A webinar via Facebook Live was moderated by YB Khairy Jamaluddin, Minister of MOSTI, on 7 April 2020. The webinar featured Tan Sri Dr Jemilah Mahmood, Special Advisor to the Prime Minister on Public Health, and Under Secretary General for Partnerships at the International Federation of Red Cross and Red Crescent Societies (IFRC). Also joining Tan Sri Jemilah and YB Khairy was Associate Professor Dr Amer Siddiq Amer Nordin, Associate Professor at the Department of Psychological Medicine, University Malaya (UM), consultant psychiatrist at University Malaya Medical Centre (UMMC) and avid mental health activist.
TAN SRI DR JEMILAH MAHMOOD
Tan Sri Dr Jemilah noted her observation on the effectiveness of the Movement Restriction Oder (MCO) in curbing the spread of COVID-19. Additionally, COVID-19 is shown to be treatable, thanks to the capabilities of our health services. She also noted that the number of Malaysian cases in mid-April is far below what was projected by JP Morgan (around 6,300) and the Malaysian Institute of Economic Research (around 8,900). So far, only 3,793 cases were reported in April 2020.
In the short term, the MCO has been shown to be effective in curbing the spread of COVID-19 by slowing or decreasing its transmission or allowing transmission to reach a plateau. Therefore, more data is needed to assess its long-term effects. Tan Sri Dr Jemilah said that the population plays an important role in ensuring the MCO stays effective; social distancing is a crucial part of the MCO – everyone must observe a 1-2 metre separation between each other in addition to frequent hand washing and sanitising.
As noted by Tan Sri Dr Jemilah, the MCO is but one way to slow the transmission of COVID-19; it can only be eradicated totally with a vaccine, which we still do not have. At this moment, a lower infection rate ensures that the number of patients does not overwhelm the Malaysian healthcare system.
Risk Communication is Essential
Continuing the session, Tan Sri Dr Jemilah highlighted a point on the COVID-19 pandemic. She stated that this pandemic is often viewed as a health issue, with plenty of focus on vaccine development and hospitalisation, among other health-related aspects. However, she believes that risk communication should also be prioritised. The people should be educated on how COVID-19 is transmitted, and how social distancing, sanitising, and washing hands works to reduce its transmission. With this knowledge, the people can be more responsible and hold themselves and others accountable for their actions. With this knowledge, they would feel less “forced” to carry out these measures because they understand better. Contrary to popular belief, Tan Sri Dr Jemilah stated that the people is the first line of defence against COVID-19.
Humanity is Key in These Difficult Times
During the session, Tan Sri Dr Jemilah also shared the experiences and lessons that she gained from other missions of health and humanitarian crisis. Once again, she emphasised on the importance of effective risk communication in handling a pandemic and epidemic. The people’s adequate understanding of how a disease spreads and how to stop its transmission is a vital part of managing a pandemic or epidemic.
Tan Sri Dr Jemilah cited the handling of risk communication in Ebola-stricken areas. When carrying out risk communication, the local culture, religion, and habits needs to be taken into consideration when explaining the reasons why precautionary measures need to be carried out. In the case of Ebola-stricken areas, burial rites are an important component in any culture a last farewell to the deceased. By making the local community understand the importance of a safe and proper burial methods, they have managed to prevent more than 10,000 deaths.
Tan Sri Dr Jemilah reminds everyone that access to treatment should be available to everyone. Treatment needs to be impartial, neutral and be given to all including the marginalised segment e.g. the homeless, refugees and migrants.
Tan Sri Dr Jemilah mentioned the social stigmatisation that comes with being a COVID-19 patient. Stigmatising patients for having COVID-19, especially by discriminating them according to the “clusters” and blaming them for making life difficult for the rest is demeaning and unnecessary. Furthermore, COVID-19 should not be viewed as a death sentence. Instead, she insists that everyone move forward and be united as a population in curbing the spread of COVID-19. In addition, she reminded viewers to take this pandemic as an opportunity for self-reflection and working towards spiritual and/or religious self-improvement.
Living in a Post-MCO Era
Tan Sri Dr Jemilah noted on how the pandemic has affected Malaysians. The COVID-19 pandemic has shaken up the entire cultural system and how everything operate. Malaysians are known to be very sociable people, with frequent physical contact (such as via handshakes) and regular socialising with friends and family. Post-MCO, we cannot return to the old ways; she stated that at least six to nine months needs to be given to make way for adjustments to our habits, such as reducing socialising and practicing social distancing. This ensures the virus’ transmission rate remains low. That said, the pandemic has also made us realise that we can still survive on less physical interactions and going out less.
Furthermore, Tan Sri Dr Jemilah encourages us to focus on improving the environment; these novel diseases might have been brought upon by environmental disruptions, and steps to recover from it should include improving the quality of the environment.
Moving forward, Tan Sri Dr Jemilah called for a wave of innovation in how we do things. On the education side, classes can be divided into smaller virtual classrooms to improve focus and efficiency. The COVID-19 pandemic also highlighted the need for Malaysia to improve its internet connectivity; she cited South Korea’s high internet connectivity was one of the reasons the country has a relatively low learning curve in facing the COVID-19 pandemic.
Additionally, Tan Sri Dr Jemilah encourages more community-based innovations: we need to find ways to provide financial assistance to those who need it the most, in the swiftest manner. E-wallets is one of the solutions that is currently used, but its use is limited by technology access especially among those in rural areas; novel ways of providing financial assistance could be developed to ensure everyone receives the required assistance.
Tan Sr Dr Jemilah would also like to see innovation on the medical and health aspect of fighting COVID-19. We stand to benefit tremendously from better test kits that enable swifter and more accurate diagnosis; novel methods of examining patients that ensures the safety of patients and healthcare workers (e.g. booths that enable face-to-face examination without physical contact); barcode identification and information exchange to expedite diagnosis and assist tracing; as well as building and maintaining a vast repository of data and utilising artificial intelligence (AI) to process the data in an effort to understand and predict COVID-19’s behaviour via computer modelling.
Tan Sri Dr Jemilah reminded everyone that this situation will not be permanent. However, a pandemic will not be a one-time occurrence and we need to be prepared when it happens with another disease in the future.
Assurance for Those Experiencing Mental Distress
Tan Sri Jemilah provided some insight on how to give assurance to those who are experiencing mental health distress during the pandemic while living under the MCO.
A major issue faced by those with mental health issues is stigmatisation; they are apprehensive about disclosing their mental health issues. Tan Sri Dr Jemilah felt that the current situation might be a good opportunity for us to open the conversation on mental health. Avenues should be opened to improve quality of life in all aspects, especially mental health; that said, everything will take time to improve.
We need to assure those mental health issues that they are not alone; what we are experiencing is experienced globally by everyone. It is also important to tell them that it is normal and okay to feel distressed in these difficult times.
Social media can be used to educate the people about the signs of mental health distress. This is to ensure that everyone can identify these signs within themselves and the people around them, then respond appropriately to provide a mental health first aid.
When faced with difficult people who do not understand the importance of social distancing, Tan Sri Dr Jemilah advises a loving message to approach them: “because I love and care for you, I am practicing social distancing”. There are other methods of expressing our love in these difficult times, such as sending food and supplies to one another.
On Women’s Safety
Domestic violence is something that exists in all communities all over the world. Women, children, and men alike will experience domestic violence. The rise in cases during the MCO could be attributed to underlying psychological pressures exacerbated by the current situation.
However it is caused, victims should not accept domestic violence as normal behaviour. Victims should seek lifeline e.g. trusted relatives and friends that may assist them. Tan Sri Dr Jemilah advised creating a secret code so the lifeline may identify when victims are in danger. She also advises victims to find safe space in the house as well as keeping their phone on them at all times and making sure that it is charged at all times. Simple yet effective measures such as wearing clothes that are difficult to snag or grab when being abused may reduce injury. Adopting a ball-shaped posture when experiencing abuse is also good to protect vital organs, head, and face.
Aside from personal protection measures, law enforcement is important. Authorities need to make sure that prompt assistance will be provided when required to stop domestic abuse. At the same time, risk communication on domestic abuse must be carried out because it is a real crisis, especially during this pandemic.
ASSOCIATE PROFESSOR DR AMER SIDDIQ AMER NORDIN
In the session, Dr Amer presented several points regarding mental health and wellbeing during the COVID-19 pandemic. One common mental issue that may arise or be exacerbated by these difficult times is anxiety. In the early stages of MCO, someone with anxiety could be triggered from the misunderstanding of the current situation due to lack of reliable information e.g. how COVID-19 is transmitted. However, as time goes by and more reliable information is provided, understanding has increased and those who have anxiety may feel more at ease. This also illustrates the importance of risk communication in ensuring the mental health and wellbeing of the population.
Adjustments Pre-, During and Post-MCO
Dr Amer explained that the phases of pre-, during, and post-MCO needs to be considered. In view of the issues faced pre- and during MCO, steps need to be taken to ensure the adjustment to a post-MCO world be as smooth as possible.
According to Dr Amer, a proper plan for transitioning from MCO to post-MCO period needs to be in place. Once again, risk communication is required to inform everyone on what to expect when transitioning into the post-MCO period. That said, no matter how much preparation we do, there will be those who are well-adjusted and those who cannot. Dr Amer reminded viewers that COVID-19 is a global pandemic; Malaysia is not alone in facing this. Therefore, we need to prepare for the post-MCO world collectively and individually. What is considered the “new normal” now, will be just “normal” in the future: sanitisers will be equally essential as your mobile phone when going out, social distancing will not be a catchphrase anymore. There will definitely be some differences in how we conduct our daily lives and it will be the norm.
Dr Amer stated that telehealth and telemedicine (the provision of healthcare and medicine remotely by means of telecommunications technology) has seen significant growth during the MCO period. Patients who are apprehensive to seek help in person due to risk of exposure as well as restricted opportunities of movement during MCO may utilise apps to seek medical assistance. Dr Amer also mentioned the growing segment of apps that educate everyone on risk communication. Echoing Tan Sri Dr Jemilah’s observation on internet connectivity, Dr Amer stated that the MCO also revealed shortcomings in communication especially in teaching and learning, notably internet and equipment access. We need to realise that internet is a basic need of the 21st century that should be provided to everyone.
According to Dr Amer, one will experience several phases in facing change: it starts with a loss of control during periods of difficulty e.g. a pandemic, leading to shock; this will be followed by anger (due to being restricted in movement and loss of ability to do anything during the MCO). At one point in the process, despair would surface; eventually this will lead to acceptance. Preparedness is at the core of mental health and wellbeing. Those who are more prepared to navigate the COVID-19 pandemic will cope better than those that are not.
Besides that, economic uncertainty is also starting to creep in. Those who have not worked since the beginning of MCO as well as those who are working but are on leave will feel uncertain about their future of employment. Whatever uncertainties we face, it is important for the authorities and professionals to start preparing people for the next step in facing the world post-MCO.
Mental Health Assistance
Previously, Malaysia has experienced other disasters, both natural and man-made. As such, MOE has already prepared psychological first aid to everyone for difficult times. At the moment, this assistance is particularly valuable for frontliners and those who are suspects or diagnosed positive with COVID-19.
In a commendable and beneficial move, MOE, MERCY Malaysia and 18 other NGOs have collaborated to create a mental health psycho-social support programme called Crisis Preparedness and Response Centre (CPRC) with the cooperation of state departments of health and hospitals nationwide. Additionally, through collaborations with NGOs and social enterprises, health assistance can also be delivered via phone or internet. Dr Amer cites Befrienders as an example: an NGO that provides active listening to those that need help. During the MCO, most of the support has moved from phone calls to Skype calls.
Mentally Preparing for the Post-MCO Era
Dr Amer emphasises on the importance of preparedness, guided with reliable information from trusted sources. The more we are able to identify and understand the issues that we are experiencing, why we are in this situation and why we need measures such as social distancing, the more we are prepared for living post-MCO.
Ever since the MCO started, talks about the “new normal” has already been under way. The sooner we realise that we will not be going back to the old ways of living, the better we will adjust to the new normal.
Preparedness will also lead to altruistic or meaningful engagement. For example, by understanding why social distancing is important to our self and to others, it is easier to accept why it is essential for the sake of everyone.
Domestic Abuse During the MCO Period
Dr Amer acknowledges the rising cases of domestic abuse during the MCO.
Dr Amer explained that from a psychology standpoint, acts of abuse arises from a lack of control. Understandably, some sense of control is lost during the MCO. This gives rise to feelings of anger and when left unchecked, one might be prone to lashing out to abuse others.
Domestic abuse is not just experienced by women; men and children and the elderly will experience it too. Dr Amer advises us to check on our family or friends e.g. neighbours as they might be experiencing abuse. It is more important than ever now to be more attentive and watch out for each other. It is okay to overreact than be apathetic in these trying times. Children and the elderly should also be given extra attention: they might not have the ability to get away from abusive situations.
In closing, Tan Sr Dr Jemilah reminded everyone to practice social distancing, wash and/or sanitise hands frequently, as well as disinfect workspace and cooking space often. These are simple, effective, and important steps in staying healthy and safe from COVID-19. She expressed hope for everyone to stay strong together in fighting this pandemic.
After expressing his appreciation for creating a dedicated space to talk about mental health in the scope of MCO and the COVID-19 pandemic, Dr Amer
Post-MCO: earlier on, the emphasis was on MOH, but moving fwd, in terms of mental health, bio-psycho-social lifestyle, spiritual, innovation. We need the whole network of Ministries to assist in mental health and wellbeing of all Malaysians after MCO, on various topics e.g. work, innovation, women, religious and spiritual leaders to work together with MOH to formulate programs to help everyone to cope with all the phases of MCO. If we are to face another pandemic in the future, we will be more prepared.