Literature to recover from covid-19 in Peru

The mental health team of the Vitarte Emergency Hospital, with some donations of books for patients, in Lima (Peru) Jacqueline Fowks

At the Ate-Vitarte Emergency Hospital, in the eastern area of ​​Lima, the mental health team has organized a collection of books for covid-19 patients, especially for those who come out of mechanical ventilation equipment or those who they will continue to receive oxygen non-invasively for a long time in their recovery.

"Guided reading complements individual psychotherapy, thus generating awareness of what is happening to them, or disconnecting from the hospital environment that they perceive hostile, reducing negative thoughts and recovering cognitive abilities", explains the psychiatrist Diana Alcántara, in charge of mental health at the establishment .

The sanatorium, inaugurated in March, only receives those infected with covid-19, and when the pandemic ends it will become a critical care hospital, therefore the objective is to set up a library for patients.

The experience of the medical corps has been intense in observing the mental health of patients who come off mechanical ventilation or are connected to oxygen for one or two months, and whose contact with their relatives is through video calls, because in hospitals specialized in this disease there are no visits.

Sufferers have many reasons for restlessness, anxiety, or depression.

Peru currently has about 1,700 intensive care beds, but the number of hospitalized people using other oxygen devices is five times higher.

“In the first months of the pandemic, we have attended more than 210 patients in a 24-hour shift.

There were only two people in mental health and they gave priority to the relatives to make them understand that before 48 hours there was no possibility that they would have news of the sick, "says the psychiatrist.

In July, Peru reported a daily average of 200 deaths from the virus, and in September the average is one hundred.

Until Friday, the health authorities registered more than 32,000 deaths, but they estimate that the figure could be 50,000 taking into account the excess of deaths compared to the previous year.

Since March, the country has reported more than 794,500 confirmed cases.

Alcántara is part of a mental health team of ten people, with eight psychotherapists and a nurse.

“When the number of patients has decreased considerably - last Friday there were 120 patients in the hospital - we had the opportunity to review how to complement the psychotherapy session, which is similar to that of a private consultation, with various purposes: to detach them from the environment hospitable that they perceive hostile, or for the opening of the duel, or so that they accept the condition in which they are.

So, among many options, we find bibliotherapy ”, he says.

A hostile territory

The Ate-Vitarte Hospital looks new, well lit and clean despite being located in a poor district: on the floor, green and yellow ribbons mark the uncontaminated areas;

there are both health and cleaning and surveillance personnel.

Why does the patient feel like enemy territory?

"Because they are out of their comfort zone, despite receiving good treatment," explains the psychiatrist, and because video calls are not enough.

Upon admission, patients cannot enter with a mobile, therefore, these communications are made with the devices - tablets and mobiles - of the mental health team.

“Sometimes due to the lack of communication they believe that their family does not care about them or that they are going to abandon them, or they want to be discharged in two days because they do not accept that the infectious process does not resolve quickly.

The lung has been damaged and they will not be able to return to work as quickly as they want ”, he adds.

"Here we receive patients from all socioeconomic conditions, from all over Peru, we see how their faces change in video calls, and we also see repetitive behavioral patterns despite having gone through this disease: there is irrationality and cognitive rigidity", describes the psychiatrist .

According to Alcántara, when some patients realize that they require oxygen, they question the treatment by diverting attention to another aspect and complain.

“They say, for example: Why is the bed so hard? Why do I have to share a room with that patient? Why does that patient's blanket enter and mine does not?

The treatment is going to be expensive.

At that moment we have to introspect with them and explain the possibilities of each of the tools in each hospital environment, each procedure, so that they take it easy and accept it calmly, ”he says.

The book in medicine

That's when the books act.

“When negative thoughts invade the patient, physiologically the heart rate increases and the breathing begins to be shallow because it is distressed.

We have seen that with reading the indicators go down because the emotional state changes and they can achieve control ”, says Alcántara.

In addition, bibliotherapy plays another role in patients who receive many medications and sedatives for mechanical ventilation and at the same time for hypertension or diabetes, or because they are older, or self-medicated before arriving at the hospital.

Some of the substances have side effects that impair perception, orientation, and memory.

The mental health team then uses guided reading of novels or poetry to assess whether patients regain their cognitive abilities, such as speaking, retention and comprehension of the text.

“Unfortunately we have grown up in Peru thinking that if we go into a mechanical ventilator we are going to die, but if we are connected soon, there is a better chance of living: we have to explain all that, and we also tell them that when we leave (the device) Soon they will think that people want to harm them, or they want to remove their organs because due to the drugs they can enter a hallucinatory state, ”says the mental health officer.

Rosa Bazalar, head of the department of diagnostic support at the same hospital, explains that books are very important for spirituality and for dealing with depression in patients with covid-19.

The Ate-Vitarte Hospital has placed a box to receive book donations until September 30, in the hope that the library will be not only for patients, but also for visitors - who will return when the pandemic ends.

They lack books on Peruvian and universal history, but they are also waiting for fiction and comic books.

"It is also an invitation to Peruvians to read and for society to see compassionately those who have experienced this disease," says Alcántara.