6.0 – Talkoot! A Finnish way of working together – exported

Talkoot event was part of the official Helsinki meets Cape Town even series, facilitated by CPUT and organized in the impressive RLabs, in Bridgetown, Athlone – one of the townships of Cape Flats. RLabs was started as somewhat a personal spinoff of another Living Lab – or so I’ve heard, and was founded in a lot shared with other interesting societal initiatives in Bridgetown. One of their biggest projects is to create an opening for the gang members of Cape Flats for move away from the gang life. And a convincing, heart thumbing example of RLabs produce was an ex member of the infamous American gang who took us on walking tour around the area. We walked to the stores that were, and still are one of the main hangout spots of the Americans in Bridgetown. Behind the stores there was an electricity center building, that was somewhat white – more yellow, that was called the White House to the American gang – because the gang was actually formed there. There abouts we also got to hear that the ex member leading us on the tour wasn’t just any member, but actually the son of the founder of the gang. He gathered us as a group around him, whenever he wanted to tell us something about the surroundings – but he seemed to gather the still loyal, still into gang life members around him as well – and this gave us an opportunity to talk with them. The conversation with an American gang member , clearly high on substances was just flooring to me. He told us about his three kids, he told us about his substance abuse and he told us that the neighborhood was – in his view – actually getting better all the time. But directly after this, he also told us that he himself was actually getting worse and worse every day. And this made me think, that if he is somewhat one of the unofficial, unwanted member of the illegal – but highly actual structure of the community – getting worse but maybe in it letting the community outside gang life to get better. But should it be worth it? Should one’s wellbeing, as a member of the community but not maybe member of the legally sound society, be the cost of the community’s wellness? So, do two wrongs make it right? No.

Workshop groups were formed around two key issues in township communities, but most applicable to people living in illegal settlements as well; issue of sanitation and waste management and issues around healthcare. I chose the latter based on few other workshops and the upcoming workshop in Johannesburg I was heading in few days, once again – I’ll tell you more about it later on. The group members varied from people working with the communities, to community planners, from healthcare workers to designers and so on. The workshop was constructed in a way that another township too in Cape Flats – Khayelitsha brought some of their shared issues to be worked in Bridgetown to benefit both. Our group had healthcare and community workers from the actual communities to feed us with first hand info, and to co-create the solution. These people were an neccessary and valuable assess to the work to have an proper understanding of the context and the scale of the issues. The sharing of this info was done by story telling – story telling being used to have that maybe one specific case but known to be repeated through many of the less privileged citizens of the Cape. We seemed to spend a lot of time again on the problems, which is good for the setup of the workshop. We even spend some time on the barriers and disadvantages in and of the situation before we actually talked about any possibilities or wished outcomes. I recognize a slight trend here and this could be because the people driving their own issues see the group as a good forum of authorities to make things move forward, or it could be that since these sources of first hand information do really live these  issue everyday – they’re locked in it. These or neither, problem centered has a new definition to me now, we should call it problem driven but as we usually work it is highly solution centred.

Our group gave the floor to the community workers and listened to their problems concerning healthcare. And the first issue, that seemed also to be one of the biggest issue and ended up being our focus too – was the community clinics way to make people queue. Most of their patients came in with no booking, and queue outside of the clinic from 5 am, even though the clinic opens at 7 am. They have an one queue policy to everyone, so even the people getting for their test results, or collecting their medicine or came because of an acute reason all stand in the same line and go through the same counter and this of course creates a system paralyzing bottle neck to get in to the service chain. Another big issue that comes from this system is that a lot of the people queuing will actually be left outside and without treatment due to the opening hours of the clinic, so some people needs to take another day off from work, pay free, and come queue next morning 5am again.

So first we of course looked into streamlining the existing queue system or even creating a new one. People seemed to be keen on figuring out a mobile application the let you know when your time is precisely or when the queue is the shortest to create an opening for the patients to come, but these suggestions too seemed to have faults that made the system as dysfunctional. If you think of the system how patients are treated nowadays is that you have one doctor seeing one patient – face to face, so the agreed time to meet becomes an issue of perfection, if the patient is late then the doctor waits and looses valuable time from treating other patients, so basically this system of people queuing and doctor just taking them in as they come is some what most effective to the doctors time management. Then again if you put out info that hey the spot is free just for you, but you put it out to enough people to make sure the doctor as a resource is used to its best – you just create the queue that wasn’t there. So instead of jumping the gun and looking at the issue that is actually just the result of a somewhat broken system, we started to look at the bigger picture – what is successful medical treatment and it is fragile! You need timing, skills, needs, resources, place and so on come together on that same crossing of space and time. From this spider chart we started listing the key elements we have to try to manage in this systemic mess; staff – resources – and patients.

We looked in to the issue of cueing through these elements and figured that tangible or intangible resources, as well as staff are out of our scope to manage as such. We can write an pamphlet to the hospital management and ask for them to get a better queuing system, or write to the local politicians that we need more resources – or ask the god to make us not sick anymore, but in this highly realistic context – none of the above seemed feasible. So Resources are out of our reach, lets look in to the staff – and the only fault there seemed to be the lack of staff, not so much their inefficiency. So I asked the group; Do you think you’ll get those 200 more doctors that you actually would need to treat all the clinics patients – unanimous: no. Well, do you think that the trend of being sick will go out of style so the queues just aren’t there anymore – again no. So we – to me – were facing a somewhat a dead end. And what do you do the milk’s on the ground already? You suck up your disappointment and see what else you can drink? This way of really pinpointing our project to something that is absolutely community led felt appropriate in the group, since there were no officials, just normal people from different communities. We also started to think about the hospital staff and their daily routines – every morning they open the gates to let the first people in, they know that these people have been standing there for quite a while and they know that the tail end of the queue will be cut and told to come back tomorrow, maybe even again on the day after tomorrow. This triggered something in us: mutual disappointment for the lack of those needed elements of successful treatment, this also spreads ill attitude to both sides of the counter… Hey, we have something here – we started to talk about attitude change through disappointment management.

We looked at the clinic system whole through the different elements played and taking part in it; what needs to be fixed and through harsh realism – what actually could be fixed – bottom up and through the elements we can manage, and this was firstly and mostly the patients, so us. We already established that both sides us and them we’re already approaching each and every point of contact, the visit to the clinic, with attitude ready to be disappointed. Through group discussion it was established that much of the disappointment, almost generically comes out of misunderstanding the situation or the other side, so we though of creating dialogue between these two parties who in the end do aim for the same end result, but are both sometimes tied down by resources, or other reasons from producing the hoped outcome.

So the disappointment management could be done, like the days tasks introduction, through storytelling. A member of the community could go to the clinic and tell the staff the stories they hear and know to be true from the patients issues concerning the healthcare and at the same time listen to the hospital staff and hear their stories of their daily struggles too. This would create an open feedback forum and ripple trusted information through both sides of the service. So we wanted to get the straightest possible line to do this, and basically framed the solution as this simple; we spot the community leaders – like shop keepers, priests, teachers or such and gave them the opportunity to go and take part in clinic staff meetings and then organize their own meetings to tell the people what went on in there and then again take it back to the hospital and so on. This would be an ongoing somewhat community facilitated discussion and thus, the platform for future co-creation of their services. Our group members, who represented communities at our table agreed with this idea and though that not only it would be useful and meaningful, but easy to organize.

This concept of ours, to me, is a perfect example of stochastic thinking. We’re basically looking at the issue of “there are too long queues in front of the hospital” and come up with a solution of facilitated discussion. The reason we ended up to it was the realization, that no matter how well all the other aspects of the clinic as a service would be managed, if the attitude stays the same – none of it matters. And then again, since almost all other aspects of our case were matters beyond our reach of change making, it is most effective to start from within. We manage what we can, a small thing – a conversation, and with that we probably could alleviate a lot of other problems that makes the whole system ill.

I wish we could have the time to go and actually meet the community and those people queuing to the clinic, but then again we had a group who did rightly represent them and in that served as a good assessment body to the end result. I think in the end we were all happy about the days talkoot – and exhausted, we gave it our best and gave it our all. Then we had braai and drinks, like you should in the (new) very traditional South-African talkoot. Good food, good music – really good people in good spirits.

I did really learn a lot from this workshop: for example, that stochastic thinking does apply to systemic issues generally well – the cause and effect is often indirect and the solution needed could be most effective like that as well. I learned that moment of successful service provided by one and received by one is a fragile split second chance in time and space – of course if there is no chance of negotiation, like when the issue at hand happens to be something so personal and important as ones health. I realized that at a dead end, with no options to get over, it’s probably more useful to manage internal actions than trying to effect outside aspects outside of your reach. I might have figured out that to a complex problem, it is better to come up with a simple solution – since complex solutions will probably just bring out new even more complex issues, and it’s not about that the solution needs to always be the solution, the solution just has to fit the empty place in the complex puzzle. And most of all, when thinking about two opposite sides involved in one issue, like patients and staff, like citizen and city, like the ones in the city and the ones living outside – they have a resource that they share and getting these opposite groups together is basically best done by getting them to co-manage the resource that have and get to share. Social change surely has to lye in the connecting surface different systems inside the system share. I’ll probably follow up on this idea on my upcoming conclusions from the whole trip.

Thank you everybody who managed, organized, facilitated and joined this wonderful event – to name few; Lovely people of RLabs, Aki from the Finnish embassy, Wonderful volunteers from Urban Soul and from Social Justice Coalition, Anne from AGI, Rael and Francois from CPUT.

More of this kind, please!

Links:

Talkoot! Helsinki meets Cape Town

RLabs

A video of one group’s journey at The Talkoo!

Athlone, Cape Flats (Wikipedia)

The Americans