Meeting

Back of a dirt bike. Dusty road. Bumps. One hour. Sore back. Aching knees.

Nelly, Janine, Phillip (the leader of the Kenyan Nuru team; AKA “Chairman”) and myself each with a separate hired boda. On the way, I saw a rope tied to a tree get pulled tight, blocking the road. The tightener was an un-uniformed man, whose friend came down to the road demanding twenty shillings of each of the drivers. My boda was in the lead, and my driver reached for money. Before he could get it, the other three pulled up beside us. I don't know quite what it is about motorcycles, but though the eight of us were on our way to a business meeting, we looked imposing. Imposing or not, all the drivers paid. My suspicion of the 'tollbooth' was not assuaged by the receipt that was given in exchange for the money. To my great surprise, when we approached a second rope-puller, the receipt satisfied him and nothing further was paid.

That is how to get from Isibania to Kehancha. That is the way to the division headquarters for the Ministry of Health (MOH). About 200,000 people are served by the Kehancha division; all administrative work at any government facility in the district must go through them. And so must we. Our fate lies in Kehancha.

Nelly was recently elected Board Chairwoman of the board governing the Nyametaburo Health Center. The previous board was ineffective at best; at worst... let's just say we're still looking for twenty-five thousand shillings. The Chiefs (appointed Kenyan executive leaders of our location) seem sincere in their desire to improve the community so were more than happy to aid in changing the board upon finding out its condition. But they can't change signatories; we need the MOH for that. The facility also lacked many of the forms and plans that a facility need to operate efficiently.

We drove up to the Kehancha hospital compound, a well manicured facility surrounded by gates and barbed wire. Unlike US hospitals which like to build up, this was laid out almost like a resort. There were a dozen buildings separated by grass and pathways, all shaded by tall trees. It really was a lot more pleasant an atmosphere than what is brought to my mind by the word “hospital.”

As we approached the guard, the gates were immediately opened for us and our posse entered. We dismounted and were instantly greeted by the secretary of Dr. Bongo, the MOH leader of the division. She escorted us to Dr. Bongo's office and we filed into what would soon become a cramped meeting room. To my chagrin, the chairs were solid, hard wood, all in right angles to the ground; the complaints that would be filed by my back, already aggrieved by the hour ride, promised to inflate the length of an already long meeting.

The meeting was primarily with the well-seasoned and eloquent bureaucrat Dr. Bongo. He was very good friends with Philip, which bought us a few rapport points from the beginning. To answer all our questions and to question us properly, Dr. Bongo brought in his key staff members: the division pharmacist, the record keeper, the chief nurse and the administrative person. And for the course of the next three hours, we discussed how a new board of directors would properly be set up, monies promised by WHO and IMF, how to order equipment, and the role of NGO's in Kenyan Healthcare.

The power dynamics were quite interesting. Dr. Bongo many times, to our delight, addressed Nelly many times rather than Janine or myself. Nuru's plan is to be out in five years, so empowerment of local leaders is essential; his mild snub of us Americans is precisely what we want. We have usually had the problem of the Kenyan being snubbed in favor of the muzungu. Fortunately, Dr. Bongo wants exactly what we do: no external influence. I think he just wants it sooner than we do.

After the official meeting, Janine and I started our scavenger hunt. All the papers we needed were on the premises...somewhere...we hoped. I first went with Mr. Atemba, the record-keeper. I followed him to his office, catching the faint but now-very-familiar smell of bat guano wafting from a roof space nearby. It seems that Nyametaburo is not the only place with bat problems.

I entered Mr. Atemba's office, passing bundled stacks upon stacks of papers (we discovered in the meeting that records are government property; to destroy government property for any reason is a crime). I sought what Dr. Bongo described as the “Bibles” of the MOH in Kehancha; three operating plans relevant to our division. Mr. Atemba sat down at what looked to be a five-year-old Dell. He valiantly searched and eventually found the documents (and along the way was gracious enough to give me whatever government documents I thought looked interesting while peering over his shoulder). Success! But how did Janine do?

It turned out that all the things on her scavenger hunt they didn't have. And the reason they didn't have them was that they didn't exist. Like a six-year-old's Christmas list, our list was a just a little bit optimistic. But some of our biggest disappointments were things like procedures for a facility board of directors and operating procedures for running a health center. Actually after more searching (i.e. asking the records person who referred me to the administrative person who referred me to the secretary who dug through a 12” pile of random papers to find a poorly-copied circular letter sent from Nairobi) we found the guidelines for running a board. They were theoretically also sent to Nyametaburo. Lacking a second copy or a copy machine on the premises, I used my trusty camera.

After all this, we regrouped and we loaded up into a Toyota hatchback and headed home (and by “we” I mean ten people).

With such difficulty in obtaining these documents, I doubt that all the hard work that was put into the reports will trickle down to other health facilities with less tenacity. The planning and production of some of these documents is very good, much better than I expected. But the implementation of those plans suffers for poor communication channels. Or perhaps they suffer from poor written communication channels. I suppose this is to be expected with so few computers available. The verbal communication is quite robust; meetings with those in charge of facilities are common. I suppose conversations with those enforcing the rules would suffice. But me, I'm a litigious American and I want papers.

In reflecting on the day, I really think Nuru and the MOH want the same thing, but we see it coming about in different ways. The government is rightfully wary of foreigners coming in and taking over. Western NGOs have a bad track record. And, I think, we are rightfully wary of the government not being effective. African Governments have a bad track record. And now we must work together.

By the end of the day, we learned much about the MOH and how Nyametaburo should proceed. All in all, it was very successful. Nelly was introduced as the Board Chairwoman, the papers which the facility needed were collected, and we made new friends. We learned that MOH is wary of us, but not at all hesitant to work with us.

Our explicit goals are the same: to improve the health of the people in our area. There is no fundamental reason why we cannot work together. But we must dance the dance. Give and take, push and pull. And try not to step on each others' toes.