Sylvia's Journal

Compared to the birthday breakfast I would have had at home, this one here in Man was a bit below the grade, a quarter limp baguette, a vache qui rit triangle and a Lipton teabag dipped in warm water served by a surly waitress. But a week from now I will make up, no doubt, with a spectacular replay.

On the second day of the workshop the group struggled to formulate a measurable result related to better coordination. Not surprisingly, people came up with more meetings and more people at meetings. We pushed for better and more creative results, such as setting up local structures to improve emergency preparedness, but the general attitude is one of victim – we are low on the country’s political and economic ladder and we never get enough money.

People don’t like it when I push them to be more creative and become agent rather victim – this is after all a leadership development program. There is some comfort in being able to decline responsibility and blame others for problems.

This may all seem very theoretical from a distance but yesterday a young woman, secretary of the regional health director whose district director is with us, died in the region’s referral hospital after childbirth. She leaves behind her newborn and two small children. Everyone is very upset about this (though they also remark this happens a lot – as one could see in the maternal mortality statistics).  It seems that the handovers were not done well. When people act as individual professionals and are looking only at their own responsibilities when their task is done, this is what happens. Although lack of trained personnel is sometimes a cause for such tragedies, at this hospital there were enough trained personnel. Heartbreaking, over and over again.

I sometimes think that working in teams, taking on a collective responsibility for outcomes, and willingness to shoulder blame is the biggest challenge in countries where people either have lived in constant fear of getting lost in the crowd of anonymous poverty or are still close enough to be worried. It’s puzzling as I am dealing generally with the educated upper middle classes.

When I challenge the constant coming and going of people holding their telephone in front of them as if it pulls them out of the room, I am told these are urgencies. I count. “You had 10 urgencies today?” (this is not a doctor on duty). “Oui, it is my boss asking for information.” “Can’t you ask your boss to leave a message and you will call back during break time?” They look at me in shock. What, ‘contredire le chef?” Culture and poverty…it is going to be a long journey.

In my profession it helps to be an extrovert. Usually I am energized  by people who are learning, or eager to work together for a common goal.  But today, during the break, I went upstairs to my room and made my own cup of Nescafe rather than standing in line for exactly the same thing, and since I am not eating any of the stuff that is served at break time (all contains processed sugar) why bother?  Maybe it is because I am tired of having one event after another and being surrounded by people all the time. Or maybe it is because I am getting to be more introverted as I am getting older. Tomorrow I will be a little older.

At lunch time we had a heated discussions – I have heard the arguments over and over. They go something like this:

Me: “Why are there no women in any of your teams?” At first they joked. “We did this express.” When I took their response serious, they became more serious: “Women don’t want to work in this part of the country.” “Why,” I asked. “Because of the crisis (=the contested presidential elections four years ago that dragged Cote d’Ivoire into a nasty civil war). “But that was many years ago,” I said.

We went a little deeper. “They don’t have the right credentials.” “Why,” I asked (why is a great word in my work).  “Because they are nurses and midwives (at least in the health sector).” Me: “There are no women doctors?” At our table is a female departmental director (a doctor). She and a representative of an international NGO contest what the men are saying. We ended up with this: “This is how things are ‘chez nous’.”

Me: “You are willing to put a doctor at the head of a structure? Especially if this person (usually a man in most countries) knows nothing about management or leadership, or for that matter good governance? And, therefore does a lousy job such as depressing morale, being a poor planner, not understanding teamwork or delegation at best or being toxic  at worst? Someone who wastes resources (including such highly valuable resources as human energy and goodwill)? You prefer doing that (failure nearly guaranteed) rather than considering putting someone in charge who has demonstrated her management and leadership capacities but who isn’t a doctor?” “Yes” they say, “because a nurse or midwife could not possibly supervise a doctor!” There you have it. Checkmate!

One of my favorite sayings these days is that we tend to generate most of our own problems. Sometimes people get very angry when I say that, but I ask them to consider the practical consequences of accepting this thesis: if you agree then you can do something about your problems. If you don’t accept it there is not much you can do, and you will have to live with all these problems of today and all those in the future. The latter are the complainers – I have met too many of them.

What our leadership development program does is reduce that number quite a bit – our current facilitators are proof. They have started to question a lot more than they did before and in doing so they become change agents. We are working on a critical mass of questioners and critical thinkers, though this will probably not happen in my lifetime.

The passport has surfaced and I should have it in my hands when I board the flight for Addis. Miracles happen and DHL sometimes messes up.

Today we distributed the tasks for the three day workshop that starts tomorrow. I will do very little as I have handed over the baton to the team from Cote d’Ivoire, a mix of MSH staff and ministry of health staff. That was my job and it is nearly done. There were some misaligned expectations of the local staff, our rookie facilitators who inquired about per diem and facilitation fees, a manifestation of the disease we have created called ‘perdiemitis.’ I invoked good governance by saying if there were written rules about that on government letterhead we would gladly pay. Of course no one can produce such a document.

We wrestled with French translations of several words that were invented in Anglophone cultures. Every country and every French speaker seem to have his or her ideas about which French word best represents these essentially untranslatable concepts. We use Leadership and Management instead of Direction and Gestion – there are nuances that get lost in translation. Try to translate stewardship!  We are having endless conversations about this.

The whole notion of andragogy is still alien to people. They have received a classic French education that starts with definitions. One of my new trainees was wondering why we are asking all the questions to participants, like this one “think of a time when you worked in a great and productive team? What made it great?” Luckily one of the people I trained a year and a half ago, the cohort that is now taking my place, explained patiently that it is all about discovery of what knowledge we already have inside us. Yeah!

In the meantime I am counting the days to leave this hotel, have a good massage and a pedicure. This will happen in Addis. I looked up the hotel we will stay in and it has a picture of two Ethiopian beauties smiling in their white towels in the hotel spa. Here, the closed I come to spa is the wrapping on the tiny guest soaps “Spa, les fleurs du coton.”

The hotel owner is apparently some sort of priest or evangelical on Sundays. He showed up in flowing white robes when we settled into our conference room last Sunday. Seeing him in his flowing robes reminded me of the chapter in the brilliant Congo book about ‘la bière et la prière. On Monday he was dressed in ordinary clothes with a ladies handbag crossed over his chest like a conductor, except conductors don’t have ladies handbags. In it is a calculator and probably money. He spends a lot of time calculating.

He doesn’t seem to take his management duties very serious. This morning he sat down in the restaurant watching TV while the curtain rail (including curtains) on one side of room had collapsed onto a couch but he didn’t seem to notice. He doesn’t seem to be in the least concerned about his surly staff, the state of the kitchen, the lax security (regarding personal possessions, not terrorists) and the quality of the breakfast.’

The prefect who came to open our alignment meeting told me it was his third opening of the day. I asked him what else was going on in town. There was a UNICEF meeting to teach the gendarmerie who to deal with kids that had committed (presumably petty) crimes. I was glad to hear. Apparently they treat these kids now in a way that isn’t very nice.

The second workshop he opened was about gender. He told me that men beat their wives and this was a bad thing (I agreed). A research study conducted in the surrounding countryside had revealed that some 42% of the men interviewed (he didn’t know the sample size) beat their wives regularly. “Why, I asked?” “It’s cultural,” was his response. To my astonishment he then added that 48% of the women wanted to be beaten by the husbands. “Why?” I asked again. “It’s cultural.” The percentages indicate that 6% of the women want to be beaten but aren’t. I would love to see this study.

In between my work I am chasing my second passport that, according to the DHL tracker, arrived at its destination (our Abidjan office) last Monday. Proof of this, also available on the internet is that a certain Mariama Coulibaly signed for it, even though the package wasn’t addressed to her. As it turns out there is no Mariama Coulibaly in our office and so we are wondering where my passport went and who this mysterious Mariama is. It is not a minor thing, losing one’s passport, as there is a thriving trade in American passports. On top of that, it contains my entry visa for my next stop, Addis, as the visa in the passport I traveled on sofar expired last Monday – the same day my second passport landed in Abidjan.