Interviewee Amina:

A lack of infrastructure is not just an inconvenience but a huge barrier to the education system.

[Music]

Ciara:

Mali is a country with many challenges, and one of the biggest is its infrastructure. We’re talking

about things like roads, electricity, water systems, and buildings but mostly things like proper

school facilities.

Voice acted by Cynthia Wright, Amina, a teacher who’s been working in Mali for over 10 years

has experienced this firsthand.

Interviewee Amina:

I’ve spent most of my life working in schools in rural Mali and I’ve seen the situation up close.

Mali is a beautiful country but the infrastructure here is a huge challenge. And when it comes to

education, that challenge becomes even more severe. I’ve worked in schools where there are

no proper buildings, no access to clean water, and where students have to learn in classrooms

that are barely more than open spaces under a tree.

[Music/kid chattering]

Ciara:

Classrooms in Mali, especially in rural or underserved areas often face major challenges related

to poor infrastructure which affects both the learning environment and the overall educational

experience. Research shows that in 2022, 519,000 children were out of school across Mali due

to school funding and armed group threats and attacks. In 2022, the number of children

dropping out of school in the country has increased by 15 per cent, according to the Norwegian

Refugee Council.

Interviewee Amina:

I’ve seen classrooms with broken walls, no desks, and no teaching materials. In some places,

the roof of the classroom is missing entirely and the children still come to school every day

hoping that they can still learn something. But it’s incredibly difficult to teach in those conditions.

Ciara:

Many schools in Mali have classrooms that are made with basic materials like mud bricks, clay,

or bamboo. These buildings often lack proper ventilation and can get very hot during dry

seasons which makes it difficult for both teachers and students to concentrate.

There is also a shortage of textbooks and other learning materials. In some cases students

share textbooks or may not have any at all. This shortage makes it difficult for students to fully

engage with the curriculum and also limits their ability to learn independently.

Interviewee Amina:

The lack of basic facilities like a solid roof or proper walls means that the classrooms are often

too hot in the dry season or too cold when the rains come. There’s no ventilation, and the

classrooms can become unbearable, especially with large groups of students. I remember days

when I would be teaching, and the children were so uncomfortable, they could hardly focus.

And when it comes to basic things like textbooks and supplies. I often have to teach without

textbooks because there are just not enough to go around. Students can’t take notes because

they don’t have notebooks or pens. And as a teacher, you end up trying to make up for the lack

of resources by using whatever you can find chalk, old paper, anything to try to make the

lessons more engaging. But it’s not easy.

Ciara:

Having these poor conditions of school buildings and the lack of proper facilities can lead to

inconsistent attendance within students. According to UNICEF, education in Mali has been

improving over the last decade but more than two million children aged between 5 to 17 still do

not go to school, and over half of Mali’s young people aged 15 to 24 are not literate. These

students may end up staying home due to uncomfortable or unsafe learning environments or

because they have to help with household chores or farming.

Not to mention, the lack of basic sanitation facilities like clean water and functional toilets can

lead to health issues, mostly to younger students. This can lead to absenteeism and negative

affects on academic performance.

And even teachers often have to work under difficult conditions with inadequate training, low

salaries, and limited resources. They may also face challenges such as a lack of teaching aids

and large class sizes which can mess with their ability to deliver effective lessons.

Interviewee Amina:

It’s truly heartbreaking, honestly. I’ve seen kids who have to walk for hours just to reach school,

often in the scorching sun or through muddy roads during the rainy season. They’re already

exhausted by the time they arrive and it’s difficult for them to focus. I remember one student, a

little girl, who would walk over 10 kilometers each day to attend school. She would get there,

exhausted and hungry and still do her best to learn. But when the classroom itself is not

conducive to learning, and when you can’t hear the lesson properly because of the noise from

the outside or the heat becomes unbearable then there's literally no surprise that some kids

eventually drop out.

Some children stay home all together because their parents see no point in sending them to

school if the conditions are so poor. They would rather keep them at home to help with chores

or farming. It’s a difficult situation because education is seen as the way out of poverty, but how

can you succeed when the basic infrastructure isn’t there to support it?

Ciara:

Multiple international organizations are working in Mali to improve the education system by

providing resources, building better classrooms, and offering teacher training. However the

challenges of widespread poverty, political instability, and inadequate government funding make

these interventions slow and pretty uneven. According to the Norwegian Refugee Council, in

2020, the Malian state budget for education amounted to USD 637.3 million. There was a start

but only 13% of the national budget was allocated to the construction of classrooms and 4.8% to

the acquisition of teaching materials.

[Music]

Ciara:

Some schools have embraced community based solutions where there's local families and

communities that contribute to building and maintaining school infrastructure. This might involve

using local materials, volunteer labor, or raising funds to improve the school's condition.

In urban areas and more developed regions, there are schools that are better equipped with

modern buildings, access to electricity, and more learning resources. However these are the

exceptions rather than the rules and many children still attend schools with subpar conditions.

Interviewee Amina:

There are some efforts but the progress is slow. The government has tried to invest in

education, and there are some international organizations like UNICEF for example, and they

are working to improve infrastructure. I’ve seen new schools being built, but they are often few

and far between and many of them are located in urban areas. For the rural schools, where

most of the population lives, the improvements are minimal.

One of the problems is funding. Even when new schools are built, there’s not enough money to

maintain them properly. So while we might have a shiny new building, it’s often just a shell

because there’s no furniture, no books, and no real resources to make it functional.

And when we do get support, it’s often in the form of temporary solutions, like mobile schools or

tents set up as classrooms. These help in the short term, but they don’t provide a permanent

solution. We need proper, long-term infrastructure development.

Ciara:

Despite the challenges posed by poor infrastructure in Mali, the resilience and determination of

the people in the educational sector have allowed them to keep pushing through. As the

younger generation becomes more educated, they are increasingly advocating for better

infrastructure and educational reforms. This awareness among youth and local leaders fuels

hope for change by driving the belief that progress is possible despite these current challenges.

Interviewee Amina:

There are days when I feel like I’m fighting an uphill battle. But I always remind myself of the

kids. Despite all the hardships, the children still show up every day, eager to learn. Their

resilience is incredible. They have so much potential, and I see the spark in their eyes when

they understand something I’ve taught them.

What keeps me going is knowing that education is one of the few ways to break the cycle of

poverty. Even though the infrastructure isn’t where it needs to be, I believe that the education we

can provide, no matter how limited, can still make a difference in their lives. That’s why I

continue to push forward, even when it’s hard.

[Music]

Ciara:

The government and families in Mali play an important role in overcoming the challenges of the

educational system. Community driven initiatives, financial contributions, and cultural values of

education helps to keep these schools open and functioning despite the many obstacles. But

the limitations of these efforts are due to poverty, inconsistent resources, and the pressures of

other daily needs which mean that further systemic support from the government and

international organizations is important to ensure sustainable improvements. The community’s

resilience mixed with external support holds the key to overcoming the infrastructural challenges

and improving education outcomes for all children in Mali.

Interviewee Amina:

On a larger scale, we need a comprehensive approach like one that addresses not only the

buildings but the entire education system. We need better roads to connect rural areas to the

cities, reliable electricity for schools, and proper facilities like clean water and sanitation. We

need to ensure that teachers are properly trained, supported, and paid.

And most importantly, there needs to be a long term commitment from both the Malian

government and international organizations to fund education and infrastructure projects

consistently. It’s not just about building ne8w schools, it’s also about ensuring that they are

maintained, that resources are provided, and that the community is involved in the process.

Ciara:

To overall improve Mali's poor infrastructure then a comprehensive and sustained approach is

needed, combining government action, community involvement, and international support. The

government must prioritize education and infrastructure investment, allocating funds for building

and maintaining schools, providing proper sanitation facilities, and ensuring reliable electricity

and water access. Communities should also be empowered to take part in local decision making

with resources directed towards sustainable solutions such as locally built classrooms and

volunteer driven programs.

[Music]

International organizations can provide technical assistance, funding, and resources to

complement national efforts. Plus investing in teacher training, distributing learning materials,

and addressing gender disparities are needed to ensure that the infrastructure supports a high

quality and inclusive education system that benefits all students.

Interviewee Amina:

Truly, if we can create the right environment for learning then these children can thrive. And not

only that, but Mali as a whole can begin to move forward, break the cycle of poverty, and build a

stronger future.

Ciara:

This podcast was produced by Ciara Mickens for the Spring 2025 Global Health Course at

Guilford College.

[Outro music]

access for mothers giving birth and their newborn children in Gaza?

*intro music*

[Narration]

Many women in Gaza go into labor with no hospitals or doctors nearby to safely deliver their

baby. Without any access to proper prenatal care, their baby is at risk of being born prematurely.

[Shatha Elnakib]

These women are just under unimaginable, unfathomable stress because of the, you know, the

impossible conditions they're living under.

*music*

[Narration]

To understand why Gaza’s healthcare system is in ruins we need to go back seven decades.

The roots of this problem date back to 1948, when hundreds of thousands of Palestinians were

displaced from their homes during the Nakba with many seeking refuge in what is now known

as the Gaza Strip. This mass displacement was recognized by the United Nations, which in its

Resolution 194, called for the right of return for Palestinian refugees displaced during that time.

The displacement of the Palestinians continued, along with continuous airstrikes over the next

seven decades, leaving Gaza’s healthcare system in shambles. In 2007, Israel and Egypt

imposed a blockade on Gaza which severely restricted the movement of the people, goods and

supplies which included medical supplies. This blockade has made it nearly impossible for

hospitals to continue functioning as usual. This blockade on Gaza is still in place meaning

limited medical supplies and other resources.

[Shatha Elnakib]

Israel decided to stop aid in Gaza with the end of the ceasefire. And so this is what we call

weaponization of humanitarian aid using humanitarian aid, which is not supposed to be a

weapon, but using it as a weapon against people. Telling people you have to acquiesce to our

political demands in order for you to get your humanitarian aid. So this–we're seeing this play

out. And of course this is not normal. It is not legal. It is very much a war crime to prevent

civilians from having access to humanitarian aid.

[Narration]

That’s how Dr. Shatha Elnakib, an Assistant Scientist at Johns Hopkins Bloomberg School of

Public Health, describes the situation with regards to aid in Gaza. Dr. Elnakib has researched

the crisis in Gaza specifically how it affects pregnant women. In an article for The Lancet, she

writes about the harsh conditions for pregnant women in Gaza and her research reveals the

severe lack of maternal healthcare.

*music*

[Narration]

With hospitals already struggling under years of blockade and bombardment, this weaponization

of humanitarian aid only worsens the crisis. Medical facilities that once provided essential care

are now barely functioning and nearly two thirds of them have shut down completely. Only 39%

of hospitals in Gaza are still partially functioning.

[Shatha Elnakib]

Once they get to the facility, facilities tend to be overcrowded. They tend to also be understaffed

because healthcare workers are unable to get to the facility the same way that these women

can't get to the facilities because of, you know, the destroyed roads...And so the priority

becomes to dealing with these mass casualties, these trauma injuries. Just you know, so you

know, according to the latest estimates we have around 112,000 people who have reported

injuries according to the WHO’s most recent situation or SitRep. And as you can imagine, these

are people who have burns who have complex trauma injuries. These are not simple injuries.

Right, because, you know, because of the nature of the war, because of the relentless

bombardment, the use of weapons that are, you know, quite cruel, white phosphorus included.

And so these people's needs are often so acute that they will take precedence over other things

like routine pregnancy care, for example, or antenatal care. And so the needs of women,

particularly pregnant women, then become deprioritized.

[Narration]

For pregnant women, this means barely any prenatal care, leading to more premature births,

low birth weights, and higher risks of infant mortality. In overcrowded and makeshift maternity

wards, doctors are forced to work with minimal resources. There are shortages in some of the

most basic medical supplies like gloves, gauze, and disinfectants which leads to many births

taking place in unsanitary conditions risking infections for both the mother and the newborn.

[Shatha Elnakib]

There's, you know, scarcity in oxygen. And statements from health providers themselves have

indicated that certain surgical procedures, including C-section, which is a very serious surgical

procedure, are now being conducted without anesthesia or women are being cut open without

any anesthetic. And at times, without even electricity, you must have read in the news how

doctors were using their telephone flashlights because there was no electricity in hospitals and

they were conducting these very advanced surgical procedures in the absence of electricity.

*music*

[Narration]

But the crisis in Gaza’s hospitals doesn’t end after the mothers give birth. Even when babies

survive birth, they face yet another challenge: a lack of electricity. Gaza has been in an ongoing

electricity crisis since October of 2023. According to the World Health Organization, as of 2023,

130 premature infants in Gaza rely on incubators and 61% of those incubators need electricity

to function. Without reliable electricity, life-saving equipment like these incubators are shut down

and so according to the United Nations, during this past winter alone eight newborns have died

of hypothermia. Infant mortality rates are one of the biggest indicators of a population’s overall

health. They reflect not only access to medical care, but the stability of infrastructure, and

access to other essential resources. But in Gaza, where hospitals are barely functioning, these

numbers don’t just signal a health crisis, they represent lives lost to conditions that should be

preventable.

*music*

[Narration]

At first, it might seem like this is an issue happening far away, with no direct connection to the

people in the United States. But in reality, U.S. taxpayer dollars directly fund the Israeli

military–its weapons, its airstrikes, and the destruction of infrastructure including hospitals in

Gaza. According to the U.S. Department of State, through the U.S. Foreign Military Financing

program, Israel has received some of the most advanced military equipment in the world.

According to USA Spending, a website run by the U.S. Department of Treasury, this program is

funded by U.S. federal revenue which is primarily taxpayer dollars meaning American citizens

are directly financing the military operations in Gaza. The Department of State also reports that

since Israel’s founding in 1948, the United States has provided Israel with over $130 billion in

direct aid. This financial and military support makes the U.S. more than just a bystander.

[Shatha Elnakib]

I think international pressure is very important and we have just, we have seen big hegemons,

big countries in the West failing to exert international pressure, you know, not just turning a blind

eye to what's happening, but rather, you know, they're very much complicit materially. So they

give the money, they give the weapons.

[Narration]

While there has been a lot of material support for Israel, efforts to aid Gaza have also been

made, though they face more obstacles that make the aid delivery process more difficult.

Humanitarian convoys, organized by international agencies like the United Nations and the Red

Cross, have managed to deliver resources, such as food, medical supplies and other essential

supplies despite the blockades and ongoing airstrikes. Temporary ceasefires including the most

recent one have allowed for the aid from these convoys to reach Gaza safely. The United

Nations Relief and Works Agency has set up field hospitals to provide medical care on the Gaza

Strip. In addition, organizations like Doctors Without Borders and Oxfam have also played a key

role in providing emergency medical care and essential services to the people in Gaza by also

setting up field hospitals, supporting the few functioning hospitals remaining in Gaza, and

operating mobile clinics. But beyond these humanitarian efforts, local governments and

individual countries are also taking action to address the conflict. The Oxford City Council has

recently voted to divest from Israel in support of the Boycott, Divestment and Sanctions

movement against Israel. South Africa has also been vocal in its support for Gaza, even taking

legal steps against Israel by bringing a case to the International Court of Justice, accusing Israel

of committing acts of genocide in Gaza. While these actions are different in terms of approach,

they both reflect a growing global movement pushing for accountability and consequences.

[Shatha Elnakib]

Beyond rebuilding hospitals, we need to make sure we have long term strategies that ensure

that healthcare remains protected and accessible. And we're not just talking about, you know,

let's rebuild and reconstruct, but how do we prevent this from happening?

[Narration]

Despite the growing global movement for accountability and the humanitarian aid efforts, these

alone cannot truly address the devastation in Gaza. International organizations such as UNICEF

and the WHO must not only fund the rebuilding of hospitals and ensure people have access to

medical supplies, but they must also support the training of local healthcare workers and equip

them so that they can continue operating hospitals effectively in Gaza. Long-term unrestricted

aid is crucial for rebuilding Gaza’s healthcare system, but true recovery won’t happen until a

permanent ceasefire is reached. Many ceasefires in the past have been fragile. For example,

the most recent ceasefire which took effect on January 19th of this year, was violated when

Israel resumed its attacks on Gaza. According to Amnesty International, this was a “unilateral

resumption” of the war meaning the attacks were one sided, and they resulted in the deaths of

at least 414 Palestinans including 174 children. This was a clear violation of the ceasefire

agreement and this is only one example of many where Israel has failed to honor such

agreements. Achieving a permanent ceasefire requires more than just a temporary pause in

violence; it requires strong diplomatic efforts that address the root causes of the conflict. This

includes pressing the international community to hold Israel accountable by ensuring that they

honor the terms of a permanent ceasefire. A first step would be the lifting of the blockades on

Gaza. Lifting the blockades would let aid reach Gaza without any obstacles. But for any peace

agreement to hold, the international community also has to ensure accountability for war crimes

and violations of the international law. While these are important steps towards a permanent

ceasefire, they would only be the beginning of a very long process.

[Shatha Elnakib]

We need better humanitarian diplomacy. We need international pressure to prevent attacks on

medical facilities everywhere, not just in Gaza. I mean we've seen in Syria, we've seen in

Ukraine how health facilities, health infrastructure is very much targeted as part of war tactics,

right? It’s part of the strategy of war. And that needs to stop...And it's not just obviously about,

you know. Rules of war around healthcare, but also rules of war against, you know, not

weaponizing food, not weaponizing water, not weaponizing aid. These are basic fundamentals.

Like I said, that are part of a rules based order that we have been living under for the last how

many years, 60 years more. And so we need to make sure that the rules based order, you know,

is back. And it's not just an anarchy and a jungle.

*music*

[Narration]

Gaza’s healthcare crisis is not just a humanitarian issue but also a moral and ethical one.

Hospitals shouldn’t be battlegrounds or places for airstrikes. The lives of pregnant women and

newborns shouldn’t be collateral damage during a so-called “war.” None of us choose the place

of our birth, yet for many, the circumstances of where they're born dictate whether they will

survive past their first year of life. As we continue to witness this ongoing crisis, we must ask

ourselves: What steps are we, as the global community, willing to take to ensure a future where

every life, regardless of the place of birth, has the opportunity to live without the constant threat

of violence and destruction to their healthcare and basic human rights?

*music*

[Narration]

This podcast was produced by Sarah Zaraf for the Spring 2025 Global Health Course at

Guilford College.

Bronwyn: I don't think things can change in the midst of chaos because everyone's fighting for survival in that mode and it's understandable why. The people in Somalia are not the ones contributing a lot to climate change themselves, they're feeling the impacts of it from other countries. 

Narrator: Bronwyn Tucker is a professor of the Environmental and Sustainable studies department at Guilford College. According to the Intergovernmental Panel on Climate Change “climate risks are appearing faster and will become more severe sooner than previously expected”. This has led to a dramatic increase in extreme weather conditions such as droughts, floods, hurricanes, and wildfires. These impacts have left people in Somalia in a dire state with hundreds of thousands of people becoming displaced in search of food and water with over 4 million people currently facing acute food insecurity. This means every year over half of the population is left undernourished causing infant mortality rates and severe health problems such as malnutrition, malaria, and tuberculosis to skyrocket. 

Bronwyn: In Somalia specifically there's been such a positive feedback loop of okay conflict and then crisis so I don't have enough food and I'm fighting for food and then I'm degrading the environment because of how I'm trying to get food or burn down trees to make fuel and that creates more conflict and shortage and then greater environmental degradation so it's all kind of moving toward that same path of challenge where if there was a moment where they could feel like they had enough and didn't have to fight for it maybe there could be a moment for a discussion about what could be next.

Narrator: The main concern is the ongoing malnutrition because it's such an immediate health concern nobody has the foresight to plan short term relief and long term sustainability to slowly reduce the problem all together. Data has consistently showcased Somalia’s extreme weather, facing major droughts and floods, but other issues such as their governmental system have created barriers to reduce food insecurity as well. According to the US government, Al-Shabaab is a terrorist clan militia that has violently fought for control over Somalia's federal government for decades. This has made it much harder for the government to implement long term infrastructure due to their lack of power and control. With the contagious outbreaks, droughts, food shortages, floods and other governmental safety issues it makes it nearly impossible to only tackle one issue at a time. 

Bronwyn: Well I think if you asked anybody hungry they'd say please feed me first before we make long-term plans but that only lasts so long right? And there's that phrase you can give a man a fish or you can teach a man a fish and I think it's not even necessarily about teaching because these people know how to farm they know how to do these things but the world is changing around them and there's also a lot of conflict. If a country is struggling so much that they just can't meet their people's immediate needs that's when aid comes in so that they can then have the space to think long term and that's what's tough.

Narrator: Exactly these are everyday people who are clawing to meet their basic needs. They don't have time to be concerned with environmental impacts or long term effects. They're living one day at a time trying to support their families and themselves. And since 80% of the population is employed in agriculture and it's also 70% of its total GDP the lack of yield is extremely concerning for them. Somali people are forced to focus on themselves. The amount of food available is extremely limited and the food that is accessible in proximity is even more unattainable for them price wise. Evidence consistently shows that the changes needed to offset food insecurity are too large for the citizens to make themselves, it’s up to the government to make large-scale systemic reforms.

Bronwyn: I don't blame a lot of people in the world who are doing things that are really causing negative consequences to our planet when they're just trying to survive. I would do the same thing if it meant taking care of my children.

*Music Playing*

Narrator: Programs from the European Commission and the United States have been supplying immediate relief for food and water but these programs won't help the country sustain itself long term because of the changing climate. And while the US provides aid, they contribute greatly to the issue of increased climate change as well. The aid they give can’t even compare to how much they influence the root problem. In 2020, China accounted for 27% of total greenhouse gas emissions and the US alone accounted for 13.5% globally as well. People don’t realize that it's not just huge corporations impacting climate change either. Their daily tasks like shopping, driving, and showering actually have an impact too. Not to mention the amount of food waste and overconsumption that accounts for 44% of the average household's yearly carbon emissions. There's multiple avenues of decreasing our personal carbon footprint, many of which have been successfully used in specific cities and even entire states. 

Bronwyn: Live simply so that others may simply live. I love that idea of you know what do I need versus what i want and how do my wants impact others needs. So rather than being self-serving or taking more than you need if you have that sense of community that you want to take care of and then you trust that community even if you're only impacting your immediate area and you're not affecting the whole world I think to be sustainable you have to trust other people to kind of be in on the plan long term because when you're thinking about your immediate needs and just surviving who cares about tomorrow and the environment right but if you can trust that you have a community of people that will work together towards something that will be long term good you can make short term sacrifices as long as you're meeting your basic needs.

Narrator: A community of any size can work together to make change when there's trust and motivation within it. Despite China’s authoritative government many environmental activists have come together to protest their countries climate change impacts. We’ve also begun seeing examples of this in areas like Boston, Massachusetts as well where they've increased the use of public transportation by threefold, greatly reducing the amount of greenhouse gas emissions produced by single family vehicles. Columbus, Ohio has also started initiatives to increase the amount of solar energy sources used creating 4000 jobs related to the projects as well. The United States and China must work to reduce greenhouse gas emissions to mitigate global negative environmental impacts while Somalia must work to implement sustainable agriculture techniques so they can adapt to the damages that have already been done.

Bronwyn: The children growing up in those places are learning a lot by doing with their parents and maybe the internet's not as valuable but as climate change affects things and they have to adapt and maybe it will be valuable to see what other crops can be more drought resistant or water catchment methods to be more resilient when floods come and capturing some of that rain when the droughts coming in so education and information about infrastructure to support those types of fluctuating events would be valuable but in general I think the cultural knowledge is what we need to preserve.

Narrator: And agriculture is also very group effort based, one person isn’t maintaining an entire farm so community is vital. It’s important to recognize the impacts that individualism has when most of the agriculture in Somalia is maintained by family units. And agriculture knowledge is passed down informally through generations but the impacts of climate change make it a lot harder to adapt to the environmental changes. Utilizing sustainable farming techniques to bounce back the agriculture sector is the only thing that could truly reduce food insecurity rates as evidence shows increased rates of crop production in Africa when using them. The short term solutions have already been drained. Charitable aid just can’t continue at the rate Somalia needs it. 

Bronwyn: If it is sustainable ag it has to be good for the earth and then it's going to be inherently good for you because if you're taking care of the soil and having strategies that improve the land the land's going to be more productive for you. Specifically I think Somalia could plant more vegetation that's protected so that it was helping to stabilize soils during their floods and also this would allow them to regenerate more renewable resources for fuel since they're using a lot of biomass or wood for cooking and heating and then having the extra vegetation would also help retain water so that when they have they have the rains it can be more deeply soaked into the ground and held in the ground so that when droughts come it's not so easily lost or it's not run off of the soil surface it can actually penetrate and all these things would lead to enhanced food production because you're having healthier soils.

Narrator: Utilizing the tree crops that are native to Somalia to protect other more sensitive crops is extremely helpful as it benefits multiple aspects of the land. According to the USDA, agroforestry protects other smaller crop species, helps reduce soil runoff, improves soil health, produces more food to harvest, and even reduces carbon and other greenhouse gases. This data has been consistent across the US and in other countries in Africa as well. Another option would be crop rotation which purposefully cycles specific crops that benefit each other one after the other. 

Bronwyn: Especially as climate change becomes more prominent, it's important to seek out different types of crops that can be adaptable.

Narrator: Another humanitarian program that has been a huge success is the building of earth dams which store large amounts of the runoff water from the floods. Earth dams are one of the best infrastructures because they stop flooding in homes and farms and also store water for the drought seasons. Again, this can also prevent soil runoff too. While the capacity of these initiatives has been limited, with further donations even more of these are being built. The government must start implementing these programs if they want the possibility of recovering as a whole.

*Music Playing*

Bronwyn: They're not the ones who are going to mitigate the climate change, they're going to be the ones that have to adapt and other countries are going to be the ones that have to make major changes that can actually mitigate or reduce the impacts of climate change.

Narrator: And that's exactly what we're seeing in countries like Somalia right now. Countries in the Global North like the United States and China need to seriously reconsider what federal regulations need to be put in place to mitigate climate change impacts so other countries stop feeling the damages. And like I mentioned before, people in both countries are pushing their governments to change with different initiatives and protests.

Bronwyn: You can create a little microcosm of good things happening and then if things go really well maybe you're an example for other communities or maybe another community can trust your community and you can work together. Because we're not looking out for others we're generally looking out for ourselves when we're taking action that is negatively impacting them. I don't want to make people feel guilty for what they've already been doing but help them feel empowered to do some things that might make changes in a positive direction.

Narrator: Because most people think that their individual actions can't have a ripple effect but one action can change a community which can change a town which can change a city and it just keeps expanding because change is achievable in any community. If people begin to realize the damage they are doing and strive to make change within their own community, we could have a healthier earth and that would help countries like Somalia achieve long term sustainability too. Maintaining earth dam infrastructures, kick starting community building initiatives, and helping farmers adapt to the weather are all things that can slowly build up the trust and wellbeing of the people in Somalia.

Bronwyn: I'm hoping that it's a success story where maybe the country figures out we're going to have to figure this out on our own and this is not how we want to live and we want to make sure we have resources for our people and innovate to be creative to adapt to climate change

*Music Playing

Narrator: This podcast was produced by Isabella Maietta for the Spring 2025 Global Health Course at Guilford College.

Trinity: Mark Ross, is oral health epidemiologist at East Carolina University, who specializes in socio-economic factors that contribute to oral health issues in  the United States. East Carolina University is representative of many dental schools across the United States, with a mission to develop leaders with a passion to care for the underserved and to improve the health of North Carolina and the nation.

Mark: ECU has a very strong mission to address barriers to care and to help dentists learn about what it means to live in an underserved community, and how do we address some of the challenges that many patients face with respect to oral health.

Trinity: One of the biggest barriers to dental care is patient cost. Income and the price of care play large roles in individuals seeking oral care in the Philippines. Lower income families sometimes use alternative toothpaste methods such as gargling with saltwater and brushing with baking soda. Excessive use of both of these products can lead to breaking down the enamel that is found on the teeth that helps protect them from damage. In turn to help address this access gap the Philippine Department of Health implemented the school oral health dental program which includes distributing dental care supplies to children from kindergarten to grade 6 and applying fluoride varnish to all kindergarten and grade 3 students. Due to dental tourism cosmetic procedures such as getting veneers are cheaper in the Philippines. Dental tourism is the practice of traveling to another country for dental care seeking lower costs. 

Mark: There's this cascade of factors that keep people from going to the dentist. They may have grown up in a family that never went to the dentist, so they don't go. They think that it's optional, that it's not. They only go if you have a problem. And. Until when they go, it's generally not pleasant. And so they reinforce the lack of care that you don't want to go because that hurt the last time I went. And I don't like pain so I'm going   to  avoid going to the dentist, so it's hard for people to get in a cycle of prevention and once they don't have a lot of resources financially. So there's two sides to it: dentistry as a consumer is very expensive if you don't have dental insurance. If you don't have an employer who offers a dental benefit plan, it's really a lot of money to pay out of pocket. It costs a lot of money for people to become a dentist. Typically, people graduate with student loan debt of about $300,000.

Trinity:In the Philippines, dental school costs range from 30,000 to 150,000 pesos per year, which is about $525 to $2,650 USD. with most graduates leaving dental school with 150,000 to 900,000 pesos in debt. This is considerably less than dental schools in the United states but for most living in the philippines this is unaffordable.

Mark:When our students graduate they already have a financial burden. And so it's costly for them to set up a practice, and their primary focus is on making money to pay off their loan and also to have a nice life. 

Trinity: Dental schools in the United states are so expensive and recent graduates have the financial burden of paying their debts off. It leads to a raise in consumer prices which if you don't have the money to come out of pocket or dental insurance to cover the costs leads to an access gap in oral health care. The Philippines have what's called the  Universal Health Care Act, which aims to provide comprehensive medical and dental services for all Filipino citizens. 100% of the citizens in the Philippines are covered by PhilHealth which is the insurance company that covers the Universal  Health Care Act. However, until November of 2024 PhilHealth  only covered limited dental care, such as emergency treatments and surgeries, not routine check-ups or preventive care. In November the PhilHealth board approved the PhilHealth benefit for preventive oral health services in primary care. The purpose of approving this was to address access gaps, and reduce out of pocket expenses.

Mark: If you don't have an employer who offers a dental benefit or dental insurance, it's really a lot of money to pay out of pocket. Just to get some teeth fixed. Even just to go for a check up, it's quite expensive for most people. So if you don't have dental insurance, that's a big barrier to getting dental care. And if you don't go in for dental care on a regular basis, you tend to have.  bigger problems. So in the U.S., we have Medicaid for low-income families, and states vary a little bit about whether adults are covered. But the program mandates that children are covered for dental services if they're low-income and on Medicaid. Requiring all children to have benefits in a federal plan would be the first step. The second step would be to make sure all ages are covered. And the other piece would be to get school children into clinics more readily.

Trinity: In the Philippines, there are several government-funded child oral health programs, such as the “Fit for School” program, which promotes daily toothbrushing with fluoride toothpaste alongside other health interventions. These programs aim to combat the country’s widespread oral health issues.  

Mark:So many Gov. Places have school based programs where there's prevention taught, and it's easy to get access to dental services because. A mobile van will come to the school and people will provide a screening and. Treatment and referral for treatment if they. There. So those types of programs where you can get children healthy and you know dental problems or generally chronic ones that once it starts to cycle of destruction. And loss. So early intervention and establishing a healthy foundation, healthy behaviors really would help a lot.

Trinity: The United States should focus on creating a hybrid dental care model that works to expand their government funded insurance companies that also should also implement oral health programs for school aged children because research shows that about 50% of  children aged 6-9 have had cavities in their primary or permanent teeth. While also lowering the tuition rates for dental students by increasing government funding for both private and public dental schools. In 2022 government funding for dental schools decreased to 10% which in turn caused tuition to increase and become a large part of the operating budget of dental schools. Without government funding dental schools have to find a way to offset the burden on students. This can be done by having students work in community based dental clinics. Students would see more clients and it would increase their confidence by working on an actual patient.  

Mark: ECU is a great champion for this to have dentists work in the communities. But. That are underserved. So having dental clinics in the communities that need care is a way for both the students to learn how to become dentists and to provide access to care for groups that might not otherwise get it. So it's a small thing in many ways because. It's not going to address all the needs . The need is big, but it's a small step toward helping students see what the barriers are and understand the need for policy change.

Trinity:    Failing to address these problems will continue to an increase in the financial burden placed on dental students to the point of dental school not being attainable for most even with scholarships and grants.

This podcast was produced by Trinity Whitfield for the spring 2025 Global Health Course at Guilford College

happening in the modern world. According to the Council on foreign relations the DRC

produces 70% of the world’s cobalt. Most of this cobalt is harvested whilst in unsafe

work conditions, exploiting children and pregnant women for their labor, drastically

undercompensating mine workers, and posing significant health risk to mine workers

and their surrounding communities.

DRC is another way of saying The Democratic Republic of The Congo. The Democratic

Republic of the Congo or the DRC is a country in central Africa and the main focus of

this podcast

Joining me will be Maurice the Executive Director and Co-founder of Friends Of The

Congo, a non-profit Congolese advocacy organization located in Washington DC.

(Transition Music)

Narrator/David Holland: Cobalt powers a lot of the devices that we use everyday such

as our smartphones, our tablets, and our computers. Within the past 5 years the world

has really seen a push to move away from fossil fuels and reduce our carbon footprint.

Cobalt has been seen as a means to achieve that goal.

Maurice: Cobalt is a byproduct of copper and Nickel mining and it is a mineral that is

key for rechargeable batteries, in your cellphones, in your Ipads, in your automobile. So,

Many governments around the world are moving their economies from combustion

engine, right, from oil based economies, to what they call clean energy or green energy.

That can not happen, that transition, without a mineral like Cobalt.

Narrator/David Holland: According to the Center for Collective Learning which is a

multidisciplinary research group with locations at Corvinus University and the University

of Toulouse, Cobalt mining exports have generated $5.99 billion for the DRC. And yet,

citizens and mine workers of the DRC only receive a fraction of that wealth, being paid

$2-$3 a day for their labor.

Maurice: What drives people to mining is poverty, you know, living in extreme poverty in

in the the Congo. The world bank says 60 million Congolese live on less than $2.15 a

day. Mining is an option, a way out for a number, for a lot, a lot of people.

Narrator/David Holland: As a result, parents are sending their children as young as 3

years old to work in the mines.

Maurice: Parents in some instances have no choice but to take their children into the

mines with them, right, cus they don’t have resources to send them to school, and they

have to go into mines to seek out a living so they take the children there with them. And

then the children they may help them carrying bags or sifting through minerals and

they’re exposed to the radioactive materials, so that has an impact on them in terms of

their, of their health.

Narrator/David Holland: Working in the mines is not easy. In the Congo there are two

types of mines, industrial and artisanal. Industrial mines are usually excavated by

professional companies with safety regulations and tools to ensure safety for workers.

Artisanal mines on the other hand are a different story, These mines are often dug

without proper support structures in place making them at risk of collapse whilst workers

are still inside of them. Workers also excavate these mines without proper safety gear

exposing them to direct contact with radioactive minerals.

Maurice: Artisanal or small scale mining, that’s done with rudimentary tools by your

hands and people dig you know dozens of feet into the ground to basically dig out the

mineral. And all of these minerals, just about all of them are radioactive, and then it’s a

dangerous environment especially when you go down in the tunnels.

Narrator/David Holland: It’s no doubt that the safety of artisanal mines is questionable.

What's concerning is how prevalent they are even within some industrial mine

operations, with 500,000 to 2 million Congolese working in these mines across the

country according to the World Bank.

Narrator/David Holland: Artisanal mines don’t just affect the workers who excavate

them, they also have profound negative effects on surrounding communities

Maurice: When you’re mining you’re kicking up the Earth and dust gets in the air,

particles, that are then blown and land on plants. And that destroys the plant life, again

we’re talking about radioactive material, they land in the water system, in some areas,

you have entire lakes that are just dead, there’s no fish in there, the water’s not

drinkable. And then you have a situation with industrial mining where you have leakage

or drainage that goes into the waterway and pollutes the water system

Narrator/David Holland: It should then come as no surprise that mining practices have

been linked to increased cases of asthma, cardiovascular issues, cancers, and lung

diseases within surrounding communities. But not only are local communities health put

at risk by mining companies but so is their very place of residency

Maurice: They're given concessions or land by the government. And then when they're

given the land, the government goes in and clears people off the land, and then the

companies start digging for those resources. In clearing the people off the land they

promise them, you know, health care, compensation, lodging, education. But that's

rarely delivered. And if delivered not to the level that would make the people whole who

have lost just lost their land

(Transition Music)

Narrator/David Holland: As with every commodity Cobalt is only supplied if there is a

demand for it, Who is demanding it?

Maurice: Mainly China, Mainly China, China’s a Dominant player, it’s refined and

processed there and then it’ll come back to the U.S and elsewhere as a finished

product.

Narrator/David Holland: According to the Congressional Executive Commission on

China, China refines 80% of cobalt from the DRC. The cobalt is then shipped off to

other nations such as the U.S, Japan, and various European countries to name a few. It

makes you wonder, are these countries and their companies aware of how their cobalt

is sourced?

Maurice: The companies know, there was a lawsuit against major tech companies in DC

and the lawsuit was made by international rights advocates led by attorney Terry

Collingsworth, and he was suing these tech companies, for sourcing minerals from the

Congo that had child labor in the sourcing of the minerals. And the courts ruled in favor

of the tech companies against the children of the congo that the suit was brought on

behalf of, in the ruling the court if you read the judges ruling they state explicitly where

these companies are getting their minerals from.

Narrator/David Holland: According to the Responsible Mining Foundation the

companies included in this lawsuit were Alphabet, Dell, Apple, Tesla, and Microsoft. The

courts ruled in favor of the major tech companies as they felt there was not enough

proof that they were in a venture with cobalt vendors who were known to use child labor

such as Glencore and Zhejiang Huayou Cobalt. However, the point of the lawsuit was

never to win, it was to make these companies aware of how their cobalt is sourced, and

that point was achieved.

(Transition Music)

Narrator/David Holland: Because mining is such a lucrative industry, the locals of the

Congo encounter systemic barriers and brutality when they speak out and advocate for

themselves

Maurice: They face the brunt of the security forces. The presidential guard comes in.

The police comes in, and they fire live bullets at them, they they kill them. They disperse

them. Yeah. So It's a matter of life and death.

Narrator/David Holland: Despite the oppression the Congolese have faced they still

make an effort to advocate for themselves

Maurice: A lot of those groups that come up there are self-defense groups. They have

been kicked off their land and they like, you know, we're going to organize to try and get

our land back. You know, if we're kicked off our land and this company comes in, we're

going to kidnap the workers, right? And we're going to disrupt as much as we can.

We're going to make it impossible for them to, to carry out their mining project until we

as a community are made whole. So, conflicts that come about as a result of that as

well. So it's quite common for a company to come in, kick off, kick the people off their

land, and then the people protest. They call the security forces, the presidential guard,

the police, the military, and they come to shut down the the protests

(Transition Music)

Narrator/David Holland: By exploring the framework of cobalt mining in the Democratic

Republic of Congo, we are able to see just how much the technology we use in our daily

lives comes from literal blood, sweat, and tears. Addressing the humanitarian crisis that

is cobalt mining in the DRC requires a concerted effort from governments, corporations,

and consumers alike. The entire cobalt mining system in the DRC will have to be

completely uprooted so that it benefits the DRC first. Only then can the exploitation of

Congolese locals and resources be ceased and the plight of the Congolese people be

rectified.

Narrator/David Holland: This podcast was produced by David Holland for the Spring

2024 Global Health Class at Guilford College

Citations in APA

Mariem, B. (2024, March 7). US appeals court dismisses DRC child labor case

against Tesla, other tech companies. Jurist.org; - JURIST - News.

https://www.jurist.org/news/2024/03/us-appeals-court-dismisses-drc-child-labor-case-ag

ainst-tesla-other-tech-companies/

Cobalt imports country distribution worldwide | Statista. (2023). Statista; Statista.

https://www.statista.com/statistics/1171856/distribution-of-global-cobalt-imports-by-count

ry/

Delve | Democratic Republic of Congo. (2023). Delve.

https://www.delvedatabase.org/data/countries/democratic-republic-of-congo#:~:text=An

%20estimated%20500%2C000%20to%202,(IPIS%20Webmap%2C%202020).

How “modern-day slavery” in the Congo powers the rechargeable battery

economy. (2023, February). NPR.

https://www.npr.org/sections/goatsandsoda/2023/02/01/1152893248/red-cobalt-congo-d

rc-mining-siddharth-kara

Beaule, V. (2023, February 8). Artisanal cobalt mining swallowing city in

Democratic Republic of the Congo, satellite imagery shows. ABC News; ABC News.

https://abcnews.go.com/International/cobalt-mining-transforms-city-democratic-republic-

congo-satellite/story?id=96795773#:~:text=The%20Democratic%20Republic%20of%20t

he%20Congo%20produces%20an%20estimated%2070,those%20more%20in%2Ddem

and%20minerals.

Cobalt in Democratic Republic of the Congo | The Observatory of Economic

Complexity. (2022). The Observatory of Economic Complexity.

https://oec.world/en/profile/bilateral-product/cobalt/reporter/cod

stans. The more recognizable names, Pakistan and Afghanistan, lie to the south, while up

north, Uzbekistan and Kazakhstan cozy up against one another, and to the east lies

China. Formerly under the rule of the Russian monarchy, then communist Russia, the

country entered a jarring five-year civil war almost immediately following its

independence from the USSR.

Tajikistan boasts not only the beautiful Pamir mountain ranges which run through

Central Asia, but also some of the highest infant mortality rates of all former Soviet

states, as well as a weakened medical system, decline in life expectancy, and a high risk

of epidemic disease. But the question is, why? Why do they see poorer health outcomes

now than they did even under the communist government of Russia? There is no simple

answer as to why governments fail, why civil wars happen, why we allow death and

disease to spread even in the day and age where they are preventable. But the short

answer is capitalism.

The academic answer is neoliberalism. And the real answer is much more complex than

that. Non-governmental organizations and other groups were coming in to fill some of

the gaps, including the gaps in the health system, because the economy had collapsed

and the systems had collapsed.

And so there were huge gaps. And so this was an opportunity to actually see what it

looks like when this other system comes in. And so what is this other system? Now, this

is not to say that the Soviet system was right or any other system is right and what was

happening is necessarily wrong.

It was to say that if you're delivering health based on need, and arguably people could

say the Soviet system failed in that, they didn't do that well. But if your criteria for

distributing health is need, you get a certain outcome. If your criteria for distributing

health is whether you can pay, you get a different outcome.

Because what happens is that you're relegated to your place in the global economy

based not on the hierarchy of need, but whether you can pay. And I think that's the

significant thing. So the thesis of the book was, in Badakhshan, in the midst of this

incredible famine and incredible social transition, in a very geopolitically important part

of the world, which is at the border of China and Afghanistan, these ideas of

neoliberalism were introduced, and they put populations at risk.

And we know that poor health leads to instability, political instability. And so you've got

to ask yourself the logical question, why would one do this? And if you were even there

just for the health care, which is what a lot of the NGOs were there for, why would you do

this? And that basically gave rise to the fact, well, there were these ideological forces

that had shaped themselves in the 20th century that were really defining how care was

being given. And those forces we now call neoliberalism, but they were just new ways of

thinking about the world and new ways of thinking about the distribution of social goods.

That was Dr. Salman Kashafi, a medical doctor, anthropologist, published author,

researcher, and current lecturer at Harvard School of Medicine. He spent several of his

post-grad research years studying, up close and personal, the health care woes of

Tajikistan. In his book, Blind Spot, How Neoliberalism Infiltrated Global Health, he

discusses how his experience with NGOs, non-governmental organizations, filling in for

the once-publicized health care system in the country, revealed several pitfalls of global

neoliberal system, as well as privatized health care.

Today, he joins us. Ten years after the publication of his book, and nearly three decades

since his first track in Tajikistan, discuss not only the challenges Tajikistan continues to

face, but also the prolonged ramifications of a globalized neoliberal system on health

across nations. Well, you know, when I arrived, I was in my early 20s, and I wasn't a

doctor.

I was an anthropology graduate student, and I went in, you know, just to, you know, I

wanted to look at this whole idea of social change, and I wanted to look at how, you

know, as I told you, some of these ideas of, you know, of distribution of social goods

really was coming into a space. A former Soviet Union, remember, the government was

the distributor of social goods, right? And so how that changed the dynamic between

people, and between people in the government, and people in society, etc. So when I got

there, there was a civil war going on, and there were a couple hundred thousand

refugees that had come into Badakhshan, and there was a famine.

So there was no food. Everything was being given. All the food was being given by Agra

Khan Foundation, and the International Red Cross, and then healthcare was also being

provided by Agra Khan Foundation, and by Medecins Sans Frontieres.

And so, you know, it was a really tough situation there for the people, and there was, you

know, irregular electricity. Lots of social services had broke down, because the state had

really crumbled in the post-Soviet period, and then, of course, there was a civil war. So,

you know, the state wasn't functioning properly.

And so there were lots of issues, you know, when I went there. And, you know, I lived in

villages, and I lived in, like, this little town called Khorov, which had about 10,000 people.

That was, like, the main part of Badakhshan.

And, you know, I got to know people, and people in the community welcomed me. So I

was there for a year, and I worked with one of the local NGOs. The name was PRDP,

Primary Relief and Development Program.

And, you know, so it was an incredible experience. But then I came back, and after being

in the villages, and seeing a lot of people die from diarrheal diseases, and pneumonias,

and things that are preventable, by the way, with medicines. Yes.

Five cents. I went to med school, and as I emerged, my colleague, Paul Farmer,

colleague and friend said, you know, we're Partners in Health is going to be working in

Russia. And it's exactly the same dynamics as what you studied in Badakhshan, which is

that there's, you know, there's a double standard of care for treatment of tuberculosis,

which is, of course, airborne, and is even more, you know, so many more effects.

So I started working there in Russia, and in Tomsk, where we had a project for many

years, for 20 years. Tomsk, and other, you know, other provinces in Russia, and got very,

very involved in this whole double standard of care, and, you know, treating people

differently because of where they are in the global economy, etc. Same stuff that I was

doing in Badakhshan, and, and in Tajikistan.

But now it was happening in a place like Russia, where just the economy had gone down,

but they had the infrastructure, they had laboratories, they had hospitals, etc, etc. So,

you know, I became very, very steeped in that work. And that's why it took me a long

time to write the book, because I went from that project, and writing, you know, a very

long thesis, I went to med school, I did residency, and during my residency, I did

something called the Hamidov, where I spent a lot of time in Russia, working on drug

resistant TB, and, and, you know, and building programs.

And then I went from that to just kind of being a faculty member and working and doing

a lot of healthcare delivery work. And so at the end of the day, it took 14 years to finish

this book. But I don't think that was a bad thing.

Because in that time, I'd actually run programs, I had helped start, you know, one of the

first community based treatment programs for TB and HIV in sub Saharan Africa, I'd had

the experience of the Thomas program, you know, trying to figure out, you know, we

were providing care in the prison system initially, but then later into the in the civilian

sector, because people left prison and went into the community. And, and of course,

we're infecting infecting people in the community. And the prisons were almost like a

epidemiological pump, you know, yes.

So, you know, I learned a lot. And I then became in that period, I became a member and

then chair of the World Health Organization and Stop TB Partnerships Greenlight

Committee for drug resistant TB treatment rollout globally, and got to see many, many

programs. And I learned an incredible amount from that.

So by the time I came back and finished this book, I had run projects, and I think I had

kind of, I think I toned down my criticism about certain things, but not, not my concern

about about the effects of not focusing on health outcomes, but instead going into things

with an ideological bent. So I think, you know, and you'll, you'll, you'll see in blind spot, I

often use the term dogma over data. And unfortunately, we have a lot of things like that

in the world where people say, well, you know, we believe this is true.

But even if the data shows that it's not true, that, you know, the change doesn't happen.

And the idea, of course, is that, you know, the neoliberal idea, of course, is that you will

make people completely reliant on the market, as it's as the sole distributor of social

goods, and the state really just regulates the market. In some places that doesn't work

well.

In some places, these are not, by the way, poor places, these are impoverished places,

because they actually have a lot of natural resources, they're not poor, they're made for

circumstance by circumstances and certain social structures, but you suffering. Michael

Peretti, American leftist intellectual, political scientist and academic historian has

exclaimed in a previous speech, these countries are not underdeveloped, they are

overexploited. neoliberalism gives imperialism a new face, even well meaning

organizations that seek to provide care during power vacuums, instead of replace power

structures, like the ones present in 1990s, Tajikistan, are ruled by profit margins and

spending capabilities.

They are always asked to be sustainable, in the sense that they save an acceptable

amount of people without wasting too much money. Such is the value system. They

answer to outside powers and global interest instead of approaching healthcare with a

full scope of community health needs.

Dr. Kashavi explains in his book, how NGOs as administrations are not so much

moralistically bankrupt, as much as their power is purposeful under the advent of

neoliberalist politics, and their influence may be culpable for cultural blindness. Quote,

so while certain policies may appear pragmatic or instrumental, their application can in

the words of social anthropologist Chris Shore and Susan Wright, serve to cloak

subjective ideological and arguably highly irrational goals in the guise of rational,

collective, universalized objectives. This trap, which Dr. Kashavi later refers to as dogma

over data, ignores the real needs of a community, instead providing blanketed care at

the cheapest possible rate.

This is the nature of neoliberalism. It cannot make moral, communal or ethical calls. It

does not take into consideration human life, individual healthcare practices, and it most

certainly does not care for someone who can't afford a good.

In this case, healthcare. That's how you create a just society, right? You think, you know,

what, how do we maintain the well-being of the least amongst us so that the society can

thrive, right? And I think that that's what neoliberal, like the neoliberal ideology fails to

look at, because if you leave the market as the social good, it leads to very short-term

gains, right? And those short-term gains don't often look at long-term societal goods, and

goods as in like not products, but just the good of society. And the long-term good, like

for example, is educating children important? Is having, you know, having people in

healthy housing important in the long run for the type of society we want, for the

politically stable society we want? You know, those are things that are, that they're not

short-term gains.

It's not about how much money you make today, right? And so, for example, I'm just

throwing this out there. Let's just say we were to say we want to cut down carbon

emissions from cars, because 2.5 micron air particles, the carbon emissions, of course,

hurt the environment, but 2.5 micron air particles are known to drive things like

diabetes, early heart disease, certain cancers, etc., right? So let's just say we wanted to

do that. We could decide as a society that public transit should be free.

We could say that, you know, we want to invest in public transit and make it free,

because it's like the roads. It's part of life. It should be covered by taxation.

That's a societal decision, right? And if we thought that, you know, getting people off the

roads was very, very important, we would invest in that, right? And some countries do

that. Some countries invest in like incredible bike lanes. I mean, there's different things.

I'm not saying that that's the one solution, but you look for something that's going to

give you the right outcome, right? And so I think that that's the kind of thing, not Dicey

as in like, it's not true, but this is where things do become kind of what your worldview

is, right? So preventive things, let's take the example of the HPV vaccine that prevents

cervical cancer, right? There are a lot of data that show that people switch health plans

quite often, right? So why would you want to give somebody, men and women, boys and

girls, the HPV vaccine when they're 12 or 13, when you know they're not going to be part

of your health plan 10 years from now, and that they're really only going to get cervical

or oral cancer, you know, when they're 30, right? Well, because it's part of their long-

term health, right? But it's not in the market interest to necessarily do that. There are

actually some market interests that make you do that, but not in general, okay? So, you

know, so you think of preventive care across the board, like, you know, is it in the market

interest to do that? You know, so that's like kind of like one aspect of it, right? When you

think of the redistributive power of the state, if you are trying to help the least amongst

us, or the bottom quartile, or the people most vulnerable, maybe somebody was rich,

and by becoming sick, they became poor, right? Or they have a health condition that

doesn't allow them to work. As you know, we distribute health insurance in this country

based on work.

So let's just say somebody had opioid use disorder, which is leading to, like, you know,

it's for the first time in 200 years, the life expectancy of white American men has

dropped. We have a life expectancy of men, I think it's roughly 76 right now. You go to

Singapore, it's in the high 80s, okay? So, you know, if you start to look at these things,

well, let's say you lose your job because you have an addiction disorder.

Well, how will you ever get out of it? Well, there are medicines that you need access to

them, you need access to doctors, you may need access to community support. We

don't have any of that. If you don't have health care, we don't have any of it.

And some of it, like community supports, we don't have at all, or they're very limited in

many places. So when you start to think about it, you know, you have to build a system

that allows some redistribution of social goods, like where if I'm healthy, or you're

healthy, and person three is not healthy, but has been healthy, or may be healthy in the

future, you say, well, why don't we pool our risk, right? That's like what insurance is,

you're pooling risk. So you have to start to, I think we as a society have to think more of

health care as a risk pool, and not just as a profit center.

And of course, a production, it's something that's necessary to life, it's necessary to the

functioning of a just society, it's necessary to stability of our, of our government and our

state. And there are, again, data that support all of the things I'm just telling you. And so

I think that's, we have to kind of change our orientation to that too.

Noam Chomsky, renowned political scientist, lecturer and author says, the very design of

neoliberal principles is a direct attack on democracy. But for health researchers, such as

Dr. Keshav V, neoliberalism is a direct attack on equitable health, and an equally

important human right concern. Life, liberty, and the pursuit of happiness.

And I would argue that without health, you don't get life properly, you don't get liberty,

because you're, you can't be an active participant in civil society, and a free society

requires that. And you certainly don't get the pursuit of happiness with the morbidity of

many diseases that we have. So just even, even those basic things that we as a society

have said, are critical, require that we say that certain things are social goods that, and

then that language of sustainability disappears.

Like if I told you that let's make this transit system free, and as a society, we all agreed

that, oh my God, we've got to get rid of cars on the road, we're going to stop building

new roads, we'd rather invest this in a really, really reliable transit system, like Europe

has, you know, like Germany has, or Holland or whatever. We wouldn't say, oh, it's not

sustainable. We'd say, yeah, we have to build the tech space to do that.

Because it's critical. It's as critical as having an F-35. I mean, and again, I'm not putting

down, I'm not saying, oh, it's defense versus health or whatever.

I'm saying, these are choices. We are saying having an intelligence agency is important.

Having F-35s is important.

Having border guards is important, right? Having roads in our cities are important.

Having interstate highways are important. So is healthcare important? Is education of

our young important? Are sports facilities so that kids can actually play sports and be

healthy important? Those are things we need to decide.

Somebody has said that the fire service is important. Somebody has said that having a

police force is important. Right? So why would we suddenly say, oh God, yeah, you know,

why isn't the police force sustainable and run market forces? Like if I call the police,

shouldn't I pay them $200? But if I call the doctor, because I think I'm dying from a heart

attack, I got to pay a 750 copay at the emergency department.

So we make choices all the time. So the idea that, oh my God, this is, you know, you're

interfering with commerce and we're going to become communist if we do this. That's

not the case at all.

This isn't about who owns the means of production. This is about how do we distribute

essential social goods? And can it be a mix between private and public and where should

the public play a role, you know, when we, you know, to protect the weakest amongst

us. And, you know, how do we do that? That's what this is about.

But in fact, it's often construed as, oh, I'll never be able to choose a doctor. This is like

the Soviet union. And it's like, no, no, it's not.

It's not. That's those are, those are false constructs. In America, such false constructs are

symptoms of a greater political ailment and deeply entrenched political history.

But in Tajikistan, the ills are far worse than political misconstructions. Lower respiratory

infections and diarrheal infections account for the greatest proportion of disability

adjusted life years or DALYs, loss in the nation. While the most under five deaths are

caused by preventable communicable disease.

Meanwhile, as other European world health organization regions see falling rates of

chronic non-infectious disease, the numbers are merely stagnating in Tajikistan. As you

see, at the end of the book, the private market, pharmaceutical market dominated and

people couldn't afford medicines. And the health care statistics in the region are still

really, really poor.

Yes. And so, you know, I think that they haven't had, you know, and a lot of these Central

Asian states have had really weakened health systems because it's been shifted from,

you know, from a more public centered system towards private and whoever can afford

it. And these are poor places.

In fact, you look at Tajikistan, most of the income comes in through remittances. So

anyway, I think you'd look at almost any of these companies, even our own, that people

who can't afford insurance, people who can't afford medicines, you mentioned your

grandfather, you know, they, they suffer. And in certain cases, in the case of like

diabetes, you can die with cases like pneumonia and, and, and, and diarrheal diseases

for children, you die, you know, and so, and TB also, you know, like, we've been pushing

for years now to do proper TB care, just like we've done in the United States and other

places.

And now other countries are starting to do that. But if you don't do it, you die. Like you

die.

80% of the people that don't get care die. So, you know, and if you don't die, you're you

get lung damage and are injured and same with a lot of other diseases. So, you know, to

cut a long story short, I think Tajikistan has suffered and you look at a lot of the countries

that have not really moved towards having dealing with some of these distribution

questions, including our own, have had people that are vulnerable suffered.

Tajikistan is not an individual case, but rather a case study. An example of how sudden

changes in healthcare management coupled with pre-existing inequities and disease in

tandem with healthcare privatization caused well-intentioned foreign global and

individual actors to provide less than exemplary care. These issues are only expanded

upon under a neoliberal power structure whereby profit margins reside in the periphery

of all non-governmental operations and cost effectiveness preoccupies the policy makers

mind.

Understanding the pitfalls of the system is only the first step to dismantling it and

tackling the issues which plague global health today, but it is most certainly a good start.

This global health podcast was produced for Guilford College's global health class spring

of 2024.

Narrator: “I came to A.A. in order to stop drinking; what I received in return was my life.” 

― a quote from the book “Alcoholics Anonymous” 

(Crowd in a Mexican village sound)  

Narrator: According to my dad, Mexicans are usually taught to drink by their parents and family members, instead of at parties hiding from their family. The legal drinking age in Mexico is 18 years old and is much less enforced.

The Hispanic value of familismo is a core value in Mexican culture. It involves the importance of strong family loyalty, dedication, and commitment to family. It has been discovered that familismo may be protective against misuse of alcohol and very protective of moderate drinking.

There’s an enormous importance of cultural factors in the development of alcoholism. In cultural settings that involve value conflicts result in loss of identity and community, encourage alcoholism specially when being exposed to the tradition of alcohol functioning as an escape mechanism or even as a prop for core values.  

The most common results of binge drinking are injuries, violence, alcohol poisoning, risky sexual behaviors, alcohol dependence, liver disease, and drunk driving. There can also be a detrimental effect on not only their physical health but as well as their mental state and may develop into having social problems. 

(Transition music) 

Narrator: The consumption and abuse of alcohol by Mexicans is one of the key concerns in the public health area due to it increasingly affecting the productive sectors of society including youth with damaging results in the workplace and family. Most of the following research that will be discussed was obtained by the Alcoholics Anonymous official website. My dad, Delfino Morales-Mongayo, has first hand experience in suffering from alcoholism in Mexico. He will be speaking Spanish in the audio portion. Thank you to Edgar Toscano Rivera for being the voice actor for my dad, due to accessibility reasons.  

Delfino: Qué tal espero se encuentren bien. Mi nombre es Delfino Morales. El próximo 11 de abril del 2024 voy a cumplir 20 años sobrio… (La primera vez que hice contacto con el alcohol realmente no recuerdo con exactitud puesto que era muy pequeño pero calculo entre los 4, 5 años de edad.)  

Voice actor: My name is Delfino Morales. On April 11th, 2024, I will be 20 years sober. The first time I came into contact with alcohol, I really don't remember exactly since I was very little, but I estimate between 4, 5 years old.

Narrator: Delfino was born and raised in Mexico until the age of 20. He began to drink at such a young age leading him to have numerous notable experiences under the influence of alcohol. 

Delfino: Unas de las experiencias más notables yo creo que fueron muchas puesto que fueron varios años de estar consumiendo alcohol… (dentro de esas caídas o mejor dicho ingresos a cárceles o delegaciones como le decimos aya en Mexico. Unas de las experiencias más notables yo recuerdo que ya en las últimas borracheras que tuve en las cuales ya llevando algunos días bebiendo trate de parar e inclusive trate de volver al trabajo y recuerdo que no pude trabajar. Manos temblorosas, malestares físicos, y de hecho no pude trabajar. No pude marcar una hoja de tablaroca o sheetrock como lo conocen en este país. Porque no tenía ese pulso para estar marcando las medidas que me daban los compañeros y ese fue muy triste en mi situación ya que tenia 22 años.)

Voice Actor: Some of the most notable experiences, I believe, were many due to several years of consuming alcohol within those falls or rather, admissions to prisons or “delegaciones” as we call them in Mexico. One of the most notable experiences that I remember was the last time I was drunk, in which I had been drinking for a few days. I tried to stop and even tried to return to work. I remember, I couldn't work due to shaky hands and physical discomfort. I couldn't mark a sheet of sheetrock. Because I didn't have the strength to mark the measurements that my coworkers gave me and I felt very sad in this situation since I was only 22 years old. 

Narrator: Delfino knows a lot about how culture and other major factors influence Mexicans to consume and abuse alcohol. He discusses how culture played a role in being influenced into drinking alcohol. 

Delfino: Si hablamos de México influye demasiado la cultura creo yo machista… (Mi padre yo recuerdo que cuando consumía alcohol con sus amigos o compañeros de trabajo recuerdo que me daban muchas indicaciones de como ellos creían que eran bebedores sociales y eso me lo decían ya después de 8 horas de estar consumiendo alcohol. Y me empezaban a me ofrecían un trago de la cerveza, del vino. Lo cual a mi se me hacía muy agradable porque yo sentía que me tomaban en cuenta después de tantas consejos que me daban. Lo que no sabían ellos era el daño que le estaban haciendo pero pues en México influyen eso la cultura.) 

Voice Actor: When talking about Mexico, the culture, I think, has so much influence. When my father consumed alcohol with his friends or coworkers, I remember that they gave me many indications of how they believed they were social drinkers and they told me that after 8 hours of drinking alcohol. And they began to offer me a drink of beer and wine. Which I found very pleasant because I had felt like they were taking me into consideration. What they didn't know was the damage they were doing, but well in Mexico that is influenced by the machista culture. 

Narrator: It is very normal for heavy drinking to be associated with displays of masculinity or machismo, in most cases it can encourage male drinkers to deny or diminish problems resulting from their drinking and to regard drunken behavior as being permitted or even being normal. A study conducted in 2008 at Mexico city by Diaz-Martinez et al. displayed that Latinx high school students are more likely to drink and to get drunk at an earlier age than White or Black youths. Which is the case in Mexico, kids entering middle school is usually when they start buying alcohol, according to my dad. These statements can also be supported due to accessibility. The enforcement of drinking laws vary between cities and towns. 

Delfino: Allá yo yo puedo decir que tenemos acceso libre. Aquí al menos en este país, en Estados Unidos, la venta del alcohol está restringida a jóvenes… (En México, cualquier niño, cualquier joven puede ir a comprar alguna cerveza o vino a las tiendas y es normal. Inclusive dentro de los bares en mi caso y en el caso de muchos compañeros que tuve en ese tiempo en su momento podíamos entrar a las barras a los 16 años, 17 años nos vendían cerveza y no había ningún problema. Porque muchas veces la corrupción también está ligada a todo eso, se les daba a los dueños de los bares, de las cantinas a las cuales íbamos pues le daban cierta cantidad de dinero a la policía para que no dijeran nada.)

Voice Actor: There I can say that we had free access. At least in this country, in the United States, the sale of alcohol is restricted to young people. In Mexico, any child, any teenager can go buy some beer or wine in stores and it is normal. Even inside the bars, in my case and of many colleagues that I had at that time, they could enter the bars at 16 years old, 17 years old and they sold them beer and there was no problem. Because many times corruption is also linked to all that, the owners of the bars give a certain amount of money to the police so that they wouldn't say anything. 

(Transition music) 

Narrator: After about two years after moving to the United States, was when he knew he had to stop drinking. The last ever drop of alcohol that he had was on April 11, 2004. Five days before his birthday. 

Delfino: Que hizo que decidiera dejar de beber, el tocar fondo. En Alcohólicos Anónimos, hablamos de que solamente tocando fondo… (un alcohólico es posible que pare de beber y creo yo que eso fue mi caso. Tuve que tocar fondo, tuve que quedarme sin dinero, sin trabajo con una salud deteriorada por abuso tanto del alcohol como por drogas.) 

Voice Actor: What made me decide to stop drinking, was hitting rock bottom. In Alcoholics Anonymous, we talk about how only when an alcoholic hits rock bottom is it possible for them to stop drinking and I think that was the case for me. I had to be left without money, without a job, with deteriorated health due to both alcohol and drug abuse. 

Narrator: Delfino was forcibly taken to an “anexo” group or 24-hour groups as they are also known in Mexico by his mother, who already knew that she couldn’t control his alcoholism. The National Institutes of Health claim that anexos are recovery residencies that were established by Mexican and Central American immigrants in Latino communities. Families would take anyone from 13 to 80 years old to these groups because they couldn’t control the alcoholic anymore. 

Delfino: Era todavía disfrutarlo, todo era esa esa alegría ficticia… (Cuando salgo de ese anexo alrededor del año volví a beber. Hasta que llegué a este país con el tiempo, tenía 22 años, y el haber tocado fondo es lo que me hizo decidir el dejar de beber. Me recuerdo para entonces tenía una hija de 2 años y yo sabía que no había hacer buen ejemplo puesto que llegaba todos los días tomado a la casa.) 

Voice Actor: Of course drinking for me was still about enjoying it, still having fun with that fictitious joy. When I got out of that anexo about a year later, I started drinking again. Until I eventually arrived in this country, I was 22 years old, and hitting rock bottom is what made me decide to stop drinking. I remember at that time, I had a 2-year-old daughter and I knew that I couldn't set a good example since I came home drunk every day.  

Narrator: A great source for individuals in the A.A. programs to steer clear from relapse are sponsorships. The American Addiction Centers state that they also help navigate membership, answer questions, and work on the 12-steps. Sponsorships give the newcomers an understanding, and importantly provides a sympathetic friend when one is most needed. The Recovery Research Institute mentions that according to studies, the use of sponsors lead to better treatment outcomes and those in the program with sponsors have better attendance and involvement in the group.  

Delfino: Ya no podía parar, no podía controlar la bebida y sabía por dentro que estaba siendo mal, sabía que me estaba acabando… (Fue entonces cuando me acordé que había un lugar donde sí se podía dejar de beber. Cuando estaba joven a los 14 años y estuve anexado, yo recuerdo que allá había señores y señoras que tenían 10, 5, 15, 20, 30 años sin probar una gota de alcohol y sin consumir drogas. Yo ya sabía al menos en esa ocasión que me llevó anexar mi madre a ese grupo, sembró la semilla de que alcohólicos anónimos si daba resultado. Fue en este país, en Estados Unidos, donde nuevamente empecé a buscar grupos hispanos donde hablaran el español. Fue cuando nuevamente hice el último intento decía yo por dejar de consumir alcohol.)  

Voice Actor: I couldn't stop anymore, I wouldn't control the drinking and I knew inside that it was doing me bad, I knew that it was killing me. It was then that I remembered that there was a place where you could stop drinking. When I was 14 years old and I was annexed, I remember that there were people who had 10, 20, 30 years without tasting a drop of alcohol or consuming drugs. I knew at least at that occasion when my mother had taken me to that group, it planted the seed that Alcoholics Anonymous did show results. It was in this country, in the United States, where I began to look for Hispanic groups where they spoke Spanish. It was when I once again made the last attempt to stop consuming alcohol.  

(Transition music)

Narrator: According to a comprehensive analysis conducted by Stanford School of Medicine, Alcoholics Anonymous is the most effective path to abstinence. Alcoholics Anonymous began in 1935 when two men in Akron, Ohio, were looking for a way to remain sober, they found it by forming a support group. They later developed the 12 steps. The first step is accepting one’s inability to control drinking and the last step is helping others sustain sobriety by becoming a sponsor of a new member. It is built on the simple foundation of one alcoholic helping another. A.A. has been helping alcoholics recover for more than 85 years. The A.A. program can work with several types of diseases, for example, neurosis. The Addiction Center website declared that from the success of the Alcoholics Anonymous program was born Narcotics Anonymous and Neurotics Anonymous and countless other groups that have helped people with different problems.

Delfino: La importancia de alcohólicos anónimos para mí fue es mucha. A mí prácticamente me salvó la vida… (no solamente me salvó la vida cambió la perspectiva del modo de vida ya que el programa de AA no solamente para de dejar de beber siempre me gusta decir que dejar de beber es lo menos que te ofrece el programa de alcohólicos anónimos. Ya que no es religioso, es un programa espiritual donde te hacen recobrar la fe. Que me hicieron cambiar, yo creo que todo. Principalmente mi salud, por experiencia he visto que un alcohólico no piensa en parar de beber, no quiere dejar de beber hasta que sabe que su salud está en jugeo, que su vida está en juego.)   

Voice Actor: The importance of Alcoholics Anonymous for me is huge. It practically saved my life, not only did it save my life, it changed the perspective of my way of life since the A.A. program not only stops you from drinking. I always like to say that stopping drinking is the least that the program of Alcoholics Anonymous offers you, since it is not religious, it is a spiritual program where they make you regain your faith. What have they changed me? I think about everything. Mainly my health, from experience I have seen that an alcoholic does not think about stopping drinking, he does not want to stop drinking until he knows that his health is at stake, that his life is at stake. 

Narrator: The official Alcoholics Anonymous website states that Alcoholics Anonymous has been shown to be helpful to individuals who suffer from alcoholism. It’s free and its community supports others who are also struggling with alcohol misuse. For many people, Alcoholics Anonymous has been the most effective intervention for reducing drinking and eventually stopping completely. However, this support group is not appealing to everyone. A.A. operates on the principle of alcoholism as a disease that requires total abstinence and devotion to a higher power. Mexico is known to be a faith based country although according to the National Alcohol Survey, they found that between 2000 and 2020, Latinx people with an alcoholic use disorder were about 40% less likely to attend an A.A. meeting versus white people. 

Delfino: Con respectó a esto, es muy triste y lamentable… (Las agrupaciones que hay aquí en estos estados sí tienen cierta cantidad de miembros, pero no se acercan a los grupos Americanos. Los grupos Americanos están llenos y tienen varios sesiones en el día. Y esta fe que tienen los Mexicanos incluyendo me, muchas he visto que se tiene más fe en que el equipo, la selección Mexicana vaya ganar un partido o la fe en muchas cosas como en la virgen de Guadalupe o a varios santos. Pero realmente un alcohólico basado en mi experiencia y a escuchar el historial de muchos compañeros en las agrupaciones por muchos años, un alcohólico llega a las agrupaciones sin tener ni una pizca de fe. No sabe qué es fe. Para eso, yo creo que lo que hacemos en Alcohólicos Anónimos primero dar información acerca de la enfermedad del alcoholismo, que eso es un enfermedad. Y empezar a trabajar con los pasos, poco a poco. Sin darse cuenta el alcohólico es que empieza a recobrar esa fe. Esa fe decimos, esa fe que obra, esa fe que realmente puede mover montañas. Pero mientras no se acerque a alcohólicos anónimos no va saber que es la verdadera fe.) 

Voice Actor: Regarding this, it is very sad and regrettable. The AA hispanic groups that exist here in these states do have a certain number of members, but they are not close to American groups. The American groups are full and have several sessions a day. And this faith that Mexicans have, including me, many I’ve seen that they have more faith in the soccer team, the Mexican national team to win a game or faith in many things such as la “Virgin de Guadalupe” or various saints. But really an alcoholic based on my experience and listening to the history of many colleagues in the groups for many years, an alcoholic comes to the groups without having even a shred of faith. He doesn't know what faith is. For that, I believe that what we do in Alcoholics Anonymous first is provide information about the disease of alcoholism, it is a disease. And starts working with the steps, little by little. Without realizing it, the alcoholic is beginning to recover that faith. That faith we say, “esa fe que obra”, that faith that can really move mountains. But until you get close to Alcoholics Anonymous you won't know what the true faith is.

Narrator: Bill Wilson created the twelve traditions using his knowledge of religion. The location where the Alcoholics Anonymous meeting philosophy was established, Akron, Ohio, is known to be a Catholic area. The twelve steps were written in the context of believing in a higher power. Which can be comforting for many people in Mexico, due to 78% of Mexicans identifying as Catholic, but not for people who aren’t religious or for many who have lost all faith. It can make someone feel uncomfortable being around so much talk about faith. It isn’t all there is to the A.A. program, but it’s a big aspect of the program. Depending on if the individual is open to learning about faith and believing in a higher power, Alcoholics Anonymous may or may not be a solution to alcohol abuse. 

Delfino: Fui un alcohólico que antes de conocer a la programa de A.A. no tenia fe… (Yo creo que sabia o al menos siempre me gusto creer que dios existía por mi cultura. Realmente la fe no la tenia por muchas cosas y hoy en día entiendo a los Mexicanos que son Alcohólicas. Yo no tenia muchas veces fe en ese dios que obra porque a mi vida había pasado muchas cosas. Muchas veces no sucedía lo que yo pedi a dios, si hablamos de la fe o la fe en dios, y veíamos que las cosas no resultaban hace que muchas veces los alcohólicos incluyéndome nos resentimos con ese dios, nos resentimos con la vida por muchas cosas. Tuve un papa alcoholico y muchas veces le pedi a dios que lo cambiara, que le quitara el ser borracho porque en ese tiempo cuando estaba pequeño no sabia era el alcoholismo. Hasta por eso me resentía con dios porque veía que no me daba en ese tiempo al papa que yo quería tener.)  

Voice Actor: I was an alcoholic who, before meeting the A.A. program, didn't have faith. I think I knew or at least I always liked to believe that God existed due to my culture. I often did not have faith in that God who works because many things had happened in my life. Many times what I asked of God did not happen, if we talk about faith or belief in God, and we saw that things did not work out, many times alcoholics including myself, resented that God. We resented life for many things. I had an alcoholic dad and many times I asked God to change him, to take away him being a drunk because at that time when I was little I didn't know what alcoholism was. Even for that reason I resented God because I saw that he was not giving me, at that time, the dad that I wanted to have. 

(Transition music) 

Narrator: According to Delfino, Alcoholics Anonymous wasn’t a very adopted resource in Mexico when he was initially suffering from alcoholism. This was due to anexos being more popular, in which alcoholics were locked up in a jail-like setting for a certain amount of time without the ability to drink alcohol. Although, that would usually only help alcoholics become sober temporarily. However, now there has been a growth of A.A. programs in Mexico. The Alcoholics Anonymous official website mentions that A.A. programs have evolved over the years and now offer meetings in different languages as well as host specific groups for women and people of color. Despite that, past studies have shown that Latinx people attending A.A. meetings have reported conflicts with the programs general philosophy and may be turned off by the faith nature of the meetings. 

Delfino: Yo le diría a ese alcohólico que está sufriendo que se diera un chance nada más de visitarnos de tomarse una una taza de café con nosotros, al igual que a los jóvenes… (El tema del alcoholismo, en verdad es muy extenso en ocasiones que llegan compañeros o personas por información a los grupos, siempre me gusta decirles que es en esas dos primeras hora de reuniones no se van a llevar nada es como cuando entran a una escuela. El primer día no se es muy poco lo que se aprende el tema de alcoholismo abarca mucho y muchas cosas, pero este voy a aprovechar por este medio para decirles que en verdad hay una solución al alcoholismo de la drogadicción a muchas dependencias, hay una solución y esta solución para mí ha sido doble AA y qué mejor que un lugar donde el único que queremos es ayudar a otras personas, esto es regresar la edad para nosotros en su tiempo, hubo personas que me apoyaron que estuvieron dispuestas a escucharme que estuvieron dispuesta a pasar tiempo conmigo a escuchar mis problemas y ahora nos toca hacer lo mismo para con otras personas, y eso me asegura de seguir sobrio ya que pues si ya casi 20 años sin beber. Gracias a Dios y gracias al programa de alcohólicos anónimos.) 

Voice Actor: I would tell an alcoholic who is suffering to give us a chance just to visit us to have a cup of coffee with us, same for young people. The topic of alcoholism is actually very extensive. Sometimes when colleagues or people come to the A.A groups for information, I always like to tell them that in those first two hours of meetings they are not going to take anything, it is like when they enter a school. The first day you learn very little. I am going to take advantage of this podcast to tell you that there really is a solution to alcoholism, drug addiction, and to many other dependencies. And this solution for me has been the A.A. program and what better than a place where the only thing we want is to help other people, returning the help that we received, there were people who supported me and were willing to spend time with me to listen to my problems and now we have to do the same for other people, and that ensures that I stay sober since, well, I've been sober for almost 20 years now. Thanks to God and thank you to the Alcoholics Anonymous program. 

Narrator: Mexico suffers from numerous problems connected with alcoholism. The effects of excessive misuse of drinking can form a chain whose final link is an early, unfortunate, and painful death that could have been prevented. Promoting available resources to provide assistance and support, not only in Mexico but globally, is essential. Such as Alcoholics Anonymous, a fellowship of adults who share their experience, strength, and hope with each other that they may solve their common problem and help others to recover from alcoholism. Seeking help from resources can be a crucial step in overcoming any alcohol misuse issues and lead to a useful, healthier, more fulfilling life. 

Narrator: This podcast was produced by Jacqueline Morales-Quirino for the Spring 2024 Global Health class at Guilford College

Thesis: Street sexual harassment is a major public health problem in Jamaica and very little is done to resolve it. 

Central question: What is the prevalence of street sexual harrasment in Jamaica, what is already being done to improve this issue and what recommendations is being done to address this?

Who is the audience: Average person in the US and possibly Jamaica, english speaking 

What does the audience need to know to understand your story:

    -- Street sexual harassment , sexual harassment is repeated unwanted sexual attention and street sexual harasment is harassment between strangers or in a public space

    -- The sexual harasment act was passed in 2021, however it only covers sexual harrasment in the workplace ( employer and employee), and not public/street sexual harrasment and may never will based on researched statement 

    -- “see n’ blind , hear n’ deaf” is a saying in Jamaica that means if it does not affect you personally, it should be left alone. 

   -- Street sexual harrasment is an endemic

CONTENT WARNING: The following podcast will talk about street sexual harrasment and may be triggering or disturbing to some listeners or readers. 

*soft intro music*

Interviewee: “Street harassment Sexual harassment is a major challenge in Jamaica. We've seen it well. Personally, I can give you my personal experience being someone who doesn't. Essentially, you know, you know, manifests in the typical female feminine gender with my hair that it's cut low. I often experience street sexual harassment. Hey, girl, with your short hair. Come here. I want to do this and that with you. And then they play on it to say, Hey, are you a lesbian? Because my haircut is low. So I experience street harassment”

*soft intro music*

Narrator: Most people do not remember a time when street sexual harrasment was not an issue in Jamaica. It is seen everywhere. From as small as catcalling to as big as getting groped on public transportation.

Policy and Advocacy officer at JNplus , Kimberly Roach also shared her personal experience with this issue. 

* soft intermediate music*

Narrator: But first, what is street sexual harrasment. Sexual harassment is unwanted sexual attention and advances. It is a domination of power, usually by men. Street sexual harassment is harasment between strangers and usually in a public place, like public transportation. 

Narrator: However, there has been very little attention from academic researchers and government policy makers. It took 23 emails, 11 missed calls and 9 messages to social media before I received a response from JNPlus, an organization that was willing to talk about street sexual harrasment. JNPlus primarily deals with HIV positive women that suffer from Gender Based Violence and Intimate Partner Violence also known as GBV and IPV that are also problems in the community that stem from street sexual harrasment. So let’s hear from Kimberly Roach on what JNplus is.  

Interviewee: OK, so Jam Plus is essentially again is an organization, an advocacy organization that essentially looks at the policies and laws that impacts persons living with HIV. Pertaining to sexual harassment, I would say that street sexual harassment is that we see that GBV and IPV which sexual harassment is a part of impacts the lives of persons living with HIV, but more so it's also a cause that, you know, plays into the whole HIV prevention because we want to tackle GBV. So it doesn't, you know, impact many other young women and other women who may experience GBV. They also, you know, are susceptible to transmitting HIV and also, you know, getting impacted by the virus.

*soft music* 

Narrator: The problem of street sexual harrasment begins in the community. According to reports, 41% of Jamaican teen women fall victim to this crime. It is underreported however, because the culture and mentality shuns people from talking about this. It is called the “see n’ blind, hear n’ deaf” mentality. 

*haunty intermediate music* 

Interviewee:“Citizens often silenced themselves because, you know, they don't want to talk about certain issues in the public sphere. They don't want to talk about sexual harassment in the public sphere. They don't want to talk about even sex in the public sphere. And they definitely don't want to talk about HIV in the public sphere. So it's it's a it's a ingrained cultural attitude where persons generally don't talk about certain issues that they may think is taboo pertaining to sexual harassment. It often silences victims. Persons are often scared to talk about their experiences because, you know, a victim blaming, they're going to say, Oh, it's your fault because you, you should not have worn this or are anything to blame the person who is a victim of this sexual harassment? Now, It also impacts how other people view sexual harassment. Because we have this cloak of silence over sexual harassment. Persons usually don't say anything when they see it happen to other women or Vulnerable women or young women within the society. They don't talk about it. They don't go in and say, Hey, stop this, or they don't even advocate against it. And that cause, you know, the awareness when it comes down to sexual harassment, it cause the awareness to be significantly reduce where persons don't even know that they're experiencing sexual harassment because nobody really talks about it.”

Narrator: So if it is not talked about, how do we know it is a problem? Well, one of the indicators is in the music. 

* sound mimicking popular dancehall tunes* 

Interviewee: “Regarding to music, Yes there is toxic masculinity that is displayed throughout dancehall, where he talks about women in forms of inanimate objects. You know, they don't look at women as holistic beings and their project a sexual, you know, objectivity on women. They objectify women. So yes, the culture does play a major role in how, you know, we view sexuality, we view women, and it plays our role in how this generation and the generation before played into sexual harassment. Yeah. ”

Narrator: Women as objects. This definitely plays a role in its prevalence. Research states that this can cause PTSD, lack of concentration in the workplace, and other mental health issues. Mental health that is also not talked about in Jamaica.

*sad soft music*

Interviewee: “Jamaica has yet to recognize the impact sexual harassment has on a person's been both physically and mentally. We don't have a lot of access to, you know, mental health care in Jamaica, and it's also a taboo topic. So a lot of times persons who are victims of sexual harassment or even rape, they internalized what has happened to them, and they don't have much space to discuss the issue. we in Jamaica definitely need to have more spaces that, you know, look for the holistic wellness of persons, including their mental health, and particularly for persons who are experiencing sexual violence or even harassment. They need to have social services that targets this type of work, mental health and other ways to to get over trauma that they may face.”

Narrator: So you see, in public places, street sexual harrasment is a problem. But it can only start being resolved with the government's help. In 2021, the Jamaican Senate passed an act that covers sexual harrasment in certain scenarios. Like the workplace. But is that enough? 

Interviewee: “So I'm happy that Jamaica, you know, is going forward and enacted this bill in late 2021, where sexual harassment is now covered in the law and it covers both prevention and protection. It protects essentially women and men. It protects persons who may face sexual harassment in unique situations, such as the landlord and tenant in the workplace, in the church and so on. But the bill, I think what is a gap in the bill is that it doesn't really speaks to street harassment, street sexual harassment. And for me, in the Jamaican society, that's where most persons experience sexual harassment is in the streets. So what I would recommend is that we looked at innovative ways of capturing street harassment in, you know, some sort of amendment that may come later at a later time. But I'm happy that the Jamaican government enacted this bill. It's well needed. Persons here do face a lot of sexual harassment in the workplace between tenants and landlords and so on. And it's great to see that we are taking this step to to enact this bill. But there's much more to be done. We need to ensure that sexual harassment street harassment is also a major tenant in this law so that persons on the street feel safe navigating the society every day and not just in your relationship to your landlord or not just in the workplace, but more so on a societal level and not so much on the institutional level where it's protected now”

*hopeful instrumental music*

Narrator: Many steps need to be taken to resolve street sexual harrasment. Education on sexual harrasment in public schools should be introduced to the curriculum. Social issues like the bystander effect, which is when the presence of others prevents a person from intervening in an emergency situation, need to be tackled. Bystander effect is a major resolved step since street sexual harrasment is a issue that happens in the public. JN plus has also been putting in the work to better this issue. 

Interviewee: “Ok so at JN plus we primarily deal with women who are living with HIV. So some of the work that we've been doing recently is to upscale our GBV response. So part of our GBV response is ensuring that all in our community of positive women understand what GBV is, which is inclusive of sexual harassment for those who face, you know, more violent forms of sexual harassment or any form of GBV who need, you know, psychosocial help then we have, what do you call it ,a psychologist, sorry on board at our organization, where we recommend women who are experiencing that type of thing. Well, also, we have support groups where we talk about this thing among our women, and we also educate men who are also a part, are members of our organization about umGBV and sexual harassment and why it's not OK. But also an important aspect of this is that recently we've been developing an advocacy plan specifically for positive women where um they talk about the issues that women living with HIV are facing. And one of those major issues is street harassment, community harassment and so on. So we're going to essentially ramp up advocacy to talk about this specific type of harassment more vulnerable people face ,and how we would like to see amendments in legislation to protect them from that type of harassment. But we educate both men and women, but we put a focus on ensuring that our women have support systems as well, in our support groups, as well as, you know, the mental health care that they need.”

*soft music* 

Narrator:What more can be done to tackle this issue? People on bus transport should be limited and public spaces should be more lit. Articles also suggest there should be stronger community leaders that will research and educate their communities on this issue. This has been done in countries such as Belize and the Bahamas that have approved laws against sexual harassment and have media campaigns that are also against it. JN plus also had recommendations on how to resolve this issue. 

Interviewee: “One of the recommendations that we we think would help is to have broad cultural sensitization about gender based violence and street sexual harassment, what it is, why it's not OK, and how it impacts the life of persons who are victims and also, you know, the persons who perpetuate this type of thing. So we definitely think a cultural shift behavior shift would happen if we have more awareness around it. But that is only useful when you also have legislation that could, you know, also put those who are doing this type of thing to the victims to ensure that they face the brunt of the law. So we also believe that even though we have a sexual harassment act, that a part of the amendments we'd like to see is persons who essentially harass persons because of their, you know, their sexual health if you're living with HIV or any other thing. So we want the law to also cover that type of stigma and discrimination as well. So those are the main two recommendations that we have from JN Plus.”

*more hopeful instrumental music*

Narrator: Even though street sexual harrasment is a tough issue, it can be resolved. If the community and the government go hand in hand in minimizing this issue, there will be a community of peace. 

*end with faster upbeat music*

This podcast was produced by Lacey-Ann Reynolds for the Spring 2022 Global Health course at Guilford College.

References

1. Amnesty International. (2006). Sexual Violence Against Women and Girls in Jamaica:'just a Little Sex'. Amnesty International, International Secretariat.

1. Kingston, J. (2012). Sexual harassment and sexual harassment policy in Jamaica: the absence of a national sexual harassment policy, and the way forward. Asian Journal of Business Management, 4(1), 1-19.

1. Smith, D. E., McLean Cooke, W. C., & Morrison, S. S. (2020). A discussion on sexual violence against girls and women in Jamaica. Journal of Sexual Aggression, 26(3), 334–345. https://doi.org/10.1080/13552600.2019.1643505

Thesis: COVID vaccines are nearly accessible amongst specific groups of residents within

Vietnam, especially the Montagnards considering where they live and how much income they

receive, which can increase the risk of transmission of COVID amongst those who have not

been vaccinated.

Central question: [Revised questions] What should be done and provided for Montagnard

individuals to have/get access to the COVID vaccine?

Who is the audience?

- Montagnard + Vietnamese, and English-speaking individuals.

What does the audience need to know to understand your story?

- The Montagnards live amongst the Central Mainland of Vietnam’s region.

- An individual’s hesitancy in accessing the vaccine (DaDi’s *aunt* point of view/answer).

- A brief explanation of Corona Vac.

- There is an income disparity between urban and rural areas (academic research).

SCRIPT DRAFT [Revised] (2)

Narrator: In today’s segment, where we’ll be discussing, COVID vaccine accessibility and

vaccine knowledge amongst the Montagnard community in the region of Vietnam during the

COVID-19 pandemic.

Narrator: Montagnard people are a group of natives of Vietnam, and during the COVID-19

pandemic have had a high rate of transmission of the virus.

Narrator: This is due to low health education and communication programs in the rural area

where they live. COVID-19 vaccine accessibilities are related to income, self-perceived risk of

infection, and lack of knowledge and engagement in the Montagnard community. What should

be done and provided for Montagnard individuals to access the COVID vaccine while

recognizing their situation as a rural community as to provide more useful resources that benefit

them?

*Mellow/Calm music transitioning*

Narrator: A healthcare data analyst from Buon Ma Thuot, DaDi Boun Ya, is well versed in the

vaccine accessibility of the Montagnard community.

Narrator: As a healthcare data analyst, DaDi, is a frontline healthcare worker, and her job

consists of organizing, managing, and communicating amongst Buon Ma Thuot state hospital.

Interview Questions & Discussion

Narrator: On April 27th, 2021, Vietnam experienced the fourth COVID-19 wave regarded as

the first catastrophic yet "real" wave. 927,495 cases have been reported as of November 2nd,

2021. Who were the first people to receive it? Why?

DaDi: The first people who received the COVID vaccine were frontline workers in the state of

Buon Ma Thuot. For example, healthcare workers like myself were the first group of people who

were vaccinated because we worked amongst hospitals and patients. As a healthcare data analyst,

I fear so much for the safety of my family, especially my daughter and husband. Your uncle, who

works in the state as an executive officer, is always around his co-workers and other people out

of the country. This scares me because it’s a safety concern I have when it comes to rapidly

spread viruses, which can be transmitted from close contact or airborne.

Narrator: When thinking about how to receive and access the vaccine for our benefits of safety

from the risk of transmission, how would you compare the accessibility of COVID-19 vaccines

before when it was first distributed?

DaDi: Before, many people were worried about who would receive the vaccine because of safety

concerns. The spreading of COVID became a fear in everyone's minds including myself.

Vaccine distribution was only to workers on the frontline such as healthcare workers or

individuals who worked amongst the state, so it was divided from the rest of the people in

Vietnam. When looking at this situation, gave a sense of security and hope to the people of

Vietnam including the Montagnard community because it shows that time will progress through

and some protocols need to be followed and established beforehand.

*Mellow/Calm music transitioning*

Narrator: COVID-19 has created many challenges in the Montagnard community. For example,

increased job losses, lack of viable isolation areas when tested positive, and delays in accessing

critically needed care during illnesses.

Narrator: From DaDi’s point of view as a healthcare analyst, there is a high number of

Montagnard individuals living in rural areas who receive the bare minimum of acknowledgment

and preparation for prevention from COVID-19. It’s a constant fear that people within the

Montagnard community live in today, which shows there isn’t as much guidance that they’re

receiving compared to those who are getting information that they need. DaDi suggested some

resources and awareness that benefited the community.

*Mellow chime transitioning

Narrator: What challenges do you think some Montagnard individuals underwent when

accessing the vaccine? If they were some vaccine hesitancy, what might’ve been some concerns

that people may have?

DaDi: When speaking on hesitancy and challenges, our community, the Montagnards or Ede,

some people have not had much knowledge about the current (COVID-19) vaccine. Some would

wait until the effective treatment because the COVID-19 vaccine has been produced so fast.

There was some hesitancy among those who have not got vaccinated because of the lack of

knowledge and education about the various types of vaccines, which was questionable whether

or not the vaccine was preventative because of where they were produced and researched.

As the distribution of vaccines, such as Pfizer, AstraZeneca, and Moderna, began to proceed

through the community, people felt appreciated yet grateful that they were receiving them

because it provides an extra layer of protection. But as China began its production of vaccines

for COVID, it gave some concerning thoughts and opinions amongst the community because

people didn’t know much about CoronaVac and how it was created. Some assume that there’s

been less amount of research and trials that’s been done for it to be labeled as “safe” for everyone

to have access to for their safety benefit.

*Mellow/Calm music transitioning*

Narrator: Pfizer and Moderna are both produced and researched within the United States while

AstraZeneca is produced within the United Kingdom.

Narrator: When compared to CoronaVac, which was produced by Beijing-based company

Sinovac. It’s the world's most widely used COVID-19 vaccine.

On June 1st, 2021, the World Health Organization (WHO) established CoronaVac for emergency

use. The company, Sinovac, has signed purchase agreements for 380 million doses from COVAX

(COVID-19 Vaccines Global Access). As of July 2021, CoronaVac was the most widely used

COVID-19 vaccine in the world, with 943 million doses delivered.

Narrator: CoronaVac works the same way as Pfizer and Moderna. Two doses are administered

between 14 days. The effectiveness rate is 51% against symptomatic COVID-19, 100% against

severe COVID-19, and 100% against hospitalization starting 14 days after receiving the second

dose.

Narrator: The CoronaVac vaccine has been in phase 3 trials since mid-2020 in Brazil,

Indonesia, Chile, and Turkey, which brings into question whether it creates a preventative

solution for the Montagnard community when it comes to accessing and receiving them due to

the low effectiveness rate and how it may be suitable amongst each individual when it comes to

the system acceptance.

*Slight chime/ding transitioning*

Narrator: Amongst the Montagnard community, there were a few challenges when it came to

deciding to get vaccinated because of safety considerations and the fear of developing side

effects and complications from whichever vaccine is provided.

*Mellow/Calm music transitioning*

Narrator: Since you mention about lack of awareness and education, what might be some of the

solutions that should be provided for those who haven’t received the vaccine?

DaDi: Within the Montagnard community, there are different systems in providing awareness

and guidance on what COVID is and how the vaccine benefits one’s health. Each region of

Vietnam is divided into a system of “districts,” which are led by elders or medical educators,

who play an important role in explaining the benefits of the vaccine and why it's important to

receive it because if not, there may be some consequences.

DaDi: In the beginning, COVID cases have gotten worse, which then became an important issue

to be taken seriously because everyone feared spreading to one another and being around the

community.

As soon as vaccine regulation passed, such as individuals in the group of 65 or older and then

individuals who were the age group of 18 to 46, people quickly registered to get vaccinated for

the sake and benefit of their well-being and others.

When everyone got the chance to get vaccinated, it brought a sense of relief, which brought

awareness that COVID will still be around and that getting vaccinated will bring down the risk of

people getting infected.

*Slight chime/ding transitioning*

Narrator: When it came to receiving the COVID vaccine, DaDi shares her experience as a

healthcare worker when she first received the vaccine while comparing how the rest of our

community, the Montagnards, accessed it.

DaDi: When comparing my experience with our community, I see a difference in favor of getting

vaccinated with the same vaccine. For example, some considered getting vaccinated with Pfizer

for their first and second dose. Then, for their booster, they prefer the same vaccine because they

felt it would give them an easier outcome and fewer complications of experiencing side effects.

Before the vaccine distribution, the majority of people within our Montagnard community lived

with questions and doubts about what will happen next or the next step to where Vietnam will be

if COVID is still around. There were an increased number of cases because a lot of people were

around each other and being six feet apart wasn't quite helpful for anyone.

As cases got higher, Vietnam placed a mandatory lockdown that lasted up to a month for it to

dial down, which helped a lot, but the downside was that many businesses, especially small

businesses, began to struggle because there wasn’t as much income brought home since everyone

had to stay home.

As vaccines were distributed, we’ve seen a great number of our community begin to open and

accept the helpfulness of the vaccines. Many families began to spread awareness amongst other

people and help convince them that getting vaccinated will bring everyone closer and bring a

sense of safety and acknowledgment. When looking at this, it’s a big improvement that took

small steps but impacted greatly amongst others so we could see hope for the future.

*Mellow/Calm music transitioning*

Narrator: DaDi’s narrative about vaccine distribution amongst the Montagnard community of

Vietnam indicates many crucial factors. Vaccine knowledge and resources are crucial

determinants of vaccine accessibility in the context of Vietnam.

Narrator: Strategies such as social distancing and lockdown measures help maintain the

outbreaks. If the number of vaccinated Montagnard individuals increases, each of them will be

an “immune shield”, which protects them from infection and decreases the spread.

Narrator: There are some things to be advised or bring awareness of within this vaccine

distribution and accessibility. First, the knowledge and skills of healthcare professionals. When

you’re looking at public hospitals, resuscitation, and emergency care are better than those

“not-so-good” hospitals. Second, these public hospitals are well equipped. Although the

“not-so-good” hospitals can carry out emergency cases, severe cases must be referred to a better

and more equipped hospital. Third, reaching out and increasing COVID-19 programs to create

better education and knowledge for those who want to know more and expand their knowledge

to others so it benefits future outlooks.

Narrator: Health care and distribution amongst all regions of Vietnam (South, North, and

Central) is part of the grassroots health strategy and plays a vital role in primary health care.

With this, they could foresee the accessibility and affordability of available local health services

without feeling unsafe yet feel acknowledged by individuals who put them first for their

well-being and health.

Narrator: This podcast was produced by H’Neamy Mlo for the Spring 2022 Global Health

course at Guilford College.

Thesis: Many Hispanic/Latinx daughters have struggled with their mental health due to putting

their families first.

Who is the audience?

- Spanish and English-speaking individuals

What does the audience need to know to understand your story?

- The impact of familism on mental health

- Responsibilities and tasks performed by Hispanic/Latinx daughters

- Ways to support Hispanic/Latinx daughters

Script Final

*Soft Tone Music*

Narrator: When I was focusing on the tasks and adult responsibilities that I was given at a

young age as a Hispanic/Latinx daughter, I never really realized how my mental health was

impacted by taking on adult and parental responsibilities. I had never heard of the term familism

and how it has impacted so many individuals.

Narrator: The term familism is commonly used to describe the saying “family comes first”.

Many Hispanic/Latinx parents enforce the idea of putting their family first on their children. At a

young age, the oldest daughter must take on caretaker responsibilities such as changing diapers,

feeding and providing food and raising their younger siblings. It takes a large toll on them since

they are learning to commit to all these adult and parental responsibilities at a young age. In

today’s society, women are given the opportunities to be independent by establishing their own

income. Women are able to get the same jobs as men. Although women are able to do these, in

Hispanic/Latinx culture, they are viewed as home makers who must take care of the children,

cook, clean, and many more. A cultural term for this is called marianismo since women must

sacrifice themselves to take on the role of a family caretaker. While men must become the

breadwinners of the household. The term machismo is another term used to describe men with

strong masculine pride. Because of these cultural backgrounds, daughters are automatically

viewed as a woman who should stay home and commit to being family oriented.

*Soft Tone Music Transition 1*

Narrator: Now that we have looked at the cultural background on Familism with

Hispanic/Latinx cultures, let us focus more on how it impacts daughters. Kennia is currently a

Mexican American teenager in high school, who has recently been kicked out of her household

after not wanting to deal with familism. She is currently living on her own but still has contact

with her family.

Kennia: My name is Kennia, I'm 18 and right now I just go to school.

Narrator: Lorena Del Rio-Rivera is also a Mexican American woman who has also dealt with

familism, and she reflects back on her experiences now that she is an adult. She is currently

living on her own with her husband, children, and also her youngest sibling.

Lorena Del Rio-Rivera: My name is Lorena del Rio Rivera. I am 34 years old, and I'm a realtor

in Winston Salem.

Narrator: Familism is a very important component to this family dynamic. For the first-born

sibling, this can be very difficult since you have other priorities such as school and working jobs.

In Hispanic/Latinx families, it is shown to put your family first, whereas in the United States you

are taught to become independent. Kennia had to start taking care of her 2 young brothers Santi

and Emilliano around her teenage years.

Kennia: Around the time when Emiliano was born, maybe four or five. So I was like 14 or 15

with my little brother. I just feel like there is a lot of stress on me to raise my brothers. Especially

during the pandemic since it was all on me.

Narrator: Because Familism causes daughters to have major adult and parental responsibilities,

according to research, the impact of familism on health outcomes would be intervened by the

coping and burden styles of caregivers’. When looking at this, familism is being negatively

associated with higher levels of burden, which would prevent Hispanic/Latinx daughters from

communicating and expressing their feelings. Familism causes the feeling of not wanting to

commit to a family since individuals are forced to grow up at a young age and adapt to adult

responsibilities, which they’re not able to commit to themselves mentally and emotionally. Aside

from not feeling ready to grow up soon, they must also deal with a lot of responsibilities. Some

responsibilities can include preparing bottles for younger siblings, changing diapers, bathing

younger siblings, learning how to cook for the family, cleaning bathrooms, living rooms, and

many more. They are taught to learn all these at a young age when they do not feel prepared or

ready. Both Lorena and Kennia state some of their responsibilities.

Lorena Del Rio-Rivera: Definitely cooking and cleaning, changing diapers, showering and

bathing. I didn't really get to like going outside and playing with other kids because I had the

responsibility of my other younger siblings while my mom was working. So she would do the

third shift and most of the time I had to like you know, play housewife and I was really a kid.

Kennia: I helped them with all their homework and my little brother Santi, it was on me to potty

train him and I couldn't figure out how to do it so he still doesn't know. I had to change a lot of

diapers and calm a lot of temper tantrums. And there were times where I wanted time, just alone

time but I had to take care of them.

Narrator: One of the biggest challenges of Hispanic/Latinx daughters would include translating.

Hispanic/Latinx parents are native Spanish speakers. When they came to the United States, it

was very difficult for them to adapt since most individuals speak English. Because of this, they

rely on their children to help them translate. This can complicate translating since

Hispanic/Latinx children must learn both English and Spanish. Many children must start

translating for their parents when they enter elementary school. This can be very frustrating for a

young child to do.

Lorena Del Rio-Rivera: So when I was like looking at legal papers, which you know I shouldn't

have been doing, I didn't know what it meant, so I would tell my mom like I don't know what

this means, and then you know she would say “You go to school, you should know.”

Narrator: These responsibilities take a huge toll on them because of how time consuming they

can be. Taking care of siblings or other family members takes so much effort since they are

dependent on you. As mentioned before, they have to deal with many priorities such as

education. Students who are in school and also work long hours, take longer to obtain a graduate

degree. Hispanic/Latinx parents view education as important, but expect their children to be

family oriented. This causes a daughter to not only have the pressure of family, but also

education and their job. It is very difficult for someone to try to earn their degree, while also

taking care of their family and trying to put food on the table. Lorena dropped out of school to

continue supporting their family

Lorena Del Rio-Rivera: Continuing education, I couldn't focus on me because I needed to work

so that I can help my mom and provide it wasn't until maybe my fourth sibling was old enough to

help around that I got a little bit of relief and even at that point, it wasn't like enough, I was still

like look that like wait you can't slow down on how much you bringing in. I had to work harder

to get where I am and get what I have and do what I do because it's like I had to make sure that

everybody else was good, before I could make sure that I was good.

Narrator: After listening to Lorena’s story and how hard they worked, I asked Lorena if they

had any advice for Hispanic/Latinx daughters, they said:

Lorena Del Rio-Rivera: Stay in their life gets better, you know, once you grow up and are able

to get out of that household it'll get better.

Narrator: Even though Kennia has gone through this experience, it is hard to know what to

recommend to others

Kennia: I'm not sure, because the only way for me to get out of it was to leave. I feel like it's

hard for us to speak to our parents about how we feel and whenever we do tell them how we feel,

they don't understand. Not even because of the language barrier, they don't understand because

they were raised differently. And I get it because life in their home country is different but at the

end of the day, we are not there and life is different here.

Narrator: From Kennia and Lorena’s point of view, it is clear that familism has impacted their

relationship with their families due to the fact that the responsibility of raising their siblings has

been forced upon them. In order to escape this reality to preserve her mental health, Kennia had

to move out. Meanwhile, Lorena had to put her life aside to help her family go forward. They

both had to sacrifice their time and priorities to provide for their families first.

*Soft Tone Music Transition 2*

Narrator: Many of the beliefs and values in U.S society are different from Hispanic/Latinx

society such as the view of women and mental health. Hispanic/Latinx parents were not raised to

express or understand their mental health. They were taught to work hard and do everything they

can to support their family. Due to these cultural differences, it is difficult for parents who were

born or raised in a different country to understand their children who were born or raised in the

United States.

Narrator: According to research, the Hispanic/Latinx community is the fastest growing and

largest minority group in the United States. With that being said, they are also the largest group

to not receive mental health services. This is due to lack of resources, lack of time, language

barrier, or not acknowledging mental health due to lack of education.

Narrator: In 1996, President Bill Clinton signed the Personal Responsibility and Work

Opportunity Reconciliation Act. The goal of this act would limit cash assistance for dependent

children. In other words, this act prevented Hispanic/Latinx families from receiving cash

assistance. Aside from this, most Hispanic/Latinx individuals are not able to access health care or

have many job opportunities because of their citizenship status. According to research,

discrimination policies are another factor that impacts them since it prevents them from reciveing

funds such as the Temporary Assistance for Needy Families (TANF). It is clear that

Hispanic/Latinx do not have the funds to help assist their mental health and there needs to be

more policies that will allow Hispanic/Latinx to receive the proper funds.

Narrator: Aside from providing funds or insurance to allow for mental health assistance, there

should be an increase in community mental health services. This will allow for Hispanic/Latinx

families to consider improving their mental health. According to research, Hispanic/Latinx girls

have the lowest family support and have very high conflicts with their family. This is caused due

to lack of empathy. According to research, an effective way to improve family mental health

would be Filial therapy. This is where parents are able to spend time with their children while

playing with toys. According to research, this allows families to build a better relationship and

bond since it allows parents to become more empathetic and understanding towards their

children, and children feel emotionally understood and supported. This would allow families to

communicate about the adult and parent responsibilities placed on Hispanic/Latinx daughters,

which would lead to improving the mental health of not only daughters, but parents too since

they will gain knowledge on mental health.

Narrator: Overall, it is best to educate minority groups on mental health. Some ways can

include social media, where an individual can post about the negative impacts of mental health.

Social media is constantly available to users which allows for sharing mental health resources

and mental health education. The most common social media app used for Hispanic/Latinx

communities is Facebook. Facebook would be a great source of media which would allow

individuals to communicate and also talk more about mental health.

Narrator: It is important to educate individuals about familism and help Hispanic/Latinx

daughters acknowledge and improve their mental health. Mental health impacts the way we feel,

think, and act. It determines how we handle stress and how we interact with others. Mental

health is considered an important topic in today’s society, however within Hispanic/Latinx

society it is rarely talked about. In order to spread awareness about mental health, education is

key.

*Soft Tone Music Transition 3*

Narrator: This podcast was produced by Edith Lopez for the Spring 2022 Global Health course

at Guilford College. Thank you for listening!

~Music~

Narrator: While upper-income countries are handing out COVID-19 booster shots, South Africa is still trying to get vaccination rates that are similar to the majority of the world. Why is this the case during a Global Pandemic that the world has been in, for over 2 years?

~Music~

Narrator- The COVID Vaccines, to which South Africa has not had equitable access, is protected under TRIPs. 

Narrator: TRIPS stands for Trade-Related Aspects of Intellectual Property Rights. So what is Intellectual Property and what is Intellectual Property Rights? And How does it relate to South Africa’s access to the vaccine?

~Small Chime~

Narrator: Garland Grangercan give us some perspective. He is a former CPA, has a Masters in Business Administration, and is the current Accounting professor at Guilford College. He will be explaining what Intellectual Property is, as well as what Intellectual Property Rights are.

Garland Granger: If I buy a car, I buy furniture, whatever I buy in a business, I want to protect it from being stolen, you know, so I put in the controls necessary to protect my car, I lock it, I lock my house, I do all the things necessary to protect something that's physical. But how do you protect an idea? How do you protect something that your brain created is the ability to protect what you create in your mind is the ability to protect what you create in your own mind, that's intangible, you can't see it per say as a thought. But it's because of your creativity. And it should be protected. So people couldn't take it and say, Well, I came up with that idea. And that was the whole idea of what individual property rights are and why we felt it necessary to protect those rights in the United States.

Narrator: So what is a Patent and how do you get one?

Garland Granger: Okay, so a patent is I came up with an idea of how to make a product. And I want to protect that so nobody else can steal that. So I apply to the US Patent Office, and I have to get an attorney in some legal fees and application fees. And they do the research to make sure I'm not infringing on somebody else's patent, because they've got all the patents there. So they can check it out. And if they issue me a patent, and what that means is, no one else can make that product the way I created it.

~Music~

Narrator: In order to get out of this pandemic we need global herd immunity. Herd immunity can only happen if enough people have protective antibodies against infection. These protective antibodies are in the vaccine. South Africa needs access to the patented vaccine, as well as other lower-income countries, in order to reach that herd immunity. 

Fatima Hassan can speak on how TRIPS has affected South Africa’s access. 

~Small chime~

Narrator: During a roundtable discussion with health experts and activists, Fatima Hassan, the founder and director of Health Justice Initiative based in South Africa and a health/human rights lawyer explains South Africa’s COVID vaccination situation. 

Narrator: G Brindle a theatre Minor from Guilford College will be voice acting for Fatima. 

I will be voice acting as: Els Torreel and Joseph J. Amon.

Els Torreel & Joseph J. Amon (Narrator voice acting): How unprecedented is the current situation? Compared to other challenges, for example, HIV drugs, and expensive cancer therapies, what makes COVID-19 vaccine access inequities different?

Fatima (G Brindle voice acting): Let me make the point more specific, in South Africa, we are now witnessing, firsthand, vaccine apartheid. Colleagues my age in the Global North are getting vaccinated, but in South Africa, health care workers, the elderly, vulnerable workers, and others at high risk are still waiting for vaccine supplies. This is apartheid––wealth, geography, and patents matter more than people’s lives. 

~Small Chime~

Els Torreel & Joseph J. Amon (Narrator voice acting): The nature of the COVID-19 pandemic and the political context in which it is taking place is quite different from earlier access challenges. How can we find solutions to the vast inequalities that exist in terms of access to vaccines and other technologies?

Fatima (G Brindle voice acting): At the end of March 2021, South Africa––the African country most affected by COVID-19––was still waiting for its first delivery through COVAX. We ended up obtaining a clinical trial supply of the Johnson & Johnson vaccine that allowed the vaccination of 250,000 health care workers. At the end of March, we were waiting for supplies to arrive through bilateral deals and through the African Union, all of which are highly secretive, non-transparent, and not being disclosed to the public. This is shameful.

~Small Drum Chime~

Els Torreel & Joseph J. Amon (Narrator voice acting): You have all painted a pretty bleak picture of the current state of affairs concerning the world’s response to the pandemic, in particular around access to vaccines, and the failure of global institutions to foster equity and fairness in the face of nationalism, greed, the breakdown of solidarity. Are there reasons to be optimistic moving forward?

Fatima (G Brindle voice acting): Despite being extremely disheartened by the conduct and lack of transparency of some governments and vaccine manufacturers, I am encouraged by the accelerated vaccine research being done by public health scientists and researchers, the advocacy for access globally, and the solidarity among older and newer activists with the science and public health community and worker associations.

I am also inspired by the battle being waged at the WTO to once and for all show the world why treating medicines as a commodity is not normal and fuels inequality in access to lifesaving interventions.

~Small Chime~

Narrator: Through Fatima’s testimony, we can see that South Africa is not getting access to the life-saving vaccine compared to countries like the United Kingdom, the United States, Switzerland, and other higher-income countries that have had easy access. Let’s focus on when Fatima says that she is inspired by the…

Fatima (G Brindle voice acting): “Battle Being Waged at the WTO”

Narrator: The battle she is referring to is South Africa’s fight for a COVID vaccine patent waiver also called the TRIPS waiver. This waiver would allow other countries to have access to the “recipe” of the vaccine. 

~Music~

Narrator: Moderna pledged to not enforce its patents. That is unhelpful to this issue. When using this metaphor of a “recipe” to make a vaccine. This “recipe” has many steps and components that do not come from the same aisle at your local grocery store. Moderna includes other companies’ patented processes and equipment that is needed in the process to metaphorically “cook or bake” a vaccine. 

Narrator: So, when Moderna has access to outside patents but then says “Hey we will not enforce our own patents”. That doesn’t really do anything. That does not give full access to others like South Africa.

~Music~

Narrator: The issue with this is only a limited number of manufacturers have access to the intellectual property or “recipe” because of patents. And that a limited number of manufacturers can not produce enough vaccines for everyone in the world. 

So demand is high. And supply is low. Making the price of the vaccine go up. 

Allowing the path of higher-income countries to be able to buy and hoard as many doses as they please. Without regulations or specific incentives that require those higher-income countries to share with countries like South Africa.

~Small Chime~

Narrator: The TRIPS waiver would allow South Africa as well as other lower-income countries to manufacture and distribute its vaccines with the same or some of the recipes. 

Making each dose cheaper for everyone as well as accessible. We will not reach Herd Immunity without Global Access to the vaccine.

~Music (Guitar)~

Narrator: Higher-income countries have helped, somewhat, by donating doses and funds to organizations like COVAX. COVAX is a global organization in charge of distributing donated vaccines from public and private sectors to lower-income countries, like south africa, in hopes of equitable access to the vaccine.

Fatima speaks on this.

Fatima (G Brindle voice acting): COVAX and C-TAP may be critical—but at the current rate at which they can source supplies and foster cooperation, they will not be the solution for the access crisis, especially in the Global South. They are also too deferential to pharma power and influence and rely on volunteerism, which is not sustainable in my view. Our challenge is to get as many supplies to the Global South as soon as possible—and this is why the TRIPS waiver, other compulsory licensing measures, and the voluntary transfer of technology need to be vigorously pursued. It is critical to have manufacturing capacity, to dispel the myths of the implications of the TRIPS waiver, and to use other means of sharing technology fairly (especially for research funded by public sources). Most importantly, we have to remind everyone of the impact that interrupted and insufficient access in poorer and middle-income countries will have—especially as more variants are discovered.

~Music ~

Narrator: COVAX is not enough to make sure that South Africa has equitable access to the vaccine. There is evidence that the promise of a huge quantity of donated vaccines from upper-income countries, like the UK to COVAX, was not delivered. Only 14% of promised doses from upper-income countries and 12% of promised doses from the pharmaceutical companies were delivered through COVAX.

~Music (Acoustic)~

Narrator: A vaccine patent waiver, stopping TRIPS is an answer to ensure that South Africa has equitable access to the vaccine and the ability to produce their own. In a global pandemic, 

Intellectual Property and profit should not be put first, over the lives of South Africans.

~Music (Acoustic)~

Narrator: The United Kingdom, United States, Switzerland, and other high-income countries need to stand in solidarity and support the patent waiver. This is the step that is needed. To move in the direction of ending vaccine inequality in South Africa. 

~Music (Acoustic)~

Narrator: This podcast was produced by Liz Poole for the Spring 2022 Global Health course at Guilford College.

~Music (Acoustic)~

References

Aborode, AT, Olofinsao, OA, Osmond, E, et al. Equal access of COVID-19 vaccine distribution    in Africa: challenges and way forward. J Med Virol. 2021; 93: 5212- 5215. https://doi.org/10.1002/jmv.27095  

Chattu, V. K., Singh, B., Kaur, J., & Jakovljevic, M. (2021). COVID-19 Vaccine, TRIPS, and Global Health Diplomacy: India's Role at the WTO Platform. BioMed research international, 2021, 6658070. https://doi.org/10.1155/2021/6658070 

Godwell Nhamo, David Chikodzi, Hlengiwe Precious Kunene & Nthivhiseni Mashula (2021) COVID-19 vaccines and treatments nationalism: Challenges for low-income countries and the attainment of the SDGs, Global Public Health, 16:3, 319-339, DOI: 10.1080/17441692.2020.1860249 

Hein, W., & Paschke, A. (2020). Access to COVID-19 Vaccines and Medicines – a Global Public Good. German Institute of Global and Area Studies (GIGA). http://www.jstor.org/stable/resrep25695 

Iacobucci G. Covid-19: How will a waiver on vaccine patents affect global supply? BMJ 2021; 373 :n1182 doi:10.1136/bmj.n1182   

TORREELE, E., & AMON, J. J. (2021). Equitable COVID-19 Vaccine Access. Health and             

Human Rights, 23(1), 273–288. https://www.jstor.org/stable/27040053

Lindsey, B. (2022, March 9). Why intellectual property and pandemics don’t mix. Brookings.        

https://www.brookings.edu/blog/up-front/2021/06/03/why-intellectual-property-and-pand emics-dont-mix/ 

Student: So, I have two parents who were born in Mexico and raised there, grew up there and then I have shoulder sisters who were also born there. And then I have a younger brother who was born in the United States. So, my dad didn't have a job and where they live it was just not. It was not possible for him to raise a family of three or four. I guess it was five, including them, five people with having no job and my mom's job didn’t pay enough so they came here for like economic stability. 

Narrator: Students like her have parents that come to the US to seek you better life fleeing countries of economic instability, corruption and violence. Once they get to the US, although their life is improved, new challenges present themselves, such as understanding that their parents are undocumented and what being undocumented really means. 

Student: Yes, my parents have always been very clear with us about our legal status. I think it makes it things a lot less complicated for us if we know ahead of time like what we're allowed to do, what we're not allowed to do. And yeah, but they were always very candid and very honest with us. 

Was growing up they would tell me like not to disclose that I wasn't born in the United States so they wouldn't tell so it would tell me not to tell people I was born in Mexico even though I thought that was like super cool and I wanted to share that with other people they like they really emphasize us not sharing that because with that came other questions about like how did you get here, you know and. It was just harder to explain that and they also explained to us that you know we wouldn't be able to get drivers licenses, so we wouldn't be able to drive legally just like they weren't able to. And then you know, course we wouldn't be able to get jobs without a Social Security number, or at least high paying quality jobs we'd have to like, settle for other jobs. And in that they thought that it would be more difficult for us to like get helping came to school like financially when it came to going to college or something like that. It would be very difficult for us to get. Any help from schools like in terms of scholarships or even like it would be impossible to get financial aid from the government. 

Narrator: One particular challenge that children of undocumented parents face is having to hide their identity of being a undocumented. This means constantly dodging questions, watching what people say. And maintaining distance with all their friends, which can result in having few understand their situations. Kids constantly working to hide their identities could cause anxiety and depression among them. 

Student: When I was in first grade, I think I was sharing with my friends that I was born in Mexico and my like first grade teacher. She wasn't even my teacher. I was just in her room when we were talking about it. She approached me and then she started asking questions. So she was asking you like oh, that's cool that you like you weren’t born here. You were born in Mexican, I said yeah. And then she started asking me how did you get here and like and I was like I don't know and then she's like you should start asking your parents questions like that. Then so I had like I feel, I think I already knew. That I, you know I wasn't born here and that I was undocumented, but I decided to explicitly ask my parents like what that meant and like why she was questioning me. And then they were all like, yeah, This is why we think it's better for you to not tell people that you're not born here because people will ask the questions and some people might have bad intentions. 

Student: People finding out someone's immigration status could be really problematic as it could affect their entire lives. 

Narrator: And I could get us deported, and that would mean that we would be separated like from your younger brother potentially, and you would like lose all your friends everything that you know here everyone that we know everyone you grew up around. We would have to be. We would have to go back to Mexico and I think that was the first time that I really understood what it meant to be like undocumented. And that was when I was like in first grade. 

Narrator: The other main issue that affects his children mental health is having constant fear of deportation. 

Student: 'cause I was always like scared that my parents would get deported or that I would even get deported and living with that. It's very it's not something fun. It's not something I would wish on someone else, especially like little kids growing up living with that fear. 

Narrator: These stresses that these kids grow up with are unique experiences that many would never understand. 

Student: Grow up with a constant fear and most kids don't grow up with that. If you really think about it like most kids don't grow up thinking, hey. I could get deported or my parents could get deported, you know, and it's like. It's it's more than just a fear, it's anxiety, it's stress on little kids and growing up with that is definitely not good for your physical or mental health. I mean, like everyone has their own problems, but that's just like. It's a real life problem. I'm thinking about literally. Having to leave the place where you were raised, a place that you call home or even having to leave like your parents. The people that raised you, and I think that a lot of people don't think about that, like sometimes people will be like, yeah, in death in situations you know, like you get separated from your parents. But there are situations here where like your parents are literally taken away from you. And you won't see them again, and I think that through deportation, that's one of those ways that that happens. 

Narrator: These students, living with all the stresses that come with having undocumented parents, don't always have access to resources to deal with the stress. Students with undocumented parents sometimes only have access to resources in college, but those that do not have the privilege of going to college due to financial burden may never see a therapist because many do not qualify or unable to afford health insurance. Therefore, a session with a therapist would be paid out of pocket. 

Student: Being here at Wake, they offer so many resources that I was able to take advantage of their counseling center here and start going there. But before that, there was really no way that I could really reach someone who's like a mental health professional and like my sister, also struggled with that as well. And then we didn't have insurance at that time and I only have insurance because my scholarship offers that. So, you know trying to find some- trying to find somewhere that's affordable where we could go, and also where we could feel safe and like, feel like we're not going to like- Because I know there's confidentiality, but there's still like that sense of, you know, I don't know if I can share this because I don't know if this is gonna bite me in the butt later, or like you know, this is gonna end up hurting me more than helping me.

Narrator: Another reason kids with a undocumented parents sometimes never get help to maintain good mental health is that the stress they go through have been normalized in their community. Student: Everything was so normalized and I felt like it was normal to feel the way I did, but it wasn't until I started like- When I was here at college and I got was exposed to other people who like have that DACA and as well as like you know, to friends who don't have DACA who are citizens that I realized maybe going to therapy back then would have helped me a lot with how I cope and how I deal with my issues today. 

Narrator: The burden of hiding their identity is so difficult and traumatizing to these kids that it has lasting effects. 

Student: I think the word difficult doesn't even really match up to how hard it is. You know how all the different emotions that go with you know, not telling people information that's so valuable, so important that can really alter your life. And when you do decide to tell someone it's more like you really have to trust that person, or really hope or have good faith in people, and hope that they won’t say anything. Hope that they won't use it against you. And I think in that situation it's like, thinking the best of people, but the way I was raised and my parents and did this like with good reasoning. You know you can't trust everyone that comes around because people have different political views, have different morals, think different things and so you could tell one person and they let that slip to someone and their parent. I don't know. Maybe their parents are against you, you know illegal immigration and then they like, make a few phone calls. You know anything could happen, and so with that you know you have to be very confident in other people and you have to put a lot of faith and trust in other people, which is difficult to do in general. But with something so heavy it's almost impossible to do that. But also just growing up with that, it's very difficult. You know keeping that as an adult, I feel like it's easier to to hide that, but like when you're little, when your little kid and you're still trying to understand different things, you’re still trying to like relate to other students to other kids and you can't really do that because you feel like you're hiding a really big secret and like no one really understand you. And no one knows what you're going through. You know, like you always feel like the outcast, it feels like someone different.

Narrator: One potential reason these kids are scared to seek help is that the US government has a negative attitude towards immigrants. Using bad language to describe immigrants, while other countries are more welcoming to the immigrants and have a positive image of immigrants.

Student: This, this is a little weird to say, but I felt embarrassed at first, like I was embarrassed that I was like having to tell them that “hey look, I'm undocumented,” you know, it felt like a shame, which it isn't, but it was also like a feeling of nervousness at the same time where I was just like, OK, they can either take this in a good way or bad way and they like might hate me, or they might love me, or like I don't know.

Narrator: Although this is a complex issue that involves politics, one simple way to address the issue is educating the community. Particularly teachers so that they could provide a safe environment to these kids who spend a lot of time at school. 

Student: For one, I think better education in the school system about what it means to be undocumented, and the fear that comes with that. I know like when I went to high school and I was applying to colleges, I went to my counselor to ask like you know how do I do this? How do I do that? She had no idea how to tell me what to do and that caused me more stress and then you know, it made me feel like no one can help me and I think providing that in schools would be great, especially because I was lucky enough to know people who could help me, who know to know people who have gone through the same journey. But some students don't have that, and providing that at schools would be a lot of help for them. But I also think like. It's really important kinda just change this stigma around being undocumented as something like, not bad, you know. It- people do it for different reasons. You know, come here, but sometimes, it works out better for other people and that shouldn't be the reason why, like some students have to pay the price.

Narrator: In an article titled, ‘Mental Disorders Among ndocumented Mexican Immigrants in High Risk Neighborhoods,’ which was published in the Journal of Consulting and Clinical Psychology. Researchers reported significant data that shows undocumented Mexican immigrants are at risk for mental disorders such as depression and anxiety due to post migration challenges. This means we must work to find ways to protect this population in order to promote good health in our communities. 

This podcast was produced by Saul Rodriguez for the 2021 Spring Global Health class. 

winds of up to 150 miles per hour, heavy rains, flooding, and landslides. It was

approximately 4 in the afternoon when ETA first made landfall on the east coast of

Honduras and then proceeded to bury homes along the coast and inland. Only two weeks

later Honduras was battered by another hurricane, LOTA. The disastrous hurricanes

affected over 4 million people across the nation and left more than 94 people dead and

thousands injured. Most of the people who were affected are part of the vulnerable

communities who were already struggling to get by each day as the COVID-19 pandemic

was taking a toll on their health and financial stability. People who were severely injured

by the hurricanes and in critical condition were unable to seek medical services due to the

immediate closing of health facilities as a result of the damage from the hurricanes.

People throughout Central America were and continue to struggle to survive. Honduras

is faced with a critical public health and humanitarian crisis that most of the world is

unaware of. This podcast is meant to bring attention to the current situation in Central

America, with a focus on Honduras my native land.

When hurricane ETA and LOTA hit el departamento de Cortes, the country went into a

state of emergency, everything was closed. There were many people undergoing

suffering, thousands of citizens lost their homes and lives. Yesenia who is 67 years old

speaks on the situation of her younger sister, who is 63 and the hardships her nephew and

her dealt with when their house became inundated by the rising waters from the heavy

rains of hurricane ETA

F9 [00:00:41] Mi familia si fue bastante afectada porque eh eh donde ellos viven se

inundo y perdieron todo, entonces salieron bastante afectados ellos, y han quedado pues

afectados porque psicológicamente han quedado ellos afectados.

Yesenia [00:03:10] la preocupación que tuvimos cuando ellos estuvieron, cuando estuvo

pues, estuvieron ellos en el cerro y el otro el otro sipote de Rosa estuvo en el techo de la

casa pero solo fue que vivimos la preocupacion.

Yesenia : [00:03:09] Cuando yo me comunique con ellos la primera vez ellos estaban en

el cerro y el otro muchacho estaba en el techo de la casa. La preocupación de nosotros era

que no podían rescatarlos, si no que estuvieron dos días dos noches sin comer y sin tomar

agua. Yo me preocupaba porque se podía debilitar el muchacho y se iba a caer al agua.

Yesenia : [00:04:01] A la hora que estaba comenzando las llenas yo le llame a mi

hermana y ella fue la que me contesto que están inundando, que se había inundando y que

la inundación los había rodeado.

Yesenia’s younger sister, Rosa, and her son were stranded on the rooftop of what used to

be their home for 2 days and two nights without food or water. After many phone calls

of extreme worry and pressure from Yesenia, rescue workers helped them to safety.

They lost everything that they owned. They had to leave everything behind and move in

with Yesenia. Yesenia says that her sister and nephew have not been the same ever since.

They suffered extreme psychological and physical trauma without access to any

healthcare services or any type of aid from the government.

This is just one of many extreme hardships that millions of people throughout Central

America have been experiencing through the pandemic and recent natural disasters.

According to Johns Hopkins University’s Global Health Security Index, Honduras

has one of the weakest healthcare systems in the world. In 2018 The World Bank

reported that the country only spends 7.05% of its gross domestic product on healthcare

and it operates through a private and public system. The private system is used by 10% of

the population, the economic elite, who are privately insured. The public system, The

Ministry of Health and the Social Security Institute, is open to all who have the ability to

pay and/or have medical insurance through their employer. Approximately 18% of the

population are able to utilize the public health care system. That means around 72% of

the population is left on their own to find access to medical services.

Senior citizens in Honduras are not being offered any assistance and many do not

have the help from relatives or outside sources to help with their basic needs to survive.

When the pandemic first started the government began to place restrictions on who could

leave their houses and when. People over the age of 60 were prohibited from leaving their

house and so Yesenia had to rely on her only daughter left in Honduras, who works full

time, to go and pick up her medicine and all other necessities when she was off work.

Yesenia has a history of chronic illnesses such as asthma, diabetes, arthritis and

hyperthyroidism. Given her age and her health condition it is impossible to find

employment, so she relies on the money that her children who migrated to the United

States send her to survive. For her, access to medical services and treatment has always

been a challenge, and the pandemic has only made this even more difficult. The only

option that she has for treatment is to go to a private clinic, which is extremely expensive.

F44 [00:10:39] Si me a hecho difícil porque.. porque ya para ir al médico así por una

enfermedad, el médico lo atiende.

F4 [00:10:45] Lo único que también son son en clínicas privadas. Ya en las clínicas del

Estado no mas del estado.

F6 [00:10:58] Ya no, porque como están todas ocupadas por lo de la pandemia, no

alcanza solamente de médico privado.

F10 [00:11:26] La mayoría de personas tienen dificultad, porque tal vez no hay ayuda de

alguien más. Y no, no tiene el dinero suficiente para que los atienda un médico en una

clínica privada.

F13 [00:11:41] Hay bastantes

The mismanagement of healthcare in Honduras has a history of political

corruption that has long looted the country’s most vulnerable, which is the majority of the

population. The manipulation of public funds can be traced to embezzlement, drug

trafficking, and schemes to buy overpriced medicine and equipment. Health care, a

human right, which should be a system designed by the government to take care of its

people has become a method of exploitation in Honduras.

When the COVID-19 pandemic hit, it further weakened the state of the health care

system, making it impossible for people to access medical services due to a shortage in

personnel. As reported by the CDC, in 2020 there is approximately one doctor for every

3,000 people. In addition to the lack of personnel provided, there was also a lack of

adequate protective equipment. Healthcare workers failed to receive items such as glove s

and masks that could have protected them from contracting the virus. This led to extreme

contamination and spread of the Covid-19 virus. This was the ongoing situation that the

people of Honduras underwent before the pandemic even hit. This situation worsened

throughout the pandemic and then the two hurricanes hit, destroying what little of a

healthcare system previously existed.

Today, most health facilities have been closed due to damage and injuries among

health personnel. Nine out of 18 departments (states) in Honduras have been affected by

hurricane ETA and LOTA. 61,000 people were left homeless. Due to the hurricanes and

the pandemic 95,000 are now staying in overcrowded shelters or are living on the streets.

What little access people may have had to healthcare has now become obsolete as people

are struggling just to survive. They are not only at a high risk of contracting the Covid-

19 virus, they are also in extreme danger of contracting and spreading other infectious

diseases such as cholera, dengue fever, and others. The impact of this situation will be

felt for generations to come due to governmental powers failing to address the needs of

its people.

Waiting for governmental powers to help is long overdue and no longer viable.

Solidarity and mutual aid is the only way that Central America will get through and

recover from this humanitarian crisis. That is why it is important to not only continue to

raise awareness among the people who live in larger and wealthier countries but to also

support mutual-aid organizations who are working directly with those affected to provide

food, shelter and transition relief. The Honduran Solidarity Network, Operacion ETA,

Abrassos and Operacion Frijol are some of many relief funds and organizations that are

doing grassroot work with the pueblo in Honduras. Many of these coalitions have been

started by college students with the desire of making a difference in their cou ntry.

Despite these devastating natural disasters the embracement between people has

inspired hope to those who need it. Standing in support is the only way we can help

Central America recover from this public health and humanitarian crisis.

(HANNAH) That clip is not shocking to many of us. If you live in America you know that wearing a mask, and protecting those around you has caused a political war for quote on quote “freedom”. Throughout the majority of the pandemic we had a federal government that rejected the idea of COVID-19, turned a blind eye to public health professionals and denied support for citizens With the new variants and weakened restrictions, COVID-19 in the United States seems never ending. 

RIA [ 16:03]“We have currently got the America's Cup race going on in Auckland. And there are crowds enjoying themselves on the waterfront, you know, and it's brilliant. And we have sports with actual life crowds, cheering arm and so we, we have all that normality of life”

( HANNAH ) That’s Ria. Ria is a New Zealand Native and Director of EcoQuest, .a study abroad organization that offers interdisciplinary, hands-on learning in a vibrant, sustainable learning community for students around the world to stay in New Zealand. She is talking about an annual yacht race that occurred the march of 2021. This event had a crowd of 50,000 people. New Zealand is basically COVID019 free. This seems unimaginable to me. IT is clear there are two different worlds going on. 

(HANNAH) The question is how? How is it possible to have nations so drastically different in their covid-19 response? What is New Zealand doing that the United States is not?As of March 2021, New Zealand has had only 2,350 total cases since the start of the pandemic. To put that number into perspective on February 20th, North Carolina alone had 3,234 new daily cases. 

HANNAH) One of the biggest attributes to success for New Zealand was the quick response by the government and the consistency of positive choices. Since the beginning of the Pandemic the New Zealand government implemented three key components to their success; travel restrictions, strict lockdown protocols and communicative campaigning. 

RIA [ 10:03] “I really appreciate the leadership that we had and have, because it was a science informed leadership, you know, the government was super clear about, you know, how they were making their decisions. And it was all transparent, that was communicated daily to us. And so it was also made clear as to what was our responsibility, and what was the responsibility of the government.”

(HANNAH) It is important to note the geographical makeup of New Zealand. New Zealand is an island nation, meaning it is completely surrounded by water. It comprises two different land masses making up the north and south island. Because of this it is easier to regulate who is coming in and out of the country compared to countries like the United States that share borders. New Zealand is also a rather small country. There are 5 million total residents within New zealanders.

RIA [ 9:53] “We have been super fortunate. But I don't think it was luck alone. And you know, I do believe that there are many things at play. One of course, we are an island nation, and you can actually control the borders mostly. And so. So that was an obvious tool.”

(HANNAH) The New Zealand government implemented strict travel restrictions. At the end of January 2021 Travel restrictions were lifted to a phase 1 for the first time since the start of the pandemic. New Zealanders were permitted for international travel. But U.S citizens were still not allowed to enter New Zealand. According to the New Zealand Government Travel page, all airline passengers to the United States ages two years and older must provide a negative COVID-19 viral test taken within three calendar days of travel. Travel within borders is permitted at this time as well. For those travelling within New Zealand borders it is required to conduct health screenings, and covid-19 tests. After this testing each individual would then have to do a mandatory 14 day isolation/ quarantine Quarantine is required to be done at one of the various government adhered locations.  

RIA [8:15]: ”In the first week of April, my mum passed away. And and of course, I could not travel because by then there was no global anything. You know, there are borders were close. And I actually do fully appreciate that move that our government made, you know, is that I could have left, perhaps, but it wouldn't have been very easy. And it certainly would not be easy to return.”  

(HANNAH) The New Zealand government implemented COVID-19 alert levels. These alert levels specify the public health and social measures to be taken. There are four alert levels. Level one is the least restrictive, and level four is the most. Level one is called prepare. It is where the COVID-19 is contained. This happens when there is a risk of COVID-19 in the community. Social distancing and COVID-19 testing is encouraged. And mass gatherings of 500 or more are cancelled. Face coverings are legally required in public transportation and the borders are still restricted. 

RIA [ 15:00]“Yeah, so we have a, an alert system level system is four levels. And currently the whole country is in level one. And so level one is the most relaxed mode, but it is not zero, okay, and so, so what what's being asked of us is to stay home, if you're sick, get tested, if you're sick, use the COVID tracer apps turn on your Bluetooth traces, so that we have a picture nationwide of where people are and if covid returns we can pick up who was the contact and really go hard to get people tested.” 

(HANNAH) The next level is level 2. It is the reduction phase it is done to exercise increased caution. This is when the disease is contained by the risk of community transmission has increased. “Only New Zealand citizens or residents with valid travel conditions can travel to New Zealand at this time. All New Zealand citizens and residents returning to New Zealand must complete at least 14 days of managed isolation or quarantine and test negative for COVID-19 before entering the community.” You are allowed to go to work and school, and businesses are open. But physical distancing and masks in transportation are required. Masks are encouraged in all spaces and events can only be 100 people or less. You are allowed to travel to other regions at an Alert level of 2 or lower. 

RIA [ 11:05]“We had a short period of national emergency, and everyone was just asked in order to stay home. And people did, I think we have a, you know, I think as a national trade, we may be slightly more concerned with fairness than with freedom. And so people were prepared to do this. And it wasn't easy, but people did it.” 

(HANNAH) Level 3 is next. In level three all work and school must be taught virtually. Public spaces like gyms, museums and playgrounds must close. You legally must stay home with your household bubble. Socializing outside your bubble is strongly discouraged. Social distancing is required. Masks are required in public transportation and strongly encouraged everywhere else. Traveling outside of the region is restricted.

RIA [ 12:17] “We've had two other brief periods of localized lockdown the most recent one, just a few weeks ago, in Auckland. And that was just really concentrating on you know, where, where do we see a case that's unexplained? What can we do about it? So yeah, I think not just luck, and to large degree, leadership, and definitely having a sort of science based approach really trying to understand COVID.”

(HANNAH) Level 4 is the last and most severe level. Level 4 occurs when there is a widespread outbreak and intensive community transmission. All gatherings are cancelled, businesses are closed, work and school must be done from home.All travel has stopped except for essential personnel. Individuals must stay home in their bubbles and can only move for essential personal movement. Only supermarkets, pharmacies, and gas stations can stay open. 

RIA [ 13:32]”But I think one of the things that I think I often think about is just scale, you know, like, we are a small nation, we have 5 million people. And so, you know, our Prime Minister, early on, basically pulled everyone in, for us to be a team of 5 million.” 

(HANNAH) The New Zealand Prime Minister Jacinda Ardern has made it her goal to engage her entire community within her COVID-19 response. The wording throughout the education in New Zealand surrounding COVID-19 has encouraged a community investment to keep one another healthy. There is a noticeable team based approach. Using phrases like “ what we all need to do to keep safe.” The Prime Minister prioritized public health education and frequent communication with the residents of New Zealand. 

RIA [ 24:14] “I think we were lucky that our government now freshly mentored us, they were in a way, you know, they they had a huge focus on health and well being, you know, the first budget presented by by our current government was a well being budget, you know, so, so it is it is out there, because, you know, I think we as small and actually, we are nimble, and we should be able to deal with things that matter, ” 

(HANNAH) It is evident that successful public health responses must happen at the governmental level. Not only through policy but in practice of those in political power. New Zealand is a great example of engaging your community to effectively address public health issues like COVID-19 on a mass scale. The alert level system and travel restrictions played a large role in the success in New Zealand. But more so the engagement and support from the New Zealand government to the rest of society offered trust and a willingness to adhere to public health protocols. This model is one that many countries should consider in the future. 

This podcast was created for the Spring 2021 Global Health Class at Guilford College. 

“Most of the time, especially, I think now Japan was going through a very economically hard time. And so many people, I believe, had to prioritize work over sleep.”

Anna- 

In Japan, it is common for people to be seen sleeping in public places. In Japanese there is a word that explains this: inemuri. Inemuri is the concept of ‘being present while asleep’. Some people may describe it as a precise state of unintentional napping. In Japan, sleeping on the job can be a sign of good work ethic. It can show that an employee had been staying up late the night before and putting in the extra hours to get their job done.  

To gain some insight into life in Japan and inemuri, I spoke to Professor of Japanese at Guilford College, Hiroko Hirakawa. Hiroko lived in Japan as a young woman and worked until she moved to the United States in the 1980s. 

Hiroko-  

“That's one of the reasons why I left there, because it was too much and the salary was very meager. And when I was working for other types of jobs, it was basically nine to five and then beyond five, I can do whatever I want to do. So, the salary was also very meager. And in Tokyo at that time, in the middle of eighties it was very expensive. One of the most expensive cities in the world at the time”

Anna- 

I asked Hiroko if she had experienced inemuri and what she knew about the concept, here is what she had to say.

Hiroko-

 “The first thing it came to mind was people in commuter train, because I heard that the visitors from overseas, the first thing that they noticed and then get surprised is the fact that when you get into a train, especially the morning commute train or evening commute into a subway, the vast majority of people are asleep….”

 “When I was in Japan, I thought that it's a universal phenomenon. And wherever you go, whether it is in Japan or overseas, if you go to a train and commute, you fall asleep naturally.”

Anna- 

In a New York Times article published in 2016 about inemuri, journalist Bryant Rousseau writes that in Japan, “napping in the office is often seen as a subtle sign of diligence: You must be working yourself to exhaustion.” I was curious to get Hiroko’s point of view on this, so I asked her: Is inemuri tolerated or is it something that is frowned upon by the majority of people who live and work in Japan?  

Hiroko- 

“Definitely some people look at them negatively, but not harshly judged, more like a sympathetic look”

Anna-

Typically, in the United States if any of us fell asleep on the job it could cause serious repercussions. It would not lead to praise or a “sympathetic look”. In fact, in most workplaces, it is a fireable offense. 

Sleeping on the job or in public in the United States might be considered lazy and inappropriate, but it is such a common problem in Japan that people have come to expect it and accept it— and that is bad news for sleep hygiene. Consequences of poor sleep are high and sleeping on the job is one result. Inadequate sleep affects people at individual, organizational, and societal levels. 

I am sure you can relate to what it is like to not get enough sleep. It is waking up feeling unrefreshed, groggy, and even more tired than when you first plopped down on your bed and shut your eyes….

One study published in PubMed by Kristen L. Knutson shows how a lack of sleep is directly linked to “increased risk of chronic cardiometabolic diseases such as obesity, diabetes, and hypertension.” Sleeping allows the body to restore itself. It helps the human body remain in a state of homeostasis. It would be ideal if workers in Japan could get the sleep needed to stay healthy and safe. However, there is, a cultural component to this public health issue that is difficult to untangle. Akiko Yoshida, in her article No chance for romance: Corporate culture, gendered work, and increased singlehood in Japan, notes “how normative and taken for granted it is for men to work overtime.” It is often the case that employees are viewed more as cogs in a corporate machine, and despite the fact that sufficient sleep might improve their overall productivity, their individual needs for things like sleep are not prioritized in the same way as the number of hours they work. But what’s complicated is that Japanese employers are not malicious—they don’t wish their employees harm—but the difference in priorities can ultimately lead to sleep deprivation.

Both employees and employers can be affected by inadequate sleep. One study published in 2019 explains how long work hours in Japan have serious effects on “job performance, decision-making, and safety.” The study aimed to show how employees in Japan work longer hours than those in western countries. These long work hours were measured to more than 51 hours per week within a specific industry. 

The workers who have to drive long distances into the night and work against their circadian rhythms are suggested to be at a high risk of fatigue and injury. In the same study, it was discovered that those working nighttime shifts and who had irregular work patterns were at a high risk of fatigue and injury as well. When are these workers getting their rest? 

***Lullaby Music*** 

Anna-

What can we learn from all of this? I wonder if workers in Japan could prioritize getting more sleep at night and sleep hygiene education. However, it is comforting to know that people in Japan may be more tolerant of people who may be experiencing sleep related fatigue or who may be practicing inemuri. Prioritizing sleep is important and I can conclude that no one society is getting it perfectly. But we can learn why sleep is something we should all prioritize because it will help us become healthier people. 

This podcast was produced by Anna Brown for the Spring 2021 Global Health class at Guilford College.

Maya - “ Let's look at the fact that Iceland's maternity and paternity leave as of January 2021 will be extended to 12 months. Standard leave payments are 80% of your average income. There is also a law that requires the same benefits to the mother and father. Here in the United States maternity leave is regulated by US labor law. What this means is new mothers are required 12 weeks of unpaid leave annually and this goes for both the mother and the father, if they work for a company with 50 or more employees. If you are an employee of a company with less than 50 people there is no federal law requiring them to give you maternity leave. Okay, now just think about it, if anything happened or went wrong during your birth and the doctors said that you needed to take extra time off rest and focus on you and the baby. Although now instead of focusing on resting and your baby you have to figure out how to pay your bills because you are no longer getting paid. 

Maya - Finding out even the small differences that Iceland is doing can benefit many mothers here in the United States. As someone who is on a path to become a doctor/obgyn/midwife or doula and work with mothers information like this can easily be applied to practice in the years to come ” 

*Music*

Background info / Iceland conversation: 

Maya: What would be your first thoughts if you found out that you were having a baby in nine months? Would it be insurance or government assistance? Or if there was a possibility that the doctor recommended that you get a serious operation such as a C-section?

Now when I think of having a baby, I tend to think first about wanting to be in the best financial situation possible and just hearing about different stories with the hospital bills can be alot at some points. I also think about the time off after having a baby and the dream would be to have a year off after I give birth to just have that time with my child! 

I think that many people don't realize the major and minor flaws in our healthcare system and are willing to look at what others are doing! Especially those simple laws that could assist new mothers and the days and months after birth. 

In the U.S not many mothers or fathers have the privilege to have an entire year off with their child! 

When looking into the healthcare system in Iceland I can totally understand why Iceland is one of the top 3 places to be a mother. Wouldn't you want healthcare that covers all of the cost for pre and postnatal care?

I got to have a conversation with someone at the Iceland embassy in DC. They let me know that there are alot of measures that have been put into place to make it easier for women and men to have a successful career at the same time as raising a family. 

*Music*

Maya - Hearing about how Iceland has these things out in place to assist new parents made me want to talk to someone here in the United States about their journey and experiences during pregnancy. I was about to talk to Selena Wolf Berkeley who is a English professor here at Guilford College. She shared with me her experiences and it was interesting to hear the differences between two of her different pregnancies 

Selena - “ because I was pregnant, I lost my job and then I was out of work for almost a year, so the maternity leave thing didn't really come into play then. I just took that time off to just focus on my baby. When I was working, I took four weeks off. I think the maternity leave window was six to eight weeks and I chose four because I had to go to work. We had to pay bills. And I'm the primary breadwinner for my family. So with both even after the C-section, I only waited. I think I may have waited six, six weeks. Before I came back to work.

Maya - “The embassy also mentioned to me that free high-quality child care is also essential in Iceland which can certainly help many people out when having children and stay present in their career.”

“Things that may cause prenatal stress during pregnancy are somewhat handled in Iceland starting with the healthcare that is provided to help with the initial visits, all the way to postnatal care when a doula checks up on you at home to make sure that everything is running smoothly.”

“I even got a chance to talk to Selena about the healthcare system here in the United states”

Selena - “ I had a I've had like such a wide range of an experience. So with my first I was on Medicaid for pregnancy. And I also received WIC. 

And the process for that was really grueling to sort of go into the office and sit there for hours at a time and wait for somebody to then kind of pull your life apart and talk about how much money you make and what your plans are and how you're going to take care of your baby, which was felt really condescending in a lot of ways. But then the assistance I received was amazing. I didn't have to worry about paying for labor and delivery. I didn't have to worry about paying for my doctor's visits. It was all covered by Medicaid for pregnancy. With my private insurance that I had with my second and third. It was way more complicated and I had tons of issues with it and I was at the same doctor's office, which was another thing, so with the private insurance, they they kept trying to overbill me and I would come in for an appointment, they would say, oh, well, you owe a thousand dollars this time. And I'm like a thousand dollars! You know, it was just constant issues and money that I had to put out instead of it being covered by what I was already paying for with my private insurance. So it felt like something like universal health care would be a really beneficial thing and probably feel something more like being on Medicaid for pregnancy, except maybe without the level of paperwork to go through every time with every baby.” 

Maya - This is just some of what parents go through although this is not something that they have to go through!!!

Maya - “Now that we have heard about Iceland's way of doing things and the experience of a mother here is the United States how this can potentially affect different statistics and what can we learn from Iceland?” Statistics such as infant mortality, c-section rates and financial support are just a few that I have heard about. 

*Music*

Maya - We know that Iceland has all these amazing things such as a longer maternity leave, showing the importance of careers as well as financial support. I would want to live in a place where there are only 2 in 1,000 infant mortality births occurring. Especially when both you and your partner can take off work to care for your new born baby! 

One thing that I found interesting was in a 25 year period From 1989 to 2009 107,000 births occurred in Iceland and there are only five direct maternal deaths and 5 indirect maternal deaths nobody died from postpartum pregnancies, anesthesia complications or anything like that versus in the US those are the top leading complications towards maternal dealth. Especially with high C-section rates can factor into that. Just so you have a comparison in the United states in 1987 the maternal mortality rate was 7 per 100,000 whereas in 2017 it has increased to 19 per 100,000 live births which means that more than half of the deaths are preventable.

Many people don't really know what's happening until they have a baby in Iceland they really don't have C-sections unless it's a very high risk pregnancy but here in the United States it kind of differs depending on where you go and my conversation with Selena made it even more evident about the flaws in our system.

Selena - “ you really you don't realize how much pressure there is to have a C-section until you get into the situation. And I felt so helpless like there was nothing I couldn't convince the doctor. that this wasn't my, my baby was breached. He had only but otherwise everything was completely healthy. He was still like I was fine. He was fine. He just didn't want to move. So I had asked the doctor for more time. I was actually barely 40 weeks. And he was like, no, we need to do a C-section right now. So it's definitely like a go to here that doesn't and should be.”

Maya - I want people to know that C-sections are actually a very serious procedure and is the other option rather than giving birth vaginally. When you get a c-section you are having a procedure that goes through your abdomen and uterus to get your baby out! 

I think a huge problem and a topic for another day is realizing that c-sections are procedures that should be planned for emergencies in the United states they have been scheduled for convenience of the doctor. In the United States 31% of all deliveries are C-sections, while Iceland has a 9% procedure rate! 

Now that you have heard about Iceland and you may be more aware of what's happening I want you to just ask what we can do differently especially for women who want to be in the healthcare field ... When I go into the healthcare field I want to look out for maternal health and figure out different ways that we can lower our infant mortality rates especially maternal mortality rates as well.

Iceland makes sure that they are putting both parents in a situation where they feel comfortable having and raising a baby and I feel like nobody should have to have the financial stress or worry of where they might go next or the help that they might need. I think all those stressors can lead to unexpected pregnancy complications especially if you're not aware of the different resources that you may have, and it can possibly affect you in the long-term.

Closing:

Most places should have access to maternal care whether it be free or low cost. Some resources that people can use here in the US are planned parenthood, local health centers as well as family planning centers. You can also look at what the government can help support with in regard to financial assistance throughout the pregnancy! 

This podcast is produced by Maya Chevalier for Spring 2021 Global Health Class at Guilford College. 

*Music* 

Grocery store workers, farmers, electricians, mechanics from Mexico and Central America cross the border everyday in search for a better life - a life without corruption, drugs, gangs, and poverty. In the US, there is a constant debate of whether or not immigrants should be granted access into the US. With this comes misconceptions about how these individuals come over here or why they even do. What this side fails to realize is that the conditions in the home country are so bad, that immigrants are very aware of the dangers of crossing the borders, including death. The decision of coming to the US is not an easy one for these individuals, but if it means getting out of life in which they are living in now to come to a better one, then so be it. Look at it this way: you’re watching a movie in which you end up rooting for the individual that is facing hardship to ultimately come out victorious at the end. The exact same thing is happening here. People should not have to risk death for a better life because this in itself creates a public health issue of which creates larger issues down the road.

Think about a time you went hiking, and if you’ve never hiked, think about a time you went for a walk on the hottest day of the summer. You were hot, sweaty, ready for it to be over, and you knew that it would be over… maybe in a couple of minutes or at max 3 hours. Now think about walking through a desert, on days end, with one jug of water to sustain yourself. To relate this to my hiking example, one usually only takes a water bottle and a backpack that may contain an extra change of clothes, keys, and some snacks. Same thing applies here but instead of snacks, it's documentation of who they are, instead of an extra change of clothes, it's money that is supposed to sustain them throughout their travels, and instead of keys, it's a bible. This walk through the desert doesn't end in minutes nor 3 hours, it lasts for days. This is one of the examples of deadly risks immigrants face. This desert is also a place where many immigrants lose their lives because of dehydration or heat stroke. Immigrants are aware of these risks, but that's okay! Because the light at the end of the tunnel shines brighter than the sun in the desert.

I interviewed a medical interpreter who serves in the Roanoke Valley in Virginia, my hometown. For confidentiality purposes, we will call her Mary. Mary works with people from all backgrounds, including undocumented immigrants. Because of this, I knew she had come across stories of these individuals. This is what she had to share about 2 women crossing the border from Central America, one with a child and the other alone.

Interview 1:45 

“This is a single parent that she traveled from, ya know, Central America, and her message of traveling she explained to me was like in a semi truck? And they [the people] were like laid out like in pallets but they were like in rows of 4 and they traveled in this particular truck for about 15-20 hours before they were, ya know, arriving at the destination that they were to arrive.”

Mary then goes into the gruesome reality of traveling in this semi:

Interview:

“It was the summer, so it was hot and humid. They did have air coming through just the air that was coming through the truck. They were given a small bottle of water and were given instructions simply just to sip on it if they absolutely had to. But ya know, being the way that they were laid out in the rows, she told me that the worst thing was the stench, the body odors, the sweat, and also the urine because you have people stacked one above the other in these palettes, and ya know, those above, ya know, wet themselves and urine was coming to those that were below. And she said that it was just horrendous.”

She then follows with a second story of a woman found in Texas:

Interview 3:25

“I really don't want to go into much detail because it's just crushing. A woman was raped and left there to die. Obviously she was able to relate the story later on, and that's because help did come. And those two stories have always stayed with me. It was very impacting in my personal life.” 

Mary exposes the harsh realities of coming to the United States as an undocumneted immigrant. The drowning, the tractor trailer, and the rape are only 3 examples of the endless risk factors of this journey.

My family is from Honduras and most of my siblings have crossed the border undocumented. My sisters came together but my brothers on the other hand, came alone. One of whom not only walked the desert, but also traveled by train. This isn’t your typical train ride though; my brother not only had to jump on a moving train at the right time, but also tied himself to the rails on top of the train so he wouldn’t fall off if he were to sleep. It is important to note here too that when I say traveling together or traveling alone I mean traveling with someone you know versus not. Immigrants travel to the border in groups, with a coyote, or human smuggler, as the head guy in charge, directing the way. 

Misconceptions about these families are rabid, misinformation is constantly being spread about their stories or even about them as a general group. These misconceptions add fuel to the fire about the debate of immigration into the United States. Almost every single one of these immigrants come to the US with one goal: to make money in a safe and sustainable way in order to live a better life. A lot of our produce has been picked by these individuals, our grass is usually cut by these individuals, and a most notoriously, a lot of the hard, grimy labor that no one else wants to do, is done by them. 

In our interview, Mary talks about the misconceptions she believes are attached to these individuals. She discusses how these individuals are believed to be uneducated, or unworthy, simply because of the language barrier between Spanish and English:

Interview 3:56 or 4:40

“I would say one of the greatest misconceptions is that many of these people are uneducated and some may be. I may venture to say that there is a small majority that are uneducated, but I've come across those that have left medical school for one reason or another. I’ve come across several that were instructors of higher education not just in primary schools. I have come across nurses, business owners, and many of them have professional trades such as plumbing, mechanics, electricians, so I would say one of the greatest misconceptions most of these undocumented individuals are eneducated simply because there is a language barrier and they may not speak our language [English].”

Alongside this misconception, there is also the misconception that these individuals live off of the American economy, that they live off of welfare, like food stamps, which is simply not the case. While the children of these individuals may qualify for benefits like this, they only qualify if the children have been born in the US but no benefits go directly to anyone who wasn’t born in the US. There is also a misconception that these individuals don’t pay taxes, which in turn creates a stigma around these individuals that they are living off of the government. In reality though, the IRS reported that 50-75% of undocumented immigrants file taxes each year, paying federal, state, and local taxes. The grey area here though is that undocumented immigrants may work under the table due to that being their only option in recieving any type of income, in which course, they wouldn’t be paying taxes.

Immigrants do not simply wake up and decide one day that they are going to come to the US. It takes multiple encounters with hardships in their home country to finally bring them to this decision making. The journey here is hard, and they are constantly looking death right in the face. The simple fact that they acknowledge and take these risks, speaks volumes about the circumstances present in their home country. It is not a simple one, and empathy should be present when attacking the issue of immigration in the US and resolving the public health issue that is at stake here with people crossing the border in the most inhumane and dangerous ways. As a receiving country, we should attempt to make the journey to the US a safe and reliable one, as every human has the right to live a safe and happy life.

Intro…

Every year, thousands of people cross U.S state borders in order to give their children a brighter future. This is due to poverty, violence and other problems that their country has which causes them to illegally cross to other countries. It is a risky and very dangerous journey, however worth it to give their children a secure home with enough resources to live a better life. Not only is there fear when crossing the border, but there is more fear in being caught and deported once they live in the United States. Many Latinx people live with fear everyday with the thought of being separated from their family and the new life they worked hard to build. This fear not only impacts the lives of the immigrant parents but the children as well. Problems with mental health is immerged connecting to being an immigrant or being a child of one. Depression, anxiety and trauma are created when children are exposed to the mistreatment of immigrant family members and fear of separation in detention centers.

 [Music]

ICE Agents & effects (trauma) …

During the trump administration, there was one executive order that focused on immigration enforcement where there was an increase of 10,000 additional ICE agents contracted and sent out to detain many unauthorized immigrants.  

Sending out various amount of I.C.E agents highly impacted the fear for the community. Not being able to work or do daily activities due to the fear of being taken and deported caused a high level of stress for immigrants. Not only did this cause stress and fear for the immigrant community, but it also brought mental health problems for the children and family members surrounding them. In North Carolina, there were many check points surrounding the areas in rotations. This made most of the Latinx community to have anxiety and fear of losing family members. Even as citizens, they were afraid of being stereotyped as illegal for being Latin and treated wrongfully by police at the check points. 

Juan: My name is Juan, I live in North Carolina. I’m a 21 year old and me and my parents are illegal immigrants

 Juan: I have an uncle that was deported last year. Me and him were working at the same restaurant. One day a couple of cops just came in. they did not say anything, they went right through the kitchen and threw my uncle to the floor and put the hand cuffs on him. I was really scared when I had to see that. I was and still an illegal immigrant and working illegally just like him. Along with a couple friends of mine went out the door and the owner told us to wait until the cops left. They eventually took him but the cops did not treat him any good. They threw them to the floor, put force on him and I had to see that before I could actually get out. I was in fear that they would come for me and the other coworkers as well. After going home that night I had to break the news to my parents in which my mom broke into tears along with my dad.

Because of how my uncle was treated and detained that day, my family and I were scared to find any information about him in fear of also being detained and treated with violence. We ended up asking a friend who was a citizen to help us find him. After 3 weeks we found that he would be detained for a year and deported afterwards. 

Many families, like Juan’s uncle, were separated due to more surveillance and action of the ICE agents. Most families were not informed by the detainment of their loved ones until weeks after the situation occurred. Not only did this cause fear in how the detained immigrants were being treated but it also affected their family economically. Many families lost their economic providers, leaving them with no way of paying bills. Mothers who lost their husbands were left to fend for themselves and their children to move out of homes that they could no longer afford. When a family member is detained, it can cause an immensely negative outcome to family that depend on them. 

[music]

Juan: now me and my family live with fear of being separated any day at any second. I was so traumatized that day and I was really scared and I didn’t feel comfortable working at the same job I had so I eventually quit that job. Now every time we see a cop we get really nervous and scared that we may get treated the same way.

Latinx children in the United States have high risk of mental health disorders, whether they are surrounded by immigrants in their family or are immigrants as well. They are prone to discrimination, trauma and live with fear of deportation of themselves and their family. With these issues, they are most likely to develop internalized mental health problems such as stress, depression and anxiety. The unnecessary brutality of police officers used against Latinx people does not make matters better. The traumatic situation that Juan and many other Latinx people seeing the horrible ways that immigrants are treated and detained is only one of many ways that contributes to having mental health problems. This situation led him and his family to be traumatized and live with more fear than they already felt. 

[Music]

Detention centers 

Detention centers are locations where immigrants are held, in a similar way to a jail. Sadly these detention centers are in extremely poor conditions . In an article of TIME, Madeleine Joung said that “Adults and children have been held for days, weeks, or even months in cramped cells, sometimes with no access to soap, toothpaste, or places to wash their hands or shower. Some reports have emerged of children sleeping on concrete floors; others of adults having to stand for days due to lack of space. A May report from the Department of Homeland Security’s inspector general found 900 people crammed into a space designed to accommodate 125 at most.” 

In the TIME article it also brings up a grieving mothers testimony of her experience in an ICE detention center that was heard in a committee. Yazmin Juarez and daughter Mariee were held for weeks in a detention center where sick and health people were in the same area. The testimony states that within just a week of being detained, Yazmin’s daughter Mariee had “developed symptoms including a fever, cough, diarrhea, and vomiting. “I begged them to do deeper exams, but they [the detention facility’s medical staff] sent us back to our room,” she told Congress. At one point, the staff treated 19-month-old Mariee with Vicks VapoRub, which is not recommended for children under 2.”. After 10 days of being released and taken to a hospital to seek better medical care, Mariee was hospitalized for 6 weeks diagnosed with viral respiratory infection. The mother said “all of the hard work of these doctors came too late. Mariee died on what is Mother’s Day in my country. When I walked out of the hospital that day, all I had with me was a piece of paper with Mariee’s handprints in pink paint”. 

This story is only one of a million stories and testimonies where poor conditions in detention centers is a huge issue that is either covered up or ignored. When people are not informed of what actually occur in detention centers, there is no way to fix the issue. This mother, along with many others will have to live with mental health problems of losing a loved one when it could have been avoided to begin with if given the proper attention. 

[Music] 

Separation of children from parents…

Not only are detention centers given poor conditions but it causes separation of families as well. In the Obama administration, they did detain many immigrants as well, but they tried to never separate the children from their parents. However, During the trump administration, thousands of children were not allowed to be detained with their parents. This separation led to many children being missing with no real answer as to how it happened. One can only assume that the immigrant children died, were trafficked, or adopted illegally. Separation of families can lead to stress and depression. Dr. Ana Maria Lopez, the president of the American College of Physicians said in an interview with CNN that “the effect of this type of event will follow these children into adulthood and into their entire lives. Our federal government is causing a situation that is creating a host of potential health consequences for an entire category of people”. 

By keeping families together, it could help prevent separation anxiety and depression from developing in these children. Also, if family stay together then it would have been less likely for so many children to have been mysteriously lost in detention centers. When a family sticks together, they have the ability to protect and reassure their children of their safety. 

Not only should families remain together, but the treatment of ICE agents and police officers must change as well. The mistreatment and brutality towards Latinx people who are immigrants is unnecessary. Whether one refuses being handcuffed or not, they have been shoved to walls, thrown on the ground and sometimes worse. 

[Music]

Actions contributed for a solution.. 

One way that states in the United Sates have contributed to the community is by denying to allow ice agents in their areas. According to CMS many large cities, such as New York, Los Angeles, and Chicago, as well as smaller cities and communities, have chosen not to cooperate with federal authorities in enforcing immigration laws, including participation in the Secure Communities and Section 287 programs. They said that “To date, cities such as Chicago and New York have stated that they will continue to not cooperate with federal authorities on immigration enforcement because they have no legal grounds to hold apprehended person beyond a limited period and because they depend upon the cooperation of immigrant communities to “protect and serve” the public.” 

 [Music]

Fixing the issue…

A child of immigrants or being one themselves brings on many fears that negatively affect their mental health. It is not their families fault for choosing to provide their family with better opportunities. Mental health is not a common subject to speak about in the Latinx community due to seeing how hard ones parents already works and children do not want to put more on their families plate. With this said, there should be safe spaces for children that are immigrants or have immigrant families where they can talk about how they feel. As children of immigrants, it is also very helpful to have organizations that speak up for those that cannot in our community. Being a citizen or immigrant that can participate in events that give our community a voice is one of the most helpful ways to let out what non-latinx people do not know. 

Ending quote…

Informing others of the issues that a Latinx person lives and experiences is one of the only ways to open the eyes of others. So what will you do to help my community? How will you make a difference to not see children separated from their families and mysteriously go missing from detention centers? 

This podcast was produced by Jennifer Solis for the Spring 2021 Global Health class at Guilford College. 

Intro:[0:23] COVID-19 is a deadly pandemic that has ravaged economies, torn apart industries, and ripped apart millions of families. According to Researchers, in over a year, COVID-19  has hit poor and vulnerable countries the hardest, threatening decades of hard-won gains while exacerbating existing inequalities in the poorest countries. However, apparently this does not apply to Haiti which only has 12,736 cases and 252 deaths. Today on A Conversation With Camari we will delve into how Haiti, a low income which lacks many prominent resources needed to contain a global pandemic in which many thought would ravage the country that has little access to healthcare has done such an amazing job in containing the virus compared to other countries. Joining us today is Moeisha Ciceron, who is of Haitian descent and was in able to provide depth answers as to what were some of the public health measures that Haiti took into place and here is what she had to say

[1:24]

Moeisha:[1:24] Haitian leaders were meeting with international health organizations such as the World Health Organization, to discuss precautions that they could take and encouraging them to shut down their borders in the beginning as well. They didn't allow foreign visitors basically, shutting airports down because they didn't want anybody who could possibly bring in the disease to bring in the disease. But unfortunately, their actions were a little delayed because it had already been carried into the country by tourists.

Camari:[2:05}  In 2019, Haiti averaged around 938,000 tourists with the industry bringing in an average revenue of around 703 million United States dollars. Having to close the country, effectively lost all revenue from one of the nation’s top industries, revenue that could have gone towards help with the next deadly natural disaster.

Music [2:34]

Camari:[2:47] During a Global Crisis such as COVID it is extremely important for a country to have compliance and leadership as Leadership has the power to make or break the nation and also withhold information, which is kind of sad because you'd think they'd want to express everything that is detrimental to the people of their perspective Country. Compliance is also seen as a necessity in surviving a deadly pandemic as citizens compliance can make the country look like New Zealand or the United States. Organizations such as the World Health Organization also recommend wearing masks in order to reduce transmission or further passing the virus. 2021, or the United States, which leads the world in cases. 

Moeisha: [3:10] There’s been civil unrest with the current leadership so a lot of crime a lot of looting and in these videos that I have been seeing I have not been seeing them wearing masks, I have not been seeing the being affected by COVID as much as I have seen it over here.

Music [3:32]

Camari: [3:50] The reason for this civil unrest is that according to https://reliefweb.int/report/haiti/haiti-civil-unrest-mdrht017-dref-final-report Civil unrest over corrupt government and its policies since July 2018 has severely affected Haiti and has resulted in a social, security and economic crisis which further deteriorated its precarious humanitarian situation. This crisis is such an issue in regards to the country’s response to covid due to the fact that according to https://www.thenewhumanitarian.org/news-feature/2021/3/16/how-haitis-political-crisis-is-fanning-vaccine-fears this constitutional chaos is overshadowing the country’s COVID-19 vaccine rollout, thus provoking a vaccine hesitancy and fewer immunitisations. The reason as to why Haiti having few immunisations is thai ts residents might not be eligible for widespread vaccination until 2023 or 2024, according to estimates from the Duke Global Health Innovation Center in Durham, North Carolina, thus with so few residents being vaccinated could lead to a potential surge in cases if an individual who has the virus comes into contact with a Haitian

Moeisha: [5:13] . I really think that just because they have such low cases as well that getting the vaccine is really something that they're not pushing for. But as of right now, I feel like along as Haiti's keeping their numbers low and that they're being very mindful of who they're allowing into their country and just like screening properly and making sure that nobody is testing positive for covid is entering their country, and if they do decide to open their borders to someone who had covid in the past, comes and gets in contact with the Haitian person who hasn't received the vaccine, that might cause a spread. But I guess we're going to have to just see how that plays out.

Music: [6:04]

Outro: [6:28] Well that is our time for today Moeisha thanks so much for joining us, we’d love to have you back and thank you to our listeners for tuning in today. A conversation with Camari is a conversation with the community. This podcast was produced by Camari Alexander for the Spring 2021 Global Health class at Guilford College.

Mariam Sherrif It definitely has to do with geographical location. So how I mentioned earlier my family is from Athenas and Athenas we call them campos, which is more like the village side. But within the village side, you know, there is a town. And so the town is more vibrant. And that's where some people go for tourism. The town itself is very vibrant but when you start to go deeper into Athenas, you have these small campos, you the little houses and stuff. Their water system can be completely different. And so for them, their water system could be completely different, depending on on how the family is earning their money. My uncle who who lived in Athenas he his house and his plumbing system is very much advanced. So, you know, they have running water, but they can't use the water to drink. It's more so to shower and for the plumbing system. But when you go in to different parts of Dominican Republic that are more, I guess, lower income, you definitely do see the lack of of water. You go into the richer side of the world, the president lives governor, mayor or whatever. And then you, of course, have the artists, the singers, the influencers who live in bigger houses and who probably have more access to water or accessible access to water. 

DaSh. K. Rouse The water faucet is completely contaminated. Within the country, there are septic tanks that poorer communities drink from. The issue with this is that the water is contaminated with bacteria, insects and even dead birds have been reported to be found in numerous tanks in the country. Drinking from this is dangerous, this is what leads to the people of the DR to drink from the river. As for wealthier communities, there are trucks that carry clean water for the people. Within these wealthier neighborhoods, most of the population still buy store bought rather than utilizing the trucks. These trucks rarely go to the poorer communities. Is there an alternative for those people that can't afford store bought water? Is drinking water from the river their next best option? 

Mariam Sherrif You definitely cannot drink from the faucet itself, even when you look up what should I consider when traveling to Dominican Republic online? That is one of the first things that they will tell you is that the water is not safe to drink from from the tap because of bacteria and other stuff. That being said, there is a water gallon truck that comes around to the different neighborhoods. And I'm not sure if you have to pay for these water gallons. But for my family, for example, we have a water gallon and we get a few of those to last us throughout the month. And then when we run out, we basically resupply or you basically go to the grocery store and get bottled water, which is the next best thing. And so for many people, if you could afford it, then that's great. And it's not you know, for many of us who probably don't even live by a river that's close by. So we probably have to ask, like neighbors or family, friends that live closer if we can have some other water supply in which they would probably be open to sharing with you. But for many people who I do live by the river, I'm pretty sure that their next best bet is probably getting water from the river and somehow trying to purify the water. I do know that when my mom was younger, she was telling me stories about how they would always have to carry water from the river. And that was a really, really far walk and really long walk. And if you know anything about carrying water for your family, it's not just going to be one bucket, it's going to be multiple buckets and multiple trips. So for some people, that still is a reality, but it is more of a developing country. So there's a little bit more water access around the island. 

DaSh. K. Rouse OK, so we know the next best option is getting water from the river because of the dangers of consuming from septic tanks. But cholera seems to be living within the waters of the D.R. Cholera is a diarrheal infection caused by ingestion of contaminated water. It can be deadly within hours if not treated. Children are proven to be most vulnerable. Diarrhea causes half the deaths of children under age 1 in the country. Poorer neighborhoods near the Haitaian border are affected more because they are less aware of the infection. Nearly two thousand cases of cholera have been confirmed as of June last year, according to the General Directorate of Epidemiology of the Dominican Ministry of Public Health. How is cholera being informed on the island? 

Mariam Sherrif I think one of the ways that, you know, that Dominicans are being informed about it, I feel like it's kind of something that's like well duh, like we've been knowing, you know, for many of us were kind of like, well, we just don't drink from the from the tap because it's it's dangerous. It's not good. It can get you sick. And so I feel like one way that they are being informed is maybe by organizations that come into the island to volunteer their time and are eager about spreading clean water throughout the island for Dominicans. So that's one way is by having these, like nonprofit organizations come in. My mom has she drank water? I think it was either she drank water from the tap or. They got the wrong source of water from somewhere because you can't even though you do go to a store, you can't just buy any type of water. So I know that, like, whenever we go back to visit, there's a specific brand that my family gets, and that's the type of water that my mom is more used to because it's more like the water that we have here in the States. So when she had the water, with vomiting. She couldn't eat for days. She was dehydrated, much like the symptoms of cholera. But she was able to get it treated. She was able to get some antibiotics. But, for a lot of other people who can't afford that or, don't know what's happening and they just think that it's just like a common cold or something or a stomach bug, you know, it is fatal for them. I think that one way that we can improve awareness is by going into communities of lower income or of lower knowledge. I don't know about what's happening and really trying to, I guess, educate them. And it does start with the youth educating the older community. It really does start with the government trying to take a hard stance on it. I think that it really just comes up to the Dominican people to organize around that.  

DaSh. K. Rouse In 2014, Flint, Michigan dealt with a water crisis that led to lead-poisoned water into homes. We saw a massive amount of youth within the community getting involved. Should we be getting the youth involved in these affairs, could we learn something from fresher minds that are actually living through the crisis?

Mariam Sherrif Well, you know, like you said, like there's about eight hundred and forty four million people that don't have access to clean water worldwide, so it's not just international, but it's also, you know, in our own backyard. So we take Flint for example. And, you know, we saw what happened in Flint and we saw the organizing that went around that. Right with the young activists who were basically tired of having her water poisoned. So that's one way to take a stand, is by organizing and speaking out about these injustices and, you know, viewing where these injustices are happening. Right. Is it just happening in the wealthier communities or is it happening in communities of lower income? And what type of what type of people live in those communities? Right. So I definitely think that organizing around that is very, very important. And I think that that's one issue, one way that we can get that issue resolved. Obviously, Rome wasn't built within a day, but, you know, these things do take time. But it is also a time sensitive matter, as this has to say. And, you know, another way to really stay informed is, you know, being educated about that. So like I said, like, it's not necessarily just up to the youth, but, you know, the revolution has always been in the hands of the youth. So if there's an issue that the younger generation doesn't really understand, then it's really up to the youth to kind of carry that torch and to shed light on that. 

DaSh. K. Rouse Solea Water is a nonprofit organization formerly known as Water for Panama. This organization was formed in October of 2012. They work to repair and implement new water systems. One of their values is empowering local communities by including them in every decision process.What should organizations do to help with the water crisis? 

Mariam Sherrif Well, I think that their mission or their value set at best is empowering local communities by including them in every decision and in every process. And I think that's something that the world is missing, including communities in the decision making process. Right. I think that one of the things that we see and something like anthropologists have said is that people will go into these communities not knowing what the people are facing and just want to know, this is what we're going to do. We're going to add this, this and that and the third. And it's going to be very beneficial for you guys and, you know, problems solved when in reality, maybe that just made the problem even worse and it didn't even fix the problem that they actually needed. So I definitely think that when you go into communities, it's really important to listen to what it is that they're saying and not just listening to them, but try to experience what it is that they're, you know, like you don't want to go in there as the expert, even though it may seem like you are. But really just go in there as if you live in that community. Right. As if your children are drinking this water, as if your grandparents are drinking this water or trying to cook with this water for really putting yourself in their shoes. And not just, you know, coming in as I'm the expert, I know what I'm doing or we know what we're doing and kind of dissing their emotions and their experiences.

DaSh. K. Rouse To conclude, the ultimate goal for this podcast is raise awareness for the 

country’s water crisis, to give some insight of what's really happening and not what's just being reported. Awareness leads to more involvement and opportunity to change parts of the world that's in need. Potential organizations can be planned like a sanitation task force, a cholera research team, etc. Raising awareness for the country's crisis can lead to change in policy or even create new policies like creating product-based incentives like crops or water bottles for urban areas to decrease consumptions that lead to contamination. Even increasing funding for wastewater and chlorination treatments while also increasing investments in research of preventable measures for natural disasters are highly recommended when establishing a better policy. And it all starts with awareness.

Every year, the Cuban government makes around 11 billion dollars through its medical missions, more than its tourism industry, and more than exports like tobacco and sugar. In early 2020, the world watched in horror as the COVID-19 pandemic ravaged the country of Italy. Cuban doctors made headlines arriving at the height of the crisis to provide aid, carrying the Cuban flag as they came off the plane, a moving image that is haunting given the murky industry that is Cuba’s medical missions.

“[00:10:25] Now, that's basically what by that I mean why they tell everybody thinks Cuba is like a super power when it comes to matters and it's also not free. Well, they tell you the education ministry is not free because once you become a doctor, you if you leave the island, you can not come back to the island in eight years. But once you become a doctor, they can send you anywhere in the island to that remote worst places in the island. If they want to send you that, they have to have to go there because you belong to them. That’s what they tell you, that you’re a medio basico de la Revolucion.”

Cuba’s medical missions began after the 1959 Revolution, when Fidel Castro overthrew the right-wing government run by Batista and instituted a Communist regime. Healthcare and education were integral to the Castro regime. Even after Cuba lost the support of the Soviet Union, it continued its medical missions. How does the Cuban government continue to send out so many physicians each year? How does it tout one of the highest physician ratios in the world, even when many of its hospitals are in disrepair and experiencing medication shortages? What are the conditions like for doctors working international missions? It is a source of pride and altruism today, as Castro called it “the army of white robes”? Or is it something much more sinister, as the U.S. State Department has stated “a form of human trafficking and modern slavery?” (Wulfhorst). 

Cuba has one of the highest physician to population ratios in the world. Compared to the US, it has about three times more doctors per capita. Unlike the US, where medical school admissions are competitive and limited, Cuba provides scholarships, known as becas, to students hoping to study medicine. Young, academically driven students looking to have a career often feel like medicine is their only option on the island. 

“[00:00:40] Por ejemplo, eso de la potencia médica de Cuba de verdad, una potencia médica, si Cuba es una potencia médica, porque en Cuba lo los estudiantes había más facilidades, el médico seguro por decir soy un profesional, verdad? Porque en Cuba no hay vida para un periodista o una carrera de abogado, eh?”

She says, they don’t feel like there is a career as a lawyer or journalist, so they end up in medicine. That’s Vivian Alvarez, a former employee of the Health Department in Cuba where she worked regularly with doctors, coordinating care and medical missions. 

“[00:02:10] I mean, fifteen thousand medical students every year. They become doctors in Cuba.”

And that’s Vivian’s partner, Orlando. Orlando left Cuba, but still stays in regular contact with his family and friends there, including his older brother. He helps out financially as much as he can. 

Although medicine guarantees a career, in Cuba, it does not guarantee a better life. Cuban doctors spend months to years on medical missions abroad, away from family and friends. Many do not get a say in where they will be posted. They can make up to 1000 US dollars a month working abroad, but more often make much less than that, around 100 to 300 dollars depending on how long they’ve been away. This is a huge incentive, given that many stores on the island only accept US dollars for goods.

The working conditions abroad are poor. Viviane commented on the strict rules doctors are under outside of the island: 

“[00:19:15] Ellos no tienen una vida social. Ellos no pueden tener nada solo por eso mismo, porque ellos no quieren que puedan procrear algo debido a tanto tiempo que se pasan trancados un años.”

Doctors are not allowed to have any sort of social life while on missions. They are also not allowed to have sexual or romantic relationships with any doctors on the mission with them, or anyone in the community. The government wants to make sure doctors don’t have an out. If you have a kid in another country, you have a reason not to come back to Cuba. They don’t want the children of these doctors getting citizenship in a country like Brazil for example. 

“[00:15:38] Porque no, porque a ellos les importe lo que tú haces con tu vida privada, sino porque ellos están evitando el tu tener un bebé y que nazca en ese país y entonces ya tú te quieres quedar verdad? O que te van a sonalidad. Ayuda todos los beneficios que tú no tienes en Cuba, que tú no lo ves.”

It is also a form of control. The living situation is typically outside city limits. By keeping doctors isolated from the community, the government prevents escape of any sort. Doctors cannot demand better conditions when they have no access to life in the community they work. Viviane noted that many doctors don’t know there is another way of life outside Cuba, and when some have found ways to escape, they have discovered these different ways of living. But escape comes with huge fear of the repercussions if they are caught, including getting sent back to Cuba and losing their salary. 

On each mission, military personnel sometimes undercover accompany the doctors to enforce the government’s strict conditions. Some doctors have even had their passports taken from them upon arrival by military personnel. 

“[00:18:08] And that group, at least two or three people works , straight to the to the government and information, and they tell you you cannot leave if you leave we are gonna look for you, we're going to. Take away your family in Cuba, but normally it's like something like the CIA like the military and intelligence in each group.”

With poor working and living conditions, and social contact completely off-limits, doctors also experience discrimination from the very communities they are there to serve. Local doctors often view Cuban ones with disdain. Cuban doctors are like a bandaid on the huge wound that exists within these countries. The wound? The various inequities within their own healthcare systems that go unaddressed by their own governments. Governments supplement with Cuban doctors, having no real drive or incentive to address the shortcomings of healthcare and access. 

Because Cuba is able to produce so many doctors, the ones with the most experience are often sent out on the missions.

“[00:04:18] Yeah. Basically the doctors with good experience are the hospitals are the ones that they sending out and what they have on the island right now is it's, you know, like young people, they don't have the sufficient experience.”

The government invests their physicians and exports medications in medical missions because of the large profits it rakes in for the government. This comes at a huge detriment to the health of the Cuban public. Medication shortages are common. So are unsanitary conditions. In rural parts of the island, like where Orlando’s family resides, outbreaks occur with no physicians or treatments to address it. 

Because many of the physicians still on the island are fresh out of medical school, they often lack the skill or experience to treat the public. Vivianne and Orlando both spoke at length about their own personal experiences navigating care for ailing family members. It is hard and painful to know that preventable and treatable diseases end up escalating and taking away loved ones. Both Vivianne and Orlando have lost several family members this way. 

Orlando talked at length about conditions in the hospital:

“[00:27:25] Oh, yeah. I mean, the hospitals. I mean, they have no sanitation at all. They sometimes they don't. They don't even have running water. And they have the same bathroom for everybody, and they don't have that they don't have hot water, no hot water, there is no hot water in the hospitals. Thank you. If you want to take a shower, like I say, it's sometimes it's not even water in there. You have to bring your own blankets. If you're going to get surgery.You have to bring your your your blanket and your colors and anything that you need, your own soap. Because they don't have it, yeah, now most of the hospital, the room, they don't even have the AC working.”

Some Cubans are able to access medications or better care by bartering with pharmacists or befriending government officials that can get them into the better tourist hospitals. This isn’t a common experience however. 

“[00:29:02] I mean, if if you are to get in, you know, if you follow all the news that they give to the people, I mean, it's completely different. If you go to Havana to go to hospital that you mentioned, the Cimeq is completely under military control. But if you go there and you pay with dollars, I mean, do you get a different, completely different attention for the Cubans? If you don't have a good relation, somebody with power, you will. They will. You won't be able to get into the hospital.”

It is a harsh and stark reality, a country that provides so much aid, yet seemingly fails communities on the island. And even harsher, the reality that this aid exists on the backs of many Cubans wanting a better life for themselves and their families. 

On November 29, 2018, Cuban doctors working on missions in Brazil filed claims against the Pan American Health Organization, an international public agency underneath the World Health Organization. The claims stated the agency has made $73 million dollars off the missions and also supported working conditions that violate forced labor laws. 

Despite the claims, nothing has changed and the missions won’t slow down anytime soon. They will continue raking in billions of dollars annually for the Cuban government.

[+]

A: Maria is a mother of three who’s been a victim of obstetric violence during her first pregnancy in Chiapas, Mexico who describes how every mother would imagine having their birthing experience. However that's not always been the case. 

Interview: It was going to be my first child so I imagined that my whole labor experience would come out great, I will receive good treatment and that my baby would be healthy.  

[music clip ]

A: Chiapas, Guerrero, Mexico City, and Veracruz are a few states in Mexico to have high rates of obstetric violence. This could be from living in low-income communities, lack of knowledge between doctors, or simply because of being a woman. In 2015, worldwide, every 100,000 children born, 216 women died from the most common factor of violence which is lack of attention to pregnancy and birth.     

19:00 Interview: When I arrived at first, the doctors wouldn’t attend me and I was at the point where I was to have my baby. They didn’t want to attend me because they would say that I could still wait longer since 2 other women are in labor. But I couldn’t wait because … um.. my water already broke, I was bleeding, like I was ready to give birth but the doctors kept saying that I could wait…. Well, At that moment, my husband was getting furious, he went to talk to the doctors because I knew they didn’t have the right to not attend me. Not only that my baby could die but myself as well. 

A: Maria had just arrived at the hospital and she’s already not receiving the proper treatment. According to The American College of Obstetricians and Gynecologist, it’s hospital policy for doctors to perform a medical screening examination to determine the health condition of the mother and fetus. After the examination, the doctors can determine the next step for the mother. For example, if the examination shows symptoms of the mother going into labor, then it’s best to have a delivery room prep. Otherwise this could lead towards maternal and infant death. But if it shows that the mother still has time until her delivery date, it's best to give her proper documentation of what has been treated and when she should come back to the hospital to deliver her newborn. 

1:18 Interview: There was a small complication when people arrived wounded, and they didn’t want to attend me… like they prefer helping them and leaving me. But the doctors didn’t seem to notice that I could also die... just like the baby. I'm not wounded but in my situation, the baby was about to be born and my water had already broken.  

A: Most clinics in Mexico are full of medical students who are doing a year of service but, according to government officials and women advocates, medical students are not sufficiently trained by failing to speak the local indigenous languages, and are arrogant towards the women who they are helping. 

1:50 Interview: in the room, there were 4 beds and 4 women who also were giving birth. There was one doctor attending all of us and there were also nurses.. Like about 3 nurses. 

A: But also having lack of sufficiently trained staff can lead towards crowded rooms, not having enough beds for everyone and limited resources. Women in Mexico are forced to give birth outside of the hospital or parking lots when there’s no room inside. In 2014, news reporters from USA Today stated that women’s rights advocates sought international help for poor indigenous mexican women being forced to give birth outside of the hospital in Mexico City. The hospital received 20 cases of women giving birth outside when doctors claimed there were not enough beds.

2:55 Interview: After giving birth the next day, they lifted me up and told me that I needed to get up and start walking. At that time, I still had pain...they forced me. They were like “now, it's time so get up now to walk or to do some movement.” It’s like they never gave me time to recover, never. In that, I do see myself receiving lack of attention. Not only to myself but for the other women in the room since the doctors were forcing them as well. 

A: The most common abuse during childbirth is violence against womens’ rights. According to the WHO, women of low income or women belonging to ethnic minorities have a higher risk of receiving disrespect and abuse. Health-care professionals interviewed women experiencing health discrimnation from their characteristics such as low income, failure to understand instructions and being a woman. They reported both physical and psychological abuse such as lack of respect, being strapped onto the bed, frequently being hit or screamed at and being forced against their will. 

3:33 Interview: In my situation, the baby was ready in my womb and apparently she wasn’t going to be normal. At first, I wasn’t opening all the way, I was only a few inches dilating and my baby wasn’t going to be born naturally…. If the doctors have pushed me into a natural birth,... either one of us could’ve lost our life. One doctor earlier told me that I wasn't going to have a natural birth and that I would need a c section. 

Mexico has high rates of cesarean deliveries across the world. According to the WHo, Over 60% of first-time mothers received cesarean delivery compared to 37% of first-time women who receive vaginal delivery. Having rates that high causes concern on these cesarean deliveries since it can impact the mother, the baby and high consequences of using harmful treatment during birth. The appropriate time to perform a cesarean delivery is when the cervix isn’t wide enough and your current has strong contractions. High social class women would say that cesarean deliveries are more modern and convenient while high income women would predict an older and first-time mother to be at higher risk of cesarean delivery. 

[music clip]

(4:03) Interview: For a mother who gave birth to their first child and didn’t receive good experiences, one should be careful of which hospital they choose to give birth. I don't think all Mexico hospitals are the same. It's an experience that someone receives but never expects. One would think that I would be okay, having my child here as quickly as possible and everything is going to be fine and blessed to meet my child. I was not lucky enough to get a good experience.. 

A: As of today, women are still facing obstetric violence in Mexico as well as other countries across the world. Health providers in different cities in Mexico or different countries have provided their own set of procedures to reduce obstetric violence. A health ministry in Mexico published a set of guidelines for proper procedure of cesarean surgeries and strategies of how to reduce cesarean surgeries. This encouraged the Mexican Social Security Institute to publish their own procedures and strategies for cesareans deliveries. As of 2016, Mexico’s national policy has updated guidelines to reduce cesarean practices. In Guatemala, oncologists have created a “care navigation” to avoid the chances of receiving abusive care. Care navigators are women who are professional trained to improve care experiences. In hospitals, care navigators provide assistance in medical procedures, develop communications skills and can be used as translators. This makes it more reliable for indigenious communities. If a care navigator witnesses abuse towards the mother, they offer emotional support, companionship and privacy when in need. 

This podcast was produced by Anahy for the Spring 2021 Global Health class at Guilford College.

[Music fades in, plays, then fades out]

Annie: Vietnam is a country in Southeast Asia that is populated by individuals with darker skin tones compared to those in East Asian countries. Similar to other Asian countries, Vietnam culture upholds lighter skin tones. However, most Vietnamese people aren’t born with these traits. I talked to Tran Nguyen, a young Vietnamese woman who is very familiar with Vietnamese culture. As members of a high school tennis team, I played tennis with Tran often over this last summer and had meaningful conversations about the difference in norms between America and Vietnam.

Tran: So, um, I grew up in Vietnam for, like, 10 years until I was in fourth grade that I moved to the US.

Annie: My mother, who grew up in Vietnam, painted a picture for me of the ideas surrounding skin tone there.

[Ambient city noises begin]

Annie: Stepping into the busy streets of cities such as Saigon, you will observe crowds of people riding motorcycles or walking. For the most part, everyone wears long, thick clothing along with a sunhat despite the beaming sun. Although Vietnam’s climate is constantly humid and can reach temperatures into the 90’s, Vietnamese people still persist in wearing heavy clothing just to preserve their skin tone.

[Ambient city noises end]

Tran: You have to wear sunscreen, you have to wear a hat, you have to cover your arms and legs everywhere you go. It's important to cover up every part of your body so sun doesn't get you.

Annie: Wearing excessive clothing is one seemingly harmless method of conserving a light skin tone. However, many Vietnamese people take this obsession to the next level by using skin whitening products. These products range from face creams to oils, and a quick search on Google can prove the prominence and popularity of these items. Skin whitening products are even more popular amongst Asian markets and websites, and are often accompanied by advertisements depicting beautiful, light-skinned models. In Vietnam, these products are so normalized that they can be found all over peoples’ homes.

[Music begins]

Tran: My house is right next to a pharmacy so I see that them selling sunscreen and other whitening products and in hospitals and clinics it's always there because the demand is so high.

[Music ends]

Annie: Moreover, it is not only through stores and physical advertisements that skin whitening products thrive. Social media’s growth over the past decade has enabled skin whitening products to be marketed in greater numbers to an audience of younger, more susceptible individuals.

Tran: And now, even now, when I scroll to Tik Tok or Facebook, I would see um the user, they are like advertising and selling their products on there.

[Music fades in and plays]

Tran: And people are buying into this, they like oh look after 10 days this person using that and they got better. I should buy it too.

Annie: As Tran mentioned, apps such as Tik Tok and Instagram promote these products through sponsored advertisements made through users’ accounts as well as posts made on the companies’ page. These applications consist of a large number of young girls and women, so they will be further exposed to skin whitening products and believe that they are safe to use. The increased access and exposure to skin whitening products leads to a large number of the Vietnamese community who use the products.

[Music fades out]

Tran: It's, it’s the norm, because everyone else is using it, their mother, their friends are using it, and so they are using it too, because to them it's normal. Like everyone is using it, so it must be safe for me to use it to.

Annie: This bandwagon mentality is partially responsible for the boom in the skin whitening industry in Vietnam. As beauty companies marketed and successfully sold their products, they became increasingly popular amongst young Vietnamese women. The more that others used these products, the more that individuals who avoided them were shunned. This growing trend is so dangerous because skin whitening products are harmful in several ways. First, there are countless dangerous health effects of skin whitening products. These range from mercury poisoning to dermatitis. One of the most dangerous is nephrotic syndrome, which is a kidney disorder that can cause swollen ankles, foamy urine, and fatigue. Finally, skin whitening creams may contain corticosteroids which can cause your skin to react negatively and produce steroid acne. Moreover, the harmful effects of skin whitening products are not only medically-related.

[Music plays]

Tran: Society in Vietnam, they like to have, um, a woman, especially for women, they want to have like this pure and innocent look, and so they need to be like white skin, no makeup and have thin body. So that's why white skin is so important because you have to be able to look like you’re pure because white skin is associated with purity while dark skin is considered dirty.

[Music fades out]

Annie: Apart from the social pressure to use the popular skin whitening products, there are other cultural reasons for why Vietnamese people feel the need to lighten their skin. This is mainly centered around the discrimination towards darker skin tones, which can be traced back to the colonialism of Vietnam by the French in World War Two.

[Music begins]

Annie: Vietnamese society also has a habit of fetishizing the appearance of young girls, which they have placed on a pedestal as the beauty standard for young women. This discrimination of darker skin tones has encouraged a racist undertone amongst the Vietnamese culture and turns Vietnamese individuals against those who look have darker skin, whether these are people from Vietnam or different countries. This encourages discrimination and hate amongst Vietnamese people, which can lead to hate crimes and systemic racism in professional settings such as workplaces and schools. Moreover, skin whitening products promote the beauty standard of the “pure” young woman, which can lead to pedophilic and predatory attitudes among Vietnamese men. This perpetuates damaging expectations amongst people all around the globe and can contribute to the negative behaviors we see in men in our society. For example, there has been an increase in sexual assault cases as well as pedophilia. Moreover, racist ideologies in Vietnam can affect other countries through all of Asia, which creates a chain of stereotypes and hate crimes around various communities. While this starts in Vietnam, it also has the potential to expand to other different countries.

[Music fades out]

Annie: Sadly, there isn’t a likelihood of people, back in Vietnam, moving away from using skin whitening products, at least for the foreseeable future. This is mostly due to the normalcy of these products as well as the heavy expectation that you should have a light skin tone.

Tran: They are like using it every day, no, because society make them to use it and so now if they don't use it, they kind of, like they an outcast.

[Music begins]

Annie: However, there is still hope. Vietnamese culture had existed without skin whitening products in the past, and before the colonialism and growth of Western influence, they weren’t as fixated on light skin tones as they are now. In figuring out methods of how to prevent and solve the skin whitening crisis in Vietnam, I reached out to an individual who was of Vietnamese descent but was more disconnected from the Vietnamese culture. I will refer to him as Thomas, which is not his real name.

[Music fades out]

Thomas: Oh hey, I am a male college student who's currently studying in his second year at college. I grew up completely in America, I was born and raised here, so I don't have any experiences of Vietnam, apart from one single visit when I was very young. I think my relation more so, is towards the Vietnamese American Community more so than Vietnam.

Annie: His ties to Vietnam are stronger towards the young, college-aged Vietnamese-American community. This particular demographic has shown signs of straying away from the deep-rooted need for skin whitening products and light skin tone. Therefore, a clever intervention method when dealing with skin whitening products would be to mirror the actions this community is taking. Thomas mentioned that, in college, he had never seen skin whitening products used among friends or family members. Moreover, many young Vietnamese individuals are rejecting skin whitening products entirely. This may be due to the normalization of Western culture amongst Vietnamese individuals living in America.

[Music plays]

Thomas: Many of us have assimilated to Western culture. Now, most of our ideals about beauty are based on what the American beauty standards are and not so much Asian ideals of beauty.

[Music ends]

Annie: Young Vietnamese college students also have less time to deal with extraneous matters such as lightening their skin. College life consists of a busy, stacked schedule--not only are you constantly taking classes, you are also working part-time, doing internships, and dealing with relationships.

Thomas: You walk into the library, walk into the dining room, not many people wouldn't be dressed. And just make up and all that for women, at least I seen in colleges it's not something that people use daily just because there's no need to.

Annie: Finally, as college students today have become more tech-savvy, they can easily use the internet to search up the negative effects of skin-whitening products. These findings, taken from certified health organizations, would likely deter them from using the products entirely. Moreover, the internet and social media allows for easy sharing among family and friends, which would spread the message of the dangers of skin whitening products.

[Music plays]

Annie: So, we know now that skin whitening products are prevalent in Vietnam, and that young Vietnamese-Americans are straying away from these products through their own strategies. Combining these two discussions can help us formulate a plan for how we can deal with the skin whitening craze in Vietnam.

Annie: Firstly, we know that social media has been instrumental in both spreading the skin whitening trend and reducing it. Therefore, we can use this tool to our advantage to spread awareness and education surrounding skin whitening products. One way to do this would be to emphasize the different shades of skin tone through social media apps, in order to normalize the idea that lighter skin tones do not define beauty.

Tran: Like social media and products from the West maybe will be good for Vietnam to kind of open up and accept. Like tourism is also good, because they will see a variety of people like Middle Eastern people, African people that have different skin like tones.

[Music fades out]

Annie: Next, implementing more recreational activities and educational opportunities in Vietnam could allow Vietnamese people to meet others from different communities. This is similar to the American college environment where you are introduced to a melting-pot of different individuals. This would open their eyes up to the color that follows diversity and the beauty of all individuals. Moreover, these educational opportunities could instruct them of the dangers surrounding skin whitening products, and discourage them from using them.

Annie: Finally, skin whitening products are known to be sold in shady environments under disguises of “brightening” creams and washes. Implementing requirements for these products in order for them to be sold would help to notify the user of any negative effects.

[Music fades in]

Thomas: They make people aware of the dangers that these whitening products may have. Many of these products may not have been approved by the governmental agencies that overlook standards for marketing, so just making people aware of the dangers of these beauty products may have on their health now and years from now, may serve as more effective.

[Music fades out]

Annie: These “standards” could be indicated as danger labels on the packages that come along with a pamphlet filled with needed information. When customers become aware of these dangers, this could discourage them from purchasing them and make their society as a whole aware that skin whitening products are not safe.

[Music plays]

Thomas: To anyone who’s listening to this podcast if you're interested in using whitening products, just don't, and neither you should use tanning beds or tanning oils or what not, because those increase one's chances of getting cancer. I mean, everyone has their own beauty standards and, you know, you can dress how you want, and you can look how you want, but if, in the end of the day, that beauty standards that you subscribe to will affect your overall health and take away years from your life, then you probably shouldn't do those things. You’re beautiful as you are.

[Music fades out]

Click show detail for a full episode transcript 

Hannah [00:00:12] Alcoholism and alcohol abuse do not just arise out of our biology. They also arise out of the influence of our environments. The societies that we live in can create harmful norms around drinking, exacerbating illnesses and causing premature death. Russia is an example of this. A harmful drinking culture has been created by societal and gender norms in Russia. We will discuss several reasons this is the case. But first some important definitions and background information. When a person consumes four to five drinks in one hour it is considered binge drinking. A Russian term, Zapoi is a period of at least two days in which a person is continuously drunk and is unable to function normally. Behavior like this is generally accepted in Russia. Sometimes people drink things like glass cleaner, mouthwash, everyday items that contain alcohol but are not meant for drinking. When someone consumes these for the purposes of getting drunk these products are referred to as surrogates. It is common in Russia for people who are suffering from alcohol use disorders to drink surrogates. Russia is an industrialized nation. One thing that is common for industrialized nations is to have a higher average life expectancy, but not in Russia. For Russian men the average life expectancy is sixty five years old and for women it is 76 years old. In the United States the average life expectancy for men is seventy six years old and eighty one years old for women. You might be surprised by the difference in life expectancy between Russian men and women. You might be asking why is this what made this difference? Well alcohol consumption has a lot to do with it. Russian men on average drink a lot more than Russian women and in many cases it leads to higher negative health outcomes and sometimes premature death. But why is this risk so much higher for Russian men than women? Russian gender norms, expected and acceptable behaviors and attitudes based on gender. Research suggests, that in Russia it is more socially acceptable for men to drink much more than women. Men are usually seen as the breadwinner, the provider. This can become a large source of identity and self-esteem for Russian men. It is seen as more masculine to not ask for help with issues around drinking. It is seen as masculine to use alcohol as a way to cope with problems such as job loss. For Russian women it is expected and more accepted to drink less, care for their husbands, and cope with their problems in other ways besides drinking. To learn more about this issue I interviewed Dr. In Natalya Shelkova, a professor of economics, here at Guilford College. Natalya had this to say,

Natalya [00:03:37] I think it's my personal belief, but it's also statistically true that women have more responsibilities. So, the women are generally expected to hold a job and to do most of the household work, cooking, and cleaning, and educating children and so on. I mean there are men who are doing and helping and sharing responsibilities, but statistically it's mostly women and I think women is because they're concerned about survival of the children and well-being of the children they have to be, they have to stay more focused and they're less likely to drink.

Hannah [00:04:23] Another gender norm that helps create this problem is the compliance of wives of heavy drinkers. Research suggests, that it is most socially acceptable and expected for the wives of men who are experiencing alcohol issues to allow their husbands to continue drinking. Many women end up caring for their husbands when they are experiencing health impacts from alcohol. Wives might try to convince their husbands to stay home and drink with them instead of going out, so that the drinking is potentially more controlled. If a wife is more dependent on her husband for money and labor around the house she may not be able to divorce him because of his behavior.

Natalya [00:05:07] And because of the dependence on males for household needs they just didn't have a lot of choices. You know, when the male partners were in short supply for a long time. So, I think that's partly also led to this compliance.

Hannah [00:05:41] Lastly let's look at workplace culture. Young Russian, blue collar, men face the highest risk of premature death caused by alcohol consumption. Why is this? It is very common for young men to drink together with their co-workers. It is a very important part of socializing not only to drink, but to get very drunk.

Natalya [00:06:05] It's a cultural thing, but I don't think it's purely Russian. I think it is maybe less so in the US, but I see that happen here as well. Maybe they were drinking beer and watch sports on TV, not necessarily in a group of other men, but it might still happen.

Hannah [00:06:22] This exposure to drinking can be the beginning of a harmful pattern for young men.

Natalya [00:06:28] But I also think it's a lack of growth that the job has. Career growth. I mean there is no career, basically. So a lack of self fulfillment. As well as the difficulties of the physical aspect of the job. I think that's probably the two most important factors.

Hannah [00:07:06] After the fall of the Soviet Union, in 1991, things became a lot less certain and steady for Russian people. Many parts of the economy were starting to privatise fast. Many people lost their jobs, there were wage delays, there was a lot of uncertainty moving into the future. Some men would use drinking to cope with job loss. When they got another job drinking could sometimes interfere, which would lead to job loss again, and then to more drinking. So a pattern is established.

Natalya [00:07:41] So there was a big loss of jobs, which was even more then not during the Great Depression. It was very devastating. So it was alcohol and drug addiction.

Natalya [00:08:00] So there have been since 2000, I think that's partly linked to improvement in job prospects and improvement in standard of living. And general sense of greater security and economic security. There had been a general decline in alcohol consumption.

Hannah [00:08:22] For some men when they lost their jobs and did not have enough money to buy vodka they would buy surrogates instead because it was cheaper. Some men would go on longer periods of Zapoi. Begin to spend more time with other heavy drinkers and become socially isolated from friends and family. This would begin to lead to health complications from alcohol consumption, heavy dependence on alcohol, and potentially premature death. Although the global prevalence of alcohol abuse is highest in Russia, at the time of this recording, not all cases result in death. Many people continue to live with the disease.

Natalya [00:09:12] But also I think it's a little bit of lack of opportunities for self-expression from men. And maybe lack of meaning in life. And lack of sense of responsibility for the family and. Children which I think is partly historical.

Hannah [00:09:41] Drinking problems exist all around the world. Adding to the burden of health worsening illnesses causing injuries causing deaths. This cannot be addressed with policy change alone. These harmful norms need to change to. This podcast was produced by Hannah Kaplan for the spring 2019 global health class at Guilford College.

James [00:00:00] When you give something to someone and you say it's a gift. That may not be a gift that may again put them in a position where they're actually in a weaker position rather than a stronger position. 

Colby [00:00:25] Many people would consider medical mission trips to underserved countries a helpful asset. But what if I told you that these trips may contribute to a lack of resources and raise cultural and ethical concerns? Medical missions use many funds and resources, are volunteer trips really necessary? What is a good balance between conducting these trips and contributing to existing health care infrastructure? Short term medical missions are a form of unregulated medical service aid. These trips are usually taken by a team of medical professionals or volunteers from wealthy countries, with the United States having the highest participation in short term medical mission activity. The overall goal of these missions is to provide direct medical care to people of low and middle income countries. We will be focusing on the short term medical missions taking place in rural areas of Guatemala. I interviewed James Mulholland, executive director of Companion Community Developmental Alternatives, better known as CoCoDa. CoCoDa focuses their missions on communities in Central America, providing services such as water systems, rebuilding schools, and they work with projects geared towards public health. Kokoda strives to build strong and long lasting relationships within communities in Central America, with the overall goal being people over projects, which is particularly interesting considering that many missions fail to make building relationships a priority. 

James [00:02:10] Well, one of the things that we know from the research is that about two and a half million people from the United States travel to do international volunteering every year. We know that that's about a hundred and seventy five billion dollar industry. And we know that about 80 percent of the people who go have no recognizable or helpful skill or expertise. So, I mean, it automatically creates some some real issues. 

Colby [00:02:48] Short term medical missions are expensive and may waste valuable resources. There is evidence suggesting that short term medical missions are contributing to the lack of public health infrastructure in rural Guatemala. The real problem in these areas is not due to lack of physicians or medical personnel. It is due to lack of resources. Because of this, there are few clinics, hospitals and necessary medical supplies in these rural areas. And natives are relying on these volunteer trips instead of Guatemalan services for medical care. Global health scholar Paul Farmer has made issues like these known. 

James [00:03:32] There are some very serious risks when we do interventions. I remember Paul Farmer talking about after the Haitian earthquake, you had thousands of medical volunteers come to Haiti. Well intentioned. But what happened was if I'm a Haitian with a medical condition and suddenly everybody there is offer me free service, I'm going to go to where there's free service. Well, what it basically did over six or nine months, it completely destroyed all of the private health care system. 

Colby [00:04:15] Within medical missions and rural Guatemala, language and cultural barriers exist. A cultural and language barrier adds to the already difficult task of providing effective medical care. Short term trips also carry the risk of stereotypical views and attitudes. How can a volunteer understand a new culture in a week with the typical mission only lasting five to seven days? It is difficult, if not impossible, to get acquainted with rural Guatemalan culture, making it hard to provide effective health care. Judith Lascar, who has experience with global health volunteering and is a prominent voice in medical sociology, provides insights to these concerns. 

James [00:05:02] One of the things that we learned from the research of Judith Lasker in her book, Hoping to Help, is that short term volunteering often reinforces negative stereotypes rather than challenging them. You know, how can you possibly understand another culture if you go for a week? How do you really understand their context and that you're going to bring your assumptions to that visit and largely through confirmation bias. You're going to see what you want to see and you're not going to see what may be the real reality. So I think that's really important, is helping people understand that you you are not going to be a critic or an expert in a short term volunteering experience. When you engage in a culture, if you're doing that from a hotel or hostel and then dropping in, get the likelihood that she'll do harm is is much higher. Whereas if you're actually living in a community, living with people, there's a whole different kind of dynamic in relationships. So that becomes really, really important. 

Colby [00:06:10] There is concern volunteers are focused on seeing as many patients as possible, which could result in higher rates and misdiagnosis and complications. Since these trips are short term, there is also concern about follow up treatment of patients. Which brings into question are these trips ethical? 

James [00:06:30] I think this is especially problematic with groups wanting to do medical brigades, which we do not do. We do not do medical brigades simply because I think those have tremendous potential for doing harm. It's people who often don't speak the language. They're coming down for a very short term visit. They're probably bringing medications that aren't available in that country. They may be doing diagnosis that doesn't understand the context and they may not be connected with any continuity of care. So when they leave, whatever that person's ailment may be has not really been addressed. 

Colby [00:07:22] There are many ways current medical missions contribute to harm and may weaken an already weak system. For instance, primary care and financial resources are limited in rural Guatemala, and short term medical missions do little to address these issues. Not only are proper needs not being met, there is a potential to leave target communities dependent upon outside help. 

James [00:07:46] I think one of the questions comes and Farmer talks a lot about this and his work is, is what you're doing building capacity or dependency? And and those are a key questions. So the question is when I leave, will the people I leave behind be in a better position to take care of whatever the issue we're trying to address? Or will they be in a weaker position? 

Colby [00:08:14] When considering infrastructure, free care can be harmful.

James [00:08:19] When you give something to someone and you say it's a gift,that may not be a gift that may again put them in a position where they're actually in a weaker position rather than a stronger position after you leave. And again, I've seen so often where people come down and they say we want to give people free water so they build a water system and give it to people free. And those systems usually last less than a year. The water systems we do. There is a community fee, everybody who's connect to the water system pays a fee into a community fund that then pays for repairs, maintenance, chlorination, whatever the costs are for a water system. So the water is not free. I mean, everybody that community is going to pay to support that system. 

Colby [00:09:21] Clearly, these short term missions carry many risks, which begs the question, are these volunteer trips really necessary? 

James [00:09:30] The volunteers come and they slow it down and make it more expensive. We're very honest with the volunteers and say that's what you're doing. You're going to slow this down, make it more expensive. And if they will probably have to fix some things that you as a volunteer do. 

Colby [00:09:44] Since these ships are expensive, would the exclusion of volunteers be practical considering the ethical risks, would soliciting funds alone be a better option? Funds would certainly help, but how easy would it be to solicit funds without offering a personal experience? 

James [00:10:02] We didn't set out to be a group that use volunteers, but what we discovered is if you want to raise money, if you want to do projects, that it's very difficult to do that just by soliciting funds. That's one of the things most organizations have to do, is take people to the countries, let them see what's happening and get them excited. And then those people return to the United States and become champions for for your efforts. We also recognize that people want to help and people want to to see different parts of the world and see how they can engage. And that's that's not a negative thing. So I think all organizations, whether it's universities or nonprofits, all struggle with balancing that. How do you respond to this desire to help but do it in a way that's ethically responsible and actually doesn't do harm? 

Colby [00:11:14] There are many steps volunteers can take to ensure ethical and effective trips. 

[00:11:21] Well, in terms of short term trips, I think there might be a couple exceptions where we can be helpful. For instance, if we're going in to do specific kind of surgery, that may be rare or difficult in a region, for instance, cleft palate repairs or some kind of thing with eyesight or something like that, where there really can be a an intervention that that makes a significant difference and requires very little follow up. I think those can actually be a helpful thing. If there are physicians and nurses and volunteers in the United States who who want to to engage, they should be engaging in specific communities with specific health care providers. And then they need to make a commitment to support those endeavors, not just during their visit, but in going home and raising resources and raising support and providing medications or equipment. 

Colby [00:12:33] There are also a few things to avoid when considering a short term medical mission. 

James [00:12:40] I think what we have to stop doing is going down and doing primary care. Frankly, we just say that since to stop all over the world, that just needs to stop. What we absolutely need to stop doing is volunteer tourism, where I'm a doctor and I'm going to go to Haiti this year and do my thing in the next year, I'm going to the Dominican and then I'm going to go to Latin America. And then Asia, that's just got to stop. I mean, that that is absolutely exploitative. And we're just pretending that we're doing something for other people. It's just a way to justify or fundraise to do those kinds of trips. 

Colby [00:13:21] It's important to note that this is not just the opinion of one person, but many global health professionals as well. For instance, Judith Lasker says that if short term medical trips were the best way to handle health care, then why don't you and I rely on trips such as these? 

Colby [00:13:39] How do we avoid exploitation of those in need? What did the people of rural Guatemala and other countries ultimately need? Judith Lasker again provides helpful insight to these concerns. 

James [00:13:53] So she did a lot of work with host communities and host organizations and basically went to them and asked, do you realize that you're being exploited? And the. Almost universal response was yes. Which is very odd to think about, so we have all these these organizations in in developing countries, the North Americans come and they know they're being exploited to some extent. So the question she asked is, well, why do you keep doing it? And their response was the hope of future support. And I think that's very interesting because when I talk to people who are traveling. Develop a relationship with them and become an advocate. So I think there's a big disconnect between what people in the developed world are hoping for. And what people in North America and Europe are offering, there's this kind of huge disconnect. And I think being aware of that is really important. 

Colby [00:15:00] Avoiding the exploitation of communities is a must. Going to an underserved community and helping effectively is a wonderful thing, but not if the only takeaway is a picture that is posted to social media. There is a need for a long lasting relationship within these communities. Above all else, we need to make sure that short term medical missions to Guatemala and other countries are ethical, culturally aware and ultimately effective. My name is Colby Hinkle. This podcast was produced for the Spring 2020 Global Health Course at Guilford College. 

Click show detail for a full episode transcript

Jacquelyn: So, think about the world and what it’s gonna look like in 2050. Some might think about how geographically different it’ll be. What we should be thinking about is what the populations gonna look like. Some might think that the world will be overpopulated by the year 2050. As the popular trend right now in Japan, that’s not the case. 

Jacquelyn: The population in Japan is shifting from younger generations to aging populations. Someone might consider this to be a good thing for the world, but there are potential consequences that Japan could be facing. 

Jacquelyn: So let’s talk about what’s causing the declining birth rate in Japan. There are many social reasons that this is happening… First, there is a stronger presence of virtual dating (Rani, 2013). There’s actually a Nintendo game called LovePlus. Players basically simulate being in a relationship through their game boys. Men in Japan replace a real relationship and often treat this virtual one as if it’s real (Rani, 2013). 

Music..

Jacquelyn: Second, the role of women is shifting in Japan. Parents that are getting older are relying more on their daughters to take care of them as opposed to a son (Boling, 2008). This doesn’t leave a woman much time to be married, raise children and work to provide family income (Boling, 2008). The bond between a daughter and her aging mother is thought of as, more special (Boling, 2008). Japanese women don’t necessarily see the role of marriage relating to happiness, whereas Japanese men do (Boling, 2008). Women are embracing a sense of self and their own independence now (Boling, 2008). 

Jacquelyn: Not surprisingly, compared to being married young and having a family, Japanese women enjoy living at home with their parents while working and they basically having more freedom. (Boling, 2008). 

Jacquelyn: I caught up with Kina, who is a Japanese exchange student from Tokyo. I asked her about traditional gender roles in Japan.

Kina: As a society, people have certain stereotypes of gender roles. So, and traditionally in Japan the society has been patriarchal. So, a lot of men say that women should stay in home and do some stuff, like um cooking and cleaning and laundry. And, and women should um give birth to childs and raise them up. So, yeah that’s the traditional gender role for women and men are supposed to do work and earn money. Um, more women are working now but still it’s difficult for women to work and at the same time keep like, house, yeah so but I think it’s changing. 

Jacquelyn: I also asked Jun, who is another exchange student from Japan, about his opinions of gender roles in Japan and how his friends might view the future, his response reflects what Kina was saying about traditional gender roles in Japan. 

Jun: Men should work and a women should, you know, take care of children, their children and like cooking the food or yeah something like that. Women tend to want to like want to have a like family in the future and so like men want to like seek the career instead of like family. 

Jacquelyn: It’s surprising, but some people out there don’t see the aging population in Japan as a problem (Davis, 2018). One professional working in Gerontology is Sarah Harper. So she basically studies the elderly (Davis, 2018). As an expert in the field, she claims that there shouldn’t be any concerns with the aging population in Japan (Davis, 2018). She says that countries with ageing populations don’t need the younger populations to sustain themselves (Davis, 2018). 

Music…

Jacquelyn: What’s the government doing about the increase in the elderly population? Could they be helping the world by taking in refugees and immigrants to join the workforce? Historically, Japan has had really strict policies regarding it’s borders. Could opening the borders help the issue of the aging population? One big issue of the increase in elderly and aging populations is how they will be taken care of and still receive pensions from the government (BBC, 2013). They expect it right, after working their whole lives. 

Jacquelyn: I asked Kina about the shifting age of the population and how it could be sustained. 

Kina: Because younger generation are like decreasing in terms of number, like population. Um, we have to support like elderly people by paying a lot of taxes. And so, If you get a job and when for example when you retire at the age of 60 or 65 you can get money from the government in Japan. And for example my grandma is getting money from the government but I don’t know if we can get money from the government when we get older.

Jacquelyn: When I asked Jun about the aging population he also responded in a similar way and that told me that most Japanese are aware and had in depth knowledge of the subject. 

Jun: Compared to like young people the number of like you know senior people are growing up so the problem is like the young people uh is, uh, how do you say like, responsible to pay you know the tax instead of like senior people can. So, I mean, so, this is a serious problem in Japan.

Jacquelyn: An obvious problem with the aging population is those who are of age to still work and help the economy. For Japan to open up its borders does show that the government does believe there is a problem and their trying to fix it (McCurry, 2018). Therefore, there should be some kind of policy that incentivizes people to immigrate to Japan. An obvious solution to this problem would be turning to the rest of the world for help. There is a staggering statistic that the number of people working in Japan will fall from about 55 million to around 8 million by the year 2030 (McCurry, 2015). Interestingly enough, Japan does fund aid for countries in need, but still has a strict immigration policy (McCurry, 2015). One benefit of this new policy by the Japanese government is bringing over people with skills from other countries (McCurry, 2018). They will gain even more skills while in Japan but in return they’ll go back home with these skills and help their own countries’ economies (McCurry, 2018). One criticism of this policy has been that those who have valuable skills will be able to bring their families, while those with less skills will not bring their families and will have to go back home after 5 years (McCurry, 2018). Japan will also have to provide sustainable housing, health care and basic needs for these immigrant workers. 

Jacquelyn: I asked Kina if she noticed people working in Japan from other countries.

Kina: I see many um, Asian people working in convenient stores in Tokyo. Sometimes, all, um, most of employees are for example Pilipino or maybe Malaysian people. And, yeah, a lot of Asian people are coming I think. But I don’t know if their working environment is good, if the e-employers give them enough money and treat them nicely. So, yeah I am not sure and I don’t think their environment, working environment is good. So yeah but the number of foreigners working in Japan is increasing.

Music..

Jacquelyn: If you asked anyone on the street in the United States about this issue I would guess they don’t know about it. We should be concerned with global health issues around the world. Due to global overpopulation many people wouldn’t consider the declining birth rate in Japan as a problem but in reality the research shows that is a problem. Thanks for listening.

Jacquelyn: This podcast was produced by Jacquelyn Fulk for the Spring 2019 Global Health course at Guilford College.

Kate Glenn [00:00:40] Today I'm going to be discussing the public and environmental issues linked to mining in Chile South America and in southern West Virginia. Two major mining years in the world. I come from a background of coal and I am also from and grew up in a small town in West Virginia West Virginia's main economic source is coal mining. 

Kate Glenn [00:01:05] Mountaintop removal in West Virginia is very prevalent and extremely harmful research shows it leads to the development of chronic diseases and birth defects. 

Kate Glenn [00:01:25] Fortunately I didn't directly grow up in the southern part of the state but I've traveled and seen mountaintop removal take place. Mountaintop removal affects so many local communities in southern West Virginia that also struggle with food insecurity and many living under the poverty line. Even though these events may be happening far away in another country or state and may not be visual to you in real life the impacts are still affecting you every day. 

Kate Glenn [00:02:02] In many cases there are renewable resources but until it becomes less expensive and more accessible. Coal mining will remain the number one energy source in the world. You and I use coal every single day. If we turn on a light switch or turn on the TV coal power is 40 percent of the world's electricity. And mining is the number one polluter producing 39 percent of carbon dioxide emissions and 42 percent of mercury emissions. Even nitrogen oxides produce for example smog are harmful to respiratory systems and can cause chronic diseases such as pneumonia. These toxins are harming public health. 

Kate Glenn [00:02:46] This isn't just happening nationally but also on a global scale. I've also visited Chile South America. My dad's side of the family is from and my grandma was born. She grew up in a small mining town called Chuquicamata when I went to the town it is just how I imagined small and only people living there are the workers the mine I visited was huge. 

Kate Glenn [00:03:11] And just by being there a short amount of time I could see how dangerous it was working there. 

Kate Glenn [00:03:17] Alberto Cerdo is a mining engineer in Chile's south America 

Alberto Cerdo [00:03:27] I've been working for the industry since I got out of the university as a civil mine engineer. I started in in former engineer position writing into production. 

Alberto Cerdo [00:03:40] Then I moved to business professions or positions. And then to executive positions. So I mean in most all of the areas meaning production, projects, business and all of them related with the mining of copper and mining of gold. 

 [00:04:01] Mining has been a part of Chile's culture since pre colonial times. 

Alberto Cerdo [00:04:05] Just like Chiquicamata, there ae]re local communities surrounding various mines in Chile also being affected. Researchers found that outside three mining towns they had depletion of water and even an increase in prostitution and venereal diseases. Not even mentioning they are breathing in the toxins that the mines are releasing every single day. \. 

 [00:04:23] in all of my career communities have been involved in in mining. In the last ten year I would say or 15 years it's been more in the in the media and also in the news about the mining and the relationship with the community. But the truth is that communities have always been a very important part of the mining industry and in the way that the mining related to them is by first of all offering very good quality positions offering them also developing the little towns or the cities where mining are close to it. 

Kate Glenn [00:05:16] Other environmental downsides include deforestation and erosion. Erosion causes soil and sediments to run into streams rivers and contaminate waterways. Because these waterways become contaminated. This is a threat to everyone drinking from well water or even your own tap water. 

Alberto Cerdo [00:05:35] And also mining there has to be very respectful of the communities but also very respectful of nature and in an ecosystem and biodiversity because that is very important for the communities and should be important for all of the people that works in the mining industry my experience all of the all of the relationship has has been positive. The same example of stamina. It's been really positive. And the company has been able to interact with all the community interaction with community. It doesn't mean everything is is sweet and nice human relations has ups and downs. The important is that in the mid and long term the relationship continue it continues and is and is perceived as a positive relation always. 

Kate Glenn [00:06:36] Not only did environment and communities suffer the workers are hit directly. 

Kate Glenn [00:06:41] Health impacts from mining is seriously no joke. The workers go through harmful work conditions every day. Let's not forget about the incident in 2010 where 33 miners got trapped in an escape shaft in Chile. Miners also experience polluted gases even though they wear some type of protection. It does not entirely prevent harmful gases from entering their lungs. 

Alberto Cerdo [00:07:05] In my personal experience environment and communities right now are a very important area of decision making process is not only production and cost now is is safety of the people that works in the mine safety of the people of the communities due to the mining industry. Also have a really good quality of human relations human human resource relation of people relations. 

Alberto Cerdo [00:07:38] And of course social and environmental variables that any top manager should be accountable for my name needs to be more regulated and in the future we need to find a more environmentally friendly option to fuel our electricity. Mining will not go away. 

Alberto Cerdo [00:08:03] Well mining will continue to be part of the human civilization and the human model and the way to live. We love medals. 

Alberto Cerdo [00:08:15] Not only Iron. We love copper. We love lithium. We will require more lithium more copper more cobalt in the future in order to maintain the planet away from CO2.  

Alberto Cerdo [00:08:33] So mining will continue being an activity that humans will need. 

Alberto Cerdo [00:08:39] It's not something sometimes uh that that seems to be very friendly with environment. And it's also very demanding of people. 

Alberto Cerdo [00:08:48] But is there is a need for the human race if we continue. And in light to have these more than type of life that we have every equipment every unit everything that we do today in the modern world is thanks to metals that human can actually use. 

Kate Glenn [00:09:21] This podcast was produced and scripted by Kate Glenn as part of the spring 2019 Global Health course at Guilford College. 

Click show detail for a full episode transcript 

Intro:

Today, we will be talking about a particular disease that mostly everyone knows

about. Either knows about someone who’s been affected by it or has a personal

anecdote to it; cancer. It’s not an easy topic to talk about because of the

expansive subtopics it’s associated with; so, we are going to only focus on Breast

Cancer for this episode. Cancer has a negative connotation because of the belief

that it can’t be treated effectively and most importantly prevented.

What would happen if we compared the interventions towards breast cancer that

exist or are nonexistent in California and Mexico City? Could clinics, hospitals,

or community health workers adopt a model tackling breast cancer from a

particular region and bring it back to their communities to create a positive

impact? Or would this change add on to the disparities and affect the

community in a negative aspect because of the resources that are available to

them?

**Music**

This podcast episode is titled, “A Global look at Breast Cancer Interventions

and Prevention Measures in Urban Cities ” Today on our show, I am joined by

various clinical managers, executive directors, nurses, and a variety of patients

from hospitals and clinics all throughout the Globe. They will be sharing their

experiences and perspectives with Breast Cancer in the Healthcare System in

the United States or in Mexico.

[Music]

According to the CDC as of May 29, 2018, breast cancer in the United States was

the most common cancer in women, despite one’s race or ethnicity. Breast cancer

is the most common cause of death among Hispanic women, black identified,

Asian/Pacific Islander, American Indian/Alaska Native, and among white women

it is the second most common cause of death. Based on a national survey

conducted by the NIH, the number of new cases of female breast cancer was 126.0

per 100,000 women per year.

The annual rates of cancer diagnoses and cancer deaths decline progressively each

year, but the number of new cases and deaths among patients is going up. This

occurs because of many factors such as a person’s living situation (at a geographic

level), the variability of cancer treatments available, their socioeconomic status,

and language/cultural barriers that they face.

A person’s health and well-being are very much influenced by their individual

situation, where they are in the world, and the resources that are available to them.

Imagine that you are in Oakland, California; an urban city rich with culture, music,

and an average weather of 65 degrees. Oakland’s population as of 2019 is just

over 400,000 people and an 18.9% poverty rate; higher than the national average

of 14%. The largest demographic living in poverty are females between the age of

25-34 as of 2019.

Supporting Interview: How expensive the Bay Area is and continues to be..

Especially over the last couple of years is of such concern to us and so trying to

figure out what we can do.. What little part we can play to make the lives of the

ladies who walk in these doors.. To make their lives better. We’re grateful to be

able to offer the respet that we do to our clients in big and small ways.

Not all urban cities have plenty of data information on breast cancer prevalence

and mortality rates to aid in breast cancer interventions and healthcare as a whole.

Let’s take a look at Mexico City, Mexico. The government of Mexico has a lot of

influence regarding this issue because of the corruption that exists among the

cartels across the country.

Supporting Interview:

A lo largo de muchos lugares de México, tanto en la ciudad de México como en los

estados de México, hay un gran impacto de la violencia por el crimen organizado, hay

muchos narcos y carteles. La cultura de los narcos tienen una gran influencia. Donde

muchos de ellos tienen acceso a la salud, porque tienen los recursos, tienen el dinero,

y tienen la posición y el poder como con el gobierno. Esto nos afecta a los demás,

refiriéndose a las personas como yo y a las personas de bajos recursos y que tienen

una posición social que no es buena comparada con el narcotráfico.

Information Continued:

Because healthcare management is going through a transition, a lot of the

healthcare initiatives are not tackling breast cancer research. Mexico does not have

a population-based cancer registry; so this hinders alternative healthcare initiatives.

A wide range of cancer treatments exists all across the world. Breast cancer

interventions and preventative care are being tackled differently, yet similarly in

Oakland and in Mexico City. From a traditional western approach, referring to

treatment and care in the hospital, to a more holistic healthcare approach, such as

integrative clinics. Yet, there also exists the route of no treatment and focusing on

the well being of the individual.

With this being said, Joanne Calderon explains why she believes that the holistic

healthcare approach is beneficial to women with Cancer in California.

Interview (Joanne Calderon) - “So, our clientele when I say low income women

with cancer, everyone has to have a cancer diagnosis. And it doesn’t matter what

type of cancer diagnosis; and I mention that because often people only serve

women with breast cancer. And what we have noticed is that while the majority of

our clients at any one time it’ll be between 65% - 80% of our clients have breast

cancer. The women with breast cancer, they need more services certainly. But, the

women with cancers other than breast, they barely have anything. And so, what do

we do.... We offer acupuncture, we offer all kinds of body works. Of course,

people know swedish massage; people might know Shiatsu; but we have

biodynamic massage, Craniosacral, you name it. We have so many types of

bodywork; Western and Chinese Herbs for sure. We have different types of energy

work; including Guided Imagery. Which is so important. We have Homeopathy;

people often think of homeopathy relating it back to if you have children; colds and

flus. But, I have to say the majority of our clients use it to help them manage their

anxiety, their depression, their stress.

Music

Break

Others may believe that a combination of a holistic and traditional approach is the

best option for patients with breast cancer. A breast cancer patient and survivor

from San Francisco General Hospital explains her take on this opposition.

Interview (Breast Cancer Patient) -- Yo pienso que los médicos pueden

ayudar más a las personas con cáncer y el complemento serían los cuidadores de

salud. Cuando están bien capacitados pueden hacer entre los dos un buen trabajo

para proporcionar a las personas una buena atención.

But, in a city where breast cancer data rates lack, such measures are not possible

and receiving cancer treatment at healthcare facilities might not be the best case.

An alternative approach: the caregiver system might be the best case. Cancer

Caregiver and Nurse, Mari expresses her thoughts.

Interview (Caregiver and Nurse) -- Pues yo pienso que los cuidadores y los

médicos tienen que hacer un equipo para el cuidado de los pacientes. En este caso,

el médico es el que da el tratamiento terapéutico y el cuidador lleva al cabo el

tratamiento psicológico y de rehabilitación.

Interlude: [Music break]

A person’s socioeconomic status is very influential in the type of breast cancer

treatment that they receive. This is particularly true in all of the cities that we are

taking a look at as it can be testified by two current cancer patients receiving

treatment in two different healthcare clinics. Julia is a breast cancer survivor that

received treatment at Charlotte Maxwell Clinic. Pamela is also a cancer survivor

but is a patient at UCSF.

Interview (Julia) -- Mi nombre es Julia y soy una paciente en Charlotte Maxwell

Clinic. Soy de bajo recursos y aunque sí recibo tratamiento gratis. No tengo la

oportunidad de recibir tratamiento diariamente. No me quejo, al contrario estoy

muy agradecida. Pero mi experiencia es muy distinta a la de alguien que va a un

hospital privado; pues existe más atención y ayuda.

Music

Interview (Pamela’s Husband) -- Yo soy el esposo de Pamela y fijate que mi

esposa a recibido algunas atenciones medicas en un hospital de bajos recursos.

Pero, la mera verdad de mi experiencia es que mi esposa ahorita esta atiendendio

un hospital privado. Por la diferencia de ser un hospital privado, ella atiende a un

hospital que se llama UCSF en San Francisco. Ella atiende a los oncólogos y le dan

sus citas a tiempo. Y en la experiencia del otro hospital, las citas te las dan muy

largas.Cuando llegas al hospital en tu cita; te tienen ahí esperando como dos horas.

So realmente, entre un hospital privado y un hospital que da asistencia pública, es

muy diferente la atención médica que dan hacia mi esposa Pamela.

Information Continued:

There were clear socioeconomic differences between Julia and Pamela; which

allowed them to receive “better” treatment. Yet, who defines obtaining a “better”

care. Well, it’s not the clinic or the hospital having the latest medical equipment,

yet having access to medical interpreters and resources such as food vouchers or

waivers for medical expenses. I’m referring to the language and cultural barriers

that patients face in going to a facility with higher resources as compared to one

that doesn’t.

[Outro Music]

So, folks, we are coming to an end for today’s episode of “A Global look at Breast

Cancer Interventions and Prevention Measures in Urban Cities” Thanks for

listening, and thank you to all of the interviewees for joining me today to talk about

the diverse interventions tackling cancer among underrepresented communities.

[Closing Music Jingle]

This podcast was produced by Berenice Fuentes-Juarez as part of the Spring

2019 Global Health Course at Guilford College. Sound bites were obtained from

the public domain.

Click show detail for a full episode transcript 

Intro:

- Light upbeat music

DIALOGUE:

- Me: From Guilford College’s Global Health course. This Caterina Illiano

- Monica: Health. Health in this country is a privilege not a right even though it’s defined

in the Constitution.

- Me: That’s Monica. She’s from Medellin, Colombia. She is a mom and teacher at a local public school. During the weekends she gathers people in her community to purchase the products of the wayuu people and helps them to set up stands where they can distribute their hand made goods to tourists in the city of Medellin.

- Me: Deep in desert along the Guajira Peninsula in the northernmost part of Colombia and northwest Venezuela lies the world's most forgotten tribe. The wayuu people.

- The Cerrejón coal mine is believed to be polluting the water and in 2011 the Cercado dam was built and within a few years managed to drain the river of all life. The suffering is directly related to the circumstance of poverty the Wayuu are facing and if the government stopped putting environmental stressors on the region exploiting it of its resources then the Wayuu people could grow their own food and sustainably farm in their environment. This is an issue bigger than the Colombian government forgetting its indigenous people and exploiting the land that they live on it's also a violation of humanitarian rights to block the Cercado dam and limit its water distribution amongst the region.

- However, I sat down with Monica to get more insight into how the Colombian government disproportionately disadvantages its indigenous people and has corrupted its own health care systems.

- Monica: Health in Colombia health in this country is a privilege not a right as defined by the Constitution year. People die here everyday because of the deficient provision of these healthcare services sometimes it is not provided that is given fundamentally for two reasons one because it became a business that surpasses all life and because corruption permeated at all levels and it is incredible that through a guardianship that doesn’t enforce a fundamental right where it should. Health in Colombia has deteriorated so much for this reason.

- Me: Here Monica is explaining that people in Colombia are disadvantaged because the healthcare system is corrupted and has become corrupted on many levels.

- Me: According to CDC Over 70% of children faces stunted growth and mental

disabilities due to geographical and political circumstances. There is minimal to no global media coverage documenting this tragedy. The Association of Military Surgeons of the United States have deemed these populations hard and very difficult to study and that's why the health statistics are scattered and there isn’t much knowledge regarding the current crisis.

- Monica: Well they are very very affected all the time more than is proportional and the government has been stripping them of their land for decades in fulfilling the economic and political commitments that by Constitution many should actually enjoy but many indigenous children die and for many children this is due to lack of health and due to lack commitment from the same government because they fail all the time there is no commitment.

- Me: Monica is saying here that the indigenous people are affected all of the time because the government has been stripping them of their land for decades and fulfilling the economic and political commitments but if Constitution was upheld many would actually enjoy and have better circumstances but many indigenous children die. And for many children this is due to lack of health and due to lack resources from the same government because they fail and there is no commitment.

- Music ominous

- Me: I asked Monica what she thinks will happen to Indigenous land that is now receiving an increasing amount of Venezuelan migrants due to Venezuela's current political conditions.

- Monica: I think there will be changes Well I see it difficult because with the current leadership there is not much hope the truth is a dark picture Because the more difficult the situation is becoming here in the country is getting complicated.

- Me: She told me that it was complicated and very detailed because the current leadership is not very promising and the truth itself is a dark picture.

- Me: This podcast was produced by CAT ILL for the spring 2019 global health course at guilford college.

 Click show detail for a full episode transcript 

[00:00:09] (Music fades in)

Scott Trent:

 Most shocking and really unacceptable fact this is an estimate that the Centers for Disease Control put out about three years ago that said that one out of every two black men who has sex with men will become infected with HIV in their lifetimes. If current rates continue. 

(music)

[00:00:39] 

McKinley Durham:

This is Scott Trent. Scott Trent actively works for the triad health project to prevent and treat people living with HIV/AIDS. He and his co-workers are very up to date on issues regarding HIV/AIDS. While it is more common to find people in the United States doing such work I will be discussing the issues and prevalence of AIDS in Malawi. 

(music)

[00:01:09] 

McKinley Durham:

HIV is a virus that attacks a person's immune system preventing them from fighting off infections well.

[00:01:14] 

Scott Trent:

Another way of looking at it is that you've really got to be doing something very very intimate with a person in order to become infected. It doesn't just pass from one person to other through handshakes, through sharing food, through drinking after a person or using the same restroom as them or using towel them or any of those things. 

[00:01:34] 

McKinley Durham:

This infection is very scary to think about. Even though there are medicines to help this virus in its early stages people who lack access to health care do not have the chance to help themselves get better. So this infection tends to be more prominent in developing countries. In a small country in Southeast Africa HIV/AIDS is very common. This country is Malawi. Malawi is a rural country where the village people live far from health care. If there is health care close to them often it does not deal with serious cases. Sometimes it has no supplies to even deal with minor injuries. They often are moved to another facility. The village people know that rural clinics may be of no help and the clinics in town are very far away. With nine point two percent of its population with HIV/AIDS accessible doctors are needed to be in the area with supplies for possible patients. Malawi's neighboring country Angola has HIV/AIDS rate of two point one. The United States has a rate of point three percent of HIV/AIDS. The prevalence of this disease in Malawi is alarming. People living in Malawi have many factors to why they would rather live with HIV/AIDS than do treatment. Even while antiretroviral drugs can be free of cost bus fare can be very expensive for the people living in rural areas. Also many people do not want to get tested out of fear of being shunned from their community. While taking their treatment the patients have to have food and water to take it with. Sometimes the Village People do not have enough food and water to take the pills consistently. Another big issue is when people do get tested it is often in the late stages of AIDS where there is little to be done to prolong their life. These are a few factors why this country has such a high rate of HIV/AIDS. Some of these factors that people in Malawi deal with are similar to those in the United States.

[00:03:30] 

Scott Trent:

There is the question of transportation. We can give them bus passes we do when we give we give clients bus passes so they can make their appointments and that sort of thing. But you know you don't have a car you're reliant on public transportation. It's not always there. It's not always available. It's not easy you know. And that's just to get us to get them here. If they need to get to the pharmacy to pick up their meds that's a whole other that's a whole other trip. How they're going to keep their bills paid you know how they're going um you know how they're going to keep a roof over their heads. I mean that's it's it's an ongoing challenge for lots and lots of people.

(music)

[00:04:14] 

McKinley Durham:

There are three stages to this virus. The first stage is a acute HIV infection. In this stage it is very easily transmitted.

[00:04:23] 

Scott Trent:

One of the first things that they would um first symptoms that they would notice would be the kind of symptoms you would associate with with the flu. It's really super high fever, night sweats and it's the kind of flu or like the kind of symptoms that are going to last for weeks. It's gonna be like the worst flu that you've ever had. Also things that you might notice during that time is increased yeast infections, THRUSH, which is another kind of a yeast infection you get in your throat that does not respond well to treatment.

(music)

[00:05:00] 

McKinley Durham:

The second stage, chronic HIV infection there are generally no HIV symptoms but it's still very easy to pass on to others. If the virus is left untreated it results in AIDS, which is a most serious form of the virus. With the immune system compromised, it makes it harder to fight off infections. There is no cure for AIDS but it can be prevented by the treatment for HIV which is called antiretroviral therapy.

[00:05:27] 

Scott Trent:

We've also got a new a new form of prevention that's called PrEP which is a one day pill of a right now the only drug that's avai- that's available for use as PrEP is a drug that's called Truvada and it's been used for the treatment of HIV for a number of years. But it's now also being used for the prevention of HIV. A person taking PrEP once a day provides themself with about a 99 percent protection against HIV in the case that they are exposed to the virus. There's no better you know prophylaxis out there. There's nothing that works better than that. But unfortunately here in North Carolina way too few people know about it. We've got all the tools that we need to to end this epidemic. We've got to you know you think of there's a good sort of equation that we use these days which says U=U and that stands for undetectable equals untransmittable. Treatment is the key to that. If we can identify all you know all the cases you know everything you know all the people out there that are living with this living with this virus and get them in treatment and there's no reason why we can't. You know I mean? The medications exist. The ability to get the medications to people does exist. If we can do that we will dramatically cut the number of new infections. 

(music)

[00:06:52] 

McKinley Durham

This podcast was scripted and produced by McKinley Durham as a part of the 2019 Global Health course at Guilford College. 

(music fades out)

 Click show detail for a full episode transcript 

Music Plays....

Candice [00:00:12] Hello! My name is Candice Burch and, in this podcast, I’ll be talking about

problems associated with hypertension in Ghana as well as in the United States. During this podcast

I will briefly discuss parts of the interview with Adele Alston who is from Brooklyn New York

further discussing the problems associated with hypertension in Ghana and also the United State.

Music Plays....

Candice [00:00:12] when you were living in New York tell me a little bit about when you were

diagnosed with high blood pressure.

Adele [00:00:58] It was about over 10 years ago and I was experiencing a lot of headaches. I would

try to take over-the-counter medications. But it did not resolve the issue. So, I went to the doctor

and they had taken my pressure and it was about a hundred and eighty over 102 and I was

diagnosed with high blood pressure and they put me on medication.

Candice [00:01:39] Wow how interesting is it for symptoms to arise and not even know exactly

what's going on. That's why it is important to keep an eye on your pressure at all times.

Music Plays...

Candice [00:01:59] The number of reported new cases of hypertension in outpatient public health

facilities in Ghana increased more than tenfold from about 49,000 in 1988 to five hundred and five

thousand in 2007.

Music Plays...

Candice [00:02:17] What do you think contribute to your high blood pressure? Do you think it was

hereditary? Environmental? What do you think.

Adele [00:02:26] It was environmental it was stress.

Adele [00:02:30] Also my eating habits was not up to par.

Adele [00:02:41] I used to intake a lot of salt and after using so much salt on my food for so many

years it finally caught up with me.

Candice [00:02:54] If there is a health policy put in place to help prevent or lessen hypertension

leading to heart disease then there is a possible chance for less heart problems. Secondly,

hypertension is important public health problem because it also causes death in communities.

Music Plays....

Candice [00:03:21] Could you die from having high blood pressure?

Adele [00:03:26] Yes you can. If it gets high. You can get high blood pressure and It becomes so

high that you can have a stroke or you can get heart disease. So yes, you really have to think about

yourself.

Music Plays....

Candice [00:04:02] Stroke and hypertension are among the leading causes of admissions to

hospitals and death as well. Hypertension is an important cause of heart and renal failure in Ghana.

Also, hypertension is a global public health issue and it contributes cynically to cardiovascular

disease, kidney failure, premature deaths and disabilities. Hypertension is not a good thing to have

if it goes un-care for or if it becomes out of control it can cause other health disease problems like

renal failure which then lead to the cause of death. Lastly, hypertension is an important public

health problem because not many people have the awareness, they need to control it or prevent it.

According to the National Health Insurance Scheme the awareness of one's own hypertension status

was associated with gender marital status level of education ethnicity and health coverage. The

majority of women have register with the NHS compared to men. Studies also show the

unwillingness to report and seek medical attention. This behavior could account for low awareness

of heart disease especially with the condition like hypertension that most times does not show

symptoms. In conclusion you could see there are many factors play an important role in

hypertension being aware of hypertension is super important because you can never know what

hypertension could get worse or even how to control it.

Music Plays...

Candice [00:05:29] Do you have any knowledge on why do you think public pressure is kind of

hard to treat or deal with or to be aware of in Ghana or a place outside the United States?

Adele [00:05:44] They probably don't have the correct facilities, education or having the right

providers to help the people who need the help in getting treated for hypertension.

Adele [00:06:03] That's the only thing that I can see at this point as far as versus being here in the

United States or being out of the country.

Music Plays...

Candice [00:06:16] Thank you all for listening to this podcast. I hope that it was enjoyable.

Music Plays....

Candice [00:00:12] Hello! My name is Candice Burch and, in this podcast, I’ll be talking about

problems associated with hypertension in Ghana as well as in the United States. During this podcast

I will briefly discuss parts of the interview with Adele Alston who is from Brooklyn New York

further discussing the problems associated with hypertension in Ghana and also the United State.

Music Plays....

Candice [00:00:12] when you were living in New York tell me a little bit about when you were

diagnosed with high blood pressure.

Adele [00:00:58] It was about over 10 years ago and I was experiencing a lot of headaches. I would

try to take over-the-counter medications. But it did not resolve the issue. So, I went to the doctor

and they had taken my pressure and it was about a hundred and eighty over 102 and I was

diagnosed with high blood pressure and they put me on medication.

Candice [00:01:39] Wow how interesting is it for symptoms to arise and not even know exactly

what's going on. That's why it is important to keep an eye on your pressure at all times.

Music Plays...

Candice [00:01:59] The number of reported new cases of hypertension in outpatient public health

facilities in Ghana increased more than tenfold from about 49,000 in 1988 to five hundred and five

thousand in 2007.

Music Plays...

Candice [00:02:17] What do you think contribute to your high blood pressure? Do you think it was

hereditary? Environmental? What do you think.

Adele [00:02:26] It was environmental it was stress.

Adele [00:02:30] Also my eating habits was not up to par.

Adele [00:02:41] I used to intake a lot of salt and after using so much salt on my food for so many

years it finally caught up with me.

Candice [00:02:54] If there is a health policy put in place to help prevent or lessen hypertension

leading to heart disease then there is a possible chance for less heart problems. Secondly,

hypertension is important public health problem because it also causes death in communities.

Music Plays....

Candice [00:03:21] Could you die from having high blood pressure?

Adele [00:03:26] Yes you can. If it gets high. You can get high blood pressure and It becomes so

high that you can have a stroke or you can get heart disease. So yes, you really have to think about

yourself.

Music Plays....

Candice [00:04:02] Stroke and hypertension are among the leading causes of admissions to

hospitals and death as well. Hypertension is an important cause of heart and renal failure in Ghana.

Also, hypertension is a global public health issue and it contributes cynically to cardiovascular

disease, kidney failure, premature deaths and disabilities. Hypertension is not a good thing to have

if it goes un-care for or if it becomes out of control it can cause other health disease problems like

renal failure which then lead to the cause of death. Lastly, hypertension is an important public

health problem because not many people have the awareness, they need to control it or prevent it.

According to the National Health Insurance Scheme the awareness of one's own hypertension status

was associated with gender marital status level of education ethnicity and health coverage. The

majority of women have register with the NHS compared to men. Studies also show the

unwillingness to report and seek medical attention. This behavior could account for low awareness

of heart disease especially with the condition like hypertension that most times does not show

symptoms. In conclusion you could see there are many factors play an important role in

hypertension being aware of hypertension is super important because you can never know what

hypertension could get worse or even how to control it.

Music Plays...

Candice [00:05:29] Do you have any knowledge on why do you think public pressure is kind of

hard to treat or deal with or to be aware of in Ghana or a place outside the United States?

Adele [00:05:44] They probably don't have the correct facilities, education or having the right

providers to help the people who need the help in getting treated for hypertension.

Adele [00:06:03] That's the only thing that I can see at this point as far as versus being here in the

United States or being out of the country.

Music Plays...

Candice [00:06:16] Thank you all for listening to this podcast. I hope that it was enjoyable.

 Click show detail for a full episode transcript 

Intro (Music fades out)

Kendra: The Dominican Republic is a tropical island, so mosquitos are everywhere. Los mosquitos están en todas partes, así que ten cuidado mi gente (the mosquitos are everywhere my people so be careful). Growing up my grandma would say “si no quieres que te picen los mosquitos, ponte vapor ru”. She was telling me that If I didn’t want mosquito bites to put vapor rub on my body to prevent bites. I would spend my summers with her in Dominican Republic. I never knew how mosquitos were affecting the Dominican people till I was older. The Dominican Republic, a sunny, tropical island. It's known for its beautiful blue ocean waters and white sandy beaches. But many do not know many of the issues that the people of this beautiful island face. There is an illness many Dominicans are facing that can also affect tourist. Outside of these resorts and sunny beaches many are facing extreme poverty and illness. How can this illness spread? The answer is mosquitos. Today I will be talking about Chikungunya. 

Kendra: En serio mi gente, chikungunya is nothing to play with it can literally infect anyone who is bitten by a mosquito. Once bitten by a infected mosquitos it may take up tp 10 days to for symptom to show. Symptoms include joint and muscle pain. Symptoms also include flu like symptoms. Let's get real, a lot of Dominican Republic is rural. If you need to see a doctor you need to go to the nearest city. There are many cases of Chikungunya but many are not reported cause of access to proper lab screening to confirm and because many can not seek medical help. Usually those who are infected can be infected multiple times if they do not have proper medical attention. The only way to stop the rapid spread of the disease is to avoid getting bitten by mosquitos and if you are infected by the illness to seek immediate medical attention. Which both can be very hard. What needs to happen to help la gente de la república dominicana? Dios mio to many people are being infected by chikungunya. 

Kendra: Since there is not a vaccine or treatment for chikungunya there is not much doctors can do. Doctors can treatment the symptoms of the illness but that's it. This includes treating joint pain, headaches, fever, and nausea. Let's be real it's almost impossible to control mosquitos. Is this the case for most people trying to seek medical attention? What do hospitals in the dominican republic look like? Here we have doctor Jose Polanco to tell us about the dominican health care system and seeking medical care in the Dominican Republic 

Doctor José Polanco:  At the lower level you have a socialized medical system, where each province will have a public hospital that staffed by by public doctors and that is completely funded by the state, uh the country and when I say completely funded it is grossly underfunded most of these hospitals. They are often lacking supplies, equipment, but is is a place that the community and people who come from very far can go and with the understanding that they would not have to pay for their healthcare. Obviously in some of and territories and towns there will be long wait lines,people will usually start very early in the morning to try to get in and see a doctor. Many times when patients are seen in the public hospitals the um patients families and the patient will have to pay for getting some supplies that are maybe needed for the treatment while their in the hospital. That is very common in these percentual state hospitals. 

Kendra: If mosquitos can not be controlled what can be done? What preventative measures can people take? How can chikungunya be prevented? Here is Doctor Polanco’s take on how to prevent chikungunya. 

Doctor José Polanco: How can be prevented? Chikungunya can be prevented by primarily by the reducing the population of mosquitos whether it be done by the national resources over a large area of space or individually by families and individuals and how they control their living spaces. In particular their yards and places where there may be stagnant water or any kind of water in tires or cans and pots and things like that and barrels which are used in the countryside for collecting water in some places where there is not municipal water. Those are all places that can be targeted to reduce the mosquito population overall. The other approach is to reduce the chance of getting bitten by mosquitos. So, typically in you know traveling to the dominican republic or while the outbreak was happening there in 2013 and 2014 it was highly recommended to use insect repellent and anything with dete will repel these mosquitoes. The other thing that will repel these mosquitos, is there are a tropically breed of mosquitos so they need the heat. They mostly bite during the day, but if you can be in air conditioned space uh that will reduce your chance of getting bite by these mosquitos. The other thing that is recommended is wearing long sleeves. Which obisiouslt in a hot country is hard to do but, that's another possibility. As well as using netting if your going to be somewhere where your stationary you can use netting at bedtime and things like that. Those are the two main approaches to prevent the chikungunya outbreak from continuing to spread 

Kendra:To prevent an even bigger outbreak the dominican government needs to step in and help those can not not afford these measures. Cause of course if you do not have access to replant or treated water you are more likely to get infected by this illness. This puts many people at a disadvantage. It would be helpful to have doctors come into the affected communities to educate people on the illness. It would also be helpful ask people in these communities what their specific needs are in order to fight this illness. It easy to assume what someone needs, so it would be helpful and ask what their needs are. 

Keep in mind anyone can be infected so, take preventative measures on your next vacation. Thank you for listening to my podcast! And remember mi gente cuídate y cuida a los demás. Take care of yourself and of others. I hope this educated people on an illness that is not only affecting the dominican republic but is affecting many communities in africa, asia,latin america, and the caribbean.  

This podcast was produced by Kendra Guzmán for the spring 2019 Global health course at Guilford College

(Music ends)

 Click show detail for a full episode transcript 

Boyd and Young Podcast, 2019

Goonie and Lala [00:00:04] "Mommy, Mommy"

Tiffany [00:00:04] "Yes babies" 

Goonie and Lala [00:00:05] "Oh, our recital is on Friday". 

Tiffany [00:00:05] "I don't think I can make it"

Katherine [00:00:10] Can you imagine missing your child's first school play or always being unable to attend family events, because you're tired.

Evelyn [00:00:21] Showering and brushing my teeth was like an accomplishment when it was at its worst. I thought I was just really tired all the time. 

Katherine [00:00:32] Chronic Fatigue Syndrome/Myalgic Encephalomyelitis is a serious illness that affects many body systems. Often people with CFS/ME are unable to perform their daily activities, due to the extreme fatigue they experience. The fatigue may worsen with physical and mental activities but doesn't improve with overnight rest. 

Evelyn [00:00:58] The big thing that folks also did early on in trying to be supportive, is you know say, well you know exercise more. Give lots of sort of advice that isn't necessarily helpful with Chronic Fatigue. You know, just just push through you know just keep going. And that doesn't work with Chronic Fatigue Syndrome. So I think it actually doesn't help with a lot of illnesses but that bothers me less than less than it used to. But that's part of our culture. 

Katherine [00:01:32] It is believed that the condition is triggered after an individual experiences a viral infection or as a result of a hormonal imbalance or immune disorder. But the exact cause of the condition is unknown. 

Evelyn [00:01:49] And at the beginning I thought with all my visits to the doctors I'll figure out what this is. They'll be hopefully a quick sort of cure or fix. I was pretty hopeful. 

Katherine [00:02:02] There is no single test to confirm a diagnosis of CFS/ME. 

Evelyn [00:02:06] But as the years went on and things weren't getting better. Frustration with doctors, not finding answers. It became more and more frustrating feeling sort of hopeless. 

Katherine [00:02:36] People who have CFS appear to be hypersensitive to even normal amounts of exercise and activity. Although there are several symptoms associated with CFS such as fatigue, loss of memory or concentration, enlarged lymph nodes in your neck or armpits, sore throats, or unexplained muscle or joint pain, unrefreshed sleep, and exhaustion lasting more than 24 hours. The most common thread that all persons diagnosed with this illness experience is the loss of their ability to perform daily activities. 

Evelyn [00:03:08] Accepting what I can do and what I can't do made a huge difference in terms of living the life that I could and enjoying it and figuring out how to be happy with that. To have fun in life instead of constantly fighting about what I think I should be doing rather than actually enjoying it. So I have a big symbol of that was I love camping and I still loved backpacking and my wife and I would do that all the time going camping was just miserable. And by the time we set up camp I just couldn't do anything for the rest of our time. I ended up saying "OK what is it that I love about camping, it's being outside it's slowing things down."

Katherine [00:04:20] Within the US and the UK patients have experienced medical personnel ignoring and minimizing the patient's symptoms as well as reclassification. Some have been classified as a psychological disorder. Britain's approach has been an emphasis on early diagnosis but many patients continue to report the same numerous and complex barriers to diagnosis. 

Evelyn [00:04:51] One thing that was particularly helpful I saw a slew of doctors a lot of them didn't really know what it was or weren't necessarily affirming but there are three doctors in particular that made a huge difference. One was an endocrinologist who after I said something along the lines of maybe this is just what life is supposed to be like said "no, you are in your 30s you should not be feeling like this. This is not normal." 

Katherine [00:05:32] Stress is also listed as a possible contributor. Patients who experience CFS/ME have several complications such as depression, social isolation, lifestyle restrictions, increased work absences, and a higher than normal suicide rate. The onset of CFS/ME can occur at any age with the median being 20 to 40 years old. 17 million people around the world are believed to be affected by CFS/ME. Britain and Sweden combined estimate one hundred and twenty five thousand people are affected by CFS/ME. Eight hundred and twenty five thousand people in the US are diagnosed, but there are estimates of 2.5 million people living in the US who have not been diagnosed. One possible reason for the lack of progress in the diagnosis and management of CFS/ME is that the primary doctor feels it's not productive to diagnose. There is no money to be made. It can't be a "real disease." 

Evelyn [00:07:01] So having a doctor affirm that was huge. The second doctor that was really helpful was a neurologist. I had multiple sleep studies and we found that my sleep wasn't very deep. I was waking up a lot for no apparent reason and this neurologist said "we know something's wrong but we don't know why. We know a lot about the brain. And we also still don't know a lot about the brain." Being affirmed and a doctor actually saying we don't know. I mean that meant so much to me because it felt like a lot of doctors didn't know. But they put it on me. They didn't actually know. And then the third was the integrative health doctors. They took it seriously and did a whole bunch more in-depth tests and found a lot of things that were off. So I've been working with them for the last four years. They've been willing to try new things and experiment. I mean that has just been extremely helpful. One way that I think is useful in terms of getting more information out about Chronic Fatigue Syndrome is simply talking about it. Talk with my friends about it is is really useful in terms of having more people know oh this is actually a real thing. I think there is more public information about it even now than there was seven years ago particularly with that Netflix movie "Unrest" that came out that I think was pretty good. 

Katherine [00:08:58] A disease must fit into the biomedical model of health. What is the biomedical approach? The biomedical model is how all diseases are categorized in the western world. Our body is like a machine and we need to fix the machine to fix the machine. We need to compartmentalize the symptoms. In Sweden for example, the consensus is they don't treat it as the disease but as a disorder that is psychiatric rather than physical. There is currently no biomedical funding, no clinical trials into medical treatments and a lack of medical education about CFS/ME. This leads to a lot of misunderstanding among medical professionals. Going forward, we need to educate others about CFS/ME. First, a universal classification of the disease, second we need medical personnel to be educated about the disease acceptance and treatment. And finally we need government regulated support. 

Hayden [00:10:11] This podcast was produced by Katherine Boyd and Hayden Young for the Spring 2019 Global Health Class at Guilford College. Special thanks to Aleks Babić, Evelyn Jadin, Tiffany Holland, Maria Rosales, Goonie and Lala for making this podcast possible. 

00:20 Just imagine that you're going about your normal day and then all you see is black ash raining down on you. The ash is slowly falling down on the ground like white snow, however, this “snow” is dangerous to your lungs, throughout this podcast I will tell you how people's repository system is being affected by the volcanic ash.

00:38 Music 

00:50 On January 13, 2020, the Taal volcano in the Philippines ruptured around 50 to 500 m high. This explosion was so large in magnitude that it was seen from space. On the 13th the volcano was rated a level 3 and then updated later that day to a level 4 by the Philippine Institute of Volcanology. Level 4 means that the Volcano is active with the possibility of multiple eruptions. 

01:16 Music

01:32 When closely at the ash in the lung, I interview Dr. Ellison to help me understand how it could really affect a person's health. “I graduated from the University of Oklahoma. For my medical training and complete residency and fellowship at Wake Forest Baptist Medical center. My fellowship training is in pulmonology and critical care medicine.” 

01:50 Music

01:57 Because of the eruption, many people had evacuated their homes and work area. With the ash blanketing the Provinces (which are states) many people had to be evacuated from their homes leaving all that they knew behind. Days after the eruptions there were many organizations that have stepped up and helped evacuate families and individuals. When telling other people about this topic they don’t understand why people choose to live there. There are two main reasons why people live there. One tourism, locals benefit from the volcanoes because they are a tourist attraction. It is easier for them to live closer to their work. Two, the volcanoes enriched the soil, providing fertile soil for growing and harvesting crops. The Taal volcano is actually a part of the Pacific Ring of fire, so the locals understand that there could be a potential eruption at any time. “So if they know that they're going to be in an area of volcanic ash all they can do is prevention. They should wear masks. They should stay away from those areas because once you have deposition of the silica from the volcanic ash there is not a treatment for it. All you can do is manage symptoms. Depending on if you have underlying lung disease, we can give inhalers and we can give medications but it's not going to cure that exposure to volcanic ash once it is deposited in your lung tissue.”

03:18 Music

03:23 To give you a more basic idea of what ash is, it is the remains of a fire. “Because we are expelling content of the core of the earth, or the crust of the earth it can come in various sizes.” Depending on what the size of the ash is, it can result in where it can go into your body and how it can affect it. “With the larger particles those that are greater than 10 microns it can mostly be in the Oropharynx. As you get to smaller particles about like 5 micrometers they, it can get to the trachea or the large airways called the bronchi. Once it gets smaller than 5 microns that when you really worry about Alveolar sac irritation. That is deep-seated lung irrational and that can cause inflammation and what we call acute exacerbation of respiratory issues.” To put in laymen’s terms the larger particle can be predicted to be the area in your throat where your mouth and nose meet. And the smaller particles will probably end up into your main lobe that goes into your lugs or in the area that separates your two lungs. “And so when we talk about the negative consequences are they having just one, are they irritated by just lung particles. Two are they having acute silicosis reaction, or three eventually over a long period of time when we're talking 10 years of exposure for those people in the areas of volcanic ash will they devolve chronic silicosis.” Acute Silicosis can cause your lungs to fill up with fluid which leads to shortness of breath and low O2 levels in the blood. While chronic silicosis can cause your lungs and lymph nodes to swell and make it very difficult to breathe. Just imagine having crystals forming inside your lungs. 

05:20 Music 

05:27 Let’s say there is a young woman named Tala, she is around 20 years old and lives with her parents and younger sister. To help support her family she works at her local farm. On January 13 the eruption happened, which caused everyone to panic. Because she was out in the field and not aware that this was supposed to happen she inhaled some black ash when trying to get home to her family. She started to cough while her parents were telling her to pack up her things because they needed to evacuate. Little did Tala know she was having an immediate reactive airway disease. “We worry about people that are being exposed to it, especially with chronic lung disease developing something called chronic silicosis. If you truly have a diagnosis of chronic silicosis that is related to volcanic ash then it can lead to pulmonary fibrosis. And that is another way to describe the stiffening of the lungs, where people aren’t able to breathe as well they have a chronic cough, they have chronic shortness of breath related to the lung pathology changing from these depositions of the minerals.” She and her family ended up being put in this large building with other people. Even though her and her family had a meal to eat, they didn't have anything to call home. Her parents are worried about her and her sister. There haven’t actually been many studies to look at or compare for children in these situations but “One of the more common things that we try to keep an eye for is undiagnosed asthma. So those children that haven't had an exacerbation before might be having an asthma attack when they are exposed to these particles.” Despite the many cases that doctors do catch of undiagnosed asthma there are children that are healthy but still face problems. “Even kids with healthy lungs, sometimes they can have reactive airway disease. And they will respond by coughing or lung irritation bronco spamming, those types of lung reactions due to the irritant.” After getting adjusted to living in a shared community space Tala and her family were finally allowed to go back to their home. When they arrived back it was heartbreaking to see. The weight of the ash made the home concave into itself. Without a home to go back to, they stayed with family friends while Tala and her family rebuilt their home. With the help of environmental specialists in the Philippines, the family was able to rebuild their home with a mixture of leftover ash and plastic. Even Though everything is looking up for Tala and her family, there is still the threat of them having Acute or chronic silicosis. Dr. Ellison mentioned that it can take up to 5 weeks to 5 years for it to occur. “Often time it can lead to poor quality of life and if you're not able to breathe then it leads to long term lung and heart issues.”

08:20 Music

08:30 Given that the Philippines is a middle to low-income country, medical supplies is scarce, therefore it's hard for the locals to get the things they need. “You know, what I recommend and what is recommended by the CDC is an N95 mask, so those are able to filter out particles that are less than .4 micrometers small. So I mention to you before particles that are 10 or 5 micrometers large, we can filter out those particles and hopefully prevent any airway reactions from the volcanic ash.” This knowledge should be spread throughout the provinces so people can understand what to do when the time comes. “If you are actually in or exposed to the volcanic ash, just know that these particles are small and can stick to your clothes. And so we always tell people and it's been recommended from a national international level that your clothes can carry particles. So if you wear the same clothes that have been exposed to the ash in your house or in your car, your risk exposure to your family to yourself at a later point in time.” should be common knowledge. If someone wasn't able to get a mask or were exposed to the ash they might have these long-term effects. 

09:50 Music

09:55 As it's been a few months since the volcano eruption passed, now the updates are about the cleanup effort for the provinces and areas that were affected. Many local and national corporations are getting evolved. The major organization is the Philippine Red Cross. They have created different teams to help provide care for everyone. An example is how they have an action team that directly correlates to emergency health and they also have a community-based volunteer team to help with people that have a non-emergency issue. The Philippine Red Cross has also helped evacuate and rescue people days following after the eruption. They have provided dust masks, hot meals, and other services for the evacuees. During this time there are only a few ways that the government and agencies can clean up the ash effectively. There have been many community organizations like Asian medical student Association that have come together to help provide healthcare to people that needed assistance. The most effective way to clean up the ash is to sweep it up and then put it into plastic bags and seal it, from what is shown people are following the suggested method of clean up. It’s yet to be determined how the plastic bags are effective the environment.

11:05 Music 

11:18 My name is Taylor Young. This podcast was produced for the Spring 2020 Global Health course at Guilford College.