Sylvia's Journal

It was the ultimate challenge, working with a group of unknown size, representing unknown parts of the ministry of health, with a new colleague, although a seasoned facilitator, entirely new to our program, and with people I have no relationship with – and with whom it is hard to do so without a voice.

We had tried hard to get a few minutes with another high positioned individual who gave us an appointment at the exact time we were to start our afternoon meeting; somehow my colleague thought this was possible and I surrendered. I did a lot of surrendering these last few days and had very low expectations. Getting access, even if for a few minutes to a high level official can be a major victory and the highlight of one’s day. I also surrendered to being sick and without voice and to all my colleagues from the other projects, who know our methodology well and could run such a meeting on a minutes notice, not being available at all.

I had a rough night, waking up every two hours, then with this cold symptom, then that, feverish and dreading having to get up and go to the office and then do this meeting. There was no question of canceling it – it was such a victory that we were told about 30 people would attend from across the mid to senior level of the ministry. The next time we would be able to those people would be in January, when I am not able to come here.  I had to observe my colleague in action and be confident she can take this on without me. In a way she had to, since I could only whisper to her when I felt she needed some re-direction.

Given all this, the meeting went better than I could have hoped. We introduced the notion that a vision is like a dream but with wheels underneath (=action).  That’s the session they found most memorable. And I got a good idea what the fruits of better leadership and management and governance would look to them. Nothing earth shocking but something to refer to later and because of that, quite helpful.

On Thursday morning I decided to see a doctor, fearing a sinus infection was in the making (which it turned out to be). My colleague accompanied me; she is now quite used to interpreting my whispers to a third party. We were told to wait 10 minutes in a rather full waiting room, with me being the only foreigner. Although I don’t like foreigners being treated more politely and faster than the locals, being rather sick, the principle wasn’t as strong anymore.

My colleague (V) told me that 10 minutes in Madagascar could be an hour. I surrendered and settled into observation mode. After about half an hour we saw a young female doctor. I was not greatly impressed by the thoroughness of her examination and had to remind her to look into my ears, as these had been under pressure the night before. To do this she had to find a new battery.  V and the doctor talked for a while about grogs and other local remedies, pushing me to get pectos (whatever these are, pastilles probably) and soak them in whiskey, and voila, my ailments would be gone. They were really working hard on me, demonstrating how annoying it is when people give you unwanted advice. I had been listening to this and other home remedies for two days now. Everyone has had what I have and everyone has their own remedy which I should try.  I had no appetite for alcohol nor sugary pastilles – I think I am ingesting enough sweet things, now realizing that over the counter medicine for a cold are all sweetened with sugar. This means a temporary pause in my low sugar diet.

I was told to get an X-ray to see if I had a sinus infection. I didn’t know X-rays could do that, but since I am not a doctor and finding out whether I had a sinus infection was the main reason for going to the doctor in the first place, I obeyed and we moved to another waiting room. A radiology technician was working his butt off, I commended him for that. There were so many people waiting, some quite sick and disabled. The medical centre promises on various billboards to do scans, ultrasounds and other high tech things. I peeked around the corner into the ice cold scan room. Impressive.

My first X-rays had a spot on them and had to be redone; by now we had been there 2 hours. We got the results quite quickly – there is no one reading the X-ray except the doctor. She was in an emergency and so we had to wait another hour before the verdict was read: yes, had a sinus infection and received a total of 5 drugs (a spray, a syrups – oh that sugar – and antibiotics, effervescent prednisone pills and a pack of tiny blue pills). It is a complicated regimen  of 3 times per day for 5 days fo one drug and 3 times in the morning for 3 days for another, and 3 times after meals for a third, etc. It’s hard to get my head around this but I will try anything to be among the talkers again.

The whole thing cost me about 50 dollars: 9 dollars for the consultation; five and a half dollars for the X-ray and 35 dollars for the drugs. It is clear who is making the big bucks here. Pharmaceuticals is clearly a lucrative business since no one leaves the doctor’s office with just one prescription. I think my pharmacy colleagues at MSH are trying to do something about this.

By the time we were done it was also time to get to the conference room at the ministry and run our meeting.More about that later

When I woke up on Tuesday my voice was completely gone, not even a croak. Part of me was rebelling against this affliction and the other part sighed and surrendered. What else can one do? I am sure that the fighting would only prolong it.

And so I went through the day whispering. It is funny that when you whisper, other people also start to whisper around you.

We took another chance going to the ministry hoping to see the big boss and have him approve the meeting on Thursday that we had started to prepare with an underling. We positioned ourselves in the anteroom to his secretary; a large room with some 20 chairs arranged along the walls. On one side was a large bureau – the center piece of a bureaucracy (= the power of the bureau). Since I couldn’t really talk I observed. There was a constant coming and going of people, many quite young. Everyone carried a folder or a brief case or some other container for papers. Sometimes papers got filled out but most came with papers already done.

The sign on the entrance door to the secretary’s office says ‘knock and then enter.’  But some people just sat down and waited. It wasn’t like a doctor’s office where you are called in, and so I never understood on what cue people got up, knocked and went into the next room.

The next room was populated by three people sitting there amidst piles of papers, some loose, some in binders and folders, piled up high. My colleague left a handwritten note for the big boss, who she had taught some years ago, asking him to just see us for a few minutes. The secretary wasn’t very friendly. I gave her my card and she copied it on a piece of paper. We went back out to the anteroom and continued the wait.

I had to go to the bathroom. This required an explanation of who I was and a key, which I got. I am not sure why the bathroom was locked as it wasn’t in pristine condition. I know in many ministries of health the toilets are locked because people wander in from the street and foul the place up (really foul).  For a moment it looked like I couldn’t get out as the lock fell apart when I tried to open up. I had visions of being locked in there for hours and nobody daring to rescue me not knowing whether I was still doing my business. Eventually I got out and shortly thereafter we got our break with the big boss. Not having a voice was really awkward. My colleague had to do the talking and I sat close to the boss, whispering to him now and then.

The rest of the afternoon we worked on the program for Thursday, for which we have now received the official green light, and me whispering my colleague through the exercises she will have to do.

As the day progressed, my allergic reaction to Tana got worse. By the end of the day I had a full blown laryngitis. I am told that the air quality in Tana is similar to that in the big Chinese cities – really bad. My body had a near instant reaction to the toxins in the air – as soon as I had left the airport my eyes began to water and my throat started to hurt. I hate to think what I am ingesting with each breath of air. Air intake is not so easy to regulate as sugar, darn.

I spent the day getting to know my new colleague, a seasoned facilitator who will be running the leadership program here. She too is coughing and having a reaction to the air quality; so at least I am not alone. I was told by my colleagues that a cut onion on the table will keep the cold from wandering around. I forgot to get myself an onion for my hotel room – which, by the way, also smells funny and was apparently sprayed to keep insects at bay; more toxins.

We had hoped to make a courtesy call to the general secretary of the ministry of health on this first day to get some marching orders or test ideas on how to use my ten precious days here. This turned out to be a very difficult task. My new colleague has tried to set up appointments for two weeks now without success. Some people are apparently not all that keen on this project. Why is anyone’s guess?

By mid-afternoon we decided to go to the ministry and hang around hoping to catch the important people in between meetings. Getting there was an adventure. We took a taxi, a rickety Renault 4L that hung together with wire and duct tape. Every time the car stopped the driver had to put two wires together to start. Then, half way through constant traffic jams he pulled over to get a couple of liters to gas to get us to our destination; and then all hell broke loose with a monsoon type thunder and lightning storm. And it was then that I learned about real rain and artificial rain. Artificial rain is created, according to my counterpart, by blowing salt into the air. When I came back to my hotel I looked it up and got the more scientific explanation of what is called ‘cloud seeding.’ I had no idea such a thing existed.  And so we experienced artificial rain and, presumably real rain as we are on the edge of the rainy season’s start. I couldn’t tell the difference as both types of rains created instant rivers dashing down the steep streets of Tana. A toddler would have been swept away. Our taxi’s roof held but water came in through all the ill-fitting windows and doors. At least it brought some cool air in the otherwise stifling heat.

We arrived at the ministry when many people were leaving, a cause de la pluie, apparently. Given the puddles and rivers and resulting intensification of already intense traffic jams, I could understand that, but it didn’t help with our mission.

Luckily my colleague knows lots of people as she has had a long career in educating government officials on such topics as leadership, public administration, management, etc. People embraced her left and right and she took advantage of introducing me to everyone so that we could start seeding the place with snippets of what our leadership program can do.

Having already given up on getting an audience with the right people and then have these people call a meeting so we can show our wares, we were surprised to suddenly find someone who could call the meeting and reserve a room. That would be Thursday. Now I badly need to get my voice back because that is my main instrument.

I spent the morning of my Saturday in Johannesburg working. When I am on a trip some of the other work continues. I wanted to clear my plate and thought I did when I learned there were other files to review though not visible to me in the Google Drive; most of the time I like Google Drive but yesterday I didn’t.

I treated myself to a Lebanese mezze for lunch, a macchiato on a terrace and then a pedicure. I decided that I hadn’t quite earned the massage yet (that’s the Calvinist in me).  For dinner I feasted on softshell crab and a magnificent glass of white wine at the Koi restaurant, a chain I know from my Pretoria stays that has an interesting cuisine. I eat my meals fast as there is no one to converse with. When the tables filled up and people were waiting to be seated I offered the other three chairs at my table, looking forward to some dinner conversation, but the wait staff looked at me as if I was off my rocker. Apparently one doesn’t do that here.

Back at the hotel I found that my suitcase was heavier than the airline allowed. I filled my hand luggage and succeeded to stay under the 20 kg for the flight to Tana. I left my cliff and other bars, that I now know contain a lot of sugar, for the hotel staff. I am holding on to the various packages of chocolates but that is for the teams I will work with. Bringing chocolate to Madagascar is like bringing coal to Newcastle, but I couldn’t think of anything else to bring.  Should I now feel guilty about bringing gifts that I no longer deem edible, at least not for the next 40 days?

And now I am in Tana, not at the usual boutique hotel where I have always stayed as it is full. I am put up at a “you-could-be-anywhere-in-the-world hotel.” It looks just like the one I will be staying in in Abidjan in a few weeks.

I am looking out over leaden skies. Everything is wet – it is the rainy season here, hot and humid. As soon as I got off the plane I started to have watery eyes and sneeze– I am beginning to think that I am allergic to Tana, as this has happened each time I have come here.

And now I am going to have my free welcome cocktail (a beer I think) at the bar downstairs and check out the sauna, hamman and espace sportif – all of which I get to use for free, the boutique hotel doesn’t quite have that. And then I am going to celebrate my last free night trying to finish the book Congo (by David van Reybrouck) that my sister gave me in June.

The period I am reading about now (early 50s) is exactly the time that my father travelled across-Africa (hitting some of the same cities I am doing now) on a brewery trip that took 3 months. Travel is a bit faster these days.  I can’t remember whether he stopped in Congo, but if he did, he may well have met some of the future giants of Congo politics (as they were each associated with a beer company – Lumumba, Congo’s first prime Minister was at Polar beer, and Kasavubu, Congo’s first president was with Primus beer). I have my father’s diary at home and only skimmed through it once. I was embarassed by the racist undertone of his writing about the locals het met (presumably mostly servants and servers) and the luxurious life that the Belgians and French lead: houses at the most beautiful spots, camembert and french wines flown in regularly – they live like kings, my father remarked. The diary sits in a box with postcards from african cities: palms, neatly painted colonial architecture (without the black mildew), an occasional car and bus and here and there a bare-breasted African woman.