I thank the Malta Medical Students Association for the invitation they extended to me and for taking the initiative to discuss an issue that worries me greatly – that of mental health and the effects brought about by the pandemic.
I have to say that I am pleased to address this audience of aspiring medical professionals both as President, as well as a medical doctor myself.
The subject of mental health merits a fully-fledged discussion, particularly considering the prominence it acquired during the Pandemic.
Our focus on the clinical and physical effects, and prevention of COVID 19, should not come at the expense of the attention we should concurrently allocate to the effects it had, and is still having, on mental health.
I encourage you to take up these discussions with your fellow students and friends from other Faculties, as they would have different ideas on this, and other issues from a different perspective.
By way of example, I refer to a Seminar organised by the Faculty for the Well- Being of Society, which I addressed only a few days ago.
I must say I was impressed by the depth of information and the analysis carried out on the mental effects of the Pandemic.
There are really no limitations on this kind of cross-fertilisation of ideas and opinions, and on the extent of knowledge at this day and age.
You can connect, at the click of a button, with any counterparts or sources of information, both locally and abroad.
I urge you to make use of these opportunities to connect physically and virtually worldwide. These fountains of information complement your text books, and your hands-on practice in your general formation.
When I was your age, I made the best of what was available myself.
There was no internet. No computers. I enjoyed travelling.
Even with the restrictions in place back then in the 1960s, I travelled through divided Germany, Poland, Norway and Italy.
I discovered a whole new world.
Do not give up on these opportunities to widen your knowledge beyond the purely medical parameters.
Coming to today’s subject, I feel we need to cover as many mental health angles of this Pandemic as possible, and look at the effects it is having on all segments on our society, and on the different stages of our lives.
I will start off with the early years – Children.
They have been greatly affected as their schooling routines have been disrupted.
While online schooling was a welcome solution to keep the curriculum going, it is a far cry from the in-class level of understanding and interaction with both the educators and classmates.
In school, children socialise, make friends, vie with each other.
They cannot do this through on-line lessons.
At home, in the family, they had to sacrifice time spent with their possibly vulnerable grandparents or give up completely on family gatherings.
The Pandemic also exposed children to some unprecedented sense of fear, fear of the unknown, fear of losing a relative, of getting sick themselves, of being stuck in a boring and gloomy routine for months, with restrictions on going out or meeting friends.
Children, as they are known to do, must have also absorbed the sense of uncertainty that their parents or guardians have been going through for more than a year now – over the loss of a job, reduced incomes, the inability to plan for their families, and so on.
It is very important that a narrative for children is widely shared, to explain in simple language what the virus entails, how the measures to prevent its spread work, and how children themselves have a role in overcoming the pandemic, for them not to feel helpless.
Another directly related effect, is the increased reliance on technology to keep children occupied. This undoubtedly worsens the already excessive amount of time children spend with their tablets and smart phones, rather than having active interaction with family and friends.
I wish to place particular emphasis on children who were already vulnerable, or who required special attention, before the onset of the Pandemic.
These are now doubly disadvantaged, and we have to increase our efforts to make sure they do not fall through the net.
The same feelings must have been experienced by YOU – young adults – who at the height of energy and enthusiasm, have had to press the ‘pause’ button on your lives.
The dramatic effects of a lockdown on mental health should not be underestimated.
Many have reported experienced feelings of anxiety they were not familiar with in pre-Covid days, resulting in confusion, loneliness a sense of loss, and sometimes depression.
Some had to find solace in their families, in music, the arts and creative activity, and even technology and the digital world.
This was the best option under the prevailing circumstances.
One way of giving a feeling of empowerment is to ensure a clear understanding of the reasons for restrictions that had to be imposed – to convince them that there is a very serious purpose behind this curtailment in our liberties and habits … eg not going out for a pizza, no sport, no games, no pub, no clubs etc.
It is very important, and crucial, for our children and students – as with us adults
– that they feel they too can safely ask for help through counsellors or mental health professionals, if the need is felt.
In adults, COVID brought about several parenthood-related challenges.
First and foremost, comes to mind the parents’ immediate responsibility to keep children healthy and safe by observing strict hygienic and cleanliness regulations.
Other previously unexperienced pressures had to do with restricting (at times completely) children’s access to family and friends. Parents had to become the child’s teacher, educator and entertainer in one and the same day, while also probably working from home, on their regular job.
One can easily relate to the levels of stress encountered by working parents as soon as announcements of school closures were made. In many cases, the automatic ‘safety-valve’ of grandparents could not be resorted to, due to them being particularly vulnerable.
I wish to make a specific reference to the role of women in all of this.
In a majority of cases, it was the wife and the mother who, despite being a working woman, was taking charge of home-schooling, extra-curricular activities at home, and the adaptation to a new routine.
We, and the international community in general, need to work much harder, towards balance, on this front.
In some cases, parenthood itself was not only affected, but also delayed. Aside from purely medical reasons, delayed weddings, economic factors, job uncertainty and a general hampered ability to plan ahead, have led to a reluctant postponement of parenthood.
Moving on to the elderly, I believe COVID has shaken their lives to the core.
In my opinion they were the worst-hit, and the ones that suffered most.
This can really been defined as a ‘Perfect Storm’ due to the combined effects of their pre-existing morbidity, increased isolation and social exclusion, mobility difficulties and financial constraints, as well as their vulnerability, as vividly portrayed in the daily death reports of aged persons.
During the Pandemic, especially in the first turbulent months, I often reached out, first of all to those confined in residential homes, detached from their families, for months on end, as well as those living by themselves in private residences.
The Pandemic must have had a terrible effect on the mental well-being of our elderly citizens, and resulted in added solitude and in some cases, isolation, with all the negative considerations, that brings along with it.
Others must have definitely felt the impact of restricted, or complete lack of access to their son and daughters, and grandchildren.
Of course, this was done in their best medical interests, yet the effect on their mental well-being was a definitely negative one.
Over and above all this, there is an element of fear – of going out, of getting sick, of being hospitalized without the possibility of visits, and worst of all, of dying alone.
I know of cases where the elderly still refuse to leave their houses out of this impending fear, even though there has been some easing of the Pandemic and most of these elderly have been vaccinated.
During this last year, I have made several appeals to our community, to extend gestures of solidarity with our elderly in these very difficult circumstances.
I cannot emphasise enough the need for solidarity with everyone around us – but most of all – with the old and the vulnerable.
This is also my appeal to all of you.
Make sure you invest in your professional knowledge, but not only with adequate academic and practical preparation.
Besides these obvious requirements, to make a real difference in your patients’ lives in future, you need to also have that dose of human understanding and compassion that will make you more humane.
This will show in the way you explain an illness, how you follow the patient during treatment, how your break bad news to the patients themselves and their families, and in many other circumstances where tact and sensitivity are needed.
This is the ‘X FACTOR’ – to use a term you will surely understand – that will make you outstanding medical professionals.
I hope you have fruitful discussions over the coming two days, and above all I wish you successful and rewarding careers.