Transcript

Derek Smith:

Hello, and welcome to Baylor Connections, a conversation series with the people shaping our future. Each week, we go in-depth with Baylor leaders, professors, and more, discussing important topics in higher education, research, and student life. Happy New Year. I'm Derek Smith, and our guest on Baylor Connections today is Emily Smith. Dr. Emily Smith serves as assistant professor of epidemiology in Baylor's Department of Public Health, an expert in global health, and an advocate for coverage for child surgical care globally. Her research informs the United Nations efforts to bridge the gap between need and access to surgical care for families around the world. Closer to home, she's known on social media as Your Friendly Neighbor Epidemiologist, where she shares information about public health, and specifically COVID-19 over the past year, in a format that makes data both accessible and actionable. It's been a very busy year and, Emily Smith, we appreciate you so much coming on the program today. Thanks so much for joining us on Baylor Connections.

Emily Smith:

You're welcome. Happy New Year, thanks for having me.

Derek Smith:

Well, it's great to have you here. I know a lot of people have a probably followed your page at some point, or seen one of your posts on social media. In fact, I actually saw one of your posts shared by someone outside of the Baylor family before I realized it was you, so it just shows the power of social media and how doing something like this can spread. But when did you start Your Friendly Neighbor Epidemiologist page on Facebook, and could you have imagined what role it's turned out to play over the last several months?

Emily Smith:

The quick answer to that is no. I started it in March at the very beginning of this, because at that time we had heard chatter of a pandemic and should we be scared of it or should we not, and that's what epidemiologists do, they look at diseases and the spread. I'm not an infectious disease epidemiologist, but I knew enough of the lingo to help tell people, "Yeah, we should pay attention to this one." Then we started hearing flatten the curve and R0s and all that epidemiology jargon, and what did that actually mean? I started it to be friendly to my neighbors, hence the name Friendly Neighbor Epidemiologist, and just to get the information out of what does it mean to flatten the curve and how to explain that to our children, not thinking that it would last this long, thinking it would be followed by my mom and her friends and a couple of my friends that I could rope into it, but I could have never imagined it had the reach and resonance that it does today. I'm grateful for that. I mean, people want real information in a social media world where there's just a lot of info out there, a lot of bad and some good, so trying to be helpful.

Derek Smith:

Well, how many followers are you at now, since March of last year?

Emily Smith:

Now, I'm at 55,000 followers with about three to four million per month. My husband and I were laughing at that, because I remember when early in April and May, when it would get shared by 10 people and I knew them all, and I thought that was helpful, but it has resonated with people to be very strong at this point. I'm grateful for that. I mean, I know people want real information that is not politicized or an agenda, and hopefully they're finding that on my site.

Derek Smith:

Well, we've seen many of those posts, going viral has taken on a different meaning here for most everyone in recent months in particular, but many have gone viral on social media. Are there questions or topics that have generated the most interest? What stood out to you about what has really resonated with readers?

Emily Smith:

There were things that surprised me in 2020 and now in 2021, a few days in. I think what surprised me at the beginning, well, really throughout 2021, is COVID, we all know, exposed a lot of underlying problems or inequities that have been around for a while, but some of us probably have not seen it as much. We know that the pandemic disproportionately affects communities of color, much higher rates than our white brothers and sisters. We also know that those living in poverty are disproportionately affected, especially for essential workers who have to make a decision between food and healthcare. That matters with COVID because you need to get to care quickly to stop it in its progression. Where does faith come in, in all of this and what surprised me, and we all saw this happening, we saw in 2020 when the pandemic became politicized, so did wearing a mask and now we see it a little bit with vaccines, but faith became entangled in this messy way that I'm sure lots of people are going to write their dissertations about that in the years to come. But over time, this issue of faith over fear became almost a mantra to not wear a mask or to not stay at home and go to an unmasked church service or defy even stay-at-home statewide orders. As an epidemiologist, it really made no sense when you look at the data. Many of us were trying to remind our Christian friends that loving our neighbor means wearing a mask and distancing and staying at home, but what surprised were the comments that started coming in. We started seeing that really more around August, is when it started ramping up. I started receiving some threats and harassment, and frankly, some really awful messages or comments, but then I started receiving racist comments that were blaming the pandemic on riots and Black funerals and Black Lives Matter rallies, but we actually had data showing that was not the case. In fact, it was for other big events happening at the time, but not those. The worrisome part for me were all of the threats or those comments were from Christians, some I know and some I don't. But the point isn't about me, the surprising part is how intertwined faith and masks and freedom and race, poverty, became in this really messy way. That surprised me in 2020. What is surprising me now is more people are asking questions, more Christians are asking questions of, "This is not what we want to do anymore." There's almost a lament of, "I want to be a witness to the world. I don't think we did a very good job doing that in 2020. What is the next step of loving our neighbors?" Some of that's going to take some courage. It's a new normal, to me, it's like Jesus talking about the new wine skin, but it's a new way of moving forward that understands everything I just talked about in 2020 and comes to terms with that and then chooses a different path. That's my hope in 2020 is that we, as the Church, would be uncomfortable with what we saw in many parts of the nation in 2020 and move into a different direction, according to the cross, to redefine our freedom according to the cross. Those are very pendulum swings for me. 2020, one surprise was pretty negative, and then 2021, I'm seeing more and more Christians say, "I want a new way, and I want to do it differently."

Derek Smith:

Visiting with Dr. Emily Smith. Dr. Smith, well certainly, our prayers for you and your family are that the kinder of voices on there went out more in every way of what you've just described. You mentioned the emotion that some people feel behind it and you talked earlier about getting out information that isn't agenda-driven, that's helpful. For you, as an epidemiologist, we know that there's so much misinformation out there or rumor or more people might see something even from something that looks official and have it be wrong, have there been interactions on the website or on Facebook that have been meaningful to you in helping people maybe debunk a theory that's wrong or just better understand what's really truthful and what actions are really helpful?

Emily Smith:

Yeah. I think it's helping people take a little bit of a breath of what is real and what is not. I read a statistic months ago that fake information transmits quicker, about six to 10 times quicker, than real information. In social media, that is so true. Some things can look legit and they're not. I think just being a platform where people can come and take a little bit of time to actually talk through what the chatter that they might be hearing or seeing is helpful, but if anything, it would just be requiring patience and a little bit of time to think through the larger picture of maybe what people are seeing on social media or even hearing.

Derek Smith:

Visiting with Dr. Emily Smith here on Baylor Connections. Zoom out here a little bit. We've talked about your Facebook role as Your Friendly Neighbor Epidemiologist. Obviously, a lot of people know you through Baylor, but many might not know about your broader work at Baylor and globally with a number of organizations in advocating for surgical care for children. We highlighted that briefly at the top of the show, but I'd like to switch gears and talk to you about that because I know that's a real passion for you. Could you describe better than I just did what your interests are in these areas and how you got involved in this area of research?

Emily Smith:

Yeah, for sure. They segue pretty nicely, and hopefully I can tell why that story matters in a minute. But pre-pandemic, I'm a global health epidemiologist and so I'm interested in children who need surgical care in some of the poorest countries of the world. The main country I work in is Somaliland. It's the fourth poorest country of the world in the Horn of Africa. I've been there for about five years now with a fantastic team of surgeons and midwives and nurses that are working to try to better their country. What's interesting about surgical care too, for kids, is it's almost a bellwether. If we can increase surgical care for kids, then you can increase trickle down effects to maternal health, prevention networks in terms of nutrition. It's a bellwether metric for the rest of the healthcare system. My work is to try to, from an epidemiologic standpoint, to figure out how many kids in these low-income countries actually need surgical care and how many of those got care, and then to fill in the gaps of since we have that large gap, what's preventing them from getting that care? To give you the example of Somaliland, it looked like from our data there were about 250,000 children who needed surgical care. That ranges from breaking your arm all the way to a congenital head surgery, a brain surgery, that's pretty invasive. Of those, in a one-year time period, there were about 1,200 children who actually got surgical care. That gap is large, but it's not as simple as just hiring more doctors and building more hospitals. What we identified is the main barriers for these families are one of geography, it's too far away to get care, and then one of poverty, so having to make these decisions between getting surgical care for your kid or feeding the rest of your family. Those issues around health systems and poverty and inequity, that's where it segues really interesting into COVID, with what I'm doing with Friendly Neighbor, because I've been very vocal about COVID in the US is affecting racial minorities, poverty, it's hitting our essential workers much harder. COVID is highlighting what we see in low-income countries, the inequities that have always been here but are really bringing it to the surface. The love your neighbor aspect on a global health, what I was doing pre-pandemic for Somaliland, is definitely taken effect here in the US as well, love our neighbors that live marginalized and poor in the US.

Derek Smith:

This is Baylor Connections. We are visiting with Dr. Emily Smith, assistant professor of epidemiology in Baylor's Department of Public Health and Your Friendly Neighbor Epidemiologist on Facebook. Dr. Smith, you mentioned that you've presented to the UN. Let's set that up a little bit more. I know you're a member of the Global Initiative for Children's Surgery, it's a relationship that began when you were at Duke and has continued now that you are at Baylor. Could you tell us more about that global initiative and how you ended up getting to present to the UN and what that relationship looks like?

Emily Smith:

Sure. The Global Initiative for Children's Surgery is 200-plus countries strong of providers that are on the ground. These are anesthesiologists and surgeons and nurses. What is really unique about this global initiative, it is at least 75% represented by the countries themselves, so a lot of ownership, local ownership, from these low and middle-income countries. Most of them are the medical providers and so I get to help out with the fun epidemiology research side of it. I consider that as being more of a support, for sure, of I'm the learner and they are the teacher and how can I come alongside them and answer the questions that they would like answered. Many of them are working with these issues of poverty as well, because the geography and poverty related to children not being able to get surgical care is pervasive regardless of what country you go into. I was very fortunate to just be able to go to the United Nations with the statement from them of when we talk about universal health coverage, we have to include children who need surgery. That was a profoundly humbling experience to be able to go to such a large platform that you see on movies or you see pictures of and to really talk about children and why, even though they might not have as big of a voice as adults, they're very vulnerable in terms of health.

Derek Smith:

As you present to the UN and as you think about proposals to make, what are maybe some of the biggest questions that need answered? Obviously, some in terms of it serving the children around the world, but maybe even in terms of obstacles that you sort of have to think about, well, how do we bridge this gap logistically?

Emily Smith:

Yes, and that's such a great question. I think is to get everybody at the table. When we talk about improving surgical care, it is about hospitals, but it's also about human resources. It's about getting the Department of Labor there for building road infrastructures, what about ambulances that need to get quickly to those communities? It's also about local ownership. We need the people from a grassroots campaign that are champions within their own community to advocate of what works. We see that not happening sometimes in global health, where there's a colonial view of doing global health, of us going in to communities and already defining the solution. The script really needs to be flipped, where the people that are the local champions, which are sometimes the grandmothers that have the best beat of the community, come to the table and help us work out policy issues of what do you think we need to do to actually get the care for the children. I'm a peacemaker at heart, I love diplomacy, and I would like to see more of that happening, of top-down plus bottom-up approaches in terms of global health.

Derek Smith:

When you think about presenting to the UN General Assembly, what are some of the proposals that you made and what are some of the next steps now that those have been made?

Emily Smith:

Yes, there's a push for universal health coverage. I know sometimes that gets some bad rep that it's a certain type of ideology, but it's just providing health coverage for all, for all people, especially those at the bottom margins. At the UN, our push for children's surgical care to be included in universal health coverage was part of a bigger package that went to the larger General Assembly. I hope that there is more and more momentum, especially right now with the pandemic, for universal health coverage and what that means. Really, it's a global expansion of loving your neighbor. Especially in post-pandemic era, the hardest hit countries and the hardest hit people are those who have been on the margins, so I think the time for universal health coverage, there's not been a better time to really think through that and roll that out more. I hope that we hear more and more of that from global leaders.

Derek Smith:

As you think about surgical care being a part of that, are there any potential obstacles to that or any just areas that you think about here's how we need to bridge the gap in terms of getting this as a part of that broader agenda?

Emily Smith:

Yes, I think the biggest obstacle from the agenda standpoint is convincing people that when we talk about surgery we don't necessarily mean expensive. I think that is a common misconception, that surgery has to be expensive. In the US, it certainly is, but it doesn't have to be. Especially when we talk about some of these low-cost, high-value surgical procedures for children, those aren't as expensive as one might think. Also, investing in surgical care for children, when you look at the bang for your buck, you get a whole lot more bang in terms of economic development, but also just on an individual effect for children. That will be the next hurdle, is convincing people that the cost effectiveness of surgical care for children is right in line with some other public health interventions, like immunizations or bed nets for malaria.

Derek Smith:

We are visiting with Dr. Emily Smith here on Baylor Connections. Dr. Smith, as we head into the final moments on the program here, I wanted to tie it all together and just ask what's next for you as we head into a 2021, the meat of 2021 here. What's on your plate that maybe you're excited about in relation to your research or in terms of just serving the public the way you do on Facebook or otherwise?

Emily Smith:

Yes. Well, in terms of Facebook, I'm so hopeful for 2021 because of the vaccines coming out. Hopefully the site can just continue to shepherd people through some of the nuances of getting us out of this pandemic. Then there is going to be a rebuilding recovery period from the faith community standpoint of asking questions that have bubbled up because of the pandemic. I hope to do that on the site more. From a professional standpoint, I definitely would like to bridge out into these poverty aspects of now that we've defined the problem of surgical care for children, then how do we actually meet that in a way that matters on the ground to the families, but also informs policy. I'm hopeful to bridge that a little bit more this next year.

Derek Smith:

Well, that's great. I know you've been very busy and there's still more to come, and we appreciate you taking the time in the midst of that to share with us on Baylor Connections. Happy New Year to you and your family, and thank you so much.

Emily Smith:

You as well, thank you.

Derek Smith:

Thank you. Dr. Emily Smith, assistant professor of epidemiology in Baylor's Department of Public Health, our guest today here on Baylor Connections. I'm Derek Smith. A reminder, you can hear this and other Baylor Connections programs online at baylor.edu/connections, and you can subscribe and leave reviews on iTunes. We hope you'll do that and joining us next week. Thanks for joining us here on Baylor Connections.