Interview to Ms. Gloria Nirere, Menstrual Health Management Trainer in Uganda

 Menstruation matters in resource-limited countries where poverty substantially impacts menstruation health management. In this connection, PEAH had the pleasure to interview Ugandan stakeholder Ms. Gloria Nirere currently involved as menstrual health management trainer at Kampala based WoMena NGO. Previously, Ms. Nirere long served in poorly equipped Ugandan contexts where she performed tasks concerning clinical research, community health, humanitarian assistance, and project management at local and national level

 By Daniele Dionisio

PEAH – Policies for Equitable Access to Health 

INTERVIEW

 

Ms. Gloria Nirere

Menstrual Health Management Trainer

WoMena Uganda  

 

‘Sanitary pads are very hard to buy because the economy is high. Mum cannot give you the money to buy. Not everybody can even get enough money to buy a cotton wool or tissue paper and using a cloth we always fear because it may fall off while with friends’  

— Anonymous (15 years old, Kasese, Uganda) 

Worldwide, a large number of girls and women struggle to manage their menstruation in a dignified way. They not only lack access to menstrual health products, correct knowledge about menstruation and support from their communities but also have limited access to suitable and safe facilities for changing and disposing of sanitary materials.

Source: WoMena

 

PEAH: Ms. Nirere, let’s start with a glimpse on menstruation matters in your country and to what extent does poverty impact menstruation health management.

Nirere: Menstrual Health mattters have for long not been considered as an important aspect in the most part of the Country. Most people think menstruation is easy to manage but the details of what entails in menstrual health management are not their concern. You find that out of 10 girls, 1 has knowldge about menstruation for her first time menstrual period and the rest struggle silently with pain and fear not knowing what to do next. It is just a few families where they have got chance to access education where a small light is shed about menstruation. Even up to date, most women and girls shy so much away from discussions related to menstruation.

I would say that poverty highly impacts on menstrual health management because most of the beneficiaries give an excuse of lack of money to buy decent sanitary pads leading them to use papers, a piece of cloth, sponges and leaves. On the other hand traditional beliefs and myths about menstruation has caused a lot of menstrual health challenges where women and girls are not free and comfortable during their periods.

PEAH: WoMena is an NGO working with implementation of reproductive health solutions in low-income contexts, focusing on menstrual health & management. Tell us more, please, around WoMena story and profile.

Nirere: The NGO mainly aims at providing menstrual health training to adolescent school girls, women, refuguee settlements, men and boys  and providing menstrual health management products like the menstrual cup with reusable sanitary pads (Afripads).

Credit: WoMena

The key focus is to tackle issues that have come up with stigmatising women and girls due to community related beliefs and myths by involving local and national leaders; and male in menstrual health related issues.

PEAH: In depth, as regards WoMena field activities and approach to menstrual issues?

Nirere: As a WoMena trainer, field work activities involve:

Credit: WoMena
  1. Training of Trainers (T.O.T’s), these are participants who are mainly leaders ( Local Council, teachers, church leaders, district heads etc.) in a community. They are trained to volunteer by training the beneficiaries in the community where they belong. After the training, participants are issued with training materials to support them during trainings. However, if they happen to train, normally they are guided by the trainer from WoMena to monitor and support during the training. They are trained so that they can guide a participant to clarify on certain issues in the absence of the WoMena trainer.

In addition, for the case of school going children, the school organises the parent meeting which is mainly held to train parents and get consent of whether they want their children to have the menstrual health products or not.

  1. T.O.B’s (Training of Beneficiaries)

The beneficiaries are trained in detail about menstrual health management and product use and care. This training is composed of both female and male sex, the male however excused in the last phase for training of product usage (this is done mainly by schools). At the end of training, their given evaluation forms serve to check whether they acquired knowldege from the training.

  1. Refresher training

Before distribution of the product, a refresher training is held to get the depth of knowledge which was acquired in the first training. It also enables the trainer to know areas that need to be retrained to beneficiaries.

  1. Distribution of menstrual health products

Distribution focuses on consent of a parent to her child (18 years and below) or consent of a beneficiary. It also depends on whether the beneficiary participated in all the trainings. Normally, soap, small bucket, a pair of knickers, menstrual cup and reusable pad are distributed. (this depends on funding organisation on whether to give both the menstrual cup and reusable pad).

  1. Follow ups

After a period of 3 to 6 months, 2  follow ups are done to check on product usage and care, challenges and formulation of reports basing on the information obtained from the field.

NB. The top-bottom approach is used to tackle menstrual health issues since acceptance and cultural issues are majorly the main threat to sensitizing communities about menstrual health issues.

PEAH: What do you think about the importance of education and male involvement in menstruation matters in Uganda?

Nirere: It is a very good staregy to involve men in menstrual health issues because when you look at the African setting, the men have most say in financial, social and economic matters of a family and a community. If they ignorate about menstrual health issues, it is very difficult to support their wives, daughters and menstrual health initiatives in communities.

Credit: WoMena

That’s is why WoMena is focussing on male involvement in menstrual health issues by not only having male trainers, but also having male coordinators and trainers in local communities to push the message ahead.

 PEAHWhat are your duties and tasks in WoMena?

Nirere: I faciliate menstrual health training through planning for training sessions and materials, conducting training evaluations, carrying out  follow ups and writing reports associated with the outcomes of the training.

PEAH: Kindly, detail around the effectiveness, safety and acceptance of WoMena backed menstrual cups as menstruation management method in Uganda’s reality.

Nirere: Menstrual cups have not for long been used in Uganda, even the elite women are resisting to use the menstrual cups. Just like any form of new technology being introduced to a place, to which there’s always resistance, this as well applies to menstrual cups.

Credit: WoMena

There are majorly two ares which cause fear among women, most wonder wether the virginal area will become wide, some wonder it is too big to enter the vagina  and others fear that it takes away virginity of a girl child which is highly valued. But through trainings, the Organisation has collaborated with other international organisations like Care international, Save the Children, UNHCR to train women and girls on use and care of menstrual product; and tackles frequently asked questions. Currently, the menstrual cups are on market and the number of women and girls using the cup is gradually increasing.

Credit: WoMena

Adoption of the menstrual cup will tackle very many challenges which come with use of disposable pads, among which the cup is durable because it takes 10 years in use, environmentally friendly and it is less expensive since you do not have to buy pads every month.

PEAH: In this regard, are follow-up study reports on menstrual cups currently available?

Nirere: Yes, they are available but these reports are shared to partner Organisations which fund projects we do.

PEAH: Does WoMena work together with national and/or international partners?

Nirere:  Yes please, information on partners is on the Website.

PEAH: Before engagement in WoMena you long served in poorly equipped Ugandan contexts where you performed tasks concerning clinical research, community health, humanitarian assistance, and project management at local and national level. What challenges did you face there?

Nirere: Very many challenges indeed,  but I embrace the fact that I was able to learn a lot of various skills:

  • First challenge was the strong traditional attachements and ignorance of people. For example, someone tests HIV+ and they go for traditional healers for help. In the process they end up dying or coming to seek medical assistance in critical condition.
  • There’s a lot of dependency where people believe that their lives entirely depend on government support. Even when there’s partial support, someone is not willing to top up to get the assistance they need.
  • Illegal selling of government drugs and extortion of money from patients on free services which is unprofessional.
  • Selling of donated material or property by beneficiaries to the community, this has created big challenges in refugee settlements.

PEAHThank you Ms. Nirere for your insightful answers and highly commendable engagement

PEAH News Flash 377

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 377

 

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Implications of Covid-19 Pandemic on Health Systems

The situation bound up with Covid-19 will have not only an impact during the current crisis or the near future. Its effect on the future of health systems is something that will need to be followed closely as it may have a negative impact towards achieving the Sustainable Development Goal (SDG) number 3, with the draining of resources from other sectors to tackle the current pandemic affecting the rest of the SDGs

By Francisco Becerra-Posada MD, MPH, DrPH

Public Health Consultant, Mexico

Implications of Covid-19 Pandemic on Health Systems

 

 

Once the Covid-19 epidemic in China started moving to other countries, it was clear that at some point the WHO would declare a pandemic [1] once it had initially been declared a Public Health Emergency of International Concern (PHEIC) in January of this year [2]. Given the rapid dispersion and high contagion rate, the world has come to adopt drastic measures as we all have seen globally, cities or country-wide lockdowns, mobilization restrictions, etc.

The amount of all sorts of resources devoted to tackle the pandemic, and the global economic implications of the lockdown and border closing, is unprecedented, with many countries moving fast to authorize specific emergency and budgetary measures to confront the problem, [3],[4] while other have been slow to react. Decisions by governments to prohibit exports of health goods for national consumption, will too, place extra pressure to dependent countries on imports. The pressures of SARS-Cov2 virus on health services and systems is and will continue to be overwhelming. The world has seen patient crowded hospitals, exhausted medical and paramedical staff, and health services devoted to the pandemic.

The risks of all health resources devoted to Covid-19 are necessary, but health services can’t and should not forget about those patients with chronic ailments, such as diabetes, hypertension, HIV, TB, or in need of cancer treatment or that had received a transplant and who are in need of their medication or medical control. Countries and the world are closely following Covid-19 related deaths; however, we don’t know about deaths of other diseases not linked to Covid-19 that due to lack of access to medication or supportive health care are occurring.

Good things also come from these kind of global health events. Science advances faster and international collaboration is enhanced, barriers are down, and a common goal is being sought. Seeking a medical treatment, performing genomic mapping and sharing the SARS-Cov2 genome, working on a vaccine, and developing rapid tests for faster diagnosis and epidemiological control are examples of it.

As the numbers of positive cases increases globally, we can only have a glimpse of the costs and demands to health systems and services the pandemic is causing. From testing, consultations, hospitalizations, patients in ICU and all their needs, etc., plus demand of equipment, personal protection equipment, medications and many other resources that were not budgeted for and are now needed in order of taking care of the demand.

Resilient health systems are important to sustain the strains these situations can bring. If norther countries with good infrastructure and important budget allocated to health are suffering from the over demand, we just can imagine what will this demand cause to low- and middle-income countries’ health systems, systems that might be weaker that those of rich countries, and that may not have enough resources to finance the unexpected demand.

This situation will have not only an impact during the current crisis or the near future. Its effect on the future of health systems is something that will need to be followed closely as it may have a negative impact towards achieving the Sustainable Development Goal (SDG) number 3, with the draining of resources from other sectors to tackle the current pandemic affecting the rest of the SDGs. Even more, if the global economy will suffer in the years to come as many predict, SDGs will be seriously jeopardized and the people living in a state of vulnerability might be the ones most suffering.

Social determinants will widen and people in those groups might take longer to come back to the level of lives -even difficult ones- they were living before the crisis. Those who survive on a daily income, work as informal vendors, or day to day workers, if cities and countries shut down their income will also shut down. Their livelihood will be affected, as well as the ones of small businesses and starts ups that have been forced to close and nevertheless their expenses still have to be taken care of, such as rent, electricity, etc.

This is the moment countries’ governments have to take and move forward social support to sustain their vulnerable groups, as well as to support the productive sector with financial incentives and emergency measures. How countries cope and invest for their future after Covid-19, will determine the recovering and coming back to what we used to know as “our normal lives”.

 

References

[1] https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020

[2] https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200131-sitrep-11-ncov.pdf?sfvrsn=de7c0f7_4

[3] https://www.ft.com/content/5919c6fb-1f5f-315d-8353-94f04afcf340

[4] https://www.ctvnews.ca/politics/canada-pulling-out-all-the-stops-to-fight-covid-19-trudeau-on-1b-plan-1.4848070

PEAH News Flash 376

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

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Interventions to Curb Covid-19 Spread in Uganda

A report here by a field engaged stakeholder about the challenges Uganda currently faces regarding the feasibility of interventions to curb nationwide Covid-19 spread

By Gertrude Masembe*

Kampala, Uganda

Interventions to Curb Covid-19 Spread in a Low-Income Country

Feasibility Challenges

 

Covid-19 commonly known as Coronavirus disease was declared a pandemic by World Health organization in March 2020 after its devastating effects in Wuhan China where it is believed to have started. The disease-spread continued rising with escalating numbers and currently stands at 462,684 with over 20,834 recorded deaths according to the World Health Organization (WHO) Database (25th March, 2020). Italy, Spain and China are the worst hit with African countries trailing behind.

Uganda had remained virgin to this pandemic until the 21st of March when a first case tested positive, a traveller coming from Dubai.  Three days later, the cases increased to eight and subsequently to 14 by 25th March 2020 (Presidential address, March 2020). Cases so far confirmed include an eight-month old baby from a rural district. This has set in motion panic among the population culminating into a presidential address with a directive to close all schools, institutions of learning, places of worship, places of entertainment and banning public transport except for goods as these were deemed, to be hot spots for further spread. Additionally, the airport and all borders were closed to prevent inflow of people into the country since all neighboring countries had already registered Covid-19 cases. Masses were advised to observe social distancing leading to banning of any meetings of more than 10 people but this is far from being achieved. A local leader in the city suburb, during an interview on 24th March 2020 mentioned that he was hearing about social distancing rule for the very first time which is worrying because he is supposed to be a conduit of information within his community. The people have also been advised to wash hands with soap, stay home and where possible use masks but unfortunately masks readily available and sold by vendors have been confirmed to be ineffective. A number of avenues including televisions, radios and social media channels like WhatsApp and Facebook are also being used as mediums of information dissemination for preventive measures but sadly most of the messages and updates are relayed in English leaving out many with no grasp of this language.

The ministry has availed hotlines to ensure quick response in case of either identified or suspected cases though some delays have been cited in a few cases as reported by the masses and members of parliament over the radio and TV telecast.  The President has remained committed to this cause, held two additional presidential addresses to update the masses about the Covid-19 situation and further given clarifications regarding preventive measures as recommended by WHO. It is also important to note that shopping centers, pharmacies and the transport industry have heeded the president’s directive and are now implementing guidelines by putting in place hand washing places with soap and sanitizers.

Despite all the above initiatives many areas are still grappling with solutions to this pandemic as panic and stigma builds up for those suspected to have been on the flight from Dubai carrying Uganda’s first Covid-19 victim. During a parliamentary session discussing issues related with Covid-19 on 24th March 2020, members cited long distances to isolation centers as an impediment to combating this pandemic. One fishing community for example has a facility that is 20kilometers away from nearest health center while another community is 185Kilometers away from isolation center.

On the other hand, a few facilities are reported to be lacking protective gear as communicated during parliamentary session on 25th March 2020, making response to emergency cases challenging. The slow response by Ministry of Health (MOH) for cases has been noted which could promote community spread.

How much time should be allowed before a directive takes effect? For example, in the case of transportation of goods between countries by road, the directive to close borders came into effect when trucks were in transit and some drivers and their travelling parties were stuck within communities near border points. This calls for harmonized planning between both countries.

To the common person I should say, the pandemic has come with its challenges due to price inflation for imported consumables. The masses are also into panic-shopping forcing prices to respond to the law of supply and demand. Though hiking prices of items seems to be an inhumane action, this situation is inevitable as vendors rush to cash in on the available opportunity. The local goods have also had their prices doubled when there seems to be no shortage.

As observed, many efforts have been put across but anticipated goals will only be realized if the population fully rallies behind their President to combat the pandemic. Social distancing which is key is not yet being adhered in the case of slum areas while hand washing in the transport industry seems to be a habit in only loading centers in major towns. Personally during my taxi ride from the city suburb where loading was being done, there was neither a sanitizer available nor a washing facility for the passengers and this leaves me wondering if people are truly committed to fighting this war!. However, we have faith that our Health Ministry together with health workers will do whatever it takes to combat this virus given their experience with previous pandemics and hopefully the masses will unite and collectively work to support these efforts by giving hundred percent commitment to observing WHO guidelines and MOH Standards of Procedure.

 

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*  Gertrude Masembe is an executive leader with proven management background; effective problem-solving skills with demonstrated ability to work in rapidly changing environments. She has demonstrated expertise in strategic planning, organizational development, project management and business intelligence across diverse spaces in the development sector. She attended Makerere University and specialized in Social Sector Planning and Management. Her passion is community development which cuts across various sectors like health, education and economic empowerment

E-mail: trudymasembe@hotmail.com

 

Plague and Depression in the Just-In-Time World

At a time when a key consequence of the last decades of globalization has been an increase in inequality, we do not know what post Covid-19 pandemic worlds will look like. A critical question is whether preparedness for future pandemics will secure the place on national and global policy agendas (and the financing!) that it has long deserved.  On this point, against the background of recent events and in the current context of disdain for science in many countries most capable of supporting it, optimism is difficult to sustain

By Ted Schrecker

Professor of Global Health Policy, Newcastle University

Plague and Depression in the Just-In-Time World

 

In the early 1990s, I picked up a book called The Borderless World in an airport bookshop.  Published in 1990 by Kenichi Ohmae, who was then and for many years afterward the Japanese managing director of management consultants McKinsey & Company, it was a heavily business-oriented introduction to the processes of globalization that were to unfold over the decades that followed.  It was also a rather breathless vision of a neoliberal utopia in which “individuals vote with their pocketbooks” without concern for where and how globally recognized brand-name products are actually made – kind of a global duty-free shop.  For Ohmae, rather than being providers of public goods or mechanisms for collective choice about the future, governments had “become the major obstacle for people to have the best and the cheapest from anywhere in the world”.  The book changed the course of my professional life, directing it towards the study of globalization and, for the past 20 years, more specifically towards globalization and health using the conceptual lenses and analytical tools of political economy.  Perhaps this is why one should stay away from airport bookshops.

We are now learning about some of the less attractive aspects of the borderless world and its transactional view of human organization, with a vengeance.  We have known for a long time how easy it is for viruses and their hosts to get on transoceanic flights.  We have also known, to some degree at least, about the vulnerabilities introduced by just-in-time production and supply chains that cross multiple national borders, with increased opportunities for high-impact disruption of such basics as food supply.  And a few observers, notably the brilliant health journalist Laurie Garrett, have warned literally for decades that the equation of less government with better government was limiting ability to respond to eventualities like the coronavirus pandemic, the most disruptive global event (so far) in the experience of most people now alive.

From a health equity perspective, it is hard to know where to start when discussing the epidemic.  In the United States, it has dramatically revealed – and will almost certainly widen – the health inequalities associated with an uninsured population of 30 million, and millions more with inadequate coverage.  As CBC News noted, ‘poorer people are less likely to get tested early, to have health coverage, to be allowed to work from home, to get paid leave and to work or study from a video connection’.  The vulnerabilities of millions of workers in the ‘gig economy’ extend far beyond the United States, with swiftly deployed compensation schemes less likely to reach them than workers whose employment is less precarious.  In the UK, poor families were reported borrowing to buy food a week into a multi-week lockdown, and the impact of a decade of austerity combined with neglect of basic public health principles to lead one professional to comment: “The public and media are not aware that today we no longer live in a city with a properly functioning western health-care system”.

To state the obvious, the virus is likely to have a truly devastating impact in many dense and hyper-unequal cities in Asia, sub-Saharan Africa and Latin America, where much employment is informal; social distancing is impossible; governments’ already limited fiscal capacity will be further weakened by capital flight; and health systems can muster only a fraction of the resources available in high-income countries, where many health systems like the UK’s are already stressed to the breaking point.  It is not far-fetched to envision declines in life expectancy comparable to those that occurred in some countries during the first years of the HIV pandemic in sub-Saharan Africa.  And most Sustainable Development Goals are now just a fond memory of better times.

The pandemic has also revealed the economic and human costs of today’s market fundamentalist model of vaccine development, which paediatrician and infectious disease specialist Peter Hotez has described as a “broken ecosystem”.  In a long piece in The Guardian from which that quotation is taken, he indicates that he might have a Covid-19 vaccine to offer today, based on earlier research on SARS (another coronavirus) had he been able to find funding for a clinical trial during the last decade.  Quite apart from the human benefits, literally trillions of dollars could have been saved.  At this writing, the non-profit Coalition for Epidemic Preparedness Innovations (CEPI), which was established to overcome some of  these problems, was urgently calling for US $2 billion (roughly equivalent to one day’s military spending in the United States) to continue its work on Covid-19 vaccine development.  However, scale-up and commercialization will remain reliant on considerations of profitability, which is far from reassuring although over the short term demand would seem assured and supply capacity may be a primary concern.

We do not know what post-pandemic worlds will look like.  A key consequence of the last decades of globalization has been an increase in inequality in most societies, rich and poor alike.  In The Great Leveler, his magisterial examination of economic inequality over la longue durée, historian Walter Scheidel argues that inequalities within societies have narrowed substantially only after four kinds of disruptions: mass-mobilization wars, transformative revolutions, state collapse, and major plagues.  Covid-19 is certainly a major plague, and its social and economic impacts are emerging as similar to those of mass-mobilization wars in many countries.  Conversely, it is possible to imagine a ratcheting-up of inequality, as often happens after financial crises. Economists also cannot predict the extent to which economies will bounce back relatively quickly, as opposed to experiencing prolonged periods of stagnation; the interconnectedness of economies of course complicates the picture, though strong incentives may exist for unwinding some of those interconnections, like the UK’s reliance on imports for half its food supply.  A critical question, as well, is whether preparedness for future pandemics will secure the place on national and global policy agendas (and the financing!) that it has long deserved.  On this point, against the background of recent events and in the current context of disdain for science in many countries most capable of supporting it, optimism is difficult to sustain.

 

Pharmaceutical Business in Somalia

At a time when governments are urged to take on their duties and tackle the global health threat posed by poor quality, fake or counterfeit medicines trading, PEAH is pleased to publish an appeal, just a thought, by a field engaged Somali advocate 

By Mohamed Said Ali

Senior Healthcare Consultant at KPMG

Case in Point: Just a Thought

Pharmaceutical  Business in Somalia

 

  • Somalia has a long uncontrolled coastline (Indian Ocean and red Sea), where the most  legal or illegal trade transactions go on. Moreover, internally bordering countries are open (Ethiopia, Kenya, and Djibouti), with no potential government influence  
     Credit: OCHA
  • For those reasons, high volume loads of drugs are imported without legal procedure and negligible quality control. Let us keep in mind this: poor governance and local health authorities  incapability blamed to be the base of drug disaster.
  • Drug conservation in Somalia is  not standardized or not performed genuinely. For example, in southern areas temperature oscillates 18-25c, while in the Red Sea  coastal areas temperature oscillates 35-55c. This results in incredible drug expiration which impacts badly to victims (humans and livestock).

Needs

  • Conservation system performance
  • Efficient installation of solar system
  • Establishing  legislative committee
  • Inviting affiliated companies
  • Negotiations  and committing with the government is an official issue

         

                      

 

PEAH News Flash 375

News Flash Links, as part of the research project PEAH (Policies for Equitable Access to Health), aim to focus on the latest challenges by trade and governments rules to equitable access to health in resource-limited settings

News Flash 375

 

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The World at Risk: Covid-19, Global Sustainability and 1 HOPE

Key steps towards overcoming the world’s complacency (or negligence) towards external risks are, first, to recognise the interconnections between all human – nature relationships, a central premise guiding the UN-2030 Sustainable Development Goals or Global Goals.  And, secondly, as Covid-19 has made clear, there is an urgent need to change our worldview (belief systems). In short, we are all tasked to transcend national and personal vested interests and adopt a new mindset:

replacing the current view of limitless resources, exploitation, competition and conflict with one that respects the sanctity of all life and strives towards health and well-being for all - the planet and all species

 

By George Lueddeke PhD, MEd, Dipl. AVES (Hon.)

Chair, One Health Education Task Force and the international One Health for One Planet Education initiative (1 HOPE) 

(One Health Commission and the One Health Initiative)

The World at Risk

Covid-19, Global Sustainability and 1 HOPE

 "It is the long history of humankind that those who learned to collaborate and improvise most effectively have prevailed." – Charles Darwin

 

Introduction

The world is experiencing an unprecedented crisis. We are facing down a coronavirus pandemic that, according to Francois Balloux, professor of computational systems biology and the director of the University College London (UCL) Genetics Institute, is “the most serious global public health threat humanity faced since the 1918/19 influenza pandemic” (1).

The 2020 cataclysmic pandemic is reaching all corners of the world leaving no one unaffected – medically, socially, economically, and psychologically. As with previous bacterial outbreaks threatening humanity, this potentially dystopic threat will pass, but its impact is transforming the world we know in just a few short weeks and months.

This paper highlights some of the immediate effects on society, aims to encourage readers to reflect on current global priorities with a view to finding new ways to strengthen our capacity to ensure global sustainability and well-being in the longer term.

Coronavirus – a Global Wake-Up Call?

The novel coronavirus outbreak emerged in Wuhan, China, a city of 11 million people.  The virus SARS-CoV-2 is understood to have originated in bats and passed on to humans at the end of 2019 through contaminated meat at a seafood market where wildlife was also traded illegally. Spreading rapidly across the globe many thousands – possibly rising to millions of people – are now forced to self-isolate to slow down or stop the transmission of the infectious disease.

Severe restrictions on travel and business have been imposed alongside partial or complete border closures and total country lockdowns, including social distancing, school closures and banning mass gatherings. The number infected with Covid-19 along with rising deaths globally – especially among the older population and those with underlying medical conditions – are unprecedented in the modern age as – without a vaccine – are  the limited options available to governments mainly relying on testing, tracing contacts, quarantine, hand washing  and maintaining social distance.

It appears that China’s all-of-society approach to contain the virus (vs delaying it via acquiring ‘herd immunity,’ Britain’s first strategy) and giving local authorities high autonomy, placing routine health services online, coupled with severe restrictions on people movement seems to have worked.  Few new cases in a population of about 1.4 billion are now reported with other nations, for example, Singapore and Taiwan, showing similar results.  At the time of finalising this article (March 25 – 16:00 GMT), according to the Worldodometer (Coronavirus  [update]), there were 445,815 Covid-19 cases; 19,770 deaths (15%) with 112,037 recovered (85%). Countries with the highest number of cases are China, Italy, USA, Spain, Germany, Iran and France.

With infections now across all global regions and efforts to stop the virus from spreading, the impact of Covid-19 on human capital – social and economic – is unprecedented. The virus affects society as a whole – including those in the front line of  infection defence:  healthcare workers – potentially weakening  health care systems especially in poor countries where billions are living under  intolerable social conditions,  lacking safely managed sanitation, and  are already struggling with a myriad of infectious diseases (e.g., cholera, HIV/AIDS, TB).  Just about every aspect of life as we know it has been impacted – manufacturing, travel and tourism, shopping, hospitality, businesses, stocks, leisure, education, healthcare – to name just a few major areas.

The United Nations has warned that the crisis could lead to the loss of nearly 25 million jobs around the world with the global economy facing a financial crisis similar to 2008 or even the 1930s. The groups most affected are not the professionals but low-paid workers working in the service industries-most of whom could benefit from provision of a universal basic income.  With the threat of a recession (depression?) governments, in some cases using emergency powers, are trying to help with emergency stimuli – grants, interest-free loans, tax cuts.  Following similar schemes in Denmark, Sweden, Germany, France – with others soon to follow – the UK government has now initiated a wage support scheme subsidising 80% of the pay for workers who would otherwise be laid off while also introducing new welfare measures – the total bailout costs about £44 billion adding to the national debt with the deficit becoming the largest ever recorded. Fragile economies – e.g., African countries – may not be that fortunate unless institutions like the World Bank intervene.

The Folly of a Limitless World

There can be little doubt that pandemics  alongside other  existential planetary threats we face – environmental degradation, geopolitical (e.g., weapons of mass destruction [WMDs]), technological (e.g., artificial intelligence [AI] for non-peaceful purposes),  ideological extremism – (political/religious) – necessitate a global redirection towards well-being and sustainability (2).  Covid-19 reminds us that that the survival of all species (humans, animals, plants) is wholly dependent on treating all life on the planet with respect and ensuring an ecologically-healthy planet.

As Allister Heath, editor of The Sunday Telegraph, reminds us, perhaps the most important lesson from the current crisis is that ‘never again must we fall foul of Panglossian stupidity and assume away the risks of a catastrophic pestilence’ (3)

Covid-19 puts into sharp focus the futility of self-indulgent or vainglorious thinking that has characterised much of our political and economic debates and decision-making in the past few years (4). So-called ‘strongmen’ or political extremists (far left and far right) who pursue division over unity at a time when the spirit of ‘oneness’ is imperative (2) might find Percey Bysshe Shelley’s poem Ozymandias (5) a sobering read – especially the last few lines:

“Look on my Works, ye Mighty, and despair!

Nothing beside remains. Round the decay

Of that colossal Wreck, boundless and bare

The lone and level sands stretch far away.”

Key steps towards overcoming the world’s complacency (or negligence) towards external risks are, first, to recognise the interconnections between all human – nature relationships, a central premise guiding the UN-2030 Sustainable Development Goals or Global Goals (5).  And, secondly, as Covid-19 has made clear, there is an urgent need to change our worldview (belief systems). In short, we are all tasked  to transcend national and personal vested interests and adopt a new mindset: replacing the current view of limitless resources, exploitation, competition and conflict with one that respects the sanctity of all  life and strives towards health and well-being for all – the planet and all species (2).

In this regard, in 2020 the time may have arrived for world and national leaders, influencers or shapers and organisations, such as the UN, the Group of Twenty (G20), WHO, NATO, OECD, WEF, the World Bank, Universities, Civil Society organisations, and pro-environment Youth campaigners  to step forward  to reinforce and rebuild trust in global institutions – committing to shared global values, providing adequate resources and  helping to shape  and strengthen multilateral strategies, many of  which (e.g., the UN-2030 SDGs) have the capacity ‘to save the world from itself ’ (6). One of their most important tasks might be to challenge the thinking of those who subscribe to the follies that Earth resources are limitless, that climate change is a hoax and that division is preferable to unity.

The One Health and Well-Being Concept and Propositions for Global Sustainability

Recently kindly described as a ‘landmark’ publication, my current cross-disciplinary book, Survival: One Health, One Planet, One Future  is dedicated “To all those who believe  in the Oneness of  the  world” (2).

The main purpose of the book is to ‘try’ to make sense of the uncertain and tense (‘rattling’) times we are experiencing with a view to finding ways forward to ensure the sustainability of the planet and all species. David Heymann MD, professor of epidemiology at the London School of Hygiene and Tropical Medicine (LSHTM), former head of the Centre on Global Health Security at Chatham House (London), and chair of Public Health England, wrote the Foreword.

The volume asserts that – as previously mentioned – the One Health & Well-Being (OHWB) concept – that recognises the interdependencies among humans, animals, plants and their shared  environment – provides a unity around a common purpose – sustaining our planet which ought to drive/steer the 17 UN-2030 Sustainable Development Goals or the SDGs (7) in policy and practice, thereby encouraging decision-makers at all levels – especially Government, Business and Civil Society- to get behind this global initiative regardless of  ideological persuasion or divisions.

The challenge is to shift our perspective from two-dimensional to three-dimensional, ‘orbital’ thinking, as NASA International Space Station (ISS) astronaut Col Ron Garan contends – “bringing to the forefront the long-term and global effects of every decision” (8)

British journalist, author and broadcaster, Matthew Syed,  in a  commentary applies this principle to ideology and ‘our broader political culture’ where, he observes, ‘Politicians  of  left and right…tend to view things through a single lens, rigid and unbending, blinding them to what’s going on’ as opposed to  ‘creating accountability, by listening to real rather than pseudo-experts and by  acting multilaterally when wise to do so…’ and learning ‘rather than deluding ourselves with baroque confabulation’ (4).

As shown in Figure 1, the propositions are a point of convergence in Survival (2) and target  decision-makers at all levels. They call for informed, future focused discussion at the United Nations, other bodies, organisations and involvement of civil society generally. The propositions are catalysts for ‘thinking outside the box,’ individuals and organisations working toward common goals – identifying the root causes/obstacles, collaborating to find solutions, implementing, monitoring, communicating, adjusting – and thereby contributing to the creation of a more “just, sustainable and peaceful world” (7).

Figure 1: Ten Propositions for Global Sustainability

What if?

© 2019 George R. Lueddeke

Source Lueddeke, G.R. (2019). Survival: One Health, One Planet, One Future. Abingdon, Oxon / New York: Routledge. (Ch 12- Leading in an era of uncertainty, upheaval and anxiety)

 

The international One Health for One Planet Education Initiative (1 HOPE)

Drawing on the OHWB concept and the SDGs, the propositions are an attempt to narrow the gap between ‘what is’ and ‘what might (must?) be’ in order to ensure sustainability and well-being of the planet and all species.

The reality is that many of the issues had been identified already but many have received only token attention at best by decision / law-makers / organisations or have been ignored altogether. As discussed earlier, the Covid-19 crisis is a massive, hopefully once-in-a lifetime, shock that has taken everyone out of their comfort zone as companies, schools and public transport systems, and companies shut down and hundreds of thousands of firms, big and small, are at risk.

We really are in the era of the “known unknowns.” While in the immediate effective responses to patients with Covid-19 infections remain variable, in the longer term one thing we do ‘know’ is that learning from past events may be the key to our survival and the sustainability of life on earth as we know it (2).  To this end, formal and non-formal education is not only a human right but is also fundamental in advancing  ‘the three aims of building resilience, improving sustainability, and assuming responsibility’ (8),  agreed by the G20 in 2017,’ thereby reducing poverty and fostering economic prosperity.  In terms of the latter, we also now realise that our future cannot be bought at the expense of our environment nor ignoring the well-being of all other living species that have evolved over billions of years.

The criticality  of making a paradigm shift from human-centric to eco-centric thinking and behaviours is what the Covid-19 wake-up call is all about and ‘represents a precious opportunity to learn…a moment that affords an opportunity to understand what happened , why it happened and what we should do next’(4).

Proposition #7 recommends that consideration be given for the One Health & Well-Being concept to become the cornerstone of our education systems and societal institutions.  Supported by the One Health Commission and the One Health Initiative, the proposition became the catalyst for the development of the international One Health for One Planet Education (1 HOPE) initiative (9).

As one response to the issues we face globally (10), its overall vision, as summarised in Figure 2, is “a world where people of all ages in civil and governmental organizations  apply a One Health and Well-Being (OHWB) approach – recognising and respecting the interconnections and  interdependencies among humans, animals, plants and their shared environment – thereby collaboratively striving to ensure the sustainability of the planet’ (11).

Building global capacity, 1 HOPE seeks to progress understanding and valuing of the OHWB concept and the SDGs globally through a number of working groups (WGs) in each region. The WGs will be developing ideas for pilot projects for possible external funding. To date several have been established in the Americas and Africa with others soon to follow.

Figure 2: The international One Health for One Planet Education initiative

 

Concluding Comments

Unquestionably, as Caroline Stockman, chief executive at ACT (UK Association of Corporate Treasurers), stated recently we are now facing the ‘worst of the worst because it touches on everything. It’s not just that the markets are going down like they did in the financial crisis, it’s that people are worried about their loved ones dying’ (11).

As discussed earlier, urgent  priorities are  to limit the spread of the disease which is now impacting on all nations worldwide confirmed on this map in real time showing exponential daily increases.

Calling for a ‘smarter approach to development and well-being,’ the authors of a seminal article, ‘A vision for human well-being: transition to social sustainability,’ emphasised the need to identify ‘underlying issues and root causes of inadequate human well-being’ while solving ‘these problems within the context of environmental limits.’  Two key challenges in achieving global sustainability, according to the authors, are that sustainability can occur only in ‘human societies that function well’ and only when ‘something pushes them’ (12).

Covid-19 might provide the trigger  as, according to Ed Conway, economics editor of Sky News,  ‘coronavirus is one of those shocks that could force business to take the leaps that they were hitherto too nervous to make’ but perhaps less so now given the impact it is having on all human activity. As Conway concludes, this disease could force us to take a long hard look at the way we run the world, and change it’ (13).

While our hearts and minds are understandably concentrated on the here and now, this could be the moment – perhaps informed by ways forward, such as the Ten Propositions for Global Sustainability and 1 HOPE,(2) when society begins to think about ‘developing economic and political policies and institutions that serve human well-being in all its dimensions’(14), in particular the ‘restoration and regeneration’ of the Earth’s natural systems without  transgressing ‘its boundary conditions’ (15).  The younger generation deserves and will expect nothing less!

 

References

1. Science Media Centre. Expert comment on possible scenarios and responses to COVID -19.[ Internet]. 2020 Mar [cited 2020 Mar 19]. Available from: https://www.sciencemediacentre.org/expert-comment-on-possible-scenarios-and-responses-to-covid-19/

2. Lueddeke GR. Survival: One Health, One Planet, One Future. Oxfordshire, England: Routledge; 2019.

3. Heath A. At best, coronavirus is a dry run for the catastrophic pandemic to come. The Daily Telegraph: Comment.  2020 Mar 5: 16.

4. Seyed M. In a real crisis, we reach for expertise – so let’s use it to kill off the ideology virus too. The Sunday Times: Comment; 2020 Mar 16:22.

5. Shelley SB. Ozymandias.  Poetry Foundation [Internet]; 2020 Mar [cited 2020 19 Mar]. Available from: https://www.poetryfoundation.org/poems/46565/ozymandias.

6. Lueddeke GR. The University in the early Decades of  the Third  Millennium: Saving the World from  itself?  Policies for Equitable Access to Health (PEAH)  [Internet].  2020 Jan [cited 2020 18 Mar]. Available from: http://www.peah.it/2020/01/7524/

  1. United Nations. Transforming our world: the 2030 agenda for sustainable development. Department of Economic and Social Affairs [Internet]. 2015 Sept [cited 2020 Mar 2020]. Available from: https://sustainabledevelopment.un.org/post2015/transformingourworld

8.  Garan R. The orbital perspective: an astronaut’s view. London, England: Metro Publishing; 2015.

9. European Commission. G20 leaders’ declaration: shaping an interconnected world. [Internet]. 2017 (July 8) [cited 2020 Mar 20]. Available from: https://ec.europa.eu/commission/presscorner/detail/en/STATEMENT_17_1960

10. The Core Group. One Health & Well-Being: Toward Human –Nature Sustainability. George Lueddeke – Webinar. 2020 Jan 30 [cited 2020 Mar 19]. Available from: https://coregroup.org/wp-content/uploads/2020/02/30.01.2020-Final-One-Health-Webinar-Slides.pdf

11. One Health Commission and the One Health Initiative. The One Health education task force: Preparing society for the world we need.[Internet). 2019 Dec [cited 2020 Mar 21]. Available from:  https://www.onehealthcommission.org/en/programs/one_health_education_task_force/

12. Evans P, Treanor J. Pledges sow hope –and confusion. The Sunday Times: Business & Money; March 22 2020:1.

13. Rogers DS, Duraiappah A, Antons DC, Munoz P, Fragkias M, Gutsche M. A vision for human well-being: transition to social sustainability. Current  Opinion in Environmental Sustainability.  [Internet]. 2012 February [cited 2020 Mar 16]; 4: 1–13. Available from: https://www.researchgate.net/publication/257721856_A_vision_for_human_well-being_Transition_to_social_sustainability DOI: 10.1016/j.cosust.2012.01.013

14. Conway E, Virus can trigger a new industrial revolution. The Times: Comment; March 6 2020:26.

15. Khosla A. Development alternatives: to choose our future. Development Alternatives Group. New Delhi, India: Academic Foundation; 2015. Available from: https://www.amazon.co.uk/Choose-Our-Future-Ashok-Khosla/dp/9332703043

 

 

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