Thursday, May 27, 2010
GHC at the National Press Club in DC
GHC President Barbara Bush gave a great speech about GHC yesterday. View the video here.
Sunday, April 25, 2010
The Value of a Good Experience
Goodluck and I have been trying to understand what defines a good health facility in Kilwa to be able to replicate the model to other facilities. In my last video I described how it’s hard to analyze data by health facility because, for example, we don’t know if increased diagnosis at a given facility implies poorer health for their surrounding communities or better service provided to attract more patients to get treatment. Based mostly on qualitative evidence gathered from on site visits and patient interviews over the past month, however, we’ve concluded that higher aggregate numbers aare almost always an indication of exemplary medical services being performed. But what does “exemplary medical services” mean?
IDEO CEO, Tim Brown, summarizes a popular concept coined in Daniel Pink’s book A Whole New Mind saying, “once our basic needs are met − as they already have been for most people in the affluent societies of the West − we tend to look for meaningful and emotionally satisfying experiences. The value of services lies in the emotional resonance they create.” The implication is that when basic needs are NOT being met, i.e. in most third world countries and certainly all of the communities Goodluck and I serve in Kilwa, the human mind doesn’t care about emotionally satisfying experiences. Fulfilling basic needs is the primary driver behind what the mind desires.
In reference to our health facilities, I’d expect “exemplary medical services” then to mean that the necessary drugs are always on hand and ailments are successfully getting treated. And that’s it. This would also imply that each health facility we work with who has low statistics doesn’t have proper drugs in stock and that the medical staff are misdiagnosing patients who therefore aren’t getting treatment.
Goodluck and I know this is not the case. We’ve been delivering medical supplies to all facilities through the year and patient numbers remain the same. The medical knowledge of health staff, though indeed varied, doesn’t vary with the number of patient attendance (we’ve moved well-skilled health staff from a strong facility to a weaker one and after a year still haven’t seen much increase in attendance).
What we have seen is that health facilities with staff who enjoy working together, are organized with paperwork and office supplies (including drug stocks), who clean their facilities (even the cobwebs by the roof), who maintain equipments such as patient beds, and who even groom their grounds with rakes and flowers, are the facilities getting the most patients. These are the marks of exemplary medical services and they contradict Daniel Pink’s notion that only certain groups of people can afford valuing emotionally satisfying experiences. He would contend that the experiential enhancement of an inviting landscaping would provide little value in terms of increasing attendance at health facilities in Kilwa, Tanzania because it’s not fulfilling a basic need. Our experience here has suggested, however, that everyone values emotionally satisfying experiences.
What I think Pink misses in his analysis is that the definition of basic needs changes for people in the third world. Not everyone in Africa is living a stress-filled existence worried about fulfilling basic daily needs. Tanzanians in my village seem to have come to a knowing realization of what their life is like. They can depend on food sources based on the season and the amount of rain in a given season. They know the best places to get water to drink so as to avoid fatal illnesses. They know that any electricity service is always temporary. And they don’t celebrate the birth of a child because they know there’s a real possibility that the child will die in its first 6 months.
Basic needs being met in the US and basic needs being met in rural Tanzania look completely different. But from the point of view of the respective communities, basic needs are being met in the majority of cases. The implication being that it is incredibly important to think about how to create safe, enjoyable, satisfying emotional experiences when trying to achieve successful services of any kind. And in the context of critical experiences such as public health services in the third world, where there aren’t private alternatives to create natural competition, the responsibility lies on the system managers to seek out facilities who are creating this type of experience and hold them up as the standard experience all facilities should be striving to provide their patients.
IDEO CEO, Tim Brown, summarizes a popular concept coined in Daniel Pink’s book A Whole New Mind saying, “once our basic needs are met − as they already have been for most people in the affluent societies of the West − we tend to look for meaningful and emotionally satisfying experiences. The value of services lies in the emotional resonance they create.” The implication is that when basic needs are NOT being met, i.e. in most third world countries and certainly all of the communities Goodluck and I serve in Kilwa, the human mind doesn’t care about emotionally satisfying experiences. Fulfilling basic needs is the primary driver behind what the mind desires.
In reference to our health facilities, I’d expect “exemplary medical services” then to mean that the necessary drugs are always on hand and ailments are successfully getting treated. And that’s it. This would also imply that each health facility we work with who has low statistics doesn’t have proper drugs in stock and that the medical staff are misdiagnosing patients who therefore aren’t getting treatment.
Goodluck and I know this is not the case. We’ve been delivering medical supplies to all facilities through the year and patient numbers remain the same. The medical knowledge of health staff, though indeed varied, doesn’t vary with the number of patient attendance (we’ve moved well-skilled health staff from a strong facility to a weaker one and after a year still haven’t seen much increase in attendance).
What we have seen is that health facilities with staff who enjoy working together, are organized with paperwork and office supplies (including drug stocks), who clean their facilities (even the cobwebs by the roof), who maintain equipments such as patient beds, and who even groom their grounds with rakes and flowers, are the facilities getting the most patients. These are the marks of exemplary medical services and they contradict Daniel Pink’s notion that only certain groups of people can afford valuing emotionally satisfying experiences. He would contend that the experiential enhancement of an inviting landscaping would provide little value in terms of increasing attendance at health facilities in Kilwa, Tanzania because it’s not fulfilling a basic need. Our experience here has suggested, however, that everyone values emotionally satisfying experiences.
What I think Pink misses in his analysis is that the definition of basic needs changes for people in the third world. Not everyone in Africa is living a stress-filled existence worried about fulfilling basic daily needs. Tanzanians in my village seem to have come to a knowing realization of what their life is like. They can depend on food sources based on the season and the amount of rain in a given season. They know the best places to get water to drink so as to avoid fatal illnesses. They know that any electricity service is always temporary. And they don’t celebrate the birth of a child because they know there’s a real possibility that the child will die in its first 6 months.
Basic needs being met in the US and basic needs being met in rural Tanzania look completely different. But from the point of view of the respective communities, basic needs are being met in the majority of cases. The implication being that it is incredibly important to think about how to create safe, enjoyable, satisfying emotional experiences when trying to achieve successful services of any kind. And in the context of critical experiences such as public health services in the third world, where there aren’t private alternatives to create natural competition, the responsibility lies on the system managers to seek out facilities who are creating this type of experience and hold them up as the standard experience all facilities should be striving to provide their patients.
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| Freshly planted flowers at Somanga Health Facility |
Friday, March 26, 2010
Tuesday, March 23, 2010
50 Things to do when I come home
My last blog post got me thinking of all the things I want to do when I’m back in the states. So here are the top 50 I brainstormed in no particular order.
50 things to do when I come home
1. go wine tasting
2. wear a jacket (it’s been too hot here)
3. take a bath or long shower with hot water
4. eat a cheeseburger
5. watch espn
6. bbq some meat
7. have a beer from the tap
8. play golf with my dad
9. surf the internet at faster than 14k
10. eat bacon
11. drink water from the tap
12. order something on amazon.com
13. get ready for the day without having to take malaria meds
14. spend an entire day out without sweating
15. hang out with my niece
16. see a movie at a movie theatre
17. cook ‘San Francisco pork chops’ for my family
18. have my waiter give me a recommendation on the food at a restaurant
19. go grocery shopping
20. drive
21. sleep with bedding
22. sleep without waking up to any number of bugs crawling on me
23. go outside at night
24. be anonymous
25. enjoy real customer service
26. buy something at a price that everyone pays, not just a white person
27. be able to have a conversation with a stranger
28. sleep in a bed without mosquito netting
29. sit in a meeting where I can understand what’s being talked about
30. watch HDTV
31. make a toll free phone call
32. watch a youtube video
33. eat a chocolate chip cookie
34. go to a baseball game
35. go to a dinner/house party
36. go to Costco
37. listen to pandora
38. go out to a fun/nice restaurant
39. go to a concert
40. print something on a printer
41. have a mentor/manager at work
42. get bottomless fries at Red Robin
43. rent a movie
44. get a milk shake
45. build a bonfire
46. camp
47. go to a public place without getting overwhelmed by B.O.
48. go on a weekend road trip
49. hang out with an old friend
50. Get a hair cut
50 things to do when I come home
1. go wine tasting
2. wear a jacket (it’s been too hot here)
3. take a bath or long shower with hot water
4. eat a cheeseburger
5. watch espn
6. bbq some meat
7. have a beer from the tap
8. play golf with my dad
9. surf the internet at faster than 14k
10. eat bacon
11. drink water from the tap
12. order something on amazon.com
13. get ready for the day without having to take malaria meds
14. spend an entire day out without sweating
15. hang out with my niece
16. see a movie at a movie theatre
17. cook ‘San Francisco pork chops’ for my family
18. have my waiter give me a recommendation on the food at a restaurant
19. go grocery shopping
20. drive
21. sleep with bedding
22. sleep without waking up to any number of bugs crawling on me
23. go outside at night
24. be anonymous
25. enjoy real customer service
26. buy something at a price that everyone pays, not just a white person
27. be able to have a conversation with a stranger
28. sleep in a bed without mosquito netting
29. sit in a meeting where I can understand what’s being talked about
30. watch HDTV
31. make a toll free phone call
32. watch a youtube video
33. eat a chocolate chip cookie
34. go to a baseball game
35. go to a dinner/house party
36. go to Costco
37. listen to pandora
38. go out to a fun/nice restaurant
39. go to a concert
40. print something on a printer
41. have a mentor/manager at work
42. get bottomless fries at Red Robin
43. rent a movie
44. get a milk shake
45. build a bonfire
46. camp
47. go to a public place without getting overwhelmed by B.O.
48. go on a weekend road trip
49. hang out with an old friend
50. Get a hair cut
Sunday, March 21, 2010
A Year of Lent
Easter is now only two weeks away and over the past few years I’ve looked forward to Easter not only for the traditional Easter festivities but also because it marks the end of Lent, and more specifically, the end of a period of self denial of something I’ve chosen to live without. This year was different in that I haven’t chosen to sacrifice something specifically for Lent because I don’t have much to sacrifice that I already haven’t.
I chose to come to Tanzania for this fellowship year because I was compelled by the opportunity to get to work on tackling one of the worlds’ toughest challenges: HIV/AIDS in East Africa. However, though I’ve worked and traveled in the third world many times before, I didn’t realize how many American comforts I’d be sacrificing at the same time. Through the months of forced denial, I’ve come to affectionately call this my Year of Lent.
My first month living in the rural town of Kilwa, Tanzania was hard but I learned to deal with it. When the second month was harder than the first, I didn’t know if I was going to make it the whole year. But then something changed. I started to enjoy the simplicity of my life.
We have so many choices in the US of things to do that there’s an expectation that you do something fantastic with the time you have. At the same time, with so many choices, it’s often hard to decide what to do. Resting is not an option; "you can sleep when you die." Everyone goes to the movies. What can I do that’s particularly fun and unique?
I’m dramatizing it a bit but a pressure does exist to be interesting and do interesting things. The beauty of my life here is that I have very few options of what to do with my free time. There are virtually no choices and consequently there’s no stress to make the 'right' choice.
So my Year of Lent continues and my ‘Easter’ is four and a half months away at the beginning of August. Much as I’ve enjoyed the act of self-denial while participating in past Lents, I’ve also come to appreciate having a whole year of my life filled only by books to read, a beach to run on, and a bed to nap in.
I still find myself craving home and the things that come with it. However, I’ll undoubtedly miss the simple life of rural Tanzania when I’m back.
I chose to come to Tanzania for this fellowship year because I was compelled by the opportunity to get to work on tackling one of the worlds’ toughest challenges: HIV/AIDS in East Africa. However, though I’ve worked and traveled in the third world many times before, I didn’t realize how many American comforts I’d be sacrificing at the same time. Through the months of forced denial, I’ve come to affectionately call this my Year of Lent.
My first month living in the rural town of Kilwa, Tanzania was hard but I learned to deal with it. When the second month was harder than the first, I didn’t know if I was going to make it the whole year. But then something changed. I started to enjoy the simplicity of my life.
We have so many choices in the US of things to do that there’s an expectation that you do something fantastic with the time you have. At the same time, with so many choices, it’s often hard to decide what to do. Resting is not an option; "you can sleep when you die." Everyone goes to the movies. What can I do that’s particularly fun and unique?
I’m dramatizing it a bit but a pressure does exist to be interesting and do interesting things. The beauty of my life here is that I have very few options of what to do with my free time. There are virtually no choices and consequently there’s no stress to make the 'right' choice.
So my Year of Lent continues and my ‘Easter’ is four and a half months away at the beginning of August. Much as I’ve enjoyed the act of self-denial while participating in past Lents, I’ve also come to appreciate having a whole year of my life filled only by books to read, a beach to run on, and a bed to nap in.
I still find myself craving home and the things that come with it. However, I’ll undoubtedly miss the simple life of rural Tanzania when I’m back.
Thursday, March 18, 2010
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