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07 April 2020 | Story Dr Jacques Jordaan | Photo Supplied
Dr Jacques Jordaan
Dr Jacques Jordaan.

All South African citizens are by now aware of the global pandemic caused by the COVID-19 virus. Our president, Cyril Ramaphosa, placed the entire country in a state of lockdown to limit the spread of the virus in South Africa. Schools, tertiary institutions, churches, and numerous businesses (which do not provide essential services) had to close. The lockdown aims to ensure that citizens stay at home, isolate themselves from others, and that those who can work from home should do so. The consequence and reality, however, is physical and social isolation, which of course also means that many people are currently alone and lonely.

Working from home
There are several benefits to working from home; for example, you can manage your own time, work in comfortable clothes, and you can work undisturbed and with less interruptions. Although the lockdown – and thus social isolation – will only last for (maybe) 21 days, there are psychological disadvantages associated with social isolation. Many people could soon become discouraged and demotivated because of the time away from others due to social isolation. Social isolation is the absence of social interaction, contact, and relationships with loved ones, colleagues, strangers, and even society as a whole. Humans, by nature, are social beings who strive towards social interaction with others, and social interaction is essential for people's well-being and survival. Although it is also natural to occasionally seek alone time, the effect of social isolation can have negative consequences for the emotional well-being of individuals.

Consequences of social isolation
Studies have shown that long-term social isolation has dire consequences for people's physical and mental health, such as increased risk of premature death and higher tendencies towards depression. Still, social isolation – even for a few weeks – can also have a negative psychological impact on people's lives. Social isolation can lead to feelings of despair and loneliness, depression, anxiety, substance abuse, and sleep difficulties. Furthermore, in times of social isolation, individuals tend to exhibit more forms of unhealthy behavior than usual, such as smoking and drinking more alcohol. Feelings of loneliness tend to worsen when individuals are isolated with people with whom they do not have a close relationship and, therefore, loneliness becomes a more significant struggle during times of social isolation. This can turn into a vicious cycle, leading to more loneliness and depression if not dealt with. During these isolation periods, individuals may even become complacent, and consequently do not have goals and routines.

Social isolation will, however, affect people differently. More extroverted people will long for social engagement with others and might feel as if they want to climb the walls. They will just want to go shopping and spend time with others. More introverted individuals may enjoy this alone time and spend time taking long baths and reading books. However, everyone will start to experience social isolation negatively at some point. Families will, for example, not be used to these extended periods together, and this may lead to increased conflict between family members. Individuals with big homes can spend time in their gardens and exercise on their lawns, but what about those individuals living in overcrowded flats or informal accommodations. Such individuals may be more inclined to experience depression, anxiety, and loneliness. Individuals with drinking and smoking habits may become more dependent on these substances during the lockdown. Also keep in mind those individuals who have small children who are now home for several weeks and need to be kept busy and entertained by their parents. Parents are not used to being responsible for keeping their children busy productively.

Socializing through social media
People might still be fine and feel good now, but we have not yet reached the halfway point of the lockdown, and how will individuals cope if the lockdown is extended. There is, of course, hope. It is important to remember that although people are currently isolated, they can still attempt to be social by using various forms of social media. Recent studies have shown that individuals may experience less loneliness when interacting with others through various forms of social media. Accordingly, individuals need to make more contact with others and reach out to those that they have not heard from in a while. Social interaction is crucial, as many of us need social interaction to cope with daily challenges. However, also beware of negative content or fake news. Social interaction via the internet might not fulfil everyone’s needs as with interpersonal communication and interaction, but it still allows us to experience a sense of congregation and community.

Stay positive
The reality is, however, that many people also do not have access to the internet and social media, and therefore cannot communicate with others. It then becomes essential that people should continue with certain routines in their lives and to not just sit in front of the television. People still have to set goals (even smaller goals) for themselves and try to achieve them. Everyone should try to change their perspective by trying to stay positive. People need to attempt any form of exercise and keep their minds occupied with books or brain games. Fortunately, when it comes to children, most schools have provided parents with study material to keep their children busy educationally. Alternatively, parents should create some form of structure and routine for their children during the lockdown. Families can play board games and create their own fun activities. Children should also be allowed to engage with their friends via social media if they become lonely. And parents should allow their children to share their worries and concerns openly. Individuals need to be prepared, because when this mandatory period of isolation ends, everyone will have to resume their normal activities.

Get help
If not addressed, these experiences of overwhelming loneliness, sadness or lack of meaning may continue long after the lockdown has ended. Individuals who experience depression and loneliness after the lockdown should reach out to others, try to eat healthy foods, do fun things, and exercise more. Such individuals should also consider contacting mental healthcare professionals for assistance. They can also visit the South African Depression and Anxiety Group's website or Facebook page for help.

Social distancing is vital at this stage, but as South African citizens, we must remember that we are not going through this alone. We are isolated from others, but together we are all fighting the same battle against COVID-19.

Opinion article by Dr Jacques Jordaan, Lecturer and Undergraduate Coordinator: Psychology Programme Director: B.Soc.Sc. Faculty: The Humanities, University of the Free State

News Archive

Heart diseases a time bomb in Africa, says UFS expert
2010-05-17

 Prof. Francis Smit

There are a lot of cardiac problems in Africa. Sub-Saharan Africa is home to the largest population of rheumatic heart disease patients in the world and therefore hosts the largest rheumatic heart valve population in the world. They are more than one million, compared to 33 000 in the whole of the industrialised world, says Prof. Francis Smit, Head of the Department of Cardiothoracic Surgery at the Faculty of Health Sciences at the University of the Free State (UFS).

He delivered an inaugural lecture on the topic Cardiothoracic Surgery: Complex simplicity, or simple complexity?

“We are also sitting on a time bomb of ischemic heart disease with the WHO (World Health Organisation) estimating that CAD (coronary artery disease) will become the number-one killer in our region by 2020. HIV/Aids is expected to go down to number 7.”

Very little is done about it. There is neither a clear nor coordinated programme to address this expected epidemic and CAD is regarded as an expensive disease, confined to Caucasians in the industrialised world. “We are ignoring alarming statistics about incidences of adult obesity, diabetes and endemic hypertension in our black population and a rising incidence of coronary artery interventions and incidents in our indigenous population,” Prof. Smit says.

Outside South Africa – with 44 units – very few units (about seven) perform low volumes of basic cardiac surgery. The South African units at all academic institutions are under severe threat and about 70% of cardiac procedures are performed in the private sector.

He says the main challenge in Africa has become sustainability, which needs to be addressed through education. Cardiothoracic surgery must become part of everyday surgery in Africa through alternative education programmes. That will make this specialty relevant at all levels of healthcare and it must be involved in resource allocation to medicine in general and cardiothoracic surgery specifically.

The African surgeon should make the maximum impact at the lowest possible cost to as many people in a society as possible. “Our training in fields like intensive care and insight into pulmonology, gastroenterology and cardiology give us the possibility of expanding our roles in African medicine. We must also remember that we are trained physicians as well.

“Should people die or suffer tremendously while we can train a group of surgical specialists or retraining general surgeons to expand our impact on cardiothoracic disease in Africa using available technology maybe more creatively? We have made great progress in establishing an African School for Cardiothoracic Surgery.”

Prof. Smit also highlighted the role of the annual Hannes Meyer National Registrar Symposium that culminated in having an eight-strong international panel sponsored by the ICC of EACTS to present a scientific course as well as advanced surgical techniques in conjunction with the Hannes Meyer Symposium in 2010.

Prof. Smit says South Africa is fast becoming the driving force in cardiothoracic surgery in Africa. South Africa is the only country that has the knowledge, technology and skills base to act as the springboard for the development of cardiothoracic surgery in Africa.

South Africa, however, is experiencing its own problems. Mortality has doubled in the years from 1997 to 2005 and half the population in the Free State dies between 40 to 44 years of age.

“If we do not need health professionals to determine the quality and quantity of service delivery to the population and do not want to involve them in this process, we can get rid of them, but then the political leaders making that decision must accept responsibility for the clinical outcomes and life expectancies of their fellow citizens.

“We surely cannot expect to impose the same medical legal principles on professionals working in unsafe hospitals and who have complained and made authorities aware of these conditions than upon those working in functional institutions. Either fixes the institutions or indemnifies medical personnel working in these conditions and defends the decision publicly.

“Why do I have to choose the three out of four patients that cannot have a lifesaving operation and will have to die on their own while the system pretends to deliver treatment to all?”

Prof. Smit says developing a service package with guidelines in the public domain will go a long way towards addressing this issue. It is also about time that we have to admit that things are simply not the same. Standards are deteriorating and training outcomes are or will be affected.

The people who make decisions that affect healthcare service delivery and outcomes, the quality of training platforms and research, in a word, the future of South African medicine, firstly need rules and boundaries. He also suggested that maybe the government should develop health policy in the public domain and then outsource healthcare delivery to people who can actually deliver including thousands of experts employed but ignored by the State at present.

“It is time that we all have to accept our responsibilities at all levels… and act decisively on matters that will determine the quality and quantity of medical care for this and future generations in South Africa and Africa. Time is running out,” Prof. Smit says.
 

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