doesn’t quite do the trick. It wasn’t a great homecoming but luckily I caught myself. We wandered out into the yard to admire the new life that is always there when death distracts us: beans, potatoes, spinach. And there’s more: my brother and his wife welcomed their fifth grandchild into this world.

Behaviors

For two days I immersed myself in the challenges of turning an organization into a learning organization. It’s a concept that Peter Senge introduced in the 1990s and MSH has made it one of its strategic goals. Who would have thought so back in 1990? I facilitated a retreat of the team that has to lead the effort, a daunting task as it requires changes in habits and technology.

We deliberated and reflected in a beautiful place in Arlington, tucked away in a large park, and which is mostly used for weddings. We had an entire house to ourselves, moving our sessions to the terrace, then to the living room and then to one of the upstairs rooms. The days were grandiose summer days, with sprinkles at the end to reward the flowers, especially the azaleas, for their intense blooming.

I discovered Uber, the on-call taxi service provided by ordinary people making some money on the side, or maybe making this their livelihood. The rides are easy to organize, no fares or tips changing hands, all this done via the internet by computers following algorithms whizzing in the background. The rides are also much cheaper, which is good as I get more value for my (or our taxpayers’) money. But there is a downside when you look further up or downstream. The traditional taxi drivers are all from developing countries and their remittances back home are a significant source of income for their countries and extended families. So maybe the short term gains actually create long term problems that are relevant to my organization’s mission: less money streaming in to the families in developing countries, with consequences for nutrition, health and health seeking/maintaining behavior, etc. It’s a dilemma.

It seems to be school or scout trip season in Washington. I am surprised that troops of teens are lodged at the Westin, a pricey hotel, but there they were, right in my hallway, horsing around when they should have been in bed. A restaurant down the street where I ate at yesterday was overtaken by another large group, with a section cordoned off for the 50 or so teens and their tired looking handlers. This morning the breakfast staff was all flustered and behind schedule to serve the youngsters in a way that would not (but did) upset the rest of the customers. Everyone was on edge, including the Maitre d’ who barked at me that the restaurant was not open until 6:30 when it was already 6:35 and nothing was set up in our section of the dining room. It took another 20 minutes for it to look vaguely like it did the other days. When I asked about the cut up fruit I usually start my day with (and a treat in hotels) I was pointed to a bowl with apples, oranges and bananas and told to make my own fruit salad.  I am debating whether to say something about it. I sort of understand them; serving a mass of teens in an upscale hotel restaurant must be nerve wrecking for everyone.

Handled

Packing with one arm was a little challenging but since I had decided to bring very little, and put it all in a light carry-on, I managed to get it done on my own before our friend Edward came to drive me to the airport.

Although I travelled in Business Class, the 7 hour flight from Boston to Frankfurt took a big bite out of me; a bigger one than a 13 hour trip to Japan in economy. The seats were too narrow to accommodate my bulky sling and it was only with a bunch of pillows to prop up the arm that I could finally sleep. I realized that managing belongings in a small space, even in B-class, is very complicated with one arm and each action, as simple as just getting out of my seat to go to the bathroom, getting something out of my luggage, took so much energy that I’d think twice about doing anything not absolutely necessary.

I had asked for ‘special assistance’ which usually is a wheelchair or an electric vehicle. In Boston it was an old-fashioned wheelchair and a nice east European lady took care of me. She earned her tip.

In Frankfurt there was an elaborate system of handovers that went from delighting me to not delighting me: a nice man took my luggage and walked me to a seating area where I waited for my next pick up; two ladies drove me to a special assistance lounge where I shared the space with two unaccompanied minors (UMs) ages 7 and 9, whose mom had asked me in Boston to look after them as it was their first time traveling alone to dad who lives in Moscow, requiring a transfer in Frankfurt. Mom was visibly nervous. That was not necessary – they were very well looked after (and flew business class) and didn’t need my help. We parted like old friends, they to Moscow and I to the B terminal where the African flights depart.

After the special assistance lounge another two ladies took me to a bus that I had all to myself, and drove me to another terminal. That’s where things started to decline. The next handler told me she was not allowed to handle luggage and started to hang my small backpack on my shoulders. I stopped her. I explained that I could not roll my carry on and hold my backpack and asked if she was allowed to ‘roll’ luggage. She was, apparently. I was now in the more dilapidated part of the airport and the service was commensurate.

She parked me in a B-class lounge where I freed my arm from its case and did my pendulum exercises. With the double action on my right side, to compensate for the missing left arm action, I am beginning to get sore on that side too.

Homeward

The last day of our vacation raced by. We said goodbye to the elephants, the Burmese serving staff and drove into Chiangmai, some 55 kilometers to the northeast in a fancy van. The driver dropped us off at the cooking school where we offloaded our luggage and went to the market to check out the local produce. We had a guide who was just learning English but except for one item, knew all the English names of the things we would be cooking with. He bought us a sugary snack with banana paste and coconut to tie us over until we had cooked the first part of our lunch.

We were the only students in the class and thus had a semi private lesson. We picked our dishes: Axel was going to cook Massaman curry, a coconut chicken soup (Tom Kha), and Pad Thai. I picked a green curry, a spicy prawn soup (Tom Yum) and spring rolls. The cooking school threw in sticky mango rice as a bonus. We first made the most labor-intensive dish, the curries, then cut up the ingredients for the soups. Halfway through the class we ate what we produced then went back to work on the remaining dishes. When we were done we had about one hour to spare before going to the airport to catch our flight to Bangkok. We found a pedicure place and had our legs and feet massaged and my nails colored.

The planes to and from Chiangmai are jumbo jets that are completely filled and fly about 4 to 5 times a day (Thai Airways); there are other carriers as well, doing the same. It is quite astounding how many people go between those to cities. Some of the passengers are tourists but many are not. The flights are cheap, 40 to 60 dollars each way and going by road or train takes a whole day.

In Bangkok we were shuttled to our hotel for a short night. We had to be at the airport at 4 AM for our flight home, first to Narita and then via Minneapolis to Boston. This time I lucked out and got the upgrade I had requested, leaving Axel behind in his mildly comfortable Economy Comfort seat. Despite the availability of a seat that could turn into a flatbed I did not sleep at all; between the painful shoulder and the noise of the plane I could only doze. Our friend Edward who has a limo service picked us up and drove us home – we were practically comatose.

Heaven

It seems appropriate that we celebrate International Women’s Day at a place that helps to empower women and girls to keep them from falling into the clutches of sex traffickers.

This morning we got up early to ride the elephants for their early morning walk. We sat on their heads with our legs tucked under their flappy ears, leaning down on their foreheads. A one-and-a-half year old calf accompanied mama on the walk. We went up and down, with ups easier than downs as the downhill required more shoulder action to keep from tipping head-over down their faces. We lumbered along the very uneven ground, amazed at the dexterity of these giant animals.

On the suggestion of a California couple that we saw riding by our hut the day before, we had put on long pants to keep from chafing our legs on their rough hides. Three young men from Manchester (UK) had shorts and T-shorts and were barefoot. They opted for going into the river where elephants and humans alike were sprayed by the elephant handlers. The baby elephant was frolicking in the water, diving under mama and coming out the other end, then running up the slope to roll around in the sand before taking another bath.

After breakfast we had ourselves dropped off at a meditation center with a temple that is in a cave or rather under an enormous overhang of a steep rock formation. Axel is getting quite good at meditating –he can sit still for 45 minutes in spite of all his body problems. I can hardly make it past 20 and used the remaining time to follow the bats that flitted above our heads.  Two other people were meditating, one monk in brown robes and one woman in white. The woman was like a statue. The monk sat in a position that neither one of us could stand very long, one leg tucked under and the other across in front. Once in a while he interrupted his meditation with a walking meditation. If only I could see inside their heads what this nothingness was all about.

We were gifted a book (in exchange for a donation) that turned out to be translated under the auspices of an associated meditation center in Boston. It is a little difficult for my busy brain to grasp the content but I will try.

On our return we met two doctors from a medical school on the US west coast getting ready to go out to far flung villages with medical supplies. They are scouting out possibilities for medical students to come out here to get some practical experience.

We tried out more of the wonderful dishes on the menu, green curry, Tom Yum, and iced Thai tea while exploring what to do on our last day. We quickly decided on cooking school, but which of the 10 or so that advertised their classes in booklets and online?

Soon the massage lady showed up and I had another hour long massage, then Axel an hour and a half. When I was done the four year old elephant was already frolicking in the river and, the lodge guests were invited into the river to participate in the fun. Armed with brushes and pails, we scrubbed her, she sprayed us with water and everyone got wet kisses from the snake-like elephant trunk. One by one we got to ride her in the river. As bamboo rafts came by, her handler instructed her to spray the people on the raft under loud squeaky screams from the young women who rafted down, sometimes in their finest clothes.

In the evening we sat at the big common tables overlooking the river and striking up conversations with our fellow lodgers, most a generation younger than us. Axel is very good at this and in no time we had a nice community of people, coming and going, and hearing from those who are not doing 9-5 jobs; who see the world while doing what they love to earn the little money one needs here to get on. The Four-Hour Workweek is one of the favorite books that everyone seems to know.

Chill time

We picked an eco-lodge (Chai Lai Orchid Lodge) about 55 kms southwest of Chiangmai, in the mountains, that was both reasonably priced, came highly recommended, and was a social enterprise to boot. The income from the lodge supports an organization called ‘Daughters Rising,’ which focuses on teaching uneducated ethnic Burmese girls the skills, and helping them to develop confidence so they can stand up against the traffickers that raid the communities of ethnic minorities for the Bangkok sex industry. I am glad we didn’t go to the red light district which is presented as family friendly entertainment for tourists. I am afraid that even such innocent visits feed the industry.

We arrived late in the dark and had to cross, by foot, a swinging rope bridge high over the river. We were fed two fabulous Thai meals (Pad Thai and Tom Kha) and then were led to our comfortable but not fancy huts where we slept until the first batch of roosters woke us at 4:30; a second alarm came at 6:30 followed by loud music (Thai? Burmese?) and then the trumpeting of the elephants that are living right next to us.

The mornings are cold and I had to dig deep into my duffle bag to find something warm but we quickly learned that the cold only lasts a very short time. Mid-day temperatures are in the high 20s.

From our little porch we watched fellow lodge guests ride two elephants to the river for their morning bath and then had breakfasts while more elephant activity was going on right under our noses.

After breakfast our first order of business was a Thai massage, a whole body one for me and a leg and foot massage for Axel, whose foot problems are responding well to the various massages he has had. The masseuse said a little prayer before starting the massage. It is a reverent business here.

In the afternoon we were trucked a few kilometers up the river and boarded a raft that was made from thick (4 inches) and long (18 feet) bamboo poles tied together with rubber tire strips. Although we could have punted ourselves, and Axel even considered it, we were happy with our local punter/guide who navigated us expertly down the stream. It is the dry season and the river is low, so one can get very stuck with the long slender rafts, especially through narrow rocky openings.

Unlike us, the urbanites from Chiang Mai who go into the mountains for weekend fun, punted themselves. Rafting here is like canoeing on the Ipswich River on a weekend in the summer but without restrictions on alcohol. The rafts were loaded with cases and coolers full of beer. Drinking beer in a canoe is one thing, but drinking and rafting here requires more skill. This kind of rafting requires one to stand up on the slippery bamboo poles and becomes increasingly difficulty as the beer supply dwindles. By the end of the rafting trip many of the boys were hardly coherent (they practiced their little English on us: goodbye, I love you) and some had given up and sprawled down on the raft with the, more sober, girls, having taken over the punting. It was quite amusing. Counting the empties I calculated that on some rafts the average consumption was about 10 cans a person.

By the end of the trip one glides past countless little decks built in and on the river out of bamboo and palm leaves where families picnic. Spraying the people who glide past is part of the entertainment, especially for the kids who are everywhere in the ankle or knee deep water. It was all good and (mostly) innocent fun and unlikely to cause accidents. But when the rainy season starts and the water is 5 feet higher and moves with great speed down the mountain I can imagine that not all rafting trips end well.

Work and play

Axel came to pick me up at the end of Wednesday and whisked me off to a restaurant by the Chao Phrah Ya river that bisects Bangkok. When we arrived we discovered that the restaurant also offered dinner cruises and we rushed on board as staff indicated that departure was imminent. We didn’t quite know what we had signed up. It was a two hour dinner cruise through Bangkok, one half hour upstream and one half hour downstream from the restaurant.

I had barely been in Bangkok and only knew the airport, the hotel and a few places in the neighborhood of the hotel which is in the middle of the commercial district, and might as well have been Los Angeles.

Axel had been exploring other neighborhoods and was now able to show me the places (main temple, palace) he had visited.  It was a national Buddhist holiday and the temples were full and festive. It was the best way for me to see the number and variety of Bangkok’s many temples, as all were lit up to see in their full glory while we were sliding by and eating yet another spicy Thai dinner.

On Thursday the expert presentations and powerpoints were done and it was time to funnel all the inputs into a limited set of critical and actionable ideas that would not overwhelm the participants when they’d get home.

The shift meant that my role changed: until then I had played the role of traffic police and ensured that slides were loaded on the right computer and formatted correctly. On Thursday my task became more intense and demanding. I created various structures and processes that would allow the distilling, checking, and focusing of the content presented thus far and making sure people applied their best possible thinking.  I also slipped in a thing or two about leadership, something that is taken for granted and misunderstood at the same time. There was a great thirst for more about this but this was not my conference.

In the evening the talent show took place as I had envisioned it. To everyone’s surprise, four days after I asked for talent show contributions we had 14 acts and quite a few displays of talent.

I opened with a poem that chronicled the conference from start to end, followed by the partners (GDF, TBA, WHO, GFATM, with a solidarity song accompanied by guitar played on an iPad. The conference organizing committee composed new TB lyrics on a South African song. We had a fashion show where all those in national dress were called on the stage. My dress, a facilitator uniform, was made out of paper and held together by blue artist tape and staples, and was decorated with hotel mints and markers. We watched samba dancing that included the Zimbabweans who surprised us with their fearlessness.  Also fearless were the Burmese with a dance and song and the always giggling team of Filipinos (the youngest participants). They pulled me in to dance the cha-cha-cha. For once everyone found me stumbling and unprepared.

The SADC countries sang and danced in a way that made it hard to sit still, bringing the Pakistanis right onto the stage. There was a slide show of the modeling clay products produced by various participants who had understood what these colored ‘sticks’ were for and some storytelling and jokes. We finished with a slideshow put together by a representative and expert photographer from WHO-Geneva who inserted call-outs in his slides that got everyone in stitches. What we saw was a demonstration of the the Pygmalion effect (remember My Fair lady?): people live up to the expectations you have of them.

On Friday at noon the conference came to a high energy end with the usual concerns about how to keep this up. It won’t of course and we all know it. Still, the participants expressed intentions and proposed mechanisms to encourage the partners and our own staff in the field and at HQ to help stay in touch, follow up and provide support and encouragement to the country teams. We produced a Bangkok Commitments document that took 90  minutes to be drafted (not bad, considering we had 53 people doing the drafting) and then another hour edit the product.  We pasted it on a large board with the conference title and sponsor logos and then everyone signed. We said our goodbyes over lunch and everyone fanned out over Bangkok while we headed out to airport for our flight to Chiangmai in the north where we are now enjoying the first of 3 days of R&R.


January 2026
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