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Coronavirus Disease 2019

How South Africa Is Handling COVID-19

An interview with Dr. Thirusha Naidu on coping and resilience.

Thirusha Naidu, used with permission
Source: Thirusha Naidu, used with permission

Even as COVID-19 has taken a toll on South Africa with its infection rate, compassion and cooperation have helped people cope. Dr. Thirusha Naidu explains how, and gives advice on how to cultivate resilience during the pandemic.

Thirusha Naidu, Ph.D., is a clinical psychologist and head of the psychology unit at King Dinuzulu Hospital Complex in Durban South Africa and lecturer at the Nelson R. Mandela School of Medicine and the University of KwaZulu-Natal. Her clinical work incorporates psychotherapy for people living with severe mental health challenges in resource-constrained settings. Thirusha’s research spans the areas of Health Professions’ Education and the Health Humanities. She is currently writing about decoloniality, equity, and social justice in medical education and Global North-South engagement in medical education and research. She is interested in poetry as a medium in academic spaces and her works have appeared in Qualitative Inquiry, Academic Psychiatry, and the South African Journal of Psychology. Thirusha is a Fellow of the Karolinska Institutet Prize in Medical Education. She is co-editor of the book Talk Therapy Toolkit and is a co-author of the upcoming book Without Compassion There Is No Healthcare. Leading with Care in a Technological Age, McGill-Queens University Press.

Jamie Aten: How would you personally describe the COVID-19 situation in South Africa?

Thirusha Naidu: I can describe the COVID-19 situation in South Africa from my perspective as a researcher and a psychologist in a public health facility. South Africa has the fifth-highest COVID-19 infection rate in the world but a lower death rate than expected. The mental health situation is complex and multifaceted. People are accessing public mental health services less than before. This is counterintuitive as anxiety is pervasive and almost everyone can relate to COVID-19 related mental health issues. The explanation may be fear of contagion or to avoid the long screening queues that may be encountered at public health facilities.

Repercussions are only likely to emerge far into the future. Clinicians and researchers must recognize, anticipate, and plan for these repercussions. Whilst South Africans generally view themselves as tough survivors having lived through apartheid and its demise as well and the AIDS pandemic, even the most resilient South Africans cannot withstand the current social and economic restrictions with no end in sight. Health professionals on the frontline and in clinical context appear to have become less reticent about seeking help and support around the mental health challenges they face in the context of their work.

JA: What are some ways understanding South Africa's COVID-19 situation can help us live more resiliently?

TN: Perhaps as a result of having experienced many challenging events historically, South Africans in general and the South African government have taken the threat of pandemic seriously. Despite the initial phases of the lockdown being harsh and what could have been described as "draconian" in other settings, South Africans in the majority have followed the government’s recommendations—e.g. wearing masks in all public spaces and encouraging others to do so. The president offered a sense of security giving clear concise information in consultation with scientists.

Protest action is common in South Africa and many protests emerged around transport and business-related restrictions during the latter phases of the lockdown. It might be argued that protest action in South Africa is seen as necessary from a citizens’ perspective and a form of bottom-up mass communication by government. This creates a channel for even the most marginalized voices to resist.

The combination of having learned to take the threat seriously and making attempts to be prepared; as well as balancing responsiveness and adherence to government decree with a right to protest action that will be acknowledged as legitimate is what others can learn about being resilient from South Africa’s example.

JA: What are some ways people can cultivate resilience amidst this pandemic?

TN: Unprecedented times call for imagination and innovation in how we cultivate resilience in ourselves and encourage it in others. Compassion, compliance, and co-operation can be drivers of resilience in a pandemic. In modern society we tend to value our individual thoughts and rights above group and community rights. However, the practices of compassion, compliance, and co-operation require acting from a place of humility to place ourselves with others and in some cases behind others.

Lockdowns saw people confined in close proximity, having to isolate from elderly or vulnerable family members or having to be alone for lengthy periods. Health workers and other frontline workers suppressed fears for their personal safety and faced the pandemic directly. All this says that to cultivate resilience in a pandemic, we need to be reflexive about who we are in the world and how the privileges and disadvantages we live with shape how we ride the waves of a threat. Do we lament about how our lives and rights have been restricted? Or do we recognize the opportunities to be grateful for personal safety and access to basic resources? Do we think about our personal health and public health in the same terms?

How we think about these things determines our level of resilience. Cultivating resilience means looking at a seemingly unshakable negative reality from a position of personal and communal hope.

JA: Any advice for how we might use what you have learned to support a friend or loved one struggling with a difficult life situation?

TN: Fully present listening is helping. Approach the conversation non-judgementally and be forgiving towards the person in need and yourself in the discussion. Mistakes and incorrect assumptions will be made but if the relationship is important and continuous there will be room for revisiting these in the future.

Listen with humility, to understand, not simply to answer. This involves asking simple short clear questions to check your understanding of your friend or loved one’s experiences. Retell what you have heard, in your own words, to verify and list the main important points of their story and to ensure that you have heard their meaning the way it was intended. It is useful to be still and leave quiet spaces for reflection and respite.

Be respectful in your attitude and approach. Here, it helps to decide to believe that what the person is relating is what they genuinely believe to be true. This practice has been referred to as demonstrating "unconditional positive regard" or recognizing that people are the "experts of their own lives." Avoid the temptation to provide solutions. Your solutions may not serve your loved one as well as you. Ask what kind of help, if any, is required.

JA: What are you currently working on that you might like to share about?

TN: Modern medicine dominates healthcare in the world today so that we see science as unquestionable and based on reality. My current work asks, "Whose reality?" As a researcher, I am trying to bring to medical education, and research in particular, the idea that modern medicine is underpinned by a Northern (Western/Eurocentric), gendered, and racialized worldview. On a conceptual level, my work tries to show how modern science is biased to this view and thereby shapes how health, illness, medical education, and research unfolds on a global level.

In medical education, I am working to introduce theory about resistance, epistemic injustice, and epistemic disobedience (resistance to the oppression of worldviews) to encourage Global North and South medical educators and researchers to engage in more globally equitable health education, research, and practice. I teach and conduct research on contextually relevant communication and practice within my own profession and other health professions. I encourage practitioners to suspend judgement and trouble the boundaries of their practice in ways that are responsive to contextual, social, and historical determinants of health. In academic writing practice, I resist by blurring the hard lines of academic writing by incorporating poetry and creative writing interludes into "serious" academic papers.

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