As we begin 2020 Australia has already seen a disaster on a scale that is unimaginable to most. By the end of last week, at least 23 people have been killed, including three volunteer firefighters. An estimated 480 million animals have been wiped out and over 10.7 million hectares of land have been razed in the fires. The smoke has blanketed our most populous cities but also spread as far as New Zealand and South America.

Here is the current heat map of the fires still burning

https://hotspots.dea.ga.gov.au/

We, our families, our children, and our patients are bombarded with images of the fires every day. In this important podcast, Ian Lewins speaks to Liz Crowe about how we can support children in this time of stress.

You can listen to the podcast here on iTunes.

Here’s the transcript of the podcast

Ian Lewins: Hello and welcome to the podcast. I’m your host, Ian Lewins – one of the children’s emergency department consultants based in Derby in the UK, and it is my very, very great privilege today to be joined by Liz Crowe, who is an extremely experienced paediatric social worker based in Australia and internationally renowned speaker on pediatric loss, grief crisis, and bereavement work. Good evening, Liz. How are you?

Liz Crowe: I’m very well, thank you.

Ian Lewins: So you kind of reached out and well, we had a chat amongst the Bubbles team to talk about the Australian bushfires that are obviously very much in the news at the moment. I’m from the outside looking in. Is the whole of Australia on fire at the moment?

Liz Crowe: I think it probably looks like that in the media and certainly a significant part of our country has been impacted. But, you know, all of the metropolitan and urban areas of Australia are thankfully safe and while we have lost huge amounts of bushland and animal life and we’ve certainly had significant human losses, well, the bulk of Australians remain safe. And while our hearts and thoughts are constantly with fellow Australians who have been impacted, I think one of the big problems is that children are being exposed over and over again on the news, social media, listening to adults talk. And I think like the rest of the world, there are lots of children in Australia who think that they’re in that risk and danger.

Ian Lewins: I think from my perspective, very much looking out and in I’m aware that there have been bushfires and these problems over the last few years. Is this year significantly different?

Liz Crowe: Oh, this is unprecedented for the world, not just Australia. These fires have been raging now really since October -November and have gone on and on and on. We’ve had, I think, over 25 human deaths. Whole towns have been wiped out. They’re saying some of our birdlife and wildlife may not ever recover from this. But this is unprecedented. Areas of Australia look like a warzone. They look like after Vietnam or Hiroshima  – just completely wiped out. This is unprecedented, not just for Australia, but I think for the entire world. So, certainly, I don’t want to undermine or underestimate the significant loss, damage, grief, and destruction from these fires. But I guess when it comes to children, we need to be really careful about their level of exposure and their understanding. We have adults around the world who have no clue about what is the extent of damage so it’s no wonder children are feeling frightened and concerned.

Ian Lewins: And I guess. Where you’re based, is that something that you’re kind of encountering a lot at the moment, sort of on a daily basis, worries from kids? Is that your sort of interest in this?

Liz Crowe: We’re just hearing it everywhere you go. Even though I have a very open relationship with my children my 15 year old said to me last night, “Mum, are we at risk?” And I think it’s because the air quality in a lot of the major cities around Australia has been impacted for a long time. Certainly, Sydney itself as a city is not under direct threat of being attacked. But the air quality in Sydney… people have to wear masks. You wake up that the whole city is in a thick haze of smoke. And so, of course, children, like adults, are concerned and frightened. It’s slowly starting to pop up in social media – how to talk to children. I just think it’s a really important issue. And it’s not just around bushfires. I think what we’re going to talk about today is how do you talk to children about any difficult conversation or any global event or significant trauma that’s going on in the community. These are skills that will be transferable.

Ian Lewins: So I’ve got three kids of varying ages for the youngest of six to eight to 14.

If there were difficult topics around, we have them come up over the dinner table, breakfast table. And trying to manage that for different ages is incredibly challenging, particularly when the older few are very aware of things like social media and what’s popping up.

And if you look at, you know, the bushfires on social media and looking at the images coming back from sort of the firefighters, that they’re unbelievable. They’re incredible.

Liz Crowe:  And this is what I keep saying to people. This is not a mental health reaction. You know, the children feeling anxious, feeling concerned, being tearful about what they are seeing. This is not a mental health concern. This is not something we need to be worried about because the adults are doing the same thing. Emotions are normal. It is normal for children to have reactions to things. We don’t want to raise children who have no reactions to significant events. Just like we would expect children to laugh and be really joyful around Christmas and festivals and fun things that are happening on the media. They’re going to have these reactions to things like the bushfires because they’re also little humans exactly like adults. They experience emotions, exactly like adults. The problem is that they can’t process them, understand them. They don’t always have the language or the reflection skills in the ways that adults do. And so that’s what we need to be mindful of.

Ian Lewins And I guess one of the key questions when you’ve got any sort of major event like this, is trying to find the best approach. Are you very open about things? Do you actively share these things? I guess sometimes as a parent, you want to hide them away from kids? What’s the best sort of balance towards this?

Liz Crowe: Well, I just don’t think there’s any hiding away from children anymore. I think parents have always been a bit delusional and struggled around how to talk to children around difficult conversations anyway. But as I always say, you start whispering and your children adopt bionic hearing. You can stand next to a child and ask them to come to the dinner table. They don’t come. But if you’re half a kilometer away and you stubbed your toe and you swear they’ll hear you. So as soon as children pick up on any kind of nuanced change in their parents or their carer’s behavior, language, tone, they hone into that. Even babies pick up on the emotions of what’s going on in the house. So the more that we give kids information and share what the concerns are, the less chance they are to be confused thinking that they’re to blame or that there’s a problem that cannot be solved as a family. And, you know, unfortunately, I work with children who have siblings who are dying, weekly. We see that. And of course, every parent wants to protect their child from that grief.

Every parent wants to protect their child, give their child the best possible start they can in life. But if this is happening in your family, if this is happening in your community or your country, if there’s media exposure across the world, there is no protecting children from that. You walk into the grocery store today, it’s on the front page of the media. It’s on every time you click on the computer. It’s the front screen showing you what’s happening with the bushfires. It’s on all the news. Everywhere you go, people are talking about it. Nearly every major city in Australia has been blanketed in smoke.. You can’t hide that from children. And so when children don’t have the facts, when children are excluded from the knowledge or the shared understanding of adults, the only thing they can do is make it up. As an adult, you walk into the lunchroom in the hospital and everyone stops talking. You immediately think they’re talking about you. It’s the same thing with kids.

But their anxiety about what that is and what that involves is escalated. Their imagination runs wild. And what we actually do find is that we are increasing their distress rather than decreasing stress.

Ian Lewins: I think one of the things that I say to medical students who are coming to do a pediatric placement with me, who have not really been exposed to pediatric patients before, is that kids are not stupid and they know they know when you’re lying to them or not being completely honest and they don’t trust you. And as you say, we often make things potentially worse in their heads. And I guess it’s difficult, isn’t it, because, yes, we need to be open. Yes, we need to be honest. But does there come a point where there’s too much information potentially?

Liz Crowe:  I don’t think that we need to shove everything in their faces and down their throats. My kids still have a right to be kids. And you spoke developmentally before about, you know, how how do you kind of break that up? I think you aim to give information, standardized information based at your youngest child and then you respond to questions from the older children at the moment.

I think it’s really important because the exposure is so huge in Australia to say to the children these other areas of Australia  are on fire. And this is where we live. And for some families, they’re still living with the risk. And if you are living with the risk, you should definitely say your children ‘We’re living with risk. And this is our safety plan. If the fire comes closer, this is how we will know. The police will come and notify us or we will get a text message from the council on our phone. And this is what we’re going to take, including anything that’s precious to you. This is a box. You put it in here. It’s coming with us. And this is how we will take the cat.‘ And this is how to give information so that there are parameters around it. For families who aren’t at risk at all, but whose children are being exposed, exposed, exposed, I think you try to limit that. You give them information and say these are the areas that are on fire. This is where we live. This is how we know we’re not under any risk.

If we became under risk, this is how to change again. This would be our safety plan. One of the things that I think kids in Australia in particular, but certainly this may be a global problem, is all of what’s happening with the animals.  We’re being bombarded with pictures of people saving kangaroos. And I think what we need to says, yes, sadly, we have lost a lot of wildlife and a lot of birdlife and a lot of our great country has been hugely damaged. This is how the earth will recover. This is how, when animals are injured, there’s a lot of vets doing very remarkable work at the moment. Euthanizing, healing, setting up clinics  for burnt animals. And then once they have that information, move on, talk about something else, get them away from it. They don’t have to sit with it. It’s not healthy for adults to do that. Certainly not healthy for children.

Ian Lewins: Absolutely. What are we going to say if, as you say, houses and pets and belongings are destroyed? And are you finding in conversations that you’re having that it does seem to be the pets that the focus or is it sort of possessions or people or what sort of things?

Liz Crowe:  I, personally, haven’t come directly in contact with families who have lost everything. I mean, I think certainly for families who have lost everything, there’s no minimizing or hiding that from children. They’re going to have to say, “Look, we have lost all these things. You’re going to see mum and dad cry a lot. You’re going to see our friends and our neighbors cry. That’s because people are very sad about what’s happened. This is what’s going to happen next. This is where we’re going to live. This is how, you know, there’s a thing called insurance and people are making donations. We may not go back to where we used to live.”

Providing a routine and structure and reassurance about what’s going to happen next, it’s very important. For families who haven’t been directly contacted just to let kids know this is what happens. There are children out there who have lost their whole community, who don’t know where they’re going to live, don’t know where their neighbors are. And for some communities, it may be too devastating to return. Other communities, the rebuild will take years to return to any sort of sense of normal. But I think just like adults,  they need parameters. When you’re in crisis, you need to break things up into steps – this is where we’re going to sleep tonight, this is what’s going to happen next. So the children who are safe, but who are saying what’s going to happen to those pets? Pets and animals have been a big thing on the media. Provide assurance that, you know, there are lots of people working day and night tirelessly to find the injured animals.

And the animals that can’t be saved are being euthanized as swiftly and as gently as possible. Maybe you’ll need to say that, maybe you won’t. I think, be guided by what sort of questions you’re asking. I mean, you wouldn’t say that to a 4-year-old who had no clue that could happen. Just say the vet is coming in, they’re going to look after the animals. For the older kids, it will be fine to say that they’re going to be euthanized and that that happens swiftly. And that’s shocking. But that’s much better than letting an animal suffer. So it really depends. You can’t sort of say what’s the chronological age that you would talk to children about this, this and that? Because you might have a four-year-old who says what happens if there’s a koala who can’t be cured? And then you have to answer that properly.  And you could say the animals are being taken care of. So you need to be guided by what the children are asking, but lying to them… providing false securities and false hopes, that doesn’t make kids feel safe because they very much can see what the reality of what’s going on. And  fire is hugely frightening.

Ian Lewins: I just think that the thing I’m hearing a lot of through this is having a plan. Breaking it down into little bits and having a plan for each bit. is that sort of thing that provides a bit of psychological safety, I guess, for these kids?

Liz Crowe: Absolutely. Yeah, and I think parents do need to think about this before the questions come up. If parents out there aren’t sure how much their kids know, tune into them. Listen to what their conversations are. Listen to if it’s coming up in their play. If they’re finding that their children are waking more frequently, having night terrors, any of those things, ask them what it’s about and then provide assurance around that. There may be some children who just need stronger attachments at the moment. A lot more reassurance, wanting to know if they’re in the firing line . Or if there’s a lot of smoke around, playing with the kids or talking to them more. Staying with them. Putting on a night light, anything that offers reassurance. But I think that whole thing about having a plan about what to say when the questions come up is good. I think the other thing is parents really work up in their minds like I have to have this big serious conversation.

I’m going to say this. They’re going to say that. And then they interrupt children while they’re watching their favorite TV show or when a child is tired or when a child is hungry. And, of course, it just doesn’t work. And that’s not because the child’s got mental health problems. That’s because you don’t have a serious conversation with anyone hungry. Don’t have a serious conversation with anyone when they’re tired. That includes adults. So I think,  have a plan. And for those people who are potentially at risk or for those people who’ve already been impacted, break it down into small chunks about what is the plan to each day or what is the plan? Should we become under risk and have to evacuate?

Ian Lewins: I guess one of the real challenges at the moment is managing uncertainty. I’m sure you’ve come across multiple times in your work where we’re not quite sure what’s going to happen next. I mean, my understanding is that, the fires are still going and it doesn’t look like they’re stopping anytime soon.

Liz Crowe: And I guess it just keeps coming back to that plan. If you’ve got uncertainty and it doesn’t matter if it’s a fire or a flood or an earthquake or from volcanoes, any of those things. It doesn’t matter if there’s talk about separation or domestic violence. If you’re able to say to a child, “This is the plan, this is how we would know when we have to move. This is what we would take with them. Here’s a little bag and your lantern.”

You know, I grew up where we had cyclones. And when a cyclone was coming we had several nights when I was a child that we all had to bunker down in a bathroom. Four kids and our parents in this tiny bath. And the bath that was always filled with water in case we lost water or electricity. You’d hear the wind raging. We were allowed to take two precious things with us. And it was a really big thing as a child to choose what were those two precious things? But that was the rules. And we knew that. And we would take it home with us. And we knew that if something happened to the house, this would be the next step. This is where our parents would often say to us, we will be in the bathroom for at least 10 hours or we’re going to be in there for the night. So you can take two toys and a pillow. And just even those sorts of things. It provides a sense that someone is in control. Someone is keeping me safe.

And you know where to go from here. I mean, the images that are you seeing of a whole community on a beach, with this fire raging? I was brought to tears by that. We have to expect that children will react to that. And I don’t think we need to go into it. How do you look after the children who were on that beach? Because there’s such a specialized, such a small proportion and they’ll be specialized counselors going in and looking after those kids. But if your kids are saying, what happened to them on the beach, you can say, you know that they would have been frightened. But people came on boats and they looked after them and they bought the water. And this is how they got them out. And this is where they took them. And something like $80 billion has been raised so far. So to say to kids, lots of money has been raised so far and this is how we’re going to invest it. And these are the sorts of things were doing, like I’m talking to my children that, I plan in the next year or so to go to Kangaroo Island, which is an island off of South Australia that’s been hugely devastated so that we can go back and contribute to their community by tourism.

This is what we’re going to do in the short term. This is what we’re going to do in the medium term. This what we can do in the long term. Because I think what we want to also teach children is you don’t just pay attention to what’s the biggest noise in media at the time. This is going to be an ongoing issue for our country for a very, very long time. And as a community, we can’t afford to forget them. And they’re good values to teach your children going into the future – that we always remember people who had a significant loss, just like we march on Anzac Day when we remember people from World War One and we’ll look to Vietnam and all the subsequent wars that Australia’s been involved in. You know, these are the sorts of things that we have to remember both now and into the future.

Ian Lewins: Absolutely. One thing I’d pick up on that I thought was interesting is you’ve mentioned a couple of times this was saying this is not a mental health problem – these reactions, these responses, these behaviours. Do you say that because there’s potentially a push to try and label the responses as mental health problems?

Liz Crowe: I’m not a psychiatrist and I’m not a medical doctor. I’m a social worker. It really concerns me how quickly children and adults get a mental health label. This is depression. This is anxiety. Actually, to be really worried if you’re living in a bushfire area, that anxiety is real. It will not be what it’s about. It’s reactionary. It frightens me. We have children die in our unit and within a week, parents are being diagnosed with depression or kids are being diagnosed with depression. That’s grief. It’s sadness. Grief and sadness can develop into depression. Those things can be linked, but not in the acute phase. You can’t have post-traumatic stress disorder for four to six weeks. So if someone has been exposed to the fire and had to run and their kids and themselves feel very heightened, they’re in an acute critical stress response. That’s a normal response to a completely abnormal,  adverse trauma. And so I’m really keen for us to normalize kids’ distress, normalize our own distress when something distressing has happened.

When someone is anxious about something because it’s a real threat, that’s actually a protective thing. It’s not a mental health concern. If there’s a fire and I feel very anxious about being impacted, about my house burning down, that’s a healthy reaction. I’m going to run. I’m going to be alert to it. It doesn’t mean that there’s a problem. And so that’s why with kids now being exposed to all this you need to say know that’s really normal. Of course you’re worried. These are terrible, terrible things that are happening. But the kids who are affected, they’re not traumatized. They’re just impacted by what they’re seeing. So I think it’s important. Language is important. And it concerns me how quickly we go to the extremes of things. Instead of just saying they were worried. They were frightened. They were impacted. We say, straight away, they’re traumatized and they’re not traumatized. They’re going to recover from what’s happened, especially kids who haven’t actually been directly involved.

Ian Lewins: Last question then is one of the things I guess I’m interested in also was that with the job you do, how do you protect yourself? So how do we as parents or health professionals, you know, we talked about being honest with parameters. We talked about having plans to try and help and protect our children. How do you protect yourself?

Liz Crowe: Well, if you’re a parent I don’t think it’s good. Just before we go to bed at night to watch YouTube clip after clip after clip of the bushfire. That’s not going to be a peaceful, restful way to go off to sleep. So I think it’s about being very grateful, first of all. I feel very blessed that I’m in Australia. And I had neither my family and my close friends, no one’s been directly impacted. So I’m grateful for that. I feel now I have a responsibility to help those that have been. So think about being grateful for the things that we have. To do something active for those who have been impacted so that we can feel part of being. And I want to be an Australian. I want to step up and help my fellow Australians making financial contributions, doing podcasts, whatever it is, you know, making food or whatever it is that you can do to look after yourselves. I think that we just live in such a society where busy-ness is rewarded. Being exhausted and tired and frantically busy all the time is the new popularity. Slow down. Ask yourself what’s important when things like this are happening. It’s really a time of reflection, I think, where you can say, what is important in 2020? What would I like to do? Who would I like to be as a person? Whether as a parent, as a friend, as a sibling or a daughter or son, and to really invest in those things. And so often the only New Year’s resolutions you hear about people’s body image. I’m going to be super fit and had to be thin this year.

Instead of being that, say, how are you going to honor yourself? Are you going to look after yourself? What would be important? I said if people don’t talk that exercise, talking about movement in relation to eating a big burger, go for an extra-long walk, you know, have a little dance in the kitchen. Just get yourself moving. Be careful of our language that we use to ourselves and be careful of our language we use with our children. And self-care is really important. But part of that is also reminding yourself that we are part of the community. And keeping a broader perspective, because when any of us become too, over reflective or saying today, you know, if you say to someone, don’t think of the polar bear, don’t think the polar bear, first thing that happens.? Everyone thinks of a polar bear. If you go to bed every day, you think, what would it be like? This is my family. You know, what can I do for the climate? I think there’s an existential crisis to the bushfires around climate change. And what is our responsibility? If you get caught in that cycle, you build it in your mind. Whereas if you think these are the things that I can do, these are things within the realm of my power. These are the things outside the realm of my power. I’m going to really focus on the things that are within the realm of my power and that life is good and be optimistic.

 And, I did a podcast with some vets today and they were saying, while the bushfires are terrible, if you had to think about something in relation to it, that’s good… I wish we didn’t have the bushfires, but Australia has come together as a community. The world is having this huge outpouring of emotion and wellbeing and goodness and donations. That’s a good thing to know that actually humanity is still at its core, very positive, very good. And we don’t need to be hopeless about that. We can share that optimism with our children.

Ian Lewins: Absolutely. Let’s think there’s so much that people will take away in the end. I think that that positivity, the optimism is so important. So thank you so much for joining us on the podcast today and wishing you all the best.

Liz Crowe: Thank you very much. Thanks for having me. Ian.

For more on the impact of the fires on health, from those on the frontline, it is worth reading this piece from Melissa Sweet at Croakey News.