SUICIDE AND RESPONSIBLE MEDIA REPORTING: WHAT IS WRONG IN KASHMIR?

Suicide is not new to any society including Kashmir Valley. However, in recent months there has been an escalation both in the number of suicides and its reporting in media may it be print, radio, television, and social media. Every other person, probably in good faith, is telling people not to end their lives using various strategies from religious to social, mostly based on ill-founded ideas. Many people are asking why the suicide rates are going suddenly high and what has changed now that so many people mostly young are trying to end their lives. 

The World Health Organisation (WHO) classifies irresponsible media reporting as one of the major causes of the sudden increase in the number of suicides. This is due to the ‘imitative behaviour’ of vulnerable people who may be thinking of ending their life. This usually affects young people and those with underlying mental health issues. There is lots of research on ‘suicide contagion’ wherein the rates of suicide increase mainly due to irresponsible and sensational media reporting. This occurs when a suicide or attempted suicide serves as a ‘model’ or example for subsequent suicidal behaviour. The ‘model’ could be a famous person or celebrity, but could also be a relative, neighbour or friend living in the local community. The contagious effect may be precipitated by pervasive grief or over-identification with the person who has died or the circumstances in which they took their own life. One can easily understand how it works in the context of Kashmir. 

Sadly, looking at the recent coverage of some of the tragic incidents in Kashmir over the last few months indicate how insensitive, sensational, headline-grabbing and harmful reporting is going on. This is being done by individuals to major news outlets with wide circulation, the radio stations and the news coming out of the local television studios. Social media is equally buzzing with ill-formed advice and the circulation of harmful news and videos. Kashmir has been in a state of trauma for a long time now.

However, nothing else seems to have changed in Kashmir in the last few months apart from the sensational and headline-grabbing reporting of suicides. This started with a tragic death of a young man in early 2021 which was brutally sensationalised. This followed with few more deaths by suicide and the vicious cycle of irresponsible reporting and further deaths. In June 2021 there were approximately five times more suicide attempts than in January 2021.  

There is total disregard of any media ethics and guidelines when it comes to reporting suicide. Deaths by suicide remain a major public health concern around the world and sensitive reporting is needed to create awareness and demand for proper services. However, dramatic headlines regarding the methods of suicide, locations, names, and personal stories make a harmful impact and is well evidenced in scientific literature. If you look at any news article from Kashmir, you will see all or some of these things mentioned in every report. There is a complete disregard for the families of victims. Some have even published articles denigrating the deceased using religion, sermonising, cursing, blaming parents and whatnot. One wonders if there are editors who see this material, or it simply goes to print without any oversight.  There is a lack of guidance from the administration on this subject and nobody seems to know how and what to do. 

Many people including professionals like psychologists, social workers, engineers, and even doctors are taking to social media trying to help. I am sure this is all done with good intentions, however, it is doing real harm and having the opposite reaction. Apart from emotive speeches, there is a problematic use of language like ‘committing suicide, blaming people for being weak, sinners, and the list goes on. We must not forget that anyone who is thinking of ending their life is not doing it for fun and most people have underlying mental health problems. Many are desperate because of their circumstances. Suicide is a complex issue and the reasons behind it are not fully understood.

Hence, making claims that a person ended their life for one or the other reason when you have never met the person, only creates misinformation and likely escalation in the suicide rate. Blaming dysfunctional parenting or lack of moral values when you are trying to help does not make sense more so if you are claiming to be a professional. It is certainly not due to a bad upbringing which was suggested by some ill-informed reporter on the state radio. Claims like the ‘suicide bomb’ has exploded as the headline by one of the local TV channels only makes the situation grim.

There are clear guidelines by WHO and other international organisations about the media reporting of suicide. Many countries around the world have adopted these ethics so that the suicide rate does not increase, and at the same time, sensible reporting helps with educating people and create awareness. Suicide is a very complex topic that presents a distinct set of challenges for journalists, who must balance reporting on a sensitive issue and informing the public while considering what influence coverage may have on vulnerable people, including the possibility of imitational behaviour. At the same time, avoiding intrusion into the grief of bereaved families. 

It is beyond the scope of this article to discuss the guidelines which can be found easily on the internet and do not take more than half an hour to go through and grasp the basics. In summary, avoid describing the methods of suicide like hanging or jumping particularly in the headline, include references to suicide being preventable and treatable, signpost links where people can get help from, avoid dramatic headlines like ‘suicide epidemic or suicide bomb’, stay away from sensational language, don’t be judgemental, don’t describe the death or its nature, or how long or how quickly the person died, don’t refer to specific location or hotspots, refrain from giving information like the height of bridge or depth of the river, avoid dramatic and emotive picture or videos- this can glamorise the death and some people can identify with the deceased. Avoid excessive coverage or front-page splash, lead story or links to previous suicides. 

Treat social media with caution and avoid mentioning or linking to comments, or websites/forums that promote or glamorise suicide. Similarly allowing comments on such posts can be very harmful if not moderated which is mostly the case. Avoid publishing any suicide notes or messages which may have been recorded may it be voice or video.  Speculation about the ‘trigger’ or cause of suicide can oversimplify the issue and should be avoided. Suicide is extremely complex and most of the time there is no single event or factor that leads someone to take their own life. 

Lastly, young people are more vulnerable when it comes to suicide. When covering the death of a young person, do not give undue prominence to the story or repeat the use of photographs, including galleries. Don’t use emotive, romanticised language or images – a sensitive, factual approach is much safer. Coverage that reflects the wider issues around suicide, including that it is preventable, can help reduce the risk of suicidal behaviour. Include clear and direct references to resources and support organisations. 

The administration ought to issue guidelines for media reporting of suicide urgently in consultation with the professionals from the Institute of Mental Health and Neurosciences, Kashmir. This should be based on evidence and not just to gag the media. We must be mindful of press freedom at the same time which is important more so in places like Kashmir.

Civil society can help with creating awareness, normalising help-seeking, and keeping vigil at any potential hotspots. Suicide must be treated as a complex issue. Removing access to the means and methods of suicide can be the difference between life and death. Lastly, please do not try to be an expert on suicides if you are not qualified or trained in the field even if you work in mental health. Please refer people to the professionals who can deal with it. 

The media must take responsibility and bring a positive change and not become the source of this tragedy in society. 

In summary, if you want to help and save lives, be sensible, non-judgemental, offer support if you think anyone is suicidal- ask them directly if they are thinking of it, listen to them, don’t rush into giving advice, make sure they are safe and remove any harmful articles, call for help and support them to see a professional. It is not your job to treat them or give them lessons on morality or faith. Remember, suicide is preventable, and you can save a life by simply being sensible and mindful. 

https://thekashmirwalla.com/2021/07/suicide-and-responsible-media-reporting-what-is-wrong-in-kashmir/

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Dr. Mudasir Firdosi is a Consultant Psychiatrist and Honorary Senior Lecturer at St. George’s, University of London. He is also an executive member of the Faculty of General Adult Psychiatry at the Royal College of Psychiatrists, London. He can be reached on Twitter at @drmfirdosi or email at mudasirfirdosi@gmail.com 

Patient/Physician Relation: Doctors are also humans

Murtaza Rashid, Mudasir Firdosi, Shahnawaz Kaloo

The doctor-patient relationship is one of the most sacred relations. The patients’ trust their treating physician with secrets which they would not disclose sometimes even to their close relations. They trust the physician with their loved one’s wellbeing and life. Nothing probably can be more distressing than finding oneself or nears and dears in a hospital. There is uncertainty, nervousness, and fear of losing someone very close to heart. It can be a lifelong nightmare for a few. The patient expects someone to listen to their pain and agony. The wet eyes and frowned eyebrows are searching for a patient ear and saviour for a cure. Unfortunately, the patient-physician relation can turn ugly at times. We can attribute many causes to such conflicts but if we have an understanding of a few basic principles we believe most of these ill-timed confrontations are avoidable. The ideal patient-physician relationship is not limited to treatment only. It starts with trust. In turn, the physician also trusts the patient to comply with the given advice. Treatment is mutual. It cannot be one-sided.

Patients have rights which include:

1) Know details of his disease.

2) Best available treatment.

3) Accept or refuse treatment (if mentally competent and alert).

4) Know the Pros and Cons of the treatment.

5) Seek a second opinion.

6) Full privacy and dignity.

7) Take time to decide and think about the treatment.

Patients need to be responsible too. No treatment can probably be effective without the mutual understanding and acceptance of both patient and the physician. It is a collective effort. Responsibilities of a patient include:

1) Compliance to his treatment and advice of physician.

2) Preventive measures to stop spread the infection to others.

3) Be truthful to your doctor in each and everything even for non-compliance.

4) Do not abuse verbally or physically a healthcare worker if you are not happy with their services. There are laws to report such negligence.

5) Discuss your concerns with your own treating physician rather than others.

6) The whole team of physicians, nurses, health care assistants, and pharmacists to name a few are there to help you. Appreciate their efforts when due.

7) Respect the rights of other patients too. Hospital property belongs to all and needs looking after than deliberate damage.

 

These are the basic principles which must guide us to have an effective healthcare system. Many patients complain that the doctor came in, showing off to his juniors and nurses, and barely acknowledged I was there. ‘I felt like a stuffed exhibit in a museum’. Our healthcare needs to be patient-centric. Our duty as doctors is to tell patients about their problem, how it is affecting them, discuss a plan with them professionally and compassionately.  A patient may forget your name but he won't forget how you made them feel when they needed you most. Patients/attendants on the other hand too must listen patiently and respect hospital policies/timings. Our hospitals are overburdened. The doctor is a human being, with lots of responsibilities. Remember they can breakdown too. They are facing tremendous challenges daily due to non-availability or dearth of PPEs, medicines, equipment, beds, staff and other resources. They are at additional stress of catching infection and carrying the infection to their own families as well, hence putting their lives a risk for betterment of their patients. No doctor would ever want to harm his patient knowingly. Though we must emphasize medical negligence is not so uncommon. There must be stringent laws to report such episodes and rapid action taken against the offenders. Reporting such cases should be made easy and simple for the patients/attendants. An independent committee should thoroughly investigate the case. There are countries where medical negligence can lead to revoking a medical practitioner’s license temporary or permanently beside the financial settlements.  In the nutshell, as we mentioned earlier the patient-doctor relation is of mutual understanding and respect.

However, we cannot equate the healthcare system with a doctor. It is much more complex than what meets the eye. The healthcare system has been in shambles in Kashmir from a long time despite having dedicated and best-trained doctors. There is a lack of proper administration, organization, support staff, equipment, and medications, just to name a few. But any failure is usually ascribed to the treating doctor than the system as a whole which does not help. For example, the lack of an appropriate number of nurses on a ward or availability of a bed is an administrative issue which a treating doctor cannot sort out there and then. Unfortunately, for a relative of a patient in distress the doctor becomes the face of the problem and is usually at the receiving end of complaints and at times gets manhandled by emotive attendants. The pandemic of COVID 19 has brought this problem to its worst.

People are being advised to stay home and not visit their relatives in the hospital and rightly so and no attendant is allowed on the COVID wards as per the protocol. However, in a place like Kashmir where attendants do most of the nursing for the patients how will this work? Attendants care for basic needs, food, and water, call doctors, buy medicine from the market and run around to make sure the patient is getting reasonable help. If there is no attendant, who will tend to these needs? People cannot be left to die for water and food. Again, the protocols around COVID 19 are just bureaucratic without much professional input and thought. A place which does not have enough hospital beds and ventilators is putting every suspected case in hospitals and quarantine centres, strangely fumigating streets and houses creating more stigma than actually addressing the practical problems.

Even the best healthcare systems around the world failed to cope with the COVID 19 and we cannot do better if there is no reflection and reason in command. Sad incidents of people dying for want of basic care and unfortunate incidents of doctors being beaten by emotive relatives are just symptoms of the underlying longstanding problems of healthcare in shambles. The professionals need to be in charge of managing this extremely difficult situation weighing up what is possible and what not and how the limited resources can be put to best use than random pen pushers showing off their power. Sadly many people will die as this illness is still not treatable and is unpredictable. The stigma created hasn't helped either and is putting additional lives in danger as people are not coming forward and some denying the problems completely due to deep mistrust of administration. This is not surprising in a conflict zone like Kashmir where different rules are applied to different sections of people. The local population is being advised to stay home but tourists, labourers, and yatris coming from outside are allowed roaming free.   The civil society needs to rise to the occasion again to support each other and do whatever can be done in such dire circumstances. The hospitals and medical fraternity need support both morally and materially to make a positive difference and reduce the number of deaths by this dreaded COVID 19.

In the end, we must remember words of great Tinsley Harrison;

“No greater opportunity, responsibility, or obligation can fall to the lot of a human being than to become a physician. In the care of the suffering, he needs technical skill, scientific knowledge, and human understanding. He who uses these with courage, with humility, and with wisdom will provide a unique service for his fellow man and will build an enduring edifice of character within himself. The physician should ask of his destiny no more than this; he should be content with no less"

About the authors:

Dr Murtaza Rashid is an Emergency Physician, Saudi Arabia.

Dr Mudasir Firdosi is a Consultant Psychiatrist, London, United Kingdom.

Dr Shahnawaz Kaloo is a Consultant Radiologist, New Delhi, India.

http://www.risingkashmir.com/news/patientphysician-relation-doctors-are-also-humans-364074.html

Role of the religious bodies in containing Covid

Dr Murtaza Rashid/ Dr Mudasir Firdosi 

As of now Coronavirus outbreak has engulfed over three million people. There have been more than 300,000 deaths. Almost all the nations have been affected with enormous mortality and morbidity. Thousands are becoming jobless and economic recession is looming. Even the strongest of the economies are failing to cope up with the COVID 19 pandemic. Probably no one thought it would cause such a panic among the nations. Top international leaders were caught off guard. There was confusion all over. Everyone seemed unprepared. It spread like a wildfire. Major healthcare setups were shaken to roots.

A dearth of personnel protective equipment (PPE) and ventilators attracted headlines of almost all the print and the electronic media. Social media too was widely involved in narrating stories of the worst affected regions and highlighting lack of PPE.World Health Organization (WHO) and other leading experts started advocating social distancing.

Having no other option at the behest, countries one by one started ordering travel bans and lockdowns. The decisions to quarantine and social distancing were indeed hard to be made. People got stuck in foreign countries and non-native cities and villages.

The major gatherings we witness regularly are the religious ones. The four major religions of the world Christianity, Islam, Hinduism, and Judaism have billions of followers who usually perform group prayers at specific places. These places of worship where people gather in large numbers posed a major challenge for the governments and public health experts. The assembly of people at these places could easily lead to a person to person transmission.

The COVID-19 infection essentially spread by droplet transmission would have been detrimental by such a huge assembly of people.  People come in close contact and this would essentially have created a much bigger disaster than what we see at the present.  Hundreds and thousands of people visit different places of worship according to their faith daily, either located in vicinity or faraway usually as pilgrimage sites.

However, some of the holiest religious places are present in specific countries and people all around the world travel to such destinations where congregations could be in millions at a time. People have faith in their religions and it was not an easy task to stop them from visiting such places.

There were a few incidents when some people wanted to put faith in their creator for their safety than scientific advice. Also, there are lots of fake healers who exploit religion and sell cures even for COVID-19.  

As soon as the present crisis started unfolding earlier this year, both the governments and the people started weighing its consequences. It was evident from the beginning that humankind is fighting an unseen enemy.

With no vaccines or effective treatments available, prevention through social distancing remained the only recourse. Vatican City, the heart of the Catholics around the world with more than a billion followers, has roughly twenty thousand visitors each day.

As Italy was one of the first countries to be hit hard, the Vatican announced that it’s Holy Week and Easter celebrations ‘will take place without the presence of the faithful’. Most churches across the world asked the congregants to avoid physical contact and intinction.

Meanwhile, the Church of England also issued advisories and adaptations. The twin holy cities of Mecca and Medina in Saudi Arabia attract nearly twenty million pilgrims each year for Umrah (minor pilgrimage). Muslims all around the world usually come in groups to visit these religious sites.

As soon as the COVID 19 started spreading beyond eastern Asia, the authorities rightly suspended Umrah for international as well as the local pilgrims. Had this timely intervention not been undertaken, it would have caused an unimaginable catastrophe. In addition to that, mosques in the Middle East also suspended obligatory five-time congregational prayers and instead called upon the 'faithful' to pray at the homes. These were recited to them over the loudspeakers through azaan (call for the prayer).

Subsequently, most of the mosques world over asked the followers to stay and pray at home and fully cooperate with the competent authorities. The Muslim Council of Britain offered online services to keep in touch with the congregations.

India is home to near about a billion Hindus and second-biggest population of Muslims in the world. There are small and big temples scattered almost in each city and village. However, there are few temples and sites where Hindus come not only from India but from neighbouring countries too. 

Most of these temples like Shirdi Saibaba in Maharashtra, Jagganath in Puri, and Shri Mata Vaishnodevi in Jammu are visited by thousands of pilgrims daily. All of these temples were closed by the respective trusts. Famous Varanasi district banned Ganga arti (a special prayer) and yoga camps.

In a country like India with mixed religions and cultures, it is a humongous task to control all these activities. Hindus, Muslims, Sikh and Christian preachers resorted to social media to make appeals to their followers to stay inside homes and maintain social distancing.

This has been pretty effective and so far we do see a very less COVID 19 cases in India despite having such a huge population with diversity. Many gurdwaras also issued guidelines and advised devotees to take full precautions and maintain a safe distance. 

Jerusalem Israel, a city holy to Judaism, Christianity and Islam attracts thousands from all over the world. The ‘western wall’ is one of the most sacred sites in Judaism and thousands of Jews come to touch its stones and to pray.

The chief Rabbi urged the people to avoid gathering at the holy site. The heritage centre said that the visitors will be separated into prayer areas of up to ten worshippers with space between the groups. The concerned authorities removed the prayer notes between the stones and sanitized the wall.

The authorities also disinfected The Church of the Holy Sepulcher, which is revered by Christians as the site of Jesus’ crucifixion and resurrection. The visitors were strictly advised to avoid any act of devotion before and finally, the church was closed. The Islamic waqf council of Jerusalem also announced to halt the entry of worshippers into Al Aqsa mosque, Islam’s third holiest site.

Many countries and governments have issued lockdown's and curfews to contain the movement of people. It is quite understandable that to make such restrictions a success we need a positive public response. The appeals made by the religious groups have to a large extent made people stay at the home.

Without these guidance’s and adaptations, it would have been impossible to maintain social distancing. Although the proximity while attending such services is a major concern what makes it much worse is that the average age of people attending are usually older, the vulnerable population.

Epidemiological data has indicated that COVID-19 seems not to spare any specific age but affects significantly who are old with comorbidities. These congregational places could have been a hub of disease and spread it exponentially.

Almost all the religious groups have unanimously called upon restrictions on gatherings at the funerals or conducted virtual prayers. Many sports leagues and Olympics have been indefinitely postponed and these steps also strengthened the idea of maintaining distances.

Now as the curve of the Pandemic is flattening, people are worried about the effects of lockdown on economies and livelihoods of people more so in poor countries. Slowly places are being opened up with precautions. This also includes the religious places and if people are not careful, this can lead to the second peak of infections and COVID-19 related deaths.

On Sunday 31st May Pope Francis made the first-noon address from his window overlooking St. Peter's Square in three months as Italy's lockdown drew to an end. He called upon prioritizing lives over the economy, hence stressing the need for following physical distance and seriousness of the pandemic.

Similarly, the Prophet’s mosque at holy city of Medina opened up as well after 3 months to allow prayers. Many religious groups are advocating for allowing congressional prayers around the world. After so much pain, both mental and spiritual, any laxity in the efforts can bring the disaster back to any village or city in the world if people don’t take precautions.

As of now, there is no cure or vaccine in the near sight and keeping the physical distance may be the only way to hold the reigns of this pandemic. Each religion teaches human values and the preservation of human life. If there is a fear for one's safety we can refrain from what is extremely desirable ritually and make some temporary adaptations. We all belong to this planet and it belongs to all of us.

Pandemics do not choose any religion or sects. They hammer every region and country, all age groups, both men and women, regardless of having a religion or not. It is our collective effort to be successful in winning this war. We should not get misled by our assumptions and our thinking.

Stigma, fear, and blame game are not uncommon in such crisis either. Unfortunately, there were attempts to associate COVID-19 with particular faiths in some countries but overall the response has been positive and overwhelmingly understating. It is important to listen to those experts who are at the forefront of COVID-19 research. 

While people may start assembling again to fulfill their religious obligations, it is pertinent that rules and regulations are followed as any laxity can lead to further disaster. Let us win this fight together to make our planet a safe and happy place for all of our future generations. 

http://www.risingkashmir.com/news/role-of-the-religious-bodies-in-containing-covid

What should we do?

These are unprecedented times. We are worried, confused and distrustful. The
world is struggling to cope with the COVID 19 pandemic. There is no health system
in the world which can face the wrath of this unseen force. More than 760, 000 are
already infected and about 35, 000 deaths already and the numbers are increasing
day by day. The whole world has come to standstill, economies are crashing, people
losing livelihoods, and in some places, chaos is already setting in. Lots of rumours,
misinformation, fake news, and conspiracy theories, religious and other curses are
making rounds. Mankind is at war with himself. Countries which have far advanced
health systems and resources like the USA, Italy, the UK, and Iran are finding it hard
to provide appropriate treatment to everyone. What should we do in a place where
there is hardly any system and a makeshift administration? In times of such chaos,
you need a leader who people trust and listen to. We don’t have that either.

We need to be realistic. The health infrastructure, number of doctors, nurses and
other allied staff is nil to nothing when we look at the magnitude of this pandemic.
We cannot build hospitals like China did and even if we get some ventilators, there
are no intensive care facilities in most districts and who will operate them when we
do not have any trained nurses or paramedics available. The things are more
complex with COVID 19. Usually first port of call is a doctor or hospital when we
become unwell. Here if you go to the hospital, you can spread it to others including
the healthcare staff. There is no evidence that going to the hospital will help even if
you are tested positive. For those who do become severely unwell and need oxygen
and ventilator support, the prognosis is poor. In our setting, with a dearth of nursing
care, usually, families stay in the hospital, feed, nurse and buy medications from the
market. But here family members are likely to be infected if not symptomatic and if
not already infected, a hospital stay with an unwell patient will infect them. This
raises the question over who will nurse COVID 19 patients as there are not enough
nurses to do that job in Kashmir valley.

The authorities have just focused on testing and tracing people who had travelled
from outside state and this went to the level of propaganda, creating fear and
worsening preexisting stigma. Many people did not come forward with a travel
history and those put in so called quarantine, fled citing justifiable reasons like lack of
basic hygiene and putting dozens of people in the same room that feared likely to get
infected from each other. Even entire extended families of patients who died
because of COVID 19 are being put under alleged quarantine. This is not only
inhumane but hardly based on any scientific facts. Even in such pandemics, people
will need to grieve their dead.

Overall no one seems to be in-charge. One could have thought either director health
services or some other senior specialist from the public health or community

medicine will take the lead. Here we have different officials from the administration
trying to overdo each other without any thought or strategy. Demonizing people,
talking them down and then chasing them like criminals is not going help. There is no
focus on education; information sharing and making sure people don’t get inundated
by rumours through WhatsApp groups only. Can one fight a pandemic using the
decades’ old strategy of managing a political conflict with force and guns? No

What can be done?
It is time to be realistic keeping in view the infrastructure, healthcare staff and
magnitude of the pandemic which is only going to get worse. Everyone cannot be
tested or treated in a hospital. The virus has already spread in the community and
just focusing on anyone with a history of travel is not going to work. About 50 percent
infected do not show any symptoms but are contagious and carry on infecting others.
About 80% only have mild symptoms. So it is the asymptomatic people walking
around you who are spreading it as we speak. Everyone cannot be put in quarantine
or hospital and if we assume only 4 million will get infected out of 8 million; there is
no way of managing this pandemic in the hospital setting. If people are educated
and informed with clear guidelines with sincerity, most can stay home if having mild
to moderate symptoms of cough, fever, malaise and other symptoms. It is ideal to
test people to reduce contact and stress on self isolation in homes, but are there
enough resources to do mass testing.

Training and educating faith healers, peers, imams, and teachers and then using
them to propagate the message at the grass root level. Social distancing and self
isolation is the key to break the chain of spread from one to other. We know the
elderly and those with comorbid medical conditions are vulnerable with bad
prognosis. We have to buy time and protect the vulnerable in a hope that some
treatment or vaccine may be in available in the near future.
The healthcare staff and doctors need personal protective equipment (PPE),
otherwise we many lose may of them to illness and even death and if that happens,
we cannot deal with the pandemic for even few weeks. It is not enough to call them
god or bang plats for them unless there is an investment in healthcare and that
needs to be done now. Just focusing on buying new ventilators would hardly make
any difference if the healthcare staff is not protected in first place. The administration
needs to move on from the attitude of a police state to one of supportive to doctors,
rather than harassing them on the streets and beat them if they try to reach
hospitals.

Finally, people need to take responsibility. In this age, there is no dearth of
information. The internet is only partially restored but enough to know what to do and
what not to do. The infection is spread by droplets- coughing, sneezing, close
contact, hands, and aerosols in closed spaces. The virus lives on surfaces for hours
if touched and retouched. Washing your hands, not spitting in public, covering nose

and mouth when coughing, washing hands regularly, and keeping a distance from
each other is the best solution until we find a treatment. It is time to suspend
mosques, parties, weddings, offices, and any gathering completely. Funerals need to
be managed by professionals in full PPE as the virus is remains alive. These are not
easy times, people may not have food to eat, no jobs and income, so we have a
collective responsibility to look after each other and defeat this monster of a virus. As
Camus writes in his famous book Plague, ‘What’s true of all the evils in the world is
true of plague as well. It helps men to rise above themselves’, and I am sure we will
overcome this current age plague and be human again. Do not rely on hospitals,
doctors, peers, it is your life and only you can protect it for now by staying in your
homes and following the rules.

https://www.greaterkashmir.com/news/opinion/what-should-we-do/

Children of Conflict: Millions of Kashmiri Children Growing Up in a Perpetual Siege

LIVING in a conflict zone often confuses one’s existence. The perpetual state of war alters human behaviour, beliefs, and emotions. Growing up in the valley of Kashmir with never ending uncertainties, fear, and insecurity has a deep disturbing effect on the psyche of the local population especially children.

The lockdown in Kashmir has entered its fourth month now with children being the worst victims. About 1.5 million children are cooped up in their homes with parents playing the role of teachers and guards. Rounding up of underage children by the state makes the situation unprecedented. Reportedly, scores of minors have been detained without any legal recourse. With no schools, curfew, and volatile situation, it is not hard to imagine how they cope. No education and no play cannot make any child content with their existence.

Happy childhood is a key to a happy life. There is enough evidence that negative childhood experiences are key to many mental health issues in adulthood. Children look for constant stimulation and activity for engagement, otherwise, they get bored which can lead from minor behavioural problems to severe mood changes. With no schools, the forced holidays have become a burden.

Parents trying to keep children safe often restrict their movement. Children lose the freedom to play, explore and learn from natural surroundings. This is akin to be born in prison where you are caged in a scary basement completely deprived of outdoor play. They cannot even watch their favourite videos and programmes due to continued internet blockade. After being born is conflict, growing up in siege, they live under constant reminder of abnormality without any reasonable explanation as to why they cannot attend school, play or even socialise.

Children have also become victims of state politics to showcase normalcy. Recently the government tried to force them to attend schools and attend examinations. One could argue that their safety and wellbeing is put under risk to score brownies merely by forcing the local population to surrender and humiliation. With mass arrests of people, it is clear that children again bear the burden of not seeing their parents, and are constantly reminded of living in a society which is under collective punishment.

How would a tender fragile mind deal with such severity? Having a role model sans ambiguity in a child’s life is a key to development of the kid as a confident adult with self-esteem. Even a minor parental discord or conflict can ruin a child’s life forever. Now imagine a tender population with lack of direction, clarity, multiple connotations, ongoing reminders of trauma, and unnatural normalcy.

The suffering of children does not stop here. When one is born in such circumstances and grows up in such abnormal surroundings with reminders of pain, barbed wires and locked schools, without any semblance of what normal childhood looks life, the trauma becomes generational. How does generations cope and what becomes of them can ever be underestimated?  There have been numerous research studies and reports, documenting the scale of psychological trauma the population has experienced over the years. The current generation is virtually born in the shadow of the gun and continues to experience the conflict daily.

There is no family in the valley which has remained unaffected. The number of killed is reportedly more than one hundred thousand, many more orphaned, enforced disappearances in thousands, most men and youth having been subjected to some kind of torture, beatings, bullying, and the list goes on. Anyone who makes out of jail will give you a heart-wrenching account of torture from being beaten-up black and blue, paraded naked, cuts, electric shocks, sexual abuse to third-degree torture being used with impunity. Humiliation and denigration go hand in hand in the process.

Psychological issues are bound to creep up with children showing signs of distress- like irritability, behavioural changes, aggression, self-harm, suicidality, and predilection towards illicit drug use. It is hard to fathom how to help them unless the psychological and physical siege is addressed for good. With hardly any access to relaxation, entertainment, and means of education, such problems are bound to become deep-rooted.

There is no access to child counselling or for that matter mental health first aid when required. With a complete ban on internet access and wobbly phone connectivity, professionals willing to intervene are themselves helpless. The dismantling of civil society and voluntary organisations with no local governance catapults the melancholy of these children. I shiver thinking about the children living in hundreds of orphanages across the erstwhile state. The silence of world powers and people who could drive an impactful, sustainable change in the lives of these children, is equally baffling.

https://caravandaily.com/children-of-conflict-millions-of-kashmiri-children-growing-up-in-a-perpetual-siege/?fbclid=IwAR0WvbaQ8Y1N6a8nPOWNQpJGCpCeLReD69BpQc_K-0L7WyOBg2gKVASTrEE

Kashmir- Mental Health Crisis

The lockdown in Kashmir is nearing four months now since the complete annexation and demotion of the Jammu and Kashmir state on 5th August 2019. The entire population is under a physical and mental siege, official and unofficial curfew, with no public transport. There are numerous reports of intensifying health crisis with people finding it hard to reach hospitals more so in emergencies. The entire population remained without any phone connectivity for more than 2 months with people not able to reach their loved ones in and outside the state. Internet access remains suspended. Because of the uncertainty, and not able to know about the wellbeing of old, unwell, and frail, the entire population has been plunged into an anxious state of being. Moreover, the political situation has created a state of despondency, hopelessness, and a sense of grief. There does not seem to be any agency or person to whom people can turn for help or support.

There have been numerous reports in international and local media about the physical health crisis due to the ongoing war-like situation, including deaths of pregnant women, cancer patients, and mostly the undocumented deaths of those not able to reach for help.

When it comes to the mental health of the besieged Kashmiri population and Kashmiris living in India and other countries, it can be summed up as a collective trauma and punishment. A recent review in the Lancet suggests that 1 in 5 people living in conflict zones suffer from mental health problems including depression, anxiety, and Post Traumatic Stress Disorder.

It is known that conflicts involving killings, disappearances, rape, torture, collective punishment, arrests and lack of access to optimum healthcare are fertile grounds for both physical and psychological morbidity and mortality. With 8 million people put under such conditions, it is not hard to fathom the hidden epidemic of mental health problems which the local population is suffering and dealing with in utter silence. Overall, it is very hard to predict the scale of the adverse psychological impact of the lockdown and associated political connotations.

Kashmir was already known for the high prevalence of mental health problems including depression, anxiety, and other stress-related disorders due to the ongoing conflict situation from many decades. One in ten has lost an immediate family member and one third has lost someone in the extended family. These figures are from a decade ago and with the current unprecedented situation when around 8 million people are being put under lockdown, one can argue that entire Kashmiri populace is experiencing some kind of psychological trauma and distress. This is worsened by the mass arrests and alleged torture which is reportedly being broadcasted on loudspeakers in some places. Thousands have been put behind bars, including minors with no legal recourse. This is a perfect breeding ground for the development of many mental disorders.

Not only Kashmiris living in the valley but those living outside India and other countries are equally suffering due to the uncertainty of the situation. A survey revealed that more than 90% of Kashmiri diaspora showing symptoms of anxiety and depression in the first month following the lockdown with predominant symptoms of acute stress, insomnia, and impending doom due to inability in contacting their loved ones.

Children are the most vulnerable group of the population who have been deprived of schools, play, and any sense of normalcy, which is essential for optimal child development. It is a known fact that childhood adversity plays a major role in the development of many psychiatric problems in later life.

A secure, stable and memorable childhood is a key to productive adulthood, to be able to lead a normal life, have families and function as a responsible member of society. With millions of children being brought up in utter confusion, siege, and uncertainty about the safety of their families, is likely to produce a generation of traumatised people like in any war zone. A sense of security is important for children growing up, but if adults are not safe themselves, how can they make sure that children grow up confident and secure. This is likely to lead children to develop behavioural problems, insomnia, irritability, poor academic performance, just to name a few.

There were some reports of a dearth of psychotropic medications but more importantly, it has been the hesitation to seek help or attend consultations with doctors which has made many to relapse in their symptoms. The attendance in the hospitals had sharply declined more so in the first two months and only desperate families would somehow try to bring their patients to the hospital when not able to manage at home. Many vulnerable psychotic patients who usually don’t seek help and roam freely on the streets have been put under risk and some have been admitted to hospital. At times they have been shot dead in the past for wandering in prohibited areas. There are also reports that people with dependence issues are relapsing due to non-availability of drugs or access to treatment. Overall, the silent epidemic of trauma has become a part of daily living in Kashmir.

One wonders how things can change for better unless the political situation improves, and there is some respite for people. Lest the basic human rights are respected and people feel safe, no amount of medication or counselling even if it was available would help. Repeated exposure to trauma, no sense of belonging, and total helplessness do not let patients recover in the best possible settings. To help recover from this psychological trauma and prevent further harm, there is a need for immediate action both politically and on the ground to address basic human rights, recourse to legal help, re-joining families, letting minors go home and finally resolution of the dispute. Doctors and therapists can only then be able to treat people.

The question remains, is anyone listening?

https://www.ha-asia.com/in-kashmir-the-situation-is-triggering-a-new-wave-of-mental-health-issues/?fbclid=IwAR2QEgTLbuEQHwTBbnjBN6ydwCbdCsb5WGPtLazlKtvxlL9gFvXisRO2kog

Kashmir- The curious case of Indian Collective Conscience

Kashmir has been cut off from the rest of the world for more than two months now, with little certainty about what is coming next.  Kashmiris living in and outside the erstwhile state of Jammu and Kashmir remain disconnected with hardly any means to communicate with each other. Just a few days ago some mobile connectivity was restored.  Terrible stories of loss, grief, and mourning are making rounds on social media, few news outlets, and mostly within the minds of Kashmiris.  The days of siege have become another statistic with most losing count.  People are hearing about the deaths and ill-health of their loved ones with little detail or ability to make it to the funeral or the bedside.  No one is talking out about the children stuck in homes, shut schools, and not to mention those beaten, tortured, and incarcerated.  People with chronic and acute diseases are dying undocumented with only God to blame.  The collective punishment of Kashmiris is working.

The perpetual worry about that ‘phone call’ has traumatized so many.  One fears that people are developing traumatic stress even when not physically present in the valley.  Even when people do manage a phone call after begging or borrowing, the harrowing silence on the other side says it all.  Although most people talk about everything being well, the deafening silence you hear even when words are being spoken is unmissable.  How does a nation reconcile and sleep at night with this travesty in their name?  Here a billion or more souls if not always celebrating, are content with what is being done to millions of other human beings in an alleged part of the same country in their name.  Who shares the blame if something wrong is happening?  The home minister of India declared that ‘It is all in your mind’ and everything is ‘normal’ in Kashmir.  You may refuse to agree with him but most of the Indians, educated, illiterate, liberal, religious, atheists, left-wing, right-wing, rich, poor, men, and women are convinced that Kashmiris need disciplining and that this is for their best.  How does one argue with that?

Most Indians are ordinary, hardworking, friendly people, who claim to love animals and would not harm a fly.  How do they reconcile with what their state is doing to fellow human beings?  Indian friends, the close ones, like others, decided to remain silent.  They would not even ask if the family was alright and did we manage to get in touch.  They will bleed for you in case of an accidental injury to you and will remain by your bedside till recovery.  But what is happening here then?  What kind of morality has been created?  Would sympathizing with Kashmiris mean a betrayal of their own country?  What about the claim of belonging to the same country?  Please feel free to ponder. Something has happened.  Somewhere the fear of the other has been used so convincingly that it has managed to break all the bonds, be it of friendship or simply of being human.  After all, India claims to be the propagator of vegetarianism, desperately trying to save cows even if that means ignoring the lynching of fellow citizens while practising ahimsa and non-violence.

Lately, the concept of the ‘nation first’ is doing rounds.  Nothing can be said or written against ‘the nation’. But what makes the nation; the current ruling party and the Prime Minister, the land, or the idea of a map in one’s head?  Or it is the religion of the majority, the conquest of minorities or something else. What about the people who live in that besieged piece of land?  Do they also make the nation?  Maim, punish, and kill people to save the nation from some unknown force.  Does the nation need saving or a self-fulfilling prophecy of destroying the nation is in action?  Treating Kashmiris as an extension of the neighbouring country and punishing them collectively to revenge generational hate for the neighbour only proves Kashmir is not part of the ‘alleged nation’ on whose name all this is being done.

History is a witness that nationhood was used by most tyrants, convincing the majority using fear, prosperity, and superiority as tools to rise to power.  Once in power, unimaginable things were done in the name of the nation, building on the fear of minorities and weaker sections.  Although none of the fascists remained to live their dreams and were victims of their own cruelty, but in the process the death and destruction they managed to offer humankind is unimaginable.  Once they are done with one group, they do have to go after others.  You cannot fathom that a fire set in a neighbour’s backyard will not spread to burn the whole village.  It has already started, people are even being booked for writing open letters, and students are being thrown out of colleges just for some minor criticism of the dear Prime Minister.

The generational trauma, displacement, and human suffering change the course of history both for good and bad.  What is then the solution, dignity in living or living with dignity?  It does not take long to realize that putting others through pain and suffering does not make any nation happy.  You may think that whatever is happening has nothing to do with you, but everything done in your name is your burden.  More so, instead of thinking and questioning, blindly condoning the state action seals the deal.  Some argue that if Kashmiris did not create trouble, in other words, aspire for freedom and demand a referendum as per the promises made to them by all the parties involved, Jammu & Kashmir will still have been a statehood the least. Blaming victims is not a new strategy.  Like Kashmiris have a choice to decide.  They are still to make to the table allegedly meant to decide on their fate. Who does not desire freedom?

Lastly, it is not late to question yourself, if not the state.  Are you sure you know what is being done in your name?  Are you the nation or the next victim of the nation?  If you are the nation, then own it and live with the consequences.  Democracy cannot be imposed, neither can freedom.  Everyone knows it is not about development, freedom of women or education of youth.  Neither is it about terrorism as mostly purported to slander Kashmiris.  There is still time to question the alleged truth unless you have decided to be the hangman in a mask.

https://countercurrents.org/2019/10/kashmir-the-curious-case-of-indian-collective-conscience?fbclid=IwAR1nUEhD6tI51FfbZZMqFbkdzZQSQv1Z2i4U_gFj-4TSjfLYDZUpyaPCwp4

We shall talk

https://mudasirfirdosi.wordpress.com/2019/09/14/we-shall-talk/

Doctors, Veterinarians & Psychiatrists Of India – First Do No Harm

The situation in Kashmir is no mystery these days when it comes to the international media, organisations of repute, and academics.  Kashmir is ‘normal’ when it comes to the Indian government and Indian media houses.  For Kashmiris who live in a total information blackout, day to day survival is the only thing which matters.  Being a psychiatrist who has trained and worked in Kashmir, I cannot stop thinking about the mental anguish, fear and uncertainty which the entire population is facing.  Not able to get through to loved ones locally or from outside the state, just makes the agony worse. I had numerous calls from people around the world, strong men and women, breaking down in tears, experiencing panic attacks and some deciding to go back into the unknown, just to be with the family, no matter what the consequences.  After all, is it not better to share the tears and pain than face the numbness on your own.

With all the major news outlets around the world talking about lack of access to healthcare, baby food and essential medicines, many reputed journals like the Lancet and the British Medical Journal (BMJ) wrote editorials urging and cautioning about the worsening of health of besieged population. Not only the physical health but the ongoing mental trauma people experience made worse by virtually living in an open prison with total information blockade.  As a doctor, I was relieved like many other likeminded professionals who understand the need for professional organisations to raise their voice and at times question politicians, when it comes to the health, safety and wellbeing of people.  Then came the time to face reality, that not all doctors who work under strict professional and moral code, no matter in which country they practice, writing scathing criticism of the Lancet and how dare it take a view on the ongoing suffering of millions of people.  The reality started hitting when in some of the WhatsApp groups; doctors started signing petitions and even planned on trolling the Lancet journal on social media, arguing that it will prevent others from following the Lancet.  The minute I questioned them, asking don’t you need to look at the evidence, the reports of looming health disaster, shortages of medication, the result was not different. National interest comes first; the mood of the nation comes first, no matter if eight million people are caged in their homes not having access to basic amenities necessary to sustain life.

Then came the open letters from Indian Medical Association (IMA), various other doctors organisations and even the Indian Veterinary Association (IVA), not only criticising the Lancet, but at the same time showing complete disregard for human beings and health concerns with total and complete lack of empathy. It would be hard to argue if this is in context of the totalitarian state policies which is taking root in India, racism, communalism or just mob mentality. After all I have trained, worked, debated, and argued with same clinicians for years now and we have always been humans and friends at the end. Did I question myself? Yes, I did. I went back into history, terrified how doctors in Nazi Germany assisted the state in most inhumane experiments and interventions using the same arguments of national interest as my current colleagues from India or Indian origin seem to put forth.   Looking at the letters they wrote to the Lancet journal, one does not have to be an academic or a professional to see that apart from jargon of interfering into the internal matters of a country, there is almost no scientific argument which could put the Lancet’s editorial concerns on the wrong side. 

If this was not enough, a news article published in the daily newspaper The Hindu published on the 22^nd August 2019, wherein the current President of the Indian Psychiatric Society (IPS) was planning to protest against the Lancet editorial at the International Conference of World Psychiatric Association in Lisbon. Not only that, he also claimed that IPS has thirty members from Kashmir and the Lancet should have contacted them first, arguing there are hardly any mental health issues and if there are they are due to the inference of a neighbouring country, a favourite of the current political disposition to dismiss any idea about welfare of Kashmiris.  He also questions why the Lancet didn’t publish something when as per him; there was a publication about mental health issues published in 2006. The official letter issued by the President of IPS looks like a dossier from ministry of external affairs talking about Pakistan, terrorism and Osama Bin Laden. In no way does it come across as a letter drafted by a professional body representing highly educated psychiatrists of a country. There is no evidence based argument, no references to any scientific research whatsoever which could have proved the Lancet wrong. The letter talks about coming generations of Indians especially doctors and students carrying an unpleasant memory. What about millions caged at gun point and children staying home trying to avoid the barbed wires?

As a Kashmiri psychiatrist who happens to be a member of IPS as well, I would like to know did IPS at any point try to contact their registered members in Kashmir or did they just splash their names on the letter used to criticise the Lancet. How does a national organisation representing almost all psychiatrists in the country makes videos, issues political statements and politicise about Pakistan, but at no point thinks of questioning the politicians about policies which are putting the physical and mental wellbeing of millions of people at risk. One does not have to be a scientist to understand that putting an entire population in siege, arresting their children, cutting off their all communication links will scar them psychologically forever, more so when the exposure to trauma is more than 70%. One out of ten people have lost a loved one directly to the current conflict and one out of three has lost someone in their extended families.  There are hundreds of publications in peer reviewed journals from local Kashmiri psychiatrists, orthopaedics, surgeons, sociologists, and other specialities talking about the mental and physical morbidity as a direct result of on-going war like situation in Kashmir. This will only get worse and no matter what professional jingoism will say, the reality of mental scarring is real.

Lastly, the members of any organisation have every right to question the decisions made by their representatives, may it be a country or a professional body.  Would the politically minded office bearers of IMA and IPS clarify if they had consulted their members before making sweepings statements, made fun of the scientific premise they claim to follow, shown utter contempt of their terms of reference and more importantly denigrated the pain and suffering of millions of people than becoming their voice. I am sure if there was a responsible body in the country, all these doctors would lose their licences to practice due to probity issues and not adhering to the code of conduct which no doctor should forget. Will the members of IPS ask their president to resign remains to be seen? When the siege is over, I am sure the Kashmiri psychiatrists will have a story to tell and many more scientific papers to write on the very trauma inflicted on them and their loved ones.

‘Dear Indian Psychiatry Society.... Psychiatry has come a long way from just using chains... !’ , wrote a friend to me who happens to be an Indian psychiatrist as well.