 Good day, viewers. Welcome to Ang Kalusugan Ay Karapatan. I am Dr. Menchit Padilia and today's topic will be Filipino resilience in the times of COVID-19. The American Psychological Association defines resilience as the process of adapting well in the face of adversity, trauma, threats, or significant sources of stress. In simpler terms, it is bouncing back from difficult experiences. We Filipinos are known for our resiliency interface of disaster. The current pandemic has brought about sadness, fear, and anxiety in facing the unseen enemy. But these reactions are normal reactions to not abnormal situation. Psychological factors have a great impact on the mental well-being of individuals. Our deepened connections with family and friends, faith in the supreme being, and the Bayanian spirit help us rise above the circumstance. This also emphasizes that the delivery of essential mental health care should start in the community. The state has recognized the basic rights of all Filipinos to mental health in the Promulgation of Republic Act 11036 or the Mental Health Law. This law affirms the basic right of all Filipinos to mental health. One of the objectives of the law is to integrate strategies promoting mental health in educational institutions, workplace, and in communities. Our episode for today will focus on psychosocial issues affecting resilience and mental health in the Philippines. Welcome to another episode of Kalusugan Ay Karapatan. We are fortunate to have with us today Dr. Anselma Tronco, chair of the Department of Psychiatry at Philippine General Hospital, and Dr. Laurel A. Melanie Elma, head of the section of Child and Adolescence to share with us their expertise on the topic in today's episode, Filipino Resilience in the Time of COVID-19. Good morning. Good day, Dr. Lani and Dr. Nonet. Let's ask the first question then, Dr. Lani, what is resilience? Resilience in our context as of now is being able to adapt, being able to live in the new normal after all of the changes brought about by COVID-19 such as the quarantine, isolation, maybe fear, maybe grief, and then for children and adolescents for them to be able to continue with their development, to be able to achieve their developmental milestones in spite of the changes brought about by COVID-19. So what you're saying is that resilience, when you said adapting, it's really bouncing back despite all of the issues that you mentioned. And it's not really just for children, it's really for children and adults. So Dr. Nonet, so I heard about the bouncing back of children, but what about adults? Do we also have to bounce back and adapt to the situation? We all bounce back. Most of us, we do not become shells of our former selves because of the disaster. But I think what is not very much emphasized and not being talked about is we have what is inherent in our culture. Our culture helps us bounce back and there are many not few. Okay, so let's maybe just tackle that part. Bouncing back for adults, how is it manifested? Assuming we have the same scenario of the COVID-19, I will ask both of you on how do adults bounce back and how do children bounce back. Let's start with Dr. Nonet. For example, when a person loses a job as a daily wage earner, some Filipinos at that level of society, what do they do? They learn to sell fruits and vegetables and fish, which they did that before to earn a living to survive, to feed their family. Or for example, when teachers like us cannot go to the hospital to teach and to do our work, what do we do? I learned how to connect with social media and learn Viber and Messenger and therefore now does not feel the physical isolation because I could work from home and I could connect through my gadget to the department of psychiatry. So what you're saying is that to become productive, you have to use another tool or come up with another way of earning a living and that way because of the situation, you're actually bouncing back, okay? What about in children? How does it work? Pa, pa, pa, ang lisil yan sa bata? Well, we have a change in situation, like they're now at home, they're used to being in school, being with their friends but they are now able to adjust to the family situation and the parents are also there to support them in terms of their resilience. Children may have their own resilience and the parents and caregivers are important in terms of supporting this resilience and even fostering this resilience. They may bounce back by keeping in touch in spite of not being able to go to school but they keep in touch through online just like in adults and they may also keep in touch with their elderly grandparents, so call them also online and maybe even learn new skills at home, being able to participate in chores at home and that will help them also adapt. They have responsibilities, new responsibilities and they will come out of this pandemic as more resilient. Okay, so is it normal for a person to be resilient? Yan ba e automatic na because of the current disaster? There's an innate thing inside me that will tell me that I have to be resilient. Does it work that way? The human impulse regardless of adversity is to grow well and healthy. Okay. That is the basic nature of the human being, even trees, even plants. Adversity brings out always the need to survive, the need to thrive, the need to grow. So that is the normal reaction to find another way to bounce back and adapt to the situation. But is it the same with children? Yes, it's the same with children. They may even be resilient in terms of the crisis that we are having now but they need more of the support. They need more support because they have not had experiences that will make them as resilient as adults. So they are also resilient but they will need our support so that they will be able to become more resilient and to come out of this pandemic being more resilient. Okay, I mean that's really nice to hear but then if you watch the television or listen to the radio, they don't talk about resilience at the beginning. They talk about psychosocial issues that have come to us, adults and children and I want to ask you now, what are those psychosocial issues that are we talking about? If we're saying that the automatic reaction is resilience, so what are these psychosocial issues that are being mentioned? Let's start with Dr. Nonnet. There has been a lot of studies globally about the nature of psychological reactions using instruments that document the population's reaction and what is written or what is shown in YouTube or the internet is that it's really post-traumatic stress disorder because disaster is traumatic, it's anxiety, it's depression, it's stress but we need to take caution when we interpret the data when they say 30 to 50% of these people who are in the pandemic like COVID-19 are anxious, depressed, have traumatic stress disorder or depression. Those data does not mean that 40 to 50% of us are ill. These reactions in fact should be better viewed as in this abnormal situation These are normal emotional reactions of normal human beings like us. Only a few, maximum 10% will actually be what we call ill and we'll need specific special psychiatric or psychological intervention. Okay. What about children, Dr. Lani? For children, when it comes to looking at the psychosocial perspective we have to look at their situation. For example, school closures, it's a very important situation that they have to adjust to as of now. Their life is in school, part of their support network is school and school closures affect so many children. They may have lost graduation ceremonies that they were looking forward to and also they may be receiving mental health services in schools and then this are no longer available. Another psychosocial situation that is important for children would be the effects of the quarantine, effects of the isolation, possible separation from their caregivers, from their parents. These are very important. And for children also grief, like if a parent is lost because of the illness they may be dealing with grief and the parent is usually the person who will be there when the child is fearful or when the child needs support and then what if the parent is the one that is lost during this situation. And our children are also vulnerable to the effects, the economic consequences of this pandemic. So child poverty may have many effects, like one of them would be increased in the learning gap because those who are in higher income families may be able to continue with online learning in spite of the school closures. They may be able to continue because they have internet, they have computer but what about our younger children? And also the psychosocial situation for children would include an increased studies have shown that there may be an increase in abuse, maltreatment, domestic violence during periods like this, like COVID-19. So there are many situations affecting them. So those are situations but what is the actual psychological concern because Dr. Nondit was saying that there's a level of anxiety that's heightened. So in children are you also talking about anxiety or is it more of depression? Or what is the response to the situations that you mentioned which are the more common ones? So the response depends on their age, on their developmental level. So in preschoolers we may see that they have fears of being alone, they may become more clingy towards their parents, they may have nightmares, sleep changes, appetite changes and they come out more in behavior. They may not be able to say and explain that I feel afraid, they may not even know that they are feeling afraid. They may just be angry or irritable, there may be an increase in temper tantrums but it's actually a reaction. For school age children, they may be able to talk about being anxious or being sad and then you can see them isolating themselves or may be being more clingy also or sometimes they may have appetite changes or even sleep changes, they can also have nightmares. And then for our teens, behavior and emotions also, they can talk about what they feel, they are usually very much involved when it comes to situations where there is discrimination or injustice, they know how to react already to our situation and then it may also be difficult for them to follow quarantine rules. So that can be a sign, a symptom when it comes to adolescence. So that's interesting, depending on the age group, the manifestation can be different and we have to be very conscious that for the younger age, they may not be able to express, they cannot say, I'm anxious, I'm sad, I'm afraid but actually in behavior it can manifest. Dr. Naudit was saying that this is normal. So it is, well of course it's normal to be anxious because we're all anxious, all of us are anxious but when do you know that it's becoming an abnormal level of anxiety? Dr. Naudit. There are two dimensions to do for. On top of feeling anxious, what is it that are the other things that the person is experiencing? Is it difficulty in concentrating? Is it difficulty in sleeping? Is it becoming irritable when you relate with others? Is it the inability to keep still and put attention so that you could accomplish tasks? A range of cluster or you're experiencing a lot of physical symptoms that make you feel that you're really sick and you are thinking what's wrong with me and you worry about it? And then the period, some people, it can be in a prolonged period that they already experience, for example, the feeling that they are really sick and they already even become feel depressed. Okay, so that's a good point. We're saying that anxiety is not really depression. Okay? And it is normal to be anxious when there's a new situation. So now my question is what is the definition of depression and how do you know or how will a family member know that somebody in the house is getting depressed? Depression at the first level is a human reaction. It's part of our lives. We feel sad. But when we become depressed to say that there is reason for concern, there are many other things beyond the feeling. We lose interest in things that usually make us feel pleasure. We could have difficulty in sleeping or we oversleep. We can overeat. We don't have appetite. We can't concentrate. We become retarded. We can't move about or we just sleep the entire day or we lose the hope and we become even thinking of ending our lives and that not life is not worth living. Put all these together, the person becomes unable to again function and he will not be able to earn a living. He will not be able to relate to friends. He will isolate himself with people and eventually becomes a vicious cycle that is not worth it. So what you're saying is that if there is somebody in the house who seems to be who stopped moving on and becoming productive or let's say just started isolating himself from the rest that could be a sign that something is going on and that person may need professional help. So it's not always verbal. It can be something that you can observe. Is it the same with children because right now the concern is not just the children can watch television or play outside but the peer system in the adolescents different. So are we expecting the same reactions, Dr. Lani? Actually if we talk of criteria for the diagnosis of depression it's similar with children. So like what Dr. Tronkel told us different signs and symptoms. It's not just a feeling of being depressed but it has to be in combination with other signs and symptoms. What may be prominent in children and adolescents will be physical signs and symptoms. Like they say they have a headache, every day I have a headache or for younger kids, I don't want to go to school, masakitan can ko e. So the physical signs and symptoms may be the additional manifestation in children and also when they are irritable they may be both either depressed or anxious and it comes out as irritability tantrums. So the manifestations may be the same as in adults but we have additional behaviors to observe when it comes to children and adolescents. So it's really very different because in adults it can be a sign of withdrawal or isolation. You're saying now that it is possible in the children it will be possibly tantrums and having a lot of physical signs. So earlier Dr. Nonet was saying that out of all the patients who are anxious maybe about 90% will really just bring back to normal life and only 10% will need professional help. When we say they need professional help what does it mean? The first thing is really to determine whether or not this person is sick of what psychiatric condition. I think this is the first step. The correct diagnosis given a thorough assessment even through the internet it doesn't have to be face-to-face. The chancellor has come up with a system where there is a bayanihan in PGH. People can call and they can be scheduled for telemedicine in PGH. So there is no reason if you need help and assessment that you cannot be assessed because it's COVID. The important thing is that when you feel that you have emotionally responding beyond the normal reaction how the courage no fear in seeking help. I think that's the most important thing. With the correct diagnosis what is the most important thing that should be given attention that one to engage this person or you will be engaged to put your reaction in the context of a still normal human response there is a part that is normal and there is a part that needs to be treated with medication and with specific psychiatric intervention. Three, your family will have to be involved. Mainly because in the context of the Filipino patient we will not go far if we do not involve our families. So I actually want to commend the department of psychiatry because they have come up to remind for health workers and sometimes it only really means having to talk to somebody to tell you that it's actually okay it's alright and what you're feeling is also the same as what I'm feeling. We've mentioned many times Filipino resilience but in Tagalog what is resilience, Dr. Nonet and Dr. Lani? Is there a Tagalog word for resilience? I think to capture the Tagalog concept of wellness the first it's actually did that come to me, it only came to me when you brought that question. I think it's really the Tagalog speaking people who could relate to this very well lakas ng loob. lakas ng loob kasi yun yung nawaw wala when we become actually weaker yung isang nakikita natin at the describe ng hina ang loob so that's why I'm saying lakas ng loob might be a very good way of capturing resilience which is English. Paran sinasabi mo malakasan loob ko anuman ang manyari sa akin ay magagawan ko ito ng paraan. Kung mahina ang loob ko ay hindi na ako kikilo at magihintay na lang ako. So lakas ng loob. What about you Dr. Lany? What do you think is a good word for Filipino resilience in children? How do we describe it? Because when you're talking majority of our patients are now will speak in Tagalog and then say you cannot just tell them resilience tayong mga Pilipino. So what is your Tagalog word? Um Wala na ako exact na Tagalog word to describe resilience but I would agree that lakas ng loob would be a nice way of saying Ay salamat. Yes, yes even in children although it may be vague when it comes to talking with children if you just say lakas ng loob. With children we tend to be very concrete why we don't just say ay nako kailangan magpakabait ka you have to be very specific about what the behaviors are. What the behaviors for the child to be said to be mabait what are the behaviors required so maybe in children if we say resilience to be resilient we have to say the exact behaviors. To be able to follow the routines at home. To be able to be calm in spite of the changes at home to be able to keep quiet when you have to keep quiet to be able to play when it's time to play. So you may have to define resilience in very specific behavioral outcomes with children. Again the management is different. In adults we are talking about moving forward in productivity and for children we want to be specific with certain attitudes. We've talked about fear, sadness, anxiety, depression. I think what's important now is how do we transition adults and adolescents and children moving from a world of being so negative right now because of the anxiety to something more positive. Dr. Nonep. There are many points of you to answer that question but I personally feel that it has not been quite discussed, talked about and not being given much attention. We as a people as Filipinos we may have to take a hard look at what is actually embedded in each one of us as a value. We have the values that will make us resilient in COVID-19. One. We are fearful, anxious, depressed. We are actually grieving in a community. There is communal grief and what does that lead to? In this communal grief we try to find meaning in this loss. And what do we hear? We see the sense of community in the Bayanihan spirit despite our difficulty we are able to see what can we do to be part of the process of healing in this COVID. That is very Filipino. Two. Before COVID and more during COVID we are really a prayerful people and this sense of connectedness and spirituality in the accounts of people who survived COVID. They survived COVID. They almost died. The single most important thing that they feel made them hold on and live is the sense of prayer and connectedness to God. More than the medicine, more than many things they feel that it was God's connection that's two. Three. In the past, 20 years ago, 30 years ago when disaster strikes, there are many stories about how humor makes us feel relieved I mean, the respite from the sense of drudgery and pain in Pablo Cagendi Oro in Rial, there is still a sense of humor and sense of positivism in the Filipino. That is, I think, we should recognize and we should look into ourselves. So we have that sense. Four. The very language when we ask, Kamustaka. It's not how are you, how is the weather in the western world. Kamustakan means I want to find out how you are feeling at this point. It is a sense of human connection in our day-to-day life. So put all these together. There are a lot in us embedded in a culture which is in each one of us that makes us resilient as a people. So Dr. Nonet, sometimes it's we have to do it consciously and I think that's what's lacking among ourselves and even the current situation. We don't talk about the good things that are happening to us. We only talk about the challenges and the obstacles and the bad things that are happening. So do you suggest that we make this like an exercise for everybody that we explore what we can be grateful for? That kind of point of view, gratefulness, if you pause a little, if you ask what is it that we should be grateful for I think it's going to spin to draw and have an internal discourse in our minds or among our friends and you'll be amazed that you'll end up feeling good and happy because there are many things that are very good that are also happening in this pandemic. Many things but we need to have an internal discourse and we need to converse and talk about it. It's up to Donny. Yes. What about Dr. Lani? Let's talk about children. Is this a good thing to work on? Actually, there are beneficial consequences of this pandemic. Like the parents are at home, there is increased social support for these children and maybe the parents have values for them. The values of as Dr. Tron mentioned being grateful, the value of humor may be translated into value of play with children they can benefit from the presence of the parents during this time of pandemic to be able to absorb all of these values that we as Filipinos have. So it's similar but we have to transmit it to our children. But maybe first of all, since there's a lot of anxiety, maybe even confusion, maybe the kids do not really understand it very well. Maybe they have their own questions. We would also have to speak to them at a level that they can understand. Like for preschoolers we have story books in Filipino that we can read to them, we can read them together and they give information about COVID and how to protect themselves during these times of COVID and there are videos that you can watch together and the children can be help to be able to do something like for PGH, for the healthcare workers we ask children to make drawings and to submit them to the section of child psychiatry some made drawings, some made art artistic productions and we compiled all of these and gave them to the healthcare workers. So this will make the children feel that there is something I can do during this pandemic I can be productive and responsible also during the pandemic and for teens they are also able to do a lot like they have been able to make masks they have been able to make face shields and then donated this to hospitals and maybe even there were some students who tried to find donors to help a particular institution so we are able to empower also our children and adolescents so the message I'm getting is that there has to be a conscious effort to talk about resilience to talk about the positive things that COVID has brought to our lives. We talked a lot about PGH but do we have this, do we have these services throughout the country, Dr. Nonnet because I think everybody is anxious so we've got to find out how are we going to reach to the 100 million Filipinos right now of them being anxious with the current situation again I would like to put this premise disaster is danger and opportunity we always talk about danger and suffering but we need to highlight the opportunity that COVID brings so in that perspective from the viewpoint of mental health because I'm an advocate for mental health in the country this is the opportunity for the formal health system to respond to engage in conversations about emotional reactions to the crisis and that it's the best thing we can do to make a survival so is this available in the community Dr. Nonnet I know we have very limited psychiatrist but how are we going to reach out to all of this to all the Filipinos like the health system the mental health and emotional aspects of health is the last in the list even in terms of money in terms of training in terms of discourse so very nil but I'd like to say that hopefully because of this people will listen and say let's invest in mental health in the community because there is only 700 psychiatrists in the country we cannot respond to the level of the committee but the psychiatrists could help people in the local health system the barangay and the doctors and the nurses we could help them acquire some skills to engage social issues that are relevant to becoming well so what is in the mental health law that's going to push for what you are recommending it is already a requirement the universal health care has in it mental health as a particular aspect of the universal health care and so since the Philippines is devolved from the province to the district to the rural health unit at the barangay there will be a cadre of people with a level of expertise defined by field health there will be remuneration or cost of it and then there will be guidelines on how people will be able to provide the service depending on the kind of need at the level of the barangay that is a dream work but it can be done because there is a technology social media is there medicine work the tools to make people feel better and have the lakas na lob is also there and as a people the Filipino health worker is a feeling people so it is not difficult to actually create the services okay that's good so what are we looking at how do we look at how we will deal with these issues now in a new normal I'm going to ask Dr. Lani because 50% of the population is really pediatric and that means you've got 50 million and even if you just have a fraction of that 50 million with these kind of problems how are we going to deal with it in the new normal well since most of our children are supposed to be in school I think it's very important that we are able to bring back learning it can be online learning but if possible if there are other measures that can be done for them to be able to go back to their schools because in the past we have made use of schools the teachers the guidance counselors to be able to reach out to these children to be able to reach out to all of them nationwide but we can device programs for teachers to be able to train them to pick up problems in the children and to be able to manage them at the level of the schools and we can also reach out to the pediatricians because they are all over the country and then they are in touch with these children and adolescents so we can speak with them and maybe manage them initially so the ones that will be referred to us will be the really difficult and complicated ones but they can be managed already in the community through our schools, the teachers and the pediatricians so the message is handling mental health cannot be left to the psychiatrist we have to engage the different sectors national government to local government the educational system as well as the network also among the physicians so just one final message from our two guests as our Dr. Lani final message to our viewers and the general public and to the doctors so to our viewers we have to believe in the resiliency of children we have to believe in it and then to foster, support it maybe teach coping strategies if needed sometimes it will just be being there with them, accompanying them on this journey of resilience and for our doctors maybe if you are just caring, you are a caring physician that is enough for the mental health needs of the children and adolescents and if in spite of being caring supportive, it's not enough then please do refer to a mental health professional I'll bring it to my most important thought that take a hard look within ourselves discourse within yourselves and friends many values in us that makes us survive this and make us resilient our sense of prayer and spirituality our connectedness with friends and family our sense of community captured in the word by any hand in the way we engage one another and start a conversation which is really talking about how you and I feel and most important in the world the sense of humor because laughter is a single most important action that makes us feel better regardless of the circumstances well thank you Dr. Lani and Dr. Nonet thank you for explaining Filipino resilience and telling us that we have it and that means we'll be able to get over this crisis marana salamat sa inyong lahat the Chinese character for crisis what's danger and opportunity in the same breath this pandemic brought about fear sadness and loss of control our connectedness our sense of family and community and faith our core values that are embedded in us making us Filipinos resilient in the time of COVID-19 thank you for watching kalusugan ay karapatan