Health Equity… by Syd McGillis, MPH Class of 2020

“Our vision is to achieve equity in health and health care for diverse populations.” – Health Equity Action Research Team 

Health equity – we hear about it, but what does it actually mean? The way I like to look at it is everyone has the right to be healthy and have the access to do so. In order to achieve true health equity we have to acknowledge and eradicate the barriers that exist so strongly in our society, specifically targeting marginalized populations. Knowing my privilege, and acknowledging that my experiences as a White woman in healthcare are vastly different than that of others, I am driven to make changes within our healthcare system that better support Indigenous people. I am passionate about health equity and how we can achieve it, and this passion led me to wanting to work within this area of public health.  

This summer, I have had the great pleasure of working with the Health Equity Action Research Team (HEART) in London, Ontario. HEART’s mission is, “to identify, implement and evaluate ways to improve health equity, through both service improvements and linkages to address gaps” (n.d.).  HEART is made up of multiple teams designated for specific areas of work. I am working on the Indigenous Health team, focusing my research on diabetes and culture. We are currently creating an interactive, simulated, online training module that demonstrates the complexities of living with chronic illness and culture’s influence over health and wellness. Additionally, we are working to capture some of the adversities that Indigenous peoples often experience; and how colonization, historical (and present day) trauma, and systemic racism all contribute to creating an imbalanced health system that fails to support Indigenous people. Through this training, students will gain a more meaningful and actionable understanding of how to be culturally safe practitioners. This training module will be used this fall in the Schulich School of Medicine and Dentistry for second year MD students. They will have the opportunity to follow the theoretical patient through his life as an Indigenous man with newly diagnosed diabetes, and witness the barriers and adversities that greatly affect his quality of life and health outcomes. It’s been truly eye-opening working with the Indigenous Health team on this project. Next steps for the project include creating the script and beginning the filming process for the multi-media aspects of this training. I am so excited to continue to work with HEART and see our final product come together. Thank you to everyone at HEART for your dedication, support and passion. Let’s continue to work, advocate and fight for health equity. 

To learn more about HEART, please click the link below:

https://www.healthequityactionresearch.com

Stay well, stay safe, and stay passionate!

Syd McGillis, BScN, RN, MPHc

Working in Policy with Heart & Stroke… by Lauren McKay, MPH Class of 2020

This summer, I am completing my MPH Practicum with the Heart & Stroke Foundation and I am thoroughly enjoying my experience so far. When I look back to March, I was excited to move to Ottawa to work at Heart & Stroke’s national office. I was looking forward to exploring our capital city, connecting with leaders in public health, and welcoming every opportunity presented. Of course, with the onset of the COVID-19 pandemic, I am now working from home in rural Vittoria, Ontario.

I am working under the supervision of Stephanie Menezes, Policy Analyst with the Policy, Advocacy, and Engagement (PAE) team at Heart & Stroke. Stephanie’s kind and calm demeanor made me feel very welcomed and supported from the first day of the practicum. As a graduate of the Schulich MPH program, Stephanie has walked in my shoes before and has a strong understanding of the skills that are beneficial for me to both apply and learn during my practicum. Working from home has been a bit of an adjustment, but everyone at Heart & Stroke has made me feel so comfortable and included, despite working remotely. During the first two weeks, Stephanie arranged for me to meet several members of the PAE team through video meetings. During these meetings, I was exposed to current projects and priorities in each of the PAE streams. It is clear that everyone at Heart & Stroke is passionate about their work.

During my practicum, I will be contributing to several projects on relevant public health issues. The first project I began was assisting Stephanie with vaping-related policy work. Vaping has been a hot topic over the past few years, especially with the emergence of vaping-related lung illnesses last fall, and there is a growing vaping crisis among Canadian youth.1 My role has been to review the evidence on vaping, respond to feedback on advocacy materials from editors, and stay updated on changes to vaping legislation nation-wide.

I am also working on an academic article on Heart & Stroke’s response to COVID-19 in their community of people with lived experience (PWLE). Given that individuals with pre-existing heart conditions are at risk for more severe symptoms and death from COVID-19,2 the PAE team committed to supporting this community during the pandemic through a variety of channels. I am enjoying learning about Heart & Stroke’s COVID-19 response from the other authors, who include individuals from the PAE team and PWLE.

In addition to these two projects, I am working on a pharmacare jurisdictional scan. So far, this has involved researching and summarizing prescription drug coverage in OECD countries that are comparable to Canada. I was surprised to learn that Canada is the only country with a universal health care program that does not include prescription drug coverage outside of hospitals.3 The patchwork of prescription drug coverage across provinces and territories contributes to inequities in access to medicines and health outcomes.3

The other projects I am working on are related to nutrition. For these projects, I am working with my fellow classmate and Heart & Stroke practicum student Julia Ianiro. Both of us have a keen interest in nutrition and food policy so it is an exciting opportunity! We have just begun a jurisdictional scan on front-of-package nutrition labelling and will also be developing advocacy materials on the topic. As well, we will be updating Heart & Stroke’s jurisdictional scan on marketing to kids’ legislation.

We are only five weeks into the practicum, and I have already learned so much! I have learned about the policy-making process, how Heart & Stroke conducts advocacy and engages PWLE, how heart disease and stroke impact Canadians, and more. Most of all, the practicum has reinforced my passion for public health. In my free time, I have been volunteering with a local organization to provide nutritious meals and food hampers to families with need. It is definitely a difficult time for many, and I am grateful for the opportunity to make these hard times a little better for some families. Although it is hard to believe, the end of the MPH program is in sight. I am looking forward to seeing what is in store over the next few months and anticipate many more opportunities to learn and grow with Heart & Stroke.

Reference List

  1. en-vapingcrisis-positionstatement-web-march-2020.pdf. https://www.heartandstroke.ca/-/media/pdf-files/canada/2020-position-statement/en-vapingcrisis-positionstatement-web-march-2020.ashx?rev=975ea72beba24ca4926c3e0f797fd9e2&hash=BC687CFC2BC130A283B268EF74A94812. Accessed June 12, 2020.
  2. COVID 19 What the data shows. Heart and Stroke Foundation of Canada. https://www.heartandstroke.ca/en/articles/covid-19-what-the-data-shows/. Accessed June 12, 2020.
  3. final-en-pharmacare-policy-statement-2019.pdf. https://www.heartandstroke.ca/-/media/pdf-files/canada/media-centre/final-en-pharmacare-policy-statement-2019.ashx?rev=f327cd0cf1694c82a9ed4e8796690260&hash=4265750EEC42755D9691DE7735C22FF2. Accessed June 12, 2020.

COVID-19 Response: Why Social Distancing Is Difficult in Developing Countries… by Joycelyn Asantewaa-Akuoko, MPH Class of 2020

It is undeniable that social distancing is one of the keyways of reducing the spread of COVID-19[i]. Several researchers and public health officials have emphasized the effects of social distancing during this pandemic. Others have criticized the name, stating the psychological effects of the lack of social interactions and the need for isolating people in groups and in communities of close contacts, to mitigate the negative effects of individual isolation during the pandemic[ii]. In places like Canada, social (physical) distancing is, for the most part, attainable due to several reasons. These include the institutional capacity to impose restrictions, economical advancement, living environment, and other structural tools that have been put in place by authorities to ensure that social (physical) distancing is maintained during the prescribed period[iii]. Canada is fortunate enough to be able to maintain distancing measures however, some parts of the world are unable to afford this luxury.

In developing countries, social (physical) distancing measures are difficult to implement and sustain due to the long-standing structural inequalities that stem from economic, social, and political disparities[iv]. These disparities continue to threaten the livelihood of people in developing countries and are exacerbated during the pandemiciv. There are many reasons why social (physical) distancing is difficult to implement. Ranging from the lack of compliance generally as a result of misinformation of the disease, source of livelihood that requires self-employed individuals to continue working in unsafe conditions during the pandemic, to the low institutional capacity to impose mandatory restrictions and provide a social safety net for its citizens[v]. Religion and culture have also been shown to largely influence social behavior in developing countries. There have been reports of some faith-based organizations downplaying the virus and attributing the source to divine interventionsiv. Arguably, the largest threat to maintaining social (physical) distancing in developing countries is the living environment. Physical infrastructures are mostly slums and informal settlements where small spaces are often occupied by large familiesv.  These are just a few reasons why developing countries struggle with implementing and maintaining social (physical) distancing protocols.

Finding workable solutions for these countries is crucial to ensure safety and contain outbreaks of the disease. So far, some developing countries have implemented some level of protocols to reduce the spread of COVID-19. Countries like Ghana imposed weeks of lockdown in areas with surging cases[vi]. They also adopted a form of social safety net by delivering cooked meals to impoverished areas that were under lockdown[vii]. To date, other measures to ensure public safety such as maintaining a two-meter distance, wearing face masks, and using hand sanitizers in public spaces is strictly enforced[viii]. In my opinion, Ghana is an exemplary country for other developing countries to follow in the way its government is handling the pandemic. The country continues to maintain low COVID-19 cases and is one of the lowest countries with COVID-19 reported deaths. I would suggest that developing countries should employ a community-based approach in tackling the pandemic, involving community leaders to encourage citizens to comply with public health official`s prescribed measures of flattening the curve.

Social Distancing Infographic

References:

[i] Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

[ii] Block, P., Hoffman, M., Raabe, I. J., Dowd, J. B., Rahal, C., Kashyap, R., & Mills, M. C. (2020). Social network-based distancing strategies to flatten the COVID-19 curve in a post-lockdown world. Nature Human Behaviour, 1-9.

[iii] Patrick, K., Stanbrook, M. B., & Laupacis, A. (2020). Social distancing to combat COVID-19: We are all on the front line.

[iv] Obeng-Odoom, F. (2020). COVID-19, inequality, and social stratification in Africa. African review of economics and finance, 12(1), 3-37.

[v] World Health Organization: Regional Office for Africa. (n.d.). Coronavirus (COVID-19). Retrieved June 10, 2020, from https://www.afro.who.int/health-topics/coronavirus-covid-19

[vi] Garda World News. (2020, March 29). Ghana: Authorities impose lockdown on two regions due to COVID-19 from March 30 /update 3. Retrieved June 10, 2020, from https://www.garda.com/crisis24/news-alerts/327316/ghana-authorities-impose-lockdown-on-two-regions-due-to-covid-19-from-march-30-update-3

[vii] Erhabor, O., Erhabor, T., Adias, T. C., Okara, G. C., & Retsky, M. (2020). Zero tolerance for complacency by government of West African countries in the face of the COVID-19 pandemic. Human Antibodies, (Preprint), 1-14.

[viii] BBC News. (2020, May 01). Coronavirus in Ghana: Online funerals, face masks and elections without rallies. Retrieved June 10, 2020, from https://www.bbc.com/news/world-africa-52467495

 

‘Welcome to the Team!’: The First Three Weeks of my Practicum Experience, 500km Away… by Chloé Eward, MPH Class of 2020

I started my practicum experience on the morning of May 11th, 2020. “Welcome to the team!” exclaimed all 10 members of the Krentel research team.

I felt reassured and relaxed. Despite having myself and my fellow practicum student colleagues welcomed by Zoom call on a Monday morning amidst a pandemic, the Bruyère team greeted us with warmth and laughs. Seeing only friendly faces and kind smiles, I instantly felt a part of the team.

In defiance of the world’s uncertainty and social disconnection, Dr. Alison Krentel – Chair of the Canadian Network for Neglected Tropical Diseases (CNNTD) and leader in global research for the control and elimination of neglected tropical diseases (NTDs) – planned for the development of a supportive learning community.

“We like to have team meetings every Tuesday morning to catch up and see how everyone is doing. We also plan to host our own Lunch N’ Learns every Thursday to keep everyone feeling present and accepted.”

Our first Lunch N’ Learn was hosted by Dr. Krentel, who took the opportunity to introduce NTDs as a global burden of disease. Lymphatic filariasis, schistosomiasis, and trachoma are all diseases I had never heard of before, which had disconcerting socio-ecological and physical implications. Dr. Krentel discussed the different research areas and implementation strategies which are most important in the management of NTDs, such as Mass Drug Administration (MDA) and the inevitability of patient non-compliance. I was filled with wonderment; it had seemed as though my passionate interests had fallen into the course of my career.

By the following Tuesday, in time for our second team meeting, I had already been working with a member of Dr. Krentel’s team within Bruyère to help plan, design, and publish a fundraising campaign on behalf of a community centre in the Ottawa area. Just one week in and I had already been supplied with trust and responsibility that would teach me much about organizational coordination and communication. This task not only allowed me to apply various skills I had learned throughout the Master of Public Health (MPH) program – such as program development and team management – but it has also granted me the opportunity to apply my language skills in both English and French.

In parallel with the fundraising project, I have been working on developing the foundations for my main practicum project, a survey research study. CNNTD is a network of individuals and organizations who have interest in mitigating the physical, emotional, and socio-economic effects of NTDs. However, despite their work, many Canadian global health organizations are not aware that their activities contribute to the elimination of NTDs; activities such as deworming and school-based programs are thought to contribute to the eradication of infectious diseases, unconnected to reality of NTDs. As such, Dr. Krentel and Amy Davis – the network’s advocacy and policy officer – have interest in developing an online survey to gauge Canadian global health organizations’ interest in the advocacy for and management of NTDs as a global burden of disease.

The beginning of this project entails the submission of an application to the Bruyère Research Ethics Board (BREB). With much encouraging help and guidance from Amy and Dr. Krentel, I was able to complete my first REB application for approval to quick start our survey research study. I am only three weeks into my practicum with CNNTD and I have applied skills I learned throughout course work in the MPH program and accomplished one of my practicum ambitions. With kind smiles, constructive feedback, and confidence from the Krentel research team, I was able to kick-start my remote practicum experience with a bang.

Overall, the Krentel research team at the Bruyère Research Institute has been nothing but welcoming and informative. I look forward to having the opportunity to go to Ottawa and meet the team in person. I have no doubt that my practicum experience with CNNTD will only continue to challenge and inspire me as I go on until the end of July.

Stay tuned for another blog post in July on the results of the survey study!

Thank you for reading,

Chloé Eward

Supporting Campus Health and Wellness at King’s University College…by Laura MacKenzie, MPH Class of 2019

Reflecting on the past twelve weeks, it’s hard to believe that I’m wrapping up the final days of my practicum! I completed my placement within Student Affairs at King’s University College where I worked under the supervision of Doreen Vautour, the Associate Dean of Students, and Joanna Bedggood, the Manager of Student Wellness. I suppose I shouldn’t be in much disbelief that my time at King’s went by so fast, my supervisors kept me very busy with many different projects, all of which concerned promoting campus wellness in one way or another.

The first two projects involved developing resource guides that focused on cannabis and sleep. Cannabis had been chosen because it was a hot topic on campus. It was identified that there was a need to deliver educational content from a harm reduction perspective in light of cannabis legalization in Canada, as well as Western University and its affiliates becoming 100% smoke-free on July 1, 2019. The topic of sleep at King’s was ironically being “slept on”. This past March, Master of Social Work students from King’s were available during Student Appreciation and Wellness Week to answer questions and offer sleep strategies, which also coincided with World Sleep Day. However, there was still a need to continue to deliver educational content beyond one week per year. The resource guides contain relevant background information, common misconceptions, additional resources for students, bulletin board and poster ideas, and a brief analysis of cannabis and sleep wellness initiatives from other universities and colleges. The resource guides will be utilized in residences at King’s as well as in other aspects of campus life when there is a need to relay health and wellness messaging.

The third project expanded on the work of Danielle Robinson (MPH Class of 2017). This project involved updating an inventory of wellness initiatives and activities that are available at King’s, then subsequently determining their alignment with the eight key action areas of the Okanagan Charter.

In 2017, King’s signed the Okanagan Charter which puts forth that “Health promoting universities and colleges transform the health and sustainability of our current and future societies, strengthen communities and contribute to the well-being of people, places and the planet” (Okanagan Charter, 2015, p. 2). The updated inventory aligns with a continuous commitment to ensure health and wellness are being upheld in campus culture, practices, and policies.

In total, there are 73 inventory items that capture formal and informal ways of promoting and achieving wellness, such as personal counselling services and campus green spaces. The inventory highlights all that King’s offers and shines a light on lesser-known wellness activities. When receiving feedback from a fourth-year student at King’s, it was gratifying to hear that they learned about the importance of mental health initiatives in a university setting and that there were health promotion activities available for faculty and staff, not just students.

Unfortunately, there is no certification process that goes along with signing the Okanagan Charter to indeed prove that a campus has followed through with their well-being commitments. However, I was fortunate enough to have my supervisor, Joanna, ensure that the document I had prepared would not be stuck in an office desk, only to be revisited the next time another MPH student came around. In the final weeks of my placement, I presented the inventory to the Campus Wellness Committee and then again to the Senior Administration team at King’s. In both instances, I was able to share the findings, offer recommendations, and join in on the discussion about how King’s can further promote health and wellness on campus. Joe Henry, the Dean of Students, plans to pass the inventory along to the Canadian Health Promoting Universities and Colleges Network with the hope of acknowledging the work King’s has done to advance health promotion and well-being on campus. The inventory also appears to be a unique outcome of the Okanagan Charter that other academic institutions aren’t currently doing, so it will be interesting to see how this document is perceived.

My last project focused on weather and university-based walk-in counselling services at King’s. I’ll spare you the details for now, but if you’d like to learn more, be sure to visit my poster at the Practicum Showcase!

I had an amazing experience at King’s and I wouldn’t have been able to do it without the continuous support from Doreen and Joanna. Having the opportunity to create educational resources for university students, paired with a better understanding of how health and wellness initiatives complement traditional support services leaves me feeling more prepared to enter the workforce as a public health professional!

References
Okanagan Charter: An International Charter for Health Promoting Universities and Colleges. (2015). Retrieved from https://internationalhealthycampuses2015.sites.olt.ubc.ca/files/2016/01/Okanagan-Charter-January13v2.pdf

PHAC-tually speaking – Moving from theory to simulated reality … by Amalka De Silva, MPH Class of 2019

“Welcome to the federal government!” We were greeted with such enthusiasm and excitement on the very first day of our practicum here at the Public Health Agency of Canada (PHAC). You know the feeling when things start off so high it’s almost expected that they will crash back down eventually? I mean it just has to, what comes up must come down right? Well I can tell you with certainty that this is not always the case. Things here at PHAC only got more exciting, the work only got more interesting and the opportunities to learn only grew.

One such opportunity was engaging in the “Canadian Government and Decision-Making in a Strategic Context Exercise,” led by the Department of National Defence. The purpose of the exercise was to mimic a national crisis in hopes of training future leaders who will soon be responsible for the safety of Canadians. The exercise was nothing short of intense. On the very first day, the admiral cautioned the team with very few yet terrifying words, “No mistakes. Does anyone here not understand what no mistakes mean?” At this point silence filled the room. “Now get to work.” Originally, we thought we would be sitting along the sidelines, watching as some of Canada’s brightest worked under pressure to mediate the crisis and protect the public. However, although we were students, we were drawn upon for our expertise in the field of public health. After a year spent developing our knowledge and building our skills, we were finally able to put them to use and we became part of the team.  With “no mistakes” echoing at the back of our minds, we carefully advised important decision-makers on the public health implications of the crisis and how the Public Health Agency of Canada should proceed.

With a running clock, imperfect information, and resources that were slowly depleting, the simulation exercise had successfully managed to create what felt like a highly realistic public health crisis. Being in a graduate level program that is predominantly course-based, concepts are taught and learned, but a real situation, or in this case a simulated version of reality, are when these concepts are really driven home. In this case, the largest lesson was that of jurisdictional authority, or which branches of government legally speaking have the power to act in a given situation, and the problems associated with it.

When working at the federal level, especially in a field dedicated to the health of the public, what you want to do versus what you are actually able to do are very different. The crisis started off at the local level, and then moved to the provincial level, and although it seemed that there was an argument for the federal government to take on a leadership role, with federal resources and personnel available for immediate dispatch, authority remained with the provincial government. Despite growing fatalities, we could only act in a supportive capacity. We could not make any decisions on the ground, all we could do was plan for the worst and prepare to act when called upon. It was only when the situation, as could have been anticipated, crossed provincial borders that the federal government could take on a more active role. We have learned in the classroom that health is ultimately a provincial responsibility. However, with an emergency scenario as large as the one in the exercise, I was automatically ready to jump in, but my feet left the ground far too quickly – no matter the situation, jurisdictional authority holds.

I, like my classmates, pursued a career in public health to serve population health needs. So, to be told to slow your horses, don’t step on any toes, and to be ready when called for, seemed counter-intuitive to me. In the case of such a large health threat, shouldn’t there be a better relationship between the federal and provincial authorities? Should we not be more concerned with the protection of the public than who’s in charge and where we may be over-stepping? Even in cases of crisis, are we really unable to separate health from politics or are they too inter-woven to ever be pulled apart? Don’t get me wrong, in the exercise the provincial authorities were handling the situation and the federal government was quick to get organized, but this unspoken tension is ever present in real life. Although technically, there is a lot of coordination between the two, barriers exist and they still seem to work in silos, afraid to overstep, careful of the jurisdictional boundaries. I believe that if we truly want to respond quickly, efficiently, and effectively, if we want to make well-considered decisions regarding the health of Canadians, we need to find a way to enable the federal government to work more collaboratively with their provincial and territorial partners and vice versa, particularly when there is a crisis. And why shouldn’t we? Having a good, positive working relationship between different levels of government only means more resources and more brilliant minds working together to better the health of Canadians.

All this being said, how do we accomplish this? Perhaps the answer lies in our understanding of why things are the way they are. Is it the constitutional restrictions set in place? “Not within our mandate,” is a term often said and often heard. Is it a lack of trust between the two partners? Could it be that the needs, goals and priorities of each level of government differ and in some cases can be conflicting? A party’s motivations may not be well understood and during times of disagreement, there is no overarching imperative that actually protects the health of the public. If we determine the underlying reasons, what exactly is the solution and is a solution even possible? Well Jordan’s Principle is a great example of collaboration between the two different levels of government. Through new legislation, immediate funding is now available for Indigenous children to access basic health care services while jurisdictional issues of payment occur later. The parties were united in their goal to protect the health of children thus they were able to find a way to overcome jurisdictional issues in times of crisis. So does this mean we need new legislation to mediate the issue? I’m not sure. I know that working collaboratively is possible and it has been done. However, this is no simple issue; it is a challenge with no easy solution.

My practicum placement at PHAC has honestly been the learning opportunity of a lifetime. We are able to engage in different areas of public health and are invited to participate in meetings and exercises. Pursuing education is valued and asking questions is encouraged. As I continue to work here, I continue to learn new things, and reflect on old things. Albert Einstein once said, “The important thing is not to stop questioning. Curiosity has its own reason for existing,” and I look forward to the new questions that lay ahead during the remainder of my time here.

Shifting from Vertical Programming to Integration … by Harvir Sandhu, MPH Class of 2019

The air is cool with the air conditioning, natural light fills the room, the harsh fluorescent light clashing with the warmth from the window. Everyone around the table is fixated on Dr. Krentel’s words: “How do we integrate vertical programs into the health system. Can we?” Pens stop tapping, team members look at one another, attempting to answer the question in their minds. I stop typing. What does it mean to build capacity within health systems in the Global South? What does the integration of vertical programming into a county’s health system look like? Can it be done?

Bruyère Research Institute sits on top of a small hill, overlooking Ottawa. In it, it houses a family of global health researchers, who are tackling problems such as integration of interventions into health systems through a gender equity lens. The solutions to their questions have real world, large scale, and immediate impact. Sitting in on my first meeting, I did not recognize many names, and after spending a bit of time googling, it was an odd experience realizing I sat in a meeting across individuals who have pioneered change through research and policy all over the world.

This world of global health is familiar yet foreign. Introduction to health systems sufficed during the school year, but now, sitting across global health trailblazers, who have been working in this field for years, is an enlightening experience. Many researchers and policymakers are now being pushed on shifting the trajectory of intervention programming from what was once comfortable to new territory. Vertical programming is how many programs are delivered in the Global South, the top-down approach familiar to researchers and funders alike. With Sustainable Development Goals shaping research questions and policy, it is now necessary for interventions and programs to consider how they will integrate into the health system.

In lectures during the MPH program, I often sat with a gnawing sense that the work many of us will embark on will pick up from where previous researchers and policymakers have left off. As global health shifts toward integration instead of stand-alone programs, more work – necessary work – will be required from those of us who venture into the field. This field requires years of work fueled by urges to create change while requiring patience to deliver. It is evident, the passion which drives individuals to pursue global health as their line of work.

It is a daunting endeavor. The complexities of this issue are at the forefront of my mind whenever I sit down and read over previous papers in relation to top-down programming of mass drug administrations to eliminate a neglected tropical disease named lymphatic filariasis. I have sat with my laptop, NVivo open, reading and analyzing interviews over the course of many weeks. My goal is to understand how receptive mass drug administrations are for communities who have been on the cyclical receiving end. I can say that speaking to the community and understanding exactly what has worked for them and what is problematic is a strong step forward. Global health is a world of collective effort, and the work I am doing is a part of a shifting culture from universality to culture specific and contextual work, and I am more than happy to do my part.

There is a small fire escape to the side of the fourth floor, where I often have my breaks. It’s a quiet spot and the greenery is beautiful. Most days I can see the train coming in, and on these warm summer days, I spend my breaks digesting what I read or learned and I am hopeful. The direction global health is headed is one that is of promise and one that works with the community. Top-down approaches need to be phased out. Whether it is diagonal programming or horizontal programming, the goal is to build the community and be sustainable. Vertical programming leaves communities reliant on external aid, which should not be the norm. In light of Malaria, HIV, and TB, we have lost sight of diseases which lead to great morbidity. Many of these diseases, often neglected tropical diseases, require programming that will need to be a part of the healthcare system. As Dr. McKinley says, “Work with the community, not on the community”. For us to work with populations and provide them with the tools to be healthier and more resilient to communicable diseases, we need to ensure we leave communities stronger.

Developing an Epidemic and Pandemic tracker for the Canadian Red Cross: Reflecting on the World through Numbers…by Janel Dhooma, MPH Class of 2019

I wiped my glasses and proceeded to read the appeal once more, Emergency Appeal for Madagascar, Plague Epidemic.  On the report, the number on my screen seemed as though it was pulsating, emphasizing the six zeros behind the 1.  There are more than 1 million people in Madagascar right now, right at this moment, in need of aid to address the plague epidemic within the country.  I proceeded to read the next report on my list… Revised International Appeal, Democratic Republic of the Congo, Ebola Virus Disease Outbreak and Containment Strategy 2019, 15.5 million people to be assisted.  My list went on.

I was looking at the world behind my screen, listing the number of people needing the support, the amount of aid required, the interventions proposed and the amount of resources to be sent.  Sitting at my desk at the Canadian Red Cross (CRC) National Office, I was tasked with tracking the past and present epidemic and pandemic responses of the Canadian Red Cross throughout the globe.  I was responsible for looking through a series of reports, appeals and other data trackers from 2011 until now (July 2019) to make a consolidated tracker that both the Global Health Unit and the Emergency Response Unit could utilize.  Going through big data and learning my way around excel and the PowerBI database, I’ve managed to consolidate around 100+ responses and read through many reports in order to make a comprehensive list.

As the numbers tell their story, I reflect on the limits of human compassion.  I watch the world through the millions needing aid, receiving support and resources sent, yet kind humanitarian acts are still lacking in countries where they are needed the most.  Political frontiers, civil and international conflicts, funding and poor infrastructures are some of the main barriers that prevent aid from reaching the utmost in need.  Some of these countries are conflicted since governance are non-existent or simply because they are overruled by people who simply view millions of individuals as statistics.

So what can we do? Tackle it upstream and shake boundaries?  Organizations such as the International Federation of the Red Cross Society and International Committee of the Red Cross are going through those boundaries contributing their support for the vulnerable.  But could we achieve so much more?

What does it take for us to act upon a tragedy such as these epidemics affecting millions?  Do we need that one narrative to compel the hearts of millions to donate for support or do we simply leave it towards our moral intuitions to guide our either passive or active judgments?  Literature has observed that when looking at large numbers of people affected by natural disasters or epidemics in this case, are under-weighted since it does not convey the same affect or emotion to motivate a decision compared to the one narrative that simply provokes action (1).  Thereby, humanitarian acts by organizations such as the Canadian Red Cross might possibly be deemed insufficient as resources and support are limited by humanity’s compassion.

Psychosocial numbing or ‘statistical’ numbing is a theory where we as humans feel indifferent to the suffering of large numbers of individuals versus one individual whose narrative resonates and ‘tugs at our heartstrings’ (1).

I looked back at my reports and proceeded to plug in the numbers, thinking that the copying would become muscle memory but as I continued on the numbers did not register as the usual ‘plug and chug’.

The inability for us to scale our emotions toward large amounts of people is limiting us from contributing and supporting aid through organizations such as the Canadian Red Cross.  I read through hundreds, thousands and millions of people needing aid, and I reflect upon the capacity of the Canadian Red Cross and what they have done and contributed to over 58 countries within the last 8 years with more than 100 epidemic and pandemic emergency responses servicing the millions.  The projects they had for practicum students interested me greatly and I knew I would enjoy my internship here, hoping to leave some small contribution for them – contributing my part towards this humanitarian organization.  The Canadian Red Cross’ mission is ‘to improve the lives of vulnerable people by mobilizing the power of humanity in Canada and around the world’ (2) and it achieves just that and more.

The Canadian Red Cross has been a leader within global health with its many initiatives towards curbing the transmission of disease and global health programs for long-term preparedness and recovery.  I was drawn towards its humanitarian acts from a personal standpoint as back in 2013, the super typhoon Haiyan left my home town back in the Philippines in shambles.  As the country gathered as much resources they needed from other NGO’s, the Canadian Red Cross was also there to help us pick up the pieces and steady us on our feet.  With only a few more weeks until my time has wrapped with the CRC, the excitement and interest towards this tracker project has not dissipated.

Humanitarianism, the word itself has quite the definition, not to mention the responsibility behind it. I have always, always, had quite the—how do I describe it? Vigorous humanitarian spirit in me that was somewhat waiting to be unleashed—would unleashed be the right word? I digress…  Another appeal popped up, same bold headings, this time: 2014, Disaster Emergency Relief for Guinea, Measles, 1.6 million affected; 2012 Emergency Appeal for Sierra Leone, Cholera Outbreak, 1.5 million.

I was pacing myself to read through the appeal to make sure I have the details ready for the tracker.  My thoughts wandered towards the humanitarian acts the Canadian Red Cross and other partner national societies have contributed towards these epidemics and other disasters around the globe.  These organizations value these numbers as lives not just statistics, and I wonder, if we start grounding our moral compass to value life AND lives – we would probably accomplish something far greater in aiding the millions in need…

References:

  1. Slovic P. Psychic Numbing and Genocide: (718332007-003) [Internet]. American Psychological Association; 2007 [cited 2019 Jul 7]. Available from: http://doi.apa.org/get-pe-doi.cfm?doi=10.1037/e718332007-003
  2. Canadian Red Cross. Epidemic and Pandemic Preparedness and Response: Leveraging the Capacities and Experience of a Global Movement. 2016.

Strength in Numbers: Neglected Tropical Diseases and Global Health Advocacy…by Linda Holdbrook, MPH Class of 2019

Prior to beginning this practicum placement, I did not know that intestinal worms could even be considered a ‘public health problem’, or that the words “deworming” and “humans” could be used in the same sentence. However, over the last 8 weeks, I’ve learned that for people living in areas where neglected tropical diseases (NTDs) like Schistosomiasis and Soil-transmitted helminths are endemic, intestinal worms are an all too common reality. So common, in fact, that over 1 billion people in the world are impacted by them (WHO, 2017).

My practicum placement is at the Bruyère Research Institute in Ottawa. I am part of a diverse team of researchers, housed in a unique building with lots of character. My practicum supervisors, Dr. Alison Krentel and Mary Ellen Sellers, have been extremely supportive and encouraging thus far. Dr. Krentel is a global health researcher who specializes in NTDs, and Mary Ellen is a previous alum from the Western MPH program! It’s also great having Harvir on the same team, a fellow classmate and familiar face!

At this point you might be wondering, what exactly is a “neglected tropical disease”, and how can a disease be “neglected”? Briefly, neglected tropical diseases (NTDs) are:

  • A group of 20 communicable diseases (and counting!) that largely affect people living in poverty (Schistosomiasis and Soil-Transmitted helminths are only two of them)
  • Classified as “neglected” because they are overshadowed by other diseases like malaria, TB, and HIV/AIDS (“the big three”)
  • Diseases that generally cause disability, as opposed to death, making it easier for the international community to “forget” that they exist

Estimates suggest that 1.6 billion people are affected by NTDs, mainly in Asia and Sub-Saharan Africa (WHO, 2017). In some ways, we can also say that the “neglect” extends beyond the disease, to the affected individuals themselves. Though the term “NTDs” refers to neglected diseases, we are talking about neglected people as well.

My role at Bruyère is to support an advocacy coalition called the Canadian Network for Neglected Tropical Diseases (CNNTD). The CNNTD was formed in 2017 and works to raise awareness amongst policy makers and mobilize Canadian action to end NTDs. The main deliverables I am working on include strengthening the social media presence of the network through Facebook, developing a deworming program, and submitting a proposal to Global Affairs Canada to fund deworming initiatives. Currently, deworming medications exist to treat intestinal worms, but barriers such as gender inequality prevent certain populations from accessing them. The goal of the proposal is to address these barriers and improve health.

One of the first lessons I learned during my practicum was that things move pretty quickly around here! Within my first week at Bruyère, I had the opportunity to attend a roundtable event with other global health organizations in Ottawa, to discuss the need to integrate water, sanitation, and hygiene (WASH) into health programming. This experience brought to mind several of our class discussions in the MPH program, especially the Social Determinants of Health course! Another exciting opportunity was being able attend a meeting with the Steering Committee of the CNNTD in Montreal. The purpose of this meeting was to map out the future of the network, develop advocacy strategies, and highlight opportunities for funding. It truly represented the interdisciplinary nature of public health, as professionals from various sectors and organizations were in the room!

More and more, I’m realizing that so much of what we learned in the MPH program is applicable to my practicum. I am constantly discovering new insights on concepts covered in class and it has been quite the “full circle” experience to see everything tie together. For example, one morning I had the task of writing a statement for a Member of Parliament. The statement needed to give an overview of NTDs, describe the relationship between NTDs and gender equality, and highlight why Canada should make NTDs a priority for overseas development – all in under 1 minute! This experience allowed me to draw on the framing techniques covered in Health Policy, the influence of gender on health as discussed in Social Determinants, and all of the writing practice from the many policy briefs!

Overall, my practicum has been an amazing experience. Perhaps the most important takeaways I’ve learned, in regard to global health advocacy, is to be persistent when engaging with policy makers, and not to underestimate the power of making connections and building relationships. The saying that there is “strength in numbers” could not be more fitting in this context. We all have a role to play in determining which causes receive adequate attention, and together we can work towards increasing Canada’s leadership in eliminating NTDs. I’m looking forward to what July will bring, and I am extremely grateful for this learning opportunity!

L. Holdbrook and Bruyere
Harvir, myself, Dr. Krentel, and Mary Ellen at a Mobilizing Event for the Women Deliver Conference. We went to parliament to talk with other activists, students, and professionals about gender equality and NTDs. We even got to listen to amazing speakers like Mrs. Sophie Gregoire-Trudeau!
L. Holdbrook - 2
At the event, we were all asked to brainstorm, “What steps are you taking to promote gender equality?” Here are some thoughts from my supervisor, Dr. Krentel: “Improving delivery of treatments & care for women and girls with neglected tropical diseases”
L. Holdbrook - 3
“Can you spot Harvir? These flowers are from Parliament Hill, where we attended “Question Period”, and got to see the MPs in action. It reminded me a lot of our debates and mock activities in the classroom – some of y’all would make GREAT politicians! (Hint: she’s hiding in the flowers!)”

Are Death Tolls just Statistics? A Reflection on Humanitarian Aid and our Role as Public Health Professionals…by Rachelle Roussel, MPH Class of 2019

I sit in the back of the room each Monday morning listening to a recount of all natural disasters that have occurred within the last week: Heavy rainfalls and floods in Tanzania. Earthquake in El Salvador. Tornado in Chile. These situations are not making their way to my newsfeeds and I would not have known about them had I not be sitting in on the “Emergencies on the Radar” meetings at the Canadian Red Cross. Yet despite the radio silence we observe from national news outlets, across the globe people are constantly being affected by natural disasters. Some families displaced, others lost livelihoods and infrastructure, and some lost human lives. I’ve noticed that over time these words stop being as shocking: “6 casualties” they say.

It brings me back to our environmental health class where we were asked how many lives lost is too many? 1000? 100? 1? The class debated – I was settled on 1. Perhaps this stems from my background as a Registered Nurse (RN). After reciting the Florence Nightingale pledge and vowing to protect my patients, I had difficulty compromising. I can admit that before completing the MPH, I sometimes had a hard time seeing the bigger picture. Now 10 months into my Master’s degree, I am completing my final practicum placement at the Canadian Red Cross national office in Ottawa. Here, I research the intricacies of international aid for major health deployments during disaster response. My research ideas were sparked by the Global Health Unit after the landfall of Cyclone Idai and Cyclone Kenneth in Mozambique where roughly 1.5 million people were affected and over 600 people have died.

600 people. Is this our number? It’s an awkward question when you have finite resources, but one that often requires an answer. Have I stopped humanizing death in a global context in order to rationalize each dollar spent – have people’s lives just become statistics? To be truthful, I don’t think that’s my problem. I feel as though instead, I am learning what it means to be a public health professional. This seems like a dark assessment of such an essential discipline, but in this field we find ourselves in positions fighting for resources so that we can allocate them where we feel is most necessary… and no one can seem to agree on what ‘most necessary’ means.

As I reflect, I often think that as a Canadian RN, if all my patients needed the same intervention, they would essentially all receive the same treatment. Some may receive more of my time or a quicker triage, but all will be sleeping in the same hallway, with the same nurse, and receiving the same healthcare. I recognize that this is majorly oversimplified, but essentially my nursing career was never a zero sum game – my patients did not often lose because another gained. Now I am here in public health, where it becomes a debate of which program will receive funding and which country will the Red Cross send an Emergency Response Unit – what dictates this need and how many people must lose their life? If we provide for one country, does this mean that another goes without? Who makes that decision? – I don’t think I would want their job. As I finish the MPH, I learn that it is ever changing and still constitutes most of what runs through my mind during each Monday morning meeting.

So what do we do now? Do we challenge these death tolls or accept them? Unsurprisingly, Western’s MPH program does not teach us to simply conform to norms. As I write this practicum blog, I have engaged in a reflection that I still do not have my final answer to – how many lives are too many? 1000, 100, or 1? All I can say with confidence is that context matters. Trust me when I say that those two words have been said dozens of times in each class because truthfully, there is not an area in healthcare where it isn’t relevant.

As I approach the end of my practicum placement with the Canadian Red Cross, I have learnt that Mozambique’s 600 casualties could have been 6000. The humanitarian aid sector has made strides in international and global health to focus on capacity building and collaboration during disaster response. This means that disaster prone areas can better help their population, request less international aid, save resources, and improve health outcomes. To better represent this train of thought, I present Mozambique’s dynamic response to Cyclone Idai and Kenneth where the Ministry of Health (MoH) worked tirelessly to combat cholera, malaria, and other waterborne illnesses with Water, Sanitation, and Hygiene (WASH) stations post disaster. Cholera Treatment Centres were also established to treat cases that would inevitably arise. Because of these interventions, hundreds of lives were saved. Though we know that the initial effects of the tropical storms had immense impact, including 600 lost lives, as we mourn the tragedy that arose from natural disaster, celebrate the accomplishments in better health moving forward. You may disagree, and I urge you to question my thought process because as we know, 600 lives are still 600 lives.

As I end my reflection, I encourage those who are already established in public health, currently pursuing it, or considering it as a career path moving forward, to reflect on how you plan to utilize your power. We are granted with privilege in our field and are required to optimize it to institute change. Whether we seek better international responses to disasters or focus our efforts in domestic contexts, take pride in our small wins and continue to advocate for more.