The last few weeks have been very up and down. I’ve gone from feeling extremely frustrated to excited and motivated. I find it amazing how quickly the mood of the project can change.

A series of frustrations crept up on me lately- it can be extremely difficult to find out what is happening here. It’s easy to see the resulting problem- but it’s so much more difficult to understand the reasons and complexities to why the resulting problem occurs, and one of the most frustrating things for me is how long it takes to get to the bottom of it. A recent example-in a high DR-TB area, all TB suspects should have culture and drug sensitivity testing (DST) as well as smear to begin treatment- yet many were not being tested. To figure out why they were not being tested took weeks of questions, discussions, confusion and misunderstandings. Were the doctors and nurses aware they could get these tests, what lab was producing the smear results, why were the samples not being sent to the central DST lab? Finally, we got to the bottom of the problem-the incorrect form was being sent with the samples. Yipee, finally understanding the problem should result in a solution! But no, the sheer number of samples that would need the additional tests would overwhelm the lab as there are not enough staff to cope with the work. So a decision was made to focus on expanding our activities to the new areas, and getting it right in the new areas. We can’t do everything at once, a priority has to be set. But it doesn’t make it any easier when you see a way to make something better, and then can’t fix it-frustration sets in!

But I started this by saying I’m now feeling motivated and empowered. The long-time MSFers often accuse “first missioners”, (people who are new to MSF like myself), of not being realistic about what one can achieve. They are so right, I came here hoping to make things better and want to do it all at once… but then the longer you are here the more one begins to settle into a frame of mind where you believe things can’t just be changed that quickly and some things might even have to be accepted….

It was just at this point that I was sent on a management training course along with a handful of the other international staff and a dozen of the national staff managers. I have to admit, I wasn’t all that excited about the course until I went on it! As well as learning a ton of useful tactics to be a better manager, communication, negotiation, planning etc. our team went through a transformation and came out feeling more empowered and motivated to bring about positive change. I’m hoping this feeling lasts!