Archive Page 74

Planes and hospitals

When we traveled to Japan some years ago, during the SARS or Avian flu crisis, I always wondered who in their right mind would step forward and surrender to the white coats, admitting one was sick. Who knew what would happen to you afterwards? But when I landed in Paris on Saturday morning I would have thrown myself in their arms. I was sick as a dog, having a hard time breathing which created panic and more constriction.

I had about 3 hours between flights and dreaded another 7 and a half hour on a plane in my condition. I pondered whether to look for a clinic but by the time I decided I should do so, the track to the clinic was so long and required me to enter France with thousands of other tourists and might have risked missing my flight, so I soldiered on.

It was the longest return trip to the US, longer than my circuitous trip from Mongolia via the DRC. In hindsight, that trip was a piece of cake. Everything is a piece of cake when you are healthy. I tried to limit my coughing, respectful of my fellow travelers. I hate it when I am surrounded by coughers (I actually was on my way out, so that’s maybe where it all started). But the hardest part was the shortness of breath, not being able to take a big deep breath. I had gotten used to the coughing by then.

By the time I landed and exited from the immigration area, Axel said I looked decidedly grey. We resolved right then and there to go straight to the emergency room. And that is where I spent the next 6 hours until they admitted me to the ward around 8 PM.

I wasn’t able to sleep until 10 PM when all the diagnostics were completed. So while I was being poked and questioned I imagined I was upgraded to business class and had a seat that turned into a bed – the same up and down buttons allowed me to pick a position that was most comfortable.

But the food couldn’t compete with the airline food, not even economy class. At 8 PM I was ravenously hungry, not having eaten much during the last 24 hours. I received a plastic box with a cup of chicken salad, 2 slices of wonder bread, a half cup of apple sauce and a small bag of chips (“a joy in every bite”). Emergency services clearly do not think of nutrition as a variable in getting better.

I have not had wonder bread since my youth in Holland. I think it was called King Corn bread and came from America so it was very cool. I thought it was so much yummier than the rough brown bread that I miss so much now. We used it also for fishing bait as it balled up nicely to put on a hook. I was thinking of those fishes going for the white little ball as I chewed my emergency dinner, trying to get the big globs of tasteless white dough to a size small enough to swallow. My hunger made me very impatient.

I was put on nebulizer treatment which made me jittery as if I had an overdose of caffeine. After the third treatment, although super jittery, I was able to relax and breathe a little more easily. I was also put on a drip and started on antibiotic treatment. X-Rays and a scan were made to determine whether I had pneumonia, and if so, what kind. Given the number of countries I had visited in the last 6 months the infectious disease specialist was also called in. Had I been in Ebola territory? Had I been in hospitals and in contact with patients? I explained that in my line of work public health is not about direct patient care. Interesting the doctors said. You have ants in your pants, said the nurses.

Finally, after I had already left the hospital the next day, the confirmation came through: streptococcal pneumonia. I was relieved it was not a virus and the antibiotic treatment is in full swing. It is an excellent time to recover at Lobster Cove.

Throughout the ordeal I counted my blessings: to live in a place that has good care, good hygiene and an insurance that pays. I thought about the many people around the world who have the same affliction until they die or are so miserable they can no longer participate in life. You don’t appreciate good health and health care until you need it. Still counting…

Return

I watched in astonishment and horror the news about the Malaysian flight that went down in the Ukraine. A local conflict brought into many Dutch families’ homes in ways they could never have imagined. It never occurred to me that overflying conflicted places could be dangerous. I will be flying tonight over some turbulent areas too, Mali, Libya.

I try to imagine the reasoning that led to the launch of the missile, if that is indeed what happened. Was it an error? Was it a bet, an overdose of testosterone? We will probably never know.

I have made my way to Ouagadougou after a slightly less restless night but I continue to cough in a way that, I am sure, my fellow travelers tonight will not like. I reserved a day room in a small guesthouse recommended by a friend. It is very cute, very African in the way foreigners would characterize African – wrought iron furniture, nice textiles, tiles, wooden statues and art. It also means there is a mosquito net which one finds rarely in African hotels. I was told by the management of the hotel I stayed in on my way in, and the same chain also in Bobo, that guests don’t like mosquito nets because they say it unhygienic. I find that rather surprising given that my bed has a blanket that I doubt gets washed between customers. The pillows and mattress, once you look under the covers, are rather gross and the shower curtain had not been washed in weeks, if ever, slippery with mold.

I was picked up at the airport by a taxi sent by the guesthouse. It was an old Mercedes that, after some buffing, would have done nicely in an antique car parade in the US. The driver too, he was also antique, wiping the windows with a dirty old rag so I could see the city.

It has been raining heavily which means the temperature is below 30 and people are happy. Unlike in Holland where, if you are not a living from the land, rain is seen as a disturber of plans; here it is a source of joy and life.

Waiting

The weather is a little cooler than yesterday; there is a breeze, but other than that, in the middle of the day, everyone seems to be waiting. Everything has slowed down. We are in the middle of the holy month of Ramadan. Those who fast are waiting for the sun to set. I am waiting to leave for home and the hotel staff is waiting for people to ask them something. The general feeling of lethargy is all around; so well described in Naipaul’s Bend in the River, though there is slightly more action in Bobo.

After a meeting in the office to tie up loose ends and review our work, past and future, I said my goodbyes and returned to my hotel to take a nap. It didn’t do me any good. i went for a short walk to pull some more money out of the wall. On the way back I walked past the two supermarkets. I felt like buying an ice-cream to give my throat some relief but the supermarkets still close several hours in the middle of the day – I would have to wait. I remember that supermarkets used to be closed when we lived in Dakar, decades ago – everything stopped during the middle of the day. Nothing has changed.

Then and now men lie on their traditional African chair planks, one plank inserted in another at a 120 degree angle – sometimes they scratch their crotches – it is the one pervasive image I have of African men that stands in sharp contrast to the women – always busy taking care of stuff or earning money. I watch the young men across from the hotel. Some sit in the same position for hours, never moving. They chat with other men and I wonder how they earn a living. Sometimes, when I cannot sleep at night I look out on the street, and there they are, still in the same position. It may be 1 o’clock in the morning. It is one of the big questions I have – why don’t the women put them to work?

The lethargy also creates a sense of ‘never mind,’ or que sera sera,’ a fatalism that whatever comes will come. Of course all this pertains only to the men I see in the street. Office men, functionaries, professional staff work hard, or at least they say they do. It has been a long time since I actually made 9-5 days in an African office and things have changed. With internet there’s always work.

I returned to the hotel, not wanting to wait for the supermarket to open. I am not even sure they have ice cream. Their dairy and vegetables cases are mostly empty, reminding me of Soviet stores in the early 70s –and I probably should not trust ice cream in a climate as hot as this one – I am sick enough as it is.

The lethargy has spread to me. My respiratory troubles make me not want to spend any energy on anything – it’s too much of an effort. But I don’t want to sleep either; afraid I have another sleepless night. And so I just wait, watch the hours go by. It is probably exactly what my body needs right now.

Dragging along

My body has made it very clear that this travelling should stop. People have been asking me how do you do it, and in this trip the answer is revealed, not well. Yesterday I dragged myself through the day, sputtering and coughing with very low energy. I was relieved when the day ended and went to bed early in the hope of a good night sleep. But the night brought little relief as my body kept reminding me that I am not well and shouldn’t be here, but rather in lobster cove, being attended to by my best friend.

I keep drinking enormous quantities of hot water, lime and honey but it feels less effective now, aside from hydrating me in this warm place where temperatures remain in the upper 30s.

The explosion in Ouaga has been explained in different ways but I was glad to learn it was not the beginning of the revolution. Some said it was an error, others it was revenge.

The workshop concluded with a reformulation of the projects that the remaining people will focus on. I will support the group and my colleague from afar and he is, at least according to the budget, on his own for the next workshops. Although I cannot come to his aid in person, I hope I can help get some support for him as doing this on his own would be more than a small challenge.

Peace and bees

We completed the second day of our three day workshop yesterday and some things are starting to come into focus – which is exactly the idea as this workshop is about focusing. I was able to hold on to my voice although I am starting to sound like a frog. I continue to drink liters of water, warm water with honey and lime. It seems to work, maybe even better than the medicine I don’t recognize.

We talked a lot about the elements that make or break a good work climate, which, not surprisingly, inserted a lot of energy in the group. It’s a near universal conversation that could be held, more or less about the same topics. The tendency, here and elsewhere, is to look for solutions in rules and procedures, better understanding of them and enforcement. They are technical solutions to adaptive problems and, I am sure, none of them will produce what they are really seeking – others to change their behavior so that we can all be happy.

I am reading, in the empty moments, Kegan and Lahey’s formidable book about Immunity to Change. It appeals to me as a psychologist and a facilitator of change processes. It helps me see more keenly where we engage in wishful thinking and where change may really be possible.

In the evening our small MSH team was invited at the house of a long time friend and mentee from Guinee who has lived and worked here for 8 years. He built a house on a house lot that was given to him as part of some important celebration here in Burkina Faso, five years ago which turned out to be a great investment. It seems that people who invested in land and houses did better than those who put their money in banks. He certainly has done well.

The talk about land and houses led to my query about the country in West Africa (or even Africa for that matter) where each of them would prefer to live if they’d have a choice. Considerations of quality of life, political context and environment entered into the calculations. To my surprise none of them said Burkina Faso and I understood that all believe that sooner or later this place will explode in a presidential crisis and as a result of poor management of government-opposition conflicts. When I asked whether this would be an internal affair I was told by all that no conflicts in Africa are internal affairs only. And here I thought that Burkina Faso was this peaceful, sleepy place.

As if to underline this condition I received from our International SOS Security Advisories an automated message this morning that explosions in Ouagadougou destroyed some 30 houses yesterday. The Laarle area of the capital is cordoned off for further investigation by police and security forces. I checked on the international and then local news but there is no mention of this; international is all about the same as it has been the last few days: Gaza, Ukraine and Germany winning the world cup. The local news has a talk show about values. A search on the internet on ‘explosion’ and Ouagadougou’ turns up that there is an explosion in the number of internet cafes in Ouagadougou while the connections remain poor. Indeed, I can’t find anything else as further queries tell me the pages cannot load.

In the meantime the virus attacking my larynx seems to have given up and has morphed into a regular common cold, hopefully losing steam in the next 24 hours. It must have been the honey. I am grateful to the local bees who have come to my aid and put the aggressive virus in its place.

Slow start

My colleague provided me with some medicine to stave off the laryngitis. I followed his directions without questioning – which, when I read the instructions later, I probably should not have done. He gave me some anti-inflammatory and antibiotic tablets, suggesting a dose higher than suggested. I took one without the other, not wanting to contribute to the creation of super bugs here in Burkina. Although I didn’t feel in top form during the day, I was good enough to manage my malaise and keep my voice. I also drank about 3 liters of water.

Now, in the evening, having discovered I already took the maximum daily dose, I am fading fast. The cough and throat ache are worsening. I will make it a 12 hour night.

We had a slow start for the first day of our 2nd leadership development workshop. Two people showed up at nine, and slowly, over the next one and a half hour the remaining 7 showed up. I used to get really upset about such things and wanted people to be more disciplined. But all this wanting and pushing didn’t make a difference and now I simply accept it rather than judge it as a lack of interest. Who am I to know what the reasons are for people’s behavior? It’s better this way. From time to time I would ask whether we could start and then waited for my cues.

As a result we sort of slid sideways into the workshop; more of a conversation than anything else, during which I learned some interesting things – so it wasn’t lost time, as I used to think. Time spent speaking with others about things that matter is never really lost.

I had expected that we would have more than enough time to complete today’s program, and even continue sessions from the second day. After all, the program is timed for the entire morning and part of the afternoon during which at least 7 teams are supposed to present the results of their scanning activities over the last 2 months.

We never had 7 teams. We started with four, then one dropped out and it was clear that another team had been inactive. Still, in spite of having only two teams present, we weren’t able to complete all sessions scheduled for today. In some ways it is easier to work with a very large group because you move on even if not everyone is there. When there are only 9 people in the room, in 3 teams of 3, you can’t do that.

Nevertheless, I think we are off to a good start. We continue to move back and forth between two languages, with the Liberians being good troopers and mostly participating in French; occasionally we switch to English and then the Francophones are good troopers. We have the handouts and facilitator guide in two languages handy and so the bilingualism of this program is working out OK. Sometimes I don’t even know which language I am speaking.

We spent quite a bit of time talking about positional versus relational approaches to leadership and gender, which in French is sexospecificite; a mouthful that trips me up each time. We agreed finally to just say gender and use the English only, after having agreed that we don’t just mean women.

Thinking

Last night I was invited for a traditional Senegalese meal by my colleague who, since I left in April, has brought his newborn, toddler and wife up to join him. They are all from Senegal and we feasted on Tjeeboudien, a combination of rice, fish and vegetables, eating from a common platter. One eats from the section of the platter directly in front and then staying within that section. It is the role of the host or hostess to constantly shove the choicest pieces to the sections of the guests. And all along we watched, on a tiny screen, the final match of the world cup.

I woke up with all the signs of a laryngitis in the making. Here I have come 6000 miles and now I am losing my voice? I sent an urgent text to my co-facilitator who is also a doctor, to get me some miracle medicine hoping to stop the progress. For once I didn’t bring my salt packets to start gargling as soon as I got up.

The shower was cold and the shower curtain slimy with mold. At breakfast the rancid butter from yesterday was still laid out as if I hadn’t said anything about it and the freshly squeezed orange juice was immediately invaded by a large shiny fly.

One could take all this as signals that this is not going to be a good day; but then when I watch what is happening in Gaza, I tell myself to get real. I am sure they take rancid butter, cold showers, slimy curtains and flies in the OJ anytime there if these rockets could just stop.

This little outing into thinking that somehow the universe conspires against me on certain days is, I have to remind myself, a relic from a time when the human mind (mine and others) were primitive and not ‘self-authoring, establishing a sense of the world that is made by myself, not authored by some magical force. It reminds me of situations where I was working with people who weren’t able to do this self-authoring and thus totally in the grip of something that would not do them any good, without knowing it. This brings me back to Gaza. What are they thinking?

Arrived

I am back in Burkina, after a not too strenuous trip, even with my tendinitis brace. In Paris I saw my name on a TV screen which I hoped, and indeed was, a slight movement forward, from the main cabin to Premium Economy, which is like a mini business class – a smaller version of the fancy B-class seat, an amenities pouch of a slightly inferior quality and content than the B-class one, and a little cone with French regional ‘friandises,’ all high sugar content, which I munched down immediately after having deliberately stayed away from sugar the entire week.

Given that I have a very expensive ticket, over 3000 dollars, the upgrade felt more like an entitlement than a nice geste from Air France.

In Ouaga I was helped with my carry-on by a nice American gentleman whom, with many others from the US military, had come to Ouaga for some training or other, presumably to stop the advances of insurgents in the region. It is quiet military preparedness action, it seems, that doesn’t get any media coverage as there is nothing acute and newsworthy going on here at the moment.

At the hotel, a different one from the not so good experience at Palm Beach last time, was pretty much the same, room and general ambiance wise; except the staff was nicer and more attentive. They had prepared a room with a mosquito net which is not standard issue here in this country where malaria is endemic after we had made a special request.

Unfortunately I could not have a mosquito net AND internet connection which seemed like an unfair choice. In the end, the need to be connected to the world and talk with Axel prevailed and I declined the moustiquaire; instead I cranked up the airco which is about as good as if not better than a mosquito net.

It is Ramadan in the Moslem world. I am always surprised that in places like this that are mixed Moslem/Christian, food places are closed during the day, including the little cafeteria at the airport where I had planned to get a coffee and a croissant, given that I had no dinner last night nor breakfast as I left the hotel too early. Even the little pain au chocolat served on the plane to Bobo last time were withheld. I gather it is a business decision but it feels unfair to us non-fasters. So I keep nibbling on the cookies and chocolates brought with me from the AF lounge in Paris, not a great diet after my week of eating well.

I called the driver who had served me so well last time and he picked me up in a car driven by what looked like a younger relative who was just learning to drive. The young man made demi-tour on the otherwise empty road in front of the hotel and just barely missed hitting the only other car on the road. The back of the car, since I had last seen it, was all dented and the boot didn’t lock anymore. I suppose these were the results of the new driver experience. I was dismayed to find out that the young driver was taking me to the airport (only 10 minutes away and in a city still mostly asleep) as my driver said, “je vais me reposer un peu ici.”

My young driver must have gotten a talking to by his dad or uncle because he drove to the airport at a snail’s pace. This made me feel even more uncomfortable. But he was trying hard and super concentrated. The back of his T-shirt said something else worrisome; some quote from Ezekiel that hinted at being happier once reunited with those who had already passed into the afterlife.

Bobo on Sunday morning was as dead as one could expect on a Ramadan weekend but the hotel restaurant was open and serving breakfast. There was even a mango and an orange to make up for the horrible diet of the last 24 hours.

Three young boys were the only other guests in the restaurant. The smallest, about Faro’s age, was clad in only a T-shirt, bottoms bare; he kept fumbling his privates and then headed for the small case were the bread and croissants were stored. I was glad he couldn’t figure out how to open it, as there was no one supervising the kid; it didn’t seem like his older brothers (not that much older) noticed that there was something not quite right about the situation as the little man’s hands moved back and forth between his privates and the breakfast fare (on his own table).

Transits

The week that started with a funeral ended with a wedding amidst the bees and the birds and the flowers and the trees of the horticultural society in Wellesley.

In between these two events I had my left wrist injected with cortisone to put an end to a debilitating tendinitis. The cortisone will kick in, according to the hand doctor, by the time I reach Ouagadougou. This means I am
traveling there with my left hand in the old brace, leftover from the carpal tunnel period fixed in Dubai several years ago. The brace helps to solicit assistance heaving my carry-on wheelie in the overhead bin. It worked beautifully and even kept the seat on my left unoccupied on the first leg of my trip.

I am leaving what is New England at one of its best periods: warm, the water swimmable (which few people would ever call warm), lobsters for dinner, crabs jostling into our traps, raspberries ready and a vegetables garden overflowing with greens, while the tomatoes and potatoes are readying themselves for our dinner table. And then little Faro never more than 3 hours away; his new yellow crocs awaiting him to be tested out in lobster cove alongside his Opa who also got new yellow crocs.

And here I am once again in a plane, once again on my way to Francophone Africa, to add my contributions to those who are advocating for better leadership, management and governance of health programs in West Africa.

Dinner

The team I helped to set on its leadership development course less than 2 months ago in Cote d’Ivoire is doing the second workshop in the series of 4 on its own. I am in frequent contact with the team and marvel at their enthusiasm. Despite being in a place with poor internet connections, they insisted I be part of the workshop.

After trying various ways to connect we finally settled on Skype and I found myself live in the workshop, presumably projected on a screen and with my voice amplified. It is weird to be in a workshop and yet not – they could see me but I was looking at my own video picture – remembering to look at the camera on top of my screen rather than the screen itself. I received the beloved West African clap (someone hollers ‘triplet’ which is followed by three small claps and one thunderous one with hands pushing the clap to the object of the clap) – twice even. I received them with a smile, knowing I was on camera. I am awed, amazed and honored by the way this community has boarded the leadership train.

I left work early to enjoy Lobster Cove on another beautiful summer day, before heading out into the steamy Sahel on Friday. Axel had not checked the lobster traps yet, which he had baited with the remains of the 40 pound striper. His 12 foot dory isn’t quite made for two adults and hauling in lobster pots– he usually does the lobstering on his own – but I decided to be his lobstering mate, more ballast than help. The ocean was choppy with big swells, which made for good exercise for Axel the rower. His months of exercise at the gym are paying off. It felt great to be out on the water and I counted my blessings – what a place to come home to.

Four of the five traps contained only undersize lobsters which we threw back to grow some more, replacing the two day old striper bait with freshly caught and still bloody herring. Wondering what we would have for dinner we hauled in the last trap which contained it: 3 lobsters, two of them a pound and a half. It is the time of the year when lobster start to molt, shedding their old hard shell and growing a new one that is soft for a while. For this they come in closer to shore.

One of the large lobsters still had a very hard shell, which required a hammer to open; the other large one had just molted and thus had a very soft shell. It splashed liquid all over me after it was cooked. We didn’t touch the third one yet; it is neither hard nor soft.

The perfect day was completed with a massage by our friend Abi who worked hard on my sore foot – the healing process of my ankle seems to have stopped for a while, even made a turn for worse. I have picked up my PT exercises again which seems to help a bit. I was told by the orthopede’s assistant that it is not unusual for such regressions, what with the other joints and muscles having to work harder with the main joint being fused. It may be the equivalent of a strike, a protest against the extra work.


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