Category Archives: Voices

Is Egypt’s Economy Surviving Corona’s Bumpy Ride?

April 6, 2021
By 28847

Christine Guirguis, a 2020 Sylff fellow from the American University in Cairo, addresses the outlook for Egypt’s economy in the face of the coronavirus pandemic. Egypt was one of only three countries in the region to maintain positive growth in 2020, an impressive record given the difficulties it has experienced over the past decade, as Guirguis details.

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View of Cairo from the top of Cairo Tower, August 25, 2014.

Egypt’s economic condition in 2012–13 was dubbed the worst crisis since the 1930s. The severity of the economic troubles reached its peak in the first half of 2014 with a fall in the GDP growth rate to 1.2%—the lowest in about 50 years—as well as a rise of the inflation rate to 9%, a surge in the unemployment rate to 14%, a fall of eight places in tourism ranking, and a shortage in essential food products. As a result, Egypt’s economic status as of 2014, which was downgraded from emerging market to frontier market in Russell’s Annual Index, left the country scrambling to rescue its 86-million population at the time.

Before reluctantly resorting to the International Monetary Fund, Egypt—whose national security is a safety valve to the region—had received generous aid from the Arabian Gulf and Saudi Arabia totaling as much as $30 billion. While such aid breathed life into Egypt’s economy, the bill was far from paid.

In 2015, three-quarters of Egypt’s budget vanished into subsidies, government wages, interest payments, and capital loan repayments; only 5% of the budget was left for other purposes. In the same year, the crash of a Russian airplane due to an act of terrorism marked the Egyptian tourism’s clinical death before it was gradually resuscitated in 2019 by stricter security measures in airports. This was when Egypt decided, on November 3, 2016, to brace up for a $12 billion IMF loan by devaluing its currency by 48% and fulfilling the IMF’s requirements by way of cutting subsidies, increasing VAT, and floating the currency.

Luxor temple, Luxor, January 2015.

In a recent television interview, Mr. Tarek Amer, governor of the Central Bank of Egypt, talked about the Herculean responsibility he had in his hands in 2015. Egypt’s foreign cash reserves were only $800 million, an amount Egypt normally spends in a week. Consequently, its economy would have faced the risk of a total shutdown unless an urgent “surgery” of painful economic reform was done. The political and social sensitivity of the November 2016 decision, at a time when Egypt was craving for stability, rendered the proposal impossible from the point of view of almost all the cabinet members. No one was able to digest the unimaginable scenarios that could have taken place if the economic reform process had failed to meet its purposes, especially because its probability of success was estimated to be between only 10% and 30% at the time. With no alternatives on the horizon, President Sisi gave the green light for the execution of the economic reform proposal, a decision that signified a new, independent approach that enabled Egypt to skip the limitations that had long impeded its economic restructuring.

In a country where a quarter of the people live below the poverty line, the government wanted to ensure that its measures would not cause a humanitarian crisis or a social backlash. The government kept intact the cash transmission programs and subsidized food systems launched earlier.

Given the painful austerity measures, some envisioned a doomsday scenario taking place in Egypt. Yehia Hamed, a former investment minister in Mohamed Morsi’s 2012–13 government, wrote an article in the Foreign Policy in 2019 where he conjectured that Egypt was heading toward bankruptcy and warned Europe against a mass flocking across the Mediterranean of Egyptians fleeing an inevitable bleak fate.

In response Ahmed Shams El Din, an Egyptian capital markets professional and adjunct professor at the American University in Cairo, published an article on the same news site where he expressed his wonder at the former minister’s criticism of securing an IMF loan even though the government in which he served had approached the IMF in 2012 for a loan. He noted that Egypt’s economy is growing rather than collapsing, with the account and budget deficits cut in half and a 5.5% growth in 2019 compared to 2.2% in 2013.  

The current pandemic is already suffocating some of the biggest economies, supporting the IMF’s description of it as “the worst economic crisis since the 1930s depression.” For Egypt, the challenge is tougher due to losses in the main revenue sources, such as tourism, the Suez Canal, and remittances, which together constitute 15% of Egypt’s GDP. Therefore, in its June report the IMF initially expected a decline in Egypt’s GDP growth rate from 5.6% in 2019 to as low as 2% in 2020—a percentage it later changed to 3.5% in its October report. Given the global economic challenges, this relatively low growth rate makes Egypt one of three countries in the Middle East and Central Asia to maintain a positive figure in 2020.

Antique Bazaars, Aswan, January 2015.

During the apex of the global pandemic uncertainty in 2020, Egypt managed to pay $35 billion of its liabilities without suffering a severe decline in its foreign currency stockpile or any shortage of essential goods. This explained Egypt’s ability to maintain its credit ratings by Standard & Poor’s at “BB” in April 2020, by Fitch at “B+” with a Stable Outlook in July, and by Moody’s at “B2” in August. Based on these ratings, J.P. Morgan praised Egypt’s economic performance, stating that, thus far, its economy had successfully withstood the test of the pandemic and kept the trust of the international community. Hence, Egypt’s economy has been given well-grounded positive appraisals.To contain corona’s economic repercussions, the Egyptian government allocated 100 billion Egyptian pounds (EGP) as a stimulus package, including half to support the severely affected tourism sector, EGP 8 billion for the health sector, a 14% increase in pensions, energy cost relief for factories, fewer taxes on businesses, more cash transmissions, and financial support for irregular workers until the end of 2020.

Egypt’s top priorities in the economic agenda include augmenting domestic savings, as well as adopting a more liberal approach toward the market, revisiting tax penalties and exemptions, and laying the basis for a fairer accountability system.

Teaching Literature in Times of Pandemic

March 3, 2021
By 28851

A scholar of Italian literature, 2020 Sylff fellow Nataša Gavrilović compares today’s situation with that of Renaissance-era Italy to contemplate the role of literature—and, more broadly, of the arts and humanities—as well as of teaching it, particularly at times of crisis like the current COVID-19 pandemic.

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During the period of the flourishing of culture and the arts on the Apennine Peninsula—at the same time that the voice of humanism was becoming louder and clearer with each new day, via epistles or treatises, or among the members of informal circles later known as accademie, but always in the form of dialogue—Italy (or what would actually become Italy only three centuries later) was struggling amid continuous warfare.

Today, the traces of fifteenth- and sixteenth-century art and philosophy are far more visible than the scars left by the innumerable battles that at some point even became a “new normality,” just as the plague and other disasters did. Eugenio Garin, one of the twentieth century’s greatest scholars of European humanism and the Renaissance, sees this particular moment of crisis as one of the crucial factors that informed that period’s most important thought, oeuvres, and philosophy with a universal message, but always formed in one’s own microcosm, in a dialectical relationship between the contextualized temporary and the eternal.[1]

There is no need to expound on the greatness and value that the works and names from this period continue to hold for humankind, beginning from the very concept of freedom and unlimited possibilities innate to each and every individual, through the novel approach to and importance assigned to education, to the myriad discoveries in the fields of science and art.

Time will show whether the crisis we are coping with now will yield this kind of fruit to the generations to come, in the form of new ideas and thought-provoking works and discoveries. Nevertheless, one thing is for sure: the very concept of crisis means rethinking the values we cultivate, the system(s) we have created, and the steps we have taken in order to understand, adjust, and improve, so as to give meaning to our existence and make life on Earth if not better, then at least more bearable. Obviously, the humanities cannot face the pandemic from a medical standpoint, nor can they find a cure or create a vaccine. Are the humanities therefore redundant at this very moment, and, moreover, is teaching literature a false utopia when almost everything appears to be falling apart and when bare survival looms large in everyone’s mind? Is it an escape or a long journey toward the Promised Land?

Niccolò Machiavelli

Staying in the field of my research interests as an Italian literature scholar, I must call on what another Italian thinker wrote. I am referring to Niccolò Machiavelli, who has universally influenced political and historical thought and whose life and works are an evident product of the fifteenth- and sixteenth-wecentury crisis. In Chapter 25 (“What Fortune Can Effect In Human Affairs, And How To Withstand Her”) of his most famous treatise, The Prince (Il Principe), the Florentine author explains that one can and should fight against the unpredictable force of Fortuna, and not only that, but one even stands a chance to win (“Nevertheless, not to extinguish our free will, I hold it to be true that Fortune is the arbiter of one-half of our actions, but that she still leaves us to direct the other half, or perhaps a little less”). A memorable picture follows: Fortuna is compared to a raging river. If we survive its first strike, it is wise and necessary to think about what happened, to think it through thoroughly, engaging all our ability, experience, and knowledge gained by reading ancient authors, and analyzing our reality in order to be prepared when another similar situation arises. Because, as he says, “though its nature be such, it does not follow therefore that men, when the weather becomes fair, shall not make provision, both with defenses and barriers, in such a manner that, rising again, the waters may pass away by canal, and their force be neither so unrestrained nor so dangerous.”[2]

And isn’t that what teaching literature means, or at least should mean—an active and fruitful dialogue, both with people of the past and with our present times, so that one may (re)think critically and maybe even protect oneself and others from tragedies and disasters? Hence, to talk about the past, about philosophy or poetry, is to enrich your own existence, to observe the world from endless points of view. Furthermore, to convey knowledge and experience is to create future thinkers, to show them the way of honor and dignity: the dignity and virtue of curiosity. For, although a world made of words is a fragile world, words are all we have to communicate, express, create, learn, and understand. 

Due to my research activities, I happened to be at the University of Padua when the pandemic began. As I was witnessing the panic spreading along the stunning and peaceful Italian squares, my life-saving thought was the research I was (and still am) conducting; not because it made me forget the circumstances in which I had found myself—on the contrary, it was helping me to go beyond these circumstances and consider them from another, wider perspective. A few months later, in Belgrade, from the role of a doctoral student I returned to the role of a teacher. The need for reading, understanding, and sharing is a constant, and it was still there, helping me look toward the stars while rethinking the Earth. That is also what literature lessons should aspire toward: an endless “good fight” to create a context in which virtue can thrive. Our students’ questions, their curiosity, and the long discussions we have, even—or rather, especially—in these trying times, are both a strong proof of this innate human hunger for dialogue and a vital light of hope.

Literature cannot find a cure for diseases, but offers instead the benefit of the doubt, teaching us to consider everything with a pinch of salt and showing that, through the centuries, it is the doubt that has been the vital force of every kind of progress. Thus, talking about Petrarch’s existential doubts and antithetical thoughts, about Dante’s contempt for the uncommitted (ignavi), that is, those who lived their lives without making conscious moral choices and who therefore deserve neither Heaven nor Hell, or reading Pico della Mirandola’s speech about man’s freedom to be anything one decides to be—all this is not an escape, as it illuminates both the one who teaches and the one who learns (if there is any difference between those two); sometimes it is a shimmering light, as fragile as words, but it surely never goes out.

Words are delicate, fluctuating, ambiguous. To say or write is not enough, it is how something is said or written that makes the whole difference. That is what literature teaches and how literature should be taught. To translate is impossible, yet necessary, as noted by two of Trieste’s scholars, Guido Cosciani and Guido Devescovi. The same goes for teaching—teaching literature in particular, and especially teaching literature in times of a crisis.[3]

 

[1]     E. Garin, L’umanesimo italiano: filosofia e vita civile nel Rinascimento (1952), and E. Garin, La cultura del Rinascimento (1967).

[2]     N. Machiavelli, The Prince, translated by W. K. Marriott, downloaded from: https://www.holybooks.com.

[3]     C. Magris, Istantanee, Milano, La nave di Teseo, 2016, p. 178.

Survival Is Insufficient: Reflections on Social Safety Nets and the Need for Ritual, Connection, and Meaning

February 19, 2021
By 19658

Sherilyn Tan Siy, a 2007 Sylff fellow, currently lives in Japan with her husband and young children. Using the apocalyptic novel Station Eleven as a point of reference, she ponders how the COVID-19 pandemic has impacted the lives of the family members, as well as those of others, and what revelations it has brought.

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In late January 2020, I was reading Emily St. John Mandel’s 2014 novel Station Eleven, an award-winning novel that takes place in the Great Lakes region before a fictional swine flu pandemic wipes out 99% of the population. Unlike many apocalypse novels, Mandel treats a grim subject with subtlety. Through her calm writing, she creates word tableaus that have the effect of making the unexpected stunningly beautiful, the sinister a little bit eerier, the dramatic even more gripping. It is the mark of good fiction when you begin to feel as the characters would in their situation and, despite the grimness of the subject, refuse to stop reading. Long after I have put the book down, the dread of living in a world where the few remaining people struggle to carry on weighed me down. Is there any meaning to surviving? Would we even want to be alive then?

Siy, center, with her family.

The novel bothered me so much I passed it on to my partner so we could discuss. We went out for dinner soon after he finished reading. The timing could not have been more inauspicious. Then Prime Minister Abe was slated to make an important announcement the following day, and the public, suspecting a possible lockdown, emptied the shelves à la Station Eleven of toilet paper and shelf-stable food. We asked each other, “Will this be the last time we will be able to eat out?”

My heightened unease could have been influenced by hormonal changes in my body in the third trimester of pregnancy. Our third was due to arrive in April. How safe is traveling to Tokyo by train for my check-ups? Will the hospital be overloaded with Covid-19 cases? Can my partner stay and support me in the delivery room? What sort of world will our baby be born into?

But I had more pressing and immediate concerns.

Schools abruptly closed down a few weeks short of the end of the academic year. My two children—aged nine and seven—grieved, left in limbo. As the weeks turned into months and there was no indication that school might restart anytime soon, my seven-year-old son asked whether he has already moved up a grade. First graders were required to keep a neon yellow cover on their schoolbags to enhance visibility when crossing the street. He could not wait to remove this thing that marked him as a neophyte. I realized then how important structure and rituals are, especially for children, and how the pandemic robbed us of the small and big ceremonies that mark time and growth. And so, after dinner one night, we played graduation music from the Internet and clapped after he solemnly unfastened the neon yellow cover and threw it away.

In conjunction with the sudden shutdown of schools, my after-school English classes—a significant source of my income—were also suspended until further notice. Projects for my travel writing work got canceled, and one of the international companies I worked with dissolved permanently. Some friends and family suddenly found themselves furloughed, laid off, or simply out of work. In the food bank that my partner runs, we saw a sudden increase in people lining up at the pantry. The pandemic is not a mere inconvenience but has real consequences to individuals, especially women who are likely to take on the no-work-no-pay type of jobs that allow for flexibility in childcare but also tend to be low wage and come with no security.

In my panic, I worked harder and longer at my job at the organic center, took on more shifts, and worked until the very day before I gave birth. I hurried back to work a month later, baby strapped on to me, partly because I was terrified of losing my job in a world that has become so uncertain. It turns out I need not have worried too much. Because people are cooking at home more and becoming more health conscious, orders for our organic food products skyrocketed, and our company had to move to a bigger warehouse and hire additional staff.

My partner and I are both foreigners living in Japan. We do not have family roots or cultural connections to Japan, so we often talk about the ideal country to live in and whether we might thrive better somewhere else. Now, our conversation is shaped by our most recent experiences. We consider ourselves fortunate to be in Japan where the pandemic has been handled fairly well compared to our home countries (the United States for my partner, the Philippines for me). Throughout the last trimester of my pregnancy until the birth of our son, the two hospitals we went to were never crowded. The pandemic also underscored what social safety nets Japan had in place.

・During the period of emergency measures, families suddenly felt the financial burden of feeding children at home all day. We realized how much we relied on school lunches at our public schools to provide that one affordable, nutritious meal for our kids every day. School restarted in June.

・Daycares—affordable and professionally run here in Japan—remained open, easing concerns of parents who cannot work from home.

・Books helped us keep our sanity. When our local library closed for two months, we realized how much we miss this public asset. We were lucky enough to have access to the online cloud library from my partner’s home state in the United States, but it is not a replacement for a physical space to retreat into. The library opened again at about the same time the school resumed.

・At this time, when the slightest cough is worrisome, having national health insurance gives us some peace of mind that we will be taken care of without going bankrupt.

・The national government provided a one-time ¥100,000 cash handout per person and initiated other cash grants for single parents, students, and small businesses. Local governments distributed support in the form of coupons that can be used in stores.

In Station Eleven, the year the deadly flu struck is, years later, referred to as Year Zero. With only 1% of the population left, the world is an unrecognizable mess. Covid-19 is nothing like Station Eleven, but it has made us rethink the ways we did things: What is absolutely essential? What is unnecessary? What can we do without? My introverted partner and I have been happily avoiding face-to-face meetings and gatherings and saving time and money conducting business online. There’s no need for new clothes, and makeup is frivolous when more than half your face is covered in a mask if and when you do go out.

On the downside, there’s “Zoom fatigue” and the almost-impossibility of forming warm human connections online. What we suddenly realize is most important, more than ever, are good relationships with the people we live with and see every day, our partner and children. All the time and work we have put into our family, on learning how to repair conflict and enjoy spending quality time together, even before Covid-19, has made us closer and given us a buffer in this prolonged stressful period.

Maybe this pandemic raises not only the question of whether life can or cannot return back to normal but whether we would want it to. My daughter is a member of the mini basketball team. Before Covid-19, the team used to have all-day games during the weekends. With the pandemic, everything was canceled, and we realized that we rather like having our daughter spend time with us during the weekends. Now that all-day games are slowly resuming, we find it harder to say yes to them. Covid-19 has helped us sift through what really matters and only commit to things that we truly want to do.

In Station Eleven, some survivors of the fictional pandemic banded together into a nomadic performing group called the Traveling Symphony, bringing Shakespeare to settlements across Canada and North America. On their caravan is painted the motto “Because survival is insufficient,” a line the author took from Star Trek: Voyager and, really, the thesis of the novel. Now, more than ever in the midst of alienation and collective anxiety, it is not enough to be merely alive. We search for meaning. In our family, we find ourselves doing gratitude exercises more frequently, finding small things to celebrate.

My baby, born in the thick of the pandemic, is an unusually happy baby. He can recognize when someone is smiling at him even when half the person’s face is covered up with a mask. If the person isn’t smiling, he is keen to make them smile with his gurgling. At eight months, he tries to reach out to pull down people’s masks. This is not a new reality for him but the only reality he knows. One of the lead characters in Station Eleven, Kirsten, says that the post-apocalypse world is hardest to bear for those old enough to remember how the world was before. “The more you remember, the more you’ve lost,” she explains. In some ways, yes, that is true. But if Covid-19 has forced us to rethink our lives and cull through what’s essential, then all is not lost.

A Triple Crisis in the Indian Sundarbans

January 7, 2021
By 25159

The article describes how the people of the Indian Sundarbans delta, who have adopted migration as a means of survival in an ecologically fragile deltaic region in eastern India, have been affected by the combined impact of the global pandemic and tropical cyclone Amphaan, which struck India in 2020.

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Inhabitants of Banashyamnagar in the Sundarbans queue for disaster relief while trying to maintain social distancing norms to prevent the spread of COVID-19. (Picture by Amartya Ray)

The word cyclone was coined in the city I am writing from, Calcutta. A colonial officer, Henry Piddington studied tropical storms peculiar to the Bay of Bengal and named them cyclones after the Greek word ‘kuklōma', meaning the coil of a snake. When in 1853, the colonial government decided to build a port in the lush green deltaic region south of Calcutta, Piddington wrote an anxious letter to the then Governor-General of British India, Lord Dalhousie, to explain how the plan might not succeed should a cyclonic storm strike. True to his word, fourteen years later, a ferocious storm razed the newly built Port Canning to the ground. Nearly two hundred years after Henry Piddington’s lifetime, the forested deltas of present-day India and Bangladesh, called the Sundarbans, continue to reel under severe environmental stress.

People began settling in the hostile climate of the Sundarbans during the colonial period when the British Raj decided to deforest much of the largest mangrove forest in the world, and the natural shield of the eastern portion of the Indian mainland against sea storms, for agricultural revenue. Because of their low-lying, riverine and coastal setting, inhabitants of the region have never been unfamiliar with the threat of cyclones. But those living in the ‘transition’ zone between ‘stable’ inland areas contiguous with the mainland and ‘core’ seaward areas of legally protected mangrove forests, remain most vulnerable to environmental hazards. Located along major tidal rivers, only 23 percent of the roughly 1.5 million inhabitants of the transition zone had access to safe water in 2011, while less than 2 percent could access storm shelters.

The region faces a basket of environmental hazards round the year. It experiences sudden-onset extreme weather events in the form of about nine cyclonic storms a decade, a third of which are severe. In the recent past, Sidr (2007), Aila (2009), Phailin (2013), Hudhud (2014) and Bulbul (2019) have struck the Sundarbans with cycles of immense destruction. In the background of recurring cyclonic storms, are slow-onset environmental hazards that people have lived with for centuries. Some of these, such as a rising sea level, salinisation of soil and water, loss of ecosystem services and failure of the ring of embankments built to protect the region from erosion have led to decreased access to safe drinking water, lack of food security and inadequate WASH (water, sanitation, and hygiene) facilities. Salinity in soil has reduced land productivity in a region primarily dependent on agriculture as its chief livelihood strategy. Salinity in water sources and lack of piped water supply have resulted in poor health outcomes and high diarrhea-related mortality, especially among children. This year, however, the people of the Indian Sundarbans face a triple crisis. In the fourth week of May, the deadliest tropical cyclone to have ever impacted the Bay of Bengal, Amphan, coincided with the ongoing COVID-19 pandemic in the background of deep-seated impacts of slow-onset hazards.

The Sundarbans is celebrated as a World Heritage Site, a recognition accorded by the United Nations Educational, Scientific and Cultural Organization (UNESCO) to the rich biodiversity of the Indian Sundarbans in 1987 and of the Sundarbans of Bangladesh in 1997. But its 7.2 million inhabitants confront as part of everyday life a web of slow-onset and sudden-onset climate stress and socio-economic vulnerability that lead them to migrate from the region in search of work to adapt to  their hostile living conditions. There are also instances of environmentally-induced displacement in the region. The islands of Lohachara, Suparibhanga and Bedford have already submerged in the sea, while Ghoramara has shrunk to a fourth of its original size, witnessing the displacement of thousands to the neighbouring island of Sagar. Climate change and human activities such as tidal-based aquaculture and overexploitation of natural resources further aggravate the impact of environmental hazards in the region. In fact, sea level rise in the Sundarbans does not result only from eustatic processes, or the thermal expansion of sea water due to global warming, but also from isostatic processes, which is a local decrease in land level due to compaction of soil and deltaic subsidence. Isostatic processes contribute to about 3 to 8 millimetres of sea level rise in the region every year.

Environmental migration has no locus standi in international treaty law at present, nor are there any national legal provisions in place that can support or compensate migration from the Sundarbans. Policies on disaster risk management in India are limited to disaster relief that address extreme-weather events alone. They do not include instances of displacement or migration due to environmental stress. Additionally, environmental change cannot always be separated from other drivers of migration, and it is therefore difficult to identify environmental migration as a discrete phenomenon. Cross-country research has shown environmental migration to be a multicausal affair, with factors of extreme poverty, socio-political insecurity and environmental dangers reinforcing each other in driving people to move. It is no different in the case of the Indian Sundarbans, where the living standards of the people are grave. According to a household survey conducted after Cyclone Aila of 2009, in a typical group of thousand residents, 510 people, most of them children, were found to suffer from some form of malnutrition. The survey revealed three broad patterns of migration from the region: long-term migration to distant big cities in search of work, seasonal migration during paddy-sowing and harvesting seasons to neighbouring districts as farm labour, and short-term migration to the nearest big city, Kolkata, for informal employment in masonry, sanitation services and public works. Although these people are not called forced environmental migrants because the term does not legally exist, environmental hazards and climate change contribute to the absence of employment opportunities for which they migrate. Extreme poverty both arises from and contributes to their vulnerability to environmental hazards.

When COVID-19 broke out in March, India witnessed the imposition of a nation-wide lockdown with only four hours’ notice. Businesses shut, streets were emptied, factories stopped and workers were laid off. Over 90 percent of India’s population work in the informal sector, and migrants form a large share of it. With abject poverty at source and little income in big cities, migrant workers in India straddle extreme uncertainty and vulnerability even without a pandemic or its economic fallout. But with the COVID-19 crisis, loss of work, and the government’s stringent lockdown rules, they were left with no choice but to return to their home states.

From very early into the lockdown, special repatriation flights were arranged to bring back Indian citizens stuck in foreign countries, but no effective measure was undertaken to facilitate the reverse exodus of migrants from cities or to provide them with alternative sources for earning a living. In a recent report by the country’s central bank, push factors such as high cost of living in urban areas, loss of employment, uncertainty of the lifting of the lockdown, and limited access to social and unemployment benefits, combined with pull factors such as the onset of winter harvesting season, employment opportunities in public assistance programmes in their native villages, and wanting to feel secure with their families, acted as major drivers of the massive reverse migration of migrant workers. With inter-state transportation halted, millions of migrants began a long journey home with babies and bundles under their arms, an unrecorded number of them collapsing on the way. By late March, about 250,000 to 300,000 migrants had returned to the Sundarbans alone. This amounted to an increased threat of disease in the islands, loss of remittances in migrant households, increased pressure on natural resources and an overwhelmed local labour market.

When Category 5 cyclone Amphan struck Bengal and Bangladesh in the afternoon of 20 May this year, inhabitants of the Sundarbans were already neck-deep in trouble. With a surge of return migration, loss of jobs and inadequate public health facilities making living conditions dismal, the cyclone caused irreparable damage to life in the Sundarbans. The 111 mile per hour winds washed away huts, cattle, trees and electric poles, broke through the protective embankments that had been built around the islands and filled paddy fields with seawater. People thronged in school buildings and storm shelters despite fear of contagion. In a month’s time, the spread of COVID-19 surged from 3,103 cases and 181 deaths on the day of the storm to nearly 5,500 cases and over 300 deaths in the region by early June. The state government estimated over 28 percent of the mangrove forests to have been damaged. The storm ripped off the 100 kilometre long nylon fencing that had hitherto prevented tigers from straying into human habitations. Subsistence agriculture, the dominant livelihood for most inhabitants, was badly hit. The agricultural department of the government estimated heavy losses incurred by 1,08,000 farmers across 17,800 hectares of crop field. The surge of brackish water in fields and ponds killed off fishes and rendered fields uncultivable for years ahead. With hundreds and thousands of extra mouths to feed, man-tiger conflicts spiked as islanders began venturing deep into the forests in search of fish, crab, honey and firewood.

When Cyclone Aila had struck in 2009, able-bodied islanders migrated out in search of work. Their families remained behind, living on a thin flow of remittances. But with the devastation of Amphan, a global pandemic showing no sign of decline and an unprecedented surge of return migration into the Sundarbans in early 2020, possibilities for exploring economic opportunities outside the region— the primary means of adapting to environmental hazards at home— remain bleak. The state government announced 827,000 dollars in aid for rebuilding life in the Sundarbans after Amphan while the central government has released 130 million dollars from the National Disaster Relief Fund for the state of West Bengal. But short-term relief cannot reverse the damage caused by Amphan unless supported by forward-looking strategies of overcoming the triple crisis of slow and sudden-onset environmental hazards, poverty and COVID-19 that the region faces today. Some climate experts and economists point to the benefits of planned and managed retreat of inhabitants living in the transition zone to more stable zones over in-situ strategies of adaptation while others point to the dangers of extracting people from their land. But with inhabitants trapped in a public health crisis amid extreme environmental and economic vulnerability, migration will have to be managed and facilitated by the state instead of scraping by with local efforts of building resilience.

Acknowledgement
The author would like to thank her friend Amartya Ray for his insightful comments. He went to the Sundarbans along with his mother Chaiti Ghoshal with relief for 500 inhabitants of the village of Banashyamnagar on 4 June 2020. Both of them are film actors in India.

 

Reprinted from the IOM's special blog, https://environmentalmigration.iom.int/blogs/triple-crisis-indian-sundarbans

 

Mental Health in Crisis: The Impact of COVID-19

December 17, 2020
By 24113

Elvisa Frrokaj  is a psychologist-psychotherapist (MSc, PhD-C.) and a former Sylff fellow at the University of Athens. She discusses the impact of COVID-19 on mental health, describing the detrimental influence of the pandemic on mental health, which, as studies are beginning to show, is in jeopardy.

***

The Importance of Solidarity in the Face of a Pandemic

In both my capacities as a person and a psychologist at the community level, I share the same passion with the SYLFF Association for making the world a better place. I utterly believe, as we say in Greece, that all people can contribute positively to a situation, each by adding a “small stone.” This means that by cooperating and thus becoming small parts of a large sum, it becomes much easier to tackle the challenges of life. As we humans are social animals, the value of a strong commitment to giving back to the community is of utmost importance to our physical and mental well-being.

Coronavirus disease 2019 (COVID-19) was a very representative example of the aforementioned need for commitment to community and a very good opportunity to realize that by working together toward a common goal, we greatly increase the odds to achieving impressive results. The prevention of the spread of coronavirus depends on our individual responsibility, intertwined with collective-community responsibility.

Profound, Unprecedented Changes

When the first measures against the COVID-19 pandemic were enforced around the world, I was shocked, as I could foresee the impact the unprecedented restrictions in personal freedoms would have on public mental health. More particularly, in Greece between March and May 2020 we were in full lockdown. In order to leave home, we were required to send a text message stating the reason for moving. The same applies now for many countries in Europe, as a second lockdown is becoming part of our lives.

For the Western world, this state-enforced control over highly valued personal freedoms is unprecedented and takes a heavy toll on the individual’s mental state. The current situation is something that most of us could never have imagined to ever experience. In myself as well as in my clinical experience as a psychologist, I am seeing a broad palette of negative emotions: surprise, fear, anger, sadness, disappointment, and a sense of insecurity and vulnerability regarding our and others’ health. What is becoming more and more apparent is that COVID-19 will not leave us unscathed. The impact to mental health is happening; it is wide. and it is deep.

As a professional I am seeing the same symptoms, emotions, and thoughts. This new condition is affecting individuals at a personal, interpersonal, and communal level. The common feeling to all is that they do not know the duration of the profound changes they are forced to incorporate in their lives. “Until when?” and “After this, what?” are the most prevalent questions. The inability to make any safe predictions regarding the duration of the pandemic increases the stress on people, who feel helpless due to the perceived lack of control of the situation. For all these reasons, mental health and well-being are in jeopardy.

Scientific Studies Confirm the Observations

The crisis caused by the ongoing pandemic is a new, unknown, and unprecedented challenge that seems to have mentally affected a vast number of people. Recent studies have shown that COVID-19 constitutes a new stress factor or a trauma (Gorwood and Fiorillo 2020), causing several problems, such as intense stress of the unknown, frustration, anger, posttraumatic stress disorder, depression, and several other mental disorders (Shuja, Aqeel, Jaffar, and Ahmed 2020). Patients with mental disorders seem to have been affected more. A strong correlation has been documented between higher exposure to the effects—direct or indirect—of the pandemic and loneliness, depression, and anxiety disorders (Hoffart, Ebrahimi, and Johnson 2020).

The mental health effects of the COVID-19 pandemic may be profound, and there are suggestions that suicide rates will rise, although this is not inevitable. Suicide is likely to become a more pressing concern as the pandemic spreads and has longer-term effects on the general population, the economy, and vulnerable groups. Preventing suicide therefore needs urgent consideration (Gunnell et al. 2020). An area of key concern is the potential of the conditions caused by the pandemic to exacerbate existing psychiatric conditions and influence the manifestation of their symptoms. For instance, patients with paranoid psychosis seemed to have increased illusions under particular COVID-19-related conditions (Coogan, Faltraco, and Thome 2020).

As psychologists at the community clinical level, Ms. Iliana Fylla (psychiatrist, scientific director of the Mobile Mental Health Unit of Child and Adolescent Center, KMPSY, on the island of Chios, Greece) and I studied the consequences of COVID-19 on the psychopathology of our patients after the lockdown that was enforced from March to May 2020. Our studies documented the worsening of mental health among a sample of 450 patients of KMPSY. Thirty-nine of the patients claimed to have experienced a worsening of their mental health after the pandemic. Figures 1 and 2 below illustrate these findings. This study was published at the 28th Panhellenic Psychiatric Conference held in Thessaloniki, Greece, from October 29 to November 1, 2020.

 

Figure 1. Mental Health Disorders (ICD-10)[1]

 

Figure 2. Symptomatology after Covid-19 (ICD-10)

 

More specifically, Figure 1 shows the percentage of the symptoms of mental health patients that were claimed to have worsened. Among all our psychiatric patients (total patients: 450), 39 patients presented a worsening of psychopathology. Figure 2 shows in detail the degrees of worsening of mental health symptoms after lockdown. Thirty-nine of 450 psychiatric patients seemed to have more illusions, delusions, suicidal thought, sexual disorders, and so forth.

In sum, the results of our study confirmed the findings of other studies and showed that 11.5% of mental health patients at KMPSY presented recrudescence in their psychopathology (79.0% women, 20.5% men).

Reviews have shown that this pandemic has been compared to natural disasters such as earthquakes and tsunamis, wars, and international mass conflicts, but in these situations the threat is recognized easily, whereas in pandemic the threat is invisible, could be anywhere, and could be transmitted from any person nearby (Gorwood and Fiorillo 2020). The pandemic has created many problems. In this study patients with “affective disorders” presented more intense symptoms. Some of them also had suicidal ideation, increase of compulsions, illusions, and delusion. The best way to confront these consequences is to reinforce and enhance the care support network.

Actions for Public Mental Health

In April 2020 the Psychology Association of Chios took a series of actions to raise awareness in the local community about COVID-19 and foster and reinforce the mental health of people with useful tips and advice. As part of these actions, we gave an interview on local television (https://bit.ly/3519HHl), in which we talked about the psychological impact of the pandemic on young and older people. Understandably, people experience negative feelings such as anger, despair, and depressive symptoms that are caused by the lockdown (April–May 2020). Lockdown affects not only mental health patients but also people who have not had mental health issues before. We tried to propose constructive ways of better managing the situation.

After that, we created a small video (https://bit.ly/3evzCtH ) as an advertisement with a social message—“Keep the coronavirus away and be safe”—in which each psychologist expressed feelings and emotions about COVID-19. Finally, we published articles with tips on how to confront the situation. This multifaceted approach helped people in the local community to stay positive, reduce stress, and avoid panic. I believe that such organized action from professional and scientific organizations can effectively help people confront the situation and the impact of COVID-19.

Useful Tips

  • Read reliable sources that are based on scientific data to avoid misinformation, which implies more stress.
  • This situation is unprecedented on a global level. The feeling of “helplessness” is expected but renders us more vulnerable mentally. Try to find ways to manage this feeling by being creative or dealing with things that make you happy and positive.
  • Find alternative ways of communicating with friends by socializing and having fun using tools that modern technology offers (e.g., Skype, Zoom, Google Meet). It is an opportunity to communicate with our friends and other people or to spend your time by watching interesting videos on YouTube.
  • Listen to music, read a book, or exercise to improve mental health and well-being.
  • Provide support and dedicate time to elderly people who may feel lonely or to your children and family. Try to show empathy if they are afraid or help them psychologically by listening carefully to their concerns and trying to rationalize them.
  • Be positive and focus on what you can control.

 

To Sum Up

This undoubtedly is a difficult and challenging period, but we can find ways to adapt and be happier living through it, even though there are radical changes in our daily life. It is crucial to focus on the present, in the “here and now,” and to the things that we can control. It is a period that shall pass and may present a good chance for all of us to treasure those little things in our lives, the most precious, which sometimes we take for granted or ignore altogether.

Let’s hope we will get through it soon.
Be strong and take care!

 

References

Coogan, A.N., F. Faltraco, M. Fischer, and J. Thome. 2020. “COVID-19 Paranoia in a Patient Suffering from Schizophrenic Psychosis: A Case Report.” Psychiatry Research 288 (11).

Fiorilo, A. and P. Gorwood. 2020. “The Consequences of the COVID-19 Pandemic on Mental Health and Implications for Clinical Practice.” European Psychiatry 63 (1), e32: 1–2.

Gunnell, D., E. Arensman, K. Hawton, and L. Appleby. 2020. “Suicide Risk and Prevention during the COVID-19 {andemic.” The Lancet Psychiatry 7 (6).

Hoffart, A., S. U. Johnson, and O. V. Ebrahimi. 2020. “Loneliness and Social Distancing during the COVID-19 Pandemic: Risk Factors and Associations with Psychopathology.” Retrieved from psyarxiv.com/j9e4q. DOI: 10.31234/osf.io/j9e4q

Shuja, K.H., M. Aqeel, A. Jaffar, and A. Ahmed. 2020. “COVID-19 Pandemic and Impending Global Mental Health Implications.” Psychiatria Danubina 32 (1): 32–35.

[1] ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). 

The State of South African Education: Covid-19 Implosion Brings Good News and Bad News

November 24, 2020
By 25517

How much worse will things get in our education system? Teachers are familiar with the effects of extended periods of downtime, like that during the Covid-19 lockdown. The longer children are out of school, the more difficult it is to get them back into the routine and into the headspace needed for learning.

 

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I have some good news and, unfortunately, some bad news too. Which would you like to hear first? Most people want the bad news first so that they can move on to the good news and end on a high. And this is the formula I will use. The bad news is, unfortunately, very bad: Take cover! Tsunami warning for the SA education system! Get ready for waves of poorly educated children exiting the education system over the next decade or longer.

But how much worse could things really get in the education sector? Have we not already reached rock bottom? No, I suspect that we still have some way to go. One of the unintended consequences of the Covid-19 lockdown in South Africa has been to push our already ailing education system to an unprecedented low.

“Children are not the face of this pandemic. But they are at risk of being among its biggest victims… in some cases, by mitigation measures that may inadvertently do more harm than good. The harmful effects of this pandemic will not be distributed equally; they are expected to be most damaging for children in the poorest countries, in the poorest neighbourhoods, and for those in already disadvantaged or vulnerable situations.” – United Nations Policy Brief, 15 April 2020.

Covid-19 will naturally affect those who are the most disadvantaged to the greatest extent. This is also true in the field of education. The renowned psychologist Edward Thorndike’s “Law of Learning” provides further support for this. It states that the more one learns, the more learning one can achieve in the future. Learning generates further interest in learning.  

In fact, at a biological level we know that being exposed to interesting ideas and being curious triggers the human body’s narcotic-like dopamine chemicals to flood the brain, a positive stimulus that guarantees the individual would want to recreate these experiences.

Conversely, one who has not been exposed to learning opportunities would be less inclined to seek out cognitive stimulation. Thus, children who are described as educationally disadvantaged and were physically locked out of the education system and left to their own devices during the Covid-19 crisis are at much greater risk of not making adequate school progress in the future.

What do we know about the effects of extended periods of downtime on children’s learning? Teachers are very familiar with such scenarios as they often see a tailing off of children’s learning after long holidays and even long weekends. The longer children are out of school, the more difficult it seems to be to get them back into the routine and into the headspace needed for learning.

Teachers at the training working with the BCP materials.

In these situations, teachers constantly have to revert back to previously taught content. These learning setbacks might not be permanent, but they impact future learning.

Human cognitive development is a complex and individual process. How do we start to intervene in it? 

The good news is that we have accumulated a lot of knowledge about this process and that cognitive science does have a fairly good grasp of the fundamental principles that guide effective teaching and learning.

Most importantly, we know that human beings are cognitively modifiable, thanks to the pioneering and extraordinary work of the late cognitive psychologist Professor Reuven Feuerstein. The implications of this seemingly unassuming statement are profound for educators and for children not already in the learning loop. The notion of cognitive modifiability gives substance to the cliché that “all children can learn”. For too long we have been dominated by a deterministic, all-or-nothing view of human cognition; either you have the “smarts” or you don’t.

Children who are working with the BCP materials.

This recognition of cognitive modifiability has resulted in the development of cognitive intervention programmes, such as Instrumental Enrichment, Bright Start and Basic Concepts Programme. While traditional curative (remedial) programmes aim to close gaps in content learning, cognitive programmes aim to promote the growth of cognitive structures that are needed for higher order and abstract reasoning.

But is it possible to enhance the development of cognitive processes inside the classroom and can teachers do this? It is our experience that emergent cognitive structures can be enhanced and teachers can be trained to become mediators of learning. Mediated learning differs vastly from traditional “chalk-and-talk” pedagogical approaches on both a philosophical as well as humanistic level. 

Human mediators are caring, engaged, open, interactive and intensively involved with their children in the classroom. Young children happen to need these kinds of engagements to free up their involvement and participation. Children who take risks and share their thinking and are able to express their ideas are set on a path to improve their thinking, to reflect on it and consider the views of others.

So why are such cognitive educational approaches not being used more in learning institutions, particularly for young children who are not already engaged in learning and might have cognitive vulnerabilities? 

Children who are busy with an activity related to the programme

The Basic Concepts Programme is being extended across Grade R classes throughout the Northern Cape. The Northern Cape Department of Education has been forward-looking in helping to establish solid cognitive foundations needed for enhanced learning. There is an understanding that cognitive development and the school curriculum are not mutually exclusive activities, but both are integral. In a pilot study we have found almost universal improvements in school readiness of children who have been exposed to this cognitive programme during their school day.

The disruptions to teaching and learning in these very unsettled Covid-19 times might, in fact, allow those invested in education to pause, take stock and re-evaluate our understanding and approaches.

How does our practice as educators align with what we know about learning from cognitive science, and are we following the best evidence-based practices that will help children to improve their learning? It might be that the unintended outcome of the crisis also mobilises those involved in education to develop a range of special interventions to re-establish an interest in learning. 

All children can learn and make educational progress, but it might be that some children need a more thoughtful, intentional and mediational approach to successfully re-enter the educational mainstream. 

This article acknowledges the Douglas Murray Trust and Ryoichi Sasakawa Young Leaders Fellowship Fund for their generous support of the work done by the author with the Northern Cape Department of Education.

*  *  *


Reprinted, with a lead by the author, from DAILY MAVERICK which is one of the largest and most credible online newspapers in South Africa; https://www.dailymaverick.co.za/opinionista/2020-11-02-the-state-of-south-african-education-covid-19-implosion-brings-good-news-and-bad-news/.

[BigDataSur] “WhatsApper-ing” alone will not save Brazilian political disarray: An investigation of the affordances of WhatsApp under Bolsonarism

October 16, 2020
By 27510

This article reflects on the role of “WhatsAppers”, defined as social activists appropriating WhatsApp as a primary platform to organize and communicate, in relation with the rise of Bolsonarism in Brazil. Affordances of WhatsApp usage by social actors are explored in the light of responses to Bolsonarism, along with their implications in the current time of crisis.

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Photo credits: Lo Cole / The Economist

The research illustrated explores the affordances of WhatsApp and its appropriation by the WhatsAppers in Brazil, here defined as social activists appropriating WhatsApp as a primary platform to organize and communicate. I explore the importance of the Global South context in shaping such affordances, focusing on local epistemologies which bypass the structure of mainstream Brazilian media. As illustrated elsewhere, the empirical analysis combined different qualitative methods, yielding insights into the communication and action repertoire of the group studied, not without considering reflections on research ethics and their implications in the context studied.

WhatsAppers: Towards a new research agenda

This research stems from an analysis of the social interactions of UnidosContraOGolpe (UCG), a leftist group in Brazil, which was a WhatsApp “private group” emerged in 2016 to oppose the controversial impeachment of the then-president Dilma Rousseff. The case study resulted into the first empirical MA dissertation in Latin America to explore digital activism on WhatsApp private chats as an emerging field of political action. To do so, a ‘meso-micro’ analysis was used – on the meso level, to identify the modus operandi of group interactions and, on the micro level, to capture individual motivations, tensions, and expectations. At the core of the investigation, the researcher’s identity was disclosed, following social actors through their chat environment and adopting an ‘engaged’ approach, whereby the research is designed with the goal of empowering social actors. In practical terms, this inspired a triangulation of qualitative methods, including digital ethnography (to identify and analyze the practice of social actors inside the chat domain, through a long “zoom” perspective on social interactions in the private chat group), content analysis of selected posts (to understand how the group emerged organically and self-organized in a contingent manner) and fifteen in-depth semi-structured interviews (to elicit values and motivations from the perspective of individual active participants).

This dissertation argues that WhatsAppers are characterized by their ability to appropriate the chat group as a means to participate in political life. Engagement with political activism becomes an intimate and familiar affair, mediated by a personal and omnipresent device, that enables a unique approach to mobilization. In general lines, everyone could be a WhatsApper, including those not previously politically active. A WhatsApper could be someone who already is entwined in other social media networks of politics and mobilization or not; they can be someone from a poor, middle or rich class background. In other words, WhatsAppers interact digitally with others, combining online and offline political actions. Through the lens of digital sociology, the case studied reveals that WhatsApp stands out as a platform for civic engagement, promoting new spaces of digital activism for three main reasons: the chat app (1) affords structurally new forms of political participation and collective engagement, (2) forges communities of mutual interest, and (3) promotes collective decision-making and individual autonomous actions on a small scale. However, drawbacks are found in howbots can influence conversations on WhatsApp, fake users can hijack chats, and group members may be threatened by surveillance attacks.

Bolsonarism: into the Brazilian political crisis

In 2019, the first year of Jair Bolsonaro’s government, Brazil has seen a record deforestation and a drop to zero applications of environmental fines. Bolsonaro nominated a human rights minister who was well-known for preaching sexual abstinence as a state policy. Sons of the president are under investigation of crime and corruption. Also, Bolsonaro has nominated a secretary of culture extolling Nazi propaganda. Moreover, every week the Brazilian “anti-president” openly attacks the press, and recently was considered the worst leader to struggle against the Coronavirus pandemic.

The political scenario in which Bolsonarism surges is widely recognized as reflecting a crisis of political representation and the widespread disbelief in politics and traditional parties. Bolsonarism can be understood as “a political phenomenon that transcends the figure of Bolsonaro and is characterized by an ultra-conservative worldview, returning to traditional values and nationalist and patriotic rhetoric”. Facing this scenario, an urgent question should be addressed: what is really happening to Brazilian democracy?

Looking back, looking forward

Brazil is an extremely unequal country along multiple dimensions that include internet access. Part of the semi-illiterate population gathers their information almost solely through visual messages, audios and videos from thousands of WhatsApp groups, thanks to the “zero rating” fees provided by telecom companies that replaced more expensive short-text messages. The larger context of Latin America makes an excellent test bed for the study of WhatsApp social interactions because “96 percent of Brazilians with access to a smartphone use WhatsApp as primary method of interpersonal communication”. According to the Reuters Institute, 53 percent of Brazilians use “ZapZap” (as the app is commonly known in the country) to find and consume news. Everyday citizens also use “ZapZap” to order pizza, stay in touch with family, transfer money, make doctor appointments, learn, spread gossip and date.

While the leftist “UCG” WhatsAppers were calling for political action, far right activists were articulating themselves in WhatsApp private groups and beyond, also combining online and offline activities. Progressive sectors were as well unable to build a national digital campaign, with very rare exceptions, such as small local initiatives like UCG. Consequently, the potential of digital activism on chat apps was later weaponized by far-right groups that not only appropriated public and private groups on and with WhatsApp, but also acted as pipeline to other social media. Digital information became a “weapon” that is still used in “out of control” mode nowadays by Bolsonaro’s supporters, taking advantage of the high penetration of WhatsApp in Brazil, and facilitated by the limited digital literacy of the population. In fact, Bolsonaro ran a successful campaign in 2018 based on a combination of bottom-up authoritarianism and digital populism. His supporters were helped by bots to spread misleading content “weaponizing” various WhatsApp groups.

COVID-19: creative WhatsAppers from the margins

This case presents important implications for the ongoing crisis. Brazilian citizens are currently bombarded with COVID-19 related disinformation and facing a chaotic portrait, while far right activists occupied larges spaces on digital networks before and after the 2018 elections. Moreover, there are lessons learned from the inability to stop Bolsonarism’s digital army, namely: send messages which everyday citizens can trust. Today, Brazilians behave more and more like consumers instead of citizens, trusting the market more than science – perhaps this is precisely the gap that paves our country for thousands of deaths during the coronavirus pandemic.

Brazilian mainstream media are currently discussing who might be a potential presidential candidate for the next elections in 2022. However, a deeper question is whether democratic values will still be upheld at that time. The composition of Bolsonaro’s government reminds us that Brazilian’s young democracy is now more capitalist, colonialist, patriarchaland is heading towards a dangerous and irresponsible political adventure, and the outcomes are unpredictable. During the pandemic, social distancing, hand washing, hand sanitizers, masks, respirator machines and lockdowns are privileges of the Global North, while in the South, many will not even have access to minimum services.

As the title suggests, using WhatsApp for chatting and hanging out alone will not solve the political Brazilian disarray, but perhaps creative WhatsAppers could provide a spark to create national-transnational solidarity. Namely: high speed participatory decision-making to deliver groceries, collect money, produce masks, share scientific information, mobilize against COVID-19 related disinformation, reach poor families and fight for emergent democratic imaginaries. The UCG case study still works as a well-informed internal communication strategy for connecting and activating social solidarity networks that grounds for hope, especially because it reveals the battlefield of political struggle that enables scientific shared information, civic engagement, collective mobilization, and solidarity. Lastly, the coordination of online activities combined with actions on the ground by WhatsAppers triggers digital activism in times of pandemic.

About the author

Sérgio Barbosa

Sérgio Barbosa is a PhD candidate in the program “Democracy in the Twenty-First Century” in the Centre for Social Studies (CES), at the University of Coimbra and a Sylff fellow sponsored by Tokyo Foundation for Policy Research. He is a member of the Technopolitics – a “Latin” research network connecting Brazil and Ecuador with Spain, Portugal and Italy. His research explores the emerging forms of political participation vis-à-vis the possibilities afforded by chat apps, with emphasis on WhatsApp for digital activism and social mobilization

Acknowledgments

The author thanks Silvia Masiero for her careful review (and beyond) and wishes to thank Charlotth Back and Jeroen de Vos for their comments and suggestions. He extends his gratitude also to Stefania Milan and Emiliano Treré for launching Big Data from the South initiative. This blogpost has received funding from the Sylff (Ryoichi Sasakawa Young Leaders Fellowship Fund) Research Abroad – SRA fellowship sponsored by the Tokyo Foundation for Policy Research.

 

Reprinted, with a lead by the author, from DATACTIVE Big Data Sur blog, https://data-activism.net/2020/06/bigdatasur-whatsapper-ing-alone-will-not-save-brazilian-political-disarray-an-investigation-of-the-affordances-of-whatsapp-under-bolsonarism/.

Leia em portugues

Providing Space for Good Conversations on YouTube amid the COVID-19 Pandemic

September 18, 2020
By 25157

James Martyn completed his Doctorate at Massey University in New Zealand in 2014–16 as a Sylff fellow. He currently works as a psychologist at the Department of Corrections in Tauranga, the fifth most populous city of New Zealand, and privately as a mental health consultant. Amid the worldwide COVID-19 pandemic, James has been utilizing his expertise in creating space for good conversations through a short video series on YouTube, covering such useful topics as stress and better habits under the difficult circumstances.

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Introduction: Good Intentions

I have always wanted to be the sort of person who can be helpful in a time of need; to know not only that I can help if needed but that the type of help I can provide is useful. It is one of the things that led me to become a psychologist. But if I am honest with myself, there are many days when I feel like I fall short. As I sit and reflect on life, I often feel an internal pull toward doing more for others: to give more, be more, and have more of an impact. Too often, I think of the “big” things I wish I could do or might do in the future to be useful. However, during these times, it is easy to discount the small and perhaps equally important things we can do today to be helpful. It is my intention to focus not only on the big things in the future but also on the small things and the small ways in which I can be more outwardly focused today.


Coronavirus: Different Boats, Same Storm

Amid the coronavirus pandemic in 2020, we have all witnessed and experienced a rapidly changing world. These changes have contributed to a wide range of very real challenges that we have either experienced or observed in ourselves and in others. Whether the challenges were experienced emotionally, physically, socially, psychologically, or spiritually, there are very few people who have not been affected in some way by the recent circumstances. 

While I think it is a misconception that we are all in the same boat together during this pandemic, I certainly feel we are all experiencing the same storm. At times the figurative rain and wind have felt unrelenting. During this time some of our boats, for a variety of reasons, continue to fare better or worse than others. But like all storms, this too will pass—although this particular storm will be long remembered. The storm’s gift and curse is that it has brought to our attention a number of areas, personally, nationally, and even globally, that may require some repair to ensure our safety and the safety of others in the future. 

In our small country of New Zealand, with just over five million in population, it is easy to see that we have been incredibly lucky as a whole, despite the suffering of many. As of this writing, our country has been fortunate enough to be able to lift almost all of its coronavirus restrictions, despite some fluctuates across the country. However, New Zealand, as with many other countries, continues to face struggles. The increased stressors, pressures, and uncertainty that have arisen alongside the implications of the coronavirus have had and continue to have an impact on many people’s mental health and well-being. 


How Can I Be Helpful?

Just a few months ago, our country, like many others, entered full lockdown. We began to face the challenges of social and community disruption, financial pressures, and interruptions to many aspects of our daily lives on a scale that we had not seen before. While many people did not experience significant difficulties, for others the impact and uncertainty brought considerable stress. 

As a psychologist, I continue to work with adaptations to my day-to-day activities. In one of my roles, I work as a consultant with a friend and colleague at Lumind.co.nz. Lumind is a small start-up consulting and training company that we created with the intention to provide accessible, useable, and relevant evidence-based psychological information to businesses and community groups. Our aim is to help groups to “mind what matters.” Talking via Zoom, at one point we discussed the likely implications of the coronavirus on mental health. We wanted to help in some way, to find a place to step outside of our comfort zone. Together, we have often discussed the “big” ideas and dreams about what we can pursue. In doing so we have dreamt, strategized, and reflected, often at the expense of acting in the short term. This is not to say that taking time to think big is unhelpful, but I feel our focus on the future can at times lead to missing the smaller opportunities that lie in front of us. Consequently, as we spoke about wanting to be useful in this moment of the coronavirus pandemic, we decided to put aside our preconceptions of having a polished product and simply try to give some of our knowledge and resources to others. We tried to be useful in our own small way.


Our Mental Health and Technology Focus

Our particular area of interest at our business, Lumind, is the intersection between mental health and technology. It is our view that at present, psychological resources are not delivered effectively. Access to evidence-based psychology assessment and intervention in the community is typically bottlenecked by limited service resources. This is due in part to numerous barriers that surround current mental health treatment and delivery, which have contributed to discrepancies between treatment needs, availability, and uptake. Consequently, too many people who could benefit from psychological resources and greater well-being ultimately miss out on or are not afforded equal opportunity for access. It is our view that technology is one critical component that can help disseminate evidenced-based psychological resources and potentially improve access to appropriate resources in the future. We feel that this may subsequently work to improve mental health and well-being for many who may have otherwise missed out. 

Mental health and well-being has become an increasingly popular topic in recent years. New Zealand was the first country in the world to develop a “Wellbeing Budget.” Additionally, the number of well-being-focused websites, applications, podcasts, books, and other resources has grown exponentially. On the whole, this is a great thing. However, not all content is created equal. It is our view that there is a lot of information available through technology that has good intentions, but not all are evidence based. In some cases, the content and delivery method may even lead to a negative outcome. As such, we feel that psychologists should have a voice in the well-being and technology area. Lumind wants to be part of the conversation.


Creating the “Minding What Matters” Video Series


With this in mind, outside of our normal work, we decided to do something small using technology—something that utilized our expertise. As with any time you put yourself out to the public, it was very easy to think of the reasons not to go ahead. For instance, there was plenty of other content available online; our video and audio quality was relatively low; given that our content was casual and unscripted, we may say something incorrect or that may be judged differently than our intention. However, when we came back to our intention—to show support to our community in a time of need—we felt that the benefit was worth the effort. 

As psychologists, we are not trying to pretend we “have it all together.” We understand that we have our own paths climbing our own personal mountains with their own unique set of challenges. However, from our vantage point on our mountain, we may be able to see your position from a different angle. Our perspective, as well as the skills we have developed along the way, may be valuable to share. As such, my colleague and I decided to put together a short video series titled “Minding What Matters.” Each video was a casual, lighthearted, and short conversation with other psychologists. Together, we chatted around a particular topic area that we thought may be helpful during COVID-19 and beyond. 

The result was a series of nine videos available on YouTube with such topics as “virtually supporting someone who is struggling,” “dealing with anxiety and worry during difficult times,” “parenting tips during stressful times,” and “why bad habits strike during stress.” In total, we have had around 900 views so far. Our intention has never been to obtain media views, but to be useful. It has been great to see that a few people have found it beneficial along the way. We have had positive feedback from people in care-type roles and helping professions, strangers, parents, and our friends. That is all we could have asked for. 


Conclusion: Remembering That Small Steps Matter

We are well aware there is better content with better quality available. But I think there continues to be space for both small and big projects; space for good conversations around relevant topics and based on evidence-based principles. In the future, it would be great to work more in this space, perhaps even take more risk and step further out of the comfort zone. But it has been a valuable experiment, one that has taught me to not take things too seriously and that taking small steps to help others today may at times be more effective than waiting for the “right time” to make many big steps to help others in the future. I think there are a lot of opportunities out there, ready for psychologists and other professions to share their skill set. I am learning to be bolder and to open my eyes to what these opportunities may be, both now and in the future. I hope you are too.


Lumind Channel on YouTube

https://www.youtube.com/channel/UCFr_ZQRaUGIVatjTrdVlbYg

Lumind is a start-up psychology consulting and training company consisting of co-directors Dr. James Martyn and Matt Hegan. Lumind aims to provide accessible, useable, and relevant evidence-based psychological information to businesses and community groups. Lumind’s purpose is to help people focus their “mind on what matters.”

Episode 1: Why This Series
https://youtu.be/vppYkanPXXI

Episode 2: Being Who You Want to Be
https://youtu.be/vppYkanPXXI

Episode 3: Anxiety and Worry during Difficult Times and Lockdown

Episode 4: Mindfulness—Calm in the Chaos of Lockdown
https://youtu.be/ztv625cG1T4

Episode 5: Psychologist Parenting Tips during COVID Lockdown

Episode 6: Mental and Physical Performance during Lockdown
https://youtu.be/TRnck0X_qVE

Episode 7: Virtually Supporting Someone Who May be Struggling

Episode 8 (BONUS): Psychologist Learns from 6-year-olds—How to Be a Good Friend in Lockdown

Episode 9. Why Bad Habits Strike during Times of Stress
https://youtu.be/RKMrPMR6t4Y

What COVID-19 Can Teach Us about Prison: Reflections on Criminal Policy and the Words of Albert Camus

August 31, 2020
By 24051

Rui Caria, a PhD candidate in criminal law at the University of Coimbra, summarizes the ongoing discussions about the confinement of prisoners under the COVID-19 pandemic. He discusses the human dignity of prisoners and the purpose of prisons and punishment by drawing on ideas that Nobel Prize winner Albert Camus describes in his famous novel The Plague.

* * *

Introduction

During my second semester, like many others, I had my life put on hold by COVID-19. I was sent to work from home, and class lectures were provided by Zoom, allowing me to keep studying by looking through the tiny box that is my computer screen. As much as one tries to halt the fall of productivity, it eventually gives way to reflection; one that is personal as much as social. By looking at the other tiny box that is my TV, I could watch the news and learn about all the people who found themselves confined.

During quarantine, I found it fitting to reread a novel by one of my favorite authors: The Plague, by Albert Camus. It made me realize that the most fortunate of us were confined at home; others, not so fortunate, were confined in the places where they had made their travels. But there was a third category of confined, one that is seldom talked about: prisoners.

 

To Release or Not to Release?

Across the world, there was a great discussion about what to do with prisoners during the pandemic, the question being whether they should be released or not in order to minimize the risk of a health catastrophe in prisons. The importance of the issue was highlighted by various entities, from the World Health Organization (WHO) to the Council of Europe. The debate had to grapple not only with the big question itself—to release or not to release—but also, if the question is to be answered affirmatively, on what grounds they should be released.

In my country, Portugal, legislators approved an extraordinary regime of prison flexibilization in the midst of the COVID-19 pandemic. This new law (no. 9/2020) allowed for a partial pardon of prison sentences, a special regime of reprieve of sentences, an extraordinary regime of licenses for administrative leave of inmates, and extraordinary anticipated parole.

The Portuguese Parliament (Assembleia da República).

On the other side of the world, in the United States, which has the world’s largest number of infected combined with the world’s largest prison population, policy solutions have been suggested to reduce the number of people in jails, as well as in state and federal prisons. These focus not only on increasing the number of releases but also on restricting the number of admissions.

Regarding increasing releases from federal and state prisons, some suggest considering the following for immediate release: inmates nearing the end of their sentence (who are expected be released in the next few months); those in minimum security facilities and who are on work release; those who are medically fragile or are older; and those whose offense is considered “minor” or have a “low likelihood” of committing another serious offense.[1]

Many prisoners have sought compassionate release—the release of people who are facing imminent death and who pose no threat to the public. But this has proven a lengthy and cumbersome process, some of the shortcomings being the requirement that a person be extremely close to death or so incapacitated that they do not understand why they are being punished; the requirement of a statement from a medical professional; and the ability of decision-makers to overrule recommendations from medical professionals and prison staff.[2]

Some have pointed their finger at the new policies to release prisoners, calling them opportunistic political moves to try to solve the problem of prison overcrowding that preceded the pandemic. But this was only one of the many outcries from the public regarding the release of prisoners.

 

Why Release?

The WHO has pointed out that due to the concentration of people that is inevitable in prisons, inmates find themselves in a state of special vulnerability regarding COVID-19.[3]

However, the virus is not the only problem, or it would be a smaller problem if it were not for the poor health of inmates. The WHO has also noted that inmates, regardless of the pandemic, already tend to suffer from graver health issues than the general population. These health issues stem from weakened immune systems, caused by lack of sunlight, stress, malnutrition, and such diseases as tuberculosis, from which inmates particularly suffer.

One of many overcrowded prisons in the world.

Adding to the health problems that exist—and have existed for a long time—in prisons, the environment itself makes social distancing impossible. Compared to cruise ships and nursing homes, two other types of environments considered prominent incubators for the virus, prisons possess comparable or smaller quarters and people do not have in-room access to the necessary hygiene products and water.[4] 

This situation is made worse by the fact that many prisons suffer from overcrowding and poor overall conditions and that prisoners are put in collective cells that are too small. Many of these situations have already reached the European Court of Human Rights and suffered their condemnation.[5]

 

Why Punish and When Do We Stop?

The discussion also made the public ask itself, even if subconsciously: Why do we punish? What are the limits of punishment? When is punishment over?

In Portugal, when the state intervenes by utilizing criminal law—that is, when it criminalizes any behavior and punishes it—it must do so in obedience to the constitutional principle of necessity. This means that criminal law comes forward not arbitrarily but only to protect lawful values inscribed in the constitution or derived from it. These are values that correspond to the necessary conditions for the individual’s free development, to the realization of his fundamental rights, and to the sound functioning of a society built around these goals.[6]

This means that criminal sanctions serve the purposes of protecting lawful values and aiming to socially rehabilitate the offender. Both these purposes are considered when determining the length of the prison sentence.

Prison of Coimbra in Portugal.

Despite being inscribed in the criminal code as one of the purposes of the prison sentence, social rehabilitation often seems not to be a priority, its failure being one of the weapons utilized to argue the failure of criminal law. One needs only to look at the lack of conditions from which prisons suffer to observe, as many criminologists have already noted,[7] that in many cases it dissocializes more than it socializes.

This fact, combined with the perception that the public has of prison, helps cement the popular idea that people should not leave prison before the time prescribed in their sentence, that they should be punished until the end, for there is no chance they will be rehabilitated before that. With these ideas in mind, it easily arises in the public discourse that someone who has committed a crime is a criminal forever and so should be forever punished, without the opportunity for rehabilitation, for there is no chance of it happening.

 

The Prison and Plague

In his famous book The Plague, first published in 1947, the Algerian-born French philosopher and Nobel Prize winning writer Albert Camus tells the story of the fictional town of Oran, which is stricken by the plague.

In his story, the people of Oran are confined to their town and homes because of this plague. At one point, Camus reflects on how their condition is equal to that of exiles and prisoners: “Thus, too, they came to know the incorrigible sorrow of all prisoners and exiles, which is to live in company with a memory that serves no purpose. . . . Hostile to the past, impatient of the present, and cheated of the future, we were much like those whom men’s justice, or hatred, forces to live behind prison bars.”[8]

Albert Camus

There could not be a better description of what many of us went through in the past months of the year 2020 due to the pandemic. However, even if we felt like this, with different words but with the same feeling, parted from family, friends, and lovers, did it serve to make us reflect? Did it make us more compassionate and understanding of our fellow man?

The discussion surrounding the release of prisoners during the pandemic is, in my understanding, of special importance. It had the capacity to bring the topic of prison and inmates back into the public eye—even if briefly and amid the greater concerns of the pandemic, in which we are still living. In this way, it allowed for the public to be made aware, once more, of the special vulnerability of inmates that derives from their poor health and the poor prison conditions in which we keep them, even in the twenty-first century.

However, despite being made aware of the problems faced by inmates, and sharing the feeling of confinement, the public response to releases during the pandemic was still stained, for the most part, with intolerance. Besides the already mentioned accusations of releases being a “quick fix” for the prison overcrowding problem, less elaborated arguments could be summed up in the following statement: “Prisoners should stay in prison.” It was even possible to hear some people saying that not only should prisoners not be released earlier, or on time, but they should stay in prison forever.

This sort of speech was not novel or exclusive to the pandemic. That specific discussion was only a symptom of a greater problem: the way society still conceptualizes punishment. I had the opportunity to witness this firsthand. In the summer between the two years of my master’s degree in criminal law, I worked as a tour guide in an exhibition dedicated to celebrating 150 years since the abolition of the death penalty in Portugal. It was not uncommon to hear people say that it was a mistake to abolish it and that it should be brought back.

Of course, this is the extreme end of that sort of speech, but it is common for people to think about prison as nothing more than punishment, as if the more suffering is inflicted, the more justice will be done. In today’s criminal doctrine, at least in the European continental tradition, the conceptualization of prison as pure retribution is largely obsolete. Prison is not supposed to aim at the past, punishing the offender as an incarnation of divine retribution, but should be aimed at the future, in helping him live his life responsibly without committing crimes by socially rehabilitating him.

Offenders, despite having committed crimes, are meant to be treated as human beings, being recognized for their dignity as well as granted a chance for recovery and redemption. How would we have felt if someone had told us that never again should we leave our homes? Should we never see our loved ones again? Should we never hope for the future?

As much as we need a change in public and criminal policy, we need a change in the public conscience about the purpose of prisons and the value of human dignity. We certainly had, and still have, the opportunity to let the virus teach us something about prison and about humanity.

 

[1] Peter Wagner and Emily Widra, “Five Ways the Criminal Justice System Could Slow the Pandemic,” Prison Policy Initiative (website), March 27, 2020, https://www.prisonpolicy.org/blog/2020/03/27/slowpandemic/.

[2] Emily Widra and Wanda Bertram, “Compassionate Release Was Never Designed to Release Large Numbers of People,” Prison Policy Initiative (website), May 29, 2020, https://www.prisonpolicy.org/blog/2020/05/29/compassionate-release/.

[3] WHO Regional Office for Europe, “Preparedness, Prevention and Control of COVID-19 in Prisons and Other Places of Detention: Interim Guidance,” March 15, 2020, 1.

[4] Aleks Kajstura and Jenny London, “Since You Asked: Is Social Distancing Possible behind Bars?” Prison Policy Initiative (website), April 3, 2020, https://www.prisonpolicy.org/blog/2020/04/03/density/.

[5] Recent cases include J.M.B. Et Autres c. France [J.M.B. and Others v. France], 9671/15, May 30, 2020, https://hudoc.echr.coe.int/eng#{%22itemid%22:[%22001-200446%22]}, and Sukachov v. Ukraine, 14057/17, May 30, 2020, https://hudoc.echr.coe.int/eng#{%22itemid%22:[%22001-200448%22]}.

[6] Claus Roxin, “O Conceito de Bem Jurídico Como Padrão Crítico da Norma Penal Posto à Prova,” Revista Portuguesa de Ciência Criminal 23, no. 1 (January–March 2013): 12.

[7] One of the fundamental works in this regard is: Erving Goffman, Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (London: Penguin Books, 1991).

[8] Albert Camus, The Plague (Harmondsworth: Penguin Books, 1960), 69.

Action to Address a Stakeholder-Identified Need: Development of a Questionnaire to Improve Resolution after Medical Injury

July 27, 2020
By 25572

Associate Professor Jennifer Moore, a former Sylff fellow at Massey University in New Zealand, implemented a research project to assess the needs of injured patients and their families after medical injury with funding from Sylff Leadership Initiatives (SLI) from January 2019 to April 2020. The survey tool she developed and refined throughout the project is expected to facilitate better and happier reconciliation processes between healthcare organizations and injured patients and families after medical injury.

* * * 

“I wish there had been a questionnaire like this that was given to me after the hospital injured me! I recently had a hip replacement, and the provider posted a survey to me. It was so bad that I didn’t complete it. I thought, ‘Do these people have common sense? What does this mean?’ I wonder if they didn’t do what you are doing and [trial] the survey with the actual patients. I think it is so important to actually trial test it on patients first.” (Injured patient from New Zealand, comments during a cognitive interview, January 2019. The word in brackets in the quotation was edited by the author).

 

Introduction

This project was the first to attempt to develop a questionnaire to assess injured patients’ and families’ needs after medical injury. We pretested a draft version of the questionnaire with injured patients and families in New Zealand and the United States. In the quotation above, the injured patient highlights the importance of pretesting questionnaires to increase the likelihood that it will be an effective tool.   

Medical injury is unexpected harm caused by medical care. After heart disease and cancer, medical injuries have been identified as the third leading cause of death in the United States; this conclusion is consistent with findings from research undertaken in other countries, such as Canada, Japan, and New Zealand, and these statistics have generated calls for “greater attention” to medical injury because of the scale of this global issue.[1] An additional well-documented issue is that healthcare institutions’ responses to medical injuries, particularly their attempts at resolution, frequently fail to meet patients’ expectations and needs.[2] The literature also highlights that poor responses from healthcare organizations exacerbate the psychological, physical, and financial effects of medical injuries.[3]

During my recent research about the resolution of medical injury, the key stakeholders and participants identified another important social problem that requires action. Most healthcare organizations are interested in doing a better job of meeting injured patients’ and families’ emotional, informational, and practical needs after medical injury but currently lack tools to evaluate how well they met those goals.

Jennifer with her daughter Rebecca and two research participants

Research Objective, Methods, and Dissemination

Therefore, this project’s key objective was to address that gap, and stakeholder-identified need, by developing a questionnaire that healthcare organizations can use to assess how well they met the needs of patients who suffered medical injuries during their care. To develop the questionnaire, we undertook the following steps.

  • We designed a draft version of what we call the Medical Injury Reconciliation Experiences Survey (MIRES). This draft was based on findings from our two previous studies of injured patients’ experiences of nonlitigation approaches to resolving medical injuries.
  • We performed a content analysis of transcripts from a stratified random sample of interviews conducted with injured patients in New Zealand and the United States in 2015–16.
  • We extracted themes describing what is important to patients following medical injury and developed a draft questionnaire with question domains and items corresponding to these themes.
  • We revised the draft questionnaire following review and feedback from expert clinicians, risk managers, and patient advocates.
  • We pilot tested the revised questionnaire on a sample of 24 injured patients and family members in the United States and New Zealand, conducting cognitive debriefing interviews focused on the comprehensibility and completeness of the questionnaire.
  • We further revised the instrument based on this feedback. Thirty-seven revisions were made in response to their suggestions.
  • We traveled to New Zealand to disseminate and implement the questionnaire to key stakeholders in New Zealand, such as district health boards' public hospitals, the Ministry of Health, the Accident Compensation Corporation, and the patient advocacy group Acclaim. I traveled around New Zealand (particularly Christchurch, Dunedin, and Wellington) to meet with representatives from the key stakeholder organizations to explain the questionnaire to them and to discuss how best to implement it in their organization.
  • We are in regular, ongoing contact with the representatives of the key stakeholder organizations in New Zealand to answer their questions about the questionnaire and to ask about their initial experiences using it.
  • We submitted a paper to an academic journal that reports the results of the survey development.
  • After the COVID-19 travel bans are lifted, we will travel to New Zealand again at the stakeholders’ request to discuss implementation progress and to undertake any further edits to the questionnaire that may be required.
  • Once the COVID-19 travel bans are lifted, I will also travel to the United States again to discuss implementation progress at the participating hospitals. The intention was to visit the United States in May 2019, but that trip was canceled because of COVID-19. (Sylff funded the New Zealand part of the project, not the US part. We are very grateful to Sylff for their support.)

Once our research paper is accepted, it will be important to disseminate the paper, because our project is the first to attempt to develop a questionnaire to assess injured patients’ needs after medical injury. Further research could use our questionnaire to undertake a full validation study.

The final version of the questionnaire included the following domains:

  • perceptions of communications with healthcare providers after the injury (11 items);
  • perceptions of remedial gestures, such as apology and compensation (12 items);
  • indicia of the patient’s overall satisfaction with the reconciliation process (3 items);
  • the nature and impacts of the injury (5 items); and
  • characteristics of the patient (5 items).

 

Conclusion

Jennifer with a patient's research participant's puppy during the cognitive debriefing interview about the draft questionnaire.

Injured patients and their families expressed the view that they appreciated the opportunity to assist with the survey design process. The survey was feasible to administer with pencil and paper, taking around 10 minutes to complete. The MIRES appears to be comprehensible and acceptable to patients and offers a practicable means by which healthcare organizations can assess how well their reconciliation processes are meeting injured patients’ needs. One of the US patients who participated in this project observed that the “questionnaire has the power to help so many other patients like me.”    

[1] Martin Makary and Michael Daniel, “Medical Error—The Third Leading Cause of Death in the US,” British Medical Journal 353 (May 2016): 2139, https://doi.org/10.1136/bmj.i2139.

[2] Frederick S. Southwick et al., “A Patient-Initiated Voluntary Online Survey of Adverse Medical Events: The Perspective of 696 Injured Patients and Families,” BMJ Quality and Safety 24, no. 10 (October 2015): 620–29.

[3] Elaine O’Connor et al., “Disclosure of Patient Safety Incidents: A Comprehensive Review,” International Journal of Quality in Health Care 22, no. 5 (October 2010): 371–79.