Let us dream conference 2020

1PANEL HEALTH SECTOR Theme: Mindfulness for Health Sophia J Woodard (Moderator) Mansoor Ahmed S Founder, CEO and Well-being Coach of CSR Officer at CBM, Bengaluru, India. Ashanti Truth, North Carolina, USA. Prasun Dutta Chowdhury Suja Isaac Assistant Project Manager at Telenet Owner of SOUKYA International Holistic Foundation, India. Health Centre, Bengaluru, India.

Health Sector: Panel 1 | 101 Welcome to the Mindfulness in many.  I am the CSR Officer at CBM, Health Workshop. I am Sophia Bengaluru, India. I am responsible to J Woodard and am delighted to be raise resources and financials, largely your moderator. We want to talk using CSR, which is a law in India.  about mindfulness. It is an ancient, I raise funds across Tax Deduction holistic practice that is derived from Account Number (TAN) India, largely sati, which is a state of constant to empower rural communities. The awareness that is an important projects are designed to be inclusive element in the Buddhist tradition. It in nature, to integrate women and is based upon the Zen, the persona, children and people who have as well as the Tibetan techniques. A disabilities.   great summary for mindfulness is this amazing quote that I love by the Prasun Dutta Chowdhury - I am Buddha and it says, “Do not dwell in Prasun from Bengaluru, which is the past, do not dream of the future, located in the southern part of India. concentrate the mind on the present I basically take care of rural health moment”. care development. I am working as an Assistant Project Manager at I would like to introduce our Telenet Foundation. My main task  panellists today. They are Mansoor is to provide health consultation to  Ahmed S, Prasun Dutta Chowdhury, people in rural areas . . So we have set and Suja Isaac. I would like each of up two clinics that cover almost ten them to take a moment to introduce villages and we also  have set up tele themselves We will start with consultations, so that people need Mansoor Ahmed. not  go out of their houses. From their homes, people can consult their MansoorAhmed S - Hello everybody specialist doctors. This saves their and the audience across the globe. I time and builds up their confidence. understand we have audiences from I am also taking care of conducting 80 countries or more. Thank you an awareness campaign, which is for the opportunity to speak to so

102 | Let Us Dream Conference 2020 related to health and hygiene across For the last 22 years, I have been in ten villages.  this field along with my husband,  a homeopathic doctor, Dr Isaac I have also set up tele-consultation Mathai. We run three different projects  pan India, for mainly truck organizations,  one of which is South driver and  painter communities. Kia,  an international holistic centre. Wherever they are, whether mobile We have the Sahaya, which extends or stationary, they  take a call and the same kind of treatments to the pursue their tele-consultation. I masses. Finally, we have the South started my career as a sports physio Care Foundation for the last 24 years, involved in rural sports development. which helps people even in the rural I have majorly worked in northeast areas.  We have doctors in Ayurveda, India. So far, my experience has been homeopathy, Yoga and naturopathy in rural sports development and in three systems of medicines.  health. I build confidence that says yes, mindfulness is effective in our In fact, we are India’s first and day-to-day life. I must conclude my maybe only NABH with a national introduction by repeating:  believe accreditation in hospitals and in yourself, trust, enjoy and respect health in these three systems of yourself.  medicine. We have guests from over 105 nationalities, who contact us, Suja Isaac - I am happy to be mainly through word of mouth. We invited as one of the panellists on have different kinds of clients and today’s mindfulness topic in health. we feel that we treat people from I am Dr Suja Isaac, the owner of royalty as well as  the rural areas, so SOUKYA International Holistic we cover the entire span of people Health Centre, Bengaluru, India. I  using safe, traditional, time-tested finished my Doctorate in Vitamin medicines.  We believe that it is an D supplementation. I have been a important intervention to work Lecturer, so I love teaching, because along with western medicine, to be I believe that communication is key. complementary. It has to  work as

Health Sector: Panel 1 | 103 an integrative medicine. This is our life. Mindfulness is practised in a approach.  lot of traditions. One of them is the Christian Judeo and is used in the Moderator - Sophia J Woodard  - context of sharing and being able to Welcome. Our panelists and I be in a place of stillness. Mindfulness look forward to this morning’s connects to whatever we consider to presentations and the opportunity be our divinity. It enables  people  to to interface and interact with our concentrate  on paying attention, on audience. This is an exciting topic, being singularly  focused only on especially at this time, when the one thing at a time. It opens them world is facing many health-related up to the idea of being exposed to challenges that are centered around or being awakened  to the beauty anxiety and stress. With that, I would of life as opposed to its ugliness.  It like to share at this point that I am helps to create a quiet mind and also really excited by the opportunities practised in the tradition,  supporting to participate and support this work one in learning the art of gratitude. that we are taking up  as health and In the Buddhist tradition, which is wellness professionals, because this from where  mindfulness originated. is an extraordinary time for us to I love this quote and this description be able to bring more wholeness to  about mindfulness, as it is a mirror societies and to the world at large.  thought. It reflects only what is happening in the now, not yesterday, Let me talk for a few moments not tomorrow. There are no biases in about how to practise mindfulness that place and that is where you need meditation to create a centered life, to keep your focus.  considering that so many people are in a state of unwellness. We need to It teaches acceptance through be able to talk about how one can the Buddhist tradition,  creates incorporate mindfulness as a holistic intentional living and  appreciates tool  and practice,  to create a more the Judeo-Christian practice too. It centered, harmonious and balanced also promotes gratitude. 

104 | Let Us Dream Conference 2020 So how does mindfulness support begin to take deep breaths, closing our well-being? There are several your eyes, centering the mind and ways, according to a Harvard beginning to focus.  You should be University study in 2018, which intentional about the breathing, points out that mindfulness helps because  it is so important. Be kind to to reduce hypertension. It ignites yourself, and in that,  practise the art or activates the parasympathetic of surrender and whatever is one’s nervous system, which ultimately authentic spirituality. Surrender is promotes releasing stress. Finally, it always  part of that.  helps to bring clarity and  supports anxiety, which is a very important What are the outcomes of element, particularly today,  in the mindfulness? It teaches us the art of 21st century.  surrender,  helps to create holistic  health tools that  support us in Tich Nhat Hanh said - “Every one developing our dreams and  teach us of us has seeds of mindfulness. The how to nurture our  souls. It opens practise is to cultivate it”. How do you the gateway for us to be able to live cultivate and practise mindfulness fully and efficiently.  in your life? So here are some tips, some steps  that you can  incorporate I will close with these two great into your life in order to practise quotes:  mindfulness.  “In your (divinity, infinity, spirit) Mindful meditation begins by light, I learn to live” - Rumi.  creating your own sacred space, whatever it might be. It could be Also,  “I am not what happened to outdoors, in your bedroom, or any me, I am what I chose to become” space that is comfortable for you. - Carl Jung I would like now to turn Choose a quiet spot and get into the my attention to Mansoor and offer mood of silence, whether you sit on this opportunity to share with the a chair in the  lotus position, and audience. Thank you and I hope you enjoy the presentation. 

Health Sector: Panel 1 | 105 Mansoor Ahmed, S - I think much Until I had to move to a mainstream has been said on mindfulness  and school. Unfortunately, the school its importance. I would like to start was not inclusive enough and I faced from a different perspective and a lot of challenges, especially while look at this wonderful opportunity pursuing extra-curricular activities of a mindful learning/sharing and and other engagements. Of course, opportunities to validate my belief if the intention of the teachers would anybody wants to question it.  I would be caring, compassionate and with like to start by acknowledging that I a tinge of sympathy, which I might strongly believe that mindfulness has not like but had to accept as  reality. impacted my life and even benefited I was left alone in the classroom, just me immensely.  For instance, just to stare from the little window when to give you the background, I was the children were playing. Obviously, diagnosed with a disability because what happens when you are alone of a wrong injection, which  left me is that you wonder and start  asking paralyzed at the age of four. I was put why does it happen only  to me? I in a wheelchair and sent to a regular think this is the first time that I felt school in a developing country. Most the difference a  bit negatively and mainstream schools do not accept probably started feeling ashamed children with disabilities. So you of my body. I  began to hate myself, can just imagine three decades ago, which obviously resulted in anger, what the situation was in India. I was depression and finally impacted  my not accepted and fortunately  was academics.  introduced to a special school. There were many happy children, so I had a Luckily, I came across a book that I happy life and also  got rehabilitated picked up from the street, for which with the help of therapy and probably I think I  paid less than a penny in some mindful therapist, who made Indian rupees. I still have the book. me believe that I can stand on my I think it is by Dale Carnegie, which feet again and walk.  talks about a positive mindset, maybe gratitude and how to see a  glass as

106 | Let Us Dream Conference 2020 half full rather than  half empty. I and really understand why there is think it helped.  an increasing number of suicidal cases across the globe and in our I did well in my career and the country. In fact, the report says that second memorable event was two more men attept  suicide  compared years ago, when I got struck by  a rare to women in India. I was very close neurological condition,  Gillian Boris or probably just a step ahead of Syndrome,  which left me paralyzed committing suicide right away. and  wheelchair-bound again.  Fortunately, for the second time, I suddenly remembered Yogi, who This time it was more difficult introduced me to meditation.  because I was married with two  kids. As a parent, I had lots of dreams, but I would also  like to differ slightly I was back on a  wheelchair with no with the meditation that is  largely hope. I was depressed and  thought practised in a silent room. I  was of attempting suicide, which is not obviously in a very  quiet room, inevitable when you are alone and because I have  a huge, Muslim especially when you have experts family. Usually, the Indian Muslim saying that I was struck by  a  rare families are quite large. You then get condition,  from which it would take a lot of love, care and people to visit three years to recover. It was very you. Obviously, there was a lot of obvious that it also had huge financial disturbance. I had also come across implications.  someone who gave me some Arabic chants,  called zikr. As I am an Indian, I was going through a lot of pain I do not understand what it means. I and even contemplated suicide, did some further research and found which seemed less painful than to that it was nothing except  positive experience the pain of  thoughts  affirmation and gratitude.  alone. Still,  now I have compassion

Health Sector: Panel 1 | 107 Moderator - That ties into our  you are very welcome to give your earlier conversation  about gratitude. contribution.  Your life story is extraordinary  and I applaud you for everything that you Prasun Dutta Chowdhury - With have been courageous enough to much said by Sophia, I would like share. I would now like to allow the  to add one thing: Mindfulness is a other two panellists to speak. But  is concept of acceptance, compassion there anything final that you would and detachment. It is a very secular like to say? practice, which is  easily accessible to all.  We can practise this alone if we Mansoor Ahmed S  Yes! I think as want we can practise this as a group per the research, there are at least or we can attend a class. So I must say 7 million bits of information in the there was a research meta-analysis mind’s processes and only 60 bits done by Hoffman and Associates can be processed, which means that in 2010, concluding a process multitasking is a reality, just  like on mindfulness-based cognitive mindfulness is. Thank you.  therapy and mindfulness-based anxiety control. They successfully Moderator - Thank you for being concluded that yes, mindfulness very transparent. Your story is very makes  an impact on  cognitive inspiring and I believe that it will really processes. It conducts therapy and help some of our audience members, stress reduction in many clinical who may be going through these  conditions. So, we are open to health challenges, to  understand everybody. If you have  any question, the power of mindfulness, in order we are ready to address it.  to support them in working through the experiences that they are having with their health. Prasun Dutta,

108 | Let Us Dream Conference 2020 Moderator - Yes Prasun Dutta, in which we are calm, at peace  and we  appreciate your input and your composed. When we reach that stage, expertise today. Suja Isaac, would we are able to think with clarity,  pay you like to add something.  attention,  and think  in a holistic way. It is not only the attention to Suja Isaac - This is a very relevant detail but the awareness of the whole, topic we have today of mindfulness  so that we can  concentrate on the regarding  physical and mental details with our mind. I would also health. Mindfulness is defined as like to share mindfulness as about the practise of paying attention to  being mindful of all our senses. the present moment. We need to There is a lot of toxicity in the world be in the moment, so that we can in terms of pollution, the adulterated pay attention to the details, because food and water.  when you are in the present,  you are able to do any task with clarity and We have a lot of information that concentration and you will do it far we have experienced. There is so more effectively than if you have much information overload through a cluttered mind. Therefore, it is the media, through WhatsApp, important to draw one’s thoughts into Facebook and social media. I think what you are doing at the moment, it is also important to decide what whatever the task  may be. You we want to see and read. Do we want might be walking, eating, exercising,  to experience news that we choose speaking or paying attention in the or do we want to clutter ourselves classroom. But mindfulness is very with toxic information, which is essential to be able to give your 100 irrelevant to us? All this should be percent to the entire process that you helping us to  gather our thoughts are involved in at that moment.  and be composed. I think we should be mindful of what we see and smell.  I would say that mindfulness supports  Very often we have experienced, different systems of medicines  with while we grew up,  the smell of a  a  reason to  achieve a state of mind grandmother baking a cake!  You are

Health Sector: Panel 1 | 109 able to recall that  smell. Now, the to appreciate what we have on our moment you smell a cake, you are plate. Let us be mindful of what we reminded of your grandmother. .  eat, so that we will be able to taste and identify whether it is bitter, salty, There is a lot of connection between sweet or pungent.  Some of the tools your senses and being mindful of we use to optimise even exercise, the situation. When we have been  including  yoga,  meditation and exposed  to some smells and  sounds, pranayama, is important. We can or just calm music,  or gossip, what we even breathe along with treatments are trying to aim for is  positivity and such as  shirodhara, which helps us becoming uncluttered in our minds.  to be calm and composed. There Therefore, we have to use tools that are several traditional, time-tested, can help us to be mindful and  calm. natural healing techniques, which When we talk about the mouth, one can use as tools to help one it is not only what we eat but  also achieve mindfulness.  what we speak  that should make us careful and mindful. In this world, if Moderator - That was a pericope, on something is said inappropriately, it how we can incorporate mindfulness may hurt the sentiments of another. into our lives. It really gave us tools So, I think it is very important to be for that and some other best practices mindful of what we speak .  for utilizing mindfulness,  because that is actually one of the  questions Speak wisely. Likewise, the food  we from our audience. I would like to ingest is also important. Be mindful start from the very first question that of what you eat and pay attention. you already addressed through your The thought of gratitude, of having extraordinary conversation, that is, food on our plates, is mindfulness. how do we practise mindfulness? While you are eating,  make sure It was the  very first question that that you  do not waste food. There came from the audience and you are so many children and many already addressed that question, Dr people who are hungry.  We need

110 | Let Us Dream Conference 2020 Suja Isaac. Would anyone like to add lying on a flat surface, looking  anything? upward  at the sky, closing your eyes, feeling each joint, breathing in Prasun Dutta Chowdhury - Like  and  breathing out and feeling the Suja,  I would like to segregate the positivity of the moment. Walking issue into  two parts. One is self meditation is like finding a space actualization and the second is paying of about 15 to 20 feet to walk, think attention. Accept yourself, live in the positive, enjoy each step you take  moment, focus on breathing and and enjoy the breathing. Similarly, paying attention.  As Suja Isaac said, for sitting meditation, just sit in one when you are eating, pay attention place, cross your legs and keep your to the taste and smell of the food, so palms on your lap, do deep breathing that you  love it.  Accepting yourself through your nose and feel positive. is like  accepting your best friend So that sums up what I want to say and  favourite hobbies. Live every  as an extension of Suja Isaac’s speech moment so that you  find joy in on the question of  how to go with  simple pleasures. Focus on breathing the practise of mindfulness.  whenever you are in negative thinking. You must sit somewhere Moderator - I would say that was where you  breathe in and breathe helpful, because it is important out. You should feel the air going for the audience to know what  the into your body and then going out. various types of mindfulness are. This gives you positive  energy for  How can people incorporate those yourself.  types of mindfulness, which you have articulated, into their daily Regarding meditation, I would like practice? With that, what is the to mention  body scan meditation, importance of mindfulness from the sitting meditation and walking or terms of a psychological intervention movement meditation.  Movement perspective? In other words, why does meditation is just tai chi or yoga. mindfulness have more importance Body scan meditation is just about in this present 21st century? We

Health Sector: Panel 1 | 111 are seeing mindfulness more and are practising destruction more than more every day in the context  of ever.  psychological intervention. Are there any panellists who would like Suja Isaac - As I mentioned earlier to speak on that just for a moment? and also as Mr Mansoor said,  regarding the amount of social Mansoor Ahmed S - I think the very media we are involved with possibly tool that we are interacting with, because of a need, we need to be ie technology, is the  number one selective. I also think it is  important reason. While I do not like to blame, that in today’s age, what is relevant I suggest there are things such as is to get enough sleep,  exercise - notifications that we can switch off to give attention to all aspects and when we do not need them. For not just about but every aspect that example, I have switched it off right is required for a healthy lifestyle. now when it is important to be I think that it is important to know mindful and listen to the speakers. how to pay attention to everything. Similarly, I think the usage of When we talk about psychological technology and information  should well-being, one has a limited time be limited,  as Suja Isaac highlighted. of 24 hrs, but we need certain hours Not just toxic information, but any of sleep, exercise and certain work kind of information. I think that has hours.   resulted in a lot of destruction, which is directly impacting our health and If we do not prevent this overload, wellbeing relationships as well as  our the mind is going to be bogged down social interactions. I am sure there with a whole lot of information. It will are times we go for an anniversary, be difficult to try and decipher what but we are on television, WhatsApp to take and what not to  and to filter, or Skype, because we are not fully right from  wrong when the mind aware and attentive. So, this is why is jammed. We need to limit what is I think we are more distracted and required. There are many  political  events going around the world. I do

112 | Let Us Dream Conference 2020 not think that is going to affect our but as you said, it is challenging. As lives and work and businesses.  We Mr Mansoor said, there are so many take care of what we need to take care destructions every day and every of and spend  time  on being mindful. time. We are just inundated. We are I think what we do will bring a lot of distracted by a series of  sounds from psychological sanity to us. technology and  noise of all kinds of things, situations, circumstances and Moderator - This has just tied in to jobs.  a question our audience has asked about how we stay ‘unbothered’ So, the next question from one of about things that are not important our members is - how do we get in in the context of mindfulness. What touch with each panellist? Perhaps you just shared about being focused each of you can  provide your contact on what is important to  you and how information, so that the audience to stay in a   place of centeredness,  as can have access to you and be able to well as in the mental space of being reach out.  If you have websites, or connected to what is your truth - that other links such as  LinkedIn, or any will be my language.  I think also that kind of information, that will be very as a piece, we have not talked a lot helpful. We are just now beginning to about love. How to stay in a  place, share that. With that, I would like to in the consciousness of love, because ask a very important and insightful it  is not just an outward or a verbal question. How does one control the expression but a way of being, of thoughts that are brought on by staying connected, tapped into your the pandemic, so that our health divinity, spiritual consciousness and does not suffer? Would anyone like truths. That supports us as humans, to share any thoughts on mental because that is where we come from management around the pandemic?  - the source. Love is being able to operate in this sense of alignment Mansoor Ahmed S - I would like of balance and harmony of thought. to share something which is very We really like to have more love, practical. I hope it will be useful. As

Health Sector: Panel 1 | 113 I mentioned, I am a fundraiser and you first need to learn how to love during a pandemic we are required yourself. Once you  begin to, you can to raise more resources than ever. serve the nation and  the people. So However, as an individual, I was I must say thank you to each one of going through the same  worries that you.  I am available on LinkedIn if everyone has. What if I lose my  job, anybody would like to ask me any because NGOs are actually on the line, further questions across the globe compared to  any other sector,  as we - students or anyone.  I am open to are hugely dependent on resources answer anyone. You can search  me from corporates and external out with my name - Prasun Dutta resources. The few things I want to Chowdhury.  say is: firstly, I started volunteering so that I got the opportunity to give Suja Isaac - As a closing remark, I back to the community and  forget would like to share that if it is easy my own challenges. The second is and helpful and  you can take a break, that I started writing down as though just think about insights, what your I have been interacting with a friend, aims and goals in life are - both the keeping in mind some  suggestions I present,  short-term and long-term would like to give to Mansoor, that is, goals - and focus on how we need to myself. These are the two practicals achieve them. . We do not need to that helped me.  worry about what X and Y are doing, or how to keep up with them. We just Prasun Dutta Chowdhury - need to be focused on what we want, Mindfulness is  a great addition, what  our passion is, how we can  because it has a traditional cardiac follow our goals and then take steps care and also controls our daily lives, towards analysing  what they need to stress and moods. We must practise reach and how.  mindfulness as part of our essential ability in our everyday lives,  like Just stay focused on achieving your eating and breathing. You must goals, especially if it helps you to give yourself everything, because be mindful. During this pandemic,

114 | Let Us Dream Conference 2020 people need not worry about other fullness. Prasun Dutta, would you like issues, especially  things that they to share your contact information cannot deal with. Let us do what we please.  can do to help ourselves. Like the serenity prayer, do have the courage Prasun Dutta - I have already shared to change  what you  can  and the and  am available on LinkedIn with serenity to accept what you cannot. the same name - Prasun Dutta So let us focus on what we can do.  Chowdhury. Anyone can send me a request. We can join and take this  This is the  thought I wanted to share. forward. I think I am already in touch As you  asked earlier, you can reach with Mansoor through LinkedIn.  me through  the Soukya website,  www.soukya.com. Any emails sent Mansoor - I will just share a quick from there would reach me. Thank tool, especially in the time of crisis. you so much for  having me here on For continued connection, I am the panel.  I hope what I shared was available on LinkedIn. Just a quick of some help to people who have tool, because there was one question been listening. that specified - do we need to set aside some separate time for mindfulness Moderator - Absolutely, thank you or meditation? I practised something for sharing. Thank you for your called three-by-three, which says willingness to offer exceptional you should identify three objects, insights and your expertise  from take a deep breath, name the object,  an academic perspective,  on how inhale and exhale.  You can  do that to help people live a more fulfilling just three times in a  day and we life.  I think that at the end of the day, know we take 20,000 breaths a day. everything that we talk about as a You can do this anywhere and in any panel is centered on helping others, environment.  including ourselves. We are trying to help  others to be able to find their centre, balance in life and live in its

Health Sector: Panel 1 | 115 Moderator - We appreciate you, Moderator - I would like to thank all  our panellists today for the Mansoor, for  the breathing contributions and insights that you have shared, with techniques and tips technique that you shared. It ties as well as your own personal stories, particularly Mansoor. You were into  mindfulness as an important courageous enough to share your life experiences and how you have technique. Getting into the space been able to take to mindfulness and other techniques, because we know of mindfulness is all about deep that mindfulness is just one holistic practice among many others, which breathing and getting into that space, we can use to live in a healthy  world.  where you are in tune with your So I would like to thank all  the panellists for your expertise, time, breath.  intimate sharing, willingness to articulate some experiences that Prasun Dutta - In conjunction with you have had and how our audience Mansoor’s suggestion, practising can ultimately utilize mindfulness mindfulness has a great effect on  practices to improve, expand and our autonomous nervous system. So strengthen, restore and most of all I think that was a great suggestion by empower their lives. I appreciate Mansoor.  you and if anyone wants to contact me, please feel free to reach me at Suja Isaac - If I may add in the context Ashanti Truth (ashantitruth@yahoo. of world peace, with so much going com). Thank you again, panellists, and on, I think it’s good being mindful I hope that everyone will continue about being spiritual. Yes,  we know to enjoy the rest of the  workshop religion is important for us and our that we are organizing  today. Have personal beliefs, but fundamentally, a great day!  we are all children of God. We need to just be mindful of being spiritual and  becoming good human beings. It is important across all religions, castes and creeds.  I think that is also  important for world peace. 

2PANEL HEALTH SECTOR Theme: Mental Health Care and Resilience Kevin Washington (Moderator) Tiffany Bates Chairperson of Sociology and Psychology Assistant Professor at Louisiana Tech at Grambling State University, Louisiana, University, Ruston, Louisiana, USA. United States of America. Shashi Mudgal Malathy Murthy Research and Development Consultant in Life Skill Trainer and Counsellor for Mumbai. Emotional Needs.

Health Sector: Panel 2 | 117 Good day, wherever you are with people aged one to 101, but my in the world. It is a pleasure focus is on women, girls and their to be with you today. My name is resilience! Happy to be here.  Kevin Washington and I am your moderator. We are joined by three Shashi Mudgal - My name is Shashi. dynamic presenters, speakers, I have been working as a Research healers, counsellors and therapists, and Development Consultant in who will share their insights into Mumbai. My primary interests are how we can improve our lives with literature, psychology and gender an element of resilience,  that is, studies. I have been working with resisting anything that will destroy various other intersectionalities. us internally and elevate us for I have been doing restorative perpetuity.  justice, gestalt and team-centered interaction as a psycho-humanistic I am joined by Murthy, Bates and psychoanalysis method and my Shashi, who will  share their work. bent of mind is mostly with groups We begin with Tiffany Bates on who - definitely women, working on their you are, and remind our audience to strengths, talking about everyday be prepared to put in questions in lives and trying to converge around the chat, so that we can see and feel those areas.  those questions and the outstanding panellists here can actually address Malathi Murthy - I am Malathy them. It is over to you, Tiffany Bates.  Murthy, working as a Life Skill Tiffany Bates - My name is Tiffany Bates and I am an Assistant Professor Trainer and  Counsellor for at Louisiana Tech University in Ruston, Louisiana, USA. I am also Emotional Needs in a reputed NGO. a licensed professional counsellor, as a private practitioner, so I work My profession focuses on teenagers,  women’s groups, underprivileged, orphaned and homeless people.  I mainly focus on women’s  groups, giving them occasional training.

118 | Let Us Dream Conference 2020 We empower and place them in the major challenges that you have jobs and  strengthen their financial all faced  in your communities?  independence. We also conduct handholding, to care for their needs, Tiffany Bates - Well in my area, based on their requirements and there are two major universities skills. Mainly, we empower them with -  Grambling State University and all types of training and counselling Louisiana Tech University. One of sessions.  I concentrate mainly on the effects  I see is the impact on women’s, as well as children’s groups, students. Some just go home and ranging from higher secondary to some are not  able to connect as  working class sections. During  this they normally would. It triggers off tense, emotional pandemic situation,  incidents of depression, stress levels there seems to be a lot of imbalance and anxiety. In terms of homes, there among teenagers, which has created are some cases of domestic violence, a demand for online counselling.  so there  are many who are not able This is where I work and this is about to connect  or get out as we often wish me.  to. But again, when we talk about resilience, we are  referring to how Moderator - Kevin Washington  - we are processing that information. Your introductions  lead me to ask  We will talk about that  later.  you all a question regarding  the outbreak, epidemic and pandemic. Shashi Mudgal - Well I would like to An outbreak is something that focus on two aspects, thematically. I happens in a certain area, an epidemic would like to start with an umbrella happens in a country and a pandemic theme, which I mention because strikes  globally. The pandemic of I look at it as a collective. I try to coronavirus is actually impacting the understand the dichotomy of what health and wellbeing of people, but happened to our world  in the home also  the economy.  What have been as well as in the work front. You know this dichotomy of working at home,

Health Sector: Panel 2 | 119 which does not recognise that there of collective failure or one of  not are other kinds of  tasks at home being able to understand what is too. There is this aspect of blurred happening, even for  intelligent boundaries. Sometimes, we are tied human beings!  We are not  able to up to unknown enemies,  the carrier grapple with it. So these are things being our own species. So, there are  a I have been seeing and focusing lot of uncertainties and  unanswered on,  writing academic articles and questions. doing some research around gender violence and the pandemic.    I think we are  all suddenly working from home, which was supposed Malathi Murthy - During this time, to provide a  sense of security, but women at home are very depressed became a kind of prison,  as we were because of male domination. I all crumpled into our physical spaces. am getting calls from women We are not  able to understand and complaining that   they are  not  grapple  with the situation entirely. able to manage at home. We are In that way, when I talk about focus seeing an issue of  underprivileged themes, I want to bring out things children and parents not able to get that are more magnified now, due into online classes. Around me, there to this situation. We understand the are many  who are underprivileged, difference in power, the hierarchy who  do not have Internet facilities,  that we suffer,  increased  depression, mobiles or laptops.   enhanced  limitations in using our mental faculties and even suffering We are trying to draw these children domestic violence.   into classes, take online sessions  and teach  them resilience, so that they I understood that, as a community, can cope with the situation. Students these issues were  shifting from an suffer from suicidal tendencies and individual to the community and there is currently no training.  I back. This amounts to  some amount have even received a few calls on

120 | Let Us Dream Conference 2020 drug issues, which people have no to  interact. It  is our main modality understanding of how to cope with. for interaction and even now, People are also complaining about rather than having a conference, the workload.  we are interacting via the Internet. It seems that you speak to the idea Most people are saying that their that would occur. There are these companies are giving them  too recurring issues that all of you have much work. There is no socialization highlighted, including the idea of with other workmates and the work access, depression and socialization.  often becomes harder. Working These are the three critical things from home, sitting alone in  front that I want to grapple with.  of a computer  all day is stressful. All these problems are being recorded. Question - When you suggest Children feel sad because they are depression, how is that related to the not able to meet their friends and type of culture and gender?  Tiffany play. Academically, children are still Bates to start with... confused over  online platforms and do not know what to do or how to Tiffany Bates - On issues of operate  gadgets, as parents are not depression, in my culture, basically very well-educated. They are not  we talk to each other as family able to look into academics either.  members or attend  the church as our safe haven. However, all those factors Moderator - So what you presented have now been impacted, so we were is the divide between classes. It is a left with our own thoughts. What we system in the sense of who would should now do is try to communicate have access to online services. If you and appreciate the importance of do not have the Internet, you cannot counselling. Being able to talk to get instructions and if you do not get  someone and normalize some types instructions, then you are left out of feelings is important to reassure of the conversation or opportunity someone that they are not alone. A

Health Sector: Panel 2 | 121 person should be able to understand because humans indeed interact. that there is something  they can do, That is how we become energised in including talking about  issues and  general,  through connections with practising better self-care, which is other people. You mentioned the something we have to do regularly in idea of the Black church. If people order to maintain our sanity during do not have the  connection that this pandemic.  influences spiritual links, it could lead to feelings of depression and We can’t control external factors,, sadness. That is a question, which I such as the pandemic. However, think Shashi could answer  better.  we can control ourselves and our reactions to situations.  So, basically Question - In your opinion, how has having that understanding, or not the pandemic affected specifically being limited by something that underprivileged women? How has it we have been taught in our culture, triggered  domestic violence? but actually reaching out for help, is important. We should stay connected Shashi Mudgal - I would call that a during these times, though we  are coincidence, because I was actually physically distanced. It is important  preparing my mind to talk about it.  to stay connected, as it is beneficial Just to set a context regarding that, I for our social and mental health and  would keep the pandemic in  mind build  up our community too.   and then  depart into the concept of blurred boundaries, exactly like what Moderator - Is it right not to interact I started talking to you about. I am and communicate? That is what we do just trying to understand, setting a as human communities - we interact context to talking about the  aspect and  communicate. The students of who earns what money, who has want to come back to campuses to what kind of power - there is power socialise.  If we say no, you cannot distribution among the members socialise, I think that is an oxymoron, of the family. Who earns what kind

122 | Let Us Dream Conference 2020 of money, what gender the  person that we live in. We have seen a lot of belongs to, the kind and number women, mostly domestic workers of children we have in the house - that I work with, who belong to the everyone has to understand that  we informal sector and have lost their see  too much of each other’s faces in work. Though they are people who the intimate space we have. That is are looked down upon, these women exactly why I used the term ‘blurred were contributing subsistence and boundaries’. second incomes to their families, but have lost their jobs.  The aspect We are not just human beings per se of losing power as the bread earner but humans with voices in our heads. is gone. So now who is important? Is During our years of growing up, this it the one who has more power, or is aspect of the biomedical view of it the one who makes more money? mental health was missed out.  One So all these questions start coming needs to understand the sociological up when someone stares into your model of mental health and there eyes. You start to question yourself is an important time to address about your role. Who is the  person this right now, because we have to you have been, who are you now and  define it all in simple terms. Mental who have you become?  health means  optimum utilization of your cognitive, relative and  other Moderator - That was a powerful intellectual capabilities,  being able speech on being and becoming.  We to relate with other as individuals say that we are human beings, while and evoke  meanings from life. I always say that we are humans becoming. Humans are becoming The pandemic has been acting better today than we were yesterday as a challenge for us to  make the and will be twice as good  tomorrow. optimum utilization of our faculties. These experiences facilitate us to We are  not able to communicate become something distinct, so it is with each other in the physical spaces this idea of reinventing ourselves.

Health Sector: Panel 2 | 123 Ms Malathi Murthy, what have you situation. If this goes on a long run, I seen related to  domestic violence don’t know what to say.  It remains a and women and how can we begin to question of how well  they are going address some of those challenges?  to cope.  Financially, how they used to take up things is not going to be Malathi Murthy - When I look  maintained, because they may have at domestic violence, I find that had many commitments earlier, women are treated very harshly. For when they had an occupation. Now,  example, a husband has lost a job and all of a sudden, when they lose their starts to badly treat a wife, as he is jobs,  they are not going to fulfill their not able to get work.  Emotionally, it commitments. . We are all in  great is very disturbing for each and every trouble now.  one in the family. Even the child is disturbed.  They used to get free food Moderator - It is good that you from the school, but  now that  is not mentioned  activities. I think what is happening. In the shelter homes happening is that we are spending a now, they are not able to manage lot running and doing and not just their food or their daily needs. They being. This is forcing us to think have to cook food  in their houses.  about “how to be” and through  that I am suggesting that people have As Shashi said, the breadwinner is not to figure out how to be together.  I able to earn anything. All that anger  have to figure out how to be with you due to lost financial opportunities is and how can I be with myself too. being  shown on  the children and We have to be at peace in this and the wife, who are suffering a lot. The that  is very challenging. There were communication in the family is not some question statements  about as much as it was earlier, because conviction and I want to come to  a lot of quarrels between family those as part of our closing session. members due to loss of income. But there is one question; People are not able to cope  with the

124 | Let Us Dream Conference 2020 Question - Have you all seen an Sometimes, people think being increase in the caregiver’s stress  due on social media is how  you can to lack of support from schools and get  connected. But later,  you find other therapists? Do you have any yourself even more depressed ideas for parents?  after using social media. So at times unplug, gather a moment for Tiffany Bates - Absolutely, caregivers yourself, and then reconnect.  Again, burn out. It is happening on so many it is about self-concept and knowing levels right now. You mentioned how to communicate what your something important that we should  needs are.    reflect on now, especially we, who are used to not asking for help. But Moderator - It is true that part of now is the time that you may have to ourselves is tied with that of others. say listen. I am drowning and I need If we talk about a cultural construct help. I have all these responsibilities of identity, I have value and worth and I have a hard time balancing because there  are others too. I want them. Do not drown while you try to to field this one to everyone about help everybody but make sure that the interventions and we are going everything is okay, especially with into the next step. So let me talk yourself. Know how to reflect, reach about interventions. We are going out and to communicate. It is all to close at where you were Tiffany about self-concept and  self-control Bates, and the steps that we can take and being able to communicate. next.  We have all been trained or So while we are doing that, find the exposed to therapeutic models that happy balance, even if so much is teach us how to interact with others.   going on outside, just in your area, in your own backyard, taking in nature, Question - Do you all feel that the taking a breather and unplugging models that we have received are from social media for a moment.  culturally appropriate or responsive to diverse populations in general

Health Sector: Panel 2 | 125 and are very helpful for what we find to understand that mental health ourselves in now in these conditions, per se right now has received a lot exacerbated by class, race and other of attention and focus because it has factors?  So we will start with you, gone out of the radar.  Shashi, because you are here and you have a great deal of regular training Mental health always went out of the in Gestalt,  TCI and other areas.  radar, because of so much stigma in What do you think about that? Do this part of the world. I could vouch you think our training has prepared for the stigma that was associated us to deal with a diverse population with this part of the world, that we and for moments like this?  understand everything about the collective, the culture that we belong Shashi Mudgal - I would like to to. It’s about us. So somewhere down bring to your notice that we have the line, “the me has lost myself in made some history.  I mean that we us”...and this aspect of wanting to have become  part of history now. perform and be this or  that - I don’t Never before in humankind did we know where I belong, so I think we know something of this. Therefore, need to take these things seriously as if this has never happened, we need a policy. You know we need to make to find ways of doing what t we have policy stage interventions.  never done. We need to think about it, reinvent the wheel for ourselves I think we must promote action now and try to understand that we research initiative, especially with belong to different cultures and mental health awareness and needs that we have  to address,  we also need to build different most importantly, as an academic models put together. I would like and  researcher. I would like to to recommend that we should propagate that one has to sit  and work on the sociological,  not the build or construct evidence-based biological model.  I do not know if knowledge. You know systems have I am sounding aggressive,  but I am

126 | Let Us Dream Conference 2020 trying to understand that we need Moderator - That was powerful, I to disseminate useful knowledge mean you set me thinking, because that we have built and make use of TCI developed out of, I think it was the expertise of stakeholders, bring Khan, who talked about it. How do everything together, start rewiring individuals who have been impacted our systems and give importance by the Jewish Holocaust redefine and to the biography, the experiential reassess their lives? It seems to be a aspect of human beings.   cultural practise phenomenon and I think what you were speaking about I work with  a group called theme- is the necessity of developing that centered interaction, which mostly type of a model in this condition, talks about I, Me and It. “I am me” in this state grounded by cultural and the “us” is part of the different thoughts and ideas. We want to shift terms - spaces.  I am a daughter,  I am into other things that we can do for a worker, I am a wife, I am a friend, I resilience, but I do not want a cut-off am an acquaintance, I am a therapist emergency, you can say something .... I have so many roles to deal with so go ahead, Malathi Murthy. You and so I have other things to do in have a thought.  my workplace. Always remember that there is a biography that I carry. Malathi Murthy - Here what we are I can never separate myself from my looking at is faith in God, which is workplace,  or from my homespace. very important. Spirituality  plays a So when there is an aspect in which  major role. . Hope and love within biography is not given importance the family has to be taken care in a  culture like ours, one needs to of. We can guide the caregivers work around that. I don’t know if I in the community,  as  awareness am making sense.  has to be given to the community. Fundamentally, it has to be taken care of, like mental and physical care.  The awareness has to be given at the

Health Sector: Panel 2 | 127 community level as  it is a very big finding is that diverse populations pandemic situation and challenge that have had the practice of having for counsellors or anyone who plays gone without are finding other ways an important role to boost each and of coping. Other populations are not every individual.  In our area, we can coping in the same way, because they just look at  those people and then we  want to do what they want to.  So try to boost them, to see how we can here is a thought question on cultural enhance the performance. . That is response - what do you give people? the major take. Tiffany Bates, you talked about going outside in the community. How do Moderator - Very good. But here is you tell people? How do you begin? the shift now. What do we do? How Do you help us to make sense of do we apply culturally responsive everything that’s happened, which interventions? What do we do as does not make sense to us? therapists? How do we tell people who are going through these Tiffany Bates - Very good! challenges now? How do we do the Acknowledging what is right and work and allow people to heal and wondering  about what I can do repair? I think the first step is to gain about it. First, we know what is going a  sense of understanding of where on,  what we can do and I think part we find ourselves.  Too often, we of it is acknowledging the situation find ourselves resisting and fighting and then prioritise our mental something inevitable. It is like one health. When we talk about theories, is caught in a riptide in the ocean, I think we are recognizing narrative so to speak. You cannot fight the therapy through telling  stories. The ocean. You have to go with the tide connectivity that we talked about for a moment to come out of it - and earlier, sharing our stories and what we too often we want things to look a are experiencing without  the shame certain way, because we are used to attached to it - that is important. them being that way. But what I am Someone talked earlier about losing

128 | Let Us Dream Conference 2020 jobs, you know sometimes there is write into the narrative. The beautiful shame in not being able to provide, thing about narrative work is that it so telling our stories and trying to tells us that the book has not been connect to resources is important completed. Too often, we consider Acknowledging what is going on our lives to be over, but we are always now and where I  go from here - just reauthoring certain sections, so that talking about it is a good thing. We we can come up with new outcomes.  need to prioritise our mental health. There are ways of doing that. When Shashi Mudgal, the idea of I talked about nature earlier, I meant reinventing yourself or making that going out just helps you to get yourself better but also remaining Vitamin D, centering yourself and committed  to social justice is  part having your own thoughts, as well of the work that you do. What do you as reflecting where  you can go from share with people that helped them here - I think that is a good start.  to become better in these moments?  Moderator - You all mentioned this Shashi Mudgal -  I am just thinking idea of what I would say. I think that as individuals, we are in or we people roam free in their heads belong to one group or the other. We without adult supervision. That is, are part of the family, workplace  and people begin to “get  caught” in their a group of friends. We are part of a own thoughts. So when you said go group of acquaintances,  community, outside,  I think there is some other religion, race and so many other step that would have to be taken too  things. So I would like to think that along with that, which could be some it is not about romanticizing this re-focusing of attention. But I love aspect of resilience being defined this idea of the narrative. How do in the premises of being perfect, we write a rescript of our narrative having it all in control, converged and the stories that we begin to tell? in one space and being something We now have new outcomes that we that I cannot imagine.  I feel that

Health Sector: Panel 2 | 129 one needs to understand individual to come back, we will do it again and responsibility and that things will we will put it all together. That is one fall apart. That is going to be the of the few positives.  definition of a new normal. Let it all fall but believe in rising again. I Moderator - Ok, rescript, let it fall will start all over and over again. I apart and know that it can all come will connect to my group, whether it back together again, because it has is my family, community, religion, done so  in the past. This is just a church, or NGO. So just coming sequel, we have been through this back into the community that way before, humans have gone through is trying to understand that there is these things … that was powerful and collective wisdom that we all share.  I see you smiling. You know what that means to you on multiple levels You know that when I work in gestalt, right now, ok.  in dreams and fantasy, I work with women colleagues in the office space. Shashi Mudgal - It’s impromptu. I It is very interesting how authentically think it just came from my biography, we are all in the same boat. It is truly I do not know. It is a beautiful love, a existential that we all suffer and  are platform for me to connect with you not able to tell each other,  rationalize and it feels good in my body actually, and say it is ok, we cannot have it all.  I am a body person, so it gives me a As Tiffany Bates said,  let’s us all now good feeling. I just smile.  pull ourselves together and rewire, rescript, work around  concepts and  Moderator - And again, that is part go back to our community societies, of the healing process as we engage our religious texts, practises and re- in the work. We even find our own parent ourselves. You are not really healing moments, so just to be able giving in and you feel that it is all to know there is a divine download falling apart. I say let it fall apart. that comes into us, through us and That is right, but have the resilience then it is like aah … did I say that. This is what I call divine download. It just

130 | Let Us Dream Conference 2020 comes and that is when we know we other issues, we need to  cope with are in the right moment.  that situation and  encourage them.  Malathi Murthy, there is a question For example, I had a call recently about domestic violence.  I know that from the  mother of a five-year- Shashi Mudgal deals with it as well. old, who was really in a very bad But Ms Murthy, regarding the idea situation. Her husband had no job of domestic violence and victims and her child was diagnosed with of victimization - is there anything diabetes. The mother did not know you can share with us about women, what to do. We encouraged her to children and domestic violence and take up our training and get a job. At  how can they express themselves in that time, I could see that it would  this time of the pandemic to get help take more time for her to recover and assistance? but as I counselled her, she built up her resilience and  coped with the Malathi Murthy - In this situation, situation, because she wanted her  I would like to say that  when “I” child to be taken care of and the is replaced with “we”, even illness medication to be given. It was evident becomes wellness. As Shenan said, that the situation would  teach us so just one person on the job does much.   Now she is doing well. She is not really impact the community. able to take up a  situation and handle It is  time that we  work together,  it better than she did earlier. That is to ensure that in the community, how we need to learn how to build people are working  and will recover up our resilience. That is why  I think very soon. This resilience  is like working together plays a major role. a superpower, which we need to I learnt that resilience is something activate.  We need to take it up and very important that we need to focus see that when  people are suffering on at this time.   and in depression, anxiety or some

Health Sector: Panel 2 | 131 Moderator - When “I” becomes the labour that she used to do, the  love- “we”, it is powerful and indicates how labour that is not even recognized.  we can work together. Shashi, we want to close  the program now.  That is why I talked of blurring boundaries that we have, like working Shashi Mudgal - I am sorry, I from home. The whole world forgets thought it was finished. Let me look that women work from  home. This at the anthropological, sociological is not even recognized as work in and theological framework, just our Constitution. All this issue  of  to understand domestic violence, the burden being on one gender placing it in context. I just feel that becomes  only her responsibility.  It there is a lot of history to it. This is a little lopsided. In an argument aspect of who controls the resources, we have as stakeholders, we  attach who has money, who makes everyday strings and do something.  decisions, who runs the property, who pays the bill... There is a lot Moderator - Indeed! There are of powerplay in domestic spaces, various challenges. The gender because there is somebody who is discourse is important, but some of it “a have” and there is somebody who does not have cultural connotations.  is “not a have”, but lives in a very Yet, that is power anyway. We can intimate space. So just to understand just go on and on. This is really good. that, I do not feel that all  the burden There was a question statement here. has to fall on the woman to educate It will be your closing statement, with herself and to feel  this love-labour of your thoughts tied together, Tiffany wanting to fix everything all the time. Bates. Students’ anxiety and stress is This is a burden on women. When  I  not just being really discussed much look at the woman’s situation  from here. Can you speak on  that?   her point of view, it is always a burden on her. You know this productive Tiffany Bates - Just last night I had a session, well past 9  O’clock, talking to students and encouraging them to

132 | Let Us Dream Conference 2020 connect with their professors. They Moderator - Students’ stress plays were closing themselves off and out in multiple areas. You mentioned  putting up a wall as well as  putting calling out for help, not being able everybody out.  I said to one student to go to the counselling centres as I do to many, that you have to and having an unprecedented communicate what is going on. There workload.  In school, the idea of are counselling centres on campus what Murthy mentioned - online and maybe you cannot go there classes - is something that many physically. But you need to speak to students have never taken.  Many someone there and  let them know instructors are just learning to teach  what you are going through, as well online, so there is that anxiety and as the struggles. Sometimes, students tension that mounts when certain do not want to do their assignments, things are loading, uploading or not so they fall behind.  downloading, even as  other kinds of  activities take place.  So there is So that part is about being able miscommunication  and also several to communicate on what is going students who get frustrated with that on and not making assumptions. I as well as other  expectations. So how am going back to what I said about do you communicate  all you know,  meaning and making. It is very no matter what language you speak? important to control what you can There are many things that get lost and communicate to say I need help. in translation.  It is very important because there are several students who are currently So this is what I am saying. We can experiencing anxiety and depression say something in text one way or in and we as professors  won’t know that writing in another  way, which  get until they communicate. We need to  interpreted in other ways, based do what we can to help them through on where people are at the time, so this tough moment.  things get lost in translation.  You can add anxiety to not being able to

Health Sector: Panel 2 | 133 do the normal things that one would There are some things that need to do at the time. For example,  during be torn apart to be made better.  the fall in the United States’ football season, individuals are looking and There were things that happened thinking of playing football, but at the as you mentioned, Tiffany Bates, moment, there is going to be no foot about Hurricane Katrina, when  on the ball. The idea is that people New Orleans was disrupted. But in interact and socialize around these that disruption, we became more events. Now it has been dysregulated. aware of the economic disparities There is another problem of not that existed within the state. But we being able to communicate. When have also  found out that there are you  get the chance, you have to other disparities that exist across communicate with a mask on.  this world.  So sometimes, letting it fall apart breaks the status quo and  All these have caused a lot of people we may begin to address the issues to feel a level of anxiety, depression that surround us. We can become and sadness, because of not being able better in communication when we to connect. I think that you would  learn how to use computers better have offered us some suggestions to communicate. We improve as and thoughts about how we can  communicators when we begin to recalibrate, relook and rethink who examine the phenomena of how we we are,  how we function and how  became dysregulated. We upgrade we use this moment as a moment our health care, law, and all aspects to move forward. As Shashi Mudgal of life when things fall apart. Chinua said, let things fall apart. It is okay for Achebe has a book called When things to fall apart. We do not need Things Fall Apart. He is a very to have everything always together, powerful author.  but knowing that they do come back together again and many times  are I think you have hit some powerful better than they were is important. points here about resilience, knowing

134 | Let Us Dream Conference 2020 it is not a destination but a process. we talk about maintaining hope. The I think this is  what you spoke idea of maintaining  multiple levels about.  Someone asked me about of love is important. With love, all strong convictions within students things are possible, because we know or young people, because they do when we feel love, we are in love not seem to have it. Shashi Mudgal, and when we are in a space of love you mentioned something – that if it allows us to pick ourselves up and they do not have that, they have to move forward.  learn how to have it in this moment, because things are happening around So, I think this idea of resilience is a this. You mentioned reinventing moment of transformation.  It has yourself and I use the word reinvent been executed very clearly. I thank and rescript, restructure or how can you for sharing and taking  time out you become a better person anew. to engage with everyone, because I I think this is the moment to begin have been inspired. I woud say that again, to reassess all relationships, no I have a ‘divine download’,  which matter where we find ourselves. Just leads to  ‘unlimited upload’, in assessing that to become a better self order to be able to actually do the is important.  unthinkable. So, thank you so much. We will wrap it up here. You were so Malathi Murthy, you mentioned fantastic. I feel much better and hope faith, hope and love. We know that others feel  better as well, due to the power of faith, the belief  in the  marching orders that convince something which is not there but us that we can take steps to improve. knowing it will be there. We know that it can be there and that without faith it is impossible to do anything. The idea of hope is important, especially if you have someone who is hopeless  and someone who is in despair, so

3PANEL HEALTH SECTOR Theme: Health care Disparities Seema Rani (Moderator) Amudha Founder of Heal Ur World, India. Certified Clinical Practitioner in the National Health Services in Lancashire, UK. Camalyn Woodard Vishal Rao Board Certified Member in PM and R and in Chief of Head and Neck Surgical Oncology spinal cord injury medicine. and Robotic Surgery at CCG Cancer Center, Bengaluru, India.

136 | Let Us Dream Conference 2020 This is the Let Us Dream 2020 membership in multiple medical International Triennial Virtual organizations, including Atlanta Conference Second Day panel Medical Association and American discussion on Health care Disparities. Medical Association. Welcome I welcome the audience, the panellists Camalyn Woodard.  and the team. My name is Seema Rani. I am the founder of Heal Ur I lastly welcome Vishal Rao, our World and I have been contributing third panellist,  who has completed as a mental health professional a post graduation in autorhivinglogy during this COVID-19 pandemic, by and fellowship in Head and Neck researching and helping people to Oncology Surgery. He is presently cope with mental stress.  the Chief of Head and Neck Surgical Oncology and Robotic Surgery at I also want to introduce our panellists. CCG Cancer Center Bengaluru, India. Amudha is a certified clinical He is also an editor for the Journal practitioner in the National Health of Precision Oncology and has Services in Lancashire, UK. She has over 100 national and international more than 20 years of experience in publications to his credit. Vishal is an the clinical practitioner’s field, where International Advisor to the World she has served  UK society during Health Organization on tobacco- the pandemic. Amudha has been free initiatives and is a visiting awarded for her patience as well as faculty of John Hopkins University recognition for the best services for Leadership Programs. I welcome the patients in critical care.  audience and  hope that we will have a great session discussing Health care I welcome Camalyn Woodard, who Disparities. Now may I ask Amudha received her Medicine Doctorate Robert to speak about what Health Degree in 1989 from Louisiana Tech Disparities mean to her and what she University. She is board certified in PM and R and works in spinal cord injury medicine. She  also holds

Health Sector: Panel 3 | 137 has found most helpful to reduce limitations in delivering quality them.  health care.  Amudha Robert - Hello everyone Addressing health care disparities and good evening. It is afternoon in is important for us, because the the UK and I live in the northwest part population is becoming more diverse of England, so it is a good afternoon now. So as health care workers, to my colleagues and friends in when we focus on these health care the UK. It is a great opportunity disparities, we always treat people to join you all in the Let us Dream equally, no matter whether they are Conference, 2020. Thank you very young or old. We do not perpetuate much for involving me. Thank you,  any discrimination, nor do  we think Dr Seema Rani, for your wonderful about their age, gender, religion, introduction.  race or anything. We always support people and as  individuals, we assess Health care Disparities signify and help them. We also know that this inequities  in health and health population is becoming more and care issues among  groups. It could more diverse. We are actually taking be linked to social, economic or stock of differences between people environmental disadvantages. It can and groups, to give a positive value to occur in many dimensions and  can those differences. That is how we care be related to age, gender or even for people.  By ‘we’ I mean doctors, sexual orientation, racial ethnicity, nurses, paramedics, pharmacists, location and the physical and mental technicians and other specialists and disability status. So our presence therapists,  the security team,  mental means a lot in addressing these health and support workers. All these disparities for health care providers are people we work with together as a and health care workers in present team to reach people and help in the situations. It is an important matter community as well as in the hospital. for us, because the disparities in health and health care is just giving

138 | Let Us Dream Conference 2020 When I talk  about our team, as  a disparities mean to her. How nurse, I would like to mention  our demographics like age, ethnicity, responsibility in  addressing these gender and socio-economic status health-related disparities, because influence health care disparities.   we are standing on the front line communicating with the people. We Camalyn Woodard - Good evening. I address quite a lot of people  in our am Camalyn Woodard. Thank you so present world, I think we are more much, Seema Rani, forthatwonderful advanced.  We are not just  caring introduction. It is a pleasure and for people, but we expand our roles honor to be here to speak at the Let and specializations.  I work in the Us Dream Conference 2020. I do community as a practice nurse and have a few slides that I would like to developed as a clinical practitioner, show you. If you can pull those up, I so we do a lot to reach the people. We would appreciate it.  work as a team and address health disparities, which will help us to So, this evening, I would like to reduce them in future.  briefly discuss racial and ethnic disparities in health care. Health Moderator - Seema Rani - I think disparity, as defined by Health People it is very noticeable that  a change  (2020), is a particular type of health is coming into our society. We difference that is closely linked with thank people like you, who were social, economic and environmental actively involved in giving the disadvantages. The key word right information and the correct to indicate  health disparities is way to take these challenges in life, ‘difference’. So, in the United States, especially COVID-19.  That is great health differences across ethnic information from you.  groups have been recognized for over 30 years. When I speak of Now, Camalyn Woodard will ethnic groups, I mean  primarily introduce herself and speak about African-American, Hispanic, Native her version of what health care

Health Sector: Panel 3 | 139 American, Native Alaskan and Asian- be their income or education. So, Pacific populations.  this may be related to the colour of their skin. Health disparity starts in So why is this important? The the delivery room and  continues United States Bureau from 2020 throughout the lifetimes of African- states that today,  about four out Americans.  of  ten Americans  belong to ethnic populations, but it is expected that Some data is showing that African- by 2044, that number will be at Americans are less likely to receive least half. So addressing health care kidney transplants when they are disparities at this point in time will on dialysis and are also less likely to be very important to go forward, as receive pain medication when they cost and  improvement of health are  born with fractures. They are outcomes is involved. As far as health more likely to die prematurely from care disparities are concerned, health diseases and strokes. Some where do they begin? They start in of this data that I have presented the delivery room and for the sake regarding health disparities will of brevity, I am going to speak about certainly impact  outcomes. We know the African-Americans, not only that health outcomes are determined because I belong to that group, but by how long someone lives, as well as also because this research was done the quality of their lives. However, mostly on them.   driving those health outcomes are the foundations, which are the Let me show you a picture of a policies and programs instituted in a pregnant woman. It explains that community or in a government.  health care disparities begin in the delivery room. Our research  clarifies So I will start with some of the that African-American women are health factors that are found to three to four times likelier to die be important  for outcomes. The during delivery, compared to women  ones we as clinicians, doctors and from other nationalities  whatever nurses are familiar with are health

140 | Let Us Dream Conference 2020 behaviors. When we talk to patients, presentation is the other two health we find out how they can improve factors that we do not really address. their health outcomes. If they smoke, I think because a lot of us are  either we tell them to stop, and if they are not familiar with or just don’t realise overweight we tell them to diet and their impact  on health outcomes. exercise.  If they are not complying That is the economic,  social  and with their medication, we talk about physical environment and why they those rules too  with them. So those are  important. Let us start from are the health behaviors that are the very bottom, with the physical important.  environment.  The other aspect of health factors We look at where the patient lives, that we can address and  are more say maybe near a factory, which we familiar with are  clinical care will call a plant. These facilities are systems. We provide improved spewing toxins into the air, which  is access to health care for our patients going to affect air, water as well as soil in some communities, especially the quality. So, the physical environment disadvantaged African-Americans. is going to impact a patient’s life. There are very few hospitals or Housing is very important, as some medical clinics for patients to visit. people are living in old homes that So we talk to patients about how have lead-based paint.  We know the they can get to places and hospitals effects of lead on children. So these whenever that is needed. But we are two physical, environmental also make sure  that health care is factors that also impact the health affordable and available to most. outcomes of patients, but  we normally do not address them.   These are two types of health factors -  health behavior and clinical If I move up the ladder to the social care that we are familiar with as and economic factors, those are clinicians and that we address, but driving most of our health outcomes. what I would like to bring into this These are entities that we really do

Health Sector: Panel 3 | 141 not even think about, but address many cases. Certainly, it is going to when we have a patient in our clinic. affect children’s educational skills, We start with a less disadvantaged attainment and their cognitive community facing  poverty. The abilities. That in turn affects the communities are not safe and you type of employment they engage in, can imagine that you are telling which  also impacts their income. We patients to improve their health, that know that rich, educated or white they need to walk more and live in people do well and have better health safer environments.  But what are outcomes than other groups.  the chances that it will happen?  Most probably it won’t!  So community I think we need to go back again to safety is very important. I will go start with policies and programs that on to talk about family and social impact our communities through support.  social, economic and physical changes in an environment. As Sometimes, we found, especially clinicians, the policies and programs among our veteran patients, that are extremely important and I think they live alone. They do not have they drive health outcomes. I think family support and some of their as clinicians, we would  do well to problems would be related to mental advocate some of these changes from illnesses. Some  have lost contact a political standpoint, so that we can with people, but we know that social help not only African-Americans but and family support drives health Native Americans and other ethnic outcomes. These are the three issues groups, who  have been adversely I am going to cover under the social affected by health disparities. and economic factors and I think they are very important.  Moderator - What you brought in was interesting. Social and economic Education  among the poor, factors and physical environment, which a lot of us take for granted, get disadvantaged communities are in overlooked. . So those were interesting under-resourced school systems in

142 | Let Us Dream Conference 2020 points, Camalyn Woodard. May I context in which  I introduced our now request Vishal Rao to give his center was to tell you how we have take on health disparities and how been able to use these models. Now, insurance and government policies fundamentally, what I would like are playing a role in reducing health to address through this discussion care disparities.  is health care disparities, I think Camalyn beautifully alluded to the Vishal Rao - I am Vishal Rao and you aspect of defining disparity. The have already introduced me. I am fundamental divide comes between representing HCG Kansas. We are health and disease and I think the a chain of about 26 cancer centres primary responsibility of health care spread across the globe, but we now  disparity bridging would be the three also have a presence in infertility points that I have alluded to - keeping clinics and some general speciality people healthy, treating them when hospitals. We are a publicly listed they are sick and protecting the company and brand, which is our families against financial ruin.  bioinformatics CRO and clinical diagnostic wing that works on These are the three fundamental precision medicines. That is a little goals that define health care brief introduction about our center.  disparities for me. Health care has As I told you, we have 26 centers been misconstrued with medical across the world and we recently care, which is about treating illnesses. entered  Africa and Vietnam.  So health has not been about wellness but  about illness,  throughout, across Our model, ‘Hub and Spoke’, has all governments. Unfortunately, been studied by various schools, if you look at the fundamental such as the Harvard Business School philosophy of medicine, you know and others. They were studying how that an ideally healthy society we are balancing health care models should have fewer doctors, fewer across the globe and how we are able hospitals and fewer illnesses. But it to deliver affordable health care. The has gone completely in the reverse

Health Sector: Panel 3 | 143 direction, because we have marketed out of interest to know how each more illnesses and the fundamental of these models bridge disparities, structure of health seems to be because that will fundamentally getting revealed only  today. So I am define to us how every one  of them asking some basic questions to our has been successful.  audiences  in terms of health versus disease. I am  a person who not only If you look at the global care ratings, manage disease   but also propose India is far below 100 plus, but it is policies to the government.  Mostly, interesting to know what  the top the government says -  let us build a three countries in the world are doing hospital. I then say that our discussion to bridge health care disparities.  I is about helping  to  reduce hospitals am sure that globally, no one has got and not about building another one.  the mantra  to have bridged them completely.   There is always a divide, The fundamental model, whether but I am trying to introduce the it involves  a patient, a hospital or a topic in a very fundamental way, to doctor is the ecosystem, which  I call say that these are the broad models the dynamic PHD [Patient, Hospital that everybody needs to study and and Doctor]. Now if you examine address.   these models, you can see that they revolve around the Beveridge Models India is a very interesting hypothesis by the UK, the Bismarck model by and as I said, I am representing a France, National Health Insurance health care centre.  We have a world by Canada and Out-of-Pocket Model within this country. We have the in the USA. There are various models Beveridge model, the Bismarck that are being exemplified  and there Model, the Out-of-Pocket Model is a mixing and matching in many and the National insurance Model of these places today. Broadly, I am - all four in one country. We have talking about the framework and I the below-poverty-line schemes think each of these would be very from the government, such as  the interesting for the audience to study, centre’s Ayushman Bharat or state

144 | Let Us Dream Conference 2020 government’s policies.  We have naturally, we are seeing a lot of things the employer schemes,  the above- that we really need to bridge.  poverty line  plans, which I call Out- of-Pocket spending and  the beyond- I am talking as a private health poverty-line policies, which are care provider, who also believes in insurance for the elite. I keep telling building a world within our center. So my friends in the West that  if you now we have a  government scheme,   want to study the world, then come Out-of-Pocket expenditure, the to India, because you have the entire Government Employee Scheme world within a country, with every Models and Insurance Models. In model working here.  my center at CCG, I have all the four models working well. The idea is that Within my state, I can take you to every patient who walks into that area whichever peripheral system you would be able to be given justification want and you will have data on every and treatment in a rightful manner single aspect.  I believe it is a very and we do not deny them care. That is wonderful model that we are having, the fundamental rule of health care. yet we are struggling for balance. This is what Camalyn alluded to very I think that is very crucial. It is not beautifully in a presentation that we that we bridge the health care gaps. should not deny health, because it  The biggest gap that I feel in this is is a fundamental right. You cannot that every year in India, more than deny anyone of anything based on 30 million people are falling below financial considerations,  ethnicity the poverty line, because of out-of- or social reasons. You cannot deny pocket expenditure. This is glaring health care for anybody.  data before us because you know that our GDP spending is about one  So I will just end with a couple of percent. In other countries like the thoughts that I feel are key thrust UK, they are spending three percent areas that the government and of the GDP on research alone. So policy makers would like to look into.  I think it is very important to

Health Sector: Panel 3 | 145 have a health impact assessment. It The second point I want to emphasize is crucial to understand what is going is health-in-all policies. I believe the to be the impact of policies and biggest impact that health policies funding. How are we going to re- can make  is  impacting non-health utilize? Unfortunately, I believe most policies. For example, we are talking governments do not have a health about the Municipality Act, the impact assessment  scheme.  Agriculture and Fertilizer Act and  the Sanitation Act.  It is very important strategically to keep looking at the health impact There are so many areas that  assessment. When we presented health policies need to include. So our oral health impact assessment I was telling my honorable minister on tobacco-related diseases  to the  that every department should Government of Karnataka, I showed have a health representative. The the Chief Minister  that every municipality, the rural development year, we spend close to a thousand board and  the water supply crores, or maybe millions.  on just department all should have a health tobacco-related diseases, involving representative. That is when you give heart,  lung  tuberculosis, cancer and a 360 holistic perspective to health in cardiovascular diseases and strokes.  all policies and I am going to refer to the slide which Camalyn showed. The So imagine the health impact aspects of social health determinants, assessment now. When I presented which she actually  spoke about, are this,  I said: “You only earn about the social determinants of health. Rs  100 crore from tobacco-related It is very important to know that taxes, but you are spending thousand social determinants of health need crores on curing diseases. I want to be addressed to  fit health care these policies to be implemented.  I disparities.  want taxes to initiate growth, because I think that is crucial.”  Health in all policies actually means that we should address the social

146 | Let Us Dream Conference 2020 determinants of health. The third changers’, because medications are issue that I think is very important going to push people  further into to many countries across the globe poverty. So generic medicines are is the doctor-patient-ratio, which is going to be game changers when what globally doctors are struggling quality control measures are brought with. I think we need to involve into them. Generic medicines can be  innovative health care models.  For game changers. example, when I was at the Harvard Business School a couple of years Moderator - Sorry to interrupt ago,  I had a very interesting lesson that, I just noted that we have some with a group that was working in questions from the audience. One of African health care.  the questions that popped up in the chat box is:   They told me that in one of the African  countries, they tied up with Question - What are the barriers to the mobile health care and health some patients accessing services? insurance providers in a combined This is open to all panellists.  program. It was done in a  way that the more you speak the more your Vishal Rao -  The biggest barrier health care insurance got covered. people talk of today, if you look at the This is a win-win situation that they grassroots,  has been fundamental developed. They were able to deliver access to good quality health care.   more health care, because people If you have to take this structure started interacting through mobiles [models] at the primary health care and were able to create a model of centre and  are able to get a good their  own.  diagnosis, you have actually made a larger difference, because the I think it was a win-win model. cascade of delayed diagnosis and That is where we need to innovate poor outcome begins here.  on models. Generic medicines are  crucial  and are going to be  ‘game So immediate access to good quality health care is lacking, which brings

Health Sector: Panel 3 | 147 us down to how we can take  the best the community. So they are getting health care using technology to the help already. They have been heard most peripheral borders of the state and  are achieving what they actually or country.  The second aspect is wanted to.  Camalyn also mentioned in urban areas. How do you access socio-economic determinants of affordable health care? These are health, such as  poverty, low income the two fundamentals, urban versus and education, which  is affecting rural, that we are looking at.  people.  Moderator - These are barriers and So  if we need to have a clear society, challenges, both at the fundamental I think people should have access level. I guess that answered the to more in the community rather question. There is another question;  than coming to join queues,  because there is a lack of access.  Health care Question - When can we achieve workers are not reaching the people, a disparity-free health system in that is why they are becoming very ill, developing countries? I think it is a even with mental health problems.  relevant question.   It’s affecting their social life and automatically peoples’ health starts Amudha Robert - I would like to say  deteriorating and they end up in that actually, because I have been  in hospital. The health leaders need to the NHS in the UK, what I have seen have  help from the government to is like what Vishal has mentioned. We review and reach out to communities.   have to reduce  hospitals, not build more. I agree with that.  Because Moderator - One nice thing you lack of care in the community is said is that we have ‘hope’. Sorry, leading to people queing up outside Camalyn., Can you express your the hospitals. That is not happening thoughts...  in the NHS in the UK. We have a lot of services and also an expanding Camalyn Woodard - Certainly. It role of  nurses,  therapists and is important to deal with  health specialists supporting  people in disparities.  Firstly, you have to

148 | Let Us Dream Conference 2020 recognize  that they are issues. Once the department and  see on average you recognize that and put that on about 30 to 40 patients of cancer. the table, you start addressing each About 95 percent of the cancer cases one of them. Some of the health we diagnose are  tobacco--related. factors that are mentioned were not Now, my fundamental question is on the table earlier. We need to try -   should I be looking at increasing and deal with and change people’s my practise further, or should I behaviors. We can look at some of the be looking at how  I can reduce policies and  laws that are out there, my  OPD? If I work on tobacco as Rao and Roberts said and push for control, I can save more lives than change. When we start doing that, , just removing their jaws all my life! we can  start  truly addressing health Fundamentally, I believe that I am disparities. But it starts with some of talking against my own profession. . these policies and programs in our If we had to bridge  health disparities. communities.  I have been doing this and working with the government. . My livelihood Moderator - We have to do things at runs as I conduct surgeries and give  the grassroots level. Vishal, there is a more chemos and radios.  So I am question for you from the audience.  asking you, would you like to put me out of a job? How could you do that Question - What is your thought effectively? on lifestyle changes required? How do we solve problems related to the You have to work for tobacco control. health disparities if we are to resolve That is the answer for it and  it is how  issues related to  say, cancer?  What you bridge health care disparities. is your expertise in dealing with The fundamental importance - I disparities? How do  you bridge it? think, is that I am bringing it to a larger philosophical discussion here Vishal Rao - I am just giving a simple - if I say that lifestyle changes are model. Today, I am talking about my important to you in the capitalism own profession. I mean, as a Head- model, we believe that you make a and-Neck Surgical Oncologist. I run

Health Sector: Panel 3 | 149 profit out of somebody’s problem. Moderator - So, your simple answer That is capitalism, hard core to the people who asked the question capitalism. Conscious capitalism says was, you know, let us work on this to that the problem should persist,  that get a tobacco-free lifestyle, to start you should not solve the problem, with.  but keep the problem running, going because that is where the profit is Vishal Rao - Absolutely. We  coming from. Now health care cannot emphasize  health for all, , not adult thrive on such a ‘philosophical’ trends, in which  we look at fewer  capitalistic model, in which we plan pesticides and less preservatives. in to let the disease flourish, because order to reverse the trends.  there is profit emerging from it. Moderator - I hope that answered If you have to bridge disparities, your question,, dear audience. There you have to go to the fundamental is another question that has been philosophy of this particular posed: Is increased privatization of question and say let us not have health care going to bridge these disparities,  because I do not want disparities? to make profit out of this problem. For that, the government has to Vishal Rao - I think what is important take a joint approach and say that to ask is - - why is health care  on the one side, I will look at health becoming privatized? One argument and on the other side, I will look at is that  it talks about delivering sustainable health and self--delivery quality, which  has never been models. They also need to look at the delivered by  government health care cost and payment of running a health systems alone. Quality health care system, which the government of at most requires incentivization so today doesn’t want to do, because private health care is able to live up they realize that health is a costly to this goal of quality health delivery affair. No government wants to take much better than the government. . the bold step of owning health care.  That is what   we are able to witness  in India. To deliver quality health