Groupe de champs
Complexity theory

I remember a public health colleague once saying to me “Know what it is that you do, and be able to sum it up in 1 minute when asked”. Yet the report I submitted this month was 19 pages long, and I’ve just not been able to cut it down any further.

I remember a public health colleague once saying to me “Know what it is that you do, and be able to sum it up in 1 minute when asked”. Yet the report I submitted this month was 19 pages long, and I’ve just not been able to cut it down any further.

Basically, the programme has three main elements: Paediatrics, HIV and Women’s Health; but each is going through a transition of one kind or another.  In paediatrics we’re in mid-transfer from the MSF hospital (Bon Marché) to the Government Hospital. As regards the HIV, we’re working on building capacity in the hospital and trying to procure reliable drug supplies, whilst tailing off our own programme.  And for women’s health, we’re reducing certain activities whilst setting up a new programme offering comprehensive care for victims of sexual violence, which will ultimately be delivered by 2 local NGOs with technical support from MSF at the inception phase.  Combine this with the security reports, the construction of a new paediatric block and installation of a water supply in the hospital, the administrative workload involved in laying off 120 staff, and the occasional medical evacuation – and 19 pages feels scarcely sufficient.

These 19 pages reflect 2 characteristics of our programme that are much less salient in the work of a doctor – scale, and complexity. (Yes, I tend to compare everything to the work of a doctor, because this is my reference point, the work I know best). Having to deal with several hundred staff and several thousand patients may not seem a challenge to a public health worker, but as a clinician I never see more than 10 staff and 40 patients a day. And although people, and medical consultations, are not easily predictable, with time one tends to develop an approach - a way of being, communicating, and reasoning - that allows one to take each new consultation in one’s stride. The process of taking a history, examining, making a diagnosis, and formulating a treatment plan is more or less universally applicable. Here, by contrast, we are dealing with complex systems – structures with so many variables (so many of which seem unknowable) that it seems impossible to predict what will happen next, which partner will suddenly see a cut in their funding and have to pull out, how political factors will influence the turn of events. And since every event, no matter how subtle, has the potential to change the system, a report must logically cover everything there is!

So, I congratulate our team on writing this concise 19 page report. For it represents a brave attempt to sum up complexity in (just over) a minute.