Doctors who fought for their lives in the Intensive Care Unit (ICU), a team that allowed more than a thousand patients to say goodbye to their relatives through a video call, and stories of relatives coping with their duels allow us to deepen and reflect on the importance of a parity between physical and mental health in Peru.
By: Karla Velezmoro
Every time the intensivist doctor Rodney Garay Bernuy, hears the alarms of a mechanical ventilator or an infusion pump, the one that administers the drugs, he sweats profusely and has a tachycardia.
«Those sounds generate a reaction in me. I’m not afraid, nothing, but I feel that reaction,» says Dr. Garay, who continues to receive psychological therapy to overcome the consequences left by the battle he waged against Covid – 19 two years ago.
«Eight months I received pharmacological medication and continuous psychological sessions. But now I have a psychological session every two months. I no longer have sleep problems, nor do I have angry and abrupt reactions, I am managing anxiety and depression better,» the doctor mentions.
Today, two years after fighting Covid
For two years, in which he fought against Covid 19, he has not returned to practice as an intensivist.
Although he feels more stable mentally and emotionally, he has not yet been discharged. For now, his return to the hospital, which has helped in his process, has been in the administrative area.
While he tells me that he hopes to be able to return to the Intermediate Care Unit next year, he shows me what is currently his office at the Alberto Sabogal National Hospital, one of the most important in the Callao region, the main port of Peru.
Doctor Garay, had a second chance
Dr. Garay is a survivor. He was in the Intensive Care Unit for 63 days. He was intubated and had a tracheostomy.
In total, he was hospitalized for 77 days, from June to September 2020.
This hard process, added to the rehabilitation that he had to undergo to recover the mobility of his body, led him to experience a roller coaster of emotions: despair, anguish, anxiety, confusion, frustration.
At 60 years old, he managed to beat COVID-19 but it left him with physical consequences such as the pulmonary fibrosis that he suffers from, and psychological consequences such as the emotional state of lability (abrupt mood swings) that he tries to overcome with treatment and with the support of his family and colleagues.
Mental health, a priority after the pandemic in Peru
The pandemic has impacted in one way or another on the mental health of Peruvians. Loss of loved ones, loss of employment, loss of free movement during the height of the disease, loss of socialization, loss of the world as we knew it.
According to the Directorate of Mental Health of the Ministry of Health of Peru, the most frequent problems dealt with by the mental health system are anxiety and depression disorders.
The psychiatrist Víctor Cutipé, Director of Mental Health, stated that both disorders have increased after the pandemic.
He specified that in 2021 they treated 432,504 cases of anxiety, a figure that has tripled since the Peruvian mental health service began to record cases in 2009.
In the case of depressive symptoms, the figure has doubled. At the end of 2021, they attended 232,831 cases, unlike the 105,000 attentions of 2009.
In Peru, the supply of mental health services has increased.
Given this, it is pertinent to mention that the increase in figures also coincides with the greater offer of services that exists today, as community mental health centers have been implemented. But that is still insufficient.
According to the Platform for Monitoring Mental Health Actions, until August of this year, the Ministry of Health (Minsa) has provided 4,264,042 services to 1,048,120 people.
The Directorate of Mental Health projects that by December 2022 more than 6 million care will be carried out for more than one and a half million people, a figure that would exceed that registered in previous years.
Although adults are the ones who have been treated the most for mental health problems (35.18%), there is concern about the increase in care for children and adolescents; both populations add up to 31.5%.
Community Mental Health Centers in Peru
In this regard, Alex Rázuri, Head of the KUYANAKUSUN Community Mental Health Center of Cercado de Lima, specified that the post-pandemic has been very detrimental to the population at extreme ages:
- Children and adolescents: due to altered family dynamics.
- Older adults: due to their retirement situation and abandonment by their children.
Due to these causes and conditions, anxiety and depression symptoms begin to emerge.
KUYANAKUSUN serves an average of between 115 and 170 people each day. After the pandemic, their number of attention increased by 100%.
«We see the entire surrounding area of Lima, a jurisdiction that covers approximately 550,000 inhabitants. It would be a great help to have more mental health centers,» said Ràzuri.
There are currently 248 community mental health centers, a model of care system that exists only in Brazil and Chile, but it is still insufficient.
“Historically, we had 10% coverage and a 90% care gap. We currently expect to reach the end of the year with a little over 30%. If we had 10% of the health budget, we would have much more solvent services at the national level,” said Dr. Cutipé, Executive Director of Mental Health of the Ministry of Health.
Currently, the budget is 2.3% of what is allocated to the health sector.
“The World Health Organization (WHO) made a desperate call to all States to invest more in mental health services, taking into account that since the beginning of the pandemic, the future affectation of the population was already foreseen, fundamentally due to the consequences. Of the pandemic: a population that had lost family members and losses in their living conditions, even more so when we know that in adults the main protective factor for their mental health is financial security and job security,” he explained.
Even so, they managed to implement various plans during the pandemic, such as the “Protected Homes”, residences for people with severe mental disorders who live on the streets.
As well as a pilot project that allowed nearly 1,500 Covid-19 patients to say goodbye to their families through a video call before they died.
The last call
«Mom, you are the best mom in the world. I am proud to be your daughter. I love you, everyone loves you very much, all the people you helped have been doing a chain of prayers for you, they love you mom. I thank you for everything you you have given me. We have always been the two of us”.
This is the letter that Karina, as we will call her, read to her mother, who was losing the battle against COVID-19 at the Villa El Salvador Emergency Hospital, the largest district in the south of Lima.
Karina could see her mother through the cell phone screen. But his mother was with her eyes closed. I could hardly breathe. His prognosis was poor. With a broken voice he continued.
“I thank you for all the values you have taught me. I will maintain them. I will maintain the business for which you have worked so hard. I will take care of it…. Rest now, mom. I will always remember you as that strong woman… .».
Karina couldn’t finish reading her letter; she started to cry. Then he saw how his mother shed tears. I had heard her. Karina was able to say goodbye to her, an opportunity that thousands of Peruvian families did not have.
In Peru, more than 200,000 people have died from COVID-19. During the first two waves, the emergency situation reached such a point that the health system collapsed.
People died waiting to find an ICU bed. It was in the midst of this situation that «The Last Call» emerged.
A way to say the last goodbye
“The families could not see their relatives who were hospitalized. They were informed through telephone calls of their health status. Families lived in constant anguish and fear at the sound of the phone. When people died, the drawers were closed and the questions arose among relatives: will it be my relative or not,» says Jessica, a psychologist from the «Last Call» team.
Along with other colleagues, Jessica saw the latent need to be able to generate contact between patients and their families, in order to work on anticipated pain. An initiative that was already working with cancer patients in other places.
This is how the «Last Call» initiative was launched at the Villa El Salvador Emergency Hospital.
The coordinator of the project, the psychiatrist Linda Gonzáles, explained that since it was a small team, they decided to work with patients with an unfavorable prognosis because they were the ones who needed the most emotional support.
«The list of patients waiting for an ICU bed was 100. We worked, then, with those patients with high pulmonary compromise, who presented comorbidity and who were on that waiting list, which was between 70 and 80», he specified.
a farewell letter
They then contacted the families and prepared them for the anticipated mourning. They were asked to write a farewell letter to their family member in which they expressed affection, gratitude, apologized, and forgave, a letter that they would read through a video call.
“Daily we make approximately 15 video calls. But there were times when we reached 25. Most patients agreed to communicate with their relatives; others did not accept because they did not want their relatives to see them in poor health,« recalled Dr. Linda Gonzales.
During the first wave it was older adults who died; in the second wave adult patients. “There was a young patient, 38 years old. He had two little girls, one eight and one five years old. He reminded me a lot of my husband. During the video call, he said goodbye to his entire family and his girls. When this call ended I couldn’t breathe anymore. I couldn’t eat. I remember how he begged me for an ICU bed, how helpless I felt…” Dr. Gonzáles pauses and breaks down and continues in tears: “I can’t imagine my little boy saying goodbye to his father like that.”
«It was gratifying to help them have that last contact»
Giulliana Macedo, another of the psychologists who was part of this team and who today is the Mental Health Coordinator of the Villa El Salvador Hospital, recalls that they managed to find an ICU bed for this patient in another hospital. but unfortunately he died on the way. . «Seeing so many people die in such a short time, seeing them say goodbye is not easy, but it was gratifying to help them have that last contact,» he tells me.
Each member of the «last call» team remembers the cases they attended, the mothers concerned until the end to leave everything ready for their children to continue their lives; to parents asking for forgiveness, expressing their feelings and saying “I love you”; to his children; to those patients with whom they shared their last supper.
«If you have to leave because you do not respond to treatment, it also matters as parts, it matters to leave accompanied,» emphasizes the psychologist Salazar. «It was what the patients deserved, to say goodbye to their families,» adds psychiatrist González.
“I am at gate 2 of the hospital. I have come to collect the death certificate. My mom passed away. I appreciate everything they did for me. I felt accompanied throughout this process. I feel sad for my mom’s departure and at the same time calm because I know I did everything I could. My mom didn’t go alone with me until the last moment…”, Karina tells the team of your Last Call, who expose this case in different academic events.
«Having the resources to take care of mental health in the worst conditions is not a plus, it is a right»
“Mental health is a right; it is also a means, and it is an end. Feeling good is an end, but it is also a means for the satisfaction, development, and fulfillment of the person, but also for the development of society itself. Having the resources to take care of mental health in the worst conditions is not an addition, it is a right”, clarifies the Director of Mental Health of the Ministry of Health, Yuri Cutipé.
The last call and the arrival of the vaccine
The “Last Call” team made, forgive the redundancy, its last video call on September 2, 2021.
After this team, which was made up of ten professionals, all of them have returned to their usual tasks that they had before the pandemic in the hospital; already with a different panorama, because with the beginning of the national vaccination strategy from February 9, 2021, medical personnel turned to the vaccination process.
In Peru, more than 70% of the adult population currently has all three doses of the COVID-19 vaccine and more than 90% with at least one, according to the Ministry of Health.
However, this vaccination process is under scrutiny due to the alarms launched by the Comptroller General of the Republic due to the loss of vaccines that are about to expire.
Since last October 1 in Peru, masks are only used in hospitals, public transport and closed places; This is how, for the thousands of people who have lost loved ones, today, feeling less fear in the streets is a voice of encouragement in the midst of pain.
Grief, coping with the death of a loved one
The lessons learned in this project, which sought to reduce pathological mourning and illnesses associated with the mental health of family members who were unable to adequately say goodbye to their loved one, are usually disclosed in academic spaces and it is hoped that they will be replicated at the time. In cases of terminally ill patients.
Thousands of Peruvian families are facing atypical bereavements as they have not had the opportunity to fire their relatives due to the restrictions imposed by COVID-19. Some do so by receiving psychological therapy or psychiatric treatment; others rely on the support provided by their families and friends.
Paola and her family received family psychological therapy for the loss of her brother, because at the time of his death the whole family was hospitalized and they only found out until they were discharged.
“At the beginning it was very difficult, especially for my parents. It has been more than a year, and I understand that I must learn to live with this. But Christmas, birthdays, are really very hard”, he tells me, after confessing that they are treated in a particular way for fear of stigmatization in their work centers.
Facing loss with faith
And just as there are those who seek to overcome grief by receiving psychological help, there are others who cling to their faith like a tree trunk in troubled waters.
That is the case of Iliana, who has found a refuge in religion to cope with the pain that COVID-19 has left her with.
“Maybe I consider myself emotionally resilient or I haven’t started to process it (grief) yet. Losing my mother, my brother and my 24-year-old nephew in a week, seeing how the oximeter showed less and less and dying little by little in their beds, resigning myself to luck, to the miracle and to their respective strengths, has left in a shock that walks in the background, subconsciously, perhaps because I have to move on for my daughter, for the opportunity to stay alive», narrates Iliana.
«If my daughter had not existed, I would have abandoned the life I have today for one of dispossession and volunteering and missionary help,» reflects Iliana, who lost part of her family during the second wave of the coronavirus here in Peru.
Heal the pain by supporting each other
And while some find com
fort in religion, there are those who choose to channel their pain by helping others who also suffer the loss of loved ones.
Wilson lost his father on May 11, 2020, when the first wave of Covid-19 began.
“Two years after all, this has happened. I think that my way of coping with it has been a community mourning because when my dad died, many friends died, parents of my friends, people from work, teachers, and one story was more heartbreaking than the other, entire family groups died and seeing everything That made me understand that there were people who were suffering much more than me and that we had to give each other support. All this made me understand that death comes; maybe it shouldn’t have been that way, but in the end death is going to come to all of us”, says Wilson with a hopeful voice.
And precisely those who have seen death up close share the lessons they learned in what may have been the most difficult moments of their lives.
«Patients who had the opportunity to say goodbye to their relatives always complained about not having done what they wanted. That’s why we have to live in the present because life is leaving us at any moment,» psychiatrist Gonzáles tells me.
Instantly, she remembers and tells me that just before the «Last Call» project was completed, she decided to resign from her position to enjoy her little boy and take him to class for the first time.
Today, after a year, he has returned to the hospital and resumed his care in the office. Practice mindfulness (meditation) to enjoy the present more.
For Dr. Garay, living today is also his new way of life, openly saying what he feels as well.
«You don’t have to save things for later, if you have to say something to someone or you have to talk or share, you have to do it. Then I’ll do it, later, no, what I have to do I’ll do,» he tells me determinedly. Well, Dr. Garay knows that COVID-19 has left him with consequences for life, scars that will remind him that he has to move on; that he has a new chance to live.