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From the Front Row: Global public health – mental health, trauma, and the COVID-19 pandemic

Published on December 10, 2020

 

The following is a transcript of an episode of From the Front Row: Student Voices in Public Health, the University of Iowa College of Public Health’s student podcast. This second episode of our global public health series focuses on mental health. Alexis and Steve talk to Rafael Muñoz, CEO of Human Reinvention based in Ecuador. He shares his thoughts on mental health and trauma as public health issues as well as how the pandemic is impacting the mental health of individuals.

Alexis Clark:

Hello, everyone and welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is Alexis Clark, and I’m joined by Steve Sonnier, and if this is your first time with us, welcome. We’re a student-run podcast that talks about major issues in public health and how they are relevant to anyone, both in and out of the field of public health. Today, we’re excited to welcome Rafael Muñoz, the CEO of Human Reinvention based in Ecuador. Rafael earned his masters in work and organizational psychology from Erasmus University in Rotterdam, Netherlands. Rafa, welcome to the show.

Rafael Munoz:

Hi Lexi.

Alexis Clark:

Let’s start off with your path. How did you get to your current position?

Rafael Munoz:

Well, my public health career path started perhaps when I was a child, my mother was a psychologist so I was always into these topics, I grew up with psychology all around me. But formally, it all started when I became a clinical psychologist USFQ here in Ecuador, it is perhaps the biggest and best university of the country. But afterwards, instead of working directly into the clinical side of it, I decided to go and work in the organizational side of the psychology. So I ended up working in a multi-national in HR and I was in charge of the selection processes throughout the country. And I was also in charge of developing Salesforce. And after a couple years over there, I decided to go and get my master’s degree in positive work and organizational psychology in the Erasmus University Rotterdam, which was great. It’s one of the top universities in the world, so actually I’m really happy with that.

Rafael Munoz:

And at the same time, when I decided to go and get my master’s, I started Human Reinvention, my company, which combines both the clinical psychology part and the organizational psychology part. So in this company, I basically help people develop in a personal and in a professional way.

Steve Sonnier:

That’s really exciting to hear about, especially the positive psychology side of things. Because I know that’s a relatively developing field, at least what I’ve seen in the United States, when you’re looking at public health education and that practice too of psychology and the organizational side of things. What does that look like in Ecuador and also at the Erasmus side of things, how did you get involved with those ideas initially?

Rafael Munoz:

Actually it is great that you mention the positive side of it because as you said it is a growing field all over the world, even though it started perhaps year 2000, so it’s been basically 20 years already in the field, but it hasn’t gained its whole potential. And from Ecuador, the way public health education I practice from, the positive psychology side, actually I can say that it’s beginning. We have a saying over here that it is that we are in diapers. It is quite funny because it means that we are completely a baby, we’re not a full grown up yet, so we have a long way to go. For example, here in Ecuador, we do not have a mental health bar. So insurance companies, they don’t know what to do with a mental health issues, companies they don’t know what to do with their employees.

Rafael Munoz:

For example, if any of them has acute stress disorder and they need to spend a couple of days at their place, or for example, if someone breaks the law, but this person, who breaks the law, what happens if he has any kind of mental issue, is he going to be treated the same way? So there is no clarity at all of how things should be handled here in Ecuador. For example, we also don’t have code of ethics. So we are at the beginning, a lot of people could perform any kind of negligence or they can be really informal with their practices. Perhaps there are a lot of psychologists, they call themselves like that, but they don’t even have a title. There isn’t one institution who can regulate them and who can regulate our practice. I have as myself, if this is perhaps something that it is because of the people who is in charge or because of the budget that the State designates to mental health.

Rafael Munoz:

And I was checking the numbers before and actually, in Ecuador, we are at 17 million people and there are only 787 clinical psychologists who work for the public institutions. That makes that for every psychologist, clinical psychologist there is here in Ecuador working in the public sector, there are 22,000 people who need to be handled by him. And I was also checking how much money was designated from the GDP in Ecuador, and for example, in 2019 only 0.002% of the GDP was directed to public mental health. I repeat, 0.002%. That is almost nothing, that is less than $2 million over here. And if you divide these per capita, it is going to end up being almost 12 cents of dollars per capita. So that is almost nothing that is being invested right now in Ecuador for public mental health.

Steve Sonnier:

Has the coronavirus situation changed that at all, has that act as a catalyst in any way, shape or form to say, we need more attention for mental health services here in Ecuador?

Rafael Munoz:

That’s a great question. And I think that I also thought that that was going to be quite a boost for the mental health system to improve itself. And actually I would say that we are happy that the Congress is already evaluating it, but perhaps that’s going to be ready in one year. So it is a small step, but we need to take steps faster. And also it is quite alarming that the budget for public mental health, which was specifically target like that in the national budget disappeared for 2020. And actually they said that more money was going to be directed to the whole health system but instead we’re not seeing that that is the case. We are checking the numbers and the money that was directed to public mental health, has not been put into the general health.

Alexis Clark:

So in your opinion, do you think mental health is the public crisis of Ecuador or what is drawing the government’s attention to, since it’s obviously not mental health awareness?

Rafael Munoz:

Yeah, exactly. It is obviously not mental health awareness right now, all the efforts are being put into overcoming this crisis. So we didn’t have a lot of ventilators here, a lot of respirators here. So at the beginning all the energy was set to bringing more of these ventilators to the country. But still right now, we don’t have as many, so the country just decided to put us all on lockdown until, so that we can flatten the curve. But at the end, perhaps it did work for a while, but people needed to get out and start working. So if we’re talking about what are the greater needs in public health right now, I would say that there are a lot, for example, we have a lot of places, a lot of regions here in Ecuador, they don’t even have clean water and which is such a valuable thing in these moments. But if I would have to say something, I would always aim for prevention and promotion from mental health and also not mental health, but my strength is mental health, so I’m going to stick in this area.

Rafael Munoz:

And I will always support that we need to have mental health promotion and prevention taught in a school, the same way that children go to schools and they end up learning about science about math, they should also learn about how to manage their emotions, how to manage their thoughts, how to be more effective and efficient with their actions. And mostly also they need to start thinking about how they want to live. They need to question themselves so that we have thinking human beings, instead of people who just repeat what they were taught to do and what they were told to do. So my aim goes always to prevention and promotion, instead of trying to be palliative science, a palliative brand. We always have to aim to go from what we already have us functional and try to take these people from functional to extraordinary, from functional to be performers. So that would always be my aim.

Steve Sonnier:

I’m thinking about a conversation we just had the other day, actually about the idea of, if you have a mind, right? You want to be able to change it essentially. We are just not supposed to be these individuals that keep on in the same set pattern that we want to evaluate things. And one idea that also came to my mind when you were talking about the need to teach folks at a young age about how to regulate your emotions. I’ve seen a lot of pickup for teaching meditation in schools, something very simple like that, where you can emotionally self-regulate. In your practice for your company, with Human Reinvention, what is your market? Who are you trying to reach out to in this practice? And what successes are you seeing with this? Because it seems like the emotional side of things and the mental health side of things is like you said, really early in development in Ecuador.

Rafael Munoz:

Yep, totally. Over here things are really early in development and such small changes like the one that you were saying to teach children in school, mindfulness and how to meditate so that they can regulate, those are going to be great steps once these children are fully grownups and they know how to manage their emotions better. So my ideal audience with Human Reinvention are the people who are already in companies, but who feel that they are not fully fulfilled. Who are there because perhaps they needed the money someday, but now they got stuck and they don’t know perhaps how to get out. They don’t know exactly what success means for them, they don’t know exactly what they are looking for, or perhaps how they’re going to be there for five more years, 10 more years. And right now is a moment when they start questioning themselves and how to live. That’s where the name comes from, Human Reinvention.

Rafael Munoz:

And I emphasize in re-invention because a lot of people thought that life was going to be A, but they ended up finding that life is B, but they prepare themselves to live as if they need it for A, but perhaps not for B. And right now with the coronavirus, people are seeing that perhaps it is not even A or B, they find themselves in C, so now they have to adapt themselves to go and start feeling fulfilled, feeling well, achieving that wellbeing, achieving that purpose, achieving that meaning, that flow in C. My vision of the company is to help people and not only individuals, but also companies achieve their desired goals in life. And I know this is a broad definition, but it involves the personal side and the professional side. So companies, they’re just a sum of people, but these people are the ones that are going to thrive and are the ones that are going to take this company to be what their company really wants to be.

Rafael Munoz:

So that is my approach to people. This is also what I sell. So my ideal audience as I said, are people who are already in companies working, they are really functional, but perhaps they are not in their desires setting and they really want to feel fulfilled.

Alexis Clark:

How do you engage positively with the community you work with? Do you consider yourself an advocate for that community?

Rafael Munoz:

Right now, the best way to engage positively with this audience, with this community that I work with, has been through strategic alliances with companies. I think that the pandemic has been a great catalyzer to open up the doors for psychology within companies, because the companies have started to see that this is such a great need because we have right now direct stresses and also indirect stresses. For example, something could happen to me directly, or perhaps that is going on with my wife or with my daughter, with my son. So all of these things end up influencing the way I perform, the way I show up at work. And even though we’re doing that online right now, we don’t have the vision right now. So it isn’t that I go to work and it is only work and whenever I leave my work, it is only my home life. So right now everything came into a mix. And when everything is mixed together, it is beautiful because we get to see those influences quicker, we get to see those correlations faster.

Rafael Munoz:

For example, there is some someone who is fighting with his wife at home, that is obviously going to affect how he presents at work. So companies finally starting to appreciate these links that we have because we are the same person who shows up at work and the same person who goes and has dinner with his family. So right now, what has been the best moment because this company, as I said, have opened up, so right now these are strategic alliances that I’ve been making with them, has made it easier to get to the people because the company is also supporting these spaces. It is not a taboo anymore, it is not a stigma, it has become something positive for them to go to be with a professional psychologist, organizational or clinical, for them to start having more clarity. For them to start being more emotionally stable, and for them to have more clarity, mind clarity. And so they can be sharp when they need to be.

Steve Sonnier:

I think that’s a very incredible point to point out right now is that investment that we’re seeing in workers, from companies that has traditionally not been there and the recognition too. I think that is one of the unifying things of the experience of the pandemic, is that we are all going through it in very different ways. And then having that consciousness to make sure that we are accounting for how our employees act and what the stressors are that they face at home. When you’re thinking about us eventually emerging for the pandemic in different nations, coming out of it at different speeds. How do you envision the world transitioning afterwards, especially when it comes to this mental health side of things?

Rafael Munoz:

Vision that I have for a better and healthier world after the pandemic. I don’t see this as coming back to the previous normality that we have. I see these as creating these great reset that has been used, yeah, these great reset for a better world, a greener world, a world where people have more sustainable mindsets with sustainable. I don’t just remark that we’re going to have more awareness of our connection with the nature, but we’re going to have more awareness of how we act, why we do things, how should we do things? So we’re going to end up questioning more the way we do things because we have seen already that things can be done differently. So afterwards there isn’t a set way to proceed. So if we’re going to end up working back in offices, the question would be like, do we really need that? Is it really needed for us to be eight hours over there? Wouldn’t it be easier if some of us can work online in different places in the world? Should we travel that much? Should we commute this much?

Rafael Munoz:

A lot of questions are going to come up. For example, why do we need psychologists in the companies? This is new ways of going forward. So my vision of these better and healthier world is going to be a world where people is more aware of why they do things, why they do things and what for they make them. I also think that this is going to boost the climate change struggle that we’re going through, but I think that we’re going to end up having people who have greater wellbeing, because they’re going to, if they start questioning a lot of the status quo, they might do things in a different way. They might thinking that the path that they thought that was almost predetermined for their lives, it is not the only path. So they can go and try to do a different one. I think that afterwards, I hope we are going to have people who are more congruent with their lives.

Rafael Munoz:

So if they start questioning themselves, what is success for me? What is a great life? If I could die tomorrow, what would I really like to do? Instead of being stuck in a company, instead of being stuck in a position that they really don’t want, that they don’t feel like they are thriving. So my vision of this perfect world would be a world where people are congruent. They know where to go, they know what to do, and they really pursue it instead of trying to accommodate to things that perhaps they really don’t want. So it is a world where people are more aware of the things that they are doing, what for and how all of these is connected. Not only to the people, like really close to them, but also to the whole world, to the whole climate. So I think that this is how we’re going to end up going.

Alexis Clark:

I think it’s a great point that you brought up about people taking a look at what really is important to them. And if we take away any positivity from the coronavirus, it’s the ability to slow down and look at each other and look at what’s important to you. In Ecuador, I know it’s very rare for people to have international travel under their belt. You have had numerous experiences around the world. Can you tell us a little bit about your education and the work you did in other countries and how do you think it helped shape your perspective as a professional?

Rafael Munoz:

Yeah, Lexi, what you were saying is actually what I wanted to say that afterwards people are going to start questioning what to do, and they’re going to set their values to what really is important to them. In my case, this has also, perhaps these links to my education and my experiences outside my country, because I got to see that there isn’t one way of doing things. So I also questioned myself at one point of my life, what was important for me? How do I really want to live? How do I really want to do things? If I want to do this I always came up with a question like why, what for, what I’m going to, what is it that I’m going to earn? So being outside of the country, having a great education, that is really evidence-based, that it is really research based, has taught me that research and evidence and evidence-based practices are the best ones. Instead of just being someone who has a great idea and tried to sell it to everyone.

Rafael Munoz:

So being outside of the country has taught me a lot from the scientific view, but perhaps it has also taught me about all these ways of living that there are not only one, all these worldviews that they are always different. And from my experience working, well, going to a university outside of the world has opened up the doors for me to be able to have a lot of clients around the world. So right now, for example, I have clients that are in the US, I have clients in the Netherlands, in Italy, in Argentina, in Ecuador. So it has been great because it opened up the doors for me. Perhaps you already know that I own a great degree, and that’s why I am really appreciated. I really I’m happy with my path because right now I get to see all these different perspectives, all these different values that people has on a daily basis.

Rafael Munoz:

And these shaped my perspective as a professional, because I will never forget if in one day I am talking with someone who is in the US and also talking with someone who is in Europe, in Italy, they have a different reality. So this is the greatest thing, because it teaches me that our realities are not given, are not set, and we can change them. So this is the greatest thing of going abroad, having a great education based on science, but on the other side, being able to look to all these different worldviews and realities.

Steve Sonnier:

That’s always really exciting to hear. And it very much hearkens back to the point of travel, broadens your mind regardless. For our side in the State side, sometimes it can be hard to get out of our States, but I found that each time I’ve had the opportunity to move, it’s been an incredible experience to see how other folks live. I’m thinking about your opportunity to talk with so many people across the world when they’re interacting with you, what is their sense of how mental health care or the values of mental health care are approached in their countries versus their interactions with yourself?

Rafael Munoz:

I am not sure how the structure of the public mental health systems work in these other countries with greater details. But for example, I was in the Netherlands when the first peak of the coronavirus was hitting Europe and while Italy and Spain were collapsing, the Netherlands never got into a lockdown. They were never scared of the virus because they had such a confidence and trust in their systems that their measures were really light. So they basically just asked the people to maintain the social distancing, but besides of that, they encouraged people just to keep working, to doing the same things, because they also wanted the economical side of the country to be strong, but they had all these confidence in their public health systems. And in comparison here in Ecuador, as soon as the first coronavirus appeared, Ecuador decided to get into a strong lockdown.

Rafael Munoz:

They implemented really strong measures and perhaps we remain in full lockdown for half a year. Right now the measures have become a little bit lighter, but still, we have some mobility limitations, we still have a lot of, almost all of us are working online, but in comparison to the Netherlands, everyone was relaxed. Where here in Ecuador, everything is a mess, everyone is really scared of the virus. There is a big mis-information, but in all the other countries, the message was clear. There was a head who was leading all the speech, but over here, mis-information is a big thing. And that’s why I think they opt to put us all into a lockdown for half a year, because they didn’t have a different option and we don’t trust our public health system that much.

Alexis Clark:

So in a perfect world, would you like to provide services both in-person and virtually, since you have customers all over the world, or would you like to focus basically just on the virtual component of delivering mental health?

Rafael Munoz:

Actually, I love to just provide services online. I think it is way more efficient because you don’t have to travel there. You don’t have to ask everyone as your client how they got here. If they were able to find a parking lot, or if they are comfortable, if they want a glass of water, everything is more to the point. So the time of the meeting is let’s say 5:00 PM. And so he shows up 5:00 PM, 5:01, you are already going to the point, you’re already with content and you’re already working. Perhaps I do miss working with big groups because working with groups online is not the same thing, because you’re not able to keep an eye on all of them, to keep an eye in the dynamics of the group. So actually that’s why online, I’ve only been able to provide mental health services to individuals, but not to groups.

Rafael Munoz:

So in a perfect world, I would love to keep providing mental health services all over the world to individuals. And I would really love to come to companies and try to be over there with groups and try to, I don’t know, from groups dynamics to group cohesion, to groups performance. So actually I do miss those topics.

Steve Sonnier:

When you’re looking at the ability to talk with so many different folks with different backgrounds and your experiences abroad, and then also back home in Ecuador. Reflecting on those, what’s one thing that you thought you knew, but were later wrong about?

Rafael Munoz:

I would go in a different direction and instead of getting an idea from all of them and from all these different backgrounds, I would like to say that perhaps I thought three years ago, that organizational psychology was boring, that it was mostly administrative, that it was really impersonal. But now that I am really completely deep down this ground, I really love it because it is really dynamic. You end up working with individuals, groups, companies, the baseline is that people and companies want to flourish. There is always going to be, I don’t know, a path forward for all of us. So I really love being into these brands and being in these brand while the pandemic is around because it has given us a lot of perhaps strength and power. So then now companies and individuals look at us as more valuable, and it has given all of us and the world an opportunity to rethink the way we’re living and rethink how each one of us has lived so far. Because once after the pandemic is gone we’re going to have a second opportunity to end up living how we really want to do.

Alexis Clark:

Yeah, I agree a hundred percent with them. It’s almost like a start over for many aspects, especially in terms of healthcare in general. So I wanted to thank you Rafa, for taking the time out of your busy schedule, to meet with us and talk with us on From the Front Row.

Steve Sonnier:

It was a pleasure to meet you and just such fascinating conversation. And it’s really good to hear about all of your work. So we wish you the best in the upcoming year and hope you stay safe and healthy out there.

Rafael Munoz:

The same for you guys, keep safe.

Steve Sonnier:

That’s it for this week’s episode of From the Front Row. Major thanks to our guest Rafael Muñoz for coming on today. This episode was hosted and written by Alexis Clark and Steve Sonnier. This episode was edited and produced by Steve Sonnier. You can find out more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple podcasts, and SoundCloud as the University of Iowa College of Public Health. If you enjoyed this episode, please share it with your colleagues. Our team can be reached at mailto:mcph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Keep on keeping on out there.