Global Health Blogs with Professor Swahn

Learning about Global Health has been an enriching experience. It has allowed me, and I am sure my classmates as well, to gain insight on issues and even solutions that other countries experience. The Global Health course has widened our perspectives as future public health professionals. Though the Covid-19 pandemic has altered the way the course is normally taught, effective teaching was still accomplished with the current course structure and activities. The readings, class discussions, and content materials we engaged with have all helped to cultivate a great learning environment. However there are other technologies and tools that can be integrated into the course to enhance the learning experience, especially during this mass transition to virtual living. Many people are working virtually from home, enrolled in school virtually, and visiting their healthcare providers virtually. Implementing a virtual reality component in courses such as global health could serve as an educational benefit for students by helping them achieve a much more substantial learning experience. It would help create a meaningful distance learning atmosphere by allowing students and our course instructors to be in the same room instead of our now normal Zoom and/or WebEx calls.

Virtual reality can be utilized to increase student’s learning and engagement by transforming the way their educational content is normally delivered. Textbooks, supplementary readings, contextually relevant videos, class discussions, lectures, and even guest speakers have been used in the past to curate an efficient classroom environment that promotes genuine learning. Virtual reality technologies can catalyze these efforts by creating a virtual world that allows students to see the content material they’re currently learning and also interact with it. Most people learn best by doing, so being able to “physically” engage with the environments they’re learning about would solidify their content retention by enabling emotional reactions to be created which will allow them to better remember what they are learning due to the experiences being meaningful and memorable. I don’t have any personal experience with virtual reality games, but I have witnessed other people use them and it is amazing at how engulfed they become with the world or activities they are participating in. It’s as if they forget that what they are currently experiencing isn’t reality because their bodies are under the belief that it is genuinely in a new place both physically and mentally. Translating these experiences into a classroom setting will allow students to learn new subjects by equipping them with the opportunity to virtually live it.

Depending on the activity, kinesthetic learners such as myself can unintentionally direct more of their attention on grasping the instructions instead of fulfilling them. Including virtual reality in educational settings can provide a supplemental experience anchor to the instructions so that students are motivated to discover for themselves by having the opportunity to learn by doing rather than just reading or watching educational videos. Visual learners would also benefit from virtual reality teachings because their access to visual aids wouldn’t be limited to just book illustrations or content supportive videos, they would be able to explore the topics and gain a better understanding of them.

Virtual reality would also benefit students by broadening exposure to different career paths. Public Health is such a diverse field. There are so many paths one could take with an MPH degree. This aspect of virtual reality could be particularly useful for MPH students by enriching our professional development with field work experiences that appeal to us. Regarding the Global Health course specifically, it could also provide students with field work in the countries and communities we learn about. Students would be able to gain firsthand experience assessing the global health issues we discuss and even collaborating with community members to develop effective solutions. Tapping in to our public health career interests would be extremely feasible. For example, MPH students interested in program planning could use virtual reality as an opportunity to do so. Some universities are already experimenting with virtual reality learning such as the University of Westminster. Their law students have used virtual reality technologies to hunt for clues to develop a murder case rather than compiling a case the usual way by reading witness statements. They were afforded the opportunity to walk around a building and form judgments on if someone would have been able to witness the committed crime. MPH professors could use this teaching mechanism to employ students with hands on experience creating, implementing, and evaluating interventions for the public health issues taught in their courses.

Google Expeditions is an app that features a library of virtual reality “field trips”. Some of the included field trips allow students to travel back in time. MPH students would find monumental educational benefits utilizing this feature of the app. In the Foundations of Public Health course, we could travel back in time to the very first public health/epidemiology intervention conducted by the “Father of Epidemiology”, John Snow. In the Global Health course, we could time travel back to the very beginning of the COVID-19 outbreak and collaborate on ways to effectively reduce, and maybe even eliminate, the spread of the virus. If widely implemented in school systems, this feature would be groundbreaking for students learning capabilities. Instead of discussing history, we would be able to witness and engage with it ourselves.

Lastly, virtual reality can provide social connectedness for students which is especially important today. Our new normal consists of staying isolated inside our homes to protect ourselves from catching this misunderstood, ever-changing virus. It would also enable student’s empathy and cultural competence by taking them outside of their usual classroom experience and allowing them to gain a concrete understanding of people’s unique circumstances across the world. This is of special importance and relevance today due to our current situations. Injustices across the nation, and the globe, continue to happen despite the pandemic we still have yet to overcome. Empowering students with these opportunities to learn about cultures, economic statuses, and accessibility experiences to vital resources such as education and healthcare outside of their own will shape them into becoming advocates for social, racial, and economical change.  

   Technology has come a long way over the past few decades. One area that has seen drastic changes and improvements in technology is healthcare. From the digitalization of patient health records to easier access to healthcare providers and services to cost effective health care, technology has helped to improve the lives of people around the world. As healthcare technology continues to improve, there will be a bigger focus on virtual reality (VR) and augmented reality (AR) and less of a focus on in person face-to-face care. This change will allow people in the remotest parts of the world to have access to providers and other healthcare services that they have never had before.

            One specific area of medicine and technology that is gaining traction is telemedicine. Telemedicine allows one to talk to a doctor live over the phone or through video chat anywhere in the world. Telemedicine also allows one to send and receive messages from providers, allows for people to have access to healthcare regardless of where they are in the world, and provides people with more cost efficient, affordable healthcare. Whether telehealth is used through a smartphone app or set up at a community center, it has the ability to work in any setting around the world.

Telehealth is extremely cost efficient, and in developing countries where much of the population barely subsists, it is a desperately needed solution. A recent study that was conducted found that telehealth in the United States saved individuals anywhere from $19 to $121 dollars per visit. When applied to large groups of people telehealth has the ability to save governments and non-profit organizations hundreds of thousands of dollars when medically treating people in developing countries.

            Access to healthcare is something most people take for granted in developed countries, but according to the WHO and World Bank half of the global population lacks access to essential health services and approximately 100 million people are pushed into extreme poverty due to health expenses. Lack of access to healthcare can have a detrimental effect not only on an individual’s health but can extend to families and communities as well. The two regions with the largest gap in available healthcare services are Sub-Saharan Africa and Southern Asia. Lack of access to healthcare in these two regions of the world puts a lot of people at risk of poor health outcomes and potentially death.

            In order to implement telemedicine in Sub-Saharan Africa, Southern Asia, and other remote areas of the world, global health leaders are going to have to draw on many resources. The most important resource that will be needed is funding. Mobile telehealth centers can cost upwards of $30,000, which will need to be provided by either governments or private organizations.  There will need to be trained staff at the telehealth center with proper knowledge of  how to use the equipment and can assist patients. A doctor or other trained healthcare provider must be available to treat patients through the telehealth platform. A translator may also be needed if the doctor or healthcare provider does not speak the language of the people they are treating.

            While implementing telehealth in developing countries, global health leaders are likely to face some challenges along the way. Two of the biggest challenges that will be faced in order to implement telehealth in remote areas of the world are infrastructure and location. Remote locations around the world, often times have no electricity or unreliable electricity; electricity is an absolute must for a telehealth system to operate. It is estimated that the average electric power consumption in Sub-Saharan Africa is around 124 KWh per capita per year which is barely enough power to power a light bulb. When it comes to choosing locations for telehealth services, it can be hard to pick locations that are accessible to rural locations. One solution to this problem is making the telehealth systems portable with their own power supply so that they can be moved around to different regions, guaranteeing everyone access to care.

Another challenge of telehealth medicine in rural settings is the administration of medical care and medicines. If a provider prescribes a treatment or antibiotic for their patient via telehealth, the centers must ensure they are stocked with basic medicines and supplies as well as with trained personnel to administer medications or perform the required treatment. Another challenge of telehealth medicine in rural settings is a lack of healthcare policies and regulations in a lot of developing countries. A lack of policies and regulations can lead to corruption, unqualified healthcare providers working at these telehealth sites, and, at worst the wrong medications prescribed or procedures incorrectly administered.

            While there are some challenges that global health leaders will face when implementing telehealth medicine in rural and remote locations around the world, the benefits outweigh the challenges. Telehealth medicine has the potential to improve people’s health and lives around the world. Healthcare is not privilege but a basic human right. Telehealth medicine would provide that right to all populations of the world.                     

The Impact of covid in Brazil

          Covid-19 has left its impact on the world with some countries reporting higher prevalence and incidence rates than others. Brazil is inconsistently dealing with this pandemic, reporting alarming numbers of confirmed cases. With the global cases reaching 129,456,315; Brazil currently has confirmed cases of 12,748,747 with 321,515 deaths. The social inequalities that this country faces are contributing to the high rates of this pandemic. Brazil has 26 states and is the seventh most populated country and the fifth with the greatest territorial extension worldwide (Neiva et al). This makes it extremely difficult to have consistency when establishing plans to put interventions in place to protect the population from this pandemic. Poor living conditions, poor infrastructure, and a health system that is currently facing challenges are only contributing to the increase in numbers. Social and economic disparities among regions are related to the COVID-19 pandemic. Another factor that contributes to the rise in numbers is the composition of the Brazilian population.  Brazil has many risk groups with a large population older than 60 with comorbidities and over 500,00 indigenous citizens who have limited access to hospitals. With the lack of financial support, there is an increased chance of precarious conditions with no access to healthcare.  Efforts are being made to provide vaccinations to the population. Currently, 19,155,981 doses have been administered with 4,234,605 people being fully vaccinated, of which 2.02% of the population is fully vaccinated. With the country facing political distress the citizens are greatly impacted. Without the proper leadership, there is a lack of government support and trust of the citizens of Brazil. During this pandemic, there was a poor initial response from the government in the response to putting in place action plans to protect its citizens. The health ministry and the media failed the public in providing proper data and information about the pandemic. As a result, the population had a low adhesion to quarantine and adherence to recommendations.  The projection is that Brazil will have the highest number of cases worldwide if there are no interventions and policies put in place to reduce the numbers. Through organizations like COVAX which is the focus on promoting equity through the administration of vaccines to protect the health of populations, there can be a decrease in the rates of new cases and deaths. The first step in increasing the percentage of vaccinations will be to develop a social marketing plan with the focus on addressing the needs of populations across the region and educating and building confidence along with building trust across all sectors of the population. Another approach that needs to be considered is modeling countries that are having greater outcomes in regard to a reduction in incidence and mortality rates. A partnership of countries in the midst of this pandemic is critical for the survival of this country. There also needs to be a restructuring of the government and strong leadership in place to assure that the people of Brazil will have the opportunities that other countries are awarded and measurements in place to make sure that treatment and vaccinations are equitable for all people. With the financial support of the WHO and organizations, leadership, medical support, and the right strategies, we can stop the bleeding of a country that is failing its people. When we look at combating this pandemic we need to look beyond the borders of countries and aid those who are suffering; there need to be a global effort in place.

Reference:

Marson, F. A. L., & Ortega, M. M. (2020). COVID-19 in Brazil. Pulmonology, 26(4), 241-244.

Neiva, M. B., Carvalho, I., Costa Filho, E., Barbosa-Junior, F., Bernardi, F. A., Sanches, T., Oliveira, L. L., Lima, V. C., Miyoshi, N., & Alves, D. (2020). Brazil: the emerging epicenter of COVID-19 pandemic. Revista da Sociedade Brasileira de Medicina Tropical, 53, e20200550. https://doi.org/10.1590/0037-8682-0550-2020

     The year 2020 will be an unforgettable one as most of the year was spent in lockdown due to the emergence of SARS-CoV-2 better known as Covid-19. Covid-19 was first identified in the Wuhan, Hubei Province in China in December of 2019. According to the World Health Organization (WHO), the first reported cases of Covid-19 were thought to be pneumonia of some unknown origin and it wasn’t until January 12^th of 2020 that China publicly shared with the world the genetic sequence of Covid-19. Since the emergence of Covid-19, it has rapidly spread around the world affecting every country. Some of the common symptoms associated with Covid-19 are fever, cough, headache, and new loss of taste or smell. While there was very little knowledge of Covid-19 in the beginning, we quickly learned that masks and social distancing were the best way to protect individuals and prevent the spread of Covid-19.

Of all the countries in Africa affected by Covid-19, South Africa was hit the hardest. As of March 8, 2021, South Africa has had 1,521,706 confirmed cases of Covid-19. Morocco that second most affected country in Africa had 486,325 confirmed Covid-19 cases as of March 8, 2021. Currently, the CDC has placed South Africa on the Covid-19 level 4, the highest level, and urges all travelers to avoid the region, and if they must travel to South Africa to wear a mask at all times and maintain social distancing.

South Africa is a very complex nation made up of several different ecosystems as well as several different ethnic groups. It has a population of roughly 56 million individuals with the majority of the population being black South Africans, followed by white South Africans. Until 1994 South Africa was under apartheid which segregated blacks and other non-white South Africans from white South Africans. Because of the apartheid, black and other South Africans of color were forced into poverty, something a lot of them still have not recovered from. South Africa also has a large percentage of their population living with HIV, approximately 7.5 million people; of the 7.5 million living with HIV, black South Africans are disproportionally affected by the virus.rted on March 6 of 2020. There were 756 new cases reported for Tuesday March 30, 2021. The age group with the highest prevalence of Covid-19 is 60 to 69 years old. It has also been discovered that individuals who are HIV positive or have active TB  are at an increased risk of death from Covid-19. The highest percentage of cases come from the Gauteng region.

With the emergence of Covid-19 in South Africa, the country’s leaders implemented an alert system with 5 different levels with 1 being the least restrictive and 5 being the most restrictive. From March 26 to April 3 of 2020 the country went on ‘alert level 5’ which resulted in a full lockdown. During this time of full lockdown travel was banned except for essential travel, retail stores were closed, alcohol sales were prohibited, and people were to remain at home and social distance from other people. The full lockdown was able to slow the spread and decrease the Covid-19 incidence rates, and the country was able to slowly decrease their alert level back down to a level 1. The country did experience a second wave of Covid-19 in December of 2020 and had to increase its alert level from a 1 to a 3 which included restrictions on activities including in the workplace and socially. With such strict lockdown measures, South Africa was able to show the world that implementing such measures works to slow the spread of Covid-19.

Covid-19 has taken a toll on the South African healthcare system. Prior to Covid-19 most public sector healthcare facilities were overextended, understaffed and poorly resourced. With the emergence of Covid-19, resources were stretched even thinner. Public hospitals were running out of beds, doctors and other staff were being overworked, and when the country was in their tightest lockdown people in rural areas had difficulty accessing care all together.

Out of South Africa’s total population of 56 million people, only 263,878 people are fully vaccinated. So far, the only people being vaccinated against Covid-19 in South Africa are their health care providers. Once healthcare workers are immunized the country plans to do a phased rollout of the vaccine to the rest of the population. Along with healthcare workers, South Africa should have included individuals with HIV or TB as some of the first people to be vaccinated since they are more likely to have poor outcomes if they were to catch Covid-19. The second phase of their vaccine rollout should include the elderly, and the third should include the rest of the population. The best way for South Africa to get their vaccine campaign and rollout messages out to their citizens is through television, radio, and advertisement including internet.

While South Africa has fared better than some countries when it comes to Covid-19, it was still the hardest hit country in Africa. As case numbers continue to rise the South African public health care system struggles to keep up. While the country was able to slow down the spread of Covid-19 through strict lockdown, they are continuing to see new cases on a daily basis. Since South Africa has such a large population living with TB and HIV, their most effective strategy at combating Covid-19 will be through vaccinating their population.

New Zealand has maintained one of the lowest COVID cases since its inception last January. This can partially be due to this country being geographically isolated in comparison to other countries with much higher COVID cases such as the United States. However it is largely due to the prevention and de-escalation measures that were effectively implemented by its government. The country anticipated the pandemic to spread quickly and widely from their disease models projections and therefore began implementing a pandemic influenza plan earnestly in February. Parts of this plan entailed preparing hospitals for the expected influx of patients and initiating border control policies.

All of the preparing executed by government officials was soon needed as their first Coronavirus case was reported on February 26^th. Shortly after, community transmission rapidly occurred causing national leaders to switch from mitigation strategies to elimination strategies by implementing strict countrywide lockdown measures that were designated at Alert Level 4. This occurred exactly one month after the first case was diagnosed, on March 26^th. After 5 weeks of lockdown, New Zealand experienced a rapid decline in cases and receded to an Alert Level 3 countrywide lockdown for 2 more weeks. The last known case was reported in early May. On June 8^th, national leaders moved to Alert Level 1 and declared that the pandemic was officially over in New Zealand, only 103 days after the very first identified case.

Since the last reported case in early May, the only other cases have been from international travelers that are confined to government-managed quarantine for 14 days after their arrival. With cases low, New Zealand’s economy has returned to operating as it did pre-Covid. Public life for citizens has mostly returned back to normal. However, it is advised that this country plans to respond to resurgences of cases with control measures such as mandated masking. Surprisingly, masking was not a part of their elimination strategy. Considering the strict countrywide lockdown measures this is understandable but I still wonder how citizens protected themselves from catching the virus when they had to fulfill their essential tasks such as grocery shopping or walking their pets.

The total case count for New Zealand thus far has been 2,501 with only 26 deaths. There has been a resurgence of cases more recently (February 11) in the country’s largest city, Auckland. The city had to go into a mandatory three-day lockdown following the discovery of these unexplained cases. This happened to be the first lockdown the country enforced within 6 months. Prior to this lockdown, citizens had gone back to the normalcy of life prior to Covid-19 such as returning to work, attending concerts and even sporting events without having to wear a mask.

Due to this country being able to efficiently eliminate the spread of the virus prior to vaccines being available, the distribution of current vaccines isn’t as urgently needed as it is in other countries. However, being that New Zealanders are still experiencing unexplained, random cases I would firstly allocate the vaccine to healthcare workers, and then to those that are most vulnerable of being infected. This would include children, the elderly, and young adults and adults that have respiratory health concerns. Among the reported cases, there have been relatively few fatal outcomes. I believe that the best way to allocate the vaccine to citizens would be to firstly obtain a consensus of those that desire to receive it. From those that expressed wanting to be vaccinated, prioritizing the most vulnerable. This country has done an outstanding job of containing and terminating the virus from its communities. Providing vaccines to citizens would further help to reduce the spread of the virus, and catalyze the efforts being made by government officials to completely eradicate the existence of COVID.

As aforementioned, New Zealand should still implement COVID-related precautionary measures. Though cases have been managed to be kept at minimal levels, we can never be too sure or safe with this virus. It is still an infectious disease we know so little about. Especially with the emergence of new strains and variants. Just when we think we know what this virus is, something else happens and we seem to find ourselves back at square 1; trying to piece together this unknown pandemic of a puzzle. It was advised that this country enforce mass masking (I am still so shocked to know that masking was never enforced being that the main spread of the virus is through air particles). I am sure that if masks were publicly mandated, and social distancing measures were strictly implemented, cases would continue to plateau for New Zealanders. I don’t think that life will ever go back to “normal” once this is finally resolved. I believe, well mostly hope, that the same sanitary initiatives that are being implemented now will continue on even after this pandemic is over. I know that we are all earnestly waiting to be able to enjoy our lives as freely as we did before, but I don’t think that would be the wisest thing for us to do as individuals, communities, countries, and as a united team that is globally warring with COVID. It is my belief that the safest, surest thing for us to do as we progress through these unprecedented times is to continue being safe. Continue being cautious. Continue being considerate.  

I have to commend New Zealand on handling the pandemic in a way that other countries could certainly benefit from. Government leaders have done an outstanding, upstanding job of putting their citizen’s health and well-being FIRST. Their swiftness in implementing evidence-based risk assessments, decisive government action, instating border-control measures, community transmission control measures, and case-based control measures were an effective, critical way to eliminate the spread of the virus. Having empathetic national leaders also played a crucial role in reducing spread. By providing citizens with a strong sense of care and confidence, they are much more likely to adhere to necessary pandemic control measures.

Blog #3

The COVID-19 in Costa Rica:

For this week’s blog post, I decided to highlight the COVID-19 pandemic’s impact on the Central American nation of Costa Rica. This country’s COVID response is personally relevant to me as my fiancée and I intend to get married there this December (2021). We also got the opportunity to visit the country this past December to explore and assess wedding venues and the feasibility of hosting a wedding next year.

First, I want to review how Costa Rica has handled the pandemic thus far. The Costa Rican Ministry of Health identified its first possible case of coronavirus on March 5th,  2020 in a woman who was returning from a visit to Italy and Tunisia followed by the first confirmed case the next day in a woman who traveled in from New York. This was Latin America’s first COVID-19 case. From there, new cases were reported daily. 

Among a population of about 5 million citizens, the country has identified 216,764 cumulative cases and 2,957 deaths, about 4.3% and 0.06% of the population respectively, per Johns Hopkins COVID-19 Dashboard. In contrast, the 30.5 million cases and 552,019 deaths identified in the US make up about 10% and 0.17% of our population, respectively. Costa Rica’s incidence rate is 4,255 per 100,000 people, approximately half the rate in our state of Georgia. This particular statistic absolutely made my fiancée and I more comfortable when deciding to visit last December. Johns Hopkins also reported 192,699 cases recovered, with approximately 21,108 current active cases. I was unable to find any hospitalization statistics with credible citations.

To stim the spread of COVID-19, the Costa Rican government joined the majority of other nations in implementing multiple mandates and curfews. However, in June, a significant increase in positive cases in the northern region of the country exposed the exploitation of migrant workers, but again the government was able to step in and contain the outbreak. Overall, Costa Rica handled the pandemic relatively well compared to other nations, particularly states/cities in the United States. Though less densely populated than most US metropolitan regions, the speed and seriousness with which countermeasures were implemented was remarkable. This YouTube video of a Costa Rican citizen truly breaks down how and why the nation’s response was so effective. Of course, Costa Ricans also benefit from a universal healthcare system.

The country had shut down international travel up until mid-November, making us one of the first groups tourists to return. Tourism makes up a significant part of Costa Rica’s economy, contributing 12.5% of the country’s GDP and 11.7% of direct and indirect employment in 2012 (Blanke 2013). Per a UN Economic Commission for Latin America and the Caribbean (ECLAC) report, the tourism boom directly contributed to reducing the countries poverty rate to 3% in 2007 (UNEP 2011). A report from the National Institute of Statistics and Census in November 2020 found that the poverty rate has increased to its highest level since 1992, with extreme poverty reported at 7% and unemployment going from 12.3% in March 2020 to 24% (INEC 2020). Thus, they have faced significant economic hardships alongside the health burden of the COVID-19 virus.

Throughout the rest of March 2020, the Costa Rican government took steps to mitigate economic burden of COVID through a “Plan Proteger” program aiming to provide governmental financial support to a total of 800,000 people most affected by COVID-19 outbreak. New solidarity taxes were implemented on workers making more the ¢500.000 salaries (Costa Rican colon, which is about $814 USD) to offset burden on the unemployed and workers already impacted by salary reductions.

Regarding Costa Rica’s vaccine response, the nation received its first shipment of 10,725 doses on December 23, and began distributing vaccinations the following day on Christmas eve to the elderly and healthcare personnel. As of March 29, 2021, 224,094 (4.44% of population) have received at least 1 dose with 160,263 (3.18%) fully vaccinated (Our World in Data). They’ve followed similar rollout plans to the United States, prioritizing staff and residents at retirement and nursing homes, followed by first responders and other healthcare personnel.

Along with its universal healthcare policy, Costa Rica benefited from consistent messaging from its government and health authorities, reenforcing the seriousness of the disease. The nation also touts an adult literacy rate of 97.9% per the CIA’s World Factbook (for comparison, the US is at about 86%). During our visit, we gained first-hand experience of how citizens were adhering to mask mandates and social distancing. The Costa Rican people made it clear they wanted to do everything scientists had deemed necessary to return to normalcy as soon as possible with minimal loss of life.

Although repercussions of COVID are still reverberating throughout society in many ways, Costa Rica has provided an excellent blueprint for how to appropriately respond to such a crisis. We are elated for our return this December.

(Note: was unable to add images throughout this time for some reason. Attached relevant images/screenshots below.)