We tried something new this weekend with Jasmine. We decided to have a camping trip, a feat we had not accomplished since our daughter had been born.
It was great to be back in the wild and enjoy the addictive feeling of freedom that comes with camping. We were proud to see how quickly we put up the tent. The first day of camping experience had kept Jasmine occupied. With few toys and limited access to the mobile phone, my daughter learned to find fun in everything around. Sand, sea shells, sticks were good enough to create an ice-cream. She even picked leaves to cover the cow dung, and a swell of laughter - hers - followed. Having spent a day of imaginative games, she got tired.
The clock's hour hand had long crossed eight, and my daughter felt her eyelids grow heavy. Everything turned dark in the countryside after the sun went down. I imagined that Jasmine would be snoring soon after snuggling down happily inside the tent. What I hadn't realised was that she might not be ready for the darkness in the wild.
"I want to go home," she whispered first and then repeated the sentence aloud. Tears followed. So we were telling her it's too late to catch the boat home, and I was starting to wonder if it was all worth it.
I'd tried to calm her down a couple times, but she was not having it, not one bit, not with the darkness outside her comfort zone, the cold outdoor camp, and her longing for sweet bedroom at home. We walked around and watched hundreds of stars lighting up the sky. She became fascinated, got quiet, listened, and forgot about the darkness. Then, half an hour later, when it was dinner time, she asked to count the stars with us. So we went ahead, amazed at the starry night.
"Good enough, and let's go home," Jasmine told me after we'd said good night to the stars.
"Go home? Now?"
"I mean the tent," she quipped with a smile.
Sunday, December 1, 2013
Tuesday, November 12, 2013
Habit
Sure, people always fall prey to everyday habits and routines. Most of us (and I must confess I count myself among them) keep doing the same thing - like looking too much at the mobile phone. It's the first object I reach for in the morning and the last thing I look at before bed.
It all seems so natural. Thing is, if you've read Charles DuHigg's The Power of Habit, there's a good chance you'll understand how a habit - like a parasite, only much worse - enters our brain and lives there.
The basic rule of habit is straightforward. It's a habit loop with three stages: the cue, which is a trigger in the first place; the routine, which is the behaviour itself; the reward, at the end, to satisfy the brain and guarantee that the loop is worth replicating. Straightforward idea, really.
To show you how a habit kicks in, let's think about the urinal in public toilets. For more than a century, the urinal has been one of the dirtiest areas. What would you do if you happened to be given the task of latrine cleaning? I learned the trick from a story at Schiphol, Amsterdam's international airport. Imagine, for a moment, holding your breath in front of the urinals and getting mad about the spillage (which is a tactful term to describe the amount of urine that hits the walls and floors). Can we shape the behaviour and habit of those visitors of the toilet? Remember the habit loop? Not many do, except a smart guy Jos Van Bedoff. Van Bedoff managed to change the habit of thousands of men at Schiphol, because he exploited the habit loop. Guess what is the cue that he invented?
A fake but life-sized fly etched into the white porcelain wall of each urinal.
The rest is easy to understand. Et voilà! Spillage was cut by a whopping 80 percent.
It all seems so natural. Thing is, if you've read Charles DuHigg's The Power of Habit, there's a good chance you'll understand how a habit - like a parasite, only much worse - enters our brain and lives there.
The basic rule of habit is straightforward. It's a habit loop with three stages: the cue, which is a trigger in the first place; the routine, which is the behaviour itself; the reward, at the end, to satisfy the brain and guarantee that the loop is worth replicating. Straightforward idea, really.
To show you how a habit kicks in, let's think about the urinal in public toilets. For more than a century, the urinal has been one of the dirtiest areas. What would you do if you happened to be given the task of latrine cleaning? I learned the trick from a story at Schiphol, Amsterdam's international airport. Imagine, for a moment, holding your breath in front of the urinals and getting mad about the spillage (which is a tactful term to describe the amount of urine that hits the walls and floors). Can we shape the behaviour and habit of those visitors of the toilet? Remember the habit loop? Not many do, except a smart guy Jos Van Bedoff. Van Bedoff managed to change the habit of thousands of men at Schiphol, because he exploited the habit loop. Guess what is the cue that he invented?
A fake but life-sized fly etched into the white porcelain wall of each urinal.
The rest is easy to understand. Et voilà! Spillage was cut by a whopping 80 percent.
Tuesday, November 5, 2013
Volcano
Everyone can get angry. Eight till eighty. Get along with anyone long enough and you will come across a volcanic moment.
One of my exemplary colleagues never loses patience with his patients, and for heaven's sake, exploded few days ago at a wedding banquet. That's after the waitress poured the salad dish on his girlfriend's dress. You could cook a six-pack of eggs next to his burning face. Quite right so?
However, many of his friends find it unbelievable as if that's the sight of a volcano in Hong Kong instead of Indonesia. This, I fear, is as unusual as a saint using obscene language in their minds. That raises a point worth clarifying: that showing anger is not a sin.
As I learn to teach my daughter to feel okay with anger, I get to appreciate that anger is indeed one toolkit of emotion - and an essential energy source. And just to stretch the mystery of anger a little bit further, it's a birthright.
There's a line from Aristotle that's an old favourite of mine: "to be angry with the right person, to the right degree, at the right time, for the right purpose, and in the right way."
Sunday, November 3, 2013
Echoed
No argument: growing up in impoverished Afghanistan town is never easy.
Ten minutes in the desert and already the feet felt raw. How do the kids walk all day without shoes, I wondered as I read the novel And the Mountains Echoed by the acclaimed author Khaled Hosseini (whose novels The Kite Runner and A Thousand Splendid Suns have sold a combined 38 million copies worldwide). The first few chapters of his latest novel drew me to the touching tale of a brother and sister.
The brother heard about another boy whose family owned a peacock. It would be hard to think of a better gift than a peacock feather with a beautiful large eye at the tip. The ten-year-old brother wished he could bring the gift to his sister. He negotiated. In a last-ditch effort, he traded his shoes for the iridescent green peacock feather.
By the time he made his way home shoeless, his heels had split open and left bloody smudges on the ground. If you'll let me, I'd like to tell you a little bit about his soles: thorns and splinters had burrowed into every cell of his skin. You could hear the brother's groan with every step, and possibly feel the barbs of pain shooting through his feet.
Ten minutes in the desert and already the feet felt raw. How do the kids walk all day without shoes, I wondered as I read the novel And the Mountains Echoed by the acclaimed author Khaled Hosseini (whose novels The Kite Runner and A Thousand Splendid Suns have sold a combined 38 million copies worldwide). The first few chapters of his latest novel drew me to the touching tale of a brother and sister.
The brother heard about another boy whose family owned a peacock. It would be hard to think of a better gift than a peacock feather with a beautiful large eye at the tip. The ten-year-old brother wished he could bring the gift to his sister. He negotiated. In a last-ditch effort, he traded his shoes for the iridescent green peacock feather.
By the time he made his way home shoeless, his heels had split open and left bloody smudges on the ground. If you'll let me, I'd like to tell you a little bit about his soles: thorns and splinters had burrowed into every cell of his skin. You could hear the brother's groan with every step, and possibly feel the barbs of pain shooting through his feet.
Imagine going to work or school barefoot and finding no path other than the bumpy road. You just keep looking at each step. Because if you don't learn to do this, you'll learn a painful lesson. Keep going. About an hour passes, and you're still only half way through. I had such chance to find out how it goes yesterday. Let me explain.
That's a charity walk to raise money for poor children in countries like Bangladesh and Zimbabwe. That's meaningful, right? And probably the most important thing is that we have to walk without socks or shoes. I brought my daughter to walk with us. She might laugh at the somewhat funny way of walking. And then it turns out that it isn't that funny. Of course, there will always be a flickering moment of insight, like learning to feel sorry for the poor children without shoes - which is, needless to say, how I wish my daughter could learn.
That's a charity walk to raise money for poor children in countries like Bangladesh and Zimbabwe. That's meaningful, right? And probably the most important thing is that we have to walk without socks or shoes. I brought my daughter to walk with us. She might laugh at the somewhat funny way of walking. And then it turns out that it isn't that funny. Of course, there will always be a flickering moment of insight, like learning to feel sorry for the poor children without shoes - which is, needless to say, how I wish my daughter could learn.
Monday, October 21, 2013
Itineraries
My Indonesian domestic maid really wants us to visit South Korea. Well, Korea is not a bad choice, but we kept thinking until recently.
The downside with Korea is that my maid's boyfriend works there as an illegal citizen. She'd love to go there and meet her sweetheart - but she can't get the visa without our company.
We finally agreed to go. That made my maid happy. This isn't to say that going to Korea doesn't take any kind of courage. I'd be lying if I swear my maid won't hide in Korea and elope.
I told my daughter we won't travel together with our maid in Seoul. She nodded. This time we bought a travel guidebook (that tells us a great deal about the parks there) and borrowed a Lonely Planet guide. We didn't speak Korean and yet we found ourselves bouncing around in the enormous Children's Grand Park. One of the best things that we found in the park is that she'd never run out of ideas (or energy) in the playground. She ran up and down and made new songs - she really loved the castle with two decks.
It was much more than that. At the zoo in the park, she learned how to distinguish boy mandarin ducks from girl ones by their plumage. She became fixated by the way how cormorants catch and swallow fish.
Two days later, my daughter thought of going to the park again. We did.
We combined the activity with a visit to the Seoul Children's Museum just next to the park, and that turned out to be right decision. As we wandered and wondered through the museum, discovering grasshoppers and tadpoles with magnifying glass, learning to create handmade motion pictures, we almost missed the chance to visit the royal palace - one of the "has to see" items listed in travel books. That's perfectly fine. Trust me, you should consider yourself really lucky to make up and tick your own to-do list within a journey.
We left Seoul (together with our maid, by the way) feeling enlivened and proud that we'd stumbled on an itinerary that celebrated the triumph of the travel with children.
The downside with Korea is that my maid's boyfriend works there as an illegal citizen. She'd love to go there and meet her sweetheart - but she can't get the visa without our company.
We finally agreed to go. That made my maid happy. This isn't to say that going to Korea doesn't take any kind of courage. I'd be lying if I swear my maid won't hide in Korea and elope.
I told my daughter we won't travel together with our maid in Seoul. She nodded. This time we bought a travel guidebook (that tells us a great deal about the parks there) and borrowed a Lonely Planet guide. We didn't speak Korean and yet we found ourselves bouncing around in the enormous Children's Grand Park. One of the best things that we found in the park is that she'd never run out of ideas (or energy) in the playground. She ran up and down and made new songs - she really loved the castle with two decks.
It was much more than that. At the zoo in the park, she learned how to distinguish boy mandarin ducks from girl ones by their plumage. She became fixated by the way how cormorants catch and swallow fish.
Two days later, my daughter thought of going to the park again. We did.
We combined the activity with a visit to the Seoul Children's Museum just next to the park, and that turned out to be right decision. As we wandered and wondered through the museum, discovering grasshoppers and tadpoles with magnifying glass, learning to create handmade motion pictures, we almost missed the chance to visit the royal palace - one of the "has to see" items listed in travel books. That's perfectly fine. Trust me, you should consider yourself really lucky to make up and tick your own to-do list within a journey.
We left Seoul (together with our maid, by the way) feeling enlivened and proud that we'd stumbled on an itinerary that celebrated the triumph of the travel with children.
Thursday, October 10, 2013
Metric
I'm not a great fan of performance indicator, particularly those key performance index in our hospital setting. It's really about a quality metric that is worse than useless.
It is often the case that hospitals struggle to get a better score to prove their quality. But the score might tell otherwise. The performance score runs lower and lower, unlike the hospital team's anxiety that swelled and swelled with each passing day. So eager we're to fulfill the quest of performance index that we strive for the top score by hook or by crook.
The obsession with scoring system is understandable. The scoreboard has been in place for all of us in school, from clan to clan, culture to culture, and it is embraced earnestly and repeatedly. The hard truth is, most parents believe in the score. Some students, and many teachers, do. An important and oft-quoted metric on the scoreboard is the "intelligence quotient." But there's an old parable in which two cavemen were frightened when the earth shook with each footfall of a grumpy sabre-toothed tiger. The first caveman named Ug, with his mathematical and logical intelligence, tapped his chin and calculated the angle from which the tiger is approaching to the nearest degree. His mate, Thug, with the bodily or kinetic intelligence, ran away. "Who's the clever one now? Ug or Thug?"
I will say that, whether you're a parent or a hospital manager, should not miss the article "Performance Anxiety - What Can Health Care Learn from K-12 Education?" published recently in the New England Journal of Medicine. So, then. You will see how similar the health care and education system have been misled by the shortsighted performance measures. Examples of the top-down performance measures at school: students' achievement in standardized mathematics or reading tests, teacher's certification status. Just as how physicians lose performance points when patients cannot meet certain performance targets because they were dealt bad genetic and environmental hands, teachers are hold accountable for students' varied developmental timeline and many other uncontrollable factors in their lives. In turn, the author proposed a new bottom-up performance measuring system that, for instance, looks at the discussion and questioning skills, ability to engage students in learning, the expectation that students will correct their mistakes. The proposed measures to be assessed in hospital are similar: measures of patient experience such as effectiveness of physician communication about diagnosis and treatment.
Still, in the presence of pay-for-performance programs, many of us will pay more attention to the top-down performance measures. One good example of such outcome measures is the complication of venous thromboembolism after surgery. That's referring to a blood clot that forms in a vein deep in the body. It's a neat trick to blame and punish the "bad apples," referring here to those hospitals with more event rates of venous thromboembolism. Is it that simple? A new study, using data for nearly 1 million surgical discharges from 2800 hospitals, makes a solid argument against this measure. To cut the story short, the venous thromboembolism rates simply reflect how aggressively doctors look for them, but probably are not directly related to quality of care.
In other words, because some doctors more aggressively look for complications, they find more and appear to have worse outcomes. Good lesson to learn.
It is often the case that hospitals struggle to get a better score to prove their quality. But the score might tell otherwise. The performance score runs lower and lower, unlike the hospital team's anxiety that swelled and swelled with each passing day. So eager we're to fulfill the quest of performance index that we strive for the top score by hook or by crook.
The obsession with scoring system is understandable. The scoreboard has been in place for all of us in school, from clan to clan, culture to culture, and it is embraced earnestly and repeatedly. The hard truth is, most parents believe in the score. Some students, and many teachers, do. An important and oft-quoted metric on the scoreboard is the "intelligence quotient." But there's an old parable in which two cavemen were frightened when the earth shook with each footfall of a grumpy sabre-toothed tiger. The first caveman named Ug, with his mathematical and logical intelligence, tapped his chin and calculated the angle from which the tiger is approaching to the nearest degree. His mate, Thug, with the bodily or kinetic intelligence, ran away. "Who's the clever one now? Ug or Thug?"
I will say that, whether you're a parent or a hospital manager, should not miss the article "Performance Anxiety - What Can Health Care Learn from K-12 Education?" published recently in the New England Journal of Medicine. So, then. You will see how similar the health care and education system have been misled by the shortsighted performance measures. Examples of the top-down performance measures at school: students' achievement in standardized mathematics or reading tests, teacher's certification status. Just as how physicians lose performance points when patients cannot meet certain performance targets because they were dealt bad genetic and environmental hands, teachers are hold accountable for students' varied developmental timeline and many other uncontrollable factors in their lives. In turn, the author proposed a new bottom-up performance measuring system that, for instance, looks at the discussion and questioning skills, ability to engage students in learning, the expectation that students will correct their mistakes. The proposed measures to be assessed in hospital are similar: measures of patient experience such as effectiveness of physician communication about diagnosis and treatment.
Still, in the presence of pay-for-performance programs, many of us will pay more attention to the top-down performance measures. One good example of such outcome measures is the complication of venous thromboembolism after surgery. That's referring to a blood clot that forms in a vein deep in the body. It's a neat trick to blame and punish the "bad apples," referring here to those hospitals with more event rates of venous thromboembolism. Is it that simple? A new study, using data for nearly 1 million surgical discharges from 2800 hospitals, makes a solid argument against this measure. To cut the story short, the venous thromboembolism rates simply reflect how aggressively doctors look for them, but probably are not directly related to quality of care.
In other words, because some doctors more aggressively look for complications, they find more and appear to have worse outcomes. Good lesson to learn.
Wednesday, October 9, 2013
Praise
I received a phone call from my daughter's kindergarten yesterday morning. That's her school picnic day. If you're worried that the call was to announce the cancellation of picnic, don't worry - the weather was perfect. The call was all about my daughter's lunch box.
"Hi Jasmine's daddy. Auntie Elsa didn't give Jasmine back the lunch box yesterday when the school bus came. The lunch box is with us, and Miss Rebecca will bring you the lunch box today. Remember to ask Rebecca in case she forgets; Jasmine will need the box to bring her lunch tomorrow."
I didn't say much, except the two big words "Thank you." It's beautiful to have such a sunny day and a fabulous school team.
We received the lunch box, and then told Jasmine the story.
"Well, not really," my daughter answered in a soft tone. "Auntie Elsa didn't forget. It's me. I forgot to take the lunch box."
I didn't know what to say, except two words "Good girl."
Confession time. I had not the foggiest idea where her laudable honesty comes from.
"Hi Jasmine's daddy. Auntie Elsa didn't give Jasmine back the lunch box yesterday when the school bus came. The lunch box is with us, and Miss Rebecca will bring you the lunch box today. Remember to ask Rebecca in case she forgets; Jasmine will need the box to bring her lunch tomorrow."
I didn't say much, except the two big words "Thank you." It's beautiful to have such a sunny day and a fabulous school team.
We received the lunch box, and then told Jasmine the story.
"Well, not really," my daughter answered in a soft tone. "Auntie Elsa didn't forget. It's me. I forgot to take the lunch box."
I didn't know what to say, except two words "Good girl."
Confession time. I had not the foggiest idea where her laudable honesty comes from.
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