Sylvia's Journal

The return flight had a few glitches. Not the kind that can easily be fixed by one person because they are ‘system’ glitches. But what is ‘the system’ when you try to fly home?

The Ghanaian Delta staff valiantly tried to load the plane to New York without the help of computers because ‘the system was down.’ I found throngs of people in front of the Delta check-in counters, a full two hours before departure. It was a good thing I had checked in online and printed my boarding passes on hotel stationary. As a result I breezed through check-in and formalities and bypassed the crowds. Still, the people at the gate did not believe that my ordinary piece of paper, the seat assignment section ripped off along the non-existing perforated line, was actually a real boarding pass. This self-service check-in is clearly not a common practice yet on that side of the Atlantic.

Check-in without the help of computers can be done but the manual system is rather slow and flawed. As a result the boarding process was hopelessly chaotic because most people had not received a seat assignment. The plane left an hour and a half later than planned. It was a lucky day for at least 35 people who were pushed forward into the large but empty business class. Among them was Gloria, one of the senior managers with whom I had just spent 3 days at our retreat. It was her lucky break at the start of her vacation.

There was a different kind of chaos awaiting us on the other side of the Atlantic – a traffic jam at JFK which kept us searching for a spot to park and then waiting for a people mover, the funneled buses on retractable stilts. One people mover parked at the rear of the plane which disappointed all the people in business class, especially those who had found a seat near the front door in the hope of being the first out of the plane. Just when we had all moved to the back of the plane, waiting for another bus, one showed up in the front. The mass of people heading for the back door turned around and rushed back to the front door as if the tide had turned and eb turned into flow.

All in all it took over an hour from touch down on the runway to stepping inside the Delta terminal. There was much stressing around me, and we had not even gotten to the city itself! Many people had missed their connections. Not me, I had four hours of waiting ahead of me and so it did not matter where the waiting took place.

Arriving at the Delta terminal at JFK does not show America at its best to first time visitors. The place is grungy and not very welcoming. The TSA lady, asked to do a body search on me because of my sling, inquired what the thing was. I answered that it was a sling, as politely as I could. She then asked me to stick my arms out. I told her my arm was in a sling for a reason and that I could not raise my arm. This was a new concept. After making sure there were no traces of explosives on the contraption I was admitted to the inner departure sanctuary for my next flight.

More glitches as we waited to unhook ourselves from the jet way. Our 10 PM flight was ready for take-off at 11 PM precise. Axel was waiting for me in Boston; it was now close to midnight. There was one more glitch: something big (an accident or a mega construction project) on 128 South had closed the highway and we were ramped off to find our way through exurbia back to 128  a few exits further south. We arrived home after midnight and I tumbled into bed, beyond tired, around 1 AM. It was a fitful sleep but a happy one after this very long day. I am home again with my honey.

Saturday is for rest, in principle; as is Sunday. But this Sunday is for travelling back to Manchester by the Sea and yesterday was for finishing the work of this trip and the last day of work of nearly 23 years of work at MSH headquarters. It hasn’t quite hit me, but it is momentous.

I completed our report as far as I could get and in the late afternoon we met to complete the missing pieces. In between we played with friends. Jacqui was one of them. I met her in Rajindrapur last Decemer at the BRAC conference and we clicked, as they say. She is from the UK and her husband is from Denmark. His job here has earned them a CD license plate. I am not sure it helps them much in traffic jams but maybe it helps in other ways.

Jacqui was the chief of party of one of the USAID projects that has just ended and did not win the follow on project, against all expectations. This means that Jacqui is free now and available on the labor market. This is good for MSH.

Jacqui was one of the lucky people who got to chat with the Obamas during their visit here in Ghana. Laterwe met with Barbara who also shook hands with our president and his wife. Everyone agreed that the Obamas visit was spectacular and special in addition to being a lot of work and, traffic wise, a pain in the neck. Barbara told us there was a baby (Theresa) sitting on the lap of her parents near the family planning station, who was picked up by the president (presidents do this sort of thing) and that this baby is now referred to as the Obama baby. Maybe the parents should consider a name change (Obamia? Or simply Michelle?)

After a lukewarm Nescafe capucchino-wanna-be, Jacqui took us to a shop to get one of the many designs of cloth with Obama’s photo in large ovals. She also took us to a small shack-like store of a long-term resident Swedish seamstress whose unusual designs told us something about her unusual mind. We had not expected to go shopping and so the prices exceeded what was in our purse.

At the end of the morning Jacqui left us to return to her family and we pursued our (re)discovery of Accra. I found the Lebanese silversmith I had first visited with a colleague some 8 years ago. We spent a lot of time in the store that is like a living room with thousands of lovely and not so lovely pieces of silver jewelry, hiding in a regular house off the main shopping street. I practiced my rusty Lebanese and bought a few pieces to be gifted away. Lunch was across the street, Lebanese of course.

And now it is time to zip up the suitcase, pay my bill and say goodbye to Diane and Ghana, for a while.

At 6 AM the car park outside my window is teeming with people carrying small and big bundles. Taxis and small buses stand ready to take people wherever they want to go. It is Saturday morning and time to travel. I am told that much of this travel is to relatives far and wide to attend funerals and weddings, events for which people are spending more than they can afford and go deeply into debt.  William has told me about this disastrous social trend that drags middle class people below the poverty line. Apparently it is the Christians more than the Muslims who engage in this Ghanaian version of keeping up with the Joneses.

Like any gathering of people, it is also a good place to sell stuff or to preach; both are happening in a cacophony of voices, colors and sounds: it’s pure eye candy. I try to capture it on my small low performing camera. Where are my daughters with their equipment and skills when I need them?

William drove us back to Accra after the completion of the retreat, more or less on schedule. The HR director and the DG joined us at mid morning, something we had hoped but did not want to believe until we actually saw them. They arrived just when the participants, in self selected teams, had made commitments to take a small bite out of a series of huge challenges, observed during the visits we made earlier, in cross functional teams: one group took a bite out of the human resource challenge, another out of the resource management challenge, another sat down to tackle infrastructure challenges, a fourth team took on quality assurance and the fifth team decided to get their own house in order to improve the functioning of the national health insurance scheme. All challenges are enormous and represent nearly intractable tangles of interests, agendas, stakeholders, schemes, models, languages, and a history of piecemeal and failed attempts.

We call these leadership projects that give senior leaders a chance to rehabilitate themselves in the eyes of those working at the operational level and improve their management and leadership skills. It is opportunity to show that they can make a difference for the levels below that keep pointing fingers at them. There is a tendency to want to take on everything at once and cover the entire country, in the process making the task so difficult that everyone gets paralyzed or feels so impotent that any action feels risky. This, I believe, is the cause of much of the inertia that we see and that people complain about.

I also believe that the inertia comes from not seeing it; everyone else does the same. I provoked the participants a few times on their passivity when their team members did not show up at agreed upon times. No one took action; no one called his or her team mates, even after dropping a few hints. People want to be congratulated on being on time themselves; when I told them it doesn’t count until their teams are complete there was this vacant look on their faces. It made me want to wave a large flag in front of them, shouting, ‘anybody home?’

They all say they want to change this habit they consider dysfunctional. But it is lodged deep in their cells.  It will take an enormous and sustained effort to dislodge it. As Mark Twain observes: “Habit is habit, and not to be flung out of the window by any man, but coaxed downstairs, a step at the time.” We did a lot of coaxing these last few days.

Many of my observations about senior leaders were confirmed by my friend Seth who is now high up in the ministry of education. He happened to be in the neighborhood of our hotel yesterday and we met in the hotel bar and talked about his new role and his past history with the regime that is in power again. Seth and I met at a conference in Zanzibar some 3 years ago and have stayed in touch. He will be one of my sounding boards for my theories about senior leaders, since he is one himself.

I am disobeying doctor’s orders and slept the entire night without my sling. I can’t stand it any longer. The physician’s assistant had told me some weeks ago that he usually lets patients take the sling off at night after four weeks. In two days it will be four weeks. I let my body guide me: the discomfort is less without the sling than with it.  I can move my shoulders in several directions without any pain.  I assume this means it is not frozen, something I was worried about.

The chaos of getting 22 people off in 7 cars to 7 different destinations as close to 8 AM as possible did not materialize. Our Ghanaian colleague Philip had been fretting over getting this right, not an easy task, and then everything was right. At lunch time everyone returned and the field visits had been completed without a hitch, with spirits high. There had also been some bonding across organizational divides; there is nothing like sitting together in a car going over bumpy roads. It reminded me of a field visit I made with a bunch of family planning professionals from all over Francophone Africa in Benin. We travelled over bad roads for 700 km, from early morning to deep into the night. We sang songs for hours, told jokes, changed tires and pushed the car out of mud; we became friends for life!

I accompanied two gentlemen from the ministry of health and we were  expertly chauffeured by driver Valentine over roads that had lost their hard top here and there. Although our destination was not far, it took us exactly an hour to get to our destination. We were warmly welcomed by the midwife in charge, just outside the Labour Ward where some hard work was being done by two women who had reached their term. No husbands were present – labor, even with an extra ‘u’ is women’s work.

Over the next couple of hours we chatted with various employees and explored the buildings and rooms that were part of the health center. The senior leaders were told to present themselves as students, counter cultural for sure. There had been much concern before the visit about whether this was possible and shouldn’t we surprise people. But none of these fears came to pass, as I knew from experiences elsewhere.

The health center consisted of the main block with wards and consultation rooms, a block of dilapidated staff quarters, an incinerator, two containers that houses the generator and the ambulance, a block of rooms for specialized services and something that was referred to as the ‘new’ building, a large unfinished structure in a corner of the compound. Work had started some 8 years ago but they had run out of benefactors or the benefactors had run out of money.  Inside it did not look like a new building anymore.

A matron who had been taken out of retirement had settled into one corner of the building overseeing a makeshift recovery ward. The ward has two beds, one covered with two crib mattresses instead of an adult mattress, a bench and a crib. ‘It’s not enough,’ she said. Sometimes she has to ask the least sick person to move over to the hard bench. We were all inspired by her commitment, passion for her work, concern for the community and can-do attitude. She surely was able to make something out of nothing. Asked about her retirement, she answered that she was too good and too strong for that and that she plans to continue working under contract as long as she can.

Throughout our tour the accountant accompanied us, pointing out the places where resources would make a difference and places where they themselves had made a difference in the absence of a response from their own employer, the government of Ghana.

At the family planning clinic we found the nurse talking with one of the outreach workers, a young man who does vaccinations as well as HIV/AIDS outreach. We asked the nurse to teach our driver how to put on a condom. He was a good sport and demonstrated at the end of the lecture that he had understood everything well, from hand washing to opening the package and rolling the condom down on a wooden model; all this done with great care and clarity and a good dose of humor.

On our way back to the hotel we stopped at a tiny community health center staffed by community nurses. We learned much about the reluctance of the (very poor) local people to be referred to the next level health center and how this has led to true telemedicine: the nurse in charge calls the physician assistant, who is the person in charge of the referral health center  (the one we had just visited ) who coaches her trough his cell phone on how to give care that he would have given. It is not ideal but she learns from this and the patients benefits; another form of can-do/make-do.

I interviewed three young community nurses who are entering their second year after 3 weeks of practical work. They had just returned from their community outreach rounds, checking up on the vaccinations of babies and mothers. Their eyes sparkled and their uniforms were spotless but brown; the coveted white uniforms are not for them until they pass next year’s exams.

After lunch we compared notes among the seven teams, using appreciative inquiry as our approach: what had they seen that was inspiring, touching, surprising (in the positive sense) and life-giving (literally and figuratively). What we heard stood in sharp contrast to the supposed incompetence, low morale, mediocre care, inertia, drug supply problems and poor management that we are usually being told about by the top people in the ministry, people like the ones  we had in the room.

We were encouraged by the interest and enthusiasm from our participants; there is no more coming and going and, aside from things like punctuality, everyone is fully participating and deeply involved in the program.  I provoked them around the punctuality issue. There is much denial about their own behavior and they are rarely confronted, except by their bosses, who probably don’t manage themselves very well either. There is also much inertia and little sense of collective responsibility. A few individuals are proud, and want recognition for being on time and ‘sticking to the norms.’ Yet there is no action to make sure their whole team is present, even after several hints. Although Americans are culturally considered individualists, and Africans collectivists, when you look closely you see that the educated elite has drifted far afield from the collective sense of duty and responsibility, may be not in their words, but surely in their actions.

We ended the day with two exercises, one called the Helium Rod, which we fabricated out of flipchart paper, and the other about shared vision, using a gadget that we also constructed out of material found locally. Experiential exercises are still a novelty here. It is one place where we can put a mirror in front of the participants and show them what they actually do, as opposed to what they say they should be doing. In a place where senior people don’t ever get direct and honest feedback about what they should be doing differently, this is the only way to confront people so they can see what they need to work on. Intellectually they buy this, but there is a sense of impotence when it comes to action.

Today the rubber will hit the road. In a reflection about the effect of the appreciative inquiry many expressed concern about it being a bit artificial and not contributing to the solution of problems. The problem-focused approach to work and life is so deeply entrenched, and so pervasive that it has become embedded in their very cells and doing anything else feels wrong. We told them we will get to these problems later but first wanted to establish a solid foundation of knowing what is going well so that this can be supported, enhanced and extended.

Today we will focus on their challenges. We will put them to work, in teams, on analyzing how they can remove obstacles they observed in the field. I have a premonition that they will find ways to push the responsibility for solving these problems further up the chain, thus reinforcing the practices that firmly keep in place the roadblocks that everyone can list in their sleep and that have been identified in countless reports for as long as I remember but that no one feels empowered to tackle.