EP90 Emergency Preparedness with Noor Jamal, Stephanie Parchment, and Cesar Figueroa

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I AM GPH EP90 Emergency Preparedness with Noor Jamal, Stephanie Parchment, and Cesar Figueroa
EP90 Emergency Preparedness with Noor Jamal, Stephanie Parchment, and Cesar Figueroa

Maureen: Hi, my name is Maureen Zeufack and you're listening to the I AM GPH podcast. In this episode, I get to speak with three graduate students here at NYU School of Global Public Health, Noor Jamal, Stephanie Parchment and Cesar Figueroa. This past summer, the three of them took a course called Emergency Preparedness for Health Organizations, taught by Professor Robyn Gershon. The course aimed to equip students with disaster management skills for the current healthcare domain, even giving students a chance to strategize on solutions in teams. 

As you might imagine, with the current COVID-19 pandemic, this course was especially relevant. In this conversation with Noor, Stephanie, and Cesar, we discuss the importance of emergency preparedness, their insights in the COVID-19 pandemic, and the US's preparedness for it, and the significance of taking this course at this moment in time. If you would like to hear more, then stick around for this episode.

Maureen: You're listening to the I AM GPH podcast. I'm here today with Noor Jamal, Stephanie Parchment and Cesar Figueroa. Thank you guys for coming on the show.

Stephanie: Thanks for having us.

Noor: Glad to be here.

Cesar: Thank you so much for having us.

Maureen: Can you tell me a bit about the course that you took, Emergency Preparedness for Health Organizations and why did you pick this course?

Stephanie: Okay, so I'll start. The course was taught by Dr. Gershon. She is truly an inspiration and just awesome to work with. I think that it was really enlightening and it made me think about career paths that I did not expect even existed before. So I really appreciated the course and the work was something that we could use in any capacity afterwards. So it was a very useful class.

Noor: Yeah. I took the course for similar reasons. So I had originally wanted to take another course by Dr. Gershon, but I believe that was full or either unavailable last semester. So I took Emergency Preparedness and I learned so much. It was always a topic I wanted to learn. But I think the course exceeded my expectations and it was that much more interesting to learn about in the midst of a pandemic. So it made it that much more relevant and felt like the work that we were doing was really going to make a difference. And it just made it that much more motivating.

Cesar: Yeah. And for me, I have to echo what Noor and Stephanie have mentioned. I think that it was very timely being in the middle of a pandemic and having to deal with so many logistical aspects of taking care of the pandemic itself. It seemed like the right course to take during the summer. I am a healthcare worker myself and we are very well-trained obviously in how to take care of individual patients. However, it's a completely different story when you're dealing with an event of this magnitude. So it was really enlightening because I learned a lot of the things that happened before closed doors and in the higher aspects of administration in a hospital. So I really was appreciative of that and I did learn a lot. And I agree with Stephanie that Dr. Gershon was an amazing professor.

Maureen: So something in the same vein of thought you guys had been discussing is how did today's climate impact or influence your learning or the understanding of the topic at hand?

Stephanie: Well, I would say for me personally, I have what if fever, and my mind is constantly evaluating, what would I do if this happens or what would I do if that happens? And I thought that within this climate, we as public health professionals or those who are trying to further our careers academically, we always think, what could I possibly do with this degree? We are imagining what we're going to do with it. And I think in this climate and with this particular class, I didn't have to imagine as much. I was seeing what I would be able to do at work with the public on the news and in class. So it was very practical, the influence that the climate and the class had for me.

Noor: I think when you're learning about a topic like emergency preparedness, it can seem so far fetched. Even when you're in school and you're learning about natural disasters, it might seem like, "Oh, that'll happen maybe once a decade," or something like that. But for me, this was the first time, and maybe for you guys too, the first time living through a pandemic or even seeing one in my lifetime. And so just taking this course and learning about it while that's happening, just made it seem very relevant and made it seem like, "Yes, this is real and it can happen." And working in this field, it just made it seem much more fulfilling for that reason.

Cesar: Yeah. And I think for me, once again, taking care of an event as large as a pandemic that has affected so many lives and has affected so many livelihoods and has affected so many aspects of our country, learning how incredibly important it is to work together and work in groups and work towards a common goal really is, that was an important learning for me because you learn that what happens at, for example, the federal level impacts what happens at the local level and vice versa and how it is important to have that kind of teamwork. So as we probably will discuss later on, this current scenario has left us with a lot of learning points and I think that that was what was more important for me during the course of the learning.

Maureen: That's really fantastic to see how relevant this course was, especially right now and how that has definitely had an impact on people who took the course. What are some of the key challenges or deficiencies you noticed and what would solutions look like for emergency preparedness?

Cesar: Well, I'll start. I think that once again, kind of piggybacking on what I said before, in terms of importance of teamwork, I think that one key challenge was coordinating all different aspects of response to the pandemic and how that had a huge impact on the way that things went here in the US. I think that from the get-go, from the very beginning, particularly during the first one or two months of the crisis, we were flying blind. We didn't know who to test, we didn't know how to test them. And whenever we knew, we had a pretty high suspicion that somebody may be infected, we did not have the tools, we did not have the testing to know who was infected and who was not. And from there, many other things happen. If you don't know if a patient is infected, you don't know who to isolate. You don't know what sort of precautions you need to take.

And if that happens, your staff, your clinical staff, can get infected themselves. And then they call in sick and then you don't have people to take care of patients. So I think that that was one of, I would say, the main challenge of dealing with this is that we knew that we had our enemy, but because we couldn't even see our enemy, we couldn't fight it properly. So I think that moving forward, I think that that's one of the biggest lessons for me. We need a very robust response as a society to identify what the threat is. And once we know, and once we identify the threat and we know and we learn the magnitude of the threat and then we can respond appropriately. So that was one of the biggest challenges, if not the biggest challenge from my point of view.

Noor: I definitely agree with that. I think since the virus was so novel and it still is, there was so much learning to be done about what we know about it and how to combat it. And I think that we're still seeing that today. I remember when the pandemic first started, mask wearing wasn't really recommended by healthcare professionals, unless you were the person that was sick. And now we're seeing mask wearing be so prevalent and encouraged. And so I think that just goes to show how much we're still learning about this virus. And it makes it so much harder to treat or to give recommendations when it's something so new to even healthcare professionals. And I think we're still going to be learning about it and there's a certain level of confidence that you have when something's been around for a long time. But since that's not the case here, it makes it a little bit hard to do all those things with just a really strong sense of confidence.

Stephanie: Yeah. I agree with you both. I think that one of the deficiencies that I noticed for sure was that not only within health organizations, because our plans were focused on health organizations, but nationally, there was just a lack of training. And we tend to not see an emergency coming until it's too late to mitigate or prepare. And so we get stuck spending more time and money and energy in the response and recovery stages. And because of that, during any emergency, it just becomes a lot more chaotic. We have to realize that during the emergency is not the time to start brainstorming solutions and stuff like that, because in the middle of all of this, in the middle of the chaos, it seems more easy to skip a step, miss a step or not see a better option that is available. So on one hand you have that.

But on the other hand, the point of creating the types of plans that we created, these emergency plans, is not to lay out step by step what to do, step one, step two. It's more to have somewhat of a guide. It's going to serve as a guide, like what do we need to do and serve as a checklist, like what are we doing? What do we need to keep doing? Are we doing everything? And then as a grade book, like have we done everything that we need to do well? And that's pretty much it. Making that a practice that we do all the time is something that I would recommend as a good solution to take.

Maureen: So with the knowledge that you've gained in this class, looking specifically at the United States, do you feel like this country is adequately prepared for disasters? Why or why not? And what factors would you say play into this preparedness?

Cesar: I think our country is prepared for this and many other types of disasters. I think that the infrastructure is here. I think that the ingenuity is here. I think that the resources are here. One of the things that was so useful to learn from this course was the fact that we do have a guide book. We do have a map and we do have the resources that tell us when to activate certain resources within the government to respond to any kind of disaster or tragedy or pandemic or whatever it is that it's called. So I think the infrastructure is there. But the infrastructure is only good as the people who use that infrastructure and the policies that surround that infrastructure. I think that we as a country, for COVID-19, we were not really prepared and I think that we actually lost a lot of time. We were one of the last countries to be affected, but we were the hardest hit.

And during the weeks and months even, because remember that the first case was recognized at the end of December or the first case occurred at the beginning of December, but then the confirmation came at the end of December. During those many weeks or months, we could have learned a lot more about the virus and we could have reached out to other countries and learn from their experiences and know exactly what kind of illness this disease was causing and what kind of practices were common in different hospitals and different countries. So I do think that we are prepared and we are probably one of the best prepared countries in the world, but the resources have to be coupled with good policies and with good directives to use those resources in the best way possible.

Stephanie: I agree. I agree. And I would certainly say that for the US, I think that there's this popular understanding that bad things won't happen to us, kind of. We weigh the rarity of the occurrence with the population size, and we think the odds that little old me, that I would be impacted by this actual emergency would be slim. And so we don't worry about what could happen because we're so preoccupied by what is happening. And so for the US, that would include being preoccupied with how much money there is to make, in all honesty, and preparation for situations such as these. The investment in preparation is kind of like a deferred gratification. So you are investing in being prepared for a situation like COVID-19 or a pandemic because you want to protect your citizens because you want to prevent an economic collapse and such. And so without heavily weighing or really seeing the value in that deferred gratification, the end result, you won't really want to invest. And so we don't always see the benefits of saving, like immediately, we won't always see the benefits.

Noor: I agree. I agree with many of the points mentioned. Overall, I do not think that the US was prepared for the pandemic. And I think that simply because there's just so many systems that come into play. I do think of course, we have so many resources, so much opportunity, so much money here, so much knowledge and so many well-trained and experienced individuals. So I think we have the foundation, as mentioned, to be prepared, but I think because of so many systems interplay, whether that be the government or the economy and just where our priorities lie, I don't think it was there at the time. And I don't think it still necessarily is.

And that's for many reasons, but I don't think that we were prepared. And I still think that we are facing something for so long that other countries have overcome and we have been facing it severely, not just in low magnitude and the cases are rising again. So I do think the foundation is there, but I don't think that we are prepared. And I think that's a matter of where our priorities are lying and just so many reasons. But I hope that we can get past that because we do have everything it takes to be prepared.

Maureen: So you all speak of this wealth of opportunity in the sense that we could be doing things, but it has to do a lot with leadership and the systems in place. So unfortunately, with this topic, there's a lot of things to criticize and many areas to improve. What, if anything at all at the moment, are we doing right?

Stephanie: I'd say something that we are doing right, would be that I see many people are actively asking those around them to comply with the recommendations such as wearing masks and social distancing, and many others. Especially within the region that we are in, you can't enter many stores without wearing a mask or get on public transportation without wearing a mask. And that's something that I think is great. Whether or not it could go further, it certainly could. But I think that if we're going to commend anything, that could be something to commend.

Noor: Yeah, I agree. I think what seems like small public health practices, or maybe even obvious practices like hand washing, social distancing, wearing a mask, they might seem so minuscule, but I think those are things that we're doing right, as long as we stay consistent and prioritize those things. And also just the people, especially in clinical care, that are dedicated to this and they're motivated and they're at the front lines. I think that's what we're doing right is having people that are inspired and continuing to put their own lives at risk to help move this pandemic, like progress past this pandemic. I think that's one thing that we're also doing correct.

Cesar: Yeah. I think that at the local level, I live and work in New York City and it's been pleasantly surprising to see that so many people actually comply with the recommendations from public health officials, from Department of Health, from different institutions that have been promoting the use of masks and hygiene and social distancing and so on and so forth.

I have to say that also the healthcare worker group, not because I'm a healthcare worker, but the constant communication between healthcare workers, between academic hospitals, academic organizations, professional organizations, and the cooperation between those organizations has been amazing in that we are able to share our knowledge and we can share from our experiences and what we're finding, what we're encountering in our patients and so on and so forth. And I think that as a society, I tend to be optimistic in terms of our ability to actually come together and create therapeutics. Now we have two potentially breakthrough great vaccines coming up that may be our way out of this situation. I think that that's actually something very commendable and I think that is something that proves how society can move forward as one. And if we put our minds and our hearts into it, we can overcome this and potentially greater crisis, when we band together and we move together as a society. So I think that that's very positive.

Maureen: So on that note, can you talk about how you all approached merging creative ideas with data-driven decisions to build your plans? Because it's easier to dream up something great, but then how do you put that on paper in a compelling and logical way?

Cesar: I think that one of the greatest things about this course is how structured it is. I have to say and I have to confess that I had never put together something like a disaster or a preparedness plan for a pandemic, and it's something that is very, very structured. You go from a different background saying, this is a problem, identify the problem, what are the potential implications of this problem, what's the legal framework that allows you to respond to a pandemic. I didn't know that there's a specific legal framework that actually allows you as a hospital or as a healthcare organization to respond to the pandemic. And then after that, there is also a structure, the HICS, the Hospital Incident Command System, that is a very well organized, very meticulous way in which hospitals are given the tools to say, this is who is going to be in charge in case there is a crisis or if there's a pandemic and this is how each one of these people are going to respond to the crisis.

So I think that that kind of gives you the idea that you start with a problem and then you start elaborating around it and you are able to put together a final product. So I think that that was very good about this course. They helped us understand the problem and then start, step-by-step, putting together a plan. I think that that was very useful.

Noor: Yeah. I definitely think the templates were super helpful to kind of stay on track. For me, it was more of a balance between trying to stay a little bit creative, but also focusing on the facts and the statistics and trying to prioritize that because ultimately that's what's important. I believe the creative aspect kind of came into play when you can decide which order to put things in. Also in, I believe, the appendix section, we kind of had a little bit of leeway in what we want to add there. I think my group added a mental health section. So there was some room for creativity, but I think just balancing that structure that came with the course, trying to focus on keeping your plan organized and accurate and putting the numbers and everything in there was really the bulk of the plan.

Stephanie: I would say that it was very interesting to work on these plans. And I did get to implement a bit more creativity in some of ours. I would say for my group's plan, it was very interesting. We did work with the incident command system as was mentioned, and it is very structured. And the reasoning is because it's standardized. You want everyone to understand what this word means, who this person is and all of that. And it's very well tied together so that people from all types of organizations can work across agencies.

You want the people working in the hospital to be able to communicate with the people in federal agencies, working for the military, anyone, everyone should know what everything means. And that standardization did allow for a kind of organization that was really necessary for these plans. And Dr. Gershon did such a great job of helping us understand what all these things meant. Though I would say the creativity came into play because each plan was devised and created for a different type of institution. So for our plan, we were working on a critical care hospital for cancer patients, but there would be another plan for a nursing home or another plan for a very large public hospital. And so for each plan, you're going to have to think of what is it about my healthcare organization that I need to make sure is addressed within this plan?

What is unique about this institution that should be addressed because people are going to need to know? And not all of those organizations function the same way. So that's where you're going to have to think a bit to make sure that whatever it is, is included in the plan, and you don't have people trying to figure out what they're going to do, they forgot this part, I don't know what to do. But it was really well organized and it was a great process. I also did not get the chance to do this before. So it was great.

Maureen: In public health, we often discuss the need to have different people at the table to make decisions, from statisticians, to epidemiologists, to community health experts, to even good communicators. So as we look towards the future, what sort of expertise do you think we need at the table? If you could assemble your Emergency Preparedness Avengers team, what kind of skill sets and backgrounds would you recruit?

Noor: One thing that I find really inspiring that came out of this pandemic is that we see everyone in their different occupations come together to build a functional society. And I think that's so amazing. Whether it be the grocery store workers, the clinical staff, UPS workers, it's just so interesting to me. And that's why I think everyone's voice matters. I think nobody has any background that would not be useful. I think everyone's background is relevant.

And I definitely think of course after the public health professionals, such as epidemiologists and community health workers, I definitely think people at the front lines such as physicians, nurses, I think their input is really valuable just given that they're at the front line, seeing everything unfold. But I definitely would have some policy makers at the table as well. I think unless there's some sort of government regulation and action being taken, I don't think that there's really change on a large level. I think without that, I think everyone's making decisions on their own scale based off of what they prioritize and there's a lot of individual level change. But I think when you have policymakers, government officials at the table, I think that's what really drives forth change on a larger scale. So those are some of the people that I would have at the table, but the list is endless.

Cesar: I agree. I don't think that there's any one single occupation that could not be utilized in responding to a disaster or a pandemic. I, as a healthcare worker again, we don't learn about how to do proper PR for example, or how to do proper communication strategies, how to communicate to patients, for example, to caregivers, how to communicate to the general public. So I think that that is absolutely important and I think that any one profession within a healthcare organization, whether it is an acute care hospital or a nursing home or a dialysis center or whatever it may be, a clinic, whatever it may be, there's always going to be somebody who can do some aspect of this response.

And to echo something that Noor was mentioning that I completely agree, I think that there are responses on many different levels, of course. I think that at the highest levels, so at the level at the state and above level, is absolutely important to have the input from policymakers, from lawyers, people in the legislature, politicians, lawmakers, because a lot of times it's important that those recommendations, whatever recommendations we may have actually are enacted and are enforced and that there's some sort of enforcement because that's important in order to guarantee that everyone in the community follows the guidelines. Because otherwise, if everyone does whatever they want, then things sort of fall apart. So I think that it would be a very big team indeed, but definitely every profession has a role to play when responding to an event of this magnitude.

Stephanie: I certainly agree with you both. I think that actually, you both gave me the idea for the superhero. Here's the superhero, the professional that is capable, right? Because this is a little imaginary. The professional that is capable of assuming whatever role is really necessary at that point within their level of expertise or skill range. And I would say that is the number one important person in the Emergency Preparedness Avengers team, because as we discussed within our class and on our team, and I keep saying our team because Cesar and I were actually on the same team.

So that's why I keep saying that. But I think that what we discussed was that within an emergency, a lot of the times you're not going to be doing whatever your normal job is. So it's kind of just like whatever you normally do, forget about it okay, because they're going to do whatever the incident command needs you to do or whatever new role you're assigned within whatever you're capable of doing. And so that is the scale or the superpower, I guess, that would be really, really important during an emergency. You need to be able to step in where you're needed.

Maureen: You make a great point about the flexibility, adaptability of a person. So that leads into my final question. And that is where do you see the career opportunities here? What sort of indicators or movements in this industry should future public health students and practitioners be paying attention to?

Noor: I think the pandemic itself has opened many doors in public health. And in terms of its attractiveness towards the general public, I think we'll see a lot more people coming towards this field, which is awesome. I think it really put public health on the map. And I think currently there's a lot of opportunities and things like contact tracing and direct care, but I hope that this pandemic will open more doors in the field of emergency preparedness because I think it shouldn't have to take a pandemic to really open those doors. I think those opportunities should already be in existence and there should be preparedness planning that's already happening in the event of something like this happening. And then if it does happen, those same rules can help alleviate some of that burden, but not have it come to such a large magnitude. And I think that's what public health does, is prepare for these types of things. And then once they exist, kind of help bring them back down a little bit.

Stephanie: For sure. I think that we should, for those who are searching for career opportunities or just wanting to understand more about what you could possibly do with a class like Emergency Preparedness or getting your certification in emergency or disaster science, I would say there are certainly opportunities in the Department of Health. Each of them, more than likely, has a division that is specifically for emergency preparedness. Many organizations, like fire departments, have search and rescue teams. You're looking at the private sector.

If you're working for a hospital or something like that, or a nursing home, there are certainly infection control preventionists and surveillance specialists and stuff like that, that are a huge part of and have a very important role in preparedness, especially for things like outbreaks. So there is a lot of opportunity and there is also a lot of room to grow.

Cesar: I think that the opportunities are endless to be honest with you because not only healthcare institutions will always need a committee or a group of people who ensure that the policies and the procedures are in place in case something happened. And something can be, Professor Gershon was very nice in describing those situations, something as simple as a blackout, losing power, losing energy, that's a crisis. And you have to have people who know how to respond to that crisis. And then from that to a pandemic, to a hurricane, to a flooding, every healthcare setting is going to need somebody who provides that guidance in terms of preparedness.

If you go out of healthcare organizations, there's a lot of other organizations that also do need these kinds of committees and these groups and these people who are trained in preparedness. For example, in NYU, we do have a team who is working constantly to provide procedures for all sorts of incidents. So I think that the opportunities are definitely endless. Another very, very positive, and very enjoyable aspect of the course was that Dr. Gershon brought a lot of professionals who gave us talks and gave interviews. And these people work in all sorts of organizations, people in hospitals, in nursing homes, in the city, for the Department of Health, first responders to 9/11. I think that one thing that we can be guaranteed and we can be sure of is that there will always be another crisis, the next crisis. So I think that the career opportunities are endless. And I think that that's a reason why this was such a great opportunity to be able to take this course.

Maureen: Wow. It certainly sounds like there's a wealth of opportunity and possibility in the field. And I think with people such as yourselves who are coming up now, we have some bright spots to look at towards the future.

Stephanie: Fingers crossed.

Maureen: So as we come to a close, are there any final thoughts or things you would like to share or bring forward to the table?

Stephanie: Yeah, I'd actually like to share something. So first and foremost, I'd like to thank you so much for sharing this platform with us to talk about emergency science and disaster science. I do also host a podcast if listeners would like to check it out, it is called Black Hypothesis. It's a STEM from the culture podcast that helps to expose people of color and especially Black people to the diverse career options within the STEM fields, such as public health, which is one of our featured topics given I am in the global public health field. We have a culturally sensitive and very lax conversation about interesting topics within the realms of public health, environmental science, and engineering, and many others.

And so if they, your listeners, or anyone would want to feel inspired to find their own voice, to share their academic experiences, or want to get a grasp of how to explain what you know in a culturally sensitive way or just one to engage in some fun conversations, they should look us up on social media platforms at Black Hypothesis. And we're also available on Spotify and Apple Podcasts. And they can also send us an email at blackhypothesis@gmail.com if they'd like to be on the show or have any questions or anything like that.

Maureen: Thank you for saying that Stephanie. Noor or Cesar, would you like to share anything else as well?

Cesar: I just want to thank you for letting us share our experience in the course. It was a truly enjoyable experience. And I think that all those students who are looking into different possibilities within our school and within the big realm of public health, emergency preparedness and disaster science is something that is really, really interesting, relevant, and it will open a lot of possibilities for you. So if you're thinking about it, go for it. Professor Gershon is amazing. We all love her. So you will not be disappointed. Once again, thank you for having us.

Noor: Yeah, thank you so much for having us. I definitely agree with that point. I think if there's people or students out there that are interested in the field, especially emergency preparedness, there's so much I didn't know about the field until I took this course. And it's definitely a growing field. And public health in general, as we touched on before, it's so versatile. There's just so many aspects that you could go into. And so I think it's a very broad field and you can do a lot with it. So I would definitely recommend. And of course, NYU's program has been really enlightening for me and it's been a great experience for me. So thanks for letting us share the plans and for having us here. It was really a good experience.

Maureen: Well, it was a pleasure to have you three on.

Cesar: Thank you.

Stephanie: Thank you.