Back to school-back to reality (A COVID19 reality)

Today I attended an online webinar titled: Getting children back to school safely. Taking into account my own and other parents anxieties around whether or not to send children back to school, this was a very useful webinar, which answered many of my concerns. The webinar had a panel of experts who have done extensive research into the impact of COVID19 on children, drawing from global research, in areas in which the pandemic has hit and children continued to attend school or have resumed schooling after lockdown restrictions were lifted. As we have not reached this point yet as a country, it is valuable to look to those who have and learn from their experiences.

3 questions formed the basis of the discussion, namely:

Do children get covid19?

Are children covid19 super spreaders?

How can we make schools relatively safe?

The first speaker Professor Refiloe Masekela , Pediatric Pulmonologist and the Head of Department of Paediatrics and Child Health at the University of KZN, Durban, South Africa, answered the first question. In summary what I gathered from her discussion was that children aged between 0-19 years are less affected then the adult population. There is something specific in children which seems to protect them from the virus. She explained the virus, which is a respiratory virus, requires a certain receptor to break through our body and cause infection. She referred to a receptor called ACE2 (forgive me I’m not a doctor, so these terms were rather foreign to me, as I tried to keep up with the discussion), which is immature in children. From a very brief google search, I discovered that ACE2 is a specific protein that allows the virus to infect human cells. Called the angiotensin-converting enzyme 2 (or ACE2 receptor), the protein provides the entry point for the coronavirus to hook into and infect a wide range of human cells.

She further explained that children have fewer of these receptors in comparison to adults and may this contribute to understanding why the infection rate is lower in children in comparison to adults. She also explained that children’s immune system play a part, as it is considered to be more robust then adults aging immune system. If we think about it, it makes sense, our little ones are always putting their fingers in their mouths, fingers which have touched various surfaces, which contain various germs. Thus, she states that children have other viruses in their upper respiratory tract and COVID19 has to compete with these viruses in order to affect children. Furthermore, she highlighted that most children have fewer chronic diseases in comparison to adults, such as hypertension etc.

She then went on to discuss typical symptoms that may present in children. I found this interesting, as schools are getting ready to receive children and highlight as part of their preventative measure they will be having thermo-scanners. Prof. Masekela stated that the presentation of fever in children is rare, some may exhibit coughing, but key symptoms to look out for in children include:

-sore or red throat

-runny nose


She also emphasized that children may also present as asymptomatic (no symptoms) or with mild symptoms but majority are unlikely to require hospitalization. Among children, high risk groups were identified and included children under the age of 1 (possibly since their immune systems are still developing) and those with comorbid health conditions, those listed were: Chronic diseases in chest (lung disease); Chronic asthma (Mild or moderate asthma not at high risk, if well controlled); Cardiac disease and severe neurological disability; and Immunosuppression. Dr. Moherndran Archary (a panel expert who I will elaborate on later) added to this by stating that children who may get infected and do not have comorbid health issues may recover themselves, as children’s immune systems are robust. Recommending bed rest, hydration and nutritional needs are met.

Professor Sithembiso Velaphi, a Pediatrician, Associate Professor with the University of the Witwatersrand and Head of Pediatrics at the Chris Hani Baragwanath Academic Hospital in Johannesburg, South Africa, answered the second question, highlighting that the viral load in children is lower than in adults and yes they can affect others but are less likely to. Why you ask? Well firstly, because of the lower viral load, lower tidal volume (breathing lower) and coughing or sneezing less forcefully then an adult. He further stated prevention is better than cure and it is important to maintain social distancing, hand hygiene and screen for symptoms, as we need to remember that we are not isolated beings and children coming home from schools need to be educated about hand hygiene, especially if they have elderly at home or vulnerable individuals.

Doctor Moherndran Archary, a Pediatrician Infectious Disease Specialist in the Department of Pediatrics and Child Health at King Edward VIII Hospital affiliated to the Nelson R Mandela School of Medicine at the University of KZN, Durban, South Africa, than answered the third question: making schools relatively safe. He acknowledged that for parents the priority is keeping their children safe and acknowledged the confusion media and other reports may be giving: keep kids home when numbers were low versus send kids to school when numbers are high. How does this make sense? He explains that the pandemic will be with us for the next 1 to 2 or 3 years (if a vaccine does not materialize) and since we have not yet reached our peak, we have limited data and as time goes the data is evolving and developing further. Thus, they have learnt more about the virus over time and this has shown that children are not as severely affected. He draws on various research samples from various countries, as do the other speakers, to make this point. I will post the link to the webinar recording as soon as it is released so you can have a look at this and fill in any info gaps you may have after reading this post.

Dr. Archary also emphasized that the virus will hit us in waves and that the next wave is expected in the next 2 to 3 months. Thus, his presentation on a risk mitigation strategy was very useful for me, as I thought about the reality of keeping my child at home for 2 to 3 years or biting the bullet and finding a way to live with our new normal. His presentation looked at what schools needs to have in place for students return. I think all school heads should have a look at this as they prepare for the reopening of schools. I have attached pictures of his slides which explain these safety measures. It is our responsibility as mental health professionals, teachers, parents and citizens to ensure that the measures are put into place and help our schools to resume some form of educational normalcy, as this may be our new normal for the next 2 to 3 years.

Prof. Masekela also reflected on the impact of keeping children out of school on their mental wellbeing, as children are isolated, have limited peer support and structure is taken away, which could result in feelings of depression and anxiety. Mental health a key issue that is often forgotten as we focus on physical health during this pandemic. We need to be mindful that this is a difficult and anxiety provoking experience for our children too and finding helpful ways to engage with this is important for their mental wellbeing, as well as our own as the adults that are their caretakers.

Written by Sumaiya Mohamed (Senior Psychosocial Trauma Professional)



The need for a context-sensitive, trauma-informed response to Covid-19 pandemic: Inequality and opportunities for a transformed society

South Africa is a country with a history of state violence, structural discrimination and disempowerment. The arrival of the Covid-19 pandemic and its gradual increase in infections and deaths is more devastating for South Africa because we are still battling with inequality, poverty,  crime, and gender-based violence, to name a few. Granted, the pandemic did not bring these issues, however, it brought to light what thousands of activists have lamented since the dawn of democracy. If Covid-19 does not get to you, the aforementioned ills certainly will. This is the reality of many South Africans living on the wrong side of the inequality line and below the poverty belt. Unfortunately, the focus on flattening the curve, does not mean that these issues take a pause or seize to exist. If anything, they have gotten worse, and the people who were already vulnerable, are in a worse position now more than ever.

The swift and decisive response by our political leaders and their ability to mobilize resources is highly commendable. It gives hope for a new dawn of effective leadership that we have not seen in South Africa in many years. However, this is overshadowed by the lived experiences of those living under impoverished and dangerous circumstances as well as the state’s dark cloud – corruption –ever-present and lurking for its chance to pounce on opportunity. Left unattended, these existing and exacerbated issues, coupled with corruption, could see South Africans suffering devastating effects that far exceed the effects of the pandemic. Foresight and an effective response to the pandemic is required, in order to ensure that the future implications of decisions made today do not cause further damage to the lives of the people who are often left excluded. Thorough evaluation of policies and their implementation, and the newfound enthusiasm and dedication to serve the people, could mean a transformation and a real attempt to address the inequalities and injustices that continue to haunt South Africa.

Self-quarantine /isolation/Social distancing

Most of the regulations that have been put in place have proved more effective and realistic in upper-middle-class societies due to their inadequate consideration of the realities of the poor and vulnerable people in our society. Although the government has made great efforts towards providing supplies such as food, dignity aids, and funds for the unemployed, these are by no means long-term or sustainable interventions. Some issues such as inadequate housing, and unemployment, go deeper and need long-term approaches that aim to address inequalities. Historical and present day structural vulnerability limits underprivileged people’s ability to “access basic needs such as food, medical care and proper housing”.[i] The legacy of the apartheid regime still exists as the most disadvantaged people live in low income and densely populated communities[ii] . This means that people are often unable to comfortably fit their entire family under one roof without sleeping toe to head. Communities that are structurally built to squeeze as many people as possible and provide foot-to-gate space in the name of a yard, make it difficult to keep one’s “social” distance.

These challenges have meant that most people living in poverty have not been able to adequately comply with these regulations. They are unachievable due to densely populated communities, and could further pose more danger in the event that a family member contracts the virus. The spread could be devastating for a whole family that is forced to squeeze into a small house/shack. It is important to acknowledge the more long-term and sustainable responses such as taps to provide running water for communities and other infrastructure that have been built during this time. This indicates that there is the possibility for more transformative interventions that will not only save the day, but provide security for generations to come.

Enforcement of Covid regulations

We have seen the “law” enforcement of these regulations in poor communities, taking a quick turn for the worst. “Legitimized” state violence and humiliation has put an added strain on vulnerable communities. Most people in townships, for example Evaton in Sebokeng, where official state offices are often a distance away, the time it takes to go stand in line for a permit and then go stand in line for groceries or healthcare poses a challenge. People often opt to go straight to their store or clinic, also hoping to not be outside long enough to meet the police or the army. Should one encounter the SAPS or SANDF on their way, they risk punishment and humiliation.

This form of intervention that has been adopted by some SAPS and SANDF personnel is reminiscent of apartheid state violence and the civil and political wars experienced by many of our clients, at the CSVR trauma clinic. The trauma from the past gets re-experienced in a process called traumatization.[iii] This should by no means be taken lightly, because oftentimes, unprocessed trauma makes its way down generational lines and results in what we see today in South Africa. A country ailing with trauma from the head down. I imagine there isn’t adequate context-sensitive and trauma-informed briefing and debriefing before, and during the deployment. Which would be a big oversight by the government. In fact, trauma-informed approaches should span to all areas of government due to our country carrying the burden of half cooked processes of rehabilitation. Therein lies the opportunity to begin to understand, empathise and intervene appropriately.

Dropping the ball.

I have found it particularly alarming that 424(as of the day I’m writing this), schools have been vandalized during the pandemic since schools closed. I wonder how this is possible with increased police and military presence, but an old lady selling atchar in Dobsonville is arrested because she does not have a permit? This is a classic example of letting all other balls fall and focusing only on one.

Furthermore, families are losing their livelihoods and corruption comes to steal from those most affected by the close of businesses, when they have no other way of making a living during lockdown. Unfortunately, the government has the responsibility to have its eyes and ears everywhere, at all times. Things like corruption, (where we see reports of mismanagement and theft of food parcels meant for communities, confiscated alcohol and other prohibited goods during lockdown being kept by the police, money being stolen from roadblocks)  need to be rooted out, pandemic or not because they continue to undermine efforts of “moving the country forward”.

The spotlight on mental health

Mental health awareness has already been gaining momentum even before the country and the world, was hit by this pandemic.  Since the start of the pandemic, greater levels of awareness on mental health have risen. I cannot open my internet browser without seeing an article on self-care, mindfulness or meditation. And I love it! In light of being forced to be alone or without the distraction of the outside (with the exception of the internet of course), more people are becoming aware of the self and getting to know and understand, hopefully, what goes on in our minds and hearts when we are not stuck in traffic or queues, or bars or school and work.  I believe I speak for all when I say, it has not always been easy. For some, like myself, a very comfortable loner and introvert, the breaking point hit much later. For some, it has not hit as yet, and perhaps the lifting of the lockdown may bring emotions of anxiety as the comfort of being alone is taken away from us. So don’t worry, you’ll get your share! Jokes aside.

We should always spare a thought for those who are already dealing with mental health challenges from the past. Those in continuous traumatic situations. Those who have experienced past trauma and find themselves, in a way, “back at the scene of the crime”. Those faced with the power play of policing, being trapped in a house with your tormentor (as in the case of child abuse and neglect, and domestic violence), being triggered and re-traumatized by loss of personal space, uncertainty and seeing soldiers with guns, being overwhelmed by stress as you fail to put bread on the table for your family. Dare I say, we all, in one form or other, can find ourselves in this category.

I would like to draw attention to the realities of mental health, particularly in South Africa. It is still widely viewed as a privilege and something that only affluent people and those with resources can access. A number of reasons would support such sentiments. The under resourced mental health clinics and hospitals in rural areas and townships[iv] and the lack of mental health services in most schools, also in rural areas and townships, coupled with the stigma that surrounds mental health. All these undermine the efforts towards normalizing mental wellness and providing effective and quality mental health services. The point here is that, whilst some people have to make tough decisions with regards to starting online therapy or choosing between telephonic or video therapy with their current therapist, others have no idea that help exists. Many are not aware that their emotions are normal and valid, and that they can, with appropriate interventions, gain a better understanding of themselves, and perhaps, heal from their pain and trauma.

A lack of understanding and normalization of mental health, may lead to appropriate emotions in response to the pandemic such as anxiety, fear, helplessness and despair, being expressed inappropriately in the form of violence, neglect, self-harm. This may especially be the case where individuals or families have existing pathologies of transgenerational trauma or limited knowledge about emotional regulation, which is the case for many South Africans.

South Africa is a wounded country, led by wounded leaders[v]. This is a reality and we cannot continue tiptoeing around these issues because they threaten the dreams for healthy individuals and society, and a developed nation. What we need in these times, is empathy[vi]! Empathy provides the basis of human connections, which in return, informs human interactions. The lack of empathy means that human connections are based on a lack of compassion and understanding, and thus the interactions that follow are self-involved and lack the ability to see, acknowledge and feel with each other.


As we approach the lighter regulations of the lockdown, we should think more about what this period has taught us as a nation. We hope that the leaders will be able to reflect on their interventions and re-evaluate their approaches towards the betterment of people’s lives and the country as a whole. There are many texts that have been written during this period as many have shared their thoughts, experiences and considerations, to provide some light as to what the people are feeling and thinking.

South Africa cannot afford to take a hit on its road towards an equal and just society under the guise of swift interventions to flatten the curve. When handling or carrying out interventions and regulations in the South African context, it is not possible to roll out a blanket response. Due to the fact that South Africa is an unequal society and those on the wrong side of this inequality have found themselves fighting for their survival and dignity. Regulations should speak to the realities and context and have more foresight for the implications of such regulations and interventions, not only on the economy, but on the society’s physical and emotional wellbeing, post Covid-19.

Written by Charlotte Motsoari

Question marks




[i] Quesada, J., Hart, L, Bourgois, P. (2012). Structural Vulnerability and Health: Latino Migrant Laborers in the United States. Medical Anthropology 30(4), 339-62.


[ii] Botes, T., CHOCHO, L.M.S., KELLOW, G., ENGELKING, E. B., KHOFI,  L., BOSIRE, E., COSSA, ., MALOPE, D. (2020). How A Pandemic Shapes The City: Ethnographic Voices From South Africa. Medical Anthropology at UCL.


[iii]  Retraumatization is a conscious or unconscious reminder of past trauma that results in a re-experiencing of the initial trauma event. It can be triggered by a situation, an attitude or expression, or by certain environments that replicate the dynamics (loss of power/control/safety) of the original trauma.


[iv] The South African Anxiety and Depression Group reports that there is only one psychiatrist for every 390,000 people in South Africa. Furthermore, two thirds of South Africa’s psychiatrists are employed in private practice.


[v] Mogapi. N. (2018). Cabinet Reshuffle: Wounded leaders, leading a wounded nation. Daily Maverick.


[vi] Empathy is the capacity to understand or feel what another person is experiencing from within their frame of reference, that is, the capacity to place oneself in another’s position.

The intrapsychic pandemonium of a global pandemic

Exploring the psychological impacts of the COVID-19 pandemic has dipped into both my intellectual and empathic reservoirs. It has challenged me to ponder upon my professional and personal journey with trauma. Firstly, it is important to acknowledge that the majority of global society has experienced at least one major trauma in their lives. That is the part of your being that I hope gets to read this – the part of your being that is able to connect with these words from a human perspective. Secondly, it is important to acknowledge the trauma that has been caused by the severe acute respiratory syndrome corona virus.

There isn’t a need to delve upon the physiological impact of contracting the virus. That has been discussed, and information has been widely disseminated. What seems to be the quieter conversation is the psychological impact of living (or dying) through the pandemic. Granted, our journeys will all be different, and how can they not be? There are people who have experienced complex trauma. There are people who have experienced trauma. There are people who have not experienced trauma. There are people who don’t know.

Reflecting on some of the conversations that have been shared with survivors of trauma, I am burdened, intrigued, and empowered. There is something about the corona virus and the subsequent lockdowns and restrictions that are akin to a political war. As we sit in our homes, we are reminded that our homes are no longer just homes. They are both our prisons and our places of refuge. They are now the structures that have been given the mandate to keep us safe from this plague. We sit in our homes, with the illusion of safety. But, are we really safe? What are we even staying safe from? There are no gun shots to remind us that there is a threat to humanity. There are no screams of fear and terror to be heard, but the dread is there. This equation does not balance. Have our autonomic responses been tampered with? Fight, flight, or freeze, right? What options do we really have? We are frozen, imprisoned by an invisible war that attacks us – not through bullets or grenades or machetes, but through contaminated respiratory droplets. Our quarantine partners, friends and family, those who we stay at home with may be the very people who could cause us the most harm, and vice versa. Our family systems have been threatened and our safety nets have been broken.

So as the calendar dates change every 24 hours, to many of us, they freeze in this war. In this intrapsychic conflict, we can’t fight, we can’t flee, so we freeze. Our limbic systems work in overdrive in response to this imminent threat, this ongoing trauma that is working precariously in our unconscious. Many are in survival mode, as the hypothalamus codes what it can. If you have experienced trauma in the past, your trauma response patterns may be recalibrating. This is why we are all responding differently. This is why even within ourselves we may not have the ability to contain our emotions consistently for a long period of time. We are unpredictable even to ourselves…and why not? The world’s predictability has been reframed into statistics of infection, death and recovery [repeat].

Institutions are closed and the streets are deserted. The roar of industry is a distant whisper. As we acknowledge both the collective, and individual trauma that this virus has inflicted, we begin the journey of healing. For the most part, we are uncertain of what it will look or feel like. There are so many dynamics and projections, that it is difficult to know what stage of trauma you are fighting with, fleeing from, or freezing in. It is a journey of knowing that the outside world may eventually reflect some semblance of “business as usual”, but we as human beings are forever changed.

For those of you who have embarked on a battle against complex trauma before COVID-19, I salute you. I salute you for existing and functioning in a traumatic space where you didn’t have the “comfort” of the entire world experiencing it with you. I salute you for receiving empathy, when even your words were never enough to express the fear, and the loss, and the grief. There are many whose trauma has been triggered and there are flashbacks, nightmares, and memories resurfacing of the wars and crimes against humanity, the outbreak of Ebola, the spread and stigma of HIV, the fight against hunger…… To some, this pandemic has a texture of normalcy. To some, there are wounds that have been re-infected. To some, their privilege will see them through.

There is something about working therapeutically with trauma that has been enlightening. Some of my recent existential moments have been inspired by the narratives of the precious and resilient people who have been violated by the injustices of the society that we all live in. I dedicate these words to those people. May their lives remain powerful enough to force us to stay human as we continue down the yellow brick road…

Written by Amina Mwaikambo


Healing the healer

We travel to unknown places – arid, devastated, or even dangerous – both physically and psychologically. We carry this big basket of hope, of life, of sanity. With this heavy basket, we jump through hoops, crawl up walls and are often met with hostility and suspicion, an uncertainty about this new form. We are met with resistance from the wolves in sheep’s skin who are nourished by the vulnerability of the flock.

In the basket, there are parcels of strength and empowerment. There are tools to clear the cobwebs from their dreams and hopes for a future better than this, and a quietening of the noise around to reach serenity within. With the basket in tow, we travel to meet those who are at the edge of their cliffs.

Upon receiving the honour, to trek through the ebbs and flows, to leap through the hoops, and crawl up the wall with this heavy basket, in order to touch those who have reached their limit, we present the parcels and lay out the tools. We seek not to impose, but to tread with caution approaching the lion with a thorn in its paw. We seek not to offend, but to acknowledge, reflect, validate and normalise.

We have swollen faces from turning the other cheek, and soiled lips from kissing “you-know-whats” in order to be allowed to leave an individual, well, Human. We return home. We kiss our loved ones “hello” as they celebrate our return, but we all know we haven’t really returned. We never do. We are never at the point of reclining and putting our feet up. We never allow ourselves. We all know that with bruises barely healed, the soil still grinding our teeth, we’ll be refilling this basket once more, for those we left at home. This healing business is not a part-time occupation, we do it in all corners of the world, including our own, at all levels of consciousness.

We walk into the office, normalised fatigue and all. “Take a self-care day” is the song on our lips and all shall be well. But we don’t know how to practice self-care for ourselves. We hardly do it. We assume that we are automatically attuned to our internal world, and inner peace because we work with others’ internal worlds and help them to stay attuned. Meanwhile, all along we’ve been ushering others to the river without ever stopping for a sip ourselves.

Lest we forget…“you cannot pour from an empty cup”. What makes us great healers, is our humanity, our ability to feel. Let’s be human, and feel.

Refill, restart, reset. Allow yourself to pause, even in chaos. Do not only focus on helping others to regain their equilibrium in a time of turmoil. It is okay to centre yourself. For your benefit, for their benefit. “Breathe beloved”. Heal the healer.

Dedicated to the millions of healers around the world.

By Charlotte Motsoari

silhouette photo of man with backpack standing in seashore during golden hour


When only a piece of paper might let you see me…. and even then you may decide that’s not good enough

The influx of displaced people the world over has increased in recent years, with more than 68.5 million displaced people globally and more than a million nationally (UNHCR Report 2017). Of course this number doesn’t capture the true reality of people on the ground as many displaced people are undocumented and so may not be included in the statistics. Individuals migrate for various reasons, some economic, others political. Whether economic or political they come seeking refuge, seeking a better life in another country.

In the past 2 years, listening to refugees and asylum seekers relate the stories of their lives in South Africa, there is a common thread of not being recognized, not being acknowledged and not belonging. Individuals speak about being in the country for 8 or more years and still falling under an asylum seeker permit, or worse receiving 1-3 month extensions. Or their legal documents expire and are not renewed, leaving them in a state of fear, as they fear being arrested for being undocumented and being detained and sent back to the very place they left for fear of death. Our clients live in a state of uncertainty, fear and confusion. They wake up every day and participate in a society that has not yet decided if they belong.

They do not possess the documents that allow them to fully participate in society, that allow them to receive health care, that allow them to have a stable job, that allow their children to get an education. They are the shadows in the dark. They do not want to be seen for fear that you will ask who they are and though they know who they are, they don’t have the right piece of paper to make you believe them or want them.

Taking into account xenophobic attacks in 2008, 2015 and most recently in Durban (2019), this communication of ‘you don’t belong’ is getting more direct, more aggressive and more violent. And though 2008 and 2015 are significant markers of xenophobic violence, the reality is that xenophobia occurs every day in our society: Through the way society engages with labels such as ‘makwerekwere’; perceptions that ‘you foreigners just come to have babies here’; and projections, ‘you come to take our jobs’. Does the othering defend against our own inadequacies as a nation? Can we and do we want to sit with those inadequacies? Realities that poverty, unemployment, corruption in government, poor service delivery and divisions still exist in our democratic, post-apartheid, rainbow nation South Africa? Is our Ubuntu only for those who possess a South African ID?

I have papers (dompas) officer

I am flesh, I am blood

I am emotions of pain, fear and sadness

I also possess the ability to laugh, smile and feel joy

I am human or have you forgot

Because the paper that I hold says refugee

Because the paper that I hold says seeking asylum

Because I hold no paper

Have you forgotten that my veins are blue and my blood is red

Have you forgotten that I too have a family and want the best for them

Have you forgotten that I too feel hunger pangs

And worse pain when I see my baby crying from the same hunger pangs 

Because my paper doesn’t allow me to work a stable job with benefits

Because my paper doesn’t allow me to think of a future beyond this week

Because I have no paper

You have forgotten my humanness 

You have forgotten we are one human race

You have forgotten I have the same human rights like you

You have forgotten your principles of Ubuntu

And so I lurk in the shadows with hopes that you don’t see me

Because even if you do, I don’t have the right paper for you to see me

Not as a refugee, asylum seeker

But as you see yourself: human, belonging, deserving, a mother, a father……


Written by Sumaiya Mohamed

%d bloggers like this: