Kids and COVID-19

00:00:00 [music]

00:00:10 Samantha: Hi, I’m Samantha and welcome to The Layman’s Doctor Podcast where we’re Bringing Medicine Home. Now, we’re practicing social distancing. So if you hear anything wonky with the sound, we’re recording this online today, and the date is the 16th of April. I have a guest with me. I have Dr. Carolyn Jackson with me today and we’re going to talk about COVID-19, but more specifically, children, everything that you can think about, and possibly more about COVID-19 and having your children with you. Thank you for joining me, can you kindly introduce yourself to our listeners?

00:01:06 Dr. Jackson: Thanks very much for having me. I am Carolyn Jackson. I’m a self-appointed children advocate. My professional training is in pediatric surgery. But I work a lot with kids in all different realms. And I actually founded and currently run a child wellness centre, where we focus on psychological and nutritional wellness for kids.

00:01:27 Samantha: Okay. Great, great. Yes. Was it Caribbean Tot? Yes.

00:01:40 Dr. Jackson: Caribbean Tots to Teens. And even though we say Tots to Teens, we will stick with you right till the end of university.

00:01:41 Samantha: It’s been about a month or so, I think, since our first case of COVID-19 here in Jamaica, and one of the first things that happened was that schools were shut down, right, which meant that a lot of persons had to have their kids at home, even with a lot of them still going to work. I can imagine for a lot of persons that was kind of a– maybe I can describe it as a huge shift in their daily life and their daily activities. So for you, how do you think parents can kind of make the situation at home better for their children, not necessarily in terms of schooling? But this must be a scary time for a lot of kids right now.

00:02:49 Dr. Jackson: Right. So this situation is different from, for example, if your child was ill, or even if you had three children who were ill, because what is happening is not just that the child has been displaced from their day-to-day activities, but parents and caregivers are also displaced. So where, under normal circumstances, suppose as a kid you had chicken pox, your parents don’t have chicken pox, so they can be that strong place for you. In this situation, a lot of parents and caregivers are looking for their own strong place, their own reference point, because the shifting sand is affecting all of us.

In this situation, everybody is looking for an anchor. And so that is one of the huge differences between this particular homeschooling, work from home period for family dynamics and other situations where people may find they’ve had to pull their child out of school or their homeschooling for a long period. The amount of uncertainty, not just for the child, but for the adult, for the community, for the family, for the nation, for the whole world, it is a lot. And children feel it, they feed off it. And even when you try to actively protect them from the uncertainty, they know that things are not the same, and not just for themselves, but for everything around them.

So I do think– anytime somebody ask me about health, I say there are four pillars to good health, and it doesn’t matter what the situation is. If you can refer back to those four pillars, then you should be able to find yourself some kind of strong footing. And the four pillars that I look at are eat, sleep, move, and love. So when I say eat, I’m talking about nutrition, but it’s not just nutrition. It’s the relationship of nutrition. It’s the psychology of nutrition. It’s the experience of cooking together. It’s the experience of eating together, everything that surrounds getting nutrition into your body.

Sleep: that in and of itself, is a huge issue. A lot of teenagers and even younger kids are flipping and becoming nocturnal. So they sleep all day and they wake up all night, and sometimes it’s easier to just let the kids do that, but on a long-term basis, it’s not sustainable. So that’s eat, sleep, move. If we have to be inside, how do we exercise? How do we move around? And if we can’t burn off all this anxious energy, then it starts to drive us crazy and we begin to start bombarding, getting more angry, get easily irritated in the house. So that’s it. That’s the third important pillar.

And then the last, now, is love, which really I’m talking about relationship. So it is important to– despite the fact that everybody’s in the space together, to actually be aware of how you are relating to people. And in your household, it can reach a point where I feel like you’re talking to me like I must be the teacher, but I’m not. Or you’re talking to me like I am employed to you to do housework, but I’m not. And so how we speak to each other, how we relate in the house, we have to remember what that core relationship is, and consciously take the time to foster that core relationship because, as I said, there’s nobody in the household who is feeling like the anchor, feeling steady.

Everybody is on this ridiculous wave of change, where on any given night when you go to bed, you don’t know what is going to be the situation for you, your job, your community, your ability to drive up and down the very next morning. So I always refer back to those four pillows and I walk through those four pillars, one by one, with parents. And we can look at what are some of the things that we can do just to reinforce these four things, and give ourselves some reference points to say, “Okay. I’m doing okay with this. This is something we can hold on to. This is something we can build on.”

00:07:14 Samantha: Okay. You touched on the fact that children can feel anxious energy and known when something is wrong. But I think some parents might be reverting—might revert to coddling children and try and hide what’s happening, especially maybe the younger children. I don’t know if you may have to go by age range for this, but how can parents and guardians explain to children in a way that’s not too scary, but helps them to understand that something big is happening in terms of this pandemic now?

00:07:57 Dr. Jackson: Okay, so it really starts with the parent and what do they know and understand about the pandemic. And as adults, I know a lot of us are just afraid, and there’s a lot that we do not know. So it is important to take the time as a parent to think about what, especially for younger kids, what is important for me to explain to this child? And one of the things that’s overwhelming for kids is the talk about death. Because there is a strong wave of death associated with this. In Jamaica, we have not had that experience, but I don’t think there’s any Jamaican who doesn’t know somebody who knows somebody who has lost their life. And that wave of grief is affecting us in different ways. And so, as a parent, what do you want your child to understand?

Now, with really young kids, it is– a big-picture concept is a little more irrelevant to them. With very young kids, their reference points are short in terms of timeframe, and their reference points are small in terms of location. So if you say to a child, “I can’t send you to your daycare anymore because the–” it’s important that they understand that it’s not that the daycare is going to make them sick or that the daycare is an unsafe place, right, because for them, they have now established in their mind that this is a safe place and these are safe people. So it’s important to say that the daycare is still a safe place because you’re going to send them back there one day, right? But at this point in time, we’re not sure if we all go there, then we could get sick. So it’s important that we don’t– all of us don’t go until the virus has passed. So those local and specific references for younger children is much more useful.

For older children, you can explain to them on a more national level. And then teenagers, I mean, they do their own research. Most teenagers are quite up-to-date. They are the ones who will ask you questions that you can’t answer. But with the younger kids, the reference point had to be to themselves. One of the big things that children are going to worry about is are you going to die, mommy, daddy. Are you going to die? Are you going to leave me? And Jamaica, we have an unfortunate, highly traumatized population. We have a lot of children who have experienced either secondhand or firsthand violence, trauma loss. And so for them, this is piling on to what is already happening in their life. When you talk about children who have been to school where a classmate’s mother has been killed, or the teacher has died, or there’s– so many of our children have been exposed to trauma and violence that it is a real fear for these kids. Is this thing going to come along and add to the risk that I’m going to lose my security?

So as parents, what you want to do is assure them that you are doing your best to keep safe as a parent, and you’re doing your best to keep them safe, and just highlight to them, “See. We’re doing what the TV says. We’re washing our hands. We’re using our sanitizer. We’re very strict about it because we want to keep safe for you.” So that reassurance is very important. And sometimes, it can almost seem annoying. “Is this child going to ask me the same question 10 times?” But it’s because they want that constant reassurance because if 10 times a day you hear that more than 30,000 people have died in the US, then 10 times a day you want to be sure that your parents aren’t going to be next. And so a lot of reassurance and reminding them that we are doing what we can, we are being as safe as possible, we are taking the precautions because we love you and want to be here for you.

00:12:10 Samantha: Okay. An interesting point that you brought up with the four pillars that you have is with sleep. I’ve definitely been seeing where a lot of– on social media especially, a lot of persons are saying, “I can’t tell the concept of time anymore. It’s 3 o’clock in the morning and I’m up. It’s 10:00 AM.” So do you suggest that– at home, that they actually keep a– it’s not a schedule, a routine where you still have bedtime, you still have wakeup time, just in an effort so that when we do go back to normal, it has less of an effect on their sleep patterns?

00:12:55 Dr. Jackson: Well, what I would say is maintaining a normal diurnal– maintaining a normal wakefulness in the day and sleepfulness in the night, is not just about being able to adjust to work when you– or to be able to adjust to school. When we flip, our sleep pattern, it affects how we function. So people, for example, who work on night shift chronically, we know that it affects how their bodies function. One of the key things it affects, it increases anxiety and a feeling of helplessness. And in a time like this, you really want to be able to minimize that. But there’s no question about the fact that flipping the wakeful period is going to affect how your brain works. So it’s not just that, “Well, we all know ain’t nobody going back to school this term. So if you want to stay up all night, go ahead.” But there is the issue of how it impacts our function when we are awake.

So I would never say that if you used to wake up at 4 o’clock to be able to leave your house at 6 o’clock in the morning, then you must get up at 4 o’clock. That I think is ridiculous. But you do want to have morning and you do want to have bedtime. A bedtime is critical for young children. It is really critical. Bedtime is a time of day and it’s not just a, “Okay, 8:30, I’m turning off the light.” It’s the routine of bedtime. We say, “Okay, it’s 8:30. We’re going to start getting ready for bed.” We turn off the TV for a little bit. We go brush teeth. Everybody gets their last glass of water. Everybody takes their last pee. Sit and read with your kids for a little bit for about 10, 15 minutes, depending on how old they are. And that whole routine, which can last about half an hour, especially for younger kids, is very important because it calms them. It grounds them. It gives them an opportunity to ask you things that in the busyness of the day, they didn’t ask you before. And it allows them to go to sleep and have a good sleep.

And then for younger kids, it now frees up the adults to be able to have those conversations that they didn’t want to have around the child, to be able to just relax because when your kid is up, you’re on duty. So you know you’re– even if you’re working from home, you’re locked away in your office, or you’re pretending to be locked away on the table right next to them, when your child is gone to bed, it gives you, the caregiver, an opportunity to exhale a little bit, and gives you an opportunity to even just think your thoughts. So you don’t want your kids to be going to bed with you. You don’t want your kids to be going to bed after you. So setting a bedtime and embracing the bedtime routine can be very, very helpful for young kids.

For older children– and when I say older children, I’m going to say maybe right up to about third, fourth form, they can do their own thing for their bedtime. You can extend the hours. They don’t have to get up at 6 o’clock. But you don’t want to fully flip. You don’t want to fully flip because there are not only just the psychological impact, but the opportunity for them to get involved in things that you don’t want them to be involved in is going to increase. So for their mental health, for their safety and security, sleep is very important. And I can tell you, any night I get less than six hours sleep, I wake up with every symptom of coronavirus [laughter]. I wake up with sore throat, headache, rusty cough, fever. And then by the time I drink my cup of coffee, my fever is gone, my rusty cough has stopped. And then the nights when I get seven hours sleep, I wake up and I don’t have any symptoms.

The impact of sleep is real and it’s very important for children, and we need to– it can help us even as caregivers because it forces us to put a little routine into our own life, where that is possible. Now that we’ve gone a whole month, we really have to embrace that. Although things are changing, there needs to be some kind of routine in this change. Because this is going to last at least another five or six months. We have not begun to see the increasing cases in Jamaica yet, so.

00:17:50 Samantha: I think when you said five or six months, people breath just going stop and be like, “I thought this was going finish by May.”

00:17:59 Dr. Jackson: No, I mean, I listened– The Ministry of Health and UWI TV did a presentation on March fifth, before we had our first case. And they were using the projections of combining SARS and influenza. And basically what they said was they were looking at, maybe, 2.6 million Jamaicans would be affected. They were looking at how many would end up coming into hospital in the hundreds of thousands. And they were looking at those figures, starting at about eight weeks, or peaking eight weeks after the inflection point. I don’t think we’ve reached our inflection point yet. So the reference number for us can’t be 20 cases or 50 cases or even 1,000 cases. We know that this virus is here. We know that more than 50% of Jamaica will be exposed. And what we can control is how fast it moves through our population. But it is going to move through our population. It is going to move through.

00:19:05 Samantha: Yeah. And when you say the inflection point, do you mean like the peak or–? I don’t know.

00:19:12 Dr. Jackson: If you look at the bell, you kind of have those little flat skirts and then it starts to really go up. So when that start to really go up, that is what I would call the inflection point, when you start to see the change where it looks like it’s about to take off, as opposed to when you’re just getting two cases today, skip a day, three cases today, skip a day, when we’re talking about consistent increase in cases daily.

00:19:42 Samantha: We have updates almost daily, so we’re constantly having information in this day and age, where everything is up-to-date. Do you think we should let our children watch them with us? Or maybe keep that away from them or wait until they’re, maybe, a bit older?

00:20:09 Dr. Jackson: I think that definitely is going to be a decision that a parent has to make based on how they understand their child. In general, younger children don’t need to see that. As I said, their reference point is very short. They’re talking about today and tomorrow. And so the other thing is, with younger children, when they see a repeated news report, for them, it’s happening again. So if they were to, for example, watch a report of a car accident on the highway at 7:00 in the morning, and then they see the same report at 3:00 in the afternoon, for them, there were two car accidents. So it is important to guard younger children from overexposure because, one, it doesn’t mean that much to them if it’s 7 or if it’s 70. They don’t [inaudible] what’s the reference point? And two, it increases anxiety for them.

For older children, you have some children who are very interested in the science. They’re doing the research. We have a whole heap of budding epidemiologists and statisticians out there following it on the internet. And if you can have a good conversation with your child, by all means, you should. I think it’s just for the parent to really look and see, is this creating anxiety from your child? Or is it giving them a sense of purpose? So I can follow this, this is something I can do, this is something I can understand to help me not feel as helpless. So you really have to look at your individual child, because in a family, you may have one child that can’t miss it and wants to watch it is. For them, it’s like football scores or cricket scores, where they’re interested in the numbers and the tracking. And especially since there’s no sports around, maybe this is their sport. But you have other children who just find it overwhelming. And if I’m going to hear 20,000 people died, I feel like all 20 of them are lying on top of me and it’s crushing me. And I don’t want to hear it again. So you really have to know your child, and each child is different. So just be tuned in to what is happening with them. And if somebody prefers not to hear it, then try to keep it away from them.

00:22:28 Samantha: So school has been out for, what, a month now. Doesn’t really seem like it’s going to be opened up, at least not until September. I don’t know. I’m trying to be hopeful. How can parents balance keeping their child learning, but not– but also balancing having fun and stuff like that?

00:23:00 Dr. Jackson: So that is a tough, tough, tough balance to get because it’s not just you entertaining your child, but you have work to do as well. And for those parents who are working from home, and are glad to be able to work from home because we would like to get whatever version of the salary we were getting before we would like to continue getting it. Working from home and monitoring your kid is very difficult, very, very difficult.

I find that parents help each other more than anybody else can in terms of coming up with ideas for how to manage. And if you can do virtual sharing– so this mommy is going to have the group on Zoom for this two hours, while all the other mommies get a chance to do two hours of work. And then, we switch it or– but even when you do that, kids want to touch base with the parent. They will pop out of the two hour session because they want to just make sure you’re still there. They want water. The tummy feel funny and just want to make sure you’re there, share the joke that was told. They want to connect. And it takes a lot of reassuring.

But sharing that burden where you can, is certainly very, very advantageous and electronic babysitting can– I’ve heard of a couple parent groups that have been doing that and it’s working fairly well for them. It’s going to take time for kids to adjust to this new approach. But it is a very difficult balance. I can’t say I’ve heard any foolproof, “This is the thing to do.”

Even when you have situations where the teachers take the class time and are actively teaching– because some schools, the teachers are actively teaching; some schools just send the work and the parent has to do it. But even when you have the teacher actively teaching, that kid still wants to make sure that you are still there. So it is difficult. It is difficult. I’m sure that all the self-help gurus are going to come up with some good ideas for us. But right now, I think everybody’s just trying to figure it out for themselves.

00:25:34 Samantha: Yes, how to work while your kids are home. How to work while under quarantine, stuff like that. I can see it now. I think persons have already been sharing and putting out– let me just make my Yeng Yeng pass [laughter]. But persons have been shared and talking and persons are getting ideas. It really is something new for us here. But one of the major ways that we can prevent spread is by social distancing, hand washing. For persons at home– and when it comes to, I say, social distancing especially, how do you think parents can navigate that one tactic with their children? But if you are non-healthcare worker, what are your thoughts on social distancing within the home?

00:26:55 Dr. Jackson: So if nobody from the home is going outside– so say, for example, parents or caregivers are working from home and children at home, if nobody is going outside, there is no need for you to socially distance yourself from each other. If you have three kids who are all together in the house, have been all together in the house all along, they do not need to space out from each other. And in that situation, it’s usually recommended that one adult, ideally, be assigned to going outside. So for example, going to the supermarket, going to the pharmacy. If only one person does that, then you help to protect your inside unit or your safe unit.

So it is very, very important that children understand that this, in the house, is their safe space. They can touch the table in the house, they can touch one another, and this space is safe. Now, in this situation where you have someone in the house who is high risk for one reason or another– so if you have someone in the house, for example, who is immunocompromised or a little bit older than 65, 75, then that person now becomes somebody that we all want to protect. And so you frame it for them how they will need to stay away, how they create space for somebody.

In your situation, if you have a parent who is within essential services in whatever realm, but they’re out on the street touching people all day, then you want them to understand that, okay, is there a transition zone at your home? Is this where they come in, take off their mask, wash the face, wash the hands, change the clothes, so the child understands that we have put aside that contamination from outside, and now we’re going to allow this person to enter our safe space. If it is that that person, by the nature of their job, is going to put– is going to compromise people and they’re self-isolating, then explain to the child, “This is still your safe space. But that person won’t be able to fully participate in the safe space.”

But I can tell you, I have had kids come to my office and anybody who is coming to the office has an urgent problem. And the two-year-olds and three-year-olds and four-year-olds, they want to– I have on my mask, they want to jump in your lap, they want to tear off the mask. They’re not the least bit concerned with me and my physical distancing issues. It’s not natural to children, and it’s really just best to keep the kid at home. Define to them what their boundaries are and let them be free in that space where they know that they’ll be safe. The less you have to take a kid out, the better off you’re going to be. It is very difficult for children to manage, even big kids, even high school age kids. The instinct to hug and to greed and to– Jamaica is very inna yuh business, inna yuh face [laughter]. And it is difficult. And the safest thing to do is to just keep that child in their safe space. Don’t let them out.

00:30:18 Samantha: Yeah, especially– because I’m on pediatrics now, so just working with kids, they like to touch a lot of things. They put a lot of things in their mouth. They like putting their hands in their mouth, everything is very in their mouth. And they like to be held and they like to be around people and they want to share your space with you. So I find that especially for children, the best thing that we can do is, yes, keep them home and keep them safe so that we– we’re having issues now with adults understanding social distancing and for children, it’s really just natural. They see somebody they like, they want lift up, they want hand, they want you to feed them, all of this.

00:31:18 Dr. Jackson: Exactly.

00:31:19 Samantha: And this is a nice segue for– let’s flip the script. Past prevention, we’re now at someone who is positive for COVID-19. Recently, we’ve been talking about breastfeeding while positive with COVID-19. Because it’s so new, I’m sure they’re persons wondering, “Okay, but suppose I have it and I have young children? Many persons might not be able to ask someone to come in and care for their child. So many might be wondering, “If I test positive, will I be able to care for my child? Will I still be able to breastfeed? What do I need to change? What do I need to do differently?”

00:32:08 Dr. Jackson: Okay. So for a mom who is caring for very young kids– so I start off with a mom who has been isolating and doesn’t have any known exposure and doesn’t have any symptoms, she can breastfeed. She can care for her children in a normal way. For a mom who is confirmed to be positive, ideally, you would like that mom to be isolated from the family. It is extremely difficult to isolate a mom from kids. And I think that might be one of the scenarios where if it is possible to isolate the mom elsewhere, it might be a little more realistic.

In a situation where a mom is breastfeeding and positive and she’s otherwise well– so she’s an asymptomatic carrier, but we’ve found that she’s positive, it is recommended that mom wear a mask, but she can continue to breastfeed. It is only moms who have symptoms, I believe, that they have asked to stop breastfeeding. And that takes me to the very important point that primary healthcare cannot be surrendered while we fight the pandemic.

And why I say that: breastfeeding provides important immunity to babies for them to be able to fight whatever is coming. And vaccines that children get, particularly in the first two years of life, are very important for children. And even in this current state of the pandemic, it is important that parents stick to their vaccine regime because the last thing you want is your five-year-old who has been at home with all your other kids, finally gets to go back out and bam, we have a measles epidemic, we have a mumps epidemic, we have– I can’t imagine having a child with that type of contagious viral illness while we’re still looking at cases of COVID in the hospital.

It’s just a scary and overwhelming thought. And it is critical. And it is a global recommendation that children under two should continue to get their routine vaccines because their immune system needs the support. We can’t take the chance that they end up getting something else because we’re trying to avoid COVID-19.

00:34:47 Samantha: Exactly. I think right now, we’re really getting to see how much of a role health and the healthcare system plays because, yes, we’re under lockdown, everything is under standstill, we’re quarantining, we’re at home, we’re staying home. But some things, like doing your well-baby checkups, certain– well, I don’t want to bring up clinics, but certain persons still will have to be seen for their appointments, depending on what they have. I, personally, am not sure if it really is possible to just cancel– just stop everything. Vaccinations have to be going. Babies are still being born, so they have to be getting their BCGs. I think we can debulk the system or skeletonize it, but there’re certain things that will have to stay.

00:35:50 Dr. Jackson: So there are two specific programmes that are considered mandatory programmes. So even if we are at war, and bombs are flying, mandatory programmes are HIV treatment and immunization. Those two programmes must be maintained. And right now, I am very proud to say that we are indeed maintaining offering immunizations and offering care for our HIV patients across the country. The access times might be a little different. And I appeal to parents, even if you’re outside of the age of immunization, but if your child has a chronic illness, now is the time to talk to your healthcare provider.

Find out if we have an emergency and we are on lockdown, how do I get in touch with you? Do I get in touch with you by email? Do you have a WhatsApp number? What can I call? If your kid is asthmatic– my pumps, lay them out; send a picture. This is pump A. This is when I use it. This is pump B. This is when I use it. Be very clear, especially for kids who have respiratory problems, be very clear as a parent, what is my action plan? Because you don’t want to be in a problem six weeks from now, when you have to get police escort. No doctors are going to be in their office. The hospital is only taking emergencies, and you end up with your hands in the air.

You really have to be proactive now. Now, we see it coming, so in the same way that if a hurricane is coming, now is the time to batten up the windows. The wave is coming. And now is the time to prepare for your kids, especially kids who have chronic illness, as a parent, to have that master plan. Write it down, shared it with the doctor. Did I get that right? These are the things that usually happen? How should I deal with it? If my child has seizures on their regular amount of medication, what is the first thing I do at home before I try and get in touch with the health system? And the thought that I’m just going to jump in a car and go to the hospital is not the primary thought we– as parents at home, we need to have a clear idea of what is the first thing that I can do. And be sure of everything that you need.

00:38:12 Samantha: So these are questions that parents should ask, but– and at the same time, not but, and at the same time, persons involved in primary care and clinics that are still going on now, can offer– so I know that for some places or most places, in terms of medications, at least having a more than one month supply.

00:38:36 Dr. Jackson: Definitely.

00:38:38 Samantha: And for asthmatic, definitely have to understand their action plan, their green, yellow, and red zones and what to do in those moments. And just having an understanding of what to do and when to come in, or when it’s an emergency.

00:39:00 Dr. Jackson: Right.

00:39:02 Samantha: So hopefully, I hope that parents, anybody listening to this will call a parent or if you’re a parent, and [you?] say, “Oh gosh, I need to get in contact with my doctor.” And this “get in contact” doesn’t have to be physically going to their office.

00:39:16 Dr. Jackson: That’s right.

00:39:17 Samantha: But simply calling the office, emailing the office, and asking them for some guidance during this time. And I suppose, when you have things that maybe– I was about to say like a cold, but with COVID you know, maybe call the hotline for a cold, but–

00:39:37 Dr. Jackson: If you have cold symptoms, please call the hotline. But allergies is another big thing. A lot of Jamaicans have allergies. A lot of kids sneeze down the place. I’m surprised and happy that my neighbours have not called the police on me. Because several mornings I wake up and I sneeze for several minutes and I listen out to hear if there’s a siren coming. But I know that it’s my allergies; after 10 minutes, it’s gone. It’s not an ongoing symptom. And if you know that your kid has allergies, you need to have a clear– do I have my nasal spray? Do I have my antihistamine? When do I give which one? What is the step one? What is the step two? You don’t want it to be a situation where the child is sneezing down the place, you’re starting to freak out now because in your mind, everything is starting to merge together and you just give them every single medication you have in the cupboard. That’s not where you want to be. You want to have your step one, step two, when do I call the doctor, how do I contact my doctor because a lot of offices are changing how they communicate. So make sure you know how you’re going to find your doctor if you have a problem.

00:40:53 Samantha: And now we’re seeing where a lot of doctors are doing telemedicine as well

00:40:58 Dr. Jackson: Oh yes.

00:41:00 Samantha: Where for certain issues, you can just contact them. I’m not really sure– well, you contact, you make an appointment, and you can see your doctor at that time. I couldn’t have this and not talk about healthcare workers because healthcare workers are human too. They have children. The have young children, older children, and I think it might be difficult for them, especially during this time. How do you think it can be easier for them and on their children, being an essential worker now?

00:41:44 Dr. Jackson: So that is a real challenge and being an essential worker is one element because it increases your– being away from the child, not following the rules that they’re hearing about on TV. Everybody says, “Stay home and yet you’re getting up to go out every day. What’s up with that?” So it’s not just that you’re not following the rules, so the child is now going to wonder, “Are you actually safe?” But the risk of a healthcare worker being infected is significantly higher than a lot of other services. And so the risk of– the concern of, “Am I going to bring this home to my children? Am I going to bring this home to my parents? What should I really be doing as a healthcare worker?”

And there’s so much unknown that it is impossible for me to really make a recommendation. But I will say is healthcare worker who are in low exposure experiences– so if you work, for example, in a clinic or you work in an office that only sees well patients or screening, so on and so forth, and you know that you’re a low exposure, then it is easier for you to feel comfortable that if I decontaminate myself well – and there are 10,000 YouTube videos – then, it will be okay for me to interact with my family.

Healthcare workers now, who work in an environment where they actually work with positive patients, or they are working in an environment with aerosol formation – can’t remember the verb [laughter] – then, those healthcare workers that are at higher risk of contracting it and of being able to transport it home. And so you have to make the decision.

The other day, I was talking to my husband and I said to him, “I want to be, if I could choose—because since 80% of us are going to get it, I’m going to assume that I’m going to get it. I want to be an asymptomatic carrier, and I believe that a low dose inoculum is my best bet.” And he said to me, “What do you mean?” And I said, “Well, you know, if I get exposed to a tiny bit of the virus at the office and I get exposed to a tiny bit when I go to the supermarket, then hopefully my immune system will build up and I never reach the point where somebody sneezes in my face with it, or I never reach the point where somebody coughs in my face with it, which would be a high dose.” And he said to me he had no– he ever thought of viruses in that way. He figured once one single virus touch you, you’re going to be infected. I said, “No, your body works pretty hard and fast and if that was the situation, all of us would have it already.”

00:44:53 Samantha: Exactly.

00:44:53 Dr. Jackson: Your body works hard and fast to try and protect you. So when you put in these measures, your body, your chemistry is working with you too. And so for healthcare workers who are in that more high-risk exposure, it’s really to look at what is that dose frequency or what is that dose volume that I really have to consider separating myself from my family. Right now in Jamaica, we’re very, very, very lucky because the amount of persons in hospital is small. I well understand in a situation where your hospital population is mostly positive patients, then there is a definite advantage to separating yourself from your family in that period, just because the dose frequency is changing.

It’s a difficult thing. Right now, mostly, we’re not there. I mean, I know a lot of dentists who have closed because they just don’t want to increase that dose of exposure to themselves. But it’s a personal decision. Am I going to continue to work? Am I going to stop working? If I am going to continue to work, am I going to separate myself from my family? And if I am going to separate myself from my family, I don’t know any doctors who have any spare homes next door, so where am I going to go? So there’s a lot to be considered and we have this period now where we have the luxury of time to consider it. It needs to be high on the list of things that our high-exposure staff members have to think about, doctors, nurses, cleaning people, all of the people who really are going to have that risk of exposure, to consider: how will I protect my family long-term?

00:46:57 Samantha: Yep. Exactly. Thank you so much for having this conversation with me. You answered a lot of my questions. I was really curious. I think curiosity stemmed from the fact that I’ve just started working with kids at the beginning of this month, and COVID also came out– well, not came out, became topical for us here in Jamaica in the last month or so. So thank you so much for sharing. I really hope that persons have learnt and have gotten ideas from it, especially in terms of preparing for the pandemic, especially if they have children with illnesses. And also, the four pillars that you have mentioned: sleep, nutrition, moving and love. I hope that they consider it and adapt it to their new lifestyle.

00:48:07 Dr. Jackson: There is one thing that I want to bring up. As I said, I have a wellness centre and we do mental health and nutritional counselling. A lot of Jamaicans don’t recognize that children can have mental health issues. Children find things difficult to cope with under normal circumstances. The most common things we see are usually grief, having lost a grandma or a parent or so on, and trauma, and divorce. Those are the things that really will– children will struggle to cope with. And when they come for mental health care, it’s not that they’re coming for drugs or medication or so on, they’re coming to learn how to cope with what’s happening with them in their life.

And over the years, we have had a series of clients, obviously. And what we have found now, this stress aggravates previous issues for quite a few of our clients. And it’s important for parents to be able to say, “I think my child has reached a point where they are– I can’t help them. They’re just not coping,” and get mental health help for your child in the exact same way that if your child was asthmatic and not breathing, at some point you’d say, “Let’s’ go to the hospital.” If you find that your child is not coping with what’s happening around them, get mental health help. We offer telehealth services at the counselling centre for both mental health and nutrition, so there’s no excuse to come out of this quarantine 75 pounds heavier than you were [laughter].

00:50:07 Samantha: Wow, drag. Drag.

00:50:09 Dr. Jackson: Oh yes, I am putting it out there. Now is the time to learn to cook and now is the time to learn to meal plan. But if you think your child is having a problem, be that support for them and get the help for them. So we offer mental health by tele counselling and so on. And I know that there’re quite a few other psychologists in Kingston and across Jamaica who are doing that. So don’t say that because we’re all home in the house they’re just going to have to work it out. We need to be practical, we need to be honest, and we need to be that strength that the child can come to us and we recognize for them what they need and help them to get what they need.

00:50:51 Samantha: Exactly. I know for the childless persons out there that this has also been useful because there’re some tips in here that I’m going to take back and use in my own personal life. And I don’t have any kids, even though I’m kind of a big kid in my opinion, so.

00:51:12 Dr. Jackson: That’s the best life.

00:51:14 Samantha: A lot of these things I can use for myself as well. So thank you, again, so much for coming. You have anything you want to say, anything you want to promote? How can we contact you? You want to give any shout outs?

00:51:32 Dr. Jackson: I am a big Twitterholic. My family think I’m on Twitter too much, drcjpj. And so if you want to contact me, that’s a very good way. Professionally, I work at Kiddie Care Pediatricians and they answer the phone when you call. We’re still open. And I want to give a big shout out to my Caribbean Tots to Teens family. They have adapted, they have adjusted. We have done everything we can to maintain good quality, continuous mental health services for our clients. And we are trying to come up with all the ways that we can help those parents who are struggling at home to really be able to give their kids that additional support. And I really want to shout them out because in the midst of all that they are going through personally, they still make themselves available to the kids who need the help.

00:52:29 Samantha: And how can we contact them?

00:52:32 Dr. Jackson: Tots to Teens is best contacted via their phone number, which is– I’m going to say go on our website, Carib, C-A-R-I-B, Tots, as in little babies, T-O-T-S, the number 2, teens, T-E-E-N-S. Everything for us is CaribTots2Teens, our website, our Instagram, our Twitter, our Facebook. Our numbers will be there. Our WhatsApp number is up. If I knew the WhatsApp number by heart, I would tell you [laughter].

00:53:08 Samantha: I will also link all of these in the show notes. So when I put this out, I will put your Twitter handle and all of that information that you just said in this for the one block, all there so persons can find it there as well. Thank you so much, again, for sharing with us and for speaking with us.

00:53:29 Dr. Jackson: It was a pleasure to be here and I hope that somewhere along the way, we helped one child to have a better time in this difficult time.

00:53:37 Samantha: Yes. I can be contacted on Twitter and Instagram @thelaymansdr, that is thelaymansdoctor@gmail.com. Feel free to send me emails, questions, anything. Also, for a chance to be featured on one of these episodes. On any site that you’re listening to this to, please subscribe, rate, and share with a friend. Again, thank you so much for listening. [music]

[END OF AUDIO]

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