Dr. Jibril AbdulMalik is a mental health professional with not less than 15 years in practice. The Senior Lecturer at the Department of Psychiatry, University of Ibadan shared insights on the emotional impact of COVID 19 on frontline workers such as health personnel and journalists. He also shared coping strategies and his expectations of life after the pandemic. The excerpts of his interview with Rasheed Adebiyi are as shared here.
Tell us about yourself
My name is Dr Jibril AbdulMalik I am a consultant psychiatrist with the University College Hospital, Ibadan. I am also a Senior Lecturer with the Department of Psychiatry, College of Medicine, University of Ibadan. I am the founder of Asido Foundation. Asido Foundation is a not-for-profit mental health advocacy organization that was launched last year in 2019 with the aim of promoting better understanding and awareness around mental illness, reducing the shame and stigma that is usually associated with it in our society as well as helping individuals and the affected families and their caregivers to be able to access the care and the support they need. Our hope and motivation is to have a society that is mentally healthy. A society that is free from shame and discrimination for any individual who has a mental health problem as there is none for physical health conditions. That is ultimately what we aim to do. Through our website and social media handles, we engage with the youthful and literate population to push out a lot of positive messaging to encourage people, to inform people and humanize the experience of mental health challenges. That is what we do.
Could you tell us more about Asido Foundation? What motivated its establishment?
In the course of over my one and a half decade of working in mental health across the country, it’s become very clear to me that the biggest challenge we have is that of ignorance, stigma and discrimination. A huge proportion of our population still do not understand what mental health or mental illness is all about, there is still a lot of superstitious beliefs and on account of this many affected individuals are taken to prayer houses, to traditional healing homes and so on and so forth where unfortunately a lot of human right abuses take place. Last year, the Human Right Watch presented a report on the state of mental health services in Nigeria. Shortly after that there were a lot of police arrests in Oyo State and Kaduna State where illegal treatment facilities where hundreds of people were chained in very inhumane situations and circumstances.
So this is the reality of what we are dealing with in the context of our society that people do not have access to the right information and so therefore those who are affected with mental health problems suffer a lot of abusive practices, disregard of their human rights and lack of access to quality mental health service even when it is available. In a nutshell, a lot of suffering is going on. And we feel that if we just remain in the teaching hospital and wait for those who know to come to our clinics, the number of patients we see is pitifully small. Even though, we are busy as we are. It is still pitifully small compared to the magnitude of the burden within the society itself. And so what that means is that I would estimate roughly that we see less than 20 percent of the burden. The remaining 80 percent are in traditional healing homes, religious homes or they are locked up and chained in the villages so that they will not embarrass their family members. So, our motivation therefore was to try and put out the right information out there so that people would be armed with information and they can seek the right treatment so that they can get better and also to reduce the stigma, the embarrassment and the shame as well as the human right abuses. So this is the motivation. We started by writing weekly articles for The Tribune on Thursdays for a column titled Your Mental Health and You. That has been running consistently since August, 2016. Launching the Asido Foundation last year was to amplify the impact of what we have been able to do with the weekly column we have been writing so that we can pool more resources and get volunteers and together all of us can have a more impactful change in our society at large and the entire continent in the long run.
As a mental health professional, what are the likely mental issues that may arise as a result of the COVID-19 pandemic?
As a mental health professional, the mental issues that may arise from the COVID-19 pandemic stems from the fact that as human beings there is a lot of fear associated with the pandemic; fear of being infected, fear of losing loved ones, fear of losing income as well as the uncertainty because the situation is so drastic now and nobody can say for sure how long this is going to take and when it’s going to be over and so can that we can plan. And for us as human beings when we lose that sense of control over our life and we feel helpless and we are constrained because of the lockdown to stay at home and so on and so forth. That feeling of vulnerability, the uncertainty we have to deal with, the fear of infection, the anxiety over challenges that are coming up, the loss of income, the restrictions, all of these place a lot of stress on individuals that are coping with their emotional wellbeing. There are likely to be cases of anxiety, depression especially for those who are previously vulnerable, even new people are developing these problems. Some people are turning into alcohol and drug abuse in other to cope with it which again is harmful to their mental wellbeing. We should know that prolonged anxiety and stress is harmful to our immune systems and the immune system is our best option to fight against the Coronavirus as there’s no treatment at the moment.
The immune system is the best option to fight against it and when you’re stressed and anxious for a long time it weakens your immune system which makes you more vulnerable to developing this. Some individuals have Post Traumatic Stress Disorder (PTSD) because of the trauma of being infected, or seeing someone who has been infected, losing someone who is a loved one dying from it. All of these things are mental health challenges; anxiety, stress disorder, depression, substance use problems and disorder especially PTSD are the most common mental health problems that we may see resulting from the isolation, the loneliness, the loss of control and the difficulties, loss of income, and so on that is associated with the lockdown.
For those at the frontline of the battle against the virus- health workers, journalists, security personnel- what are the mental health issues they could be exposed to while on duty?
For those at the front line, the health workers, the journalists, the security personnel, they are more likely to experience a higher degree of the problems I had listed earlier. For a health worker for instance, who has to wake-up, dress up and go to work everyday not knowing whether the patients they are going to see have corona virus because it is not written on the forehead. Some patients are asymptomatic, they will not have the symptoms of corona virus. They may have come to do something else at the hospital. At the same time, so while taking all the precautions and wearing the protective equipments where it is available. It is still not possible to guarantee that you won’t get infected. They go to work every day with a lot of anxiety and worries, they are stressed because they are trying as much as possible to be careful and then when they go to work and interact with patients, they still have to come back home to their families and there is also the risk that they may bring the infection to come and infect their family members. So this places a lot of stress on the health workers and that all health workers would have to show up, I mean other offices can shut down. Health workers still have to show up, they can’t shut down, so that’s the situation.
Of course, journalists have to report the COVID19 pandemic because it’s topical because they have to report on the number of new cases, number of deaths, number of total infected and so on, what causes it and also report the human angle side of people who are suffering, on admission, how they are feeling, and those who have recovered, how it works for them. These are very intimate details of the pandemic that may also increase their own anxiety, predispose them to developing depression and other mental health problems including Post Traumatic Stress Disorder because they are like indirectly experiencing what is going on and having to write it up and report on it, so they are also going through it. And also the security personnel that have to be at the forefront of ensuring that implementing the lock down and so on and so forth. They are also at the front line of exposed risk.
Experts have continued to hammer on drastic changes post COVID 19. What are your expectations after the war against the virus might have be won?
My expectations after the COVID19 pandemic is over is that it will help all of us to take a second look at our life and re-strategize. For instance, we need to get our priorities right. If you previously thought that you couldn’t do without travelling for vacation every summer outside the country, now there is lockdown and there is no vacation. You can’t even travel outside your state or city or outside your town, yet you will not die because you cannot travel for summer.
So if you like wearing, buying plenty of shoes and other things and I know that this experience has shown us that when push comes to shove, we need very minimal things to be content and to live a happy life. We don’t need all the things we previously used to love. If you used to love going to the cinema, you can’t go to the cinema now. If you used to love watching premiership matches, there are no premiership matches to watch. If you can’t do without watching the Champions League, there are no matches to watch. There is no sporting activity that you say I must not miss as all sporting activities are cancelled. Even the Olympics has been postponed for one year and so on. So, in essence the point is that there is nothing that we can’t do without. So we need to re-strategize our life and reappraise our priorities to see what are the aspects of my life after the pandemic I want to resume and which aspects do I need to delete because they’re not really helpful and they’re not contributing to my life. That is number one.
Number two, the different approaches to doing business. Many universities are doing online courses. Many jobs and offices are now having to work from home and offline. What all this means is that life as we knew it before the pandemic is likely to change after the pandemic and we have to be ready to embrace new models of doing business, new models of social interactions and so on and so forth
And for us as human beings too, we are likely to appreciate more the liberty and the freedom to go out and interact with other human beings at social events freely without fear unlike now that we are practicing social distancing when you can’t shake hands, you can’t gather together in mosques or churches for any ceremony and all of that so this is going to transform how we relate for us to appreciate the value of being able to interact and mingle freely with other human beings. It is something to savour, treasure and be grateful for. We also need to be grateful for good health. I also hope that our government at all levels will begin to pay more attention to fundamental things like our healthcare services to ensure that our healthcare services at primary care level, secondary care level and tertiary level are all invested in. Our government has not been investing in our healthcare services as well as education.
We hope that this will be a wake-up call that would encourage them subsequently to pay attention. Now nobody can travel abroad for any treatment. And we have to use the services we have in our country. These services have previously been neglected. This is a wake-up call. I hope that all Nigerian citizens would make sure that it is on the front burners so that we do not go back to business as usual after all of this and forget to save for the rainy days so to speak. This is because it is not until the pandemic comes that we begin to run helter skelter. It is before it that we should struggle to invest in our health care services and strengthen it. Even well developed countries are struggling despite the level of their quality healthcare systems hitherto. For us, we are at sub optimal capacity which makes us more vulnerable. Our prayer is that we do not have a significant level of community transmission that would put us under distress.
What coping strategies do you suggest?
We shouldn’t just talk about the problems without providing solutions to them as to how to cope with them. Some of the things that are helpful to make us cope including ensuring that we stay calm and we control our anxiety. There are so many pieces of fake news on social media and anxiety provoking messages that we have to ensure that we avoid. If watching news network and reporting of the event is becoming too much for us to swallow, then we should switch off from them. Also, we should rely on reliable sources of information such as the WHO, the NCDC or any official government organs responsible for disseminating accurate and responsible information. Even though we are locked down at home, we can deploy technology, we can have video calls with family, friends. We can call friends we have lost touch with for a long time, create time to reconnect with them and find out what’s going on, now that we have the time, we can deploy that time to invest in social relationship and build our networks. We should also not be involved in spreading fake news and sharing alarming information unless we verify it to be true. We can try to use this opportunity to acquire new skills. If there’s a book you have always wanted to read, you always wanted to use Microsoft word, Excel , PowerPoint and you didn’t have time, now you have the time, anything you want to learn there are YouTube videos that are very helpful, this is the time to improve yourself, invest in your self-development and acquire new skills.
We should also most importantly comply with the preventive strategies: wash your hands regularly, stay at home except it’s absolutely necessary to go out. And observe social distancing. It’s also helpful to exercise regularly, it doesn’t mean you have to go to the gym. You can dance for 30 minutes, jog or use skipping rope and do many things within your home or around your compound. That’s helpful. When you do that, when you exercise your muscles, it causes them to relax which reduces your stress and anxiety. It also releases feel good chemicals or hormones in our body that make you feel better and lift your mood and then it helps to sleep better when your muscles are tired.
So exercise is a very positive thing to do. It’s important to bond with our family. Many families have become strangers sleeping under the same roof. This is the opportunity for couples to rekindle their relationship, strengthen it, spend time with the children. Siblings too should spend time with each other and strengthen their ties of family of bonding. That is something that is positive that we can use this opportunity to do very well.
Lastly, it’s important to eat healthy diets, drink plenty of water, rest well and don’t forget that our biggest weapon is our immune system okay and to nurture the immune system, you need to get a balanced diet. You should do things that make you happy. Anything that makes you happy, create time for it. If you like watching movies, reading, reading different types of novels and so on, please do them. This is so that you can stay positive and optimistic. Have fun, play games. You savour each moment so that you look at the glass not as half empty but as half full.
Thank you for your time
You are welcome