Life after death in the time of covid-19
The covid-19 pandemic, and corresponding health restrictions placed on hospitals and funerals in South Africa, have completely changed the way we grieve and say goodbye to our loved ones.
“Standing there in the cemetery, looking at the deep holes all around me, I just remember being overwhelmed with anxiety,” recalled Margarida Khadhraoui about the day of her brother’s burial.
“They’re probably all filled now,” she reflected.
Khadhraoui, a 50-year-old mother of two young boys, is just one of the many South Africans who have experienced loss during the covid-19 lockdown period, which began in March. The nationwide lockdown was characterised by various health restrictions, with one being a ban on all hospital visitations to prevent new coronavirus infections. These health restrictions compromised people in different ways, but for many it affectedtheir last moments with their loved ones, along with their grieving process.
Lost final moments
The ban on hospital visitations remained throughout the duration of South Africa’s strictest levels of lockdown, being levels five, four and three. In August some hospitals began to allow visitations, with News 24 reporting that covid-19 patients at the “end of life” stages would be allowed visitors, but still in line with strict safety protocols.
Khadhraoui was not so lucky. Her brother, Alvaro Jose Oliveira Goncalves, passed away right before such exceptions were established, so she was unable to visit him before he died.
“The most difficult part of it all was that when my brother was admitted, we weren’t able to visit him. Usually when someone is ill, you go see them and it almost gives them that push to fight and carry on, but we couldn’t,” said Khadhraoui.
Khadhraoui remembered her brother having flu-like symptoms a few days before he was admitted to hospital, but he had not thought a covid-19 test was necessary. He assured Khadhraoui that he was fine and, because he had no pre-existing issues that would put him at a higher risk for covid-19, she let it go.
Early one Friday morning in late July, Khadhraoui received a distressed phone call from her sister-in-law, who exclaimed, “Margi, Alvaro can’t breathe!”
Khadhraoui told Wits Vuvuzela, “It was all so sudden. He had some symptoms, but he was fine, and then her couldn’t breathe two days later. We managed to get the paramedics to the house that morning.”
She added, “His oxygen level was at 56, which is really bad. Your normal level should sit at 94 or 95, so they immediately put him on oxygen and rushed him to the hospital.”
Goncalves was first diagnosed with bacterial pneumonia, which is an infection in the lungs caused by bacteria. It was later confirmed that he had tested positive for the coronavirus as well. Goncalves stayed in Linksfield Hospital for two weeks, and remained on a ventilator throughout.
The day before he passed, he was intubated and placed in an induced coma.
“I knew he wasn’t going to make it. I could feel it. I told my husband, ‘my brother’s leaving us,’ and I got the phone call 10 minutes later,” said Khadhraoui.
While rummaging through her bag for tissues to conceal tear-filled eyes, she said, “I couldn’t be there to hold his hand, tell him that I’m there for him or tell him to not be scared. I don’t think he necessarily needed it … I was the one that needed it.”
Stefanie Bove, a clinical psychologist of 16 years, explained that the covid-19 restrictions, and new circumstances created by the pandemic, will have an effect on the grieving process experienced by individuals who have lost loved ones.
“Grieving under these circumstances will definitely affect one’s general mental wellbeing, more so than usual. And the restrictions will play a role in the prolonged grieving process,” said Bove.
Bove, who consults for Saheti School in Senderwood and has her own private practice in the Bedfordview area, confirmed that she has had more people coming in for grief counselling than before the start of the pandemic.
Bove told Wits Vuvuzela, “I think that most grief now will result in complicated grief because there are so many new factors that have come into play. For example, not being able to have contact with loved ones or not really being able to say goodbye.”
Complicated grief refers to a prolonged grieving process, as described by Mayo Clinic, an American academic healthcare company. It is associated with, for example, difficulty in recovering from loss and resuming one’s normal life.
While psychologists may have different versions of what a normal grieving period is, Bove explained that a normal grieving period usually lasts three months. With the new circumstances created by the pandemic, however, Bove believes new factors have made it more complex and difficult to predict.
Khadhraoui recognised the covid-19 health restrictions, which prevented her from seeing her brother, as a big challenge for her.
“I needed that comfort,’’ she said. ‘‘I still struggle to come to terms with the fact that he is gone. And I don’t know if I’ll ever get over it.”
Another area disrupted by the covid-19 pandemic and lockdown restrictions in South Africa was the funeral industry.
The health restrictions placed on funerals denied many South Africans control over the way in which they laid their loved ones to rest. Funerals play a big role in how we say goodbye to our loved ones and so, according to Bove, can also have implications on ones grieving process.
“Rituals are so important because it’s essentially saying goodbye officially. Covid has meant that those rituals are thwarted, resulting in an even deeper sense of loss of control, and death already has that effect,” said Bove.
The first restrictions placed on funerals began before lockdown, on March 15, when President Cyril Ramaphosa announced a national state of disaster. Restrictions included a limit of 50 attendants at funerals. When lockdown began, further restrictions were added to the government gazette, such as a one-hour limit on funeral services and a ban on night vigils.
South Africa is known for its cultural diversity and so naturally there are many different funeral rituals. Consequently, health restrictions have disrupted these rituals.
Nelisiwe Makaringe, a 19-year-old first-year student at the University of Johannesburg, studying public management and governance, was affected by these restrictions during her nephew’s funeral.
Makaringe and her nephew, Sifiso Mo’koena, were the same age and grew up together. She often referred to him as her brother when talking. Mo’koena passed away suddenly in May from an unknown cause.
“He became really sick one day and started having cramps in his stomach, so he went to Thelle Mogoerane Hospital [in Vosloorus]. We still don’t know what his cause of death was because the hospital records say, ‘natural death’, but he was negative for covid,” said Makaringe.
Although Mo’koena did not pass away from the coronavirus, Makaringe disclosed that the family was still affected by the pandemic due to the funeral restrictions, as some of their African and Christian rituals were not allowed.
Makaringe told Wits Vuvuzela, “With African homes, the deceased usually comes home in the casket a day before and stays overnight at the home. We then have the funeral and memorial the next morning, and afterwards people usually cook and have a celebration. We weren’t able to do any of that.”
Makaringe said the inability to bury Mo’koena the way they had hoped to, had an impact on the way she and her family have grieved.
“The funeral was so rushed. We weren’t even able to have a memorial service. How can you have a funeral in one hour?” exclaimed Makaringe, an air of frustration in her voice.
“Afterwards, I felt like he hadn’t died,” Makaringe added.
Funeral home workers have been on the front lines during the lockdown, so they have witnessed the way in which families have been affected by funeral restrictions.
Willem Schuwte, an assistant manager at AVBOB Funeral Parlour for the Johannesburg Central Business District branch, has been involved in funeral arrangements during the lockdown period and has had to interact with, and assist, families throughout.
AVBOB is one of the few funeral parlours that offer grief counselling to the families they assist.
Schuwte told Wits Vuvuzela, “A lot more people have requested [grieving counsellors] during lockdown. I definitely think that families have been affected by these restrictions.”
Dealing with families during this time has been extremely challenging for Schuwte due to the families’ reluctance to accept the new health restrictions. Schuwte explained that the body should go straight from the mortuary to the grave site, as outlined by covid-19 health regulations in South Africa.
“[The new process] doesn’t fit in with some beliefs, and families don’t always understand or want to comply when they are told that their loved one can’t be transported or buried the way they want,” said Schuwte.
Bove reiterated the importance of funerals in relation to grief. She said, “When you’re not given a chance to attend or pay your last respects correctly, it complicates the grieving process.”
Technology: A saving grace
Technology has proved to be helpful in many ways amid the pandemic. One such way has been through the ability to livestream funerals when family members or friends have been unable to attend.
Schuwte has seen many families utilise technology to livestream funerals via Zoom, Facebook and other online platforms. He said, “A lot of families have been livestreaming. It’s become the new norm, and I think it’s a trend that’s going to stick around.”
Livestreaming funerals has not only provided a way for those who cannot attend to say goodbye to their loved one, but has also eliminated the high risk of being exposed to the coronavirus when attending physically.
The high risk of funeral gatherings has been continuously seen throughout the lockdown period in South Africa. During the initial level-five lockdown period, three funerals in Eastern Cape accounted for more than 200 covid-19 cases, as reported by News 24.
Sumentha Naidoo, a 45-year-old mother of three and logistics manager at Whirlpool (a home appliances company), personally experienced the benefits of technology when she was able to attend her uncle’s funeral online.
Naidoo’s 71-year-old uncle passed away from the coronavirus in August. He had previously attended a family member’s funeral and his family believes he was exposed to the virus there. Due to the unfortunate circumstances, the family decided it would be best to have the funeral via Zoom.
“The family did it over Zoom because they didn’t want to put anyone in that position, especially since my uncle had gotten the virus from a funeral,” Naidoo told Wits Vuvuzela.
She added, “We would’ve been scared too, because we (Naidoo, her husband and children) had just recovered from the virus ourselves.”
Naidoo explained that, although technology had been extremely useful, she wished there was no need for it, as physical support and comfort are important when grieving.
“With Christians, but especially in our Indian culture, friends and family come together the very same night someone dies. There are always people around, and that support is so important. The family was missing that embrace of a loved one, and it’s a big part of mourning,” said Naidoo.
Bove highlighted the way covid-19 restrictions have changed the expected behaviour at funerals and prevented people from conveying compassion during the sensitive period after loss.
“Social distancing makes it so difficult when you’re not able to extend normal gestures of love and care. And even afterwards, there’s no celebration. This could all prolong the normal grieving process,” said Bove.
Many South Africans have experienced loss under the already stressful context of the global pandemic, but all have been unique in their own personal way.
Khadhraoui struggled to hold back tears and subtly wiped her nose as she described her experience.
Tearfully she said, “We were only a year apart but, being the oldest, I was almost like a mother to him. Whenever there was a crisis, he knew, ‘Margi will fix it’. I felt like it was my responsibility to look after him, and I couldn’t even be there to hold his hand.”
FEATURED IMAGE: The Braamfontein Cemetary in Johannesburg remained quiet over the weekend of October 31, despite the rise in deaths during the covid-19 pandemic. Photo: Catia De Castro.