I did not arrive to work in Sierra Leone in any kind of leadership capacity.
Prompted by the news and the conviction of Faith, in October I signed up with USAID and then with Partners In Health to serve as a clinician caring for patients with Ebola. I was initially scheduled to go to Liberia but with the growing need in Sierra Leone I was rerouted a week or so before my travel date. We arrived in Sierra Leone on Wednesday December 3rd, trained aggressively and began working in the Ebola Treatment Unit (ETU) in the Maforki Chiefdom of Port Loko by that weekend. Providing care to these wonderful people in partnership with the courageous Sierra Leonean nationals and a cohort of exceptional international professionals was one of the true honors of my life.
Although I was not formally in a leadership role until I became ETU clinical lead the last week or so of my time there, I was aware of the challenges and I was very impressed with the leadership team assembled. Applying the critical dyad of “attention and intention,” I discovered that in the ETU, as is usually the case, leadership lessons abound: “If the spirit of the student is in you, the lessons will be there” (Sir William Osler). Here are several of my observations.
Master Narratives and Names. New expatriate staff arrived at Maforki regularly. It would have been very easy for the “long-timers” (those who had already been there a week or two) to develop the kind of exclusivism that could disrupt team development and undermine the “changing class picture.” One solution was to aggressively learn the new peoples’ names and stories and take the initiative to reinforce that knowledge by introducing them by name and “narrative” to the folks who were already there. People won’t readily surrender personal identity to take on group or team identity until the former is at least acknowledged. The same practice was an important part of getting to know the local national staff and to build the team with them.
We need to practice “intentional inclusivity.” This follows by purposefully including newcomers into existing rituals. For us at Maforki this meant eating meals together and inviting new colleagues on the morning walk to the ETU through the town of Port Loko. It was a tremendous opportunity to get to know one another and to reinforce our new, shared identity. “Not good with names” is not a viable excuse in leadership.
Lead from the front. Nicollo Machiavelli wrote “It is the duty of a good general to be the first man in the saddle and the last out of it.” One of the most difficult aspects of work in the ETU was learning to accomplish the clinical tasks while wearing the personal protective equipment (PPE). The outfit included a Tyvek suit, plastic apron, boots, mask, shield and multiple pairs of gloves (I always wore three). The process of ritually removing these garments (“doffing”) took a good 20-30 minutes if done fastidiously. You were always anxious to get on with the process so you could get out of the suit. (On top of which there was no way to urinate while in PPE, which added an occasional sense of urgency!) Still it was always a choice to allow the more junior people to leave first and to monitor them carefully for safety as they went through the process. Who should get to get out of the saddle first?
Practice calm in chaos. We all need to know our leadership style in comfort and in chaos. I have long known that my style of comfort is characterized in Goleman’s model as “affiliative;” focusing on the importance of people and relationships. I value the input of others and in chaos I have the tendency to oscillate from firing from the hip with too quick decisions that may lack the collective input to the relative paralysis of dialog that involves too much “thinking out loud.” So what I try to do in chaotic moments is to be quiet (not natural for me) to listen, to decide, then to reinforce, move on and check back with the results of the decision. It is a discipline that has taken practice and even after many years, still requires intentional reinforcement.
Ditch discouragement and disparagement. “Bitching” (pardon the language) is a natural way of blowing off steam in stressful situations. People and circumstances can be frustrating and the process of complaining and commiserating is therapeutic. Unfortunately it can also be destructive if it degenerates into slander or gossip. And it can be poison if it proceeds unchecked. Discussions about an individual’s performance have no place in public unless you are talking about yourself and the anecdote ends with laughter(!) Similarly, habitual negativity can become a weight that drags everyone down. There may be a time and a place for both, but the leader’s job is to redirect the discussion when necessary.
Resist retreat. Everyone gets worn out. I found that by about week three or so, my enthusiasm for going in to the red zone waned through the course of the day. I noticed the same trend in some of my colleagues who seemed like me at times to look subconsciously for other tasks to be spared the arduous, intense physical and emotional work. The first step is to acknowledge that the feeling is normal and may even be self-protective. And then one has to consider again Machiavelli’s “rule of the saddle.” Leaders should be the first in and the last out. In some of these times it was helpful to have a trusted colleague with whom one could commiserate in private, and then together like Rocky Balboa, we would “get back in the ring.”
One of my good friends, Colonel Mark Thompson reminded me a decade ago,”You don’t really have to be good to be a leader… you just have to be present and positive.” I would expand to this degree: the definition of a good leader may well be the one who is both present and positive, whether he or she is in a formal leader position or not.
And so effective leadership often boils down to this: showing up and looking up.
Henry V 4.3 