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If you have not yet been infected, then you have definitely been affected by COVID-19.

Everyone is dealing with the so called new normal thanks to the pandemic. It means different realities to different people across the world as it continues to wreck havoc on lives since 2019. For some it has resulted in a numbing effect while for others it mimics daily addition of salt to a raw wound.

Many people have found great opportunities with this disaster but for many others it has marked huge losses, pain and disappointment. Whichever the case; the risk of poor health remains high due to the great level of uncertainty, scarcity of resources and stress. Therefore; it is important now more than ever to guard your wellbeing.

The combination of the direct effects of the disease on individuals and their families, and the indirect effect on financial security, unemployment and social isolation has led to an increase in emotional and psychological challenges worldwide. Lockdowns around the world have led to an increase in domestic violence cases as the victims are restricted to stay in the same place as their perpetrators, with no escape. Stigma and discrimination against persons who have tested positive for COVID-19 is another major source of distress, in addition to several already existing physical and mental health issues.

Worry, stress, loneliness, anxiety, depression, insomnia, harmful substance use, self-harm or even suicidal behavior and other emotional responses are to be expected during such times of instability; And; for those already suffering non-communicable diseases like high blood pressure, diabetes, cancer and mental illness, the extra pressure serves to exacerbate their conditions.

An additional challenge is that physical distancing regulations make it more difficult for many to access appropriate healthcare services. On the other hand; with the focus on bringing the pandemic under control, some local health facilities have been converted to COVID-19 care centres leading to deprioritization of non communicable diseases.

Self care should be a priority now more than ever. Taking basic steps to safeguard your health during these unprecedented times does not have to be complicated.

Start by being deliberate about the information you pay attention to. It is good to stay up to date; however, excess in the form of constantly changing alerts, continuous social media updates and mainstream media coverage if poorly managed can lead to infomania hence panic, paranoia as well as feeling overwhelmed despite the urge to want more. Screen sources for facts and relevance to your own reality before paying too much attention to them.

Know and practice self awareness. While there are various tips for looking after one’s health during this pandemic; not all would work for everyone and it is important therefore to realize what would work for you as an individual. Excessive pressure and uncontrollable stress even with good intentions only leads to triggering or exarcerbation of health problems. You cannot control and manage everyone and everything but you can be intentional in making choices that would promote your own physical, mental and emotional health. 

Physical activity will keep your health in check. Step out and appreciate your environment. Take in a deep breath of fresh air and enjoy feeling it go through your nose into your lungs; let go of stress as you exhale. Challenge yourself to at least 30 minutes daily of exercise that makes your heart beat even a little faster and your body sweat. Regular exercise has a profound positive impact on non communicable diseases as it relieves stress; improves memory and immunity; helps you sleep better; and boosts your overall mood.  

Eat and hydrate well. Avoid excess of anything. Do not skip meals in the name of losing weight. Observe that your diet has at least protein, vitamin and carbohydrate. These can be locally available foods therefore don’t need to be costly. Avoid smoking, excessive alcohol and any other psychoactive substances because they increase the risk of non-communicable diseases which in turn affects your life expectancy.

Get a good night’s sleep and speak to your family physician if suffering insomnia. Good-quality sleep makes a big difference to how we feel. Try to maintain your regular sleeping pattern and stick to good sleep practices such as avoiding screen-time in bed.

Maintain positive social connections as part of your self care. Building stronger, broader social connections in your life including with family, friends and other associates can increase your feelings of happiness and self-worth. Constant meaningful communication and a practice of genuine empathy goes a long way in achieving this.

Be kind to yourself. Taking time just for you, even if it is just a few minutes to retreat and just sit.  Pay attention, listen to your body and respond to it. Be intentional in assigning standards and value to yourself and do not beat yourself too much over other people’s opinions of you. Remember, not everyone might be genuinely caring or having the same perspectives as you. Others may also have their own challenges to deal with including a lack of empathy. Plan your breaks and use them to do something that makes you feel calm and happy such as a hobby or pursuing a new interest.

Know that it’s normal to have ups and downs in life. Talk about how you’re feeling with someone you truly connect with and trust. They could be experiencing similar feelings and sharing would be of mutual benefit. They could also lend a listening ear as you pour out your heart and in the process you could gain new insights. Remember that a problem shared is a problem halved.

Finally; but not the least; keep in touch with your family physician. Get regular checkups and check-in frequently to ensure that you remain physically, mentally and emotionally healthy.

Your health is your most valuable asset; make it a personal responsibility to guard it jealously and give it the attention it deserves. 

It is a shame that Gender based violence has been normalized in our society.

Approximately 1 in 3 women and an unclear number of men are affected by GBV globally. It can be economical, physical, emotional or psychological. Anyone can be a victim or perpetrator of any form of GBV but intimate partner violence is the most widespread. Many a time the physical form is talked about because it is the most apparent; however; all forms of GBV through action, word or omission are equally damaging and should stop.

It is a global pandemic that ravages and forces victims to subordinate to the perpetrators resulting in impaired physical and mental health; stress; anxiety; loss of self-esteem; demotivation and depression. This in turn interferes with victims’ ability to reach their full potential; participate in economic activities or engage meaningfully in other life interests. It causes stigma and affects reputation. In fact, research has shown that sexual harassment claims have a greater effect on a company’s reputation than other forms of misconduct like fraud. For instance; allegations of sexual harassment by senior staff and drivers at the ride-sharing company Uber resulted in 56% of survey respondents refusing to use their services. In another example, allegations of sexual abuse and misconduct by construction workers on a major Ugandan infrastructure project resulted in the World Bank cancelling $265 million worth of funding and issuing a public statement.

The ultimate result of GBV if poorly managed is often the damaged goods syndrome which directly affects individual productivity.

A person with this syndrome believes they are no longer good enough nor worthy due to the negative effects caused by GBV on their self-esteem. This warps their expectations of anything good coming their way and in fact will often not accept it fully. Self-sabotage and/or harm is rampart in people suffering from this syndrome. It is not uncommon for them to even blame themselves for abuse experienced.

The casual or negative response to concerns raised about GBV in society contributes to survivors deteriorating to this syndrome. They are left feeling that they are making a big deal out of nothing. It is fertile ground for not only health complications, economic losses but also the all too familiar societal norms that lead to re-experiencing of GBV or attempts to cope through channels like substance abuse; and the cycle continues.  

Let us improve our attitude to this issue and take a more serious stance.

Rather than rationalizing in favour of perpetrators of any form, give the victim the attention and support they deserve. Listening with empathy, encouraging and guiding them to get health and legal help goes a long way. In some instances you may need to step in and be their eyes, ears, voice and do a lot of care seeking on their behalf. Remember that anyone can be a victim or a perpetrator of GBV.

Let us rally behind legal frameworks like the globally recognized standards for addressing violence and harassment set out in June 2019 by the International Labor Organization (ILO). They increase accountability from organizations through a more comprehensive way of responding to GBV including taking steps to prevent violence; to protect survivors through remedy and compensation; and to develop awareness raising, reporting and grievance procedures.

Identifying potential risks, leadership commitments to diverse, equal, and respectful workplaces backed by adequate resources would form a foundation to tackle root causes like gender inequality and mistrust amongst staff. Without this foundation, efforts to raise awareness can appear tokenistic and lack legitimacy. Clear policies and procedures including reporting and grievance mechanisms not only empower staff to take appropriate action when needed, but also reassure survivors, accused perpetrators, and whistle-blowers that the organization will handle cases effectively.

It is not an easy issue to tackle, but we all can deliberately take norm-shifting initiatives within our circle of control. We have a lot to gain, including improved overall performance, productivity and retention thanks to good mental health. 

Motherhood should be a step in ascending the ladder of growth and development rather than a source of poor mental health.

Teenage mothers or mothers to be are at high risk of depression which is the leading cause of death among young people aged 15-49 years; a bracket that holds many teenage mothers. It also increases the risk of suicide by 20%. Though the prevalence rates vary in different countries (14-23 %); the consequences are dire across the globe affecting both mother and child; more so during the recent unprecedented crisis in mental health occasioned by the COVID-19 pandemic. On the other hand, depression among teenagers is a predisposing factor for unplanned pregnancy due to the increased risk of psychoactive substance use and abuse including Gender Based Violence.

A vicious cycle therefore exists between depression and teenage pregnancy.

The variation in prevalence across countries depends on social determinants such as cultural and religious beliefs; socioeconomic status and individual risk factors such as genetic predisposition, co-morbidities, previous history of mental health conditions, psychoactive substance use, poorly managed stress, physical and emotional abuse, diabetes, thyroid disease, complications during pregnancy, negative thoughts about motherhood and quality of relationships.

Consequences of depression in teenage pregnancy affect both mother and child. Symptoms can occur before child birth(antepartum) or after (post partum). Antepartum depression occurs during pregnancy and is characterised by sleep and appetite changes, mood swings and excessive worry. A lot of these symptoms are easily confused with the normal changes experienced during pregnancy. It is therefore beneficial to maintain close engagement between the mother to be and a health professional. Antepartum depression causes miscarriages, increases risk of high blood pressure, diabetes, suicide and homicide. Additionally, mothers with chronic illnesses easily falter on the consistency of their treatment and follow up appointments when depressed. This predisposes them to complications which can also affect the unborn baby negatively.

Post partum depression refers to sadness, anxiety and exhaustion that lasts more than 2 weeks after childbirth. Mood swings, changes in dietary and sleeping habits, difficulty in decision making, difficulty in bonding with baby, suicidal thoughts and anger characterise the condition. It is the commonest mental health problem for new mothers with a prevalence of about 15%. It can start during pregnancy or after (perinatal depression). This condition predisposes to neglect of the new-born as the mother may not be interested in bonding with, feeding the baby nor honouring the mother and child clinic appointments. The end result is malnutrition, increased risk to childhood infections and slow development which may affect learning ability, behaviour and metal health conditions later in the baby’s life.

Teenage mothers should be closely followed during the antenatal clinics to screen for risk factors for depression and measures including psychotherapy put in place to avert the dangers. They should be encouraged to be deliberate about remaining physically active; observing good diet and sleep habits (e.g sleeping when the baby sleeps); avoid psychoactive substances; keeping in touch with family and friends; asking for help when in need and positively managing stress.

 Full blown symptoms of depression are treatable to allow one live a normal life.

Teenage mothers and mothers to be deserve the best mental health care. This will not only ensure their safe navigation of the motherhood milestone but also that the next generation thrives since the mothers will diligently prioritize wholesome health for themselves and their young ones.

Thriving during this milestone should be the norm rather than the exception.

Let us all take stock of reality and invest in the wellbeing of our teenage mothers and mothers to be as a means to avert depression and give them and their babies a better chance at life. Incorporating prevention into our national health and education programs would go a long way in saving lives and promoting happy motherhood experiences. 

 There was a time when reading used to make everything better for you. From fixing your broken heart, shortening a lengthy day, cooling your nerves just before an important interview and even uplifting your lowly moods. Those days, you could be passing through hell and not even realize it because books offered you a nice escape, to beautiful shores, Rocky Mountains, deserts whose air was laden with too much dust you wanted to cover your eyes with your hands by just reading about them. These days, you hardly enjoy a book.

As a matter of fact, you are finding it increasingly hard to pick a book and start reading. Every time you talk yourself into reading one, you barely go through the first ten pages before the over powering urge to stop comes again. There are ten books all book marked at page ten that you have started to read in this past week alone but couldn’t go beyond the tenth page. You don’t get the kick you used to get from reading anymore. You have tried movies but realized every time you start watching one, your thoughts wander. The movie plays on till the end only for you to realize you have no idea what the movie was even about. You can’t read, you can’t watch a movie, and as if this is not enough, you can’t seem to fall asleep at night.

On those nights when you fall asleep, you can’t stay asleep for more than two hours. And on those days (which is every day by the way) you have nothing to keep you company apart from your own thoughts. You realize you would give anything just to run away from this hopelessness that has descended upon your world. Three quarters of the time you are lying in your bed turning, tossing and even then, you don’t want to get out of that very bed where you lie gazing into space. Every time you push yourself to get up, the farthest you get is to the bathroom. Just to empty your bowels and pee, take a really quick shower on the day when you feel it is absolutely necessary, serve yourself a mountain of food and sit on the bed that you last made two weeks ago, and eat all that food. You have added a few inches to your waist, the clothes hug your body more, three skirts are threatening to burst at the seams.

You know you are headed for obesity but that is the least of your worries now. You know you are supposed to feel better in the morning but all days are the same old and dull to you. You feel as lonely on Friday nights as you feel every Monday morning. Your friends no longer call. They are tired of the lack of enthusiasm on your voice when you finally choose to answer their calls. You have missed friendship re unions with no explanation and they are tired of trying to pull you down from your high horse. Your mother has made peace with the fact that you are going to call home once in a blue moon.

She is okay if you are okay.  You don’t care about social media any more. You are tired of running into your ex everywhere in these streets of face book. You are tired of trying to tell yourself that he doesn’t deserve you. Probably you are the one who doesn’t deserve him with your body looking like a roto tank with all the eating you have been doing. You feel so empty; you have a pain that you can’t even describe. You slap yourself. You want to feel physical pain. You wish for someone to come and beat you up. Or even for a matatu to run over you, break a limb, break something in your body, leave you in a coma where you will lie and wake up and scream over a physical pain. You know whatever is happening to you is not even normal.

You are in a place to the extreme left of sadness. If you could walk even a little bit, then walk yourself to the bus station and ask them to drop you at a hospital gate. Because you are depressed and if it is going to get worse, you will commit suicide… Most of your friends aren’t even going to realize that you are depressed. If anything, they will accuse you of all sorts of things. Maybe we can’t blame them. We live in a society that has taught us that it is okay to be unhappy. That we don’t even deserve too much happiness. That we can’t blame anything in our lives for the feelings that we feel.

Dr. Mokeira J. Nyamache[/caption] Certainly, 100% good or bad is a fallacy. Do we pay the price for herd immunity or isolate until we find a cure and vaccine? And how will the masses be able to follow the guidelines whichever way we opt for? Floods are now competing with COVID-19 for lives in my country, malaria cases are going up, and cholera outbreak is in full swing with death toll competitively rising. As if that is not enough, unemployment has soared on eagles’ wings and pests are taking away the hope of at least a meal a day in many homes with the government opting for yet another huge loan to salvage the situation; we will pay when we pay. Simply thinking, two are better than one. Knowledge and experience are synergistic and yes, waiting to learn everything from own experience is a bit on the slow side of life.

  Let me tell you a bit about one patient that became a friend. A brilliant soul who eats life with a big spoon. Never too sad no matter the circumstances and even when I don’t think we should joke, he beams with laughter and says “Doc, you need to always be two steps ahead of them.’’ By the way, he has never specified who ‘them’ is and each time I ask, diversion is norm. The man is the age of my father and an excellent scholar in his field. One day we had to discuss a change in his management plan because the treatment was failing.

It was a tough conversation and I had lined up some of my super specialist colleagues to explain the situation that we were battling. The 45-minute discussion felt like it had lasted a whole day because of the weight of the matter. I did not know how my next consultation alone with him would be but I had to compose myself, hopeful for even a miracle. Nothing prepared me for what was to come next. He was physically frail, but his spirit as beaming as ever. He said he wanted to tell me a story before going home and so I needed to make time for him. I did. He told me about the six blind men of Indostan. I had not heard it before. Eager to learn they all went to observe the elephant though all were blind.

To one, upon touching the elephant was like a wall, and to the next like a spear.  To the third like a snake and to the fourth a tree. The fifth and sixth likened the elephant to a fan and rope respectively. And all were satisfied in their own blind worlds that they knew what an elephant is. He said if I forget everything about him, I should never forget the two things: this story and the need to always ‘’be two steps ahead of them.’’ Two years later, I was preparing for COVID-19 response targeting one of the most vulnerable populations I have ever interacted with in my entire career. Truck drivers, key populations and the communities along transport corridors and near borders. In my past, I had met several other categories of undeserved populations but these were different. Tough and real situations on the job taught me about their unique needs. 

 Therefore, as usual while planning, I was looking for opportunities to maximise the benefits for them and thankfully, I found a link to the national task force in preparation for COVID-19. I requested to participate in the discussions but seemingly, an envelope on the table was the pass in. After a few conversations, I thankfully got a chance to be there, even as much as the proverbial envelope was still unavailable. I was excited to see colleagues from years past in the frontlines across the continent and I knew I was in the right place at the right time. Our beneficiaries would definitely get consideration among these great minds. My knowledge and experience were limited, but I was confident in the power of synergy. To continue....

Dr. Mokeira J. Nyamache 

You see, these populations by the nature of their economic activities were mobile, lived in close interaction with specific communities, were stigmatized and largely lived in low socio-economic states. So thanks to my loud thoughts the task force was drawn to the attention of key populations’ and truckers’ needs and circumstances which would make them highly at risk as well as a source of spread across borders. A good discussion ensued even suggesting inclusion of WASH partners in the plan for hygiene considerations.

I left the meeting a happy doctor, knowing my clients would be well catered for in the national and by extension regional contingency plan. I drafted the infection prevention and control guidelines for them in my head and could not wait for the enrichment that would come from sharing it with the task force. That moment felt like true service to humanity. Never mind that the chair of the meeting seemed to struggle with the definition of the term key populations and the relevance of truckers in this discussion. In my naivety I offered to explain just so that the minutes would capture the details accurately albeit briefly. Notably though, the minute taker upon reading through the draft notes prior to the meeting conclusion had coined a term to refer to these categories of populations and my attempt to have it correct was met by ‘’the members of the task force will understand the point’’. I trustingly rested my case.

The phone call

Nothing prepared me for what would come next. It was about 3:00pm and I was in the office having late lunch while updating my colleagues on the meeting when my phone rang and I eagerly picked up as it was from a colleague from the meeting. She was responsible for its convening and worked for an influential global health organisation. She said that she had received concerns about the ‘’controversial topics’’ I raised in the meeting: key populations, truck drivers, transport corridors, borders. She asked if our organisation did HIV programing and I responded that it was one of the programs under our primary healthcare umbrella. She said that our contribution was not welcome nor valid for COVID-19 contingency planning based on the complaints from the Ministry of Health leadership in the task force. My attempts to explain the logic to her for almost 15 minutes were futile.

Finally I requested at least for training of our frontline staff. That too was denied because they were not really in ‘’the line of danger’’ because they were dealing with ‘’just truckers and key populations who were mainly HIV positive and being followed up. By the time a person reaches your team,’’ she continued, ‘’ they will have been screened and so no chance of risk. In fact, it would be impossible for a COVID-19 client to reach your team before being reached by a different facility…’’ She seemed to be saying. My heart sunk. I knew better and suspected that in a short while we would have to contend with reality: infected truckers crossing borders and key populations moving to different locations due to movement restrictions and closure of hotspots. Three weeks later, the dilemma arose at the western border and just days after that, a truck driver tested positive. That trucker was one of our regular clients and the first in a growing list of truckers being diagnosed positive across our network.

On the brighter side, not all was lost and our close working relationship with the ministry still allowed us to forge ahead in partnership. We started trainings, awareness raising campaigns and active case finding. The guidelines I had drafted in my mind came to life and our target population was getting the attention it required. Thinking back to the phone call, I could not help wondering if it was not too late firefighting as was the norm in these parts of the world. Perhaps if the controversial topics had been included in the planning, the ongoing trucker case numbers might have been less.

That aside however, I could not help weighing knowledge versus experience, and the answer was the same as before: synergy in timely application of knowledge and experience; inclusion would be a good addition for perspective too. Then I remembered my patient and the blind men of Indostan, it should never be about who gets credit but about credibility of the intervention knowing that no one knows it all. After all, nobody is perfect and this thinking would keep us ahead of the virus I am sure. So now, each day I watch the news or receive reports from my colleagues in the frontlines about more truckers turning positive I remember that afternoon phone call. They won’t let me forget it. It reminds me to grow no matter what.