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. In this week’s episode hosted by Steve and Alexis, CPH alumnus Dr. Edrisa Sanyang (16PhD, 12MPH in OEH) shares his thoughts on the importance of working with a global mindset to address public health issues, while building and strengthening local connections to create community-specific programs.

Alexis Clark:

Hello, everyone. 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 health issues and public health and how they are relevant to anyone, both in and out of the field of public health.

Steve Sonnier:

Today we’ll be chatting with Dr. Edrisa Sanyang, who has significant experience in the field of public health in The Gambia. Dr. Sanyang, Thanks for coming on the show today.

Edrisa Sanyang:

Thank you so much for inviting me.

Steve Sonnier:

Can you give a brief background into your career in the field of public health. And then also touch on how you partnered with our college of the public health as well?

Edrisa Sanyang:

I started public health way back in 2001 after completing my higher national diploma in environmental health. So I briefly work in urban areas focusing on environmental sanitation, childhood immunization, maternal and child health related issues. And then later went to rural Gambia, very remote part of the country focusing on the same assignments. And did that for a couple of months to a year, and went back and joined the University of The Gambia for an advanced degree.

Edrisa Sanyang:

From the completion, I later joined an international NGO called ChildFund, where I supported a water and sanitation project, mainly to rural deprive and vulnerable populations. So I did that for a couple of years, both on term. So water provision, as well as some educational activities on sanitation and hygiene. Then I later came to University of Iowa, where I started with the student exchange scholar program, and came back for my MPH.

Edrisa Sanyang:

And from the MPH, we won an international project involving multiple countries in West Africa, all the 15 West African countries, including The Gambia. So I led that project for a couple of years and came back for a doctoral program on injury epidemiology. And that’s how departments have started getting deeper and deeper. While at university of The Gambia, we did work with some [inaudible 00:02:39] program. These are minority, health and health disparity projects from the University of Iowa. And we had students from Iowa to Gambia, orienting them onto public health practice in the field.

Alexis Clark:

When addressing public health initiatives, why do you think it’s critical to have a global mindset opposed to just being country specific?

Edrisa Sanyang:

That’s a very important question. Public health is so diverse and it’s so complex. Determinants are very broad and very complex. So you cannot just have one approach to address a public health problem. You need to have multi disciplinary approach, multiple components, to address public health problems. And it also need multiple institutions and countries to address that, especially in the era of global travels, a lot of increased network between countries, between communities and so on.

Edrisa Sanyang:

So focusing on individual countries, will not definitely address individual country public health needs. It needs a collaborative effort, it need synchronizing activities, synchronizing programs, transfer of knowledge and skills. That’s the only sure way we can address public health problems.

Steve Sonnier:

When you’re talking about the collaborative approaches because it’s a very key component of things that communities in one nation, are very similar to communities in another nation, right? They can have similar social determinants of health, they can be impacted by similar issues. How do you ensure that your work has an impact on the communities that you work with, especially if you’re part of that community? How do you really drill into that aspect of things?

Edrisa Sanyang:

The best approach is to make your interventions or your project as relevant to the needs of the community as is possible. When it comes to the how, is oftentimes best to do some community participatory projects. Involve the community members in identifying what the needs are, involve them in addressing those needs. They know their priorities, they know their concerns.

Edrisa Sanyang:

So going to that level and design some interventions on project at community level, and provide supports… Because some of them, from a personal experience for example, when I was working on the ChildFund project, the design involved the communities, the implementation also involved the communities. And they come back during our steering committee meetings.

Edrisa Sanyang:

Oftentimes, most adverse project don’t involve the beneficiaries, they don’t involve beneficiaries in decision-making, but that was what we definitely do away with. We make sure that every community had a representative in the starting committee. They bring their problems to the center level, and that we make a collective decision as to how we can address those problems.

Edrisa Sanyang:

And eventually it worked out very well. The participation was very high, the desired outcomes were definitely had higher impact on the community and improvement in the livelihood. So participation is very key for public health.

Alexis Clark:

So you’ve been in the United States for the last decade. Thinking back to your time and education in The Gambia, what does it look like? What does public health education look like? And what does practice look like there versus the United States?

Edrisa Sanyang:

Public health practice, I keep saying this and I emphasize it all the time. Public health practice in The Gambia or in middle-low income country, is somehow a bit different. Maybe it’s because of the income status, maybe it’s because of a lot of different factors, but low-middle income countries, put a lot of emphasis on public health. And I think they practice it in the most appropriate way. That’s my opinion, in the sense that The Gambia, for example, institutionalize a lot of different approaches like community participate approach, the PRA, or sometime they call it community appraisal systems.

Edrisa Sanyang:

Eventually, what happens at that level is the committee members identify what the needs are. But within that, we also have a multi-disciplinary approach team, where you have different professionals from different backgrounds, come together to address a common public health problem. The weakness to that effect is, you have that multi-disciplinary approach at the intervention point level, but you don’t have it at policy level.

Edrisa Sanyang:

And this is where we have a huge limitation. And so among developing countries kind of focused on those things, definitely to address about the needs. In the United States, we do have some decent public health approaches. But most of the time, from my experience being in this country for about 10 years, it’s not community intensive approach. So that is kind of where we have some of those differences coming in.

Steve Sonnier:

When you’re looking how those differences impact the response to public health, what do you see as The Gambia’s greatest public health need? You talked a little bit about how your country’s more oriented towards focusing on public health over the policy, tendencies the United States, where do you see those needs really starting from?

Edrisa Sanyang:

Good question. Gambia has focused a lot on infectious disease, and this is the same for most lower-middle income countries. But if you look at the epidemiological trends, the disease pattern is definitely changing. To my mind, I could be bias because of my research, my trading, but to my mind and in fact this is backed by data, our major concerns would focus on NCDs. Non-Communicable diseases, but specifically the cancers.

Edrisa Sanyang:

But still more specifically road traffic. 90% of all traffic deaths around the world affect lower-middle income countries. The Gambia for example, is the fourth country in West Africa after Liberia, Guinea-Bissau, and Burkina Faso, with high road traffic related mortality. And if you compare Gambia to those countries, we are just a tiny bit. Gambia is just a little over two million people. So literally, if you compare with the rest of the countries around the world, we are 17.

Edrisa Sanyang:

So that is very scary for that small, tiny country. We have improved road infrastructure that’s correct, but the deaths that are associated with road traffic is definitely alarming. And nationally, recently in the social media, you can feel that the country is definitely feeling this and they are putting up strategies to address some of these concerns, because it has multiple effects. Effects on disability and are not just there, because most of the time the victims are vulnerable road users, like pedestrians, bicyclists, even children going to school, or even bread winners.

Edrisa Sanyang:

And we believe is going to on a long term, drive the poverty levels very high for the country. The sad part about it, is all those planning efforts should be backed by data. And this is what we definitely lack in The Gambia. There is a very good data system collecting data on infectious diseases, but we don’t have that for road traffic or similar NCDs in the country.

Steve Sonnier:

With the road traffic side of things, I’m thinking about here where you’ve got electricity, you’ve got that road infrastructure. I’m not familiar unfortunately with the exact situation with the United States, traffic incidents and death, but for The Gambia, what are the areas that need investment in that policy might be missing, that the surveillance might be missing, what are some key actionable solutions that need to be taken?

Edrisa Sanyang:

Yeah. The key actionable solutions, first over hauling of our national road traffic laws. Because they were created before independence. Most of them except the seatbelt law, child restraint law, and cellphone use law, with the exception of those three most were created in the ’50s and ’60s. That need to be rebuilt totally and we need to update those laws.

Edrisa Sanyang:

Speeding is a major contributing factor. About 80% of road traffic crashes is associated with speeding, vehicle condition. So a lot of different things need to be critically rebuild and government to come up with appropriate laws and policies, to create a very good structure that will definitely help curb the road traffic incident. The way licenses are done, is terrible. It’s definitely terrible.

Edrisa Sanyang:

You can be in your home so long you have money, you can call somebody that you need a driver’s license without doing any computer based test to show your competencies, without doing any road test to show your competencies, and you get your driver’s license the following day, and you’re on the road driving. You don’t even know how to drive. Most of the crashes are associated with drivers like that. And there is nothing like point-based system, where if you kind of default or cross arrows during driving, police would apprehend you and suspend your license or something like that, no.

Edrisa Sanyang:

As a matter of fact, it’s so different from the United States. Because we don’t have police as part of the traffic, we have police in specific location to check for some of these driver violation related issues. And drivers would fix their demeanors or whatever, they would make sure that when they get into a police checkpoint, they do things that’s are in accordance with the law.

Edrisa Sanyang:

And once they pass the police check point, they just do a little willy-nilly and eventually, most of those resolved in fatal crashes. So there’re a lot of different things to fix in the country. I currently have an undergraduate student working with me on a policy brief and we plan on going to The Gambia in the summer, to talk to the lawmakers and see specifically, what our recommendations are, what they need to prioritize to address road traffic problems in The Gambia.

Steve Sonnier:

With addressing those road problems in The Gambia, you had mentioned the issues of infrastructure and going on from there, to the police staffing situation. Beyond those two areas, I’m thinking about the awareness and who is getting into these accidents. Are the demographics of these individuals known? Is it lower income individuals, or is it younger folks who just want to go for a ride? What does this look like when it’s folks who are trying to get the licenses that you’re talking about?

Edrisa Sanyang:

Yeah. In terms of the demographic, most of the victims are young people. Mostly between the age of 15 and 45 years. And these are the productive workforce of the society. I recently conducted a study, completed the data collection, compared in Gambia and Tanzania in terms of how youth perceive road traffic crashes in those countries. And I’m working on developing manuscripts out of those.

Edrisa Sanyang:

But these are the exact studies. I interviewed police… It’s so interesting seeing the police perspective, how youth perceive this, how they go about driving in the motorways. And if you talk to the youths, is also very interesting in terms of their perspective, how the police approach safety on the road. And it’s all very interesting out there. And definitely we need to come together. That’s my job, as a country to look at those portholes and definitely come up with appropriate strategies to address them in the country.

Steve Sonnier:

When you’re looking at these issues as a whole, is there something that stands out to you with road traffic safety, that everyone should know about in The Gambia? Is there a specific pressing issue that folks really need to be aware of back home?

Edrisa Sanyang:

Yes. To my mind, folks need to know that speeding kills. They need to know that speeding definitely kills. They need to know that you can wake up at the start of your day, and become disabled few hours later. And when you are disabled, we don’t have those safety nets in the country. And eventually what happens, is you become a burden on the family. In the sense that if most of the time again, for a lot of our crashes, it’s not just the youth, but the professional groups who are breadwinners of families.

Edrisa Sanyang:

So if you die, yeah you die. But if you get disability, you become a total burden on the family, because you don’t have support systems where government can take care of you. Instead, if you are working, your wife is working, kids are going to school, you are a victim of road traffic crashes, what happens is you eventually at home and your wife would also leave work and support you at home. So that increases poverty level.

Edrisa Sanyang:

So people need to know all these things and they need to keep calculating all these things. Destruction is a major problem. Cellphone use is so high and we believe that it’s definitely distracting a lot of drivers. A lot of other things, drug use is also super common. And we need to address them, we need to definitely address them. The quality of the vehicles is another thing. Most of the time they are used vehicles, 20, 40 years old. And they still do a lot of things to maintain them, but eventually, they can easily fail.

Edrisa Sanyang:

And all those things are contributing factors to road traffic crashes in the country. So people need to know these things. People need to ask questions before they join public transportation system. Those things are important, but overall, the outcome is what people need to understand. If you’re involved in a crash, what are the likely outcome? I’ve tested it a couple of times during lectures, during the meetings, to ask a whole group who in that group, has a family or a neighbor never involved in a crash. You will never see anyone. So it is a national problem.

Steve Sonnier:

So when we’re reflecting on the opportunities that you’ve had so far in the field of public health, what’s one thing that you thought you knew, but were later wrong about?

Edrisa Sanyang:

Yeah. Initially I thought communities I worked for, communities I served, know very little about public health, but I was definitely wrong. Gambia for example, had a lot of different approaches to educating the community. And they know a lot. For over the years, radio communication was the best way that communities were educated on public health issues. Then it later transitioned, we had what we call the Kanyeleng. These are individuals, groups that sing traditional songs, and they use some of those things to communicate special messages to the communities.

Edrisa Sanyang:

I think what we are lacking… I’m digressing a bit because I want to give some context to this. What we’re lacking now, is adjusting our communication approaches to ensure that we use modern technologies. Because those modern technologies, are already being infiltrated by false information. Like think about Facebook, think about WhatsApp. There’re a lot of WhatsApp groups all over. And some false information have been transmitted to the communities.

Edrisa Sanyang:

And over time, my fear is for the new generation, the foundation that was built in educating the community, would definitely fade away. So I think the public health practitioners in Gambia if they’re listening to me, is to change the strategy, move on, use the modern tools. Otherwise, the bad information is leading you in using those modern tools. And eventually we will find it very difficult is to have back the public health back tools we have.

Edrisa Sanyang:

So coming back to the specific question you asked about. When I was with the ChildFund project, and I was educating people in terms of alternative methods if you don’t have sanitizing or hand cleaning, you can use some local products like ash for example. I thought that was used to the community. And there was one silent young lady at the corner, whispered that you can use ash. That was shocking to me.

Edrisa Sanyang:

So sometime you under estimate what the communities know in your public health intervention. But involving them, they will bring a whole lot of experience on the table. And they can relate the interventions that you’re going to design together with them eventually to improve their health and wellbeing.

Steve Sonnier:

I think those are very good key points, especially now when rightly so, we are concerned with misinformation. And incorporating communities, especially younger communities into how those messages are delivered. And making sure it’s a successful delivery and reaching folks to make them aware of best public health practices and accurate ones too. So I think those are very good points to tie in together, especially for public health practitioners everywhere is.

Steve Sonnier:

Kind of not treating it like it’s a marketing strategy necessarily, but product testing, right? We’re trying to test out this message of how do we protect members in our community? And having folks from different backgrounds is very essential whether they’re young, they’re old, they’re experienced with technology, or they’re not, having those diverse experiences is critical. And I appreciate you bringing that to our attention. I want to thank you for the opportunity to interview you today and really appreciate you coming on the show and giving us your insights.

Edrisa Sanyang:

Thank you so much Steve. It’s my pleasure. Thank you.

Steve Sonnier:

That’s it for our episode this week. Major thanks to Dr. Edrisa Sanyang for coming on with us today. This episode was hosted and written by Alexis Clark and Stevland Sonnier. This episode was edited and produced by Stevland 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.

Steve Sonnier:

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.