Do Doctors have fear?

The short answer is 'Yes, loads of it'.

Doctors are worried about the impact of the COVID epidemic on their family, health and finances. The call of duty seems such a burden now. It is fear that is making people avoid covid duty- the complaints of poor pay, poor facilities, unfair demands- these are all mere excuses.

Fear is definitely warranted too. The administration and society at large has been jealous of the imaginary privileges that doctors have- actually doctors have no privileges. They pay the same rates and taxes, and have to encounter the same struggles as in the average person's life. The deep resentment of the community towards doctors manifests as repeated persecutions in subtle and forceful ways. Thus doctors, too have lost trust.

Doctors want to know if they will get ppe, medical treatment and in event of demise - something of a support for their family. Many doctors are the only breadwinners of their families. So its very reasonable for them to be fearful. A simple answer to convince doctors to work is to offer them these facilities in writing- a proper letter of appointment mentioning all the things is needed. Anything less indicates an administration that is commitment- phobic and not trustworthy. How can you expect someone to put their life and the security of their family at risk for some flimsy verbal assurances?

The administration, particularly senior doctors in positions of authority need to understand the psychology of fear and address it because it is legitimate. Going for COVID duty without any sort of documentation based on which doctors can hope for even the basic care and compensation- I dont think other corona warriors are being expected to do so. I exhort the senior doctors to stop speaking threatening words of punitive action and instead initiate a dialogue to dispel fears of doctors. It should be done for every person in this situation- why not for doctors then?

We are confused and not at all serious about COVID

so I stepped out to get some essentials from the medical shop and I was relieved to find just one customer before me. Only one customer allowed in at a time and I could see what was happening from my place outside. Grandma had a 4 year old with her. And they were trying to choose a bag of chips. So each bag of chips was shown to the youngster who held it for a while and then returned it so she could see what was the next choice. The girl had a large, ill fitting mask hanging under her chin and Grandma also wearing something resembling a mask. After a good 20mins wait, I had to request them to hurry up and then after another 10mins of haggling over the price they were leaving. So I asked Grandma why she was outside with a small child and she showed me that the child had a rash that hadnt gone for about a week now despite the Doctor's advice. She was here to show the rash to the chemist. The Dr's note said 'Chickenpox' and sure enough the kid had a rash all over body that was typical of chicken pox. Grandma not convinced, pharmacist refused to treat the child and so Grandma proceeded to the next shop for advice.

Coming out I notice most folks roaming quite casually without masks. At a bread shop, the owner asks the customer 'where is your mask?'. Asks him to stand back to maintain social distancing. And as if the shopkeeper has abused him the man shouts a tirade at him about being insensitive to an old man who has merely been forgetful! Next I go to the lab for my blood test. Every new person has to be instructed by the staff to wear their mask properly and maintain social distancing. Most people wear their masks to cover only the lower lip. Its too hot when the mask covers the nose. And if it covers both lips, we cant talk. Some wear it like a scarf bunched around the neck and then pinch one end of it around the nose sometimes- how they decide when the nose and mouth are to be covered I could not find out.

Covid epidemic is real. And its spreading fast in Mumbai. Studies have shown that it can be controlled if everybody uses a mask- a fabric mask is sufficient. But the mask has to be worn by everyone, at all times when outside the house and the mask has to be closely fitting to cover the mouth and nose. How can this detail be conveyed to the public?

COVID- 19 and my experience

COVID-19 has affected people's mental health in different ways. Its not all bad. For example children are thrilled to bits that their parents are around. Except for people in troubled families, generally everybody is appreciating this time they are getting with each other. The need for diversion and entertainment has actually gone down with people really discovering that they love to just do things around the house or be with their family members.

However, I was much surprised that I saw a spurt in referrals for acute psychosis. It appears that people here have vulnerability to psychosis, as a population. Its also possible that the other folks reached Psychologists, while Acute Psychosis cant do without a Psychiatrist's medical intervention so I had to see them. Anyway- people developed delusions about having COVID- that then progressed into delusions of persecution that someone was trying to give them COVID purposely and so on.

Our Police and Chief Minister have constantly been worried about poor compliance to the lockdown orders. In my mind, this is a problem that needs to be researched and understood from a psychology perspective. The non cooperation is a feature of 'normal' individuals and needs to be understood from the perspective of culture and personality. Expert in fields of sociology, anthropology and social psychology need to be consulted on getting a plan to avoid overcrowding. It something urgently needed, because the triad of social distance, hygiene and personal protection will need to be followed for a long time to come.

I expect that this year schools will need to be online. I am not going to present the practical issues like lack of devices, etc as that is not the worry of a Psychiatrist per se. My problem is: As we are not allowed to prescribe stimulants after tele-consulting, learning challenges of children with ADHD may be magnified.  We Psychiatrists will really need to come out with coping strategies for families with children. A lot of their learning will have to be supervised by parents and parents need to be seriously empowered by modules on teaching along the lines of home- schooling. But home schooling isnt as rigid as a regular school curriculum is- and therefore parents are going to be struggling to cope with the speed. So schools also need to see if they can have a time table where longer parts in one subject are covered in a day and only 1-3 subjects done daily.

As we brace for a new lifestyle a lot of learning and unlearning will be needed and what do you think can help families and children?