Welcome to Covid's Lasting Impact caring for
immigrant, migrant and Asylee patients. A ten episode
miniseries within Migrant Clinician Network's On
the Move podcast, a podcast dedicated to providers
who work with vulnerable populations, specifically
migrant populations. In this miniseries,
MCN provides clinical teams including community
healthcare workers and primary care clinicians
with UpToDate information expert guidance.
Resources and relatable case stories for
identifying, treating, and managing COVID and
long COVID among US based immigrant migrant
asylee and limited English proficient patients
in the outpatient setting. MCN is a national
nonprofit with extensive experience providing
timely, practical solutions at the intersection
of vulnerability, migration, and health.
Each episode provides clinicians with
impactful tools and information for improving
the quality of COVID care for vulnerable
populations. If you want to hear future
conversations on the topic of health justice,
be sure to subscribe to the On The Move podcast.
For resources mentioned in today's podcast, be
sure to click on the link in our episode notes to
go to our podcastpage at migrantclinician.org/podcasts
welcome.
Everyone to today's podcast, and the title
of today's podcast is The Psychosocial Impact of
COVID on Patients and Family Dynamics. And I'm
Doctor Ed Zuroweste. I'm the founding medical
director of the Migrant Clinicians Network,
and I'm happy to begin our first
episode of MCN's podcast miniseries,
which we've titled Covid's Lasting Impact.
Caring for immigrant, migrant and asylee patients,
and I am delighted that our first speaker
is Doctor Kaethe Weingarten, who's with
me today. And we're going to talk about the
psychosocial impact of COVID on patients and
families and how clinicians can help vulnerable
communities suffering from these impacts.
So Doctor Weingarten is the director of
the Witness to Witness Program for MCN,
and we've shortened that to W2W. And the goal
of W2W is to help the helpers, primarily serving
healthcare workers, attorneys and journalists
who are working with vulnerable populations.
Kaethe received her doctorate from
Harvard University and is taught at
Wellesley College in Harvard Medical School.
Where she was an Associate Clinical Professor
of Psychology in the Department of Psychiatry at
Children's Hospital in Boston and then Cambridge
Health Alliance and at the Family Institute
of Cambridge. She founded and directed the
program in Families, Trauma and Resilience at the
Family Institute of Cambridge. She serves on the
editorial board of five journals in 2002.
She was awarded the highest honor
of the American Family Therapy Academy, the Award
for Distinguished Contribution to Family Therapy
and Practice. She's written about her work in six
books, which she had authored or edited, and over
100 articles, chapters, and essays. Her most
recent book, Common Shock, Witnessing Violence
Every Day, How We Are Harmed, and How We Can Heal.
Won the 2000 and Ford Nautilus Award for Social
Change. Doctor Weingarten's work focuses
on the development and dissemination of a
witnessing model and her work on Reasonable
Help Hope. Reasonable Hope has been widely
cited and I have to say on a personal
note, that I am so delighted that we met
Kaethe probably a little over five years ago.
And for the last three years, she has brought
witness to witness into MCN. And it has been
a huge game changer for our organization,
not only externally where we work with the
clinicians that work with the population
that we serve, but also internally. It's been
a great help to the staff of MCN. So welcome,
welcome, welcome, Kaethe to our first podcast.
Thank you, Ed. I'm delighted to be here.
All right. Kaethe, as I mentioned, has done
a great deal of work and actually came into
MCN right when COVID was beginning. And
so she's done a tremendous amount of work
on helping us develop our our work with
COVID, working with our clinicians,
but also working with the population we serve.
And as I mentioned before, a lot of work with
the stress and strain that COVID has.
Created to our staff alone. So Kaethe if
you wouldn't mind briefly explaining
how your work has related to COVID.
So you know I think you're you're right that in
March of 2020 when in so many areas of the country
people moved into quarantine or isolation
or some people were using the term lockdown
that was a a moment that.
Our programming had to pivot, and what
we really tried to do was to help people see that
the skills they already had could also pivot to
address the emerging needs of the communities
they were working with. But one of the things
that we also wanted to point out was
that when you have a public health.
Disaster or emergency, it means that for
clinicians, they are going to be experiencing
the same disruptions or similar disruptions to
the people they serve. And there is a term for
it called shared trauma. So the clinician who
may be concerned about the impact of COVID on
their family, their extended family.
Is now serving and helping a patient
and a family with the same concerns. And
so one of the the things that we try to
help clinicians with is first of all to
accept this is inevitable. If we're in
a context where everybody is going through
the same thing, yes, you know, they're going
to be challenges that are, they're not unique.
But they're unusual, and we have to accept that
there's, you know, we have to be thoughtful about
this. The second thing that we tried to do is
to say under these circumstances, it's even more
important than usual to address your own selfcare
if you're not taking care of yourself.
If you're not attending to the needs of your
family, you're not going to be able to show up at
work and do your best work. So we really emphasize
self-care in a very particular way. We've also
introduced the importance of the concept of
self compassion, where we really are trying to
build skills for clinicians to recognize that.
Yeah, the situation's gotten really complicated
and self blame perfectionism. Those kinds of
coping strategies don't really work
in that context of complexity. But
extending compassion to the self and managing
self-care that actually does help people cope.
I've got some other questions. I'd like
to to really delve in a little bit deeper
and do a deeper dive here. So can you
let's let's start out by saying can you
explain how social and structural factors
can affect the health of body and mind?
Sure. And I and I appreciate your
saying body and mind because at least
our perspective and our program is that the.
Body has an impact on our mind. The mind
has an impact on our body, that this is an
integrated holistic system. And then we know that
our, you know, individuals in different
communities have differential access to
resources and our access to resources impacts.
Our individual and family and community
resilience, and we need resilience
to get through difficult times.
So there are structural injustices in our
country. We wish there weren't, but there are
and it shows up in differential access to well
paid employment, just even employment itself.
Shows up in differential access to adequate
housing, healthcare and their stressors. More
stressors for some people than for others. And
during COVID this was all of these might say,
health inequities. Structural injustices were
amplified for the communities that, you know,
MCN and the our constituents primarily serve.
Okay. My next question is how have you seen
COVID and long COVID impact families through
changes in functioning of the body and mind.
So you know, I could, you know this is a
topic I can talk on for a very long time.
I think initially you know one of the one
of the experiences that happened internally
to families is that there could be different.
Perspectives on whether COVID existed or not,
whether somebody had COVID or what to do about it
if they did. So there was kind of in the in the in
the situation where COVID was new for all of us in
any family, there was often just plain confusion,
What is this and what do I do about it?
And there really wasn't absolute clarity.
Coming from sources, public health sources,
the CDC, that everybody agreed, this is,
you know, definitive information and you
may well, I know you remember, but many of
our listeners will remember that even in the
beginning, many people I certainly did. I was
wiping down all of my groceries when I brought
them into the house I let my mail rest for.
24 hours before I touched it, you know, we
had one idea about how COVID spread. And then
it changed. And of course, when information
changes, sometimes people feel more confident
in the new information. And some people feel
less confident. They feel like, well, you know,
you said this and now you're saying this, I
can't believe you. So that also had an impact on.
How families coped then? It was often
very confusing. If should I go to urgent
care? Can this person stay at home? Does this
person need to go to the emergency department?
You know, how urgent is the situation? And
inside families? Unfortunately, often this
produced conflict, so let's say the wage earner.
Had symptoms that the wife thought were symptoms
of COVID and the wage earner said no, they're not.
And if I don't show up at work, I'm going to get
fired. And if I get fired, we're not going to eat,
you know, we're going to lose our housing. And the
wife was saying, yeah, but if you get really
sick and die, you're not going to have a job
either. So you can see how conflict took off.
And that was just in the context of a possible
COVID diagnosis. Then we can kind of fast forward
and we know that some people who did get COVID
went on to really suffer longer term and in the,
although there's a great deal of variety in what
is now called, you know, long COVID symptoms.
It is very often accompanied by lasting fatigue
and poor memory and what is called colloquially
brain fog. Or you can imagine how fatigue,
brain fog and difficulty with memory
show up in family life, right? So these
are these are difficult for the individual.
But they have impacts on families. So and that's
sort of an overview I hope that's no it's very
some suggestion no very helpful and and in your
your program is called witness to witness I and
I think for the our audience it'd be great if
you could just tell us what is witnessing what
what do you mean when you're saying witnessing
so a witness is somebody who.
Is present for and really taking in and
understanding what it is that they're observing
in the person that they are the witness to.
And when we do that, let's say in the context
of family life, let's say I have a partner
or I'll say let's say I have a
child who's sick with COVID and.
I've had a grandchild just like with COVID. But
so this is, you know, real. And you see the person
having a high fever and, you know, vomiting
and feeling awful as a witness to your child,
your grandchild, you're really taking
in. This person is suffering and it has
an impact on you. You're it's not that. You're
not a bystander. It's not like, oh, I see it.
And it doesn't impact me if you are a witness,
it you are present, you observe, and
it makes a difference to how you feel.
In some situations we can feel effective and
competent because we know exactly what to do.
But in other situations we are a witness and it's
confusing and we don't know what to do or we don't
have the resources we need to do.
What we know needs to be done.
And in those situations we don't feel effective
and competent. We feel frustrated and we feel
helpless. And during the experience of
COVID, for many families, they felt they
were in that witnessing position where they
felt frustrated and helpless. What do I do?
And that's certainly the case.
In families where you have a person with
long COVID, where the family member really, just
as the you know, medical profession is uncertain
what the best treatments are, the family member
is uncertain about how best to help their family
member with long COVID. Is exercise good? Should
they rest when they're tired? Should they push
through fatigue? It's all really very confusing.
And then you're witnessing it is having an effect
on you, but it's just, you know, you feel
frustrated because you don't really know
what to do. Those are great aspects and it really
tells how witnessing the suffering of others has
a big impact on all the family members. So we can
shift gears a little bit and talk about self loss.
If you can tell us, give us a definition of
what is self loss and how can illness create
an experience of self loss for patients. So I I
appreciate that question and I will tell you that
when I introduce the concept of self loss in
the webinars or the peer support groups or the
you know various contexts in.
Which our programming exists,
We get people very teary and they go finally I'm
hearing something that helps me, puts words for
an experience that I'm having. So people who live
with a gap between who they have been and who they
are now are living with self loss and that gap.
Is painful. So if you have been a very energetic
person, enjoyed being out in the world,
and now when you exert yourself you are
completely exhausted you your experience of who
you are, what you can do, is really different
from the idea you have about yourself and.
You know actually you know actually how you
are able to act in the world and that gap we
call self loss okay, great, that's that's very
helpful and I think we probably have a lot of
clinicians on the line here for this podcast.
And so and and when we say clinicians
at the Migrant Clinician Network we're
that's a very broad category. We mean anybody
who has any interaction with patients with
the community that they're dealing with. So
outreach workers and nurse practitioners and
physician assistants as well as doctors,
nurses and dentists are all clinicians
in our mind. So Kaethe how can clinicians who.
Are aware of psychosocial impacts of COVID and
long COVID. How can they help their patients
and their families moving forward? So what?
What advice do you have to those of us who are
clinicians out there? So this may seem like a
strange piece of advice, but it is one of the
first pieces of advice that ioffer clinicians
if they have not had COVID themselves.
I strongly suggest that they think about or
recall the worst case of flu they've ever had and
they remember what that was like. And that will
ground them or help them be present to patients
who come in and talk about either an acute case
of COVID or long COVID the second, I think.
All of us need to kind of do what is called
embodied listening, where we are, allow
ourselves to, well, truly witness,
to be fully present. And at the same time, we
have the humility to know that although we want
very much to understand people's experience, we
can't do it without hearing from them. Right? So.
We really need to be asking people to help us
understand what it is that they're going through.
I think, as I mentioned earlier, that
building resources of self compassion
are really important and an easy way
I think of doing it is to ask yourself
in this situation, if my best friend
were feeling this way, what advice?
Would I give them? Because often we know exactly
what will be helpful, but we don't do it for
ourselves. Whereas we are very capable of wanting
our best friends to take the best care possible
of them. And then I think we have to kind of
be able to build up the muscles for tolerating
frustration, uncertainty, and of course, grief.
Because some of our patients will die, some of
our patients will be very sick for a very long
time and we want to be able to be alongside them,
be present and it's hard. It's a muscle has to
be, you know, built up. I think it's important
that you emphasize listening. You know, I think as
clinicians we're always good at asking questions.
But we're not as good as listening to the answers
and we're not as good oftentimes at hearing
what we're listening to. So not only do you
listen, but you have to hear what the person's
saying and and then really internalize that and
and and try to help them. So I think these are
all very, very helpful, Kaethe. And and I I want to
mention that W2W has an abundance of resources on
the topic of witnessing and emotional health.
W2W has a podcast called We Do Hope
which shares information about various topics to
sustain reasonable hope for clinicians serving
vulnerable communities. So I would encourage our
listeners to to listen to those podcasts and all
these resources will be linked on the web page
in the notes section of this episode. I'd like
to thank all of you for joining us today.
To speak with Dr. Weingarten about this,
like to thank Kaethe for for this presentation
and everything she does every day for not only
the population we serve but the staff at at
MCN and any final thoughts before we close.
I think what I would underscore is the point that you made.
About the importance of hearing when we listen
and I feel very heard by you, Ed, thank you very
much. So you can can reach Kaethe and W2W through
their web page as well as emailing them at w2w@migrantclinician.org.
I also want to share that
MCN is hosting a free webinar on COVID Care.
Since the public health emergency ends today,
we're going to have this webcast on May 31st
and you can sign up on our website for some
more expert guidance and tools to improve
the quality of COVID care for vulnerable
populations. You can follow our podcast on the
move with MCN and come back and listen to more.
So thank you very much for participating and thank
you again, Kaethe, for all your experts expertise.
And sharing with the audience and hope you
all come back for our next podcast, thank you.
To access resources mentioned in today's podcast,
click on the link in our Notes section. To go to
our podcast page at migrantclinician.org/podcasts,
visit migrantclinician.org/signup to
join our e-mail list and subscribe to
our blog to get updates on new MCN
podcasts, resources and webinars.
Migrant Clinicians Network is a national nonprofit
dedicated to providing practical solutions at the
intersection of vulnerability, migration,
and health. We offer technical assistance,
health provider capacity building, resource
development, research and data and evaluation
support, and virtual case management for
mobile populations and free resources and
training. The information in this podcast is for
trained healthcare professional education only.
Information should only be used in combination
with UpToDate, national and international
guidelines. The information is not to be used
as healthcare advice for the general public.
