Wednesday, October 9, 2013

Perception

My friend, J, is involved in some training that follows this structure;


  • One & a half day training course on X
  • First follow up visit to each hospital with revision of principles of X & then a practical session with a real patient
  • Second & third follow ups in hospital working on the wards to help practically apply X into daily nursing practice.


The first follow up has a form which she helped develop. It's first question was "What is your understanding of X?" but this was changed by a non-native english speaker into "What is your perception of X?" You can always rely on a Cambodian to make things more complicated.

At a recent one & a half day training session my friend had a meeting afterwards to discuss how the first follow up visits were going & to make sure the khmer staff understood & could use the follow up tools correctly & consistently.

Question 1. What is your perception of X?

Oh yes the NGO trainers all nodded - we normally get an answer of 50%!

50%? my friend asked puzzled but the question is designed to see what the participants understand & remember about X from training, why is that a percentage?

No, no - she was confidently told - this is the right answer, they only understand half.

Her heart sank as she then spent the next 45 minutes with her Cambodian colleague, the one who had changed the wording of the form, explaining what was actually meant by question 1.

Her assistant & my best Cambodian friend kept very quiet. The staff who didn't understand what perception/understanding meant were high status Cambodians from an NGO Hospital and if he had asked them "What is your perception of Bong's iPhone? 70%?!" they would have no doubt snorted & said it wasn't fair as he has worked with my friend for over 5 years and me for 2 & a half years, so of course he has a better understanding of English & of X. So not to be thought of as proud he kept quiet leading J to think maybe he too thought that 50% was an acceptable response to question 1. In fact my low status friend had asked the same question to a small border hospital only the week before & had been told "X is a system & method of approaching patients, it improves patient care, it facilitates handover, it gives nurses professionalism & autonomy" - In a room full of misplaced arrogance & over confidence he had started to doubt that this had actually been the correct answer.

Still its good to know that the high status arrogant Cambodian NGO hospital workers can recognise the benefits of capacity building in others even if they resist it so forcefully for themselves.

It was 5pm when my friend & her Cambodian counterpart finally felt they had explained the correct meaning & response of question 1. Only another 25 to get through before 5 30 & home time.

The next week the first follow up was done at my base hospital & one of the NGO workers came to help my friend & her low status assistant. As the NGO worker had done previous follow ups he wanted to take lead for the session, which started of course with question 1. The question that generated 45 minute of discussion to clarify its meaning only the week before.

When he asked it the response from staff was "30%" and without blinking or comment the high status & self professed extremely "intelligent" NGO hospital worker went on to question 2. My friend & her assistant quickly exchanged glances & an eye roll, then with his boss's tacit approval my Cambodian friend stood up & politely interrupted the NGO hospital worker. He respectfully asked if he could ask question 1. again and when he did the response he got was - "It is a system & approach, with 5 steps, to delivering quality nursing care, improves professionalism etc. etc. etc."

The NGO worker didn't even flinch. After a 45 minute conversation & explanation only a week ago he still clearly did not understand the first question on the follow up form but was either too proud/arrogant/ignorant/narrow minded/stubborn/incapable  * delete as appropriate to admit this.

And this is an example of what in my perception is the biggest problem I face here.

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