Quarterly Newsletter Jul–Sep 2021
Issue 09
Our Mission
Being called to follow the inspiration of the Gospel and the compassionate attitude of Jesus, we strive with conviction for excellence in all areas of training and nursing practice for the benefit of the community.
Our Vision
Catholic Church Health Services is an organisation whose members envision enhancing the quality of life of our people by providing a holistic approach to health care through trained, dedicated and compassionate staff.
Our Values
The Catholic Church recognises that training institutions, medical and nursing services are a continuation of the healing Ministry of Christ.
Therefore, our service will be comprehensive and holistic, embracing all people of our nation regardless of creed, colour or social status.
Catholic Church Health Services expects all of its personnel, regardless of whether they are paid or volunteers, to practice the values of:
- Integrity
- Justice
- Compassion
- Excellence
Contents Inside
- M&E Master Training a Success
- CCHS signs contract with APNG WLN
- Revised template helps dioceses
- Families urged to share
parenthood responsibilities - Pom Clinics get new computers
- Lae CCHS staff completes prescribers training
- ASRH Workshop a Success
- Clinic Receives 2nd Donation from Curtain Brothers
- other stories….
Cardinal encourages CCHS staff to get vaccine
The 62nd Catholic Bishops Annual General Meeting was held in Port Moresby recently.
In attendance, Bishops not only discussed their primary task of evangelization but also addressed key issues that are affecting Catholic faithful’s in the country. Bishops from the Solomon Islands were not able to join the weeklong meeting due to the COVID-19 restrictions. The AGM took place at the Catholic Bishop Conference on the 22nd to the 29th of June.
One of the key issues addressed is the COVID-19 situation in the country. President of CBCPNGSI Archbishop Anton Bal stated during a media conference at the end of the AGM that apart from their usual planning for the life of the church, they understand that their Catholic people and many other people of good will expect guidance from them on how to respond to challenges of these days in light of the gospel.
The Church being aware of different views on the pandemic, continues to maintain the advice from health experts that COVID-19 is real, dangerous, and deadly. Urging people to wear mask in crowded places as an obvious form of respect and care for the health of others.
“The Catholic Church maintains that there is no necessary conflict between faith and science. We therefore accept the findings of science that vaccines, specifically COVID-19 vaccines, genuinely protect against contracting COVID-19, spreading, becoming seriously ill, and dying from COVID-19. We encourage everyone to be vaccinated. We are well aware that the Astra Zeneca vaccine, as with most COVID-19 vaccines, have drawn on cells from aborted fetus. This is very unfortunate and we hope that vaccines without this complication can be developed. In the meantime, since there is no other choice, the common good requires that everyone seriously consider being vaccinated.”
His Eminence Cardinal Sir John Ribat, Archbishop of Port Moresby says that with so many misinformation , people are confused and scared. “I am fully vaccinated and so are the other bishops, priests and many people. In PNG we see that people are already dying from the disease. Many people have worked hard to create these vaccines with God’s wisdom and blessing and it is fairly to help us all save lives.”
“So to our health workers, I would like to encourage you to lead the way. What are we afraid of? We should see this as an act of charity from God to save lives. The danger is with us, let us take the vaccine to safe guard our lives as we face the threat with confidence and know that God is with us through this. Let us work hard to save lives and not be afraid.”
SECRETARIES MESSAGE
I would like to welcome everyone to our 3rd edition of the CCHS Pulse for 2021 as we explore stories that highlight our achievements and challenges across the country. With COVID-19 challenges, the Catholic Church Health Services have done outstanding work in maintaining normal operations under the guidelines of the COVID-19 Preventive measures within our facilities. I applaud all staff that has contributed exceptionally, making sure our people receive the healing they seek, physically, spiritually, or emotional.
CCHS has been blessed to have received donations in kind in this quarter. I would like to thank the Rotarians for the donation of clinical equipment and personal protective equipment (PPE) that we received in good faith. I also take this time to acknowledge respective business houses that have supported our health facilities with cleaning equipment and materials for pandemic measures. Your contributions have helped our facilities continue providing health care services to our people.
As we reflect on some of our key achievements in the 3rd quarter, I am pleased to mention that presentation of the CCHS Report was acknowledged by our bishops during the 62nd Catholic Bishops Annual General Meeting in July. Furthermore, our 1st Board Meeting was held at the National Office after much delay due to the pandemic measures.
I would like to acknowledge team at National Office for their tremendous effort in collating the 2022 Budget and submitting it to Department of Treasury in August 2021.
I am proud to say we successfully completed capacity building activities through trainings and workshops facilitated by the national office. Three significant workshops were Master Data Monitoring and Evaluation Training, HIV Prescribers Refresher Training and Gender Transformative Approach Training.
Moving forward, we have significant activities planned for the 4th quarter. A pilot Leadership Training for the management and Health Managers in October by Advancing Papua New Guinea Woman Leadership Network Inc. The training will later be rolled down the dioceses. We also have the HIV Prescribers training in Mt Hagen and supervisory visit to Alotau and Madang.
I want to take this time to congratulate the two new Bishops, His Excellence Bishop Justin Ain Soongie of the Diocese of Enga, His Excellence Bishop Joseph Durero of the Diocese of Daru- Kiunga and Bishop Elect for Aitape Diocese, Father Siby Mathew Peedikayil. May the almighty God give you all the strength and joy you need for this very important ministry in the Church. I pray the we all will work together to encourage and support each other’s vocation with God’s people.
Let us be humbled that our work is the continuation of the Healing Ministry of Jesus Christ, to serve all people of our nation regardless of creed, color, and social status. Aside from the accomplishments, we pay our respects to our staff and families that have left us, may they rest peacefully in the grace of God. We pray for their souls to find eternal peace and for each and every one of us still alive, good health and wellbeing.
May God Bless you all.
Sr Jadwiga Faliszek
CCHS National Secretary
SHRIP UPDATE
Sexual and Reproductive Health Integration Project (SRHIP) is progressing with the implementation of activities in the eleven provinces. Despite Covid-19 restrictions there were key achievements and some challenges that were identified in the third quarter.
With continuous support from our International project partners ASHM and Burnet we were able to implement activities planned out for the year. Our in-country partners such as PNG Sexual Health Society Director Dr John Millan was instrumental with his support to the technical team within the CCHS National office and providing clinical consultations with the clinics in Port Moresby and refresher trainings in the provinces.
The highlights for the third quarter are the complete maintenance of the New St Joseph VCCT building, and the Youth and Adolescent Health (YAH) Assessment in St Paul’s Urban clinic (NCD). The Covid-19 support for messaging is on-going with different Sexual Reproductive Health topics, a new Covid-19 Live Vax talks with SRHIPPNG Covid-19 Support WhatsApp Group has been established, also Identifying the Covid-19 Champions and Printing of the Covid-19 IEC materials. All these was made possible with team effort from all partners under SHRIP!
There were also a number of Virtual trainings conducted to strengthen capacity building in the areas of Data Monitoring for M & E officers within the 19 Diocese, ART Prescribers training to most of the CCHS ART clinics and a Gender Training that seeks to sensitize our clinician around various gender approach and interactions.
There were also challenges with the Igat Hope Management team which CCHS has done corrective measures and are supporting the internal management and payroll system. Community engagement effort with the work of the Peers in the clinics are gaining recognition with the contact tracing and counselling techniques used to support patients in care.
On-going efforts have also been carried out in the eleven provinces with the DHSIOs, HMs and clinical teams continuing SRHIP activities in the diocese for the full integration of the 13 VCCT clinics. These activities are complimentary to the major Health services in the provinces. The Sexual and Reproductive Health services are paving way for Health systems strengthening within the diocese which also resulted in the negotiation of Service Level Agreement with five Provincial Health Authorities (PHA). SRHIP will continue to support capacity building at clinical and administrative levels. Two new clinical Prescribers training will be held in October and November of this year which will follow on from a special pilot of Leadership training to be held sometime in October. The project now has two to three months remaining for activities to be completed. Dioceses that are implementing this project will be contacted accordingly by the National Office for next steps.
Head Office News
M&E Master Training a success
Participants of the Data Quality Master Training are keen to utilize and share what they learned during the three days at Emmaus Conference Centre, Don Bosco Technical School in Port Moresby.
Monitoring and Evaluations officer for Mt Hagen CCHS, Sharon Geru said that she’s determined to go back and pass on what she learned to all her colleagues. “I would like to not only hold an Inservice with our Diocesan Health Manager and the Officer’s in Charge of our 15 health facilities but also include all the other staff.”
She said the training gave her a more in depth understanding of her role and the importance of what she does in the diocese as an M&E officer.
The training equipped the participants with knowledge and skills to support their dioceses and facilities in the management, reporting and use of quality health and HIV data.
This was the second DQM training hosted this year by the CCHS M&E team with the assistance of ASHM’s International Program Advisor, Nikki Teggelove. The participants are CCHS M&E officers form the Highlands, Momase, and one from Southern Region. CCHS M&E officers for the Niugini Islands and Southern Regions have already attended the same training in Kokopo in July.
The training was officially opened on the 3rd of August by the CCHS National Secretary, Sr Jadwiga Faliszek and Projects Director Graham Apian. Sr Jadwiga encouraged the participants to be more open to new learnings during the training as well as from each other’s successes and challenges. “I want you all to learn as much and when you go back, hold an Inservice and pass on what you learned here,” Sr Jadwiga said.
CCHS Projects Director, Graham Apian who was at the closing of the training, presented the 11 participants with certificates for completing the master training.
CCHS signs Contract with APNG WLN
The National Catholic Church Health Services recently signed an agreement with the Advancing PNG Woman Leaders Network Inc on the 27th of August in Port Moresby. APNGLWN will be collaborating with CCHS in areas of capacity building for Health Managers.
National Secretary Sr Jadwiga Faliszek said this is a very important area as it is a lifelong skill that our health managers will need to empower them in their work. One of the main challenges that the training will address is the lack of proper communication and feedback mechanisms.
Through the contract signing, CCHS intends to equip its health managers and middle management with new knowledge that will build a skillful workforce that is accommodating to growth, accountability, and responsibility, to benefactors and funders.
APNG: WLN is a company that provides tailored leadership and management trainings that are specifically designed with the help of their international counterpart the WomanLeadInstitue’s Curriculum. APNG: WLN Project Manager Cathy Alex thanked CCHS for giving them the opportunity to run the trainings. “We’ve got 4 trainers in the country that’s been trained to deliver that curriculum, but it will be more tailored to the needs of CCHS.” Cathy said.
A pilot workshop is scheduled to take place on the 11th to the 14th of October, before more trainings will be rolled down to the CCHS Officers in Charge throughout the nation.
Revised template helps dioceses
A fundamental component of Project Management is ensuring transparency through accurate acquitting of public funds.
Project Finance Officer Wilfred Kakau form the National Catholic Church Health Services said that to achieve this, comprehensive and manageable financial tools must be tailored to articulate all aspects of the perceived financial reporting structure.
The formerly used Cash Book, Activity Implementation Plans (AIP) and Plan Activity & Plan Budget (PAPB) reporting templates although enabled Health Managers to take stock of their activities they lacked direction in terms of substantiating actions and providing measurable financial outcomes in each deliverable.
“There were impeding setbacks faced with having only one bank account comprising of several grants. As a result, Dioceses faced perpetual difficulties in determining ending balances at months’ end for each grant.” Kakau said.
The experience paved way to the recent inception of three (3) interactive and all-inclusive financial templates for the Sexual Reproductive Health Integration Project.
The templates were each simply designed to improve the capacity of DHSIOs and Dio-cese Health Managers in the management and coordination of their project funds in reaching more targeted areas.
Many have warmly embraced the simplicity of the documents and expressed their gratitude as the templates have vastly enhanced their professional confidence and team morale in this space.
“It’s very helpful, we now understood well how to do our budget and work towards achieving our AIPs and also keeping track of our remaining balances.” DHM for Vanimo CCHS said.
Kakau explained that to achieve value for money (VfM) in all their grants, a uniformed financial structure aligns all expenditures in conjunctions to their donor’s budget line. Which allows the National Office to effectively and efficiently mature their risk-and-control frameworks to make them more robust and sustainable over time.
Diocese News
Families To Share Parenthood Responsibilities
Every Tuesday at the St Therese Urban Clinic is Well Baby Clinic days. Mothers, fathers, and their babies line up outside the clinic waiting to be let into the clinic – eager for antenatal care, post-natal support, and immunisation for their children.
Among them was a young couple Nelson Joseph and partner Nashaly Kolove, first time parents to one-year-old Lenny. They have been regular faces at the clinic since Nashaly’s pregnancy.
It was a fitting scene for the World Breast Feeding Week which in 2021 was themed “Protect breastfeeding: A shared
responsibility”.
Breastfeeding contributes to babies’ survival, health, and wellbeing and with the added pressures of the COVID-19 pandemic, mothers need more support from partners, family, friends, and health workers.
St Therese clinic nurse Rebecca Lama encourages mothers to bring their partners to the clinic if their child is sick or is due for immunisation.
“It’s rewarding for me to see all the mothers that have come through my doors for antenatal clinic now bringing their husbands with them to the clinic,” she said.
Rebecca said that breastfeeding mothers also need to recover from childbirth and need support from the family to be healthy and give the baby the opportunity for a long and healthy life.
At clinic, nurses walk mothers through pregnancy, birthing, and life with a baby. Where possible, they encourage breastfeeding for at least the first six months of a child’s life to promote healthy growth and mental development.
In addition to antenatal care and routine childhood immunisation, the clinic also tests pregnant mothers for tuberculosis, HIV, and other diseases to ensure their babies can get off to a good start to life.
New Equipment's to help HIV Services
Staff of the two Catholic Church Health Facilities in Port Moresby are happy recipients of new equipment’s bought under the FHI 360 HIV Programs. New computers sets, phones with sim cards and filing cabinets were bought by the Diocesan Health Manager to help her staff at the two facilities continue their work in HIV.
DHM Sr Geraldine Arua said phones are for the 4 trackers who contact LTFU (lost to follow up) clients and patients to return to care and services. She added that along with these items were two filing cabinets are for filing of clients and patients documents.
Monitoring and Evaluations Officer for CCHS Pom, Jessica Kasawen said FHI 360 has been supporting them with the roll out of the index testing and tracing to break the chain of transmission.
The CCHS clinics were St Therese in Hohola and St Paul in Gerehu. These clinics have been working tirelessly with the Expert Patient Counselors to trace their active ART patients’ close associates.
ART Prescriber Christine Amdi explained that since the integration of HIV standalone clinic St Joseph Freinademetz with St Therese and St Paul Day Clinics in 2017, they have since been using the same computers.
“The computers have been very slow and needed an upgrade, but now we are very thankful to the FHI 360 HIV Program as through their support we were able to get new equipment’s. “she added.
Under the USAID HIV Support in PNG, FHI 360 has been providing technical assistance to the National Department of Health and it’s implementing partners included CCHS, Anglicare PNG, Hope Worldwide, Living Light Health Services and the Salvation Army.
Lae CCHS staff completes prescribers training
Eighteen health workers from the Diocese of Lae Catholic Church Health Services will be given certificates as HIV Prescribers after completing their clinical attachment practical with the Centre of Mercy Clinic in Lae.
The participants were made up of a medical doctor, five nursing officers, eight community health worker and four Community Health Worker Volunteers attached to the four CCHS facilities in Lae. The HIV Prescribers training itself took place on the 15th-18th June at the Pastoral Center in Lae.
It was organized by the Diocese and supported under Sexual Reproductive Health Integration Project. Director for PNG Sexual Health Society Dr John Milan and Master Mentor Mary Norowen facilitated the training as a follow up of the Basic STI/HIV Refresher Training in December 2020.
Purpose of the training was to train the health workers to be competent and confident HIV Prescribers.
Norowen said 5 out of the 18 participants trained have completed their two weeks of practical. It included HIV Counseling & Testing (Pre-Counseling & Post Counseling) where she assessed them on how to prick, collect blood and apply buffer. After completing that she assessed them on their Adherence Counseling after a patient is found positive and the documentation and Registration to ART.
She said it’s important to have prescribers in all CCHS facilities because HIV is spreading and there are people living with HIV everywhere.
“People will be traveling and moving from one place to another, and I believe all CCHS facilities should have HIV prescribers there with ART drugs. We cannot ignore or neglect them; they must be on consistent treatment so that the virus will be suppressed in their system.
Lae Health Integration Officer Samantha Tirang said it was a privilege and step forward for Lae CCHS health workers.
“Thanks to SRHIP, we were able to invest in capacity building of our staff as well as create a working environment that is competitive yet competent.” Tirang said.
“When we have the skills and know what to do, it reflects in our work performance. Patient care and satisfaction improves; hence we will be able to share and reduce our workloads.”
Despite COVID-19 restrictions, preventive measures were taken during the training to create a safe and successful training.
Diocese News
ASRH Workshop a Success
CCHS Bougainville conducted a successful five days of Adolescent Sexual Reproductive Health workshop with 3rd year students at the Arawa Nursing College from the 5th -9th of July 2021.
The focus of the workshop is to improve the living standards of young people to live a healthy reproductive life with respect, trust, and discipline.
Bougainville Diocesan Health Manager Michaeline Pau said that as Clinical Service Providers, they should not judge but advocate for the benefits of informed decisions making as they educate the adolescents, providing a holistic friendly health service.
“The expected outcome has proved the workshop was a success and the participants have now increased their level of knowledge and capacity of understand.” Pau said.
The students took part in a pre-workshop and after workshop test to evaluate their understanding and knowledge of ASRH. Before the workshop the pretest result was 59% and the post test result was 88%. During day four of the workshop, the students went through the Youth and Adolescent friendly health services putting more focus on Nursing standards, Moral Ethics, and Improved Patient Management Care.
Present at the closing ceremony was Chief Executive Officer of Rural Health Service for Central Bougainville, Dr Cyril Imako, when all the participants received their certificates after the workshop.
Clinic Receives 2nd Donation of Sanitizers
St. Paul Urban Clinic received another generous donation from the Curtain Bros PNG on the 11th of August 2021 in Port Moresby. Officer in Charge of the clinic, Sr. Gracey, was humbled and thankful for the donation in kind made by the company with ten boxes of Antibacterial hand sanitizers.
Curtain Bros Group is a building and civil construction company with operations based throughout PNG. The company had made their first donation to the clinic earlier this year.
CCHS Port Moresby Health Integration Officer William Vagi thanked the Crane Manager of Curtain Bros PNG Neville McNamara for the donation, saying it will go towards helping the staff to continue enforcing the COVID-19 preventive measures within the clinic.
“We will utilize the hand sanitizers with our patients and staff as we enter and exit the clinic every day,” Vagi said.
St. Paul Clinic is a day clinic serving a catchment population of more than 25 000 people. The clinic integrated its primary health care with HIV services in 2018 to provide HIV Clinic. ST Paul currently has a total of 220 active HIV client that visits the clinic for the ART collect and counseling.
The National CCHS office is grateful for the ongoing support of local business houses that are making donations to the CCHS facilities across the country.
Utai opens new health Facility and staff house
The Catholic Church Health Services of Vanimo Diocese celebrated the opening of a renovated service building and a new staff house at Utai on the 7th of August 2021.
The officer in Charge of Utai Health Sub-Centre took the initiative to seek help when he realized that Utai Health Subcenter was becoming hazardous for his patients and his home was crumbling around him.
Patrick Esis is from Utai Village. He started working at the HSC in 2015 as a Community Health Worker then was appointed as the OIC by the Health Secretary in 2017.
“I have been doing my work, helping the people, but my living condition was getting worse and worse every day. My home was crumbling around me, I had issues with lighting and water supply, and I also saw that we were also not providing quality service to our people.”
Present at the ceremony was the Health Secretary for Vanimo Diocese Amanda Niweke, Integration Officer Rachael Markus, Fr Joseph Runai of Wasengla representing the Bishop for Vanimo Diocese, local parish priest, OIC for all the Vanimo CCHS facilities Manager for Amanab Block 5&6 and the local people.
Esis is one of the landowners in the project areas that Amanab Forest Limited (AFL) is logging the forests. Instead of getting all royalty payments, part of it was going into a trust account called the Project Development Benefits Trust Funds. The trust fund is purposely for funding infrastructure and community development projects within the project area.
Esis wrote a proposal to the AFL to seek funding under the Health and Support Levi and was immediately approved. He hired a contractor who started work in June and completed the renovation with the new house in August.
Utai HSC has a catchment population of 5000 plus, with 4 Health Workers serving 13 clinic sites. Of the 13 sites, five are mobile, and seven are outreach overnight sites. Esis explained that from the 7, 4 have road links to them while three are hard to reach and require travel by foot.
The OIC also built a cough triage out of bush material before the new infrastructure development for his people.
The facility is now operating fully after closing some services like delivery, MCH, and antenatal care during the month of June.
COVID-19 CORNER
CCHS Supports the uptake of COVID-19 Vaccine
The Catholic Church Health Services being a commission under the Catholic Bishop Conference of Papua New Guinea and the Solomon Islands support the uptake of vaccines as a tool to stop or prevent the spreading of the Sars-Cov-2.
A survey was carried out in July by the National CCHS office states that more than 30% of its Health Care workers in the country has already been vaccinated.
Vaccine hesitancy among the staff is very high though all the provinces reported that they have had COVID-19 sensitization workshops while some received pre-vaccination workshops.
Vaccine hesitancy is real, globally and in PNG. People have understandable concerns about taking the COVID-19 vaccine for many reasons – due to the speed of vaccine development, after hearing rumors about vaccine effects on the body or just because they would prefer to wait and see others take it first. And yet, vaccines remain the key pathway out of the COVID-19 pandemic. As health workers, we all have a role to play in getting vaccinated and promoting COVID-19 safety measures including uptake of the vaccine within the community. This is a tricky time with so much information and misinformation circulating on COVID-19 vaccines.
We have a SRHIP COVID-19 WhatsApp Group that we invite CCHS Health Workers
join a panel of local and international SRHIP facilitators ready to answer your questions or concerns in the chat. We look forward to some great discussion on COVID-19 vaccination and can’t wait for your inputs and insights then!
What is COVID-19???
Why are we so focused on COVID-19? Isn’t it just like the flu? These are common questions during the pandemic, especially among groups who believe COVID-19 does not exist or are anti-vaccination. So, let’s dive deeper …
The flu (caused by influenza viruses) and COVID-19 (caused by SARS-CoV-2 coronavirus) are both contagious respiratory illnesses. And the symptoms of both are somewhat similar (cough, fever, lethargy, sore joints and muscles). However, SARS-CoV-2 is much more contagious and can cause more serious illness than influenza. Influenza has a reproductive number (R0 value) of 1-2 meaning each infected person passes it on to 1-2 more people. The R0 for COVID-19 delta is estimated at 5-8!
Most importantly, SARS-CoV-2 was only identified in 2019. As a new virus, the global population has therefore been susceptible to infection and there are extremely limited treatment options for severe COVID-19. WHO estimates ~300,000 people die from influenza each year. In comparison, there have been 4,463,827 (4.46 million) COVID-19 deaths reported since the start of the pandemic – with mortality believed to be well under-reported! And this is despite intense lockdowns and restrictions in many countries around the world!
Influenza creates seasonal burden on health systems, but the SARS-CoV-2 pandemic has created stress on health infrastructure, economies, people and health workers like we have never seen before. Never play down symptoms as ‘the flu’. If you experience cough, fever, headache, shortness of breath, aches and pains, extreme tiredness, loss of smell or taste, nausea or vomiting, or chest pain then go get tested for COVID-19!
And remember to protect yourselves, your loved ones and community by adhering to your personal controls (social distancing, mask wearing, respiratory etiquette, meeting in ventilated spaces and handwashing). Prevention is always best!
Coping with Work Stress During Covid-19
The COVID-19 pandemic has created high levels of stress among health workers around the world and in PNG. If we do not take care of ourselves, stress can lead to burnout. It is important for health workers to recognize the signs of stress and look after themselves to prevent burnout during this challenging time.
Signs of stress and burnout include:
• A loss of capacity or interest in bearing the suffering of our patients
• Physical symptoms like loss of appetite, nausea, stomach pain, and diarrhea. Headache and chest pain may also present.
• Sleep disturbances or the need to be busy all the time
• Feeling tired, drained most of the time and feeling sick a lot
• Mood swings and loss of motivation to come to work.
How to reduce stress:
• Keep yourself well informed. There is a lot of misinformation on social media. Get your information from reputable sources
• Stop listening to the news all the time!
• Start the day with a relaxing routine – try deep breathing exercises
• Eat regular, well-balanced meals
• Exercise regularly. A short 20 min walk will reduce your stress level considerably
• Do something relaxing and pleasurable every day
• Socialize in a COVID-19 safe way with family and like-minded friends. Do not keep talking about the pandemic!
• Set boundaries and take a break from technology
• Avoid cigarettes, alcohol, and stress-producing environments
• Get a good night’s sleep
• If you are not coping, ask for help.
Upcoming Important Dates
