Down but not out: What helps people bounce back

The pandemic has knocked some of us down. We need to help one another get back up.

Singapore’s whole-of-nation approach to fighting Covid-19 is a model for how we need to support people struggling to get back on their feet, says the writer. ST PHOTO: LIM YAOHUI

We're just one week from the end of 2020 and miraculously, the days of isolation during the circuit breaker that lasted through much of April and all of May now seem to me like a distant past.

Children went back to school, people are back in restaurants and toilet paper is back on supermarket shelves.

The way Singapore has bounced back is surely worth celebrating.

But we are not out of the woods yet. Many countries are fighting fresh waves of the Covid-19 pandemic, and we must keep our masks on and keep a safe distance from one another, even as we mix and mingle in larger groups of eight.

Still, it's worth pausing to reflect on the lessons in resilience this year has yielded. And to remember those who are still struggling to get back on their feet.

Down but not out

Down but not out was the title of a recent speech by Mr Ravi Menon, in which he spoke about resilience in a post-Covid-19 world.

The managing director of the Monetary Authority of Singapore quoted boxer Rocky Balboa, protagonist of the Rocky movies that starred Sylvester Stallone, and said: "Resilience is about getting back up again even after being knocked down... and to keep moving forward."

That is what Singapore is doing, by bubble-wrapping travel and gearing up to host the World Economic Forum next May.

No country can move forward from a public health crisis if its health system breaks down.

Singapore's did not.

I got a glimpse of behind-the-scenes measures to support healthcare workers when I spoke to a cousin who had been posted to the National Centre for Infectious Diseases during a surge in infections.

She said she was kitted out not just in personal protective equipment (PPE) but also work clothes that she would shed at the end of each shift at the hospital, where she would also shower before heading home.

I marvelled at this system, which saved healthcare workers the headache of having to mark out a "dirty" zone in their own homes and separately launder their work clothes that might have been contaminated, a burden some nurses overseas shouldered while working long hours.

That was just one measure among many that kept the healthcare system resilient.

In an article published by online journal BMJ Global Health, experts from the Saw Swee Hock School of Public Health described a national strategy that stretched from the clear communication of risks and the containment of Covid-19 spread, to stockpiling PPE, mobilising manpower for outbreak response and financial support for those infected and on quarantine.

This entire infrastructure was what sustained doctors and nurses fighting at the front line against Covid-19.

Where such support is lacking, exhausted healthcare workers may feel they have no choice but to quit, as large numbers are doing in Sweden. That's when a healthcare system breaks down.

"Many aspects of resilience are limited but they're renewable," says Professor Ann Masten of the University of Minnesota, who studies resilience in human development.

"Our resilience is always changing. For example, if you don't feel well, you won't have as much resilience as when you do.

"If you don't get enough sleep, you won't have as much resilience and so forth," she explains in an interview with the American Psychological Association.

"Just like our immune system under difficult circumstances, we do have the capacity, as parents and people, to surge.

"We do have surge capacity, but that may be temporary. We can get depleted.

"Day after day after day, if you are working hard to deal with challenging things, you can simply get exhausted and overwhelmed, and then we need to step back and try to replenish and restore our capacity."

When people struggle

Singapore's whole-of-nation approach to fighting Covid-19 is a model for how we need to support people still struggling to get back on their feet.

We need a whole-person approach that pays attention to the range of personal, social and institutional factors that affect how well someone deals with transition.

Financial aid, such as the new Covid-19 Recovery Grant for lower- and middle-income workers still dealing with job or income losses, helps.

But money alone is not enough to support people through change.

They also need other resources, such as information, guidance, emotional support and coping strategies.

Dr Nancy Schlossberg's 4-S model of transition, widely used in the field of career development, provides a useful framework for measuring how well equipped a person is to deal with transition.

The four S's are Situation, Self, Support and Strategies.

Situation refers to the triggers for the transition, and other stressors or past experiences at the point of change that may hurt or help.

Self refers to a person's socio-economic status, gender, age, state of health and psycho-social resources - such as outlook or spirituality - that have a bearing on one's ability to cope.

Support refers to family, friends or a community that can provide the love, acceptance, sense of self-esteem and guidance a person needs.

Strategies refer to ways of coping, such as reframing to give a sense of meaning or control.

Before a transition, a person's life is pretty organised into certain roles, relationships, routines and assumptions, says Dr Schlossberg in an interview available on YouTube.

Then, you enter a "never-never land that can last from six months to six years", until you get a new life and establish a new set of roles, relationships, routines and assumptions.

"But what makes the difference," she says, "in how you negotiate this murky middle period are the four S's. Those are your potential resources for dealing with the transition."

You can have 50 people in a room all having the same transition, she adds, but each is handling it differently.

That is what we need to remember when helping people through transitions, whether they be seniors dealing with retirement, mid-career folk facing job losses or fresh graduates entering a tough job market.

We need to adopt a whole-person approach and help each of them find or grow the resources they need to cope.

Dr Schlossberg cited a concrete example of such help: The National Aeronautics and Space Administration paired 55 people it retrenched with a buddy each from its human resource department, to support them until they found new jobs.

Here in Singapore, charity We Care Community Services adopts a whole-person approach to help recovering addicts.

Its RiSE programme - which I volunteer with as a career coach - is supported by the President's Challenge.

As its name suggests, RiSE helps former addicts recover and integrate into society through employment.

Everyone in the programme is supported by a counsellor, a recovery guide and a career coach.

This is labour-intensive work that some may regard as inefficient. But if we can help a person bounce back instead of letting him sink into despair, that outcome is surely priceless.

During the depths of the Covid-19 outbreak, we found ways to let healthcare workers know they were not alone.

We need to do the same for those who continue to grapple with difficult transitions.

That gives people a chance to renew their resilience.

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