MSF staff share five important tips for adjusting to life in confinement

Since entering lockdown, life in the UK, and indeed in many countries around the world, has been transformed.

We’ve been asked to stay at home and to practice physical distancing and good hygiene to stop the spread of COVID-19.

For many MSF staff overseas, these types of restrictions are not new.

In many places where we work, our teams need to live in various forms of confinement for their safety, as they provide medical humanitarian aid in places affected by insecurity, war or outbreaks of disease.

“As MSF staff, we know what it’s like to not be in control. We regularly deal with curfews, extended stays in the safety room and limited movements.”
Saman Perera, MSF project coordinator

Here, our staff share their tips for surviving lockdown to prevent the spread of COVID-19 and, ultimately, save lives.

1.  Remember why you’re in lockdown

“I think it’s important to remember your purpose for being confined,” says Catherine Flanigan, a nurse who recently worked with MSF on the search and rescue ship, Ocean Viking, in the Central Mediterranean.

Catherine was confined to the ship for weeks at a time, with very little room to move, especially when the ship was packed with rescued people on board.

Catherine (Right) and other crew members head back to the Ocean Viking after a rescue in the Central Mediterranean. © Hannah Wallace Bowman/MSF

Catherine (Right) and other crew members head back to the Ocean Viking after a rescue in the Central Mediterranean. © Hannah Wallace Bowman/MSF

Her role in the medical team was to provide care to all rescued people, with a special focus on survivors of violence.

“I didn’t mind being confined on the ship,” she says.

“Any inconvenience paled in comparison to the importance of the job we were doing, which was saving lives. And that’s true for all of us right now.”

Andrew Cadle, logistician

Ask yourself what is the most good you can do in this given situation. It could be reading about a subject to further your work or personal goals, or investing in the people you are confined with, learning a new language, corresponding with friends and family. For me, the personal reward of pursuing this “most good” is helpful in keeping me motivated.

Madeleine Smith, administrator

The most challenging part of being in a relationship in a confined space was trying to find moments to nurture the relationship rather than falling into the humdrum of the daily routine. It was hard at first, particularly while living in a team, but we managed it. Doing some kind of project together can help bring an appreciation for your partnership. My partner Shane and I made a vegetable patch and worked on it together each Sunday.

Edna Bartholome, financial coordinator

Daily but limited media on the pandemic. In the beginning, I was getting really stressed watching all the news on TV and following all the tweets, online alerts, etc. I now only watch New York State Governor Cuomo's daily briefing, which is very organised, fact-based and therefore calming. Around dinner time, I check for real breaking news only for 15 to 30 minutes to get updates. It’s helping me to manage the stress by disciplining myself on exposure to the issue.

One of the things that we enjoyed as a group in Gaza on weekends was playing Cards Against Humanity. It was hilarious and so politically incorrect that it was great contrast to the compassion we need to have for our work. I just learned that a version of this is now available to play online.

2. Accept your new reality

Once you’ve reminded yourself why your movement is restricted, it’s important to accept the new rules.

Hopefully, you’ve learned to live with the lockdown measures currently in force in the UK and are ready to adapt to any changes over the coming weeks and months as the government moves to the next phase of its COVID-19 response.

“Accept that confinement is the new norm, don’t try to fight it,” says Dr Tom Niccol, who recently spent six months working with MSF in South Sudan.

Dr Tom Niccol recently spent six months working in a remote hospital in South Sudan. © MSF

Dr Tom Niccol recently spent six months working in a remote hospital in South Sudan. © MSF

Tom’s movement was restricted to the hospital and accommodation compound for months on end due to violence and instability in the area.

For six months, he worked as medical doctor in this extremely remote area, where MSF has run the hospital since 2014. 

Tom says while it’s easy to fall into the trap of questioning the new rules and regulations, it’s better to accept that the boundaries are there for a reason.

“You will be more at peace in yourself when you accept this notion, rather than being in a constant state of wanting to challenge authority,” he says.

“Remember, your liberty will return!”

Rasha Khoury, obstetrician-gynaecologist

It helps me to not think of this as a time to “get through” but as part of my life that I am choosing to be 100 percent present in: I chose to live in this city, I chose to be a health worker i n a safety net hospital, etc.

Not thinking of myself as “stuck” in my hospital or my apartment but breaking up each of those spaces into smaller spaces that I move through and narrating for myself “now I am in the kitchen to make breakfast”.

Breaking up the day and night into segments with some tiny ritual or routine (meals, dedicated work hours, exercise or time to connect with family and friends) and not letting those times bleed into each other.

3. Have activities… and snacks

Construction manager Jeff Fischer recently returned from a six-month assignment in Kunduz, Afghanistan, where staff movement is restricted due to insecurity.

The only permitted travel was from the accommodation to the worksite, where Jeff was managing the construction of a trauma hospital.

When military activity escalated, the team was forced into an even smaller space for days at a time.

Jeff says it’s important to have some activities and projects on hand.

MSF construction manager Jeff Fischer. © MSF

MSF construction manager Jeff Fischer. © MSF

“I was aware of the context of the assignment before I accepted it and arrived with chocolate and jigsaw puzzles to share,” he says.

“I also took a cheap ukulele and began to learn how to play it… quietly. The team was comprised of people from about a dozen nationalities and sharing recipes and cooking together became a favourite pastime; we even built a wood-fired pizza oven in the small garden.”

Catherine Flanigan echoes the importance of keeping occupied. She was on board Ocean Viking when it was quarantined by Italian authorities for 14 days as COVID-19 hit Italy.

“We tried to keep busy, doing work and training sessions,” she says.

“We tried to entertain ourselves a little bit as well with games, a quiz, movies, normal stuff. The ship was probably the shiniest it has ever been, and we cleaned and cleaned again. But it was really difficult to be out of our normal routines and to not able to do the work we’d come to do.”

Aditi Jani, lab manager

Mental exercise: Sudoku, puzzles, meditation, reading. Journalling really helps if you’re frustrated – you can write it all down and release your emotions onto paper. Clean your room or home, get rid of junk you don’t need (you will feel so good throwing it away), redesign your living space.

Vanessa Hardy, pharmacy coordinator

Social distancing is really just physical distancing, so stay connected. Call, text or play games with friends and family, such as Words with Friends and Scrabble.  Research and plan things you've been wanting to do – map out travel plans (for when the time comes) learn to sew, learn a new language, learn an instrument.

4. Have a routine, including exercise

While on assignment in South Sudan, Dr Tom Niccol found it helpful to have a routine to give some structure to his days.

“Sometimes it’s daunting to have so much time free time without access to any usual tasks to fill the day,” he says.

“Devise a routine even if this is scheduling mundane chores, such as morning – washing clothes; midday – family catch up via phone, etc. This will help to structure the day, maintain productivity and provide you with a reason to get out of bed!”

Exercise, even with limited space, is also recommended for its clear physical and mental health benefits.

“I purchased a skipping rope, resistance bands and a yoga mat. In a one-metre by two-metre floor space, I am able to do cardio and resistance exercise,” Tom says.

Urshula Edwards, supply manager

Exercise! Endorphins are a great way to combat any negative feelings isolation may bring. I recommend the Down Dog app – it’s the best for self or group practice. You choose your level, speed, area of the body you want to work and the type of yoga you want.

Learning! Generally, throwing myself into work helps me not to feel isolated. Although many (myself included) are unable to work, we can still put our minds to work. There are lots of free classes online at Coursera and edX.

Sally Parker, midwife

The way I cope in these lockdown situations is to do some sort of physical exercise every day. If I can, I either bike or walk outside, or if that’s not allowed, I exercise inside. I love to read and so make sure I have good books. I also like movies and download those onto my iPad. I love food and wine, so cook new dishes and experiment in the kitchen.

Kim Comer, logistics coordinator

One day a week is different. I sleep late, I put on a skirt, I read a book. I keep a routine and always eat at the same time – no snacking. This keeps days framed. Smokers have a good idea, every two hours they stand up and get outside for 5-10 minutes of “me time”. I don't smoke but those breaks are a great idea.

5. Find the positives

Confinement can be challenging, with little access to many of the activities that bring enjoyment.

Many of our staff overseas also live without creature comforts; for instance, while in South Sudan, Dr Tom Niccol lived in a tent with no access to hot water.

But our staff suggest it’s helpful to look for the positives within the new boundaries.

“Confinement forced me to rest,” says Tom. “It forced me to be innovative and learn coping strategies for ‘alone time’. I was even more connected to friends and family, as I had time for extended chats.”

Jeff Fischer says the cramped living conditions, against the backdrop of explosions and gunfire, “gave rise to a close camaraderie”.

“The main ingredients for living comfortably together in this context seem to be tolerance, respect and consideration for others, good manners and a sense of humour.”

Saman Perera, project coordinator

Now is the time to be kind to yourself, and by extension, to each other. Take the time you need to sit with and process your emotions and reach out for professional help if you are overwhelmed. You still have some control in your life, and it is important to focus on this. 

As MSF staff, we know what it’s like to not be in control. We regularly deal with curfews, extended stays in the safety room and limited movements.  Most of us already have plenty of practice making the most out of difficult situations and this coronavirus situation is no different.

It may be helpful to think, “Even though I am painfully bored, what activities can I do that I genuinely enjoy, even in quarantine?” or “I know that I am lonely but is there an old friend that I have not reached out to in a long time?” or even “The gym is off limits and I am frustrated, but can I start running for the first time?” You may not be able to control everything, but you can make a concerted effort to steer your thoughts into a more positive direction.

And finally, it may be important to refocus some of your thoughts in difficult moments. Consider starting a gratitude practice or journal. Having an attitude of gratitude and appreciation helps because there is always something or someone to be grateful for, no matter what the circumstances. 

Is there a favourite coworker at your hospital that you will get to see today? Are there wonderful things about your children or parents that you are just now discovering because of this crisis? Purposefully looking for the good (instead of the bad) in a situation can be a deeply healing experience.