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

Africa’s Bounty – Kindness of Strangers

Africa’s Bounty – Kindness of Strangers

We are often asked “how do your services start”?

We are most often contacted directly by health ministries asking for specialist service development, service provision or outreach services for hard to reach children or communities. We are sometimes asked by NHS Trusts, medical or mental health teams to assist with service development or clinical needs, and then we are sometimes surprised by the most simple and unexpected turn of events that can lead to positive change and clinical collaboration.

We offer an example.

Earlier this year we were unable to get internet access via any of the three (or four) providers offering services in South Africa. We were located in the area close to Cape Point. We were providing clinical services, online, at the time.

A woman who owned a shop and restaurant in Scarborough offered that we use her top floor for our online work for the day. The top floor was not in use at the time, and we were offered the setting we required for our work, including the privacy and security, to be able to continue with our online work for the day. She refused to take any payment for assisting us.

We asked this kind woman and also her staff whether there was something we could help them with after the morning’s work whilst having a meal at their restaurant. They directed us to one of the staff members who spoke to us of a local clinic needing doctors.

We visited the clinic the next day and spoke to the nurse in charge. She was interested in medical assistance. We liaised with colleagues in the Department of Health and relevant universities who we have liaised with previously, and who have consistently been most helpful. We were informed that a significant need exists and that medical or specialist input would be appreciated. We offered our availability to assist in any way we can. We currently have availability due to recently closed borders in target areas. We can possibly aim to be available once or twice a year to offer input if required. Further to receiving the word to proceed from relevant professionals, we will return to this clinic to offer our input. We currently have 5-10 volunteers who might be able to offer additional assistance.

This chain of events started with the kindness of a stranger at https://www.thevillagehub.co.za – we thank you.

We are grateful for the positive liaison we have had with professionals and staff we have known for years and with professionals and staff introduced to us this year.

The positive energy in South Africa, often observed and experienced, remains unmatched in many countries, and this is often the driving force to create positive change in challenging circumstances.

Our door remains open to you.

For anyone else concerned about children or communities:

We are always available to discuss service development for high risk and vulnerable children or communities. If you would like to discuss service development, provision or outreach services with us, please email us at admin@mentalhealthbus.co.uk to arrange a meeting with our directors.

We are currently waiting for borders to reopen in Latin America and the Pacific to continue with service development projects. Countries in Europe as well as a county in the UK have asked for assistance with service development or service reviews further to serious or critical incidents.

Mental health needs for children have increased markedly in the UK and Europe since the onset of the pandemic. There is currently no bed available for a child with serious mental health concerns in the UK (this has been the case for weeks and months).

Simple measures can however reduce or prevent serious morbidity and mortality in children (and reduce the need or prevent admission for many – which is the aim for most Child Psychiatrists). These measures are unfortunately not prioritised as part of global measures to protect children, families and communities in many countries, especially developed countries, during the pandemic. We have written extensively regarding this matter, corresponding with relevant authorities since March 2020, and will continue to do so. We thank the many professionals who share these concerns and who work tirelessly to ensure that no harm is caused or that risk of harm is reduced by ensuring that bio-psycho-social initiatives during the pandemic are evidence-based (based on longstanding good clinical evidence).

We are always interested to know about areas or countries with specific clinical need for children and we always aim to be available to assist in any way possible. We do however require a certain context during the pandemic, including that bio-psycho-social evidence-based guidelines are followed to prevent harm.

Consultation, supervision and training can create sustainable change, and although we prefer to be present in person, we also offer online assistance where appropriate.

We always aim to remain involved with previous projects, visiting once a year or when needed to ensure that goals of sustainability are achieved.

A world can change for children, communities and countries by simple acts such as kindness, offering assistance, gratitude, reciprocity, communication and collaborative work. It does take a village to achieve anything good in this world.

Let’s work together.

#Scarborough #CapeTown #SouthAfrica #TheVillageHub #Positive #Energy #Gratitude #Change #WorkTogether #Clinic #Doctors #LatinAmerica #Pacific #Europe #UK #ServiceDevelopment #Children #Safeguard #Health #MentalHealth

Let’s Do This

Let’s Do This

This is an example of positive public messaging. This messages inspires an ’emotion’ or ‘feeling’ that is positive (hope, energy, camaraderie). South Africa is using this catchphrase to motive the public to engage in vaccines. This sign, or signs like this, is seen everywhere on the roads. There are no messages inspiring fear or uncertainty (as observed at the time earlier this year).

This catchphrase is used by many children in therapy to motivate them to remember their ‘game plan’. In Liverpool, in the UK, in 2004-5, children presenting with anger and aggression often choose this particular catchphrase during CBT (Cognitive Behavioural Therapy), which had a positive effect on their therapy. We were informed at the time that the catchphrase was inspired by Vin Diesel in Fast and the Furious, and that it inspired a belief (thought) that “we will be successful”, “we will make it happen”.

These beliefs (thoughts) and emotions (feelings) inspired calm (a low blood pressure, heart rate and respiratory rate) and an improvement in high levels of impulsivity, anger, anxiety and aggression, as well as behavioural changes (children presented as more confident and because they believed they would be successful with their goals, they were mostly successful with their goals – strategies to manage their anger). Thoughts or beliefs, feelings or emotions, physical health, symptoms or signs and behaviour are connected, each to each other in every way.

Good clinical outcomes require therapists or doctors to consider every factor. Some children prefer to focus on behaviour, some on thoughts, some on emotions, some on physical changes (breathing or meditation) and some on a combination of these items.

Medication can often be avoided if the correct therapy is provided by therapists in effective manners.

This catchphrase has helped many children and it has also helped families and adults.

Simple initiatives or measures can often have significant positive outcomes in complex or high risk contexts.

CBT can help children presenting with anger, aggression and violence, however, for children with longstanding losses and trauma, CBT (or behavioural therapies alone) is often less helpful compared to psychodynamic therapy or CAT (Cognitive Analytical Therapy) and social support or interventions.

Attachment style should always be considered, along with other predisposing, precipitating, maintaining and protective factors when deciding which therapy and which therapist would likely be appropriate for each child. There is no recipe or checklist system. We would recommend liaising with a professional with training and experience in various therapies for their recommendations further to a detailed clinical assessment; at a minimum the therapist or doctor should have training and experience in at least one type of behavioural therapy (there are more than one kind), CBT, CAT, systemic family therapy and psychodynamic therapy.

It is also very important to remember that social interventions are essential for most children, for instance relating to safety, supporting schools and ensuring that children have regular access to normative activities where learning, general development achieving, positive social relationships and enjoyment are encouraged. Connexions, working collaboratively with Social Care, used to be extremely valuable in this regard in the UK to support children and families. Most child psychiatrists in the UK valued their input; it made a significant positive difference for almost all children in CAMHS (Child and Adolescent Mental Health Services).

Most families associate Social Care with child protection, however Social Care usually has many teams to offer creative and flexible input to support children, adults and families (often providing respite to families or introducing children to new hobbies or interests such as horse riding, boating, sailing, art classes etc), and only 1 team usually relates to child protection (families are usually always informed without delay if there are any child protection concerns – transparency (and trust) is always prioritised).

#positive #message #emotions #thoughts #health #behaviour #anger #hope #catchphrase #SouthAfrica #therapy #CBT #CAT #psychodynamic #Liverpool #VinDiesel #FastAndTheFurious #school #children #development #trust #progress #success

Let’s move forward together in unity – every community – every country

Let’s move forward together in unity – every community – every country:

A medical crisis or pandemic is a time for collaborative working, congruent approaches, clear leadership by medical professionals with appropriate training and clinical experience in bio-psycho-social risk assessment and risk management, good communication and consistency – following only good clinical evidence.

Medical doctors, colleagues and the general public find the leadership, podcast, narratives & information provided by Dr David Nabarro, Chair of Global Health and Co-Director at IGHI Imperial College London, WHO COVID – 19 Special Envoy most positive, reassuring, helpful and valuable. http://www.4sd.info/covid-19-narratives

It is essential that we work together to protect the most vulnerable and the general public, children and adults, in every community and in every country.

It is essential that a global health plan is agreed upon and followed to protect every person equally.

Initiatives have to reduce risk, protect the general public and therefore be based on good clinical evidence considering systemic bio-psycho-social risk and protective factors.

Many medical doctors agree that many initiatives currently increase risk and harm, and evidence supports this concern. Please consider supporting evidence and statistics with markedly increased figures relating to general medical, mental health and social concerns including child abuse and risks to children, as documented in 2020 by organisations such as the WHO, UN, UNICEF, NSPCC, Oxfam, England’s Children’s Commissioner, RCPCH, the Trussell Trust, Young Minds, MIND, Samaritans, NCMEC, Alcohol Change UK and the National Domestic Abuse Helpline.  

First do no harm is a prevailing principle to protect during all medical or mental health crises. We have to ask ourselves whether there is good clinical evidence to support decisions and initiatives in every context. Delays increase risk during medical crises.

We have to learn from previous decisions and clinical audit findings (audits have to be completed). We have to ask the right questions. We have to understand the ABC’s of every decision and initiative during this pandemic (the motivation, predisposing and precipitating context, what the initiative looked like, felt like for individuals – qualitative and quantitive details, and then the biological, psychological and social consequences for every initiative put in place). This will facilitate prevention and protection for tomorrow.

The World Health Organisation is a global organisation with professionals with varied global, medical and mental health training, experience and expertise. The WHO’s recommendations are relevant to every person in every country. The WHO has gone to great lengths to facilitate education and protection – let’s spread the word – let’s be curious – let’s read their recommendations and the information they provide (we have shared some on previous posts), and let’s work together, in unity, to move forward without delay. https://www.who.int

#ImperialCollege #WHO #positive #forward #health #consistency #leadership #communication #PreventHarm #education #children #protection #elderly #vulnerable

#elephants in the #KleinKaroo #SouthAfrica

Positive Narratives

Colleagues, families and children often ask us what they can do to ‘change the narrative’ of their lives – to ‘think positive’ – to ‘have positive stories or experiences or information to dwell on, rather than to live with a focus on fear or loss’.

This question made us reflect on the story of the 3 orphaned elephants adopted in Buffelsdrift (above). Experiences or adventures often lead to being exposed to new stories, new information and to learning – this occupies the mind and it expands the mind – encouraging growth and life.

We have been asked to provide examples of #positive and enjoyable #adventures in #CapeTown #SouthAfrica where good clinical evidence is followed such as facilitating social distancing at all times and general hygiene, which is relevant in this context.

1. #Buffelsdrift in Oudtshoorn (photo) where Mr Andries Van Schalkwyk is committed to the safety, enjoyment and relaxation of his guests. Social distancing is facilitated at all times, even during #game drives, where solo game drives are offered. This is not offered by all #safari or game farms in South Africa (we have checked). We were inspired by the story about the adoption of the 3 baby #elephants and their journey, and relationships with the staff. We recommend a visit.

2. #Villiera game drives, close to #Stellenbosch – very educational and lovely environment.

3. #MonkeyTown in Somerset and #WorldOfBirds in Houtbay are committed to rescue #animals and education. Children love the #monkeys – they are free roaming.

4. #EagleOutreach in #Spier wine farm, close to Stellenbosch, and #Cheetah Outreach in Somerset share their commitment.

5. #Boulders famous for hosting #penguins shares their commitment.

6. #Crocodile tours offered by Andrew at #LeBonheur close to #Paarl is most educational. We have never seen cleaner areas for animals. The farm also offers excellent food and accommodation.

7. #4×4 #GearUp with Sam and Jarred – very educational to prepare for challenging terrain.

8. #BikeSavvy with Brent – very educational and teaches safe #motorcycle techniques. Many villages in islands can only be reached by 4×4, motorcycles or boats.

9. #Snorkel with Craig Foster in Cape Town’s waters – there is no better place for peace, silence and beauty (and interesting relationships). Please see ‘My #Octopus Teacher’ on Netflix.

10. #Sailing in most areas and #boat trips to #CapePoint – most spectacular. Lessons are available locally with accredited teachers. Dolphins, seals, penguins and Southern right #Whales are often seen when sailing.

Based on our or our colleagues’ experiences at the time, these were some of the most enjoyable experiences in recent times.

We always recommend to avoid close contact with wild animals (and never feed them). If they approach you, we usually recommend to slowly and calmly move away. If they jump on you (monkeys for instance), calmly move towards the guide and ask him or her to assist you – always remain calm, so that the animal will remain calm. If there is no guide, the animal will often become bored and move away. Don’t have food or drinks on you when visiting places with animals (they will be reluctant to move away then and risk can increase). Wild animals are wild, and this is often in their best interest and in yours or your child’s best interest. Guides will offer help and give advice, however, remember to also follow your own gut and mind with these decisions if you feel or think that guides are too confident or taking unnecessary chances, which seldom happens, although it can happen (eg if a guide tells you that you can go closer or touch the animal). It is important to follow the guide’s advice when he or she tells you to stop or move away or not touch or feed animals or return to your vehicle. Most guides prioritise safety and have years of experience in maintaining safety for animals and humans.

#Animals can #teach us a lot and can be especially helpful in #social and #emotional #development for #children – such as forming a healthy #attachment and #learning about #interaction #communication and #responsibility – we recommend introducing animals to children at a young age (safely and in age appropriate ways).

Travel and the traveller

Travel and the traveller

Clinically appropriate measures based on good clinical evidence are required to reduce risk during this pandemic.  The emphasis needs to be on the traveller, whether the traveller is high or low risk in the context of severe COVID-19; this is indicated by the clinical picture presented to us since January 2020 (please see paragraph below).  Where the traveller is going within the country, where the traveller will be staying, mode of transit, purpose for visit – these are all essential matters to consider in any risk assessment, as it has been previously. 

The important matter is that the responsibility should be on the traveller (autonomy); education, discussion with informed and appropriate health professionals (trained and supported GPs), weighing decisions and making informed decisions considering recommended, necessary or indicated vaccines or protective equipment required. 

“80% of the time COVID-19 is a mild disease that feels like a minor cold or cough”, as reported by Prof Peter Piot, Director for The London School of Hygiene and Tropical Medicine, and 95.5% of the general population will likely not require hospitalisation, only 4.5% of the global population will likely require hospitalisation if infected with SARS-CoV-2, as reported by The London School of Hygiene and Tropical Medicine. 

There are individuals at high risk for severe COVID-19 (eg the elderly, immune compromised and some with underlying medical conditions) and there are individuals not at high risk for severe COVID-19 – two clinical risk groups – one high risk group and one low risk group in the context of COVID-19. Ask your GP if you are not sure in which group you are.

Educating the public in terms of general health, infectious diseases and this pandemic is essential to achieve good clinical outcomes.

Global Health Plan

A global health plan is clinically appropriate and required to address a global health crisis.  We have given examples of why a global health plan is essential for a good clinical outcome during this pandemic in previous correspondence.  Our reasons have included for instance the consistent approach that high risk individuals for severe COVID-19, such as the elderly, be vaccinated first, without the delay in the second vaccine, where appropriate, and that staff offering high risk work such as medical doctors and other healthcare workers engaging in clinical work, teachers, Police, Social Care be given an opportunity to be vaccinated as the second priority. 

This clinical recommendations is informed directly by the clinical presentation of this virus. 

Consistency in terms of travel, quarantine or PCR tests would also protect the global public.

Let’s move forward together with eyes wide open – let’s ask questions and consider good clinical evidence.

Helpful websites:

TRAVEL AND WORK

http://www.travelhealthpro.org.uk

http://www.nhs.uk/conditions/travel-vaccinations

BORDERS AND TRAVEL

https://www.iatatravelcentre.com/world.php

https://canitravel.net

https://apply.joinsherpa.com/travel-restrictions?affiliateId=americanairlines

https://www.worldnomads.com/travel-safety/worldwide/worldwide-travel-alerts

https://www.wanderlust.co.uk/content/coronavirus-travel-updates/

#travel #traveller #education #responsibility #SouthAfrica #nature #antelope #Blesbok #Blesbuck #Wanderlust #WorldNomads