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Coping with loneliness in lockdown

Thu, 2020-04-30 09:43

Over the past few weeks, the world has changed drastically. What was once considered normal, such as spending the afternoon in the park with friends, may now be considered a criminal offence. Our way of life, work and church have all had to change and adapt in the wake of the current COVID-19 pandemic. While we can all understand the need for social distancing and isolation, it is nonetheless a significant challenge.

As Christians, how do we respond to the mass isolation and the loneliness that we and others face? Here are a few of my thoughts:

  1. Remember that though you may be physically isolated, Jesus said that he would never leave us or forsake us (Hebrews 13:5-6).
    Despite the physical distance, we may be experiencing now; God has promised that he will not leave his children. For those facing this lockdown alone, be encouraged that though you may find yourself now spending most of your waking hours in your home isolated and cut-off, God has not and will not forsake you.

 

  1. Ask God what he may want to teach you in this time.
    Often when we are busy and occupied with many tasks, we may fail to be sensitive to what the Holy Spirit may want to teach us. This mandatory time of isolation may be uncomfortable and undesirable; still, it may also be the thing that God wants to use to draw your attention closer to him and develop areas which you may not have otherwise addressed. Our God can work through unpleasant situations and bring about good (Romans 8:28), so be praying that he would open your eyes to what he wants to teach you at this time.

 

  1. Reach out to others
    Why not reach out to a friend/ colleague and arrange to speak on the phone or video chat? Use this time of lockdown to strengthen your relationships and go beyond superficial. Try to be intentional, perhaps suggest a regular catch up and ask how you can be praying for the other person. For many of us, this could be a time to get to know people without the busyness and distractions of ordinary life.

 

  1. Fill up with the truth
    We live in a digital age where news can be accessed 24 hours a day, and though we need to be well informed, the constant flow of headlines can be overwhelming. The Bible repeatedly implores us to read, study and meditate on the Word (Joshua 1:8; Psalm 1:2; 2 Timothy 2:15). During this time of isolation, try to replace the constant headlines with God’s unchanging truths and promises.

 

  1. Remember that Jesus also faced loneliness
    Jesus is well acquainted with the loneliness: he was forsaken by his closest friends on the night of his death (Matthew 26:38-41) and even his father (Matthew 27:46), making him a high priest who can truly empathise with our struggles (Hebrews 4:15). Knowing that we pray to a God who not only understands but has experienced our troubles, we can approach him with confidence to receive the help we need (Hebrews 4:16).

How good is it to know that God understands, he is with us and will bring us through this season?  I have found the words of Psalm 46 particularly encouraging during this season, whether it’s loneliness, anxiety or fear we are facing; we can find encouragement in the fact that ‘God is our refuge and strength, a very present help in trouble‘. God is with us, and we can be confident of this unchanging truth.

For more reflections on this topic, I found John Piper’s response to the issue of loneliness in the current pandemic, really useful. I would encourage others to listen at desiring god.org.

 

Dr Paula Busuulwa is an FY3 trainee doctor in London

Categories: Discussion

Palliative care and COVID-19

Tue, 2020-04-28 10:42

I didn’t pay much attention to them at first. The news stories about Wuhan and the Facebook posts from Christians there asking for prayer. I probably said a few ‘arrow prayers’ but didn’t really engage. It was all far away, and it wouldn’t ever impact us. I’m sorry, Lord. I’m challenged to widen my circle of concern and engagement.

COVID-19 is now here. Changes we have been discussing around our ways of working get a kick-start as staff move out of buildings and embrace digital communications technology. Skype and PPE intrude on working days. I dislike both of them. The very thing that brought me into hospice care is the human contact. Presence, proximity and touch are fundamental to palliative care. They are also my ministry, given the stringent prohibitions around sharing faith in a healthcare setting.

It’s not the same caring for the dying from behind the barriers of mask and gloves.

I read of the experience of Italian colleagues who found that palliative care had to be ‘brutally’ adapted. Early on in our own experience, it has been the restrictions on visiting that have injured most, both families and staff. Seemingly inhumane and rapidly changing guidance, in the name of safety.

For a while, common sense in applying the guidance went out of the window, a testimony to the prevalent fear. Thankfully, pragmatism and compassion in caring for those at the end of life once again prevail.

I sense the fear all around. I sense it amongst some of our staff. I even sense it initially in the posts from Christians in my Facebook newsfeed. Come on, Church! We of all people should be hope carriers.

Society’s new mantra is, ‘be safe’. Precautions are necessary, but what are such messages doing to the collective psyche in a culture that already idolises safety? As believers, personal safety should be low on our list of priorities. I reflect on the early Christians who stayed behind in Carthage and other cities across the Roman Empire to care for plague victims and the evangelistic fruit of their service and sacrifice. I listen with excitement to the testimonies from believers working on COVID wards.

Stories from London start to mirror those from Italy, and we begin to take the possible impact on our region seriously. There is talk of a local Nightingale Hospital. This is a defining hour. Inwardly, I sense that it isn’t going to be as bad here as they are predicting. We are not London. I tell colleagues that based on prophetic conviction rather than science. But I prepare for the worst and trust for the best. And we need to support the wider healthcare community in this crisis or else the credibility of hospices may be in doubt.

We adapt our community and hospital support, and we temporarily increase the number of our beds (all with precious piped oxygen). We offer to help out with the Nightingale. The option of us taking COVID patients comes to the table.

I meditate for several days on worship and sacrifice. I am genuinely not afraid for myself. I dwell in Psalm 91, reciting it aloud every morning when I arrive on the ward, declaring its truths over the hospice, staff and city. My being there will make a difference, as will the handful of other believers in the clinical team. I carry the presence of God. But I am burdened by the possibility of losing one of my nursing or medical colleagues. It seems a reasonable sacrifice to lay down one’s life while trying to save others. But almost all of our patients are already dying. Laying down one’s life to enable them to have a better experience? If I died as a direct result of my work, wouldn’t that be a terrible waste? But a life poured out in service and worship of Jesus is never a waste – the alabaster flask attests to that. The kingdom isn’t utilitarian.

I recommend that we isolate part of the hospice to take patients dying with or from COVID. It is the right thing to do, but it will put staff in harm’s way. I tell my team that I will personally attend any COVID patients admitted to the unit, even if it means coming in when I am not meant to be at work. Their response is humbling and inspiring. They won’t hear of it. In fact, they will preferentially protect me, as my age puts me at higher risk.

The kindness of strangers is all around us in this crisis. It makes me believe that great blessing will come out of it. That and of course, the certain knowledge that God works all things for good to those who love him (Romans 8:28).

Three weeks later, it feels like a bit of a ‘phoney war’. There have been cases in the city, and some deaths and the heart-breaking stories surrounding those. But the expected surge hasn’t happened here. It was going to be Easter, then predicted mid-May, now possibly the autumn or winter. We have hundreds of empty hospital beds. And we’ve only just had our first COVID patient in the hospice. We wait. And pray. And trust

Because you have made the Lord, who is my refuge, even the Most High, your dwelling place, no evil shall befall you, nor shall any plague come near your dwelling; for he shall give his angels charge over you, to keep you in all your ways. (Psalm 91:9-11 NKJV)

Dr Jeff Stephenson is a consultant in palliative medicine at a Southwest England hospice

Categories: Discussion

Coping with loss of control

Fri, 2020-04-24 08:48

We are used to a sense of control over our lives and our day to day decisions. I can choose when to go to the shops, what colour to paint my house, what plants to plant in the garden. I can choose what level of risk I’d like to take: whether it is the speed I travel downhill on my bike or running the quiet streets at night. Covid-19 is limiting our control and choices. I can continue to choose what plants to plant, but I can’t wander around a garden centre to choose them. I can choose when to go to the shops but only once a week. I have been told that to gather as a family is too risky and at work, I am told where I have to wear PPE and where I don’t. It is no longer my responsibility to consider for myself what risk I am willing to take. We are all asked to conform, which for a society that celebrates diversity and individualism is deeply counter-cultural.

Added to this is the top-down decisions about where you will be redeployed to, enacting plans by seniors that may differ from your usual practice and changing rotas. This forces us to become more submissive in a profession that encourages flat hierarchies and discussion. It suppresses the medical instinct to lead, challenge and perfect through debate. The changing work patterns and locations remove the support structures that give us a sense of control. Simple things like not being able to access the changing rooms because you don’t know the code; not knowing where to make a cup of tea; not being able to grab a glass of water because you are in PPE, all serve to amplify these micro stresses and frustrations. We are learning to accept adequacy because perfection cannot be achieved. This too is stressful and frustrating for those who like to feel in control and perform to the highest level (which is most doctors and nurses I know).

The concept of control over our lives is an interesting one. Do we really have it, or is it just an illusion? If we do have it is it only over the mundane – what to eat, what to wear; or is it deeper – do I control who I am, can I change whether someone will live or die? The author of Ecclesiastes points out that whatever we do, the sun will continue to rise each morning, the rain will end up in the sea and the seasons will change. Knowing that the fixed patterns of the world continue despite the chaos around us gives a sense of stability. In the sermon on the mount, Jesus applies this metanarrative to our individual lives. He calls us to pray each day ‘give us our daily bread’ and not to worry about where our clothes and food will come from. He reminds us that all that we have comes from God and is under his control. However, Jesus ends this sermon with a warning that if we don’t act upon his words, we are like the man who builds his house upon the sand. So, we do have some choice and control over our lives.

The Bible has many cautionary tales of failure and heartache when leaders choose to use what limited control they have to do things their way. When God’s plan for our life coincides with ours, it is easy to think that we have ceded control to Him. When we are asked to do things that make no sense to us, our pride bucks against this, and we resist. It exposes our sinfulness just below the surface. Simple obedience to rules that aren’t harmful but appear senseless allows us to practice humility. The current top-down approach at work reminds me of the officer training I received at Sandhurst. There is no good reason why water cans need to be positioned in a particular place on a shelf, but it teaches cadets to obey, to think of themselves less in order to become part of the greater whole that is the army. Obeying guidance on PPE in a non-grumbling manner helps the nurses to feel like the doctors are working alongside them. By supporting the senior nurses and setting an example, we can shift the mood from frustration to confidence in our safety. We become a greater whole as a ward team rather than individuals with our own agendas.

Covid-19 challenges us to put others first and to obey instructions we don’t fully understand. Learning to respect those above us is important. Paul reminds us that all authority comes from God, and so we are called to respect and obey. Knowing that our foundations are built upon the rock that is Jesus Christ allows us to humbly acquiesce to these requests. As I reflect on my experience of obeying instructions, on where I need to be and in what level of PPE, I am struck by the opportunity it brings to demonstrate the fruits of the Spirit. We are called to love our colleagues and bosses by peacefully obeying the commands given to us by others. To bring joy in doing so in a non-grumbling way and being patient as things change for the umpteenth time. We can be kind and good to our colleagues by facilitating their breaks and providing a positive environment to work in. I can be gentle in my challenge if a challenge is required, and it even allows the practice of self-control as I am neither able to eat, drink or pee in PPE! We may have lost control over many aspects of our lives, but we retain control over how we respond to this and are comforted by the knowledge that ultimately God holds all things in the palm of his hand.

Alice Gerth is an Anaesthetic Registrar in East England

 

Join with us at 19:00 (7 pm UTC) each day to pray for frontline workers, our nation and the world as we deal with the COVID-19 pandemic at #COVID1900Prayer

Categories: Discussion

Some biblical answers to suffering during the COVID-19 pandemic

Thu, 2020-04-23 12:59

In the midst of the COVID-19 pandemic, people and physicians around the world are facing trials of many kinds: the threat of illness, the death of loved ones, scarcity of health care resources, and the loss of patients. As Christians, the experience of suffering can cause us to ask difficult questions: How can an all-powerful, all-loving God allow suffering? Why did he set the universe up in such a way that suffering is possible, and why doesn’t he intervene when suffering gets out of hand? While suffering can be a difficult concept to understand, looking at biblical examples of suffering can help us to grasp an insight into both the causes of suffering and God’s attitude to and presence in suffering.

There are many examples of suffering in the Bible. Some of them can be understood as the natural consequences of ignoring God’s teachings. In Proverbs, the teacher talks of the inevitable suffering that comes from humanity’s desire to ‘go it alone’. ‘Can a man scoop fire into his lap without his clothes being burned? Can a man walk on hot coals without his feet being scorched?‘ (Proverbs 6:27-28).

This cause-and-effect relationship can be seen whenever we pursue selfish goals rather than God’s desires for us. For example, the relationship between promiscuity and sexual disease or the harmful effects on marriage when one of the partners becomes sexually involved with a third party. This suffering is one consequence of ‘free will’, which while allowing us to worship God genuinely, also opens the possibility for us to make the decision not to follow God, a route that often leads to some form of suffering.

Other kinds of suffering are seen as a force for discipline. One example is in the book of Jeremiah, when God becomes displeased that his people are turning toward man-made gods and adopting lifestyles which do not obey his commands (see Jeremiah 8:13).

Yet there are other examples of suffering – perhaps like the current pandemic – which don’t seem to fit so neatly into either of these explanations. Because of this, at the heart of the challenge of understanding suffering are questions about the character of God. God’s character and attitude toward suffering can be seen in his presence and purpose among his people in the midst of suffering. When God allows his people to suffer, he does not do so vindictively but rather to bring them closer to himself.

In the gospel of John, Jesus encounters a man who was born blind. His disciples immediately look for some rational cause to explain this man’s suffering. ‘Rabbi,’ they ask, ‘who sinned, this man or his parents, that he was born blind?’ Jesus responded that neither the man nor his parents sinned, but rather, ‘this happened so that the work of God might be displayed in his life’ (See John 9:1-5). In this encounter, Jesus reveals that one of God’s purposes within suffering is that God’s glory would be revealed to his people.

Another way that God uses suffering for glory is as an opportunity for spiritual formation. In this sense, suffering is not a force of destruction but rather a force of transformation and spiritual construction. James writes in his gospel, “Consider it pure joy, my brothers and sisters, whenever you face trials of many kinds because you know that the testing of your faith produces perseverance. Let perseverance finish its work so that you may be mature and complete, not lacking anything.” (James 1:2-4) When God allows suffering, he uses the turmoil and hardship as an opportunity to reshape us, as the Holy Potter who is moulding us to more closely reflect his image.

Important to understanding God’s attitude toward suffering is recognising that at the heart of the Christian gospel is a God who himself is not above the strife of suffering. Rather, he endured great suffering so that those who believe in him would escape the death of their sins and have eternal life. The epitome of Biblical suffering is the crucifixion of Christ for the salvation of all of humanity. Jesus’ suffering was part of God’s plan at a critical moment which restored humanity’s relationship with God and allowed God’s will to be fulfilled. God is not ambivalent towards suffering but rather uses it as a force which can create greater, holier outcomes. While we can take comfort in this, it is important still to acknowledge that we may never truly understand why God allows suffering. This can be hard to understand and accept in today’s world of unanswered questions, but we can have faith that God’s purposes are higher and holier than ours and that he does use suffering to accomplish his will and reveal his goodness.

As Christians, how should we respond to the immense, worldwide suffering that is occurring during the COVID-19 pandemic? We can look toward Jesus and the ways in which he cared for those who suffered. In the gospels, Jesus had a particular concern for the outcast, the marginalised, and the weak, and he worked to meet their spiritual and physical needs. Suffering is an opportunity for Christians to show the secular world what Christ’s compassion and love looks like. In a crisis, Christians should be recognised by their love and care for those who are suffering as we work to meet people’s physical and spiritual needs in the spirit of Christ, who met the needs of all those he encountered. Our love for others reflects Jesus’ love for us, and our personal sacrifices reflect his ultimate sacrifice for all of humanity. While only God may know the answers to our questions about why particular suffering occurs, we can take hope in the understanding that he is present in our suffering and uses suffering for his glory and our good.

 

Ana Worthington is a volunteer with CMF. She is a pre-med student at Wake Forest University in North Carolina, who would be completing a semester abroad at Cambridge University, were it not for the coronavirus.

This article has been adapted from the CMF File ‘Human suffering: Biblical perspectives‘. by Pete Moore PhD, a freelance science writer and author who works at the interface of science, medicine and ethics.

 

Remember to join us every day at 7 pm (BST/UTC+1) for #COVID1900Prayer, a chance to pray for health workers, our nation and the world as we respond to COVID-19

 

Categories: Discussion

Uncertainty: our new normality

Wed, 2020-04-15 08:28

We’ve heard a lot about how Covid-19 affects the lungs, often catastrophically. But what about the heart? This disease can expose issues of the heart we have been blissfully unaware of, and that can be painful.

The pandemic has disfigured life as we knew it in the UK, and our ‘normality’ is now characterised by uncertainty. How many people will die today? When will we ‘flatten the curve’? When will a vaccine be ready? And the more personal questions: How many of my colleagues will die? Will my family members all survive this? Will I?

We don’t know. We hate not knowing, don’t we?

Secrets exposed

The UK is not without its problems, but we’re comparatively affluent, predictably rainy, and well vaccinated; given those circumstances, we trust God. The last few months, however, with all their unanswerable questions, have brutally uncovered something festering in my heart, up to now successfully concealed by a reasonably comfortable life. Covid-19, it turns out, is a revealer of truth. My once-compensating heart is suddenly in decompensated failure (metaphorically speaking). In the Bible, King David knew the feeling when he was surrounded by ‘innumerable evils’ and confessed, my heart fails within me.

Uncertainty reveals where our heart finds security. In what are we trusting? Safety nets litter our lives: Avoiding carcinogens, locking doors at night, effective vaccinations. But when we have never smoked and find a lump; when we lock the door, and an intruder climbs through the window; when there is no vaccine, we remember the truth: The whole creation groans and labours as with birth pangs. The intensity and frequency of contractions is increasing.

Eating healthily is great, and locking doors is sensible, but helpful privileges can morph into an illusion of safety. Consequently, we are utterly shaken when an invisible virus reminds us that actually, safety in this world does not exist.

The object of our trust

The same David who felt his heart failing within him because of the dangerous world he lived in also knew there was one place of refuge.

In peace I will lie down and sleep,

for you alone, Lord, make me dwell in safety.’

Psalm 4:8

You alone, O Lord, make me dwell in safety. Not you and my burglar alarm. Not you and my airbag. Not you and the day that the vaccine is finally ready and we can leave our homes in confidence, protected by the wonders of modern medicine yet again. No. You alone.

I can’t remember a day of my primary school career that didn’t involve a game of Tag (or Tig). The only safety from lurking taggers was being ‘on den’ – be that a tree, a bench or a bin. There, you were untouchable.

Is David saying that trusting God gives us guaranteed immunity from disease, disaster and death? Is trusting him like being on den? Of course not. Before he was crucified, Jesus told his disciples (and us by extension), ‘In this world you will have trouble’. Why would he leave them on such a cheery note? As if hearing our question, Jesus says in the same verse, ’I have told you all this so that you may have peace.’ We might ask how a life filled with difficulty and sadness can give peace. Don’t miss his two final words. Trouble in the world. Peace in him. ‘He himself is our peace’. Our peace does not come from divine protection from all forms of suffering, but from trusting who our God is.

The big question Covid-19 has caused me to ask is: ‘Do I trust God?’ My disturbing response was a resounding ‘I’m not sure’. I always knew He was in control, but I’ve realised that isn’t the same as trusting him. A god who is all-powerful but corrupt is not a god our hearts can rest in. Likewise, a god who is wonderfully kind but lacking authority is not a god who can be our peace. Trusting God means believing that he is both in control and thoroughly good.

God has used uncertainty to expose my suspicion of him and replace it with confidence that he is as kind as he is powerful. He is as powerful as he is kind. Hallelujah!

A process when panic strikes

Mistrust of God inevitably births panic, which in my experience is soon followed by an onslaught of worst-case scenarios parading themselves across the catwalk of the mind. It’s tempting to stop these thoughts in their tracks and send them packing. Instead, here’s a suggestion. When anxiety comes, allow yourself to go to your worst-case scenario. That will be different for each of us. Imagine Coronavirus has done its very worst. Are you able to say, it is well with my soul? I’ve found it is possible, but only if I talk myself through two logical implications of God being both all-powerful and all-loving.

  1. My God is all-powerful and therefore [insert worst-case scenario] will only happen if he allows it to happen.
  2. My God is all-loving and therefore if he allows [insert worst-case scenario] to happen, it is for his highest glory and my highest good.

That simple two-step process has become my rescue remedy when uncertainty causes my doubting heart to panic.

Maybe, like me, this pandemic has exposed a mistrust of God of which you had been completely unaware. You were compensating in comfort, but Covid-19 has made you feel your heart is suddenly in end-stage failure. God is being gracious by bringing these things into the light and giving you a golden opportunity to renew your trust in him. Here on earth, we will have many trials and sorrows, but we can have peace because our God can be trusted.

My flesh and my heart may fail,

But God is the strength of my heart and my portion forever.

Psalm 73:26

Categories: Discussion

‘Green zones’ for the vulnerable may be a cheap and effective option for preventing coronavirus spread in low-resource settings

Tue, 2020-04-14 08:56

 

The US and Western Europe have so far been the hardest hit by the coronavirus with over 80 per cant of cases worldwide – but there’s good reason to think that the Developing World will ultimately suffer most.

According to a recent report, 40 million lives may be at risk this year (see my previous post).

Controlling the spread of the virus will be a very different prospect in low-resource settings. What techniques are likely to work best?

A recent paper from the London School of Hygiene and Tropical Medicine (LSHTM) is advocating so-called green zoning – rather than quarantining those already infected by the virus (red zoning), those individuals who are both unaffected and vulnerable are protected by being separated off from the rest of the population.

This may appear counterintuitive – after all developing countries have a much lower proportion of older people – in Wales, for example, 21 per cent are over 65 whereas in Ethiopia only three per cent are.

But the authors identify three reasons why populations in the developing world are likely to be more vulnerable to COVID-19.

First is reduced social distance. Larger intergenerational households, intense social mixing between the young and elderly, overcrowding in urban slums and displaced people’s camps, and specific cultural and faith practices such as mass prayer gatherings, large weddings and funerals – all lead to higher transmissibility of the virus.

Second is high numbers of vulnerable patients. Non-communicable diseases (NCDs), like diabetes, hypertension and chronic respiratory disease, undernutrition, tuberculosis and HIV all make it more likely that coronavirus infection will push people over the edge.

Third is weaker health services. Fewer hospital beds, fewer health professionals, less intensive care facilities and poorer infrastructure and healthcare delivery systems. Inadequate water and sanitation make it worse.

The strategies that have worked so effectively in containing the virus in East Asian countries like Singapore, Hong Kong and South Korea – widespread testing and meticulous contact tracing – are very resource-intensive and less easily replicable in low-income and crisis settings.

Lockdowns are also likely to be very harmful for societies in which most live from hand to mouth and have little if any savings. And when people are stretched beyond their ability to cope they are less likely to comply with control measures.

There is also little prospect of scaling up intensive care to the levels required and isolation of cases in dedicated high-intensity wards might offer little benefit as most transmission would still be due to mildly unwell people spreading the virus to close contacts and family members.

For all these reasons, it may, therefore, be a better use of resources to focus on protecting the vulnerable.

In Ebola epidemics, the aim of isolating the ill into a contaminated ‘red zone’ is primarily to protect the healthy. But with COVID-19, the red zone is everywhere, so it makes more sense to protect those more likely to suffer fatal illness from the rest of the population who are much more likely to survive the infection.

The risk of coronavirus infection increases with age with a particularly high risk among those aged over 70 (or even 60 in low-resource settings) and/or living with NCDs and other immuno-suppressing conditions.

The authors suggest three options for shielding high-risk community members – house-hold level, street-level and neighbourhood or sector level. In the first two arrangements, healthier members of the high-risk group could care for those with disabilities.

Stringent infection control measures should operate with all options. The green zone’s boundaries should probably remain virtual, but a single physical entry point, with handwashing facilities, should be established and food and other provisions should only be exchanged through this point.

Given that it may be difficult to isolate at-risk people for long periods the strategy should be discontinued as soon as safe to do so. This could be ascertained by serological testing, which is likely to be very cheap once widely available.

Detailed guidelines need to be developed and other feasible, high-yield interventions should be undertaken simultaneously (eg staying home if sick, limiting public transport use, reducing super-spreading events at funerals or other mass gatherings, promoting hand-washing, soap distribution).

In the meantime, those who develop symptoms of COVID-19 (fever, continuous cough) would be tested (if possible), isolated and quarantined for 14 days in the usual way (red-zoned), along with their close contacts (family members).

This approach would enable the rest of the community to carry on with normal life (with frequent handwashing etc), knowing that if they did catch the virus they would be very unlikely to suffer serious symptoms or die. Meanwhile, immunity would build up gradually in the general population.

This simultaneous green zone/red zone approach also has the advantage of avoiding the negative effects of lockdown on the economy and normal life, whilst protecting those most vulnerable, until a time when a vaccine is available to confer longer-lasting protection.

Longer-term, as with other viral illnesses like influenza or HIV, it will be vaccines or antiviral therapies that will best protect people in low-resource settings – but in the meantime, in the absence of these, protection in green zones seems a sensible, practical and low-cost option for reducing mortality.

The protection of the vulnerable resonates well with Christian ethics – and green zones operate on the ‘Passover principle’ where those located in safe places (marked by blood on the lintel) were kept from harm. With Easter coming up soon – this may be a good way to motivate faith leaders, who are often the most trusted voices in developing world communities, to protect their flocks.

 

This blog was previously posted on the ICMDA Blog on 2 April 2020 and is used with permission.

Categories: Discussion

Mental hygiene during coronavirus

Thu, 2020-04-09 09:07

The Coronavirus pandemic is turning almost every part of life upside down, both in and out of work. And one of my greatest concerns as this pandemic unfolds is the effect it will have on the mental health of clinicians. As a Senior House Officer in Accident and Emergency (A&E), who suffers from pre-existing depression, I think (for now at least) I am more worried about the risk posed by Coronavirus to my mental health than my physical health.

The Effects of Coronavirus on Mental Health

There are many ways that the pandemic can affect the mental health of clinicians. We are seeing a rapidly escalating number of very unwell patients come through our doors, and we are witnessing many dying in our care without their families around them. We experience the unnerving feeling of powerlessness as we manage a condition with no curative treatment, and as we watch world governments struggle to suppress their epidemics despite extreme interventions. We are constantly bombarded and often overwhelmed by masses of information from news outlets, press briefings, social media feeds, WhatsApp groups and journal publications, making it harder than ever to leave work at work. And like the rest of the nation, we feel the loneliness of social-distancing and self-isolation. So how can we look after our mental health during the Coronavirus crisis?

The Importance of Mental Hygiene

In an essay titled How to Be a Recovering Perfectionist, Prof. John Wyatt advocates for the importance of daily ‘mental hygiene’:

We all know that if we wish to remain healthy, we need to practise physical hygiene… Just in the same way, it is helpful to practise the discipline of mental hygiene. That means monitoring the content of my thought life and choosing to fill my mind with positive and healthy thoughts rather than negative, damaging and unhealthy thoughts. And just because I did this yesterday, does not mean that my thought life isn’t important today and every day to come. There is a daily discipline of keeping my thought life healthy. 

The apostle Paul gives a wonderful illustration of mental hygiene in Philippians 4:8. ‘Finally, brothers and sisters, whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable–if anything is excellent or praiseworthy–think about such things.’

It’s an interesting list. It starts with truth. Mental hygiene starts with focusing on truth and realism rather than lies and fantasy. Of course, this includes the truth of God’s unconditional love and care for us, his acceptance of us in Christ and the limitless forgiveness he offers. Second, Paul refers to the noble, the right and the pure. These are all aspects of goodness. We are called to focus our thoughts on everything that is good and morally pure. Third comes everything that is lovely, excellent and attractive. These are all aspects of beauty

I think Wyatt’s points are profoundly helpful for maintaining good mental health. So how can we fill our minds with truth, goodness and beauty during Coronavirus?

Truth

Meditating on truth necessarily involves filtering out all the junk and noise that jams our minds. It is clearly vital to keep up to date with the latest clinical and government guidance. But it is also wise to be careful about how much time we spend scrolling through our social media feeds and reading opinion pieces about what the future holds. I think many of us would benefit from cultivating the discipline of regularly turning our screens off.

Goodness

My social media feeds are saturated with sad statistics and anxious forecasting. But amid the pain of the pandemic, there are positive stories to be grateful for and celebrate. Communities have come together to look after the sick and vulnerable. The nation has united across political and social divides to support the NHS. People are finding more time to talk to friends independent of geographical proximity. And the environment has had a sudden cleanse. Whilst we cannot hide from the pain and suffering of the pandemic, we can still meditate on these good and encouraging events.

Beauty

We may not be able to visit art galleries or theatres, but we still can fill our minds with beauty. Normally, most of us rarely have time to regularly play music, paint pictures or watch films. But with our social calendars now emptied, we have novel opportunities to utilise the stillness and quietness of lock-down, for enjoying the beauty of music or art or literature or cookery at home.

Concluding Thoughts

As Wyatt mentions in his article, as Christians, we believe that truth, goodness and beauty find their richest and ultimate fulfilment in the gospel message of Jesus that we remember this Easter weekend. Out of love for us, he descended from Heaven to Earth to bear our pain and grief even unto death. He then defeated death by rising on that first Easter morning. The most truthful, good and beautiful thing we can fill our minds with, on a daily basis, is the gospel of Jesus.

As this pandemic unfolds, I am fearful of the effect it may have on my mental health and that of my friends and colleagues. These days are going to be challenging for all of us, for a whole host of reasons. But I do also believe one of our best weapons against Coronavirus is regular and disciplined hygiene – both physical and mental!

 

Benjamin Chang is an FY2 doctor in North London, former President of Christians in Science London, and a member of the CMF Speakers Track. He recently spoke on the struggles being faced by health workers during the COVID-19 crisis on the Speak Life podcast

 

Remember to join us every day at 7 pm (BST/UTC+1) for #COVID1900Prayer, a chance to pray for health workers, our nation and the world as we respond to COVID-19

Categories: Discussion

Compassion, faith and hope: preparing for COVID19 among refugees in the Bekaa Valley

Wed, 2020-04-08 08:44

Informal Refugee Settlement in the Bekaa Valley in Lebanon.

Susan is a Northern Ireland trained GP who sensed God was calling her to serve overseas. Having connected with CMF a couple of years ago, she came on our Developing Health Course and said ‘I have found my tribe‘ -people who had a heart for the same things as she did.

What Susan did not know was that in a very short time she would be involved in helping co-ordinate MEDAIR’s efforts to prepare for COVID19 in Lebanon, a country already coping with huge numbers of vulnerable refugees from Syria.

She writes:

‘The sun rises over the Bekaa Valley, and as in so many homes across the globe, babies cry, older kids and adults rub their sleepy eyes and get ready for the day. However, these families are some of the 1.5 million Syrian refugees in Lebanon. Try to imagine “home isolating” or “social distancing” when your home is a one or two-room tent -shared with ten other people. This is the reality for the Syrian refugees who live within the 6,175 refugee settlements in the Bekaa.

‘I am a Northern Ireland GP working in Lebanon with the Christian humanitarian organisation, Medair. Within this country, which hosts more refugees per capita than any other in the world, Medair is working alongside Syrian communities and low-income Lebanese families. Our aim is to help provide safer places for them to live, improved health care and community support.

‘Since I joined Medair here in February, I have been helping to co-ordinate our preparation and response to the COVID-19 crisis. Lebanon too has found itself in a whirlwind of the unknown and panic. Coronavirus finally breached the country’s attempted defences on 28th February, and we have watched the numbers steadily rise to 133 people confirmed to have the virus at the time of writing. It’s a very different role from what I anticipated. However, finding strength, purpose and peace through a strong faith in God, I am discovering that it is challenging but also a privilege to be part of an amazing team.

‘It has been a week when things have escalated dramatically worldwide. I find myself alongside other humanitarian Non-Governmental Organisations (NGO) workers, in meetings with the World Health Organisation, Ministry of Public Health and UN. Working hard to minimise my “imposter syndrome”, I realise that most people are just doing their best to get a grasp of what is going on. We all want to find the best way to deal with coronavirus while navigating a dangerously fragile economy. The cost of health and protection supplies has gone up 100 times in the space of one week!

‘We have now moved into the “Critical Programming” stage. This allows most staff to work from home with the exception of emergency or life-saving work. And yet, we are also preparing to ramp up for “COVID only” work. This includes holding awareness-raising sessions, manning ambulance helplines, providing transport and caring for those who are ill – both those with coronavirus and without. Despite our current Medair job descriptions, many of us are first and foremost doctors, nurses and midwives. There is much debate about what “Isolation” could look like in a refugee settlement. “Complicated” is a massive understatement!

‘A focus group was held with some of the Syrian refugees, and the responses were fascinating, although at times concerning. Many reported that they would not attend hospital for diagnosis or treatment, fearing expulsion from the country. Some of the camp members are incredibly proactive and forward-thinking. Meanwhile, others refuse to accept advice and continue their cultural practices of visiting the sick and following unhelpful traditional “cures”.

‘Although there is no official confirmation yet, we are working on the assumption that COVID-19 is probably already in the Valley and possibly in the unprepared camps. But, without a doubt, the most contagious diseases on the rise are fear and panic. Combating rumours and replacing them with facts has been one of my biggest battles so far.

‘The UN High Commissioner for Refugees (UNHCR) recently wrote that the coronavirus is a test of our systems, values and humanity“.

Dignity, integrity, accountability, compassion, faith hope
‘These are Medair’s six core values. As a global community, we can get sucked into referring to “cases” and “high risk populations”, forgetting that these are people with stories and loved ones. I’ve been struck that it has never been more important to keep Medair’s values in clear sight. Last week, at a meeting, there was uproar because one of the country’s first critical coronavirus “cases” had previously had a diagnosis of cancer. “Why was this not shared with the public?” angry attendees demanded. “It would have relieved so much public anxiety if they had known he was ill already“. When the noise finally died down, the speaker quietly responded, “We did not share this information, because the man’s family did not know he had this cancer.

‘Gulp! Dignity. Integrity. Accountability.

‘But then, in hope-filled contrast, I had the opportunity to speak with almost every member of staff in our team. The purpose was to ask about what they’d be willing or feel able to do if we go into “corona-only” humanitarian actions in the camps. I was also just concerned to see how they were holding up in the stress.

‘I came away, so encouraged and inspired almost to tears by these incredible people who, despite their fears, are finding courage and kindness. My favourite conversation was with a Lebanese member of our Monitoring and Evaluation team (a role that normally involves lot of statistics and numbers) –

Sous: “Dr Susan, I will do anything. I will do it all.

Me: “Thank you so much, that is really amazing…but Sous, the first two options on this list are roles providing health care for patients with coronavirus if they end up in isolation.

Sous: “Oh…OK…. But will you teach me how to help?

Me: “Of course.

Sous: “Then I will do it all!

Compassion. Faith. Hope.

‘It is such a privilege to work with wonderfully courageous teammates like Sous. People who have been living in survival mode for years, not just because of the current crisis. When our international staff were given the opportunity to return to our homelands because of the likelihood of Lebanon’s airport and borders closing in the next few days, it didn’t really feel like we needed the choice. For each of us, leaving was not an option. For me, the biggest challenge is not whether or not I will get coronavirus. As a GP back home, I would still be “front line”, but, rather, concern about being separated from loved ones, who also may become unwell. And yet, in the middle of so much that is unknown, as a Christian, my firm belief and hope is that safest place for my family and me to be is exactly where God has put us for this moment. Whatever may come.’

Susan Brown is a GP working with Medair in Lebanon

 

Prayer request for Susan and the Medair Lebanon Team: Points to praise God for
  • For protection so far in mind, body and soul. please pray that we would continue to be able to be a peace and hope carriers, from a place of overflow and not just scraping the bottom of the barrel
  • For our incredible National Staff team who despite their fear and anxiety are working over and above to help those around them, while looking after each other as well
Points to pray for
  • For wisdom as the team as plan and co-ordinate our response to COVID 19
  • For protection in health and travel for our team and also those that we serve here
  • For ease of physical access to be able to provide support to the people that need it the most
  • For so the people of Lebanon who have already dealt with so much and are facing the crisis often from a place of weariness and at times a sense of hopelessness

 

To find out more about Medair’s response to coronavirus, please visit: https://www.medair.org/emergency/coronavirus/

 

Remember to join us every day at 7 pm (BST/UTC+1) for #COVID1900Prayer, a chance to pray for health workers, our nation and the world as we respond to COVID-19

Categories: Discussion

The Developing World and not the West will bear the brunt of coronavirus

Tue, 2020-04-07 08:29

With 80 per cent of coronavirus deaths in Western Europe and the US, the focus of the world’s media has understandably been there. The UK alone has seen over 5,000 deaths to date, and rate of new deaths being reported is doubling roughly every three days.

But COVID-19 is affecting 199 countries and territories around the world.

Among these are 27 countries with between 3 and 40 deaths today (where the UK was on 14-19 March) and 28 countries with one to two deaths today (where the UK was on 5-13 March) – so that’s another 55 countries that on deaths per day are only 9-23 days behind us.

Of those 55 countries over 20 are in the developing world. At the current rate of spread – a twelve per cent increase in global deaths per day – we would expect to hit 100,000 total global deaths by today, 7 April, 500,000 by 21 April and 1 million by 28 April.

But if we were to run this forward to the end of the year what would we find?

new report has claimed that doing nothing to combat the virus would leave the world facing around 40 million deaths this year.

But they also claimed that up to 95 per cent of these could be saved if countries act quickly.

Researchers from Imperial College in London have looked at the impact of the pandemic in 202 countries using different scenarios based on data from China and Western countries.

Their conclusions?

If countries adopt strict measures early (at a stage where there are only 2 deaths per 1,000,000 population per week) – such as testing, isolating cases and wider social distancing to prevent transmission to more people – 38.7 million lives could be saved.

But if these measures are introduced later (at 16 deaths per 1,000,000 population per week) the figure could drop to 30.7 million.

On the other hand, social distancing alone would save only 20 million lives.

The effects of the pandemic are likely to be most severe in developing countries – communication is worse, health facilities are poorer, there are fewer health professionals and a high incidence of chronic infections (like TB) and noncommunicable diseases (heart disease, lung disease and diabetes).

Different demographics mean that older people make up a smaller proportion of the population (21 per cent of people in Wales are in the vulnerable over 65 age-group but only 3 per cent in Ethiopia) but this is more than compensated for by the larger populations and the increased risk posed by larger multi-generation households.

The ten most populous countries in the world include India (with 1,380 million people), Indonesia (273m), Pakistan (220m), Nigeria (206m), Bangladesh (164m) and Mexico (128m). That’s 2,371 million people – about a third of the world’s total population – in just six countries.

The ten next most populous countries include Philippines, Egypt, Vietnam and Democratic Republic of Congo (DRC) with a combined population of over 400 million.

This Is over twice the population of Western Europe (currently 195m).

There will be 25 times more patients needing critical care than beds available, compared to seven times more in high-income countries, the report says.

Seeking people’s compliance with infection reducing measures like social distancing in a wealthy and technologically advanced country like the UK where education levels are high and communication easy – everybody can be reached easily by text and social media – is one thing.

Achieving this in many developing countries where infrastructure, transport and communication systems are poor by comparison, literacy levels relatively low and where governments and police are more likely to be corrupt, unaccountable, under-resourced and unmotivated is another prospect altogether.

According to the BBC, after the lockdown was announced in India last week, people in Delhi and the financial capital, Mumbai, quickly thronged shops and pharmacies amid fears of shortages.

Meanwhile, millions have been left jobless and without money as a result of the shutdown.

It has also sparked an exodus from major cities, where thousands of migrant workers are setting out on long journeys back to their home villages after transport was stopped.

India ranked only 80th in Transparency International’s world corruption perception index in 2019. Indonesia, Pakistan, Mexico, Nigeria and Bangladesh ranked even lower at 85th, 120th, 130th and 146th equal respectively among the 180 countries included.

Corruption means that nothing can be achieved quickly and efficiently. But as the virus spreads, only the most draconian measures will lessen the impact and the countries least able to protect themselves will be among the hardest hit.

Prof Neil Ferguson, from Imperial College London and author of the report, said: ‘Our research adds to the growing evidence that the COVID-19 pandemic poses a grave global public health threat.

He adds that ’sharing both resources and best practice is critically important if the potentially catastrophic impacts of the pandemic are to be prevented at a global level.

Strategies to suppress the virus will need to be maintained in some way until vaccines or effective treatments become available to avoid the risk of another epidemic.

The West has huge expertise and now experience in battling COVID-19. But what will we do to help the less-advantaged global south as they face an even bigger challenge?

One thing is clear – if interventions are to have an impact and go any way towards saving 95 per cent of the 40 million who could die this year then we must act quickly. In a matter of weeks, it could be too late.

We cannot wait as long as we did in the West before acting – as developing countries do not have enough hospital beds and oxygen, let alone ventilators to provide back up if prevention of the spread of the virus is unsuccessful.

 

This blog was originally posted on the ICMDA Blog on 30 March 2020 and is re-posted here by kind permission.

Categories: Discussion

Caring for your mind during lockdown

Mon, 2020-04-06 08:37

When Boris Johnson announced a UK-wide lockdown, my immediate response was fear and dread. Many people are currently living in fear of catching Covid-19, and understandably so. However, for some of us, this virus may present a greater risk to our mental health than it does to our physical well-being.

I find myself in this category. I have struggled for many years with recurrent depression and OCD, and I have learnt that getting well and staying well takes a lot of effort and persistence. For me, it also takes consistency; change is my nemesis. A new job, increased workload, moving house or anything else new and stressful can threaten to trigger a relapse. Many of the things that keep me well involve getting out of the house. For example: going to work, being involved in a church community, playing with my wonderful nephews, socialising with friends, or simply stroking every fluffy dog I meet in the park! Lockdown has put a temporary pause on many of those things and has summoned back my old foes, change and isolation.

Let me be clear, lockdown is an essential part of fighting this virus, and it is important that we comply with these restrictions. I am not complaining about the lockdown, and I am immensely grateful for those still going out to work on the frontline. However, this crisis impacts all of us, and some will struggle with the emotional impact more than others. For instance, some of you may already be dealing with a mental illness and find that your treatment and support has been interrupted or reduced because of this crisis.

These are tough times, and a lot is outside of our control. However, thankfully there are still some things you can do to look after your mental health or, if already unwell, to help you recover. I’ve chosen seven to get you started.

 

  1. Be careful what you feed your mind

We feed our minds just like we feed our bodies. Right now, watching the news excessively and constantly scrolling through social media is the psychological equivalent of drinking poison -it will make you sick. More specifically, it may provoke anxiety, despair, increased loneliness and even hopelessness. Yes, you may want to keep up to date with what’s happening in the world and stay informed of ever-changing guidelines, but you should limit how much time you spend doing this. Set a time each day that you will engage with the news, limit that time to no more than 30 minutes and then put the news away. Unless you live in a cave with no contact from the outside world, other people will inform you of anything important you have missed.

 

  1. Routine, routine, routine

Full disclosure: I hate routine. Routine is boring. I want to get up when I feel like it, stay up as late as I want and do my work at whatever time I choose. However, this would be a very bad idea. Sometimes the things which help us mentally are boring but necessary. Routine is one of these things. Your daily routine has changed, so make a new one that you can stick to throughout lockdown. Plan a time to get up in the morning, a time to complete whatever tasks you need to, a time to exercise, relax and connect with others and a time to go to bed. Then stick to it. Making yourself go to bed at a reasonable time may be boring, but it is essential. Your brain needs sleep, so give it what it needs. If you struggle with sticking to schedules, don’t beat yourself up but do try again tomorrow. Eventually, you will get into better habits.

 

  1. Go outside and exercise

I hate exercise. Believe me, I much prefer sitting on the sofa watching Netflix while scoffing a crème egg. However, the evidence is irrefutable – regular cardiovascular exercise improves mental well-being. It releases endorphins, increases energy and improves self-esteem. The problem is when you are depressed or anxious, the last thing you can be bothered doing is going for a run or hopping on your bike. If your motivation has disappeared, then start small. If you have somewhere green within walking distance, then why not unplug, leave your phone at home, listen to the birds and notice the sensation of breathing in the fresh air. Even if you prefer exercising indoors, make sure you still use that one permitted trip out every day. You may not enjoy it at the time, but you will feel better afterwards. If you are struggling to do this, ask someone to text you each day and check you have done it. And ignore your brain when it creates excuses to stay indoors. We don’t live in Siberia; you really won’t freeze or melt in the rain; you have a coat for a reason!

 

  1. Spend time with God

Just as physical health impacts you mentally, so does your Spiritual well-being. Don’t get me wrong, mental well-being is not the aim of spending time with God, rather it is to deepen our relationship with him, be transformed by the Spirit and bring God glory. That said, it also improves mental well-being. In this time of global crisis, the only true and lasting peace is the peace of God (Philippians 4:7). The only real comfort and hope is to be found in the one who has conquered death and gives everlasting life. There is so much other noise competing for our attention, even in lockdown, so make sure you are taking time each day to listen to the voice that matters most. Cast all your anxieties on him for he really does care for you (1 Peter 5:7).

 

  1. Connect with others

Good relationships are key to mental health, and yet mental illness can torpedo your motivation to connect. When I am depressed, I desperately want to withdraw from everyone and everything. Being around others feels exhausting and socialising can trigger self-critical thoughts such as ‘I’m so boring’, ‘nobody wants me here’ and ‘I’m a burden.’ However, withdrawal makes depression worse. Let me repeat that: withdrawal makes depression worse. Right now, we are physically distanced from one another, but we need to stay socially connected. So, pick up your phone and reply to your messages. If you live with someone, spend time with them. Say yes to that Zoom call and connect with the people who care about you. You may not want to, but you need to, and the more you force yourself, the easier and more enjoyable it will become.

 

  1. Challenge unhelpful thoughts

Right now, your mind may be predicting worst-case scenarios or telling you lies about yourself or about God. For example, ‘my loved ones will definitely die’, ‘I am so useless for not being able to help’, ‘God must not be loving or in control’, ‘I will certainly fail my exams’ or ‘I’m a failure for feeling like this.

Do not trust all your thoughts because thoughts can lie. Unhelpful thoughts left unnoticed and unchallenged can lead to anxiety, despair, inappropriate guilt or misdirected anger. If you are struggling emotionally right now, then take notice of what you are thinking, write those thoughts down, and check out if they are in-keeping with reality. If you feel anxious, perhaps write your worries down as they arise, place them in a jar and give that jar to God in prayer each day. If you struggle to challenge negative thoughts by yourself, then share them with someone you trust and listen to their perspective on them. However, set limits around this, so you don’t ruminate on them all day. Most importantly pray that God will guard your mind and help you believe what is true and reject what is false.

 

  1. Ask for help when you need it

Those of us who work in or are training in caring professions are notoriously bad at seeking help. Yet if you are struggling emotionally, this is the bravest thing you can do. Speak to someone you trust, phone your GP or make use of other support services. However, maybe you have already done that, but now it feels like that help has disappeared with social distancing. I know things are more difficult, but there are still people you can talk to. Your GP or mental health practitioner has not disappeared and will be doing phone consultations. Many counsellors are offering online video sessions; crisis helplines are still running. A&E remains open, and the people who have been helping you still exist and still care about you. This season will pass and face to face support will resume. Until then, focus on the resources that are available and do the things which you can do to aid recovery.

 

Perhaps you want to talk to someone at CMF about how you are doing emotionally or spiritually. CMF have set up a pastoral care and well-being programme to offer free, confidential one-to-one support to any healthcare student or practitioner in the UK or Ireland. If you would like someone from this team to listen to you, journey with you through this season and pray with you, we are available seven days a week. Most of the team are current or former clinicians, and all have experience in listening and pastoral care. We can also signpost you to other services if appropriate. Email  wellbeing@cmf.org.uk and leave your name and number so someone can give you a ring. You don’t have to be a CMF member to access this, and we aim to respond to everyone within 24 hours.

Categories: Discussion