Voices from Global South Discuss Sustainable Public Health Approaches

Accessibility is one of the most important aspects of providing public healthcare around the world, according to panelists representing Colombia, Guatemala, and Kenya during a virtual Teach-in on Sustainability panel on November 20.

The Teach-In on Sustainability is an annual, college-wide exploration of how Emersonians can contribute to a sustainable tomorrow through communication, the arts, and the liberal arts.

The panel was virtual because José Melvín Ramírez Hernandez, a licensed nursing supervisor and nurse educator of the Intecap Región Central in Guatemala, and Mathew Kinyua Karia, a Lecturer in Speech-Language Pathology from Kenyatta University in Nairobi, Kenya, called in from their home countries. Elma Lewis Center Executive Director Tamera Marko also participated and spoke about public health in Colombia. Marko co-founded MobilityMovilidad.org, an organization that collaborates with women and families in Medellin to document their stories of displacement, violence, resilience, and rebuilding, participated in the panel.

Communication Sciences & Disorders Professor and Graduate Program Director Robin Danzak facilitated the panel, and translated English to Spanish and vice versa.

Panelists spoke about determinants of health and healthcare systems, and the impacts of the systems.

Marko said that since the 1950s in Colombia, people have had to flee their homes for different reasons and squat on land they don’t own. That leads people to have to navigate official channels, which look down upon the displaced.  

“The first thing you need besides shelter … would be potable water. And then be able to access basic food to stay alive,” said Marko. “They know how to make potable water stations and grow things. It’s combining rural knowledge and ancestral knowledge and translating that to an urban area, while constantly defending their tents that are sometimes burned down, or they’re kicked out by police.”

At the end of 2023, there were officially 5.1 million displaced people in Colombia, according to the Internal Displacement Monitoring Centre. There are more than 3 million Venezuelans seeking refuge in Colombia. That puts stress public healthcare.

In Nairobi, Kenya, there are the haves and the have nots, said Karia.

“That’s the key determinant – economy,” said Karia. “Food security is very key as a social determinant. Access to healthcare is another determinant. There are issues of insurance.”

Karia said that Kenya needs to be more focused on preventative healthcare so there is less of a need to cure disease, but it needs to be accessible and affordable. He said that doctors are paid decently, but healthcare workers such as nutritionists and physical therapists need to be paid decently, adding that specialized healthcare is part of good public health.  

In Guatemala, public health care covers 70 percent of the population, 18 percent are covered by social security, and 12 percent are covered by private insurance, shared Hernandez.

The determinants of public healthcare are income, education, gender, and ethnicity. There are issues with access to health services, availability of services, and the quality of services, Fernandez said.

“To improve it, it is necessary to apply equity, responsibility and commitment to contribute to improving the cultural, economic, and political conditions in the country,” translated/paraphrased Danzak.

All panelists said that healthcare is less accessible in rural areas, and that leads to inequity. Hernandez said the lack of infrastructure makes it difficult for rural communities with fewer resources.

“We need more trained medical personnel to cover these communities,” said Hernandez. But he said labor conditions and healthcare worker salaries are very low, and that leads to nursing professionals leaving more rural communities instead of staying to improve them. This problem has been prominent for many years, he said, and among other issues, that leads to high infant mortality.

Innovation Bridges Gaps

Hernandez said that telemedicine is very helpful in providing accessibility.

“This is something I am doing to help reach far away communities,” said Hernandez. “I can reach out to specialists…and help people access care. This is new in Guatemala. In some of these rural communities there is not great internet, but people can use WhatsApp. We are moving forward with technology.”

Karia added that when he’s not teaching, he’s does community outreach to provide care.

Marko said there is a stigma of displaced people that somehow, they’re breaking laws, or it’s their fault they’re displaced, or they’re dangerous. That’s why Marko’s organization MobilityMovilidad.org, is important. She said that students making video for the organization is more convenient and easier than hiring a professional film crew.   

“We’ve done things with study abroad programs, and students have access to technology and access to go across international borders and can do it in different places to connect stories with health needs,” said Marko. “They’re not doing it in a political way, they’re doing it under an umbrella of public health.”

Marko said to make one of the videos from a mountainous area, they received permission from seven different gangs to walk through their territory, 2,500 feet up into the Andes Mountains. They had permission to stay until sundown.

She provided an example of how the organization is creating change in the public health system. A video was made of a person in need, and at a public screening, they sat the person featured in the film next to the mayor, so when the lights come back on, the mayor is right there sitting next to the person in need.

“Media is there covering the documentary, but because the media is there, the conversation happens, and promises are made,” said Marko.

Infrastructure for the Future

Karia said he’d like to see more organizations partner with the government, and among other initiatives, develop a program to create more healthcare workers. There are only a few dozen speech pathologists in Kenya. He continues to train future speech pathologists, and hopes that his students will be practicing professionals in the coming five to 10 years.

Hernandez said he’d like universal healthcare in Guatemala so that access can be equitable. He has great respect for medical professionals who travel across mountains to go where people need care, but utilizing technology to increase telemedicine is vital

“I have seen people go to the hospital because they have a need that could have been mediated by technology,” said Hernandez.

Marko said healthcare needs to be looked at globally. To talk about public health in Colombia, is to talk about what’s happening in the United States.

“There can be conversations across the Americas,” said Marko. “We’re talking about distribution across individual borders, inside countries or neighborhoods. How can a system of healthcare be in the forefront of the conversation instead of capital? How can systems of healthcare be a planetary conversation, and be part of education from kindergarten all the way through university?”