hello everyone uh it's Antonio again
uh welcome to again to our resilience
talks this is the fifth
uh so you can hear below in the
description see the chapters also
subscribe the channel uh you can receive
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today i am delighted to have a professor
from harvard that is going to talk about
health systems in mental health so i'm
delighted to
present the dr benjamin cook
ben thank you so much for your uh for
accepting my education yeah thank you
antonio it's great to be here
great so ben uh i will jump to now
to the first uh first actually i would
like to present
to the audience your a little bit of
your uh
of your bio so dr benjamin cook is
associate
professor of psychiatry and director of
uh research lab
at the harvard medical school so he
holds a phd in a
health policy from harvard university in
uh
an mph in health behavior and the health
uh
education from and c chapel hill
so dr cook is a health services
researcher
focused on improving quality in of life
and access and quality of treatment for
individuals
living with mental illness and substance
use
disorder so his research tracks
healthcare disparities
uh in the us he also is a mentor for
faculty and students
lastly he has been principal
investigator on several
major grants from the national institute
of mental health and agency
for healthcare research and quality so
ben can you tell us a bit what
challenges do you think of it 19
brought to the health system
yeah the the list is long this was not
an
an easy time for health care systems in
the united states
maybe the perspective i can give you is
from two places where
where we have research centers one is at
cambridge health alliance which is a
suburb of
boston it's a number of the neighboring
towns in the city of boston like
cambridge somerville everett malden
revere and then the other research
center where i work is
in the bronx in new york city
there's a center for health equity there
so you know those two places
in some ways saw the brunt of
uh the covid pandemic because of where
they were situated one
in boston which had some of the first
cases and the first super spreader
events
and then in the bronx which was really
the epicenter
of the epicenter of the first wave of
the pandemic
and a lot of cases right that area right
yeah a lot of kids really huge yeah
i mean think about them at montefiore
einstein
in the bronx they had 2300 deaths
whoa whoa okay that's in one hospital
system so
imagine the uh the changes that had to
happen
so rapidly in that hospital system
um and they're bigger than cambridge
health alliance and so had the ability
to adapt in some ways but
and cambridge health alliance faced huge
numbers of
virus so so one one thing that we
worked on really quickly was to try and
adapt and hear my experience is probably
better at camera health alliance was
was to try and anticipate when we would
run out of beds
right yeah that's a crucial thing
we knew from italy and from wuhan
that if you ran out of beds then you
would have to make terrible decisions
about who can come in and who can't
based on
their severity are based on their
prospects
their comorbid conditions also the
question about ventilators now
and then there's a question about
ventilators exactly yeah so we were
trying to model what the cases looked
like
in the area and then of the cases who
needed to be hospitalized
and then of the hospitalized who needed
to be ventilated
and then who would get better and who
would die so we those were the kinds of
things that we were modeling
as the first wave hit and um
and we we realized that we were going to
lose our bed capacity within a month
or so when we were looking at this in
march
and and um and so the health system just
had to scramble
to figure out where they were going to
put
patients and so they put a lot of
effort into changing
different wards like the psychiatry
inpatient
became a coveted ward the um
tufts dormitories the university
dormitories nearby
became places where they were that they
were going to use for rehabilitation
they worked with the state to send
people to the convention center if that
needed
okay big improvisation right also no
causation yeah
but you know it was all last minute
because
and and um and real and i don't know if
they got it quite exactly right i mean
they did a heck of a job and the
hospital system did a heck of a job but
but they also at the same time we're
trying to communicate with their
providers many of them who weren't
coming into work
to tell them they had enough personal
protective equipment
to tell them that it was going to be
safe when they came into work
there's a lot of protests among nurses
especially who are the ones most
impacted by kova so there were dozens of
healthcare workers that
that passed away during the pandemic so
they were busy doing all of that
communication
they were busy trying to figure out how
to create a safe space
that had separation between people
how to allow or not allow families there
were so many
things that they were so many fires to
put out to get ready for the wave
that was coming that that often they
were
just going day to day trying to live day
to day and not
doing enough planning for the for the
month ahead
so this would i don't know if this
question sorry uh
to interrupt but of course as i
you are saying it comes to me this so
did it happen the different kind of uh
um interpretation of uh the orders from
i don't know if it was disparities
between the orders from administration
and then the
the each state did you sense that it was
a confusing everyone knew what it was
supposed to do or it was like
confusing no i don't want to put
politics here
but but it's inevitable because also in
brazil
we see this confusion about
what to do right no no no that's right i
mean
in massachusetts i i think there was
a somewhat concerted effort because
there was such
little federal leadership coming from
the federal government that in the end
the states took over okay yeah okay
federal landing state and massachusetts
state
and new york city the leadership
had to take over at some point
although you know of course if there was
an
earlier federal response if there was a
uh federal response that was um
consistent and uh consistent across
states
if there were resources if the if the
testing
uh there wasn't a three-week hiccup in
the
tests rolling out if there wasn't there
wasn't enough resources for testing
in the early days which set us back you
know
millions of cases uh thousands of lives
so yeah right uh the lack of federal
response was a big deal
and we ended up losing more lives
than we should have in massachusetts
but that being said i think the
governors in new york and the
in the city of new york they just had to
do
as much as they could as rapidly as they
could and
yeah real life no one expected right
this right yeah
there was a real lockdown here in ways
that there weren't in other states and
there still
continues not to be in other states and
so
so i think we'll just keep seeing these
waves of
of the virus coming back and and whether
or not the healthcare systems i
i think they're better prepared because
of new york and massachusetts experience
and others
okay they they learned the
yeah from the crisis some of the stories
that we heard were
we i was talking to uh one of the
the primary paradox and and they
were working with um respiratory
therapists
in in the ed and and the respiratory
therapists who are in the aed
were real time
uh intervening with different
medications
and different positions it ended up that
putting people on their stomachs
took a lot of the pressure off the lungs
in those early days and then there was a
hydrochloroquine
that medication that was yeah by the
by the president and so some people were
trying that out but it had no effect so
they were doing real-time
experimentation i
had no effect so okay i had no effect
but you know it was it really set them
back from trying other things and
um so the question uh the question about
you were saying the beds in the
in the ventilators how did it turn out
well or yeah so i i think we got the
um the general date more or less right
when we were going to hit capacity okay
great
and so we were prepared for that in some
ways
uh and and our institution made
agreements with other places that had
more beds that we could send and
send patients to and like i said we
converted some of the other awards
for overflow so that was oh okay so it
didn't went
out of control right because we heard in
the news like new york was really
yeah was the the worst was california in
new york right
no yeah i think new york was was
probably the worst
the worst yeah overflow and um
oh okay so fortunately it didn't went
like uh out of control right
yeah yeah right they were doing the best
they could i mean it was
it was uh just just harrowing it you
know they
it's worth saying that the the
circumstances in the bronx are so much
different too than
in cambridge and the surrounding areas i
mean
about the bronx where you have apartment
buildings with
dozens of floors with multiple
families on those same floors all using
the elevators
you're talking about a density of i
forget what the number is
but a hundred thousand people per
square mile or something like that in
the bronx you have a lot of people on
top of each other whereas in other
cities that density is like 20 000
per square mile you have so many people
all on top of each other in the bronx
and so you can imagine if the
covid pandemic goes it's going to go
like wildfire in a place like that
how is the demographics there the bronx
in the in sometimes it was poor people
but
now they still know yeah i i think it's
uh
it's known as one of the poorest
counties in the u.s
and a lot of racial okay
it was you had also disparities right
you study that also right
yeah we heard like they were
hugely affected uh all around the world
right
yeah well the more vulnerable more
affected
yeah absolutely antonio yeah
no there was a study that just came out
that put a number on it that said
you know if you live in a neighborhood
or or a city or
town that has 10 more
uh black residents per capita than
your risk goes up by 300 percent of
getting coveted
in massachusetts those were the numbers
that that came out yesterday so
and in the bronx um it was also true
when you looked at the different
boroughs the bronx was really the place
that had the highest rates of covid
in those areas that were more likely to
be
black neighborhoods latino neighborhoods
diverse neighborhoods poorer
neighborhoods or the places where it was
really impacted
and that's a real mix of forces that
have been growing over the years in
terms of
employ stable employment and healthcare
access
and overcrowding redlining
had created housing policies that
segregated many of these populations in
these
neighborhoods that have poor health poor
health access to
foods to healthy foods poor access to
parks
and the list goes on and on the layers
and layers and layers
of ways in which these communities were
vulnerable to covet
is has a long history and
ended up being a really crucial factor
for why they
they having really high rates of covert
and death rates it was
it's it really speaks to so many of the
inequalities that we have in our country
it was just a like a precipitation of
all of these things that have been
coming out
that that have been building for decades
in our country
yeah so uh ben in your opinion
secondly what are the key factors that
build resilience in a health system what
do you think
yeah i like your uh your focus on
resilience antonio in this
yes i have to put your questions about
resilience because my channel is about
resilience but of course you are a
specialist in the health
system so i tried to but you can
talk of course and i'm delighted to hear
what you have to say because
you are really
into this in these issues right
yeah yeah yeah thanks enter
yeah um welcome well first of all i
guess i'd say that
the this idea of resilience
and thinking about it um as an
individual idea is a
is a strong one it carries a lot of
weight and
you know i i uh i have a lot of that in
my
in my family background too my my
really okay was from north vietnam and
and okay father was part of the
uh part of the country that was
separating from the french and so she
really grew up in a in a civil war
uh and a war for independence from the
french and then a civil war in
north vietnam between the vietcong and
and the nationalists that wanted to
preserve somewhat of a democracy instead
of communism
so she was removed from her
home at nine and spent a long journey
heading to south vietnam with her five
brothers and sisters i think she had
another brother or sister along the way
and and her parents were gone so she was
the nine-year-old taking care of the
family during his long journey to the
south
um and then she made it to the south and
then in south vietnam the
war came and so she um
she emigrated to the united states and
uh and you know think about resilience
right
yeah exactly think about feeling inside
it takes as a
as a nine-year-old to just keep bouncing
back and bouncing
back when your parents are gone you're
taking care of five kids and you're
they were really one through the
rainforest in north vietnam to get to
the
to the boats that were going to take
them to the south and um
and then and then my dad is a is a
is a long time triathlete and so you
know he has these uh
ironman triathlons that he's done where
where he
he was out on the kona coast with 35
mile per hour crosswinds
in the middle of this 112 mile bike and
and has no energy and then
where do you find the energy uh that
kind of
that kind of resilience is you know i i
just admire and draw so much strength
from both of them
great great there's a flip side
resilience which i also wanted to say
which is
it's it's a it's almost a luxury
to exercise resilience and i i don't
know if this came up in the
stuff that you've done or the things
that you've thought up thought of but
but in some ways folks who have
encountered systematic
racism systemic oppression and those
things for them to
get beaten down and then pop back up
again is resilience but
but it's also survival it's also their
everyday lives
and and in some ways to be able to do a
triathlon where you
you know go to hawaii and you have a
fancy bike and your
show you're resilient after after having
a hard 50 miles on the bike
that's very different resilience than uh
so you
you say different levels of resilience
yeah yeah
maybe it's different levels of
resilience or um
you know is it resilience is it is it
too much of a focus
on on an individual and an individual's
resilience
when when and we're not addressing the
systemic issues i mean you keep popping
up from
decades and decades of segregation
residential segregation and jim crow
laws and and police brutality
and is that resilience if you keep
popping up
it is i think so but but to say that
because you resist that resist that
toxic uh
environment right yeah yeah exactly
that's resilient but
but it starts to lead people to think
well if more people were
just more resilient then this wouldn't
be a problem they just need to be more
resilient
and it starts to take the lens away from
the actual problem which is the years of
segregation and the years interesting
yeah
i it come to to to think you shouldn't
need the uh to be resilient right
because the
system and think some some systems are
some
in unjust systems or some unjust
situations
yeah yeah i mean there are times of
course we're all going to go through ups
and downs in our lives
and um and resiliency will matter that's
part of being
you know the human condition but there
are also systemic
things that make it so some groups of
people have to be resilient
every day yeah and the stress
just wears them down and and makes it so
they're
more likely to have health problems and
mental health problems so
exactly it's like an addendum to the
theory of resilience or something like
that but
so you think that is a bit
individualistic uh
construct yeah it kind of turns the lens
on an individual and might do that
to an extent that that misses the
the larger system yeah yeah no i i
totally agree yeah you have the
of course the individual uh story and
the individual uh
um bouncing back as you were saying
yeah but then you have yeah the
community the
you have the the system yeah exactly
great
ben so and what about the the health
system
i have a tangent thanks for letting me
go off a little bit yeah i'm here
insisting no no because you have so many
of these questions
also here in portugal i think we have a
completely different
health system as the u.s but uh
because our is more public right
so i guess you're not so uh
that case but uh interesting for us
because
um how can we tackle how can we deal
with this
even you said i think one factor that is
learn with the right
i don't know if this is a factor but
yeah learned a bit with this
no i think the ways there are
a number of examples in which healthcare
systems can do
a better job in a pandemic and maybe can
become more resilient to these waves of
disasters that that are likely to come
whether it be
from the weather or from yeah a lot of
effective
viruses like this or so the
you know one example of this uh
of resilience at the health system level
might have been
the ways in which telepsychiatry flipped
it it was like a switch that flipped on
so so think about uh
tens of thousands of appointments uh
over a year of psychiatry visits and
those include medications
and long-term therapy and
cognitive behavioral therapy medication
management
on and on and on right and then all of a
sudden
the hospitals were closed for outpatient
business ah okay yeah so they had to
switch
and cambridge health alliance was able
to do that within days
i mean this was a project a cambridge
health alliance had thought about for
years
and had it had been in the planning
process
but they teamed up with epic who does
the electronic health record
with google who runs a lot of our of the
platform of the electronic
health record system and other uh of our
platforms in the hospital
and within um five days they had a
telepsychiatry up and running
there was a user interface there was the
ability to bring in interpreters to the
to the meeting and and all of the
providers were trained uh in a very
short amount of time
how to use these these different systems
so it's an example of of the fact that
once you
do put a team and you orient them in the
same direction and you bring in the
corporate entities that are working with
the healthcare system you can really
you can really move things very quickly
oh great great
so that's example resilience i i mean i
don't know
yeah we're we're looking now at what
that meant for treatment and whether
switching to video and telephone
was better or worse for certain groups
there's a lot of folks who who just
couldn't figure out how to get the video
to work their internet connectivity
wasn't as good
and so they switched to telephone um so
so that's uh we'll see what the problems
are there we found that no shows have
gone down because
now there's no longer this need to take
a couple buses to get to the
outpatient office you can just pick up
the phone in between
for a half an hour in between taking
care of your children or
at your job and so they're okay it's
being on the phone and telepsychiatry is
probably likely here to stay but
but i think there are going to be people
who are left behind by not having that
in-person contact and
um so again yeah again the disparities
right
yeah exactly perhaps in in in general in
situations of
hardship if you are vernal vulnerable or
uh
more uh you are you are
always more affected right in if your
foundations are not so uh
so strong right it comes the storm and
everything is ruined right i think
that's right but
you know i think this may be an example
and it's worth looking for that is where
disparities are reduced and and where
uh where they can be reduced
it can be alleviated so so there was a
lot of uh
things that happened in the communities
and chelsea
for example was a hard-hit latino
community
in the boston area and there were
community organizations where there was
an
absence of spanish-speaking folks to
deliver food and spanish-speaking folks
to make sure everybody was healthy
and getting tested and checked up if
they were sick
the community or number of community
organizations
popped up into the vacuum there and
filled in the spaces where the
government
really so the people organize themselves
right yeah people organize themselves
and that's phenomenal right in some
catastrophes we see that
people unite now in the beirut in uh
lebanon right i saw something also that
uh people
all of the sudden young people for i saw
that example they reunited everyone
and they yeah they started helping
everyone it was really
yeah i think so that's worth you know i
think part of it is that
the vulnerable communities are going to
be
harder hit for the most part by these
things but
it's also worth seeing ways in which
they
bounce back or you know they're
resilient as a community against these
larger forces
and create their own organizations to
support the community members and
and you know there are these other
things that you can see like maybe
uh telepsychiatry is something that will
be in the end
a place to reduce disparities and access
to mental health care
you just have to and talk to a provider
and no longer do you have to travel
a long ways to get to your provider
and and maybe it's uh you know you don't
have to deal with child care you don't
have to deal with the transportation
barriers
you don't have to take off three hours
of work you only have to take off a half
an hour of work
and and so maybe we'll see these large
disparities and access to mental health
care shrink
with more of a move to telephone so
so i think seeing where the
where the uh exacerbation of disparities
are but also where the reduction and
disparities are from these things
yeah and perhaps yeah what i see is that
this the completely different the
case in portugal in in the us
because as i told you you know you have
a public
access to to the health system but for
example the psychologists the access to
psychologists because it's a continuated
uh help that
you need you don't have so much so i
don't know you're in your because for
example yeah you have
like a uh one consultation or
or that but then continuated the help
not so much but
even nevertheless the the health system
is very
pretty much open and it covers a lot of
things
but in that case you are saying that if
people
don't have like health insurance in the
u.s right it's very difficult to
yeah access to even the mental health
even if
more difficult or it's the same as other
um no the numbers that you see for
mental health care are so
uh so much lower than than diabetes and
as long as things like that i mean of
those that
need care so those who are in serious
psychological distress our national
studies show that
about 50 of the population
gets any treatment at all and then if
you start to look at blacks and latinos
and asians those numbers are more like
20 to 30
of them with serious psychological
distress receive
any treatment at all and then if you
think about substance use those numbers
are in the like five to ten percent
range
and you you can't imagine diabetes or as
you just can't imagine percentages like
that
right so so the the healthcare system is
it's it's really one of its biggest
failures in some ways it's the inability
to treat
folks with mental health and substance
use problems i it's not an easy
and easy population to work with but
there needs to be more flexibility to
make mental health care accessible in
the community
to have longer hours to make the
treatment relevant that it's not just
medications it's got to be
in a place that's culturally relevant
i think portugal does have a nice model
we've worked a little bit with spain
also they really
okay inventors that have intake
walk-in intake for substance use
treatment here in the united states you
need to go see a primary care provider
that's going to take a while
the primary care provider assesses you
and then may send you to a
substance use treatment provider but
there's going to be six months between
when you first feel like you have a
problem and when you finally see
somebody you can help you with it
so so you see people from uh immigrants
they see an economic
opportunity right because you have so
much people
coming in right the right do you have
the the the the biggest uh immigrant
community right in the world
or yeah no may be true
but then they perhaps they they have
that factor
of the excess else access to health that
yeah yeah yeah but they still come in
right they still have a see an
opportunity how do you see this it's a
little bit
yeah well paradoxical around
that's interesting that you think about
that as a as a paradox
it it may be that um
that there i think it it may be that
there's a change
now given covet in the response and
and the ways in which yeah no okay
putting up barriers to immigrating into
united states but
but yeah if you go back uh a year or
something like that i think
that the u.s was still a place where
there were just a lot of jobs
and and folks need food and housing and
and so they're willing to you know walk
a long way from central america for
example to
try and find a way into the united
states and
and and for them the the jobs and the
food and the ability to provide for
their family
is a much higher priority than getting
the mental health care or the health
care
many of them are very healthy that's the
only way they can make it in from this
oh yeah yeah like the minimum so yeah
yeah yes i understand what they're
saying i have uh
survival yeah a lot of faculty and
physical and mental in order to make it
for those long journeys so so i can see
why they would
prioritize getting employment and things
over the lower access to healthcare
but that doesn't mean that once they're
here in an active part of our economy
that
we should say well you're here you have
our you have jobs what are you
complaining yeah of course yeah
i'm trying to see from from outside the
the question
or trying to understand their
way of thinking yeah yeah yeah yeah i
i i think i think you know a lot of
stories that we've heard about for
example
salvador and families from yeah from el
salvador they
were under some pressure in their home
cities for with uh gangs for example and
there was a lot of violence in some of
their towns and
and so they said the way we're going to
survive this is is to head north and
we'll
we know folks in in the us that will
take care of us and then they take a
long journey uh up through mexico and
mexico
often what you hear about is traumatic
experiences
in their home in el salvador and then
traumatic experiences between el
salvador and the border
these long journeys that are often run
by
coyotes or other folks who who
might abuse financially sexually you
hear lots of
exactly and then you get to the border
and
there you have all the problems with
customs and enforcement
you've heard about separation of parents
and children
at the border at the u.s mexico board
yeah yeah
and then maybe you get it and then you
finally
make it and then you've had multiple
traumas along the way
and you get to the city and finally feel
like you can breathe but
but many of these cities now have these
layers of
social problems that we were talking
about at first with related to housing
and and and crime and multiples kind of
structural segregation rules that keep
those neighborhoods
so it's so interesting so you have also
different kind of resilience
resilience uh traits or
in in in the immigrants because some
they actually thrive and others don't
so you have different uh right
yeah because yeah the thing about the
american dream and all that
i don't know i'm putting here also you
have different kinds of um
yeah outcomes yeah there's a lot of
variation
and you know it's it's kind of back to
this individualistic
idea that's so involved in the country
and why it's uh
why uh social programs are underfunded
there's a long history of us being
exceptional and individuals
and and so that story of someone making
it through that long
journey making it and then creating a
place of success
in harvard so yeah and then
and then and then yeah making your kids
going to school and
doing well that there's a there are
stories like that that
that keep a lot of folks going and keep
the pressure off
the the folks that that uh
under resource social programs right
they say
if you were just like the those model
minority immigrants then you could pull
yourself up by your own bootstraps you
would be resilient yourself you don't
need any social programs
uh to pull yourself up look at uh look
at
and then you list out an example of the
few people that have really made it
it's it's a way i understand the time
that in our country we've
we've created factions uh and torn at
the social fabric of our
of our country the vietnamese and the
and the asians are one good example of
that i
the there's this minority myth about
uh about asians of being amazing in
school and they always get the highest
education
whereas vietnamese they came much later
they
they came from a war-torn country so
there
these weren't the academics that came
from china in the early immigration
years and they weren't didn't come with
a lot of assets and now you see
a lot of vietnamese living in poverty
and that kind of breaks this
minority myth but it but it doesn't fit
with the
with this myth that that uh immigrants
come and they pull themselves up by
their bootstraps their resilience so why
can't you be like that
okay so you don't uh think that
that is so um that can happen
or that that myth yeah of the american
dream
yeah yeah i think it's been a nightmare
for a lot of people it has a nightmare
yeah
exactly and you see all the el salvador
people or the
right from central america right or um
yeah yeah yeah i mean north america
those are the neighborhoods where
where uh kovet was the worst right so
yeah because
you come from something to get a job and
then there's this lack of social fabric
the lack of social programs made it
the lack of federal response to coven
impacted your community the worst of all
so so you kind of came from one fire and
hopped into another fire so do you have
any correlate
in your studies do you have any
the correlation that sees that
immigrants that thrive have something in
common
do you can you tell us
there's any study about that yeah
there's
there's been a lot of uh i'm completely
going out of the subject but it's i'm
interested in subjects and you are
so specialist so i would like also to
there's
there's been a number of studies about
this immigrant paradox and thinking
about
and the immigrant paradox at least in in
psychiatry is the idea that
immigrants even though they have lower
socioeconomic status
their employment and income and and
wealth
is lower than the average population
their mental health seems to be better
whereas usually you see a direct
relationship between
wealth and employment and income and
mental health
here you have folks with little wealth
and employment and
income who are uh who are doing well
mentally and so there are a number of
studies that are trying to understand
what it is that
that's driving that paradox oh okay
interesting
and we've done one study that showed uh
that the ad the longer you
stay in the u.s the worse your mental
health gets
and so by the time the latino immigrants
are
are 20 30 years into the u.s their
mental health is back looking like the
average
in in the us and the next generation
you're starting to look much more like
the us in terms of mental health
problems
and so we it decreases the mental health
yeah yeah
so you start to think about this toxic
exposure to the united states
and and and what is it about the us that
that's so that's so toxic um and
and what is it about certain immigrant
groups that's resilient to that
to that toxicity is is some of the
things that people are trying to study
one thing we found that was toxic was
your exposure to discrimination
so there have been quite a few studies
that show
how much discrimination gets
under your skin uh gets into your
mind the constant there they can be
microaggressions or they could be
you know missing out on a job or missing
out on a
nice apartment because of the color of
your skin or
because you don't speak english as well
or or because you're
you're dark fair dark-skinned latino or
things like that yeah they all have a
a real impact on discrimination which
then has an impact on your mental health
so
what we found was that as you stay in
the us for longer
you experience more discrimination you
perceive more discrimination you see the
discrimination that's being thrown at
you
and then your mental health it's one
pathway that we that we thought that
that could explain this
the other one is intergenerational
conflict and once you start to have
children here and you're trying to raise
and you have the u.s culture and you're
trying to preserve your
your culture from brazil or other
countries
then you start to have this
intergenerational conflict and you see
that as a driver of why the mental
health problems go up
for for the parents and the children
so those are kind of two of the right
factors and there are probably many more
driving yeah but two is already
yeah it's insightful thank you so
just a bit now coming back to the
this is we could be here all day because
it's so vast
right but um coming again
uh to the health system uh issue so
uh the health professionals how what do
how do you see the challenges they face
in the pandemic you already talked a bit
but also i would like to know the health
professionals and also
you think the people were prepared
people in general
two questions in one but yeah yeah
uh the health professionals um
really had a uh incredibly difficult
time
because of the lack of preparation for
something that was so unexpectedly
big you know you have a
president who's who's leading uh
policies and
saying it's going to go away we just
have a few cases and those will go away
and now we have over what uh you know a
million cases
180 000 deaths in the united states we
were just
from a federal level so unprepared and
then that just trickles down
so then states try and scramble to come
up with something without the federal
support
hospitals try and scramble to find
something to do without the state
without sufficient state support and
then now you get down to
the level where the rubber hits the road
and that's
that's the providers that's the health
care providers
so we i work closely with two
psychologists that
at montefiore and einstein who were
providing support services
to to frontline healthcare workers
as well as environmental services
workers and janitorial services workers
and food services workers
they said there was so much stress
during those peak times for those
workers that
we one story was that uh my colleague
was talking to
a woman on her way she had just gone
home to sleep for four or five hours but
she had to get back to the emergency
department
and she was calling her for help because
she was shaking
she was so over traumatized by seeing so
many deaths and
feeling like so much was out of her
control she
the usual ways in which she knew how to
take care of people were out the window
you can imagine how unsettling that yeah
be for for healthcare providers and so
she said she would just and then she got
into work and then
and then it would go there there were
people coming in
every door they were trying to triage
people and then her shaking would stop
and then she would she would get better
because she was working
working working in the in the middle of
all that
and then after she got a break and to go
home and sleep
they come back again the shakes come
back again you know
so so i think for for them
a huge challenge was
absorbing all of this stress and
death and illness and grieving and
families not being able to grieve so now
the
nurses are the ones that are are doing
the grieving for the families through
the phone and
just imagine all of the layers
of of stress that they were facing so i
think we
that was totally underestimated the the
stress and the
and the amount of uh trauma that
that the health care workers would
receive so i think that's
next time if there's a next time uh
to be able to handle that in a better
way to provide support services
to do a better job so that there never
will be these situations where you have
to figure out how to triage people in
and out of the hospital
like they did in new york um and then i
guess the other
big one was do we protect how do we
protect
the janitorial environmental services
and the food workers because they're
many of them passed away across the
country
and there was much less attention paid
to their safety to their personal
protective equipment
and that's just an extension of what we
were talking about earlier those are
usually the poorer folks the
folks from racial and ethnic minority
communities so
so those are some of the challenges i
think is how do you
equitably create safety
and how do you create a place that does
not have as much
psychological distress
so ben yeah um
exactly so in in in finally i would like
to hear from you
uh the training of of health
professionals what what are the areas
that
you think it should be it could be more
developed
the some issues arise now in the
pandemic that
show some
perspective that could be improved in
the professionals yeah
um improved or helped right
in terms of uh i think there's a lot
known now about how to
how to triage how to treat how to um
how to take care of folks once they're
sick
with covet and and so the mortality
rates i think have come down and
and the problems with full
emergency departments has not been as
bad as it was in those first
weeks in new york and massachusetts and
other places
i i think the training of the health
professionals
should shift upstream
now especially we're still in the middle
of this pandemic
and we aren't doing enough still for in
terms of wearing masks and
socially distancing and
a lot of kids are going back to schools
now and universities and you already see
super spreader events occurring at
parties and
and so i i think there still needs to be
more education
more training more support from
different levels of
government on how to keep more waves
coming and we have 180 000 deaths in the
united states and the
forecasts are for 300 000 deaths i mean
more more the soldiers the u.s soldiers
killed in the world wars you know
is yeah you have close cases now have
you
yeah sure still 20 in massachusetts
there's still
10 to 30 deaths every day
a couple hundred uh cases being recorded
every day so
we're not out of this i know there are
places in europe that are doing much
better than us
and portugal is one of them but yeah
yeah fortunately yeah
now we had a big a bit of increase but
yeah yeah but you never know we are
expecting the
the winter uh wave right
uh yeah yeah let's see who's going to
mix in there
it's going to be hard to harden
all that so i would train public health
as
is something that is not as sexy as uh
as as the like life-saving surgery but
it's the one that's going to save
hundreds of thousands of lives
exactly yeah exactly yeah and people
sometimes i don't know if you agree
but people sometimes forget that this
prevention measures like
masks and all that not only lives but uh
you it's it's to prevent the the crash
of the system right
because yeah exactly right exactly
yeah i mean sometimes people don't
understand
in some views of again
too much individualistic also
that talk about personal freedom and all
that
that is okay but when you live in a
community i live in
with each other and also the question
about uh
um the system right the health system
practical
it's a practical issue right yeah yeah
yeah no it's like a running theme in our
talk today right this uh
really individualistic stuff oh yeah
nowadays yeah again
since the the french revolution or the
or always so so then
you know so i think more education on
the public health side is so important
and then
and then we talked about uh these layers
of
social determinants of health that are
impacting black and latino
populations and coven there needs to be
more education on how to
start to pull out the threads of of
systemic racism and segregation that's
been happening in our
in our country and we need to educate
more health professionals
more public health professionals on on
how to do that work
of desegregating housing
making better food available to people
improving employment reducing
environmental contamination in
cities where brown and black people live
there's a lot
more work to do to make this country
more equitable
the police violence we've been trying to
get a big issue
improve uh uh the ways in which they use
deadly force against black men
so there's a lot of education i think
that we can do on the equity
side in this country that will just
raise up
the health overall of the us the way we
get along these
the discrimination the microaggressions
the way that we carry around
psychological distress
a lot of that's just because of the of
all the the
tension that we're we're holding in our
country so so i i
it's exactly that's a big deal right
like
how do you educate a lot of people in
public health and how do you educate a
lot of people to be anti-racist
but uh yeah league issue yeah there's a
lot of efforts
uh going on around the world so so to be
able to lift that
lift those efforts up i think is really
important there will be another talk
about that question ben thank you so
much
for your time sorry for this diversion
all the time it was a nice conversation
you're a great facilitator
uh thank you thank you uh so ben thank
you so much and you all for watching
so don't lose the next week another
video bye
you
