Gentle France

Gentle France

“Gentleness is a divine trait; nothing as strong as gentleness, nothing so gentle as real strength.” R Sockman

A 14 year old boy sits down next to a 80 year old woman sitting alone on a park bench in the village. He asks her what she bought. She shows him her vegetables that she bought at the market. She tells him what she will cook tonight, that it will keep her strong, and that it tastes very good. He smiles. She asks about his skateboard. He shows her the wheels. Until today, they had never met. These are the experiences France offers every day, and in every corner, from what we have observed or from what has been reported to us. Powerful protective factors can be found in this brief example.

Individuals of all ages like to connect with individuals of all ages; eye contact is made, smiles are shared, brief enquiries regarding health, comments regarding the weather (usually pointing out how good it is), simple acts of respect and validation. Interactions are often brief, but always or usually meaningful. Individuals stop, make eye contact, and greet each other as they enter an establishment, or as they are handed their coffee. Strangers stop to greet you, wish you a good breakfast and comment on the good weather.

Calm, focussing on plenty and patience (and offering or receiving someone’s full attention) are part of the tradition in France from what we have observed over 20 years.

“From serenity comes gentleness, comes lasting strength.” P Brown

France has highlighted the importance of focussing on child protection concerns in recent months during the pandemic. France has considered good evidence in relation to practical, academic and theoretical challenges. Many charities in France look after those without a voice.

Most comment that they feel ‘home’ and ‘accepted’ in France, even after their initial arrival. France is a place where many feel welcome. Camaraderie (often working together with common goals eg protecting children), liberty and equality are evident in France.

Liberté, Egalité, Fraternité are not mere words in France, but experienced. Most people leave France with one main lesson, that everyone from every walk of life eats the same excellent quality of food, and that you can have the best meal of your life for 3 euros. Months or years can be spent discussing the bread and the butter. Simple things are treasured and expert skills are valued in these domains. Many report “airlines can learn from France’s approach to food”. Attention to detail, relating to all matters, including quality of bread or butter, makes all the difference and translates into quality of life, strength and success. People are inspired by skills, enjoyable food, beauty, by tidy parks and colourful gardens.

Many now report “France is a place where we can find normal, breathe, we can exhale, we can find calm”. Markets provide a world of experiences in every small village. Conversations started, treasures found, stories shared and moments made. Lives are sustained and made worth while by simple things and precious moments. Restaurants are open and Jazz live concerts continue. Spirits soar as the audience enjoys the talent. Communities come together to connect and enjoy together, with evidence-based safeguards, such as regularly washing hands and remaining calm and positive. Simple evidence-based initiatives, decisions and priorities relating to protective factors, promote and sustain immune systems, general health, mental health, development and well-being.

“In this world there is nothing softer or thinner than water. But to compel the hard and unyielding, it has no equal. That the weak overcomes the strong, that the hard gives way to the gentle, this everyone knows, but no one acts accordingly.” Lao-Tzu

Patients, children and families, medical and mental health colleagues often contact us to ask us “where do I find some normal to protect my (or our) health”. Normalcy, autonomy, liberty are evidence-based protective factors for health, mental health, development and well-being. Other examples of protective factors are provided above, such as being part of a community, support networks, friendly conversation, enjoyment and calm.

Medical doctors use the phrase ‘evidence-based’ when good or very good clinical evidence supports the statement or initiative.

We have been asked to write about bio-psycho-social protective factors for health, mental health, development, well-being and success. Health, mental health, appropriate development and well-being are some of the building blocks for success and victory with goals. We have liaised with several organisations, visited many places, and provided lists for several months. We know our colleagues are asked the same questions.

Simple evidence-based protective factors can change the course of individuals’ health, mental health and development. Let’s work together to focus on good clinical evidence.

#health #gentleness #strength #beauty #positive #QualityOfLife #SimpleThings #calm #enjoy #success #victory #France #Liberté, #Egalité, #Fraternité #children #Jazz #LiveMusic #travel #airlines #food

Italy’s Roar

Italy’s Roar:

Every country or area in a country has their own sounds, smells, tastes, traditions, colours, cultures, styles or narratives. Everyone perceives and enjoys these connections differently.

We usually wake up in Italy with the sound of roaring laughter. Children, young people as well as adults of all ages laughing together, often not long after sunrise.

We can learn from Italy’s laughter. Laughter, togetherness and enjoyment, as separate items, but also together, benefit general health and mental health to very a significant degree.

We can also learn from Italy’s focus on beauty, children, communities and food. Everyone, from the fisherman to the mega yacht owner eats the same quality food – excellent food (see recent tweet regarding fish market / shop in Genoa – wait to see fresh fish prepared in the old traditional way – worth a trip – but go early).

Much energy is spent on making the environment or setting beautiful, which gives powerful messages. Music is played, table cloths and candles are ready – “making things beautiful is how we look after yourselves and each other – it means we care”.

We are inspired by Italy’s and Genoa’s many outreach projects for vulnerable individuals – the focus is often on education, learning skills and being part of a healthy community. In Cape Town in the 1990’s – all mental health patients well enough, in one of the main mental health hospitals, were taught a trade or skill such as planting vegetables or basic farming skills, so that when they are discharged (often after months or years), they have opportunities of employment, which help to contribute to a sense of achievement, meaning and being part of a community, which help with confidence and relationships, general health and mental health. These factors, from education to employment, also lead to less poverty and less crime. Most things are connected and the solutions are seldom complicated; solutions often start with education and empowerment – sustainable solutions leading to independence. Giving is not giving unless the goal is sustainable independence.

Simple things often make the greatest difference for adults and children with health or without health difficulties.

We are frequently asked what our thoughts are regarding happiness, general health, mental health, mental state and children – for vulnerable children and adults – and also for privileged and healthy children and adults. The answers are not different.

We will share some thoughts regarding these topics and the effects of for instance music, food, the environment, cognitions, emotions, behaviours and physiological changes such as breathing in future postings. Medical doctors, surgeons, professional athletes and many others use these simple techniques to achieve goals and to inspire or maintain calm or a positive mood.

Many medical colleagues, professionals, patients and families report that they currently “find it challenging to be calm, positive or hopeful or go on with life during this time” and have asked for general thoughts. We recommend that you speak to your GP if you have concerns about yourself or anyone else without delay – getting a general check up or screen in terms of general health and mental health has never been a better idea than now during this time. If you have the ‘all clear’ from your GP – there are many options to consider to move forward – different approaches will work for different people.

Many children and colleagues report that there is nothing more important than having a dream, a goal, a plan – and moving towards it – slowly – whilst enjoying every step of the way.

Where to start – some thoughts:

Step 1 – Be inspired – find a topic or interest that moves or inspires you – that you are very enthusiastic about – it might be Italy, food, sailing, surfing, tango, salsa, working with animals, playing the saxophone, speaking French, horse riding, performance driving, motorcars, travelling, gardening, photography – anything. If at first you cannot think of anything go on an explore adventure phase – read books, magazines, visit forums or webpages, arrange experiences such as sailing or golfing or spending time in nature or with animals – enjoy the explore phase to find something that moves you… there is no rush and ‘pressure’ will sometimes prevent you from reaching this goal or delay the process. Think about what you enjoyed when younger or what you would like to remember as part of your life when you are older. Try to avoid ‘tick box’ items or ‘what looks good on paper or to friends’ – you have to be moved by it – you alone – for yourself. This might be the second most important stage. You can start step 1 at any age.

Life’s blows cannot break a person whose spirit is warmed at the fire of enthusiasm. Paele

Step 2 – Spend time reading or researching this topic – enjoy every moment. You do not have to leave your home for this stage. Do not rush this stage.

Step 3 – Surround yourself with items related to the topic – a theme – for instance if your topic is Italy find suitable music, food, clothing or images. Do not rush this stage.

I have overcome nightmares due to my dreams. Salk

Step 4 – Pause – ensure you are enjoying the previous stages. Dream. There is no rush. Take it slow. Life is a game of inches. Slow progress is often good and sustainable progress. These 4 stages are protective factors for general and mental health, and positives in a life and should be enjoyable and relaxing.

He who has a why to live can bear almost any how. Nietzsche

Step 5 – Prep – start the preparation phase. Think about what you would like to achieve, what you hope to gain from it, why, how it will look like, feel like, as much detail as possible, think about when you want to achieve the first phase or the goal and how. Take it slow – achievable is good. This stage, if completed effectively, will guide and aid the next stage, as the foundation for where the house (plan) will be developed and built.

Everything worthwhile in life takes hard work. Diamonds are only chunks of coal who stuck to their jobs. Smith

Step 6 – Plan – start drawing up a plan – on paper. Read and research thoroughly. Consider risks, weather patterns, training, tools and equipment required. Speak to people with similar interests, professionals and experts. You might meet interesting people. This is the most important stage. Ask for second or third opinions regarding your drawn up plan and goals, as well as thoughts on your progress. This stage is lengthy, as it often takes a long time to develop a good plan, based on information gathered, and to complete required training, learn skills and collect tools. Enjoy this stage. Don’t rush it – rushing this stage will mean a less likely chance of success or achieving your goals.

There is no shortcuts to any place worth going. Sills

Step 7 – Jump – believe in yourself knowing you have prepared and planned well, that you have people at hand to ask for advice if need be, a safety net, and that you will enjoy the ‘getting to the destination’ as much as you have enjoyed the first 6 steps and the destination itself. Don’t give up. Adapt and adjust your sails. Know you should and will never stop learning.

Hold on, hold fast, hold out, patience is genius. Comte de Buffon

There is never a rush – as long as you keep moving forward slowly. Remember good and sustainable progress is often 3 steps forward, 1-2 steps back – that is how we learn, that is how we grow and achieve our goals.

Nothing great is created suddenly. Epictetus

Every one of these 7 steps are protective factors for general health and mental health.

#Italy #Genoa #laughter #children #community #enjoy #health #happiness #positive #calm #skills #education #MentalHealth #goals #dreams #progress #persistence #perseverance #success

Children, Schools and Social Risk

Children, Schools and Social Risk:

UNICEF reminded us, April 2020, “while our eyes are firmly focused on how to avoid or treat COVID-19, the serious consequences that will challenge us far beyond the current pandemic – the hidden impacts – are not yet front of mind. This must change. Not only are children and young people contracting COVID-19, they are also among its most severely impacted victims. Unless we act now to address the pandemic’s impacts on children, the echoes of COVID-19 will permanently damage our shared future. According to our analysis, 99 per cent of children and young people under 18 worldwide (2.34 billion) live in one of the 186 countries with some form of movement restrictions in place due to COVID-19. Sixty per cent of all children live in one of the 82 countries with a full (7%) or partial (53%) lockdown – accounting for 1.4 billion young lives. We know that, in any crisis, the young and the most vulnerable suffer disproportionately. This pandemic is no different. It is our responsibility to prevent suffering, save lives and protect the health of every child. We must also ensure that risk-informed decisions on COVID-19 control measures are made based on the best available evidence in order to minimise and prevent any collateral damage, and to provide mitigation measures so the damage is not lasting.” https://www.unicef.org/press-releases/dont-let-children-be-hidden-victims-covid-19-pandemic Most agree,18 months later, that we have not prioritised these goals.

Significant concerns have been raised in terms of increased statistics relating to child abuse, mental illness, developmental problems, general health and well-being for children due to indiscriminate mandatory initiatives not based on good clinical evidence. 

Many agree that child abuse and mental health statistics need to decrease significantly; early detection, prevention and access to appropriate services are essential steps to achieve these goals. We offer assistance and training in this regard, often pro bono. We have extensive experience in teaching and training, for example teaching medical students at the University of Cambridge, teaching medical doctors specialising in Child Psychiatry on the MRCPsych course in Cambridge and offering training to GPs, Paediatricians, Psychologists, Social Care, Police, Prisons and Youth Offending teams. Most of our training currently offered relates to identifying child abuse or mental health problems in complex presentations such as children with neurodevelopmental problems or hard to reach children. Please contact us for further details.

Recommendations to safeguard children – many colleagues recommend; 

• ending indiscriminate mandatory initiatives, not based on good clinical evidence, where evidence exists that harm is caused and risk is increased without delay.  “The benefits of wearing masks in children for COVID-19 control should be weighed against potential harm associated with wearing masks, including feasibility and discomfort, as well as social and communication concerns.”  WHO  https://apps.who.int/iris/rest/bitstreams/1296520/retrieve. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/covid-19-vaccines/advice and https://www.who.int/news/item/10-08-2021-interim-statement-on-covid-19-vaccine-booster-doses,

• schools need to re-open and remain open, but with education (age appropriate and enjoyable approach) regarding evidence-based risk reduction and protective strategies for children and staff in the context of COVID-19 and general health; it is important that children’s anxiety levels remain low in the context of ‘germs’ or infections to prevent mental health morbidity, often common in certain age groups,

• daily healthy school meals with educational, enjoyable opportunities to learn skills to cultivate herbs, fruit and vegetables at home and prepare enjoyable, healthy meals,

• education in schools regarding important life skills such as managing finances, starting businesses, applying for work or conflict resolution,

• education in schools (staff and pupils) regarding general safety, child abuse and mental health (practical and age appropriate approach) – we offer pro bono question and answer sessions in schools where any individual can ask any question,

• normative activities for children – regular opportunities outside schools where children can engage in enjoyable, positive and meaningful activities, including group activities, in the community with responsible adults and peers with similar interests, where opportunities are offered to develop social support networks, learn new skills and experience a sense of achievement. Normative activities promote normal child development (physical, social, emotional, cognitive and language), general health, mental health, general well-being, and reduce risk. Good clinical outcomes and prognoses in general and mental health usually require a bio-psycho-social approach. Children described as ‘hopeless’ (never an accurate description) are often referred to us, and we have consistently observed that prognosis can change markedly with the introduction of a patient specific and appropriate bio-psycho-social treatment plan. It is our recommendation that electronic activities or tools be excluded during normative activities; electronic activities and tools can offer other benefits to children, but we recommend that this is considered separately, based on our experience.

• positive narratives; many children with a background of ongoing or past significant trauma often report the life event that precipitated sustained positive change in their lives eg “one message” by a teacher or other adult, “who believed I can do better and have better”, “I saw she saw me as good, so I thought ok I must have good in me”, or provided by a setting eg “Disney’s message that anything is possible if you work hard and believe changed my life”. We have written extensively regarding the importance of positive public messaging and narratives, and the direct effects on thoughts, beliefs, emotions, behaviour, physiology and clinical outcomes.

• access to general and mental health services and specialist consultation without delay for serious presentations, we have shared extensively details regarding our concerns relating to children waiting more than 5 years for consultant input or for comprehensive assessments to screen for medical, neurodevelopmental and serious mental health concerns, 

• formal and urgent review of A – child mental health teams (by individuals with experience in managing bio-psycho-social risk in clinical settings), B – regulations under the Mental Health Act relating to clinicians with clinical responsibility for children and adults detained under the mental health act. We have shared comments regarding the urgency of identifying medical concerns in patients with mental health problems, early and accurate mental health diagnoses, safe and user-friendly practices in CAMHS teams and in general health clinics. 

• formal and urgent review of current policies, processes and emergency legislation in the context of COVID-19 and the definition relating to ‘state of emergency’ and ‘covid deaths’ (definitions need to be consistent and need to make medical sense – medical and legal colleagues raised concerns that some nations finalised legislation in haste and omitted appeals processes to safeguard the public or allow for the inclusion of medical opinions),

• training regarding identifying mental health problems, risk or child abuse in complex and high risk clinical presentations – child abuse can sometimes present very similar to other mental health problems such as anxiety, or neurodevelopment disorders such as Attention Deficit Hyperactivity Disorder (ADHD) or Autism Spectrum Disorders (ASD),

• service development and training regarding engaging hard to reach children, such as children refusing to attend appointments or children in high risk contexts such as homeless children or young offenders,

• a greater emphasis on child protection by governments – child protection concerns and an awareness of child protection in general have been emphasised in many countries in 2020 and 2021 – for example questions have been asked about adult nudity on beaches or next to pools where children are present, or at homes when children are present or have peers visiting, which most agree is not acceptable and does not protect children or promote healthy child development. Concerns have also been raised regarding general settings or policies in communities or schools relating to various topics. We have extensive experience of working in child protection, looked after children, foster and adoption, unaccompanied minor, youth offending as well as children’s drug and alcohol teams. We know that the children’s views, or views of professionals with decades of experience in these fields, are not considered in many or most of these decisions, which will often increase risk to children and communities.

These recommendations include evidence-based protective factors relating to child development (physical, social, emotional, cognitive and language), general health, mental health, social risk and general well-being.  

Many agree that we should ask ourselves whether our decisions in the last 21 months contributed to harm or to protection for children and adults, based on evidence available, and that we need to focus on investing in or preparing for the future, knowing that the most logical place to start is with children’s welfare.

We asked children and young people in various countries where they would suggest the world starts to invest in a better future. Most replied that we should start with reviewing the definition of leadership and good leadership; “some things are as simple as building sand castles, but the focus is not on the problem and solution, the focus is on what is to gain from it”, young person in EU country.

#positive #PositiveChange #children #MentalHealth #Development #schools #leadership #clinics #health #normal #normalcy #messaging #narratives #prognosis #ADHD #ASD

Kindness – Gentleness – Definition of Strength

Kindness – Gentleness – Definition of Strength and Leadership

This photograph was taken in Africa. We noticed the umbrella hat flying off and rolling into the intersection. A youngster stopped his ‘big truck’ (“bakkie”) and then stopped the traffic to collect the umbrella hat and return it to it’s owner. We see little acts of kindness like this on a daily basis in South Africa, now more than ever.

Not ever have we received more emails or statements regarding kindness than the last year. Many have stayed close to the road of kindness to survive and thrive, many have taken a different road. Confidence is required for kindness, and a cause greater than oneself is often helpful to remain focussed.

We recently received an email from the GMC (General Medical Council) regarding kindness, an email we will remember.

Kindness opens doors, starts conversations and can change the ‘hopeless’ or ‘impossible’ to ‘possible’, because kindness often leads to trust and hope, which changes the narrative and prognosis or outcome. Simple measures, simple approaches often have the most significant effects.

Our patients, children, often want to talk about what strength or success means. They often associate strength with kindness. Children often see what is most important in life.

A patient of 15 recently commented that “adults sometimes don’t see kindness as a strength, because they are afraid and they act tough, which doesn’t work, because even animals only follow calm animals, they can see through anything else”.

Quotes on kindness and gentleness:

You can accomplish by kindness what you cannot by force. Pubilius Syrus

Gentleness is a divine train; nothing as strong as gentleness, nothing as gentle as real strength. Ralph Sockman

He who smiles rather than rages is always the stronger. Japanese saying

What wisdom can you find that is greater than kindness? Jean-Jacques Rousseau

Constant kindness can accomplish much. As the sun makes ice melt, kindness causes misunderstanding, mistrust, and hostility to evaporate. Albert Schweitzer

Three things in human life are important. The first is to be kind. The second is to be kind. And the third is to be kind. Henry James

Leadership:

Leadership styles can differ in different contexts, areas or eras. We teach children by doing, not by telling. We can shape our future by focussing on our children.

What is your definition of a leader, success, power, strength, courage or wisdom?

Kindness along with these concepts are different things to different people.

Think about individuals you associate with leadership, success, strength, wisdom, courage?

Individuals who have changed history are mostly remembered as kind, gentle and smiling. Mandela liked to promote the smile; he often spoke of how important it was to smile. He had a good smile, he smiled with his eyes. He stopped to speak with people. He asked questions. He cared about the answers. He spoke of the mistakes he made, of how everyone can make mistakes, of how only the strong forgives, of how anything is possible.

It always seems impossible until it’s done. Mandela

We can all make the same positive difference in this world by how we interact with this world today and tomorrow. Almost anything important starts with kindness and gentleness. Let’s ask more of ourselves and of each other.

We have experienced the most kindness from children in the worst circumstances (we have provided narratives); they are often more calm, confident, gentle, generous and kind than any adult in a privileged context. Let’s learn from each other.

#kindness #gentleness #gentle #generous #courage #wisdom #strength #success #Africa #children #leadership #confidence #calm #trust #hope

Frontrunners – Dilemmas and Travel Options

Masking Dilemmas and Travel Options

We are asked the following questions regularly by medical colleagues, patients and their families:

1. “Where can we go where we don’t have to wear face masks?”

2. “Where can we go where we don’t need a PCR test, which can stay positive for 3 months when you have been healthy and not a health risk to anyone for 2 months or more?”

3. “Where can we go where we don’t have to quarantine or take tests after arrival?”

4. “Who accepts the AstraZeneca vaccine (most of the global population’s vaccine, excluding mainland China) now?”

5. “Where can we go where we can experience some normal to sustain our health?”

6. “Where can we go where we can experience some freedom to sustain our health?”

Vaccine data (currently):

• Oxford-AstraZeneca vaccine is used in 181 countries, Pfizer-BioNTech is used in 111 countries, Moderna is used in 64 countries, Johnson&Johnson is used in 38 countries. There are many other vaccines on the global market.

• As of July 2021, the AstraZeneca vaccine is recognised by the most countries (119) globally, followed by Pfizer (90).

• To date, AstraZeneca has released more than 1 billion vaccine dosages.

• To date, more or less 4.31 billion doses of vaccines have been given to the general public.

• More or less 15% of the global population is now fully vaccinated.

Medical and mental health colleagues, patients and their families are concerned about face masks for many reasons, these are the most common:

1. “People now started smoking again to avoid face masks, at least 50% of people I know.”

2. “My patients report increased drug use, prescription and non-prescription medication use and alcohol use to cope with face masks, which has been a firm pattern for the last year. People say they use near nothing or absolutely nothing on days they don’t have to wear face masks.”

3. “Many of my patients and even colleagues say face masks make them constantly anxious, agitated, irritated, often very angry, aggressive and many say very depressed and suicidal. This has devastating effects on health and on a society and especially a society’s children.” Patients report that it is “helpful to know others feel the same, that I am not alone, that there is nothing wrong with me for having these feelings”, which is why many of these statements are shared.

4. “Many of my patients are now so dependent on face masks, they even wear it when alone at home, with symptoms of OCD, phobias and depression. Mental health concerns will increase significantly in years to come.”

5. “Many people are handed face masks by others, even professionals in hospitals, with unwashed hands, touching both sides of uncovered masks, and no one seems to realise that face masks must be clean to reduce risk, otherwise it increases risk for infection, but masks are now a rabbit’s foot or symbol of care or safety, which unfortunately is far from accurate.”

6. “My patients and even colleagues report that their health has taken a turn for the worst only due to stress due to lack of freedom to leave home, travel, have a normal life, and most importantly, having to constantly wear face masks even though there is no good evidence and in many cases it makes no clinical sense, similar to PCR policies that make little clinical sense. The truth is many medical doctors don’t believe that all of this ‘abnormal’ is clinically indicated and many think it only causes harm.”

7. “Clinical evidence must be good, otherwise it can’t be called clinical evidence, all medical doctors agree with this, and it must mean something, and rights of liberty, capacity, competency, choice, autonomy, normalcy, must mean something, if we are to protect anyone. I hope the new normal means one thing; following good clinical evidence and medical leads with experience in medical crises.”

8. “There is a place where face masks might be helpful, but clinical evidence, context and clinical indications must be considered, it is also very important to consider that face masks, when mandatory for everyone indoors or outdoors and / or associated with threats, increase mental health risks and social risks (such as child abuse, domestic violence, drug abuse) for a very large part of the population, a larger part than high risk to covid” and “it is so crucial that people make decisions about masks for themselves, that they are not told what to do, this reduces risk on all fronts”.

9. “Look at the countries where face masks are ‘recommended’ or ‘encouraged’ in certain contexts, rather than ‘mandatory’ or ‘with threats’, it is very clear that a good outcome requires respect for the patient and clinical evidence.”

What Does The Evidence Say?

What Do International or National Health Organisations Say?

There is currently no good clinical evidence that supports the indiscriminate wearing of face masks for the general public in the community, indoors or outdoors.

Please see relevant statements from the WHO and ECDC regarding when face masks might be useful or helpful.

Please know that it is essential when engaging in a behaviour, such as face mask wearing, to engage in the behaviour safely (quality of behaviour), otherwise risk might increase markedly rather than decrease.

We have asked 50 individuals in more than one country, different age groups, cultural and educational backgrounds, what ‘safe face mask wearing’ means and most responded – “cover your nose and face”. Not one person responded that only clean hands must handle a face mask and that face masks need to remain in clean environments between use, which are essential. In many Asian countries face masks are purchased alongside, same purchase, face mask bags.

It is also important that the person makes the decisions regarding when the context requires a face mask, rather than officials. This is standard practice in Medicine. This falls under ‘quality of behaviour’. This is likely to reduce clinical risk, rather than increase clinical risk.

Recommendations regarding Face Masks by the WHO (World Health Organisation) and the ECDC (European Centre for Disease Prevention and Control):

WHO

“At present there is only limited and inconsistent scientific evidence to support the effectiveness of masking healthy people in the community to prevent infection with respiratory viruses, including SARS-CoV-2” World Health Organisation.

More details available at https://apps.who.int/iris/rest/bitstreams/1319378/retrieve.

Recommendations regarding face masks, World Health Organisation:

1. “Wear a mask IF you cannot maintain a physical distance from others”.

2. “IN AREAS WHERE THE VIRUS IS CIRCULATING, masks should be worn WHEN you are in CROWDED SETTINGS, WHERE YOU CAN’T BE AT LEAST 1 METRE FROM OTHERS, and in rooms with POOR OR UNKNOWN VENTILATION.”

3. “Individuals/people with higher risk of severe complications from COVID-19 (individuals > 60 years old and those with underlying conditions such as cardio-vascular disease or diabetes mellitus, chronic lung disease, cancer, cerebrovascular disease or immunosuppression) SHOULD WEAR medical masks WHEN physical distancing of AT LEAST 1 METRE CANNOT BE MAINTAINED.”

4. “Caregivers or those sharing living space with people with suspected or confirmed COVID-19, regardless of symptoms, should wear a medical mask WHEN IN THE SAME ROOM”.

https://www.who.int/news-room/q-a-detail/coronavirus-disease-covid-19-masks

ECDC

Recommendations by the ECDC (European Centre for Disease Prevention and Control):

1. “IF YOU ARE INFECTED, the use of medical face masks (generally pale blue in colour and available from pharmacies) MAY reduce the risk of you infecting others.”

2. “CONSIDER using a face mask when visiting BUSY, ENCLOSED SPACES, such as grocery stores and shopping centres, or when using public transport, WHERE IT IS NOT POSSIBLE TO MAINTAIN A SOCIAL DISTANCE FROM OTHERS.”

3. “We strongly RECOMMEND the use of medical face masks for individuals with risk factors for severe COVID-19, for all people in airports, and for all passengers during flights.”

4. “Wear a face mask indoors and outdoor WHENEVER PHYSICAL DISTANCING with other people CANNOT be guaranteed”.

https://www.ecdc.europa.eu/en/covid-19/questions-answers/questions-answers-prevention

https://www.ecdc.europa.eu/en/covid-19/prevention-and-control/protect-yourself

Many countries have different approaches:

Recommendations as published in newspapers in a country in Asia, February 2020, a country with experience and relative success in managing previous and current outbreaks of coronavirus:

1. “Do Not Wear a Mask” unless at higher risk: “Do Not Wear A Mask If You Are Well.”

2. “Who Needs To Wear A Mask? IF you have a Fever, Cough or Runny nose and IF you are Recovering from an Illness.”

CDC

It is our understanding that the CDC has recommended that masks should not be compulsory where 95% of the attendees have been vaccinated, this includes cruise ships.

Cruise Ships and Flights

It is our understanding that in some of Hong Kong’s Cathay Pacific flight departments, face masks are not mandatory in certain contexts.

Please know, as mentioned before, during the first 5 months of the outbreak masks were not compulsory during nearly any of our flights. Many airlines confirmed that they maintained good ventilation and adequate spacing or social distancing. It must be added that these flights were mostly in Asia and that core temperature and symptom screens were common and consistent practice, which markedly reduced risk. We have monitored statistics during the start of the outbreak. It is our opinion that this practice did not increase clinical risk.

HollandAmerica, Celebrity and Norwegian (NCL) cruise lines also offer cruises without mandatory face mask wearing policies in most contexts. Contexts where masks must be worn include disembarkation.

Conclusion:

The WHO and the ECDC therefore still do not recommend indiscriminate mandatory face mask wearing as an initiative for the general public; it is clear that the WHO and ECDC specify specific contexts where this initiative can possibly reduce risk on balance, which cannot be ignored, generalised or misinterpreted.

These recommendations also make sense from a clinical point of view based on clinical training and clinical experience, along with research and statistics that risk is increased and harm is caused by these initiatives if not applied as clinically indicated.

Our Clinical Opinion and Recommendations:

Clinical Opinion:

Based on more or less 15 years of clinical medical training and more than 20 years of clinical medical experience in the NHS, further to critical review of the clinical evidence available relating to face mask wearing, we agree that there is currently no good clinical evidence supporting the routine and indiscriminate wearing of face masks by the general public in public settings and therefore we agree with the recommendations of the WHO and ECDC as above.

Please know that ‘critical review of clinical evidence’ is a specialist medical subject where medical doctors specialising in different specialist fields or departments undergo extensive training and then subsequent testing and examination in the field to appropriately evaluate clinical evidence.

We offer services in developing countries. We have extensive experience with systemic bio-psycho-social risk assessment and management; mental health, social risk as well as general health clinical presentations including serious medical problems and infectious diseases, along with implications relating to vaccines, nutrition and the immune system.

We are concerned about ‘blanket’ policies and mandatory statements relating to face masks where no clinical evidence supports these initiatives, such as in areas where there is no or little crowding and good ventilation. We are concerned when the focus is not on education and allowing the public with capacity to make decision regarding the wearing of face masks, to make these decisions for themselves; these decisions should be in the hands of individuals in the general public. It is our opinion that this is paramount to protect mental health, general health and reduce social risk and harm.

We are concerned about increased harm in terms of social risk, mental health risk and general health risk eg due to negligent wearing of masks or secondary to chronic anxiety, anger and depression.

We have shared these thoughts with relevant authorities, who mostly share our concerns.

Recommendations:

1. Crowding can be and should be reduced, limited and avoided in most contexts. Crowding can lead to many general health, mental health and social risk concerns in any circumstance, not only in the context of a pandemic. Many countries have as cultural norm, a priority, to avoid crowding.

2. Ventilation can be and should be improved, increased and maintained at high standards. Poor ventilation can lead to many general health concerns, not only in the context of a pandemic. We have raised these concerns regarding waiting rooms with GP surgeries for the last 20 years.

3. Evidence-based protective factors for mental health, general health and social risk should be prioritised. We have discussed these at length.

We have been asked to share thoughts regarding Vaccine Passports and Vaccines for Children:

It is our opinion that the general public should be educated regarding potential benefits and risks of vaccines, and then be asked to make individual, educated and weighed decisions, as with any health or medical question or decision. Capacity and Gillick competence are relevant, as with all medical decisions.

The general public, professionals along with medical directors and CEOs have the responsibility to make decisions within the boundaries of the law to protect and to serve. Relevant laws prevent deprivation of liberty for good reasons relating to general health, general development, mental health, social risk and well-being. The definition of ‘state of emergency’ and relevant implications relating to deprivation of liberty, autonomy and normalcy should be reviewed on a regular basis and communicated to the general public.

The relevant clinical picture, as mentioned previously, has to be considered. Many viral infections or outbreaks pose a very high risk to nearly 100% of the population. We have discussed the risks relating to this outbreak.

Most medical doctors, many professionals and emergency staff agree to accept the vaccine, because they work with individuals at high risk for severe covid (5-20% of the global population).

Considering that most of these vaccines currently only have emergency approval status, it is our opinion that these vaccines should not be recommended or mandatory for children (and possibly young people) at this stage. Neurodevelopment is not ‘completed’ at age 18, some indicate that an age of 35 is more accurate. Doctors usually explain and help patients to weigh immediate, short term and longer term (over several years or decades) risks and benefits when making decisions. First Do No Harm is a principle most medical doctors prescribe to with significant commitment.

Different protocols or policies are required for individuals at high risk for severe covid compared to those not at high risk for severe covid to protect both groups equally. It might be necessary to have two protocols for individuals with vaccines and without vaccines for a period of time, however, we do not believe that refusal of entry or deprivation of liberty should be relevant in these circumstances.

We have been asked by medical, mental health and legal colleagues who agree with these concerns and statements to share these views in this forum. Many of our colleagues have recently presented with serious health or mental health concerns, and clinical outcomes can be improved significantly with a focus on protective factors and good clinical evidence.

WE ALWAYS RECOMMEND THAT YOU FOLLOW THE LAWS, RULES, POLICIES OF YOUR LOCAL GOVERNMENT AND THE LOCAL GOVERNMENT WHERE YOU ARE VISITING.

#Cruiseship #cruiseliner #cruise #flights #airlines #travel #borders #open #normalcy #positive #tourist #Europe #vaccines #VaccinePassport #Medical #neurodevelopment #vaccine #capacity #Gillick

The Road Ahead

The Road Ahead

The border to France was quiet, the border crossing was quiet, never had we seen such a quite border crossing in 10 years.

France greeted us with warmth and kindness. The French was interested to ask questions about our work and tell us about ‘potjie kos’ (traditional South African recipe) as well as local wildlife experiences on offer.

The train did not leave frequently, so everyone, not many people, had to wait more than 2 hours for the next train. We were informed that no ablution facilities were available on the train due to the pandemic. The website indicated that food was not available at the terminal, however, we were pleased to be informed by staff that food was available, and staff even offered to escort us back so that we could access food and drinks.

Simple gestures, good conversations, kindness from strangers are always memorable, can make a journey, and often lead to ripple effects of more positive.

Once in France the roads were busy with Europeans driving south in France with bicycles, canoes and boats. Nearly every European nation was observed on the French roads.

Road stops offered good food and facilities, along with excited conversation regarding Summer; some facilities even offered new toilet seats (rather than rims).

We arrived at our destination at 10pm. We were interested to see everyone out and about buying ice cream, having coffee, walking along the beach or shopping at the night market. Face masks were now not compulsory outdoors, which many appeared to appreciate. We were delighted to find normalcy. The community shared this delight.

The community reported that they were “a bit worried, because the northerners bring their face masks with, then everyone starts wearing masks again, then it becomes compulsory again”.

There is no need for tests or self-isolation or quarantine in France for individuals who have had vaccines. France asks people to behave responsibly and trusts people to behave responsibly, so most people appear to behave responsibly. Human behaviour is often very simple.

Colleagues have commented for years that the need for specialist medical services for children in France, like many European nations, and the UK, are significant. We therefore applied for our medical and specialist registration to be registered in France, so that we can assist.

We offered our assistance to provide services for vulnerable children and families in France, especially around Marseille and Toulon.

Simple conversations, along the road or with colleagues, often lead to change and different roads taken.

Many are concerned about ‘what lies ahead’ and ‘when will this end’?

The road ahead is what we make of it, what we decide it will be.

We need to ask questions about good clinical evidence and risk. We need to be proactive. We need to review outcomes and statistics. We need to speak up, respectfully. We need to work together for a solution that will benefit everyone. We need to understand that many have lived in fear for more than a year (for various reasons), we have to be accountable, we have to be kind, we have to be gentle, we have to be strong, we have to move forward and prioritise good clinical evidence only.

The road ahead is what we make of it. Based on our 15 years of clinical training and more than 20 years of clinical experience, we agree with so many of our colleagues, that ‘a new normal’ should be a ‘better normal’, not an ‘abnormal’ – that it should include education, a commitment to good hygiene (eg quality of river water) choice, respect, autonomy, normalcy and liberty.

Let’s decide – that the road ahead will be brilliant. We will work together. We will focus on achievable goals and evidence-based bio-psycho-social protection.

Thank you France for prioritising children’s safety, well-being, health and mental health by bringing this topic to the forefront of many public conversations. This will make a difference.

#France #trust #kindness #food #conversation #markets #travel #tourist #border #Marseille #Toulon #Doctor #NewNormal #Future #Positive #children #safety

Wimbledon – Let the Games Begin

Colleagues report that they were able to attend the games at Wimbledon, however, they needed to provide evidence of vaccine status.

Colleagues report that face masks were not mandatory at Wimbledon. Colleagues report that they were able to experience normalcy during Wimbledon, which they appreciated.

Like any game or strategy – several approaches or tools are required to achieve goals. Vaccines are only one tool in the tool box to maintain and protect general health.

Protective factors include for example following evidence-based initiatives such as asking about current or recent symptoms or positive tests, checking core temperature, regularly washing hands, especially before eating or touching the face, remaining home if you are sick or have symptoms, as well as remaining calm, positive, engaging in positive, social, enjoyable and normative activities, normalcy, liberty and autonomy.

Please see current statistics.

#Wimbledon #Tools #Health #Normalcy #statistics #strategy #success

UK June 2021 – Let’s Reflect

UK June 2021 – Let’s Reflect.

Observations, experiences and reports in the UK in June 2021:

Education is key.

All medical doctors and professionals we liaised with agreed that the “basics were not done”, which included education.

• We observe at least 5 individuals in the general public in the UK every day with active symptoms of a flu or cold (not COPD or related presentation). We observe this pattern in the UK more so than in other countries.

• Many individuals still report that they want to avoid the vaccine “because I don’t want headaches”. Many report that they don’t understand or know what the side-effects or risks are (or benefits). Many report that they still don’t know what the risk is that they will end up in hospital if they get sick.

• The public is asked on a regular basis in the UK “do you have one of the three symptoms of COVID”, which most doctors agree, is misleading. 

Many report that they want information and “it is not ethical (clinically indicated or legal) to force people to get vaccines without longterm information on side-effects for an infection that only puts 5-20% in hospital, … and then when you get the vaccine, the rules in the UK are more draconic than ever”, as reported by a medical colleague. Many report that all vaccines are associated with risks, minor risks and more serious risks such as anaphylaxis (although not occurring often) and making vaccines mandatory will only last until the first person presents with anaphylaxis who was “forced to get a vaccine”, as reported by a legal colleague.

It is important to add that most medical doctors (all of our medical colleagues) would recommend the covid vaccine to all adults within the general public, however most medical doctors do not believe that it should be mandatory (medical doctors prefer to focus on education, choice, capacity, weighing risk for individual patients).

Most if not all of our medical colleagues and their families (not children) have had the covid vaccine.

Many medical doctors do not agree that the vaccines should be offered to or mandatory for children (under 18) at this stage unless specific clinical indications. Some doctors believe this age group can extend to 20 or even 35 due to neurodevelopment (unless clinical indications).

Many professionals and medical doctors in the UK report that they, along with the general public, are still not attending health related appointments:

The reasons are as follow (experiences in June 2021):

– “Most of the population or a large part had the vaccine, yet we still have to wear masks, not enter empty shops (or offices) together, there is less freedom than January, than last year, it makes no sense.”

– “The only monitoring that is done is the collecting of phone numbers and addresses, no one asks about symptoms or temperature, seems that is not the important thing.”

– “The PCR tests can stay positive for months for healthy people who are no risk, so why risk going and then be told I have to take a test because someone is sick, I can be healthy and have to stay in isolation, they base their decisions on tests that make no sense, I know people who had to stay in isolation for 30 days or longer, all healthy”.

– “They close the toilets, I can’t cope with that.”

– “They force me to wear a new mask that they hand to me with their unwashed hands touching both sides, if I say I am not happy, they become very rude and hostile.”

– “People are more rude than ever, and when we say please stop being rude, they turn around and say ‘you have been rude from the start and you are shouting at me’, this has become such a predictable pattern that many doctors now avoid health appointments, because they have a lot to lose, whilst the person who treats them with rudeness often has no or less training or qualifications and has less to lose”, as reported by many medical colleagues.

– “We can’t deal with the rudeness and hostility, most people are totally hysterical, I can’t deal with that stress on top of everything else, so we’ve not gone to dentist, health or eye appointments.”

– “I went for an eye appointment and the person shouted hysterically that my mask is not fitting well enough, that she can’t visit her mother in hospital if she gets sick, now I must sit there and let her be my doctor after she shouts at me.”

– “After being shouted at that there is a small gap between my nose and my mask I ended the appointment, I am not happy to tolerate abuse from professionals.”

– “They lock the door after every person entering and leaving, and everyone has to wait in the parking lot in the rain, never did they think to put a chair there, or give an umbrella, but the point is our health is not important to them, their health is the only thing they seem to think about.”

– “I was shouted at when I used the wrong disinfectant gel, apparently there is a gel for staff and a gel for patients.”

– “I have travelled throughout the pandemic, in every country except one other and the UK, healthcare professionals and staff were friendly and professional; there are a few gems in the UK, but many are anxious and therefore very rude, which most try to avoid now.”

It is important to add that many report positive or very positive experiences at many appointments, however this appears to be less frequent.

We mentioned the above for one reason – it is important to create an environment in health or health related services where patients ‘feel’ or believe they are considered as equal human beings with relevant needs (such as access to ablutions, shelter in storms or cold weather – “not told to avoid certain staff alcohol gels”), respected, protected and listened to. Small and simple steps can lead to compliance and attendance of appointments.

Confidentiality and Privacy – Medical Records:

Many individuals in the UK report significant concerns regarding their health information being shared with third parties for research (possibly in the near future – September); “we can opt out, but most don’t know we have to opt out otherwise it will be shared, and worse still, we have to ‘opt in’ to online services to be able to ‘opt out’ of this sharing of information with third parties for research, which seems illegal and unethical”, as reported by a medical doctor.

Many medical doctors and professionals engaging in high risk work are very concerned about having to ‘opt in’ for online medical services, considering that they consistently avoid certain online activities (eg where address etc is available).

Many medical doctors are concerned that they now need an ‘app’ on their phones to show their vaccine history in order to travel. Many medical doctors would like to avoid medical information on apps or online. Many prefer a paper copy with evidence of vaccines.

We understand that some countries ONLY accept a paper copy with evidence of vaccines.

Many also report concerns regarding having to send an online photograph to ‘verify identity’ and report that this increases risk rather than reduces risk, especially for individuals working in high risk fields, and mainly serves to gather data and information on the public.

Many report that it is illegal to deny access to places unless electronic evidence of vaccines, that paper copies should be sufficient. Many doctors also comment that they do not believe entry should be refused for individuals if they have not had vaccines, that this relates to coercion.

Education in terms of relevant laws relating to confidentiality, and the sharing of medical information, is required for the medical professional, the authorities and the general public.

Human Rights:

We were informed last week by a solicitor that the UK might “abolish” or not continue to accept the Human Rights Act in the near future. Human rights are protected by the European Convention on Human Rights (ECHR) which was made part of the UK law by the Human Rights Act 1998. Human Rights protect individuals from acts, and omissions of the State and public authorities acting on its behalf, such as the NHS, but also oblige those authorities to take steps to protect them in certain circumstances.

Relevant to Healthcare:

• Article 2 – Right to life (relevant in safeguarding within hospitals, during any detention such as quarantine or prisons) – Jury inquests

• Article 3 – Freedom from torture, inhuman or degrading treatment (the importance of treating individuals with respect at all times)

• Article 5 – Right to liberty (choice, competency, capacity when making decisions regarding medical or mental health treatment, which includes medication or therapies)

• Article 8 – Right to private and family life (confidentiality, privacy, security)

• Article 14 – Right to non-discrimination (Equality Act)

Other legislation such as the Mental Health Act, Children’s Act or Equality Act are also relevant with these above items.

Liberty is sometimes deprived for patients for instance if they present with dementia or serious mental health problems where they are, at the time, a serious and imminent risk to themselves or others. However, in these circumstances, many safeguards (such as appeals processes etc) are in place to ensure and monitor (very regularly) that risk is balanced, and that clinical and general needs are met.

Many are concerned that there are no such safeguards available for the general public in travel related quarantine or self-isolation.

We have not identified these concerns to this degree, from firsthand observation, in any other country.

The UK is a wonderful country with enormous resources. To whom much is given, much will be required. Let’s take the lead to protect the general public. Let’s reflect, let’s learn, let’s change course.

We want to thank Cambridge, our GP surgery as well as relevant professionals including specialist and GP colleagues, the CCG and especially Cambridgeshire Council (especially the international travel lead) for their assistance and helpful communications in June 2021 and also last year. We sincerely appreciate your input, thoughts and commitment to prioritise evidence-based guidelines to safeguard communities.

#Cambridge #normalcy #liberty #respect #calm #health #HumanRights

Traffic Light System – Clinical Sense?

Traffic Light System – Does this make Clinical Sense in this context?

We have written about this topic previously.

This photograph was taken at an airport of an ‘orange’ country at the time to indicate the flight patterns.

We have not liaised with one medical doctor who agrees that the traffic light system (green – orange – red system for travel) makes clinical sense in the context of this pandemic, most agree that this increases bio-psycho-social risk significantly.

Clinical initiatives have to make clinical sense; laboratory situations do not exist outside laboratories.

It is essential to liaise with medical doctors with experience in bio-psycho-social risk assessment and management when considering initiatives to safeguard children and the general public.

We will provide a recent example.

Earlier this year we returned from a red list country via a European country (orange list) to arrive in another European country (orange list). Please know that different countries see different countries as ‘red’, ‘orange’ and ‘green’ – for instance, one country may see Portugal as green, whilst another country sees Portugal as orange at the same time. Please also know that these colours change constantly (often whilst individuals are in a country on holiday or for work).

We arrived in the ‘orange country’ airport from the ‘red’ country. Thousands of individuals from various countries (red list, orange list and green list) eg India, South Africa, north Africa, Turkey, Maldives and the East gathered together in the large waiting areas to enter through immigration, and then in the shopping and dining areas at the airport of this European ‘orange’ country for at least 5 hours, but up to 15 hours for many.

During our wait at the airport, before boarding for our next flight, we observed one of the staff members at this airport wearing a mask, but removing her mask every few seconds to wipe her running nose and to cough over the food in front of her (she was sweating and looked physically unwell presenting clinically with what appeared to be a flu or cold). She did not wash her hands once between customers or at any time during our observation. She worked at the food counter and touched the food constantly as she handed it to passengers and staff who ordered food (with the same hand she wiped her nose with and coughed with). She also took food from passengers to heat up and then return to them.

Further to observing this consistent pattern we liaised with her and her manager, asking them to remove the food from circulation and to change staff members so that the staff member with the symptoms could go home to recover and be tested. They agreed.

Passengers and staff, further to these joint experiences within this airport for 5 hours or longer, leave on various flights to return home or for onward journeys.

Stop here and ask yourself whether a traffic light system makes sense here – even for one person? Ask yourself also whether we can tick the Education tick box yet? Simple initiatives, such as education, saves lives. It is our clinical / medical opinion, based on 15 years training and at least 20 years clinical experience (working with patients) that a traffic light system in this context, will not reduce bio-psycho-social risk, but that it would rather increase risk for the general public.

We left for another European country (also for work) and after a few weeks, upon our return from this orange list country to the UK (another orange list country at the time), the flight was filled with individuals from a red list country, who had arrived the same morning, however they were on the same flight as us.

Stop here and ask yourself whether a traffic light system makes sense here – even for one person?

Now know that 90% of these passengers, from this red list country (not South Africa), absolutely refused to wear face masks, which caused significant hostility on the flight.

Further to observing this increasing hostility, we asked the staff to ask the passengers to comply with guidelines and wear face masks, however, the staff said they could do nothing, that this was a regular occurrence (often weekly) on this particular flight to the UK (from this orange country). The staff was not able to speak with authority to the passengers, but said that they had raised these concerns before with their authorities without a response.

We landed together in London, all from an ‘orange’ list country, although 90% of our flight was from a ‘red’ list country that same morning, but this was not registered in the UK.

Stop here and ask yourself whether a traffic light system makes sense here – even for one person?

Many report that they would do “anything to avoid hotel quarantine, because we would not make it, but it falls on deaf ears, people care about control not people’s safety or health”. A family recently made a special request that their family member with dementia not be subjected to quarantine in a small space, however, this was denied. We were informed that no medical doctor in the UK had the authority to end travel related self-isolation or quarantine for any person for any reason including child abuse, domestic violence, suicide (or homicide) intent or plan, or fire or for serious health concerns such as chest pain (concerns relating to medical emergencies). We have liaised with legal colleagues regarding this matter. We have also raised these concerns with Public Health England and NHS England; many or most medical colleagues share these serious concerns. These concerns have also been shared with international health organisations and international organisations and courts safeguarding children.

We have flown in many airplanes without masks, as were the policies, especially during the first 5 months of pandemic (this did not appear to affect statistics and our personal preference, as stated before, is usually to avoid mandatory mask contexts), however, we observed that the staff and many passengers were uncomfortable with the significant hostility within the plane which often seems to exist between ‘mask wearers’ and ‘non mask wearers’, and this is why we asked staff to intervene.

Microbiology and virology colleagues comment that individuals who are at home with an infected person (close personal relationships such as partners, children and parents etc) probably have a 15% chance of becoming infected and sick themselves, which is less than most people in the general public would have guessed (this is in a context where no one wears masks at home). We have not confirmed this statistic, however, it is based on professionals’ experience and estimations.

Most medical colleagues agree that the traffic light system in this context makes no clinical sense, much like the generalised policy that everyone should wear face masks, and that this increases frustration, anger, anxiety, depression and general bio-psycho-social risk rather than reduce risk and harm.

Most medical doctors agree that regular exposure to agents and pathogens (as part of normal life, leaving home, social interaction in the community, travelling etc – not purposefully exposing a person or self to risk) stimulates, educates and strengthens the immune system to be able to defend against infections and risks. Many agree that remaining at home or in one country, closing borders, will not benefit the immune system at all, “it just postpones things for when you open the door”. Many comment on concerns that the general public is then also “often so afraid to leave home then, and the chronic anxiety makes their immune systems crumble so their defences to viruses and variants are like newborns, not developed”.

Initiatives have to be based on good clinical evidence to reduce bio-psycho-social risk and prevent harm, and a longterm and systemic view is not only required, but essential.

Nations have to work together, taking a global approach, rather than mark each other as ‘green’, ‘orange’ and ‘red’ if we are to move forward and safeguard the most vulnerable.

Let’s not waste time. Let’s focus on evidence-based protection.

#travel #borders #together #exposure #health #immunesystem #flight #passenger #airport

Sweden’s Surprise

Sweden’s Surprise

Sweden offered many positive surprises. The first surprise was this fox near our cabin the first morning. Many wonderful surprises followed.

We have observed, firsthand, the various approaches and initiatives of at least 20 countries during the outbreak since January 2020 (we were in Asia at the time). We have been interested in the various public responses along with clinical bio-psycho-social outcomes. We have also been interested in how the media ‘paints’ the pictures for the general public not currently in the various countries. We were particularly interested in a comment by the media earlier this year “the virus sweeps through the townships” when we were present in the townships and observed the exact opposite with many asking “why do people in townships not get sick”. Microbiology and virology colleagues comment that this is likely due to ongoing and regular exposure to various agents and pathogens which promote a strong immune system, whilst child psychiatrists also comment that the mental state and attitude in townships often promote a strong immune system.

Many have not travelled during this time, entered or exited through borders, so are unaware of the different approaches, policies, procedures and processes, along with responses by staff, leaders and the general public.

We have documented the various patterns and we have shared some of our observations and concerns in confidence with organisations, such as health ministries and public health departments, who have requested to remain on our mailing list.

We have been very interested in the clinical outcomes, including increase in social risk, for children and vulnerable adults in various countries.

We requested to meet with children’s social workers in Sweden to discuss Sweden’s unique approach (compared to many countries in Europe and the UK) and the clinical outcomes identified.

Based on our firsthand observations and experiences, Sweden’s approach is more similar to the approach of Singapore and South Korea where evidence-based clinical initiatives are prioritised (these countries have experience in the relative successful management of previous similar viral outbreaks).

As a colleague in Sweden commented, “the general public is asked rather than told, that is the difference”, liberty, autonomy and normalcy are respected as protective factors for mental health as well as general health; “important for remaining calm and positive which support a healthy immune system”. The general public is “very calm, very positive, very happy to be in Sweden” and engages in behaviours that reduce risk consistently such as remaining at home when sick, or covering nose and mouth when coughing or sneezing, or washing hands regularly and effectively (without overdoing it). He reports “no one is scared, no one feels trapped, no one is told what to do, people feel supported as if we are working together”.

A comment from a colleague in South Korea recently “the difference is no one was forced to do anything in Korea such as wear face masks, close shops or stay at home, but people are given information and options, nothing would have worked if people were forced, now people rather prefer to work together, but if they were forced, nothing would have worked out well, and now people are calm and they feel positive because their rights are not threatened”.

As mentioned Singapore recommended during the first months of the outbreak that face masks not be worn unless in certain contexts, such as when a person has symptoms. We observed, firsthand, calm and positive thoughts, feelings and behaviours in Singapore. Singapore prioritised education and normalcy as protective factors, which is an evidence-based approach for this particular viral infection. Many countries in Asia followed this approach the first few months of 2020. Many agree with a colleague from Asia, “too much pressure from the West means we all have to do what the West does, although we know it won’t work”.

Statistics in these nations support these initial approaches.

Children benefit significantly from calm parents, calm carers, calm communities and calm leaders. A systemic approach is important, which implies that everything is connected: A calm leader leads to calm communities, which leads to calm adults, calmer households and this benefits children’s safety, well-being, health, mental health and development.

Mental state is very important in the environment for children. A mental state of calm, positive thoughts, hopefulness, enjoyment of life and activities (not ‘feeling’ trapped, but ‘feeling’ free to make choices), and so forth, is one of the significant factors that create positive change and maintain mental health and general health for children. We have written about other factors such as safety, normative activities, positive relationships, education, food choices and so forth.

Social risk, such as alcohol and drug abuse, general violence, domestic violence and child abuse can be limited and reduced significantly by simple initiatives inspiring calm such as education regarding infections, viruses, vaccines and general health or hygiene, however, initiatives have to be evidence-based (based only on good clinical evidence). Many report that they don’t believe their country’s general public has been educated regarding viruses or vaccines.

We appreciated the very significant degree of normalcy, autonomy and liberty in Sweden. These are longstanding evidence-based protective factors for general health and mental health (and this often reduces social risk). These experiences benefited our health personally, and we were interested to see the general public’s absolute compliance with recommendations (from what we observed). A colleague commented, “it makes sense, if you force someone to do something, most adults won’t do it, you have to treat adults like adults or you get defiance, depression and violence in independent adults with normal attachment styles”.

There is still currently no good clinical evidence that supports the wearing of face masks for the general public as a generalised rule. This statement is supported by the WHO and European-CDC. These organisations offer advice regarding when face masks might be helpful and of benefit. We have provided links of these statements previously. We have been informed that the CDC (USA) now states that face masks are not (or do not have to be) mandatory on cruise ships where 95% of the passengers are vaccinated. Some states in America, such as Florida, have no compulsory face mask initiatives for the general public, whilst California takes an opposite approach. Please see relevant statistics.

It is also relevant to know that face masks are not mandatory in Sweden, which is also an initiative based on good clinical evidence, because there is no good clinical evidence to support mandatory face mask wearing for the general public. We observed that more or less 10% of individuals wore face masks indoors and less outdoors. People do however respect the importance of ventilation and a reasonable degree of social distancing.

We have not experienced more normalcy and more following of evidence-based research in general approaches or initiatives in any country compared to Sweden since August 2020. We are very grateful for these valuable experiences. We thank you.

#Sweden #calm #positive #normalcy #normal #liberty #children #happy #healthy #Health #Immune #ImmuneSystem #travel #borders #evidence #autonomy #fox