Bruised faces, shrivelled figures, exhausted health workers and panicky populace. This is the grim scenario of the world that greets the screens of most Television sets in our Homes. Scenes of nurses and doctors running to save lives, people wheeled up and down the corridors of hospitals and isolation centres, grim and pain-aching recollections of the relatives of patients. All this fill the air and are constantly transmitted to the world by every media outlet seeking to “stay relevant and on top of the news” of the coronavirus. As the New York Times of 29th April in the opening paragraph on the Covid-19 Units recounts; There is little respite for nurses working with the Coronavirus patients… when nurses do take a break, a soundtrack of wailing sirens reminds them what lies ahead on their return.” This and more instances tell the horror, the shocking episodes and experience of our society. Gripped in fear of the contagion, anxious about the falling economy and the rising death tolls, greeted with more and more horrendous news of lockdown, and with little hope in sight for the cure, the world has woken up to 2020 as the year of nightmares that never goes off the mind. Can we uninstall 2020 and install it again? This one has virus. This comic relief relates the unexpressed desires of so many.
There is an existential void. In his short piece on fertile void, Daniel Nilson captures an aspect of the human paralysis: We are isolated from each other and starved for real human connection and touch. It is impossible to measure the toll this has taken on us from being deprived of human connection… Everyday seems the same as boredom rises more and more. We have lost the meaning of our days. Everyday seems like the previous one. Will there be a cure soon? What will become of us if no vaccine is found in the nearest months? Will life return to normalcy? More questions than answers are on the minds of many people. The stream of sad news, the bombardment of the mind with rising figures of death and the panicky situation created by various persons across the walk of life. All these; do we know how much they impact on the mental health of both the frontline workers, the patients who are victims of the pandemic as well as the population that sits back at home is a semi-prison like circumstance? While we battle for survival is on-going, the aftermath of the pandemic will have a huge gap for mental health care.
Reaching and talking to people around Maiduguri, North-East Nigeria and those beyond reveals not only the human misery but the pile of mental health challenges of varying degrees. I Fear for my health as it worsens every day. If one does not die of this coronavirus, one might die of the deprivation and side effects of this deadly disease. But what on earth is all this! This expression of Mairo resonates the anxiety of thousands in the midst of the global novel Coronavirus Pandemic. Fear, anxiety, self-isolation, these are words often used these days. However, we run through it so quickly that we fail to note the implications on the mental state of those who express them or even live with them. With the declaration of Covid-19 by WHO as a global pandemic on 11th March 2020, so much has changed in the lives of individuals, families, communities and nations.
Global and local concerns are those of knowing the nature of the virus and putting measures to stop its spread. The anthem; regular washing of hands, social distancing, avoid large gatherings, see a doctor when you experience any of the symptoms (fever, dry cough, shortness in breathing or frequent sneezing) have been well taken in and recited by everyone like a parrot. These obsessive-compulsive-like patterns of life rigorously shoved down the minds of people has its consequences. While increasing hygiene practices, they rob people of the spontaneity and normalcy desired. They raise fears and push people to already believe they are contagious. Truth is that they show the vulnerability of each person, but in this case of Coronavirus, vulnerability is taken for infection.
Living in Maiduguri, North East of Nigeria where already the Boko Haram/ISWAP on-going crisis has reduced the population to refugees in their fatherland, traumatized thousands and left many barely surviving, the additional case of Covid-19, worsens the mental health of the survivors of this de-humanizing violence.
Musa who lives in the neighbourhood with Internally displaced persons relates; We cannot shake hands nor embrace each other the way we use to, we cannot visit our neighbours without coming home to wash our hands before anything. Worse is living with fear, not sure if along the road while in the tiny “ keke napep” one has picked up the virus from an unsuspected person. Everyone is suspect.
Suspicion, mutual mistrust, isolation and restrictions. These now underlie the interpersonal relational patterns. This view of Musa above underlines the heightened sense of fear, mutual suspicion and isolation that the Virus has brought. Not only has it fractured the fragile fraternity enjoyed by the majority of the Internally displaced Persons (IDPs) but has added suspicion and reduced social contact. The visible affection hitherto enjoyed as the social norm to reduce the pain of separation and frustration of being driven from their homes is now compounded by social distancing rules.
More and more people feel the pain of this isolation. An isolation not only physical (which is precautionary) but social and psychological. The contagion has changed the mode of perceiving and interrelating. It has created a psychic distance and upset the fragile social balance. Fear rather than trust drives people to action. This is gradually robbing us of rationality and turning the world into a little cave. To survive in this cave, one must keep the adrenalin high.
Speaking to Esther a one-time victim of Boko Haram hostility, she said; I have a serious pain in my stomach. When it starts, I cannot sit nor lie down. For three days now I am not able to eat. Sometimes I just feel my head ringing and my heart pounding. I do not know what is wrong with me. I am afraid to go to the hospital as anything now is considered a Coronavirus case.
A visit to Maryam, an old woman who was suffering from a different ailment showed how deeply seated her fear was. How sad to have many children yet I live alone without any help. Imagine if I die now, no one will come to my funeral. I cannot even stand up and help myself. I thought with this lockdown I could rest but instead, I am down with this sickness. Coronavirus scares me more than death. Or is it better to die than live such- a prisoner?
A routine which helped to put order into the daily lives and activities of many persons has now been cut short. People can no longer go out, nor engage in social interactions. These routines defined how much people feel about their success and their success in turn added to their self-worth. People are anxious, some feel frozen while others are frustrated and not being able to do the “normal”. Adjusting to a complete lockdown does not come easily. With poor housing set up, erratic power supply, limited space to move, restrictions to meet friends and relatives, the stressors become overbearing.
A nurse who works with the old population spoke of her fear about keeping the in-patients safe. But added to the fear, is the constant frustration of the old people who cannot have their families visit them in the hospice. Many times she has to place a video call to the families of the old who feel lonely and abandoned. On her part she says;
I easily get tired; I notice my anxiety growing everyday. Now I work 12 hours a day and at night I have to go for a routine check by 3:00 am to ensure the grannies are alright. Our auxiliary workers can no longer come in to help us. We make do with the resident personnel to wash, treat and feed the old-people. Everyday I am overwhelmed by the fatigue of work, by the fear of what could happen should an emergency arise and by the constant emotional breakdown of the very old ones.
Another side of this pandemic is the pain and frustration of siblings who are separated from their loved ones after the contagion. They are instructed to self-isolate for 14 days. And should the worse happen, they are deprived of proper mourning of the loss as they cannot witness the funeral of the deceased. This aggravates the grief and loss. This already resonates with the fear of Maryam above of losing every form of consolation and sibling presence.
The level of anxiety is high. The stress on normal life has increased and people are developing an obsessive-compulsive trait or even worse a paranoid perception of each other. Some are showing mild forms of depression. We do not know how much longer people can hold on. Cases of frontline workers returning home to cry or even cry at the bedside of a dying patient abound. Those who feel locked at home are getting bored, if not frustrated. This calls for a serious intervention. While searching for medical solutions to the pandemic, the unintended effects of preventive measures are a serious challenge to mental health. An all-inclusive approach that integrates psychoeducation, psycho-care and wellness must be placed on the table too. For instance, tele-media houses could add to their jingles not just messaging on how to avoid the virus but also messaging on how to live healthy at home and stay mentally fit.
We must begin to plan now and work even faster to alleviate the impending mental health disaster. While economies are hoping to open and slowly grow, schools dreaming of resumption, sporting activities warming up for a re-start, yes all these will contribute to the restoration of normalcy, but more capacity building and resilience work has to be done. Now is the time to begin to roll out those resilience-building techniques to avert further repercussions.
Note: All the names in this article are pseudonyms. The real names of the persons who spoke have been changed to maintain confidentiality and privacy.
Father Joseph Bature Fidelis is a Catholic Priest of Maiduguri diocese and a Clinical Psychologist. He works as the Director of the Diocesan Psychosocial Support and Trauma Care in Maiduguri. He also works with Justice Development and Peace Commission to bring Help to Internally Displaced Persons.