Sylvia's Journal

Exactly at 9PM I was picked up by the ICRC driver. I congratulated him on his punctuality. Going to the airport, in many developing countries, is a bit of a trust fall; in this case in particular since the next Air France flight wouldn’t be until 4 days later.

As we drove to the airport I noticed military everywhere. It was true that we drove by kilometers of barracks, but still, the police and military ought to have been behind the serpentine wired walls, not in front. The driver commented that it was possible that the president was either on his way into town from the airport or out of town to the airport. That worried me a bit.

“What happens when the president is on the road, and how would you know he is coming or going your way?” I asked. “We never know, you just find out when it happens. It’s simply bad timing. Everyone is stopped, whether in a car, on a bike, by foot. Even ambulances are stopped,” said the driver. “It can be a long as an hour wait.” That made me a bit nervous. I watched the police and military intently to see if the president was approaching. He obviously was not, because they did not look very alert, chatting with each other, checking their phones. I could relax.

I made the flight and the driver hurried back home as soon as I had been deposited.

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.

Today we concluded the conversation about the activities (in the plans) of the teams of Niamey and Zinder. They indicated what they had been able to accomplish and the things they had not been able to do or finish, and why. And what was the impact (the successes and failures) had on the improvement of the efficiency and effectiveness of the services they provide. And finally they pulled out what they could learn from all of these experiences. As it turned out one of the teams had come to realize that all the things they had not completed where entirely within their ‘sphere of control;’ it was their very behavior that got in the way. That led to an animated discussion with everyone, in the end, agreeing that they were the only people who could turn things around, not needing any extra resources (or if so, very little), not even extra time. It’s that simple.

Of course, words come easy; people know exactly the right words to use (team spirit, listening to each other, be responsible), but I know that action is a little more complicated, especially when confronting people is simple not part of this culture (easy for me to say, as a Dutch person, where confrontation is common and not automatically a threat to friendship or work relationships. I think here the things are more complicated.

We ended the day with an exercise that required printing out two pages – the things that would be so easy for me back home, but here not so. I walked back to the center in 35 degree heat to print the pages, but the person was locked out of his computer – there was no alternative other than walking back and transcribe the necessary information from my computer, by hand; the IT man said he could help out and we walked back to the center, back in the heat, and now we were successful and arrived, papers in hand, just when the session was about to start, with 2 minutes to spare, ooooff (wiping brow). 

I had hoped to go for a cooling swim after all that walking in 33 degree heat but the pool was ‘sous traitement.’ To kill all the little beasties in the pool, the guard explained me. I asked when the treatment was done and learned it takes 72 hours – some beasties! It may explain the slight green tinge of the water and the cloudiness when I swam on Saturday.

onoOf the 72 hours only 24 are done so it looks like I had my one and only swim the day I arrived. I stayed for a while by the pool, sweating and looking longingly at the water, but then remembered it was full of hard to kill beasties; I had a beer to cool me off and then ordered my dinner and went upstairs to change out of my bathing suit. I went down for my habitual dinner of brochettes on the unattractive terrace, by myself, in the unrelenting heat, even at 6PM. This time I was armed with Swiss bug spray, complements of ICRC, to deal with the more visible beasties swarming around me. I had my brochettes with veggies giving myself a break from frites.