Where I find myself at the moment.

Some of you may be wondering what’s been happening with me – or maybe I flatter myself by thinking that you’re wondering – but I’ll just warn you that this post is all about me, so if you’re interested in reading about Cambodia, move along, folks – there’s nothing to see here.

(And isn’t blogging just a huge exercise in self-absorption anyway? Who am I to think anyone wants to read this crap?)

I came here thinking I had skills to offer. I was quickly asked to organize and manage a clinic. I was told that the clinic was “a mess”, that no one had time to put any systems in place and therefore it was chaotic and not as effective as it could be. While I had thought I wanted an opportunity for more direct patient care rather than administrative work, I felt it could be a worthwhile challenge and that I might have the skills needed to do the job.

So I tackled it, full on. I set about trying to understand how things worked and how I could improve efficacy and efficiency. I asked everyone who worked there a thousand questions. I made notes and lists and spent time at home developing forms and systems.

When I was told that a donor had recently purchased a vehicle for the clinic’s use and that it would be available for us every day during clinic hours, I expected that was true. When the car wasn’t available or had no gas in the tank, I questioned why. When I was told to put repair requests in writing so they could be taken care of, and then nothing happened as a result of those requests, I asked what was getting in the way and how could we overcome this obstacle. When I was told that I should purchase things needed for the clinic and then request reimbursement, I did so, but then I was told by someone else in the organization that I couldn’t do that. I asked why I was hearing two different things. When a pharmacist who helps fund the clinic came to visit and provide some recommendations to improve patient safety and financial viability, I took those recommendations and made sure that all the systems we were putting in place were compatible with his identified goals. Then I sent an email update to people within the organization and the pharmacist, and was told I was “not allowed” to communicate with donors.

I was asked to “be the boss” of the clinic, to “get this place running smoothly.” I took it seriously. Together with the GP who was there during my first two months on the job, protocols were developed, and unnecessary and dangerous prescribing by the Khmer “doctor” were drastically reduced. Some nurse volunteers came and went and reported a positive experience in the clinic. We stopped running out of medicines as the inventory and purchasing systems went into place. We began to keep actual records of patient’s clinic visits. We began to refer patients to other appropriate healthcare providers in the community to get them the specialized care they needed.  The Khmer translator staff eagerly studied new vocabulary and seemed genuinely happy.

There were enormous challenges, but it was exhilarating at times. Progress could be seen. It was far from perfect, but some things were working and some were in the process of being figured out.

But I made some mis-steps along the way. I have little tolerance for those who aren’t willing to put in some effort, and a couple of people within the organization (but not directly in the clinic) struck me as those who were much more interested in their own best interests than in doing a good job. While I thought I was being polite but firm, they thought I was being rude – my mistake in not yet understanding the cultural implications of my communication style. Unfortunately, both of these people happened to have more power within the organization than I understood initially – though to this day I cannot understand why they do. And while there are very few people in the world in whom I cannot find any redeeming qualities, these two might be at the top of that short list. I suppose it’s fair to say that I don’t like them, and they appear to know it (despite my efforts to be diplomatic) and I’m sure they dislike me too. Language gaps (one is Khmer and one is Nigerian) mean that that the subtleties of communication are lost and we probably don’t even read each other’s body language very accurately.

Anyway, the damage was done. My occasional efforts to smooth over ruffled feathers went nowhere. I began to get fewer responses to my emails and calls to the organization’s directors, until I felt I was being ignored completely. So I carried on, providing email updates where I thought appropriate, and wondering how an organization could ask someone to do a job and then never think to check in from time to time about how the work was actually going. Not exactly my management style – but then again, I should have known something was off when I was told by one of my nemeses mentioned above that my management style was “wrong.” I was told that I “worked too hard” and I needed to slow down and tell other people what to do so they could “earn [my] approval and be proud of themselves” for that. I explained that my style is to try to set an example, and never ask anyone to do anything that I’m not willing to do myself (if I’m capable.)

And then I was called into his office to be told that I “wasn’t a team player” and that I asked too many questions. I told him that nothing would please me more than to feel part of a larger team within the organization, and I had been hoping that management would extend any invitation at all to be part of that team. (Perhaps responding to emails would be a good way to start…?) In the meantime, I had worked hard to focus on the clinic and nurture a sense of teamwork there, which I thought was going well.

Then I was told – and this is a direct quote, because I was taking notes and I even asked him to repeat himself – that “the goal of ‘the team’ is to actualize the dreams of the owners of the organization.” I was stunned – I would have bet that the goal was to provide the best educational and health support for the population we identify as our clients.  And I would never have thought of the founders of a charity as “owners.” The depth and breadth of the gap between our styles and our vision about this work became suddenly clearer – this very well-paid “manager” had his priorities, and I was not playing by his rules. He had plenty more to say, as did I, but there was no common ground.

There were other issues that left me with unanswered questions: issues of transparency, fiscal responsibility, mission and purpose. I will leave those topics alone.

This meeting marked a change in perspective about my place in this organization.  Long emails were sent (some were accidentally sent to my blog subscriber list – oops!) and got perfunctory replies.  I spent many hours wrestling internally with whether I would stay or go – I believed in the potential of the clinic and I enjoyed my coworkers there, but I couldn’t imagine staying on in a place where I had such vast differences with the management (and “owners”) of the organization. I wondered if leaving the position would mean I was selfishly prioritizing my own ego over the potential good I might be able to do by staying. I asked myself if my expectations were reasonable, and whether I came here to have an easy life or a productive life. I thought in circles about what I saw as the problems and whether I thought they were insurmountable. I berated and then forgave myself for not understanding the lay of the land soon enough. I wondered what to do.

And then they made it easy. During a two-and-a-half hour meeting with the “owners” and management, I was told the following:

•        I did a lot of really good work in the clinic, but
•        I didn’t understand the chain of command
•        I was not allowed to communicate with people outside the organization
•        I needed to slow down – in fact, I should probably “take some Valium, like the rest of us!”
•        I must 100% support the philosophy of the organization

Then I was asked if I could do that – change my personality and 100% support their philosophy. Since no one has ever defined what the philosophy is, I am left to draw my own conclusions about it based on my observations over three months.

I told them I would think about it, but there wasn’t much more thinking to do. Two days later I gave them one week’s notice. (I figured that I gave the VNA six month’s notice after working there for 23 years, so one week was sufficient for a job I held for less than three months.) They seemed surprised.

The worst part was telling the clinic staff. I was not prepared for tears from young Khmer men. I struggled with how to explain the decision without putting them in any position of discomfort about conflicting loyalties. I cried with them. Then I worked harder than ever for the final week to accomplish as much as I could.

I spent a week being pissed off and sad and self-righteous and discouraged. I exercised enough self-restraint not to blog about it then. I whined on Facebook and to my friends via email. I endured the psychic discomfort of questioning my own motives.

Then I spent the weekend in the hammock and got a grip. And as I so often do, I found solace and direction in a quote from someone else:

“I beg you..to have patience with everything unresolved in your heart and try to love the questions themselves as if they were locked rooms or books written in a very foreign language. Don’t search for the answers, which could not be given you now, because you would not be able to live them. And the point is, to live everything. Live the questions now. Perhaps then, someday far in the future, you will gradually, without even noticing it, live your way into the answer…”   - Rainer Maria Rilke

So I’m learning. And I’m trying to live the questions rather than expect to find the answers. When the time is right, I imagine I will find other things to keep me busy. In the meantime, I will read and write and study Khmer and take bike rides. I will spend time in the hammock. I will listen to the birds and the dogs and the geckoes and the monks. I will grow sunflowers and cherry tomatoes. I will see what happens next.

Most of the clinic and outreach team - over for drinks on Friday night.