The Lived Experiences of Bereaved Filipino Families of the Deceased Due to the COVID-19 Pandemic.

The typical highlight of Filipino mourning of conducting funerals and burials has ceased due to recent health guidelines which required the deceased, who tested positive for the virus, to be cremated and buried right away to avoid further spread of the disease - making bereavement more complicated. This paper investigates the experiences of bereaved Filipino families who lost their loved ones to COVID-19 through a qualitative research design. Researchers explored the experiences of at least three (3) COVID-19 bereaved families through a descriptive phenomenological approach and analyzed the data using thematic analysis to extract the bereavement process experienced by the participants. The findings of the study highlight the changes to the Filipino funeral practice caused by the pandemic and the major roles of connectedness, and cultural and religious beliefs in the Filipino bereavement experience.

Introduction

Bereavement is best known as a condition of being deprived of the presence of one’s loved one (can be anyone whom one has had a close relationship with) due to their death (Riordan et al., 2020). Further, it is a period in which a person who experienced loss undergoes grief and mourning (Mughal et al., 2018). This term has become more relevant over the past years since the spike in death rates caused by the COVID-19 (Corona Virus Disease of 2019) pandemic (World Health Organization [WHO], 2020). After more than a year, there have already been a total of 48,361 deaths in the Philippines and 5,200,267 deaths globally as of November 29, 2021 (WHO, 2021), leaving behind millions of people deprived of their loved ones’ existence. With the phenomenon of death due to a common cause happening in vast numbers globally, grief and mourning have also been experienced by those who were left bereaved.

Grief is a multi-faceted and multi-layered, socio-culturally shaped emotion experienced by people in response to wide array of negative emotional and physical experiences (Petersen & Jacobsen, 2018). As the term grief is used in several contexts, the researchers clarify that grief in this study is used under the context of loss due to death. There are various culturally-influenced manifestations of grief which people of different cultures experience in response to their loss. However, the commonality among these experiences is the presence of negative emotions such as sadness and longing, accompanied by memories, images, and thoughts of the deceased (Fagundes et al., 2019; Shear, 2012). These emotions are an inevitable part of bereavement and are thus essentially expressed through the process of mourning.

Parallel to grief, mourning varies among cultures. It is characterized as the outward expression of grief through various ways, including religious and/or cultural customs about passing, which stimulates the process of adjusting to one’s new reality after the loss (Mughal et al., 2018). Furthermore, it is triggered after a person suffers loss (Fernández & González-González, 2020).

It is significant to know the meaning of the terms “grief” and “mourning” as both make up the concept of bereavement and are essential to understand (1) how bereavement is uniquely expressed within the cultural context of the Philippines, and (2) how Filipino bereavement is affected by the current challenges posed by the pandemic.

Filipinos share the features of grief formerly discussed along with other features influenced by Philippine culture such as the need for the presence and involvement of all extended families, the need to express respect for the deceased by obediently following rituals, the need to have an intimate communication with God in line with the strong influence of Christianity in the Philippines, and several others (Giannopoulou et al., 2018). These unique features of Filipino grief scaffolds the common cultural and religious practices that characterize the Filipino mourning.

Being that the Philippines is associated with having a collectivist culture, it is a common practice for Filipinos people to seek and obtain social support from other people (Broomhall & Phillips, 2020). This culture offers an insight to the deep sentimentality invested by Filipinos towards their deceased loved ones when they mourn - hinting the importance of social congregations and interactions in wakes and burials as being part of the process of Filipino mourning. Furthermore, the funeral practices in the Philippines reflect the Filipinos’ belief of the existence of the afterlife which highlights their invested importance in commemorating the deceased. According to Goldade (2017), prominent religions in the country (i.e. Catholicism, Islam, etc.) impose this belief along with their unique funeral practices. The commonality among various burial practices is their emphasis on 1) the belief that the deceased have transcended to the afterlife/better life as a positive appraisal, thereby alleviating negative feelings from the loss (Asuncion et al., 2016); and 2) commemorating the deceased during their wakes, visible among the mementos and pictures surrounding the casket of the deceased (Goldade, 2017). Commemoration, as an important concept of Filipino mourning rituals, has played an essential part in the process of gradually moving on with life. In a sense, commemorating the dead gives importance to the idea that it is essential to acknowledge the reality of the loss and that the deceased deserve to be honored, remembered, and recognized (Szczesniak, 2022). Commemoration rituals in the Philippines extend even after burial as Filipinos hold “novenas” (prayer for the deceased) on the 9th and 40th days after burial (Goldade, 2017). Asuncion et al. (2016) found in their study, seeking to understand loss in suicide-bereaved Filipino families, that commemoration has an important purpose in the continuing lives of the parents of the deceased as it helps them compensate for their negative thoughts through holding on to pictures and remembering positive memories of the deceased. This then implies that the idea of commemoration upheld in typical Filipino funerals helps ease bereaved individuals into reconciliation.

The combined picture of Filipino grief and mourning discussed, which highlights the importance of physical, social congregations and practices parallel to their religious and cultural beliefs, briefly characterizes the Filipino bereavement. Meaning, Filipino bereavement, under the normal circumstances, relies heavily on physical and social rituals for the bereaved to be able to ease into reconciliation – the gradual acceptance of one’s new reality without the deceased loved one (Wolfelt, 2016). It is, therefore, evident that Filipino bereavement has become vulnerable to the changes imposed by the Philippine government to combat the rapid spreading of the COVID-19 cases within the country.

The necessary restrictions and health protocols in times of the pandemic have made Filipino bereavement more complicated. Visitor access to healthcare facilities for COVID-19 patients whether with mild or severe symptoms is agonizingly prohibited (Centers for Disease Control and Prevention [CDC], 2020), preventing families from being able to take care of their dying loved ones. The need to protect the population and observe preventative measures against the coronavirus disease has led to the immediate cremation of COVID-19 victims within 12 hours after their death which contradicted the usual whole-body internment tradition of Filipino mourning (Go & Docot, 2021). Mass gatherings under the context of funerals has been severely limited during the height of community quarantine along with the limited mobility of people (Romero & Gregorio, 2021). Such constraints have caused a disruption in the mourning process of many families (Aguiar et al., 2020). Furthermore, present-day bereavement challenges such as isolation of the dying person, social distancing, lack of social support, guilt of being the carrier of the disease, and inability to see or hold the deceased for the last time has resulted in a higher prevalence of prolonged grief (Johns et al., 2020). Meaning, Filipino bereavement has suffered from the necessary health restrictions due to the pandemic and has had a significant impact to bereaved individuals who are prohibited to undergo some of the accustomed funeral arrangements and procedures.

In the age of COVID-19, physical distancing and the protocols limiting outdoor mobility has driven a wedge between certain moments of interaction, and it is a time-tested situation for Filipino bereavement. Due to the novelty of this situation, the status quo opens a wide gap in research, particularly in investigating the bereavement process of Filipinos under the problematic context of the pandemic as it is yet to be thoroughly explored in all of its facets.

In this paper, the researchers sought to bridge the aforementioned gap in research by answering the question “How do Filipinos go through the process of bereavement during the COVID-19 pandemic?”. The researchers utilized a phenomenological approach to investigate the phenomenon of bereavement experienced by the Filipino people whose loved ones passed away due to the pandemic. The researchers were then able to extract the Filipino bereavement experience from the emergent themes extracted from the narratives of participants in this study. As research investigating Filipino bereavement is scarce, more so under the context of the current pandemic, the findings of this study seek to contribute to the understanding of this phenomenon which can help in formulating interventions to support bereaved families and to provide information to future researchers who may investigate the phenomenon further.

Methods

Research Design

This research fills the gap in literature tackling the phenomenon of Filipino bereavement during the pandemic as there are very few research investigating the phenomenon at the time of the formulation of this paper. Furthermore, several literatures studying the impacts of the pandemic to the Filipinos has focused more on observing and studying concepts like stress, anxiety, depression, and other psychological concepts of the general population - which makes the focus of this research unique and essential.

The researchers have used a qualitative research design to engage in an in-depth analysis of the experiences of bereaved individuals. This design is typically characterized by its utilization of non-numerical data to analyze and understand experiences in various studies (Silvermann, 2020). The bereavement and coping of individuals who experienced a loss of a significant loved one were explored through this method.

Furthermore, the researchers used a descriptive phenomenological approach, a common method among qualitative research which inquires for the participant’s experience of a phenomenon (Sloan & Bowe, 2014) - which in this paper looks into the phenomenon of grieving due to the loss of the participants’ loved one who died from COVID-19 during the interview.

Participants

Purposive sampling was used for the selection of participants. This selection method is an intentional selection of participants on the basis of their ability to provide and elucidate a concept or theme relative to the topic of interest (Robinson, 2014). The researchers tapped on personal acquaintances who have experienced loss due to COVID-19 to gather participants.

In line with the ethical considerations set for this study, the researchers adhered to the following standards in participant selection:

• The participants were at least one (1) family member from three (3) families residing in Metro Manila. According to the World Health Organization’s (2019) International Statistical Classification of Diseases and Related Health Problems (11th ed.), grief responses persist typically for not more than six (6) months after the loss of a loved one as those grief responses persisting for longer periods or for more than six (6) months meet one of the criteria for diagnosing Prolonged Grief Disorder. For this reason, the chosen participants were dealing with the loss for at least six (6) months after the death of their loved one who died from COVID-19.

• Only members of the family who are at least eighteen (18) years of age, and of any gender were interviewed for this study.

• The participants were strictly first-degree relatives of the deceased living under the same household.

• Furthermore, socio-economic status is a factor that affects the difference in the experience of bereavement among people (Chenube & Omumu, 2011). To further standardize the participants and make an observation of the bereavement phenomenon in a consistent context, the researchers chose participants among the lower-middle class using the income classification of a 2020 study from the Philippine Institute for Development Studies (PIDS) (Albert, et al., 2020).

The following are the description of the participants in terms of their preferred alias, age, gender, place of residence, deceased relative due to COVID-19, and how long have they been dealing with the loss:

1. Codename: Apple

Age: 44 years old

Gender: Female

Place of Residence: Tondo, Manila

Deceased Relative Due to COVID-19: Mother

Socioeconomic status: P43,000/month (lower-middle class)

Apple has been dealing with the loss of her mother for 9 months when she was asked to narrate her bereavement process. Her mother died on the 16th of March 2021 due to COVID-19.

2. Codename: Nali

Age: 53 years old

Gender: Female

Place of Residence: Mandaluyong City

Deceased Relative Due to COVID-19: Husband

Socioeconomic Status: Preferred not to disclose the exact amount but declared she is in the lower-middle class upon seeing the PIDS bracket.

Nali has been dealing with the loss of her husband for sixteen (16) months when she was asked to narrate her bereavement process. Her husband died on August of 2020 due to COVID-19.

3. Codename: JV

Age: 24 years old

Gender: Male

Place of Residence: San Juan City

Deceased Relative Due to COVID-19: Father

Socioeconomic status: P30,000 (lower-middle class)

JV has been dealing with the loss of his father for twenty-two (22) months when he was asked to narrate his bereavement process. His father died on March of 2020 due to COVID-19.

Data Collection

Semi-structured interviews that consist of open-ended questions were utilized by the researchers to allow adaptability to participants’ emergent narratives which would normally not be possible through structured interviews (Jamshed, 2014). All interviews were conducted individually by the researchers, who are 4th year undergraduate students trained under the discipline of psychology and psychological research, with the use of interview guides.

Standards for the demographics of the participants to qualify for the study have been thoroughly discussed, consulted with a research adviser, and decided a month prior to data collection. This was done to (1) standardize participants to see bereavement in a consistent context and to increase transferability (see “credibility and trustworthiness of qualitative data” section of methods); and (2) arrange a feasible manner of data collection – meaning, location and socioeconomic status of participants matter in terms of accessibility to the internet which is the manner of communication feasible for researchers to use in light of travel restrictions. Meeting was done through an online video conference.

The limited mobility due to placed travel restrictions during the conduction of this study have prompted the researchers to conduct one-on-one interviews via online conferencing platforms at the participants’ convenience with a duration of around forty-five (45) minutes to one (1) hour. The participants were asked to give their time of availability and preferred video conferencing platform for their ease of access. Both the participants and interviewers stayed in a room within their houses where they can be alone and with a stable Wi-Fi connection to conduct the interview privately and ensure confidentiality.

Furthermore, participants were given a consent form, using google forms sent to their emails, prior to the interview for them to read and affix their e-signature, which contains the purpose of the study, the specifics of the interview including the duration and study/interview procedures, the interviewer’s contact information, the statement of voluntary participation and rights of a participant, the assurance of strict adherence to uphold confidentiality, and the data privacy act of 2012. Due to the sensitive nature of this study, the researchers were accompanied by a guidance counselor on stand-by during the interview – details of which were also stated on the consent forms. During the interview, they were asked off and on record for their consent regarding the recording of the interview and were read the consent form on record for their verbal confirmation.

Interviewers started the interviews by establishing rapport and easing participants towards tackling the open-ended questions. Interviewers initially asked the participants regarding the events that took place when their loved ones tested positive for COVID-19. This section of the interview included questions such as “How did things start?”, “How was he/she diagnosed with COVID-19”, “How did you feel about knowing he/she has COVID?”, “How long was he/she hospitalized?” etc. Researchers also opted for a gentler approach of asking questions that lets the participants know they have a choice to answer or not like asking the question “Is it okay for us to talk about things until the passing of your loved one?”, etc. Interviewers further deepened the conversation by easing the participants into the next section of the interview which inquire about the participants’ insights, feelings, experiences, and their observations regarding the experiences of their family members a few days, weeks, and months after the death of their loved one. This section of the interview has been handled with utmost care in line with ethical considerations. Lastly, interviewers asked the participants about their current state and allowed them to compare it to their experience discussed in the previous section. Afterwards, interviewers proceed with debriefing by summarizing and confirming the responses of participants, expressing gratitude for their participation, and providing contact numbers should participants have any further questions or would like to add or redact statements from the interview. Overall, the interview guide is composed of 9 open-ended questions divided into 3 categories namely: moments before passing, moments after passing, and current state.

The data collection process was conducted starting from the 3rd week of December of year 2021 until the 2nd week of January 2022.

Data Analysis

The gathered recordings were transcribed verbatim after the interview sessions. Transcription is done by the researchers to ensure accuracy. Data from the transcribed recordings were then analyzed using thematic analysis. This method of data analysis is characterized by the identification and reporting of themes or patterns seen within the data (Braun & Clarke, 2014). Furthermore, it is a flexible method analysis which allowed researchers to deeply explore and analyze the experiences of the participants. All six researchers were completely involved in the process of analyzing the data. Each researcher has read all of the transcripts of the interviews to ensure rigor and credibility. 36 pages of text/transcribed interview were deciphered by the researchers. Initially, all authors have manually coded all of the data, line by line, individually, marking phrases and words which are similar or can be grouped. Researchers then presented their coding to each other and have rigorously debated and discussed codes which are to be retained and removed. The remaining codes were then discussed, refined, and condensed into themes by researchers altogether.

Credibility and Trustworthiness of Qualitative data

The credibility and trustworthiness of the data gathered for this study has been assured through various measures taken by the researchers which will be thoroughly discussed in this section. Researchers have carefully considered the 4 criteria for qualitative validity and reliability detailed by Cypress (2017) which considers credibility, transferability, reflexivity, and confirmability as essential criteria.

In terms of credibility, the researchers sought to depict the experience of bereavement of participants accurately and truthfully through conducting regular member checking. This is done through constant presenting and checking of data and generated interpretations with the study’s participants, from which data were gathered, through meetings via video conferencing platforms. This is accompanied by peer debriefing involving 2 qualitative researchers whose backgrounds are as follows: Reviewer A, is a PhD degree holder in psychology specializing in qualitative research; and Reviewer B, a masters’ degree holder, qualitative researcher and guidance counselor specializing in grief counseling. Reviewers have assessed the transcripts and findings of the study and gave suggestions/points of improvement. Peer debriefing is likewise done through scheduled meetings via video conferencing platforms. Investigator triangulation was also achieved by comparing the findings of researchers after individually analyzing the data gathered from the interviews.

Researchers assured transferability through purposive sampling – setting specific criteria for participants selection as an attempt to establish standardization (see “Participants” section for further discussion of participant selection criteria). The reason for such standardization is to analyze the phenomenon of bereavement in a consistent context to increase transferability of findings. Meticulous transcribing of data was done by researchers themselves by having all researchers listen to the recorded interviews and transcribe all interview sessions individually. The transcribed data of each researcher were then cross-checked with the transcription of their fellow researchers for accuracy and consistency. This is also to allow all researchers to immerse themselves in the interviews (i.e. listening to tone of the participants’ voices which may otherwise denote expressions not detailed by the transcribed data) to gain better understanding of the data before conducting an analysis. This helped establish consistency of the findings and increase transferability.

Dependability of qualitative data was established by having the reviewers, along with another expert qualitative researcher who is a registered psychologist with several published research regarding Filipino experiences during COVID-19, look over the transcribed data for the validation of the themes and findings of the researchers.

Lastly, confirmability was achieved through regular meetings of researchers discussing and debating each other’s reflexivity regarding data analysis, which were done via online video conferencing platforms, to mitigate researcher bias. Discussions were documented via recordings which were then transcribed for easier perusal and review after meetings. Data audit was done to further examine the procedures and analyses for potential bias.

Ethical Considerations

Ethical approval for this study has been obtained through rigorous review of the university ethics committee. Due to the constraints posed by the ongoing pandemic, the researchers have secured digital letters of permission with affixed e-signatures from the participants. The participants were further asked verbally if they consent to be interviewed during the scheduled date of their interviews. Only participants/members of the family who are 18 years and above were then interviewed for this research. Although bereavement manifests differently for people, this age range principally ensured the presence of mental maturity and better thought articulation which then helped to minimize any repercussions in consideration to the sensitive research topic. They were encouraged to freely and honestly narrate their experience in response to the given questions. They were also given the discretion to refuse to answer a question or cease from participating anytime if they wished to do so. Furthermore, in consideration of the sensitive nature of this research, a psychologist/guidance counselor was present during the interview proper who supervised and gave support when the need arose. Informed consent for recording the interview were also given to participants. The participants were then assured of humane treatment and strict compliance to the confidentiality of personal information throughout the course of the research.

Findings

The participants were asked to narrate their experiences starting from when their relatives were diagnosed with COVID-19, when their relatives passed due to COVID-19, until their present situation. Overall, there are 7 emergent themes extracted from their narratives which will be presented in this section with supporting data in the form of direct quotes from the participants.

Theme 1: Entering the hospital with hopes of recovery (“We expected to bring him/her back home”)

Participants detailed their experience of their loved ones’ hospitalization. All of them reported that their loved ones have co-morbidities before acquiring the disease. Their relatives were initially reported to have shown signs of pneumonia upon hospitalization. Despite the presentation of common COVID-19 symptoms and witnessing the rapid deterioration of their loved ones’ condition, participants reported to clinging on to hope for their loved ones’ recovery and expected that they will still be able to bring them home. It was only after the death of their loved ones that the positive results of their swab tests for COVID-19 were released to the participants.

“Nag-expect pa ako nat–lagi ko naman kasi siyang dinadala sa ospital eh, lagi ko siyang sinusugod kasi nga meron siyang breast cancer, pero lagi ko naman siyang naiuuwi na okay na… nag-expect ako talaga na iuuwi ko siya nang maayos, na gagaling pa siya.”

“I expected that—I always bring her to the hospital, I always bring her there because she has breast cancer, but I am always able to bring her home in good condition… I expected that I’ll be able to bring her home in good condition, that she will still recover.” (Participant Apple)

“Kala naman kasi pneumonia, sabi naman ng doktor pneumonia, tapos ang alam talaga namin makakauwi kami sa bahay. Sabi niya pa sa akin pag-uwi, kakainin na lahat niya ng kakainin, hindi na siya mamimili ng pagkain, ganyan. Tapos magreresign na siya sa trabaho niya, ayaw niya na doon. Hindi namin alam na, basta hindi namin inexpect na hindi kami sabay uuwi.”

“We really thought it was pneumonia, the doctor said it was pneumonia, we really knew we will be going home together. He (deceased spouse) told me that he will eat all the food he wishes to eat when we get home and that he will never be a picky eater ever again. He also said he will resign from his current job because he doesn’t want to work there anymore. We didn’t know that… we didn’t expect that we will not be going home together.” (Participant Nali)

Theme 2: The Unexpected Happened “It All Happened So Fast… It Was Too Late When We Knew”

The participants narrated the moment of their relatives’ passing as they succumbed to the disease. Participants reported feeling disbelief twice: first when their loved ones quickly deteriorated and passed not too soon; and second when they found out that their loved ones are positive for COVID-19. Two of the participants were made aware of the result after their loved ones died. Participant Apple, on the other hand, found that her mother was positive for COVID-19 a few days prior to her death. However, her feelings of disbelief happened almost similarly to the two other participants.

“So nangyari, after 3 days, nung sinwab test ang mother ko bigla siyang nag-positive sa COVID. Dun na, dun na kami naalarma kasi dadalhin na siya sa COVID area, na yung mga pasyente dun, lahat puro COVID dun na hindi namin siya pwede makita at hindi rin namin siya pwedeng alagaan… 1 week lang siyang nandun sa COVID ward, wala na. Bigla na siyang ano, sinabihan na kami ng doktor na, “ate, ano padala mo yung cellphone niyo kay mommy para i-video call niyo siya kasi very weak na,” “very weak na si mother”, sabing ganun nung doktor kaya siguro mga around 1:30 ng hapon, navideo call ko pa siya. Nakita ko pa siya eh, pero parang mahina na rin talaga siya. Ayun, tapos mga bandang 3:45p.m., dineclare ng doktor na wala na. Nag-collapse na yung lungs niya, hindi na talaga kaya.”

“My mother suddenly became COVID-19 positive after 3 days of her swab test. Right there and then, we were alarmed because she would be in the COVID area (ward) together with other COVID-19 patients where we could no longer see her and take care of her… She stayed in the COVID ward for 1 week and then she passed away after. She suddenly… the doctor told us that “have your phone delivered here (COVID ward) to your mommy so you can video call with her cause she is very weak already”. We had our video call with her around 1:30p.m. I still saw her [breathing] but she is indeed already weak. And then at 3:45p.m., the doctor declared her death. Her lungs collapsed already, it cannot sustain her anymore.” (Participant Apple)

“ah kasi nung time na yon medyo matagal pa lumabas yung resulta ng swab test. Kaya inabot yata kami ng halos isang buwan dun sa ospital bago nalaman na positive pala siya. Kaso huli na nung nalaman na positive pala siya. Ah syempre ako nung una di rin makapaniwala, kala ko lang kasi na pulmonya lang ganon. Na kaya ng antibiotic hanggang sa malalaman na lang namin sa doctor na kailangan na tubuhan na pala siya kasi nahihirapan na talagang huminga”

“Ah, during that time, swab test results take long to release. It took a month after we knew he had COVID. It was too late when we found out he was positive. Ah, at first I couldn't believe it either, I just thought it was pneumonia. That antibiotic is enough. Until we find out from the doctor that he needs to be intubated because he is really having trouble breathing” (Participant JV)

“ …ini- swab test, kaso yung swab test ang tagal- tagal bago namin nalaman. Patay na siya saka namin nalaman… Sinabi ko sa asawa ko, ayaw niya pa rin, lalaban daw siya. Tapos noong pag- 5 days nang umaga, sabi niya “mommy nahihirapan na ako huminga talaga, hindi ko na kayang huminga”. Tapos sabi ko “pumapayag ka na ba na palagyan ka ng machine?” sabi niya “oo”, kaso noong time na yon wala ng machine. Hindi na siya umabot sa ano, yun namatay. Oo ang bilis talaga. Kasi hindi naman siya talaga sakitin, mataba siya eh, malaki maganda ang pangangatawan niya. Kaya hindi ko akalain, hindi rin niya akalain, hindi namin akalain talaga na yun lang, ganon lang mamamatay.”

“… He was swab tested, but the result of the swab test took too long. He (deaceased husband) was already dead when we knew. I told my husband [to agree to get intubated], he said he doesn’t want to and that he will still fight. After 5 days he told me in the morning “mommy, I’m having a hard time breathing, I can’t breathe anymore.” The I asked him, “Do you agree to be put under the machine now?” he said yes. But at the time, there were no machines available. He couldn’t wait for it anymore, and there he died… Yes, it was indeed fast. He is not sickly at all, he was even fat; his physique was good. That is why I did not expect that, even him did not. All of us did not really expect that he would die in that way.” (Participant Nali)

Furthermore, the participants described their thoughts and feelings shortly after the death of their loved ones. Participants reported to have felt hurt, and sadness from the fast unfolding of events and sudden passing of their relatives. The following statements depicts these feelings:

“Ayun, ang masakit pa parang ang bilis, ang bilis lahat nung mga nangyayari... Ayun, so ganun kabilis. Kasi nag- expect pa ako na– lagi ko naman kasi siyang dinadala sa ospital eh, lagi ko siyang sinusugod kasi nga meron siyang breast cancer, pero lagi ko naman siyang naiuuwi na okay na.”

“What hurts most is that it felt fast, the events happened so fast. Because I was expecting that– I always bring her to the hospital, I always bring her there because she has breast cancer, but I am always able to bring her home in a stable condition” (Participant Apple)

“Lahat din kami nalungkot siyempre. Biglaan talaga. Di rin namin iniexpect. Kala namin malakas na siya kasi tatangalin na yung tubo. ok naman na yung, umu- ok na daw yung paghinga niya ganon. ok na yung oxygen level niya. blood saturation niya ganon. Ayon… halos kami lahat umiyak non. Specially kaming dalawa ng kapatid ko na madalas nagbabantay sa kanya. Kasi sobrang pagaalala namin. Sobrang effort din namin halos ginawa namin lahat para masave yung buhay niya. Kaso wala talaga. Yun sobrang nakakalungkot nung time na yon.”

“We were all sad too, of course. Really sudden. We also did not expect it. We thought he was strong because the tube was about to be removed. It's ok, he seems to be breathing like that. His oxygen level was ok and his blood saturation… Almost all of us are crying at that moment, especially me and my sibling who always looked after him (deceased father). We were very worried. We gave all our effort to save his life but to no avail. That’s what’s most saddening at that time.” (Participant JV)

Theme 3: The Brief Moment of Keeping a Straight Face “I Don’t Want My Family to See Me Crying”

As the participants continued narrating their stories, most of them expressed that their initial thought was to focus on assuming responsibility for the burial of their loved ones despite feeling devastated at the same time. The participants expressed feeling emotional distress. However, the participants chose to delay the expression of these emotions in order to assume responsibility and function for their family’s sake. This is reported by participants under the context of avoiding shared vulnerability to family members as they express their immediate need to execute burial rites of their deceased loved one which needs to happen immediately given the very short opportunity due to the public health protocols.

“So, nung time na yun, talagang nandun lang kami sa ospital nung kapatid ko, yung bunso kong kapatid. Siya lang talaga yung kasa- kasama ko dun eh, kasi binabantayan namin, baka mamaya ma- cremate… Actually, ang totoo niyan, never akong nagpakita na umiiyak ako sa mga kapatid ko. Hindi ako nagpapakita sa kanila na umiiyak ako. Sa daddy ko, hindi nila ako nakitang umiyak nung mamatay ang mommy ko, kasi ayaw ko silang mahawa eh. Ayokong panghinaan sila ng loob… yung father ko nakadepende rin sa'kin dahil ako yung ano eh ako yung panganay sa'min.”

“At that time, me and my youngest sibling were just at the hospital. He was the only one with me because we were looking after [my mother's] body, they might cremate it… Actually, to be honest, I never show myself crying in front of my siblings. I don't let them see that I'm crying, even to daddy. They never saw me cry when mommy died, because I don't want them to feel the same way. I don't want them to lose hope… my father also depends on me because I am the eldest among us.” (Participant Apple)

“Bale balisa, tulala, pero mas inisip ko na lang asikasuhin ko muna yung dapat asikasuhin para at least maiuwi ko yung papa ko sa amin kasi bawal siyang tumagal ng twenty- four hours dun sa, ano bang tawag dito, punerarya, kasi mataas yung chance na mabulok yung katawan niya don. para macremate na rin agad.”

“Well, I was anxious and dumbfounded, but I thought I'd take care of what needs to be taken care of first so that at least I can take my dad home with us because he's not allowed to take twenty-four hours there, what do you call it, funeral home, because the chances are high that his body will rot there. So he can be cremated immediately.” (Participant JV)

Theme 4: Funeral Rituals Amidst the COVID-19 Pandemic (“We went straight to burial without holding a wake”)

Participants reported that they did not hold a funeral service for their loved ones and went straight to the burial with a few attendances from very close friends and immediate family – contrary to the typical setting of Filipino funerals lasting almost a week, with a viewing of the deceased, and attended by several people including extended family members and others. Most of the participants, who are catholic, also reported that the body of their deceased relatives cremated. They have also reported practicing short religious rituals for the dead at home with only their immediate family to compensate.

“Straight na siyang nai- cremate eh. Kasi yun ang kasagsagan ng COVID, hindi na sila pwedeng patagalin. Kailangang icremate na siya. Hapon na siya kinuha ng cemetery. Sabi umaga icrcremate, so umaga kami mag- iina nagpunta nalang sa sementeryo. Doon na lang namin siya hinatid. Kami- kami lang mag- iina , saka mga kaibigan, best friend niya nandoon din, pumunta.”

“He was cremated right away. It was the peak season of COVID, the bodies were not allowed to stay as it is. They needed to be cremated right away. The cemetery staff retrieved him in the afternoon. They told us he will be cremated in the morning, so we went to the cemetery early the next morning. We just accompanied him [cremated remains] there. I, my children, and his best friend were the only ones who went there.” (Participant Nali)

“…actually di na siya binurol, nagpasiyam na kami na tinatawag, siyam na araw ng pagdadasal. Kumabaga. Tapos, ayun social distancing pa din. Kasi nga sobrang lala pa ng covid nung time na yon. Talagang sobrang severe ng mga cases.”

“… actually we didn’t have a wake anymore, we just had a what we call “Pasiyam”, nine days dedicated to praying. We observed social distancing cause it was the height of the pandemic at the time. The cases were real severe.” (Participant JV)

While most participants had their relatives cremated as it wasn’t against any of their religious beliefs, participant Apple narrated her experience with the burial her mother in a casket, following her religion’s practice (her religion being Iglesia ni Cristo (Church of Christ), whose beliefs are against cremating a person’s remains). She reported that her mother went straight to burial after passing. This event happened at the height of the pandemic where remains of the infected are immediately cremated. She stated that her mother’s burial setting was made possible through the help of their church minister who arranged for a funeral parlor to retrieve and prepare her mother’s remains for burial.

“…kasi hindi pwedeng patagalin dahil ang protocol talaga ng government that time, once na COVID yan, ang kinamatay ay COVID, automatic cremate yan. Kahit anong religion, cremate yan. Pero nung time na yun, yun nga tinawag nga namin agad sa kapatid ko, sa asawa niya na ministro. So, kumilos yung asawa niya, tumawag sa sentral, tumawag sa lokal din ng Solis, lahat ng ministro that time nag- uusap usap sila. Kontakan sila n'on. Around 8p.m., tinawagan nila kami, sabi sa akin ano, “Ka- Apple, pwede na po nating ilibing si mommy bukas ng alas otso ng umaga”. Oo, sabi ko, “san po natin ililibing? May punerarya na ba?” Sabi niya, sabi nila, “wala na po kayong iintindihin. May darating na pong punerarya bukas diyan ng alas otso ng umaga para pick- upin yung mga labi ni mommy, tapos diretso na po tayo libing sa North Cemetery.” So, nung time na yun, talagang nandun lang kami sa ospital nung kapatid ko, yung bunso kong kapatid. Siya lang talaga yung kasa- kasama ko dun eh, kasi binabantayan namin, baka mamaya ma- cremate . Eh bawal sa religion namin. So, 8p.m. na ng gabi, 'yun na, nakipag- usap ako sa head security nga nung– ewan ko, may isa pang head na nakausap ko dun sa hospital na nangako ako na bukas na ng umaga, 8a.m., kukunin ko yung bangkay ng mother ko ta's ililibing na agad namin. Diretso libing na, wala ng burol.”

“… [the body] cannot be preserved longer because the protocol of the government at the time was that a patient who died from COVID must be automatically cremated. Any religion sees their dead cremated. However, at that time, we called my sister whose husband is a minister. Her husband called our church’s main office and local branch in Solis. All the ministers at the time had a meeting [regarding my mother’s burial]. They called us at around 8p.m. and said “Sister Apple, we can have your mother’s burial tomorrow at 8a.m.”. They further told us, “Where should we have your mother’s burial? Did you call a funeral parlor already?“. They also said, “You don’t have to worry about anything. Funeral parlor staff will arrive there tomorrow to pick up your mother’s remains, then we will head straight for her burial at North Cemetery”. So that time, me and my youngest sibling stayed at the hospital. She was the only one with me. At 8p.m. I pleaded with the head of security – I don’t know, there is still another person in-charge in the hospital whom I spoke to and promised that I will pick up my mother’s remains at 8a.m. and that we will have her burial right away. We went to burial straight away without holding a wake.” (Participant Apple)

Theme 5: Feeling the Loss After the Rites: Facing One’s Thoughts and Feelings Regarding the Loss

Participants were asked about their thoughts, feelings, and activities after the burial of their deceased. They have expressed various thoughts and feelings regarding their loss which, according to them, went until a few months after. They also narrated how their family members went through the experience. The narratives from the participants regarding this have discernible features which can be categorized into two subthemes due to observable distinctions of their feelings which cannot be categorized under one theme.

Subtheme 1: An Encounter with Depression

Upon careful analysis of the narratives under the theme, the participant’s narratives consistently contain sadness, avoidance, isolation, and crying as concepts that describe part of their feelings. These feelings are consistent with characteristics of feeling depressed which is a normal emotional response to loss (Tyrrell et al., 2021) - meaning that their reported feelings are part of the grieving process and are subclinical. The following statements justify this subtheme.

“Ako, sa totoo, ano umiiyak ako gabi- gabi . Siguro for almost 1 month, iiyak talaga ako pag madaling araw kasi lagi ko siya naiisip…Tapos may time na mas gusto kong mag- isa . Mas gusto kong mag- isa sa bahay kasi ano eh, kami ng partner ko, 2 lang kami sa bahay. Siya, okay lang siya lalabas siya. Ako pagdating ko sa work, nasa bahay lang ako… Oo, ayoko ngang umiyak. Naiiyak ako pag naaalala ko kasi ang mommy, naiiyak talaga ako…Hanggang ngayon, pag nakukwento ko yung experience ko yung experience ko na yan naiiyak ako kasi ang sakit na mawalan ng magulang…Yun, ako yung napansin kong naging epekto sa'kin ng pagkawala ng mother ko, siguro nga, siguro nagkaro'n ako ng depression kasi hindi talaga ako nakakatulog… hindi makatulog hanggang sa 'yun na nga, meron akong iniinom na sleeping pills before para lang makatulog.”

“Me, to be honest, I cry every night. I think, for almost a month, I've been crying at dawn because I always think about her… Then, there are times when I want to be alone. I prefer to be alone at our house because... me and my partner are the only ones at our house. He's okay to go out. [But] I just stay at our house when I arrive from work…yes, I really don't want to cry. I feel like crying whenever I remember mommy. I really feel like crying… Until now, I still feel the pain of losing a mother since mommy was my best friend… I noticed that the impact of my mother's passing to me is, probably... I probably had depression because I can't sleep… I can't sleep until I was prescribed to take sleeping pills before going to bed.” (Participant Apple)

Apple experienced sadness indicated by her frequent crying at dawn, the urge to isolate herself as she prefers to be alone, and difficulty of sleep. It was further expressed by Apple that the emotional pain due to loss is still experienced by her until present times. Aside from her personal experience, Apple also narrated how she saw the experience of her family members.

“So, siguro nung 2 days before mawala si mommy dun lang niya nalaman.Sabi ko nga, sabi ko, “'Dy, nagka- COVID si mommy. Nakasagap siya ng COVID sa ospital...” Ayun, dun ko lang din nakita yung daddy ko na umiiyak siya kahit nakatalikod sakin, ganun talagang ano, alam mo yung... ang sakit talaga! Hindi ko ma- explain pero hanggang ngayon, pag naiisip ko lahat, talagang masakit… Sa kapatid ko, naging iwas siya, tapos para siyang na- trauma dahil ayaw niyang humaharap sa tao.”

“I think 2 days after mommy passed, that's when he was informed. I told him "Dy, mommy had COVID. She caught COVID at the hospital..." That's when I saw daddy crying with his back towards me. You know that... it felt painful! I can't explain but until now, It hurts real bad whenever I think about it…My brother became avoidant, and it seemed like he was traumatized because he doesn't want to face people.” (Participant Apple)

The experiences of the family members, according to Apple, include sadness and avoidance of interaction with other people. Almost the same experience was narrated by Nali in terms of her personal experience and the experience she saw from family members.

“Sobrang lungkot na lungkot ako, parang hindi ko na kaya. Pero pinalalakas lang ng mga anak ko. Yung ano, noong bago- bago pa parang ayokong pumunta sa pinupuntahan namin, ayokong sumakay ng jeep kasi pag sumasakay ako ng jeep naaalala ko siya kasi lagi kami magkasama. Noong time na pumapasok ako, naaalala ko siya kasi sinusundo niya ako pag wala siyang pasok. Ayoko rin makipag- messenger kasi pag ganyan naaalala ko siya, lagi siyang tumatawag sa akin. Ayokong pumunta kung saang lugar na mayroong naaalala ko siya. Ayokong lumabas….Malungkot, ang sakit sakit, nawalan ako ng kaibigan, nawalan ako ng asawa, nawalan ako ng best friend… parang ayaw ko mag- isa , pag nakita ako umiiyak ako, ganoon din yung bunso ko… Yung bunso ko ilang buwan siyang hindi nagsalita, ayaw niya makipag- usap , iyak lang siya nang iyak, para siyang na- depress kasi siya yung pinaka- paborito (na anak)... hindi siya talaga [nakikipag- usap sa iba], Kain lang siya kaunti, tapos wala haharap siya sa wall, nakahiga na nakaharap sa wall at nagse- cellphone , pag kinausap na namin iiyak na lang siya bigla.”

“I was very saddened, it felt like I can't take it anymore. But my children strengthened me… When [our loss] is not too long ago, I feel like avoiding the places we usually go to, I don’t want to ride the jeepney because i remember him since we use to ride the jeepney together. When I go to work, he always picks me up during his day-off. I also don’t want to chat people on messenger because I remember the moments when he used to call me… I don’t want to go to places which remind me of him, I don’t want to go out… Saddening, it was very painful. I lost a friend, I lost a husband, I lost a best friend… I do not want to be alone, they always see me crying when I am alone, same with my youngest child… My youngest son was not speaking for months, he did not want to communicate. He was just crying and crying. He seemed depressed because he/she was the most-favorite child… He really doesn’t [talk to others], he would just eat a bit, then he would lay down facing the wall using his phone. He suddenly cries whenever we talk to him.” (Participant Nali)

Nali’s experience involves crying, sadness, isolation, and painful emotional feelings. She also actively avoids the things she used to do and places she used to go to as they remind her of her deceased husband. Furthermore, according to her narrative, her child did not speak for months, prefers to isolate, barely eats, and suddenly cries when spoken to. JV, on the other hand, focused on his personal experience.

“Babalik na ako sa bahay. Magmumukmok na uli sa kwarto. Tapos, paulit ulit lang hanggang sa umabot ng tamaan din ako ng covid, positive din ako. Dinala ako sa kalinga, tapos ayun mas lalo akong nadepress kasi siyempre pano na yung mga kapatid ko doon, ano yung kakainin nila pag wala ako, tapos malalaman ko rin nagpositive yung iba sa kanila... ay hindi, ako lang pala yung nagpositive, sorry. Tapos sila naman parang naging PUM or person under monitor… Nandun parin yung emosyon ko na sobrang lungkot kasi magisa lang ako don umiiyak ako hanggang sa kinocomfort ako ng mga nurse don kasi ayun nga alam din nila na kakapanaw lang ng papa ko tapos ganito din yung nangyari sakin… ganon, parang nung time na yon napapansin ko rin na bumbalik ako sa routine ko nung kung ano yung ginagawa ako nun kapag parang [unintellgible] magmukmok uli sa kwarto ko, sa madilim na kwarto ko,”

“I went back home, and sulked again in the room. Then, just over and over again until the covid hits me, I'm also positive. I was brought to Kalinga. Then I got even more depressed because of course what about my brothers and sisters there, what will they eat without me, then I also found out that the rest of them are positive. Oh no, I'm the only one who's positive, sorry. They seem to be PUM or person under monitor… I still have my emotions that are very sad because I'm alone. I cry until the nurses comfort me because they also know that my dad just passed away and then this is also what happened to me… It’s like, at that time, I notice myself slipping back to my usual routine of sulking in my room, in my dark room.” (Participant JV)

JV experienced extreme sadness not just because of his father’s passing but also because he tested positive for COVID-19. He stated feelings of sadness and crying, and prefers to isolate himself in his room before his diagnosis and after being allowed to go home still due to the loss of his father.

To summarize, a part of participants thoughts and feelings regarding their loss is focused on sadness, avoidance, and isolation thus giving rise to the emergent subtheme.

Subtheme 2: The Worries of the Bereaved Warrior

Along with their depressed feelings and increased inclination to withdraw from everything, the participants further exhibited and described feelings of worry, fear and being troubled in the aftermath of their loved one’s passing. These worries and woes primarily include anxiousness regarding the safety of their family members in the light of the COVID-19 pandemic, familial and career reasons that arise from the increased responsibilities that their loved one’s might have left behind

Upon looking at the narratives of participants regarding their thoughts and feelings about their loss, as mentioned in the previous section, there are discernible features that separates feelings of depression and anxiety - thus giving rise to the subtheme which is also subclinical within the context of bereavement as it is a normal response to loss (Smith et al., 2020). The statements made by the participants below exhibits and gives a clear view upon the feelings of anxiety that they felt and might still be facing.

“So, yung takot ko rin that time, syempre medyo may edad na yung amo ko, takot din ako kasi syempre pag nawala yung amo mo, mawawalan ka rin ng trabaho diba. Ilan kaming mawawalan ng trabaho kung sakali. 'Yun, kaya ang lalapit ng mga kakilala ko na tinamaan talaga ng COVID.”

“My fear at that time... since my boss is quite old... I was also afraid since if he dies, I will lose my job. A number of us will lose our jobs if that happens. All the people I know who had COVID are close to me.” (Participant Apple)

“Hindi ako makatulog kasi naiisip ko – meron pa nga akong ano eh, nagpa- doctor ako, na niresetahan pa 'ko ng sleeping pills, yung mga ganun na mga ganung factor. Tapos, parang naglabasan yung mga sakit ko nitong ano, kasi nga due to stress, 'yun.”

“I can't sleep because I think – I still have... I went to the doctor who prescribed sleeping pills... those kinds of factors. And then physical illness appeared due to stress” (Participant Apple)

“Para akong naloloka, hindi ko kaya. Sabi ko "paano na lang ako, tatanda ako mag- isa ". Yun, di ko kaya”

“I felt like I'm going insane, I could not live without him. I said, "what about me? I will grow old alone.” (Participant Nali)

The aforementioned statements clearly differentiate various ways on how their anxiety manifested and how they reacted. Apple exhibited career insecurity as well as worry about her own health, while Nali exhibited worry about the uncertainty of her future without her husband. Furthermore, Apple expressed that her family, especially her brother, exhibited germophobic tendencies in the aftermath of her mother’s passing - fearing contraction of COVID-19 which factored in the death of their mother:

“Ang observation ko sa kaniya everytime na pupunta ako dun sa kanila, kasi siya na lang ang binata eh, siya ang kasama ng parents ko sa bahay, talagang iwas na iwas siya sa'kin dumikit. Tapos, ano, pag nandun ako sa'min, parang halos ayaw niya lumabas ng kwarto, tapos mega- ispray ng alcohol sa akin. Talagang– actually ganun talaga kami eh, nagsspray talaga kami ng alcohol buong katawan, hubad ng slipper, hindi pinapasok ng bahay, ganon. Mas maingat siya eh, kaysa sa daddy ko. Ang daddy ko kasi, takot din naman, pero mas nakita ko sa kaniya na ano, dun sa brother ko na nagka- trauma siya, ayaw niya ng, parang ayaw na niyang humarap sa ibang tao talaga. Ayaw niyang lumapit ganiyan. Ganon, tsaka halimbawa, yung mga anak ko pupunta sa kanila, parang oh kailangan naka- face mask, kailangan spray talaga ng ano, alcohol.”

“My observation of him was that everytime I go there, out of all of my siblings he is the only one who is single so he stays with our parents, he avoids having physical contact with me. Then whenever I visit them, he almost does not leave his room, and he would mega-spray me with alcohol. Well, actually that's how we really are, we really spray alcohol all over our bodies and we do not wear our slippers inside the house. He is more careful than my daddy. My daddy is actually scared as well but I observed it more from him (my brother) that he was traumatized. He does not want to face other people, he does not want to get too close to them physically. For example, when my children would also visit them, he somewhat requires them to wear face masks, and to really sanitize with alcohol.” (Participant Apple)

“Tapos, ano, pag nandun ako sa'min, parang halos ayaw niya lumabas ng kwarto, tapos mega- ispray ng alcohol sa akin. Talagang– actually ganun talaga kami eh, nagsspray talaga kami ng alcohol buong katawan, hubad ng slipper, hindi pinapasok ng bahay, ganon.”

“...Then, whenever I'm at home, I almost always don't want to go out of my room, then I mega-spray myself with alcohol. It's just really... We are actually like that, we spray alcohol all over our body, we remove our slippers, we don't let each other in [unless we do that]” (Participant Apple)

The statements above expressed fear that the family had in catching COVID-19 that developed due to their mother’s passing. It is evident that Apple’s brother exhibited the most prominent sign of anxiety as he developed germophobic tendencies such as avoiding skin contact even with his own family members and limiting his time outside his room.

All in all, the statements show that most participants have exhibited anxiouness which manifested in various ways that significantly impacted their daily life after their loved one’s passing.

Theme 6: The Importance of Relatedness and Togetherness in Filipino mourning: “Damayan (Mutual Sympathetic Aid) Amidst the Loss and Bereavement”

In terms of dealing with what the participants have gone through, they seek a support system. The support system, given the cultural context, is shown collectively through presence by peers and/or family, and has shared acknowledgement of loss, and coping. The following statements have shown the collective support system or “damayan” among their family or friends:

“...tinulungan kami ng Iglesia ni Cristo: taga- pamahala ng Iglesia tinulungan kami, para mailibing agad ang mother ko kinabukasan…Ang naging setup namin sa paglilibing sa mother ko, naka- zoom lang kami para napapanood ng mga uncle ko, yung nasa Amerika, yung mga tita ko, yung ibang uncle nasa Bulacan, yung iba nasa Quezon City. 'Yun, pinanonood lang nila yung proseso kung pa'no namin nalibing yung mother ko. Ganun lang…Yun, 'yun lang siguro yung gumagaang ang pakiramdam ko kapag may naririnig ako na relatives namin na nagsasabi na, “hindi mo naman pinabayaan ang mommy mo tsaka daddy mo. Lagi kang andiyan sa kanila.” Ta's every time na nakukwento ko siya, halimbawa, ang mga friends ko kasi nakaka- chat ko na lang, kasi yung iba kong kaibigan, nararanasan din nila na yung mother nila, pumanaw din dahil sa COVID.”

“... [Our churchmates from] Church of Christ helped us - the minister of our church helped us so we can have my mother’s burial the next day…Our set-up for the burial of my mom is that we used zoom for my uncles in America to be able to watch, as well as my aunts and uncles in Bulacan and Quezon City. They watch the process of my mom's burial… that’s it, I think my feelings feel lighter when i hear my relatives say “you didn’t leave your mommy and daddy alone. You were always there for them.” Then everytime I tell [my story] to my friends for example… because I only chat my friends [nowadays]… since some of them also experienced losing their mothers due to the COVID.” (Participant Apple)

Apple expressed that her religion, family, and friends helped them go through their feelings during bereavement. The active participation of their churchmates, the presence and affirmation of their family members despite the distance, and the relatable company of their friends helped Apple cope with her feelings.

“Yung mga anak ko, siguro alam nilang malungkot ako, ang sweet nila sa akin. Hindi nila ako iniiwanan… Tapos niyayaya ko nalang siya, tara punta nalang tayo sa Divisoria ganyan ganyan. Pakonti- konti , nilalabas ko siya para dalawa kami malibang. Yun nung time nilalabas- labas ko na siya, lumalabas na rin ako, pakonti- konti , nawawala na yung lungkot.”

“Maybe my children knew that I was sad that they are always sweet towards me. They never leave me… I always ask my youngest child to come with me to Divisoria. Little by little, I take him/her outside for the both of us to be entertained.” (Participant Nali)

Nali expressed that she felt her children’s empathy towards her feelings and their efforts to comfort her. She also did the same towards her children, especially towards her youngest child who exhibited significant changes in their behavior.

“Ayun, sa tulong ng mga kaibigan ko, ah madalas ko namn silang nakakausap, ganyan, salamat naman at parang nalagpasan ko yung... yung depression or kung ano mang lungkot sa buhay yung nararamdaman ko at that time”

“Well, with the help of my friends, ah I often talk to them, that's how it is, thank you and I seem to have overcome the ... the depression or whatever sadness in life I was feeling at that time” (Participant JV)

Lastly, JV expressed that the company of his friends helped him overcome his feelings of sadness. The aforementioned narratives indicate the sense of collectivity as participants go through bereavement which significantly helped in improving their emotional state. At the same time, their own sense of collectivity also allowed them to help their family members as they collectively go through the experience.

Also, with Nali and her kids, they bonded more, as she said with her statement:

“Yung mga anak ko, siguro alam nilang malungkot ako, ang sweet nila sa akin. Hindi nila ako iniiwanan.”

“Maybe my children knew that I was sad that they are always sweet towards me. They never leave me…” (Paticipant Nali), This statement showed that Nali and her kids stood with each other’s side and gave emotional support, and during the start of their acceptance stage, they continued to support each other as further shown by Nali’s statement:

“...tapos niyayaya ko nalang siya, tara punta nalang tayo sa Divisoria ganyan ganyan. Pakonti- konti , nilalabas ko siya para dalawa kami malibang. Yun nung time nilalabas- labas ko na siya, lumalabas na rin ako, pakonti- konti , nawawala na yung lungkot.”

“I always ask my youngest child to come with me to Divisoria (a market). Little by little, I take him/her outside for the both of us to be entertained." (Participant Nali).

From the statements above, it can be seen that the shared acknowledgement of the loss and the interconnected coping with their friends and family helped the participants through their bereavement. The need to be connected with peers and family, in the Philippine context, is part of the bereavement support system of

Theme 7: A Filipino’s Take on Reconciliation (“I Wish You Were Here But I Know You’re In a Better Place”)

Under this theme, participants narrated their experiences regarding their gradual ease to accepting the loss of their loved one. Participants reported notable experiences which allowed them to gradually face their new reality. Most of them reported experiences related to their religious belief in afterlife – believing that their loved ones are now happy and free of sufferings in heaven, and experiences highlight their efforts to continue showing love for their deceased through commemoration. The following statements below characterizes this theme further:

“Ako masasabi ko ngayon siguro okay na ako. Okay na yung pakiramdam ko, okay na rin yung– may time na naiisip ko si mommy, pero naiisip ko siya na masaya ako na sasabihin ko, “my ah, okay ako dito”, ganiyan. Tsaka pag may time kami, dumadalaw kami talaga sa sementeryo. Dinadalaw namin siya, ganun. Nung birthday niya! Birthday ng mother ko nung October 6, pinaghanda ko siya, kahit na wala siya. Parang gusto ko masaya eh. Masayang family kahit na medyo wala na siya, ganun. Yung paborito niyang cake, binili ko.”

“For me, I would say that I am doing okay right now. My feelings are fine, I am also fine already if I think of mommy sometimes. But I was thinking of her being happy and I would say “my (mommy), I am fine here”. Also if we have spare time, we would go to the cemetery and visit her. During my mother's birthday on October 6, I cooked for her even though she was gone already. It was like I wanted it to be happy. A happy family even though she was gone. I also bought her favorite cake.” (Participant Apple)

“Noong namatay asawa ko, yung isa kong anak, pina- tattoo niya yung pangalan ng asawa ko. Pati ako pina- tattoo ko yung pangalan niya sa wrist ko.”

“When my husband died, one of my children had my husband's name tattooed. I also got his name tattooed on my wrist.” (Participant Nali)

Nali also added:

“Kasi yung pangalawa, mahal na mahal din niya daddy niya. Ayun, di rin siya maka- recover , gusto niyang maalala talaga daddy niya kahit dun na lang sa tattoo niya, hindi niya makakalimutan kasi pangalan talaga ng daddy niya na malaki, malaking pangalan sa dibdib niya.”

“Because my second child, he loved his daddy so much. He cannot recover from it, he wants to remember his daddy even just by his tattoo. He will not really forget because his daddy's name is a huge, huge name (tattooed) on his chest.” (Participant Nali)

“Kumpara noon na palagi akong, ayun sa tulong ng mga kaibigan ko, ah madalas ko naman silang nakakausap, ganyan, salamat naman at parang nalagpasan ko yung. Yung depression or kung ano mang lungkot sa buhay yung nararamdaman ko at that time. Kaya nga ginagawa ko na lang yung best ko para kumbaga gusto ko maging proud yung mama't papa ko sa akin na nakapagtapos ako na nagsipag ako, nakapagtapos ako, sana makapagtapos ko rin yung mga kapatid ko ipapangako ko sa kanila. Yun na lang ang iniisip ko.”

“Compared to before when I always… with the help of my friends [since] I always talk to them… thank goodness it’s like I was able to overcome my feelings of depression of whatever sadness I feel in my life at that time. That's why I'm just doing my best so that I can make my mom and dad proud of me. that I graduated. that I worked hard, I graduated, I hope my siblings can also graduate. I will promise them that, that's all I'm thinking” (Participant JV)

The statements aforementioned show the transitional progression of participants towards accepting the loss of their loved ones. All of them have also exhibited a commonality; they all commemorate their deceased loved ones. They are recognizant of the fact that all they can do in this present time is to continue living and functioning while maintaining their dedication of keeping the dead unforgotten and remembered. However, the participants have shown individual differences in practicing commemoration. Apple openly acknowledges that she is continuously getting better as time passes by. She also remembers her mother through occasional visitations in the cemetery and lively celebrating her birthday. On the other hand, Nali together with her daughter made permanent commemorations that were embarked physically; Nali had a tattoo of her deceased husband’s name in her wrist, while her daughter’s tattoo is on her chest. Then JV assumes the responsibility of working hard and helping his siblings to “make his parents proud”.

Given these similarities, Apple and Nali also incorporates mystic/religious practices and beliefs in their process of acceptance:

“Kaya parang ano, nagkaro'n ako ng parang peace of mind. Sabi niya (kapatid), “siguro 'te, sinasamahan ka ni mommy kasi lumipat ka na ng bahay.”

“That's why, I felt like I had peace of mind. She (sister) said, "maybe mommy accompanied you when you moved to your house.” (Participant Apple)

This statement of Apple shows her belief in the afterlife. The physical absence of her mother has transcended to an idea that her mother is in peace, yet a view that she is now “a soul” who is with Apple in her new house. Furthermore, Apple also expressed that her dreams bare significant meanings about her mother’s peaceful state, and that it assists with her recovery:

“Alam mo yung feeling, iba yung pakiramdam. Parang dun ko lang naramdaman na at peace, at peace na pala si mommy. Kasi dun sa panaginip–alam mo parang ang saya-saya ko n'on, sobra!”

“You know the feeling, it feels different. I felt that mommy was at peace at that time. Because in my dream – you know I felt very happy.”

Apple added:

“Hindi ko ma- explain , pero kapag pala yung taong mahal mo nawala, pero pag napanaginipan mo siya, ibang peace of mind talaga yung nararamdaman mo, ibang happiness kasi nakita mo ulit siya eh.”

“I can't explain, but I felt like if your loved one passed... but you dreamt of them, your mind feels at peace. You feel a different kind of happiness when you see them again.” (Participant Apple)

Incorporating it to her process of reconciliation:

“Ako lang, pinagdadasal ko lang siya, sila. Nagrorosaryo lang ako gabi- gabi . Tapos noong 40 days na yung asawa ko, mayroon akong kaibigan na nag- aano sa simbahan, nagseserve sa simbahan, yun ang pinapunta ko sa bahay para mag ano ng 40 days lang.”

“It's just me, I'm just praying for him, for them. I just pray the rosary every night. Then during his 40th day (after death), I asked my friend who serves in the church to come to our house and order a prayer for him.” (Participant Apple)

Summarizing, the aforementioned statements exhibit the individual experiences of participants as they undergo the continuous process of reconciliation and acceptance which is still happening to this day. Furthermore, these statements have also shown distinctions on the participants’ individual differences on practices and acting upon their state of reconciling with the reality of their loss.

Discussion

The findings of this study highlighted the experiences of bereavement of Filipinos under the limitations and challenges posed by the COVID-19 pandemic. Findings have detailed the persisting influence of culture and religion of Filipino participants to their experience of bereavement – especially on how they mourned for their deceased despite the pandemic restrictions.

Findings on the subject of funeral practices exercised by the participants have detailed the lack of usual face-to-face setup and funeral ceremonies contrary to the pre-pandemic Filipino mourning described by Giannopoulou et al., (2018) and Go and Docot (2021). These findings indicate that the restrictions under the pandemic have caused a disruption to the typical Filipino mourning and bereavement activities, which are similar with the findings of Aguiar et al. (2020).

Despite this, the continuation of certain religious practices of some participants, such as conducting prayer rituals for the dead, even under the context of the pandemic, with a slight adjustment of setting and number of attendees, denotes the persisting influence of culture and religion to the mourning process of Filipinos described by several literatures (Goldade, 2017; Giannopoulou et al., 2018).

Furthermore, findings suggest that filipino bereavement under the pandemic involves an initial brief moment of sublimation. Based on the narratives, sublimation acts as a filter by allowing a person to focus on being productive and functioning but without denying the fact of their loss - as they remain functional to (1) assume the role of being responsible in providing their deceased loved-ones with a decent burial, and (2) taking into consideration the reaction of their family members. There is a lack of literature supporting this finding therefore confirmatory research is needed to further provide a more solid ground for it.

Findings also suggest that Filipinos express two distinct groups of feelings and experiences as they process their loss. The first subtheme characterized by the bereaved participants’ feelings of sadness, and exhibited avoidance and isolation are similar to the findings of Tyrrell et al., (2021) discussing characteristics of depression under the context of grieving which is a normal emotional response to loss. The findings are also supported the findings of various research which identify the effect of bereavement as causing sadness, loneliness, changes in social ties (Glatt, 2018; Muhammed & Idowu, 2020), daily routine and eating patterns, and behaviors (Stahl & Schulz, 2014).

The second subtheme characterized by the participants’ expressed anxious feelings connected to their experience of loss denotes the existing role of a subclinical sense of anxiety in Filipino bereavement. Although there are few studies assessing the role of subclinical anxiety with grief, the narratives presented above support the claim of Smith (2018) that anxiety and grief have a significant link in that symptoms of anxiety are frequently present among people who have experienced loss.

Findings further gave light to the Filipinos’ need for social connection and support in coping for their loss. The reports of participants’ desire for the company of their family and friends as they go through bereavement is consistent with the findings of Broomhall and Phillips (2020) discussing on how Filipinos are associated with having a collectivist culture since it is a common practice for them to seek yet obtain social support from other people. The statements above have shown how the friends and families of the participants showed empathy and connection with them, and how it helped with their bereavement.

Lastly, the participants’ reported experiences pertaining to commemoration practices inclined with religion and exhibited belief that their deceased loved ones are in the afterlife concurs with the result of a study by Asuncion et al. (2016) that had shown that believing in the idea that the deceased have transcended to the afterlife corresponds to positive appraisal, thereby alleviating negative feelings from the loss. Commemoration was also collectively seen as an important yet healthy practice of accepting the loss; cherishing the memories of the deceased promotes the idea that the participants were necessarily honoring and remembering their dead loved ones (Szczesniak, 2022). Furthermore, these religious practices were seen as pertinent to Filipino bereavement since all in all, the Philippines is a country that has numerous religious funeral and posthumous traditions (Goldade, 2017).

Limitations

The findings of this study are limited to the members of bereaved Filipino families whose loved ones died in a hospital and whose socio-economic status is on the bracket of “lower middle class” with an income within the range of 21,914 to P43,828 as per the PIDS 2020 study (see Albert, et al., 2020). The findings, therefore, does not represent experiences of families whose loved ones passed in other settings and those who belong on a different socio-economic status. It is, recommended that future researchers explore the phenomenon of Filipino bereavement in other settings and on family with lower socio-economic status. The researchers dealt with at least one (1) family member from three (3) families residing in Metro Manila, Philippines. The family member/s who were interviewed are at least eighteen (18) years of age and above and are dealing with the loss for at least six (6) months after the death of their loved one due to COVID-19. The participants are strictly first-degree relatives of the deceased living in the same household. Furthermore, the deceased loved ones of participants have underlying co-morbidities, and participants received their COVID-19 results after their death. This study is limited to analyzing the experiences of family members of bereaved Filipino families whose loved one died due to COVID-19 in the Philippines. Due to the travel restrictions posed by health protocols to mitigate the spread of the disease at the time of the conduction of this research, interviews were done via video conferencing platforms online. Researchers did not encounter any notable challenges despite conducting interviews of sensitive nature through these online platforms.

Conclusion

This research has viewed and provided an insight to the phenomenon of bereavement through the experiences of bereaved Filipinos who lost their loved ones due to COVID-19. In the light of the challenges to bereavement posed by travel restrictions and safety protocols, connectedness, and the cultural and religious beliefs of Filipinos have played a major role in the process of Filipino bereavement. This is achieved by Filipinos through adjusting their mourning practices by conducting rituals which are feasible to be conducted inside their homes to compensate for their inability to host a wake, and by maintaining connection and involvement of friends and family in the grieving process through conducting video calls and having constant conversations with them.