Med school repeater running big hospital

When Dr Allan Pamba took over as the CEO of The Nairobi Hospital early this year, the facility was akin to a mammoth mammal punctured in one of its lungs, occasionally gasping for air.

The entire board had been shown the door. There was little goodwill amongst different stakeholder groups. On his desk were four damning forensic audits by Ernst & Young impacting people who were being handed over to him to manage.

Then coronavirus threw the spanner in the works. There was pressure on him to wave his magic wand and offer the hospital a new dawn.

He was coming in with his Master of Science Degree in Public Health and two Bachelor’s degrees in Medicine and Surgery. He had been in the relative comfort of a 10-year cushy job in the UK, working for GlaxoSmithKline (GSK).

He also had experience as a herdsboy in a village in Nyanza as the apple of Patlisa Okulo’s eye (his late grandmother) who had raised him and helped him “shatter the glass ceiling.”

“I took this job on the principle of good governance,” he told JACKSON BIKO recently.

So he first drained the swamp by sending 16 senior hospital staff home, cordoned the hospital during the early days of Covid-19, and then temporarily closed six outpatient clinics.

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Are they out of the woods yet?

“No,” he says. “But we are much better than we were in March, revenue is slowly climbing. Things are moving.”

The mammal is breathing better.

Do you believe in destiny and ever wonder what would have happened had you remained in the village, herding cattle, with a litter of children, probably married to two or three wives?

(Hearty laughter) Bliss! I tell you what? I have. Isn’t that the paradox of life? The time I enjoy the most right now is when I’m back in the village, in my shorts, chicken roaming around, no one caring who I am, simple people with such a refreshing outlook of life. Do I believe in destiny? I believe it’s been written but it’s also an open script that you can mould.

Are you religious or spiritual?

I used to be very religious. Now I’m spiritual. Religion sipped through in my early adult life. I was raised by a Catholic father and grandmother. I went to Strathmore, a very good and strong Catholic school that took my religion to a higher level; mass and confession every day.

I once had a conversation with a priest about having a calling to priesthood. But it didn’t happen, and now many times when things don’t go well in life, I always think that’s because I dissed God. (Chuckles). Also, I knew I would never be celibate. (Laughter)

So from a village to a public school in Eastlands, to a big pharma in London. What’s the one thing that marks a journey like this? Apart from the usual things successful people mention like hard work, resilience, dedication, spreading your bed...,what’s that thing that brings you here in your opinion?

For me it was my grandmother, my dana, shattering the glass ceiling. We were nine children. I was number five. I was left in the village with my grandmother to help her and so we spent a lot of time talking. Father Klaus, a Catholic priest, was the first white person I ever saw. He was huge and had a shock of grey hair.

She used to tell me that he comes from a faraway land that sounded like ‘heaven’. I wanted to go there. I loved rivers. I used to throw things in the river and imagine they were going to Father Klaus’ land. So I think that was probably the start of it, my grandmother helping me fantasise about going to this ‘heaven’.

Then the second part was my father who ruled his house with an iron fist when I moved to Nairobi. He was a typical African man. He scared us. He gave examples of poor people and said we would end up like them if we didn’t work hard. That fear propelled me to do well in school.

What kind of insecurities did you bring to this job, having come from a multinational?

My biggest fear coming back was that I had no networks in Kenya. I had been away for so long I felt like an outsider. I didn’t quite get how things worked here anymore. When I worked for GSK Nairobi, I was in a cocoon of a global company but when I stepped out, it’s when reality checked in.

The insecurity I came in with was that I wondered if I would be able to work with the standards that I was used to, keep my integrity and still grow this hospital.

I miss Bob Collymore. I never knew him very well but we had two or three loose conversations, very pithy and very informative to me. I believe he came on a platform of driving good governance in Safaricom. I came to this hospital on the same platform.

When you came here you had to drain the swamp, to use the expression of a distasteful man. How difficult is it to come in as the new guy and shake up things— fire people, change the order— and risk being seen as the bad guy. What prepares you for something like that?

A lot of things. It starts when you’re young. I have had moments when I have slept hungry. That’s a life lesson because it prepares you for something.

I’ve had moments when I have failed and failed tremendously; I repeated medical school, as a student leader. It was the most embarrassing thing ever then, but I learnt something.

There were moments before we graduated as medics that I didn’t have a penny to rub together. The point I’m making is that there’s not one defining thing, I think it’s a series of things that happen in your life that builds your resilience.

I hate to compare these two because they are like oranges and groundnuts, but being a father of three and running this place, which one takes the most from you?

(Laughs) Unfortunately, right now this takes the toll out of me. My children are still young, so all they want is play and for me to be present. Their needs are not as complex yet.

I don’t know if this is a cultural or racial question but having worked in the UK, do you see a very distinct differentiator in terms of work ethics?

A good question and an interesting one too. Believe it or not, we work harder. We work harder, they work smarter.

The other distinction, (Pause) I hesitate to say this, but it is a fact. I saw more integrity there than I see back home, sadly. People there value their good name more than we do here. They still have a sense of bashfulness if they’re caught doing something wrong, so they won’t do it. In Kenya, I have had people who will lie to me in my face so they can get away with Sh40,000 from the till. Few people care about their names.

Some would argue that to be able to know how to work smart you first need to work hard. Isn’t it the work smart mentality that makes some people want to cut corners?

There’s a good point about what you’re saying. The people that I saw working smart, either did it at the back of technology or they worked hard for short bursts of time.

When you work hard, you discover systems of efficiency. For example, if you’re doing project planning, I found the projects there running quite well not because of the strength of the people in the team, but because of the system under which they are working with. They have project planning apps or templates that will organise everyone.

What would you be doing if you were not in health?

(Sighs). I had ambitions of being a musician. I love dancing. I don’t get time to dance anymore.

Would your knees still allow you to dance?

(Laughter) No. They are getting old and rattly.

What does your wife do and how did you meet?

Aaah! So Beth is a pharmacist by training. She works for an NGO called Population Council. I lived in the UK, she lived here but we met before that.

When I first saw her I thought, ‘this is the woman I will marry.’ But she wanted nothing to do with me because apparently, my reputation was not very good then.

Perhaps she said ‘I’m not touching that with a ten-foot pole.’ (Chuckles) I gave up, I went to the UK and we met there through a mutual friend briefly, and I tried again. We had dinner but we didn’t really gel. Later, when I was in Kenya for a meeting, I knocked on a door and guess who opened the door? Beth! She said, “Oh it’s you.” (Laughs) I kept showing up.

Like a bad penny.

(Laughs) And the rest is history.

There must have been great expectations when you got this job. Does one ever learn to embrace fear and failure?

A very insightful question. As they say, it gets lonely at the top, and I have felt it. I have had my moments of fear, even though I never show it. It is normal, the question is what you do with that fear.

When I started, I thought ‘I’m gonna botch this up so bad, the whole world will get to hear about it.’ You know when you’re outside Nairobi Hospital, you think that Nairobi Hospital is amazing, the buildings look good… And the truth is, it is amazing. But no one ever tells you the depth of issues that an institution is grappling with.

I was very lucky I had a few confidants that I could have conversations with and say look, ‘I don’t know what I’m doing.’ I think it’s very important, as leaders, to have the humility and accept that we can’t have all the solutions. We should recognise when we are out of our depths and be able to ride off the wisdom of others.

I consulted quietly. I got pointers. Then I applied the principles of leadership. Be visible. Give direction. Act with authority. It was chaotic at the beginning but our revenues are coming up slowly because we dipped down to about 35 percent bed occupancy, now we are back up to 65 to 70 percent.

Are you out of the woods yet?

No. Not quite. But we are on a recovery path.

Do you find that as one climbs the corporate ladder the fear of failure increases or decreases?

I think it’s a very personal thing that depends on one’s ethics and motivation. Do you have a parochial motivation or do you want to get wealthy off the job? When you get a leadership role, you have a responsibility that exceeds you. And the more you see that clearly, the more it humbles you, and the more you fear failure.

I’d hate to ask anyone this question but I like your answers, so I’m curious about how you can handle this one. Are you a better father or a better husband?

(Laughs loudly) Biko, that’s such a low-blow question. There is no way I can come out of it unscathed. (Laughing) But I’d like to believe I’m both. (Pause) Let’s just say it’s a journey. I’m growing in both.

How old are you now?

49 years old.

What do you wish you knew 10 years ago?

I wish I knew how hard parenting was, I would have appreciated my parents better. I think I was a little bit hard on my parents. My dad was a tough guy, but I was very unforgiving, in terms of what I expected from them.

What do you want to be remembered for eventually when the fat lady sings?

(Chuckles) Oh my God! I’d like to be remembered for being a good parent, a patriot, and somebody who contributed to the betterment of Africa.

Editor's Note: This interview was done before The Nairobi Hospital Board terminated Dr Allan Pamba's employment contract.