2021; Volume 22, No 6, June
Mental Health & Palliative Care: Our experience during a humanitarian crisis
By Chitra Venkateswaran, MD
IAHPC Board Member; founder and Clinical Director, Mehac Foundation
Our pandemic experience in Southern Kerala has been fraught with challenges—as well as immense learning—starting with the first wave of COVID-19 and a national lockdown that led to some improvement by the end of 2020, only now to be now faced with a much, much more devastating second wave.
At Mehac Foundation, we focus on improving the quality of lives of people and caregivers with mental health issues. Most belong to vulnerable groups, such as the elderly, single women, migrants, people living in slums or coastal areas; many are living with other chronic illnesses. These are typical calls we have received during COVID-19:
A home visit to provide information for a family. Photo used with permission.
A longtime client, a mother, who has diabetes and chronic respiratory issues, and her daughter, who has seizures and chronic psychosis, called to say, “We are so scared to go out. What is this new illness? [...] we never worry about medications, we know you will arrange it.”
A bedridden grandmother with early dementia asked, “Can you find me a phone for my grandson for studying, he is crying as he is not able to attend his classes from school?”
Another client said, “We did not get any ration from the government as we did not have a ration card. I was also not able to go for work due to this COVID. But you came with the ration kit; I thank God, God bless you.”
“My son, who has severe anxiety obsessive compulsive behaviour, and my husband, who has panic attacks, struggle with the pandemic. Since you are meeting us regularly I am so relieved, both of them are so reassured. Please take care of yourselves, do not come like before, calling by phone is more than enough.”
These enabling narratives reflect the vulnerability, resilience, compassion, and mutuality interwoven with sweeping changes the pandemic has brought to people’s lives and to the work we do in the community.
Consistent followup is our mantra
Mehac during COVID-19
Of 2,852 patients:
- 565 had regular followup (teleconsultations/visits)
- >500 needs-based help for stable patients from referrals and distant outreach centers.
- 78% were contacted by phone
- 22% were without contact numbers: volunteers/health workers reached out to them
After the 2020 lockdown, a needs analysis survey showed:
- 63% wanted clinic visits
- 37% preferred home care visits
Virtual clinics were arranged for 6% of patients.
We are learning that our model at Mehac can retain an effective impact by sustaining continuity of care. We need a renewed focus on social needs, starting from providing ration (food) kits, recharging phones, getting smartphones to allow connectivity, helping migrants to register to return to their hometown, and networking for additional beneficiaries. This includes facilitating referral by other health care providers while also ensuring patients get pain relief and adequate supplies of morphine and other essential medicines. Mehac partnered with government bodies and the Indian Medical Association to help provide teleconsultation services to migrant workers and COVID-positive patients. Consistent followup was a mantra for the team. An extra effort was made to check on the well-being of team members including continuous updates for knowledge and skills.
Mental health advocates
trained after the 2018 flood
Kerala has been facing one humanitarian crisis after another. Devastating floods in 2018 taught us about preparedness and provision of comprehensive care in the community. It also gave insight on how networking can achieve goals effectively. We prepared for future crises with training programs, including one that trained 2,000 community volunteers as mental health advocates. We did research that showed ongoing impact from the floods one year later; survivors told us that a unified community response is essential. If not provided, distress is immense.1
Preparing a base of care
via relationships and more
Distributing rations during the pandemic. Photo used with permission.
Establishing services in the community with local partnerships, empowering community, enabling responsibilities, constant and consistent presence in the community of team members, and regular liaison have been principal components in our model of work.
- Strong community relationships with our patients helped us transition to remote support systems, doing only need-based home visits or consultations.
- Leveraging technology to deliver services strengthened our outreach to patients (by phone, platforms like WhatsApp, and Zoom), allowing us to follow up and identify non-adherence to medications or early signs of psychosocial distress.
- We worked as part of the PalliCovid Kerala group that developed the “Palliative Care in COVID-19 Resource Tool Kit for Low- and Middle-Income Countries,” which has reached over 1,800 frontline health care workers in 15 countries, including 20 states in India. 2-4
While for now we are simply responding to the pandemic, we will also keenly study the outcomes of these changes, looking at the sustainability and how much of this can be used in future.
Learn more about Mehac Foundation, listed in the IAHPC Global Directory of Palliative Care Institutions and Organizations.
References
1. Daniel S, Manuel Athul J, Leng M EF, Venkateswaran C. Qualitative Study to Evaluate the Psychological Symptoms of Post-Flood Survivors in a State in South India. Abstracts from the 11th EAPC World Research Congress Online, October 7-9, 2020, Palliat Med; 34(S1): 112. DOI: 10.1177/02692163209
2. Daniel S, Venkateswaran C, Sunder P, Nair S, Chittazhathu RK, et al. Responding to Palliative Care Training Needs in the Coronavirus Disease 2019 Era: The context and process of developing and disseminating training resources and guidance for low- and middle-income countries from Kerala, South India. Indian J Palliat Care 2020; 26(S1):8-16. DOI: 10.4103/IJPC.IJPC_131_20
3. PalliCovid Kerala. Palliative Care in COVID-19 Resource Tool Kit for Low- and Middle-Income Countries, Version 3, December 2020. https://palliumindia.org/2020/06/resources-for-palliative-care-in-the-context-of-covid19. Accessed on May 21, 2021.
4. Palliative care training for health care providers treating people with Covid-19 (PalliCovid ECHO). https://palliumindia.org/2021/03/pallicovid-echo-jun7. Accessed on May 21, 2021.
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