010: Tiffany & Naeem

COVID-19
Written By Tiffany Yu

Tiffany & Naeem | COVID-19 and Mental Health from a Frontline Health Worker in Zambia ft. Naeem Dalal, MD

Listen on: Apple // Spotify // Google

In this episode, we’re chatting with Zambian medical doctor Naeem Dalal about COVID-19 in Zambia and mental health among youth, our frontline health workers, and all of us.

We discussed:

  • How Naeem became passionate about youth mental health

  • The importance of preventative health and digital safety

  • COVID-19 in Zambia

  • Our frontline health workers, mental health, and compassion fatigue

  • The importance of empathy and sleep

Show Notes

About Naeem Dalal, MD

Naeem Dalal is leading grassroots to systems-level change around preventive and mental health. He has a track record of impact as a youth mentor, Global Shaper, academician, medical doctor and public health chairperson of the Zambia Medical Association. Using a holistic lens to promote health and well-being, he incorporates the voices of people with lived experiences coupled with evidence base science through research to bring about systems level change. Naeem is passionate about Brain health and his super power is 'Self Belief': Be kind, be brave but most importantly, be YOU, because nobody does YOU better than You.

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Transcript

Tiffany Yu: Welcome to Tiffany & Yu. I’m your host, Tiffany Yu. On today’s episode, we’re joined by Dr. Naeem Dalal, a Zambian medical doctor who is passionate about brain health and mental health. Naeem is a proud third generation Zambian working as a frontline health worker during this pandemic. I’m really grateful he took the time to chat with me because our frontline and essential workers are overwhelmed and overextended during this time. But he knew how important it is for us to be talking about mental health right now. May is Mental Health Awareness Month, but we will continue to have these conversations all year round. He and I chatted about youth mental health, the mental health of our frontline workers, and all of our own mental health. This is our 10th episode. I can’t believe we’ve made it to 10 episodes. But I wanted to put a quick plug in here that the best way you can support this podcast is by sharing it with someone else or by taking 2 minutes to leave us a review over at Apple Podcasts. This allows others to discover these conversations and I hope you enjoy this one.

Tiffany Yu: Hi everyone. It's Tiffany here. And you're listening to this episode of Tiffany & Yu. Today, I have a very special guest with me, Dr. Naeem Dalal. Hi Naeem! 

Naeem Dalal, MD: Hey Tiffany! 

Tiffany Yu: Naeem is another one of those special friends that I haven't met in person yet. He and I are both part of the Global Shapers Community. We've interviewed a bunch of other Global Shapers throughout this podcast. Naeem is based in Lusaka, Zambia. Is that correct? 

Naeem Dalal, MD: Yes, I am. 

Tiffany Yu: Again, we are navigating some time zone differences. I believe it's nine hours this time. Naeem-- He's a medical doctor right now. He's getting his Master's in Psychiatry. I thought I would just kick it off to get the origin story of what made you decide to get interested in medicine and the Master's degree that you're pursuing now. 

Naeem Dalal, MD: Yes. Great. So born and bred in Lusaka, Zambia, third generation Zambian, went to medical school in Zambia, graduated in early 2015. And then, when you graduate as a medical doctor in Zambia, you have to do compulsory 18 months of internship in all the four major disciplines of medicine, which is obstetrics and gynecology, internal medicine, pediatrics, which is child health as well as surgery. So I went through all those rotations and, what I found was there was a gap in mental health and psychiatry. So that's really the reason why I decided to join mental health. Now, looking back in hindsight, in when I was in obstetrics and gynecology, I was exposed to a lot of young adolescent girls coming in with early pregnancies and also having exposure to a lot of women who are going through postnatal mental health challenges. And this just kind of made me question the need for mental health, just in the field of obstetrics and gynecology. Then when I went into internal medicine-- we have a high prevalence of HIV in Zambia, right? So I was part of the renal unit and many of the patients were going through dialysis. I came across this one person who was not taking their medication for HIV. And I took the time to find out why, only to find that this person did not want to live. And the way they wanted to end their life was by not taking the medication. And when I probed further, through my various reviews, I found out that this person did not want to self harm because of the taboo of suicide in Zambia. So again, the cultural perspective came in, but that just gave me insight into the need for mental health. When I went to pediatrics in child health, we have a high burden of malnutrition. Now malnutrition is in under five. Now again, the question came in, why is it that children, who are supposed to be looked after, are coming in with malnutrition? And that's true in the capital city where I am in Zambia. So when I sat down again and sat down with the guardians, I found out that the guardians actually had a lot of challenges, psychosocial challenges, and this is why they will not be able, majority were not able to look after their children because of social, as well as psychosocial challenges such as financial burden as well as self-medicating and coping with substances like alcohol and other parents, actually had underlying psychosocial disorders. So again, that gave me an insight saying, Hey, there's actually a gap in mental health. Then finally, my final rotation was actually general surgery where I was in emergency ER until this one day, this young girl came in. And she was referred a few hundred kilometers outside the capital city, came to the hospital where I was based. And this young girl had taken, she was 16, and she had taken battery acid to end her life. Not once Tiffany did I ask this young girl, why? Because I was so engrossed in my surgical rotation, making sure I stabilize this young girl. I take [inaudible], make sure we save this life. But unfortunately, I could not save this life, but after she passed on, her mom said to me, thank you very much. And I was lost for words, and her mom explained that she saw her daughter smile just by my words. And she said that her older sister had also taken her own life. And that was because of the social abuse that her daughters went through. And this just brought me back to reality. And the fact that mental health is equally real. And it made me restructure my understanding and. Just this focusing on the disciplines of physical health is not real health and the need for mental health, and this is how with the gap in mental health in Zambia, I decided to say I am going to specialize in mental health and psychiatry.

Tiffany Yu: What you're touching on there really reminds me-- so I have a spinal cord injury called the brachial plexus injury from a car accident as a kid when I was nine. And my dad also passed away in the accident, but in my rehabilitation phase so much of it was fixated on the physical therapy. And to be honest, I received no mental health support until a little less than five years ago. And so even in my work, I think there is a very prevalent mental health component that people don't focus as much on because you can't see it as clearly as a physical injury or physical disability. You've done a lot of really great work around youth mental health advocacy. It looks like you have this project called Ganizo? 

Naeem Dalal, MD: Ganizo.

Tiffany Yu: Tell me a little bit more about that. 

Naeem Dalal, MD: Before I go into that, thank you so much for sharing and I'm so sorry to hear that. So youth mental health basically stems from what you just shared. You know, majority of the mental health conditions start as early as the age of 14 and up to 75% are found out and diagnosed as early as 21 to 24. And that's just a stem of understanding that if we want to find out and if we want to treat mental health, we need to catch it early on and we need to try and come up with preventive innovative measures. Brain health is very difficult to diagnose because there's no biomarkers, unlike in physical health. But we've making so many strides and we're now coming to understand that mental health is more, not just environmentally linked, but also genetically linked. And this is why my passion stems in identifying mental health in terms of youth and how can we come up with innovative ideas and ways to identify mental health early on and get people the treatment they need so that they can live healthy, active lives. I usually compare mental health to noncommunicable diseases like hypertension and diabetes. If you get the correct lifestyle support, the correct social support, and if you identify and treat it, you are going to have a healthy life and you are going to live just as any other person. So this is why I am so passionate about youth mental health. And also secondly, my experience and my practice is, majority of the people in my country, in Zambia, are youth. And that is the population that I get to serve and in service driven delivery. So again, that's another reason why I am so passionate about mental health. So Ganizo basically means thoughts. And one thing that I need to stress is that mental health-- terms such as depression, terms such as schizophrenia, terms such as psychosis, as well as terms such as DNA, are not really translated and not really understood in the local languages in a country like Zambia. So, Ganizo came from that stem where I'm communicating to people in my day to day practice and I'm using terms that are more coming from the Western world. Trying to explain to people that you're feeling low, you are depressed, you are going through a process. It's not a one day thing, you know? Through my frequently asked questions and feedback from my patients and my clients and my service. I came to an understanding that, we need to convert and translate these, diseases, these disorders in local languages so that more and more people understand. So that's where the term Ganizo came about. It's a Chewa word for thoughts and brain health. And what I basically do is I go out in communities and I have started a psychosocial peer support network in the youth. Youth that are more inclined in understanding what brain health is and wanting to be more self aware. And again, coming back to the stem of psychology and personalities and personalities forming in youth and adolescence is another reason why youth mental health really intrigues me because that's the time, just out of primary school going into secondary school, going to high school, from high school, you want to go to uni and you really want to find yourself, who are you and what is your purpose? And that's the time majority of the environmental stresses and factors come in. How do all of that interplay into an individual coming up with a mental health disorder? So all of that really intrigues me and that's how I ended up with youth mental health as a passion. That's how I actually found myself in Global Shapers. And also that's how I am practicing today. 

Tiffany Yu: And that's how you found yourself at Davos this year, right? 

Naeem Dalal, MD: Yes. So I was invited to Davos to basically make a case for youth mental health and investing in mental health in general. So, there's a campaign called Speak Your Mind. Speak Your Mind is a campaign that is amazing. I actually recommend everyone to look it up. It's a campaign that is run by advocates in mental health. The beauty about this campaign is that it's not just run by individuals who are passionate about mental health, but it's also people with lived experiences, and I believe people with lived experiences are the best advocates. So they come from various countries. Right now, more than 16 countries have come together to advocate for mental health and make a case that mental health is just as equally, if not more important than physical health and the need to invest and act in it. So that's a campaign that's come up. we need to invest in mental health so that people can live their best lives. And the whole point comes from is from idea that if an individual is unwell mentally, and for instance, they're having, a person has depression and they're having a low moment in their life and they're not going to work, the family is affected because the person is probably not bringing in money. Okay. The person's community is affected as well as the economy in a indirect form is directly affected. So the whole point is how can we make people who have mental health actually live stable lives so that the economy also thrives? Because you remember one in four people, that's the statistic, right? One in four people is at risk or has a mental health disorder. So that's the whole idea with Speak Your Mind campaign and also, that's how I found myself at Davos. 

Tiffany Yu: And the World Economic Forum sees this as important as well. They partnered with a youth mental health research and clinical translation center called Orygen, which I think you had done some policy consultation with them. They're actually coming out with a Global Framework for Youth Mental Health on May 27th. This episode is going to go live before that, so we'll include a link if anyone wants to join, but together they developed this Global Youth Mental Health Framework to support and guide local implementation of youth mental health care in any resource setting or country. So I'm really excited to see what the findings were. I was really excited to see that partnership between WEF and Orygen and to see that you were involved in those conversations and also really excited to see the World Economic Forum bringing mental health to the global agenda, and also really highlighting the power of lived experience. And I know Sanju talked a lot about how he really appreciated how valued his lived experience was on the World Economic Forum stage at Davos. 

Naeem Dalal, MD: Yes, I totally agree. I'm actually excited about it because they literally traveled the whole world, the whole globe, and they literally consulted every part of the world. And not just looking at a professional and clinicians like myself, but also looking at people with lived experience. So I'm really, really excited and yes, people should look out for it. 

Tiffany Yu: Awesome. So, this was more of a funny question, but as I was doing research for our conversation, I saw that in your Twitter bio, it had said, an apple a day doesn't keep the doctor away, but today when I looked, you changed it. So just wanted to know a little bit more about what that original saying was in there for what the significance of that was and why you changed it to what it is now. 

Naeem Dalal, MD: All right. Okay. So it's just a pun, really. People underestimate the need for prevention and preventive health, and that's where the whole old, you know, the old saying comes from an apple a day in the early days used to be a saying used for nutritious foods and lifestyle. And we often, today in today's world, we often get very engrossed with our reality and forget the need to focus on ourselves. We're very impact driven, but poor at self-care and introspection. So I usually tell people to say, an apple a day will not keep me away because, no matter what you do, if you're not really focusing on the preventive part of your lifestyle in terms of your health, you are going to fall ill because of mental illness or physical illness. So that's just the point I often use to let people know that, I'm not that kind of a doctor that's gonna stay away if you take an apple everyday, you really need to focus on yourself. And then, the thing that I changed to today, was, just, saying that the words that we use and we tell children to say, sticks and stones may break my bones, but words will never hurt me. That's just to help children build self esteem and just keep going. But I find that very overwhelming in the sense that because now we know with a lot of research that, recurrent chronic stress, verbal, including, even things like verbal harassment can literally lead to changes in the person's brain. And that is why words are literally very, very strong, and it can literally shred your brain. So that's, that's just the change. Just being in the neuroscience piece of it. 

Tiffany Yu: Yeah. I love the message. Words definitely do matter. I will specify that when you did have the old an apple a day doesn't keep the doctor away, you did have the emoji of an iPhone and an Apple. So I thought it was interesting to kind of make that distinction because, I know one of the things you also advocate for is digital safety, creating those boundaries there as well for your mental health. 

Naeem Dalal, MD: Yeah, very, very true. So one of the panels that I was part of at Davos early this year was digital safety in the youth. And I was on the panel with Molly Burke, other professionals in cybersecurity as well as a teacher. It was an open forum. What that basically means is it was driven by the youth in Davos that wanted to discuss this topic, which is digital youth. And now with COVID-19, we're all digitally connected and the need to be aware that you need to understand your digital self and your digital footprint is equally as important as your reality right now. And I often tell people that there's no such thing as good or bad people online. It's just people. And there's no such thing as a hacker being just a technology. It's someone else on the other side. So you really need to be aware of what you're doing online. And also, you know, how social media and as individuals, we are a social being and how social media has literally taken over how we're always found with our gadgets and the screen time and everything, how it has a direct effect on our brain health. So all those things are really coming up in my clinical practice and just in the whole brain health sector. And we're more and more curious in finding how, as we drift towards technology driven society is how that is affecting our health and wellbeing. 

Tiffany Yu: First of all, Molly Burke is so cool. I don't know her personally, but really amazing disability advocate, a blind singer, performer. And you got to be on that panel with her. But I think the other thing is, I was at a session yesterday where they talked about , logging into whatever social media channel you use the most, and just unfollowing. Like taking a Marie Kondo approach, and if the content isn't bringing you joy to unfollow, and it's not anything personal, but a big part of it is, the thing about social media is that sometimes you just don't know what content you're going to get. And for those of us who may have some triggers. We also don't know what type of content we're going to see that may trigger us in a certain way. So all of that said, I'm going to take a quick break here, and when we come back, we will continue the conversation with Dr. Naeem Dalal.

[break]

Tiffany Yu: And we're back from the break. You're listening to this episode of Tiffany & Yu. This is your host, Tiffany Yu. Before the break, we were chatting with Dr. Naeem Dalal about his journey into becoming a really passionate advocate around youth mental health, some of the work that he is doing around digital health, and some of the work he's doing around really advocating for getting everyone at all levels, from governments to those more on the grassroots level to really invest in youth mental health. Hi Naeem! 

Naeem Dalal, MD: Hey Tiffany. 

Tiffany Yu: Most of our listeners, I believe, are US-based. Right now as we are recording this. We are, I want to say probably in week nine or so of San Francisco's quarantine, slash shelter in place. What's the situation in Zambia right now? And what's your role in all of this? 

Naeem Dalal, MD: All right. Okay. So Zambia is in Central Africa, right? And we are a landlocked country with the most altruistic people. Very welcoming and caring people. We recorded our first case of COVID-19 in late March, and restrictions were put in place to mitigate the foreseeable consequences of COVID-19 right. so as of today, the total numbers of cases that have been recorded after over 20,000 tests have been up to 920 cases. And we are a population of about 18 million people. And, the cases that have been recorded so far, we've had a death rate of seven. So we're in the single digits, and we're very grateful for that. Now with us in Zambia, we've never had a full lockdown. And the reason is behind this is we are landlocked. And we literally, are dependent on other countries for our basic necessities coming in our country. So the question many Zambians have because of the trajectory of the disease here is COVID-19 real and the needs to choose life versus livelihoods as many live below the basic daily wage earning line, a majority of the people live below the socioeconomic status that they require for them to keep up with their living. And it's more a standoff between basic physiological needs of food, water, shelter, and warmth, and this disease, which is COVID-19. So, we have not had a lockdown, as I said, but preventative measures of hand washing, physical distancing, putting on a face mask are being advocated for, and many people are abiding by it. But because of our economy, relying heavily on tourism as well as agriculture, it has taken a huge toll. And, we are concerned because a lot of people, having to choose between livelihood versus actually abiding by these preventative measures. So. That's how COVID-19 is attacking Zambia. Really, it's the consequences of COVID-19 that many people are concerned about, even through my advocacy. So apart from being a psychiatrist registrar in my practice, helping out frontline health staff as well as people who are testing positive in isolation, helping them with the psychological and psychiatric element of treatment. I'm also the public health chairperson for the Zambia Medical Association. And part of my responsibilities involve advocacy as well as sensitization and, public health, delivery of information to the people. And based on my advocacy and outreach is so far to the grassroots, it's really, the question. To say, should we really just keep these preventive measures in place and let the economy run? Or should we actually follow suit with the strict measures and see how this all pans out? Because people are literally, for lack of a better term, literally suffering and they need the basic physiological needs of food and shelter over their heads. And there's a lot of stigma associated with COVID-19 here, no one can actually openly say that I tested for COVID-19. Because of the nature of the disease itself. People don't really understand that, this is a disease that is lethal and it is causing havoc all over the world. That's another thing. And also based on the knowledge that people have and getting the knowledge and questioning, you know, at the base of the needs, should I focus on not getting the disease, or should I focus on getting the meal that I need to survive? So these are very hard hitting questions that people have, and it's really overwhelming to see an already overwhelmed economic situation get even most stressed. 

Tiffany Yu: You wrote this great piece for the World Economic Forum Agenda called Africa cannot afford to lose doctors to COVID-19. And I just want to read two quotes from your piece. You said Zambia's healthcare system is already overburdened with one doctor for every 10,000 people. In my practice so far, I have already made the hard decision of who gets to live and who gets to die based on resources and their chances of survival. So that second sentence I just read is like my worst nightmare. You know? So in my disability advocacy work and a lot of what we are really focused on is how do we prevent discriminatory triage plans and practices if our disability community is getting difficulty getting access to beds. Are you still finding, you and other doctors having to make these types of hard decisions? 

Naeem Dalal, MD: I just want to say that that was a really hard piece to write because it was very introspective of what I was going through. And also based on this survey and the discussions I was having with my fellow colleagues here in practice. And when you read the headline, which says Africa cannot afford to lose any doctors, that was not saying in any way that any country can afford to lose any healthcare providers. The afford in that statement basically means the cost of price of something, you know? And this was  the whole essence of that title. And coming to the point that for every one doctor, at 10,000 people, that's how limited the healthcare system is. What I mean to say, Tiffany, is that we are already working in a very constrained healthcare system where resources, basic resources like gloves and masks and, you know, day to day activities that we carry out in terms of our procedures. We already don't have that many resources. With COVID-19, the need and creating resources and also, creating bed spaces for individuals who come in because it's an infectious disease is already straining the already overburdened healthcare system. For instance, let's take me for an example. I have a clinic where I see an average of 60 patients in a day. And then I am made to actually go and review patients at the isolation center. If you're going to take me out from my daily clinic, what happens to all those people who are coming for services at my clinic? So they miss out? So these are the hard consequences of COVID-19 on the healthcare system. People who are in the care and who are getting services are being made to wait because, it's for lack of a better term, not an emergency and it's a basic review. And we have digital poverty, not everyone. In fact, majority of the Zambians do not even have access to smartphones or mobile phones that they can communicate and we can use telehealth. So all of that is very, very overwhelming. And then coming to the point of the second quote where, you know, where I referenced to say, so find my practice making the decision of who gets to live and who gets to die is based on resources. I will simply say in a basic triage setup where you know, this person needs blood, this person requires urgent blood, but the blood bank is just has maybe two units of blood and then now you have to start choosing. You have two patients and you clearly know that both require blood. Then you start questioning, who am I going to transfuse the blood to. You know, so this is, this is just one of the many, many, many examples that we have to go through as healthcare workers in a resource constraints, constraint setting. So that's, that's where it was just an introspective piece when, you know, I was seeing all the news coming in from Spain and Italy, and it was heartfelt to see the decisions that the healthcare workers were making there. And it was somewhat a resonating, view from all of us here in Zambia who are already making these decisions based on the resources that we've been working with and so far. So that's where that, the article came in from.

Tiffany Yu: Thanks so much for writing that and for being vulnerable. I want to acknowledge that you are on the frontline. I really appreciate you making the time for this conversation. I think that for those of us who are based in the US, having access to smartphones, having access to wifi and the internet are things that we don't really think about, are very much rooted in privilege. So I think you being able to shed a little bit more light on what the realities are in other parts of the world are really important for our listeners. And I know that we're having this conversation likely at the end of a long day for you. So, again, appreciate your time. And I do want to provide a little bit more context here. I reached out to Naeem about a month ago with a desire to have him come on the podcast because I had seen him speak on a mental health panel related to another project called Block COVID. And he chatted about how we really needed to not only invest in everyone's mental health, but really talk about mental health for first responders. And so a month ago I heard back from Naeem, he said he was happy to do the interview, but he was really swamped. And so I was just like, I feel bad reaching out to someone who is on the frontline, taking up more of their time. But then, you heard Sanju's podcast. Then you asked me if we could make this conversation happen. I was curious if you wanted to expand a little bit about the mental health side of being on the frontline. And if there is any support there or what support do you need right now? 

Naeem Dalal, MD: in the beginning, there were all those articles that were coming out all over the world, being acknowledge as heroes, you know? And then. It was somewhat a mixed feeling because you know, you're going through a moral dilemma because COVID-19 is not your average disease. it's infectious. You at risk of getting it and if you do get it, you are at risk of actually falling prey to it. And then at the same time, if you do catch it, then you easily can spread it to your friends and family. So all of that is somewhat overwhelming for every healthcare worker out there. Everyone I spoke to all my colleagues, everyone, we often talk about it as saying, we did take this oath, we do want to save lives, but we don't. We need to make sure that we're equally looking after ourselves. But then we are so resilient in the sense that we have to help people, that we often forget about our own wellbeing. So that's something that a lot of people are going through. what we call like a moral dilemma in terms of, you know, the, the oath that you've taken as a healthcare provider versus providing care. And then at the same time, you're also looking at the authorities and the leaders and the people making the decisions. And you're questioning to say, I am helping people. I need to make sure that I'm safe as I'm helping other people. So, you know, that's where the question of personal protective equipment comes in. And, when you see someone on the road on the streets wearing, an  N-95 mask or a surgical mask, and you're questioning yourself, you say, I'm working in the hospital with people who have COVID-19 and I don't have that. What's really happening? It's not just the leaders, it's also the people that I'm staying within the thing community who are really, you know, putting that kind of a stress on me as an individual and fellow healthcare workers. So all those things really kind of, you know, play with, with your mental wellbeing. And, and the other thing is, as healthcare workers, we have shifts. We have our shifts. We have either eight hour shifts. We have our. 24 hour shifts, what we call our call days. Right now what's happening with COVID-19 is everyone is on a 24 hour shift, and when you're on a 24 hour shift, you often tend to miss your meals, you often tend to overlook your sleep and you kind of, you know, bring your immune system down because you're always constantly working mentally and physically fatigue. Now imagine doing that every day for at least a shift of 14 days or seven days, and then you exchange. That's so taxing on an individual that is literally leading to people's, going through a lot of, you know, psychological stress and what I think healthcare workers would need. And I think I'm really grateful to a lot of leaders, world leaders coming out and talking about is mental health support and psychosocial support. Really that's really, really needed for healthcare workers right now because in as much as we're superheroes, we are human and we are really going through the most right now.

Tiffany Yu: Referencing this April piece that you wrote, the last sentence of it is a call to action saying, for now, we don't want claps or hero salutes. We need a steady continued supply of PPE. And when you show up at work and you don't even have the baseline you need to protect those that you're caring for, I think that can also weigh on your mental health as well. So, I did want to reference again back to our WhatsApp chat. yesterday in preparation  for the conversation we were having today, you sent me a note saying, I've been having a long week, and exhibiting symptoms of compassion fatigue and compassion fatigue is a phrase , I've heard it in my work. and I think for those of us who work in social impact or have more of a care mindset, that is something that happens. But I was wondering if you could explain to our listeners what that is and what it looks like. Compassion fatigue. 

Naeem Dalal, MD: So compassion fatigue is the two words really. just put together fatigue, feeling overwhelmed, physically. But then compassion is where you are unable to feel what another person is feeling when you're trying to be empathetic towards another person. So with me in particular, I'll explain it. based on me as an individual. I've been going through, helping train people with psychosocial support and resilience, fellow health care workers who are going out as FirstLine respondents. I'm actually helping with, digital health tele-psychiatry with patients in isolation centers here in Zambia. I'm helping people who are reaching out to me as healthcare workers in terms of them needing support when they're. having compassion fatigue really. So all this is really making me feel overwhelmed. And what's this leading is a diminished ability to empathize, you know, to feel compassion for others. And it's kind of like a negative thing because you're not, I'm supposed to provide support and care for people, but if I'm not able to do that, then it's really not really fair to the other person. So with the long week, just to give you a background with the long week, it's just I've had all these, pending things that I'm supposed to do. and then I have these responsibilities in terms of my full time work. so it's, it's kinda just been overwhelming. And because of that, I've been feeling powerless, you know, like I feel like I need to do more because I'm supposed to help people. I'm just having difficulties with concentrating at times. and I can tell that because I'm usually one person who usually picks things out. And also I found myself, not as responsive as I'm usually with people. So these are little flags that I know for myself that, okay, you know, Naeem, you're not your usual self, so you need to take a backseat and you need to feel better. And, the other thing, the other reason why the compassion fatigue is even more pronounced now, not just for me, but other people, is because of, you know, the news and the media and just listening to all these stories, everything you used to do with COVID-19, and knowing that. There's so many consequences and so many people are directly affected and knowing that there's only so much that you can do. I know we as healthcare experts in mental health say, you know, just deal with what you can deal with everything else that you can't deal with, don't focus on it, but you know, it's so much harder than it is, to just say that. You know, so all that is, is, is what, is leading to me. That's why I told you to say, you know, I don't want to end up not delivering in this podcast and that, you know, some pointers on what we will discuss. And that's why I was very open and said, Hey, I'm, I'm eliciting symptoms of compassion fatigue and I'm very open and I always am very vulnerable and I speak, to my mental health and I'm very open about housekeeping rules and with my mental wellbeing as well. 

Tiffany Yu: For sure. Thank you for being open. Also, I think just leading by example in that way of being compassionate as well. And so, we talked about wanting to be informed, but not being overly informed if it's gonna impact your mental health. we're seeing this secondary crisis around mental health. So the United Nations published this policy briefing earlier this month on calling for global action on mental health amidst the pandemic. I know you mentioned you have been involved with the Speak Your Mind campaign. They have put together an open letter. I did see you signed your name to it. The open letter is urging, and this is something you brought to your platform at Davos as well, is to world leaders, politics, corporate social leaders, to really take action and invest in mental health. do you want to chat a little bit more about the letter?

Naeem Dalal, MD: Yeah. I'm really grateful. As I said, we see more and more world leaders coming and talking about mental health and the need for mental health. Earlier on this year at Davos a big theme was around mental health and how do you invest in mental health and get the, impact through it. And, you know, seeing, the UN and the platform of Antonio coming out and talking about mental health and needing to invest in it is very, very much needed right now because it's not just COVID-19. But also going. In forward about how this will impact people's mental health. And the other thing is the open letter is just talking to that saying, you know, we need to be straight. We need to be open. We need to be honest and say this has had a direct impact in each and everyone's life. And that impact is more psychological, emotional, and mental in nature. And we need to focus on that right now because you are going to not have productive people if we don't focus on people's mental health, and if we want to have productive individuals, the future will definitely not be as productive as we want to bounce back. And that's the whole point with this open letter to get people to just come on board and just take that initiative. So I would urge everyone to actually go onto the link. And sign it and also be aware, be more aware. And the other point about time to invest, it's not just financial investment, but it's also human capital. Get more people to join the field of mental health and help other people. And also as an individual, socially, as an individual, you can invest in your mental health by being more self aware of your own wellbeing and making sure you are going to be productive to yourself and your friends and your family.

Tiffany Yu: And one of the things I chatted with Sanju about was about how, as of right now, we don't have enough mental health providers for everyone who's going to have mental health issues as a result of this pandemic. I think gaining the tools around empathetic listening, the difference between empathy and sympathy is really important. I'm actually learning that this whole period is a really important lesson in empathy for me. I have realized that this pandemic is hard. It's hard on all of us, but in very different ways. So I'm living by myself. It's hard to be sheltering and live by yourself, but it's also hard to be sheltering and with other people, especially if there are some complex dynamics involved there. if you go to gospeakyourmind.org/open-letter, you can sign your name there. You can learn a little bit more about, what we are we, cause I have signed it as well, even though it doesn't show up on the list. I think that investing in your own mental health is super important. You did write another article for the World Economic Forum Agenda called 10 tips to safeguard sleep in the anxious times of COVID-19 . I wanted to chat a little bit with you about, why am I not sleeping well right now? And do you have any tips for me to really get better and deeper sleep? 

Naeem Dalal, MD: Yeah, but before I do, I just wanted to speak to your, your feedback on empathy. I have a question for you, Tiffany. You know how everyone says, in fact, every mental health expert right now will tell you to say, if you feel overwhelmed. Reach out to your friends and family or someone close to you. Now I have a question to you. If someone reaches out to you, Tiffany, how do you help them? Or if you reach out to someone with the hope that you are feeling overwhelmed, what do you expect from the other person? 

Tiffany Yu: I think that's a really beautiful distinction. I think, at least for me, it is no expectation on the outcome. So for example, you and I chatted very briefly about this, but one of my friends and a really incredible disability advocate, Stacey Milbern, she passed away on Tuesday. It was also her 33rd birthday, and it really affected me. And I took to social media, I posted a picture and some really great memories I had of Stacey and a couple of people reached out. And I think for me, it's just knowing that they're there. Maybe I will take advantage of it. Maybe I won't. I think part of my coping mechanism as a result of going through this car accident as a kid and really having to find self soothing and self healing, I oftentimes will turn inward in hard times. And what I found is, my turning inward now is more being very transparent about where I am. So I've been getting a lot of email requests for different things. That's almost like you telling me you're experiencing some symptoms of compassion fatigue this week. I've been telling people, Hey, I think giving myself space to grieve. I lost a friend earlier this week, so I may be a little bit slower to respond. So I think part of it is just the transparency of letting other people know where I am. but then, I think if people reach out to me, it's always been, validating everything that they're feeling, but also just maybe not responding. I mean, I remember  you providing this on the Block COVID panel at the end when they were like, if you had one message you wanted to leave, and I can't remember if it was you or one of the other panelists, but it was, listen and listen with no need to respond.

Naeem Dalal, MD: Thank you for sharing again, and I'm sorry for your loss. You know, right now everyone is going through COVID-19 stress directly or indirectly. People are grieving. People are overwhelmed. People don't know, uncertain times. You know, one thing that I know is that people are reaching out, but then people are reaching out to people who are equally overwhelmed in one way or the other. When I say time to invest in human capital, it's not just people. Also invest in your own mental health by just learning skills of basic empathetic listening. You know, listening skills of when to be silent and when to just understand another person. This will go a long way, not just to improve your own wellbeing as you've put it where you know when you overwhelm you, you kind of go inward. It's very important to do that. And that's something else that I'd like everyone who's listening in to say, it's not always about advocating for mental health and pushing for awareness. It's also about your own self. Make sure that you focus on yourself and if there's one skill you need to learn right now. It's how to listen and how to listen deeply. That is very, very important because this is what everyone needs right now. And that's one thing that I'd like to say. Coming to the sleep element of it, I always say this to everyone. We have three pillars of wellbeing. What really makes who you are and what makes you function at 100% and these  three pillars are your own wellbeing, your self-awareness of yourself, which is your mood., followed by your sleep. You know, you need to have basic restful sleep, which is for an adult, seven to eight hours or nine hours of sleep. And when I say restful, you need to just have a time out and shut out and just let your brain just go through the process of detoxifying through sleep. And finally, your diet, your nutrition, your appetite needs to be continuously, the same that you've been having. And these are the pillars to wellbeing. So when it comes to sleep, the reason why I wrote that blog piece was to just make people realize that as we are isolating self quarantine, as we're in lockdown, as we're socially disconnected, but right now with digital media and you know, the phones and everything, we are more and more connected. We need to understand that we can't break our schedule, that our brain and our brain health needs to remember that we are nocturnal individuals. At night, we are supposed to find our sleep and we have to let the neurons and neurotransmitters do their thing. So, so this is very important because when you're stressed, clearly your sleep pattern is going to be overwhelmed. So hence the need to just bring that basic blog article out on the importance of sleep and why this is the best time to actually get you to reboot your system.

Tiffany Yu: It's been really interesting for me because I think it's just not having an outlet for my anxious energy. Part of it is, here in San Francisco, I live in an apartment complex. So the decision to leave the apartment also means shared hallway, shared lobby space. exiting my own building is a bit of a production, and then also going outside. So I haven't gone outside as much as I'd like. So I'm wondering if part of it is because I'm not active as I used to be, not walking the 10,000 steps. There's just a lot of pent up energy that isn't having an appropriate outlet that is then impacting my sleep. 

Naeem Dalal, MD: Yeah, definitely. The way you've described it, your workout routine has clearly changed in terms of, when I say workout, many people think, just physical exercise that you do in a gym setup, but also just your basic day to day activities that you do. If that's affected, then you are going to have a disturbance in your sleep pattern. What I'd advise you to do really is, you know, still have a schedule of your bedtime and your nap times. What I mean by that is, If you go to bed at say 9:00 PM then just make sure your gadgets are off and you are reading a good book or you, you're just, you know, in your space where you sleep and you have all your distractions away, you need to have that schedule. Even if you're going to clock in five hours and you're just tossing and turning around on your bed for maybe two hours. You just need to have that basic routine for at least two weeks before you come back to and a cycle. But overall, that's, that's very, very important. And in the article, that's what, that's what the whole sleep hygiene pattern talks about. It's really, making sure that you have a routine so that your body, internal body clock gets used to it.

Tiffany Yu: The reason why I wanted to bring that up, not only did you write the article, which I thought was really helpful, but what I'm finding is I can meditate as much as I want, I can express gratitude and journal as much as I want or exercise as much as I want, but if my sleep is not good, I'm noticing that it is really impacting everything. So being able to really prioritize that, has. Honestly, it's been a real priority to try and get my sleep better in check .

Naeem Dalal, MD: Definitely. As I said, brain health has a direct correlation to sleep and, all the toxins get detoxed when you sleep and without sleep, your longterm memory, your short term memory does not go into longterm. And there's all these, health-related consequences in the absence of sleep as well. 

Tiffany Yu: Yeah, for sure. I will link the article in the show notes as well. There is something he outlines, called the 10 commandments of sleep hygiene for adults. But all of that said, Naeem loved having you on. if we want to continue the conversation with you, what's the best way to to follow you? 

Naeem Dalal, MD: Twitter. I'm very active on Twitter as well as LinkedIn. I'm very active on those platforms. 

Tiffany Yu: Great. And perhaps by the time this episode goes live, maybe the Twitter bio has changed. He's keeping us on our toes. last thing for you. What are you doing to take care of yourself? 

Naeem Dalal, MD: One thing I usually like to do is just reach out to my people. And when I say my people, my siblings, I'm very close to my siblings, so they really give me grounded. So that's my self care routine. I really just need to make sure that I keep in touch with them. And now that they all have little niblings, you know, I call my nephews niblings, so I'm just making sure I reach out to them. So that really helps me. And also being honest, like I did with you, telling you, Hey, I'm not in a good space. That's my housekeeping. 

Tiffany Yu: Beautiful. Thanks so much Naeem for being on our show!


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