What is Global Health?: Recent Episodes
What is Global Health?
Health--a central factor of every human life across the world. Yet, much of the discussion around important health issues remains limited to specialized professionals. To break down these boundaries, the “What is Global Health” podcast creates meaningful and shareable interviews between influential global health professionals and students. We cover relevant, current issues in public health, including health policy, environmental health, and epidemiology. Ran entirely by student interviewers, our podcast also offers a creative, fresh approach to intersectional topics, such as mental health or patient narratives, under the umbrella theme of public health.
The podcast works to spread accessibility of public & global health beyond the academic and professional world. Through conversational dialogue, we hope to increase public awareness of public & global health issues as well as inspire new interest in the field. The “What is Global Health” podcast is produced by the Journal of Global Health, the most widely-distributed student public health journal in the country.
In this episode of What is Global Health, Eliana Weinsaft speaks with Barnard student Jem Hanan and The Cooper Union School student Joseph Hedaya on factors that make it difficult to eat food due to dietary restrictions and meal plan regulations on college campuses. College students were interviewed for this podcast to hear their thoughts…
Professor Bill Bower Image credit: https://www.publichealth.columbia.edu/profile/bill-bower-mph In this episode of “What is Global Health,” Kyle Tong speaks with Professor Bill Bower about the training of lay health workers, the current Tuberculosis landscape, and Bower’s extensive experiences in global health. Professor Bill Bower is a Special Lecturer in Population and Family Health at the Columbia University Mailman…
Professor Rachel Austin Image Credit: https://barnard.edu/profiles/rachel-narehood-austin In this episode of “What is Global Health,” Eliana Weinsaft (BC’27) spoke with Professor Rachel Austin from Barnard College’s Chemistry Department about her research journey, and what students should keep in mind if considering a career in science or research. Professor Austin gives insight into opportunities within the institution and…
This episode is a continuation of the last episode. Lucia Arico-Muendel speaks with Dr. Valerie Flaherman more about her research on infants in low- to middle-income countries, focusing on ethical considerations, COVID complications, results and next steps. Dr. Flaherman is a pediatrician and global health researcher at the University of California, San Francisco. Her research…
In this episode of WiGH, Lucia Arico-Muendel speaks with Dr. Valerie Flaherman about her research on how breastfeeding and formula-feeding regimens affect infant growth during the first month of life, mainly in low-income countries such as Guinea Bissau and Uganda. Dr. Flaherman is a pediatrician and global health researcher at the University of California, San…
In this episode of “What is Global Health,” Monica Manmadkar spoke with Dr. Mary Beth Terry from Columbia University’s Mailman School of Public Health on the malaria epidemic. Dr. Terry gives insight into how data science is being used increasingly in public health analyses and research. Dr. Terry is a professor at the Mailman School…
In this episode of “What is Global Health,” Bowei Li (CC’26) spoke with Dr. Bradley Pitcher from Columbia University on the risks associated with volcanoes. Dr. Pitcher explains the health consequences that volcanoes induce and the tradeoffs that communities make in living near them. He also gives insight into future trends in volcanic activity in…
In this episode of “What is Global Health,” Madeleine Hum (CC’24) spoke with Dr. Patrick Kachur from Columbia University’s Mailman School of Public Health on the malaria epidemic. Dr. Kachur gives insight into traditional prevention and treatment solutions used to combat malaria and explains the significance of the new malaria vaccine that has been approved…
In this episode of “What is Global Health,” Phalaen Chang (CC ’23) spoke with Dr. Marni Sommer on the importance of menstrual health and education and discussed some solutions moving forward.Dr. Marni Sommer: Dr. Marni Sommer has worked in global health and development on issues ranging from improving access to essential medicines to humanitarian relief in conflict settings. Her particular areas of expertise include conducting participatory research with adolescents, understanding and promoting healthy transitions to adulthood, the intersection of public health and education, gender and sexual health, and the implementation and evaluation of adolescent-focused interventions. Her doctoral research explored girls’ experiences of menstruation, puberty and schooling in Tanzania, and the ways in which the onset of puberty might be disrupting girls’ academic performance and healthy transition to adulthood. Dr. Sommer also presently leads the Gender, Adolescent Transitions and Environment (GATE) Program, which explores the intersections of gender, health, education and the environment for girls and boys transitioning into adulthood in low-income countries and in the United States. GATE also generates research and practical resources focused on improving the integration of menstrual hygiene management and gender supportive sanitation solutions into global humanitarian response.
Transcript (via Sonix)
Phalaen Chang: [00:00:06] Hello, everyone, and welcome to this episode of “What is Global Health?” Although awareness of menstruation has been steadily increasing, especially with social media through Tiktoks and memes, the complex issue of menstrual health often still remains undiscussed and unexplored in many low and middle income countries and even in many parts of the United States, education around mental health is lacking, leaving girls inadequately prepared to feel comfortable with the changes in their bodies. Social stigma and lack of access to toilets add another layer to the problem, often creating barriers for girls education and obstacles for their health. Today, we have invited Dr. Marni Sommer to explore this complex and important issue of menstruation as a public health issue with us and shed light on some solutions moving forward.
Phalaen Chang: [00:01:02] Dr. Marni Sommer has worked in global health and development on issues ranging from improving access to essential medicines to humanitarian relief in conflict settings. Her particular area of expertise include conducting participatory research with adolescents, understanding and promoting healthy transitions to adulthood, the intersection of public health and education, gender and sexual health, and the implementation and evaluation of adolescent focused interventions. Her doctoral research explored girls experiences of menstruation, puberty and schooling in Tanzania and the ways in which the onset of puberty might be disrupting girls, academic performance and healthy transition to adulthood. Thank you so much for being here with us today! So kind of to get things started, how were you first made aware of menstruation as a public health issue?
Dr. Marni Sommer: [00:01:57] Yeah, well, that’s a fantastic question. And I would say it was not considered a public health question or issue when I started. So when I looked into exploring this issue, I had gone back to school to get my doctorate degree. I had been working in public health, but I had had this prior life experience of being in the Peace Corps in Eritrea and teaching in a school that didn’t have bathrooms. And I mean, there was one bathroom that the teachers used, but the kids didn’t have bathrooms. And it’s one of those things I used to think about. This was like ninety five to ninety seven in this village. Where do they go? The girls walk sometimes an hour to get to school on the road in this rural area, they sit for eight hours in the way the schools are constructed in a lot of the way they’re managed in a lot of countries is the kids don’t move, the teachers move. So I was thinking: they sit in this room for eight hours. They’re squished like three or four to a bench, you know, what do they do? Do they not come? Do they wear like lots of cloth or? So I had been thinking about it in the mid 90s. I had been hearing at the time that girls never leaving school after puberty, they’re getting married, they’re not finishing.
Dr. Marni Sommer: [00:03:08] But that was just sort of anecdotal. And we were told to focus on girls as a priority because they were leaving school. So it wasn’t until 15 years later when I went back to get my doctoral degree and I was thinking, I’m in public health and what do I want to look at? And, you know, I felt very strongly about girls education. I got good education growing up. I got to go to good school. I you know, I went got to go to nursing and public health school. And so it felt unfair to me that girls were not that there was still a gender gap in the schooling. So in 2004, when I went back to school, I thought, well, let me look into that and see if there’s a public health aspect to it, because I’d really love to do something. And it was as I was looking at all the reasons that girls were not staying in school or not going to school or leaving school early or struggling in school. There was distance and fees and so on. But then there would be this occasional mention in a UNICEF report or UNFPA, which is the U.N.Population Fund report, saying, well, puberty happens or their toilets are an issue. But then when I would try to find out, well, what’s the evidence? Because I’d like to read more about that, because I had had that question 15 years earlier as a Peace Corps volunteer. I would find like these tiny little footnotes that some male anthropologist in nineteen twenty seven, like, was in a village, you know, and he thought that periods were an issue. And first of all, not enough people are talking about this because there was very little it was very hard to find any evidence when I would search in the literature, there was nothing when I would search for what we call the grey literature. So you’ve like the scientific literature and then you say literature, which was like UN reports. There was only like these random little footnotes. And so I thought, this is ridiculous. Why is why is there no data? Why do we not know what girls say? I see that the schools don’t have toilets, you know, so that’s when I started looking into and it really wasn’t that was 2004. It really wasn’t, I would say until two thousand, 12 or 13 that it started to finally gain some traction as a perceived public health issue.
Phalaen Chang: [00:05:21] And kind of, building off of that, you talked a lot about how, like menstruation affects education and on how education connects with health.
Dr. Marni Sommer: [00:05:30] Yes, of course, again, a great question. There’s this great linkage between girls education and health. And I’ll just talk about girls for today, because that’s really where most of the evidence is. We know that. And it depends on the amount of schooling. But we’ve known for decades that if girls stay in school, they are more likely to vote. And we’re just talking elementary or primary school. They’re more likely to vaccinate their children. They are more likely to use contraceptives and therefore not have as many children because they understand the benefits. They are more likely to understand the importance of nutrition and sanitation and all these things for their children. We know they are more likely to, if they have more education, be protected from HIV. They’re more likely to have a delayed sort of adolescent, you know, their first child. So we know there’s a lot of benefits to population health, to those girls themselves and to their future families if they are educated either to the primary level and some things to the secondary level. But what if getting your period knocks you out of school or makes it very difficult for you to do well in school? And there were sort of two different tracks or ways I wanted to explore that that I thought sort of had hypotheses about what was I thought, OK, well, what if, as we know and this still happens in some cultures, you get to the age of your body developing and your first period. And if you look at the anthropological literature, that first period is sort of a sign of womanhood.
Dr. Marni Sommer: [00:07:02] I mean, it’s a sign of womanhood in practically every culture. And so, you know, but it has implications for womanhood that are stronger in some places than others. And so I wondered, you know, is that first period a trigger or an indication to that community or society or ethnic group or where the girl lives that it’s time to get married or time to have a baby, which usually means you don’t get to stay in school. So I wanted to explore sort of the social cultural linkage, and we know for sure that used to happen a lot. That happens less. But I would say there are still places in the world, including in Tanzania, where I did my study, where that probably is still happening. But there’s still many parts of the world where you reach puberty, you get your period, and that is either you need to be protected because somebody might get you pregnant and that will ruin the family honor, or that’s a sign that you’re ready to get married or have children. And then there’s the more practical sort of issues that I wanted to look at, which sort of stemmed from that time I spent in the Peace Corps, which was, well, what about access? What about the school environment, the social environment and the physical environment? And by that I mean, well, the social environment. Are the teachers supportive? Are there peer support of do they understand what it’s like to manage your period for the first couple of years and or if you have bad cramps and or, you know, if you don’t have enough materials? And are teachers supportive? Do you get the information you need to learn about your bodies? Are your fellow students, girls and boys supportive and then the physical environment? You know, do you have the materials and supplies that you need? Do you have pads or good cloths? Do you have underwear? Are there toilets in that school? If there are toilets, are there enough toilets? Are they safe? Is someone going to attack you if you use them? Do they are they clean? Do they have a lock on the door? Do they have somewhere to throw a pad? If you’re using pads, do they have water or if you’re changing and you get blood on your hand or you have a blood stain on your skirt, will you be able to wash it? And if not, if none of those things are true or only some of them are true, what does that mean for girls willingness or a female teacher to go to school and she has her period to stay there the whole day and so on.
Dr. Marni Sommer: [00:09:10] And so there’s other aspects as well, like if she has cramps or, you know, is there a way for her to go rest without being stigmatized? You know, is there a potential to get menstrual, you know, to get pain medicine or is that not culturally acceptable? Or are there not nurses or people to give pain medicine? So so it’s a sort of two avenues that I wanted to explore that I think are the ways in which we think those are sort of the main ways in which we think it may impact.
Dr. Marni Sommer: [00:09:36] And then as you start to get into the classroom, you know, if you don’t have supportive teachers, you know, Will, if a girl isn’t standing up for two days, you know, will the teacher punished her, not understanding that maybe she’s and is afraid she has a stain or she has bad cramps or she’s not or she’s nauseous, you know, so I think and then the other thing that nobody talks about is that when you look at the symptoms of when people have their periods, there are a lot of women and or anyone who has their period who in the first couple of days maybe they have GI problems, you know, they have a little diarrhea or they have to go to the bathroom or, you know, no one talks about that. But what do you do if you don’t have a toilet, you know, or a toilet that you can go to when you want to and you feel safe and. It’s clean and so on, so so those are the different ways in which first education and health are so intertwined. And then I think menstruation and health intersect and education intersect.
Phalaen Chang: [00:10:33] That’s great. Thank you so much. So earlier you had mentioned how comfortable teachers were or how well educated teachers were on the subject of menstruation, could be a potential barrier as well for improving the mental health and hygiene and awareness of girls. And a lot of your work had to do with the educating of younger students, like you mentioned, making books for them. Has there been efforts towards educating teachers as well?
Dr. Marni Sommer: [00:11:01] Great question. It’s really interesting, the dynamic with teachers. When we went to Tanzania, when I was doing the research for the first time, I one of the things we always do is we look at the syllabus to see is, is puberty or is menstruation even in the syllabus. And so when we went to Tanzania in 2006 and I looked at the syllabus, it was there, it was covered first challenge. It was covered much later, like they would have been menstruating for a while by the time they learned about it. So that was challenge number one. Challenge number two is which I heard from the girls, is that the syllabus covered like the biology, you know, what is reproduction? What is your uterus, what happens in a girl’s body, what happens in a boy’s body? But there wasn’t practical guidance around that. Maybe you’ll feel this way and this is how you use a pad and, you know, this is how you stay clean. And so the practical guidance was not anywhere, you know, covered. And then the other issue that we found that we heard about is that many teachers, female teachers, were very uncomfortable talking about it. So even if it was there, they would skip it. So, you know, they might say they taught it. But in fact, when you talk to the girls, it was like it was like it didn’t exist. And so it’s a great idea to have a teachers guide. I know that, for example, in Kenya, they have a new menstrual health and hygiene policy that comes with the teachers guide, because I remember I edited it a couple of years ago.
Dr. Marni Sommer: [00:12:31] I don’t know that it’s rolling out into the schools yet, but I think it’s about there’s a couple of things teachers need to feel really comfortable. You need to make sure that sort of their cultural beliefs around menstruation are talked out so that they are teaching accurate information and being sensitized to girls needs and and they need to feel empowered. One of the things I know parents in a lot of countries where I worked are concerned about, and I think teachers feel the same way as they’re a little afraid to talk about it because they’re afraid they’re going to be asked questions they can’t answer, you know, and as the authority in a school, they don’t want to be seen not able to answer questions. So I think a teachers guide is a really important piece of what needs to happen. But the other challenge that comes up is that talking about puberty in periods may or may not be. It’s not like it’s kind of like America in some places. It’s not part of the testable curriculum. And you certainly don’t want people getting tested on puberty in periods. But when some when there’s a really strong emphasis on testing and what you have to get through, that’s mandatory. I think covering puberty in periods in a supportive way is not enough. It’s not mandated in enough places. And so therefore teachers may or may not be motivated. And so I think you have to look kind of holistically.
Dr. Marni Sommer: [00:13:55] They need to feel well equipped to do it and comfortable and confident and the school sort of educational system needs to support them doing it. And then the third issue that may come up, which certainly came up in a couple of countries where I was, is the the nature of the discipline between teachers and kids. There’s still some corporal punishment. It’s not always the most positive relationship. I mean, the same in the U.S., I think, although most places fortunately, we don’t have corporal punishment anymore. And so a teacher may or may not be who that kid is comfortable talking to. So sometimes I think you have teachers that they feel very comfortable with. Other times it may be challenging. And so I think in a perfect world, there’s like visiting teachers, you know, people who they can you know, any kid can ask a question of and not worry. They’re going to get a bad grade because they asked a question about their bodies or not feel shy, are uncomfortable with a teacher who has control over their academic success. So I do for sure. I think teachers are a really important part of the equation. And we’re working with a Canadian NGO right now in Sierra Leone that’s very works very closely with the teacher training institutes. And we’re developing pretty books there with the idea that there would be a teacher guide so that teachers and it’s going to be really interesting to see how that works.
Dr. Marni Sommer: [00:15:13] And I think they’re going to practice with the teachers sort of talking about the issue. But I think the issue of cultural beliefs is I think that practice is really critical, because one last thing I’ll say is when I was in rural towns, the girls were telling us I mean, this was 15 years ago. So I don’t know. But now that, you know, you had never told anybody we were interviewing girls. They were 16, 17, 18, and we were the first people, our little team that they’d ever told they were menstruating, and when we said, well, why is that? Three or four of the girls said, well, if I tell my mother that I got my period, she’ll die. I’m thinking, oh, that’s very dramatic, so it took me a while to figure out why they believe that the reason they believe that was teachers was the primary school teachers had told them. So it’s like you just want to make sure, you know, that you are understanding the cultural beliefs as part of that training. But I think you want to go in and understand the local culture, understand the local beliefs and come in with just to know that, like just doing a training guide is a key part of it and a very few countries have it. So absolutely, that would be a good stepping sort of first step, but that you need to do a bit more to make sure they actually are teaching on it in a way that you want them to be.
Phalaen Chang: [00:16:30] So, yeah, I’m kind of on that note, in class, you talked a lot about the books and the training guides and and what really stood out to me was an emphasis on, like making sure that the voices were from the girls themselves and making it really relevant for them. I was just wondering if you can talk a bit more about that process for people who aren’t in the class and some considerations and that you had in mind so that you weren’t like making anyone get in trouble accidentally so that people could practice it. And kind of because I know of cultures like our stigmatizing it. But you want to kind of push against that stigma a little bit like how do you balance doing that and
Dr. Marni Sommer: [00:17:07] And yeah. So I think when we when we do the research in any country, it’s critically important to us, any study we do, whether it’s girls or boys or grown ups, whoever the participants of that study, whoever the vulnerable or the population is that we are trying to understand their experience. It’s deeply important to me and my team and to many other people, I think, who do research like this, that we really hear directly from the people who are at the center of that experience. And so in this case, it’s obviously the girls in the schools in Tanzania. And so we asked them we came up with methodologies that involved a lot of anonymous writing about their first periods or ways in which they could share their stories and their experience. And not it wasn’t necessarily they didn’t have to say it out loud, because I think in particularly and I don’t think there’s any country that I worked in where the girls just we would never ask and they would never launch right away into talking about their first period, particularly teenagers, I think. And that may be shifting as more and more countries talk about the issue as it becomes more normalized. That may shift. But certainly when I was in Tanzania in 2006, that wasn’t the case.
Dr. Marni Sommer: [00:18:20] And so. When we have the girls right there, first, a story about their first period, I was just talking to somebody about the method yesterday, we separate them in the classroom. We give them a piece of paper. We tell them six times. We do not want to see their name on that piece of paper. And then they write their story and then we tell them, turn the paper upside down. We will collect the paper. And I work really hard with my research assistants to make sure they do this right. We collect the papers upside down. You know, a clever news, so curious. They immediately want to turn over. And then I yell at them across the room because we don’t want the girls to think we’re going to look at their handwriting and know which handwriting goes with it. You know, it’s all about trying to make them feel as confident as possible that whatever they’ve written on that piece of paper will never be linked to them. And we may go a little overboard. I’m sure there’s some girls who don’t care that much. But I think we want to just sort of convey this is your private story. Does it mean that there’s anything? Taboo about periods, we just want you to not feel, because oftentimes I would say the stories we get talk about feeling ashamed and embarrassed and you know that those are powerful emotions.
Dr. Marni Sommer: [00:19:31] So we don’t want them to feel outed or like we are publicizing. So I think in the data collection and we always ask their permission, we say we want to do a book for girls or if we’re doing the boys book, we do it that way. Can we use this story? One day we’re going to take a selection and use it in a book for girls in this country. We will not use your name. Are you OK with that? And they always have said they’re absolutely OK with that. I just feel badly because sometimes these are wonderful stories and they don’t get any credit for it. But but but this way nobody has to worry that their story is getting out there. And then I think the other thing around, you know, we design the books. It doesn’t always happen this way in terms of their usage to be kind of like Judy Blume when I was growing up. We all read these Judy Blume books, which are about growing up now. They’re not like our books. They’re heavier text. They’re much more in depth.
Dr. Marni Sommer: [00:20:22] But I had this idea that this book would be something a girl can read privately at home. She gets to keep the book, take it home, read it in the corner, read it sitting by the side of the road. So she has a private interaction with that, learning all about her body and reading the period stories of older girls from her country with the girls. I can’t write anything that’s going to make a girl feel empowered, but an older girl from that country certainly can. And actually my original idea was I was only going to publish a book of stories. I was going to collect stories and was just going to be a book of girl stories. And then I realized the girls have so many questions and they there’s so many things. They don’t know if it’s true or not true and you can’t get it that all through a book of stories. And so that’s why the stories became part of it. And so I think the idea is that we kind of normalize the topic. They all get these books, they share the books, they discuss it. But it’s not any one person’s own story who’s reading it. And so it sort of makes it a sort of normalized conversation.
Phalaen Chang: [00:21:22] Right. And earlier, you had also talked a lot about the lack of access to toilets or perhaps like water and sanitation are the material aspect of menstruation that is kind of maybe limiting for people with periods to think like should be done in that regard, because I would imagine that building like new toilets or something like that would be very expensive. So I was just wondering, like for toilets and access to like pads, maybe the solution was like, how do you go about that?
Dr. Marni Sommer: [00:21:53] Yeah, yeah. You know, it’s a good question. There is a as you may have picked up, if you look in the media, there is a real focus on giving pads to girls or giving reusable or period underwear. You know, there’s a real focus on the products and sometimes with information and well, for sure, lots of people need products or need better products. And it’s always felt like a very incomplete solution because without improved toilets or even a toilet, it doesn’t matter the best product in the world. You still need to be able to change it at some point and or sort of use the bathroom at some point. And so for sure, toilets cost more, but they also last longer. They’re not going anywhere, hopefully. And if you maintain them, then they last even longer. I think what we’ve tried to articulate is that. The right to sanitation is sort of a larger human right, and this just menstruation is just one more reason you need to meet that right to sanitation. And it is something that governments have a responsibility to do in terms of basic sanitation, whether it is in the schools, in the public schools, whether it is in the transport, in the like, at the bus stations, whether it’s in the marketplaces, you know, whether it’s, you know, wherever it is, the girls and women or anyone with a period is walking around in their society that there is this right to a toilet of some sort and doesn’t have to be fancy.
Dr. Marni Sommer: [00:23:23] It doesn’t have to have running water, but it needs to be safe and clean and available. And so, well, it does take an investment. You know, there’s so many health benefits, not that you should even need that. It should just be like one of those things because, you know, the number of you that would have come in that day for class if there were no toilets in the Columbia’s campus and anybody either period or not even have their period, like nobody would have shown up. But there were no toilets on campus or they would be back in the bushes and then Columbia’s campus wouldn’t look quite as pristine as it does. So I think when people stop and personalize it and identify with it and think about, well, how would that impact my daily life going about my business, I think it starts to feel like something worthy of investment. I think that the provision of pads and supplies are really important as well, particularly, for example, in emergency context, where maybe people fled their home. They don’t even have the cloths that they used and they couldn’t carry a lot. But it’s also kind of like. People wanting the magic bullet like, oh, if we just give them pad’s, they’ll be fine because it feels simple, you can count it. It’s a little bit like when people were first very focused on addressing the HIV epidemic. You know, it was all about giving out condoms, you know, not necessarily tackling.
Dr. Marni Sommer: [00:24:41] Well, what are the dynamics between men and women? What enables condom use? Who’s going to use it? How do you get it to people? But it was just you could count them, you know, as you can count pads. And I think that for a lot of the donors who maybe originate in countries like ours, they can really identify with a menstrual product. Trying to talk about toilets, you know, it’s like people even think about it because, you know, there’s always a toilet somewhere if you, you know, look a certain way, carry yourself a certain way, have a certain amount of means. You can always find a toilet to almost not always, but almost. Right. So so I think that’s why even though we do appreciate that, it does require some investment and of course, maintenance, that it’s sort of you can’t have one without the other or you can, but it’s not going to be as effective as if you think of it as like a holistic package, which we like to, which is the toilets and water and disposal along with the products, whatever they are, reusable or usable along with the information. Because if someone doesn’t understand what’s happening in their body or doesn’t feel confident or doesn’t feel able to manage their period, then having the product won’t matter either. So we like to sort of say it’s these three-pronged things that is a very basic and, you know, sort of what you need, you know?
Phalaen Chang: [00:26:00] Yeah, definitely. And I was just wondering if there’s any, like, current initiative improving access to toilets or improving the conditions to toilets, because I don’t feel like I care about that a lot. Like I often hear people advertising you reusable products. But anyway.
Dr. Marni Sommer: [00:26:15] Right. So it’s funny you say that because, you know, I had a number of interactions over the years when I was trying to get various op eds published about sort of work we were doing. And I had at least two editors write to me. I’d written an op ed that had to do with toilets. And they’re like, we cannot write about like art. We’re not like I don’t remember what it was like around Christmas once or like around some holiday. We’re not talking about toilets this time of year or, you know, it was just this like that’s not interesting. Our audiences want to hear about toilets. So it’s not and I say this to you know, I will get calls from journalists sometimes because there’s some new paper, some new movement out there, usually around products. And they want to talk about it because it gets in the news. Somebody has done another study or they have a new initiative and and they call to talk about it. And I say, well, that’s an interesting question and I’m going to talk to you. And then you can just see there, I mean, fortunate, I can’t see their face most of the time, but it’s like they’re least they’re like, “Must we?”
Dr. Marni Sommer: [00:27:10] I’m like, we must talk about toilets. It’s not sexy, but we’re going to talk about it. And happily, just a couple of years ago, NPR actually was willing. They did a piece. I did a piece they published. So they’re starting to be, I think, more openness. But I think when covid is over and you go to dinner parties, you know, you try bringing up period products and you try bring up toilets and you see where that dinner party conversation goes and which topic, if either is welcome, you know, which one’s more welcome. So that being said, it’s a great question. There are NGOs out there who are either related to the menstruation issue or totally separate because toilets have huge health impacts around cholera and diarrheal disease. And so there are many NGOs out there and donors who work on sanitation, water and sanitation is sort of the field that it’s called. It is not a well funded in comparison to other initiatives area. And it’s interesting because I was recently on a call with a huge donor that gathered a number of us to have some breakout groups and talk about, well, look, covid came people started to appreciate the importance of water and sanitation, washing your hands, hygiene, you know, are we can we capitalize on that? You know, was this our moment? And are people going to have a sustained interest in providing toilets and water? Or was it like we’ve lost them already? And I think there was a sense we’ve lost them already.
Dr. Marni Sommer: [00:28:39] But why? You know, why is it so? It was just an interesting hour long kind of brainstorm in these small groups around what do we need to do? To make this something that’s compelling to people and worthy of, you know, I think part of it is that. It requires sort of sustained investment, you can build a bunch of toilets, but if you don’t maintain them, they’ll be broken in two months and nobody’s going to use them, you know? And so I think that so. So there’s definitely initiatives. The Gates Foundation has funded a lot of work and sanitation. A lot of the donors do. But in the World Bank has some big projects and sanitation and water. But we’ve a long way to go. So it’s still, as you know, you can start bringing up the dinner parties because maybe every little bit helps.
Phalaen Chang: [00:29:24] Moving forward, if people are interested in getting involved with either research or initiatives to help raise awareness or build like toilets to help support the cause, what can they do?
Dr. Marni Sommer: [00:29:39] So also great question. I think, one, they can start to learn about the areas and who’s doing what. One thing that might be fun for people is we have this monthly period possie presents webinar series. We actually had one yesterday morning. And if you just go to period possie presents, if you just Google that and you scroll backwards through our recorded lectures, I mean, our recorded webinars from the last year and a half, and you will anybody will see the different organizations and speakers who presented. And I think it’s a really nice collection. It’s certainly not everything, but it’s a nice collection of people working on female friendly toilets, working on addressing sanitation, water, menstruation and emergencies. Working on our next one is going to be on addressing menstruation and workplace contexts. And so I think that that’s a nice way to sort of find some of the organizations that are out there. I think if this area is particularly compelling to someone and like something they want to do with their career, they should think about what gets them most excited. You know, is it most exciting to dig into, you know, what do young people learn about their bodies or not? Is it most exciting to dig into? I really love engineering. I want to get into toilets. You know, is it urban planning or is it development sort of thinking around how do we help societies create, you know, sanitation systems? Is it that I love menstrual products and I want to figure out how do we make these sustainable good for the environment, but in a way that’s culturally acceptable? So I think one of the fun things about public health and about this topic is there’s just an array of areas, you know, do they want to get involved in education and sort of helping school systems to be more supportive and enabling? So I think it’s just about finding, you know, if you pay attention to it, someone say to me once when I was talking about the idea for the puberty book before I had done the first one, and she said to me, you know, you really start to glow when you talk about that.
Dr. Marni Sommer: [00:31:37] So I think it’s about so then I was like, well, I have to do it then. So I think if you start paying attention to the things that make you glow, that you get very excited when you’re reading about them or thinking about them, then that can help guide you to figure out sort of what is your thing? Is it about donating or is it about actually getting in there and doing some of this work so great.
Phalaen Chang: [00:31:57] It’s wonderful. Thank you so sure. So if anyone is interested in learning more or getting more involved, the website that Dr. Sommer mentioned was period posse: p e r i o p o s s e. And it is a monthly interactive webinar series that brings together experts and mental health and hygiene from across research policy and practice to discuss key emerging issues, you can join their mailing list webinar and attend their upcoming webinars to learn more and get involved. Thank you for listening and have a great day.
In this episode of What is Global Health?, Rachel Chang and Miriam Cepeda speak with Dr. Robert Fullilove on America’s mass incarceration. Dr. Fullilove explains how putting generations of black people behind bars is not only a persisting legacy of slavery but also how mass incarceration feeds directly into the racial disparities we see in COVID-19 and other health outcomes.
Dr. Robert Fullilove is Columbia University’s Associate Dean for Community and Minority Affairs, Professor of Clinical Sociomedical Sciences, and the co-director of the Cities Research Group. As a leading public health researcher and advocator, he has served and advised both the CDC and NIH on substance abuse and HIV/AIDS.
Dr. Fullilove is actively fighting mass incarceration: he teaches public health courses in six New York State prisons through the Bard College Prison Initiative, where he serves as their public health senior advisor. Before he became a leading public health expert, Dr. Fullilove was — and still is — a civil rights activist and SNNC member. (In fact, you can find pictures of him protesting during the Freedom Summers in Mississippi.)
Mass Incarceration and Public Health | Dr. Robert Fullilove | Transcript (via Sonix)
[00:00:00] Welcome to the podcast of the Journal of Global Health. My name is Rachel Chang and I'm here with my co-host, Miriam Cepeda. Today we'd like to talk with Dr. Robert Fullilove about America's mass incarceration. Specifically, we want to discuss how putting generations of Black people behind bars is not only a persisting legacy of slavery, but also how mass incarceration feeds directly into the racial disparities we see in COVID-19 and other health outcomes.
[00:00:26] Before we start, I'd like to introduce Dr. Fullilove at Columbia University. Dr. Fullilove is Associate Dean for Community and Minority Affairs Professor of Clinical Social Medical Sciences and the Co-director of the City's Research Group. Dr. Fullilove has an extensive background in public health research and advocacy in topics like substance abuse and HIV/AIDS, and has served and advised for both the CDC and the NIH. Dr. Fullilove has actively been fighting mass incarceration for over a decade now. He has taught public health courses in six New York state prisons through the Bard College Prison Initiative and now serves as their public health senior advisor.
[00:01:05] And probably most impressive is that before he was a leading public health expert, Robert Fullilove was and still is a civil rights activist and SNCC member.
[00:01:17] Without further ado, we'd like to welcome and thank Dr. Foley love for joining us. Glad to be here. Thank you for having me.
[00:01:24] To set up the context, the US prison population has increased by seven hundred fold since 1970. In fact, the US has more people incarcerated than any other country in the world does where Black and Latinx individuals are being incarcerated at disproportionate rates. Can you explain to us why why our country has such a high incarceration rate?
[00:01:49] I think it's fair to say that we have, as a nation, never managed to get out from under a legacy that we have as a nation with slavery.
[00:02:01] Slavery was the ultimate level of social control over disadvantaged population. Since the end of the civil war reconstruction, the 20th and the 21st century, we still struggle with issues of race. So although the question might have been about mass incarceration, who we incarcerate tells a great deal. I think about what it is, how it impacts the United States as a whole and why it's such an immensely difficult problem. The fact that roughly 60 percent of all the folks who are locked up or people of color, the fact that they represent less than 20, 25 percent of the population in the United States means that their overrepresentation must mean something significant about our efforts to deal with issues like poverty or issues or issues related to education, and certainly are issues related to living space. I believe that the war on drugs is primarily responsible for this huge increase in the prison population. And it came about at a moment when instead of dealing with widespread drug use in the United States, we didn't resort to doctors. We didn't try to have the public health system manage this problem, despite the fact that substance abuse disorders are well recognized in psychiatry. What we as a nation decided to do was make this a criminal issue and make the demand that the police and the courts be the ones who would deal with this problem. So you suddenly have this massive increase with the war on drugs of the number of folk who are sent to prison, literally because of their engagement one way or other, where the issue of drug use, drug sales and everything about drugs that this nation found objectionable. So with a sudden decision and it did feel as if it came about overnight to say that the cops are going to handle this, no surprise that slowly but surely since 1980, that huge jump that you cited has produced a prison population that is large and that is largely composed of folk from communities of color.
[00:04:14] Right, that completely makes sense, and could you explain more about how this history of slavery and then segregation, Jim Crow and to redlining that still happens today, how that affects who is getting incarcerated?
[00:04:30] Sure. I think more than anything else, it's appropriate to think that in the 1970s, Richard Nixon was the president of the United States.
[00:04:39] He had just come off a period of time when we saw a real expansive movement in the civil rights movement. Thanks to President Lyndon Johnson, we had the Civil Rights Act, we had the Voting Rights Act.
[00:04:53] We have acts passed in the Congress that did their best to reduce segregation in housing. So a Republican suddenly as president of the United States, very conservative with respect to issues of race, I think it's fair to say that guided by folk who, as is the case today with so many members of the Republican Party, was really interested in an agenda that supported white superiority. It became very clear that there was an expectation with the assassination of Martin Luther King in 1968 that something had to be done about race. Daniel Patrick Moynihan, the senator from New York, basically argued to Richard Nixon, Hey. You don't want to get involved in all the mess in the 60s that resulted in a civil rights movement on the one hand. And a large pattern of urban riots in major cities in the United States on the other. Why don't you adopt the policy of benign neglect if you are concerned about the problems that exist in the minority populations in the United States?
[00:06:03] Why aren't we clear that a lot of crime in urban areas is largely fueled by drugs and drug use?
[00:06:10] How about you think about dealing with the issue of race by saying nothing but dealing with the race, the issue of race indirectly, by making sure that as the president, as a nation, we start to crack down on drug use.
[00:06:25] The American public is already worried about the role that drugs play in crime. Why not declare a war on drugs and see if you don't with that deal with the problems that are associated with minority communities, but also give the sense that for the American public, it isn't race that's driving this agenda. It's a real concern to make sure that life in the United States can be improved because it'll be a life that is pretty well free of the influence of drugs. That, of course, never happen. But the moment you put the cops in charge of maintaining a federal as well as a local policy that said we're going to crack down on drugs, where would you deploy the cops? Where would they go?
[00:07:09] Well, the answer is they'd go to the communities that have the highest rates of crime. This is hotspot policing.
[00:07:15] Let's deploy our cops to a place where they can do the most good, which is translated that they can have the most of an impact on what's going on by throwing a lot of people into jail.
[00:07:27] It's at that point that it becomes clear that the most segregated communities in the United States, the ones that were created by redlining, would also be the ones that would have high rates of poverty. And because poverty is so directly connected in too many instances to what we would consider to be crimes and to the temptation to engage in the use of drugs, we suddenly discovered that with large numbers of police going to these communities, you not only had more opportunities to be arrested, you also had more of an opportunity, if arrested to wind up in prison. So all of a sudden we discover, as was the case in the 1990s when Eddie Ellis, formerly incarcerated person, tried to study this, what you discovered was that in New York City and in New York State, 74 percent of the prison population came from those redlined, segregated communities in the city of Newark. Seven neighborhoods accounted for a substantial portion of the folks who were being incarcerated in the state at that time. That's a way of saying that in these red line segregated communities, prisons are like an extension of what's going on in the neighborhood. They are institutions that may be far removed from bed sty from Harlem or from Mott Haven, but they are communities that contribute such a large number of their residents to the prison prison industrial construct. It becomes really, really clear that our history of segregation has led to greater policing, greater numbers of arrests and greater numbers of folk ultimately sent to these colonies up north. And it's one of the reasons why, although it doesn't seem directly connected to issues of race, residential segregation, policing and mass incarceration are intimately tied together.
[00:09:24] Yes, absolutely, the link between crime and prison is is just insane how this history continues today. You're a leading scholar in public health and much of your work is centered around combating mass incarceration. Yet a lot of people, even some people in the very own communities that we're talking about, don't see mass incarceration as a public health issue. Can you explain to our listeners the role that mass incarceration has played in perpetuating health disparities among low income black and brown people today?
[00:10:00] Well, I think the best way to see it and to see it in really quite dramatic contrast is to look at what's happening with COVID-19. I think it's fair to say that researchers have identified 17 settings where you have the highest concentration of this coronavirus. 16 of those 17 places are state prisons. These are congregated facilities, their facilities that do not house one person.
[00:10:32] Incarcerated persons are often in dormitories. They're packed together. Social distancing is almost impossible in many, many states. There are no masks that are made available for persons who are incarcerated. Testing is sometimes very difficult to get. So although one should be doing it on a regular basis, the fact that it doesn't happen enough means that we not only have widespread transmission of COVID-19, we're not even able to track how bad our problems are, nor are we able to track all the things that we need to do to make sure that people are safe and healthy. It's a way of saying that the ultimate disadvantage is to be in a place where you're packed and jammed together at a moment when a viral pandemic is raised, is raging when exposure to the virus is most likely to happen, when you're close together with in an indoor setting and social distancing is impossible, as is the wearing of masks. You can't really imagine a more horrific situation than that. And I want to suggest that this is typical of what happens with mass incarceration in the United States. First off, the people who are arrested, as I've just suggested, are coming from highly segregated communities that are known for the high levels of health disparities that they house, from diabetes to obesity to cardiovascular disease. These are the kinds of conditions that are not only a part of what kills people who are living with COVID-19, but they're also the comorbidities that create so much of the mortality. Let's be clear that people who are currently in prison are from those communities. So in many instances, not only are they at risk for the transmission of COVID-19, they often have the illnesses that are part of the comorbid conditions that make fatalities as a result of COVID-19 that much more likely.
[00:12:30] Add to that how much it is the case that when you get out of prison, you are typically in much worse health than was the case when you went in. And it becomes evident that what happens in prisons can often contribute to the ill health of the communities to which people return. This is especially true of jails in any given day in the United States, some 700000 folk are locked up in local jails. They are constantly turning over. The average stay of a person in jail is about a week. Fifty four percent of the jail population will be cycling out of a jail facility and back to the community. If those jails themselves are overcrowded, if they like. The prisons are in dormitories where very little is done to obtain social distancing. If there are no mass and if there's no effort to test them, it means that these facilities automatically contribute to the rates of COVID-19 that we're going to see in the general community. If it's not the incarcerated persons, it's going to be the corrections officers and the staff. If ever there was a no win situation, this notion that we are in a pandemic that is largely fueled by the reservoirs of infection that exist in our prisons and in too many instances in the poor communities of color that contribute to the prison population, if ever there was a way of seeing the dynamic nature of the risk that is posed to the general population by our failure to take care of health disparities in inner city communities and in the prisons and in the jails, it is really clear with COVID-19 how that particular set of approaches and that particular policy has hurt us hugely.
[00:14:14] Right, that completely makes sense, and it's no wonder that that's why we have we see alarming statistics of how people in US correctional facilities are five point five times more likely to get COVID-19. And I guess like my question now is, like, if you've really clearly illustrated to us that the reason why that the high rates of COVID in prisons, it doesn't just affect people in prisons, but it actually affects the rest of the population, as you said, with prison guards and other employees and visitors coming in and out.
[00:14:50] So it seems like if we want to address the high rates of COVID-19 in the US as a whole, as a nation, it seems like the root cause is something more fundamental, something that goes all the way down to our prison system and the way we treat Black and Brown people. What would you say to this? Like, what do you think is the root cause of all of this expansion of COVID-19?
[00:15:19] Yeah, I think you're absolutely right. Once again, this is a virus that takes advantage of the poor health of the people who are infected. That Governor Cuomo, where he pointed out with great drama in his voice.
[00:15:34] Ninety four percent of the mortality is from COVID-19 arise from comorbid conditions. Well, as soon as you recognize that comorbid conditions are heavily concentrated in communities of color that are described as health disparities, it becomes evident that a virus manages to impact a population.
[00:15:58] If there is a reservoir that allows it to maintain itself, if that reservoir is long lasting, if that reservoir is untouched and untreated, not only will it be a source of infection for the people who circulate in and out, it is also going to be a source of many of the variants that we're now starting to see are part of the lifecycle of this coronavirus. It does not stay the same. It mutates, it changes, and it will mutate and change because it's got a massive petri dish of millions and millions of folk. And in the United States, with that petri dish being folks in poor communities of color, failure to deal with the conditions that create that petri dish means that we are always in danger. We are always at risk for having stuff explode from those settings to make it that much more difficult for everyone to be safe and healthy. So insisting that people understand how much the legacy of the past, the degree to which we have never been forthright, never been aggressive about dealing with so many of the problems that haunt minority populations now means that Mother Nature is exploiting that as a way of making sure that one of nature's creation, this incredible coronavirus, now has the capacity to do serious damage. I remember a lot of science fiction authors who have always felt that human beings represent a polluting plague on the planet and that Mother Nature would basically do her best to defend herself from all the evil that's represented by the things that human beings do.
[00:17:46] So what does it take to get back at us? How about you develop an infectious agent that exploits all of our weaknesses, not least of which is our desire to be independent? So we don't like to be told something like wear a mask, we don't like to be told you're supposed to social distance. And we definitely don't feel that it's appropriate for us to invest an enormous amount of time, energy and money and getting rid of community health problems that are largely about folks of color, not about the mainstream population. We would much prefer as a nation to turn our back on what's happening in Black and Latino and Native American communities. And we have done that since almost the dawn of our history on this particular in this particular country. But our failure to care for those health disparities, our failure to care for the conditions that create them, our failure to do with issues of racism and segregation has meant that we have now provided a pool that Mother Nature gets to exploit to say, I'm getting back, I'm getting back a job, you will pay the price.
[00:18:53] And if the notion is that we're too many people on the planet and this is one way to get rid of us, we are complicit in all the factors that are ultimately going to do us and our communities so much damage. And I think our inability to sort of recognize how much we are a nation that is invested in white supremacy, we are a nation that will do. Look at what's happening with the Republican Party these days, you'll do whatever we need to do to maintain the privilege and the power of mainstream white communities. We're going to do that at our peril because in the notion that somehow or other, if I keep you out, I'm also probably doing whatever has to be done to keep myself safe and healthy. The impact of coronavirus has been really to demonstrate how absolutely not true that is a failure to deal with these issues. That desire to ignore them has meant now they're coming back to bite us in the butt. And I have to believe that it's our failure to attend to the issues that have been raised in immigrants rights, civil rights and other movements is exactly why we are, as a nation in real trouble, not being able to listen, not being able to attend to these problems. They are now here to haunt us.
[00:20:10] Absolutely, I feel like you said it better than I could have ever imagined, but, you know, I feel like you, along with other activists, you haven't turned your back on these issues. Could you tell us a bit about what your experience has been, both teaching at Columbia and as well in New York City and New York state prisons through the Bard Prison Initiative?
[00:20:33] Yeah, this is a moment when I get to say College Behind Bars is a documentary that anybody who has Netflix should check out, because I think it says better than I ever could what it's like to be in that kind of setting. I really do appreciate your posing this as a question, because I've been teaching since nineteen sixty four in that long, long period of time. I have never encountered the kinds of experiences in teaching that have been a part of what I've been doing in the Bard Prison Initiative. It's something of a tragedy, I have to tell you, to be in a setting where you suddenly discover as a professor of a graduate school of public health in the Ivy League, I am surrounded by people who are doing long beards, who've been in prison for a long time, but who are at least as far at least as competent and as at least as Abel as any of the graduate students I've been teaching here at Columbia for the last 30 years.
[00:21:37] What a tragedy for the communities from which they hail to have some of the best minds in the community not there, but doing time in a facility upstate. So the experience of interacting with folks who are hungry to learn. The experience of interacting with folk who find that engagement and study engagement in academic pursuits is a way in which for them, prison walls seem to disappear. They feel liberated because while their bodies are incarcerated, their minds are free to roam. This is language, by the way, that I'm borrowing from many of my students. As a teacher, you could not ask for anything more astounding to be presenting things like health disparities that teach public health courses, and I talk about them in communities where they live. And I have people certainly understand how much and to what degree many of the issues that shaped their lives. Many of the issues that provided such an enormous challenge are literally a function of our inability to provide appropriate health care and an inability to provide the materials that can produce a really good quality of health. They get to see that those are the things that are so much a part of community life. It almost explains why they're doing time in a prison upstate. That kind of revelation, that kind of self understanding that I see so much in the book that I teach and the degree to which that self understanding leads to a commitment to go back to their home communities with an agenda that includes working to improve the health of the public. Trust me, in many, many years, more than half a century of teaching, I have never, never had anything that even remotely equals what I have experienced by doing this kind of education behind bars. It has really been something.
[00:23:35] I've watched clips of that Netflix show, that youth that you mentioned. And I remember the video of the student prison initiative. I remember them debating Harvard students and winning. And that that just illustrates your point so greatly that like all of it just comes down to privilege and who has access and who was born in which neighborhood. And what you do is honestly so inspiring, knowing what you've done to address this issue, what could our audience do to help our nation decarcerate? And what do you think public health role is in ending mass incarceration and all the other health disparities that we see within black and brown communities?
[00:24:19] Really good question, because it is at the core of my strategy, if you will, in my approach, I think COVID-19 is sort of proving that as a nation, we've made some tactical errors, if you allow me to describe them in that term that are now threatening the health of all of us, not just the folks who are on the inside. I want to believe that this is a moment of intense self-examination on the part of folks in the United States who are crying for some kind of strategy, some sort of solution to all of the problems that have been created by this pandemic. Prisons offer a unique prism into which one can view all of the impacts that a history of structural racism has created by having people understand that prisons are a microcosm of poor public policies, poor public management, and, of course, the kind of racism that makes it easy to incarcerate someone who does look like you and who is from a community that you don't know about.
[00:25:28] We have been saying forever, you have to understand it isn't just about us.
[00:25:33] What hurts us hurts you. It was a central part of the message that Martin Luther King used to try to broadcast whenever he had the chance. He was really insistent that people see the Civil Rights Movement is less about what you're going to do for black people and much more about what are you going to do for the nation.
[00:25:54] So anybody who is interested in doing the kinds of things and promoting the kinds of things that are going to have an impact on the health of the public in general will be automatically led, I believe, to looking at the causes of some of the problems we're experiencing with COVID-19, and they'll see that it becomes incredibly important to do something about mass incarceration. I'm speaking to you at a point when the governor has had to say incarcerated persons over the age of 65 now will be vaccinated against the problems created by COVID-19. He had been highly resistant to that point, but earlier. Literally Thursday evening, a number of suits were filed in courts in Brooklyn, which basically said that failure to have vaccinations available for incarcerated persons was a violation of the 14th Amendment. The 14th Amendment guarantees equal protection under the law. So it pointed out you can't have corrections officers vaccinated and leave prisoners unvaccinated because somehow or other, they are less than human. As a result of having been having been convicted of a crime and having been sent to prison, they pointed out that I'm sorry, as long as they're human beings and because they're essentially being punished not for the crimes they committed, but because they happen to be an inconvenience politically, a problem that if vaccine is going to get the general public mad, that's not enough.
[00:27:31] That's not enough. And whatever the political consequences might be of making vaccines available to prisons, the idea that we are still not ruled by what we know to be principles of public health is all the more shocking. Part of what public health gets to do is say, look, we as a nation suffer unduly from a wide variety of health conditions that are made that much worse by the degree to which not everybody has the same access to health care and that everybody has access to communities and an environment where health can be promoted and disease can be prevented. So beginning with this invocation of the 14th Amendment as a way of getting prisoners over the age of sixty five vaccinated, I would think that that principle, the justice that lies behind promoting something that does not discriminate against people because of their incarcerated status then gets us to the point of thinking about not having people discriminated against because of their race, because of their ethnicity, because of their membership in the LGBTQ community and so on and so on. I want to believe that what's happening now allows us to question democracy and the way it operates in the United States at this day. I think it's a moment where we get to say, look at the founding principles that we seem to value so much as the ones that set up the United States.
[00:28:57] Isn't it clear that what we have to do to realize the dream of the founding fathers would in part require that we not let racism? Structural racism in particular, and white supremacy be the things that ultimately bring us down because of the impact that they'll have on our health. Now, a lot of people will argue that the founding fathers were slaveholders, they were bankers. They were not really the kinds of people that we would want to associate with. I don't care. The point isn't so much who were they? It's what do we know about the document that they put together, all of the rights that are represented in the Bill of Rights, everything that had to do with the way the 14th and 15th Amendment can become a kind of a roadmap to how we have a better future. It's what leads me to believe that if we begin with mass incarceration and continue to pound the threat of how that form of oppression has impacted us in general, but has certainly impacted our health under COVID-19 that using that as a precedent, we might find a way to make this nation better and more responsive to the dream that's, I think, very uniquely characterized in this nation's constitution. That's my hope.
[00:30:13] That's our hope, too. I think that's it's everything that we're striving for, truly.
[00:30:19] It's been an honor and an inspiration speaking with you today and I guess before we close, this has been a really fascinating conversation, but is there anything else you'd like to add that you are our audience and our listeners to know?
[00:30:32] Well, I think you are students. My most important foundation was being involved in the Student Nonviolent Coordinating Committee in the 1960s when that student group revolutionized our approach to civil rights. I believe fundamentally in the power of students. I believe that your capacity to see the world as it is and not seeing the world through the blinders that are created by jobs, family and mortgages to the degree that you are, is free as anybody from having hostages to fortune.
[00:31:08] Your ability to see clearly what we need to do next. Your ability to act on what we need to do next is why I have always felt if there is going to be major change in this country, it will be started by students.
[00:31:22] And I'm hoping that anybody who's listening to this, who is a student or who supports students will see the wisdom of what I'm saying and support efforts to make sure that when voices are heard, yours are among the first that we pay attention to.
In this episode of What is Global Health?, Phalaen Chang (CC ‘23) speaks with Dr. Dan Raz on cancer screening, treatments, and recovery during the COVID-19 pandemic. Dr. Dan Raz is co-director of the Lung Cancer and Thoracic Oncology Program, Associate Clinical Professor at the Division of Thoracic Surgery, and a thoracic surgeon at City of Hope in Duarte, CA. His research focuses on identifying new therapies to combat therapy resistance in lung cancer, targeting specific epigenetic changes to improve platinum sensitivity in lung cancer, and studying barriers to lung cancer screening.
Transcript (via Sonix)
[00:00:08]
Phalaen Chang: Hello, everyone, and welcome to this episode of “What is Global Health?” Almost a year ago, the COVID-19 pandemic turned everyone’s lives upside down. Schools were closed, stay-home orders were issued, and hospitals across the country struggled to keep up with the rising numbers of cases and new demand for more resources and care than most had the resources to provide. While cancer hospitals stayed open to serve their cancer patients, I was curious about how concerns about the COVID-19 virus have affected cancer screenings, treatments and the well-being of cancer patients, especially as cases in L.A. continue to rise. We are so very lucky to have Dr. Dan Raz joining us today to offer his knowledge, wisdom and experience on this topic. Dr. Dan Raz is co-director of the Lung Cancer and Thoracic Oncology Program, Associate Clinical Professor at the Division of Thoracic Surgery, and a thoracic surgeon at City of Hope in Duarte, CA. His research focuses on identifying new therapies to combat therapy resistance in lung cancer, targeting specific epigenetic changes to improve platinum sensitivity in lung cancer, and studying barriers to lung cancer screening. So to kind of start things off, because of the increase of cases in L.A. lately, there’s been a lot of news articles and accounts of how hospitals are overwhelmed, about how they don’t have enough resources like beds and oxygen.
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So what’s the situation like for City of Hope right now and perhaps other cancer centers? And how have they been impacted in terms of like resources and staffing? And what changes have been made to ensure the safety of cancer patients?
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Dr. Dan Raz: Yeah, first of all, thanks for speaking with me. Yeah, that’s a great question. Covid has really impacted us a lot at City of Hope. In a different way, I would say, than some other hospitals, so unlike most hospitals that are just so overwhelmed with covid patients, we have a relatively small number of covid patients. We don’t have an emergency room, for example, the way most hospitals do. And a lot of our patients are very immunocompromised. And so we’ve been working extra hard to try to reduce the number of covid patients in the hospital, if that’s possible. But I would say there’s still a really huge impact. So, for example,
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for patients, patients with cancer are extremely frightened of getting covid because of, you know, being immunocompromised, you know, potentially getting sicker if they got covid, and so as a result, you know, we don’t allow visitors in our hospital, much like other places, staffing for the covid patients we have you know, we’re a relatively small hospital, so we have to section off parts of the hospital to treat covid patients. We need to have special different types of staff ratios for covid patients. And then, of course, you know, any time someone is exposed to covid or has covid, you know, they have to stay home. And so there’s been a lot of issues related to staffing.
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Dr. Dan Raz: But at the same time, you know, I’m really proud of the job that our hospital’s done. And I would say that I feel very confident that, you know, it’s still a very safe place to get care and we’re still doing surgeries and, you know, giving the people the cancer treatment that they’re getting. We’re really not delaying any cancer treatment.
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Phalaen Chang: Has there ever been a case in which a patient did catch covid accidentally or a staff member who was treating cancer patients catch it? And if that happened, what usually happens after that?
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Dr. Dan Raz: Yeah, we haven’t had that at our hospital, but I’m sure there have been cases elsewhere and, you know, I think there’s clearly places where covid is rampant, where there’s a lot of covid patients, a lot of staff with covid and there’s some spread within the hospital. But I think that’s usually recognized and people have to do their best to contain things. But I would say overall at our institution as City of Hope, some of the other cancer centers I’ve talked to, they’ve done a really good job at, you know, protecting the patients and maintaining a safe environment to get treated.
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Phalaen Chang: Have there been any scenarios in which you had to delay treatment or anything like that just because of the risk of people like you didn’t feel safe going in? So they they themselves said they wanted to delay treatment?
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Dr. Dan Raz
Yeah, definitely, I think so. For one, there are people who have gotten covid, and we really do have to wait until they test negative and they no longer have symptoms before doing any kind of treatment or any kind of invasive testing. And I think one of the things that we’ve seen that we’re really not going to know the complete impact of covid probably for at least another year or two is that there are definitely patients who have had very long delays in getting the proper evaluation that they need before coming to see us. So, you know, I’ve seen patients who, you know, we see them for the first time at our hospital, but they were maybe diagnosed with cancer five or six months ago. But there were delays because, you know, there’s oftentimes multiple appointments and testing that’s needed to be done. And those all took a very long time because of covid and a lot of other facilities. And physicians are really overwhelmed right now.
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Dr. Dan Raz: There’s a lot of, you know, people who are not, you know, non=clinical people who are not at work. So sometimes it’s harder for patients to get appointments and other places. So we’ve seen some of that. And then, you know, talking about like cancer screening, I think a lot of people have not had cancer screening because they’re afraid of, you know, seeking any kind of medical care, even preventative care and also, I think there’s also a lot of the times, you know, I treat patients with lung cancer and with early stages of cancer, a lot of the ways that people are found to have cancer is because this was found by accident.
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So, for example, people who are getting like hip surgery or knee surgery and they get an X-ray beforehand, the X-ray shows a cancer that leads to their diagnosis. And so that’s not happening as frequently anymore. So it’s it’s very you know, there’s a lot of ways where this is affected, people getting diagnosed early with lung cancer and other cancers.
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Phalaen Chang: Earlier when you mentioned about finding out lung cancer accidentally, I was going to get like the reverse also happened. Like sometimes people think they had covid and they went to get tested. And then later, after a series of things, they found out they had lung cancer. Is that happening?
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Dr. Dan Raz: Well, that’s a good question. You know, most of it’s a good–I’m sure it happens. I’m sure it’s going to happen. You know, with early stage lung cancer, the cancer, it’s about 20 percent of lung cancers are at an early stage where we can find them and operate on them and cure them. Those patients almost never have symptoms from their lung cancer. So they’re either found, incidentally, meaning kind of by accident. Sometimes they have symptoms. They have respiratory, you know, respiratory infection that goes away. But a cancer is found, you know, in evaluation for those symptoms. So I’m sure the same is the case with covid. I’ve seen a couple of patients who unfortunately had a little bit more advanced cancers, lung cancer. Once we did all of the imaging studies where at first they thought they had covid and then it turned out they had advanced lung cancer.
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Phalaen Chang: So in terms of like treatment, has the treatment process been any different? Like, are you taking more or less patients because of the pandemic? How has your schedule changed in terms of treating?
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Dr. Dan Raz: Yeah, so obviously in the beginning of the pandemic, we really, you know, everything kind of shut down and that’s not the case anymore. But I would say our volume is. Close to what it’s been before is probably like 80, 85 percent of what it has been before, and that’s very eerily similar in my colleagues when I’m talking to them. So.
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As I was mentioning, I think there’s clearly, you know, not the same number of people with early stage cancer who are being detected because they’re not, you know, just getting all of these tests that typically detect cancer, whether that’s testing for something else that finds a cancer, incidentally, or whether it’s, you know, not getting a lung cancer screening test.
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Phalaen Chang: I also read somewhere that recently four in terms of lung cancer mortality was going down and people were starting to get better at getting it screened. And today in my public health class, we were learning about how it was kind of undoing a bunch of the progress that we had made. Do you foresee that happening in terms of lung cancer, all cancers as well and how should we move forward if we are going backwards, like after the pandemic? How do we address that?
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Dr. Dan Raz: Yeah, it’s a great question. I don’t think we know the full effect. I think that I’m hoping that, you know, this is just a temporary effect. I think that probably a lot of the positive changes that have been made in lung cancer are related to newer therapies like targeted therapies and immunotherapies in patients with more advanced cancer. We’re kind of staying alive for a longer period of time. Unfortunately, even though lung cancer screening has a huge potential to put a dent in lung cancer mortality, very few people who are eligible for lung cancer screening actually get screened.
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Dr. Dan Raz: So I would love to see more people, you know, people who are 50 to 80 who were smokers or are currently smokers get screened for lung cancer. But that’s kind of a separate issue from what you’re talking about. But, yeah, I don’t I don’t know that we’re going to see the full effects of the pandemic for, you know, a couple of years. But I’m hoping that this is just a blip. And once people get vaccinated and feel more comfortable getting the care that they need to get that, you know, things will get better.
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Phalaen Chang: Has it changed anything with regards to funding towards research or other resources for cancer patients?
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Dr. Dan Raz: That’s a good question. I mean, I think there’s a lot of additional funds to study covid related issues, but it hasn’t changed. It has not changed like funding for research, thankfully. Certainly when we proposed research studies, we have to keep covid and the pandemic in mind. And it has changed the way we do research that we have to utilize a lot more telehealth for research. We have to sometimes get patients consents remotely. And right now, for example, because of the surge of covid in Los Angeles and that the impact that has on our hospital staffing, we have a temporary pause on what’s called phase one trials. So, you know, research studies that are testing new agents that haven’t been used in people before but, you know, are mainly done for safety and kind of the very first day. So those are unfortunately kind of paused temporarily.
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Dr. Dan Raz: Yeah, and I would say just speaking of telehealth, that’s one other thing that didn’t really mention that has come out of this is, you know, the CMS, the Center for Medicare, has allowed telephone and tell video calls to be done, whereas pre covid, they only permitted that in very select situations.
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Dr. Dan Raz: So right now, we are doing about at least 50 percent of our visits via telehealth, which is a huge difference from what it was before. And I think there’s a lot of positives from that. I’m hoping we get to continue to do that because it’s you know, there’s there’s pros and cons. But for some patients, especially people who live far away, it’s a lot more convenient.
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Phalaen Chang: Do you think the telehealth thing will continue even after? And how do you feel about that? Like what are the pros and the cons, I guess.
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Dr. Dan Raz: So I think we don’t really know. I think we think it’s probably going to go away at some point, but we’re not you know, nobody knows but to talk about the pros and cons. So for one know, let’s talk about the cons first. A lot of the cons are technical problems. So there’s different kind of options for telehealth fratello video. And it’s rare that we just use like FaceTime or WhatsApp or something like that because it’s not considered to be secure. I don’t really know what the actual issues with it are, but those are generally not used. It’s more like there are different platforms that are used and some work better than others. And you can imagine, especially some people who are less technology savvy, especially older patients, may have a lot more problem with a lot of physicians are still uncomfortable with it. You know, you need to have a webcam and a microphone, you know, and some patients don’t have that. Some patients don’t have you know, most people have smartphones, but some people don’t. So there’s technical issues.
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Dr. Dan Raz: I think the the pros are, again, for people who live far away, it’s really convenient, especially if it’s just to me and review scans for lung cancer screening and other cancer screening is really nice because for screening test people, people want convenience. You know, you don’t want to have to go in and, like, meet with a doctor on a separate visit and then get your tests. And that’s what traditionally has been done with lung, had to be done with lung cancer screening. They require a Face-To-Face visit before you actually get screened. So that’s made things a little bit more simple. So, yeah, there’s I would say convenience. It’s in a lot of ways more convenient for patients. And also, you know, right now we can bill for telephone calls, which we couldn’t before, not any telephone calls, but kind of telephone visits where we discuss a care plan. And so that, I think has been good for physicians because, you know, you want to feel like you’re getting, you know, when you do work that you should, you know, get paid for the work that you do.
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You get compensated for this. I think even though they don’t pay a lot for these telephone calls, that’s been nice to actually compensate people for the work that they’re putting in.
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Phalaen Chang: Yeah, that makes sense. And in thinking also about, like, what telehealth requires people to have, like Internet perhaps, or a webcam or some other device has that. And you mentioned that it was very helpful for things like screening. Are you seeing any of perhaps like disparities like amplified or exacerbated because of like telehealth or lack of access to it in terms of like screening and treatment?
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Dr. Dan Raz: Yeah, I think absolutely. I think you’re you’re absolutely right that there’s going to be disparities. You know, there are people who don’t have Internet and and so. Yes. So we try to identify that beforehand and use telephone calls.
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You know, people can have that. Telephone is not the same, like where it’s different: when you’re seeing someone and you can smile, you can read someone’s expressions. It’s just more of a connection. I think you’re absolutely right, though. I think that that exacerbates some disparities, you know, with, you know, people who are from, you know, socially, economically disadvantaged and also older adults who are not as technologically savvy.
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Dr. Dan Raz: In terms of people who have recently been treated for cancer and might be in the hospital like recovering, how might, like, everything going on with covid affect their recovery?
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Dr. Dan Raz: That’s a great question. I mean, I think obviously it’s not good to get covid when you’re recovering from surgery, but I think. The bigger picture is that I think it’s that much harder for people to know the whole experience is that much harder. From from my patients, my experience with my patients, you know, they are very concerned about getting covid. And so typically these people are really isolating themselves before they have surgery or, for example, if they’re getting other treatment, radiation or chemotherapy, really staying at home, really limiting contact with people. And that means limiting contact with family. And sometimes they’re not seeing anyone.
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Dr. Dan Raz
And even afterwards, you know, after surgery for several months, they’re really worried and so they’re staying home, they’re not seeing their family or friends. And there’s probably more of like an emotional, social, emotional impact. I think the actual going to the facility to get, you know, the treatment that people need is probably very safe. I think everyone, you know, I can speak for our institutions in a really fantastic job to keep things safe. But I worry more about the kind of emotional toll of this.
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Phalaen Chang: Mhm, I see. As we kind of wrap up, I was just wondering if you had any final words of advice or encouragement to people who might have just finished a cancer treatment, people who have just been diagnosed with cancer or people who live with people with cancer, just like my advice or encouragement during this time as cases continue to surge.
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Dr. Dan Raz: Yeah, I mean, this has been a difficult time for everyone in different ways. And I think people who are undergoing cancer treatment, you know, this has been particularly difficult because, as I mentioned, there’s a lot of isolation that happens at a at a very difficult time in their lives. But I would just say, you know, thankfully, we have these kind of video calls that allow people to still maintain a connection with their family. And, you know, this isn’t going to be forever. And I really encourage people to get vaccinated when they can, because I think that will give people a little bit more confidence and less fear of contracting covid. And so I would say that’s the kind of the biggest thing that people can do to protect themselves, protect their loved ones, is to get vaccinated when they have access to.
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Phalaen Chang: Thank you. And on that note, I just want to say thank you so much for your time today. And I really appreciated this conversation.
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Dr. Dan Raz: Thank you. Any time. Thank you. All right.
In this episode, originally featured in The Lonely Campus, Columbia University’s The Journal of Global Health podcaster Areej Qadeer interviews current medical students at the Yale School of Medicine and University of Texas Southwestern Medical Center to explore how medical education and training is evolving in the face of COVID-19. Sofia, a third-year medical student at Yale widely known as @thisgirlnamedsofia on Instagram, reflects on her experience completing clinical rotations during the pandemic while Sidrah Shah (third-year medical student at UT Southwestern) and Hanya Qureshi (first-year medical student at Yale) share how they are adjusting to remote medical education.
How COVID-19 Is Affecting Medical Education in The United States | @thisgirlnamedsofia, Sidrah Shah, Hanya Qureshi | Transcript (via Sonix)
[00:00:01] Hi, everyone, my name is Areej Qadeer, and on today’s episode of The Lonely Campus, I’ll be sitting down with three different medical students who are all at different stages of their medical training in order to get some insight on how the coronavirus pandemic has impacted their medical education. To start off, I’ll be talking to Sophia from Yale University, also known as @thisgirlnamedsophia on Instagram, a page where she shares her journey to becoming a physician in order to learn more about how her in-person hospital experiences are currently being affected by the pandemic.
[00:00:35] So just as background, I am in my third year and it’s currently the beginning of May right now.
[00:00:44] So I’m going into my fourth year and our school does things a little bit differently than a lot of other schools. So Yale does the clinical year starting halfway through the second year. So January of your second year. You start in the hospital and it’s one year for clinical rotations, and so halfway through your third year, you’re done with all the rotations, but you have not yet taken a single board exam. Most schools do it the other way where they do two years in the classroom and you take your board exams, at least step one, you take step one and then you start in the hospital and you do your clinical year.
[00:01:33] And then by the time that year is done, you’re actually finished with your third year. So it’s comes out to be about the same. But for us, it’s just like a different order of things. So what that means is that I have finished all of my clinical rotations, but I have not yet taken a single board exam.
[00:01:54] And for me, the reason that I haven’t taken a board exam is because metrics testing centers have just like shut down and have cancelled my exam.
[00:02:03] My step one has literally been canceled and rescheduled like four times now, or I just trying to get a test date and have that work out. And then currently I am on a sub internship, which is something that students do after their clinical year, but before applying to residency. So once you decide what you want to apply into for residency, you do at least one sub internship, which is you’re basically pretending to be a first year resident and trying to get the hang of things. And so I’m actually doing that right now in pediatrics.
[00:02:43] So sorry, that was a lot. If you need any clarification, go ahead.
[00:02:49] that’s definitely all really useful information. I think you have a very unique experience across the board. I’m not sure how many medical students can say the same. So since you are in and out of the hospital in this time, whenever you come home, do you usually self isolate or are you only allowed to interact with like a certain group of people? Do they have a lot of restrictions on you?
[00:03:13] That’s a great question. So in terms of being in the hospital, most sub internships have actually been canceled just for this very reason of safety of the students and then a desire to conserve the PPE and all of that. But because pediatric patients haven’t been hit quite as hard with COVID, that’s actually the reason that I’m still able to be in the hospital. And when there are patients who are likely to have COVID or have tested positive, the students don’t really like we don’t interact with those patients. It’s usually just the attending who will go in and see that patient a lot like the other residents. I want to say don’t even go in just because we want to conserve PPE every time you have to go into COVID room and you’re going to use up some like ninety five and like gowns and things like that. So because of that and because of just like safety reasons, they try not to have the students interact with any COVID positive patients.
[00:04:25] That said, like we do test a lot of people for COVID just because like even if we don’t think that they are going to be positive, sometimes, if you want to send them for an MRI, you have to test them for it because they want to know if this person is going to contaminate the entire room sort of thing. So we test a lot of people and we are able to, as students, interact with patients who are being tested if they’re not likely to be positive and then coming home. Yeah, I mean, we wear scrubs now in the hospital, whereas before this is not like a surgical floor or anything. So people used to dress business casual or business wear like white coat, stuff like that. And now everyone is just wearing scrubs. You come home or you change in the hospital, unlike those scrubs go in the wash. Ideally take a shower.
[00:05:20] Like really everyone has their own decontamination strategy.
[00:05:24] But it is there have been changes and they’re trying to make it easier for us to just decontaminate and then, yeah, definitely planning to isolate for two weeks after the rotation is done just because I mean, you don’t know what you pick up in the hospital and stuff. So ideally, I’ll just. Not see anyone for two weeks.
[00:05:51] It definitely gets a little isolating, but I guess that’s just what we have to do. And speaking of isolation, do you think that the morale in the hospital is a lot different than what it was before, like just going in, feel a lot more? Kind of. Do you feel like devastated whenever you walk in and see how everyone’s so under so much pressure?
[00:06:15] Well, it’s hard to say as someone who’s in pediatrics only because I think.
[00:06:22] Things are so different for us and they are for like the adult floors, so some of the pediatric floors have been converted to adult floors just because they needed more beds and more rooms.
[00:06:35] And I feel like the fact that that was able to happen kind of shows that pediatrics is not being hit as hard as adult, like inpatient internal medicine.
[00:06:47] And so a lot of the people that I am working with, there are changes that are happening. But certainly the brunt of taking care of covered patients is not falling on pediatricians. Then there are COVID positive patients here and there. For sure.
[00:07:05] For sure. But. I guess what I’m trying to say is that I have been shielded from a little bit of that because the people I’m working with are not under as much pressure as I would say, like internal med. Also, I feel like.
[00:07:24] There’s a lot of pediatricians who have volunteered to work in adult COVID units, and I feel like those people, from what I’m seeing, are a lot more like I don’t want to say burned out, but they are a lot more stressed. And I think the change from like seeing in kids to seeing adults like that, that’s difficult.
[00:07:47] Same thing for a lot of people who are in subspecialties like there, dermatologists who are now going back and taking care of people in ICUs. And that’s not something they’ve done for many years. It’s it’s tough. You know, it’s stressful.
[00:08:03] But overall, I think morale in pediatrics is OK.
[00:08:07] It’s I would say the schedules have totally changed for people. They are trying to keep a very deep pool of healthy residents. So people are working like seven days on, seven days off sort of thing, which to be honest, it’s kind of a better schedule than what they had before. So I feel like Yale has done a good job of like just really trying to keep people healthy and safe, so.
[00:08:35] How did the Yale administration initially react to the spread of the virus, where changes brought in immediately, or how long did it take before they implemented these things?
[00:08:46] That it is a good question. So I feel like the response was fairly quick from Yale as an institution, just because when the undergrads were on their spring break, which I think is like March six to twenty second, they were pretty much told, like, don’t come back, just stay at home. So that’s like that’s like mid-March. So that’s I would say, you know, it’s been what it’s been like six weeks since that happened.
[00:09:15] So that was a pretty rapid, I would say, like response to things. Same for the med students. Things went remote pretty quickly. I want to say it was around the same time, honestly, as the undergrads were told not to return. I know that there were students who are in the hospital completing their sub internships and rotations and all of that just stopped pretty quickly. I want to say it’s around the same exact time, like mid-March. And people they were just told, like, no, things are going to go virtual. You can’t be in the hospital right now.
[00:09:52] My rotation that I’m currently on started on April 20th and.
[00:09:58] Everyone else who is supposed to start with me in the hospital for that rotation walk, it was canceled. Only pediatrics continued because of what I said, where the pediatric population isn’t as affected. So people’s clinical activities have been canceled and things went virtual very quickly. And I, I feel like it’s been about, I want to say six weeks or so since clinical activities have just been completely halted.
[00:10:28] Do you think that Yale did a good job of listening to student responses in the decision making process because especially online, a lot of students are saying that they feel like administration just kind of made decisions and told everyone that their schedule is going to be this way.
[00:10:43] But they didn’t actually hear everyone out and, like, make accommodations.
[00:10:48] Yeah, I feel like yes and no, you know, I think, like when the decision was made to sort of get students out of the hospital, I feel like that was a pretty unilateral decision. Like, I don’t think that they necessarily asked people about it. Would you rather continue to be in the hospital or not? And that’s because my understanding is it was more of an issue of conserving PPE more than anything else. You know, at that point, like patient safety is going to come first and the people who are really essential personnel are kind of going to be prioritized, which I think makes complete sense. And I think the other part of that is just when you’re in the hospital as a student, you’re there to learn. But under the new circumstances, I don’t think that the quality of learning is going to be the same when attendings are just so worried about managing so many patients and people are coding left and right. Like, I don’t think that’s like a good environment to learn in. And I think that’s what the administration felt as well. And that’s why they made the decision to get people out of the hospital. And then once that decision was made, I think there was a little bit more time to have virtual town halls and kind of hear out people’s concerns and complaints and things like that. And so we have had different virtual meetings and students from all class have shared their concerns. And some of that, I think a lot of that has been taken into account.
[00:12:28] So, for example, I’ll tell you, for those of us who are in our third year going into fourth year, we have a set of requirements. Right? So there’s a thesis requirement. There’s like 40 weeks of like these clinical activities and research and things that you have to you sort of have to show that you’re doing in order to graduate on time. And those some of those requirements were decreased a little bit. So instead of I want to say thirty seven weeks of activities, they reduced it to like thirty three weeks. Meaning you don’t have to be doing as many sub internships and electives and things like that because they understand that it’s going to be really hard to schedule it under these circumstances. So I do feel like they gave us the opportunity to sort of share our concerns and also to propose changes that we think would be helpful. With that said, I think there are constraints like they’re not going to get rid of the thesis requirement entirely. That would be a really big change. And, you know, most people, even if you’re not able to be in the hospital, like you can still work on research remotely and try to get something done. So I feel like they’ve been understanding within sort of. I think the bounds of reasonability, but I think they’ve done a good job and I feel like for the undergrads.
[00:13:58] I almost feel like I don’t want to say it’s worse, but like they were just they left for spring break, they couldn’t come back.
[00:14:06] And and I’m sure, like, that’s how it was for you guys to just all of a sudden, like, things are kind of up in the air, at least for, I think, a lot of graduate programs. A lot of the stuff is remote anyways. A lot of the research that you’re doing, there’s like more time built in for remote things. I feel like studying for board exams, like, you know, we get time off for that. The class beneath me, actually, they should have they should have been doing their rotations right now. And then at the end of their rotations, they would study for their board exams. And the school kind of told them, you should probably use this time to study for board exams because you can’t be in the hospital. So, you know, don’t waste this time. Like you said, take your step one. And that would be a very productive use of this time. So it’s nice that we have that. But it’s also challenging, I think, to be told all of a sudden you have eight weeks like study and take this exam. It’s much less flexible than for us, where you can take eight weeks, you can take ten weeks, you can kind of do it when you want to. So that’s that’s tough as well. But but again, like, if you want to graduate in time, then you kind of have to like use this time off to do something productive and check off one of the boxes that you have to you have to do in order to graduate.
[00:15:33] So in order to graduate on time, since your pediatrics rotation is wrapping up, what’s kind of like your next step?
[00:15:40] Yeah, for me, you know, this is all happening in the totally wrong order. But my next step is taking step one, taking my first board exam, which I should have taken before this sub internship, before this rotation. So if I can get that exam done, then I will be able to apply in time. But if I’m not able to like if pro matrix cancels it again and, you know, if I’m not able to get it done before August, which is not that far, then I don’t see how I would be able to apply this year. Because, you know, I think residency programs, their understanding of some things, like they will understand that all schools have canceled rotations. I don’t think that they will be willing to accommodate students who have not taken like at least one board exam. So we’ll see. We’ll see what happens.
[00:16:36] Yeah, hopefully by August they have your exams up, because if they cancel that, then I think we won’t even be able to go back to our campuses.
[00:16:45] Completely agree with that. Yeah, that’s so true. If testing centers aren’t open by then, yeah. There’s no way universities will be open. My goodness.
[00:16:54] And then I just had one last question before we wrap up. So I’m just in terms of your, like, long term goals, how do you think that adapting to covid has affected your perception of becoming a physician or has it not?
[00:17:09] You know, I feel like this is such a loaded question.
[00:17:12] My goodness. I feel like in a way, it hasn’t affected my perception of being a physician only because I kind of knew, you know, this is a selfless group. People are spending years and years and tons of money trying to learn all all of the path things and learn about these different disease processes and how to treat them. But I feel like now. More than ever, it’s like practicing in situations which can be unsafe or they’re they’re not exactly what we anticipated, you know. There’s nowhere in the Hippocratic Oath where it implies a willingness to sacrifice yourself, right?
[00:18:01] That’s not necessarily something that people have signed up for in the same way that those who work in the military, the police force or I don’t know, like it’s people who work in those fields have kind of maybe like accepted a certain level of like unsafe working conditions or bodily harm.
[00:18:29] And that’s not necessarily something I feel like physicians really have explicitly signed on to. But like people are continuing to go to work day after day. Right. So, like. That kind of speaks to the selflessness that does exist, I think, in the field and not people are not getting hazard pay across the board. People are not getting, you know, the ideal amount of protective equipment that we would want to have. But people are still going into work. And so I feel like, if anything, it’s really just that speaks to the self and the selflessness that a lot of physicians have. And I think that’s it’s really heartening to see. It does make me think about like unionization and what physicians can do to kind of have a louder voice and.
[00:19:30] You know, kind of be able to advocate for themselves and for their patients on a little bit a little bit louder just because I think physicians like. Their primary goal is always going to be to deliver excellent patient care and sometimes when. When the situation is one where you don’t have enough protective equipment like things like that really get in the way of patient care just because if one physician gets sick, that’s like 20 lost patients, they can treat it.
[00:20:06] So it really is. I think.
[00:20:12] I think things are going to change after this and physicians will have to find a way to maybe unionize is not the right word, but like really push their interests forward. Because I feel like if there’s one thing that is really clear from all of this is just that. Sometimes what’s best for a hospital system isn’t necessarily what’s best for physicians or for individual patients, and that really sucks, but. We’re going to have to we’re going to have to make some changes as a country, I mean, I think there have been projections of like this will be the end of employer based health care. There have been a lot of projections about how things will change. I think they will. But I feel like if this has shown anything, it’s that physicians are just so selfless and. You know, just I really admire the work that my seniors are doing.
[00:21:16] To learn more about the experiences of medical students who have had their clinical rotations put on pause due to coronavirus, I next sat down with Sidrah Shah, who is a medical student at the University of Texas Southwestern Medical School, to learn more about how her remote experiences are affecting her overall medical education.
[00:21:36] You said, I’m in my third year and in like in most medical schools in your third year, you’re doing mostly clinical rotations. So that means that you’re going to the hospital and you’re working almost you’re working alongside the doctors and learning through direct patient care.
[00:21:55] So I have completed most of my rotations and every few weeks or so you kind of switch specialties. So I’ve done most of them except for pediatrics. And I had just I was actually just finishing up my OBGYN rotation when we got told that we were no longer allowed to come to the hospital because coronavirus concern that we as students were having was that there seemed initially to be a bit of inconsistency in what we could and couldn’t do, because at the end of every rotation, we have what’s called a shelf exam, which is the national exam that all medical students in the US take at the end of a given rotation. So, for example, I was on my OBGYN rotation and at the end of that, everyone in the US takes the same exam and usually we go to a testing room and it’s a test on the computer. But there’s doctors there and they make sure that it’s secure testing environment and all that. And they had told us before rotations were even canceled, they said we wouldn’t be allowed to take our self exam because there was no way at that time to do it remotely. And they were limiting gatherings of people to it was less than five or less than 10 people at the time. So on one hand, you’re sending us to the hospital and we’re around a lot of people and we’re in a clinic and we’re interacting with patients.
[00:23:14] But then on the other hand, we’re not allowed to take an exam that we’ve spent several weeks studying for and we don’t have a specific scheduled test date in mind. So that was like initially a little bit frustrating. And we did express that to the administration. And in their defense, it was obviously like this whole thing is very unprecedented and the like. Having a secure testing environment is really important, especially later on in education. As a medical student, as someone who’s going to be a physician in the future, you want to make sure you’re getting the right education, that your test scores are reflecting your actual full knowledge and not compromised in some way. So I understand why they were most strict about testing. And then after that they were thinking about, OK, how can we maximize our students education and make sure we’re not taking away their access to the hospital without any concrete reason to do so. So there was like a little bit of a lag, but it was like only a couple of days. And then after that, the whole medical community, especially in terms of medical education, kind of came on to the same page. And we’re like, OK, nationally, we’re going to suggest that students no longer attend clinical rotations.
[00:24:34] So for the students in your medical school who aren’t currently doing rotations that are mostly just taking classes and stuff of that nature, were they allowed to go home before the students who are doing rotations, like, did they hold you extra?
[00:24:49] Yes, yeah.
[00:24:50] They did just switch to remote learning for students who were doing preclinical work. And that was just because they you know, it was easier to do that. They wouldn’t be compromising their education because most lecturers are already recorded. So it usually was already just up to the student whether or not they wanted to stream remotely or come to class. So taking away something that was already optional was a lot easier to do versus canceling clinical rotations that are required to graduate.
[00:25:21] So now that you are at home taking classes, kind of translating that experience onto an online platform.
[00:25:31] Yeah, so they’ve honestly that they’ve done the best that they can and they’ve done a pretty good job the way that they initially. So when I when rotations were cancelled, the following week was the beginning of our two week spring break. So they had about two and a half weeks to kind of figure out what the next steps would be. And then after that spring break, they came up with a few online electives that we could take and that would fulfill some of the requirements that we would have in our fourth year. So typically we finish our rotations by the end of our third year. And then in our fourth year, we’re applying to residency. We’re doing what’s called a sub internship or a couple of sub internships. And that basically means you, as a fourth year medical student, are going to the hospital and functioning at the level of an intern to, first of all, improve your skills and then also to work with faculty, get letters of recommendation so that you can perform at that level before you actually graduate medical school. And then after that, there’s time that you want to take it easy so that you can focus on residency interviews and also just kind of expand your knowledge in a non stressful environment before you pick your specialty and you go all in with that in your residency.
[00:26:50] So those kinds of chiller, things like electives are things that they moved, moved up so that we can complete those requirements now. So that frees up time to finish our rotations later. So they turn some of those electives into online forms. And then also we have an option to do what’s called frontiers of medicine, which is I’m not sure if that’s a Southwestern thing or all medical schools do that. But it’s really cool. It’s a way to learn about kind of like the cutting edge stuff in a certain field and where that field is going in the future. So they require that at the end of every fourth year before you graduate. And so they give us the option of completing that online as well, and not just consist of lectures and discussions and a few projects that we can do remotely. So, yeah, so right now we’re completing a few of those fourth year requirements to free up some time later to hopefully finish up our rotations.
[00:27:53] So they basically designed it so that you all can still graduate on time.
[00:27:58] Yes, yeah. That’s currently the track that we’re on unless things and actually I did recently find out that. So our board exams like step one, step two, those had also been postponed indefinitely. And I just found out that by the end of May is when I think the testing centers are opening back up again. So that makes me hopeful that maybe we’ll be able to start going back to the hospital either in June or July or so. And that should theoretically keep us on track to graduate based on the elective options that they’re offering now.
[00:28:37] So after experiencing all of these drastic changes in your medical education, do you feel like it has affected your perception of becoming a physician? Has it altered any of your professional goals?
[00:28:51] It’s definitely been it’s it’s you know, at the same time, it’s really exciting and also really frustrating to be a medical student at this time because on one hand, know, like other medical professionals are being called on to, you know, sacrifice there a lot of their their safety and the safety of their families to go in and take care of patients. And that is at the heart of things is why most people go into medicine, is taking care of other people and trying to be as selfless as you can. So that’s like that’s really respectable. It’s really, you know, it’s an honor to be part of that field. But as students, we’re not necessarily in a place where we would be doing the most benefit to the patient if we were in the room, because we’re still learning. And part of that learning process is having mentors to guide us and people to teach us while we’re in the hospital and taking away those mentors and those physicians attention from patients right now is probably not the best move. And on top of that, obviously minimizing the amount of people who are exposed to patients, the coronavirus also means that it’s not necessarily a good idea for us to be in the hospital. And that’s the frustrating part, is we’re learning to be part of this field. We want to help out, but we’re not there yet. So it does make me more excited to finally reach that point and finally be able to take care of patients in that way. And my school has, like we have had volunteer opportunities for medical students to come help out where there is need, for example, monitoring, doing temperature checks for patients who are coming into the hospital, answering phone calls, those kinds of things. Those opportunities were offered to us. I didn’t personally participate in those because I was out of town. My family was in Austin. So I’ve been here since rotations were canceled. But there is a role for medical students. It’s just not necessarily the ultimate goal that we’re trying to achieve. But, yeah, overall, it really has just solidified my desire to become a physician.
[00:31:06] While Sophia and Sidrah had their medical school experience interrupted in the middle of their clinical rotations there are plenty of other medical students around the country who are experiencing these changes right in the beginning of either their first or second years. So to kind of get to know a little bit more about that experience. I next sat down with Hanya Qureshi, who is a first year medical student at Yale University, to learn more about how her first year experience was shifted due to the coronavirus.
[00:31:36] So I am currently a first year medical student at the Yale School of Medicine in New Haven, Connecticut. Coronavirus kind of like all medical schools, definitely impacted our in-person classes and exams and all of those things. So kind of like I had mentioned before, during first year, we’re supposed to have mostly classroom based learning. And then we also have a couple of anatomy dissections, as well as some longitudinal experiences in the hospital. So temporarily, all of those things have been put on hold. We kind of left for spring break on March seven. So about two months ago now and then midway through spring break, we were kind of told not to return. So all of the classroom activities and things have shifted online. And to Zoom or we’ve been watching podcasts from previous years, lectures, which has been interesting, and then our exams have kind of continued accordingly. We’ve actually been really lucky in the sense that a lot of our exams were not. We got to take our exams on our own time. So they open up on one day on like a Thursday, for example, and we have until Sunday night to take it any time on our own. So that has been really nice because that hasn’t really been affected, I think, as much as it probably is at other places, which is great. But I think the biggest thing that we are kind of missing out on right now is anatomy and clinical skills, where we’re supposed to learn things like physical examinations and be able to practice those on each other. We also have a good chunk of our curriculum that’s based off of in-person workshops with faculty members. And so while those have turned into live Zoome sessions, I think that that’s kind of been a big shift in terms of figuring out the new learning curve, just not being with classmates for all of those things.
[00:33:18] As a first year student, how did these changes that coronavirus has brought affect your long term medical education? Will you be able to graduate on time?
[00:33:29] Yeah, so as of right now, we are still scheduled to graduate on time in terms of what the school is doing to ensure that that happens, that means a couple of things. So, number one, depending on whether or not all of us are able to go back to campus in the fall, we may or may not continue to be remote and online during the fall semester, which would not be too different, I anticipate, from kind of what we’re doing right now, given that we still have that fall semester of didactic, primarily classroom material based learning prior to jumping into hospital rotations full time, which will be a shift. But then what I do anticipate and what they have told us to expect is kind of this is operating under the model that we return, let’s say, in January of next year. The idea is that we would spend the first two months of January and February kind of doing catch up on all of the anatomy dissections that we currently aren’t able to do, along with a lot of the clinical skills practice and physical exam maneuvers that we were supposed to learn for the remainder of this year and the fall that obviously aren’t happening at the moment either.
[00:34:40] And then the idea is, is that typically the way the clerkship model works, the rotation part of medical school at Yale involves a certain amount of didactic and a certain amount of in-person in clinic work. And so I think what they are planning on doing with us is very similar to what they’re having the second year medical students doing right now, which is they’ve kind of created this new online module equivalent of the didactic portions of the curriculum. And so that lasts approximately however many weeks that it does, I think, six or something. And then the idea is that we would then be able to start our clinical rotations instead of in January. We would start in March. And that would be when the second the current second year finished third rotations. And then from March to December, they would shorten our clinical rotations to, I think, 10 week periods instead of I believe it’s usually 12, but I’m not entirely sure. Bottom line is, is that short in each clinical rotation by a couple of weeks. So we still are on target to finish the rotation part of our curriculum and kind of be back on track with a normal schedule is starting in December of next year.
[00:35:47] How did you listen to student responses and here to student needs in the decision making process to go promote?
[00:35:57] That’s a good question. You know, I think the administration from an education perspective, has done a pretty good job given circumstances.
[00:36:06] So we were actually in the middle of what is known to be the quote unquote, hardest block of clinical medicine whenever we got sent home. And so within that block basically contains all of cardiology, all of pulmonology and all of renal.
[00:36:26] So it’s a lot of material and even under ideal conditions, I think last year, like 30 percent of the class failed that exam or something. And so they were really, really nice with us in terms of they did end up giving us they actually ended up postponing the exam by a week.
[00:36:41] And by postponing I mean, they postponed the entire school year for a week so that we we had just kind of a week of dead time at the end of our classes to kind of try to get things together and review and study. And then I guess the teachers for that particular block decided to be really generous. And the day the exam opened actually ended up making it an open book exam, which was unusual and very, very helpful. So I think all of those things have kind of been really good overall. They’ve been very communicative with us.
[00:37:12] I think the one thing that, you know, of course we all wish, but I don’t really know how feasible it would be.
[00:37:18] It’s just more so we wish a lot of us wish that there was a little bit more coordination in terms of figuring out what the plan looks like for the future. And, of course, that’s something that’s not really very readily available right now. But for us, the things that kind of got disrupted as we were supposed to have big research summer this summer, I saw a lot of people were planning on wet lab research or clinical research, and a lot of those things have been canceled. A lot of us, myself included, have already signed leases for the upcoming year. And so people are trying to figure out if they need to sublet their apartments, if they need to try to rent their apartments, because for those of us who aren’t using that space right now, that ends up being kind of thousands of dollars going down the drain for space that’s not being used.
[00:38:08] So with these new changes to your summer, what are your new plans, what do you see yourself doing in the future?
[00:38:16] Yeah, so they actually sent out a list of projects, I believe, a lot of which I think some of which actually do have to do with covid-19 things that can be done remote, long distance.
[00:38:27] I know, for example, me personally, I was planning on staying the summer and working at a lab in neurosurgery, and I actually spoke directly with the lab. And so a lot of my work, what we’ve decided to do is kind of shift the project. And I think this has happened for quite a few students. We in talking to your lab mentors, you’re able to shift your projects a bit. So that way, instead of working on the project that I was originally going to work on, they say, OK, instead of that, how about we do this project?
[00:38:55] Because this is one that you could do entirely remotely. So I think it’s a lot of stuff that people are planning on using databases and previous literature and things that can involve a lot more zoom calling as opposed to actual in-person pipetting. And for that matter, I think most of those labs are closed anyways for the time being.
[00:39:17] Has Gill made any opportunities for current medical students to get involved in helping with treating coronavirus patients in the hospital or virtually any capacity?
[00:39:27] Yeah, so within the hospital at this point, they’ve kind of suspended everything. So clerkships students.
[00:39:34] So the students who are on rotations, electives, all of those things have temporarily been suspended. They are set to resume, though, I think, after the Fourth of July. And so those students will be able to go back then. In the meantime, I think most of us are still kind of doing online learning type things. But in terms of things that we can do to actively get involved with and kind of help out in the best ways that we can help out without kind of putting a strain on the personal protective equipment resources that the hospital is under.
[00:40:07] There have been a few things I know a lot of students have been putting together a PPE drive to get more and ninety fives and can ninety fives into the Yale New Haven Hospital and New Haven health system, which has been really cool. And then there have been a lot of Google Docs and things that have been circulating around from both administration and from students. And those have a variety of volunteer opportunities. Some include working with nursing home students and nursing home members and residents and being able to talk with them over Zoome. Others have been there’s been a big push to kind of help out with babysitting residents, children, faculty members, children where needed and if possible, because a lot of their schools have, of course, been shut down. A lot of daycare facilities have also been shut down, leaving a lot of health care workers without childcare. So there’s been a big push for that and then a lot of push for all sorts of other things that have been people who’ve been working on calling refugees locally to get the word out about resources available to them during this time. So a lot of grassroots programs that are still going on.
[00:41:16] How has this experience changed your perspective on becoming a physician, or do you think that you have different feelings towards what you want to do with your degree?
[00:41:27] That’s a great question. So I think a few things I can say about that, I think any med student will tell you that one of the reasons why it’s definitely a very exciting time to be in medical training. Right. You come home and suddenly it’s like all of the things that you’ve spent so much time learning about becomes so, so relevant. And I think with coronavirus specifically, none of us really quite anticipated how relevant it would become. So we actually just before this virus kind of went on a big global scale, we’d finished our big unit on attacks and defenses. And there is our online resource that a lot of us use to help us memorize drugs and viruses and microbiome. And so we had actually just finished that unit. And it’s really funny that the coronavirus video in that external resource that a lot of us use only ended up being two minutes and forty five seconds long. I think it was the shortest of all of the millions of videos we had to watch for that segment. And it said something to the fact, it said something to the effect of essentially this is. Relatively common, but less common than rhinovirus, and it gave us two other facts about it and said, yep, that’s probably all about you’ll ever need to know about coronavirus for your us or its. And so it’s funny because looking back on that, I think that video will definitely see some retooling in the next couple of years, but I think yeah. So I think it’s things like that that, that it’s very humbling, I think at this point to be in the medical field and kind of pursuing this route.
[00:43:08] It also reminds you it’s humbling, I think, for everybody, because these are things that always happen and we never really quite know when they’re coming. And so it’s a very exciting time to be a medical student. It’s a very different time to be a medical student. I can’t say that learning anatomy over Zom is particularly easy from a textbook as opposed to in person, but I look forward to hopefully getting there one day and being able to hopefully help impact this situation. And it definitely made me realize is the importance of to become a doctor. You’re trying to pursue a field that is so based on in-person interaction, meeting people in person, assessing how are you feeling, what are you looking like, being able to decipher information based off of not only what people are saying, but how they’re physically looking. What are they what’s their body language? What are the non-verbal cues that you’re getting? And so I think that the big thing is I have no doubt that we will learn all of the didactic material that we need to learn to be effective physicians. But I think right now, the biggest part that we’re missing out on is that in-person interaction, which is kind of what medical school is all about and ultimately what being a doctor is all about. And so I think that that is it’s a it’s a very humbling time, like I said, to be in medical school or in the medical profession in general, where kind of all of these assumptions and based values that the profession relies on quite a bit have been upturned in a lot of different ways.
Dr. Stanberry is the Reuben S. Carpentier Professor and Chairman of the Department of Pediatrics at the Columbia Vagelos College of Physicians and Surgeons, and Pediatrician-in-Chief of New York-Presbyterian Morgan Stanley Children’s Hospital. Our interview is focused on the establishment of a global health initiative in the department of pediatrics at Columbia University’s Medical School. Along with providing an enhanced educational experience, this program gives pediatric residents an opportunity to undertake a global experience that can be very valuable and influential to their future careers.
Novel Residency Training – The New Global Health Initiative | Dr. Stanberry | Transcript (via Sonix)
[00:00:01] Welcome to a new edition of What is Global Health podcast. Today We will be speaking with Dr. Lauren Stanbury. Dr. Stanbury is the Rubenesque Carpentier professor and chairman of the Department of Pediatrics at the Vagelos College of Physicians and Surgeons at Columbia University, and a pediatrician in chief of New York Presbyterian Morgan Stanley Children’s Hospital.
[00:00:25] His areas of clinical expertise include pediatric infectious disease, viral infection, immunization and sexually transmitted disease. Our interview is focused on the establishment of a Global Health Initiative and the Department of Pediatrics at Columbia University’s Medical School, along with providing an enhanced educational experience. This program gives pediatric residents an opportunity to undertake a global experience that can be very valuable and influential to their future careers.
[00:00:59] Could you describe the importance of merging the two vast fields of pediatrics and global health?
[00:01:06] Sure. Well, it’s sort of a logical thing to do when you look at the world’s population, two point two billion people on the planet are children. So we in pediatrics just view the entire world as our area of responsibility, caring for children wherever they happen to be online.
[00:01:26] And as stated, the department wants to assist regions and countries to become self-sufficient in educating health care providers and delivering care to their populations. How are you working as a department to accomplish this?
[00:01:40] Ok, great question. I think the perhaps best example is the work we’ve been doing in Uganda for the last 10 years. We’ve had a long collaboration with the Department of Pediatrics at Makerere University in Kampala. When we first started working with them, we met and had what’s referred to as a needs assessment, asking them what it was that we could help them with. And interestingly enough, the initial focus was on adolescent health, not on HIV or cancer, but adolescent health. You might think, gee, that doesn’t make much sense, but the reality of it is throughout all of Africa and certainly sub-Saharan Africa as well, adolescents, once a child reaches the age of 12 or 13, are no longer seen in the pediatric wards. They’re moved over to the adult wards. And we recognize that 17, 16, 15, 14 year old is not an adult. They’re a special age group that falls under the purview of pediatrics. And so our colleagues at Makerere University wanted help establishing an adolescent medicine program. The way we went about it was we had a colleague at Macquarie that was really interested in adolescent medicine, has some training, who was partnered with one of our adolescent medicine specialist, Dr Betsy Pfeffer. It’s Dr Sabrina Kotecki, who is the Ugandan who is matched to Dr Pfeifer. Those two started working along with Dr. Susan Rosenthal, who leads our division of Child and Adolescent Health, and Dr. Phil Roosa, who’s an infectious disease specialist with a lot of experience in Africa, came together and first began developing a curriculum where we could begin to educate people in Kampala at the medical school around what is adolescent medicine.
[00:03:39] We started an annual conference where we would go over and meet with them and talk about what they were doing in the area of adolescent medicine, brought in NGOs, non-governmental organisations from the region who are working with adolescents not always in health areas, but to get a sense of what else was going along in the country with regard to adolescents and start over years as we continue to bring more people into it, that they were gaining some real understanding of what adolescent medicine meant. Ultimately, we helped them establish the first adolescent medicine clinic in all of sub-Saharan Africa. And actually, with our support, established the only adolescent national and adolescent medicine society in all of Africa. So Ugandan Society for Adolescent Health, we now find that the meeting is a very robust conference. Each year, well over one hundred participants, it’s become more of a regional meeting. So we often see other physicians and health care workers who are interested in adolescent health coming in from Ethiopia, Rwanda, Kenya, Tanzania. So it’s been really rewarding in that regard to help them develop something they felt was really important along the way is that became a more mature program we revisited. What else do you need help on? And the most recent effort has been around sickle cell disease. So sickle cell disease is extremely prevalent in Uganda.
[00:05:17] And only recently is the government started a national screening program so that at birth, children blood samples were collected. So one can determine genetically whether a child is a carrier or is likely to develop sickle cell disease. We know from our work in the United States that one of the major problems with sickle cell disease is that early children and young adults can begin having small strokes sometimes that are not recognised. So the life expectancy of people with sickle cell disease is still very short. There are still children and parts of. Africa, the DYG and childhood. Whereas in the United States, life expectancy is probably only in the fourth or fifth decade of life, and strokes are one of the major causes of mortality in patients with sickle cell disease. So Dr. Nancy Green, one of our hematologist, partners with colleagues in Uganda to develop a project around how could we screen for strokes and whether interventions that could be used. It was a very successful project that showed that indeed children were having strokes from very early age. It’s a project that’s been now funded by the National Institutes of Health and they continue to expand that effort. Looking now to be able to use a drug that’s recently been shown to be effective at reducing the likelihood of cycling and hence the likelihood of a stroke. So we’re really encouraged by by that effort and we continue to evolve based upon what they feel they’re needed.
[00:06:57] So what motivated the development of the global health program and the Department of Pediatrics?
[00:07:03] So students, including our young residents, so interns and residents, our department is responsible not only for the training of medical students around pediatrics, but then once you graduate medical school, the training of residents who are going to become pediatricians. What we find is that from year to year, the interest around global health very substantially. Some years we find a very high proportion of students and residents are really interested in getting more engaged in other years. It’s not so popular. As a consequence, we’ve built the entire programs around the passions of the faculty, always with the ability to allow students and residents to have access to the programs. So in our case with you staying your doctor for a moment, we ensure that we’ve got a safe setting for them to be able to stay. And when they’re over there visiting or involved in research projects for obviously for students in the early years before they develop into clinical skills And the work that’s done globally is usually around a research project rather than learning clinical skills based upon what what opportunities are in a foreign country. But in Uganda, it’s we have a faculty member, Dr. Kudelski, who makes sure that the students are supervised and that they get a good experience, or if there’s a research project that’s ongoing, they’ll partner with the people who are engaged in the research on the ground in Uganda to participate in one way or another.
[00:08:46] Are there any general trends in regards to the students that are being observed since the assignment of this new program?
[00:08:53] So I think all of the students would say that they found the experience very enriching. We want to make sure they’re well prepared before they go abroad. So Dr. Nickless, who could not be here today for our medical students, actually has a very rigorous course that they take as an evening course so that they can learn about what it’s like to be in a foreign country, especially in a developing country. What are the issues around ethics, customs, so that a very prepared for it. And I think that’s really critical. One wants to avoid people who have an interest in what’s sometimes referred to as medical tourism or where they simply want to go in and look around and understand what’s going on. We’re looking generally for people who have a real commitment to serve the people who are hosting them. But the students and the residents who come back all tell me that they found it an experience. It was very moving that they felt even if they were not going to go to do global health, they have a much greater appreciation for populations who are under-resourced. And they often approach problems, perhaps slightly more practical way than they would have had. They not had that experience in a place like the United States where we are so resource rich, often you don’t try to keep things economical and focused, more inclined to just be perhaps excessive with regard to test ordering and drug administration. So overall, they feel it’s a very positive experience.
[00:10:34] What are some of the greatest challenges that pediatric residents have to face when working in developing countries?
[00:10:40] I think it’s a very good question. I think probably one of the biggest ones, believe it or not, is going to be the frequency with which patients die and those topics.
[00:10:52] So it’s not around. What’s it like to find housing or food like or transportation or personal safety? Those are all things that one needs to consider, but we see so little death in children’s hospitals in the United States because of our infrastructure, resources and the talents of the people who work in it, the nurses, doctors, respiratory therapist and so on. Death is a very uncommon phenomenon here, whereas in many developing countries it’s very common. And so they often find they’re really not prepared for that. And so I think making sure that they’re aware that there are life to death decisions that are made sometimes for purely economic. Some countries will have a formulary, and if the drugs that are required for the child are not part of the national formulary, the family has to find the money, go to the pharmacy, buy the drug and bring it back. And that’s not the kind of experience that most of our residents have. And as a consequence of understanding the systems that are available in different countries, they’re quite different often than what we have. And I think that’s an area that they find, at least initially, pretty challenging as an elective for residents.
[00:12:10] How has the global health program influenced their learning careers and global understanding?
[00:12:16] I think if I understand the question, it brings to them a perspective that they really did not have before. I also think it may well be more that’s probably the main difference, is that as a consequence of having that, their way of looking at patients in general changes somewhat a greater appreciation for the issue of resources, recognizing that even our own community resources could be limited for some families, certainly not around the drugs in all likelihood, but other kinds of limitations.
[00:12:52] And I suspect more than anything else, that’s probably the last.
[00:12:57] Do you find that typically after residents return, they may want to have more a broad experience?
[00:13:03] It’s a great question and it varies, although they may wish to during residency, at least in medical school as well. You’re a bit limited in how much time you have available to work on this. We find there are some. Residents who will go on and make a career out of global health and will work internationally, perhaps with Doctors Without Borders or with NGOs, others who, if they develop an academic career, will try to find a way to have a component of their career involving working abroad. And then sometimes we find that there are specialists who are just really passionate about a country or a particular problem, and they have the expertise to go on medical missions and spend time in foreign countries providing care. So it varies all over the place, but I think it’s an important introduction so they can have that. As a consideration of making career decisions, as you know, college and medical school and even in residency, you’re all a very. Growing organism, you you are gaining information about things you didn’t know before, and that informs the decisions you ultimately make. So I think having a global health experience is important for those people who are drawn to that, because it gives you one more piece of information that can influence exactly the ultimate career decisions and directions you make.
[00:14:43] Have you received any remarks or perspectives from the other side of the relationship, like the hospitals are the pit bull that the residents were serving during their time abroad?
[00:14:53] So certainly with our relationship with Makerere University and Mulago Hospital in Kampala, the feedback that we’ve gotten is that our students work well with the students who are medical students there in Kampala. They engage and really integrate into the rounds and in conversations. So I think they are also looking to form partnerships in that setting. And it looks like it’s a very reciprocal relationship. So it’s been a positive feedback also coming from your colleagues in Uganda.
[00:15:28] Could you share one of the most influential experiences you had of working in another country?
[00:15:33] My area, infectious diseases, and my work, among other things, on emerging infectious diseases, such things, for example.
[00:15:43] So we’ve had the opportunity to I’ve had the opportunity to to be in a lot of different parts of the world.
[00:15:51] for me recognizing that infectious diseases know no borders and can come from any place.
[00:16:06] Certainly for me, at least as a person of interest in vaccine development, making sure that anything we do that’s going to improve or protect the health of children in the US is going to be available to children around the world, is an important commitment to resources across the world, a very uneven issue. And the best approach from my perspective that we can do to improve human health, protecting children’s health is is going to be through preventative measures and making sure there is.
Who: Interviews with Dr. Rachel McDermott (Barnard College); Dr. Thomas Yarnall (Columbia University); Dr. Upmanu Lall (Columbia Water Center); and Anthony Acciavatti (Columbia GSAPP)
Why: Produced and published for WiGH? & Challenges of Sustainable Development final “hack-a-thon” class project For Who?: Anyone interested in the problem of Pollution and the Ganges! More specifically, for those curious about Hindu and Buddhist perspectives of the Ganges, and how these perspectives could be employed as sustainable solutions to this global health crisis.
Created by: Max Rose Zimberg (GS ’19) and Mary Bannister (GS ’19) — April 2018. Feel free to reach out for more information on this project at mrz2108@columbia.edu and msb2212@columbia.edu S
Sourcing: Music: “World Music India – The Ganges” Visuals: We do not claim any rights to the material used within. This is simply for a school project and is not meant for wrongful distribution.
Podcasting Pollution: Religious & Cultural Perspectives of the Ganges | Dr. Rachel McDermott; Dr. Thomas Yarnall; Dr. Upmanu Lall; Anthony Acciavatti | Transcript (via Sonix)
[00:00:01] We’re here today discussing sustainable solutions to pollution in the Ganges. My name is Max Zinberg.
[00:00:08] And I’m Mary Banister, and we’re students in the Sustainable Development Department at Columbia University.
[00:00:16] The Ganges River is considered to be a sacred mother goddess by the Hindu majority population in India, and it’s also one of the most polluted rivers in the world.
[00:00:25] This awkward pollution comes from a variety of sources, but it’s mostly the result of inefficient sewage and sanitation facilities unable to accommodate India’s large and growing population, leading to unregulated open defecation, trash disposal and even cremation. The pollution is also a combination of discharge from factories, tanneries and agricultural runoff that is only exacerbated by the silt coming from the seasonal monsoons.
[00:00:52] This also includes everyday pollution from people throwing plastic in the river, bathing, bringing cows to the river and performing religious rituals known as pooja that involve throwing artifacts like flowers or even dead bodies into the river to invoke liberations of reincarnation, called moksha.
[00:01:13] Max, did you know that the Ganges River Basin is the most highly populated river basin in the world?
[00:01:19] It accounts for twenty five percent of India’s water, with 400 million people relying on the river for water to drink.
[00:01:27] This is a major public health problem, drinking or using the water from the Ganges results in GI disease, cholera, dysentery, hepatitis A, typhoid and many other bacterial diseases that result from open defecation.
[00:01:43] The Indian government has made efforts since the 1980s to counter this pollution of the river. The problems include lack of public involvement, exclusion of groups, local inefficiency and corruption and lack of monitoring.
[00:01:57] There’s also a major disconnect about what pollution even means to policymakers, environmentalists, Hindu devotees and Buddhists living in the region.
[00:02:08] Clearly, this issue involves complex interactions between many different stakeholders, which will require culturally driven and bottom up approaches rather than top down or siloed solutions or podcast aims to encapsulate these many perspectives.
[00:02:24] And rather than amplifying the role of religious activity as part of the problem, we aim to reveal the ways in which Hindu and Buddhist ideas can instead be used in tools that actually promote protection of the river.
[00:02:38] We hope to provide a larger cultural context for this complex problem and provide tools to those working for a solution at the nexus of sustainable development and public health.
[00:02:50] We are so grateful for the invaluable conversations we had with experts surrounding this issue from the Columbia community, including Dr. Rachel McDermott, Hindu goddess scholar and professor of Asian and Middle Eastern cultures at Barnard College.
[00:03:04] Dr. Thomas Yarnell, a scholar of Buddhist philosophy and ethics at Columbia.
[00:03:10] Anthony A.R.T., who is trained as a historian, cartographer, architect and author of Ganges Water Machine Designing New India’s Ancient River, who has mapped and traveled the length of the Ganges River.
[00:03:24] And Dr. Upmanu Lall, Civil Engineer and Director of Columbia Water Center and senior research scientist at the International Research Institute for Climate and Society.
[00:03:36] First, we’ll be hearing the Hindu mythological perspective from Dr Rachel McDermott moving into environmental ethics from a Buddhist perspective with Dr. Thomas Yarnell, and Mary and I will be discussing what this possibly could mean for sustainable development and the fact that the Ganges was recently given the legal rights of a human.
[00:03:59] While it is vital to understand religious and cultural perspectives, sewage and lacking infrastructure are still the main source of pollution. So we can not leave out the invaluable insights of Anthony Acciavatti and Upmanu Lall, who have both worked in connection with the Indian government on this problem.
[00:04:18] This leads into what certain NGOs and non-state actors are also doing about this issue. So we’ll end with a quick word about current solutions from NGOs such as Ganga or events like India Water Week.
[00:04:32] We’re so happy you’re here listening and we hope you enjoy the podcast.
[00:04:51] So, Professor McDermott, as a Hindu goddess scholar, can you tell us about how the Ganges River is depicted in the Hindu tradition?
[00:04:58] The River Ganges in art is depicted as a beautiful woman sitting on a crocodile like vehicle called Macara. And so when she’s supposed to be the goddess of purity who washes away all sins, there are temples to her at the very beginning of the headwaters of the Ganges, there is a temple or the Ganges comes out and people go and worship. Or so she’s viewed as a very auspicious, beatific deity who brings life and purity to the world. The problem with many people who don’t want to admit that the Ganges is polluted is that they say, well, how can the mother be anything but pure? You may think she’s impure, but actually the mother is always pure and she has been said in the scriptures to wash away all sins. So how is this mythology being applied to the pollution problems?
[00:06:02] So that’s why I say it’s a creative process, you mine your scriptures for things to use. When
[00:06:09] Ngo workers or local people try to initiate projects to help clean her up, they often will utilize imagery of the goddess and sometimes they say, well, she is our mother and she is pure, but she has been dirtied by her children such that now the way to serve the Ganges is to try to clean her and she needs her sons and her daughters to restore her. Of course, she’s always pure and in a sort of spiritual sense. But the Ganges has been defiled by pollutants and corruption and things like this.
[00:06:51] But it’s not going to help people who are factory owners. They’re not going to buy into this. They want money. They want just the way, you know, in any environmental debate in any country. You have the developers on one hand and idealistic environmentalists on another.
[00:07:13] So it’s an uphill battle. The same problem exists for the Yamuna River, which is also lets off at Allahabad from the Ganges River. And so the Yamuna River is the place where Krishna and Radha apparently sported. And so many people say, well, do say that to Krishna and Durata by cleaning up the river that they loved.
[00:07:36] Remember the story that it was full of poisonous snakes. The Elmina and Krishna dives into it and he finds one snake that has a thousand heads and he does it and dances on the heads and all the wives of the snake God come up and they pray to show it to Krishna, don’t kill our husband. And he says, OK, but go to the scene, get out of this river.
[00:08:01] So just as he tried to get rid of the pollutants or the the elements in the river that were harming it and harming people around it, you could say that let us be like Krishna.
[00:08:15] Shiva is supposed to be the God of the Ganges to Earth by us by agreeing to have it come on his head.
[00:08:21] Remember that. Because the force of it would have been too great to for the earth to bear, so he said, I’ll break the fall.
[00:08:29] So that’s why when you see images of should I be off the river?
[00:08:33] I said so again, people can say, well, Shiva did service for the river by.
[00:08:42] Taking it physically onto his body, we should do something similar. So using mythology or people’s beliefs, to help the Ganges will punish you if you keep polluting her.
[00:08:57] But I don’t know if that’s happened yet. I doubt it because then the NGOs would be put against the factory owners or against. I don’t think that.
[00:09:07] But certainly she is a mother in need, the mother’s milk or her vehicle can’t survive in this water. So we have to clean up so that the fish can survive and sort of drawing upon things that everybody recognizes about her to save a disservice to the goddess by. Helping to stop factories putting into the river for help to mother by joining cleanup crews along the bank.
[00:09:49] So interesting to learn more about the mythological underpinnings of the Ganges.
[00:09:54] And how these reinterpretations could be possible solutions, so rather than thinking of Mahat Ganga as palatable, she’s rather seen as suffering and someone who we need to help.
[00:10:08] You know that in the struggle for Indian independence from the British mother, India as a whole is shown as this as a suffering mother who needed the help of her children.
[00:10:19] Exactly. And it was a powerful way to rally people in saving mother India and declaring independence.
[00:10:28] It was actually author Bankim Chandra Chatterjee who popularized depictions of mother India in three ways, India of the past, of the present and of the future. So in the past, India was seen as daughter who’s the warrior mother goddess. In the present, she was seen as emaciated Kali, who’s a goddess of wrath and anger and darkness, much like the river is today. In the future, who knows? India has to be portrayed as a mother needing the protection of her sons.
[00:11:03] And we found this interpretation to be particularly important to sustainable development in thinking about a way a country or a society is shaped in the present, in the past and most importantly, the future.
[00:11:17] NGOs on the ground are really incorporating this idea, using theology. One really cool NGO we found is called Help US Green. They be something called flower cycling. So they take flowers that are thrown ritualistically into the river and they reuse them, employing local women to turn them into insects and fertilizer, which can be sold to make a profit on the website. They use a lot of language like that. We saw reference by Rachel McDermitt like saying how the Ganges is synonymous with the Indian civilization, but that she is dying.
[00:11:54] So they’re doing this to help the Ganges in a very creative hackathon type way and their products are pretty cool. I want some of these insects right.
[00:12:06] That’s a whole nother topic on global health, is how incense cause asthma.
[00:12:10] But that’s another podcast.
[00:12:13] So like any good hackathon, they’re solving a problem.
[00:12:17] So in India, the floriculture industry is growing at five percent annually. And to grow all of these flowers, there’s a lot of farm runoff that’s poisoning the Ganges and the groundwater. Harmful pesticides and insecticides are used to grow these flowers at such high rates and the vast amount of flowers decomposes along with fecal coliform bacteria that’s giving rise to severe diarrhea, cholera and other waterborne diseases.
[00:12:45] So we urge you to go on to their website. This is not a paid promotion, though. If you feel like sponsoring us, help us. Great. We would take some green.
[00:12:55] So essentially they’re hackathon product is a chemical free pack of seedlings where the actual package decomposes and turns into a beautiful Torcy plant, which is very culturally appropriate, given that Torcy is grown and used for tea all over India and their packaging is ripe with Hindu mythology.
[00:13:16] Deities like Ganesha you may have seen the little elephant boy who’s a remover of obstacles. So it’s very culturally appropriate and innovative solution to pollution in the Ganges.
[00:13:29] So for Hindus, the Ganges is a goddess. Buddhism also came out of India. So what about Buddhism? Do Buddhists see the Ganges River as a sacred being or even as the river has now been given rights as Ascendiant being? Now we’ll talk with Professor Thomas, your of the Buddhist perspective.
[00:14:00] It’s the first thing I would say is that sometimes Buddhist perspectives on nature and quotes are surprising to Westerners. So in general, the natural environment, at least the inanimate part of rivers and mountains and trees and so forth, is not really considered holy or sacred in most cases, although it can be inspiring. Of course, nature can be and it’s great that there are holy pilgrimage sites or sites that are considered sort of special from a Buddhist perspective that in some way contain some special energy or presence. But for the most part, nature writ large, is it really considered holy or sacred?
[00:14:37] It is considered in practical terms as the environment, in the sense that the container habitat that or support for all sentient beings, have to have the inconsiderate destruction of natural habitats that are critical for the survival on the flourishing of other types of sentient beings is considered unacceptable from a Buddhist moral ethical point of view. So in terms of times in the history of the country and any sort of destruction of of a river such as the garden season so far, that is the habitat for many types of non-human sentient beings. One final word on that.
[00:15:16] What’s important to realize that we are part of nature. Ultimately, nature will always be more powerful than human beings, even though they’re human beings.
[00:15:26] People of our nuclear weapons, scientific equipment and knowledge of the sun disappears of the earth. Temperature changes by degrees are really in trouble at a deeper level. Recognize that we are part of nature. We can control and change things to some extent due to our intelligence among the thousands of species of mammals on Earth, we humans have the greatest capacity to alter nature and as such we have a twofold responsibility. Morally, as beings of higher intelligence, we must care for this world, other inhabitants of the planet, insects and so on. I have the means to protect this world and our other responsibilities onto the serious environmental degradation that is the result of incorrect human behavior.
[00:16:09] So, Professor, now what do you say about possible solutions to anthropocentric environmental degradation?
[00:16:17] It would be helpful to find some comments by some leading Buddhist scholars and teachers. And so I turn to some comments by both His Holiness the Dalai Lama from Tibet and take note of the history of the Vietnam War and so forth.
[00:16:33] He says explosion of bombs, the burning of napalm, the violent death of our neighbors and relatives. And likewise, the pressure of crime, noise and pollution and the lonely crowd is all have been created by the disruptive cause of our economic growth.
[00:16:50] There are all sorts of mental illness and they must be ended.
[00:16:54] Anything we can do to help them is preventative medicine and political activities are not the only means to them. And so there is, again, sort of suggesting that political activities are important, but so are psychological remedies, environmental activities, socioeconomic and so forth. And he talks elsewhere in here about the need to tackle issues related to the media, education and so forth. So, again, from a Buddhist perspective, Technofile sort of demonstrating the fact that these are all interrelated issues and that cleaning up the environment, preserving the environment is absolutely critical to mental health and to the health of sentient beings. So now some some of the comments from the Dalai Lama, from the Dalai Lama’s book, Imagine All the people conversation with the Dalai Lama on money, politics and life.
[00:17:41] It could be out. Do you think democracy is helping laws to evolve in this way? The answer is yes. In democratic countries, legal system should work that way. Generally do, but nevertheless partially contrary to the principle of interdependence. Since these laws do not include, quote unquote, democratic rights for the environment and the animal realm, most legal systems refer only to human rights and do not consider the rights of animals or other beings. Share the planet with us.
[00:18:16] This point on the Buddhist view of sentient beings is very interesting right now, given the fact that courts have very recently given the Yamina and Ganges rivers the rights of human beings.
[00:18:27] It seems that a Buddhist would not agree with this, but they would see all animals that live within the rivers as having the same rights as humans do as sentient beings from a Buddhist perspective. What role do political solutions play in this problem solving problems like this?
[00:18:45] So now some some of the comments from the Dalai Lama speaking on the issue of politics, he said about actually about the election of a different one, in part because of the recently a growing chorus of support, there was nothing sacred or holy about taking care of our planet as we take care of our houses, as we ought to have confirmation sovereign, no point in going against nature, which is why I much it’s not a matter of religion or ethics or morality is a luxury that we can survive without them, but we will not survive if we continue to go against nature. And so we have to accept this tough balance nature. Humankind will suffer, of course, elsewhere and also suffer from the most people alive. Today, we must consider future generations of human biology as a human right like any other. Therefore, part of our responsibility towards others to ensure that the world is healthier than we found it.
[00:19:53] That quote from the Dalai Lama sounds a lot like the nineteen eighty seven Brundtland Report definition of sustainable development, which is development that meets the needs of the present without compromising the ability of future generations to meet their own needs.
[00:20:07] I think it’s so important that we mobilize children and people of all faith to think about the consequences of their polluting habits, not just in the short term, but what this will mean for future generations and other forms of biodiversity and life.
[00:20:25] So I can’t stop thinking about what Dr. Lal said about the dolphins.
[00:20:31] And I don’t think to tell you is that, you know, up to maybe 30, 40 years ago, there were there were dolphins. The river was teeming with life, even though there was pollution. And at this point, I don’t think there’s much of anything in there.
[00:20:46] No oxygen will do that.
[00:20:48] You know, I know the guns is crocodiles. They know all the river dolphins.
[00:20:56] Gnjidic Dolphins are actually a species of dolphin native and extend to the Ganges River.
[00:21:05] So there are all these negative externalities on the ecosystem of the country and all the animals as well as humans that rely on it.
[00:21:14] So it’s really going to take ecosystem based management. Policies that take into account the entire eco system and.
[00:21:25] Symbiotic reliance of humans, animals, plants and other natural resources, plus everybody loves dolphins, so this could be a really effective way to really rally up people’s concern for pollution in the Ganges.
[00:21:39] Lastly, it is important not to make this a purely religious or faith based issue, we bring in Buddhism here not as another religion, but as a philosophy, because we could well go into Islamic perspectives, which are incredibly important in this issue, specifically because of the tanneries that line the Ganges River. These tanneries are places where animal hides are tanned. Typically, water buffalo in this case are mostly owned by Muslims.
[00:22:04] So they receive a disproportionate amount of blame for the pollutants and runoff going into the Ganges River.
[00:22:14] So, Dr. Lall, can you explain the pollution problem from an engineering point of view and how the Ganges may be hydrologically unique?
[00:22:22] You have a series of canals that divert water from the river.
[00:22:26] If there’s one factor, this is for irrigated agriculture in the state that the Ganges flows through, OK?
[00:22:35] And there are barrages across the river that allow you to block the flow of the river and divert this water. The second thing that goes on is that there is no shortage of countries, but there is water creating things that put a nice cocktail of anything you can imagine into the river. OK, so it’s the combination of the depletion of the flow in the river, which is primarily for agriculture, a few common power plants, but including water.
[00:23:11] And what comes back from them is not polluted by just warmer water. But the warmer water will allow bacteria or microorganisms algae to grow at a higher rate, and they will consume oxygen more rapidly from the water as a result. So it is a compounding factor. The government of India plans to build a ridiculous number of water treatment plants, but the plan included no monitoring, and the plant did not include enforcement of individual pollution controls on individual plant sources. So that’s kind of where things were two years ago. And I know you’ve had various universities in India and the various government organizations fooling around with this, but I don’t think anything significant can happen. I know the people at Columbia who are working on this.
[00:24:09] There is Anthony who’s written the book on the dangers that he walked against and all that.
[00:24:16] So he may be able to give you a better narrative on what you’ve seen firsthand. But this is a situation the government doesn’t really the data on either floor in the river or on the levels of pollution in the river. Some of the Indian institutes of technology have their grant from the government for the last umpteen hearings to collect this data, analyze the study and make sense of it. I have not seen a public release of that data.
[00:24:43] There is a flood every year, too, you know. So if there is a flood, you now have sediment mobilized so that the new source of pollution, what the river is. Typically, many people have always accepted that is sediment. And there are the different you of the detriment of studying. You can’t and it’s going better, which is to try to out the better than you’d think.
[00:25:07] Right. So it is just the natural sediment. It makes the water more opaque to begin with.
[00:25:14] So it’s the sediment, the Himalayas, very month and so any day and do the best condition of the children or snowmelt or rain. There is a lot of sediment released that’s natural. And so it’s coming down from the mountains of sediment to natural sediment. You know, there might be some arsenic. There might be why this isn’t bacteria in it. But what started happening once you get out of the mountains is large population living on the shores of the river that are discharging anything you can imagine.
[00:25:52] Do you think water infrastructure projects and laws are sufficient to solve this problem?
[00:25:58] What he told the government of India when they asked me to review this stuff, what if you have no monitoring of the sediments and you don’t really know what is going on? You can see the water. You put polluted water in the river. Let’s say you dig the entire floor of the river, but you can’t run it through a treatment plant and put it back in after he disappeared back into service. So no super contaminated from decades of crap showing up under the clean water will just leave all that pollution of the Taliban back into the water column and the same time associated with daddy. Daddy, I think it’s going to pick up whatever. But they have to have consistent space and time monitoring of water and sediment through the river. And that would also allow them to figure out whether or not what they are putting down is meant to be effective. It could well be that they have to dredge a very large quantity of sediment to reach any kind of effect of that.
[00:27:02] So what you are kind of saying about designing our future, you know, the things you’re doing with America’s water and things like that, do you think that there’s a way for us to engineer ourselves?
[00:27:15] I think that the idea that you’ve got lodged with water treatment plants in a few places and hope for the best is over, and especially in that kind of a situation at every point of view as very water is generated or in some neighborhoods or whatever, they need to be able to get the technology and they should be putting that in so that you get it up right there.
[00:27:42] And is there anything you can say just with your personal experience with the Indian government now and any so.
[00:27:51] No, I won’t comment on the government, but I don’t think that they don’t want to work with them.
[00:27:58] So, Anthony, we heard from Dr. Lall about current governmental and infrastructural developments around the guarantees, given your extensive experience traveling and mapping the countries, why do you think they haven’t been affected in cleaning it up?
[00:28:17] It’s just that I think will have the capacity to solve this problem. So we’ll just have to get back to other forms. So once you develop your systems for sure, because you’re almost using this mosque air, ground floor, access to public defecation. So how do you also the structures in these areas?
[00:29:04] And again, because I think don’t of those sorts of structures, you know, politicians don’t look like you’re this. There’s also to to.
[00:29:36] So my first thought hearing about all of this pollution was that the Ganges must be completely underfunded. There must not be any sort of hydrological infrastructure at all. But even Anthony said that the Ganga basin is one of the world’s most hyper engineered places and rivers in the world. So what’s going on here?
[00:29:57] And Dr. Lal talked about a lot of this problem coming from insufficient monitoring and data collection by the government and the problem that the government changes so frequently and that this data can often be unreliable and not last past an election cycle in discussing this issue of lack of government data.
[00:30:19] What civil society organizations that they point to this supports is the Center for Information, Basic Management and Studies see Gonca. It was established at the Indian Institute of Technology and Confort as a center of excellence for coalition creation and dissemination of knowledge and information for sustainable development of the Congo River Basin.
[00:30:44] The center acts in the capacity of a comprehensive think tank to the National Mission for Clean Ganga and the Ministry of Water Resources, River Development and Ganga rejuvenation the government of India and in its stated goals and objectives vis a vis the Congo River Basin.
[00:31:02] It incorporates some of the aspects that Dr. Yarnold talked about as the Ganga, as an ecological entity near Mildura, and goes really deeply into the scientific research on developing protocols for aquifer mapping coordination with the institute, which is also where Dr Lal went to school for civil engineering.
[00:31:24] And they also hosted two really important other organizations. One is known as Ganga Pedia, which acts as a really transparent hub for the mission and management plans and everything having to do with. She Ganga’s research as a think tank, so this includes missions like ecological restoration, sustainable agriculture, geological safeguarding, basin protection from natural disasters, river hazard management, environmental knowledge and cultural sensitivity, and plans for sewage treatment, urban planning and flood plan mapping.
[00:32:06] Experts, including these at Ganga, have also come together for five different India water weeks hosted in April or January. These are events that have attracted up to four different countries and fifteen hundred different delegates with themes including efficient water management, water for all, and in two thousand and 17, water and energy for inclusive growth.
[00:32:34] They also had a theme on water, energy and food security calls for solutions. which Dr. Lall Is especially focused in this nexus between water, climate, energy and food.
[00:32:50] So as an architect and cartographer, something really interesting that Anthony Acciavatti did in his travels to India and walking and backpacking and sailing around the Ganges is placing this emphasis on drawing and mapping out the Ganges because we said four hundred million people rely on it. How is one environment supposed to know what the Ganges looks to someone else in Rishikesh? In a way, Anthony’s own hackathon project is his book, Ganges Water Machine Designing New India’s Ancient River. By the way, we are also not sponsored by this book, but please go out and take a look at it and why it is so beautiful and so well put together and researched. And in it he really calls for this remapping of the Ganges because when he first started his research, there were no maps at all provided by the government. There’s something really important in sustainable development and global health fields where the problems that we’re dealing with can be microscopic or underwater.
[00:33:52] And it’s really important that we map them out and bring them visually to the forefront of people’s minds, whether that means through an atlas, through Hindu mythology or with a podcast.
[00:34:05] Yeah, that would be really effective.
[00:34:11] Thank you so much for joining us as we’ve talked about approaching this issue of pollution in the Ganges River from all these different perspectives, from that of mythology and culture in India, from the Buddhist perspective to that of current problems and sustainable development and infrastructure management before listening, if you didn’t know how serious the problem of pollution in the Ganges is, we hope you walked away with with a heightened understanding of how we need to act now for this generation and all the generations to come. And if you did know about it in general, we hope you gain a deeper historical perspective that will lead to continued research project and talkathons of your own.
[00:34:58] Thank you so much. I’m Max Zinberg. And I’m Mary Bannister. Thank you so much.
In this episode of WiGH?, JGH Online co-Chair Renee Ren speaks with Dr. Stephen Morse on how viral infections originate and spread, how preventative policies control epidemics, vaccines, and the 2019 coronavirus epidemic.
Dr. Morse is the Professor of Epidemiology at Columbia University Medical Center. His research focuses on risk assessment of infectious diseases and methods to improve early disease warning systems. He coined the term “emergent viruses” in his book, Emerging Viruses, which was listed by American Scientist as one of the “100 Top Science Books of the [20th] Century.” Dr. Morse has held faculty and leadership positions at Rockefeller University, the National Institutes of Health, and national biosecurity and biomedical policy committees.
Image Credit: https://www.publichealth.columbia.edu/people/our-faculty/ssm20
What We Have Known About and Will Learn From COVID-19 | Dr. Stephen Morse | Transcript (via Vocalmatic)
[0:00:00-0:00:52] Welcome to another episode of What is Global Health? In this podcast, we will chat with Dr. Steven Morse, professor of epidemiology at the Mailman School of Public Health. His research focuses on the risk assessment of infectious diseases and methods of improving early disease Warning Systems. He coined the term emerging viruses for his book emerging viruses, which was selected by American scientist fourth list of 100 top science books of the 20th century. Dr. Morris health faculty and Leadership positions at Rockefeller University the NIH and National Security and biomedical policy committees. Today’s talk will focus on how viral infections originate and spread, what are preventative policies to control epidemics, and the 2019 novel coronavirus epidemic.
[0:00:53-0:01:42] So can you explain for viewers unfamiliar with your work, what’s the concept of emerging viruses? Emerging viruses are those viruses that appear like The Andromeda Strain that seemed to come out of nowhere and of course, you know, it took a while to solve that mystery to some degree. But more officially, there is a more formal definition: an emerging infection is now one that is rapidly spreading in number of cases, incidence, or geographic range and that has not been seen at least for a long time and those that have been known before and perhaps due to lapses in
[0:01:43-0:01:55] control measures like immunization or mosquito control which become victims of their own success. Many people tend to call those, as I do, “re-emerging infections”.
[0:01:56-0:02:55] But the first time we saw SARS coronavirus, for example, that was an emerging infection. It was seemed to be novel and indeed it was to the human population and was spreading both geographically in a number of cases. Can you give a quick rundown on how these viruses are spread? So between humans, and between animals and humans? Actually initially I was trained as a microbiologist and I was a lab virologist. And most of us microbiologists thought that these emerging factions were really especially the viruses which are known to mutate very rapidly really coming from the rapid mutation of the viruses and that sometimes happens. But as I started to look into this, I was very surprised actually back in the ancient days of the last century, 1988, I was very surprised to
[0:02:56-0:03:58]
find out as I think a lot of people knew, but no one had really compare their notes, that many of these emerging infections that seem novel in the human population are zoonotic. They’re coming to us from other species usually other vertebrates and often other mammals. That seems very mundane, but in fact it’s not because there’s a great variety of viruses and other microbes that are out there in the great diversity of life and some of them are unfamiliar to us. We’ve never seen them. So the changes we make in the environment and social and ecological changes have a lot to do with precipitating the transfer, or some people like to say, “jumping,” species from a natural host caring a particular infection that we haven’t seen before to infect humans, perhaps for the first time.
[0:03:58-0:04:56] Related to that topic, it is well known that viruses and bacteria mutate. Can you explain a little bit how this process occurs, and what causes them to mutate and infect people? Well, when they infect people, usually what we see, is that they’re usually quite similar to the ones that already exist in other species and in nature. And they get an opportunity to infect people. And many of them, you know, really don’t infect people and we may never see them, but there are some that are successful. So we know that bats, for example, harbor of large diversity of coronaviruses. Coronaviruses have now become famous because of SARS in 2003, and now the Middle East Respiratory Syndrome, which was first identified in 2012, and now at this very moment.
[0:04:56-0:05:55] We have another coronavirus that looks very much like SARS except, unlike SARS, which spread almost completely through the healthcare setting, essentially through lapses in infection control which shows you that nobody can do this perfectly. It’s really hard to do this perfectly because they had, even in Toronto, had a problem with SARS, when someone who came from Hong Kong picked it up there and then went back home to Toronto. And within the hospital setting, you know, it began to just spread to healthcare workers and others. But in terms of mutation, we know that mutation gives us the vast biodiversity
In this episode of WiGH?, molecular biology pioneer Robert Pollack, Ph.D talks about how scientists may surprisingly benefit from the study of religion.
“The most bizarre religion in my experience is the religion of science. The religion of science simply says that everything is explainable and if I pick the right way to ask it, I can explain it in my life so that there is nothing unknown. That’s a religious position… This machine for asking of nature ‘why is it this way’ is built on the most wonderful framework of human imagination. The answer doesn’t become smart because you’re smart, clever or articulate, but it becomes right because you frame your question in a way that it can become subject to disproof. ” – Robert Pollack
For almost three decades, Robert Pollack has been a highly accomplished molecular biologist at Columbia University, where he served as Dean of Columbia College (1982-1989), was elected as a 1994 American Association for the Advancement of Science (AAAS) fellow, and amassed over one hundred publications in journals ranging from Nature and Science to Cell and PNAS. In 1995, however, Pollack decided to stop his laboratory work and focus his academic pursuits on something rather unexpected for a molecular biologist: the intersection of science and religion. Today Dr. Pollack serves as Director of the Center of the Study of Science and Religion at Columbia University, in addition to serving as a professor of biological sciences.
Emma Cheng and Karen Gambina contributed to this episode.
Photo credit: https://rcss.scienceandsociety.columbia.edu/people/robert-e-pollack
In this episode of WiGH?, Cynthia Li speaks with Dr. Concetta Tomaino on the role of music in brain development as well as the future of music therapy. This podcast also features a musical performance from Dr. Tomaino’s therapy patients.
“I started singing the song and playing music, and the people who were extremely agitated calmed down and the people who seemed to be catatonic and not aware of anything opened their eyes and half of them started singing the words to the song. […] People with such severe brain damage could still respond to music when nothing else in the world made sense to them.” – Dr. Concetta Tomaino
Concetta Tomaino, D.A. is a music therapist at the CenterLight Health System and is a faculty member at the Albert Einstein College of Medicine. She is executive director of the Institute for Music and Neurologic Function and was the past president of the American Association for Music Therapy. Dr. Tomaino specializes in research and the treatment of patients with non-fluent aphasia as well as other types of brain damage. She has worked with acclaimed neurologist Oliver Sacks (author of Awakenings, a best-selling book that was later made into a Oscar-nominated film) in order to explore the link between music and the brain; Dr. Sacks’ book Musicophilia was dedicated to her.
Cynthia Li Margaret Chou, Sneha Subramaniam, and Connie Chen contributed to this episode.
Photo credit: https://www.imnf.org/meet-our-staff
In this episode of WiGH?, Kevin Xu and Connie Chen speak with Maya Cohen and Nicole Dussault on Kony 2012, Social Media, and Agency. “Do social media campaigns give young people a false sense of accomplishment?” And what does agency really mean?
Maya Cohen is Executive Director of GlobeMed. In the fall of 2008, while a student atBarnard, she founded the Columbia/Barnard chapter of GlobeMed.
Nicole Dussault is a sophomore at Columbia University and a globalhealthU coordinator for GlobeMed’s Columbia/Barnard Chapter. With over 45 chapters nationwide, GlobeMed is one of the largest student-driven global health organizations in the United States. Its mission is to strengthen the movement for global health equity by educating and empowering university students to work together with grassroots community organizations around the world to improve the health of the impoverished.
Connie Chen, Victoria Cui, Karen Gambina, Ved Tanavde, Kevin Xu and Karina Yu contributed to this episode.
What is special about a social movement driven by students? In this episode of WiGH?, Kevin Xu and Connie Chen speak with Maya Cohen and Nicole Dussault, who comment on how GlobeMed has empowered young people to put their visions of the world into action.
Maya Cohen is Executive Director of GlobeMed. In the fall of 2008, while a student at Barnard, she founded the Columbia/Barnard chapter of GlobeMed. Nicole Dussault is a sophomore at Columbia University and a globalhealthU coordinator for GlobeMed’s
Columbia/Barnard Chapter. With over 45 chapters nationwide, GlobeMed is one of the largest student-driven global health organizations in the United States. Its mission is to strengthen the movement for global health equity by educating and empowering university students to work together with grassroots community organizations around the world to improve the health of the impoverished.
Connie Chen, Victoria Cui, Karen Gambina, Ved Tanavde, Kevin Xu and Karina Yu contributed to this episode.