Facing COVID in the South Asian Community

We are joined by two wonderful psychiatrists Dr Shevonne Matheiken and Dr Poorna Nagasinghe for South Asian History Month. In this podcast, we discuss what it's like to have family living back in South Asia during the pandemic, the effect of COVID on deprived communities and finding solace in singing. 

See our South Asian History Month page for more related content including a number of blog posts.

Transcript

Ella Marchant: Hello and welcome to the Royal College psychiatrists podcast with me Ella Marchant. This month at the college we are celebrating South Asian History Month we will be interviewing two psychiatrists, Dr. Shevonne Metheiken and Dr. Poorna Nagasinghe. We will be discussing what it's like to have a family back in South Asia during the pandemic, the effect of COVID on deprived communities and finding solace in singing.

Shevonne Metheiken is a higher training in the East of England. She has additional interest in transcultural psychiatry, digital psychiatry, physician wellbeing and advocating for international medical graduates. Poorna Nagasinghe is a higher trainee in child and adolescent psychiatry. Poorna completed her primary medical qualification in Sri Lanka prior to moving to the UK and achieved her Masters at University College London. Her current interests are developmental psychiatry, family therapy, and mentalisation based therapy.

Okay, Poorna, Shevonne, thank you so much for joining me today for South Asian History Month. Poorna, could you tell me how you got into mental health?

Poorna Nagasinghe: It's a long story actually. So, because I always believe that when it comes to mental health, it's so important, as you might know, like there's a thing called "Mens sana in corpore sano," which means how the mind resides in a healthy body. But more so I believe that there's no health without mental health.

So, prior to moving into UK, I worked in a paediatric unit. So, in Sri Lanka, actually, I'm from Sri Lanka. And I always wanted to work with children. So, my first post here in UK was in a highly specialised inpatient unit in a psychiatric hospital. And it helped me to understand how multidisciplinary approach works. And I really like the holistic approach they took when managing patients. And that inspired me to come into psychiatry. And because of my love of working with children, I also decided to go into the field of Child and Adolescent Psychiatry. So, it actually perfectly worked for me. I like the field that I'm working in at the moment. And I'm glad that I made that decision. Because it also gives me the opportunity to manage my work and life in a balanced manner.

EM: And Shevonne, can we hear from you as well please, on how you got into mental health. 

Shevonne Metheiken: Hi, Ella, thanks for having us. So, I grew up in India, in the South of India in a state called Kerala. I had quite an early interest in psychiatry, say from high school age maybe. And went into medicine with the intention of doing psychiatry, though my dad who was a surgeon was quite confident I would change my mind. But going back to the reason why I had Catholic uncle, a priest and aunts who were my dad sisters, who lived in a convent in a rural village, and they had a psychiatric hospital and a rehabilitation centre for women with mental illnesses right next to their convent.

So what became routine was every time we visited them, which would be multiple times a year, we would also go to see the patients there. And the ladies living in the rehabilitation home. And there were no age restrictions, like in the UK in terms of children visiting and things. So in a way, I got to interact with them. And the patients really close, right, from a very young age. And I think things did stay with me from that. For example, I noticed few years on how a lot of the ladies living in the rehab, were actually living there permanently. Whereas my understanding was that it was more like a respite centre for their families where it was meant to be a short period of time. So when I asked, I was told that it's because a lot of the families didn't come back for them. And I think that really stayed with me it sort of showed me how much of an impact stigma had. Of course, it was not all with evil intentions.

There's a lot of financial implications when there's someone with serious mental illness in the family. And there's also implications for the siblings because it's predominantly at least back then used to be arranged marriages and it impacts on the siblings being able to get married because of the stigma of mental illness being inheritable. And just the general stigma in general.

So, all those things stayed with me. And I think that's what sparked an interest. So, when I came to the UK after my MBBS, I started training in psychiatry, and I'm now at the registrar level, but at the opposite spectrum of age-interest as Poorna. I like old age psychiatry the best. 

EM: And you were saying that service users were left at this nunnery?

SM: Yeah, so. So, what happened was, it was meant to be like a short term respite for the families, because there's less community support in a lot of places. And this was a very rural place. So, in the hospital that I mentioned, it was run by nurses, who were also nuns, and they only had the resources for a psychiatrist to come from the city one or two days a week. And this the rehab centre attached to that turned into a therapeutic community, or as we used to call it, where they would end up living because some of the families didn't have the ability to look after them if they took them back home, because there would be other financial implications of having to go to work. Whereas here, of course, the system is different. And there's that community support and the whole healthcare system is different, which is where the sort of deprived communities bit and the financial implications come in. So yes, so in the sense, it was meant as short term, but they ended up living there, out of no choice, and the nuns continue to look after them.

EM: Okay, thank you for explaining that. So how are the COVID waves in your home country affecting you in terms of having family who are living in South Asia? I don't know if either of you do. But Shevonne, could you take this question?

SM: Sure. Um, so I have my immediate family in the UK. So, I will say that I'm probably a lot luckier than many IMGs, I mean, international medical graduates. But what it's been like is I do have extended family there, I have my husband's family there. And it was almost like our waves were throughout 2020. So all the fears and anxieties, many of which were reasonable, whether we would all be okay, by 2021.

We have four ethnic minority doctors in the family in the UK. And as you know, from the RCPsych task and finish group's first report, more than 90% of the ethnic minority doctors who died in the first wave were more than sorry, more than 90% of the doctors who died were from ethnic minority. So, there were lots of fears. And somehow that year passed.

And as soon as some sense of normality started coming, and my parents came out of shielding after like, 15 months, that's when the COVID wave, the big COVID wave in India happened. And it was, it was really difficult, because it was almost like we were out of it. And then it was a different kind of pain, I think it was very difficult because there's this moral injury that, you know, you can't be that to help. And you're also very conscious of the difference in the health care systems. So, you know that everyone is not going to have the same access to health care, whether it's, you would have heard about the lack of oxygen and doctors really struggling as well in terms of decisions that they had to be taking. And the cultural relationships and expectations from a doctor in the family or in the extended family from relatives, is very different.

So, I think that adds to the model injury on top of all the emotional worries and fears for your family as well. And, as always, I think it impacts newer doctors who and any healthcare professionals who are new to the UK, who just come and people are still coming even during the pandemic, and they've had a really difficult time. For example, I know couple of junior IMGs, who who've lost parents, I know people who have not been able to go back for funerals, because they've just started their jobs in the UK and it's red list countries. So, all that sort of when you know all that's happening, it does take a toll and yes, I would say it would be fair to say it's had an impact on many of us. 

EM: And Poorna the same question to you. Do you have any family still living in South Asia?

PN: Uh, yes, Ella. I mean, my situation is different because my family actually lives in Sri Lanka and I'm the only one who's living here. So, the situation in Sri Lanka is a bit different because we were doing well to begin with initially and then the since mid April, the total number of COVID cases are on the rise. And there are about over 2,000 new cases each day that they come across. And currently, the number of active cases are over 30,000 in the country and country has a huge shortage of vaccines and struggling to administer a second dose of vaccine within the time period.

And the so, the initially being in a country that was doing well, and then going from there to red list country, it was actually a huge shock to the system because my parents got locked down with me during the first wave of COVID. And they were here and then they moved back to Sri Lanka. And my parents actually were among the group of people who were waiting to have their second job. And luckily, just about four days prior to that, sort of the due date, they managed to get the vaccine. So, it was a huge relief for me, but at the same time, I felt so anxious and worried and also helpless, because of being about 11,000 miles away. I, What can I do? I mean, I tried to contact and like the because the whole country is going through the difficult time. So, it's really difficult to sort of ask for someone to help because like everybody's all in the same boat. And I do feel what others might be going through right now as well.

And we are, Sri Lankans who are here, we are making a pledge to the UK Government to send the 600,000 vaccines that are needed and before the end of June, but I don't know whether we would be successful or not. But I sincerely hope it will be because I can I feel really sad for the people who are actually waiting for the vaccines. And they're, they're struggling to get the second tools. And at the same time. Sometimes I feel like we are at a better place when it comes to vaccines. And now the countries are going through this huge wave because they don't have the required facilities. So, so it actually created a lot of anxiety and tension that I'm in here with me at the same time within my family.

So, working in sort of a different country far away from home that certainly brings I mean, as Shevonne mentioned, it takes a toll. And, so, you need to bear this tension while working and then to sometimes feels like you need to park it aside, and then carry on with the rest of your life. So yeah, it has had a huge impact actually having a family back in the country.

EM: Yeah, sounds really, really challenging. Because you can't park that while you're trying to just get on with the day. It's hanging over you.

PN: Certainly because I mean, I could remember I was feeling really, really anxious going, leading up to I have us thinking like, Oh my god, it's I don't think it will be possible because everybody was trying to get like get the second dose and I was feeling so anxious. But luckily, I mean, like they had their second job before the due date. But there's a huge number of people still waiting, I feel so sad about them because I didn't think they have the same dose like the because they used to vaccinate with the AstraZeneca, the Oxfordshire, but then the country run out of it. And now they have introduced another vaccine. But the people who are still waiting, they're still waiting. So yeah, I hope actually this pledge would be successful. So we would be able to send it to the people who are in need.

EM: Shevonne, what is the impact of COVID on you and your extended family?

SM: So, Ella, I think it's changed as time goes, it was different maybe ups and downs right from the first wave to now due to different reasons. Initially, it being sort of all the supports that you had as your parent to young children being taken away because my parents had to go into shielding. We actually started their shielding before the government advice came because you're hearing reports from Italy and it didn't sound nice, I'm a bit neurotic anyway. So, I was like we have to, you know, protect them and we have my brother me and my husband work near them in hospitals and we didn't want to put them at any risk. So, that obviously added to a lot of day to day stress.

And then going forward, I had to I did have some trouble with anxiety. I haven't spoken a lot about it. And I did reach out then to practitioner health and have been getting therapy before that, which is not surprising given the statistics that have actually just been released about their pandemic report, which showed 78% of the doctors that reached out were women during the pandemic to practitioner health. And it was similar with the psychiatry support service in the Royal College as well, which was around 72% women. Of course, it would be multifactorial, but I think it just helps to highlight the sort of impact there has been and obviously you couldn't stop doing everything you were doing. So, there were all these projects, I was doing PTC work, I was leading the well being workstream, which was a bit too close to home to do in this particular year. Because everyone's talking about wellbeing now. But it's it's not that easy. And it's complicated. And you have to go through your own journeys as well in the process. So yeah, I think I'm in a good place now. And I'm hoping the worst is over. But in terms of impact on the wider family as well I think that coped better with the shielding process than just being stuck at home mum, not so much.

And in terms of extended family, we know people who've died, it'll be very different when I go back to India, i've never missed India so much ever, it's been the longest I've been away. And I know that even though we've had to reschedule so many times when we whenever we do manage to go, there'll be lots of people who are no longer there who were there before friends and family. So that's a very sobering thought. But we go on, I guess, and just try process at all, as time goes on.

EM: It's such a sad story as well, Poona. Is there anything that you'd like to add to that on the effect COVID's had on you and your extended family?

PN: Yes, Ella. I mean, you know, when it comes to the uncertainty, actually, that I always feel that there are two dimensions to it. Like, that the pandemic actually falls very much onto the zone of like, unsafe uncertainty. So, it created too many unknowns in my personal and professional life, because I worked in a unit and it got shut down temporarily. So it had, so I had to work and in a different unit which brought unexpected changes for me. And also for my training, and my family who were there with me, they couldn't fly back, as the borders got shut down. And initially, the homeschooling I had to homeschool my child. But it was quite challenging as well. I mean, like, I'm sure Shevonne might be sharing the sort of the same experience that I did. And initially, it was so challenging to get a little one to do homeschooling. And then after two weeks it became quite difficult.

So, at the same time, I felt like I was the biggest sort of the risk factor for my parents who are here, who came here just for a holiday, and then it got extended because they couldn't fly back. So every time when I come back home, I felt so anxious and that I would maybe carry something with me so. So, even though there were pros and cons, but at the same time, I felt actually quite relieved when my parents went back, because I didn't feel that I'm carrying that risk with me whenever I come back home. So, it brought actually a lot of challenges that also, sort of later on helped me to sort of reflect more about the uncertainty of life really, and how the things that we take for granted actually could have that the huge value in it. At the same time I haven't been to my country like just like Shevonne I was planning to visit Sri Lanka last year, which I postponed and of course in this year as well, I don't think we can fly because Sri Lanka is a red list country now. So, the not being in contact with the sort of the extended family it has a huge impact. And I mean, when we go there, I think it will bring up a lot of emotions at the same time. I think it will be quite overwhelming as well. 

EM: It's definitely going to be an emotional reunion and it's so sad to think that you're not just separated by a car journey. It is a really, really long journey to get there and it's like, there's only so much that video calls can do. 

PN: Certainly, and my son, I mean, I'm a single parent. So, my son is actually quite close to grandparents because they've been, visiting me quite frequently to help me with a bring up the child. So, he's extremely close to, especially to granddad and I mean, we call Archie grandma. So, he keeps saying, "Oh, I miss I miss them mummy." So, but, I mean, I explained him, but at the same time, I feel like it helps my child to build up the understanding of actually the importance of the family life at the same time, sometimes the difficulties that brings, like being living in two separate countries. So, yeah, I mean, if it certainly when we go back, it will be hugely emotional at the same time. Quite relieving, actually. So, I'm waiting, I'm counting days, I hope that they would come soon.

EM: Shevonne, can you describe the kind of effect COVID has had on deprived communities?

SM: Well, I'm not sure if I'm the right person in terms of expertise. But in my simple terms, I think what COVID shown is that I did hear this phrase, and it sort of stayed with me that we're probably all in the same storm, but not in the same kind of boats. So, whether it be starting with lockdown, and people who were in flats with young children without any fresh air options, or people who had a nice garden to get some fresh air, who would have found it a bit easier, obviously, all whether it be the risk of mortality or the risk of contracting it.

Or if you think of in our wider global perspective, with regard to the healthcare systems, or differential access to vaccines, like Poorna was referring to all those things sort of stand out very clearly through this whole thing. And it's a very uncomfortable feeling to hold on to. And I guess how you cope with that is everyone tries to do what they can so especially when you have a connection with your heritage, and so for example, diaspora organisations in the UK, so for example, for India, BAPIO, BIPA, they've all been doing lots of work with regard to the COVID wave, financially with providing teleconsultations. And we try joining everyone does their bit to, to sort of alleviate the little suffering that's possible, even though you know that it's only a drop in the ocean. And some amazing seniors have done things like bereavement training for children who've lost parents in India, sort of training teachers and doctors how to support them. So, yeah, I mean, it's definitely an issue, and I think it's raised lots of public health discussions in terms of how we build back fairer going forward post pandemic. But yeah, there's lots to think than lots that COVID has taught us, I guess.

EM: Poorna the same question to you, please, you could draw on communities in the UK or communities in South Asia?

PN: Yeah, certainly. I mean, of course, as Shevonne mentioned, actually, of course, we are in the same storm, but not in the same boat, I mean, people might have heard a lot about this, because even COVID it strikes us almost not at random. It feels like that, because the mortality is much higher in elderly people and poorer groups and ethnic minorities. And also it affects the economics, in the sense that the community is much poorer communities that the economic fallout is more and especially when we look at the exposure to infection, it is unequal because the deprived communities where there's overcrowding, the poverty and then people who are more into manual jobs, so where they have to do certain face-to-face work. And so for that matter, the exposure to the COVID and the risks are higher. So, even though they want to sometimes the prevention is better than cure, but actually the prevention becomes quite difficult and hard for them. And even though we ask all the sort of the measures to take, but how can they because they are deprived. So, this the effect actually in UK as well.

Globally, it has shown that the, the preventative aspect cannot be sort of, I would say everybody cannot use the same sort of measures in these settings. So, it actually doesn't help. So, hence, the reasons for the sort of the widespread, actually from the Asian countries partly might be due to that as well. Of course, we know about the mutants, but at the same time, the living conditions matter a lot, especially when it comes to spreading. So, I mean, I feel that sometimes, even though we know what to do, what needs to be done, but there are certain constraints when it comes to deprived communities, which becomes unfortunately a barrier. So, that put them under a disadvantage. So, even the lockdown measures, so it has sort of a disproportionate effects on the low income families with especially with younger children as well. And so that the living expenses, the extra cost that is needed, so they're struggling, so the impact actually is not equal. And so they are worst off, unfortunately.

EM: And moving on to one of our final questions, and it's a big one. How do you think you would handle a pandemic, if it were to happen again, it's obviously not something that we hope ever does happen again. But now that we've experienced one for the first time in our lives, is there something that you think you would do differently from, you know, from here in the news, because it was so unbelievable, at first that we would ever go into a UK wide lockdown that we wouldn't be able to travel. And now all of that stuff is is a reality, so Poorna, how do you think you would handle a pandemic, if it would happen again?

PN: I mean, I thought this would be the last pandemic that I would see. But so but certainly, it could happen again. But I think the learning from this pandemic is quite key. I mean, I'm not an expert at the same time, but in reading about it, and what we have sort of experienced over the last one and a half years. I think there are, there's a lot that we could learn if, if, if it happens again, I mean, I've certainly for me, I think we, I would certainly act more swiftly and need to impose, unfortunately, the tougher measures at the beginning. So, because if you go early and with stricter measures, we could have sort of controlled the peak sooner.

And also, I think the other aspect would be the effective communication. Because I've been, I certainly felt overwhelmed by the wealth of information that was coming about my personal life, about the professionial life, wherever you go, you get new information, new things to do with the changes, it's too much to keep up with. So, like effective communication, maybe from government, like maybe a text message saying like, this is what's happening, this is what you need to do. So, it's simple as such, so people can just understand actually what's happening in day to day life. And also, these messages being maybe bit concise and simple. So, they know, okay, fine, this is the current rules at the moment and this is what we need to do. And also the other key would be testing, because I think if you can test ramp up the testing, like initially, and then isolate, and trace, that would contain so it's basically going swiftly and more tougher restriction at the same time with good effective communication and testing and tracing. So, that would be my way, if I things needs to be done differently.

EM: And Shevonnne do you want to? Do you want to have a crack at the question? Or should we move on to the next one?

SM: No, I'm happy to give it a go. Right? So, with regard to what would happen differently next time, on a personal level, I would definitely keep a journal because I quite enjoy finding old entries from years ago, especially during sort of hard times in life and you forget what it was like and I love reading that I would definitely keep a journal. And in terms of a wider perspective, I think hindsight is a wonderful teacher. But I think there should always be willingness to learn from others mistakes and also what others are doing well.

Suppose I mentioned about the communication and I was reading that Taiwan had an amazing digital minister who tackled very promptly all the miscommunication and all the conspiracy theories that were cropping up because she'd employed comedians specificly to target this through social media and within 24 hours of any new conspiracy theory coming, which obviously has a lot of impact on vaccine uptake, and how much people adhere to precautions and things. So, there's a lot of good things I think, which will take time to learn from as we move on and hear how things happened in different parts of the world. But on a personal level, like I think it was about holding on to the good things that came out of it professionally and personally. And I think I would like to see it as something that gives strength for whenever the next big crisis in life happens, which, which may not be a pandemic, but I'm sure we'll all have crisis again.

EM: And on a final, a more positive note, during lockdown, there's been a lot of talk of kind of sustaining, I mean, trying to have a good mental health trying to have good mental wellbeing. And have you renewed your interest any South Asian art or music? And have you been able to use it to support your own mental health?

PN: Yeah Ella, I mean, I'm very much into music, I love music. And I used to do singing when I was back in the country. And so music actually, it has always been part of my life. And I always enjoy, I would say, the music would match the mood that I'm in. So basically, during the lockdown, I've started doing vocal lessons, because I wanted to get back to singing. And so it hugely helped me to sort of boost up my moral and to feel actually sometimes, on a bad day big thinking, well, certainly lift up my mood.

So, this is something which actually, I started during lockdown, which it is quite positive. And I'm hugely proud about it. And also Shevonne, like, I can sing in different languages, so I can sing in Hindi as well. So, I thoroughly enjoy sort of different thinking in different languages.

EM: That's absolutely amazing. And so, so amazing that you can sing in different languages as well. Shevonne, is this something that you've rediscovered as well, while you've been in lockdown?

SM: Ella, I have to be honest, and say that I honestly haven't had the time to do that. I'm very impressed with lots of colleagues, including Poorna who've managed to. I do have some ideas. But my immediate task was to just get through this. It was just that lack of headspace, I think with the young kids hats off to Poorna for managing homeschooling, I only had to do it for the two weeks when my oldest son's teacher had COVID. But I wouldn't have coped with clinical work. And that continuing so I'm really know of everyone who managed that.

So, I did learn Carnatic music, classical music in childhood as well. And I think besides that, it was more about just feeling a bit more connected. So, it would be little things that I realised I missed more. So, for example, at the school run, my son goes to a very diverse school in England and when I would hear lots of South Asian languages being spoken by parents speaking various languages, just at school drop off, like it would bring back a lot of memories, and all those little things that you miss so much, it's just sort of come back. So, I'm really looking forward to going back and sort of reconnecting with everything whenever it's possible. And just yeah, my take home for myself, was to just slow down a little bit after this whole thing is over. And so I've taken some time out, extended time out for various reasons before I go back as ST5.

So ,that's been my take away from this because I've just need to slow down and take everything in and you know, think about what really matters, which I think is what one of the things that pandemics taught us. So no, nothing exciting to share on that.

EM: I think just getting through the pandemic, as you say is an achievement in itself. You can only put one foot in front of the other.

PN: Yes, certainly. I mean, I agree with that. But at the same time, like I think it depends on the things that are important for you. So, for me, it's very much actually part of my life. I love listening to music even I mean it's not it started well before, so it's even before pandemic. I think that understanding the priorities for oneself is quite important. In this case, actually, the music goes well hand-in-hand with my life. I think, yeah, it helped me.

SM: Having said that, Poorna, I've started listening to Hindi songs a lot more than I used to before the pandemic. So, I'm with you. Hopefully, I'll get to a point where you are in the next few months once I stopped doing a lot of the things I'm doing now.

EM: So thank you so, so much for today you've both been amazing. Thank you to both our speakers, Shevonne and Poorna, for talking to us about their families and what they've experienced during the pandemic. If you would like to read our blog for South Asian History Month, please go to our website www.rcpsych.ac.uk, select News and Features at the top of the screen then choose Blogs. Thank you for listening to the Royal College of Psychiatrist podcast with me Ella Marchant.