I have worked in the field of public health preparedness for almost 18 years. It has been an honor to assist with the state response to COVID-19 as an Investigation Branch director. My most profound experience has been watching my team rise to the challenge every day, despite the public’s pandemic fatigue and the fall surge. Their dedication underscores the importance of building strong teams of empowered individuals.
COVID-19 has also given new meaning to “sustaining the response,” a topic often only briefly touched upon in emergency exercises. Thank you to all the responders out there!
George Floyd’s murder in May sparked a renewed national reckoning on the profound racism, implicit or explicit, within each of us, as well as within our country’s institutions and systems. It revealed how much the fall out of the pandemic was determined by the inequities that are “baked-in” our society.
In 2020, JSI worked with the MA DPH to study disparities in prostate cancer treatment between Black non-Hispanic and white non-Hispanic men. Sadly, Black non-Hispanic men are screened later and less frequently, diagnosed later, and receive definitive treatment less often than white non-Hispanic men. I’ve been fortunate to work with a great team both within JSI and with MA DPH and its Prostate Cancer Work Group, and we look forward to presenting findings in 2021.
Recently when working on my project’s quarterly report to USAID, I wondered what would have been different if there was no COVID-19. I was expecting that I would find that we have not been able to reach our benchmarks because of the pandemic, but voila! In 2020, we learned to be even more resolute. We found ways to remain connected. We collaborated with TB programs of different countries and had productive meetings with various government officials.
The greatest discovery in 2020 was that in this time of “social distancing,” how close we are able to be because of technology. Let me tell you about Cambodia. In “usual” circumstances, we would have waited for an introductory trip to get acquainted with the stakeholders, build rapport, and start our work. Ironically, the pandemic jump-started this process. In the past two months, we’ve had five meetings with in-country partners, and people in other countries were able to join without having to so much as leave their homes, much less travel abroad. We now feel that we are “just a Skype call away.” In fact, I am enjoying this connection with people in different countries, as we build friendships and align our collective goals to serve humanity.
Something else: I learned that appearance doesn’t matter much. Spontaneous Zoom and Skype calls have made me comfortable showing my “natural self;” just compare my professional headshot with the candid capture below!
2020 brought both challenges and opportunities. Just before the stay-at-home orders, we welcomed a foster child into our home. We stopped traveling and began virtual learning for him. If it wasn’t for COVID-19, we would not have been able to spend so much time bonding and helping him with his emotional transition.
At the same time, we had to adjust our approach to work, especially as some of our partners had to focus on the COVID-19 needs in their states. What also happened during this time is that we became more human as children and pets popped up in our virtual meetings; adapted as we provided virtual training and learned new online skills; and began new traditions in a severely circumscribed world.
Since January 2020, we have facilitated four of the Denver Regional Council of Government’s Accountable Health Communities workgroups funded through the Center for Medicare and Medicaid Innovation project. These workgroups aim to identify and close gaps in community-based services.
COVID-19 posed both a challenge and an opportunity for these workgroups in carrying out their projects. The challenge became the magnified community need for services within their focus areas: food insecurity, increased need for housing and utility assistance, and an increase in domestic violence cases. The opportunity came from the workgroups’ steadfast efforts to bridge clinical and community services and find ways to meet community needs. They became nimble in their approach and piloted innovative projects like co-locating a food pantry at a clinical site; establishing a quick guide for care navigators to connect people to housing assistance resources; providing virtual training for clinical and nonclinical staff on domestic violence resources; and creating a job aid and training to educate care navigators on utilities assistance. These workgroups deserve recognition for their efforts to improve the health of their community under the unprecedented and unpredictable conditions of a pandemic.
Like everyone and everything in 2020, Building Healthy Cities had to find creative ways to stay connected to our stakeholders who support our work in four different cities across Asia. I think something as simple as our webinar series in each city helped us build relationships with city officials and with new technical partners, while we found new ways to reach citizens and amplify their concerns, especially related to COVID-19.
In Boston, the international backstopping teams are often quite close since we meet every week. But even though the office closed in March, we found ways to stay connected. In September, for example, the Zambia SAFE backstopping team went for a hike in the Middlesex Fells. We got to meet and have in-person conversations (of course distanced and masked) with our new team members. It was a lovely break from our computer screens and uncomfortable ‘home office’ desks 🙂
This year, we launched a campaign to integrate water, sanitation, and hygiene with maternal and child health services, using religious leaders to reach out to pregnant women in their communities and urge them to get antenatal care services. Paul, one of the religious leaders, met a beneficiary who was young, pregnant, and had yet to receive ANC. After talking with Paul, she went to Amuda HCII and now has attended two ANC appointments.
When I joined the JSI NH COVID Response team, I envisioned work on a time-limited project that would help the state fulfill its role in responding to the pandemic. I don’t believe any of us thought it would consume us—day and night—or make us experts in the emerging epidemiology of COVID-19. As the pandemic grew, we entered more deeply into a landscape where change was constant and one day off meant you had to catch up very quickly on the new guidance.
Unlike most consultants working from home and dealing with isolation and family-balancing acts, we were commuting daily to an operations center. We were never lonely, but the pace was fast and furious, weekend work was a must, and there never seemed to be a lull in the workload. As this winter came on, we played a key role in dealing with the surge—with the incredible volume of cases, outbreaks, and phone calls from individuals and facilities in need of help. And we were there to provide that help.
In the beginning of 2020, our accounting department was preparing to launch an online management system for invoices and purchase orders. It was a big change and, as with all big changes, there was a mix of anticipation and trepidation about how it would go and how the staff would respond. But when our offices closed in March due to the pandemic, we realized how lucky we were to have this system in place. Kudos to our CIO, controller, and larger team for making this happen. I am fortunate that I can work from home but miss interacting with colleagues, especially those outside my department.
It was early March when Gerard Cody, director of the Randolph, MA Public Health Department, called JSI. It was rapidly becoming clear that Randolph was at high risk for COVID-19. An immigrant city, with many older adult residences and essential workers, the city worked with our team to ensure all residents had the information they needed to stay safe. JSI and city counselors planned for an initial event at a local senior center. As the danger of in-person exposure became apparent, the event shifted to virtual, broadcast from City Hall to residents via local cable TV and Facebook Live. Nevertheless, the event, conducted in Haitian Creole, Chinese, Vietnamese, and English, brought residents and their local officials closer together.
Over the year, communities across the Commonwealth shared vital information and resources. In June, we co-hosted a session of the Climate Change Adaptation Summit to focus on how the lessons from building climate change resilience, including our support of Cambridge, were being applied to the pandemic. Joining over a hundred organizations in the Massachusetts Public Health Association’s COVID-19 and Equity Taskforce, we strategized weekly to respond rapidly to emerging threats.
As a member of the Massachusetts Asthma Action Partnership, JSI participated in biweekly meetings among advocates and physicians to discuss approaches to treating asthma during COVID-19 through a racial equity lens.
In September, we joined the team of a CDC-funded Racial and Ethnic Approaches to Community Health (REACH) project in Lowell, MA. By mid-December, REACH LoWELL launched in the community, with an initial focus on growing food insecurity exacerbated by the pandemic. Local coalitions pooled resources, and learned from Cambodian and LatinX residents who envision a community in which healthy and culturally nourishing food is accessible to all.
2020 started well but soon we were hit by COVID-19 pandemic. Besides so many things the entire world has realized that disease does not respect boundaries and we are together in this crisis. We are reminded of shared responsibility to overcome COVID-19. Life goes on during chaos and crisis, and adjustments are required by projects in implementation strategies.
COVID-19 has exposed the gaps in health systems readiness in both developing and developed countries. In 2020, the Pakistan USAID Integrated Health Systems Strengthening and Service Delivery team adjusted to the changing environment and challenges. The promising thing is it worked out and program activities continued, as you’ll read in some of the stories below. Thanks to the teamwork of both our home office and field staff.
The first reported case of novel coronavirus was from Karachi on February 26, 2020. I remember the Sindh Government was struggling to respond, and there was conflicting information and confusion about roles and responsibilities in districts. In March, JSI, under the IHSS-SD activity, stepped in to help. Within two weeks we had identified and trained master trainers. The JSI team traveled throughout Sindh and, by April 1, after only 20 days, had trained 760 people in 29 districts.
During the training-of-trainers, we heard about people’s experiences and listened to ridiculous conspiracy theories about the virus. Many of these stories contained false information about transmission of virus and the differences between isolation and quarantine and suspected and confirmed cases. JSI discredited 95% of these dangerous rumors by imparting basic knowledge about COVID-19, thus decreasing people’s fear; and improving district teams’ efficiency in collecting, reporting, referring, and managing COVID-19 cases in Sindh. We trained almost 300 rapid response team (RRT) members across Pakistan.
We also sprang into action to ensure health center capacity to treat people who tested positive for COVID-19. In 2020, I looked after the logistics arrangements for JSI meetings, workshops, and trainings in five provinces. I coordinated most of the logistics for the RRT and ventilator support trainings for health care providers. We trained almost 900 participants while supporting our ongoing child health activities. The IHSS-SD ActivityMore trained more than 3,000 people in maternal, newborn, and child health in 2020. It wasn’t easy to coordinate during a pandemic, but we did it.
The USAID IHSS-SD activity has been working to improve the health system in the Punjab Province of Pakistan. While much work was temporarily halted due to the sudden emergence of COVID-19, our team kept working on this important task. Our commitment led us to achieve the highest level of approval from the Provincial Development Working Party at the Planning & Development Board. This is a big achievement, not only for the Punjab Department of Health for establishing a directorate for managing infectious diseases, but also a great leap in advancing USAID’s vision of journey to self-reliance. I am proud to be part of this momentous accomplishment.
I have been providing technical support to the Khyber Pakhtunkhwa (KP) Provincial Disease Surveillance & Response Center since the first case of COVID-19 was reported. During the critical period of the pandemic, we trained 495 people from all 36 districts of KP on rapid response. My team also trained 346 health care providers from across the province on caring for COVID-19 patients in the intensive care unit. We also trained 63 master trainers from across the province on management of mild to moderate cases of COVID-19, and supported the establishment of district disease surveillance and response centers in all 36 districts of the province.
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September 2020 concluded a five-year project with the NYS Department of Health, in which our team provided training and technical assistance (T/TA) to the statewideCreating Healthy Schools and Communities initiative. Although COVID-19 introduced a number of challenges during our final year, it proved to be one of the most rewarding as our team adjusted our T/TA activities according to the unique challenges the pandemic presented. In doing so, we worked closely with grantees to strengthen food systems, increase access to safe outdoor spaces, and promote wellness policies and practices in schools, food hubs, worksites, and more.
2020 turned out to be rich in events and all kinds of shocks. It was also another year of political dysfunction and instability in my country, during which we cried and rejoiced, sympathized and worried, and witnessed events that both inspired and frightened us.
This year will be remembered because it made everyone change—for the better, in my opinion. First, we have become closer to our values. People have realized what is most important to them; Self-development? Family? Occupation? Health? Income? Travels? Friends? Appearance? Second, we have become closer to our families, and for some, the opportunity to be together was the best.
Third, we began to help strangers more, the elderly or the sick, and we had new heroes: doctors and other people who bore the brunt of the pandemic. We have become more realistic: attitudes toward expenses and income have changed as people have had to make do with less.
My professional involvement with COVID-19 started in March as a contact tracer and a monitor of active cases, shifting to Investigation Branch co-director in May. With each role came a new perspective of the pandemic response and its functions, providing me a classic study of complex adaptive systems.
I find myself reflecting on the multiple ways that a branch director supports investigators, beginning with engaging in job interviews, onboarding, providing and supporting a learning culture that enables swift adaptation to changes in the environment, and facilitating the advancement of investigators. The intensity of the experience contributed to unusually strong workplace bonds between myself and other like-minded systems thinkers, generating intense relationships with people who I will continue to see on a regular basis, and those I may never see again. I am gratified by the opportunity to contribute my nursing expertise to the NH COVID-19 response. It is a high point of my career.
USAID RHITES N-Lango instituted measures to prevent COVID-19 infection at the office. In the field, work had to continue but the rains burst the river banks. Many roads in the region were impassable, but health services had to be provided to people in need. A call highlighting potential exposure almost sent the team on a downward spiral, and all staff had to undergo the rather unpleasant COVID-19 test. There was a lot of apprehension on the team and a lot of stigma in the region toward project staff. Luckily, staff who were infected were able to access treatment within 24 to 48 hours, and were all discharged from the hospital. The project developed operational guidelines to support staff work, including emphasizing online meetings and availing additional space to enable social distancing at the office, in addition to other standard prevention measures (masks, hand sanitizers, etc.)
