COVID-19, COPING SKILLS AND STRESS RELATED ISSUES AMONG SICKLE CELL WARRIORS IN NIGERIA

By Folorunsho Suleiman PhD, Chief Psychologist, Dept of Psychiatry, Lagos University Teaching Hospital, Nigeria

Dr. Folorunsho Suleiman

Coronavirus are zoonotic in nature. The disease (COVID-19) is caused by a new strain of corona virus (SARS-Cov-2) that has not been previously identified in humans. The disease (COVID-19) was first reported to the W.H.O on 31st of December, 2019, in Wuhan, China and since then it has become a serious public health issue globally. As of October 2020, the virus had infected more than 34 million people worldwide with over 1 million deaths.

The symptoms of corona virus disease could include: Pneumonia, Fever, Dry Cough, Sore throat, headache, shortness of breath and loss of smell. In severe cases it could lead to difficulty in breathing and death can occur if not adequately treated.

Precautionary Measures for COVID-19

Individuals living with sickle cell disorder can reduce their chances of being infected or spreading COVID-19 by taking simple precautions:

  • Regularly and thoroughly sanitize your hands with an alcohol-based hand sanitizer or wash them with soap and water;
  • Maintain at least 1 metre (3 feet) distance between yourself and others;
  • Avoid crowded places;
  • Avoid touching eyes, nose and mouth. The use of face mask should be taken very seriously;
  • Make sure you, and the people around you, follow good respiratory hygiene. This means covering your mouth and nose with your bent elbow or tissue when you cough or sneeze;
  • Stay at home and self-isolate even with minor symptoms such as cough, headache, mild fever, until you recover;
  • If you have a fever, cough and difficulty breathing, seek medical attention, but call by telephone in advance if possible and follow the directions of your local health authority;
  • Keep up to date on the latest information from trusted sources, such as WHO or your local and national health authorities.

Sickle cell disorders are a group of illness that affects one’s red blood cell, a genetic condition that was passed from parents to children. Sickle cell causes normal round and flexible blood cells to become stiff and sickle shaped, hindering the blood cells and the oxygen they carry, from being able to move round the body, hence the experience of severe and episodic pain by patients.

The painful episodes experienced by SCD patients are referred to as sickle cell crisis and are often treated with painkillers. The complications experienced by sickle cell disorders patient include stroke, acute chest syndrome, blindness, bone damage, occasional damage to organs like liver, kidney, lungs, heart, spleen and occasionally death could occur from a severe complications of the disorder.

STRESS RELATED ISSUES AMONG SICKLE CELL DISORDER DURING THIS PANDEMIC

  • Recurrent pain among sickle cell disorder could constitute some serious stressors to them
  • Poor care contacts and non-school attendance during this pandemic
  • Work and activities absences during lock down period
  • Poor quality of life during pandemic
  • Sickle cell anaemia can have a negative impact on the mental health of patients.
  • Generally, Symptoms like hearing loss, vision problems, acute chest syndrome, jaundice, priapism, leg ulcers gallstone and stroke experienced by SCD patient could constitute a stressor to patients living with sickle cell disorder that can lead to depression and anxiety disorder.
  • Reduced quality of life owing to restrictions in daily functioning as a result of the illness
  • The fear that they might contact COVID-19 because of their vulnerability may lead to anxiety or depressive illness, among patient living with sickle cell disorder
  • Poor interpersonal relationship with others in their immediate environment for fear of being stigmatized.

EFFECTS OF COVID-19 ON SICKLE CELL PATIENTS

  • COVID-19 can cause severe inflammation and injury to the lungs of a patient;
  • Respiratory infections such as COVID-19 ramp up the formation of sickle shaped cells – infection in the lungs could lead to lower oxygen levels and worsen inflammation.
  • The increase in sickle red blood cell makes patients with SCD and COVID-19 infection particularly vulnerable to developing acute chest syndrome (ACS) commonly experienced by SCD patients
  • Patient should be extraordinary careful during this period by adhering to the do’s and don’ts of sickle cell disorder conditions (i.e the use of routine medication should be taken very seriously)
  • Sickle cell patients are advised to stay at home during this pandemic and only to engage in essential travel while adhering to the NCDC 2020, precautionary measure.  
  • Clinic appointment should be adhered to in order to monitor the rate of wellness among sickle cell disorder’s patient. The use of telephone as a point of contact will be an additional advantage during this pandemic.
  • The use of hydroxyurea should be taken very seriously for patient on this medication as it minimizes complications from sickle cell disorder
  • Patients should stay well-hydrated during this pandemic.
  • Patients should wash their hands regularly in order not to be infected with COVID-19.
  • SCD patient should stay away from where they could be infected with COVID-19 (i.e stay away from people that experienced COVID-19 symptoms).  

COPING STRATEGIES

Coping skills is the use of one’s own conscious effort to solve personal and interpersonal problem by an individual, in order to master their stressful life condition.

Generally, coping skills refers to adaptive coping strategies, that is, strategies to reduce stressful life conditions.

TYPES OF COPING STRATEGIES

Problem-Focused Coping Strategies          

  • Problem focused coping targets the causes of stress in practical ways which tackles the problem or stressful situation that is causing stress, consequently reducing the stress. Examples of problems focus based on coping include planning, self-control, restraint and suppression of competitive activities.

  • Emotion-Focused Coping Strategies
    This involves regulating your feeling and emotional response to the problem instead of addressing the problem. The approach helps individuals to manage his or her emotions rather than outside circumstances.
    Emotional based coping skills reduce the symptoms of stress without addressing the source. Examples include denial, distraction, relaxation, repression etc.  
  • Avoidance Coping Skills
    This is a maladaptive coping mechanism by the individual effort to avoid dealing with stressful life condition. Here the individual uses mal-adaptive form of coping that involves charging one’s behavior to try to avoid thinking or feeling about stressful life condition e.g the use of substance to reduce the source of stress by an individual.

TIPS ON STRESS MANAGEMENT

The maintenance of health through stress management strategies requires the practice of effective life styles which are necessary conditions for people irrespective of their age or level of authority and responsibility.

  1. Form the habit of frequent medical check-up
  2. Recognize early warning signs of stress
  3. Take one thing at a time
  4. Avoid working under pressure
  5. Talk about your worries
  6. Appraise luck and misfortune objectively
  7. Learn to accept thing that you cannot change
  8. Cognitive/ Behavioural approaches: People can learn how to perceive life in a positive way rather than the negative perception that causes stress.
  9. Cognitive Restructuring: stress provoking thoughts or beliefs are replaced with more constructive or realistic ones that reduce the person’s appraisal of problem.
  10. Social support from relatives.
  11. Physical exercise, pursue a regular programme or physical exercises. Indoor games could also play a significant role in this pandemic.
  12. Expose your problem to those that can be of help (e.g Friends, Family members or your medical caregiver).
  13. Avoid the use of psycho – stimulant to reduce stress

RELAXATION TECHNIQUE

relaxation technique (also known as relaxation training) is any method, process, procedure, or activity that helps a person to relax; to attain a state of increased calmness; or otherwise reduce levels of pain, anxiety, stress or anger.

Relaxation therapy refers to a number of techniques designed to teach someone to be able to relax voluntarily. These techniques can include special breathing practices and progressive muscle relaxation exercises, which are designed to reduce physical and mental tension.

  • Progressive Muscle Relaxation. In this relaxation technique, you are expected to focus on slowly tensing and then relaxing each muscle group of your body. This method can help you to focus on the difference between muscle tension and relaxation. And it enables an individual to become more aware of their physical sensations. In this method of progressive muscles relaxation, you start by tensing and relaxing the muscle in your toes and progressively working your way up to your neck and head. You can also start with your head and neck and work down to your toes. Tense your muscles for about five seconds and then relax for 30 seconds. The same relaxation procedure can be repeated as required by the individual.
  • Breathing Exercise
    Put one hand on your belly and the other on your chest as in the belly breathing exercise. Take a deep, slow breath from your belly & silently count 1-4 as your breath in. Hold breath, and silently count 1-7 before you breath out completely as you silently count from 1-8.

  • Body Scanning Involves Paying Attention to parts of the body and bodily sensations in gradual sequence from feet to head. By mentally scanning yourself, you bring awareness to every single part of your body noticing any aches, pains, tension or general discomfort in your body.
    The purpose is to tune into your body to reconnect to your physical self. It is also an effective way to begin a mindfulness medication practice.

Mindfulness for Stress Relief

  • Mindfulness means maintaining a moment by moment awareness of our thought, feeling, body sensations and surrounding environment, through a gentle, nurturing lens when we practice mindfulness, our thoughts, tune into what we’re sensing in the present moment rather than ruminating about the past. It encourages us to open up and accept our emotions and it also helps us to reduce anxiety, stress and depression accordingly.
  • Yoga: It is a type of exercise in which you move your body into various positions in order to become more fit or flexible to improve your breathing, and relax your mind.
    The reason for Yoga is to foster harmony in the body, mind and environment and it also professes a complete system of physical, mental, social and spiritual development. Yoga’s positive benefit on mental health cannot be overemphasized.

  • Tai Chi: It involves a series of movement performed in a slow, focused manner and accompanied by deep breathing exercise. The ultimate purpose of tai chi is to cultivate the life energy within us to flow smoothly and powerfully throughout the body. The harmony of the inner and outer self comes from the integration of mind and body.

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