I have been reading Nora Bateson’s Small Arcs of Larger Cycles. It is a collection of short essays she has written over the last 5 years or so. The essays are of the kind that make you think and that change you. I am changed but not just because of the book. Nora’s essays found fertile ground in my head and heart because of what I saw here in Madagascar.
Last week we covered about 1200 kilometers, a few hundred of these over roads that looked more like dry riverbeds than roads. We went to places where foreigners are rarely seen, which meant that I created quite a stir – stares followed by smiles and waves from older kids and adults, fearful cries from the small ones.
We went to visit teams that had participated in a leadership development program (LDP) sponsored by the USAID Leadership, Management and Governance (LMG) Project. It started nearly a year ago in the region of Haute Matsiatra. The local facilitator team had selected the five best teams – best defined as ‘those who had achieved their measurable result.’ These results consisted of more women who came for their first prenatal visit, more women delivering their babies in a facility, more children vaccinated. The teams had selected those as leadership challenges that stood in the way of achieving the indicators set forth by CARMMA, the African Union’s campaign to accelerate the reduction of maternal and child mortality.
As we interviewed the teams on how they had managed to increase the numbers it became quickly clear that it wasn’t actually the numbers that were important. It was the relationships that made the positive changes possible: relationships that either had not existed before or that were of poor quality. The participants in the LDP had created relationships were none existed or improved relationships that were bad. They had moved these relationships from mistrust to trust. Contrary to popular opinion that trust, once broke, is as hard to put back together again as Humpty Dumpty, we saw that trust could be established or re-established easily.
Nora Bateson’s book and my experience here brought something sharply into focus, best illustrated with her words “Within the great whirl of life there is culture; in culture there is language; in language there is conversation; in conversation there are two beings; in the beings there are frames of perception and, in their communication, a kaleidoscope of unpredictable repatterning."
What had happened is that people had realized that it was only through the relationships, and thus through conversations, that they could hope to make things better. And in those relationships they changed as they learned about the other. The simple act of approaching and asking changes everything. It led to sharing and discovery, finding out that one’s point of view was not the only one and not necessarily the right one because it came from an expert. When interactions are based on trust rather than mistrust all things become possible that were not possible before.
And in this process people changed. We heard the same echoes wherever we went: “I changed from dictatorial to cooperative; I changed from impulsive and careless to caring and thoughtful. Ask my wife!” Those wives were often present or nearby as we interviewed the doctors at their health centers. They confirmed the changes. There was much laughter.
As a result of this trip I am changed too. I am also changing my vocabulary. I have become suspicious of words like ‘solutions.’ We ought to know by now that the problems that catapult poverty in our living room are not solvable from the mindset we have. It was Einstein who observed that problems cannot be solved from the same mindset that produced them. This quote is often cited but the deep meaning of it seems to be lost.
The mechanical, engineering mindset (every problem has a solution) is deeply anchored in our culture and it is easy to be sucked into its promises of engineering a better world. Yet I know that a better world cannot be created using an engineering framework simply because we are not made of steel and bolts. And now we are talking about systems, and system approaches and systems thinking, but they are still anchored in mechanical thinking: arrows and boxes, cause and effect, if this then that. Old wine in new bottles.
When Nora Bateson searched images for systems on Google she noticed that she had to scroll down through hundreds of images of circles and arrows and boxes before she found a picture of a human.
Indicator improvements do not make for better health care, although they may show that dollars entrusted to us were well spent. But the numbers don’t guarantee that they will continue to get better or at least stay where they are after we are gone with our extra resources, per diem, attention. I have come to believe that health care will only improve if the local relationships improve so that mistrust can be replaced by trust. It is only when people can talk together in ways that recognize that no one can do the difficult work alone and that we all need one another to improve whatever it is we want to improve.