The Challenge of Tomaro

The boat pitched and rocked in the waves of Lagos’ harbor. The seven of us huddled together inside and peered out as our pilot guided the craft towards our destination. On the starboard side we saw a verdant island come into view. From a distance it looked beautiful, with a lush cover of vegetation. As we drew near we started seeing the dilapidated shacks and the half-completed buildings and the kids running around barefoot. As we approached the “beach,” on that early September afternoon, we saw an excited group of kids and adults gather to welcome us.

This was our first encounter with Tomaro Island - an island, and its community, which would grip our imagination and consume much of our free time over the next 19 months.

We were here to conduct the first of many medical clinics, under the auspices of our Regional Medical Officer (RMO) and her team of nurses. I heard of this trip, within a few days of my arrival in Lagos, and grabbed the opportunity to go along for the ride and for a chance to practice my rusting EMS skills.

That first clinic was an eye-opener. We were expecting about 50-100 patients. We ended up seeing and treating over 300. We went in thinking of some rudimentary infrastructure to assist us, but came away knowing that this island had none. We learned along the way that this island of 30,000 residents, 10 minutes by boat from the U.S. Consulate in Lagos, had not had any primary medical care in over 18 months.

This fact more than anything else gave the initial impetus to an idea that would germinate over the course of 19 months and result in a 1-room clinic being built to serve this under-served community. A building that would serve as a base for future medical camps and for involving the local medical community in some sort of semi-regular visits to the island.

From the start, one of the elements of success of this initiative was blissful ignorance. If I had known all the challenges we would face and the difficulties we would encounter, this project might never have gotten off the ground.

The next few months were a whirl of activity -- writing a grant proposal to the J. Kirby Simon Foreign Service Trust; figuring out the myriad challenges of mobilizing materiel (cement bags, steel bars, wood) to the island; and, getting enough volunteers energized behind this idea. The key, however, was to get the rather apathetic island community involved in this project; i.e., get them to build along side us so that they viewed the clinic as their own.

Inspiration came in the form of the U.S. Navy. Knowing the penchant for island residents to be seen in the local media as partners of the United States, I heard of a visiting U.S. Navy ship that was planning a visit to the island to paint the local school. Sensing an opportunity, and knowing that our Consul-General was likely to attend, I arranged for a meeting with the island Chief. That meeting, led to a formal exchange, and resulted in promises by the Chief to set aside land for the clinic and assure support in the construction.

In the beginning, we didn’t spend too much time thinking about the how, but focused on the what. We got our resident OBO team involved in designing a 1-room building (this had the unintended consequence of introducing us to a key volunteer, Smart Ajayi, who proved to be the single most valuable contributor to the project); we got our Management and GSO offices involved in planning the complex logistics of using Consulate boats during off-peak times to transport materiel to the island; we got our Regional Security office involved in granting access to, and providing security for, our island trips; we got Mission leadership excited in this outreach effort; and, most importantly, we coalesced around a core group (Prasanna Arvind, Dr. Jan Flattum-Riemers, Smart Ajayi, and myself) that would stay focused on the goal, as many, many other volunteers would pitch in to help over the course of the next several months.

The movement of materiel took much of the summer of 2011. Multiple trips made by local employee, Smart Ajayi, not constrained by security restrictions, ensured that materials got delivered to the island in time for us to start construction in the Fall of 2011. Wanting to involve the island community in every phase of this project, we also communicated a list of requests that resulted in assurances that a foundation would be dug and cement blocks ready by the time of our first visit in August.

It was a scorching hot day when Dr. Flattum-Riemers, Martin Thomen, Smart Ajayi and I landed on the island to start construction. And, we found … nothing. No movement. Nothing we had planned for had been completed. There was no foundation dug, no steel bars bent, and no cement blocks made. How could this be?

We later found out that the long history of undelivered promises similar to this one had inured the island residents into inaction. They were waiting to see if the Americans would appear before beginning any work. This was my first indication of the challenges we would face in involving the community in the construction.

But, first, we needed a hole to be dug … and fast. And, so we jumped in literally. With no real tools, we started digging in the dry sand, some times with our bare hands. Our indefatigable RMO jumped in and started digging. On seeing this, the island men, who were standing around looking at us, became mortified. They quickly joined us and we had a “crew” going. I asked one of them later, what had prompted them to join in; his response: “we could not bear to see a white woman dig a hole for our clinic.” I was amused at this, but also encouraged, as this was the first time I had heard the word “our” used in the context of the clinic.

At the end of that first day, we had barely completed one-third of the foundation hole. As we made our way back to the Consulate, the overwhelming feeling was one of despair. How were we ever going to complete this project at this pace and with this virtual non-involvement by the community? But, progress we did; in fits and starts over the next several months. We begged, cajoled, and persuaded several islanders to work on the project in our absence. And, they did.

We planned a trip every month or so and were heartened to see a slow, but steady, rate of work. Still it took another email requesting for assistance and an infusion of a small, but enthusiastic, group of volunteers to push towards completion. We just had one more hurdle to cross.

From the beginning, I was quite sure that all the accounting needed to be transparent and thus maintained a spreadsheet with every transaction recorded. I shared this workbook with the core team often and with others who requested it. We were fast approaching the point where the grant money was running low and we needed a couple of thousand dollars more to complete the building. I sent out an email to the Consulate community (both American and local staff) reporting on the clinic’s progress and asking for donations and was amazed at the immediate response. Within 10 days of the initial ask, we received more than $1,800 in donations and pledges – many of them smaller amounts from locally-engaged staff who wanted to be a part of this “local” initiative.

Heartened by this show of support, we planned and successfully completed 3 more trips to the island finishing up work on the walls, roofing, and the final painting. We also met our goal of involving the local community in the construction and celebrated by having a group of workers join us in placing their hand-prints, in paint, on one wall of the clinic – a sort of partnership signature of all the American volunteers and local workers.

Having completed the clinic, something I had dreamed of doing for many months, I thought my single biggest feeling would be one of relief. However, it was quite disconcerting for me, standing in front of the completed clinic, thinking about how this was just the first step in a long, yet still unknown process, of bringing medical care to the island residents. Instead of relief, all I felt was this feeling of how much more work needed to be done.

In reflecting on this over the next few days, I realized that such is the quandary of development work. For every step we might take towards meeting a particular need, a thousand other needs show up wanting attention. But I also realized that we can let ourselves be drowned in this ocean of need or focus on a single need over a particular period of time, meet that need, learn from it, and move on to other (bigger, better) needs.

The broader lessons I learned from this singular project are not unique to the Foreign Service, but probably instructive on how to approach future, similar projects:

• Get behind something you are passionate about and champion it; every post has needs; find something that resonates with you. This has the unintended consequence of making a challenging tour more palatable and even exciting.
• Set a bold, clear goal and communicate it widely – even if you have no idea initially on how exactly you will achieve it; the resources will appear.
• Get a diverse group of people involved early on and share in the success widely.
• When stuck, don’t be afraid to ask for help – the worst answer you can hear is “no”; the most likely answer will be” let me see what I can do to help.”
• The Mission is wide and deep – don’t be afraid to walk in to a section you have never been to and communicate your need – again, you might be surprised by the answers you hear, and the assistance you receive.
• Get leadership involved early on – once they commit early on, they will back you all the way to the finish line
• Realize that most people want to help; all they want is clarity of purpose, a clear finish line, and assurances of integrity and transparency.

As an Entry Level Officer (ELO), I often wondered during the Tomaro Island project, if I was crazy to grapple with something this big. The many challenges that presented themselves, some of them seemingly unsolvable by a mere ELO seemed almost too much at that time.

But, looking back now, the unequivocal answer is that this project provided great opportunities. It provided me with an opportunity to understand how a Mission works and how to bring diverse groups of people together towards a common goal. It also afforded me the luxury of making some crucial mistakes in a non-work setting (and to learn from them). And, finally, it made me realize that this Foreign Service that I am a part of is made up of caring individuals with a broad world-view who are willing to set aside personal differences to work towards a common, compassionate goal.

And, that, to me, is a resounding affirmation of this career choice.