Contrasts

I have just spent two weeks in the Democratic Republic of Congo (DRC), which is the poorest country on earth, according to the United Nations Health Development Index (UN HDI). I was visiting the capital city Kinshasa and the port city of Matadi as part of a Mercy Ships Assessment Team. We were invited by the Ministry of Health to (i) build relationships with them as they have invited Mercy Ships to work in their country (ii) assess how the surgical services and healthcare education Mercy Ships offers can help their nation; (iii) assess the logistics of transporting in excess of 1000 crew backwards and forwards from Kinshasa to Matadi approximately 500 km away; (iv) assess feasibility of having 400 crew in Matadi with respect to food, water, leisure acivities etc. What struck me most was that Kinshasa was a city of contrasts and the DRC is a stunningly beautiful country. I admit to being a little scared beforehand. The DRC was afterall the poorest country on eart and I fully expected to be shocked at what I might find. I imagined a mixture of Freetown, Sierra Leone (people everywhere so it is hard to even walk in a straight line in the street) and Monrovia, Liberia they had not had running water of electricity for years making it impossible to deliver quality healthcare. Kinshasa was a sprawling city but despite 10 million people it was not as busy as Freetown, and the infrastructure was better than Monrovia. However, poverty was evident with some hospitals struggling for electricity, and equipment. As is common in other hospitals in west and central Africa the operating rooms are stark and bare…..and could be what you imagine a torture chamber to look like. But two hospitals in Kinshasa were some of the nicest I have seen in Africa. I was truly impressed, by renal dialysis units; neonatal intensive care units; CT scanners, MRI and mammography; fully equipped laboratories with PCR the only major diagnostic technique that was lacking; and fully equipped operating rooms and sterilising machines that seemed to work correctly and at the correct temperature. What a contrast between neighbouring government hospitals in the same city. Loic, one of our translators had grown up in the DRC as his parents were missionaries there and still are. His insight and understanding of the culture was immensely helpful in deconstructing the prejudices and fears I had arrived with. Rebels, rape, massacres. That is what we read in the news about DRC. A country ravaged by internal conflict, unstable, unsafe and corrupt. Foreigners advised not to travel here. TRUE, but all the trouble is far away in the east, near the borders of Rwanda, Burundi and Uganda. This is almost as far from Kinshasa as New York is from Texas. Yes, we did see evidence of corruption, and yes we had the inevitable border hassle as we crossed the Congo river from Brazzaville, Republic of Congo into Kinshasa, DRC and back again. But all the people we met in the hospitals, the port, guest houses, local workers such as taxi drivers and shop keepers, everyone was helpful and polite. A country of conflict but also one of kindness and hospitality. A country of contrasts. Matadi is in Bas Congo province. I was impressed by the beauty of the region and the kindness of the people. Rich green fertile hills and countryside. Towns of subsistent farmers, selling produce all along the road from Matadi to Kinshasa. Apparently the 3 countries, DRC, Zambia and Zimbabwe have the potential to feed the whole African continent. Having been to all three countries I can believe this. And there is a new hydroelectric dam near Matadi with huge potential for providing the region with electricity. The port in Matadi is having some renovations and will be ready for us by January 2015. So I am praying that our International Management Team decide to come here soon so we can have the privilege of walking alongside the people of the DRC and sowing seeds of hope and help them realise their amazing potential. The DRC, a country of contrasts. Jesus, a man of contrasts. Born into poverty in a stable yet he was a King. Eternal yet temporal. Life in heaven versus life on earth. And as I ponder these contrasts, I am also reminded of my own life. Poor yet rich. Earning no salary but witnessing the generosity of others who provide for all my needs. Sharing a cabin instead of living in my own house. Giving up everything but somehow gaining everything. The DRC is the poorest country on earth yet with great potential. And this Christmas, no matter what contrasts you see around you, may you know the potential and the hope that is in and around you too.

Hope for Africa

Many young people in Africa want to leave and live in other countries to make 'better life for themselves'. Why? Because they believe Africa has no hope. They feel there is not enough food, not enough water, that Africa is over populated, and there is no hope for them if they remain here. Yet, this belief, is built on ignorance and lies.

In truth, Africa is least populated continent; Zimbabwe, Zambia and DRC have the potential to feed whole of Africa, there are great rivers in Africa for water and Africa has 40% of the world's hydro electric power potential. Every single African nation has mineral wealth and many coastal nations also have oil wealth. Africa is a beautiful rich and abundant continent. Yet many people (African or not) do not know this.

I learnt some of these facts from Chris Ampadu. We have just finished running a Medical Leadership course in Pointe Noire, where Chris and I shared the speaking. Chris is from Ghana and has run leaderships conferences for Mercy Ships for 7 years training government, community and church leaders. He works for Samaritan Strategy.

How can Africa, which is the richest continent in terms of natural resources, be also the poorest continent?

Because many people in Africa do not believe the truth. Many have a mindset of hopelessness. A worldview that is actually built on ignorance and lies, thinking Africa is cursed, but in fact, Africa is blessed. Blessed with abundant natural wealth and resources.

Apparently between 1980-1988 sub-Saharan Africa received $83 billion, and yet loving standards declined by 1.2% a year and the GDP (in per capita terms) declined 2% in 1986 and 2.2% in 1988. From 1990-2003 the region averaged $20.4 billion per year in foreign aid, yet the GDP was lower in 2002 than 1980. Africa has attracted more aid per capita than any other region, and yet it remains poor. Africa has rightly rejected colonialism, yet has not yet moved into embracing her independence. Instead, she continues to rely on western aid.  Needing external money for development instead of using her own resources. Chris encouraged Africans not to see themselves as beggars. But as people with dignity and resources. To move away from the 'poverty mindset'.

Chris asked another question, When major life events happen such as death to young people, how do people in your culture explain these things?

For many African's the answer is 'Witches'. When bad things happen the first question people ask is 'who did this to you?'  

What are the consequences of this? Eg when you as a doctor make a mistake, what will people think, how will they interpret it? 'It is not your fault, it was a witch / curse'. So if people don't hold you responsible where is the motivation to improve? Doctors don't worry they will be taken to court. Witches are blamed instead, which could be rather convenient.

Beliefs ....lead to.......values......which lead to.....behaviours.....and then.......consequences

We also discussed cultural attitudes to time, women, corruption, reliance on external aid and 'the white man'. Lies such as 'corruption is normal', and it doesn't matter if you are late for work. This is why there is poverty. This is why life feels hopeless. Yet only the people themselves and their leaders can change these things.

In discussion groups the medical leaders discussed cultural lies in the domain of medicine and what impact these had. Changing these mindsets is difficult. But if we are serious about improving quality of care and patient safety doctors need the humility to admit their mistakes and short-comings, and courage to initiate change. We know on medicine that Quality Improvement is a combination of leadership and process, not just better training  and technology. But for medical leaders here to feel empowered to lead well and initiate good processes in their hospital their need to understand their own worldview and the pervaded worldview of those they work with. Otherwise they will not be able to initiate lasting change.

The conference consisted of three days. The first day was all about exposing cultural lies. The second day, the 'soft' side of medical leadership, the 'heart' side of the head, heart, hands voice concept, otherwise known as the 4 'T's of leadership: truth, trust, teamwork and training. Chris brought the African side and I brought the western medical perspective. On the final day we spent a lot of time talking about one of my favourite topics, the World Health Organisation Safe Surgical Checklist. This is an example of good process which requires leadership, communication and teamwork to successfully and sustainably be implemented in Africa. No country in Africa has managed this yet. Perhaps the Republic of Congo could be first. They certainly have the potential to be. Only time will tell. I pray that these few days have sown some seeds. I leave you with an African proverb I learnt this week

'You can count the seeds in a mango, but you can't count the mangos in a seed'

It was a pleasure to work with Chris Ampadu and the rest of the team, Krissy, Stella and Francis. Thanks for all your hard work.

Perspective

When you sail into Pointe Noire, Republic of Congo, you sail past many many oil platforms. And as you get closer to the shore you see many ships, specially designed for helicopters to land on, with helipads mounted over the bow. These ships help get workers on and off the oil platforms. Once inside the the protected walls of the port, the 'oil' presence gives way to the usual vast array of container ships. This is a very busy port, so ship after ship is lined up, and on shore, huge areas containing hundreds or thousands of twenty foot containers are clearly visible. These container ships along with a multitude of tug boats and pilot boats form the view out of my window, or should I says windows. Yes, I am lucky to have a cabin with more than one window. At least I do temporarily, because I am cabin sitting for a family who are away so I get to see this busy port scene every morning I wake up. But I used to live in a windowless 6x5 foot space for over a year. Then I was upgraded to a space with a few extra feet and a small window that overlooked the admissions tent on the dock in front of a large concrete wall. Three, over thirty somethings, sharing a cabin (smaller than the bedroom I used to have all to myself back home in England). However, now I have a family cabin on the other side of the ship, so instead of the dock I get to watch container ships being loaded and unloaded, tug boats gently nudging lager vessels in the right direction, fishing boats bringing in their catches. All the comings and goings of a busy port can be viewed from the spacious couch in my new living quarters. It is amazing how it has changed my perspective. If all I had seen was the sail into port, I would have described this place in 'oil' terms. From the other side of the ship I saw patients come and go and I had a hospital perspective. My current cabin gives a proper port perspective. My windowless cabin-space gave no perspective at all, it was dark and I needed artificial light to do anything at all. It felt like I could have been anywhere in the world.......except that not many people, even in prison, live in a windowless cell. But that is another other story and windowless cells are not my point! My point is perspective. Perspective is just that. Perspective. It is not reality. Perspective may affect how we feel about reality but it does not define reality. Whether I can see the oil rigs or not, whether I see the container ships or not, whether I see the patients coming and going from the admissions tent or not, none of that changes the fact that they are there and part of my reality. Even the gloom and dark of the windowless cabin does not negate the reality, even if it feels suffocating and overwhelming. We need to fight for the right perspective. Why? Because it helps us deal better with reality. Recently I have read a few people's blogs, witnessed a few incidents and had a couple of conversations with people. Some of them are struggling. Life is hard sometimes. That is why we need the right perspective. When we feel like we are suffocating in a windowless, dark place, we need to fight for the correct perspective. The biblical perspective which is reality. The reality that God called us here, and He is for us. He loves us and has promised never to leave us or forsake us. He calls us 'overcomers'. It is the enemy who tries to make us think from the perspective that it is all too tough, that maybe we misheard God, maybe we aren't really cut out for this life. Rejection, loneliness, insignificance, fear ......all such thoughts can come pressing in and alter our perspective. And when we are too tired to fight, or too crushed, we need our friends to fight for us and encourage us to get our perspective right. Reality is truth. Right perspective is also truth. But the wrong perspective, or a distorted perspective, or merely only half the perspective....none of these are entirely true. And if they are not truth then they are deception. Lies. I love my new cabin, the new perspective and the feeling of space. In the same way, I love the biblical perspective. The biblical perspective on life gives me hope because it gives me the truth. And the truth gives me power to overcome the lies, deceptions and half-truths that creep around and get me down. My cabin perspective is only temporary, thankfully true biblical perspective is eternal.