The Greatest Show on Earth

“We didn't reinvent the circus. We repackaged it in a much more modern way.”

Guy Laliberte

Sometimes the circus comes to town.  I used to see this more often when I was a child.  The posters were put up on fences and telephone poles announcing the lions, tigers, and bears (oh my). 

Once my mother actually took my sister and me to a circus in Honolulu, the city of my birth and early childhood, which was the billed as, “The Greatest Show on Earth.”  This claim would not pass the Federal Trade Commission advertising standards of today, and certainly didn’t pass the wow-factor even then for this 6-year-old. 

But, I do remember the excitement when my sister was bitten by a horse as she went round and round in the horse corral.  The horses were all old, a bit on the glue-side of life, and shouldn’t really have been interested in eating children.  The poor horse likely had cataracts, mistaking her bony leg for just the stalk of a corn plant.  I bet that he was surprised too and would have been heard crying in disappointment if not for the racket my sister made.  Diane made so much noise that my mother almost assaulted the guy operating the ride to stop the horses and to rescue her.  Diane had a “little” mark on her leg (not more than a tooth or two punctured her skin and then without the loss of any meat) and I don’t think this episode interfered with her subsequent equestrian career, which she chose not to pursue after all. 

Why tell you this childhood remembrance?  Not because I want to let you in on my sadistic thinking. The lesson to be learned from this digression is that circuses can be scary places which sometimes hurt spectators. 

In healthcare, professional consultants come to town on a weekly, daily, and hourly basis.  They too bring acts and animals along for us to see and enjoy.  Nothing is free, so we pay a lot of money for tickets to see these performances.  Often the consultant on parade is just of passing interest and fame.  This isn’t to say that all acts are short-lived as we know all too well with HMOs, Medicare, and DRGs.  But, do you really remember the sub-professional capitation financial arrangements (made in California) or the Joint Venture fever of earlier years to “align” physician and hospital interests (read: get the doctors to feed my beds)?  Now we are again looking forward to the newest show, the Hospital-owned Medical Group Model.  I think this act last came through town in the 1990s, causing a few hospitals lots of pain.  Sometimes the most captivating acts involve a little pain (remember my story about the horse that ate Diane’s leg?)

You will be heartened to hear that consultants are alive and well in the rest of the world.  Don’t get me wrong, consultants are very smart and talented.  Why, one or two of my best friends are consultants (I too did a little side-consulting over the years ;-)).  But, consultants operate in a world that is driven by the invective, “sell.”  To this end, the whole world is a possible buyer of consulting services when North American consultants (ringmasters without whips or chains) are on parade.  Why, North Americans represent the Greatest Practices on Earth! 

I now pay attention to the international healthcare market by reading more than just The Economist’s coverage of health, by talking with providers and reading information distributed here in the Middle East.  My caution about hiring consultants comes from knowing that native talent exists in country today at a fair price.  The real challenge is to identify the local and native talent, put them in the big top tent with really bright lights to perform.  I will watch and learn too.

Be careful and look out for the painful bite you may find in the circus tent.

Try Something New

Why don’t they just try something new?

So it comes to this, people don’t try something new. 

Until just now, I thought that change was difficult because not enough information and education had been provided to make the “changee” appreciate the value of trying something new.  (That’s right, Aristotle. Aristotle presents and defends the learning-by-doing thesis, according to which we acquire the virtues of character by doing the kinds of actions that are characteristic of virtuous people, just as we acquire a craft by doing the kinds of actions that are characteristic of experts of that craft.) After living and working in Saudi, it becomes clearer to me that trying something new is resisted because it involves giving up a known. 

Try this idea; turn off the car while you’re inside the building. Does it really matter that doing this simple act of turning off the car saves the company money on gasoline, or is it more important that the car remain a comfortable 72-degrees upon your return.  Given the 100-degree temperature here, it really is a big deal to have nice cool ride.  If you turn off the car, you can save yourself or your employer -- if the car is owned by the boss -- a little bit of money.  But, will the boss notice that pocket money you have contributed by allowing a little sweat to appear on your forehead, underarms, and below?  It is more likely that the effort is invisible to everyone except those lucky souls who get to sit next to you later that same day, and you will have suffered a bit too.

But this conversation isn’t about the weather here, although that, in and of itself, deserves a bit of airing.  It is about trying something new.  I have been trying to make things simpler in my workplace.  Why don’t we use the electronic imaging system to save documents instead of coping them into files, again and again?  Or, why is a multi-page paper memorandum used instead of the email system for communicating?  (We own all of this technology already.) People don’t understand when I ask about making better use of electronic communications and instead tell me about policies demanding original paper be issued.  Don’t think that I am suggesting that only the Saudi’s give me this story, as the expats are fully vested in keeping the status quo.  Maybe, just maybe, we could try to modify the policy to make everything a little simpler and cheaper?  Each time that a memo is lost or misplaced, the paper is dutifully loaded into the copiers (we own lots of these too) and sent by courier to another office, desk, and secretary to be read and stamped with a date and time of receipt in readiness for the reader.  So many people and hands in all of this processing must serve a function?  Or, the reality is that the process is just that, a known process.  Better to keep the routine and avoid the hassle of trying something new, at least for now. 

But wait!  Did I tell you that I tried something new today?  Restaurants here are sometimes a little scary.   Those eateries that make your eyes water and noise run are also the best places.  Today it was a place in on one of the souks that served a “traditional Indian” breakfast before a day of shopping.  What a wonderful new way for me to begin this day.

Next, camels…

I moved to Saudi Arabia seven months ago. This decision occurred after more than a two-year search for my first, and possibly only professional job out of the United States. The move -- actually packing my things, selling a car, and arranging for family to sit my home -- was straightforward. Calculating the economic impact of this move and career transition was done after talking with my tax consultant, wife, and family. (I did not mention the move to even my closest work colleagues. You know the old adage: Two can keep a secret if one of them is dead.) The new job would be an opportunity to take on new challenges and to experience life in a different way. (Like when I put on my Groucho eyeglasses and nose.)
My loving wife gave up a lot herself in agreeing to my wishes. (The teeny-weenie yellow polka dot bikini had to go.) After more than 18 years at a major university she quit her job and transitioned an only recently won research award to a colleague. Rightfully, Coralie didn’t know if she would be able to find a job in Saudi that would be productive and allow her to continue with her research activity. She did successfully secure a good position and is now busily setting up her laboratory and recruiting staff. She doesn’t know if her recent grant-writing efforts will result in additional funds to support her work, but she is hopeful.
I miss the routines of living in our California home. Life is different here. A lot of what we perceive as different is obvious. Cultural severity, social arrangements, and entertainment choices are not what we enjoyed at home. All of these things are different. Our friendships are few in number. New friends live near our home which is in one of the many housing compounds that are set aside for expatriate workers. And, we have been fortunate as we have been welcomed into the English-speaking embassies here to be part of their celebrations and events. (They’re laughing with us, not at us.)
I think one of my greatest disappointments has been the American embassy. United States representatives are not visible as they live behind thick gray walls guarded by disinterested and surprisingly rude employees. I only met an employee with an American passport a month ago, not at the embassy but at a social gathering in Riyadh. I am new at being an “expat” and can be easily surprised as life here isn’t as portrayed in the movies. Maybe that is good, depending on the movies you watch.
Still, it is shocking to find that America continues its presence in foreign lands by employing people who are not American. Imagine, waiting for 30 minutes in 100-degree heat to pass through security procedures to gain access to “my” embassy, then to find that no one was able to help me to register to vote. This employee spoke to me from behind a 3-inch-thick plate of protective glass. He told me that he had no idea how voting procedures worked and suggested I check a government web site. (“The bastard’s on to us. He knows we’re not really Americans. Always testing my knowledge of voting rights. Who do I look like, March Fong Eu?” )Do we really get what we pay for?
Now the new friends, all from Canada, England, and Australia have been truly supportive. Sometimes encouragement is offered with sarcasm. (“Yankee!”) I think the sour humor expressed by folks living under non-native conditions is understandable. Framing the obvious oddity and aggravation provides a sense of emotional release. (“Wedgies all around, my mates, for the American!”)
I know you likely don’t know this, but when you visit one of the local souks (a traditional shopping mall) in Riyadh, it happens that the major headquarters for the Mutawa, or morality police, borders the souk with a football field-sized marble yard known as “chop, chop square.” This area is where executions by beheading occur. So, the shocking nature of this type of execution has led to the graveyard humor of this not-too-artful naming of the location. And, everyone refers to this location in this way, even the locals.
Next, try something new.