Dr. Sanju George is a psychiatrist in Kerala, India.
The first documented case of COVID-19 in India was in Kerala, where it reached through a medical student from Kerala who returned from Wuhan, China. The spread of COVID has so far been contained very successfully, even though Kerala is densely populated. However, Kerala has a very large expatriate population (3.4 million) and an average of about 16.7 million tourists arriving annually, so things might very well get worse once the lockdown measures are eased. In terms of its public health policies and implementation, it would appear that so far Kerala has been a “model state” for India in the fight against the spread of the COVID-19.
To curb the spread of COVID-19, the Government of India announced a country-wide lockdown, including Kerala, on 24 March 2020. As part of the lockdown, a key public health strategy was to restrict contact between people; that included limiting people leaving their homes, shutting shops, workplaces and places of worship, and restricting access to public transportation and ending social gatherings. These restrictions were designed to ensure the maintenance of the best possible physical distance between people and thereby reduce transmission of the virus.
As the lockdown and these public health measures had to be hastily implemented, there have been several (mostly unavoidable) deficiencies in its imposition and management, including the impact on the psychological well-being of individuals. Most common psychological reactions to these situations include stress, anxiety, depression, substance use and exacerbation of pre-existing mental health difficulties. There have been recent reports of increased domestic violence and child abuse in Kerala; other psychological symptoms have included internet addiction, depression, anxiety, mood swings, binge eating, insomnia and relationship difficulties.
I am a doctor, a psychiatrist, who splits his time between teaching and seeing people with psychological difficulties. As part of the lockdown my college was closed and we switched to online teaching. I truly appreciated the benefits of technology and also realize that much of teaching and related work (such as student mentoring, teaching, staff meetings, interaction with parents and so on) could be done equally well, if not better, online. I am sure this crisis will change the face of education and travel forever. For the better, I am sure.
The lockdown made me restrict face-to-face contact with patients and wherever possible I resorted to tele-medicine (tele-psychiatry). Many patients seem to prefer this mode of consultation, since it does not require them to venture out of their homes and come into a hospital environment, which would have increased their risk of exposure to COVID-19. I was seeing more and more patients who suffered from depression and anxiety caused by the lockdown. Loneliness and isolation among the elderly was also a particular problem I witnessed in Kerala. Kerala has a large number of its people (in the working age group) working away from home (in other parts of India or outside India) and consequently many old people have no choice but to live on their own. Of all the patients I saw recently, three images stick in my mind.
First was a 45-year-old man from the UK whose father had died here in Kerala. He couldn’t travel home to Kerala to attend his father’s funeral. Second was a 28-year-old lady whose 2- year-old son died in an ambulance, because of the delay in reaching hospital. Both were in overwhelmed by immense grief and made me think about what could have been. Third, was a young girl who committed suicide because she was cyber-bullied. This brought to light the dark and dangerous side of the internet. I met her parents. I didn’t have the right words to make them feel better. I merely listened, that’s all I had to offer. I’m haunted by several unanswered questions: Who is to blame? Why? Is there more I could have done? They all wanted to be heard and comforted. I hope they found some relief in speaking to me and in prayer.
This period of lockdown severely impacted how I practice my faith, too. Sundays were never the same. I missed church and church-related activities. For the first time in my life, Holy Week passed without my being able to go to church. I had to watch it all on television. At first, it seemed superficial. Gradually, I came to like talking to God from the confines of my prayer room. I felt re-connected with God and the void in my heart was soon gone. Perhaps, this is the new way of practicing one’s faith. Yet again, technology has been a great help: some of us from our church formed a WhatsApp group to pray together and listen to God’s messages, and to carry on his Gospel work.
It has given me a lot of time to think and reflect about not just me and my family, but also about those near me: the less secure, the less privileged and the vulnerable. Through our church, some of us in my family visited several elderly people nearby to check on their health and well-being. We got them provisions, helped them pay their bills and sometimes just gave them company. We did this across religious and language barriers, and this was very well-received. Through our college, we ran a telephone helpline for the people of Kochi and this was taken up by men and women, the young and the poor, the professionals and the downtrodden. Mostly, people wanted to talk and wanted to know what was normal and what was not. Some needed reassurance, others needed counselling, and some required longer-term help.
I also got to spend more time with my wife and two children. I must say that, although this was enforced, I enjoyed it thoroughly. I got to play more with my young children, did some gardening and I derived pleasure from taking life slow and easy — getting up late, taking my time over coffee, spending time in prayer, doing regular exercise and connecting with nature over long walks. I’ve had more time to catch up with friends and family, albeit via WhatsApp/Zoom calls. I re-awakened my culinary skills — much to my wife’s relief and delight. My children and I made kites (although we didn’t fly them with great success), recorded videos of birds in our garden and studied earthworms. What I enjoyed the most was making cookies with my children, and cooking Sunday brunches for my family.
This whole experience also made me very humble, having realized how little is under our control (despite our illusions of grandeur) and how small and irrelevant our individual lives and priorities are. It made me stop and think. It made me slow down and appreciate God’s blessings in my life, the good in others and what is truly important. I am glad to be alive. I am glad to be living in “God’s own country,” Kerala, with my family close to me. I have God by my side and that’s all that matters.
I haven’t yet got answers to some questions though — like when my 8-year-old son asked me, “Dad, when will God stop COVID? He loves us, doesn’t he?”
Yes, he does. Believe!