Virginia Duffy is Heading To Africa

  I am am excited to tell you that I will be heading for Africa for 3 months to do volunteer work with children. This has been a long-term dream of combining my love of volunteer work with my desire to see this wonder continent and all its glory. As my grandchildren are growing up, I am also excited to spend some time with children. I will spend my 3 months in two different areas, with different projects. . My first 6 weeks will be at the orphanage Children of the Rising Sun, located in Malinda, which is in the Coast province of Kenya. Malinda is a beautiful area with white beaches and palm trees. It is a major tourist town with various historical sites.

Children of the Rising Sun is a children’s home that caters to the community within the area. Within the premises there is a kindergarten and a primary school for the children in the orphanage and also the neighboring community. The community surrounding the orphanage has the culture of marrying off their girl children at a tender age not paying much attention to education and enlightenment for them. The home helps take care of some of this children thus doing child rescue to enable these mothers to go to school. The home has approximately 70 children who stay within the premises and 900 who go to the kindergarten and primary school in the compound. The languages spoken are English and Swahili.

For my second six weeks I will be moving to west Kenya to work with Community Watch and Rescue Team (COWART) This is a youth run community based organization founded in 2006 by a group of focused youths who saw the need for a change in their community.

The major activities of COWART are: 

1. To promote health
2. Youth leadership development
3. Disaster preparedness and response
4. Running environmental programs
5. Youth employment programs

 In promoting health the youths carry out

-         HIV prevention programs which include organizing forums and meetings to disseminate among the community especially the youths information about the disease and also carrying out the same programs in schools where students are educated on the whole topic.

-          Dissemination of information on malaria control and prevention which include Indoor Residual Spraying (IRS), assisting in distribution of mosquito nets especially to pregnant mothers and children below 5 years. The organization is also involved in sensitizing the community on the control measures and the treatment of malaria.

 On youth leadership development

 -There is a youth Parliament that create a forum to the youths where they discuss socio economic and political issues.

-The youths are involved in challenging tasks as part of the training through overnight hiking and camping expeditions, solitude, Rock climbing and Rope course.

 Disaster Preparedness and response

-         Offering first Aid services and training to the community.

-         Training in rescue operations during disasters.

 Environmental Programs

 -         Streams restoration- cutting the water consuming Eucalyptus planted along the riverbanks and replacing them with the indigenous trees and shrubs.

-         Soil erosion control, organizing clean up exercises within the towns and man- made forests of native trees and shrubs.

 Youth employment

 -         Carrying out training in entrepreneurship, business and financial management.

-         Running community based income-generating activities solely run by the youths from the  community.

-         Holding forums where youths are taught on career choices, interview tips and CV writing skills.

 One of the great achievement cowart has had so far is that over 3000 youths from the community have undergone HIV testing and counseling.

  The organization covers the three districts of Kericho, Londiani and Bureti of the Rift valley province. I will be working in Kericho.

I am very excited and making plans to leave,  as there is so much to do!  While in Africa I also intend to go on a Safari and visit the famous archeological site where Richard Leakey found many specimens of early humans.  I will continue to blog about my trip and other things. However as I need to go to a nearby town to have internet access this will be less often. I am planning on blogging once a week. If I can figure out how to do it, I plan to put video of me and the kids on the blog.  Watch for more and send me good vibes.

Virginia Duffy

Courage is not not being afraid. Courage is being afraid and doing it anyway. Ask James Bond.  Here is a great interview that can be a lesson in reality. Click on read more and share it if you like it.

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I just finished presenting four talks for the Pensylvania State Emergency Medical Services (EMS) conference in Harrisburg.

I spoke about

• Dealing with Emotions During Emergencies
• Dealing with the Angry Person and Preventing Escalation
• Dealing with the Confused Person
• Managing the Hysterical Patient.

Watch my site for postings on some of these topics.

 I want to share some of this great experience. First of all the people. All those who attended my workshops seemed truly interested in learning how to help their patients deal with the emotional stress of emergencies.  They were open to new ideas and had lots of experience and ideas themselves about what worked to calm people down.

We all agreed that although the major focus of a medical emergency  is to save lives and prevent worsening of trauma or illness this may not be possible unless the patient’s emotions are dealt with.  Fear and other emotions must  at least acknowledged. Communicating an understanding of a person’s feelings can go a long way to calming them.

 I spoke alot about empathy and we worked hard to practice this concept and be able to figure out how to use it in common situations.  If you haven’t read my blog on empathy  please do. It remains one of the most powerful communication techniques for dealing with distressed, frightened, and angry people.

The EMS providers I met seem to have a great sense of humor. I have come to appreciate how important this is to surviving in such a high intensity emotional line of work. The frustrations of the job are many,  misuse of services, lack of support, low pay, lack of repect and recognition for the life saving work they do. The rewards can be great.

Remember these are the first people there to help you when you need it most. We need to educate ourselves about the profession and the great job these folks do under pretty tough circumstances. My appreciation and respect to all of you.

I was pretty concerned  when I read this Time article about soldiers being medicated for burnout or compassion fatigue or stress and many other psychological concerns.

How can any thinking human being be in a battle zone, risking their life and seeing others killed not be distressed?  We are fooling outself if we think this is possible.  To  think that an antidepressant will help this kind of sadness and distress is just naive.  I am sure the prescribers know better.

My bigger concern in this article is the mention of Clonazepam (Klonopin) for anxiety and Ambien for sleep.

Prescribing these drugs is asking for trouble. Persons who take Benzodiazepines like Clonazepam  are often in a “fog”.  It’s the “new age Valium”. 

Clonazepam can cause memory loss, decreased self control, slowed thinking, poor decision making and detachment.  Rest assured these are not RARE side effects but happen routinely with these medications. Clonazepam is a particular worry because it can stay in the body and have effects for more then three days. 

The warnings on Clonazepam  tells you not to drive (due to slowed reflexes, decisions and lethergy). They do not say however not to carry a gun or fight in a war !

Ambien is a sleeping pill that is a sedative. It is less troublesome then Clonazepam because the drug usually lasts about 10 hours, but it is not uncommon to have daytime drowsiness

Some rarer side effects that are very troubling can include changes in thinking and/or behavior such as:

• more aggressive behavior than normal
• confusion
• agitation
• hallucinations
• worsening of depression

Any use of drugs or alcohol can enhance all the effects of both these medications. The other worry is that long term use can cause dependence and may result in depressive feelings.

It is  my opinion that the use of these drugs makes a dangerous situation even worse. Our boys at least need to be educated about what these drugs can do to them.

What are your thoughts?

 Sorry I am a little late with this blog posting. I just got home from a trip to Long Island where I grew up. In a small beach town on the south shore of Suffolk county I spent 4 days reminiscing and experiencing many bittersweet memories.

This visit I saw some friends I had not seen in 50 years; it was amazing how the memories came rushing back in a group setting with everyone talking of their personal remembrances. We each had something to share about that time so long ago.

I got to thinking about reminiscing and wondering why it has such a strong draw.

 I know that reminiscing is something that the older we get the more we enjoy. Based on this, a magazine called Reminisce has gained a large following and made lots of money with a very simple format. We also use reminiscence with older folks as a talk treatment to help those who are sad and confused. Try it yourself with an elderly relative who is agitated or unhappy. Just ask them a simple question about their past.

 This adventure “home again” got me to thinking about the meaning and importance of reminiscing and nostalgia and trying to figure out why they are so irresistible at times.

 Here are some of my questions and thoughts.

 Ø     Is it the sweet memories and pleasure of remembering that attracts us?

 I don’t think so; many of the memories are not sweet and actually sad or painful, but these also can have a strong pull.

Ø     Is it the wish to be young and innocent again?

Being young was often not the best time of our lives, and sometimes I wonder if we were ever truly innocent. As youngsters we picked up on and experienced anxieties and worries from our environment. Even though we may not have recognized or understood these feelings we often had a vague  discomfort that we used all kinds of psychological maneuvers to avoid.

I believe that these trips down memory lane are more for self-understanding, acceptance and sometimes even personal change.

Every time I make one of these visits I realize something else that has affected me all my life, and made me who I am. This can be something I view as positive or not.

  I am a person with a desire (? need) to understand and that need drives me to search the past. It can lead to forgiveness of others, self-healing and self-acceptance that is priceless.

I also notice that the bitter in bittersweet gets less with each visit, I think I will go “home” again next year.

 Send me your stories or ideas about reminiscence in the comments so we all can enjoy and learn.

   Buried at Work? 

Ø      Avoiding or rushing through work

Ø      Rigid rules and “by the book” approaches

Ø      Dehumanizing clients

Ø      Anger and emotional outbursts

Ø      Increasingly cynical attitudes

Ø      Boredom

Ø      Stress from work interfering in social and family relationship

Ø      Physical symptoms of stress such as headaches sleep disturbance and tiredness.

Some important reminders to prevent burnout:

 Ø      Take care of you, it will relieve some of your stress and allow you to better deal with others

Ø      Learn and use self-empathy and self-nurturing techniques

Ø      Try understanding and treating yourself with care

Ø      Allow yourself to say no, offer alternatives, or even avoid situations if you feel unable to say no

Ø      Increase your self-awareness

Ø      Plan for a routine to help ease the transition from work to home. (Do not use alcohol to unwind)

Ø      Do not expect all your feelings of self-esteem to come from your profession.

Ø      Develop outside interests that have nothing to do with your work.

Ø      Try to avoid over-identification with clients

Ø      Recognize and allow your own feelings

Ø      Develop relationships outside of work where you can talk about your feelings

Ø      Practice stress reduction techniques (exercise, relaxation, meditation, distraction)

Ø      Plan for regular breaks, conferences, and vacations

Ø      Talk with colleagues to not only complain, but also to also make plans for burnout prevention, take charge where you can

Ø      Know when to say “enough”, consider transfer if necessary

Burnout can and must be prevented. Recognition of your own level of stress and taking care of yourself are the keys to stress reduction and burnout prevention.  

Burnout can also have an unexpected positive influence in your life; it can act as a catalyst to make a much-needed change. It can be the impetus to move on to different more rewarding careers. Many entrepreneurs started off as burned out employees.

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I found an online article listing questions parents should ask before considering psychiatric hospitalization for their children.  I think there are some qood questions here, but I would like to add my 2 cents to certain questions. 

In the spirit of full disclosure I am a Psychiatric NP with many years experience including inpatient units. Psychiatric admissions and hospitalizations have changed dramatically in the last 20 years. What used to be for weeks even months is now days.

1. What type of therapies will my child have while in the hospital and how are they better than outpatient therapy? The reality is that therapies in hospitals are usually limited to medications and sometimes groups. The groups are educational and do not meet the criteria for psychotherapy (aimed at some type of change).  Of course If they are done well, they can be helpful in terms of offering information such as how to deal with feelings, anger and stress managment.

 Hospital admission is not for therapy any more but for treatment of crisis, specifically to maintain safety.  Hospitalization  is best used to prevent suicide,  self-harm,  or violence.  Remember if your child is on a unit with other more troubled kids they may  copy  worse behaviors. Due to insurance company rules and today’s model of treatment the usual process of hospitalization is to stablilize and discharge the person ASAP.  This often means use of medications quickly  with little time to evaluate theraputic effects, dosages or side effects.

  2.  Will my child receive in depth psychological testing and psychotherapy by a clinical psychologist while hospitalized? Or will the treatment mainly consist of drug therapy by a psychiatrist?

This appears to be a question written by and from a  psychologists point of view. Most units do not have psychologists as therapists (they cost more) but may use them as  consultants to do psycological testing if needed (usually determined by the Psychiatrist or Psychiatric NP ). Psychological testing CAN be helpful in determining  personality style, making diagnosis and identifing learning disabilities and IQ. It is usually only done once or twice in a lifetime as these things don’t change. It is very expensive and its use is determined by the culture. ( what is the view of the value of the testing. how many psychologists are present in the system). Psychological testing is not an exact science,  neither is psychiatry or medicine.

I request psychological testing  to determine IQ and screen for learning disability, to help with diagnosis if I am unclear (notice the word help, this is not a sure thing but an interpretation).  I also like  it for what is called a validity scale, that is it can tell if the person is exaggerating or providing inconsistent answers.

The persons who manage inpatient units are psychiatric nurses and social workers, they may see the patients for a few minutes a day (as does the psychiatrist) but that’s not therapy, it is more management. The goal is usually to discharge the person as soon as possible, especially before the insurance runs out. This is not necessarily bad, but it  does tend to increase use and dosage of medication as the time for evaluation of effects is limited.

3. Will we be attending family counseling sessions regularly?

Family meetings are often part of the hospitalization. Calling this counseling is a stretch in my opinion. They are most often used to obtain or  convey information and plan for discharge. Family counseling or therapy is often necessary when working with children but this needs to be done on an outpatient basis.

4.  When our child is discharged, will it be necessary for him or her to receive follow-up care?

In my opinion any child that needed psychiatric admission needs follow up whether they recieve medication or not. Here is where family therapy is often needed.

I would love to hear your comments or experiences with this issue.

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Research has shown those who are pessimistic have a higher risk of dying young.

Those who are more optimistic have better health, and better immune systems. Although pessimism may not be easy to change, you can tone it down with practice. No one expects or wants you to be a Pollyanna, trying to keep a positive attitude does not mean to tell yourself everything will be ok when you know it won’t.

It does not mean you bury your head in the sand! Rather, it is important to try to decrease negative thoughts and unnecessary pessimism. When you find yourself having such thoughts you must say, “stop” and force yourself to recognize other more positive possible outcomes. When I am upset over a situation I often ask myself “what is the worse that can happen here”. Many times you will realize that you can deal with even the worst.

Don’t blame yourself when things go wrong. Pessimists think all bad things will last forever and good ones will be gone soon. Optimists think the opposite. Optimists tend to use active coping skills, such as those discussed above.

When I find myself angry at the world due to contact with some despicable person, I remind myself about all the good people in the world. Stay away from the nay Sayers and those who are too narcissistic to think of anyone else but themselves.

Express your emotional reactions honestly so you can effectively deal with what’s bothering you.

Laugh more: Did you know that children laugh about 400 times a day, but adults only about 25 times. Instead of bristling at life’s annoyances, try to view them as amusing. Look for humor in difficult circumstances. Try to avoid sarcasm, jibes or laughter at others expense. Laughing at yourself (especially your pessimism) is great too. Laughter is truly good medicine. Laughing at yourself is especially good for you!

There is a long complicated article in the NY Times today about suicide and impulsivity that is worth a read (if you can manage it.)

“Suicide autopsy” studies can give us lots of information, but no one really knows what goes through the head of a person just before he or she dies from suicide, it may be regret as suggested by one person interviewed by the author.

There are a few comments I would like to make about the article and suicide in general that are based on my own years of experience, and thoughts. If you can’t get through the article hopefully they will still make some sense to you.

In terms of the debate about impulsivity vs planned suicide; I believe that there is always an impulsive piece of suicide. People may have a long complicated plan in their head “just in case”, but it takes a trigger to finally push them over the edge. I wonder if sometimes this can be just the opportunity as well as it be the “last straw” type event. It is not an either/or choice.

One study indicated that victims of what look like highly impulsive methods of suicide (bridge, gun) often “display few of the classic warning signs associated with suicidal behavior” ” …jumpers have a lower history of prior suicide attempts, diagnosed mental illness…” It seems to me that these persons may have not been treated or recognized as being depressed which may put them at high risk.

Also the person who is most determined to kill them self may be less likely to let others know, due to not wanting intervention. Use of an almost guaranteed to succeed method, does not seem to me to be a sure sign of impulsivity.  Some people have been planning for a while and have chosen the method they believe least likely to fail, thus the use of a gun or a bridge.

I will never forget a man I saw years ago, who had given away all his possessions. He denied suicide, did not look in the least depressed, and had no psychiatric history. I would never have thought him to be suicidal.  If it hadn’t been for a family member who was very worried about his “generosity” with lack of explanation and forced an evaluation, I have no doubt this man would have killed himself. (He later admitted his intention).

Suicide is another one of those things we will never have all the answers for. There are many different motives and types of suicide: some with depression, some with psychotic thinking where voices are telling them to kill themselves, some with existential pain, some with physical pain, some with end of life issues. Some are carefully planned while others are impulsive. It is my belief that most have components of both.

Are we trying to categorize and understand something that may not fit into a neat clean framework? Our frantic efforts to figure things out are often attempts to control something we fear.

We certainly can help to prevent suicide, and we should keep learning, but we also need to acknowledge that there are some things we may never understand completely, and may never be able to control. Life and death are not so neatly black and white.

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Question and Answer Post

From a Reader named “Mary”

Please help me! I have been in a relationship with my live in boyfriend about 3 yrs. He is like having another child around. He does not help with things and expects me to take care of everything. He has a bad temper and although he has never hit me when he gets angry he breaks things. I want to end this relationship but when I tell him that he says he can’t live without me and will kill himself if I go. I’m scared! I don’t know what to do. I cry all the time and can’t sleep well at night.

Dr. Duffy’s response.

Mary, this is a tough situation and I can under why you feel scared. First let me tell you that unfortunately this situation is not that uncommon. Men who act like your boyfriend are often very dependent on the women they are with! They try to get what they want and need with threats of all kinds. Threatening to kill himself in order to keep you is emotional blackmail! So what to do…….

First and most important: you must be very sure you want to end this relationship. The worse thing you can do is make threats to leave in hopes that he will change his behavior. When you do this it only teaches him that you do not mean what you say. If these threats do get him to change, it is usually only for a very brief time and then the behavior starts again. So you must so some serious soul searching and make sure this is what you really want. Make sure you are really ready. Once you have done this you must put a plan in place to leave. Try not to do it on the spur of the moment or during a crisis unless you are being physically threatened!

Second: Make a plan: You must decide when you want to leave and where you will go. Many women want the man to leave the home. This is much harder to make happen (although not impossible) and the easier and safer thing to do would be to leave temporarily with the expectation that living arrangements will be settled later. Certainly who leaves the home may be dependent on who ownership. Leaving may also have some legal complications for those who are married and the advice of an attorney should be sought. If there are children involved it is more difficult but that is also all the more reason to go ahead with such a plan.

If you have already discussed your desire to leave you do not need to tell him that you are leaving until you are ready to go. In the process of leaving however YOU CANNOT COUNT ON HIM TO BE REASONABLE. Once the crisis is over and he is certain this is really the end, he may become more reasonable and able to negotiate things. Mediators are available in most areas to help separating people with just this type of issue.

Third: get the help of others. Many women are embarrassed by this type of situation and try to manage it alone. This is a mistake! Secrecy is one of the things that make blackmail effective! You must let people you trust know what is going on. Tell a friend, family members, your boyfriend’s family (he needs support too) and perhaps a professional. You do not need to reveal all the details just make sure they realize you are planning to leave and he is making threats to kill himself. A strategy that often works is to have someone he trusts with him when you actually leave. If you leave and he makes threats you may need to notify the police to check on him.

Fourth: take care of yourself. This is critical. I have a few questions here. Are you depressed? You mention crying and trouble sleeping. Now a certain amount of this is to be expected in this situation, but are you seriously depressed? This is an important distinction to make. Do you have trouble with concentration and memory? Are you anxious and feeling overwhelmed by the situation? Are you feeling hopeless, helpless and immobilized? Are you having trouble machine decisions? Are you eating? Is your energy level where it should be? Do you have a history of depression? These are some questions that might help you decide the level of your depression. Please review the symptoms of depression on the following page to help you decide if you are clinically depressed. If you are significantly depressed you may find it much harder if not impossible to leave while you feel this way. If you think this is the case you should consider having an evaluation by a mental health professional. If you are depressed there are medications and some herbs that may be of help to you. Once you feel better you will be more able to deal with this situation.

The other question I would have in this area is IS THIS A PATTERN FOR YOU? Do you have a history of getting involved in the same type of relationships? Do you seem to attract needy people (men and friends.)? Do you try and take care of everyone. Do you take care of yourself? Do you feel good about yourself? These are important questions to answer for your own emotional well being and to help with future choices.

You must remember no one is responsible for the life of another person. We all must take responsibility for our own lives. Just as you cannot cause someone to take their own life if they wish to live, you also cannot prevent it if they are determined to die. Suicide is not usually the result of a single loss, but the end of a long history of depression , problems and pain. Persons like this are in desperate need of professional help and sometimes staying with them to try and help may actually prevent them from getting the professional help they really need. GOOD LUCK!

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