Telehealth and The Aftermath of the Pandemic
When the pandemic forced a transition from in-person meetings to the virtual world of telemedicine, patients like Erika Apupalo found the shift difficult. A year later she feels going back to in-person sessions with her therapist is a thing of the past.
Erika Apupalo had been living in the United States for 13 years when she took a trip to her country of Ecuador and suffered an emotional breakdown. She didn’t expect that returning to her childhood home, to her grandma who raised her, and seeing the landscapes of her town of Cuenca would unravel a traumatic memory of when she immigrated alone to states at the age of eight.
“I was in a continuous euphoric state, paranoid and overwhelmed. My parents took me to see a therapist,” she says.
While growing up in New York, Apupalo adapted to a new language, culture and to the rhythm of the city. To a certain extent she is accustomed to life in the United States, she is a New Yorker and turned 25 this year: she likes concerts, picnics at central park, going to book releases, hanging out with friends, and seeing exhibitions of art. Except that she cannot travel outside the country, obtain a REAL ID or receive federal financial assistance because of her status as a “dreamer.”
She is one of an estimated 3.2 million of eligible young-adults in the U.S., who due to the executive order of the Obama administration known as DACA received protection from deportation and a work permit. While the ability to work in the states and the protection from deportation was welcomed by the dreamers, who arrived as a child through no fault of their own, the lack of concrete legislation and a permanent status has caused them to suffer emotional distress and depression.
Apupalo resided in Forest Hills, Queens since she moved out of her parents house at the age of 22. She rented a room in her friend’s apartment after she received the FAO Schwarz fellowship, which guaranteed her a position at Jumpstart as a youth services coordinator. The decision to move out was not a hasty one — she had been thinking of leaving home ever since she started to see a therapist back in 2017.
“It’s a bit complicated to speak about the things that affect me, but most of the times the themes that come up in the conversations with [my therapist] are usually related to the relationship that I have with my parents. When I arrived… I arrived to people I didn’t know, abandoning my granma, my friend, and all of my childhood.”
Everywhere she goes she blends in with the masses due to her petite frame and height of four feet, or stands out due to her peculiar bobbed hair style and black framed glasses that match the color of her hair. Apupalo carries a tote bag full of books of Spanish literature all the time. Before the pandemic she was often in the move, traveling from Queens to Brooklyn, where she used to work, and then taking the train to Manhattan where she attended a PEN America poetry workshop. She frequented coffee shops where she sat for hours reading, editing her own poetry. While she usually prefers to work alone, she is friendly and has a welcoming smile.
Her trips to the mall, art exhibitions, and poetry workshops came to a halt at the beginning of the pandemic. Like many New Yorkers, her lifestyle changed drastically. Her office in Brooklyn was empty by the end of March, and she started attending work meetings via Zoom. Two weeks later her roommate, who used to work as a video producer in Brooklyn, moved out of the state. Unable to cover the rent for the two bedroom apartment, she was forced to move back to her parent’s house in Ridgewood, Queens. This is where it became difficult.
Hospitals and clinics implemented restrictions that limited the amount of patients in their facilities. Telehealth was introduced as an alternative to provide healthcare services at home via a smartphone, tablet, or a computer screen. To continue her therapy, Apupalo, too, had to shift from her five-year-in-person-therapy to the new virtual world of sessions at home.
“It was very difficult to get used to it… it was like — how can I say the things that are in my mind to my therapist when there are other people around me listening? My private conversation no longer felt private”, said Apupalo.
She attended therapy around grand central twice every month. Therapy often involved talking about her status as a “dreamer,” her romantic interests and the relationship with her parents. It was the last topic that she feared speaking about now that the sessions were virtual. There are things about her trauma that Apupalo doesn’t go into details, and she mentions that it took her a year to open up about the relationship with her parents to her therapist. Moving back at home took away the opportunity to express herself freely, depressing her to the point where she needed to move out again.
In April, during lockdown, She did everything from home: work, therapy, workshops, and hung in with friends.
“We did some poetry readings online, and sometimes we just simply spoke about what was going on in the news,” says 26 year old Hiba Sheikh, a former classmate at Baruch college where Apupalo got her bachelor’s degree in communications. Along with other friends they used zoom to organize online the workshops they once had in person.
While Apupalo was getting used to doing everything remotely, the quality of her therapy calls lagged behind. She remembers the difficult months when her therapy sessions were reduced to “yes and no” answers, out of fear of having her parents or sister eavesdrop on her conversations about how much anxious to leave.
During last year’s summer, New York was feeling the aftermath of the pandemic. Unemployment was high, and restrictions still limited the vivacity of the residents. The objective for Apupalo that summer was to find a new job and a new apartment as soon as possible.
She looked everywhere, Indeed, LinkedIn, and even asked friends if they knew some of any openings. Her determination was fruitful a month later: she was hired as a Coordinator of Volunteer Participation in Project Sunshine. Her salary doubled, and three months later she was able to move into a new apartment in Brooklyn.
“It was not that great still, but it was better than having my parents or sister near my room,” she said.
Apupalo took control of the sessions that involved speaking with her parents. Three months after being general in the conversations with her therapist, she was finally able to express herself. This new found freedom to speak with liberty made her rethink the telehealth sessions, and she realized that it had its benefits.
Before the pandemic Apupalo traveled one hour to see her therapist twice a month. She remembers waking up at 6:30 AM to commute from Queens to Manhattan in the E train. She took the same route for three years. Her commute now: a simple stride from one side of the room to the other, where her desk lines up in front of a purple wall. Books are piled around the laptop, whose screen is adorned with colorful post-it notes. Depending on her mood, sometimes she logs into meetings from her bed by resting her laptop on top of her legs.
During the remote year she wrote more poetry and stories. “Since I was at home more often I decided to write something every day. I have the draft of a story that is 120 pages long that I want to propose to a publisher… don’t worry it is not about immigration,” she said smiling.
At the dawn of the anniversary of the pandemic in March, Apupalo added another element to her virtual activities: she started a masters program in Spanish Literature at Hunter College. With her work at Project Sunshine and her graduate classes being remotely, she wonders if going back to in-person therapy sessions will be worth it.
While she doesn’t know when her status as a dreamer will change or when her trauma will completely fade away, she is sure that seeing a therapist from her bedroom has been beneficial.
“I feel comfortable at home, I don’t need to travel… even if things went back to normal, I would probably continue doing [the sessions] from here.”
