My Journey on the road and of the mind ....

Month: August 2020 (page 1 of 1)

Suicide of COVID Warrior Dr. Nagendra – Karnataka Doctors Threaten Strike

Karnataka COVID Warrior’s Suicide: Rs 50 Lakh Ex-Gratia For Family, Inquiry Ordered.

“Dr S R Nagendra has said he was committing suicide as he was frustrated due to the harassment by his superiors. I will order a detailed inquiry into the matter to find out the truth behind the incident,” the Chief Minister told reporters. Bengaluru – Karnataka Chief Minister B S Yediyurappa on Friday ordered an inquiry into the suicide of a government doctor who was handling COVID-19 cases in a taluk, allegedly due to severe work pressure. He also announced an ex-gratia of Rs 50 lakh for the family of Nanjangud Taluk (Mysuru district) Health Officer, S R Nagendra.
I will order a detailed inquiry into the matter to find out the truth behind the incident,” the Chief Minister told reporters. Yediyurappa expressed his sorrow over Dr Nagendra taking his own life at his residence at Alanahalli in Mysuru district on Thursday morning. “Generally Rs 30 lakh is given to the doctors who die in line of duty but considering this as a special case, Rs 50 lakh will be given (to his family) and I have also decided to give a government job to anyone of the family.” Later, the Chief Minister said the inquiry will be completed in seven days.
He also said that besides Rs 50 lakh, whatever is due to be given to the next of the kin will be given expeditiously. Meanwhile, an audio conversation purportedly between Nagendra and a senior district level officer who is heard taking him to task for not conducting enough tests, went viral. “How many swabs have to be taken and how many are you extracting? Is it a joke? Have you come here to play? You are playing with the patients. For a week if you are conducting only 25 or 26 (COVID) tests (a day), then I will teach you a lesson. You were supposed to do 150 tests a day,” the officer is heard shouting at Dr Nagendra.
The situation in Nanjangud was tense following protests over his death. Representing the medical fraternity on coronavirus duty in Mysuru, another government doctor Dr Ravindra poured the woes of medical professionals to the state Medical Education Minister Dr K Sudhakar, who is in charge of coronavirus management in Karnataka. “Look at the attendance register. Ever since the outbreak of coronavirus, Nagendra has not taken any leave. He was staying alone for six months because he was afraid that his family may get the coronavirus,” a teary eyed Dr Ravindra told Dr Sudhakar.
The Karnataka State Medical Doctors Association has threatened to go on a statewide strike if those responsible for Dr Nagendra”s death are not suspended. “We will go on statewide strike from Monday if those responsible for Dr Nagendra”s death are not suspended. Barring emergency cases, no cases will be taken up from Monday,” Dr Gulur Srinivas, president, KSMDA told PTI.

12 Step Psychological First Aid

  1. Observation and Awareness
    You first note that there may be a need for psychological first aid due to outward appearances-what you see or hear someone saying-or because you have heard about their stressful circumstances.
  2. Make a Connection
    This will differ based on your particular relationship to the person. For example, if the person does not know you, you may need to appropriately introduce yourself. Even if you are “acting” in an online conversation, you will need to have had some history with the person or to have been introduced through a mutual connection. Making a connection means acting in a way that makes it clear you are focused completely on the person you are trying to support.
  3. Help People Feel Comfortable and at Ease
    Common courtesies such as helping someone with their coat, providing simple information, or just acting friendly and accepting can make people feel comfortable
  4. Be Kind, Calm, and Compassionate
    Show by your mannerisms that you care and are respectful. Be careful about touching. This also depends on your particular relationship with the person. If you don’t know the person well, wait to see if he or she touches your hand or arm. A brief, light touch on the hand or arm can be very reassuring or warming.
  5. Assist with Basic Needs :
    When relevant, such as providing water or food, accommodations for sleeping, and ways for staying connected with support systems.
  6. Listen : Let people talk about whatever it is they would like to talk about, but do not push them beyond what they want to share. Sometimes all that a person needs is an opportunity to “vent,” or share their feelings or frustrations.
  7. Give Realistic Reassurance : “Everything will be fine” is not realistic. Saying “I’m sorry to hear that” or “I can see how you would be feeling that way” helps people see their reactions as normal. Reassure them that resilience can help carry them through.
  8. Encourage Good Coping
    Coping behaviors are learned based on our unique life experiences. We all have our own particular styles and strategies for coping. Some are positive and some are not so helpful.
  9. Help People Connect with Others
    Connecting means not only with deployed loved ones, but also with other existing and new social connections.
  10. Give Accurate and Timely Information
    Share relevant information only if you know it to be accurate; otherwise refer to some other source.
  11. Suggest a Referral Resource
    There are many resources for information and services that are helpful for military families.
  12. End the Conversation
    This depends on the circumstance and your relationship to the person. However, leave the person with the impression that you care, even if you are unlikely to see the person again.

Crisis Intervention – A Primer

Crisis is a state of emotional turmoil or an acute emotional reaction to a powerful stimulus or demand, trauma expert Jeffrey Mitchell explains. There are three characteristics of crisis:
The usual balance between thinking and emotions is disturbed.
The usual coping mechanisms fail.
Evidence of impairment in an individual or group.
Crises may occur when individuals face actual or threatened death, serious injury or some other threat to their physical integrity, according to the International Journal of Emergency Mental Health. Individuals may also be victimized by witnessing these events occurring to others. Contradictions to some deeply held beliefs can cause crises.
Crisis intervention provides help for individuals or groups during a period of extreme distress. The intervention is temporary, active and supportive. Crisis intervention is most frequently provided by firefighters, police officers, emergency medical or search and rescue personnel, nurses, physicians and other hospital workers, communications personnel and community members.
Basics of Crisis Intervention
Three goals guide techniques used in crisis intervention:
Mitigate impact of event.
Facilitate normal recovery processes.
Restore adaptive function.
Crisis intervention techniques should also abide by the following seven principles:
Simplicity: In a crisis, people respond best to simple procedures. Simple things have the best chance of having a positive effect.
Brevity: Psychological first aid needs to remain short, from minutes up to one hour in most cases.
Innovation: Use creativity; specific instructions do not exist for every case or circumstance.
Pragmatism: Keep it practical; impractical suggestions can cause the person to feel more frustrated and out of control.
Proximity: Provide support services close to the person’s normal area of function. “The most important thing about proximity is that support must be given in a safe zone,” according to the book Prehospital Behavioral Emergencies and Crisis Response.
Immediacy: Provide services right away. Crises demand rapid interaction, and delays can undermine the effectiveness of support services.
Expectancy: Work to set up expectations of a reasonable positive outcome. The person or group in crisis should be encouraged to recognize that help is present, there is hope and the situation is manageable. It may be appropriate to tell the person or group that although the situation is overwhelming right now, most people can and do recover from crisis experiences.

Leading Crisis Intervention Models
Two leading crisis intervention models are: Albert Roberts’ Seven-Stage Crisis Intervention Model, as described in Brief Treatment and Crisis Intervention; and Mitchell’s Critical Incident Stress Management intervention system, as described by the International Critical Incident Stress Foundation and International Journal of Emergency Mental Health.
Other widely recognized models include Psychological First Aid, Mental Health First Aid and Stress First Aid.

Roberts’ Seven-Stage Crisis Intervention Model
Roberts identifies seven critical stages that clients typically pass on the road to crisis stabilization, resolution and mastery:

  1. Plan and conduct a thorough biopsychosocial and lethality/imminent danger assessment.
    The biopsychological assessment should at least include the client’s environmental supports and stressors, medical needs and medications, current use of drugs and alcohol, and internal and external coping methods and resources. Assessing lethality must first determine whether a suicide attempt has been initiated and then can continue with the client’s potential for self-harm. Imminent danger must establish, for instance, whether the person is now a target of domestic violence, a violent stalker or sexual abuse.
  2. Make psychological contact and rapidly establish the collaborative relationship.
    Rapport is facilitated by the crisis worker offering conditions such as genuineness, respect and acceptance of the client. Traits, behaviors or character strengths of the crisis worker come to the fore to instill trust and confidence in the client. Strengths include flexibility, positive mental attitude, resiliency, reinforcing small gains, good eye contact, creativity and nonjudgmental attitude.
  3. Identify the major problems, including what precipitated the crisis.
    The crisis worker should determine what in the client’s life led to that person needing help. The worker should also try to determine which problems to work on first; these determinations can help understand the client’s coping style.
  4. Encourage an exploration of feelings and emotions.
    This stage involves the crisis worker allowing the client to express feelings, to vent and heal, and to explain the person’s side of the story about the current situation. Skills include active listening, communicating with warmth and reassurance, nonjudgmental statements and validation, and accurate empathetic statements. The crisis worker can, very cautiously, eventually work challenging responses into the dialogue, including giving information, reframing, interpretations and playing “devil’s advocate.” Challenging responses can help loosen clients’ maladaptive beliefs and consider other behavioral options.
  5. Generate and explore alternatives and new coping strategies.
    This stage can be the most difficult to accomplish. Achieving the goals in stage four means that the client likely has worked through enough feelings to have some emotional balance. Now, the crisis worker and client can put certain options on the table to ensure the client’s safety, such as a no-suicide contract or brief hospitalization, alternatives for finding temporary housing or considering the pros and cons of various programs for treating chemical dependency.
  6. Restore functioning through implementation of an action plan.
    An action plan helps provide concrete plans for ultimately restoring the client’s cognitive functioning. Many clients have trouble mobilizing and following through on an action plan; obviously, the action plan is critical for restoring the client’s equilibrium and psychological balance.
  7. Plan follow-up and booster sessions.
    The crisis worker should plan for a follow-up contact after the initial intervention to ensure the crisis will be resolved and to evaluate the client following the crisis. Follow-up contact should include physical condition, cognitive mastery of the precipitating event, assessment of overall functioning, satisfaction and progress with ongoing treatment, any current stressors and how those are being handled, and need for possible referrals
    Critical Incident Stress Management (CISM)The CISM is a comprehensive crisis intervention system that may be applied to individuals, small functional groups, large groups, families, organizations and even entire communities. It spans the entire temporal spectrum of a crisis. Mounting empirical evidence demonstrates that the CISM approach provides the tools for prevention and corrective treatment, the International Journal of Emergency Mental Health says.
    CISM has seven core components
    Pre-crisis preparation. This includes stress management education, stress resistance and crisis mitigation training.
    Disaster or large-scale incident, as well as school and community support programs including demobilizations, informational briefings, “town meetings” and advising staff.
    Brief small group discussions called defusings, which are provided within hours of a crisis for assessment, triaging and mitigating acute symptoms.
    Longer small group discussions known as Critical Incident Stress Debriefing (CISD). These structured group discussions are usually provided one to 10 days after a crisis to mitigate acute symptoms, assess the need for follow-up and, if possible, provide a sense of post-crisis psychological closure.
    One-on-one crisis intervention/counseling or psychological support throughout the full range of the crisis spectrum.
    Family crisis intervention and organizational consultation.
    Follow-up and referral mechanisms for assessment and treatment, if necessary.

“What explains the uncleanliness of India? – Anant Teltumbde

The answer lies in Indian culture which is nothing but caste culture. This culture externalises the responsibility of maintaining cleanliness to a particular caste. It stigmatises work as unclean and workers as untouchables. While the world over people have imbibed a “civic sense” and primarily bear the responsibility to maintain cleanliness, only secondarily relying upon sanitary workers, in India, people derive a sense of (upper-caste) superiority in littering the place, expecting it to be cleaned by the lower-caste scavenger. If a small community of these scavengers, treated worse than shit and exploited to the hilt, is vested with the responsibility of clearing the filth generated by 1,250 million people with impunity, the country is destined to remain unclean. Swachh Bharat is not possible without annihilation of caste.”

-Anand Teltumbde.