Today, I am thrilled to talk to actually a former student of mine. One of the students I'm particularly proud of, who I met in 2007 in our Public Health Practice course in Barcelona and Dr. Rufus Ewing has just had a wonderful career. We're talking him today as a leader, not only in the Public Health Community, in the Medical Community, but a leader of a nation. Dr. Rufus Ewing is a medical doctor, he received his MPH at Johns Hopkins in 2008, but he's also been a leader of his home country. He was elected to be the Premier of the Island Nation of Turks and Caicos and he led that nation, he stepped down, served a full term. Now, he is former Premier, still very much a leader and completed a four-year term in his political office, and now full-time as a surgeon in his medical practice, and still a resource to the world working with PAHO, the Pan American Health Organization and a real advocate for the Caribbean Nations. So, Rufus, welcome. It's so great to see you again. Thank you, Thomas. It's great to see you as well, it is a pleasure being here and having the opportunity to allow to take your back as part of this lectures. I miss Johns Hopkins dearly and hope to visit some day. Say hello to the family, too. You also your wife as a graduate of Hopkins as well. So, we're doubly proud of you and all your achievements. Correct, correct. What a wonderful leader. But first let me ask, how are you doing? How are the islands doing particularly in the wake of that tragic hurricanes of the last hurricane season? Well, I would say generally [inaudible] but can do better, but for those who don't know Turks and Caicos, we are a small island of the Balkan state, made up of several islands and archipelago, low-lying islands and for us, we are indeed vulnerable to hurricanes like Norma and Maria and greatest vulnerability or risk from those hurricanes or any other hurricanes. To things like flooding, direct damage to unsound structures and of course the public health threats. Those that would result in the direct loss of life or other diseases such as infections of vector-borne diseases. So, those are some of the main threats that we face from those hurricanes, but as it relates to the Turks and Caicos even though do as much destruction of homes particularly those that did not meet the building code. Fortunately, there was no loss of life and however, there was widespread flooding due to heavy rains and storm surges and these are the stage for increasing factors such as mosquitoes, which we did see. However, there was only a slight increase in the number of dengue cases, but there was a general decline in Zika in the Caribbean in general. For Turks and Caicos last purported case of Zika was in early 2017. But following the hierarchy in [inaudible] slight increase in number of gastrointestinal, of diarrheal diseases in the post hurricane period. But the reason why we did not see as much increase in both the diarrheal as well as the vector-borne diseases is because we did had lots of pre and post hurricane health education and also an enhanced surveillance, which reduces the potential of the public health impact of our [inaudible] as it relates to infectious [inaudible] vector-borne diseases following the hurricanes. But I think that's such an important message that, first of all, it's tremendous that you did not have loss of life despite the incredible force of the hurricanes and the aftermath. But the preparation and the adaptation that you are able to do in advance, but there must have been important lessons learned that could be helpful really to the rest of the world as public health professionals think about adapting to a changing world. What were the things that were most important? Definitely. As you just said, you cannot take for granted the preparation phases where it creates an advantage you know real likely to happen during your lifetime. The Hurricanes, us being in the hurricane belt, one will see that we have to prepare for every season and so, in preparing for it, which season begins in June, we have to take seriously all of those mitigation measures from things such as looking at housing and making sure your housing is structurally sound and retrofit housing where necessary. Looking at our stormwater treatment system, making sure that our drains are clean. Looking also at a public health capacity to respond not only to prepare for a disaster or major casualty, but also to respond to those in the post hurricane period. So, preparation is key and your ability to respond on this even more important and so, for us, the response following the hurricane was a great response and there are lots of lessons to be learned I have in responding because, not often you get up and definitive in practice response in situations such as this because the practice in most instances is the realistic situation. So, there are lots of lessons to be learned from those two hurricanes as past. We've seen other other nations struggle, in the island of Puerto Rico, struggle with the power grid and safe water and even the food supply, but you must have had some resilience there and in preparation for that, were there any major public health issues related to water supply? Tell us a little bit about that. Yeah. Well, in fact Turks and Caicos, our water, we are too different from some of the other Islands like Puerto Rico and Caribbean Islands that have large rivers and most of their water supply comes from rivers, but we in Turks and Caicos, [inaudible] comes from this alienation or reverse osmosis process systems. Hence, we don't really rely on the groundwater for drinking purposes, etc. So, the risk of diarrheal diseases from that kind of water is lower compared to other islands that may be impacted. However, we are mindful that, even though we don't use the groundwater for those purposes, the water table itself which selects this where we get water from to disseminate your process [inaudible] can easily be contaminated. So, we always vigilant in task taking even the desalinated water systems that we have adequate supply. So, we are not as vulnerable to the others as that, but there are some communities however. In Turks and Caicos, where and have made the migrant communities because as you know, the other nation of or the twin island nation of Haiti. It's just 90 miles south of us and lots of migrants who come to Turks and Caicos and they reside in small communities in substandard conditions and we forever having challenges not only monitoring the structural soundness of the structures that they reside in, that are normally demolished by hurricanes, but also the issues of sanitation and water supply in those communities. So, a lot of the water that we receive during the covered period for relief goes into those communities to ensure that they have clean drinking water for those persons who have died in those communities. So, you may see a slight increase in diarrheal diseases, but it's not as great because we make sure that those persons are not disadvantaged in any way in getting access to the relief supplies and clean drinking water. So, Dr. Ewing, everyone is aware of the extreme events and the debate of whether or not they're related to climate change, but for many public health professionals, including here in the city of Baltimore, the changing climate means that we have to change the way we do public health all of the time, because of adapting to changes in water supply, changes in the climate, changes in insects, and things like that. So, aside from the catastrophic extreme events, are there things that are particular challenges to Turks and Caicos and island communities that just perhaps less extreme climate events that have changed the way of doing public health and preparing in an island community? I will go back to another aspect of public health that we, and I think Dr. Burke this is up your alley as you were a former high-ranking official in the EPA and also dealing with environmental sanitation. What we're seeing and trying to monitor now is that a lot of the buildings, even though they're damaged, some of them are still habitable. But, in those buildings that are habitable, there is lots of water damage. Because of water damage, then you have your increase infestation of things like mold. So, the respiratory diseases, as a result of mold infestation, both in homes as well as in workplaces, is something that we are monitoring because it is really creating problems in regards to persons being off from work, etc. So, that's something that we have to monitor on the side. But as it relates to Turks and Caicos and climate change, and I said before, we are indeed a low-lying nation, an archipelago of islands. Most persons got to Turks and Caicos because of our tourism product, our beaches. They are the most beautiful and the best beaches in the world. But how about with the impact of climate change, and the rising sea level, as well as the changing ocean currents and tides, and storm surge that come to the hurricane. We find that our coastal areas are completely under threat. Our beaches are a threat of erosion. Our wetlands, which sustain our natural biodiversity are currently under threat because of the rise in sea level. So, this is the real issue for us, the challenge that we will face now and any more so in the future at our most valuable assets, our beaches and biodiversity slip away from us. At the moment, we are looking at how us [inaudible] , in Turks and Caicos could make ourselves more resilient to the impact of climate change. We know that we do not contribute, our contribution to carbon foot print is minimum. But however, even though that carbon foot print is minimal, the impact, and we have as a result of the depletion of the ozone layer and if we have gas effect from gas emissions, it's felt more so in our small island developing state compared to even the larger ones. And so, we are disadvantaged in that respect. But how we still have to make steps to make ourselves more resilient. Think about putting in place [inaudible] systems and renewable energy policies to reduce our carbon footprint globally, as well as looking at how we can, as for Turks and Caicos in particular, how we can protect our coastlines by putting in seawall barriers that we have actually looking at now. Three of our biggest projects coming on stream in the next few years is looking at a coastal seawall protection, as well as a storm water drainage because of our low lying nature. How we can reduce [inaudible] and hurricanes, the excessive flooding that happens in our islands, so it could run off faster. So, those are some of the things that we're looking at and those are the things that impact us from climate change. We know for a fact and we don't know to what extent, climate change really changes the biodiversity. I personally think that more research needs to go into the area of how climate change truly [inaudible] our ecosystems, and how would the influences change in disease patterns and change [inaudible] here, and adaptation, and impacting diseases because the more we understand those things, the better we can prepare ourselves, become more resilient to the impact of climate change. [inaudible] Dr. Ewing, you have also been a a political leader of a nation and as as you know in the US and some other countries there's controversy about climate change and the causes. Is there broad political acceptance and public acceptance for the need to adapt to climate change in Turks and Caicos? Oh, definitely. Climate change is real, it's not a hoax. From statistic generally that the planet every [inaudible] has risen about two degrees Fahrenheit since the late 19th century. [inaudible] our oceans absorbing most of these heat that is being generated causing the increase of certain temperature, more intense hurricane, the melting of the polar ice caps, the sea water the level rise and in the issue of [inaudible] and not only up having heavier reading and summary [inaudible] and others with the erratic nature, the unpredictability of the weather [inaudible] that influence and negatively impact our ecosystem. So yes. it is real and really [inaudible] have adopted that climate change initiative. In agenda that I attended a meeting in 2016, one in Sweden and then another meeting that was held by the European Union on climate change and we get adopted [inaudible] that we will implement certain of the [inaudible] now policies that they have and just haven't to mitigate some of the impacts of climate change. So, we are [inaudible] into it and we're only looking for more support because there are lots of things that we can do, but obviously it requires lots of commitment from both the local government as well as us being a sovereign nation and also financial commitments for certain things that have to put in place. So that is something that I think everyone is convinced now that it is real and it is accounting for most of the impacts of hurricanes definitely that we have in here [inaudible] and more intense and more frequent. So, something needs to be done. Doc, we are running short of time now so I would like to wrap up with your thoughts on advice, Turks and Caicos, you have been there on the front lines of climate change. Really, island communities are perhaps the most vulnerable in the world to climate change. But from the lessons learned not just from the extreme events but the importance of preparation and being prepared, what advice do you have for our public health practitioners around the world as they come to grips with the changes in the world? Well, my analysis quickly because my journey into- into politics was not because we have this thing about having putting in place policies to change things and when we're looking at policies we always have certain assumptions. Whether or not there is political will, whether or not there is financial resources available, etc. We as public health practitioners cannot isolate ourselves from the politics of change, with special policies. So, we have to [inaudible] ourselves in position where we are public health practitioners need to make and provide evidence and evidence-based recommendations as it links to policy and to continue with lobbying the policy directories to implement those changes. So, we have a greater [inaudible] we just cannot just sit back and say that this is public health and this is politics. They're one and the same [inaudible] is one of the greatest determinants [inaudible] of health because if you fail to plan and implement policies that [inaudible] really good health then we would have fit in general. So we could really be more a servant as public health practitioner. Yes, we need to look at in getting the evidence. So, research is an important tool in getting all of the evidence that we then have to put together and make some recommendations, evidence-based recommendations for changes to make ourselves more resilient kind of change. But also be able to help to reverse climate change as well. I think that is the reason why the World Health Organization under the new leadership now has put climate change on of the top of his agenda, combined within the records, it was at the top of his agenda. To help drive it from the health perspective instead of only driving it from the political perspective, because it's not just economic it is health also and strongly health related. So yes, I would encourage my colleagues in public health to continue on that path and be more focused, and be more vocal and more [inaudible] in championing climate change in general. Dr. Ewing, a former student, former Premier. I can't tell you about that we are of you in the Johns Hopkins community. Thank you of your words of wisdom, your experience. Thank you for sharing with our course your tough lessons learned. Thank you again, Rufus. I am so proud of you as a leader. I'm very glad that you could be part of this course and help us reach out to the world of public health practitioners, to emphasize the public health importance of climate health adaptation. Thank you again.
