Sylvia's Journal

Our two days and a half of hard work, calling something into being that doesn’t exist yet, came to an end at lunch time yesterday. We accomplished what we set out to do, and more, the latter to the surprise of a few doubting Thomases, who admitted their delight in our closing reflection.

We went from divergent to convergent thinking, from the weeds to the clouds and back, and ended up with a good foundation of the house we are building as the faint outlines of the vision began to emerge: a space and a place where people involved in health education can connect, learn, scheme, assess, experiment, etc. At times there was some hesitation – could we pull this off, ever? – but when we closed everyone has recognized that, with enough hands on deck and good steering, we could do it. We were swirling in images, weeds, clouds, foundations, steep staircases, decks, breezy rooftop hang outs, winding dark alleys, dead ends, open spaces, etc.

Some of the imagery came from our last dinner together on the roof of an old house, located in the middle of narrow winding alleyways that could barely accommodate the tuk-tuk that took me there. It appeared to have been made for giants – steep stairs with threads double the size of what I’d call normal – and furniture larger than life. At the rooftop restaurant however, the place was for little people: tiny tables, pillows, a mufraj of sorts, with large swaths of textiles flapping in the wind over our heads, and the muezzin calling from everywhere around the island, not quite in synchrony.

Facilitating for three whole days and the intense humidity had not been kind to my ankle. An unexpected long walk to Freddy Mercury’s restaurant on Wednesday evening reminded me that the surgery had only been 2 weeks ago. I started icing my ankle again and keep my foot elevated – seated facilitation became possible because of many helping hands from a solicitous team.

The cutting of the internet cable in Egypt didn’t just affect the Middle/Near East and India, as reported, but also a good chunk of the east side of Africa. Checking in for our puddle jumper to cross back to the mainland was rather chaotic with the internet down.’ This was not a local event, as we had assumed, but something much bigger – an Achilles heel exposed.

We received hand written boarding passes after showing a print out with a ticket number. The part of the system that did not require an internet connection (dedicated workers) trumped all and showed that there are still memories here of LBI (life before the internet). We took off and landed exactly at the appointed hour. Quite amazing!

I had myself dropped off at the Hyatt where a colleague was just finishing her trip, heading out to Amsterdam. We were able to squeeze in a beer and some bar food before checking into my hotel in another part, a pricey deal for a very short night: convocation at the airport at 3:00 AM. And that is where I am right now: off to Nairobi and then crossing the continent for Abidjan.

Ten of us have converged on Zanzibar from a few corners of the world. There are two Ashoka fellows, one from Delhi and the other from Dhaka. They are the kind of people who get showcased on the Stream, Al Jazeera’s must see program about what Millenials are up to. I only watch the Stream when I am on the road. I marvel about the intensity of their social activism and the cleverness of their inventions, often combined into a successful venture. I bet there is a relatively large proportion of social entrepreneurs in this age group. One of our two fellows, I turned out, was indeed featured on the Stream, some years ago.

We started the day with introductions, questions about ‘What does your name mean and/or who were you named after?’ ‘Who are your people and what values did they instill in you?’ and ‘What is one novel and refreshing idea you have heard recently?’ The stories made us laugh and inspired us.

I am the insider/outsider in this group – insider because I am a member of the project team and outsider because I am only facilitating the work of this group of people (I am not a member of this nascent Advisory Council). But also because the world of behavior change (for health) communication is a parallel world to the one I inhibit that features management and leadership. Of course, when you think of it, we are all engaged in behavior change, our own. That is particularly true for me as I am learning to be a coach.

The work of the group is to form itself into a Council that will advise the formation of a Marketplace for organizations and people involved in ‘communication for health.’ We mindmapped the accomplishments and challenges in the field and looked at examples of effective communities of practice. Today we will put these together as we sketch a first vision of what this ‘thing’ we are calling into being might look like. We worked long and hard – beyond the planned ending time – because we had run into a challenging set of questions. The group wrestled with these for a bit until we got some traction and then we called it a day.

We had our dinner last night at Freddy Mercury’s restaurant. I had to be reminded that Freddy was a member of the band Queen. He was born on this island, destined for musical greatness according to the intro on the menu. There were pictures everywhere of Freddy and his band and the women’s bathroom was labeled Queen (men’s was Kings of course). Despite our multiple requests for Bohemian Rhapsody we were fed Brittney Spears and the likes alongside our meal. The food wasn’t quite in the same league. Sitting next to the ocean you cannot go all that wrong with skewered prawns, but I counted more heads than tails.

The restaurant offered cocktails with names designed to get foreigners to buy overpriced drinks that are in the ‘meh’ category – who could decline a ‘Romney’ or an ‘Obama,’ There were adjectives attached to those but I can’t remember. I stuck to South African white wine.

The restaurant was a 30 minute (slow) walk from the hotel and did little for my ankle. Before the operation I could not have walked both ways. Now I had trouble with the return trip only – only a small comfort. The icepack I brought, which in the hospital seemed reusable, doesn’t want to close anymore. I will have to fumble with plastic bags with ice cubes again. The operation does not appear to have improved the situation as much as I had hoped. My ankle (tibia/talus) joint has gotten stuck a few times again and the pain radiates out into my ankle bones. But right now I don’t want to think about what next as such thoughts are even more painful.

I am back in the land of Islam. The vast majority of Zanzibari are Muslim. And so I listen to the call of the muezzin and it transports me back to Afghanistan. There is something very soothing about that call – a permanence amidst chaos.

I do miss being in Afghanistan, strange as that may sound. The place has an addictive quality to it that is hard to explain to anyone who only knows Afghanistan from the media. But anyone who has ever been there (really there, not in military garb) understands, instantly. We are all bitten by the same bug.

And so now I am in Zanzibar and only barely present to the town. I made one quick outing into the old city which was sleepy and quiet after lunch. It s good to do nothing as it is very hot and humid, and any effort is met with lots of perspiration.
Today the last of the people arrive for our meeting. We reviewed the program and are mostly set. The sun is setting, the sundowners consumed and I am looking forward to another great seafood meal, meeting people I have never met before. What fun!

A peaceful night I had indeed, under my mosquito netting canopy. Nothing disturbed me except a dream about physical decrepitude, a body that ached all over. I woke up stiff and followed the wise instructions of my DVD yoga instructor to loosen up. The post breakfast massage finished the job.

I met a few of my team mates last night for dinner at the beit-el-chai restaurant across the hotel. We drunk a cool South African Chenin Blanc, sampled variations on Bouilabaise and exchanged stories.

Today is reserved for reviewing several documents that are under construction and dot the ‘i’s and cross the ‘t’s in my facilitation notes for the meeting that starts tomorrow. This will keep me busy for the rest of the week.

I tried to conduct my weekly coaching session by phone, then Skype and had to give up. The Internet connection is OK for mail and surfing but it doesn’t quite support voice.It will set me back a bit but in the greater scheme of things, I decided, it is not important enough to worry about. next week I will try again from Abidjan.

The meeting I am attending helps me understand better the context and realities of this country’s response to the AIDS crisis. The meeting has only one other white person in it, a German who just started living here. The meeting’s language is primarily Kiswahili. Although the German looks like he understands Kiswahili, he confides to me that he doesn’t. Once in awhile I recognize an English word such as ‘bureaucracy,’ or ‘sustainability.’ Periodically I ask for translation but I am mostly watching people. Occasionally my neighbor makes a remark that gives me some clues about the issues she is thinking about and that need her attention. Sometimes these are commentaries on what other people say, or on statistics; and sometimes they are topics that only women will understand.

I made a trip to the tiny internet café of the hotel where the meeting is being held to discover that the computer runs on very old software. A message showed up that the system is no longer protected from viruses because the software has not been updated. By then I had already picked up the Trojan Horse and the Rungbu virus on my pen drive. I spent the rest of the morning scanning my computer to make sure no other viruses crossed over.

At lunch I sit with a retired professor of Muhimbili School of Public Health. He is a sociologist and talks to me about the early years of the AIDS epidemic when he was a lone voice crying in the wilderness. There was and still is much stigma attached to being HIV positive and he has lost many colleagues, educated people, who even on their deathbed were not able to acknowledge the disease they were dying of.

From the presentations and side conversations I learn much about the ripples and unintended side effects of the huge amounts of money that stream into the country in the battle against the disease, especially how it affects the lowest layers of organized civil society, the community-based organizations. They are trying to implement activities at the village, ward and household levels. There are expectations that money will solve all problems yet spending the funds has repeatedly been problematic, suggesting that something other than money is needed. [Bunny, the main character in Upton Sinclair’s Oil! remarked on page 490 that “he had learned this much from his father, that money by itself is nothing, to accomplish anything takes money plus management”]. As it happens, this is also one of the main messages of our Leadership & Management Program.

Another side effect is that the care of orphans and those affected by the disease is beginning to discriminate against those who are not HIV-positive. As the wife of the President of a neighboring country commented, “why, you are making people want to be positive!” Apparently in some schools there are more AIDS orphans than non orphans (one indicator programs are being evaluated on). This of course creates much resentment among those who have managed to stay healthy, but poor nevertheless; their schoolfees are not being paid. And finally, it appears that the implementation of care and mitigation activities, two of the three major strategies, are beginning to overshadow the strategy of prevention. As long as prevention is not effective, the other two will require increasing amounts of money to sustain an ever growing pool of people affected by the disease.

One PowerPoint presentation follows another. There are close to twenty. It becomes increasingly difficult to see the forest through the trees. This is too bad because I know there are other ways to structure such meetings that would help create more of a dialogue and keep the forest visible through the countless presentations describing a multitude of trees, some the same and some different from one another. Simple mind-mapping would already have helped; not on the wall though. Hotel management has posted a sign that nothing can be put on the walls. But I could have done it on my computer, quietly in the back, if only I would understand Kiswahili. So I am struggling with how to stay awake, making to-do-lists and writing in my journal; and when that is done I play solitaire. I am sitting in the back row and so I can see that I am not the only one; but, thanks to my Calvinist roots, I appear to be the only one who is self-conscious about it.

I also break the monotony of presentations I cannot follow by taking bathroom breaks. Outside the room are large framed portraits of participants, taken in the morning, developed and printed on large glossy paper and framed in cheap plastic frames. This is a gamble that the photographers take – there is no guarantee that people will buy their pictures; and if many don’t, it will be a significant monetary loss. Apparently they know their market – they are selling well and it must make it worthwhile. They also must have learned over the years not to take pictures of the white folks because they don’t buy. That is correct and I am grateful there is no portrait of me in the gallery.

On Wednesday night, after a work session, I have dinner with William and Isaac. I came back to the hotel too late to meet their participants. This will happen on Thursday morning.

At night I pack while watching a Nigerian movie about a bad church leader. There are many fat men in it with sunglasses and sticks and skinny young women who whimper a lot. I can’t understand what they say but I don’t need to. The story is obvious. The announcement for the next episode promises that things will end badly for the church leader. That is good.

The next morning I watch another Nigerian movie. Once again there is the fat man, also with a stick, but this time also a little fat and obnoxious boy. They are bad and because of that I know they will come to a bad end. There are also several skinny, poorly dressed men who act like children in the fat man’s presence. They too whimper a lot. Witchcraft, in the shape of eggs and wax dolls play a prominent role in both movies. I soon learn why. When the movie is over the credits say ‘Thank you Jesus, you are my inspiration!’ This is Nollywood, with a religious twist.

Today’s entry can not make it from my pen drive to the website. Some incompatibility of one kind or another.  I probably won’t be able to post again until I am back home on Friday the 7th.

Yesterday I met with the person to whom I will serve as a coach; in the coaching literature this is sometimes called a coachee. I was awed by the complexity of her job and her openness to me, a total stranger from far away. She freely discussed her challenges and dilemmas. I had asked if I could shadow her as this would give me a better picture of the world she inhabits and see what she is up against. She suggested I travel with her to a meeting several hours inland from Dar es Salaam. I will spend two days and two nights there so that, as she suggested, we will have some quiet time to get acquainted and simply talk. I jumped at the opportunity.

My sudden departure from this palatial hotel means I have to put away the menu of Spa treatments that has been tempting me ever since I arrived. I had been considering the Kilimanjaro Retreat (145 minutes) that includes a Floral Footbath, a Tanzanian Coffee Scrub, a Thai Herbal Steam Bath and a Spice Massage; or, more extravagant, the 3-hour Body Symphony that includes a variety of floral baths, foot scrubs, aromatherapy, Thai herbal facial and whatnot. On the lower end was the Executive Awaken, a one hour combination of foot, back and head massage. I simply could not make up my mind over the weekend. And so I blew it because now I am checking out. By the time I come back to Dar es Salaam it will be Thursday and time to present myself at the airport for the trip home.

Later in the morning I met my colleagues at the MSH/Tanzania office which is entirely made of glass walls. It is the ultimate transparent office. You cannot pick your nose, play solitaire or cruise the Internet on your computer without anyone noticing. But because many people were traveling I could have done any of that if I had wanted to.

In the afternoon I met the team of faculty at the Muhimbili School of Nursing who are participating in our virtual leadership program that Morsi is facilitating at the moment. All but one of the team members were able to meet with me, including the Dean. We had a most wonderful chat sitting around a table and talked about the challenges of teaching nurses about management and leadership as well as the challenge of being a virtual student on top of the usual faculty workload, double now because it is exam time. It was nice to get to know this team in a different way from reading their postings online.

Back at the hotel I started packing while my IT colleagues from Boston tried to fix my email problems long distance, using GoToMeeting (which allows them to take over my screen) and Skype. After about one hour we thought they had successfully diagnosed and fixed my problem. This morning when I woke my computer up, the problem was back.

I woke up full of aches and pains more than once during the night and again in the morning. One of the pains was in my left big toe. I recognize the big toe pain from a gout attack I had many years ago. Now the big toe pain is gone but my body still feels as if it ran the marathon.

Yesterday the city was empty, as cities are on sundays in most of the world, and somber under an overcast sky. This made it the perfect day for finishing loose ends form last week, preparing for next week and cleaning out my email inbox now that I am more securely connected again. All this took the entire day.

One of two highlights of the day was breakfast. It was the most lavish spread I have ever seen; fit for a king (and president I might assume). The big dilemma at the start of the new day was where to begin? Pour myself some ‘young coconut’ juice with a splash of Champagne? And then some freshly baked croissants, almond and plain, with lavender honey or shall it be a banana shake? Take the fresh tropical fruits plain or with any of four kinds of yogurts or go straight to the muesli which is made exactly the way I used to make it in Holland as a child? The amazing array of breads in a basket was out of bounds. A little card said: not for consumption, for decorative purposes only. There were other decorations that were out of bounds, such as a large cylindrical vase, nearly half a meter tall with layers of pastel colored marshmallows and almonds. I am sure that, somewhere on the internet there is a website for ‘buffet decorations’ where people get their inspiration for such displays. I continue to fill ill at ease in a place of such extravagance in a country that has so many poor and malnourished among its people.

As part of my preparation for coaching I read about trust, mutual trust in particular. One aspect of that is sincerity. Do I tell the same version of a story to everyone or do I re-script is depending on the audience? One thing I am learning from public journaling is that I have to recognize what part of my writing is pure observation and what part is interpretation. Public journaling is good practice and a good discipline; actually the same discipline that is required for emails: would I be comfortable if the person I write about, or who observed the same event, reads my piece? If the answer is ‘yes’ I can hit the ‘Publish’ or ‘Send’ button; if the answer is no, I need to return to the facts and revisit my telling of the story. As a writer I can of course do whatever I want, embellish, adding little flourishes here or there or generalize what was very particular. But I’d get into big trouble quickly if I didn’t realize I was doing that.

During my last massage Abi, who is dabbling in astrology, remarked that I may not have enough water in my life. Many years ago a friend did my astrology chart and told me I did not have enough earth in it. I have since taken up gardening and hope that this has taken care of the imbalance. Maybe the plane crash was about too much air. And now it is water, she thinks. I heeded Abi’s advice and packed a small watercolor kit in my luggage and today I painted a Tanzanian still lilfe of fruits, collected from the fruit table at breakfast: two small plums, a banana and a tiny mango. I have lost the touch a bit but it was fun and afterwards I could eat the still life while admiring my rendering of it – fruits that will never spoil.

The second highlight of the day was dinner. I went to see Marc in his much more down to earth hotel and we had a simple dinner sitting outdoors. Marc teaches public health at Harvard and has started his own organization – D-Tree International – that is ‘bringing evidence-based medicine to frontline workers wordlwide.’ He gave me a demo on his PDA and even I could have been able to determine whether someone on retrovirals need to see a doctor or or not. Pretty nifty.