LTC2: Applying Lessons from Experience to COVID-19

Katya Gonzalez-Willette: Hello and welcome to Building State Capability (BSC) at Harvard University’s podcast series. 

Shruti Mehrotra: In this BSC podcast Shruti Mehrotra shares her experience working on humanitarian crises with Professor Matt Andrews. 

Matt Andrews: I’m with Shruti Mehrotra and Shruti works for the Open Society, and she has a good amount of experience in different crises situations, from human related crises to political crises, economic crises. Shruti, welcome. Thank you for spending time with us to share your ideas. I wonder if you could just give us a brief rundown on your experience working in crises in all the different ways and places. 

Shruti Mehrotra: Thanks, Matt. So depending on how far back you want to go, I’ve been responsible for emergency response operations during the political crisis and refugee crisis in Sudan that led to tens of thousands of refugees coming to Chad. And that was a very operational and practical role. More recently have been sort of sitting in the situation rooms in a couple of capitals dealing with political crisis. So in country. And then during the Ebola crisis recently was based in London, overseeing a set of teams who were sitting themselves in situation rooms in the three affected countries in West Africa. 

Matt Andrews: Wow. Thanks for all that service that you’ve provided to those many different places. I wonder if we could talk a little bit about the operational work that you did in Sudan and Darfur, and if you could give me just a sense of two or three lessons that you would have learned from maybe describe the work first and then kind of a couple of lessons that you have taking out of that as crucial for people who find themselves on the ground in the middle of an operational crisis. Because there are people who are in that place now in response to the COVID-19 crisis. 

Shruti Mehrotra: I think if we start off with the kind of pure emergency, the first thing I would say is sitting in a leadership position for the people who are decision makers, that these are very very hard decisions that have to be made quickly in which there is obviously clearly no perfect answer. And so I think one of the things that was definitely clear was – you have to get the best information that you can, knowing that the information you will get is imperfect and do your best to make a decision moving forward and create as adaptive of a system to continue to change your decision making over time, which to me I think is the second one. And I’m sure, Matt, you would agree to this is the kind of process by which one monitors the situation. Ideally in some kind of situation room like setting, which again in this case is going to be largely virtual because of the nature of Corona, which wasn’t the case in many of the places I worked. Where we could be with each other in person then means that you’re trying to set up a system by which you have the right people around the table with as good of information as they can get in order to on a regular basis as a decision maker, see what the choices are in front of you. And then adapting your choices quite dynamically based on what you’re seeing over time. So the idea (one) that  that there are no kind of obvious and clear and easy decisions and (two) that the process really matters. And I would go further to say (three) within that process, and especially in a situation like this, perhaps is sort of similar to the Ebola situation, is that one has to have trusted advisers. And in this case, particularly from the scientific community, was extremely, extremely important in the case of Ebola. And so the idea that there are people who are your trusted person or set of people who can help guide on the more technical dimensions of this feels very, very important. Again, recognition that there will be debate amongst the experts on subjects. But as a decision maker and a decision making team, one has to go through that debate process, but then come up with a conclusion that then is trusted and that that can be communicated in a way as a leader to foster trust with a population about the choices that you’re making. 

Matt Andrews: Right. Shruti when you were working in Sudan and you had a lot of issues at that time, were all of the experts that you had and all of these trusted people, were they on the ground or did you have some people who were also calling in virtually at some point in time? Did you have to bring in the expertise in a virtual way like people are doing now or were they all with you at all times? 

Shruti Mehrotra: So interestingly, actually, even back then, we had some of our most technical people were abroad. So even though it was more common to have a core team and a trusted team that was there every day, you know, at the same time twice a day sitting at the same table for a particular technical issues, we definitely went out of country and called in experts even from, you know, far flung refugee camps, calling people in Oxfordshire in that case who could tell us how to deal with a particular technical problem. And so even when we didn’t have a distancing challenge like we do now in terms of requiring social distancing, we still needed people to give us advice. The other thing I would say that was really important about those extra people is that the difference actually was positive because they weren’t in the weeds with us, they could give us some perspective and say, “Well, the last time it looked like this. This is really helpful.” Or just give us some general perspective that was outside of the detailed challenges and adrenalin driven hyperactivity that an emergency requires. And so I think people outside of country can be useful in a number of different ways. 

Matt Andrews: So I think one of the ideas might be that the process matters. I think that the the trust matters, the team matters. I think the information matters. And it also sounded like one of the messages was you’re not going to get a perfect response, but you need to do it as well as you can and getting good information and then in analyzing it and getting views on it. And that’s where some of these outside voices can be very useful. So maybe foremost, identifying who your bench would be of outside people and having them ready to engage with you is a good idea as well. That sounds excellent. When you were doing this, how did you manage to not burn out? Would you have any hints for folks who are working 24/7 at the moment operationally? How do you manage to kind of balance yourself and make sure that you can kind of be there for weeks, if not months and not just days? 

Shruti Mehrotra: So I will freely admit that the first emergency that I was a part of, I did not successfully balance and I myself got sick while I was there. So I’ve learned the hard way. If it were when it feels like to not manage one’s energies, and it is very understandable for people in the center of an emergency response to think that working twenty, twenty three, twenty four hours a day is the right thing to do because lives are at risk. On the other hand, even if this is not something that one can imagine needing to address for six months, nine months or a year, even running at full pace for three or four months is going to result in mistakes along the way and also not getting the best out of our team. That was how I ended up figuring out that it wasn’t even just my own self care, but I wasn’t creating a condition by which other people could perform well as well. And that responsibility, I felt very strongly. So the things I did in the second and third times I had these kinds of roles was to ensure very basic things, which I’m sure you know Matt, like ensuring that people get a reasonable amount of sleep. It will surely be less than before, but a reasonable amount of sleep is right. Basic things like ensuring that one is eating a reasonable amount and that team structures can be set up in such a way where even particularly for things like communication means that you have a morning and an evening shift. Now decision makers don’t have morning and evening shifts, still. However, to find a way to really create a rhythm, especially for people who can be switched in and out of roles or kind of share them over periods of time to kind of create breathing room and particularly the most hyperactive roles. Again, if that is possible and resources exist for that. 

Matt Andrews: Well, that’s wonderful. Thanks for those pieces of advice. One piece of advice I have on that is a bunch of a military psychiatrist advised that the people who are in supervisory roles must be in supervisory roles and must not be doers. They must hold themselves away from doing the physical work and they must keep their energy and they must keep all of that intensity from making the decision. And they say it’s actually incredibly difficult for those people because they feel like they are not doing anything. But they need to sit still. They need to preserve the energy before making the decision. I don’t know what you think about that idea, but it’s almost you know, people who are doing aren’t necessarily making decisions, but people who are making decisions must resist the urge to do. They may feel that they are not doing anything, but they actually have to preserve that energy for making the decision. I don’t know what you think about that idea. 

Shruti Mehrotra: I think that makes sense, Matt. And I would say it’s a sort of akin to the idea of the usefulness of having a bit of distance from all of the detail because that decision could be created by actual physical distance, like with external experts. People from abroad, but also being able to take some distance from the details will allow one to see, “Okay, we’re having a severe binding constraint here because I’m noticing that every day we have the same kind of problem at the same kind of time.” Because a lot of what one needs to do is to be able to kind of take the five thousand foot view or the one thousand foot view on challenges and thus not doing and being able to have that perspective is a really important part of creating a system that adapts to changing circumstances, because in each of these situations, these are quite quickly moving emergencies. There could be massive step changes. I’ve sat through dramatic step changes where we thought we were doing great. And then three days later we had fifteen times the caseload of X, Y or Z that we had expected. Having the kind of intellectual distance will be really meaningful and predicting those preventing them and then of course, having the ability to surge response in a kind of considered and non panicked way. 

Matt Andrews: Fantastic. That’s great advice. Thank you, Shruti. I wonder if we could pivot now to some of your roles when you were outside of the situation and you were maybe in a situation room, that was remote away from the actual place and you were advising into that place because I think there are many people who are gonna be in those situations now, and that’s the role that they are playing. Could you give us some description of some of that work and then maybe two or three ideas you have of playing that role?

Shruti Mehrotra: So one version of that that I did was during the Ebola crisis where I’m sitting, you know, effectively on another continent, speaking to people who are sitting in situation rooms in the affected countries. I think first I would say there’s just a supportive duty of care. I think that’s really, really helpful for those speaking from another position because it helps to just ask the basic questions of, “Have you been eating and sleeping recently? How is your emotional health? Are you getting close to burning out? 

Matt Andrews: It’s like a coaching job. 

Shruti Mehrotra: Exactly. Yeah. Yeah, that’s a great description, Matt. I think more than that, what was also helpful and I think will be very true in this particular circumstance is also being able to provide some perspective across multiple geographies. So say, OK, well you all are choosing to do this? This is slightly different than other places. Maybe an example from somewhere else is or is not sort of useful. Now, again, you know, you and I both know that that each emergency should be sort of taken on and responded to very context specifically. So context will sort of be king. However, ideas and lessons and perspectives from other environments will surely be helpful. I think the other thing that that people sitting outside can also go back into history in the way that you and I are doing now – to say, “okay, in a different sort of situation that looks or has some Hallmark relationship. These are the kinds of things that may be thoughts for you all to consider in the way that you’re responding day to day.” And I think one of them for sure, as you and I were discussing, is, is how you both manage the immediate response and dealing with urgent challenges with right now a health care emergency as well as the secondary and tertiary effects. For example, in the economy that we’re already seeing all over the world. And so that having an external perspective can be particularly thoughtful and insightful and helpful in ensuring that there’s also a reflection on sort of how to think about some of the medium and long term challenges and to help and kind of formulation of ideas and plans for them. 

Matt Andrews: So onto that, you and I were having a conversation before I started recording on this specific crisis and what makes it particularly confounding and this idea of is it a sprint? Is it a half marathon? Is it a marathon? Is it an ultra marathon? And how do you think about that? And how do you think about balancing emergency teams with perhaps for want of a better word, forward looking planning teams? Do you want to share any ideas about that issue? 

Shruti Mehrotra: So I think there’s probably multiple team designs that could be relevant, and I appreciate, Matt, your sort of snowflake suggestion on this. I think at minimum I can imagine multiple teams being bifurcated in two very sort of broad categories, the set of people who will be operating in emergency response capacity, where a lot of that is about information coming in, adaptive responses coming out and really sort of clear look in to the logistics of how things are being done. I find emergency response is often extremely logistically heavy and you really have to pay attention to movement of people, movements of in this case medicine and testing, etc., etc. The more medium and long term is of a different nature because you’re looking at complex feedback loops around things like the economy. You are doing much more analytical work on how these things relate and making quite complicated plans that may involve very serious tradeoffs that need to get worked through in an analytical way. And you could imagine having a second team of people or related teams of people who are looking at those kinds of problems, which are very closely related but different in kind, in my area and in particular for that kind of analytical and planning exercise. It may well be useful and more capable rather for people from outside the country to participate very actively in them. And I think there’s a lot to be learned across multiple geographies as to how we are going to respond to the economic impact of this crisis and indeed especially for a developing country, there’s a lot to be done in thinking about what the international community is going to need to do on the economic dimensions in particular. In addition, of course, to the health care infrastructure, because of the huge impact on economies and domestic resources that we’re going to have and the international financial institutions are going to be playing an outsized role in the medium term, and thus reflecting and influencing them as well as having them perhaps to be a part of reflections on mid-term exercises, I think will probably be quite important. 

Matt Andrews: So it sounds like one of the things that decision makers are going to have to do right now is they’re going to have to almost I don’t know if the right word is triage this situation, but work out -where is it that we have emergency responses and then start to triage those and start to, as you say, get the operational response going. That’s going to be very logistical. It’s going to be very hands on. It’s going to be very physically, operationally active. But then you need to also be thinking about what are the effects of this going to be and how do we start planning for those things so that they don’t catch us by surprise. And that’s a different kind of team. Those are maybe thinking teams. Those are maybe teams that are going to be already starting to find the money to get things going when they need to be done. They are going to be looking for political support for new ideas off the bat. So it’s different kinds of teams, but doing different things. But there’s a central team that is going to have to almost identify what those teams are. And I think earlier on you mentioned teams, you mentioned teams in the physical work you did. I think you’ve mentioned teams also when you were working even remotely with the Ebola crisis. I wonder if you have any advice on that central team that gets developed. So if I’m a public official, then it could be a head of state. It could be a school commissioner for a district. It could be a police commissioner for a province. And it’s my job, essentially, to navigate this into a cut. What needs to be done now? How do we plan for the future? How do we do those things? I don’t want to be doing this on my own. I won’t be having a group of people around me. I wonder if you have any advice on who should be in that group. There’s a split in the literature. Some people advise that you should have functional teams where you choose them really based on their technical expertise alone and you get the smartest people in the room in the subject matter. There’s others that advocate cross functionality where they say what you actually want is people who are not necessarily the expert in the area but can work in multiple areas. And you bring him into your team more because you trust them, because you know them, and because you can have a strategic conversation with them and through them bring the functional experts in. But the functional experts would almost sit on these more remote teams. They wouldn’t be on that center team. I don’t know if you have any idea about kind of who you think should be on that kind of advisory decision making team with the public leader who has to make the decisions. 

Shruti Mehrotra: It sounds to me, Matt, like those are two very fair models. So I wouldn’t want to suggest one in my experience prevails over the other. What I would say, though, is that there are a couple of roles either played by someone who is a deep technical expert or someone who is deeply trusted, who can bring in the right technical expertise that are really, really important. So I think. In every one of the challenges that had a very strong technical dimension, having a person who really masters enough of the technical dimensions I think is really important and is able to adjudicate the technical community’s debate amongst itself, as we were sort of alluding to earlier. The epidemiologists today do not agree. One has to come up with a answer as to how one thinks about the epidemiology, for example. So I think that sort of role is a really important one. I think there has to be somebody who can help bring the various parts of governments or various parts of your institution into force to get things done. So in some cases, that’s the chief of staff like role. In other cases, you have a couple of ministries represented depending on where it is. You may well in some jurisdictions have that kind of force making delivery person, even be someone who represents the military because they play an outsized role in the situation. But the person who like makes the system do things and makes sure that things happen, I think is really important. And I think another hyper critical role, especially because many of these situations involve a lot of changes in human behavior, is the person who helps the leaders think about public communication. And of course, the public indications of of everyone, all the other voices, you know, maybe the technical expert is a public voice. Maybe the person who is managing the military is a voice. Maybe the minister of health, for argument’s sake, is a voice. But the sort of core person and then the team underneath them that manages public communication, especially in this day and age of social media, which wasn’t as prevalent in the other emergencies I’ve been a part of. But just that whole machinery of what it takes to communicate, communicate, communicate about not only what the government is doing, but what people need to do. I think this is an extremely, extremely critical role. You could add a couple of others. Again, you know, these situations have a lot of incoming data and a lot of monitoring that then speed decision making. And so you could have somebody who is overseeing the kind of data monitoring and evaluation exercise. You could, of course, also include people who are thinking about secondary and tertiary effects like the economy, you know, et cetera, et cetera. I would say at minimum, those core 3 kind of sets of expertise or representation of that expertise, I think are extremely, extremely important. 

Matt Andrews: So in this case, you would be talking about some kind of health expert that people trusted who could interpret information and who could make decisions, someone who could coordinate and who could bring people together. And then the comms person, the communication person. And then you could, as you say, you could bring other people in and out. But those three people are going to be absolutely crucial for you. That’s great. Thank you. Thank you. Shruti, do you have any other pieces of advice? We’ve taken up a lot of your time and it’s been really generous of you, but any parting words you have to any of these people who are on the frontlines dealing with this? 

Shruti Mehrotra: Well, I mean, parting words being you’re doing a really important job. And pace yourself even though it may feel very, very uncomfortable to pace yourself when you feel like you should be running at top speed at all times. And I think the other one that I would say is something that we spoke about earlier, which is it sounds like it’s a trope, but it is indeed true that crises create opportunities. And so in the back of one’s mind, and I would put this in the kind of second team of people who are thinking about secondary and tertiary impact and sort of medium term planning. But the crises always reveal cleavages and gaps and challenges that may well have more interesting, creative solutions that can be brought to bear for the future. So being creative and thinking opportunistically because also because all of these crises have sort of a politicized dimension to them. Maybe there will be a political will and a real movement by people and leaders to tackle long standing issues in a very different way because of a crisis. And so I wouldn’t say that that should be the prevailing perspective on top of an emergency response. And that shouldn’t sort of distort what needs to happen urgently every day in the response phase. But as one is starting to think about recovery and rebuilding, I really, really encourage people to not think about the “re” part of building or the re part of recovery, but rather OK. Is there an opportunity for us to do something new and not just rebuild or recover in exactly the same way? 

Matt Andrews: It’s not just rebuilding, it’s building new. I think that’s wonderful. So thank you. Thank you, Shruti. Thank you so much for your time. I hope that we can connect again in the next few weeks as the thing develops. And again, thanks for all that you’ve done in your career working on crises. Let’s see how this one pans out.

Shruti Mehrotra: Yes. My pleasure. Thanks so much. 

Katya Gonzalez-Willette: To learn more about the Building State Capability Program, visit bsc.cid.harvard.edu.