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Elderly face pandemic of loneliness

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During the COVID-19 crisis, we’re battling three pandemics – a health pandemic, a financial pandemic, and an emotional pandemic. Nowhere is the pandemic of loneliness, anxiety, depression and despair more acutely felt than among the elderly.

So said Chabad House Director Rabbi David Masinter in a recent webinar titled, “Our Parents, our grandparents: the problems and the solutions”.

“Many of our seniors here have their kids and grandchildren in other provinces and places in the world,” said Masinter. “They’ve been very heavily affected by this.” Even those who live around the corner from their loved ones are often unable to be with one another for fear of infection.

Rabbi Ari Kievman, who runs the Chabad Seniors Programme in Johannesburg, has had to adjust his offerings to deal with the challenges brought by COVID-19. A panellist on the webinar, which was a collaboration between Chabad House Johannesburg and Central Shul Chabad (CSC) Melbourne, Kievman spoke of the spiritual void seniors often experience. “Perhaps it’s the soul crying out and asking for more meaning in its life,” he said. “Chabad cherishes elderly wisdom, and has a mission to promote lifelong learning opportunities.”

Before COVID-19, Chabad hosted daily shiurim, interactive lessons, and outings. “It’s important to keep seniors active, motivated, and animated,” said Kievman. “Yet, now we’re in a different era, one that we didn’t anticipate. Considering that we can’t offer these activities, we’re asking what we can do for the elderly to fill their time in a meaningful way. Personally, and with a team of volunteers, we at Chabad House have tried to reinvent ourselves in numerous ways. Whether dealing with seniors themselves, their families, nursing facilities, and retirement villages, we’ve tried to fill that spiritual void.”

Kievman and his team stay connected through daily online shiurim and phone calls to seniors, which serve as wellness check-ups. By delivering weekly Shabbos treats or full food parcels for those who need them, Chabad also ensures that it visit its seniors weekly, while following COVID-19 protocols.

“One of the benefits of having volunteers deliver the food is that personal interaction,” says Kievman. “We don’t want to just drop off the food, we want to interact with people and address any problems we observe.” This week, it’s adding activity booklets to its packages to keep seniors’ minds stimulated.

Dr Barrie Levin, a GP with a special interest in geriatrics, said it’s vital to raise awareness about the difficulties the elderly face, and unite to try and address these during the COVID-19 pandemic and beyond.

“I look at patients holistically, keeping track of their medications from different specialists, and their interactions and side effects. There are communication problems in our system which specifically affect the elderly.” While he believes in a multidisciplinary approach, Levin believes doctors, patients, and their families need to work together more effectively. “The psychosocial aspects of what the elderly experience are often neglected or not known,” he said. “I feel so strongly that as a community and as doctors and allied professionals, we’re failing the elderly.” This needs to be addressed, especially at this time.

“The elderly experience a loss of independence on various levels,” said Levin, “ranging from their car keys being taken away from them to losing the ability to walk and sometimes talk. I often get asked why the elderly are neglected. It’s because they can’t speak for themselves, and even if they can speak, they’ve lost their voice and ability to stand up for themselves, so they rely on others to do it for them.”

The psychosocial problems the elderly face have been worsened by COVID-19, he says. “They have to eat on their own in their rooms at retirement homes. Things they looked forward to like bridge games and shul visits have been stopped. A lot of my work at this time has been helping patients and their families navigate these difficulties as compassionately as possible.”

Dr Ryan Fuller, an old-age psychiatrist, echoed Levin’s sentiments, especially regarding the lack of cohesive care provided to the elderly. Yet, he said, one benefit of COVID-19 is that it’s forcing innovation regarding these issues. “These Zoom interactions weren’t allowed by the Health Professions Council of South Africa before, but now such regulations have been swept away,” he said. “We’re forced to talk to each other, learn more, and be kinder, which is crucial.”

“At the moment, we’re taking it day by day,” he said. “The COVID-19 crisis has really amplified problems. The elderly were vulnerable before, and now they’re even more vulnerable. The emotional impact on healthcare providers and on nurses is also profound. One nurse said to me, ‘There’s no textbook here. We have to figure it out as we go along, and the only way we do that is talk to each other and learn from each other.’”

Physical contact is also a challenge. “Before the pandemic, there were studies saying many of the elderly don’t have any physical contact for months, and that lack of tactile stimulation leads to further isolation on a physical and spiritual level,” Fuller said. “We’d ask nurses and carers to take blood pressure regularly, and hold hands where appropriate. Now you look like an alien in protective gear, and patients are already anxious.”

Yet, carers and medical professionals hold patients’ hands where the risk is manageable, obviously taking all COVID-19 precautions. “Sometimes people just need a hug, we need to be human,” said Fuller. “It’s important that we don’t lose that at this time. Netcare even has a compassionate policy where it allows families in protective clothing to see loved ones in hospital. There’s a perception that people die alone, and we’re working hard to ensure that doesn’t happen. It’s also important for carers to understand this isn’t just some geriatric, there’s a life and a history.”

Rabbi Yitzhok Riesenberg of CSC Melbourne said that South African expats living in Australia are anxious about not being able to travel to see their parents. “The children of the elderly are also adversely affected by the tyranny of distance,” he said. Among the suggestions made by experts is to ask nurses to facilitate video calls for seniors who aren’t computer or cell phone literate. Even if it’s just a telephone call, staying in touch and being proactive is vital. “We must ensure that the elderly have a voice, and we don’t forsake them,” said Fuller.

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Mental illness – ‘a pandemic of its own’

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“My brother was like a boxer, he took many knocks and would always get up. In the end, there were just too many, and he gave up the fight.”

These are the words of a grieving sister whose brother, an observant young man in the community, took his life two weeks ago.

Her name is being withheld to protect his identity.

“He took one punch too many, and the ongoing challenges got the better of him. Now, our family is left behind to grieve and mourn this tragic loss,” she said.

The untimely passing of this father of two has shone the spotlight on suicide and mental health in the community at a time when the suicide rate has risen dramatically in the country in the shadow of the pandemic.

“I know of four people within the community who have taken their lives in the past four weeks,” said Rabbi Eitan Ash. “This is a pandemic of its own, and I’m petrified that this is just the start.”

“I’m not a doctor or a virologist, but I spend a lot of time speaking to people in the community, and people of all ages are struggling emotionally and psychologically,” he said.

He said the community needed to address mental health as a matter of urgency “from the leadership all the way down” and make sure people knew that there was plenty of help at hand and nothing to be ashamed of.

“People aren’t seeing the light at the end of the tunnel, which is making them feel more desperate, leading them down a dark spiral of hopelessness and causing them to make terrible decisions,” he said.

Ash said people needed to see this side of COVID-19 – that depression is a disease, an illness that needs to be treated just like any other and above all, destigmatised.

“People are caught up in the medical side of COVID-19, but we need to pay attention to the psychological and emotional side as well. The psychological damage caused by quarantine, lockdown, and isolation is huge.

“Single people in the 25 to 40 age group believe there is something wrong with them when actually they just haven’t had a chance to jol and meet people,” he said.

It’s vital that the community embrace those suffering from depression, and give them a sense of belonging.

“We need to create a community brand that says no matter who you are, you are totally accepted, and we will help you no matter what your challenges are,” Ash said.

“My beloved son was driven to the point where he felt he had no way out. Something in him snapped. He had so much to give, and this is what makes it so tragic,” said the bereaved mother.

Reports this week indicate that Gauteng recorded 1 325 cases of death by suicide since April 2020, an increase of about 90% from the 695 cases reported during the 2019/20 financial year. A large portion of these include young people between the ages of 30 and 39.

According to Faith Mazibuko, the MEC for community safety, contributing factors include depression, anxiety, loss of income during the pandemic, financial difficulty, death of family members, and domestic violence.

Though the suicide numbers aren’t clear in the Jewish community, there has been a definite rise in those affected by anxiety and depression, say community-based social workers and experts in the field.

“The Chevrah Kadisha has 26 dedicated social workers dealing with hundreds of mental-health cases every month,” said Saul Tomson, the chief executive of the Chev this week.

“We are keenly aware of this mental-health crisis in the community. It’s staggering. Though suicide numbers haven’t risen dramatically during the pandemic, depression and anxiety has.”

Dr Sheri Hanson, mental-health co-ordinator at Hatzolah, said this time of year is always difficult for those going through hard times.

“It’s always tricky and coupled with COVID-19 and the uncertainty of the fourth wave, it can seem relentless,” she said.

“We’re dealing with people across the board. Every age is deeply affected by anxiety and depression which is a phenomenon that has come off COVID-19. The elderly are facing challenges of isolation and loneliness, middle-aged people have lost jobs and income, and the youth has lost out socially.

“There’s a fine line between acknowledging your feelings and not being consumed and overwhelmed by them,” she said, pointing out that it’s important to engender a sense of hope, not judging, and to make sure that people know there’s lots of help within the community.

“We need people to know that all they have to do is reach out and help is available,” she said.

In September, the South African Depression and Anxiety Group reported that there were 23 known cases of suicide in South Africa every day, and for every person that committed suicide, 10 had attempted it. Before COVID-19, the organisation fielded 600 calls a day. As of September 2021, that number had risen to 2 200 calls a day – an increase of nearly 40%. Ongoing isolation, uncertainty, economic strain, bereavement, and loss have resulted in heightened anxiety across most ages including school-going children.

Ash said COVID-19 created a total disconnect. “People live their lives in a bubble. There has been little socialising and hardly any functions. The lonely feel lonelier, and people who would ordinarily reach out don’t even know when there’s a problem.”

For this reason, he and several rabbis in the community are encouraging people to reach out.

“Call a friend, reach out to your wider circle, make that call. That WhatsApp can literally save someone’s life.”

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Heartbreak and loss as the world slams doors on SA

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Sarah Cohen* was woken by banging on the door at 04:30 on the morning of Friday 26 November. She was visiting from the United Kingdom (UK) with her one-year-old son and looking forward to enjoying all that her former home city of Cape Town had to offer. But there was a taxi driver at the front door sent by her father in London. He was to take her to the airport so that she could get on a plane that her husband, also back in London, has just booked. In light of the new COVID-19 variant, South Africa was going to be put back on the UK’s red list, and she had to go – immediately.

“It was intensely stressful and terrifying. It happened so fast. When I went to sleep on Thursday things were normal. Then I was suddenly woken up by a cab driver pounding on the door. I checked my phone to find about a thousand missed calls and WhatsApps. My husband had booked us a flight home via Munich. We just chucked everything in bags and legged it to the airport, worried we’d miss [the flight]. It was the last international flight out of Cape Town!”

She is one of thousands who have been directly or indirectly affected by the new Omicron variant discovered by South African scientists. The heartache and loss resulting from the international knee-jerk reaction is unquantifiable. Family reunions forfeited, simchas cancelled, stranded travellers forced into quarantine, and businesses bearing the brunt of the travel bans are parts of its ripple effects around the globe. Many South African Jews and their families have been affected.

Cohen counts herself among the lucky ones. “My flight was literally the only one and it left two hours before they [the UK] officially put South Africa on the red list. That’s why I can isolate at home rather than being stuck in a hotel room with my toddler.”

Carole Levin and her family were looking forward to celebrating her son David’s wedding on 16 December. But that dream was shattered in the space of 24 hours.

“David and his fiancée Daniella (Dani) Hayman have been living in the Caribbean for the last 18 months, as he got a job there. They left Cape Town in July 2020. We all thought by December 2021 we would be able to safely have a wedding.

“In the meantime, Dani’s grandmother had a fall, and she came to see her at the beginning of October. Her plan was to stay until the wedding. David was booked to arrive on 6 December. On Monday last week the COVID-19 numbers started to rise. By Thursday we realised a fourth wave was imminent. We woke up on Friday to news of the UK travel ban.”

Amid frantic phone calls from family cancelling, they tried to bring the wedding forward so that they could celebrate with those who could still make it. The only date available was 6 December. It wasn’t possible, and so their summer wedding dream was over.

They then heard that the United States (US) was banning travel from South Africa from Monday 29 November. From enjoying the lead-up to her long-awaited wedding, “Dani had to get on a flight and leave. She was distraught, devastated,” said Levin. Amid tears, they helped her pack late into the night. The next morning she was gone, on a flight to Washington via Addis Ababa and Dublin.

It was touch and go, and she sent a heartbreaking message from the airport in Ethiopia saying she had made it onto the flight to the US. “It was a very emotional moment,” said Levin. She recalls so many times in Jewish history where crossing oceans meant getting to safety, and how holding off simchas in times of trauma is a part of our story. She remains hopeful that the wedding will take place in 2022.

Tessa Snitcher, who made aliyah in 2007, said, “My mom was coming to Israel to see her grandchildren, whom she hasn’t seen for two years. She booked on Turkish Airlines. She flew on 25 November at 17:00. By 20:30 there was a cabinet meeting in Israel. By midnight they had decided to close the border to South Africans. When I woke up 05:00, my mom called me hysterically, saying she wasn’t allowed to get on the plane to Israel from Turkey.

“I truly thought that they can’t stop somebody in mid-flight,” continued Snitcher. “I was in shock. They didn’t even give a few hours’ notice to allow people to get to a destination. I had no one to talk to. I called the airport, no one could help me. I called the health ministry, they couldn’t help me. The only person who has been truly helping olim is Dov Lipman and his organisation Yad L’Olim. He did everything he could to get my mom to Israel. But after many hours we understood that it wasn’t going to happen.”

Amid the chaos, they had to get her back to Cape Town. “It was extremely difficult, but she managed to get a ticket home. I think she was in the airport for 24 hours. We were so defeated and heartbroken. When she stepped onto the plane they said, ‘This is the last flight out of Turkey.’”

Snitcher says that Israel’s response to the new variant has hurt the very people who care about the country the most. “I made aliyah, I’m a Zionist, and I feel extremely embarrassed at how Israel treated South Africans. I don’t know when I’m going to see my mom again. I could cry from that feeling of desperation.”

Carla Stein and her husband Jared have had a tough year, losing two family members in a short space of time. They were counting down the days to a trip to Mauritius. But their dream turned into a nightmare of hours waiting in airports and on planes with small children, until finally they were allowed to fly. They landed on the island and were excited to be on holiday. That is, until they were told they weren’t allowed to leave the airport. This was even after they and their children had had multiple PCR tests, and the fact that they are fully vaccinated.

They watched in horror as passengers from other countries were allowed to head to their resorts, but as South Africans, they were forced to stay put. “There were about 15 or 20 police officers in uniform blocking the [exit]. It was traumatic. They had announced only 10 minutes before that all people flying in from South Africa were required to do 14 days’ quarantine,” said Stein. Negative PCR tests and vaccines didn’t matter.

After more hours in a hot airport, they were told they would have to quarantine. “We didn’t want to get shipped off to an unknown destination. The flight before us didn’t have to quarantine, but that’s what we were told to do.”

They were eventually taken to a hotel about 45 minutes away. Although their booked accommodation could ensure their isolation, they were transported to another hotel inland. “The next day my husband was told by someone, also in quarantine, that we were moving hotels. We weren’t even informed.”

They were moved again, but still not to their booked accommodation. The hotel room they are now in has a tiny veranda – a small saving grace. “We were eventually told that we will be here for seven days, and can be released after negative PCR tests,” said Stein. “But if someone is positive from the flight we will have to quarantine for 14 days.” They plan to continue with the holiday when they are let out. “It’s very hard being stuck in a room with a 19-month-old and an almost seven-year-old. But we have made it this far, and will try make the most of this experience.”

*Not her real name.

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Tackling tough topics with teens needs ‘courageous conversations’

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At some point in their lives, most parents will probably type “How do I talk to my kids about sex?” into an internet search engine. However, experts at a recent webinar warned that depending on the internet is not enough when it comes to talking to teens about sex, sexuality, pornography, drugs, alcohol, prejudice, violence, puberty, and other difficult topics.

More than 600 people registered for the webinar, hosted by the Chevrah Kadisha social services department, with many more watching on Facebook. This shows how many parents are looking for answers when dealing with these difficult questions. The Chevrah Kadisha also launched its new e-book, Courageous Conversations: Helping Teens to Talk and Listen, which includes advice from 22 local and international experts.

All of the experts on the panel said that avoiding ‘taboo’ topics with children and teens was a recipe for disaster, since the youngsters would then turn to other sources for information, which could lead them onto dangerous paths. Furthermore, “addressing the tough stuff makes our kids feel safer, it strengthens our bond, and teaches them about the world,” said educational psychologist Ashley Jay. “If these conversations begin at home, it lays a foundation for children to recognise situations that may be inappropriate. This makes them able to speak up.”

She emphasised that feelings don’t scare children – it’s being left alone with those feelings that scares them, no matter how old they are. These conversations must not be lectures, but rather a space where ideas are exchanged and the parent becomes an ‘active listener’. “This means lot of eye contact, follow-up questions, limited interruptions and communicating as clearly as possible.”

In addition, it’s important that you “be clued up”, as children and teens often have more knowledge than the adults do. At the same time, “it’s okay to not always have the answers in the moment. Be honest that you’re learning too, and challenge your own generational biases and prejudices.”

Clinical psychologist Yael O’Reilly said that “studies show that having honest, open, appropriate conversations with our kids about difficult topics actually leads to safer behaviour. Silence gives our kids the message that we’re not a ‘safe landing’ for them.”

When approaching these issues, “we first need to understand the needs of the generation that we are parenting,” she explained. “Teach through connection – that’s the golden principle for this generation. The approach of ‘you will do as I say’ no longer has the weight it used to. We have to be actively curious, engaging, and always working on meeting our kids where they are in order to form a trusting relationship.”

Have a “stacked approach”, she advised. “Information is buildable – so start small, start young, and build it up from there. When it comes to pornography and drugs, we need to be starting these conversations when they are seven, eight, or nine years old, and building on them slowly and organically. This means we use everyday events as connection points with our kids. For example, when you see someone smoking a cigarette, ask them what they think. At a simcha, ask what it means to them when they see people drinking,” and so on.

When they are young, it’s about introducing the distinction between safe versus unsafe behaviour. As they get older, parents can start to introduce ideas in more detail. “With pornography, older tweens (10 to 12) need to have a basic understanding of what it is. This means that they have to have a basic understanding of what sex is,” she explains.

“The conversation can look something like, ‘We need to make sure that we know what isn’t safe online. Have you heard of porn or pornography? These are online sites for adults where there are pictures or videos of adults doing sexual things. These sites are for adults who want to look at them. They are never for children, but there’s no control over who clicks on them. So if this happens, what do we do? We close the page straight away and show it to mom or dad. Or if it’s being shown to us by someone else, we walk away and tell a trusted adult.’ So explain briefly what it is and what to do if they are exposed.”

Later on, this discussion can open up others about the negative messages embedded in pornography – “that it’s often violent or disturbing, sets unrealistic expectations of what sex is really like, and disregards the intimacy that comes with sex,” she explains. “When it comes to drugs, follow a similar format.”

Importantly, parents must create a ‘way out’ pact, where they tell their child that “you can call me at any time of the day or night and I will come and get you, no questions asked. This doesn’t mean you’re letting them off the hook, it just means that in that moment of vulnerability and potential danger you’re able to be a safe space for them.”

In addition, ‘no’ is only effective when balanced with ‘yes’. “Take stock of the ratio between yes and no in your home. Have some non-negotiables that are clearly communicated, but be open to negotiating everything else,” said O’Reilly. We need to remember that teens are going to make bad decisions. So expect it, “then set your relationship so that you can be the person that they can rely on in times of distress”.

Psychologist Dr Hanan Bushkin said that it was never too late to have these conversations, and that they should be part of general conversations about life. “Have conversations about values. When you say you should respect your body or others’ bodies, explain why. What are the values underpinning these instructions? The moment you explain the ‘why’, it makes the instruction much more palatable. Parents need to feel comfortable [about the topic]. If you’re uncomfortable, can you imagine what the message looks like?”

However, even if you’re not comfortable with the discussion yet, a factual conversation is better than nothing.

It’s important to portray sexuality as a natural part of being human – as natural as eating. “Explain that we all get hungry, and that’s not a problem. But we can direct that hunger at healthy or unhealthy foods or decisions. There should be no shame.”

“Teenagers are the most misunderstood people on the planet,” said Bushkin. “We treat them like children, but expect them to act like adults. Being a parent to a teenager is very hard, but being a teenager is hard too. This is an incredible opportunity to mould a child into an image you feel proud of. Having a front-row seat to your children growing up is an incredible gift and opportunity. Make your time count.”

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