Public Health and Covid-19: A Symbiotic Relationship with Mary Linehan

With over 15 years of international residency, Mary Linehan shares her experience building self-sustainable local communities. She and Cougar discuss this “capacity building” and highlight the importance of leaving people better than we found them. Additionally, she will share her thoughts on public health’s role in Covid. Was society positively or negatively affected by public health, and did Covid change public health’s trajectory?

Guest Bio

Mary Linehan is a senior technical advisor of infectious diseases at IMA World Health and has also overseen global projects with USAID. She has over 20 years of international work experience in program management, technical assistance, and research for maternal and child health; nutrition; and infectious diseases, including 15 years of residence in the Philippines, Thailand, Nepal, Indonesia, and Vietnam. In the last few years, Linehan has engaged in a collaboration with researchers at BYU to document the achievements of IMA World Health's nutrition programs.

Recorded, Edited & Produced by Christy Gonzalez, Harper Xinyu Zhang, and Tanya Gale

Transcript

Cougar: [00:00:09] Welcome to Y Health, a podcast brought to you by the BYU Public Health Department. I'm Dr. Cougar Hall, a professor here at Brigham Young University. Whether you are a student, parent or BYU fan, this podcast will help you navigate the world of public health. Our podcast strives to help individuals receive accurate information regarding public health. So whether it's global or local, we will discuss how it pertains to you. Just kick back and relax as we talk about why health. All right. It's a real pleasure to welcome Mary Linehan to the podcast. Mary. How are you doing this morning?

Mary: [00:00:46] I'm great. Thank you.

Cougar: [00:00:47] I really appreciate your time. You and I have been friends and colleagues for six or seven years at this point, and I just was really excited to get you on the podcast and ask you some questions about development, and maybe we can wrap up with some questions about SARS-CoV-2 and how we can hopefully learn what we need to learn and prepare for the next pandemic. Would you mind just giving our audience a brief introduction to who you are and your professional background? Is that all right, Mary?

Mary: [00:01:14] Sure. I am a what I consider an infectious disease specialist. I'm not necessarily an expert because as you can imagine, infectious diseases are a complex and wide group, and I really have specialized in it. But I wouldn't dare call myself an expert really in anything. But I have worked internationally for about 25 years and I've had the advantage of living in much of Asia and parts of Africa and worked with a tremendously wonderful group of people. And I have focused on child health care, nutrition, infectious diseases such as the Hib disease, malaria, HIV neglected tropical diseases. And currently I have been working on COVID and I work in I've supported Tunisia for their response to the COVID pandemic, especially for vaccine rollouts. And I'm based now in Vermont because after COVID hit, we all got to decide where we wanted to live. And this is a really nice place to be. So I'm really happy to be here with you today.

Cougar: [00:02:14] Thanks, Mary. And I agree, if I could live in Vermont, I would. Having visited you there a couple of years ago, absolutely smitten. I think you found heaven on earth in so many ways. When I first met you, you were working in DC and we were working on a project together in Indonesia. You've lived in Indonesia. Tell me a little bit about that experience.

Mary: [00:02:33] Yeah, I got to live in Indonesia for about ten years and it was really always wonderful. I actually lived there three separate times. The first time I went to help with large scale study and I helped design it and implement it. And then I left for a while and I got to go back when the Asian economic crisis happened and to Indonesia just had a lot of health and nutrition problems, I went back to help them and and worked on a vaccine study on the island of Lombok. So we live there for about four years and then came home again and was fortunate enough to go back about seven years later to work on the infectious disease portfolio at USAID. So I was based at the US Government Embassy working for the U.S. Agency for International Development, and that's where we got involved in malaria and rabies control, a little bit of HIV and and tuberculosis, which is, of course, some of the the larger scale infectious disease problems in that part of the world.

Cougar: [00:03:34] I'll just say one thing. I think travel changes us. I think it's humbling. I've never been on a on an airplane returning home where I didn't just take some notes about how I want to be a different person, whether that's something just as far as expressing more gratitude for the things that I do have or finding things that other people are doing and their approach to life that I, I want to learn from and I want to incorporate. And you just mentioned Mary, working with USA, the United States Agency for International Development. I don't know how many of our listeners know what USA does, how they work with developing nations, how they address key issues around public health and and development, and how they really strive to build capacity. Can you give us just a brief overview of U.S. aid and and some of those thoughts?

Mary: [00:04:25] Sure. It was started in the 1960s under the Kennedy administration. It has many divisions. They work in agriculture. They work in climate change. They do humanitarian response. But one of the very large and important sectors is health. Historically, it has focused a lot on maternal and child health because everybody recognized globally in the health community that if we were able to address maternal and child health issues, we would lay a basis for a tremendous amount of improvement on general global health indicators. But we've also grown into more infectious disease control programs such as malaria control very, very important presidential malaria initiative called PME, which has dramatically improved lifesaving measures for malaria globally, the very well known PEPFAR program, which is the President's Emergency Response for HIV AIDS. We also have a very large and important tuberculosis program because this is one of the largest killers globally as well. So over the course of my 25 years of work in public health, I've gone from delivering services. I started out in Nepal giving out Vitamin A capsules and running a program that improved child survival and reduce blindness among children using vitamin A. Now, we really we design programs and work with our partners who implement them locally. We've done a lot of capacity building, worked with local governments and health staff, and we don't do services very much anymore. That's done locally. And so we've shifted out of the direct implementation of programs to working with local partners. And so what the US investment in global health now increasingly is, is capacity building and strengthening the health systems that a country will have and serve its own people. It's really been an extraordinary transition over the last 50 years.

Cougar: [00:06:17] And it's a transition I really appreciate. Mary, I think I think maybe in the beginning providing services was important, but I think as we've transitioned to really that capacity building and maybe a term that that we use at BYU would be developing self reliance. And I think there's some overlap there in really coming in and providing the technical assistance, but allowing either training, building the self efficacy of, of, of locals on the ground or helping them build out their infrastructure and allowing them to address their own issues with with some guidance. And we've learned some lessons in the past, right, that hopefully you don't have to reinvent the wheel in every particular setting with every with every particular group.

Mary: [00:07:00] That's exactly right. I think one of the most important things we do is make sure that each country system has access to the same information. We do work hard to capacitate and improve local authority over their health care. I think that's very important. The other really important element of it is much more cost efficient to let local people provide services to each other than to have people flying in from outside. So as a taxpayer, that's a really good thing to know that we are actively making sure that we use funds well. Public health is all about using whatever resources we have to meet the needs of the most people, and there's never going to be enough for everybody. So continually making cost effective choices is really important, and that really requires that we allow local people to take over the services.

Cougar: [00:07:47] Exactly. You talk about capacity building, and I feel like in some circles in public health, that's a little bit of a buzz term. We throw that around, oh, and we're doing capacity building. I have observed you and Scott both. That is not a superficial. But this term for either of you, the care and the love and the concern that you have for those locals that are doing the work on the ground. When the program is over in three years or five years, where are they going to be and how have we set them up for their next opportunity, whether that's with another NGO or another program or whatever it is, and you've maintained those relationships. That's been a great learning experience for me to see how you and Scott treat others and how you really invest in people.

Mary: [00:08:31] Thank you. That's so nice of you to say. I have to say that for me, the most gratifying part of the job is walking away and seeing that it stays, that you have colleagues who you learn from, you grew with, you plan together, and then when you leave, they don't need you. They are actually so successful and so professional and have their own networks that they take what you have jointly prepared and then run with it and make it something even more wonderful. I have always felt that that was incredibly motivating, very exciting to be part of something and then to watch it grow without you.

Cougar: [00:09:02] Really appreciate that. Maybe that brings me to a last discussion point, Mary, which is SARS-CoV-2. I don't think either of us are under any delusion that public health nailed this one. I don't think we would lay off the blame at the feet of public health. But I'm wondering if you could, in a concise way, summarize what you think public health has done well and where you think we can improve. I highly doubt. I imagine you're of the same mindset that this isn't the last pandemic we're going to see, whether it's a year or ten years or 100 years where we're going to be here again. So maybe in more of an optimistic, hopeful tone, how do we take those lessons learned and be better prepared next time? So there's about three questions in there. But your thoughts on COVID, what we did, what we did well, where we maybe missed the ball a little bit and how we can move forward.

Mary: [00:09:55] I'm maybe not as pessimistic as some and maybe it's pride of of place, but I just feel like in some ways it's been an incredible boost for public health, certainly for global public health. I was so delighted to see how quickly and how openly countries shared data. We've never seen data so available in terms of who had the disease, where, who is reporting it, what kind of coverage you were getting, what kind of results you were seeing. I mean, people have been publishing and making data available, their results available before they could even get them published. And I would point to the success of the vaccines as well. And the vaccine development has never been so extraordinarily successful. And if you look at, say, the Pfizer vaccine, that was a Turkish couple in a German company collaborating with Pfizer from the U.S. I mean, an international, global effort to do something truly remarkable. So I think there are some tremendous success is really exciting things. I also think that public health agency CDC, wow, what a slap in the face. Sometimes they couldn't get the testing right. They couldn't get organized. We started to see what the limitations of just focusing on data were. If you wait for the data, you might miss a chance to actually do some good.

Mary: [00:11:08] Sometimes you have to go with a hunch. Sometimes you have to go with your very best effort. And so I think it sort of forced public health agencies, sort of the stodgy, solid one. They're getting shaken up. They're going to have to rethink how they go forward. But what they did do right, they had pandemic preparedness plans in several countries. And I'm thinking of South Korea as an example. You know, it was CDC planning and training which helped South Korea perform so well. They took the plans that we had jointly prepared and the training that they had done, and they implemented a really successful COVID prevention strategy early on. But I came away thinking that the human beings and the complexity of human interactions and communities, complexity is a huge obstacle to implementing some of the things we know that public health will tell us that are right. You can't quarantine everybody forever and expect them to have normal social relations. For me, that was a very big reminder that knowing what's going to work may not actually make it feasible for humans. They're complicated, they're resilient, but they're also cranky and don't want to be told what to do.

Cougar: [00:12:18] Sometimes it feels like that's what public health does. We put out one fire, or maybe we've only partially put out one fire, but there's another one that's more threatening to a greater percentage of the population. And so with limited resources, trying to do our best and maybe never making everyone happy. So I suppose.

Mary: [00:12:37] Right, a little bit like being a parent.

Cougar: [00:12:41] A lot like being a parent, isn't it married?

Mary: [00:12:44] Right. I do think that without question, we're going to have more pandemics. Will we do better? I don't know. I think that some of the basic limitations are going to still be there.

Cougar: [00:12:54] That's really well said. I think we do like to simplify things into sound bites and it's always messier. Let me ask you a. Question, Mary. Sure. What are you reading right now? And this could be a book. This could be research. But, you know, we're lifelong learners. We need to be in every field. Is there something you're reading right now that's inspiring you? Or maybe it's it's freaking you out, too, but hopefully it's inspiring.

Mary: [00:13:20] Actually, I'm reading Immune by Philip DETMER. It's a fantastic book. It's called Immune A Journey into the Mysterious System That Keeps You Alive. It's a sort of layperson introduction to the immune system, and it is absolutely fantastic. It's funny. It makes complicated things much more understandable, and it really made me realize how little I understand the immune system and how much I have been listening to people who advertise ways to improve your immune system and how off base that really is. But it has a whole section on COVID and also one on diabetes that have just for me, just really been captivating in terms of understanding how you can apply. A real understanding of how your body works to your own health care is very empowering, and it's one that I would really recommend for everybody. I'm enjoying it tremendously.

Cougar: [00:14:08] You know me, I'm going to download it today on Audible. Mary, you have given you have given me so many amazing book recommendations over the years and my goal is always okay. Mary told me to listen to read to this. I got to do it in the next week. Mary, thank you. You're very generous, as always. Really appreciate.

Mary: [00:14:26] You. My pleasure. Thank you for having me.

Cougar: [00:14:31] Thank you for joining us today. Catch us on our next episode and don't forget to subscribe to Future Y Health episodes.