#26: Long Covid's Impact on Global Health Equity, with Dr Rachel Hall-Clifford, PhD

Dr Rachel Hall-Clifford is a medical anthropologist and a global health expert who has done extensive field work to improve systemic health inequities around the world. When she developed Long Covid after an infection in 2022, those systemic failures became a personal issue.
Dr Hall-Clifford wrote a powerful article on her experience with Long Covid and the role wealthy countries play in the global treatment of this disease. In our conversation, she speaks about her personal struggles and the universal need for Long Covid treatment.

"Long Covid Feels Like a Gun to My Head"
https://www.statnews.com/2024/06/18/long-covid-infectious-disease-expert-personal-story-life-with-no-cure/

"Underbelly: Childhood Diarrhea and the Hidden Local Realities of Global Health"
https://mitpress.mit.edu/9780262547765/underbelly/

safe+natal
www.safenatal.org

Dr Hall-Clifford's TedX Talk on Co-Design in global public health: https://www.youtube.com/watch?v=rvRAdsQ1_hA

Rachel Hall-Clifford (PhD, MPH, MSc) is Associate Professor in the Center for the Study of Human Health and the Department of Sociology at Emory University. She is a medical anthropologist who applies social science approaches to global health research and implementation. Her research areas include accessible health care for marginalized populations, health systems strengthening in post-genocide contexts, and global health fieldwork ethics. She is author of the new book, Underbelly, focusing on the multivalent power asymmetries in global health.  Rachel is also Co-Founder of safe+natal, a perinatal monitoring and care toolkit developed with Guatemalan midwives. Global health was brought home in a new way for Rachel since the covid infection that led to long covid in 2022. 

Transcript

Zeest Khan (00:00)
Hi, I'm Dr. Zeest Khan, the Long COVID MD. I'm a physician with long COVID and I've applied all of my medical expertise to my recovery. Luckily, it's working and I want to share what I've learned with you. On this podcast, I help you understand your body and understand the healthcare system so you can move your own health forward.

We've got a lot to talk about, but remember, nothing I say here replaces personalized medical advice from your healthcare team. Let's get started.

Zeest Khan (00:37)
I am sad almost every day that I have long COVID, but sometimes I feel pretty lucky that it's allowed me to meet some really, really cool people. Today is one of those instances.

Dr. Rachel Hall Clifford is a medical anthropologist based at Emory University in Atlanta here in the United States. She recently wrote an article

detailing her experience with long COVID and her perspective on long COVID globally based on her background as a global health specialist.

After I read her piece, I immediately did several things. One, I sent it to my husband and friends. Two, I looked up her bio. And three, I tried to find her email address because I wanted to talk to her more about it.

Before I had a chance to reach out to her,

I got a message from her because she was interested in my work too. So as far as I'm concerned, this conversation was meant to be.

Let me tell you a little bit more about Dr. Hall -Clifford and how remarkable she is

so you can admire her as much as I do. Dr. Rachel Hall -Clifford is an associate professor in the Center for the Study of Human Health and the Department of Sociology at Emory University.

she is a medical anthropologist who has done extensive global health research.

She's also the co -founder of SafeNatal, a perinatal monitoring and care toolkit she helped develop with Guatemalan midwives. It's an accessible piece of technology that helps improve health outcomes for Guatemalan women.

In addition to all of that, she's also the author of a new book, Underbelly, which focuses on power asymmetries in global health. Her work focused on, as she'll explain, waterborne illnesses that cause diarrhea in children, but really she's an expert in health systems.

understanding health systems, the way they help people and the way they are flawed is very applicable to the way COVID -19 has been managed by public health entities in the United States and across the world. As Rachel will explain,

The US is really the standard bearer for the way long COVID is gonna be treated across the world. And so she explains why it is so important for us to get it right here. In this conversation, we talk about her career, her experience with global health, her experience as a long COVID patient.

and what we can reflect on and learn.

about the ways long COVID is affecting people across the world.

Without further ado, here's my conversation with Dr. Rachel Hall -Clifford.

Zeest Khan (03:40)
thank you for being here. I wanted to ask you how is the anti -inflammatory diet, how did that go?

Rachel (03:49)
yes. It's not been like flipping a light switch, but I think it might be helping. I can't tell yet, but I'm surviving it, I guess is like the best thing. It felt like such a radical mind shift. Like I'd already gone from having...

you know, a full diet to have being gluten -free, dairy -free. And so, you know, was like, that's already seemed kind of mentally intense. And honestly, switching to this was like not as crazy as I thought it might be. It's just basically like meat, fish, fruits, and vegetables. And like it excludes some vegetables. So I'm like, my gosh, that's pretty restrictive, but.

Zeest Khan (04:19)
Okay.

You're surviving.

Rachel (04:32)
like we live and learn, we're surviving.

Yeah, totally. Now it's been very weird where I'm like, suddenly a sweet potato microwave seems like a convenience food that I'll like eat it, eat it for breakfast. Like that's so weird.

Zeest Khan (04:47)
Yeah, we have our customs that we like to cling to, even though I guess it's arbitrary.

Rachel (04:53)
It's like, you know, anyway.

Zeest Khan (04:57)
Well, thank you Rachel Hall -Clifford, PhD, medical anthropologist at Emory. Those are some of your titles and I would love for you to introduce yourself to us and tell us what else we should know about.

Rachel (05:13)
Wow. Well, thank you so much for having me. I'm very excited for this conversation. So I trained as a medical anthropologist. I've lived and worked for a lot of the last 20 years in rural Guatemala. And I also trained in global public health. So focused on quite a lot of infectious disease epidemiology and my training in that regard. But when the COVID -19 pandemic hit, I thought, you know, I'm not, I don't know.

this much about respiratory infection spread because most of my work has focused on childhood diarrhea disease and water quality issues. And so I was much more attuned to that kind of global health challenge. But of course, none of us could avoid needing to think about COVID -19 over the last five years now.

Zeest Khan (06:07)
What is medical anthropology?

Rachel (06:10)
So it's really applying the...

kind of principles, ideas, and theories of anthropology, which is really just the study of human behaviors and beliefs to health, well -being, and medicine. And so it fits really nicely with global health work because I do a lot of thinking about how different health interventions, different campaigns might fit within a very, very different context from which they were invented or first conceived of.

you know, it's really fun to get to do that work.

Zeest Khan (06:43)
And it sounds like that definition studying the way beliefs affect or influence health is pretty relevant to our society and global health since the start of the pandemic.

Rachel (06:59)
Absolutely. It's kind of been funny to see, you know, this binary of training that I have between anthropology and public health that my public health brain has been screaming, no, no, no, for a lot of our pandemic response. But my anthropology brain has been like, yeah, this makes sense. And this is why people are doing this. And, you know, the systems are behaving how they typically would. So, yeah, it's been an interesting

and frustrating, frankly, time, for sure.

Zeest Khan (07:33)
I bet, and with that insight, I can imagine it's been insightful and also a little frustrating to see what humans do to sort of trip themselves up. And it's really hard to intervene. So you focused, you said, on waterborne diseases, particularly in children. So tell us a little bit about your life.

You know, you're minding your own business in 2019. What was your life like? What were your career goals before the start of the pandemic?

Rachel (08:09)
Yeah, so I'm lucky to work on several global health projects. Many of them are based in Guatemala. I typically would travel quite a lot for my global health work, spending usually two to three months of the year in Guatemala doing hands -on projects, teaching students, et cetera. I have active projects in water quality as well as in

in perinatal monitoring, which is...

ensuring the health of mothers during the prenatal period through the postnatal period. And so a project that we've been working on that was developed with Guatemalan colleagues is called SafeNatal. So in 2019, we're really, you know, taking off with that. And we've actually started doing implementations of that project in other countries. And so I really anticipated that the project would continue to grow and, you know, we would

be doing it in more and more places. And then obviously we had this big disruption of the pandemic where, you know, like most folks, I was grounded for quite a long period of time. so, you know, we are very lucky in the sense that our Guatemalan partners were continuing to work and deliver health care. And so projects continued.

And I'm so grateful for that, but sort of my engagement became really different. so Zoom meetings became the norm rather than a lot of like on -site time and hands -on time.

Zeest Khan (09:50)
Yeah, just knowing the little I do about you, I'm going to be sharing links to all of your different projects and bios. This SafeNatal project sounded, it sounds remarkable. From what I understand, it's using kind of accessible technology to help improve outcomes during the perinatal period. And you

this was something that you really helped found. You were traveling quite a bit, doing sort of living with communities from what I understand to really understand their needs and finding with them solutions to their health needs. So that must have changed, like you were saying, with the pandemic.

And then you got sick.

Rachel (10:41)
That's right. So my life just really, you know, changed yet again. So obviously as the world somewhat shut down or slowed down in the initial phases of the pandemic, I was at home. I had two small kids, but I was continuing to work and really move projects forward. Did online university teaching, which was a trip, et cetera. But then in the big Omicron wave of January,

We got COVID from my kid's school and it was our first time at least knowingly having COVID. And I got sick and kind of never got better. And so the last two and a half now almost three coming up on three years have just been a really different journey for me and thinking about health. I'm very used to thinking and listening to others about health and their challenges.

in my job, but now I'm a person who really needs to think about my own health as well. And so that's been a massive shift in self -identity as well as just kind of day -to -day life and how to logistically keep things moving.

Zeest Khan (11:56)
You have long COVID after your infection in 2022. How did you come to understand your symptoms and what led to your ultimate diagnosis?

Rachel (12:10)
you

Yeah, so my acute illness was really not serious. My husband and two children also had COVID at the same time. My husband had no symptoms. We only realized because of testing. And my children both, thankfully, seemed to bounce back within one to two days of symptoms. And I would say I had maybe five days of acute symptoms that were not serious.

the sense of at no time did I think, I need to, you know, go to an urgent care or seek hospital -based care. I had fever and chills. And the interesting thing for me was that I had bone aches that really reminded me of when I had dengue fever working in rural Guatemala. There's this like very distinctive like ache in your bones. Dengue is often called bone break fever. And I was like, man, I can feel that.

It's like it's an echo in my body of that. So, you know, after those four or five days of acute symptoms, I felt better. Those symptoms passed. And so I just kind of popped right back into mom life, or at least attempted to do so, like doing all of my daily activities and work things. But I can remember going on a walk just around my neighborhood and

This was maybe a...

a couple of weeks after the acute infection. And I realized even to just go around my block, which is quite flat, I was getting like very fatigued and feeling tightness in my chest. And so, you know, I thought, OK, I'll just rest some more and try to get that to go away. And it didn't go away, especially my cardiac symptoms got worse and worse and about two

to three months after the acute infection I would say was when my cardiac symptoms felt.

the worst. I was very lucky that I went to my primary care physician and kind of described what I was happening. I put it in terms of, you know, after I had COVID, you know, these things have been happening. And he immediately was like, you have long COVID and put it in my chart. And I think that as much as he was like, I'm reading the literature right alongside you. I don't have answers.

I don't know really any more than you do as a health scientist about this either. I think that having that.

belief that something was really wrong and was really happening to me. And then having long COVID put into my medical record was huge. I see accounts of other people who struggle to be acknowledged in the long COVID community by health providers and caregivers. And I'm super grateful that that has not been the case for me. I think that I have this kind of health science privilege that I'm able to

read from my background and kind of keep up with the literature in ways that you know maybe like everyone shouldn't have to do but I think that as long COVID patients that we kind of need to. So that was really kind of what kicked off the long COVID sort of diagnostic journey for me.

Zeest Khan (15:37)
How did you approach your illness? How did you approach long COVID and trying to find solutions and treatments?

Rachel (15:47)
Yeah, so I would say at first, honestly complete panic. I was having very intense chest pain and cardiac symptoms, pretty extreme tachycardia.

and some transient kind of shooting pains, like classic symptoms that we're trained to just think of as, you know, a heart attack that you're having some, you know, some really terrible event happen. So I was able to get in to do some cardiology testing. Unfortunately, nothing structural was found wrong and I've never had like elevated troponin or anything that would indicate a heart attack.

Zeest Khan (16:07)
heart attack.

Rachel (16:29)
So I'm very grateful for that, but at the same time it's incredibly frustrating because you want answers and I think that ultimately you're looking for something that can be fixed. I remember in a very early appointment with a cardiologist, she recommended that I start drinking loads of electrolyte solution to try to help with the cardiac symptoms, which I now understand that she was thinking of it as like a dissolve.

autonomic response and I kind of I just started laughing because actually the treatment for childhood diarrheal disease that I studied in graduate school is just electrolyte solution and so I was kind of like my gosh that's all you can offer me is like it is good it is very helpful and important tool in health but I was like man that's it. So I think after that kind of initial panic and cardiac testing it probably took a

another six to nine months for me to realize this isn't something that I'm gonna just fix. That this is like a new normal for me and it's all about like optimizing how I am rather than feeling like I can just like crack the code and fix this whole thing. I find myself still reading new literature that emerges and you know.

talking with others who have long COVID and kind of getting back in that mindset of like, I can crack this code. And sometimes I visualize myself and I'm like, my gosh, I'm like that meme of the guy with like the murder board and like all of the threads that are connected and you're like figuring it out. And I think that sometimes that's, that's my mindset, but in reality, what kind of keeps me going day to day is like sort of slow and steady constellation of things.

Zeest Khan (18:05)
Hehehehehe

Rachel (18:22)
that I can do like medications, yes, supplements, yes, but also recognizing that I have to pace myself and that I can't have the packed 5 .30 a to 10 o 'clock p schedule of activities that I routinely use to cram into every single day. Like I physically am not able to do it. And that's probably been the hardest thing to recognize and to really just let go of and have to say no to opportunities and say no to

things that otherwise I would really enjoy.

Zeest Khan (18:56)
Yeah, that's something, I guess that's termed pacing and is so remarkably challenging. Would you be willing to tell us a little bit more about how you're balancing, like how are you approaching work? How are you approaching family life? How are you doing the things that you want to do in a way that is at least somewhat sustainable?

Rachel (19:23)
Yeah, and I think like so many of us who have long COVID, I have kind of peaks and valleys and there's times when I'm like, you know, better able to do more things and times when I'm struggling to get out of bed. And I think it's the unpredictability of that that's the hardest. And so...

Managing symptoms is such a kind of preoccupation of mine. I think I feel like, I'm walking on eggshells to try to maintain the level of function that I have. So I will own, first off, that I am incredibly lucky with the type of work that I do in the sense that most of my scheduling is down to me. Like, I set the schedule during a semester.

I need to show up and teach classes, but other than that, there are relatively few like fixed obligations where I physically need to be somewhere in person. There are faculty meetings and other things, but those are more periodic. And then my research collaborations, like I'm setting those up. I'm setting the schedule, obviously in collaboration with colleagues, but most of that's happening online because, you know, I'm working with people.

around the globe. And so apart from like time zone math challenges and trying to figure out times that work for everyone, that's really flexible. There are also times when I'm not feeling well but I can maybe chat with the camera off while I'm laying down or things like that.

I feel like that's made it so much more flexible. When I really have to, I can cancel meetings. I can cancel a class if I absolutely have to kind of thing. And I'm so lucky in that regard because I think all the time like, know, if I had.

a job where I needed to clock in, I couldn't do it. if like you, Dr. Aziz, if I had a surgery scheduled and I had to be there and everything was timed perfectly to fit that, I wouldn't be able to commit to that every single day. So yeah, that flexibility has really made it possible for me to continue working towards career goals and to hang on to my job. But just in balancing, you also mentioned balancing family schedules.

You know, I think that taking care of my kids is obviously my number one priority and I will sometimes, it's like squeezing a balloon of our energy and some days I have to lay down for an hour before I'm able to go pick my kids up and I kind of do that to try to revive myself after a work.

afternoon so that I then have energy to feed them, to do homework, be able to have a smile on my face to greet them and then get them off to bed before then I can rest for the next day.

And I feel like honestly, that's what I'm able to manage and that we don't have a lot of other like social engagements and fun things that absolutely we did a lot of before. You know, planning and outing with friends that's COVID safer is always fun, but we don't do those even every, you know, maybe once a month or something, we pull something together because the weekends I usually just

need to try to rest and recover from getting through the week. And so I think it does have that Groundhog Day feeling of like, you know, having to rest and just, you know, do everything we can to get through like day -to -day needs. like the extras have had to be trimmed away.

Zeest Khan (23:20)
This is an audio medium so people can't see me nodding along as you were describing the way you're trying to schedule and fit things into your life. But it resonates so much for me. It's so familiar, especially that feeling of telling myself, OK, like my kids come home around 2 30 and by 12 30, I have to my job is to recover enough energy to be available to them.

when they come home because like you said, this is a very important part of my life that I value and enjoy and I want to save my energy and use my energy there. But there's so many difficult decisions to make and like you said, the unpredictability of this disease process makes it so challenging.

Rachel (23:50)
Yes.

Zeest Khan (24:12)
And is one of the reasons I can't reliably go back to work as an anesthesiologist because I don't know how I'm gonna feel every day and there's no accommodating. There's no, you know, it has to be in person. I have to be there at the crack of dawn sometimes. So you, you you were struggling through your symptoms and...

Rachel (24:21)
Yeah.

Zeest Khan (24:35)
recently decided to share your experience so generously in written form and you wrote an article that was initially published in Stat News. Then it was picked up I think by the Boston Globe about your experience with long COVID and your frustrations with long COVID. Especially through the perspective of your work which has been on the ground in some dangerous

situations. Can you tell us about the example that you used in your article and why you decided to write a piece and share your story?

Rachel (25:13)
Yeah, so I have to credit a really incredible global health colleague, Dr. Manu Pai, who

is just a really outspoken voice for global public health. He's based in Canada and he was visiting us last academic year at Emory in Atlanta and he was like, Rachel, you've really got to tell some of this story. I'm an academic and I typically write for academic or like practitioner audiences, not for the general public, but this colleague and friend, Dr. Pai,

really does engage public audiences more. And so he gave me the nudge to do it. And so I thought, okay, yeah, this is kind of a story I want to tell. I think that, you know, we're seeing more, hopefully, I think I'm seeing more and more profiles of different people's long COVID experiences. And they're all important and unique. And I thought I'll add my voice to that. And my goal in particular was to add voice as a global

health field worker because I think that there are so many pressing global health challenges that long COVID is not being given very much room in the field. There are always urgent things that are coming along the pike and right now with Impox is a prime example of that. But I think that it's kind of easy for me to share my story

of having long COVID as a white woman who has access to resources in the United States setting. But my goal is to really reflect that long COVID is affecting our global health workforce, but also just our global population everywhere in the world. And so that's what really motivated the piece that I wrote.

And I'll just say, I also think that for long COVID, there's just like other post -viral conditions like Emmy and Lyme and others. There's this idea that like maybe it's just in the sufferer's head or that it's not real or that it's like sort of snowflakes that might be experiencing these things. And you know, I, I...

told a couple of stories or told a story in that short piece to kind of also try to highlight like it's it's happening to all kinds of people and it's very real. You know I think of myself as sort of a very hearty person before long COVID I was very healthy but also just incredibly adventurous and not afraid of the world and like not afraid of things and I think that now you know I still continue to mask.

When I'm out in public, need to to try to avoid worsening of my long COVID condition. And I think that, you know, I'm perceived as somebody who's overly concerned about my health or kind of fearful, et cetera. And so in the piece, I was telling about a situation in Guatemala where I was with a small research team. So several years ago now, and we were held at gunpoint and robbed by some

like a large Central American gang. I won't get into that. But it was incredibly frightening, of course, to have a Kalashnikov to your student's head and people in masks that weren't respiratory protection masks, but like the balaclava masks, attacking yourself and coworkers. But it's like, I think back to that sometimes as like a touchstone of being able to keep my cool and like,

Zeest Khan (28:50)
you

Mm -hmm.

Rachel (29:03)
my strength, honestly, I was able to keep everybody calm in English and Spanish. I'm like, everything's gonna be okay, todo está bien. Trying to keep the situation relaxed and giving my team clear, calm instructions on what to do to follow kind of what our robbers wanted us to do so that no one came to harm. And we were fine. We didn't even

lose a lot of material property and apart from it being very upsetting, of course, we all got out of it okay.

And so I think that that over the years of adventurous and sometimes dangerous work in global health made me a little bit cocky in some ways too of like, okay, I can kind of navigate most situations, I've got this. And I think that's like maybe a confidence that a lot of people in my field like need to have to navigate our, you know, sometimes tricky workspaces.

But long COVID came along and obviously I'm not very well able to travel nearly as much anymore. But also it made me realize I can't talk my way out of this. There's no total estabien to get out of this. I can't calm the situation. There's nothing that I can do. And I think that that sort of feeling of powerlessness and being able to address.

like my health and to kind of, you know, maintain my life, my career, my identities. It's been incredibly humbling.

Zeest Khan (30:43)
So many of us have had similar experience where we have to sort of prove that we are telling the truth, even if that conversation is to ourselves, that what we're experiencing is real. And I think what you were alluding to is also this idea of that, you ME was called a disease that only yuppies get, you know.

Rachel (31:07)
Yeah.

Zeest Khan (31:08)
people of privilege. And speaking of that term, you your life or your career has been dedicated to health equity. And as you told your story, you used words like, I'm grateful, I'm lucky.

The disease is not one of yuppies. It is one where people in positions of privilege, financial and social, are more likely to be able to utilize healthcare resources effectively. You talk about this in your piece. Can you elaborate a little bit and talk a little bit more about

Rachel (31:29)
Yeah.

Zeest Khan (31:53)
health inequities in the US and globally, maybe from your colleagues when it comes to long COVID.

Rachel (32:00)
Yeah, absolutely. I mean, there's not a doctor's visit that goes by that I don't think about this. And the fact that I have good insurance through my good job and that I'm able to kind of gain legitimacy with providers by engaging with them as colleagues because of my academic training. All of those things mean that I feel like, I am among the most privileged few.

with long COVID and I am so mindful of that. I love, love the long COVID community that shares ideas and like treatment prospects on social media and kind of other publicly available spaces because I think that it helps all of us, but it also kind of underscores like, man, what some people can access and other people like cannot. I've had some conversations with

with colleagues around the globe about COVID and long COVID. Usually these conversations are prompted by like, you know, I won't be able to make this conference or, you know, what kinds of accommodations like often starts with me kind of disclosing my own long COVID status. But as you kind of unpack, I feel like a lot of times the first response is like, there's not really long COVID here.

And we know that there's long COVID everywhere. We look at the global excess mortality data from...

this period of the COVID -19 pandemic, and it's higher everywhere. And so, you know, there's not some magical thing that is protecting populations in the global majority world, like outside of high income countries from having long COVID. It's just their health systems are not able to keep up. Like as I was saying, there are so many fires to fight and often when

that are or at least seem far more urgent for government systems to respond to. So I was speaking with a colleague who has long COVID in Guatemala and you know she kind of acknowledged me and I'm lucky to be able to go to a doctor here and she's able to you know.

access care in Guatemala and she says that her long COVID provider estimates that about 40 percent of the population that he sees that have had COVID go on to have long COVID sequelae or post -acute you know issues and so that really coheres with the data that we see in the literature about

the longevity of postacute symptoms. And so I think that it's incredibly hard to see that so many people must be suffering and with no acknowledgement of that suffering and no access to any recourse. They may not even connect what was likely a mild acute case of COVID to new hearts.

challenges to a stroke they may have had to ongoing fatigue and other issues. And I think that that's so incredibly heartbreaking. This is made, of course, more difficult by the kind of constellation of conditions that we put into the long COVID bucket. There are so many different presentations and so many different groupings of symptoms that people can have that I think it makes it.

very difficult for providers to adequately diagnose. We know that the search for biomarkers and things like that have been elusive. And within resource constrained health systems, that sort of diagnostic searching journey is really just impossible.

Zeest Khan (36:01)
Yeah, I mean, in the US is arguably a resource constrained healthcare system too, especially in certain pockets and the inequity of care is for long COVID is likely under researched and underestimated right now. Gosh, you've given me so much to think about. It's really enlightening.

what else did we not cover here that you might want to talk about Rachel?

Rachel (36:32)
Yeah, so I mean, I guess in thinking about these inequities within the US context and then globally, I'd really like to think about all and to thank the many, many others that are doing long COVID advocacy to really argue for more government support for research

treatment and control of the ongoing pandemic. I do think that a long COVID moonshot is essential. I encourage everyone to advocate for the long COVID moonshot. We absolutely need more research. And as frustrating as it is in global health to see new health innovations come about in high -income countries and for it to take a long time to reach populations.

in majority world countries. I see colleagues in majority world countries.

pinning their hopes on a long COVID moonshot too. You know, we are poised in the US to really lead this work. There's amazing work going on elsewhere, absolutely, and of course, but we have the resources and the scientific systems to really move the needle on this thing. And so I think that we as a high income country have a responsibility to do so.

Zeest Khan (37:58)
It's such an amazing point to reflect on. You've used a term that I'm not familiar with, can you tell me again what that is? Majority world countries.

Rachel (38:09)
Yeah, so I use that term to differentiate. I still use the term high income countries to acknowledge like these are World Bank categories that are kind of mapped on to countries economic systems. We know who the high income countries are. They're often former colonial or neo colonial powers. I choose not to refer to the rest of the world as low and middle income countries as they're classified by the World Bank, but I make that

conscious decision to refer to them as the majority world because that's where the majority of our global populations are and it's kind of my acknowledgement of that and I'd like to think about how can we center majority populations, how can we center majority science, how can we support those systems. So for me as a global health worker, you know, that's the kind of framework and mindset that I try to have as I'm thinking about these sticky issues.

issues.

Zeest Khan (39:08)
I love that. Thank you for teaching me and teaching the listener. That's a great way to reframe the conversation. And we know that words are very, powerful and language carries a lot. You know, in past interviews, I've asked people who've shared their experience with long COVID, do you have any words of wisdom for the listener?

And I'll pose that question to you too, but maybe I'll also pose another and you can answer in a way that you feel comfortable. What would you want Rachel in 2021 to know? What did she need to hear before she even got sick, before she started this journey?

Rachel (39:59)
That's a big question. I think I would say girl pace yourself. But also that we wear a lot of hats in our lives, we all do, and to not prioritize one of those over others, that we're not our work, that our relationships and our families and other things, you know, I think we often say they come first.

But really putting that in context that we are enough just by being and that you don't have to be achieving to be worthwhile. And I think that that's something that our...

economy and our social systems really set us up for is that like you are your achievements and that's not really true. You're great just by being. And so I think that's also like maybe a bit of affirmation and advice for other long COVID folks out there. Also, I know, you know, I've been mild to moderate. I read and hold in my heart stories of folks with severe

long COVID, I think I would just say, you know, hold on that even in my journey between mild and moderate, you know, that the illness has phases and that you may not be cured, but you can live for and hold on to periods when things do get better and symptoms abate. And so for me, like that sort of is my glass half full to keep an eye on those times.

Zeest Khan (41:40)
That makes me emotional hearing. It's very, very touching. Thank you so much. Dr. Rachel Hall -Clifford, you do such valuable work. Thank you for sharing your story both in written form and here with me today. I hope more and more people hear your story. I wish you so much health because the world needs you.

Rachel (42:08)
thank you so much and thank you for this opportunity to chat.

Zeest Khan (42:12)
It's my pleasure.

Zeest Khan (42:12)
Thank you for listening to another episode of Long COVID MD. I hope you enjoyed this conversation with Dr. Rachel Hall -Clifford. I'm gonna leave links to her bio, to her projects, and importantly to the article that she wrote about her experience with Long COVID in the show notes below. Tell me what you think. Did things that Dr. Rachel Hall -Clifford...

mentioned resonate with you? What do you think about health disparities in the US?

What do you think about the role wealthy countries have, the responsibility that we might have to long COVID patients across the globe?

You can reach me as always at my email longcovidmd at gmail .com. Follow me on Twitter at doctor_zeest and follow me if you haven't yet. Subscribe to my new sub stack longcovidmd .substack .com. The things that are up there right now and the ideas I have for the future are.

resources that I think will be helpful to you.

And beyond that, it's a nice kind of cozy place to build a community. I hope you are feeling well in this moment, and if not, I hope you feel better in the next. Thank you for listening. I'm Dr. Zeest Khan, and until next time, bye for now.