Lowise's Bar & Restaurant and the glory of palm butter

I love everything about food. I like knowing where it comes from, how it is prepared, what ingredients go in a particular dish, the smells, the taste, the experience, everything. I should be morbidly obese considering my love for food, but I've managed to stay in shape because I practice mindful bingeing. It is a delicate balance of being cognizant of what I eat and eating copious amounts of food frequently.

I could be like most expats here and bring my own lunch (sandwiches anyone?), but I like to experience local flavor and explore. Most of my local staff eat at a place called Lowise's Restaurant (yes, that is how it is spelled). It is pronounced Louise. I have been eating at Lowise's for almost a month with no problems. I usually have someone fetch it for me because I am running in between meetings or buried in papers, but once in a while I walk over and eat at Lowise's. It is only a block away from my office. The restaurant serves only one special every day. They have the standard dish - dry fish and rice - and one daily special. I can never remember the schedule of daily specials, but I particularly like some of the specials. Cabbage with fish, and potato greens with fish are my favorite. I specify fish because if you don't, you will end up with a melange of meat in your dish. I have identified pork knuckles, beef rib tips, chicken feet, and fish heads...all in one bowl. As adventurous as I am, I prefer to eat one kind of meat at a time. I am not a big fan of beef, I prefer my pork in the form of bacon and pork belly, and I like my chicken feet in black bean sauce (dim sum). So, I stick to ordering my dishes with fish alone. Liberians tend to use almost every part of an animal, so expect to see fish heads, fins, tail, pretty much everything in a dish. Here is a picture of the daily standard dish - dry fish and rice. They say it is dry fish, but it is a whole fish, usually a snapper, deep fried and served with jollof rice. It is quite delicious, if I may say. Look at the teeth on that fish. One of my friends said it looks angry. Of course it is angry, it's been fried to death!

Dry fish and rice

Let's talk about Lowise's Bar & Restaurant. It is quite dingy, inside and out, but the food is good. Service varies by day. I have seen the same lady serve us patrons. Some days she is cheerful and makes small talk, some days she is just plain grumpy and mean. She looks young, talks on the phone a lot when she is not serving, and on some days her accent is difficult to understand. She adds charm to an otherwise dull restaurant. The music is always loud at Lowise's, almost to the point where you have to scream your order. I have suggested a few times they may want to tone it down, but they don't listen. Now I just scream my order. One of these days I hope to catch a glimpse of Lowise. All I know is that she is cooking in the back, she never makes an appearance in the restaurant. As the name suggests, there is a bar inside. It is quite small and they carry beer, water, soft drinks, and energy drinks. I don't drink at work, so I haven't tried any beer. Below is a picture of Lowise's restaurant. I have to give credit to Michael for taking this picture.

Lowise's  Bar & Restaurant

Today's daily special is palm butter. I have heard a lot about this dish since arriving in Liberia. Locals claim that, even though you can find this dish in other African countries, nobody makes it like the Liberians. Beautiful red palm fruits are mashed to create an oily sauce and meat is added. The mashing is done with hands, not a machine. Needless to say, it is a laborious process. As you may know, palm oil is very high in cholesterol. It is not good for your heart, but like most stuff that is not good for you, it is very tasty. The dish is called palm butter, because it practically is meat in a sauce that looks like melted butter. Very unhealthy but oh so tasty! I avoided it since arriving in Liberia because I am afraid of the fat content. I finally caved in and ordered it. I saw the table next to me order it and it looked and smelled delicious. My verdict: it is glorious, but too heavy for my arteries. I may have it once a year. I want to live long enough to visit various countries.

Here is a picture of the culprit. I scooped out SEVEN tablespoons of palm oil before taking this picture, and it still looks greasy. That should tell you how unhealthy it is. As mentioned earlier, there is some mystery meat in it because I forgot to mention "fish only". I was not able to figure out the meat, for all I know it is a part of a cow or Baboon (which is not uncommon here). Did I eat it all, including the mystery meat? You betcha!

Palm butter with mystery meat

In other news, Michael and I went to Miami Beach over the weekend. As I mentioned to my friend who lives near the real Miami Beach, the one in Liberia differs from the one in Florida in two aspects: amount of silicone and number of people. Usually it is just Michael and I on the beach, except for some days when someone brings their dogs to the beach (see picture below). There was a football (soccer for you Americans) match happening on the beach when we went, just a few guys kicking the ball around. We stayed for a while until the sun became intense and came back home.

Dog days at the beach

There is a bar on Miami Beach, which plays dance music at a deafening level all the time. As we were leaving the beach, the bar owner came over and talked to us. His name is Sunshine. I am not kidding. We didn't stay at the bar, but Sunshine invited us to come back again in the evening. One of these days we will take him up on the invitation.

A lot is happening on the work front. I got promoted as the Director of Capacity Building and Health Systems Strengthening in less than 2 months of being here. With promotion comes more tasks, drama, and the responsibility to supervise more staff. I realize it is part of the equation and I am thoroughly enjoying all of it. I will write more about work in the next post. Till then, cheers to palm butter!

What does it mean to build capacity and strengthen a health system??

The one question I have been trying to get answered, since I've been here. I may finally have an answer by the end of this month. I have to warn my friends reading this post: it is going to be all about work, no personal or fun stuff here.

Plato once said "the beginning is the most important part". I always believe the beginning of a project sets a tone for what's to come. One of the preliminary and major tasks of building capacity in health systems is to "define" what building capacity means for the recipient. Some call it developing a "vision". Whatever terminology you may prefer, the common understanding is that the recipient should be able to "define/ envision" what building capacity means for them.

My priority task, since I've arrived in Monrovia, has been to help/ guide/ persuade the Ministry of Health come up with an idea of what building capacity means for them. Why is this important? I'll give you another quote (I am full of these quotes today). To paraphrase what H. James Harrington wrote in Business Process Improvement:

"In order to strengthen/ change a system you have to control it;
in order to control a system you have to understand it;
in order to understand a system you have to measure it"

In my quest to strengthen/ change the health system in Liberia, I realize the need to measure it. Measurement requires definition. That is why I need the ministry to define building capacity and strengthening the health system. I could do it myself (I am thoroughly capable and competent), but I am not here to tell people what to do. I am not a dictator (although, in my spare time, I pretend to be one wearing a ridiculous crown). I am here to help, enable, and advise. So I proposed a few definitions and helped facilitate a discussion. We are making progress in coming up with a common vision.

Few days ago I delivered a talk to the senior leadership at the Ministry. It was well received, they were engaged in the discussion, and the best outcome - they agreed to finalize the vision for capacity building very soon. I am happy about this development. Now that I am gathering stakeholder participation and support - a vital component of strengthening a system - I am focusing on stakeholders at both central and county/ district level. The central ministry has heard (and got on board) with my strategy to build their capacity and strengthen the system, now it is the county and district health departments to get on board. In order to accomplish this buy-in, I will be traveling to the counties - Lofa, Nimba, and Bong - next week. I will present my strategy, introduce the instruments, and seek feedback.

The framework I am following to strengthen Liberian health system and build capacity is the WHO framework. It describes six building blocks that form the basis of a health system. Building Block 6 - Leadership and Governance - is the one that interests me the most. I strongly believe leadership capacity is the one that guides the other five building blocks. Allow me to share a diagram from the WHO framework

Six building blocks of a health system

As you can see, all building blocks work in unison towards creating/ strengthening a health system, but leadership is the one that guides other building blocks.

I believe we need strong leadership and a capacity to govern fairly in order to have a viable health system. Leadership is something that is lacking in the health system here. There are a few people at the central ministry who understand the importance of leadership and see the big picture, like Deputy Health Minister Yah Zolia, but leadership at county and district level is severely lacking. One of my objectives in building capacity for the ministry is to build their leadership capacity. I will be conducting an assessment of current leadership in the ministry - both at the central and county level - to identify issues that plague leadership. This assessment will help us develop a strategy to build leadership capacity.

Of course leadership is only one of the six building blocks of a health system. There are five other blocks for me to focus...and they will all receive due attention. I am using resources from WHO and CDC to create assessment tools for the Liberian ministry. These tools have been adapted and tested in other countries. I have first hand experience with these tools, having adapted and implemented them to health systems in Israel and India. I do not have to tell you that post-conflict systems are a completely different ball game. There are developed systems (US and most of Europe), emerging systems (India), and then there are post-conflict systems. There are not many frameworks/ instruments that have been developed specifically for post-conflict health systems, and that puts the burden on people like me to adapt existing frameworks to post-conflict settings. I like the burden because I like a good challenge. In the beginning I thought it feels like going back to the drawing board, but I have come to realize it is not even that. It is more like understanding that I need a board and pencils to draw, then embarking on a journey to procure the board and pencils before I begin drawing on a board. That's the level of  system in a post-conflict setting. Needless to say, it is challenging but extremely rewarding.

I have a lot of work ahead. We will start assessing baseline capacity next month and that will lead us to developing a capacity building and health system strengthening strategy. Analyzing the data and developing a strategy will take 2-3 months. We intend to start implementing our activities in June. I see a poetic sense of beginning because June is also the rainy season. To me, rain has always symbolized the beginning of a new adventure. It will be perfect for our adventure to begin in June.

I promise the next post will be not as dry as this one. I will add more personal and fun stuff, perhaps some pictures, for my friends.

...and the Harmattan winds blow

Last week was quite interesting... and spectacular in some ways. I haven't witnessed the beauty of Harmattan since I stopped living in Algeria and traveling in countries like Chad and Mali. I should say I forgot Harmattan exists. Well, I was reminded of the beauty of Harmattan last week.

There is nothing like it. I didn't know Harmattan winds blow all the way down to Monrovia. Imagine an entire city covered in a cloud for almost a week, only the cloud happens to be a dust cloud. It is eerily beautiful, but very discomforting simultaneously. The fine sand and dust in the air make it difficult to breathe, especially if you have allergies. The temperature falls, it is dry as a bone, and there is no sun for days. On one hand it is a good thing because you don't sweat profusely, but at the same time it is not a good feeling when you have to breathe dust.

They say entire cities come to a standstill because of Harmattan. Monrovia is not that dramatic, but there were a few flight cancellations. Still, nothing to put an entire city in a standstill. I wanted to take pictures but it doesn't matter because the pictures just look dark.

I am glad the winds blew away, because I was tired of not being able to breathe and see the sun. As hot as it is when there is sun, it is still better than being in a dust storm.

We are back to being sunny and hot again. This week is turning out to be quite productive and busy. Michael is adjusting well and he has seen more Monrovia in the last few days than I have seen in the last month. I am happy he is not a typical American expat shielded in his own bubble. More about work in the next post.

Happy Friday...Michael arrives!!

Michael arrives this evening. I am super thrilled. It has been 5 long weeks since I left him in Chicago. I was worried for a moment because all flights to Monrovia were canceled on Wednesday due to a thick haze. We haven't seen sun in Monrovia in 4 days. The entire city is covered in haze. It looks beautiful at times, and I am happy the temperature fell down because of it. No more sweating profusely.

It is funny that our air shipment and Michael are arriving on the same flight. It's funny because the air shipment left Chicago three weeks ago and we have been joking that it will get here at the same time as Michael, even though it is supposed to take 6-8 days to arrive.

Work is going well. I gave a presentation to USAID (where all our money comes from) yesterday about our strategy for this year. USAID invited other teams as well - municipal water, sanitation and hygiene, education, etc. The US government is the single largest bilateral donor to Liberia, so USAID is doing extensive work in this country - ranging from forest preservation to health care. Our strategy received the most accolades of all. Of course it did, I developed and presented it (bragging much?)! I am proud to report that other ministries in Government of Liberia look up to the Health Ministry as a model to follow. A good reason for that is the work done, and continuing to be done, by our project. You can say we are the flagship project of USAID health initiatives, not only in Liberia, but in similar post-conflict countries.

I am planning my trips to the "bush" (local term for rural areas). I should start traveling to Bong, Lofa, and Nimba counties in two weeks. I will be visiting Gbarnga (Bong), Voinjama (Lofa), and Sanniquelle (Nimba) - all county capitals. I might even take Michael with me, if he doesn't mind traveling through the jungle with bare necessities. I am going to visit health centers in these counties, introduce myself, and present them my strategy to strengthen their health system. I shouldn't be using ambitious terms like "health system", because what currently exists is bare bones. My goal is to build a viable system that sustains itself after most international aid disappears. You never know about aid money in the current economic situation, you have to be self-sustainable, at least to the extent of providing certain basic health services.

Anyway, that's my work update for the week. Tomorrow is a holiday in Liberia - Armed Forces Day. However, unlike the US, we do not observe holidays that fall on a weekend on a succeeding/ preceding work day. I was informed that if a holiday falls on a Saturday, you do not get Friday off. However, if the holiday falls on a Sunday, you get Monday off. It doesn't make any sense, just like a lot of other things in Liberia. So here we are, working on a Friday. I should take a hint from the Europeans and go on a strike for denying me a long weekend. I am more concerned that everything will be closed for two days. We already know everything shuts down on Sunday...and I mean, everything!! Now I have to add Saturday to the list because of this holiday. I better shop for groceries, water, beer, etc., this evening. 

Since I like talking about food, below is a picture of a local crab seller. The pic is not very clear, but that is him dangling a big beautiful blue crab. He stands on the street corner, a block from our house, and sells fresh seafood, whatever he gets from the ocean that morning. Some days it is blue crabs, other days it is fish. I have seen beautiful blue crabs and mega-sized tuna (at least 6 feet long). I cannot wait for our kitchen stuff to arrive in the air shipment so Michael and I can have some crab claws. Yeah!!

That's it folks! I will post more next week after Michael settles down. Have a great weekend!

My first month in Liberia

Saturday, February 4, was my one month anniversary of living in Monrovia. It has been a whirlwind journey. From being recruited to work on rebuilding the Liberian health system to getting married and moving across continents, it all happened very fast. One month I was shuttling between Chicago, Boston, and New York, and the next month I am in Liberia. Not on a visit, but to live here for two years. Moving across continents is not a new concept for me. I moved from India to Algeria when I was 11 months old, thus starting my nomadic life. Since then I have lived in 7 countries. This is another step in my nomadic existence. However, the main difference is that I now have a loving partner to do it with me.

Now I am here, in Liberia, a post-conflict country with a rich history that has been through a devastating civil war lasting almost 14 years. Liberians are resilient and committed than ever to rebuild their country under the leadership of President Sirleaf. Also known as Ma Ellen to the locals, the president is a Nobel peace prize winner with a great vision to rebuild Liberia. The United States government is the single largest bilateral aid donor to Liberia, which leads to the reason how I ended up here.

The US government's work towards rebuilding Liberian health care is contracted to a few development agencies. JSI Research and Training Institute, the non-profit arm of John Snow, Inc., is the largest contractor. I was recruited by JSI in December 2011 to rebuild/ strengthen the Liberian health system and build capacity. My prior work in other countries impressed them. Accepting the position meant moving to Monrovia for a period of two years. There you have it folks, that's how I came to live in Monrovia.

In the one month I've been here, I've met with all the senior management in the ministry of health, presented them with my strategy to build capacity and strengthen the health system, won approval of the Ministry and USAID for my strategy, found livable housing, and interviewed staff to work with me. It was all made possible with love from my partner, encouragement from friends and family, and support from my boss and colleagues. I truly cherish everything that's been given to me.

Health Minister Dr. Walter Gweningale speaking at an event where our project dedicated the newly rebuilt Tubman National Institute of Medical Arts to the Liberian Ministry of Health and Social Welfare 

February begins a hectic month of finalizing the tools I am proposing to assess current capacity of the ministry of health, and planning my travel to the "bush" - local slang for rural areas. I am looking to visit Lofa, Nimba, and Bong counties, where most of our work is concentrated. I have to hire three Capacity Building Officers to work under my guidance to build capacity and strengthen county health systems. And I have to submit abstracts for the APHA annual conference - my favorite professional organization. I am excited about February because Michael arrives this month. January has flown by quickly, yet it seems like forever since I left home and my beloved in Chicago. We will be reunited this weekend.

Internet in Liberia is highly unreliable and painfully slow. It is a glorious day when we get dial-up speed. I haven't been able to Skype reliably since I've been here and I have to downsize any pics if I want to email them. I would love to do a video blog, but it seems next to impossible considering the internet bandwidth. I have quickly adjusted to the food, or lack thereof, here. Most food in Liberia has to be imported because there is not much infrastructure to grow anything here, most of it was destroyed during the civil war. Almost all food is expensive, except for fruits and fish that you buy at the local market. There are 4 main super markets in town, all look like a glorified 7-11. Don't expect to find anything more than basics. I was told that I should be happy to have not one but two varieties of pasta at the supermarket. Since most food is imported, it shows in the prices. There are a few decent restaurants in town, most of them run by the Lebanese community, but I am yet to have decent hummus or kefta. I haven't tried all restaurants yet, but I am on a mission to find decent Lebanese food. Like most English speaking African countries, there is a sizable Indian community, although not as big as Kenya or South Africa. There is even a makeshift Sikh Gurudwara in town.

One of my favorite topics to discuss is food. I should weigh 300lbs with my love for food, but that's another topic altogether. Local Liberian food is quite interesting. Rice or fufu form the most essential part of any meal. Fufu feels like a thick ball of dough, made from the root of cassava plant. Fufu is usually served with pepper soup, which is a thin stew of different kinds of meat. Sounds delicious, but it may be shocking to some of us to find four different kinds of meat in one soup. Expect to find a chicken leg, a beef rib, some part of pig with bone and a dense layer of fat, and a fish head... all cooked in a spicy soup. Other traditional dishes I've tried: dry fish and rice (jollof rice served with a whole deep fried snapper), potato greens and rice (once again, multiple meats cooked in a sauce made of "potato" leaves), palaver sauce (different meats cooked in a onion and tomato sauce), and the worst of all torborgee (a stew made with red beans and different meats). Do you all see the theme here? Liberians put any and every meat the can find and cook them in one dish. Liberian food is a vegetarian's nightmare, there is meat (not the good kind) in almost every dish. I have come to like the potato greens when made with chicken or fish. You have to specify about wanting only one kind of meat (I ask for chicken or fish), and you will be ok. Otherwise, expect to eat different parts from different animals and fish. Like most countries in the region, it is difficult getting a decent cocktail. I have come to adapt to that as well. It only makes me appreciate a dirty martini more than ever.

I think this blog entry is getting too long. I have a lot to report and I will post another entry soon. Next time I will not wait a month to post an entry. I have to say I am truly thankful for the love and support from my family, friends, mentors and colleagues. I promise to stay in touch and keep you updated. In the meanwhile, enjoy a picture of my real back yard. It is called Miami Beach... I am not even joking.

Miami Beach - also known as my backyard in Monrovia