I’m just back from Burundi, a small, beautiful country in Africa, sandwiched between Rwanda, Democratic Republic of Congo and Tanzania. It’s capital, Bujumbura, sits on the shore of the deep, gorgeous Lake Tanganyika, where on a clear day you can see the mountains of DRC on the other side.
I went to Burundi with the Norwegian Red Cross to support trainings on a really cool strategy to fight cholera.
Cholera, as you probably know, is a diarrheal disease that still kills people in the 21st century (between 21,000 and 140,000 per year, according to WHO). It causes vomiting and what we call Acute Watery Diarrhea or AWD.
Acute, because it starts very suddenly and lasts only a few days. Watery, because the diarrhea very quickly becomes mostly water. It’s even called “rice water diarrhea”, as it looks like the whitish water left behind after you’ve washed rice. (I hope you are not having lunch while reading this!). The reason for all this water is because the bacteria that causes cholera, Vibrio cholera, has a toxin that pumps water out of the cells in the intestines.
Cholera can quickly (in a matter of hours) lead to dehydration that can result in death, even in healthy adults. Basically, it’s the dehydration that kills the person, so the treatment for cholera focuses on keeping the person well hydrated while the body fights off the infection.
In severe cases, if the person has lost consciousness or can't drink enough, this has to be done by giving the person fluids intravenously at a hospital or clinic. But in the majority of cases, giving fluids orally is enough.
When I talk about fluids I’m not talking about water, though. Water is fine for rehydration purposes in regular life, but in cases of AWD, oral rehydration solutions (ORS) with the right concentration of salts and sugar allow a much faster rehydration and a better balance of electrolytes, and thus have a much better track record of saving lives.
In any given cholera epidemic, most people won’t develop symptoms, although they will still shed the bacteria in their faeces and thus transmit the infection. Among those who do develop symptoms, only around 20% will be severe cases requiring intravenous fluids and hospitalization.
But what usually happens is that most people with symptoms end up at hospitals or cholera treatment centers anyway. In a bad epidemic, this can overwhelm the healthcare system. Plus it usually means that people are coming to the hospital late in the disease, and more dehydrated.
So, how can we provide access to rehydration closer to home to all those cases that don’t require hospitalization? Well, if you come from a middle or high income country, you might be thinking, “Duh… just go to the pharmacy and buy one of those electrolyte drinks”.
Unfortunately, that doesn’t work in poor communities in developing countries, or in camps for displaced people, which is where cholera epidemics usually happen. Here there’s usually no pharmacies, no electrolyte drinks, and most importantly, no clean and safe drinking water.
Enter the ORPs, short for Oral Rehydration Points. A place in the community where community health workers can provide water purification tablets and sachets to prepare ORS.
The Red Cross has now taken the ORP concept one step further by developing ORP kits. These compact kits can be quickly set up in the communities during an epidemic. They contain two key ingredients for treating cholera: a water filter that produces clean and safe drinking water, and sachets of ORS (plus other goodies like soap, water treatment tablets, glasses, jugs, etc).
One of the key resources of the Red Cross is its volunteers, who exist in communities in almost all countries in the world. During an epidemic, community health workers and other health staff can get very busy and be in short supply. Trained volunteers from the Red Cross can provide support by staffing these ORPs.
Volunteers can provide the communities with quick access to rehydration by giving sick people ORS straight away (with cholera, time is key) at the ORP. They also teach families how to prepare the ORS sachets at home (just mix them in a liter of safe drinking water) and how to make water potable by boiling it or treating it. They distribute chlorine tablets for water purification and soap for hand-washing.
Volunteers are trained to detect severe dehydration and quickly refer these cases to the hospital or cholera treatment center. They also provide communities with information on how to prevent cholera, such as washing hands with soap, protecting food from flies, using latrines and avoiding open-air defecation.
My trip to Burundi was about supporting the Burundi Red Cross in training its volunteers to install and use the ORP kits. Burundi has experienced intermittent cholera outbreaks, especially among the areas close to the Tanganyika lake. They now plan to preposition the ORP kits in case they are needed, to be able to respond quickly and give people in affected communities early access to rehydration.
I love simple, practical solutions like this one. I’m looking forward to seeing results from studies analyzing the impact of ORPs during cholera epidemics.
Did you like this post? I’m planning on writing more posts like these on interesting solutions to health topics around the world. Are there any particular subjects you would like to know more about? Please let me know in the comments!
One of my 2017 goals was to read at least 30 books. I'm happy to say that I surpassed that goal. Most of what I read was non-fiction, although I also managed to fit in some fiction books during the holidays :)
Here's a short list of my non-fiction favorites - those that were most useful for my personal and professional growth in 2017 - hoping that you find some inspiration for your 2018 reading list!
And if you have some good recommendations of non-fiction books, please tell me in the comments, I always appreciate a good book recommendation!
MY FOUR FAVORITE BOOKS IN 2017
I know how she does it. How successful women make the most of their time. By Laura Vanderkam.
I have been following Vanderkam's blog for some years and I finally decided to read one of her books. I'm very happy I did! This book busts the myth that women can't "have it all", using evidence from detailed time logs representing 1,001 days in the lives of women who make at least $100,000. Vanderkam presents a great analysis, with many stories and examples, of how busy women successfully and happily juggle life and career, by focusing on 168-hour (one-week periods) instead of on a single day. I thought I was a good time-manager already, but I gained many useful strategies from this book.
Rejection Proof. How I beat fear and became invincible through 100 days of rejection. By Jia Jang.
This quirky book made my days in 2017. Jang decided to overcome his fear of rejection by willingly putting himself on rejection's path for 100 straight days, while recording the whole thing and extracting lessons learned. Each day he planned a new scheme to get rejected, everything from knocking on a stranger's door and asking to plant a flower in their garden, to requesting the building's doorman to lend him 100 dollars. The results are funny, moving and eye-opening. Whether you struggle with fear of rejection or not, this is a great book to help us become more comfortable in asking for what we need (and laughing a bit on the way too!)
Decisive. How to make better choices in life and work. By Dan and Chip Heath.
I'm a big fan of the Heath brothers. Their books are always perfectly polished to ensure a seamless, ordered, and useful reading experience. Decisive is no exception. It combines stories and research to present a 4-step strategy to facilitate decision making, help us to stop agonizing over decisions and avoid biases. Decisive is compelling and funny and I love that they always include neat little summaries and tools to make it easier to remember what you learned from the book.
Option B. Facing adversity, building resilience and finding joy. By Sheryl Sandberg and Adam Grant.
Sandberg (the COO of Facebook and author of Lean In), and Grant (author of Originals and Give and Take), are both favorite authors of mine. But this book is very different from their previous ones. Option B talks about grief. The type of grief we experience from the death of a loved one. Option B has been a beacon for me, as in 2017 we lost a beloved family member. The book has helped us understand and cope better with the pain, confusion and anger that grief brings. It has taught me how to better help others who are dealing with grief, as well. If you or someone you know is dealing with grief, Option B is a great guide and comfort.
They crawl up on our speeches, push themselves comfortably into our well practised presentations, sneak up on us - despite our best efforts - when we are answering questions at a conference or an office meeting.
... you know?
They are called “filler words”, “interjections” or “pause fillers”. Whatever your preferred term, what amazes me is that these little critters exist in so many languages. In French we have “n’est ce pas?” (isn’t it), “donc” (so) and “tu vois?” (you see?). In Spanish we battle “este…” (this) and “entonces…” (then). In Norwegian, from what I’ve seen so far, we have “ikke sant” (right), a guttural non-committal sound that goes something like “mmm-mmm”, and “også” (and).
In Spanish we call them “muletillas”, which translates as “little crutches”, a very appropriate term if you ask me.
What are filler words exactly? They are words that we insert into our spoken language, but almost never written one. They’re often irrelevant words that won’t change the meaning of your sentence, and are used as a transition, to indicate that you haven’t finished speaking while you’re gathering your thoughts, or to soften the end of your sentence.
Filler words can make you look unprepared or hesitant when speaking. Yet, I also think they have a role to play in social integration. If you’ve ever learned a new language among native speakers, you’ve probably noticed that, until you’ve mastered the local filler words, you don’t feel you speak the language fluently. They seem to play a role in facilitating or marking social belonging.
So, do we need to get rid of them or not?
For normal conversation, filler words may not be that problematic. Unless you have more filler words than regular words in your sentence (and some people do!). For speeches and presentations, however, I would recommend to get rid of them. One or two will go unnoticed, but frequent use of them can weaken your presentation.
Easier said than done though.. How do we weed them out when we are not even conscious of using them?
Here are some of the exercises we use in my public speaking courses to diminish or eliminate filler words.
If you are preparing a speech or presentation, the most effective, albeit hardest way to get rid of filler words, is to film yourself and then watch the recording. This is painful, I know. Participants in my courses cringe when I make them watch their videos . But at the end of the course they systematically say this is the part that helped them the most. You’re your harshest critic. The discomfort you feel when watching yourself on video is your most powerful tool to improve your speech.
Grab a pencil and paper and count your filler words as you watch the recording. Make sure you count each filler word separately, for example, ten “um-ah”, twenty-five “like”, three “er…” and so on. Not all filler words are created equal. Determine which are your most problematic ones, and when do you use them.
Now decide how you are going to tackle them. This is where counting them separately comes in handy.
Substitute by a pause. “Um-ah” and “er” are mostly used when you are trying to gather your thoughts. Instead of eliminating them, try substituting them by a PAUSE. Repeat the phrase and in the place of “er…” say to yourself: “Pause. Breath.” . Take one long breath and then continue. For many of my course participants, imagining the pause as a word that they say only in their minds is much more effective than trying to eliminate the filler word.
We tend to dislike pauses because it seems to us like we are staying silent for too long and the audience will think we’ve forgotten what we wanted to say. The truth is, when you are on the podium, what seems like a one-minute pause to you is usually never more than a couple of seconds to your audience.
Pauses, when used purposefully, can be very powerful tools to create expectation in your audience, to signal a change of subject, or to let what you just said sink in. Don’t be afraid to use them to your advantage.
Substitute by a transition phrase. “So”, “like” and similar filler words are used in transitions. In these cases we can substitute them for “first, second, lastly” , or what I like to call “link sentences”. For example:
After you’ve decided how to tackle your filler words, rehearse your presentation again. This time ask a friend or coworker to listen to you and hold out a red card every time they hear you use a filler word. When this happens, correct yourself immediately and repeat the last phrase or two, this time without the filler word.
You’ve worked so hard on your presentation or speech, don’t let some nasty filler words dilute its power. But remember not be overly perfectionist, if a couple of filler words remain, they will mostly go unnoticed.
Let me know in the comments, what are your most problematic filler words and how have you got rid of them?
If you want to know more about my public speaking courses, go to www.happypublicspeaking.com
Being a leader can be challenging. Especially if you came to a leadership position through the "backdoor", without any leadership or management training.
It happens often: You are good at what you do. You are a great nurse, a fantastic designer, an efficient software developer. So you get promoted to a leadership position. Only you have no idea how to do this. You wrestle with impostor syndrome. You quickly become overwhelmed with all there is to do. Conflict arises.
Some weeks ago I was invited to the Neon Noise Podcast to talk about leadership challenges and how can new leaders tackle them. It was a fun interview and we got to discuss issues such as:
- What are some of the biggest challenges leaders face?
- How do you deal with feeling overwhelmed by all your new tasks as a leader?
- How do you "Build Your Dream Team"?
- How do you resolve conflict between team members?
- How can you keep your team motivated?
You can listen to the podcast here.
You can also access it on iTunes or Google Play
What is YOUR greatest leadership challenge?
What else do you think I should I talk about next time?
I have worked with several NGOs, as well as in hospital, clinics and academia. In many of these places people are collecting AMAZING data from their programmes and projects. Data that I would love to get my hands on to analyse. Unfortunately, in most of these places, they are also collecting these amazing data either on paper or on a spreadsheet (e.g. Excel).
This is frustrating for me for a number of reasons. First, in many cases there is a lot of wasted time and effort, as much of this data is never analyzed. Second, people often don’t realize how precious this data is, and the risks entailed by collecting them on a spreadsheet or on paper. Third, I am one of those people on the other side of the equation, receiving that data for analysis and usually having to deal with the data collection shortfalls.
Let’s be clear here. I’m not waging a war against Excel or any other spreadsheet for that matter. They are highly useful. I use them for a number of things, but they are just not meant to be used for data entry.
So let’s talk about why collecting your data on paper or on a spreadsheet is a bad idea and what better tools you could be using instead.
Data captured and not analysed is a waste of time and effort. Data captured on paper, if it is to be analyzed at all, and thus become useful, will need to be computed manually or be typed into a computer. Both options are inefficient, time-consuming and repetitive, so you want to minimize the time your team spends doing this. I’ve talked with many people in charge of data capturing and they are rarely if ever captivated by they work (shocking!), they just see it as tedious and meaningless.
If you are using paper questionnaires or a spreadsheet with open text cells (that is, cells that allow any type of answer), people collecting the data can fill out their responses any way they want. And trust me, they will do it differently every day, and differently than their colleague. Some will write the date of birth as mm/dd/yyyy while others will use the format dd/mm/yyyy. Distinguishing between the two afterwards can become tricky.
In other cells or paper forms, if you don’t restrict the possible answers (which you CAN do in Excel), some will write “New York”, others “NY”, others “new york” and yet others “ny”. In a clinic, you may have three different names for the same diagnosis. Some will leave key questions blank.
Whenever variability is allowed, it will flourish. The problem with this is that some data may become unusable (if you can’t distinguish the correct date for instance), or will take a longer time to clean up. Result: precious time and effort wasted (and maybe some grumbling from your data analyst).
When data is captured by hand, someone has to pass it to a computer. This is a very common source of errors. When I analyse databases it can sometimes be easy to spot these types of errors: Entries duplicated or mixed up, impossible dates of birth (e.g first of january 2035), etc. A good aim in data collection is always to try to minimize your sources of error.
To understand the difference, let’s first talk about how a data-entry system works.
In programmes designed for data-entry, you capture the data in a “questionnaire” screen, where you only see the questions for the particular person or household for which you are entering data. The questions have a restricted set of answers to choose from (e.g. “New York” but not “NY” for instance). The data you capture in this way is saved in a “table”, that will look similar to Excel, but which not everyone can access.
In contrast, in Excel or similar spreadsheet solutions, you get to see the whole table of data, and you input the data directly into the cell you want. In many cases, you can write the answer in any way you like inside the cell. Thus, using a database instead of Excel results in “cleaner” data (e.g. just one name and not three for the same diagnosis), and it protects your data from mistakes, as access to the table data is restricted.
One of the worst things that I regularly see happening with spreadsheets, unfortunately cannot be fixed. Excel allows you to move/reorder columns or rows independently, which means that you could accidentally reorder the “date of birth” column, while forgetting to do so for the “name” column, resulting in names and dates of birth that don’t match.The problem is that many of these errors cannot be undone, as there is no way to trace them, so the integrity of the data can come into question when errors are evident at the time of analysis.
In most databases created by a data-entry system, the information in a single row, which normally pertains to the same individual (e.g. name, age, sex, etc), is linked together, so that this type of error is not possible.
By now, I hope you are wondering what you can use instead.
There are various user-friendly options out there for data-entry software these days. And many are free. Data collected in them can later be analyzed with your favorite statistical package (or even with Excel if that's your thing!)
If your organization has Office packages, you might want to try Microsoft Access.Two other options that I particularly like, and are widely used in health projects are EpiInfo and EpiData, which are freely available online and not very hard to set up.
For non-routine, small-scale data collection exercises you may want to try out Google forms or Surveymonkey. I’d be hard-pressed to find a more user-friendly option than these two. They are also free for small-scale questionnaires and you can send them out by email. A disadvantage though is that they are online-based, so you need an internet connection.
So what solution are YOU using? And are you happy with it? Let me know in the comments.
Contact me: firstname.lastname@example.org
Julia woke up that morning with a strong desire to stay home and don't go to work. She daydreamed for a while of calling in sick. As she prepared to go to the office, the dead weight feeling in her stomach increased as she thought of her upcoming meeting with her very temperamental colleague.
In the past few weeks, the tension with her colleague had been mounting steadily to the point where they barely said hi to each other in the hallway and tried sitting as far away as possible at meetings. This, however, did not prevent them from harshly criticising each other's proposals.
You might have been in a similar situation. Sometimes conflicts at work get so out of hand that you might even start dreading to go to work, or attending certain meetings, or having to work with a particular person.
Unfortunately, most of us notice conflict when it is already too late and it has already engulfed us. But the best way to deal with conflict is to prevent it from growing in the first place.
So how do we go about this?
We can use a health prevention model to think about conflict under a new light. Public health specialists divide their health prevention methods into primary, secondary, and tertiary strategies.
Primary prevention strategies happen a long time before any disease or accident has taken place. Examples include campaigns to keep people away from cigarettes or to use condoms to prevent sexually transmitted infections.
Secondary prevention strategies aim to reduce the impact of a disease or accident that has just happened. They can include airbags and seat-belts in cars which limit the damage in an accident. Or providing post-exposure prophylaxis treatment when someone has been exposed to HIV, to prevent the person from developing the infection.
As for tertiary prevention strategies, these kick in when it is already “too late”, with the aim of palliating the consequences of an accident or disease. Think of lifelong treatments to control hypertension or physical rehabilitation therapy after an injury.
So how can we apply this same framework to think about conflict and help us prevent it?
In conflict, we can think of primary prevention approaches as the techniques you employ every day to build trust and strong communication with your colleagues, your boss and your team, as well as your clients or beneficiaries. Saying hi, listening to people, being respectful, upholding your commitments, etc. If you don’t have any strategies in place to build this trust, then the chances of conflict arising will be higher.
Secondary prevention strategies are reflexes and tools you can develop to react quickly when conflict starts to brew and prevent it from building up. And tertiary prevention approaches are the strategies you can put into place when an ugly confrontation has already taken place, to heal your working relationships and restore communication and trust.
In this post we’ll focus on secondary prevention approaches, as chances are that if you are reading this, you are already dealing with some level of simmering conflict.
Cultures have been catalogued along a spectrum of confrontation that goes from confrontation happy to confrontation avoidance. If you come from confrontation happy culture, you might not have that much trouble speaking up immediately when something bothers you. If you come from a conflict-avoiding culture, you might, on the other hand, consciously or subconsciously try to avoid confronting the other person for as long as possible.
No matter your cultural setting, the first strategy in your conflict prevention arsenal is velocity. Don’t let conflict simmer. As soon as you start smelling trouble, act on it.
So how do you act on it?
Instead of responding by arguing or shouting, or on the other end of the spectrum, by digging your head in the sand, start by asking directly and politely to the other person what is the matter.
This looks something like “Say Don, I got the impression that you did not like my proposal at the meeting? Wanna talk about it?”. Speak from a personal perspective (i.e. your impression) and to avoid assumptions. Avoid insulting or antagonizing phrases such as “Say Don, why are you being such a jerk about my proposal?
If you went to the trouble of asking, then keep an open mind and a closed mouth while the person answers. Listen without thinking what you are going to answer back. Just try to consider the other person’s perspective for a moment.
When you’ve done your listening, answer from a “personal viewpoint” and not as if you owned all the truths in the world. Try to shift your perspective so that you think of Don as your ally in tackling a problem -the conflict per se- and not as Don attacking you personally.
This can look like “I see your point, my impression is that this proposal can help in X, Y and Z manners. How do you think we can make it better?”. This may help you in switching the confrontation from “you-versus-me” to “us-against-the-problem”.
If things have not gone well, you can still make something of this talk by making a polite request. A request is a respectful solicitation, made in a neutral tone. For example, instead of saying: “You always interrupt me before I finish talking. Stop doing it already!” (a complaint), you might want to try something like: “For our next meeting, I would appreciate it if you listened to my proposal until the end before providing feedback” (a request). The latter will probably be received more positively and thus have more chances of succeeding.
If things have gone well, and you’ve managed to shift the perspective and move towards a friendlier collaboration, it might still be useful to make a request that aims to prevent this type of situation in the future. For example, you could say “Going forward, I think it would be valuable to talk about our proposals before the meeting, so we clear up any misunderstandings beforehand. What do you think?”
Conflict at work is unavoidable, but a good toolbox of secondary strategies can help us feel more confident in handling it quickly and stopping it in its tracks. When this fails, it is time to bring out the tertiary prevention approaches, which I will cover in a future post.
In the meantime, I would love to hear your best techniques for stopping conflict early and constructively. Share in the comments below!
You might want to browse some additional resources on resolving conflict:
The Center for Non-Violent Communication teaches “Giraffe language”, one of my favorite strategies for conflict resolution. They have freely available material on their website
The secret of productive conversations, a post by Fred Kofman, VP of Leadership and Organizational Development at Linked In, is one of his multiple great discussions on conflict resolution.
In my book Build your Dream Team. Leadership based on a passion for people, I dedicate the last chapters to dealing with conflict constructively. I discuss conflict-solving strategies for interpersonal conflict, for acting as a mediator and for helping others with intra-personal conflict.
A friend of mine, let’s call him John, has a coworker whom he refers to as “my annoying coworker”. The annoying coworker is constantly interrupting John with questions or complaints. Sometimes he loses one or two hours of his work answering his colleague’s questions.
My colleague Maria has a related problem. She’s very good at what she does, so in less than 6 months at her new organization, she’s already receiving more advisory requests from colleagues than she can deal with. People ask her for help in analysing data, editing a report or commenting on a new project. While part of her work is advising colleagues, another part consists of working on her own projects and she’s lagging behind on these because of all the requests on her time.
Many of us have trouble saying no. We get numerous requests from our colleagues and coworkers and we keep saying yes, giving priority to these over our own projects. Sometimes we don’t even realize it. Tom comes to your desk and asks you if I have a minute, you say yes, of course, and after an hour you’re still helping him out. Lisa bumps into you when you’re walking back from a meeting and keeps you for 15 minutes in an impromptu hallway discussion.
The reasons we have trouble saying no are varied. It may be because we consider it our responsibility to help out, because we want to be liked, because we think it is important for our career success, because we like feeling useful, or in many cases, because we’re caught off-guard without an acceptable answer when asked for advise/support.
Whatever your own personal reasons are, these three simple solutions can help you regain control of your time and your priorities, without saying no, by having a pre-made plan to respond to requests on your time:
Compartmentalize time for others.
If part of your job entails helping/advising your coworkers, creating adequate time “compartments” for these activities is a life-saver. Working with people is an activity that can bleed-out and take up your whole day if you don’t box it in.
In the case of Maria, for example, she started creating time-slots in her calendar reserved for her advisory activities. The next time a coworker came to her for help, she said “Yes, I would be happy to help you, I have a free slot next Tuesday that I can reserve solely for you, so we can focus on your problem”. No need to say no, just a qualified yes.
Say yes, but later.
For the “Do you have a minute?” interruptions, assigning a time-slot three days later may not be a good option. A better answer may be: “Yes, I can come and see you in 10 minutes once I finish this urgent task/email/article/call”. And then make sure you make good on your promise and call back/go see your colleague.
Build in slack.
No matter how good we become at saying no or qualifying our yes, there will always be times when saying no or even yes but later is out of the question, for example when the boss needs something right away, or there’s been an important error that needs to be fixed immediately. If this happens often, you can make sure you include “slack time” in your calendar to attend to these situations without letting them destroy your carefully planned week.
Just to be clear, these solutions are not a substitute for learning how to say no. Saying no to other people’s priorities on our time just means saying yes to our own priorities. Yet in many instances, it will be important for us to help or advise others, and in these cases the solutions proposed here can help us say yes while still maintaining control over our schedule.
Let me know in the comments below which of these strategies you’ve tried and suggest your own too!