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  • Writer's picturePaula Fontenelle

I've moved but I'm still writing

Thank you for coming here. I'm happy to share that I've accepted an invitation to blog for Psychology Today, the largest mental health portal in the United States. I'll be writing about mental health with a focus on suicide prevention. Please check my new blog by clicking below:

Psychology Today Blog

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  • Writer's picturePaula Fontenelle

Remote communities are hit the hardest

In the second week of March, when the Coronavirus was widely spread in Brazil but few people knew, my friend Helenita took her father-in-law to the hospital. At the age of 91, Iwalty Tarcha was showing signs of dehydration and refused to eat. The doctors told her that he would need to stay for a few days due to his advanced age and apparent frailty.

Iwalty was diagnosed with pneumonia the following day but the doctors guaranteed the family that the disease was unrelated to Covid-19. Three days later, he was dead after a brief period of intubation.

Helenita knew that the virus was rampant in many hospitals of São Paulo, the state with the highest number of registered deaths in Brazil, so she decided to be cautious about the funeral. “We wanted to reduce the risks of contamination, so only three people attended,” she told me. On that same week, my friend, her husband, and daughter fell ill. It was during this time that they received a call from the doctor who had treated Iwalty informing them that his test for the Coronavirus had returned positive. He had actually been contaminated while in the hospital. By then, all of them were sick; her husband experienced the most serious symptoms, including two weeks of high fever and fatigue.

Photo: Paula Fontenelle
Photo: Paula Fontenelle

Helenita’s ordeal was not over though. Four days after the death of her father-in-law, her mother, who lived 260 miles from São Paulo and had been struggling with her health, also died. “Again, I could not go because we were all sick at the time and I didn’t want to pass it on to other members of the family. It was devastating for me because I could not attend either Iwalty’s burial or my own mother’s.”

In less than two weeks, Helenita experienced two rushed, nearly empty burials; both impacted by the restrictions imposed by Covid-19. She couldn’t say good-bye to her mother and no one had come because of the recent stay-at-home order issued by the state. “Most of our relatives were not even informed of her death until days later. One of the most difficult things for me was not being able to hug my friends and family,” she told me over the phone.

Stories like Helenita’s are happening every single day, in all corners of the world, but the grief these families are facing is radically different because they can’t count on the traditional rituals that mark the loss of a loved one. Not only that, but these deaths are occurring during a time of extreme fear and uncertainty, which adds layers of suffering to a moment that when mourners usually focus on finding ways to adapt to the recent loss.

Rituals have rich symbolic value. They provide family and friends a healing path that is communal in nature. These moments create an opportunity to acknowledge the death, to feel comforted by loved ones, to start the adaptation process, and to know you are not alone.

When you die by Covid-19, the opposite happens: funerals have limited attendance if any; no contact with the bodies is permitted; memorial services are discouraged, and even when they happen, the soothing effect of physical touch is not possible due to social distancing guidelines. When talking to the clinical social worker Jill Johnson-Young for my podcast, she reminded me that another compounding problem is the fact that family members are left behind without knowing exactly what happened to their loved ones, which often leads them to imagine the worst:

"It's leaving families with all the thoughts in their heads about what probably happened, and that's causing even more trauma for them because all they have is their imagination and all the stuff on the news and on on social media. The images are terrible. At the same time, they are hearing "this is not that dangerous, it's no big deal, it's just the flu, except that it's not because their loved ones are dying."

Photo: Katie Maehler

Rituals are also culture-specific and many communities have seen their traditions being ignored due to discrimination, poor access to health services, and many times, blatant disrespect by the authorities. In Brazil, traditional and indigenous populations have been hit hard by the pandemic, approximately twice the infection rates when compared to the national average.

One of these communities are the Yanomami, Indians who live in the rain forests and mountains of the Amazon River basin in northern Brazil, bordering Venezuela. For them, death is followed by a succession of rituals that include the public viewing of the body, its cremation, the distribution of the ashes among various members of the community — in some cases, the ashes are ingested — and the burning of all the possessions of the deceased.

For the Yanomami, it is extremely important that the ashes remain within their tribe as a form of respect for their shared history, but since the spread of Covid-19 in Brazil, their bodies are being sent to distant cemeteries and their families have not been permitted to attend the burials. This rupture in the way they grieve has provoked a further sense of alienation from a society that has historically deprived them of the basic rights most Brazilians hold.

This scenario has impacted not only the Yanomami but all the surrounding populations in the area, which has the highest contamination rates in the country. As a way to help contain the virus, a group of Brazilians, including the renowned photographer Sebastião Salgado has created a fund to guarantee medical treatment and humanitarian support to these vulnerable communities. “It is a sad irony that the populations who live in the Amazon forest are dying for lack of oxygen,” says Natalie Unterstell, co-founder of United for a living Amazon. The initiative will benefit 112 indigenous groups in the region; 9.166 have been infected by the virus; 378 have died. These individuals live in remote areas with little or no access to medical care.

Photo: Erik Jennings

According to Erik Jennings, a neurosurgeon who works with semi-isolated ethnic groups who live in the Amazon region, to some indigenous populations, Covid-19 has had the impact of genocide. Part of the problem is the fact that most of the resources are concentrated in large cities and hospitals, while small communities are left to their own devices.

The dire situation of these ethnic groups was brought to my attention by a friend who is involved with this project in Brazil. After talking to him, I decided to participate by helping them bring awareness to this health crisis so that they can reach their fundraising goals.

If you can, please donate to the cause.

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  • Writer's picturePaula Fontenelle

For more than a decade, I have been working with suicide prevention and I know from experience that it is in times like these that we need to be extra careful with those at risk. But this article is not for them only, it is for all of us who are in the privileged position to help others, for those of us who woke up today not worried about where we will get the money to feed our kids, for those who can sit in front of the TV to binge-watch, and for those of us who are wondering how they can support others but don’t know how. There are many ways in which we can do that, so keep reading and find the ones that fit you.

When it comes to the Coronavirus and suicide, three visible impacts immediately raise a red flag: society’s increased isolation to contain the spread, the financial strain it has been provoking in families, and the limited access to mental health treatment many patients are experiencing.

Isolation is a central drive to suicide. Most people who contemplate it believe that what they should not share their pain. They feel ashamed, scared, and uncertain of how they will be perceived by others. Every time I am contacted by someone who is going through this, and I respond, they react with surprise. Every single time. You know why? Because they did not expect it. Suicidal people are certain no one cares, and even when they are not, they don’t know how to express what is going on with them.

The stigma surrounding suicide silences society, including those who are contemplating it.

Mental illness is also a key risk factor for suicide and right now, the quarantine is forcing clinics to shut down services and offer remote sessions only. This helps only partially because not all patients have access to it, particularly those who are served within community and agency settings. They will also have a hard time buying their medication because these are the individuals who are paid by the hour in jobs that are in a halt right now, so they might not have the financial means to afford their pills. Add this to having less social contact and limited medical assistance in hospitals who are rightly prioritizing the Coronavirus, and we have a concerning picture ahead of us.

We have been bombarded by an overload of information about what we can’t and shouldn’t be doing right now, so I decided to flatten this curve. I will focus on positive actions that will make a difference and will strengthen our human connection.

Here are some ideas:

1. Keep physical distance, but don’t disconnect — Use your time to check in with friends and loved ones. There is no reason not to phone (yes, the old-fashioned way), message, video chat, whatever works with you. If you know someone who struggles with mental illness, particularly anxiety and depression, believe me, chances are that they might be feeling worse right now. These conditions thrive during uncertainties and fear. Let them know you care. Create online communities. Again, we have to keep our physical contact at a minimum but this does not have to apply to emotional connection.

2. Maintain an exercise routine — This is key to maintaining mental health. Gyms are closed? Search for online classes, there is an infinite number of options out there. Invite friends to do it together. Offer practical help to those in need: Are they of age? Many elderly rely on their friends and family member to bring them food and medication, but this may not be possible right now. Offer to do their groceries for them. If you prefer to minimize risk, use online shopping, most supermarkets are still delivering. Older people have a hard time using technology, so do it for them.

3. Be compassionate, share your privilege — Many workers who are paid by the hour are in dire need of financial support. If this is possible for you, be there for them. For example, if you have a cleaner, keep the payment even if they are not able to provide the service. Establish a time frame that is comfortable and affordable to you and let them know what you can do. Maybe pay them in advance for future service? Give them this peace of mind. Buy gift cards from local small services, such as salons, pet shops, etc. Many offer this option online.

4. Track medication intake and needs — The drugs used for mental illness have unique characteristics. They have to be taken regularly because if not, it takes the patient weeks to regain mental, emotional, and behavioral stability. Ask those you know about their supply, whether or not they could use financial assistance and if they are older, offer to pick them up for them.

5. Parents need support — Parents have been hit hard by this. They suddenly have to home schools their kids and keep a balance between keeping their kids safe while offering them a distraction, meals, and emotional support. Check in with them regularly, maybe take turns in homeschooling, for example by doing it online. Exchange your experiences, foster community building.

6. Attend to spiritual needs — During a crisis, those who have faith and spiritual beliefs meet their communities in search of comfort but this is not possible right now. Again, use online tools to pray together, create forums and chat groups, for example. Invite your religious leaders to do the same, maybe they just don’t know how. If you don’t either, ask your 10-year-old child, they will. :)

7. Talk about emotions — Keep a line of communication open about fear, anxiety, and sadness. We are all experiencing these in much higher intensity than normal, so let’s share not only what we are feeling, but what has been working for us.

8. Last, but not least, foster joy - Send memes, watch a comedy together, play a game with your family, anything that will generate smiles and laughter. Create positive memories so that in the future, fear and anxiety will not be the only things to remember this moment by.

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