Eight-year-old Arif and four-year-old Aida have been asking for their mother. They are living with their Aunt Sarah with their elder sister Alissa,10, and three cousins, and they don’t understand why their mother has not come to take them home.
The last time they saw their mother was when she left for the hospital with their grandmother. The children lost their father to heart attack in April. Though their aunt had explained to them their mother and grandmother had also passed away last month, it’s a reality they can’t quite grasp or accept.
In just over three months, Covid-19 has turned their world upside down.
“They are lost because everything just happened so fast. First, their mum tested positive. Then, the three children and both grandparents tested positive too and all of them were separated: they were placed in a quarantine centre along with their grandad but their mother and grandmother had to be hospitalised,” shares Sarah.
Thankfully, the children and their grandfather got better but, sadly, their mum and grandmother didn’t make it.
“That was the last time they saw their mum,” says Sarah. “It’s a lot to take in. The children are lost. I want to care for them but to be honest I am not sure I can cope,” she says. Sarah has also taken over the running of her sister’s business while caring for her own children.
Social workers from the Welfare Department have reached out to them and continue to check on their well-being, providing support and counselling to Sarah and the children.
The family is still reeling from their loss and the three young children are coming to terms with their new living arrangements, which may end up being temporary as Sarah isn’t sure she can manage.
“The welfare officers suggested I consider sending them to a home if I could not cope. I’m not sure what to do yet because they are my family and I want to be able to care for them,” says a tearful Sarah.
While losing one or both parents is traumatic for children in any circumstance, the loss is even more profound in a Covid-19 death, says child and adult therapist and family counsellor Sudha Kudva.
“It happens so fast that the child has no time to even think of adjusting to it. They see their parents one day and the next day they are gone. They may want to say something but the capacity for their parent(s) to receive it is not there. And the child doesn’t know what’s happening. Maybe they had a fight the last time they interacted, we don’t know. It is very overwhelming,” says Sudha, who is a director at Abri Integrated Mental Health in Petaling Jaya.
Also, social distancing restrictions limit helpful bereavement practices in the immediate aftermath of their loss - the gathering of family to console, support and grieve together.
Sudha isn’t speaking only as an experienced therapist but also from personal experience: Earlier this year, she too lost her dad to Covid-19.
“It happened in just six days... it happens so fast.
“Covid-19 is devastating because it comes and takes away everything without us having the time to aclimatise. And children, especially those under 15 and before puberty, take everything personally. They may think that it’s their fault that their mum (or dad) got sick... they asked their mum for candy and she went to the shop and that’s why she got Covid,” says Sudha, who is a licenced counsellor with the Malaysian Board of Counsellors.
The hidden pandemic
According to a study published in The Lancet medical journal last month, an estimated 1.1 million children globally have experienced the death of a primary caregiver as a direct result of the coronavirus pandemic.
The research team, which included researchers from the US Centers for Disease Control (CDC), USAID, the World Bank and University College London, counted deaths in 21 countries that accounted for more than 76% of all Covid-19 cases. They used the same methods that were developed and validated to estimate the number of children globally who would have been orphaned by AIDS to forecast the number of Covid-19 orphans.
Calling Covid-related orphanhood and caregiver deaths “a hidden pandemic”, the researchers describe “an urgent need” to prioritise these children.
According to Unicef, an orphan is anyone under the age of 18 who has lost one or both parents due to any cause of death.
“For every two Covid-19 deaths worldwide, one child is left behind to face the death of a parent or caregiver,” said CDC’s Susan Hillis, who led the study, adding that the number of Covid-19 orphans will likely increase.
Earlier this week, a Bahasa Malaysia daily (quoting a statement by the Education Ministry) reported that some 1,517 students in the country had lost either one or both parents to Covid-19 since the pandemic started last March. When contacted, however, the Minsitry couldn’t confirm the figure that was quoted in the news report.
But, regardless of the numbers, now is the time for the authorities to step up, identify the true scale of the hidden pandemic and then find and help the children affected and protect the most vulnerable in society in their hour of need and also in the years ahead.
The onus is on the Women, Family and Community Development Ministry and the Welfare Department, says paediatrician and Chairman of Positive Parenting (an initiative of the Malaysian Paediatric Association) Datuk Dr Zulkifli Ismail. “Counsellors (from the Welfare Department) will have to take these children through the grieving process and guide them.
“Placement with relatives or foster families or adoptive families have to be worked out. They will need to be followed up and never abandoned so they can grow up feeling secure. Their educational needs have to be looked into as well as financial support.
“The Welfare Department and Women, Family and Community Development Ministry are the government agencies that are supposed to look after these Covid orphans. They would do well to work closely with non-governmental organisations that have their ears on the ground,” he said.
“Although the welfare department should, and can handle these cases, there are also many NGOs that have access to manpower to track relatives, to place the children with foster families and to also track their progress over time. These children will need to be monitored regularly and be removed if there is any inkling of abuse or neglect on the part of the caregiver,” he says.
Continuous financial support to the caregivers from the government, at least until the children reach age 18 years, will help lighten their burden, he says.
“One-off payments are insincere and wasteful. What these children need is continuous monitoring and love, not one-off payments.
“This pandemic has exposed many of our deficiencies but it has also exposed us to the plight of the less fortunate.
“For the Welfare Department, this is the time to shine and show its function as a department made to cater to the needs of the underprivileged and underserved,” says Dr Zulkifli.
The first and most crucial step in caring for a child who has gone through a sudden, traumatic loss is building trust, said Sudha.
“Love is important, of course, but what needs to be built is trust. Their trust has been betrayed by an invisible thing and their caregivers will need to rebuild this trust. And this can take a long time,” she says.
“They may be adopted by the richest person in Malaysia or the most kind-hearted, trust-worthy person but for the child, this won’t matter. Caregivers need to acknowledge and understand this. The child’s nervous system is going through trauma. It was like an earthquake ripped through their system leaving havoc within,” she says.
Children aren’t able to articulate their pain and may not even be in touch with their pain and so, it is important for caregivers to be mindful when helping them through their trauma.
“Their nervous system got a beating and it will take a while to reset. In that state, a lot of energy is generated and this manifests either in mobilisation or immobilisation as the child seeks to get back their equilibrium.
“And so, certain behaviours manifest,” she says.How trauma manifests
Some children will strive to be “gooder than good” and may appear overly responsible and on their best behaviour all the time.
While this may seem as a huge relief for caregivers, Sudha warns that it is a red flag and a symptom of a child who is paralysed with fear, terrified of being abandoned agai
“It is very worrying because their grief and trauma is being bottled up but it will manifest at a later stage.
“The shock from their loss may come maybe three years, 15 years, 20 years later,” says Sudha.
In other children, anxiety manifests in rebellion, defiance, rage or anger. And while caregivers may feel relieved that they are expressing their grief, it can be ‘tricky’, she says.
“It gets tricky when these behaviours are be directed not at their loss but at their new attachment figures.
“The child doesn’t mean to behave as such, but they can’t help it as their system is jammed inside. They are testing the waters: Do you really want me? Do I deserve a parent? Will you leave me?
“These behaviours are a symptom of the child’s internal state and caregivers must remember not take it personally. It is hard, because they volunteer with huge hearts to support the children and when such behaviors manifest, they may wonder what they did wrong or whether they made a mistake.
“But, remember, it is the insecurity of survival that’s being expressed. It isn’t personal,” she says.
Be kind, be firm
A child’s developing brain has a very limited capacity to think, especially if they are below the age of puberty and adults need to be mindful of how they talk to children about their loss.
“Don’t tell them that this happened for a reason, or that something good can come out of it because they won’t understand. They don’t think like this and will end up feeling confused.
“Children see everything as black or white: Either you are good or bad, you love them or hate them. They can’t understand abstract thought, such as seeing the ‘good in bad’ and so on. They aren’t able to see ‘the other perspective’.
“We often tell children that if we pray to God, things will be better. And if things don’t get better, children take it personally and think it is because they are imperfect or bad,” she says.
The approach to take is to “be kind, but firm”.
“It seems like two completely opposites states but this is important. Firm doesn’t mean force. We musn’t resort to force because the minute the voice is raised, all the anxiety, insecurity and fear of survival not being assured gets ignited, and the insecurity within sky rockets. The rebellion or gooder than good behaviours will manifest and caregivers will be working against themselves.
“But, be firm and set rules. Empathise with them. Set realistic limits, and following through kindly and with compassion so that the child feels held, safe, protected by us. It is tricky, and much mindfulness is really needed,” she says.
With careful nurturing, the child’s nervous system will eventually settle down, she assures, and the pain of their devastating loss can get addressed.
“Metaphorically, it is akin to going through a devastating fall that has left many broken bones and internal injuries.
“Their life has to go on but in a strange, new, weird, unusual circumstances. And, what we need to build is trust before anything else,” she concludes.