Remote control

Controlling remote management…. managing remote control….

Controlling remote management…. managing remote control….

Remote management is a term I read in my job profile before I accepted this job. As I understood it, through direct translation of English to English, it meant that from a distance I would support and supervise the nursing activity in my project. The rationale for this was explained very clearly and I knew fully what I was signing up for. But I didn’t have the insight to know just how frustrating it would be.

According to, the term remote management is used to ‘describe any process in which the controlling device is not physically attached to the actual unit’. Yep that sounds like what we are doing… The website goes on to say there are ‘four aspects to remote management: communication method, level of control, operator training and performance issues’. Aha! I can identify with these components…. And finally… ‘the primary reasons for implementing a remote management system are to improve safety and increase productivity’. It’s with this reasoning that I’m not so sure

Now admittedly this website is referring to remote controlled machinery in relation to mining, construction and transportation etc, not health care, but the comparisons are uncanny. First let me explain why I’m talking about remote management at all.

For the last year my project has been run from Islamabad – more than 1000kms away from my actual project site. Unfortunately a year ago, bureaucratic impediments restricted travel for foreigners to areas such as my project site. Our expatriates were not given extensions for their visa’s. Without these visas it was not possible to get the travel permit necessary for travel within Pakistan. As a result remote management started – but note this does not match with the above mentioned primary reasons for starting remote management. With the goal of enabling the project to continue - in effect, increasing productivity (see above) - MSF continued this project from a distance. That is all our national staff work in the project and the expatriates are based in Islamabad.

This is not the sort of decision MSF takes lightly. One of the core components of our identity is to cross borders to assist people in severe distress. To go where others don’t or can’t… and this year’s Field Association Debate (FAD) discussed this ethical question at length. By making decisions, such as moving my project to remote management, are we eroding an important part of our identity? Should we leave such places rather than compromise our values? Can we justify it by saying it happens because we want to access neglected populations in highly insecure contexts? Can we justify it by our achievements?

The project is achieving a lot. Last year MSF assisted with 2,725 babies being born, 446 newborns were admitted to the nursery, 142 children admitted to the paediatric ward and 865 into the therapeutic feeding program as well as thousands seen in the emergency room and outpatient consultations.

A few weeks ago I participated in the FAD. Two days, three association members, five expatriates, about 35 national staff and one major discussion. I think all of the participants were frustrated by remote management but I was pleasantly surprised to also find high motivation to continue in such a system. Unfortunately, because remote management occurred very quickly in our project there was little chance to prepare the national staff who remained in the field. Some staff immediately stepped up to roles of supervision and management, but without the opportunity for close guidance and support one would ideally receive. Now, instead of feeling frustrated by such a system my colleagues are looking for ways to improve it. They acknowledge the need for more training and stronger supporting systems but they are excited to keep trying to achieve positive outcomes in such challenging situation. I wonder if we hadn’t entered into remote management would we have recognized or utilized this untapped potential?

So looking back at’s four aspects of remote management:

1. Communication method

I have only phone contact. I can skype some of my staff but no photos or videos of the facilities or patients means I cannot see the babies I am supporting the treatment of… Please, any advice you have, I would love to hear. I ask on the phone “what colour is the baby?” trying to ascertain if the baby is jaundiced or has enough oxygen. The answer I get ranges from pink to yellow to blue and all shades in between. But is the pink described to me the same pink I imagine? I try to picture how a premature baby in an incubator is able to remove its own naso-gastric tube. Is the baby really that active? Or was the tube tapped incorrectly? It is as if I am blind. The few times I have met staff from the project site I feel I have learned more in 5 minutes of face to face conversation than I can in a week over the phone…

2. Level of control

Sometimes this system of working gets renamed remote control. I think of remote control cars that I played with as a child… I was never the most co-ordinated in manipulating these… I hope this is not transferred to my project management style. Most people embrace a certain degree of control in their personal lives and working styles. I am learning to let a lot of this go. We have to trust our staff and our systems but at the same time push to improve the quality and strive for better outcomes, but it’s hard to balance this push with the support that’s also needed.

3. Operator training

In remote management I think this is essential. Training, training, training. But then we need to find a way to ensure the skills learnt in training are then implemented, evaluated and further enhanced.

4. Performance issues

How do I know if a staff member turns up for their rostered shift? How do I know if they spend their working hours working and not playing games on their smart phones? How do I know that when they say they cannot get and IV cannula in it’s because of the baby’s condition and not because of a lack of skill? How will I be able to complete fair staff evaluations?

So many questions… It was never thought that it could take us so long to get back into the field and to return things to the status quo. It feels like at least once per week someone in the office will mention the improvements related to accessing our project – and it’s true, things are slowly moving forwards towards having an expatriate team back on the ground but we have to keep in mind we don’t have any way of predicting this progression and sometimes it feels like one step forward, two backwards.

One example – I arrived in the field under the impression of travelling to the field after two weeks in Islamabad. Unfortunately I missed this opportunity due to a number of factors beyond our control. However, two weeks later the situation improved so ALL the rest of my team went. On my birthday…. was I jealous? Yes!!!! Am I still jealous? Yes! Will I get over it? I’ll let you know… I had no visa so was no longer able to travel. I understand the reasons. But I also have to acknowledge the frustrations.  I’m working on Plan B of meeting some of my staff at the moment (fingers crossed).