Rural communities and the challenge of thinking about COVID-19

Rural communities and the challenge of thinking about COVID-19

René Mendoza Vidaurre[1]

 

Health comes first

-How are you doing, Pipita?

-Owing money, without beans, grey hair, and …

-If you have your health, the rest doesn´t matter

-Ahh! Yes, exactly! But coronavirus scares me …

-Who isn´t afraid? Fear is the biggest enemy of reason. Think, Pipita, your love for others is stronger than anything…Besides, the rain is coming now!

The entire world is experiencing difficult days. People feel fear, impotence, the desire to cry. The only thing certain is uncertainty. Every person would like to support themselves with something, protect themselves under the shade of a tree. But there are almost no natural, supernatural nor social “trees” anymore. It is when that Nicaraguan phrase becomes even truer, “if you have your health, the rest doesn´t matter.” And health is like the rain, it does not fall from the sky with some prayers, it is something that is provided and strengthened with human actions. And who provides it? And how is it provided? Maybe “the love” that one feels for others provides it, maybe the love with which we were made in a passionate morning helps provide it. Maybe it is time to look farther ahead, because “the rain is coming now.”

In this article we reflect on this rural world, that thin strand between hygiene and the economy, between home, church, health center, and between individual and collective actions. To do this we list the facts or risks, we start to explain this “strand”, we look at how scientific recommendations help these different cultures revive – like plants which dry up become green again when the clouds release the first drops of water, and we point out the role of accompanying organizations. The importance of grassroots organizations in protecting their communities runs throughout the article, while the notion of community matures with the turning of each page.

1.    Conditions that work for and against COVID-19

The situation with COVID-19 seems to be getting worse. The gap between the official information in any country and what is in the social networks is large, with which anxiety buzzes like a mosquito at night. In rural communities this concern is connected to the continuity of classes in school, religious celebrations in churches, and festive crowds, with or without quarantine. People think that through that “door” of the school, church or public transportation, the virus can get into their homes and pass through the community. What are the rural conditions that work for or against COVID-19?

Rural families have some advantages and some disadvantages in the face of the virus. The advantages are: the physical distance between people to avoid COVID-19 is facilitated by the low population density, and because a good number of families live on their own farms; the average age of the population is relatively young, which limits the effect of COVID-19, even though this advantage is evaporating because of poverty[2]; living in areas with little air pollution[3]; communities that have grassroots organizations with members and offices in the community itself, through which they access some information and some collective actions. The disadvantages are: if people are infected, it will be difficult for them to go to the health centers with the first symptoms[4] and it will be difficult for them to stay at home, or prevent visits when rumors buzz along the footpaths of neighboring houses, all of which have the potential to infect more people; the quality of the health centers, in any country in Latin America, is less in the rural municipal capitals  and is inexistent in rural communities.

Gatherings of people in schools and churches is the greatest risk; let us remember that in a church in Washington one member infected from between 52 to 60 members of the choir, 65 were infected in a Zumba class in South Korea, 80 people in a concert. Rural gatherings tend to happen in groups separated by the lack of connection between organizations. Cooperatives, schools, churches and party or governmental organizations (e.g. councils, mayor representatives) move in a “walled off” manner; each person in their own world, and under their own leadership. Churches move in their religious world and with their own leadership structure. Schools with their educational programs and with their own institutional leadership. Cooperatives focus on the economy with their own leadership structure. And so on. This separation means that the gatherings move separately, isolated, which is why people tend to behave in an opportunistic way: “let others spend on hygiene to prevent COVID-19”, “I don´t care, I don´t have children in school”, “I am going to church because God is protecting me, what better doctor than God?”

This separation is worse with external institutions. Markets are reduced to offering hygiene products, raising their prices because of increasing demand, and move by means of intermediation; States limit themselves to making an effort in health centers; aid organizations provide resources within the circles in which they move; and second tier organizations and NGOs expect to mediate resources[5]. None of them tend to cross over “to the other side of the river”, in the sense of understanding how rural societies move, lack experience working at the community level with grassroots organizations. This limits our ability to understand rural population from their own perspectives, and limits the communities from understanding external organizations. We live in a world of one-eyed people that is attractive for any virus.

This separation or “fortress-effect” feeds the prevalence of beliefs. It is a universal truth that when there is less information and less articulate comprehension about certain habits, beliefs prevail. What beliefs? In peasant families: “If I believe in God, nothing is going to happen to me”, “lightening is not what kills you, it is just your time has come”; “long suffering people will resist any virus”; “I am not washing my hands because my hands are hot because of work”, “chloroquine and azithromycin get rid of the virus” (self-prescribing without evidence that it cures and without investigating its damaging effect on the heart; and according to the WHO seem to increase the risks and consequences of the disease). Beliefs in external institutions: “information confuses people”; “money makes the monkey dance”; “if the economy improves, all improves”; “give them alcohol and with that COVID-19 will not affect them”; “boil eucalyptus and cypress leaves”; “read the bible where it announces the end of the world”, “everyman for himself”. Doña Coronavirus laughs and is attracted by these beliefs!

We resist learning. We read about the 15 countries of the Asia-Pacific region, China, Korea, Taiwan, Hong Kong, Australia, New Zealand, Japan and the 10 member countries of ASEAN (Association of South East Asian Nations), Brunei, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam, as the region that has best dealt with COVID-19, a region that has 2 billion people of the 7.7 billion that exist in the world. How did they do it? With good public health: they closely observe the symptoms people have, if there are symptoms, they test them, if they are positive, they isolate them in their homes or in hospitals, and they do contact tracing[6]. In other words, the more they diagnose, they more they know what to do, and thus save more lives. In contrast, national and international organizations tend not to do diagnoses to formulate and implement policies, except to appear to formally comply; our mentality of providentialism and resignation resists learning from rural populations, we do not seek to understand them, we believe that we already know them, that “the market knows more”. We are societies that seem to live like in the middle ages under the church with the inquisition, in those times “there was no reason to think, it was enough to believe”, when thinking was a sin and punished by death.

2.    Hygiene in rural societies

What is it that we need to understand? We begin with some history, to then paint something about the rural reality and show the vein that we have to continue exploring.

There are several studies on diseases and the architecture of cities and homes[7], not much on rural spaces. Public health has contributed to the fact that the population lives longer, architecture has also done that. So closets were imposed instead of armoires, because they were anti-hygienic because they accumulated dust. In the last 150 years we know of great changes in the cities of London, Barcelona or Paris; in 1866 they cleaned up most of the river Thames in London, and that clean up saved most of the people of the city from the threat of cholera; in 1844 they redesigned the city of Barcelona, knocking down walls that contributed to the overcrowding, which made lack of hygiene worse and supported epidemics; also Paris was redesigned for health purposes. Other smaller changes also had large impacts: clean water and management of sewage to prevent malaria or yellow fever; in the face of the bubonic plague, that killed 12 million people between 1855 and 1959, they rebuilt homes with more concrete and metal to keep out the rats who carried that pestilence. In other words, the design of homes and cities for health purposes lengthened the lives of people.

Now with COVID-19 architecture is challenged to redesign homes. Even though architecture has not been able to respond to respiratory illnesses, COVID-19 can cause the redesign of the home, where the idea of what is private is reconceptualized, giving way to the home as a space for school, work, reflection and gymnasium[8].

Unfortunately, there are no studies about that same relationship between architecture and health for rural areas, at least none that I am aware of. In rural areas, hygiene has been in deficit for centuries, a situation that has been made even worse by the discrimination toward the rural world. This situation of hygiene is due in part to the fact that rural families every day are grappling with land, farming, agro-chemicals, small livestock, slaughtering or the fire in the kitchen, and they do it without having protective measures like gloves, boots or masks, partly because they are living with limited water or means of catching water, on large haciendas the patrons customarily do not provide protective equipment to their workers, and partly because they do not have access to information while beliefs lead them to not protect themselves.

This daily work of women with fire, or men with the land leads them to bathe less frequently. This is not necessarily, however, a lack of hygiene; in fact, many people during the winter in Europe and the Andean altiplano do not bathe very frequently. The difference is that peasant families think that after work a person should not touch water, it is an understanding about the combination of temperatures; so it is that after making tortillas they do not wash their hands, after weeding they do not bathe “because the body is hot”. Also the lack of water and minimal infrastructure has conditioned them to carry out certain practices; women gather dirty clothes to go to the river to wash them, they spend little water to wash dishes. Likewise, little access to information has an impact on daily life, for example, dishes are not washed with Clorox that could contain the salmonella bacteria, which tends to be found in food contaminated with animal feces. We mention these points to illustrate how difficult it could be the fact that, now with COVID-19, they have to wash their hands frequently and with soap, when customs and their natural (water) and economic conditions weigh in.

Most rural homes, particularly those of low-income people, have dirt floors and are closed structures with little ventilation. For example, it is known that Chagas disease, that “forgotten illness” because the pharmaceutical industries do not see it as profitable, mostly happens in homes with grass roofs and cracks in the clay walls where the insects that cause this disease tend to live[9]. Peasant homes are a prolongation of the farm, or the reverse, for example corn is stored inside the home or above the hearth, while the cats deal with stalking the rats who are after the corn…

These rural practices became customs, and those customs, laws, which tend not to be seen by  the eyes of State institutions, markets and international aid agencies. External actors, instead, tend to see agriculture or ecology as separate from hygiene in the home and family, and the economy as separate from health, education and religion. External actors, when they touch on the issue of hygiene, do so viewing the rural reality from the urban experience, and so any weed seems dirty to them, any home for them should be in towns or villages, any farm should be mono-cropped, and any insect should be fought with agro-chemicals. From the urban perspective it is hard to understand that a home on a farm probably is healthier than a city with an over-populated cattle industry, or chicken or turkey industry, which are true virus factories.

We need to scrutinize the relationship between hygiene and agriculture, home and farm and school and church to understand the culture of hygiene in rural populations, to then look at improvements and changes to be made. Without understanding, one cannot see, Rodrigo López told us, a peasant from Waslala. How true that is! Otherwise, how can we imagine that just using chlorox and alcohol is going to prevent COVID-19? Without understanding, how they can reflect on and change their habits coming from their own cultures and farming systems, any chlorox or alcohol that they are given runs the risk of ending up in the municipal markets, as has happened with the donation of tin roofing sheets, pure bred hogs, coffee roasters or grain silos. The community, that heterogeneous amalgam of disputed realities, is like a book, inside of which dance letters, pages and imagination, opened up only by the reading of those who love it, a reading which is like a person who shells a corncob sensing a hot tortilla with “”cuajada.

Our challenge is to rethink community spaces from a perspective in which health and economics are embedded in each other. Homes on farms with materials that protect them from rats and the insects that carry Chagas disease, and at the same time are ventilated spaces, and agro-forestry farms, in communities with spaces for food, reflection, social interaction, entertainment, open field school and collective actions. Communities with fresh air, revived, which end up being the “tree” to protect oneself from the virus. This is the vein to dig into.

3.    It is the moment for organized rural societies

While we study, let us not lose the pulse on COVID-19. What should we do? If classes and/or religious celebrations continue, and if markets and States do not show they are effective, grassroots organizations (cooperatives, associations, parent-teacher committees, water committees…), located in the communities, must act to protect their communities. The effectiveness of these organized rural societies can be better if supported by organized global societies (international aid organizations).

How? These grassroots organizations must turn themselves into entities that inform, connect with schools and churches to accompany them to understand the problem and their prevention practices in the face of COVID-19, and look up while they deepen their roots.

3.1  Informing yourself and analyzing the information

 

Box 1. Symptoms for diagnosis

Dry cough + sneezing = air pollution

Cough + mucus + sneezing + nasal secretions = common cold

Cough + mucus + sneezing + nasal secretions + body aches + weakness + mild fever = flu

Dry cough + sneezing + body aches + weakness + high fever + difficulty breathing = coronavirus

Source: Pathology Department, UCH London

In the first box are the elements to tell whether a person has coronavirus, flu, a cold or just air pollution. The scientific community reveals that a person with COVID-19 can show mild symptoms, and days later have other more serious symptoms. In other words, a person could have a cough and sneezing, and not have a high fever, which does not mean that they do not have COVID-19, in the days following the other symptoms may appear. Box 1 is a simple aid to differentiate, it does not assure you that you do not have COVID-19 with the first symptoms, but at the same time helps you to not get alarmed with the first symptoms, helps you to stay calm and discern; this is a big help in rural areas where it is difficult to go to a hospital.

COVID-19 is not just a new virus, but the scientific community still does not know much about it. Current evidence reveals that a little more than 40% of people with the virus were infected by people who did not have symptoms of COVID-19. This obviously makes prevention difficult, at the same time, knowing this helps us to get a grip on the problem and respond in the best way possible[10].

 

Box 2. Recommendations

1.     Do not touch your face–because the virus enters through the mouth, nose and eyes

2.     Wash your hands with soap – the virus is dissolved with 20 seconds of hand washing.

3.     Maintain physical distancing (1.5 mts) from another person; avoid groups of people

4.     If you do not feel well, stay home. The family can help you determine whether it is coronavirus (see box 1)

5.     Avoid meetings in closed spaces without ventilation

6.     Above all, think, think, and think–it is the most vital thing that we should practice.

Box 2 has information also based on studies. Grassroots organizations can disseminate it in their communities, but first they should read and analyze it: why shouldn´t you touch your face? Why should you wash your hands with soap? Why maintain a distance of 1.5 meters with other people? Why should you stay home when you have a cough, mucus and sneezing?  The more we think about it, the more we understand it, the more we are going to put it into practice and tell other people. Talking through information allows us to think about reorganizing activities, for example, the measure of maintaining a physical distance of 1.5 meters can help so that in a religious celebration, a meeting in the cooperative, or a class in the school people take their seats maintaining that distancing, so that the meetings be for shorter periods of time or with frequent recesses, or so that the meetings might be better prepared in advance so that, like chickens, you go straight to the “grain.” Information that is thought through can save lives.

Grassroots organizations also should reflect on other contributions from scientists. Let us look at 3 contributions. The first, studies show that children under the age of 12 do not get infected much, compared to adults; in the cases when they are infected, they almost never get seriously sick, nor are they great transmitters of the virus, like they were in the case of the flu, because the amount of receptors that COVID-19 needs are less in children under the age of 12, and consequently the viral charge (in other words, the amount of the virus that they can gather) is much smaller[11]. Statistics confirm this statement, minors under 12 are less than 0.2% of COVID-19 deaths.

Second, statistics how that men become more infected by COVID-19 than women, and they tend to suffer more from the virus than women who are affected. This is due to the fact that “the blood of men has higher concentrations of the converter enzyme of angiotensin II (ACE2) than the blood of women (…). This receptor is found on the surface of healthy cells, and helps coronavirus infect them” (see: https://www.iprofesional.com/actualidad/315900-coronavirus-por-que-hombres-se-contagian-mas-que-mujeres ). Active genes linked to the X chromosome provide women (XX) greater protection against coronavirus than men”. In addition, be it for the type work in which rural women are more involved, in general they have more hygienic habits than men, for example, they wash their hands more frequently, be it because they are washing dishes, clothing or for personal care. This indicate the importance of hand washing.

Third, studies also tell us that the use of masks is preventive, but they also warn us of the risk of reusing them, because they can become a means of infection, because the virus can remain for hours and even days in the masks. The masks are more for infected people, with or without symptoms, so they do not infect other people. Why the masks? Because they reduce the particles that come out of the mouth when a person breathes or talks. When should masks be used? They can use them in school during classes in closed classrooms with little ventilation, in relatively closed churches during celebrations, when it is not possible to maintain physical distancing, when the interaction lasts a certain length of time, in places with human crowding (banks, markets…). They should also be used when you travel to town, on returning home you should wash it, in this way the mask will be ready for a new outing or meeting. Countries that have overcome COVID-19 have used the masks as part of their strategies, which is why rural communities probably will have to introduce the use of masks as part of their culture of care, particularly for the moments we just pointed out.

3.2  Linking to and contacting schools and churches

It seems easy to connect to and assume that any organization or institution will be happy to be contacted. Nevertheless, churches, schools and party structures are not accustomed to coordinate with community organizations, except to “orient them” about what to do, and treat them as their dependents. Their worlds and leadership which we mentioned previously really carry weight, they are true walls to community coordination. How is a grassroots cooperative going to react if the pastor of a church tells them, “God is our doctor, we trust in God?”[12] What is it going to say and do if the principal of a school tells them, “we can only receive support if it comes through the ministry of education”? What are they doing to do if a committee of a political party, the councils or mayor deputies say that “directions and projects only come from above?”. What can you say to the parent of a family who only believes in the patron of their hacienda? How difficult it is to be community and work for the community! There, where things get complicated, money will not even make monkeys dance.

In the midst of these worlds we have learned the following steps. First, discussing the information in figures 1 and 2 really empowers people, it is in-forming, and informing is forming. Information can be an antidote to despotic religious, political and economic leaders. Second, the cooperative or association should start from what it is and has; what do they have and who are they? Each member has, at least, a family member who is a student, believer of some religion and/or is member of a political party; they should talk with them, discuss the COVID-19 situation, and the information provided here. Third, members of the organs of the cooperatives, having now conversed at the grassroots level, visit the parent/teachers committee of the school, people with positions in the churches, (e.g. deacons, delegates of the word) and party members or government authorities, reflect with them and discuss the information. Finally, the board members of cooperatives communicate with the parent/teacher committee of the school and with deacons and delegates of the word[13]. In other words, connect with the grassroots of different organizations and institutions, their intermediate leaders, to then connect with the leadership of the organizations and institutions. In these steps, it is not a matter of convincing anyone, but of listening, bringing together elements that help to understand, and once each person understands, they will be able to see and then act – it is like preparing the soil and planting a seed, then you have to let the seed germinate and struggle to grow[14].

 

Table. Cost of kit for 90 people (1 month; in US dollars)

Products Quantity Price Total cost
Chlorox (cleaning equipment) (liters) 4 2.94 11.76
Hand towel (units) 6 2.35 14.1
Bar of soap (units) 90 0.51 45.9
Gel-Alcohol (liters) 2 5.15 10.3
Re-usable masks (units) 180 0.74 133.2
Instruction sheets 90 0.09 7.94
Total 223.20

With these steps, each organization can supply  itself with a kit of hygiene products to prevent COVID-19 (see table). Cooperatives have a social fund that they can use to acquire the kit, unless they have used it for other social agendas that they tend to have. Schools can, through the parent/teachers committees, gather resources to acquire the kit. If the cooperatives, with or without international support, can gather resources to support the schools and churches, it could make a difference, strengthening the bonds in the community, and the entire community would benefit. The more bonds there are, the more autonomous the community will be.

3.3  Looking forward

 

The sixth recommendation in Figure 2 is the most important reason for a grassroots organization rooted in the community to exist: think, think and think. Thinking is the most important element to resisting COVID-19. Thinking is looking forward and seeing beyond our noses. A cooperative is not a church nor a political party, its members are there voluntarily, they are not subordinated to anyone, they discuss and reach agreements in their assemblies, which is why they must examine their beliefs and fight with and against them. Individually they can believe or not in God, but they should not expect God to send them angels or saints to wash their hands for them, or put their masks on, just as they would not expect that he plant beans for them or remove botflies from their cattle; they can believe in their political leaders, but it is shameful to subordinate themselves to anyone. As cooperative members they have free will, their source of power is the assembly composed of the members themselves, and their reason for being is thinking, thinking and thinking in favor of their communities.

Part of this thinking is reflecting about COVID-19: How to protect their own community? If the State does not show up in a community, the cooperative must also take on that role. If the health system capacity is overcome, grassroots organizations should discuss how to help prevent the outbreak in their communities, and how to help people who might be affected by the virus. If in any country COVID-19 is being controlled, in all countries there are waves of outbreaks of the disease, so the cooperative should keep looking for those possible outbreaks. In Central America the urban waves of COVID-19 are still ongoing, which is why the rural waves that come later, can be lethal, not just for the reasons mentioned in this article, but because we are in the midst of the rainy season, which will make it more difficult for infected people to get to a health center or any support. If a community receives external support, the cooperative must be careful that that support not be counterproductive, because there can be support that displaces grassroots organizations, and when that donation ends the community´s own autonomy and their own efforts can be left eroded.

Cooperatives need to organize how a network of women can sew masks, how to make soap with lard, how to recover old ways of making alcohol in order to use on hands, how to recover natural medicine… Cooperatives need to think about connecting hygiene, economics, social and environmental elements, thinking about the food in the community beyond COVID-19, thinking about environmental sustainability with pure air and water, thinking, thinking, thinking.

4.    Role of international organizations in living communities

Even though for multiple reasons most of the international aid organizations have withdrawn from Central America, there are still international organization that are supporting the region. There also is the fair-trade network, as well as local-global networks among national and international organizations, unions, churches, social banks and universities in the world. When there is the will, there is the way, as the saying goes. If each person feels a mission of service, we can deepen those relationships of collaboration and reactivate “dead” relationships, because “where there are ashes, there was fire.” Each person and organization can play an important role if in this COVID-19 context they realize the importance of working on the community level that is organizing: what good does it do to provide individualized credit or training, as neoliberalism does, promoting mono-cropping, environmental degradation and the erosion of communities? The current situation wakes us up: people who organize and follow rules agreed upon in their assemblies, instead of gurus or chiefs who see themselves as the law, are those who really energize their communities, sustainable farming systems and contribute to social and environmental equity. Communities save communities.

Within this framework, what role do aid organizations have? Traditional donations, involving donating and awaiting reports invented by organizations “confined” to the cities, can be counterproductive, particularly if they displace the efforts of the communities themselves, which in the long term would undermine communities. Aid organizations need to connect with counterparts[15] who really are working with grassroots organizations that meet the following criteria: they are democratic, redistribute their surplus, are transparent with their information and are rooted in their communities or specific micro-territories. This type of organization will persist in the communities, while other external organizations, or those with disperse membership, will continue treating the communities like their lovers, showing up from time to time and leaving. Forming alliances with grassroots organizations so that a donation might provide an initial push, for example, with what is indicated in the table, supporting wash basins in schools with access to water, or working on agro-forestry systems that would protect water sources, where grassroots organizations might accompany their communities, and that their national partners might accompany them in the communities themselves, being careful, but overcoming fear, is the network which need to be built now and always.[16] The dilemma is not whether to leave your urban home or a rural farm; it is how we strengthen internal community assets, how we can take advantage of this “momentum” that exists in global awareness as an effect of COVID-19 to see the importance of communities. In this way, external financing to build a community response would decisively help the community deal with the virus and its new outbreaks, and help in the long term to democratize the community itself.

5.    By way of conclusion

In this article we showed the risks of COVID-19, we have begun a reflection on the relationship between hygiene, the economy and social factors, we described the strength of communities if they build lasting connections, we have emphasized the role of grassroots organizations to reflect on their values and principles in light of what is happening in their communities, and generate ways to cooperate in the prevention of COVID-19, and to innovate in ways of accompanying their communities in the midst of the uncertainty. We showed that, through these short term measures, and starting from an analysis of the processes which we are experiencing, it is possible to look forward to the medium and long term: to improve, correct, and generate habits of hygiene connecting home, farm and nature, and home, school, health center and community building.

The impact of what we are proposing, nevertheless, will be seen above all on more structural issues. For example, an exponential increase is coming of people in extreme poverty, the goal of eliminating extreme global poverty for 2030 is going to be only left on paper. The crisis for rich families of the world is how to have less desert options in their dinner, while for our communities the crisis means that they might miss a meal or face empty plates, becoming vulnerable again to any disease. This article and the previous one on basic grains aim at preventing those impacts.

The current situation also provides us with opportunities, because “behind every adversity there is an opportunity”. What opportunity? Mitigation of climate change which, in the case of rural communities, means water, land with life, biodiversity; it is the moment to rethink farming systems and intensify more sustainable forms and farming systems that stop the loss of nutrients in food because of the decreasing quality of the soil. It is the time for communities, never before has the importance been so clear of investing in communities who organize and embrace a culture of care; now is the hour for life, amen.

To look at these structural issues we must understand that it is not the economy that solves health care, it is not a matter of knowing whether the chicken or the egg is first, now the economy is public health and community health; and health, the economy, social and environmental reality are like a mountain slope, if you are on the higher part it looks different than seeing it from below, if you are on the very top, it looks different from one side than from the other, but it is the same slope, the same mountain slope.

 

“Think, Pipita, your love for others is stronger than anything else…Besides, the rain is coming!”

 

[1] The author has a PhD in development studies, is a collaborator of the Winds of Peace Foundation (http://peacewinds.org/research/), associate researcher of the IOB-Antwerp University (Belgium) and member of the Coserpross cooperative (http://coserpross.org/es/home/). rmvidaurre@gmail.com We are grateful to J. Bastiaensen and M. Lester for their suggestions to the draft of this article.

[2] T. McCoy and H. Traiano, in The Washinton Post, write that in developing countries the advantage of being young is being annulled: in Brazil 15% of those deceased because of COVID-19 are under 50 years of age, which is 10 times more than in Spain or Italy. In Mexico it is 24%, India 50% are under 60. Why? Probably: many people have to continue working to survive; in addition to dealing with the diseases of the region (malaria, dengue, tuberculosis) they also are dealing with diseases of the wealthy countries: diabetes, obesity, hypertension…See: https://www.washingtonpost.com/es/tablet/2020/05/24/en-los-paises-en-vias-de-desarrollo-el-coronavirus-esta-matando-muchos-mas-jovenes/?fbclid=IwAR3ShYUOPzWytA6i7e7HJC3jfKlVtrgSHPyunHnxYYyU7fup1Lvt2Mq7SsQ

[3] It is likely that air pollution facilitates the virus and makes its impact worse, which in part would explain why countries in Europe have had high mortality, measured by the indicator of “over-deaths” or “over-mortality” (number of deaths above the average deaths from previous years) as an effect of COVID-19.

[4] Many people even with clear signs of having been infected, decide not to go to the health centers or hospitals. Why? “They say the hospitals have no room”, “I don´t want to die intubated”, “I want my family to wake me” and “we want to now where he is going to be buried to be able to go to pray for him”. The express burials frighten the population.

[5] Interesting exceptions tend to be organizations like Aldea Global (https://aglobal.org.ni/) or Addac (http://www.addac.org.ni/) in Nicaragua, whose staff tend to be located in the rural municipalities themselves.

[6] See interview of Jeffrey Sachs, by G. Lissardy, en: BBC News Mundo, Nueva York, 15 mayo 2020. Ver: https://www.bbc.com/mundo/noticias-internacional-52672591?fbclid=IwAR0ztSK3QLNSkZjj_2rq5Tco9-_vCXphrgRrWSEnveQQYZIYG9-fPsJhdH0

[7] L. Engelmann, J. Henderson and Ch. Lynteris (eds), 2018, Plague and the City. Londron: Routledge. They study the relationship between plagues and measures to fight plagues and cities from the middle ages up to the modern era; they also include cities like Buenos Aires.

[8] D. Ventura, May 10, 2020, “Coronavirus: how pandemic changed architecture and what will change in our cities after covid-19” in: BBC News Mundo. See: https://www.bbc.com/mundo/noticias-52314537?fbclid=IwAR3LCBRj1yh_wEVsG_oMr-HdlD9C2f8AtR_hgG3dCpQkJaPMT_SrbNq3yuA

[9] Inspired in these realities and by actions of Dr. Mazza and his team, in 1995 they filmed the movie Casas de Fuego. See: https://www.youtube.com/watch?v=A6yWNBytu3U The movie illustrates the relationship between disease-insects, homes (shacks) and social inequality, the wealthy class is against homes being rebuilt, because “they are not concerned” about the millions of poor people.

[10] To help with reading about this point, see: https://espanol.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

[11] We are not saying that they do not get infected nor that they do not transmit. We are saying that they do not get infected MUCH and therefore, even though they can be infected, they are not big transmitters – in comparison with other ages. About those studies, see: https://www.vox.com/2020/5/2/21241636/coronavirus-children-kids-spread-transmit-switzerland

[12]The movie Casas de Fuego (footnote No. 5) illustrates the duality science/faith and committed science/academic science. The priest is opposed to science benefitting the most impoverished and affected communities; for him “faith and science are fighting over the same people”; a Manichean dilemma that smacks of the middle ages and that did a lot of damage to humanity. Also in this movie, that captures a good part of that experience, the University blocks the mission of Dr. Mazza and his team; fortunately Dr. Mazza and his team persist, their commitment is worth more than restrictive science, a commitment that nevertheless, they paid for with their lives, caused by the Chagas disease itself.

[13] If there are other organizations in the community, like alcoholics anonymous, water or road committees, the same is done as with the schools and churches.

[14] Note that traditional organizations tend to do just the opposite: the meet first and only with the leadership of the organizations, and then send technicians to “train” (in other words, convince).

[15] If some national or international organization wants to provide support under this spirit, they can contact the Coserpross cooperative (http://coserpross.org/es/home/) in Nicaragua, the Comal Network in Honduras (http://www.redcomal.org.hn/). Coserpross and the Comal Network accompany dozens of grassroots organizations in the region, synthesize verified information to provide to the grassroots organizations, and move about in those same territories. There are also organizations like Aldea Global and ADDAC that we mentioned in footnote 5; their uniqueness is that their network is present in dozens of communities.

[16] What would happen if a bee stayed in its hive? It could live as long as the food that it stored lasted, the honey that it produced, and then? We must understand that we, flowers, bees and humans, are all one network. The bee leaves its hive and goes from flower to flower, pollinizes, does it at the risk of losing themselves and of losing their lives. So is the network. So are we accompaniers, taking on the corresponding measures (use of mask and frequent hand washing), we should not “pass by on the other side” like the priest and Levite in the parable of the Good Samaritan, we should be inspired by people like Chagas and Mazza did and their teams in Brazil and Argentine that the movie Casas de Fuego portrays.

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