Taking ‘flow’ time, to build deep and wide expertise.
Slow fixing value, in the eye-care value chain, across East Africa.
Early morning on the first of January 2014
I had just about an hour long ‘long distance call’ conversation with my sister in law Naomi Nsubuga
She had called to wish our family well for the year head. I was taking it easy musing on what 2014 might look like. Naomi was three hours ahead of me in Kampala. Apart from her work for the Brian Holden Vision Institute she is involved in helping to run the family business EdMa Country Club located just outside Kampala in Kiteezi.
The festive season is one of the busiest. I had taken an hour of her time, it was only after we wrapped up our call did I realize ‘schucks!’ Our conversation possibly took her away from colleagues, family and friends whom she was with.
Comparing notes in context of recent work in Dublin
On reflection our conversation felt like an unplanned but appealing discussion about issues Naomi and her team are addressing as they deliver their work. Perhaps we unwittingly needed to bring 2014’s priorities into sharp relief. Alongside inspiring colleagues in Dublin (and by Skype in Nairobi) we are currently involved in a ‘research and product packaging development for export’ project with Value Added in Africa .
I was still reflecting on how a project team(whom had never worked together to a creative brief in one location) with facilitation were receptive to context and process that embody consumer profiles; how we tapped into a group absorptive capacity in order to visually interpret these profiles as mood boards then translate them into sketch ideas and rapidly evolve prototypes (that is a story for another day) in three days.
I am almost convinced about ‘creative-flow’. I may be wrong as i don’t have scientific facts to back my assertion. It has happened too often for one to ignore it. A few days later it occurred at a design thinking and innovation workshop I participated in facilitated by Juliana Goga-Cooke.
In both instances “creative-flow’’ underlined by structured facilitation stimulated rapid prototyping, informed by multiple perspectives. In Dublin between South Korean, Surinamese, American, Kenyan and Irish colleagues. I was reminded of Malcom Gladwell’s thinking in Outliers . What part does the influence of diverse backgrounds and pre-conditioning for creativity play in shaping each person’s mind-set and receptivity to new ideas? The idea that many hours of practice (deliberate or unwittingly) might have shaped their receptive thinking styles as well as their aesthetic sensibilities continues to intrigue.
It also gave me pause for thought hmmm ‘how might a transnational co-creative base support value creation with partner clients, across parts of Africa? In this respect from a cross cultural project management perspective it helps to listen curiously to professional colleagues who are at East Africa’s operational coal-face.
Back to Optometry
Naomi says “..The main challenge we face is a lack of trained personnel and low vision services. Until recently, Tanzania was the only country which recognized optometry. The latest countries to progress in recognizing optometry are Ethiopia and Uganda, with Uganda ending the final stage of a long and arduous five year battle...”
It helps to put this in context. The World Health Organisation (WHO) estimates 150 million people suffer from defective eyesight that could be prevented, pre-empted and or rectified.
The social productivity and economic impact of poor sight, poor access to eye-care expertise and responsive value chains (with functioning health, local manufacture and training structures) is significant in any economy. In economies with large rural demographics people with poor vision subsist on budgets preventing them from accessing the value in the ‘eye care value chain’; preventable eye diseases like trachoma prevail.
How might challenges within the eye-care value chain be addressed?
The Brian Holden Eye Vision Care Institute provides a base for its Africa regional teams to slow fix the eye care value chain, with a diverse set of interventions. Naomi and colleagues across East Africa are responsible for some of this interventions.
Huala’s blurry experience relative to where her eye glasses came from
Interventions range from Train the Trainer programmes to developing expertise and outreach capability across Uganda, Tanzania, Kenya, Rwanda and Ethiopia. Eye-care examinations, ability to make referrals necessary to address complex and or complicated cases is gradually becoming scalable. Work is underway in partnership with local public sector health, education agencies and international partners such as London Tropical School of Hygiene to identify eye care problems through the education system amongst children such as Huala.
“Haula is a nine year old school girl with a story that is sadly quite common. As told by her concerned father, Kato, whenever his daughter came home from school, she would complain that she couldn’t see the words written on the chalkboard. More alarmingly, he said one day she described nearly being knocked down by a motorist on the road. “At that point, I realised she was going blind and needed urgent help,” he said.“Her performance in class was not good. I took her to Mulago Masaka Regional Hospital eye department for her eyes to be tested. According to the eye doctor, Haula needed a very high prescription. She was given a pair of glasses to help her eyes see clearly and her performance at school has greatly improved. I no longer worry about her being run over on the way home”
The components for Huala’s glasses are manufactured offshore for assembly in East Africa. However should the eye-glasses need complex specialized production methods or advanced assembly perhaps Brian Holden Vision Institute East Africa might want to consider owning an eye-wear production facility.
China is a starting point at the moment. For Brian Holden Vision Institute to make its own products ‘in-region’ they will need to develop and manage all variety of complex pieces with local expertise.
There are a number of reasons why Brian Holden Vision Institute might want to develop their eye-wear products using locally available skills and materials. Many of these reasons can be compelling to people like Naomi Nsubuga (and her colleagues) who are motivated by constructive social impact. A few items to consider:
1. Forging responsible partnerships with an internationally diverse crowd of open-innovators and change-makers such as InnoCentive. In my view thought experiments are needed to unlock the potential in process mindful individuals who could evolve local approaches to product development for manufacture (with Brian Holden Vision Institute’s international network, this is probably possible).
2. Providing students plus professionals with change maker electives within the Optometry programme being set up at Makerere Universtity, Kampala.
4. Local fabrication avoids the need for import taxes and cumbersome customs, lowering the price of eye-glasses.
5. Sourcing components locally allows Brian Holden Vision Institute to support East Africa’s economy while ensuring that each eye-glasses can be repaired and serviced using available skills and materials.
5. A fully integrated local design for manufacture infrastructure frees Brian Holden Eye Vision Institute’s East Africa operation from the necessity of managing cost complicated eye-glasses production chains offshore. It could potentially decrease the size, complexity, and operating cost for Brian Holden Vision Institute as well as the cost of eye-glasses and associated components.
What to do when most countries in the region simply do not have the vertically integrated eye glasses manufacturing capacity required to make complex or semi-complex eye-wear products?
Enter the Siemens Siftung Award
I found all the responses to this project brief interesting. One — The One Dollar Glasses, whose development provided a platform for a proof of product development process concept — in particular addresses the question: how might we design an eye-glasses product development process, in an East African context?
The OneDollar Glasses project as an intervention is one dimension of what the eye care value chain might look like:
“The OneDollar Glasses are manufactured on bending and milling machines specially designed for this purpose. The spectacle frames consist of a lightweight and flexible frame made of extremely robust, rustproof and hypoallergenic spring steel wire (1 mm). The frames are manufactured by hand on a bending device which does not need a power supply.
Different physiognomies can be taken into account individually when bending the frame. The elliptical polished, unbreakable lenses are given the notches and steps for fastening in the spectacle frames on the milling attachment and can be inserted in no time. This milling machine can be operated via a decentralized power supply thanks to the low power consumption (generator or solar station).
Heat-shrinkable sleeves made of hypoallergenic plastic on the ear piece ends increase the wearing comfort of the glasses. Because the glasses have very little weight, they do not require nosebridges. Two coloured glass pearls give each pair of glasses its own personal design’’ source: Siemens Siftung Award
I view the entry team’s work lead by Martin Aufmuth as much a scalable entry by growing capability as it is an approach to slow fixing the value in the eye-care value chain across East Africa.
Where does flow seat in this equation?
I think a mechanism for unlocking people’s innate ability, at critical mass level, is necessary to build deep society wide know-how. This is where Mihaly Czikszentmihalyi musings about, “What makes a life worth living?” could be penny for our thoughts.
Might flow have anything to do with our ability to exchange productive ideas, absorb expertise and know-how whilst being influenced cross-culturally?
“…trying to understand what made them (creative people: scientists and artists) feel that it was worth essentially spending their lives doing things for which many of them did not expect fame and fortune, but which made their lives meaningful and worth doing…a kind of passion that comes from doing the best and having flow while you are working….to your heart’s content. You feel part of something larger than yourself”
It has taken roughly about ten years for Optometry in Uganda to get to where it is today from having just three Optometrists during its early days. Naomi and her colleagues with Brian Holden Vision Institute as a platform from those early days qualify as people who feel part of something larger themselves.
The first optometry school in Uganda, at Makerere University, running a little behind schedule is on course to open later this year, as a capability development facility. The idea is to position the school an integrated part of the eye care value chain. A learning environment where professionals are encouraged across the eye care value chain to build whilst thinking in anticipation of current and future eye-care needs of Uganda and East Africa. This is a result of close to five years to slow-fixing hurdles peculiar to Uganda.
“I believe that the only way forward for eye care in East Africa is to generate awareness within the industry, educate students and optometrists on the importance of their work. I mentor young optometrists providing them with a real life context of the greater issues our communities face; this way optometry in this region has ambassadors to lead us into the future.” Naomi Nsubuga O.D.
Imagining synergies on behalf of two people (Naomi, Martin and their networks) who might not have met each other but share know-how, experience and a philosophical position, it just might be loaded with possibilities that have a long-view .
