For this week's blog we have the pleasure of a YouTube Tribute to Sir Arthur Lewis by Professor Compton Bourne, former Governor of the Caribbean Development Bank (CDB), former Pro Vice Chancellor and Principal of the University of the West Indies (UWI), Trinidad and Tobago and former Chancellor of the University of Guyana (UG). One of the leading economists in the Caribbean , Professor Bourne has written extensively and has been influenced by Sir Arthur Lewis ' work and life. He helps us to remember Sir Arthur, who died in 1991: a St Lucian by birth and Caribbean stalwart with international acclaim. Professor Bourne's reflection celebrates the many facets of Sir Arthur's achievements: as Nobel Laurette in Economics; Vice Chancellor, UWI; Chancellor of the University of Guyana; Governor of the Caribbean Development Bank, Professorships at Manchester and Princeton Universities, advisor to governments and institutions worldwide; author, scholar, visionary, statesman, gentleman and friend. Especially at times like these, when the world over struggles to come to terms with the devastation of COVID-19 to lives and livelihoods, we miss the wisdom of Sir Arthur Lewis. We wish this father of development economics was around to provide the prescriptions for a revival through sound economic planning and the restoration of a viable international economic order. Let's listen to one of his disciples, Professor Bourne.....
GOFAD is grateful to Sir George Alleyne for this week's blog which is being issued on World Nursing Day, May 12, 2020. Sir George is former Chancellor of University of West Indies, former UN Secretary General Special Envoy for HIV in the Caribbean and former Director of the Pan American Health Organization. GOFAD reviewed his most recent book The Grooming of a Chancellor, University of the West Indies Press, 2018 was reviewed by GOFAD on February 14, 2019.
When Lord Nigel Crisp who is co-chair of the global movement “Nursing Now” asked me to write a comment for the international day of the nurse and midwife – May 12, I accepted with alacrity. This was not only because I had agreed a couple years ago to be one of the champions of Nursing Now and its three-year campaign (2018 to 2020) to raise the profile and status of nursing worldwide, but because of a long-held conviction that the critical role of nursing and nurses in our society was not promoted often and loudly enough. I am grateful to Professor Edward Greene for giving me the opportunity to include these comments in his GOFAD blog on this important day.
May 12, 2020 also has enhanced historical significance because it is the 200th anniversary of the birth of the legendary nurse Florence Nightingale. The theme for the celebration of this year’s international day is “Nursing the world to health”. In a sense this was prophetic, as it was chosen long before nurses and other health workers were thrown into increased prominence and yes, danger by the pandemic of Covid- 19.
Three years ago, I was a co-author for a publication that analyzed the major problems for which the world should prepare – pandemic influenza, antimicrobial resistance, the noncommunicable diseases (NCDs) and of course climate change. It is pertinent to highlight the role or rather roles nurses must play in nursing the world through these challenges. It was not pandemic influenza – at least not yet – but Covid-19 that has shown into the sharpest possible relief one of the most critical roles of nurses that sometimes seems to be taken for granted in the discussions of the technical advances in the profession and the loud and proper cries for them to take leadership roles in for example primary health care and universal health coverage.
In the middle of the pandemic and as there was no known effective treatment, it recalled the medicine of the pre-antibiotic era when successful outcomes of disease often turned around nothing more, nothing less than good empathetic and compassionate care. It brought back to me the end of Florence Nightingale’s nursing pledge of 1893 in which the nurse “pledged to devote myself to the welfare of those committed to my care”. I also recall the comment made by Prime Minister Boris Johnson about his stay in hospital and his deep gratitude to the nurses who stayed by his bed and cared him through the worst of his illness. When we laud and salute the nurses and healthcare workers as heroes of this pandemic for their courage in the face of personal danger, we also do so for the care they give to the sick in the face of uncertainty and unfortunately in the frequent assistance in helping to die with dignity.
Of course nurses in their many other roles as educators, advocates, practitioners, leaders, policymakers, teachers etc. have multiple parts to play in nursing the world to some semblance of health through prevention and therapeutic initiatives in the other three areas of challenge.
There are numerous data on the state of nursing globally and regionally and they all show the picture of a gendered workforce that constitutes almost 60% of the total health workforce and one that is projected to have a shortfall of some 6 million by the year 2030. There are many good plans and policies for helping countries to address this gap but the one that seems almost intractable is that of the migration of nurses from the less developed to the more developed countries and the often ignored fact that even in the developed world the majority of countries are both recipients and senders of their trained health workforce.
Nursing holds a special place in the annals of Caribbean health. There is justifiable pride in the Jamaicans Cubah Cornwallis who treated a future King of England and the legendary Mary Seacole – a practitioner who saved the lives of many in the cholera epidemic of 1850-1851 and achieved international fame by using private funds to go and nurse the wounded in the Crimean war of 1853-1856 . And the 20th century saw Barbadians Nita Barrow and Ena Walters excel from the base of their training at the local Barbados General Hospital. The career of Nita Barrow is a storybook journey from the local nurse to the international civil servant to being President of a major International non-governmental Organization and finally being Governor General of her country. Ena Walters similarly rose to be Matron of her hospital for some 26 years, was a major educator and has the distinction of being the founding president of the Regional Nursing Body – a professional entity which is arguably the most successful and best organized of all the health professional organizations in the region. But these only a few of the many who have brought credit to their profession through the years, but they demonstrate that a good nursing training can be equipment for excellence in other fields.
The local application of the theme for this year’s day must embrace at least three problems. First, there must be preservation of the health gains which have been made primarily through the devotion and caring of magnificent cadre of Caribbean public health nurses who have not occupied the spotlight and gained enough encomiums for their heroism. Theirs has been a meritorious constancy of community practice which is reflected in such data as the number of children who live and thrive past their first birthday. Second, nurses must be part of the advocacy that the region, while maintaining these gains, must now address the current pandemic and then ensure that the frequently used words “never again” refer to the resolve to establish the framework to deal with future epi and pandemic threats. Nurses must also be actively involved in addressing the epidemic of NCDs which do not evoke the public hysteria caused by the diseases of contagion but are equally destructive to life and living of our people.
So, on this International Day, I offer my sincere congratulations to all nurses and midwives and thank them especially for that care which is so central to their ethos and ethics. Finally, let me admit the bias that comes from the fact that my wife is a proud graduate of the school of nursing of the University Hospital of the West Indies.
May 12, 2020
This week’s Blog is being released just ahead of Mother’s Day. We therefore extend our deep appreciation and love to all mothers for their care and nurturing and for being on the frontline of our lives. We hope that the constraints of COVID 19 will provide opportunities for creative celebrations that would be no less memorable for them on their Special Day.
We have however chosen to dedicate this Blog to Eric Leopold Edwards who died at the age of 95 on April 25, 2020 at his home in Silver Spring, Maryland , USA. He was born in Jamaica and arrived in Washington, D.C. in September 1948 to study at Howard University. The trail he blazed during his more than 70 years of scholarship and advocacy played a key role in winning recognition and respect for the Jamaican and Caribbean communities in the USA and in particular, in the Washington D.C., Virginia, Maryland and the Baltimore metropolitan area. Leo was a font of knowledge. He may have been described as an historical revisionist which is an important, and integral part in seeking to learn the truth, or gain a different perspective on historical events. This orientation was crucial for Leo in presenting an objective, academic, and truth based narrative on historical events which ranged from the breakup of the West Indies Federation, the role of CARICOM, Pan Africanism, reparations, diversity in the USA and globalization. It provided a unique formula for interpreting the role of leadership, especially in the context of a changing world order. It made him highly respected by Caribbean leaders and ambassadors in the USA. And as former Jamaican Ambassador to the USA Richard Bernal recalled in an interview with Vaughan Martin on Caribbeana, on Saturday May 2, an engagement with Leo Edwards was an essential orientation for the Caribbean Ambassadors to the USA.
But his recognition was also international. Nelson Mandela paid his first official visit to the USA in June 1990 after 27 years in prison and before he assumed the Presidency of South Africa. His audience with President Bush and Secretary of State, James Baker was convened despite the fact that Mandela would remain on the Watch List until 2008 when President George W. Bush signed legislation formally lifting restrictions on Mandela and the ANC that had been in place since the mid 1980s. During that visit which included Mandela being hosted at a breakfast session of the Congressional Black Caucus, he requested a meeting with Leo who as President of Trans Africa DC was in the forefront of the struggle to dismantle the Apartheid regime, free Mandela and to remove his name from the Watch list.
Among his notable contributions include: founding Patron of the Washington-based Caribbean American Political Action Committee (C-PAC), founding President of the Council of Caribbean Organizations, Inc.; a founding Member and Secretary of the Jamaica Nationals Development Foundation; and Chairman of TransAfrica D.C. Metropolitan Chapter’s Board of Directors.
Specially Honouring Carmen Edwards
GOFAD joins the multitude of those, whose lives Leo touched, in remembering his enormous legacy. Most of all we extend our condolences and affection to Carmen, his wife, lifelong partner and collaborator at this time of her profound loss and grief. We wish her a Happy Mother’s Day. It is our hope that she and the rest of the family will be comforted by the many glowing tributes to Leo and in remembering the good times they shared during his long and illustrious life. Readers may wish to share their memories of Leo and sympathy with Carmen.
In Leo’s honour, we feature two (2) of the many tributes that have already been disseminated. We have also attached a YouTube interview given by Leo on Caribbean Nation TV which fully illustrates the measure of the man.
Two Tributes as a Pivot
The tribute below paid by Her Excellency Audrey Marks, Jamaican Ambassador to the USA and Permanent Representative to the OAS truly represents his towering contribution and profound impact:
"The late Mr. Edwards leaves a legacy that includes his service as an early president of the Caribbean Students Association at Howard University, from 1949 to 1955 and later in the Caribbean-American Intercultural Organization (CAIO) and the National Coalition on Caribbean Affairs (NCOCA).This has to be a truly difficult a time, especially in the present circumstances restricting us from being able to pay respects in person. Nevertheless, I join with numerous Jamaicans, Caribbean people, and countless others whose lives the great E. Leopold Edwards touched in immeasurable ways, trying to help bear the burden of the loss in this moment of utmost grief.”
See article DIASPORA | Eric Leopold Edwards, 'Jamaican elder statesman' dies in Washington at age 95
Another tribute by Gabriel J. Christian, Esq.Member, Maryland Governor's Commission on Caribbean Affairs 2007-2014, elaborates on Leo’s role as a Leader for Caribbean Diaspora Progress
"History notes that Leo Edwards came to Washington to attend Howard University in the late 1940s. From his student days, he was a stalwart Caribbean nationalist when our British West Indian islands were still colonies. To that end, Leo was an advocate of the independence of the British West Indian colonies, within the construct of the West Indies Federation. Unfortunately, the federation did not last; commenced in 1957 it dissolved in 1962 when Jamaica opted to become independent on its own.
Leo Edwards was born of a generation that saw academic excellence and community service as the norm for those who made up the Caribbean Diaspora in the United States. He excelled on both the academic and community service fronts. He was a firm spokesperson for the uplift of our Caribbean community. Mr. Edwards sought to advance the cause of Jamaica's development, as well as that of the Caribbean and Africa. To those ends, he worked tirelessly all his adult life. In his last years, he struggled out of his home, alongside his beloved wife Carmen Edwards to attend community events. Such was the case last year when I last saw him. Then he was attending the book launch of the memoir of Jamaica's former Prime Minister P.J. Patterson at the Organization of American States Hall of Nations. As usual, he was friendly, jovial, and engaged.
Finally, Leo Edwards was a friend of mine from my days at college in the 1980s, when he freely gave of his advice. Those of us who were fortunate to have known him appreciated the wisdom shared. Though he is gone, the beneficial legacy of Leo Edwards' service to the best needs of our community will not be forgotten. We shall remember him."
Giving thanks for the Inspirational Wisdom
While these two tributes would have provided a broad spectrum of Leo’s attributes, GOFAD extends appreciation to Carib Nations operating out of the University of the District of Columbia, Washington DC for the opportunity to listen to the inspirational wisdom from the man himself. It allows us to remember him as we was. https://youtu.be/42EqTepq9gg
May he Rest In Peace
The blog this week is based on a report by Ms. Peggy DaSilva, Chair of the Caribbean Regional Nursing Body (RNB). It is a follow up in reference to her comment made in the April 9 Blog, Celebrating 2020 World Health Day - Supporting Nurses and Midwives - in a time of Crisis. In a report covering a range of issues, Ms. DaSilva has sourced data and responses from nursing bodies in the 15 CARICOM Member States and 5 Associate Members. It is evident that the RNB is a vibrant regional enterprise that represents a critical force on the frontline of the fight against COVID 19. GOFAD joins in the well-deserved commendations for the dedicated efforts of our nurses. The CARICOM COVID-19 Dashboard tracker, places in context the spread of novel coronavirus throughout the region. The tracker on April 30 shows that there are 1177 confirmed cases, 62 deaths and 337 recoveries. Jamaica has the highest rates including 396 confirmed cases, 8 deaths and 29 recoveries.
The CARICOM region has been plagued by a number of challenges that have serious negative effects on the functioning and sustainability of health systems in general, nursing, in particular. These are not limited to migration trends that have shown a significant brain drain related to the experienced and qualified nurses. They also have implications for the quality of leadership among the nursing profession in the region. The World Health Organization (WHO) State of the World’s Nursing 2020 Report has underscored the critical role of nurses towards the achievement of universal health coverage. Nurses have always been and will continue to be central to the health systems in spite of new and emerging technologies and other modalities in the management of client systems. The growth of new and emerging infections, exacerbated by the Chronic Non-Communicable Diseases (NCDs) as we have seen in the case of COVID 19, has intensified the prevention, care and essential services demanded of nurses.
WHO declared 2020 as the International Year of the Nurse and Midwife with a call for governments to invest more in Nursing. The advent of the COVID-19 pandemic has brought to the fore the critical importance of the need for such investment. The global economic challenges affecting countries, especially small and middle to low income ones like ours in the Caribbean, are projected by the CDB and IMF, as well as our local experts to have a serious and debilitating impact on the economy and workforce. The epidemiological data and trend analysis associated with the current pandemic predict a potential second and third wave. In these circumstances, the economic and human resource impact will be especially challenging for CARICOM member states, especially if the need for additional resources required for effective management of those who are critically ill becomes more pronounced.
The immediate challenges faced by the nursing profession in the Caribbean have persisted over a long period of time. COVID 19 has however brought them into sharp focus. Based on a sample of responses from a cross section of CARICOM States the following have emerged:
There are other dislocations confronting nurses that need to be urgently addressed. These include:
The Regional Nursing Body has developed a Strategic Plan for Nursing and Midwifery (2020-2024). It was finalized and presented to the Council of Human and Social Development (COHSOD) in September 2019. Many issues contained in that plan require urgent implementation. Among them is the need to increase the number of nursing graduates, ensuring that they find jobs, are adequately remunerated and retained in the health system. Specifically mentioned in the Plan are the needs for:
While COVID-19 has placed a strain on the healthcare system as more resources are funneled toward caring for coronavirus patients, nurses and other health professionals still need to pay attention to the essential services. Maybe, the Caribbean might wish to consider paying homage to our nurses and others on the frontline by dedicating a time and day when the entire region would collectively pause, toot their horns, wave , applaud, and symbolize in whatever way, the importance we ascribe to these valiant soldiers on the battle field to save lives and livelihoods of us all. This gesture would at least bring the countries on the Region -- physical distancing together -- in line with engendering a spirit of "CARICOM as a Community for All".
Eddie Greene and Peggy DaSilva
Among the takeaways in the global fight against the coronavirus is the need to come together to tackle thorny problems. We have learnt the benefits of sharing medical equipment and research, staff and scientific expertise, and data. We have also learned the necessity of setting aside our sense of entitlement, our pride, our egos, and hoarding our resources, for the greater good of others. This realization comes when we feel that our well-being depends upon being well too. One of the most interesting aspects of the way the world has been dealing with the novel coronavirus pandemic is for the most part, the pivot that policymakers who have previously been anti-science tacked back to respecting science around the pandemic. This is the stark reality in an appeal by Dr. Rick Wright , Coronavirus Virus Vaccine Research Chief at the US Health and Human Service (HHS), who has allegedly been removed from his post for objecting to making the available the drug hydroxycholroquine ---- over the counter due to its unproven value in protecting COVID -19 patents — “ I am speaking out because to combat this deadly virus, science — not politics or cronyism — has to lead the way,” he said.
Science trumps Politics
Most compelling and relevant is the view by Paul Arthur Berkman “As a common and apolitical language, in Scientific American in 2018 that “ science brings allies and adversaries together with technology and innovation to address cross-border challenges.” Those borders may can be political, state, cultural, religious, gender, ethnic , or international borders. Pandemics like COVID -19 obliterate them all. The evidence is clear. Viruses know no state or country boundaries, nor abide by any regulations,. The ubiquity of global travel coupled with the fact that one can unknowingly have the virus and be asymptomatic, thereby spreading it to innocent bystanders, family members and friends, adds to its frustrating illusiveness. That’s why science needs to come to the rescue to stop it too, with accurate, verifiable, safe and scalable testing for the virus, the disease, its antibodies and to determine immunity to it, as well as a safe, effective and scalable vaccine. None of which we have yet. What resonates is that Science matters, but Science takes time.
The same need to adhere to scientific evidence applies to approaches to climate Science. The same principles also apply to ensure that climate action is not put in eclipse. How to strengthen resilience? Why a whole of Government approach is necessary to cut emissions and stimulate behavioral changes? What are the elements of a recovery climate plan? How to prioritize protection of biodiversity, promote renewable energy, and afforestation, and prevent soil degradation.
Positive movements since the inaugural World Earth Day 1970
The onset of the deadly COVID-19 pandemic from the novel coronavirus has made more people value science. Flattening the curve has given proof to the fact that when lives are on the line, and as people understand that their daily decisions are connected to the lives of others, people everywhere will act in accordance with the scientific findings. Knowledge of the scientific information will provide the basis for communicating effectively and combating disinformation. When World Earth day was inaugurated in 1970, the configuration of the world economy, diplomacy and international relations were vastly different from they are today. John Kerry, former US Secretary of State, who along with Al Gore, former Vice President was among the pioneers of the 1970 Earth Day movement provided a poignant reflection. According to him, the advocates knew that the solutions on climate were actually good for our economy. But they didn’t have confirmed proof. Today, looking back at the scare tactics and false information by the big polluters were in 1970, science has proven them wrong. His vivid portrait :
“That’s the story of climate change. Progress has been halted by finger-pointing, denial, replacing real science with junk science, misinformation, and flat-out lies, elevating political hacks instead of scientists and experts, refusal to work with allies and even adversaries, and leaving states and cities to fend for themselves. Sound familiar? It’s no coincidence that the same president who called COVID- 19 a “Democratic hoax” referred to climate change as a “hoax from China.” Kerry said in an interview with Our Daily Planet. (April 21, 2020)
But there’s a story of hope in the climate crisis that is the opposite of what is required to stop the spread of COVID-19. Basically there is need to shut down much of the economy to stop this disease. On climate, it is not a choice between economic recovery and climate action. The science is explicit: solving the climate crisis is the engine of our economic future. We end up healthier and create more jobs. As the pandemic upends our world, it reminds us of what really matters is the health and safety of our families and our loved ones, our communities and countries. Climate science teaches us to connect the dots between our health and the health of our planet, and explains how burning fossil fuels and climate change threaten them both.
At the same time, an expected drop in greenhouse gas emissions linked to the global economic crisis caused by the COVID-19 pandemic has attracted some optimistic prospects. According to Gerhard Adrian, World Meteorological Organization (WMO) Secretary-General in reference to a 5.5 to 5.7 per cent fall in levels of carbon dioxide due to the pandemic, this trend is only “short-term good news". It is predicted that once the global economy begins to recover from the new coronavirus, emissions will return to normal. “There might even be a boost in emissions because some of the industries have been stopped”, he cautioned.
The last 50 years have seen the physical signs of climate change - and their impacts – gathering speed at a dangerous rate. Consequently, The UN Report on Climate Change (September 2019) has warned that unless the world can mitigate climate change, persistent health problems, especially hunger and inability to feed the growing population of the world, and there would be also more massive impact on economics. The report shows that since the first Earth Day in 1970, carbon dioxide levels have gone up 26 per cent, and the world’s average temperature has increased by 0.86 degrees Celsius (33.5 Fahrenheit). The planet is also 1.1C (nearly 34F) warmer than the pre-industrial era and this trend is expected to continue. In addition the last five years were the hottest on record. This warming has been uneven, with Europe seeing the highest change in the last decade (of around +0.5C, or 32.9F) and South America and the Caribbean experiencing the least change. Other key indicators showed an acceleration of climate change in the past five year including ocean heat and acidification, rising sea level (up 112 millimeters since 1970), glacier melt and Arctic and Antarctic sea ice shedding ice loss five times higher in last five years, compared to the 1970s.
Under these circumstances, the future choices revolve around two options. One is a path of global solidarity like we experienced in 2015 with the embrace of the UN 2030 Sustainable Development Goals and the Paris agreement signed by 192-198 countries . The other is to devolve into division, hate and nationalistic authoritarianism. GOFAD is optimistic in its belief that the enormous pain and suffering of responding to COVID-19 will actually increase the chances for Climate Action.
This blog is being written before the full report of a specially convened meeting of CARICOM Heads of Government on April 15 to discuss the Regional response to COVID 19, is available. A CARICOM Secretariat press release (March 16) highlights some of the major proposals that revolve around a common public health policy, food security, inter-regional transportation, threats to security, building a robust digital architecture to facilitate commerce and assist in the fight against the virus.
The Blog is inspired by the view of CARICOM Chair and convener of the special meeting, Barbados Prime Minister, Mia Mottley. It is that "the community is being confronted with a virtual reality beyond the physical boundaries of its sovereign states". Her implicit conceptualization of the solution brings into sharp focus the prospects of the Region's collectively planning to overcome the threat of COVID 19 to lives and livelihoods in the Caribbean. She sees this as a trigger for sharpening the reality of functional cooperation and acting as a spur to an accelerated quest toward a genuine single market and economy. The Special CARICOM conference coincided with a session of the IMF-World Bank Spring Meetings (March 15) on actions to save lives globally and protect livelihoods with targeted fiscal measures. Both conferences conducted virtually, provide an indication of the new normal for governance and decision making.
In her address to the opening press conference of the IMF-World Bank meeting, Kristalina Georgieva, IMF Managing Director reinforced the extraordinary uncertainty about the depth and duration of this crisis. Referring to the World Economic Outlook, she said that it is already clear that global growth will turn sharply negative in 2020, leading to the worst economic fallout since the Great Depression. In the previous quarter, January-March, per capita income growth was expected in over 160 of IMF member countries in 2020. “Today, that number has been turned on its head: we now project that over 170 countries will experience negative per capita income growth this year. The bleak outlook applies to advanced and developing economies alike. This crisis knows no boundaries. Everybody hurts.”
This is no doubt, the virtual reality to which PM Mottley refers. It is a realization that the health crisis will hit vulnerable people hardest and the economic crisis will have severest impact on vulnerable countries. And this means that CARICOM countries will be exposed to massive external pressure, dangerously exposed to the ongoing demand and supply shocks, drastic tightening in financial conditions and the reduction in remittances. Some may face unsustainable debt burdens.
It is the widely accepted view that the response to the coronavirus will be fully resolved only when enough people are immune to the disease to blunt transmission, either from a vaccine or direct exposure. Until then, it is evident that governments that want to restart their economies must have public-health systems that are strong enough to detect and respond to cases. A template by the World Health Organization (WHO) based on empirical observation illustrates the disease progression by phases and responses.
Listening to International Experts without neglecting regional expertise
Taking a different angle, the Brookings Institute (March 2, 2020) reveals the many channels through which an infectious disease outbreak influences the economy. Direct and indirect economic costs of illness are often the subject of the health economic studies on the burden of disease. The conventional approach uses information on deaths (mortality) and illness that prevents work (morbidity) to estimate the loss of future income due to death and disability. Losses of time and income by those infected and direct expenditure on medical care and supporting services are added to obtain the estimate of the economic costs associated with the disease. However, this conventional approach underestimates the true economic costs of infectious diseases like COVID 19 and before, SARS. and HIV. These are all of epidemic proportions which are highly transmissible and for which there is no vaccine.
In the Caribbean, a study by UWI (Trinidad and Tobago) Health Economics Unit in 2000 led by Prof Karl Theodore, sensitized CARICOM Heads of Government to the exceptional costs of HIV as a percentage of GDP that jolted the region into action. This included the establishment of the Pan Caribbean Partnership against HIV (PANCAP) on February 14, 2001.
The seminal Report of the CARICOM Commission on Health and Development 2005 , Chaired by Sir George Alleyne did the same for our understanding the macroeconomic implications of the Non Communicable Diseases (NCDs). It triggered the Port of Spain Declaration (2007), "Unite to Fight the NCDs" and a worldwide movement on the wellness revolution through advocacy at the levels of the Commonwealth Heads of Government and the United Nations General Assembly. Both HIV and NCDs reflect the principles of Test, Treat and Defeat a response actually coined by Professor Clive Landis one of the current researchers on the UWI COVID 19 Task Force. An emerging slogan in this contemporary fight is: Test, Trace and Treat.
The experience from the response to previous disease outbreaks includes success through collective action. The Caribbean region was the first in the Americas to eliminate poliomyelitis and the first to eliminate indigenous measles and rubella. This among others, must have provided useful lessons about mitigating and containing the coronavirus. It is heartening to note that CARICOM Heads from what we have so far learned, have placed emphasis on:
Equally important is the recommendation for a collective approach to the international institutions for addressing the financial challenges, placing emphasis on vulnerability over GDP. The allocation of an initial package of US$140 million by the Caribbean Development Bank which follows this principle is invaluable. It is intended to provide assistance to its borrowing member states coping with COVID-19. According to CDB President, Dr. Warren Smith, "this assistance is directed mainly towards the most vulnerable within our societies and giving the highest priority to strengthening social safety nets”.
Good practices and innovations within the region — Jamaica an Outlier
Most Caribbean countries have been responding with varying formulae to mitigate the economic fallout from the coronavirus. However, the most comprehensive that we have come across is the Jamaica government’s J$25-billion fiscal stimulus package announced by the Minister of Finance to cushion the impact on businesses, creative industries, workers and the vulnerable groups including the elderly. Heralded both nationally and internationally is Jamaica's robust health programme for prevention and mitigation; its sharing information and public awareness; strict enforcement of physical distance and protection for frontline workers; and making provision for quarantine facilities.
Innovations are also to be highlighted. University of Technology (UTech) student in Jamaica, Rayvon Stewart has produced XERMOSOL , an ultraviolet technology which field and laboratory tests have found to be efficient in killing about 99.9 per cent of deadly pathogens found on doorknobs, thereby reducing the spread of bacteria. This invention may prove to be as a possible key weapon in the fight against COVID-19. It is also worth noting the gumption of two Jamaica young inventors. With the assistance of UWI Engineering faculty and UWI Hospital in Jamaica, they have used their creative talents to build ventilators and develop 3D face shields https://www.youtube.com/watch?v=q9Au4TY8yG4
On Easter Sunday night, Jamaica again demonstrated to the world its creative talents. Undaunted by the challenges, and supported by the Government in partnership with the Private Sector, its producers master minded and its artists delivered a spectacular virtual mega concert. It was dubbed “Jamaica together we stand” and connected Diasporans in Europe, North America and throughout the Caribbean raising over US$10 million to support frontline workers in Jamaica.
It is increasingly clear that this new decade will be defined by an unprecedented new reality. We are enveloped by a new normal. It is most likely to usher forms of engagements that diverge from those which previously shaped our lives. Hopefully the contours of the regional discourse on COVID -19 convened by Prime Minister Mottley, will inspire CARICOM Leaders and citizens to let virtual reality trump national sovereignty.
2020 World Health Day on April 7 passed with a whimper, dwarfed as it were, by the continuing focus globally on the war against COVID-19. Its theme, supporting nurses and midwives is incorporated in the worldwide recognition given to health care workers and others on the frontline of the fight. The annual day, inaugurated in 1950, aims at raising awareness of important health issues, including mental health, maternal and child care, NCDs, food safety, climate change and most recently, in 2018 and 2019, “universal health coverage everyone everywhere”.
This year’s World Health Day should jolt us more than ever in celebrating the work of nurses and midwives among other health workers. We are reminded of the critical role they play in keeping the world healthy. Nurses and other health workers are at the forefront of COVID-19 response - providing high quality, respectful treatment and care, leading community dialogue to address fears and questions and, in some instances, collecting data for clinical studies. Quite simply, without nurses, there would be no response. Over these seventy years of celebrating World Health Day there has been no greater disruption to the health systems and no greater challenge to health workers globally.
All over the world, nurses are foremost among health workers fighting day and night not only to keep us safe from coronavirus, but also to provide the essential services we need to keep healthy in other ways. In his statement to mark this significant day, WHO Director General, Dr. Tedros Adhanom Ghebreyesus recognizes the vital role played by nurses and midwives. “These are the people who devote their lives to caring for mothers and children; giving lifesaving immunizations and health advice; looking after older people and generally meeting everyday essential health needs”. Indeed, they are often, the first and only point of care in their communities. And, more so, in these devastating times of death during social distance, they act as surrogate family to many, giving comfort and support to those who would otherwise expire in utter loneliness. At the same time, shortages of the most basic protective equipment leave doctors, nurses and other frontline workers dangerously vulnerable as they care for COVID-19 patients.
State of the World’s Nursing Report 2020
It is fitting that in commemoration of World Health Day, WHO launched the first ever report, The State of the World’s Nursing 2020. It provides an in-depth look at the largest component of the health workforce. It reflects a global picture of the nursing workforce and supports evidence-based planning to optimize their contributions to improve health and wellbeing for all. The report sets the agenda for data collection, policy dialogue, research and advocacy, and investment in the health workforce for generations to come.
Although the number of nurses globally increased by 4.7 million between 2013 and 2018, the world is facing a global shortfall of 5.9 million nurses, especially in Africa, South East Asia, the Eastern Mediterranean and some parts of Latin America. The report predicts that the current shortage of some 5.9 million nurses will increase, as 1 in 6 nurses worldwide is projected to retire within the next 10 years.
The State of the world’s nursing 2020 report provides the latest, most up-to-date evidence on and policy options for the global nursing workforce. It also presents a compelling case for considerable – yet feasible – investment in nursing education, jobs, and leadership. A similar report on the Midwifery workforce is to be launched in 2021.
Bridging the nursing gap in the Americas
The Report documents that the Region of the Americas is home to 30% of the world’s nurses, or some 8.4 million people, of whom 87% are female. On average, the Region has 83.4 nurses per 10,000 population, more than twice the global average of 36.9 per 10,000. The figure, however, masks extreme disparities in the availability of nurses in different countries. Fully 87% of all nurses in the Americas are concentrated in just three countries: Brazil, Canada, and the United States, which account for 57% of the Region’s total population. That translates into a density of 80 nurses per 10,000 population in those three countries but contrasts starkly with the less than 10 nurses per 10,000 population in Haiti, Bolivia, and the Dominican Republic.
In the Americas, some 30% of the nursing workforce is aged 55 or older, with nearly a quarter of nurses expected to retire over the next 10 years. While there are currently 1.2 young nurses available to replace each retiree, that replacement rate will be insufficient to keep pace with population growth. This is happening at a time when there continues to be a hemorrhaging of the nursing pool in the Caribbean due to migration and the proposals from CARICOM for managed migration have not yield beneficial results.
The Americas Region also has major disparities in the distribution of nurses within countries. In the 35 PAHO Member States that have reported data on distribution, only 36% of nurses are located in rural areas, even though 50% of the population resides there. The availability of nursing personnel is also complicated by the fact that a number of countries, especially in the Caribbean, are net exporters of nurses.
Commenting on the status of the situation in the Americas, Dr. Carissa Etienne, PAHO Director said in a press briefing on World Health Day that through April 6, 384,435 confirmed cases of COVID-19 were reported in the Americas, and 11,270 people have lost their lives. “In just seven days, we witnessed cases and deaths more than double in our region. The pandemic is accelerating rapidly, and I urge governments to prepare and respond at the same speed,” she said.
Cuba's Health Brigade must be Celebrated
COVID-19 has placed a strain on the healthcare system in various Caribbean countries as more resources are funneled toward caring for coronavirus patients. The mammoth effort by Cuba in sending aid in the form of doctors and nurses to Italy and other hard-hit territories cannot go unnoticed. Cuba has been exporting doctors and nurses throughout the Caribbean as COVID-19 cases began to pop up in the region and governments reached out for help. As of 2020 World Health Day, Cuban health professionals are being or have already been deployed to: St Kitts and Nevis (30); Barbados (101); Antigua and Barbuda (29); St Vincent and the Grenadines (16); Jamaica (140); St Lucia (120); Dominica (34); and Belize (58).
To bridge the nursing gap by 2030, the WHO report says countries will need to increase the number of nursing graduates by an average of 8% every year and ensure they can find jobs and be retained by health systems. This will require investments to expand educational and training opportunities, increase nurses’ remuneration and improve their working conditions to ensure better retention. Funding these measures would cost roughly US$10 per capita (overall population) per year, the report says.
Addressing Health Disparities
COVID -19 has demonstrated the worst-case scenario involved in the spread of an epidemic into the developing-world where huge numbers of people live, where health care facilities are poor and where millions lack the money to afford whatever care is available. There are also larger emerging-market countries that will take a huge economic hit as a result of lost tourism, and basic commercial and agricultural activity. But there are more specific and immediate areas to be addressed.
Speaking yesterday (March 8) to Ms. Peggy DaSilva, Coordinator of the CARICOM Regional Nursing Body from her base in St Vincent and the Grenadines, reinforced some concerns of that regional organization about the special plight of the differently abled that was brought to the attention CARICOM Heads of Government. Among them, the need for sign language accompanying health briefings to ensure this demographic has greater access to public education; statutory mandates for construction of ramps to facilitate access to public and other buildings; and special support to care givers and care giving institutions. At the same time a release from UNAIDS (March 7) draws attention to the particular hardships facing sex workers globally, and calls on countries to ensure the respect, protection and fulfilment of sex workers’ human rights. The case of prisoners in cramped cells has led to a rapid spiraling of the coronavirus in those institutions, in most cases without adequate plans for effective preventive and remedial action. In the USA, the Chicago jail for example has the highest concentration of deaths.
While all levels of society are being affected by COVID-19, the impact of this pandemic is particularly hurting schools and places of worship, and disproportionately impacting the underrepresented communities, the sick, the elderly and the lower income groups. In the USA, statistics reveal the enormity of the disparity afflicting the black and brown communities, with Black Americans at overwhelmingly higher risks of infection and deaths. As a result, it is vitally important that organizations delivering critical social services and meeting community needs remain viable, particularly during this economically challenging time. Consideration may be given to including places of worship as recipients of support in the category of small businesses.
During this weekend’s celebrations of Easter, Christians may wish to reflect on the fact that Jesus’ crucifixion and resurrection were indeed instigated by the betrayal of ‘Judas’. The Washington DC National Cathedral Lenten Medication by The Rev. Canon Leonard Hamlin (March 8) is a fitting preview of life beyond COVID -19. "Today, what does betrayal to His teachings look like when we see the hoarding and cleaning of shelves, communities disproportionately affected because of economic, environmental, political and racial factors? When we are able to reach a point of looking back, will anything be different because of what we have been through? Will the change be limited to our habits or will change truly be in our hearts? I am praying that the change begins with me and together, we will see a different world on the other side of this moment”
For believers as well as non-believers, this sacred pledge is a truly respectful tribute to those, the focus of our celebration of World Health Day.
The devastating trends of COVID 19 continue. Judging from the experiences in Italy, Spain, and in USA, especially in New York, California, Louisiana and the increasing impact on over 190 countries the world over, the war against this invisible enemy is deadly not delusional. The new reality as expressed in a recent tracking report shows the expected exponential rate of spread, excessive demands on health systems and the stress on health practitioners suffering from lack of personal protective equipment (PPE), helmets and ventilators. The projected number of deaths from COVID-19 in the USA is estimated to be approximately 93,500 by August. This is frightening. It is a reflection of the gravity of the situation likely to afflict other countries. http:covid19.healthdata.org/.
To stem the social and economic effects of this devastation, there are examples that there is need for policies and programmes to mitigate the effects on workers losing their jobs, renters and homeowners being evicted, bankruptcies of companies, avoided, and business and trade networks, preserved. These are all prerequisites for mitigation to ensure that recovery will occur sooner and more smoothly. The enormity of the challenge is visible in many of the developed countries. Yet an IMF Report illustrates how the challenge is even greater for low-income and emerging economies that face capital flight and will require grants and financing from the global community . Antonio Gutérres, UN Secretary General advocates a Global Humanitarian Fund.
“May your choices reflect your hopes, not your fears.” (Nelson Mandela)
Nelson Mandela's aspirations are reflected in the sustainable solutions to cope with this situation gleaned from lessons learned. China, South Korea and Singapore that have flattened and bent the curve downward provide templates charting the difficulties they faced, the measures that proved most successful in mitigating the human and business impacts of the virus, and how their operational emphasis shifted throughout the stages of the epidemic based on "hopes" rather than "fears".
SDGs: Reducing Inequalities and Increasing Inclusiveness
The 2030 Sustainable Development Goals (SDGs) provide a useful set of markers linking health and economic factors. Implicit in these lessons are the inequalities that are being compounded. Unlike other economic downturns, the fall of output in this crisis is not driven by demand. It is an unavoidable consequence of measures to limit the spread of the disease. The role of economic policy is hence not to stimulate aggregate demand, at least not right away. The main objectives according to the IMF include:
SDGs: Shared Responsibility and Global Solidarity
While we were in the midst of this blog, The UN Secretary General issued a UN report, Shared Responsibility, Global Solidarity: Responding to the Socio-Economic Impacts of COVID-19. It has led to an appropriate diversion in its amplification of his previous call for a global humanitarian response. Its message is made more forceful by empirically demonstrating the impact of COVID on the 17 sustainable development goals. https://www.kff.org/ce6c676/
Among the examples of increased inequalities are:
Dare and care.
This important refrain emerged out of the lessons from China. South Korea and Singapore.
Dare to take quick decisions by a crisis management team properly informed, trusted and empowered to preserve social cohesion, business continuity, and enforcement of sanctions.
Care, demonstrated by the management team, always putting people first in terms of health and financial security with emphasis on those first responders on the frontline of testing and treatment, the back office to guarantee service continuity and the marginalized to reduce inequalities. A statement in the UN report aptly captures the present reality.
"COVID-19 is menacing the whole of humanity and all humanity must fight back . An effective response needs to be multidimensional, coordinated, swift and decisive. It needs to be a result of strong political leadership and buy-in of the population. It needs to foster public trust; be focused on human values; and supported by solid institutions, technical skills and financial resources. Everyone needs to play their part. No individual country can do it alone"
So much has happened during the past week on the contagion of COVID 19. Among the most sensational are the slowing down of the spread in Northern Italy; the surge in the USA, especially in New York; the record US$ 2Trillion stimulus package in USA; and the decision to postpone the 2020 Tokyo Olympics to 2021. There are however signs of health emergencies in other areas of the world like in South Africa for example. In other smaller countries like those in the Caribbean, there are gradual increases in numbers especially the Dominican Republic, Jamaica and Trinidad and Tobago. What has emerged as a vital outcome is that the coronavirus is not only a health crisis of immense proportions, but also requires an imminent restructuring of the global economic order.
The Need for a Global Humanitarian Plan
Mr. Antonio Guterres, UN Secretary General in a statement issued on March 25 captures the enormity of the challenges. “COVID is menacing the whole of humanity and so the whole humanity must fight back. Individual country responses are not going to be enough. Wealthy countries with strong health systems are buckling under the pressure. Now, the virus is arriving in countries already in the midst of humanitarian crises caused by conflicts, natural disasters and climate change.” He called for a Global Humanitarian Response Plan for COVID 19.
Implicit in the UN Secretary General (UN SG)’s plea is that traditional metrics and assumptions are being rendered irrelevant. More starkly Christine Amanpour, Chief International Anchor for CNN, in the interview with the UN SG (BBC March 25), pronounced : “it’s our turn to answer a question that many of us once asked of our grandparents: What did you do during the war?”
Wall Street Journal editorial “Rethinking the Coronavirus Shutdown” (March 19) proclaimed that no country can safe guard public health for long at the cost of its economic health.“ if government shut down continues ... the human cost of job losses and bankruptcies will exceed what most imagine". What it advises for USA applies elsewhere: “unless federal and state officials start adjusting their antivirus strategy now to avoid an economic recession, [the outcome] will dwarf the harm from 2008-2009". In other words, the dilemma we may soon face is the terrible choice to either severely damage our livelihoods through extended lockdowns, or to sacrifice the lives of thousands, if not millions, to a fast-spreading virus. It is with this realization that the call for a global humanitarian response to militate against inequalities, is a feasible solution.
The Next Normal or What Next
Nowhere else have I seen more viable solutions than in an article by Mc Kinsey Analysis in collaboration with Oxford University (March 25) which poses 5 scenarios for the new normal that will emerge in the post-viral era: the “next normal.”
It is increasingly clear that this new Decade will be defined by an unprecedented new reality. Even before a solution to COVID 19 is conceivable, we are witnessing the beginning of discussion and debate about what the next normal could entail and how sharply its contours will diverge from those that previously shaped our lives. The question to be answered urgently is, how to begin navigating to what’s next ?
As we write, governments around the world are scrambling to deal with the spread of the coronavirus, which has sickened at least 176,500 people worldwide and contributed to more than 7,350 deaths. These figures are likely to increase exponentially without the enforcement of stringent and effective measures. Canada shut its borders to anyone who is not a citizen or permanent resident, while the European Union ordered a halt to all non-essential travel. The USA has declared a national emergency, restricted airline flights into the country, ordered restaurants, schools and businesses except grocery stores, pharmacies and banks closed and recommended limiting social gatherings to 10. In France, President Emmanuel Macron banned all social and family gatherings, placing the country in an unprecedented lockdown. A number of African countries —Kenya , Senegal , Nigeria, Benin, and Ethiopia have declared cases while others like Zimbabwe, Chad, Tanzania, Somalia , Ghana, Ivory Coast have instituted restrictions. South Africa has declared a state of disaster and so has The Philippines. These actions together with those in China, Italy, and Spain among others provide lessons learned and portray examples of epic struggles against an invisible enemy. All these jurisdictions have imposed restrictions of between 2-8 weeks duration. Cancellation of sports activities over the world, now threatens next Summer’s Tokyo Olympics.
COVID -19 and the Distinction between Global effects and Globalization
Prof Ian Goldin, at Oxford Centre of Globalization, likened the COVID-19 pandemic to a virulent form of globalization, even more so than the 2008 financial crisis that slowed down the world economy. In 2008, the world appeared much more unified, hence global models for stimulus packages were variably applied to reduce respective economies from total collapse. Yet it magnified the inequality among and within countries. While the financial crisis may have been due to globalization, the current pandemic is a global one. Deregulation was the source of the former crisis, mainly instigated in the developed countries, but with severe impact on developing countries, with least access to effective social safety nets. The slow down on the world economy in 2008 mostly affected the vulnerable and exacerbated inequality within and among countries. Persistent inequalities were fanned by the arteries of globalization. The projected effects of the coronavirus is much more devastating with domino effects across the globe.
The World Health Organization (WHO) has deemed COVID 19 a Pandemic. Its virulence as illustrated by the number of deaths and impending social and economic consequences, is compounded by the fact that it is both a public health and an economic emergency. It exposes the need for strengthening public health, better science, national unity, regional coordination, international solidarity and social support. These elements are required to ensure economic resilience during and after the passing of the Pandemic, whose timeline remains unpredictable.
Already England has announced a COVID Bill guaranteeing £300Bn of government assistance or 15% of GDP, to provide liquidity through support packages, business interruptions loan schemes and loan guarantees, especially for small businesses and the service sector including the airlines. It also includes mortgage holidays, employment support and cash grants to support the vulnerable groups. The USA has advocated US $850bn stimulus package to give relief to small businesses and affected industries like airlines and to support those in need.
"This enemy can be Deadly but not Unbeatable"
Prevalence of the infection is different in different states. The responses are in turn based on these differences. Enforcement of China’s draconian measures to quarantine whole cities for example, has resulted in a massive slowing down of the Coronavirus. Scientists around the world are proclaiming that from an epidemiological perspective, the earlier the action taken, the better the results. But the race to contain the virus is constrained by lack of a vaccine. While the Center for Disease Control (CDC) has initiated trials this week, indications are that it will take at least a year to produce an immunological safe vaccine. Hence preventing the spread will be dependent on information based on the science and building the bonds of trust to manage the risks and achieve mitigation and containment. There is need for coherent policies as a Nudge to slow the trajectory of the virus.
Acknowledging Cuba's Effort and the role of CARPHA
What has emerged is an illustration of the ill effects to human development caused by the ideological divide. According to reports, Cuba produces a drug known as Interferon Alpha 2B, that could save thousands of lives in the COVID-19 pandemic. The drug has been produced in China since January 25 and, according to data from China, has managed to effectively cure more than 1,500 patients from the coronavirus. It is one of 30 drugs chosen by the Chinese National Health Commission to combat the respiratory disease and is currently been prescribed in Italy. The drug was first developed in 1986 by a team of researchers from the Centre for Genetic Engineering and Biotechnology (CIGB) and has benefited thousands of Cuban patients since its introduction into the national health system. It has been used as a treatment for HIV-AIDS, Hepatitis B and C, Herpes zoster or Shingles, Dengue and different types of cancers. The medication is said to increase the natural production of interferon in the human body and strengthens the immune system of patients, thus, is effective in treating the coronavirus disease. https://www.telesurenglish.net/news/Cubas-Interferon-Alpha-2B-Successful-in-Treating-COVID-19-20200317-0015.html
Small island states in the Caribbean, most of which depend on tourism and other service industries, have commenced putting in place programs to prevent the spread of the virus. Chief among these are strengthening health systems, enacting policies based on scientific information, widespread public education and establishing mechanisms for enforcement. They are also considering sourcing supplies of Interferon Alpha 2B from Cuba as part of an overall strategy.
A regional approach is essential for identifying resources, sharing expertise, resisting the temptation for bilateral negotiations that distort regional efforts. It is to the benefit of CARICOM, that the Caribbean Public Health Agency (CARPHA) has become a lead institution in the implementation of the Caribbean Cooperation in Health. in collaboration with the Pan American Health Agency(PAHO). CARPHA has the capability to conduct the necessary tests on behalf of the entre Caribbean but in particular for those smaller islands without local laboratories and test kits. It therefore must be one of the priority institutions in which to invest as a cost effective measure for the Caribbean.
In fighting the contagion of COVID -19, the world is engaged in a war of a different kind. It is most likely to revolutionize the way we live, work and play. It may well be referred to as 'social distance-together'
Edward and Auriol Greene Directors, GOFAD.