In Africa, life moves at a slower pace, towards an ironically shorter
end. Planned change, if it happens at all, happens in African time, which begins
tomorrow, and then takes a break for a while. It is almost a sign of weakness
to pitch up to a meeting on time in Africa, and it is certainly a sign of naivety,
(unless there are free sandwiches), as no one else will be there.
Even African leaders are calling for Africans to set their body clocks
to today:
In rural Tanzania, then, those planning long-term, sustainable change
need not just all the other positive attributes of change agents, but also the
patience of Job.
(The ‘Patience of Job’, as you probably know, refers to the proverbial
patience of a Biblical figure who lived, it seems, soon after Abraham.
He lost everything he had, including all his wealth, camels, sheep, donkeys,
and friends – and even his children, who all died. Then, when he had patiently proved
his submission to God, he was rewarded with twice as much wealth, and twice as
many camels, sheep, donkeys, and friends. And also ten replacement children – these
were the days before University tuition fees.)
Anyway, even Job would have raised an intolerant eyebrow at the vicissitudes
of the women of rural Africa. Not dying in childbirth surely should have been an urgent need for endless generations. African women have been far too patient.
Even if Job were getting restless for action, however, it does not imply that the alternative
way ahead should therefore be given over entirely to impatience.
I say this despite being something of an expert on impatience. Surgeons
are naturally impatient, but I have taken it to new levels, and indeed have
invented several forms of impatience previously unknown to mankind. There
cannot be many people, for instance, who never listen to the BBC news on the
radio, because it is unbearable to waste 6 beeps of their life waiting for it
to start.
(My wife, by contrast, is very, very patient. Very patient. When we
first met, she used to slow the car as she approached green traffic lights, so
as to be ready in case they turned red. Commendably safe, I am sure, but only love,
deep respect, and lack of dual controls and a cricket bat stopped me from
taking command. Safety is not everything. I eventually brought her round by
making her morning cup of tea with cold bathwater in case I scalded myself.)
Anyway, here is the paradox: When things go naturally slowly,
impatience can be a useful and necessary driver to kick-start some action: getting a caesarean done
quickly, for instance, in a culture where people traditionally meander to the
theatre when they are ready. However, impatience is a blunt instrument. Getting
things to happen quickly, and getting angry when they don’t, is likely to
produce a quick-fix solution – or drive you to an early grave without yielding
a benefit.
(The early-grave danger is a particular worry, given the paroxysmal
wrath induced in me by automated phone-answering systems:
“Hi! My name is Emma. Welcome to
the Public Toilet Opening Times Enquiry Service.
With my initially soothing but
eventually apoplexy-inducing voice, I am going to guide you through the
options, at the same time as liberally sprinkling my patronising pronouncement
with infuriatingly facile irrelevancies.
Press 1 if you would like to know
the nearest public toilet to your current location. This service can only be
accessed by honorary life members, or by adding the access code which you will
find on the door of any public toilet.
Press 2 if you would like to know
how much time and money you have wasted on our automated phone system, and
others like it, over the past year.
Press 3 if you would like to
start going round a seemingly endless set of options which eventually by
tomorrow lunchtime leads you back to this one.
I’m sorry. I did not understand
that.
Please try again, but without
hitting your phone needlessly hard, or throwing it against a wall and stamping
on the remains.
OK. Using a six-digit number
system, please say or enter on your keypad the date of birth of your favourite estate-agent’s
best friend.
You seem to be having trouble.
If you have forgotten your
security data, you can refresh it now, by logging into
http://www.pleaserefreshmydataeventhoughtogetonthesiteIneedmypasswordwhichI’vealsoforgotten@deathbyinternet.com,
and enter the length of the second molar of your first pet.
Well done. You are nearly there.
Finally, whilst you are on-line, we
need to know that you are not a robot.
Here is a 1x1cm picture of smudged
Turkish graffiti on a toilet wall in Istanbul, in a photo taken from the
International Space Station. What are the second and fourth letters of the signature?
Press 4 if you have already been
incontinent.”
It’s a tricky thing, then, impatience. It is not about efficiency, or
getting a job done as best as possible in the time available. It’s not even
about making sure that the final result is the one you want. Impatient driving
for instance, gets you there no faster, risks not getting you there at all, and
annoys everyone, include yourself, in the process.
Impatience, then, is not about passion for excellence. It is simply
about being determined that the next five seconds go to plan. Then the next
five seconds. And so on. In surgery, that it is almost always good, but in the
rest of life, impatience is a hindrance to the smooth flowing of a calm and
productive existence.
And so, finally, to the point. (Thank you for your patience.) I went
out to Tanzania nearly two years ago, to the remote villages around Berega:
I came back pumped up with impatient determination to help Berega
tackle the desperate tragedy of death in childbirth. Out of this was born EMBRACE-Tushikamane.
That project plans to begin by building a platform of women’s groups in
the remote rural hamlets, as we now know this to be an important prelude to
success.
A year ago, we had already mustered: the money to begin; the partners
to help us succeed; the experts in the methodology to advise us; the charitable
NGO to house our efforts; the freshly-mapped road plans of the territory; the
support of the community and the hospital; the potential recruits as local
project leads; three people who regularly read this blog; and even a highly
talented PhD researcher to analyse what will happen.
However, much as these achievements might have been immediately
gratifying, they are not enough. On kicking off the project, we would have had fulfilling
5 seconds, with many more of them to follow, but, finally, we would have joined
the vast list of well-intentioned failures. The reason is this: firstly, we need a
system whereby the women of the villages not just keep up the impetus, but
spread it to surrounding villages, until it becomes the norm for rural Tanzanian
women collectively to take action to tackle the roots of the problems that kill
them.
Secondly, we also need successful examples of where the women’s group’s energy
and prioritisation has led to sustainable development: better health, better
nutrition, better childbirth arrangements, cleaner water, better antenatal care,
better family planning, and so on.
Thirdly, we need individual champions to spread the lessons.
Thirdly, we need individual champions to spread the lessons.
However, for all this to happen, and happen well, our central need is to
embed the whole process in Tanzanian people, Tanzanian systems, and Tanzanian
ways of doing things. From the training of the project leads and community
leaders, through to the coordination of responses, all of this must be
integrated into a Tanzanian-led, Tanzania-based system.
To move towards this goal, we have needed the patience of Job – and so
have you, when months drift by without anything seeming to change. However, we
are getting there. We have identified Ifakara as the epicentre of these
developments, and we now have buy-in from two major players, each with a great international
reputation for making a difference:
I hope by the next blog to be able to report that we have a
Tanzanian project manager working with these Institutions, and a date for the
start: of the collaboration, of local staff selection, and of training.
After far too many generations, that will be Job well done.
