My project has so many different facets, and as I have moved along through this process there is so much need it can be a tad overwhelming to navigate. Virtually nothing is as straightforward as it seemed back in San Francisco.
I am also reminded how much I love working with small and rural hospitals, because there is often so much that can be done. The theme for my work with the hospital in Bagamoyo, Tanzania reminds me of the Rolling Stones tune: "You can't always get what you want... but if you try some time you find, you get what you need." So much of the time I spend in Bagamoyo looks a lot like coaching and encouraging people to think about what they want and putting that need into clear words. It took a while to sink in that people are not often asked what they want, more often having things sent their way, whether they actually need them or not. Unfortunately, aid has a habit of working that way, as does being a small fish hoping for some scraps from above. The matching of local priorities with some prioritization "out there" is often a mismatch.
There is also a related aspect of working in Tanzania which seems really paradoxical. Living in Dar es Salaam and being a white guy invites a steady stream of requests for money. One of my colleagues says it is because I carry myself in a "distinguished" manner, giving the aura of wealth, which makes me giggle in a decidedly undistinguished manner. So there is an element here of being very direct about asking for what one wants. This carries into the price negotiations that are a daily aspect of life here. The paradox in this context is finding that when I ask people I am working with what they want from a collaborative relationship, I get a blank face. People are not used to being asked that question.
It is also cultural. As a rule, Tanzanians are unfailingly polite in interactions. The way people ask for things uses a different language than in neighboring Kenya, where the norm is to be very direct in your requests. Here, that directness is considered incredibly rude.
I have come to love working in Bagamoyo. It is about more than the project, it is about encouraging people to think a little differently. To ask for what they want, respecting their polite nature while also being very clear. And I am thrilled to say that they have caught on! It took awhile to sink in (for everyone concerned!). And suddenly I'm finding a new energy that was not there when I first started, a sense of empowerment. I suspect people saw me, cautiously, as yet another in a line of people promising a lot and in the end delivering little. I took a page from the Rolling Stones. If you know what you want and you can clearly communicate what your priorities really are, you might actually get what you need. If you wait for someone else to decide what you want, the odds of getting what you want are pretty slim.
It seems to be working. The operating theater at Bagamoyo Hospital is getting attention. We stepped back from the amorphic statement that "we need a new theater and the kitchen sink too" (a term they found humorous after I laughed at myself and explained this weird comment that blurted out from my mouth)" and instead looked at it in stages. What can be done to make the current theater better - what would most improve the quality of care delivered and meet community need. It became a much more straightforward project. This was followed with asking what training they would like to improve their skills. This is the thrust of the idea of collaboration with the university - they get something in return, notably educational, but also a new forum for facility and equipment improvements. We set up a similar conversation with nursing, and I asked a staff member at the hospital to lead the meeting, encouraging him to guide his colleagues through the process of being clear about what they want.
I'm heading up to Bagamoyo this week with a Professor of Surgery from the university who clearly understands the district hospital context. ...If you try some time you find you get what you need. We are not yet to any specifics, but they are getting much-needed attention. Experiencing their clear requests getting a positive response puts a huge smile on my face. They can make it happen.