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From the Front Row: Public health and globalization

Published on February 4, 2021

 

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 week, Dr. Paul Bass talks with our host Steve about the challenges of public health work in developing countries, including the allocation of resources and conflicting interests.

Steve Sonnier:

Hello, everyone. Welcome back to From the Front Row, brought to you by the University of Iowa College of Public Health. My name is 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. Today we’ll be chatting with Dr. Paul Bass, who has significant experience in the field of public health, practicing in The Gambia. Paul, welcome onto the show today.

Paul Bass:

Thank you so much, Steve. I’m so delighted to be a part of this program.

Steve Sonnier:

Really quickly. Let’s start off with your background into public health and how you eventually were able to partner with our college of public health. What really got you started and interested in the field of public health as a whole?

Paul Bass:

All right. Thank you so much, Steve. My name’s Paul Bass. This a young man was born in a very remote community in The Gambia. Actually had passion for public health, which I pursue at my young age. I started with the higher national diploma in environmental sciences and worked briefly as an assistant public health officer in a community health post, where I do a lot of public health-related activities ranging from environmental sanitation and food inspection, vaccination, and all sorts of things within my jurisdiction. And I was so I had my BAC in public and environmental health. Also worked briefly in that I deviated a little but still within public health. I worked with a road construction company as a health and safety manager. A position I held for about three years and then left for my masters, which was more on injury prevention and control came back to The Gambia, also worked briefly and then had an opportunity to go for a semester-long program on road safety in low and middle-income countries, challenges and opportunities in to and University of [inaudible]. And came back again, worked briefly with the University of The Gambia. Then went ahead to do my PhD in public health at Taipei Medical University in Taiwan.

Steve Sonnier:

That’s a really excellent storied background into your experience and with the road safety side of things. Why was that specifically interesting to you? Last week we had the opportunity to talk with Dr. Sanyang. What stuck out to you about road traffic safety?

Paul Bass:

It’s interesting. Road safety started when I was working with this in terms of contracting company on road construction. And I’ve been advising employees. Of course I was responsible. I was the first point of contact for the company. I conduct induction exercise for them, I talk to them about road safety, other issues also that are related to public health that are out of road safety, public health issues, like how they can protect themselves from malaria. We are residing of, in the provinces and that’s where we have a lot of mosquitoes. So I need to educate them in a lot of the issues that are public health-related, but my focus, I’ve been always be on, road safety, which I, which is road safety. You can’t talk about injury and also leave road safety because you went into injury epidemiology, you will discover that most of the injuries are coming from road related crashes. So my passion for road safety started from there. And then I had the opportunity to attend more programs, academic programs on road safety, and this where I find myself today.

Steve Sonnier:

You mentioned the aspect of attending Taipei University and then also your experiences in The Gambia. Why do you think it’s critical that we have a global mindset and undertaking public health initiatives? Why do you not just go for a country specific focus?

Paul Bass:

Yes, it’s very important. Happy you asked that question. With this globalization, how it is we can’t be left behind in terms of public health. And we need to learn from also this practice, in as much as we learn from this practice, as I said, the globalization technology and all those kinds of things, the best consoler can learn from is the current situation that we are in as the coronavirus. This is all about globalization and this affecting public health. So it’s definitely a big problem. So what I have found in Taiwan to be a public health issue. So I also find it here to be a public health issue. Of course, whereas a means being tackled would be different. The approaches are different. We’re more or less. They are all the same public health issues or public health challenges that we are faced with. This why it is very, very important to look at it now with this, we say global public act because it’s affecting every continent and affecting everybody around the globe.

Steve Sonnier:

How do you ensure that the work that you do with your communities that you work with positively impacts them, especially if you’re from that community?

Paul Bass:

I think my time with this road construction company, actually, it was an eye-opener for me. And I’m also an eye-opener for most of the people that I was serving. It’s just now that I realized that when I meet with them, they say, “Oh, I never knew that what you were doing there was very important.” And I felt that, this was why I was so adamant on most of the things that I asked them to do. That’s how it is most of the community also, because it’s not all about the employees of the company that I worked for, but also the community, because during the road construction process, you know, there’s a lot of grading and a lot of dust emissions. So I also went to the community to educate them that there’s a lot of dust here. So if you have your utensils ensure that they are covered.

Paul Bass:

So that all foods that were prepared, ensure that they have covered to avoid contamination, all these things I was doing. And then people who tell me now when I’m working in a company, but these things are not happening. And this is for me, it’s really very sad that most of our users that are responsible for this world construction are not implementing these things or not trying to ensure that this company’s, hire people responsible, to ensure that the community that they are operating they’re safe and not already in place, but the community that where they are operating they are safe, and these are some of the things that some of the achievements for now our field, because these are the feedbacks I, we from people. Unbeknown to me that I was doing discreet efforts and I was not realizing that this was what the benefits was going to have on the community that I served.

Steve Sonnier:

With regards to the benefits for your communities that you’re serving. I imagine a big part of it too, is the education aspect and making sure that folks are informed about what’s going on when you’re looking at the practice of public health. How did that differ when you were in Taipei and in The Gambia? What did you notice between those two areas when it came to public health education for communities you were working with?

Paul Bass:

Yeah. There was just a distinct difference between the practice of public health in Taipei and the practice of public health in the Gambia. I’ll just give an example in terms of waste management. When I went in Taipei the first time, it was like cultural shock. Every evening, they will have a truck come around your street and you have to go out there to dispose of your trash. And usually you are encouraged to buy a specific polluting bag where you can put your trash, without the polluting bag, you go there, they will ask away. So in The Gambia, everybody throws anything anyhow, you eat banana you just treat anyhow after drinking from a plastic bottle just throw anyhow. But in Taipei that’s the induction that we received immediately we arrive in Taipei. You ensure that if you take banana, this, the kind of business, if you drink from a glass bottle, this is where it’s supposed to drop it.

Paul Bass:

So this is kind of practice that is difficult to educate here but as public health practitioners this what we’ve have been trying to educate people, to people to tell people that the environment has to be kept clean and it should be our responsibility to do that. Nobody else can come and clean your trash. In Taiwan, they always have this saying you are responsible your trash, clear your trash. Even after eating the attitude is there. After I finished eating, I should clean my plate. Nobody should clean my plate, but in The Gambia here, if somebody come to your house and you serve the food to the individual, the individual expect you again, to clean the place for him and the glass or whatever, you know, trash was produced. So this kind of things that I saw, that were big, big difference between if you compare Taipei and also in the Gambia here. So those are kind of public health practice that are different.

Steve Sonnier:

So for investing in public health, because I imagine The Gambia has fewer resources compared to somewhere like Taipei, how do you see the country allocating those resources? Is it an effective way of funding public health investments? Is it well done there?

Paul Bass:

It is not, it is not. Most of our funding is more or less… I just want to say this. There’s a lot of politics in The Gambia, which is not putting health first for that matter public at first people think about all the things that can, and I’m some sort of like film in the political arena. And it’s very, very unfortunate. If you look at it, in fact, the budget for health compared to what other ministries is in The Gambia is just too little. When you have to tackle the public health issues here. You go around our cities and our towns you see a lot of, waste all scattered all over. There’s a lot of indiscriminate dumping of waste, and that needs to be taken care of. It needs a lot of resources to be put in place, to be able to take care. I just cited trucks in Taiwan.

Paul Bass:

Of course, of recent, I’m seeing some municipalities buying some trucks, but to me, they are still not enough. I think the government has to come in and purchase more. But also see if you got into road traffic again, I had a doctor sign and talk about true safety in The Gambia. Here also are a lot of vehicles that we see they’re all make-shift vehicles and there’s still no resources that are put in place to ensure that, all those vehicles have been tested and are fit to drive on the roads because we don’t always talk about the number of vehicles we have, but also talk about the emissions. And that was a big, big problem here. The air pollution in the Gambia is also a big problem, even though I may not be talking from scientific point of view to say that this dimension and that I’d be made or been done and this is the level.

Paul Bass:

What physically, when I look at it, I know comparatively to other places that I’ve been to distill still a big problem or a big challenge that we are facing in terms of this in terms of resource location is definitely misplaced. When you go to rural areas where they are exposed to a lot of, hazards. Also, usually they are very neglected in terms of resource allocation, in terms of public health, even their ambulances. You go to certain facilities where they treat people sometimes even to have basic, medication is also a problem. So the challenge for public health in terms of resource allocation is very huge in this country. And we wish that the country redirect its efforts towards, allocating resources, equitably in all the regions of the country, because the concentration has been in urban area.

Paul Bass:

But even though it’s not still paying dividends, if you leave it open area. But another thing is also attitude in as much as the sources have been located to tackle public health issues, the population also have to change their attitudes. If you talk about, wisdom I just cited here, it’s all about the attitude. People they know about this thing. And that’s the unfortunate thing here. Sometimes we tend to believe that they don’t understand but they understand, but they still do what they’re not supposed to do. And that’s the major problem that we are facing, but you’d have to have resources, definitely resources that are not equitably distributed to all regions in the country.

Steve Sonnier:

I think that’s a very common we see here too, as well is the inequitable distribution of resources. And we see it a lot in Indiana, Iowa area, too, with the, the inequitable distribution for rural patient populations. When you’re reflecting on that equitable distribution, where do you think would those resources be best allocated towards what do you see as the most pressing issue that those resources, whether it be financial or a workforce assistance, where do you see that best serving The Gambia?

Paul Bass:

I think the most resources that we are deficient in most is financial. Thinking, when you come to public health of recent, we have, we training a lot of public health professionals and they are everywhere. I can cite an example. When I graduated from college, I was alone in a facility, but the same facility now, if I go there I’ll find about three or four people. So we’re not complaining much about human resource, but what we do have problem is financial resources. So they are not being put where they’re supposed to be put, when you still go back to this we expect them to do more. We need financial resources to buy more garbage trucks. We need more financial resources to buy certain equipment, to be able to assess our outdoor air quality. That’s not happening. We also need equipment to be able to assess whether this vehicle is still a road worthy or not. In terms of emission, all those things are, they all need financial resources. We may have people, we have a lot of people to do that, but we need financial resources more when it comes to public attendance.

Steve Sonnier:

It makes me think immediately of the phrase, you can’t change what you can’t measure, right? If you don’t have any data, how are we supposed to make an accurate decision on these things? So it really hearkens that importance of funding, public health initiatives, worldwide too, as well. When you’re reflecting on your experiences that you’ve been able to have across the field of public health so far, what’s one thing that you thought you knew, but were later wrong about.

Paul Bass:

Yeah, it’s just what I’ve you’re cited for. When I was walking with this construction company, actually I thought this people have no knowledge about most of this hazards at workplace. Though later I knew that they actually know about it, but it was the attitude chained was the problem. And the recent example is this coronavirus, because I come from a minority in The Gambia here. And what I discovered in starting that initiative, I discovered that most of the messages that are being sent out in terms of coronavirus prevention, usually they use English language, and other major local language. So I said to myself as a public health practitioner, I think I also have a stake and I also have to give back to my people. And then I tried to convince some health professionals, bring them together and form a health like a headphone.

Paul Bass:

And then we begin to conversation this on and we started outreach. So I went to certain communities thinking that the probably these guys know nothing about coronavirus. They tried to impress me with even a role play to tell me how somebody can get coronavirus and how somebody can prevent a human cell from Corona virus. So I got it all wrong thinking that my people are neglected. I need to go out to them and give them the rightful information. But unbeknown to me, they also had the same understanding as I do, which is very, very important because most of our people, we do social media. Now it is people communicating on daily basis, but not also that, but family members, because I know when coronavirus started here, family members, were going back to their families and talking to them about corona, which I was thinking they did not know much about Corona, they know as much as I know.

Steve Sonnier:

I think that you hit on a really good point there of recognizing that your community may be well-informed. It’s just about how is the message delivered, right? How are folks in the know about what’s going on, whether it be with coronavirus or if with other situations to public health importance, and that really relying on communities as a way for transmitting those messages and making sure that you’re incorporating those perspectives is really essential to the success of public health practitioners everywhere. I do want to thank you for your time today and for, for coming on and chatting with us. And we wish you well in the upcoming year, Dr. Bass.

Paul Bass:

And I also thank you so much for inviting me into your platform. And it’s my pleasure to always be available should you have any other future endeavors.

Steve Sonnier:

That’s it for our episode this week major, thanks to Dr. Paul Bass for coming on with us today. This episode was hosted, written, edited, and produced by Steve Sonnier. You can find more about the University of Iowa College of Public Health on Facebook. Our podcast is available on Spotify, Apple podcasts, and SoundCloud. If you enjoyed this episode, please share it with your colleagues . Our team can be reached at cph-gradambassador@uiowa.edu. This episode was brought to you by the University of Iowa College of Public Health. Keep on keeping on out there.