Monday, November 2, 2009

Are we inside or outside? These and other questions from a Malian perspective...

It has been exactly one month since my maiden post, but so much has happened during these past weeks that I am overwhelmed at the thought of writing a second! To make my task easier (and hopefully more meaningful for all of you) I have decided to take this opportunity to reflect on what it means to work collaboratively in a cross-cultural setting.

When I arrived in September, MHOP was struggling to reach a consensus with the CHAG on the issue of their re-elections. CHAG members were upset with our team, as the notion of elections suggested we did not like the work that they were doing. Some members even hinted that we were out to publicly humiliate them. Moreover, several members expressed serious concerns that MHOP has not delivered on its promises – intimating that the CHAG would unfairly take the fall for our failures during their elections. These conversations distressed us greatly, primarily because MHOP remains committed to local participatory governance and secondarily because the thought of failing the community is a difficult one to bear.

As many in “development” circles like to claim, MHOP is committed to working with (not for) the community we serve to ensure that our solutions are responsive to local needs and local capacities. But what does that mean? Buzzwords or not, how do you give them substance? Aid blogger TalesFromeTheHood has some interesting suggestions and critiques, here, where he discusses his experiences working with international development agencies. Community-driven projects take on a whole new meaning when the community cares less about microloans and more about securing AK47s to protect against warring neighbors.

Thankfully here in Bamako we don't have to tread that particular line, but that doesn't mean there isn't one to tread. So what about us? Is it enough that we have Malian staff in our core team, and that we have catalyzed the formation of community groups (like the CHAG) to assist in the design and evaluation of our programs? If we do not work effectively within those groups, if we fail to recognize our own biases or to be vigilant that our intentions match their interpretations, we risk trivializing the very core of our mission.

Now let's be honest for a minute and admit that in terms of development NGOs, MHOP doesn't play in the big leagues. We are not the kind of organization that can deliver 100,000 bug nets in under a week, or even two. We alone cannot provide free care for everyone, and we certainly cannot do it yesterday. But with a two-year CHAG partnership under our belts, a trained Community Health Worker team and a new community clinic receiving its final coat of paint, is it fair to say we are keeping up our end of the deal? Yes, most definitely, yes. We are working as hard as humanly possible to make our projects a reality and we have achieved a lot where others have not. Yet, part of “our deal” is to support the community to work for their own change, and so the fact that the CHAG has interpreted any of our project ideas as promises suggests that we are not fully achieving this higher goal. To improve, we  decided to begin within our staff.

I googled “cross-cultural communication exercises, management, africa” on Tuesday in a last ditch effort to help Devon pull together an intercultural training program for our new MHOP team. Over the past three weeks Dramane Diarra (community coordinator), Awa Ouattara (intern), and Leona Rosenblum (community health worker program coordinator) have joined us, making last week's team training the perfect opportunity to begin a conversation about cross-cultural collaboration. Unfortunately, the google-verse contains very little that addresses inter-cultural communication between Africans and Americans. (For future reference, however, if you are interested in working in Japan or China, you're in luck! Hundreds of well-paid agencies can offer you trainings on bridging the East-West divide. Go figure.)

Despite my failed search, our team spent the day on Wednesday discussing the many differences between Malian and American cultures. Drawing from “The Values Americans Live By,” an interesting piece by L. Robert Kohls, we shared our views on things ranging from punctuality, competition, freedom, and privacy or personal space. It was an enlightening experience and offered me the chance to reflect on the many hidden biases or paradigms that affect my interactions with Malians.

One major area of conflict in our office concerns time. As Americans, we expect that our time be accounted for or justified. I, for one, have always had a job where I punched in or out because I was being paid by the hour (or minute, or even second). I am used to judging my performance as both a function of its quality and of the time the task required. But how often do you think about what it means – what it really means – to talk about “spending time” on something, as if time was a thing to be used or dispensed as one pleases?

Sure, everyone knows that “African time” runs slow; but the cultural divide is not really about pace. Here, time just is. The day passes as you pass the day -- your meals, your loved ones, your life takes precedence over the ticking clock. Thus, my Malian colleagues were shocked and appalled by the suggestion that we log and justify our “work hours.” From their point of view, a job well done is a job well done, regardless of the amount of time it required. And when it takes you two hours to travel across town because your taxi blew its tire, or a month and a half to track down our clinic dossier, the logic of this view becomes clearer.

Of course, the differences in our conceptions of time has become somewhat of a trope in stories about Africa. While true, I want to be clear that many other things are similarly confounding and that at their core, neither “side” is wrong or right. To illustrate, let me describe our most recent adventure with the clinic construction crew. Mr. Maiga, the construction foreman, visited our office last week with a packet of paint chips to decide on the colors for the interior and exterior walls of the clinic. Excited that we're nearing the end of construction, we happily reached an agreement that the interior would be painted in dual tones, with reddish brown on the bottom and tan on the top, while the exterior would be a uniform deep red to help disguise dirt. We x'ed our preferred paint colors and he went on his way, asking that we stop by the clinic later to see a sample and make the final decision.

Two days later, Alex Ruby and I trekked up to the clinic with cameras in hand, hoping to okay the colors and get the final painting started without delay. When we arrived, however, we were surprised to find dual tone samples painted both on the outer walls of the clinic and inside the clinic rooms, and no deep red color to be found. After much debate, we discerned that the “interior” of the building is considered to be everything that is covered by the veranda, regardless of whether it is actually inside a room or not. Hmmmmm. As we say in Minnesota, that's different. But, really, when you are under a covered area and yet not in a room, who is to say whether you are “inside” or “outside”? It is something I never would have thought to ask but now serves to remind me that when working across cultures, there are no stupid questions. Making one's own definitions and interpretations explicit is critical to avoiding deep misunderstandings.

Cultural differences, however, cause more than just logistical friction. And when we work with the CHAG and evaluate the design of our projects, we must continue to remember that values differ and ideals are often lost in translation. For example, I recently had to quell some righteous feminist indignation when Dr. Diak suggested that the “health actions” completed by male members of the household should count for every child, while those completed by mothers only count toward their biological children. (If that's confusing, remember that Islamic polygamy is widely practiced in Mali, therefore households may include up to four mothers.) Arms crossed, nostrils flaring, I stopped him. I was appalled by the sheer iniquity of it – why should the men's actions be more valuable than the women's?

Dr. Diak patiently explained to me that asking men to do more than that would require they designate their actions towards specific mothers. That system could not only create significant family discord if fathers favored certain wives over others, but it would also likely dissuade men from participating at all. Women are the primary caregivers in Malian families and so if it means just as much for a man to contribute as it does for a woman, then there is no incentive for fathers to participate. My reaction against this design was instinctive but, ultimately,  I think Dr. Diak is right. To be successful, our program must consider carefully the economics of family life here, working within the system as it currently exists. If our ultimate goal is to encourage community engagement and co-management of healthcare, then perhaps my feminist sensibilities will have to take a back seat on this particular ride.

Similarly, while we had initially hoped to hold popular elections for all CHAG members, in light of their extreme resistance and our consultations with Sikoro's dugutigi (village chief), we may have to re-evaluate our designs. When we make a final decision regarding our selection process, we will again have to weigh very difficult issues: is it a compromise of our values to have the elected secteur-tigis choose their own CHAG representatives, or is that an expected (and accepted) form of community participation in the Malian context? In navigating these challenging waters, I trust that we will stay true to our mission to both work within the community and to improve it. And the simple fact that we are tackling these unsettling questions gives me hope that we are who we say we are: a community-driven organization.

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