Archive Page 231

A short day

It is the middle of the night and I am wide awake. I just did the greasy dishes that had been left in the sink for the elves to clean, proving that they do. I had gone to bed early yesterday, not feeling very well and too low on energy even to watch TV or a movie. But when you go to bed at 7 PM, then 3 AM is about the right time to get up; hence the middle-of-the-night dish cleaning.

Steve had gone into work very early in the morning since the lab animals do need to get fed and cleaned, even on Thanksgiving Day. He returned early enough to have a nap before our meal. The rest of us stayed in our jammies until the day was halfway done.

Tessa was mostly responsible for our cooking and I was responsible, a tradition, for the pies: one store bought and two pumpkin pies made partially from scratch (later rated lower than the 100% from scratch pies I have developed a reputation for). Axel provided the libations.

It was a glorious day for a long walk which all of us did while the ham was cooking; we followed Tessa and Steve who had gone to the beach where Chicha could play with other dogs, free from her beastly collar. The walk was a little too long for the state that our joints, muscles and tendons are in; the final stretch was a bit hard but we felt good as it made the Thanksgiving Day experience more wholesome.

By the time we sat down for dinner Jim showed up, already full from dinner at his parents; we could not convince him to start over again and join us as we dismantled the ham; he took a back row seat. We tried to connect with Sita in France during our meal but that did not work out as planned.

Green eggs and ham

I dreamt about Persia (rather than Iran) and several people with Persian names. I suspect this was triggered by my request to an Afghan colleague to help me find a native Dari speaker in the Boston area to teach me before I go back to Afghanistan again in 5 or 6 months. Not knowing the language was such a handicap that I am willing to put some energy into learning the basics.

Today is Thanksgiving Day. Upon waking this morning I went through all I am thankful for, people and situation and stuff. It is a very long list topped by people. That’s part of the wake up ritual on this day, and then I fell asleep again, also part of the ritual since there is no need to be anywhere or do anything today other than cooking our meal which we will do together; I do the pies and Tessa and Axel the rest of the meal. We don’t eat turkey, which we save for Christmas; Tessa chose ham.

To complete the arrangement we ate green eggs this morning, not with ham – that is for later – but with apple-smoked bacon, while we listened to the reactions to the Mumbai drama that is unfolding half way around the world from us. We are grateful to be living that far away and not knowing anyone involved but also knowing that the next attack could be closer to home. Life is risky.

Yesterday was my one long and full workday before the next trip. The Bangladesh visa has been stamped into my passport, the reservations are made and I should be on my way on Sunday again. This meant that many meetings had to be squeezed into this one workday. I did a dry run for my conference presentation and received some pointers to make it better and slower; the rest of the day was claimed by Ann B. who used to be my squash partner, my Halloween co-conspirator and my constant companion during many years of working in Bangladesh. Now she is interviewing a bunch of us to see if she can discern patterns in the way we go about our work and transform health professionals into ‘managers who lead’ in countries around the world. By the time the day was over I was hoarse from talking – it was also the beginning of a sore throat and possibly a cold, the first of this season.

I had offered to do the thanksgiving meal shopping and regretted it as soon as I stepped into the overcrowded and overpriced supermarket near my work. I refused to pay 45 dollars for the ham that Tessa had requested and sent Axel on a parallel shopping trip to a supermarket for ordinary people further up north.

I came home late and was not feeling well, and ready to go to bed at an early hour. But then I discovered that I had only emails of my itinerary and none said ‘e-ticket,’ which brought about a frantic search and some phone calls to my hapless assistant who was on a bus somewhere between Boston and NYC. I finally found the words ‘e-ticket’ on the Emirates website under the ‘manage my bookings’ tab and was reassured that all was well and everyone could relax again. The only thing missing, a rather important piece, is my passport which should be en route from DC to our house. Incha’allah, they say in the part of the world I am going to.

Clarity

The long awaited appointments with the distinguished Boston orthopedic surgeons finally took place. Axel came along as note taker and concerned husband. We rehearsed our questions on our slow way into town. First stop was Mass General where we learned that the tendon (posterior tibial) displacement was obvious to the naked eye. How this was missed by doctor #1 when the cast went off over a year ago and in four subsequent visits with 6 week intervals since then is a mystery. But then again, all my visits to him were rather hurried and of the ‘one-minute-orthopedist’ kind.

We also learned that this condition is rare; the top doc told us he sees at most one such a case a year. It would be a very complicated and difficult operation, without any guarantee that he could actually put the tendon back where it belonged. It was entirely possible that the sheath that is supposed to hold the tendon in place could not be fixed to keep it there, especially after such a long time.

We asked our questions about the risks of the surgery and the risk of not doing anything. The answers left us hanging a bit as they contradicted each other: one the one hand, he told us, the tendon is not where it is supposed to be and could eventually tear or split. On the other hand, correcting this condition may not make things any better (considering how well I function with it) plus of course the risk of any surgical procedure such as infection or a blood clot. It is hard to improve on a 2 (i.e. pain level) he said. Still not knowing what to do but less inclined now towards an operation, we left to see our next second opinion.

We stopped at JP Licks in Jamaica Plain for coffee and to regroup. We reviewed the answers to our questions and articulated new questions that had arisen as a result. Although we had been given a considerable amount of time with the doctor, by the time new questions surface there are subtle hints that the consultation is over.

A little after noon we presented ourselves at Faulkner hospital for a fourth second opinion. First stop was a new X-ray – required for any new patient (the darn machines have to be paid for, no?), even though I was carrying a huge envelope with all sorts of pictures that were taken in July). Doc #4 referred to the operation as a heroic one which gave us pause. After seeing me walk with ease on tippy toes (‘you shouldn’t be able to do that’) he essentially counseled against a surgical intervention and proposed as an interim measure orthotics and a return visit with a scan to establish a baseline and follow me closely through twice yearly visits.

We left the building in the pouring rain with more clarity this time: no operation right now. What the consequences are of this decision in the long run is conjecture – no one knows. At least both doctors were honest with us that this was not an open-and-shut case and the economic incentives to cut do not seem to play at this level of the professional hierarchy. I asked what they’d recommend if I were their wife, sister or daughter and was given the diplomatic answer that this would make no difference (and received no recommendation). The question was suggested by my doctor-brother in Holland. These doctors apparently treat everyone alike, so they say.

Touch and go

My dreams were about our new presidency and the people who will run my adopted country. That is not surprising since there is much talk about this. This morning’s newspaper had a picture of the team that will tackle the growing crisis. The picture was striking by what it was not: a team of grey-haired middle-aged white men. Obama is sailing the treacherous waters of not being president yet but expected to do something that will show we are in good hands. I skimmed through hundreds of emails that told me he is our savior. I am sure someone else, maybe also just back from Afghanistan, is skimming though the same number that show he is the devil incarnate.

Yesterday was part two of homecoming but in a touch-and-go kind of way: unpacking, but not entirely, filling in various forms for time spent and expenses made, reports, laundry and putting travel gear away but within reach since I will be leaving again in less than a week. The first signals from the visa front are encouraging: the visa application was hand delivered at the Bangladesh embassy in DC with a faint promise that Liz can pick it up on Wednesday and bring it back from DC.

Now that the trip to Dhaka seems more likely than it did before, I started to prepare for my 10 minute presentation at the BRAC conference about how to change established practices in health service delivery to become more effective. That wisdom is contained in a guide that was prepared by several agencies that sometimes compete and sometimes collaborate. I am representing the collaborative piece as part of a panel of people who have thought much and done research about the phenomenon of ‘scaling up.’

Part of the coming home routine is also delivering the gifts I brought home. I think Axel has claimed the small rug which will chagrin Sita (but then there is always a next time) because it is now unfolded on our bedroom floor and he does his exercises on it. Tessa got her henna which I picked up in an Indian supermarket across from my fancy Dubai hotel. As it turned out one packet says black henna which Tessa claims could not be right. She and her friend Valerie are the henna experts, so they know.

The Sinterklaas goodies from Holland will be stowed away until our hybrid Sint Nicholaas celebration on Christmas Eve before they are consumed prematurely. The bag with taai-taai, a chewy anise flavored cookie bar, is already half consumed because it makes for a perfect early morning snack with coffee or milk; but the chocolate letters are off limits – they will go in the shoes that we will put out by the fireplace for Sint to fill in exchange for carrots (for his horse). We hope it will be the new fireplace that was supposed to be installed this fall so we can burn up the 4 cords of wood from our cut up Norwegian maple.

Today Axel and I are going for orthopedic expert opinions number five and six (two were by phone so these are in person consultations #3 and #4) at, respectively, Mass General Hospital and Brigham & Women’s. One is at 9 AM and the other at noon. These are the long awaited appointments, made three months ago, which should bring some clarity about what to do with my ankle. As if it knows, it has been acting up/out a lot lately with the neuropathy at the bottom of my foot going from mild to very annoying and the pain and stiffness on both sides of my foot going from mild to sharp.

Hand-over

I am sliding in the ‘back home’ routine as if nothing has happened, waking up even a bit later than one would expect, coming from 6 time zones away. Lobster cove is shimmering in the early morning sun and beautiful as ever. Going away a lot and then coming home again is the best inoculation against being bored with what you’ve got.

Yesterday saw more snow in Holland for which the airport was not quite ready. All the planes left too late as we queued up for the de-icing and as a result we sat in the plane over an hour longer than the flight time had indicated. I had splurged once again and bought myself an upgrade with points and thus the extra hour was no problem – just more time to read.

In the morning Sietske, the dogs and I went for a long walk through cold and wet weather, good exercise before sitting for over 8 hours in the plane.

On the other side of the Atlantic Axel was waiting for me, after having had an extra hour to read the Atlantic. We headed straight for a restaurant in Jamaica Plain where we met colleague Liz for an orchestrated handover of passport and visa forms which should have arrived in Washington now. There they will be rushed off to the Bangladesh consulate for a quick turnaround visa. Taking the passport pictures in the dimly restaurant was a challenge. We first tried the bathroom with a white apron draped over the door (this failed) and then we headed for the kitchen with the kitchen staff encouraging me not to smile because that was a waste for such pictures.

In the end Liz left with a packet full of forms, letters, my passport and nine different passport pictures, just to be safe. We didn’t want to leave anything to chance. There is no room for error as there are only three workdays this Thanksgiving week in which the stamp can be put in my passport. Whether this will actually be accomplished (and whether I can thus leave for Bangladesh in a week) remains to be seen. I am trying to be philosophical about it but it appears to be high time I get myself a second passport to avoid this sort of last minute visa stress.

We stayed in the restaurant for a meal and then headed home where I tumbled in to bed, early for EST but late for Dutch time. And now I am back on schedule to resume my US life.

Cut

minerva_crowdA night full of wild dreams; maybe it was because of the overexcitement of the senses from last night’s reunion from the years of 1969-1976 of the Student Association Minerva in Leiden where I belonged to the year 1970, the first year women were allowed in. It was truly over stimulation of all senses indeed: taste (an extraordinary meal with wonderful wines), eyes (seeing so many suited and grey haired gentlemen – the women looked so much better – who were once classmates or even younger than that), ears (the noise from 300+ people make in a cavernous – concrete and wood mostly – hall that is famous for its bad acoustics), smell (the cigarette and rancid beer that they could not scrub out of the place even if they tried!) and touch (an elbow to elbow crowd with much hugging and kissing of people not seen in a long time).

pimpernod08Six from our student club (named ‘Pimpernod’) showed up; many cannot stand the overstimulation; some clubs, like my brother’s, show up for the cocktail hour (bier and bitterballen) and then eat in a normal restaurant in town where you can actually talk in normal voices and hear each other. It is puzzling why we are not doing this, since the experience is a bit harsh and it keeps some of us from cominig to the event. But there is something about enduring it with the vague chance of meeting people who were once fellow students and are now doing interesting, outrageous or important work. I am sure there were plenty of industry captains in the room who don’t sleep well at night these days.

sinterklaas_mijterThe wild dreams were about having to recite the Lord’s Prayer in front of some mitered church official (and not remembering it but not wanting to let on either) and people doing powerpoints about their lives. It all fits of course. The mitered church official must be Sinterklaas who is already in the country getting ready for his annual duties that are fairly similar to Northpole’s Santa. The local Aalsmeer newspaper showed a front page picture of Sinterklaas arriving without his miter which was found later in the room of a female inhabitant of the old people’s home he visited. Sint blushed, it was recorded, when the miter was handed back to him later. Unlike Santa, Sint comes from Turkey by way of Spain and, with his entourage, reflects both the societal values and the fashion of life in 16th century Spain.

Weather wise it felt like we were on the bridge from fall into winter. Under sun, hail and fast moving dark clouds we crossed the imaginary line that separates the two seasons. But in Holland weather is never a reason to abandon a plan. We went on a walk in the Amsterdamse Bos (woods) with Sietske’s two dogs, her own old and tired Sheppard and a visiting young terrier-poodle that had been saved from the shelter and would be a good match for Chicha.

My brother, his wife and a friend, also on their way to the reunion, drove from the west of Holland. They picked me up on the way and dropped me off again around midnight, conveniently saving me from having to sort out busses and trains. It also allowed us some quality time together before having to share each other with hundreds of others.

The event in the association’s clubhouse was exhausting and a little hard on the foot which appears to know that a visit with the two top orthopods is around the corner. One of the distinguished looking gentlemen (probably more but I knew only one), and a high school classmate, is the orthopedic surgeon for the Dutch national ballet and gave me an impromptu consultation on my tendon problems – the one on the outside he is familiar with because dancers have that problem all the time (and so do the Red Sox, especially Schilling) – the one on the other site he had never seen; so far, no orthopod I consulted with has ever seen the condition, which is why I am going higher up. On Friday night Piet and I had surfed the internet and found one consistent conclusion on all relevant sites: no conservative measures possible. This means ‘cut’ I was told.

Dragging stuff up mountains alone

In my tiredness last night I had turned my alarm on by mistake and was woken up at the usual Kabul time, when the electricity used to come on and prayers start, a little after 5 AM. The alarm interrupted a complicated dream in which we had to drag very heavy poles for a jogging course high up in the mountains. It was an impossible job to do for individuals and we all struggled on our own. I suspect the dream was triggered by our conversation over dinner with Sietske and Piet about the work we are doing in Afghanistan – dragging stuff up mountains, alone.

As I traveled from Kabul to Amsterdam I went through three seasons in less than forty eight hours: from dry-cold-blue-sky winter weather in Kabul to dry-hot-summer weather in Dubai to wet-windy-chilly fall weather in Holland. The tiny tulips in the KLM lounge at Dubai airport and the budding hyacinths at Sietske’s house complemented the experience with a nod to spring. Last night thunder, hail and rain storms battered the windows and roof of the addition that is my home whenever I am in Holland. This morning there is snow on the ground.hollandnov08

I left my fancy hotel in Dubai early morning yesterday. On Friday there is little traffic and we got to the terminal in no time. It was nice that KLM’s departure time has changed from midnight to 8 AM as it allowed for a full night sleep. I was able to exchange points for a business class upgrade which made the trip quite pleasant. I got much work done so that I return to Cambridge with only one large writing task left.

I did not follow developments in the world much during my stay in Kabul, no TV and no papers. In the KLM’s lounge in Dubai I learned from CNN that I probably have to work until I am 80 now that my retirement savings have been reduced by more than half; when I left home a few weeks ago I thought 2021 was my EYR (expected year of retirement). On the positive side, I am lucky to have a job. I also learned that the Atlantis resort complex on one of Dubai’s palm shaped island collections opened at a cost that is about half of the GNP of Liberia. What economic downturn? If I had known I would have requested a top floor room and watched the fireworks. I imagine that the fireworks alone could have built and staffed a hospital in Afghanistan for several years.

Each time I go on a complicated trip like this I am reminded of how mindful one has to be while traveling. You have to remember what you carry and where you put stuff with all the security distractions. This is now more difficult than it used to be. Today’s luggage has many more zippers and compartments than before. I repeatedly fall for that feature because it gives the illusion of being organized but actually complicates things because you have more to remember. It creates the occasional panic attack when you don’t have a routine yet with a new piece of luggage, and your passport, money or boarding pass got put in the wrong place.

Focus, structure, mindfulness also served like a mantra during my two weeks in Kabul, both for myself and for my counterparts. It was a constant challenge for all of us not to get carried away on a stream of powerful emotions like indignation, anger and frustration. They are seductive because, for a moment, you feel like you have figured things out and it is the other who is bad, not you. In such a state it is hard work to imagine a situation from someone else’s viewpoint and inquire whether the data on which these judgments are based are true, imagined or made up because of some unmentionable agenda. It is so much easier and satisfying to jump to conclusions and make harsh judgments about things and people.

Checking out

I left Kabul on Safi Airways, a local airline company that has gotten highs scores from some of my colleagues. This exit was very unlike the previous one that got us in a stall as we climbed out of Kabul airspace. With good visibility and blue skies I was able to understand what happened on that cloudy and drizzly April 10 when our UN flight pilot did a straight out departure from runway 29. Straight out is always faster and therefore cheaper in fuel use than circling the airport in an upward spiral until enough altitude is gained to get over the mountains surrounding Kabul. I don’t know whether these considerations played a role in the decision making process, but as a result we just barely scraped over the top of the mountains.

I boarded the plane with some trepidation and was glad that the skies were blue. Except for a thick layer of dust that disappeared at about 500 feet, all looked clear and I figured I would at least see whether we were heading straight into a mountain. When the pilot did a right turn immediately after takeoff I let out a deep sigh of relief and knew I was in good hands. We spiraled up and then zigzagged between the lower ranges until we reached sufficient altitude to turn to our heading. A straight out departure, even on this calm and clear day seemed nearly impossible given the height of the mountain range.

The greeting by the captain was done in two languages but the messages were different. The English was the usual standard welcome on board message but the other was something else. I presume it was a reading from the Koran because I recognized more Arabic than I usually do when Dari is spoken and God was invoked more than once. That is the difference between travelling in this part of the world and elsewhere. Invocatus atque non deus aderit, was engraved at the entrance to Jung’s house in Swisterland, imeaning ‘Invoked or not, God is always there.’ Here they invoke, just to be on the safe side.

Getting onto the plane was no small feat. I counted 13 check points between our guesthouse and my seat on the plane. The first few were handled through the car window while I was still accompanied by an escort from the office, the rest I had to do on my own with various young boys carrying my suitcase for a few meters for which they expected to be paid one or more dollars.

All of the checking is done in a cursory way or not at all. The various officials are mostly just going through the motions. In the US it is called the TSA Theater – it’s no different here. Only dumb terrorist would be caught. My female checkers didn’t even take my scotch tape away as was done in 2002 – supposedly because I could wrap scotch tape around the pilot’s mouth and eyes and then do my evil deed.

The checkpoints do of course cause many long queues and for once it is advantageous to be a woman in this country because men cannot frisk women. You have to go through a separate entrance, hidden behind a ragged and dirty curtain where one or more female officials were shivering in the cold. I must not have looked the profile of a terrorist and was ushered through quickly each time; only once did I have to open my suitcase.

On the way to the airport we passed unimaginable amounts of rebar-reinforced concrete and razor wire – a good business to be in. Tucked in between all this was the World Philosophical and Mathematical Society. I wondered what they were calculating and contemplating in there and who its members and sponsors were – or maybe it was just a front for something that had to be disguised. A Google search came up empty.

The heat of Dubai was a welcome change from the cold in Kabul. It was my luck to have once again a driver who did not know where to go. I summoned all my Arabic but he turned out to be a Pakistani with a dead cell phone. Eventually we found the place. I checked in and took a taxi to the Dubai Museum. I had contemplated going to the ski slope or camel races, and the bell captain suggested racing around dunes in a SUV followed by belly dancing but that was not very appealing. The museum was crowded with loud Europeans and I got out of it quickly and found a nice restaurant on the Creek.

I had a yummy Lebanese mezze with a lemon-mint concoction that looked dangerous but was delicious while watching the frantic activity in and around the Creek with loud noises from any kind of motor one could imagine, cars, trucks, boats and planes.

I took a water taxi back to the other side where my hotel was and ended up walking all the way back because the taxi market is a seller’s one – they are in short supply and the few that stopped where not interested in my destination; either too close by or too much traffic. And now on to Holland.

Out and about

We spent three and a half hours in a strategy and teambuilding meeting with the entire team minus one. He had to deal with passport and visa issues, something I have great sympathy for as I am still not sure how to get my Bangladesh visa in time for takeoff, just over a week from now over Thanksgiving week.

We reviewed the last two weeks and all the events that happened. They appeared disparate and unconnected from one another but not to those of us who were involved in all four; we moved from central level NGOs, to provincial level mixed teams, to the DG team and finally the entire collection in one room. It was a perfect assignment for me – two weeks of nothing but designing and watching the design come to life.

We ended the team meeting with an exercise around learning styles that resonated much with everyone as they guessed, mostly right, who had what kind of learning style; there were many aha’s and much laughing but also, I think, some recognition that all styles produce important contributions to the team’s task. I am not sure that the idea that they have a team task has taken root yet – last time I was fooled they had but now I am more realistic. It’s a novel concept and there are few role models.

I was sent out of the room at the end because they were collecting contributions for a present which was bought by the secretary and Ali and offered with much photo taking, after work hours in an empty office. One of the gifts was a porcelain ring box with Egyptian motif made in China, bought in Afghanistan which will be transported to Holland and then the US. The world is indeed flat.kabulnov2008_gifts

Pia, who used to work at MSH and set up our office some 5 or 6 years ago, came to say hello to old friends. She has her own company now and spends much time in Jalalabad and other places that are much less secure than Kabul. Like me (and Axel and Joan) she is an unlikely survivor of a horrendous (car)crash and bears a long scar on her head, horizontal, as opposed to Axel’s vertical one. We went to the guesthouse and had a real social event in our salon, which looks like an antechamber to a carpet store with all those rugs from Steve. For food and drink we did not have much to offer other than toot and tea (or water, diet coke or fanta). This did not matter because the company was entertaining enough, with Steve, Maria, then Brad and Maureen joining us later.

Pia and I took off for my first night out (which she found unbelievable so it was a rescue mission of sorts). I finally had my long awaited coronas and two tacos thrown in for good measure but not until after a wild ride all over Kabul searching first for Pia’s hotel and then the restaurant. It was a little unnerving because the driver kept saying he knew where these two places were when he did not but could not say so and of course our Dari and his English were no good for serious talk about such matters. At night the streets are fairly empty except for a few trucks and cars and of course the ubiquitous large SUVs scurrying foreigners around who have to escape their confining quarters. Being lost was particularly nerve wrecking when the driver stopped in front of a heavily guarded building with floodlights and suspicious guards coming out of the dark with large guns. After that the coronas were especially wonderful.

We met John and SueAnn from another NGO who are used to go out at night and manage to get their daily rations of alcohol, so unlike us in hotel zero. John worked for Hillary’s campaign but is nevertheless happy with our new president. John is a temporary visitor like me (TDYers we are called); his colleague works in Kabul. For Pia Kabul was a haven of peace even though she was busy on her cell phone arranging for armored cars for their staff doing reconstruction in the East and South. The freedom and normalcy of Kabul made her giddy. Everything is a matter of perspective. I was reminded of Beirut again. John had lived in Beirut and studied at AUB. I rarely meet anyone who has lived in Beirut. Of course neither one of us knew the Beirut the other described, given there was about 30 years in between.

At 10 PM the driver arrived and this time, unlike 7 months ago, I immediately recognized the car and got in without a hitch because I knew the license plate, color and make. Last time I had no idea which car to pick from the line up of large SUVs with turbaned and bearded drivers and security guards. How was I to tell the difference between those with good and bad intentions?

kabulnov2008_last_nightAnd then it was time to pack. I took the decorations down – the pictures from the Khulm bazar that I bought on my second day in Kabul which seems ages ago. I rolled up the new Maliki rug and put it in the canvas bag that brought the rolls of paper and posters on my way in, a perfect fit.

My sleep was restless and full of dreams about plane and orthopedic disasters, two things that are on my plate now and that fill me with considerable anxiety: getting out of Kabul by air and having appointments to figure out what to do with my ankle next week.

Interference

kabulnov2008facsFor our session yesterday Ali had mobilized eleven facilitators, most were his own colleagues from our project, a few from the ministry and some from another donor. Their job was to help the small group conversations stay focused on the end result: clarity on issues that they could resolve themselves and those that had to be tackled by higher level authorities in the ministry or even beyond.

After a set of predictable but unpredicted delays our session got started rather late. As planned it did get the system connected to itself with provincial, central and NGO participants talking with each other about things that held them back. It unfolded more or less as we had hoped until the previously mentioned international organization ran interference again. A two person delegation showed up to present something that was not on the program but deemed important (everything here is deemed important). Everyone argued their case (of why or why not this presentation should be inserted in the middle of our group process that was in full swing). We were like lawyers of opposing parties walk up to the bench and whisper something to the judge while the audience waits for the process to continue. In the end we prevailed and our carefully designed and agreed upon process continued; the invading delegation left with a vague promise that they would be on the program later. I know they came back in the afternoon but I don’t think their presentation ever happened.

kabulnov2008smgrpThe small groups went through a filtering process that produced a summary of the major bottlenecks (or issues, or recommendations – the language was a little unclear and I suspect stuff was lost in translation). It’s not my favorite approach, to start with problems rather than a vision, but that had been a given. Post-It notes with issues that did not fit in the current health and nutrition strategy, that did not need to be tackled right now or that could not be tackled by the people in the room were put in envelopes labeled ‘not strategic,’ ‘not now,’ and ‘further up.’ The latter was handed over to two of the 6 DGs for putting on the agenda of minister and his deputies. At least that was the plan. That too did not quite happen in the way we had designed it.

Just when we were ready for the lunch break and the system looked engaged and connected to its self, the said international organization showed up once more, this time its top leadership and a delegation from their regional and world headquarters. They took place at the high table and were invited to address the participants. Then came a goodbye ceremony of one of their staff members, presents, certificates, more speeches. It felt as if we had tumbled into a parallel universe. The impromptu event overpowered what was left of the design of the day and from then on everything defaulted back to familiar patterns of large public events. The energy that had filled the large ballroom only hours earlier had all but dissipated and everyone went back to telling (top) and asking (bottom).

There were some feeble attempts made to refocus the event but it was out of our hands. At 5 PM Steve and I quietly walked out and headed into another dust-filled traffic jam across town. We did not get home till 6 PM. One of our colleagues called at 9 PM that he was just home. The event he had put so much effort in to organize had droned on hours past its formal ending time. May be it was a big success, or good enough but I don’t think it did much for encouraging leadership in the provinces, despite the exhortations to lead.


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