By Katerina Bavaro
As I was scrolling through Facebook the other day, I came across a post on one of the groups that I am a part of. It read: “Short course, An Equity-approach to pandemic preparedness and response by PIH and UGHE, opportunity to receive a certification”. I was intrigued by this since I had yet to see a course be prepared on such an issue (and the certification was an added bonus); the course was also free of charge.
I eagerly signed up for the course that would be covered over four days as information about PIH, the organization in charge of the course called Partners in Health, started rolling in and I started to learn about their mission and values as a non-profit. I was nervous at first, coming from a non-professional background as an undergraduate student hoping to study Public Health, but I was curious about how professionals felt about the response to the pandemic and how prepared they thought countries such as the United States were. When it was time for the first session to start, PIH introduced themselves as well as their partner UGHE, which stands for University of Global Health Equity, a health sciences university located in Rwanda, Africa. They explained that the purpose of this collaboration was to discuss pandemic preparedness and response from two perspectives: a North American one and an African one. This amplifies the importance of an equity-based perspective to leadership, especially given the current situation in the world.
The first session, titled “the Global Overview of COVID-19 and Health Equity”, discussed topics such as expert mercy, a term coined by Dr. Paul Farmer, one of the co-founders of PIH. He defined it as a “compassionate fellow feeling with interventions that save the sick and slow down the spread”. Expert mercy can take many forms — from a meal delivered to someone unable to leave their home to an oxygen mask for someone in need of urgent medical care (Expert Mercy: The “Secret Sauce” We Need to Confront the COVID-19 Pandemic). From the introductory session, I further understood that the organization and investment of Public Health systems in various countries expose underlying factors about the community itself as Public Health and Medicine will never be perfect. Expert Mercy reveals what is needed in a specific time and place, and the gap is exposed as underfunded communities suffer. The next generation of global health leaders ought to concentrate on equity and what that means before, during, and after disasters such as global pandemics. What is needed is preparedness and response early on, as well as the implementation of clinical care and social support. The next generation of leaders need to lean towards Social Medicine, which will support the Public Health system. We need pragmatic solidarity within our communities, which starts with organization and investment early-on.
The second session covered Contact Tracing and Equity, specifically the Massachusetts experience with Care Resource Coordinators, an idea implemented by PIH. Topics were discussed such as agency for the underprivileged who are unable to respond to restrictions due to the pandemic and the importance of equity and leadership. Speaking about the United States, and Massachusetts in particular, what was reinforced in this session was the division of the public health system as the planning for a pandemic such as COVID-19 was not coordinated between states. It is up to each individual state to determine the public health measures they want to take and public health is often not integrated with treatment in the United States. PIH then explained that they are implementing Care Resource Coordinators or CRCs in an attempt to solve this problem. They worked with the state of Massachusetts to link cases and contacts back to available resources and recognized certain resource gaps. They accompanied cases and contacts by being representative of different backgrounds and spoke various different languages. They found community partnerships and resources searchable by town and compiled them into one large database. Overall, they wanted to help those feeling socially neglected and care for them since isolation and quarantine are acts that can be taken only by privileged communities.
The third session covered COVID-19: Inequity and Racism in the United States, and how the Navajo Nation is fighting COVID-19. We discussed the isolation that the Navajo Nation feels and how inequality and racism have contributed to that. We also spoke about how important community is during times like these and what the Navajo Nation is doing to reconnect their community.
The fourth and final session prompted a response with the title, “Equity and Innovation: The Response to COVID-19 in Rwanda”. We turned to the University of Global Health Equity for guidance. The discussion now took us across the globe to a tiny country of twelve million people. The panelists explained that they had been working on a joint task force in Rwanda with the minister of health, defense, finance, economic planning, internal security, and local government. Rwanda has been on its way to rebuilding its public health system since 1994 after the genocide occurred and has left some lasting effects on its people. Rwanda has tried to rebuild its public health system by including some of the following factors: evidence-based leadership, socioeconomic and human development, program equality, care at the community level, and collaboration across sectors through infrastructure. They have also tried decentralization hoping to fight corruption within the political system and focus on health as a human right. What is important to them is that citizens have a voice in the healthcare system and that their initiatives are monitored for quality. COVID has tested Rwanda’s methods and has proven that its equity-based approach to leadership has been working. Based on previous program implementation and NGO plans with the Rwanda government, they have brought in a lot of investment and organization, which has helped them with pandemic preparedness and response. By making care affordable and sustainable, they have been able to see improvement in several areas that have helped during the pre-virus era, in the midst of the virus, and will continue to seek further improvement after it passes. Though there are challenges such as the movement of people and borders as well as collecting real-time data, Rwanda’s investment into its own community has allowed for various opportunities. These include changing behaviors involving hygiene, surveillance of all communities, implementing a new radio learning program for students, and having robots in hospitals that complete tasks to help out frontline workers. What Rwanda has done is that they have invested their money into the right places in order to get long-term returns instead of short-term, which is typical for countries such as the United States. By combining leadership with equity, they have reunited the once divided people of their country. Nobody is left behind and everyone has a voice as health is a human right that is taken seriously by Rwanda.
This course made me realize that the intentions people have, based on their place in the world, leadership, and initiative, can change what feels like a hopeless cause into something that betters society. Becoming a good leader means that you need to address issues such as equity and you need to be comfortable with being put in uncomfortable situations. You will never know the extent of the divide of your people unless you hear all the voices and the cry for resources that they need in order to stay safe and healthy. As current and future public health and medicine workers, we need to focus on Social Medicine and its influence on the public health system. We need to encourage leadership among communities and equity among all resources provided. We need to ensure that the people who come into our workplaces are healthy, but we also need to think about those who don’t and what we can do to help them feel secure within the community. Our mission should be healthcare for all, and though it can be costly, it is the right investment to target issues such as equity. All we need now are more leaders to advocate for this.
Bibliography:
Nair, Priya. “Expert Mercy: The ‘Secret Sauce’ We Need to Confront the COVID-19 Pandemic.” Samuel Centre For Social Connectedness, 6 May 2020, www.socialconnectedness.org/expert-mercy-the-secret-sauce-we-need-to-confront-the-covid-19-pandemic/.
Resources:
Facebook group mentioned: https://www.facebook.com/groups/publichealthchamps
PIH: https://www.pih.org
UGHE: https://ughe.org