Fieldset
COVID-19 in Venezuela: "This is no time for photos"

The mental health of patients, their families and frontline health staff has been a fundamental part of COVID-19-related projects run by Médecins Sans Frontières/Doctors Without Borders (MSF) across the world. For Yotibel Moreno, MSF communications officer in Venezuela, managing the pain caused by the virus became personal when Yotibel’s own uncle was admitted to MSF’s COVID-19 care unit in Caracas.

A photograph which has been edited to look like an illustration, showing Yotibel Moreno in the MSF COVID ward

I joined MSF's communications team in 2019. Since then I have seen close up the work of doctors and nurses, as well as teams specialising in logistics, social work, infection prevention and mental health. All of them working together as they care for patients with COVID-19.

I have cried with emotion at seeing patients add their handprints to the hospital wall as a symbol of triumph when they are discharged...

I have seen how each element of the system functions, and how this is only thanks to the dedication of every team member. I have interviewed patients who have recovered and are thankful to the teams for the care they received, and I have cried with emotion at seeing them add their handprints to the hospital wall as a symbol of triumph when they are discharged.

Facing the impossible

During this time, I have also known of patients dying, and have seen how aspects of this pandemic complicate people's reactions to bereavement. The impossibility of physical contact with their loved one while they are in the hospital is one factor, but it goes further. There's the impossibility of being there, closely following the course of the disease; of accompanying a patient through times of discomfort, insomnia, complications or fear, and the impossibility of carrying out the rituals of bereavement and letting go.

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A staff member holds a sign saying "Thank you MSF" in front of the wall of footprints
In front of the wall of handprints

MSF has found ways to get around these difficulties. The MSF team caring for patients with COVID-19 uses daily follow-ups, telephone calls and audio and video messages to keep relatives informed about a patient's progress. This practice maintains links between patients, staff and family members, helping to manage the guilt sometimes felt by family members for having to leave loved ones alone in hospital.

First-hand

But having seen this so often in my work, it was my turn to experience the pain at first hand. My uncle Miguel was admitted to MSF’s COVID-19 care unit with severe symptoms.

From the first day, the team called to report on his progress. They explained things clearly, giving us all the information we needed. Knowledge brings peace of mind and reduces fear, anxiety and pain, or at least that's how it was for us.

On several occasions, we sent audio messages with encouraging words for Miguel, which kept us feeling connected to him as a family. The mental health team told us when they had been with him and encouraged us to keep sending the messages, to give him strength. They also monitored our family's mental health by checking in with everyone who lived with him.

The days passed and Miguel's condition worsened. He was admitted to intensive care and one day they gave us the news that no one wanted to hear: Miguel had died.

A state of bewilderment

After the news of his death, time began to pass in slow motion. Fear took its toll; the physical distance separating us as a family, the impossibility of meeting, hugging and getting through this time, all made it harder.

In the middle of a pandemic, knowing that a relative has died, not being able to be with them, being unsure of the steps to follow, makes you sink into a deep state of bewilderment. As at the beginning, the information we received continued to be the best support.

Final farewell

When a patient dies from COVID-19, the World Health Organization recommends that relatives be allowed to view the body, maintaining their distance and taking all necessary precautions to prevent infection. At Hospital Vargas de Caracas, in an area separated by a glass wall and supported by MSF mental health staff, relatives can say their final farewells in an intimate and respectful space.

Some weeks before my uncle’s death, a photographer and I had attempted to document this space and the protocols following a patient’s death from COVID-19.

I was aware of the delicate nature of the situation and had no intention of invading the intimacy of this moment for a photo or story. We ended up not taking any photographs as there was no opportunity.

I was grateful to the staff for doing their work and respecting the decision of family members not to be photographed. At the end of our visit, the photographer asked me to go behind the glass screen where the relatives sit and took a photo of me instead.

In my heart, I was grateful not to have achieved our aim, without even imagining what I would experience days later.

The morning after

On the morning after Miguel died, I was with my father, my cousin Miguel Angel and his girlfriend, seated opposite the MSF mental health team. With their hands freshly washed and their masks full of tears, the team told us what his final moments were like and what the medical and nursing team had done to help, and they gave us encouragement and listened to us.

They told us about the different grieving processes many families experience, the psychological support available, the legal steps necessary, and offered us the chance to say farewell.

The stages of grief

One way of understanding grief is in stages. In this approach, denial is the first stage; it means not believing it when you receive news of a death.

The second stage is anger, anger and frustration; you blame the healthcare system, the doctors or God.

Negotiation is the third stage. This is when the process of acceptance begins, although the attempt not to accept it persists; it tends to be expressed in a request for extra time, in the desire for an opportunity to do things better, to rectify things. In this stage, rituals can help you process your loss: scattering the deceased’s ashes in a significant place; preparing a meal of their favourite foods as a tribute; attending mass or any religious practice; or doing any other activity in line with one's values and beliefs.

The fourth stage of bereavement is sadness. Nostalgia wells up; you feel that life no longer makes sense and you feel how difficult it will be to live without this person. You feel, live and acknowledge the loss.

The fifth stage is acceptance, when you recognise the loss as a reality.

Part of the story

I returned to the hospital's space for final farewells hand in hand with my father, walking where the relatives go, without a camera, without the aim of taking a good photo or getting a good story. This time I was part of the story.

I couldn't stop thinking about that time when I'd come to this area with the photographer, the time when we didn't achieve our aim. At that moment, there with my father, I understood that no, this is no time for photos. The dignity of that moment and the privacy of the pain deserve only words.

We entered, we said goodbye. With great sadness about Miguel’s death, I would like to thank each of my MSF colleagues for the respectful, humane and professional treatment they offer each patient with COVID-19 and each suffering family member.

I would like to tell the rest of my family that we came, we said farewell, no loose ends were left, and we were able to close the cycle of pain.

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