Grieving in our times

Dr. Alonzo Gabriel was one of UP Diliman’s most promising young faculty, specializing in food science and technology. Only 39, he already had many awards and grants for his teaching and research.

Last year, Al was diagnosed with cancer, and last month, he developed complications associated with the therapy. He was rushed to the National Kidney and Transplant Institute, which put him in the isolation tent they’ve put up for suspected COVID-19 patients because, as a cancer patient, he was classified as “immunocompromised,” meaning having weakened immune systems. They also swabbed him—you’ll hear that term more often now, which refers to taking samples from the throat to test for COVID-19 infection.

Al’s condition deteriorated and he died after a few days, but his body could not be released until the COVID-19 test results came out, which happened the day after his death. It took all of five days to release the results, which happens very often in the Philippines, delaying the proper treatment of patients. The test results were negative.

We see here how our poor testing system affects the care patients get, the problems continuing even after death. In Al’s case, there were even Facebook postings claiming he had COVID-19.

The Department of Health has rules on handling the remains of COVID-19 patients, requiring that they be cremated within 12 hours after death, with no embalming.

That’s problematic for several reasons. Al’s negative test results came out a day after his death. In practice, many deaths are presumed to be COVID-19 even without testing or with delayed test results, with all the terrible implications of that presumption for the grieving family and friends. For financially strapped families, the 12 hours becomes an added burden, as they have to look for money to cover hospital bills and now the cremation.

Last week, broadcaster Arnold Clavio posted news he got from an informant about an unnamed Metro Manila hospital leaving cadavers in the hallway. The government-run East Avenue Medical Center eventually had to come forward to respond, its spokesperson Dr. Dennis Ordoña explaining that the hospital only has freezers good for five bodies.

The COVID-19 crisis, combined with the DOH rules on quick disposal of the dead, will affect many other hospitals as relatives scramble to raise the money for hospital bills and cremation. (And once again, Pasig Mayor Vico Sotto shows the compassionate way by offering financial assistance for cremations.)

Because of the COVID-19 anxieties, all kinds of rules have cropped up. In the case of Al, only three people were allowed to attend the cremation, and there were no religious rituals performed.

These regulations run counter to traditional death practices in the Philippines. Muslims do require burials before sunset on the day of death, but do not allow cremations. Non-Muslims, on the other hand, have a prolonged lamay or wake, with an endless stream of visitors coming to pay their respects. Rituals are important during the wake and the funeral, another large social event.

Traditional practices can pose risks for infection, but the DOH should refer to the World Health Organization’s document released last week offering guidance to faith-based communities for religious activities. In a section on safe burial practices, the document recommends that “embalming, burial, and cremation should be allowed for the remains of persons who have died of COVID-19.”

DOH regulations also stipulate that once a COVID-19 cadaver is placed in a body bag, it cannot be opened anymore. But the WHO states that viewing should be allowed “in accordance with local physical distancing restriction, with no touching or kissing of the body and thorough hand-washing before and after viewing.” Safety precautions are prescribed as well for those handling the remains (i.e., hospital and funeral parlor personnel).

I may as well point out how in the case of Al, the difficult grieving in these COVID-19 times was even more overwhelming for his partner, Anril, as he faced many legal restrictions on what he could do because he was not Al’s legal spouse, or an immediate relative. Yet Anril was Al’s partner for 15 years.

Given existing restrictions, we will have to modify many of our traditional practices, from drawing up a special power of attorney for a partner who you trust and depend on, to planning for memorial services after the lockdown. I also tell friends not to rush a decision on where to inter the ashes and to just bring home the urn for now.

It’s not just life, but also death, that has been put on hold.

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