Festina Lente - "make haste slowly"...

Two weeks ago, I found myself once again, sleeves rolled-up, in front of a large crowd of almost 200 collaborators across the TB and HIV program response space in Nigeria. We were at the “IHVN TB/HIV Integration Bootcamp”, and I had been asked to help guide and facilitate what was to be a very rigorous week-long engagement of stakeholders who had converged at this workshop to find feasible and immediately demonstrable opportunities to implement an integrated TB/HIV program.

While there have been several instances in the past referencing this approach to addressing these two very closely related diseases of public health interests (with both epidemics feeding off each other), the IHVN Institute of Human Virology Nigeria grant under Global Fund’s GC7 round of funding to Nigeria, is really the first time, one implementing partner has been saddled with responsibilities for delivering program outcomes in response to both diseases as well as developing appropriate models of jointly leveraging the common resources (health workers, data systems, commodity supply chains, laboratories and community demand creation efforts) of both programs to address the population health needs.

As contentious as the issues we deliberated were, the bootcamp ended on a very positive note, with very clear agreements and recommendations and I am very happy that we were able to resolve a lot of the major pain points for the stakeholders at the “bootcamp”.

Many of the stakeholders who approached me after the meeting, apparently very impressed with how I had managed the rigorous sessions, which on many occasions, appeared to be on the verge of breakdown, had challenged me to reflect on how I and the other co-facilitators, had so successfully managed the discussions and document our process if I could. I have ruminated over this request since the meeting, and I have arrived at some recommendations on how to navigate difficult conversations with skill and confidence. It requires a combination of preparation, empathy, active listening, and clear communication.

1. Preparation: Before the conversation, take time to understand the issues at hand. Identify your objectives for the conversation and anticipate possible reactions from the other parties involved. Before the meeting and at the end of each day, we met as part of the planning committee to deliberate on the discussions of the day, how things evolved and how we would proceed the next day. Having clear objectives and evaluating our progress on a day-to-day basis, helped a lot.

2. Start Positively: Begin the conversation on a positive note to set a constructive tone. This could be by acknowledging the other person's perspective or expressing your intention for a productive dialogue. We were very intentional about hearing all of the conflicting viewpoints and then, taking from them, what was common and giving every collaborator a sense of belonging and self-worth.

3. Break up the discussions: Use group work session to break up the discussions and allow people enter their "expert rooms" for deeper reflections, exchange of ideas and consensus building by committees of expert. Let group members lead in the areas they know best.

4. Empathize: Show understanding and empathy towards the other person's feelings and perspectives. This can help to build trust and open lines of communication.

5. Listen Actively: Pay close attention to what the other person is saying. Avoid interrupting and ask clarifying questions if necessary. This shows respect for their viewpoint and can help you understand their concerns better. Even when commentators make long speeches to narrate their contributions, paraphrase and summarize what they said to reassure them you were listening and to help others in the room, connect to the points that had been made, so everyone remains on the same page.

6. Communicate Clearly: Be clear and concise in your communication. Avoid using jargon or complex language that might confuse the stakeholders. Be intentional about clarifying terminologies and ambiguous statements and establish working definitions for the discussions if necessary.

7. Stay Calm: Difficult conversations can sometimes lead to high emotions. It's important to stay calm and composed, even if the other person becomes upset or defensive. Use laughter and jokes to douse tension and maintain a positive outlook by reminding everyone that we are all working towards the same objectives.

8. Seek Resolution and be flexible: Aim for a resolution that respects both parties' needs and concerns. This might involve compromise or finding a new solution that wasn't initially considered. Also, remember that it is okay if a resolution isn't immediately found. Sometimes, difficult conversations are the start of an ongoing dialogue. The key is to maintain respect and openness throughout the process. Agree on a bit of trial and error and revisiting the discussions if agreements do not work out as expected.

From the above, it is clear to see that we have to commit the time and encourage others to do so too. If time does become a major constraint, then re-evaluate what can be achieved within the available time and plan to continue the conversation, at another agreed time. As our great friend, Dr. Ntia Nsikak Ntia emphasized in his presentation, we must remember to “make haste slowly (Festina Lente)”.

Special thanks to Margaret Shelleng Oluwafunke Odunlade (Ilesanmi), MBChB, MPH, mMBA Dr. Lawal Bakare Nsikak Ntia Akinwumi Fajola Tajudeen Ibrahim Obioma Akaniro MD Mojisola Mobolaji-Bello Olayemi K. Olupitan Ronke Agbaje Charles Mensah. PhD, MBA. FCA, CPA, CGMA, MACHE UDUAK DANIEL Gabriel Undelikwo Margaret Zamzu for the excellent collaboration and the opportunity.