Challenges – Wednesday, March 19, 2014

Mekelle driver discovers a street light

Mekelle driver discovers a street light

The hallmark of modern industrial civilization is efficiency.  Efficiency is what allows high productivity of goods and services at low cost.  Efficiency cannot be achieved without order.  Random behavior destroys efficiency—it disrupts the flow of productive work.  Random behavior introduces disorder and disrupts process.  To achieve efficiency, a certain regimentation and standardization is required.  This requires changes in work habits.  The worker in a highly efficient system of production is constrained in what he or she can do—too much individuality introduces disorder into the system and disrupts the flow of work.  The assembly line (which is highly efficient, but is also highly regimented) is what allowed Henry Ford to mass-produce the Model T Ford and transform American consumerism.   Standardization of techniques and the development of mass production allow better and better understanding of the production process and this, in turn, leads to systems analysis and the weeding out of inefficiencies.  Systems analysis—by looking at the details of the process—also leads to improvement in quality as the system is more and more finely tuned.

Efficiency is not possible without reliability.  Systems reliability is a key component for the efficient production of goods and services.  This is most notable in the supply chains associated with manufacturing:  if raw materials and component parts are not of high quality and readily available, efficiency suffers.  Efficiency is only possible in an enabling environment that allows producers of goods and/or services to work to the best of their abilities.  An enabling environment is both physical and mental:  the physical infrastructure needed for efficient production—power, water, communications, maintenance, and so on—is key; but equally as important is a mind-set—a culture—of attentiveness to detail, of mindful awareness of the work environment, of anticipatory problem-solving so that problems can be avoided through advance planning.   Achieving this mindset is part of an education process that grows up alongside the changed methodologies of the production of goods and services.

Developing the mental disciplines needed for efficiency is difficult.  It requires that a person to internalize certain rules for the governance of his or her behavior that are adhered to with minimal external enforcement.  A great example of this is driving a car in an industrialized country.  It requires a social agreement to drive on one side of the road (on the right in the United States but on the left in Britain), an ability to govern ones’ behavior by reading signs that give instructions and following them (no left turn, one way street, exit here for Pasadena, speed limit 45 mph, etc).  Imagine what it takes to stop at a red light—voluntarily—and to begin driving again when the light turns green.  These are not difficult tasks, but they are tasks that require you to govern your behavior by paying attention to impersonal, non-human, mechanical signals and to stifle any spontaneous impulse to behave otherwise.  The fact that traffic cops lurk in the background to give tickets to offenders against these social conventions is a motivation, but not one sufficient to prevent mass disobedience.  We are schooled to behave in this manner for the greater good of society and to achieve efficiency:  drivers who follow the rules allow traffic to flow readily, easily, and efficiently, but at a certain cost to personal freedom—the freedom to drive how you like, where you like, when you like.

This rather abstract and long-winded digression is a preamble to a discussion of the challenges of daily living in Mekelle.  What is contained in the previous three paragraphs is unremarkable (perhaps even boring) to an American or a European.  For the Japanese these concepts are embraced with almost religious fervor, thanks to their admiration (nay, almost their worship) of an American professor named W. Edwards Deming (ask any Japanese schoolchild if you don’t know who he was) who trained Japanese businessmen according to his philosophy in the 1950s and transformed the Japanese economy.  (Hint:  Deming is generally regarded as the “Father” of Continuous Quality Improvement systems analysis).

The work day here revolves around the solar day.  The sun comes up around 6:30 and sets 12 hours later.  The workday is chained to the solar day because electric power is, well, unpredictable.  We have had major power outages every day for a week now, sometimes three or four in a day.  At least one lasted 14 hours, for no obvious reason (the weather has been gorgeous).  Unless you want to work by candlelight (which we have done), you had better get your mission-critical chores done by sunset.  The unpredictability of the power supply means you need to recharge electronic devices as often as possible so you don’t end up being caught without power.  It also means you need to be careful about using surge-suppression technology without fail.  My computer battery lasts all day (fortunately); others aren’t so lucky.  Ayder Hospital also has unreliable power; this can be more serious than not being able to boot up your laptop.

The water supply is similarly unpredictable.  One of the major Ethiopian industries is bottled water.  The water supply in Mekelle is reasonably safe (at least for washing dishes and bathing) but few people drink water out of the tap.  A large supply of safe bottled water is one of life’s necessities, but the supply is somewhat unpredictable.  We buy 24 liters of bottled water nearly every time we go out shopping, and hope that the distributor has enough in stock.  (We have been looking for the large 20 liter bottles for month, but none are to be had).  For the last week we have been without water from the mains more often than we have had it, which means that we need to have several large buckets handy in the kitchen to save up a store when there actually is water from the tap.

For the last week, we have had internet access only sporadically.  WiFi doesn’t  exist most places.  We each have EVDO “tethers” purchased from EthioTel (the monopoly Ethiopian telecommunications company) that plug into USB ports on our computers.  Finding them to purchase was not easy.  Then we had to register them at EthioTel, pay an activation fee, and “recharge them” every month with 700 Birr to get 4GB of internet access.

Wireless telephone service is relatively inexpensive, but spotty.  You must fill out an application for a SIM card, provide a passport photo, pay the fee, purchase your cell phone and then “charge as you go,” meaning there are no “plans” here—you pay for service as you need it.  You do this by purchasing “mobile cards” at any corner shop (issued by EthioTel) in 25, 50 or 100 Birr denominations.  You dial a number on your phone, dial in your phone number and some activation codes, scratch off the mobile card to see the PIN number, and enter the number on your phone to recharge your phone account or your internet access.  Sometimes it works; sometimes it doesn’t.  It is considerably cheaper than Verizon (you get incoming calls for free on your cell phone).

The entire communications network across the country goes down periodically.  Over the past week, the internet (EthioTel) was down more often than it was up.  The system is spotty and unreliable.  On a recent trip to Addis Ababa, we were unsuccessful in reaching anyone by phone; fortunately, even when voice phone service is “out,” you can usually send a text message that gets through.  Imagine what this does to business.

Development and construction of the Ethiopian telecommunications system was contracted out to the Chinese.  Halfway through completion of the plan, there was a falling out with the Chinese and the contract was switched over to the French.  While the French were working on the system, there was another falling out and the contract was given back to the Chinese—so what you see is the finest amalgamation of Ethio-Franco-Chinese engineering imaginable.

Traffic flow in Mekelle follows the same pattern, although we are fortunate that the traffic is very light compared to large African cities like Addis Ababa.  Most of the traffic on the road consists of scores of bajajs (or tuk-tuks as they are known):  imported Indian motorcycle rickshaws, which are liberally interspersed with cattle, donkeys, horse-drawn carts, pedestrians, a few bicycles and the occasional motorcycle.  We live about three blocks up from the only functional traffic light in Mekelle (If you want to give directions to a driver to our house from downtown Mekelle, just tell him to ‘drive to the traffic light and turn right’—you’ll almost be there).  It works about 85% of the time; most people obey it because it’s a novelty, I think—almost a tourist attraction—rather than an ingrained code of behavior.

The idea of “traffic lanes” is also a novel concept which is largely ignored.   The idea of “lanes for traffic” that are separate from “lanes for pedestrians” is also not an operational concept.  The main roads in town are easily two lanes wide on each side, but unmarked, so traffic tends to drive in the middle of one side or another, straddling the lanes, or wanders leisurely from side to side.  In the middle of the market the smooth flow of traffic (if it ever really exists) shifts to complete turbulence as pedestrians, bicycles, bajajs, animals, taxis, and heavy-goods lorries all jostle for position in the narrow streets and cut in and out of any lane, cutting in front of someone turning left to make a right hand turn with a bicycle riding in between the two turning vehicles (sometimes it is a horse-cart or two donkeys).  Every driver and every pedestrian is completely oblivious to their surroundings (many talking on cell phones as they drive or walk) and yet—because everyone is totally oblivious everyone seems to realize that everyone is totally oblivious and somehow manages to take that into consideration.  [One frightening aspect of Ethiopia is that it can make you talk like Donald Rumsfeld!]  The fact that most traffic in Mekelle never gets faster than 25 miles per hour is a saving grace—if traffic moved at American speeds, the carnage would be unbelievable—and yet, within the limits of the system, it seems to work.  There are thousands of low-speed “near misses” every day, but the only significant traffic accident I have seen was a single-car accident in which the driver  somehow managed to hit a light pole in the middle of the empty roadway that runs near our house.

The turbulence of daily living with its fragile supporting infrastructure means that huge amounts of effort are expended on what would normally be considered routine activities.  Buying bread takes a trip to the bakery.  Buying vegetables means a trip to the vegetable market.  Buying eggs requires another trip.  Buying honey takes still another trip.  Canned goods or imported luxuries requires a trip somewhere else, and if you need a specialty item (such as when you are looking for electrical or plumbing supplies), you may have to visit 10 or 12 different shops before you find something acceptable—if you complete the purchase at all.  This means that an inordinate amount of time is taken up simply dealing with necessary activities of daily life.

And speaking of time, time-keeping is different in Ethiopia, both according to the clock and according to the calendar.  Many Ethiopians keep time according to a 12 hour clock that starts—not at midnight as ours does—but at dawn, or 6 AM.  Thus, a local may tell you he will show up at “7:30” by which he means 1:30 PM.  That is, since timekeeping starts at 6 AM, 7:30 means 7.5 hours after 6AM, or “1:30 in the afternoon.”  If you can’t figure that out, you are dead.  I am often dead.  Being “on time” is also very flexible concept:  plus or minus 15 minutes counts a punctual.  Oh, and by the way, domestic flights on Ethiopian Airlines often leave when the pilot is ready, irrespective of the posted flight time—this may result in a plane leaving an hour earlier than you had anticipated.  You need to be at the airport 3 hours before flight time to take this into account.  It is far more important than getting through the ritual security checks.

Beyond that, the Ethiopian calendar is not the same calendar that we use.  That would be way too easy.  The Ethiopian calendar (also called the Ge’ez calendar) is an ancient calendar used throughout Ethiopia and Eritrea which also functions as the liturgical calendar of the Ethiopian Orthodox Church.  It is based on the older Alexandrian or Coptic calendar, which is derived from the calendars used by the ancient Egyptians.  The Ethiopian calendar adds an extra “leap day” every four years.  The year begins on August 29 or August 30 (calculated according to the Julian calendar).  The Ethiopian calendar diverges with a 7 or 8 year gap from the modern Gregorian calendar, based on an alternate calculation of the date of the Annunciation of Jesus.  The calendar has 12 months of 30 days each, but in addition it adds a 13th month of five days (six days during leap years, leap day falling on August 29 rather than February 29 according to our calendar).  Just so you know, we are currently living in 2006.

When these issues run together in a healthcare system, the results are often difficult and inconvenient for patients and doctors.  Over the last few weeks numerous surgical cases have been cancelled because nobody can find sterile operating room drapes.  There is no power or water for the autoclaves, and nobody really seems accountable for solving the problem.  Supplies are inconsistent and unpredictable.  Today the operating room had no water so we had to scrub our hands with alcohol.  Surgeons must use whatever suture is at hand (often with inappropriate needles or less than ideal fit-for-use of the material and the procedure).  Everybody understands this and everybody adapts.  At the end of the day, people are better off than they were 50 years ago, but not as well off as they could be if the system ran better.

The most critical need in Ethiopia is for better management, at all levels of society.  There are huge inefficiencies to be corrected, which result in significant personal hardship, particularly within the medical system.  [Our surgical patient today had been here for 6 days waiting for a set of sterile surgical drapes for use in an elective rather than an emergency operation).

At the same time, efficiency is not everything.  Being a slave to maximal efficiency often cuts something out of the heart of human life.  Ethiopians are warm and open to one another.  They greet each other effusively with a half-hug using one arm, or a full hug with both, and women often greet women (and close male acquaintances) with three kisses on the cheeks.  They are always ready to stop and talk.  They make time for one another, even in the course of the day (the “lunch hour” here is actually 90 minutes).  They will go well out of their way to make honored guests (like us) feel welcome and comfortable (I could write volumes about this already).

Ethiopians who have been to the United States often comment that Americans are rather cold and don’t “have time for one another,” that we are always looking at the clock, that we are uneasy accepting generosity and are always calculating debts and balance sheets (who owes what to whom or how much one needs to contribute, as if we have our eye on the accounts and not on the friendship).  We are slaves to the clock, to time management, to efficiency, and in the process we tend to starve our human relationships.

They are right, of course.  In the States I worked like a dog:  12 and 14 hour days, even on the weekends.  It takes a toll.  In Ethiopia I am enjoying the sun and am re-learning important facts about friendship and family life that had rather gotten pushed to the side.  This is an enormous blessing, and I can learn to cope with some of the inefficiencies.

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