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We are not all in the same boat

We Are Not All in the Same Boat

 

 

We Are Not All In The Same Boat

 

Terry McGovern on COVID-19

 

“Pregnancy, TB? We haven’t tested for any of these conditions yet,” says Terry McGovern of Columbia’s Mailman School of Public Health. We are not all in the same boat. A veteran of the AIDS epidemic, McGovern tells Laura, “We should have learned by now that science has to take into account the intersecting factors that make up the reality of people’s lives. If we don’t, not only will women of color, caregivers and the already compromised take the biggest hit, but we will fail overall to contain the COVID-19 coronavirus.
Terry McGovern is the chair of the Heilbrunn Department of Population and Family Health at Columbia University Mailman School of Public Health. For more of Terry, check out our show, How We Can End Gender-Based Violence.

Transcript

 

 

Laura Flanders:

 

I’m here with Terry McGovern. She is a chair of a department dealing with international reproductive rights and public health at the Mailman School of Public Health at Columbia University. Terry, welcome. Thanks for joining us. It is Wednesday, March 18th. You’re dealing with a lot when it comes to global health right now. What are you actually seeing around you right now? And then I want to hear what you’re hearing from your experts and colleagues at the school and internationally.

 

Terry McGovern:

 

First of all, I started my career responding to the HIV epidemic. So, I’m sad to say I’m having a whole lot of deja vu right now. We’re seeing missteps from the federal government. We should be way further ahead than where we are instead of passing the legislation that needed to make sure that the 92% of nurses who are women get what they need. The vast majority of unpaid workers, who are women—mostly women of color—are taken care of. The Republicans have been wasting time making sure that nothing in any relief package would allow for the funding of research labs that also work on fetal tissue. Their obsession with abortion has actually slowed down the response, and of course the government at the highest level acting cavalierly about what was happening in China, and which was totally predictably going to land here.

 

So we saw that in the HIV epidemics. Sadly, we’re also seeing what we saw in the HIV epidemics, which is kind of a response which is very much wedded to inequality and privilege. And what I mean specifically is that if you watch TV, you’re not seeing a lot of women who really knows what goes on when women suddenly have to care for their children who are out of school, when women can’t get access to contraception, when clinic staff are suddenly shifted to have to deal with COVID so they’re not there to give maternal care for childbirth. None of those women are in command, are being heard from. We have learned a lot—a lot of kind of sad lessons—from HIV, from SARS, from ebola that domestic violence increases, that there’s always sexual and reproductive health impacts that have to be looked at specifically from the beginning, that we have to look at the data in an extremely disaggregated way by rape and disability in order to actually address and have an adequate response. We’re making all of these same mistakes here again.

 

So, there’s been a lot said in the media that pregnant women are fine. We don’t know that. We’re hearing some reports from other countries that there may be some issues. There’s kind of been a blanket statement about children not being affected… It’s way too soon to say any of those things. We really are learning with each day, but we do know that in this country, it’s very clear that certain people are able to get access to tests, and others are not, and that is an issue of inequality.

 

Laura Flanders:

 

Are you saying that it isn’t true that we people over 60 should worry, or that mostly people over 60 should worry?

 

Terry McGovern:

 

I’m saying it’s way too soon to be making a statement like that because we don’t know. The data is not disaggregated in a way that’s very clear. It may be generally true that you’re more at risk if you have an underlying condition or you’re older, but if you’re a pregnant woman who has a severe respiratory illness, if you’re a child with certain predispositions, I think it’s way too soon to be able to say you’re fine, you’re just at risk of transmitting the virus. We don’t know yet.

 

Laura Flanders:

 

What’s your evidence that everybody who needs a test is not able to get a test right now?

 

Terry McGovern:

 

Oh, there’s just so many people we’ve heard from who have gone five times, six times, seven times, and in states where they’ve been affected by cuts to clinics, cuts to Title X funding, so we have healthcare deserts all throughout the country. So people with the least access to care are having a terrible time getting access to tests. Now, the situation is going to improve, but many, many people say to me that, why are we reading that an entire basketball team has access to testing and people that we know with severe symptoms can’t get testing? So you know, there’s lots of examples of people talking about knowing that they’re positive when lots of folks still don’t have an ability to get a test still.

 

Laura Flanders:

 

You said politics is playing too big of a role. How so?

 

Terry McGovern:

 

I mean, the idea that Republicans would be spending any time trying to get anti-abortion language in COVID relief packages is just obscene. They ought to be figuring out how to get states respirators. They ought to be trying to figure out how to address the specific needs that women healthcare providers have and looking more, much more carefully at how we are responding. What are we doing about gender based violence? We know that in one province that quarantined in China, rates trippled. I’d like Republicans to spend some time on those issues, not just trying to get abortion language in the law.

 

Laura Flanders:

 

So based on your experience from the AIDS epidemic, what do you wish had been the first steps, or what do you wish would be the steps at this moment? What would we be doing if you had your druthers right now?

 

Terry McGovern:

 

Well, first of all, we would be listening to women—often women of color—healthcare providers who know these issues inside out, who have dealt with the aftermath of these other epidemics and actually letting them have the power to design the response.

 

Laura Flanders:

 

Why them?

 

Terry McGovern:

 

Because they actually know what happens and how to address it, and they’ve lived through it before. Though, I think, you know, we need people who have been in the midst of this mix and have seen the fallout from the failure to deal with intersecting issues. That’s, of course, what we’re talking about, that’s what did not happen in the HIV epidemic. Intersectionality was not considered, so we didn’t think about people—women—when we studied men who had HIV in the early days. We came with a definition that didn’t include gynecological symptoms. It didn’t include folks that were prone to having TB because they were living in overcrowded conditions. So, we’re gonna have the same situation here, where there’s gonna be intersecting factors for people.

 

Laura Flanders:

 

But we’re told that everybody is in this big boat together, that we must all pull together, that it affects everybody, there’s no boundaries, etcetera, etcetera.

 

Terry McGovern:

 

Well, it certainly affects you differently if you’re able to escape your work and go to a place where the infection rate is quite low. It’s certainly gonna affect you differently if you’re very, very ill and you’re afraid to go to a clinic because you’re undocumented or you’re documented but you know the new public charge rule will hold your use of Medicaid against you. There’s lots and lots of reasons that people do not have equal access to healthcare, and they’re all gonna play out in this epidemic, this pandemic.

 

Laura Flanders:

 

So going back to what you wish we had in place, because one day, we’ll be beyond this—we will want those things in place, and we’d better be ready to know what we’re asking for.

 

Terry McGovern:

 

This administration has weakened our healthcare system in every way possible. They have consistently attempted to weaken the Affordable Healthcare Act. The Affordable Healthcare Act made it so so many more people had access to healthcare. It improved the situation vastly, and this administration has been chipping away at it since it came in, specifically restricting Medicaid, specifically gagging Title X—if you have Title X funds and you talk about abortion, you can’t get funding anymore, specifically expanding the criteria by which undocumented people or people who want to change their immigration status, if they use Medicaid, they can actually lose their Green Card. These are all things, actually, also creating this order where it’s OK to discriminate against LGBTQI people. These are all… You pile all of this together, and you’re not in a good situation for a pandemic that needs everybody to have access to healthcare. So that’s part 1. Part 2 is we should have learned by now that we need to look at health crises in an intersectional way. We need to be looking at gender, age, disability, race… We need to be thinking about people’s lives and who are the healthcare workers, and who are the unpaid care providers. Sadly, women, mostly women of color. So, what are we doing to address those conditions? So these are things, and then of course there’s the science part of it. Have we learned yet that we need to be looking very specifically at sexual and reproductive health issues on specific women’s health issues during these crises? No, we seem to never learn that. So I wish that we would take all the things, oh, then fourthly, gender-based violence. I wish that we would take the lessons learned of all of these different epidemics and put the people who actually know how to address these in charge and actually will stand up and say, no, it’s not the same for everybody. Yes, we need to respond as a community and care about everybody, but it is not the same for all of us, it’s just not.

 

Laura Flanders:

 

Two more things: anything that we should be aware of that you are hearing from as part of a global health community, and then secondly, what is your advice to people, especially advice to exactly the demographics that you’re talking about?

 

Terry McGovern:

 

The lot of kind of production—drug production, all kinds of production of supplies—out of China, a lot of those factories and manufacturers have been shut down. We’re hearing a lot about shortages of supplies. Medical supplies, some pharmaceutical supplies… So, the issue of what’s available to assess the impact is quite overwhelming. I think in fragile health systems, how if the numbers really skyrocket, how people really need to be in the hospital and need respirators, how that’s going to happen is a big question. So I think the issue of inequality, as always, is just leaping up, and women in having to be the caretakers. And, again, if you think about any kind of situation where you have people congregated together, the likelihood of transmission is quite high, and, again, inequality plays out there. I was thinking, I was speaking to someone about the populations who are illegal in many countries—transgender people, sex workers, people who use drugs—they’re often afraid to access the healthcare system. So, if they become very ill, it gets very difficult in places where they’re very criminalized. So all of these issues come into play in this pandemic, but I would say the first issue being the weakness of the healthcare system.

 

Laura Flanders:

 

What did we do in the AIDS epidemic that might be useful right now?

 

Terry McGovern:

 

We did exactly, I think, what I am trying to do here. We raised the issues, we challenged the scientists, we demanded leadership that came from affected communities, and we demanded that the government do more than just make statements that are inaccurate about everybody being in this together, etcetera. So I think we also found a way to have joy and humor, and we used the arts, and we resisted with joy I like to say.

 

Laura Flanders:

 

Well, we give joy for you being there. Thank you very much, Terry.

 

Terry McGovern:

 

Thank you.

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