Saturday, May 8, 2021

Covid -19 condemns Botswana to a disenfranchised grief crisis

By the end of this week at least 71 Batswana had died from Covid-19. For most Batswana who are now going through a Covid-19 information fatigue the 71 is nothing but a number.

For the 71 grieving families, friends and relatives this apparent societal trivialisation of their loss is not helping their disenfranchised grief.

Giving an insight into how Covid-19 health protocols make the mourning process painful and difficult to go through, Social Work Senior lecturer at the University of Botswana Dr Poloko Ntshwarang explained to Sunday Standard Lifestyle that, “the deaths of COVID-19 19 impact all of us, patients, friends, family members, and the society at large. In all honesty, care is supposed to meet both the physical, spiritual, psychological needs of everyone especially the patient. So, when someone is sick and they can’t be with their family it is painful. We have palliative care and best practices for caring for patients, COVID-19 19 defies such kind of practices because it distances the patient from their loved ones and vice versa. When someone is sick, they may be in both physical and emotional pain and sometimes the physical is made worse by not being in a proper emotional state of mind with family and friends around you.

We also have to bear in mind that gadgets like phones and tablets which are now being used to as a means of getting closer to the patient don’t always work for everyone. Some people aren’t technology savvy, some might not have the physical capacity to even use those things. Although they prove convenient, they aren’t always fulfilling, face to face social interaction is actually more important that we care to think. We have lost basic human interaction.  Spiritual needs are also no existent. We don’t have the opportunity to gather, we don’t have spiritual encouragement to gather, prior to this pandemic, churches used to go to hospitals and pray for people but now your own church members can’t come and see and pray for your recovery and it makes people lonely and scared all alone.”

The distressing experience surrounding the death of Botswana’s first Covid-19 casualty, a 79-year-old Ramotswa woman revealed the extent to which grief associated with Covid-19 is disenfranchised. Her dying wish was to be buried in her backyard. Relatives rolled their sleeves and broke their backs to grant her last wish. Midway through digging the grave and preparing for the funeral, government officials rocked up and stopped everything.

The grieving family was told that home burials had been suspended, so they could not grant their matriarch her final wish. Between reeling from the anxiety and frustration of not being able to honour their mothers last wish and running around to find a last-minute alternative burial site, they were told they would not be able to say a final goodbye to their mother. The old woman could not be buried in her finest and favourite clothes. Instead, it was the grim anonymity of a hospital gown. Her corpse was sealed away and the family was told they could not see her one last time before her body was interred.

Some Batswana families are having to deal with worse. Dr Orapeleng Phuswane-Katse, medical physician with the Ministry of Health share with the Sunday Standard the pain of seeing Covid-19 patients die lonely deaths.

Surrounded by their caretakers, ensconced in their face shields, N95 respirators, contact gowns, and nitrile gloves—fully insulated from loving human touch. As the coronavirus stalks victims around the world, one of its scariest aspects is how it seems to feed on our deepest fears and prey on our primal instincts, like the impulse to be close to people we love when they are suffering and near death. In a painful irony, the very thing Covid-19 patients need in moments of fear and anxiety could also kill theirs loved ones. As a result, many friends, relatives and family members can’t get to their loved one’s bedsides to whisper last goodbyes or reconcile old grudges. Religious end-of-life rituals, too, have been stripped away. The unspoken tragedy of this whole COVID experience has been the loss of humanity toward the end of someone’s life. The presence of strangers such as health care workers at the death may not mitigate the loneliness of the experience.

Dr Orapeleng Phuswane-Katse’s account confirms versions by sources close to Covid-19 death beds who revealed that the healthcare providers who are already exhausted with work overload, and living with the constant fear of contracting infection themselves, may sometimes compromise their capacity to express sensitivity and empathy to patients and bereaved relatives. They may also be affected by secondary and vicarious trauma which again jeopardises caregiving.

Dr Orapeleng Phuswane-Katse bemoaned that, “to rob patients and their families of the last goodbye is something painful and heart wrenching to see. Due to the nature of the disease, a patient who seemed to be getting better can suddenly get worse, which means they have to be admitted to hospital. If treatment fails, terminally ill patients will be on their deathbeds completely isolated. Usually, doctors-nurses try to be by the patients in these times but given the danger of transferring the infection and the sheer volume of patients, they are unable to do so. It has a heart-breaking impact on the people who lose loved ones, when that person has died alone. This is one of our biggest social taboos, we believe that people should not die alone. In the current circumstances, it’s probably more accurate to say that how we treat the dead is being altered. The focus has shifted to safeguarding public health –the physical health of the living (against the threat posed by the virus). People are now forced to mourn in isolation. Closure is very important for the grieving process. A loved one dying alone takes a huge mental toll on families. It impairs the family’s ability to grieve and cope with the loss.”

This does not only affect families bereaved by Covid-19. Because the virus is easily spread by contact with respiratory secretions, local hospitals and healthcare institutions are now discouraging visitors to come to the hospitals to see their family or loved ones. This includes death-bed patient who are dying of other illness. Thus, most patients are dying alone in hospital rooms with only strangers at the bedside during their last breaths. The moral conflict (being held back from doing what you think is right) among care providers when they see patients dying alone is unbearable and leads to ongoing grief and sadness. Prior to the pandemic, family members could see their loved ones in the hospital through the course of hospitalization, be with them as the illness progressed over days to weeks to the end of life. COVID-19, has however, forced hospitals to be somewhat inhumane – pits the desires of dying patients and their families against a duty to minimize the spread of the pandemic.

This led to stark restrictions in visitor policies in health care facilities, with even more strict rules for patients stricken with COVID-19. However, the visitors would not be able to hold and comfort the patients in their last moments, which is when a person with serious illness often seeks solace and comfort from a familiar face and voice. Under normal circumstances, these acts of mercy would not have seemed indistinguishable from cruelty. For families and friends who have lost loved ones, it’s an agonizing experience that has left them bewildered over how to grieve and find comfort during the pandemic. COVID-19 steals the precious final days, hours and moments spent together when a loved one is dying, leaving those grieving in emotional limbo, and sometimes feeling guilty that their loved one died alone.

This is not helped by the fact that for bereaved family members, relatives and friends, the proper expression of grief is curtailed. The impact of the loss is unaddressed and the grieving process is inhibited. The protocol of Covid-19 burials limits the number of people who can attend the funeral. This prevents friends and other relatives from physically reaching out to the bereaved and offering support. Most traditional bereavement practices and rituals which are associated with giving loved ones a proper and dignified send-off have been banned.

Disenfranchised grief which is a clinical condition occurs when a person’s loss cannot be openly acknowledged, publicly mourned, or socially supported. This can trigger the onset or relapse of psychiatric and physical disorders There are fears that this pandemic may lead to a national mental health pandemic.

According to health officials, Disenfranchised grief can have multiple effects such as depression, emotional disturbances, withdrawal from society, psychosomatic illnesses and low self-esteem. Compared to those with more socially accepted types of grief, many of those dealing with disenfranchised grief tend to abuse substances and have difficulty in forming healthy relationships. Moreover, people dealing with disenfranchised grief often have trouble in coping with subsequent losses.

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