Dehydration - MIET AFRICA
Caring for Others
© MIET Africa: 2014
All rights reserved. You may copy material from this publication for use in non-profit programmes if you acknowledge the source. For other use, please obtain permission from the publisher.
Developed and produced by MIET Africa with the financial support from the National Lottery Distribution Trust Fund.
Published by MIET Africa
PO Box 37590
OVERPORT 4067
South Africa
Telephone: +27 (0)31 3100
Email: miet@miet.co.za
Website: miet.co.za
Contents
Introduction 1
Section 1: Finding out about HIV&AIDS 2
Why is everyone so worried about HIV&AIDS? 2
What is the difference between HIV and AIDS? 2
Where does the virus live and what does it do to the body? 3
Why is there no cure for HIV? 3
There is no vaccine against HIV 3
How does the virus spread? 3
Blood 4
Semen and vaginal fluid 4
Mother to baby 4
How is the virus NOT spread? 4
How can a pregnant woman prevent HIV spreading to her baby? 5
Prevent re-infection 5
Get medication 5
Don’t give birth at home 5
Feed wisely 5
How can I protect myself from getting infected? 5
No sex 5
Stick to one sexual partner 5
Stick to a sexual partner of about your age 6
Use condoms 6
Take the test! 6
Talk about it 6
Who is the most at risk of getting infected? 6
Sexually active people 6
Babies 6
People who share instruments that have touched blood 6
What is safe sex? 7
Very safe 7
Safe 7
Unsafe 7
How will I know if I am infected and what will happen? 7
How long will I live once I am infected? 7
Stages of infection 7
What can I do to live positively? 8
Know yourself 8
Get support 8
Get the facts 8
Take special care of your health 9
Get medication 9
Live in hope 9
What are my rights as an infected person? 9
Informed consent before testing 9
Confidentiality 9
Treatment 9
Employment 9
Education 10
Knowledge and information about safe sex 10
What can I do to help in the fight against HIV&AIDS? 10
Do 10
Don’t 10
Where can I get help and information? 10
Section 2: Common health issues and illnesses 11
Antiretrovirals 11
Combination therapy 11
Resistance 11
Side-effects 11
Alcohol abuse 12
Allergies 12
Signs and symptoms 12
What must you do? 13
Anaemia 13
Arthritis 13
Asthma 13
What must you do? 13
Bed sores 14
Bleeding 14
Light bleeding 14
Heavy bleeding 14
Blood pressure (high) 15
Bronchitis 15
What must you do? 15
Burns 15
What must you do? 16
Cancer 16
Chickenpox 16
Signs and symptoms 16
What must you do? 16
Choking 16
Signs 17
What must you do? 17
Cholera 17
Signs and symptoms 17
What must you do? 17
Colds and flu 17
Signs and symptoms 17
What must you do? 18
When must you get medical help? 18
Constipation 18
Coughs 18
Disability 18
Dehydration 19
Signs and symptoms 19
What must you do? 20
Rehydration solution 20
Rehydration solution dose (how much to give) 20
Diarrhoea 21
Signs and symptoms 21
What must you do? 21
When must you get medical help for diarrhoea? 21
Drowning 21
Fever 22
What must you do? 22
Food safety 23
Do 23
Don’t 23
Headaches and migraines 23
What must you do? 24
Heart attacks 24
Signs and symptoms 24
What must you do? 24
Hepatitis 24
Signs and symptoms 24
What must you do? 25
HIV 25
Lightning strikes 25
Malaria 25
What must you do? 25
Malnutrition: undernutrition/overnutrition 26
Maternal conditions 26
Measles 26
Mental health problems 27
Causes 27
Meningitis 27
Mumps 28
Signs and symptoms 28
What must you do? 28
Complications 28
Pneumonia 28
Signs and symptoms 28
Rabies 29
Sexually transmitted infections (STIs) 29
Signs and symptoms 29
What must you do? 29
TB (Tuberculosis) 30
What must you do? 30
More about DOTS 31
Tetanus (lockjaw) 31
Universal precautions 31
Vomiting 33
What must you do? 33
When must you get medical help for vomiting? 33
Water 34
Make water safe for drinking 34
What must you do? 34
Worms 35
What must you do? 35
Section 3: Introduction to counselling skills 36
What is counselling? 36
Counselling is … 36
Counselling is not … 36
Why do people need counselling? 37
Your role in the counselling process 37
Stage 1: Help the person to tell their story 37
Stage 2: Help the person to consider their current options 38
Stage 3: Help the person to make an action plan 38
Stage 4: Help the person to commit to implementing the plan 38
Characteristics of an effective counsellor 39
Two poor counselling sessions 39
What are the characteristics of a good counsellor? 40
How should a counsellor act during a counselling session? 40
What should a counsellor avoid doing? 41
Counselling skills: Reflective listening 43
Step 1: Reflection of content (also called summarizing) 43
Step 2: Reflection of feelings—these may be explicit (i.e. clear) or implied (i.e. suggested) 44
Counselling skills: Asking questions 47
Some common errors in questioning 47
1. Asking too many questions 47
2. Closed questions 47
3. Leading questions 48
4. Questions that probe too deeply, too soon 49
5. Poorly-timed questions 49
6. “Why?” questions 49
An effective counselling session 50
Working with children who have been abused 54
The safety of the child 54
The health needs of the child 54
Disclosure and communicating with children 55
Disclosure 55
Why don’t children disclose abuse spontaneously? 55
Why don’t children make a full disclosure? 55
Child abuse accommodation syndrome 56
Things to think about before your interview a child 56
The interview 57
Feelings that children may find difficult to manage after abuse 59
Section 4: Taking care of yourself 61
What is stress? 61
Assess your stress levels 61
Identifying and assessing negative stress 63
Causes of stress 63
Effects of too much stress 64
Getting “hooked-in” and burning out 64
Signs of being hooked-in 64
Signs of burning out 65
So … what is “normal”? 65
Ways to cope with stress and care for yourself 66
Assessing how you manage stress 66
Debriefing support group 67
Relaxation exercises 69
Answers 72
Two poor counselling sessions (Answer) 72
An effective counselling session (Answer) 73
Contact list 76
Introduction
The goal of home-based health care is to treat illness or injury in the home—i.e. to provide assistance to patients (including babies, children and the elderly) in their homes. Carers may also be required to provide assistance to people facing emotional crises as a result of sickness or accidents.
This aim of this handbook is to give information to carers so they can provide care and support to people in their community.
The handbook is divided into the following sections:
Section 1: Finding out about HIV&AIDS
This section answers some of the questions that people have about HIV&AIDS, such as, what it is, how you get infected, how you can avoid infection, and how to live positively with the disease.
Section 2: Common health issues and illnesses
This section gives basic information about symptoms (signs) of common health problems and illnesses, listed in alphabetical order.
Section 3: Introduction to counselling skills
This section aims to help you to understand the counselling process and to practise listening and questioning. It introduces you to some basic counselling concepts. It also gives guidelines on working with children who have been abused.
Section 4: Taking care of yourself
This section looks at what stress is and what to do about it. It aims to equip you with the skills and knowledge to identify signs and causes of stress in yourself, and to take appropriate action to help you cope.
Section 1: Finding out about HIV&AIDS
South Africa has very high rates of HIV infection. It is important that everybody knows about the disease: what it is, how you get infected, how you can avoid infection and how to live positively with the disease. This section answers some of the questions that many people have about HIV&AIDS.
Why is everyone so worried about HIV&AIDS?
HIV is a pandemic, which means that very large numbers of people are infected and dying from it. South Africa (and KwaZulu-Natal in particular) has the most HIV-positive people of any country in the world.
We are all affected by the disease, whether we are infected or not. This is because it isn’t only a health problem, but also has a big effect on society and our economy.
The disease attacks people of all ages and all income groups. Once you have the virus, you have it for life because there is no cure. It is also very difficult to stop it spreading because many people feel it is shameful and keep it secret. There is a crisis, and more resources are needed to help people living with HIV and to help their families too.
Our only defence is to understand the disease, change our behaviour and live healthy lifestyles.
What is the difference between HIV and AIDS?
HIV stands for Human Immunodeficiency Virus (HI virus). A virus is a very small organism that enters the body and attacks certain cells. The Hi virus destroys the cells of the immune system, which are the cells that protect the body from disease.
Eventually, the body can’t defend itself against any other germs and viruses. This is when AIDS sets in.
AIDS stands for “Acquired Immune Deficiency Syndrome”—i.e. acquired (something you picked up outside your body) immune (your body’s defence system) deficiency (something you lack) syndrome (a group of illnesses or diseases). In short: AIDS is a number of diseases you pick up because your immune system is so badly weakened.
There are many possible signs of AIDS—for example, thrush (whitish spots) in the mouth or vagina, swollen lymph glands in the neck and underarms, losing your appetite for food, or fever and diarrhoea that isn’t easy to explain. If such signs won’t go away, it could mean that a person has AIDS. People living with HIV&AIDS die from different diseases, for example: pneumonia; wasting (when the body can’t absorb nutrients from food to build itself, and you get very thin); brain infections; some cancers.
|Very important |
|You may have an illness such as thrush even if you aren’t infected with HIV. If you are infected with HIV, you may have some of these |
|symptoms, but that doesn’t automatically mean that you have AIDS. |
Where does the virus live and what does it do to the body?
HIV lives inside the body. It is a “retrovirus”, which means that the virus becomes part of the host cell (the body cell it attacks). So, every time the host cell forms new cells, the HI virus is in the new cells.
HIV targets the cells of the immune system, called CD4 cells—our protectors. The CD4 cell fights all types of infections and diseases. But when the HI virus invades CD4, CD4 can no longer protect the body from other invaders. A healthy person has a CD4 count of between 600 and 1400. But as the virus grows and makes more viruses in the body, the number of CD4 cells (the CD4 count) drops very low. After a while there is no defence system left.
HIV can’t live outside the body. If infected body fluids leave the body and don’t enter another person, the HI virus in those fluids dies very quickly.
Why is there no cure for HIV?
There is no vaccine against HIV
The best way to stop a virus from infecting a person is by using a vaccine against it. This means putting a much weaker form of that virus in the body so that the body can build up antibodies to fight it. After that the antibodies will fight off the real, strong virus if it ever enters the body. However, there is no HIV vaccine yet because
• The HI virus can change and this makes it very difficult to create a vaccine.
• Many tests have to be done to prove that an HIV vaccine is safe for humans. Animals are often used for such tests, but no animal suffers from exactly the same HI virus that attacks humans. So it is difficult to test possible vaccines.
We hope that a vaccine will be found soon. But a vaccine can’t cure people who already have the disease. But it would be used to stop uninfected people from getting HIV.
How does the virus spread?
The virus spreads thorough four types of body fluid: blood, semen, vaginal fluids and breast milk. These body fluids are passed between people in the following ways:
Blood
Blood can be exchanged by sharing needles, blades or toothbrushes that have blood on them. Blood transfusions (when you’re given someone else’s blood in hospital) are safe because all donated (given) blood is automatically tested for HIV infection.
Semen and vaginal fluid
These are exchanged through sexual activities when the genitals (your private parts) are stimulated and produce these fluids.
Mother to baby
A mother can pass on HIV to her baby during pregnancy, birth or breastfeeding. The risk of passing it on is high but it doesn’t happen automatically. An HIV-positive woman can take antiretroviral drugs to protect her child and reduce the risk of her baby becoming infected with HIV.
|Note |
|Other body fluids such as vomit, faeces (poo), urine (pee), tears, sweat and saliva (spit) don’t contain enough HIV to transmit the virus. It |
|is safe to take care of someone who is sick, and to come into contact with these body fluids. But if you do take care of someone, wear gloves |
|because there may be other dangerous germs in these fluids. |
How is the virus NOT spread?
HIV cannot be spread by any of the following:
|[pic] |
How can a pregnant woman prevent HIV spreading to her baby?
Prevent re-infection
If you are HIV-positive, you can get infected with HIV again. This makes it easier for your baby to get infected. Always use a condom when you have sex to protect yourself from getting infected again.
Get medication
Ask your health worker about antiretroviral medicine (ARVs). Since 1 December 2009, all HIV-positive pregnant women in South Africa qualify for this treatment, which lowers the chance of passing HIV on to your baby.
Don’t give birth at home
Try to have your baby in a hospital or clinic. Make sure that the nurses and doctors know you’re HIV-positive so they can do something to protect the baby from HIV during birth.
Have your baby tested as early as possible for HIV.
Feed wisely
You can pass on HIV through breast-feeding, but there are ways to lower the chances of this. If you have safe water for mixing, use milk formula instead or breast-feeding, or you could breast-feed only for 6 months.
|Note |
|Mixed feeding—i.e. mixing breast milk with formula—in the first 6 months of a baby’s life brings a bigger risk of passing on HIV. |
Talk to an experienced health worker about ways to feed your baby safely. You can also contact the AIDS Helpline on 0800 012 322.
How can I protect myself from getting infected?
Here are some of the things you can do:
No sex
Don’t have sex until you feel sure that you really want to and that you’re with the right partner. It’s good to wait. Delay your first sexual experience for as long as possible.
Stick to one sexual partner
Having more than one sexual partner is very risky and is one of the biggest ways that HIV spreads. Do you know who your partner has been with? And do you know who their previous partner has been with?
Stick to a sexual partner of about your age
Research shows that the risk of getting HIV increases when your partner is five or more years older than you.
Use condoms
By using condoms you’re having “protected sex”. This is the only way to protect yourself from your partner’s past sex life. Using condoms takes a bit of skill, so you need to practise and be prepared before you have sex.
Take the test!
Check your own HIV status, and change your lifestyle as you need to. If you test negative (i.e. you haven’t been infected with HIV), take steps to stay that way. If you test positive, make sure that you don’t infect others and take steps to prevent getting re-infected yourself. Get treatment from your nearest clinic. If you test negative but have recently had unprotected sex, take a second test after three months. Why? Because after infection there is a time period when the virus doesn’t show positive but can still be passed on.
Talk about it
The more you talk and ask questions about HIV&AIDS, the more knowledge you will get. Help spread the word, not the virus!
Who is the most at risk of getting infected?
Sexually active people
The virus is mainly spread through sex. Anyone who is sexually active risks becoming infected. Statistics show that the most infections are in the age group 17 to 25. Women get infected more quickly than men. This is because women have a larger surface area for the infected body fluid to enter through (the vagina), than a man has (the penis). Sex between different age groups pushes up the risk of HIV infection and so does sex with more than one partner.
Babies
Babies are at risk of being infected from mothers who are HIV-positive.
People who share instruments that have touched blood
People who share needles and toothbrushes are also at risk of infection because small amounts of blood remain on the instrument.
|NOTE |
|Blood transfusion in South Africa is safe as all blood is screened (checked) for HIV before being used. |
What is safe sex?
Different types of sexual activities are safer than others.
Very safe
No sex, dry kissing, hugging and massage (stroking and rubbing), masturbating each other (because there is no contact with body fluids).
Safe
Sex with a condom, wet kissing (kissing with open mouth and mixing spit).
Unsafe
Any full sex act (vaginal, oral, anal) without a condom, or with semen in the mouth, or sharing sex toys. Having many sexual partners increases the risk of infection a lot.
How will I know if I am infected and what will happen?
You may have HIV in your body and not know because you feel and look healthy. An HIV test is the only way of knowing for sure. If you find out early enough that you are HIV-positive, you can change your lifestyle and stay healthy for a long time.
When you go for the test, you will have pre-counselling. A health worker will talk with you about how the test is done and what happens if you are infected. Then you will have the test. Then you will have post-test counselling, when your health worker will explain the results to you.
If the test shows antibodies, it means you have the HI virus in your blood and are HIV-positive. If there are no antibodies, you are HIV-negative. However, there is a window period where you may be infected, but the antibodies don’t show up yet. So it is a good idea to have the test again after three months.
No one can force you to test for HIV, but the government wants all South Africans to choose to take the test. In April 2010 the South African Government launched a major HIV counselling and testing campaign (HCT).
How long will I live once I am infected?
Everybody reacts to HIV differently. The World Health Organization (WHO) has worked out a guide for the way the disease progresses in a person.
Stages of infection
Stage 1
When a person is infected, it takes 10 to 21 days for their bodies to start reacting to the virus. There can be flu-like symptoms, sore joints, swollen glands or tiredness. Then these symptoms go away and there may be no sign of the infection for many years. It depends on how you live your life.
Stage 2
On average, after having HIV in your body for 7 to 9 years, the infection starts to show again. By this time, the virus has broken down the immune system so much that the body gets infected again and again with many types of diseases. There are often mouth ulcers, weight loss, skin rashes and fungal infections of the throat and airways.
Stage 3
Many of the symptoms from Stage 2 get worse and more noticeable. Other symptoms also appear, such as bad lung infections, diarrhoea for longer than a month and sores in the mouth, throat and female genitals (i.e. private parts). At this stage, the disease is called AIDS.
Stage 4
This is the most severe (worst) part of the disease. There may be diarrhoea all the time, the brain might not work properly and the person usually loses a lot of weight. Opportunistic diseases (diseases that get a chance to enter where the body is weakened) attack the body. Some of these are: TB in the lungs and other parts of the body; thrush in the throat; herpes; pneumonia; diseases carried in the blood; types of cancer. After being diagnosed with full-blown AIDS people survive for about 18 to 24 months on average. If symptoms are treated, they may go away for a while. Eventually, the person will die.
What can I do to live positively?
It is very scary to find out that you are HIV-positive, but there are things you can do to take charge of your life. It is important to live as well as possible.
Know yourself
After finding out that you have HIV, you may have intense feelings, such as anger, sadness, denial (pretending it’s not true) and wishing for a quick death. These feelings are normal and lots of people feel this way.
Get support
Find someone to talk to. You can also call the free AIDS helpline: 0800 012 322.
Get the facts
HIV leads to AIDS and it is complicated. There is lots of information available, and many untrue stories. There is no cure. Find out the best way to live with HIV to get the most out of life. Find out what you can do to strengthen your immune system so your body can fight.
Take special care of your health
This includes eating a healthy diet, taking regular exercise, keeping busy and mentally alert (aware, awake). Focus your spiritual life on hope and healing. Many people start giving care and support to others who are in the same situation. Take care not to pass the disease on to others.
Get medication
Scientists have developed treatments called antiretroviral medicines, such as HAART (highly active antiretroviral therapy). These medicines don’t destroy the virus, but they help control the number of infected CD4 cells from reproducing too quickly. Talk to your clinic about medicine. (Also, see Section 2: Antiretrovirals.)
Live in hope
Many people live a long and fulfilled life with HIV. Some infected people never develop AIDS at all. A cure might be found. None of us knows when we will die (whether we are HIV-positive or not), so it is best to make the most of each day.
What are my rights as an infected person?
You have the same human rights as a person who isn’t infected and have the right to live without fearing that people will discriminate unfairly against you, push you away from them or bully or frighten you.
Informed consent before testing
No one can force you to take the HIV test. If you do test, the person who tests has to give you counselling about the test.
Confidentiality
The result of your test is confidential (private, secret) and it is illegal for the person who tested you to tell anyone else. Only you can choose to tell others your status.
Treatment
No health care worker may turn you away because you are HIV-positive. You have the right to ARV treatment when you meet the criteria. Speak to your health worker about this or call the free AIDS helpline: 0800 012 322. You also have the same right to all other medical treatment as everyone else.
Employment
You may not be refused employment or dismissed from your job because you are HIV-positive. You’re entitled to work as long as you’re physically able to. If your work puts your health at risk, an employer should place you in another work area where you’re less at risk.
Education
Schools, colleges and universities must have a support programme and policy to allow learners with HIV to study for as long as possible. They also have to ensure a safe and caring environment for learners.
Knowledge and information about safe sex
Everyone has the right to know how to prevent infection. Sexuality education is part of the school curriculum. Condoms are available free of charge.
What can I do to help in the fight against HIV&AIDS?
The AIDS challenge is huge. There is no easy way to beat HIV&AIDS. But every person who talks openly and without discrimination about it is taking a good step forward.
Do
✓ Talk about it and get involved
✓ Spread the word, not the virus
✓ Help to create a safe and caring environment
✓ Follow a healthy lifestyle, whatever your status is
✓ Help to raise money for those in need; every small amount helps
Don’t
← Don’t discriminate
← Don’t spread false information
← Don’t deny that HIV&AIDS is part of our lives
← Don’t believe you will not be affected
← Don’t stigmatize the disease because you’re ignorant about it or you fear it
← Don’t spread the disease
Where can I get help and information?
It is important to get support and not to feel alone. Talk to a counsellor, talk to family and friends if you can, and join a support group with other people living with HIV. Talking about your status can help you accept it and make the best of your life. There are lots of support organizations. Check at your clinic or church for the closest one to you. Find other contact numbers in the Contact list at the back of this handbook.
Section 2: Common health issues and illnesses
This section gives basic information about signs and symptoms of common health problems and illnesses, listed in alphabetical order. Basic information is given on precautions and treatment, but remember you aren’t a nurse or a doctor. If the problem is serious, it is best to get medical help as soon as possible. See Contact list at the back of this handbook.
|Antiretrovirals |
|ARVs are medications used to lower the levels of HIV in the blood. |
|HIV grows by moving into certain cells in the body, including the CD4 T lymphocytes. It uses this cell to copy itself and make millions more |
|viruses. Then the CD4 T cell dies. The virus then goes into other CD4 T cells and infects them. This cycle happens over and over again. |
|As the disease progresses, more and more CD4 T cells are infected and killed and the numbers in the body decrease. You can tell how far the |
|disease has progressed by the number of CD4 T cells left in the body. As the disease progresses, the number of CD4 T cells gets lower and |
|lower. |
|ARVs can’t kill the virus and don’t cure HIV&AIDS, but they stop HIV from making copies of itself. So, they keep the CD4 T cell count high and|
|so help the body to stay healthy for a long time. Then HIV lies dormant (it doesn’t do anything) in the body but doesn’t grow. |
|There are 3 groups of ARVs, with many different types of medicine in each group. These groups act on the HI virus at different stages in the |
|process of copying itself. |
|Combination therapy |
|Each of the different groups fights HIV in a different way so people usually take a combination of medicines from 2 or 3 of the different |
|groups. Some people call this combination a “cocktail”. Others call it HAART (highly active antiretroviral therapy). |
|Resistance |
|HIV sometimes builds up a resistance to these drugs, and then the cocktail gets changed to a different combination of medicine. |
|Resistance can come from not taking the medicine properly. As soon as the person stops taking the medicine as prescribed, the HIV starts |
|making copies of itself again. HIV quickly gets out of control and starts to flourish. There is nothing stopping it making copies of itself so|
|it grows and the levels of HIV in the blood become high. Because the CD4 T cells are killed in the process, the CD4 T cell count drops. |
|Side-effects |
|ARVs do have side effects. In the short term, the main one is nausea. In the longer term, they change the pattern of how fat is laid down in |
|the body. The may cause liver disease, and there are other less common side effects. |
|AIDS |
|See Section 1: Finding out about HIV&AIDS |
|Alcohol abuse |
|Drinking too much alcohol is a problem for the people who drink, and for those around them. It harms the health of the drinker. A drunk person|
|loses their sense of judgement and this often leads to violence, unhappiness and waste for families and communities. There are support |
|organizations such as Alcoholics Anonymous (AA) that help alcoholics (see contact list at the end of this handbook). |
|Allergies |
|Some people’s immune systems over-react to certain things, causing an “allergic reaction”. They can get this reaction if they touch, eat or |
|breathe the things they are allergic to. |
|People can be allergic to many things, including |
|Pollen |
|Some medicines (such as aspirin or penicillin) |
|Hair from cats or other animals |
|Dust |
|Feather pillows |
|Some types of food, such as seafood or dairy products |
|Bee stings |
|Certain chemicals, spray paints or insecticides |
|Some allergic reactions are mild, while some can be very serious. |
|Signs and symptoms |
|There are many different signs and it depends on what you’re allergic to. Common signs for different allergies are |
|An itch or rash on your skin |
|A runny nose, sneezing and itching or burning eyes |
|Difficulty with breathing or and asthma (see Asthma, below) |
|Diarrhoea (e.g. in children who are allergic to milk) |
|What must you do? |
|Some allergic reactions—such as anaphylactic shock (person collapses) or sudden airway obstruction—are life threatening and need immediate |
|medical attention. |
|For less severe allergic reactions, you can use anti-allergy medications, such as an antihistamine, which you can get from the clinic or |
|pharmacy. |
|Find out what causes the allergy and avoid those things. Keep animals out of the house, clean in corners and under beds to get rid of dust. |
|Put bedding and furniture in the sun sometimes. Wash curtains and beat carpets to get rid of the dust. |
|Anaemia |
|Anaemia is having less than the normal number of red blood cells or haemoglobin in the blood. Anaemia is caused by a lack of iron, and |
|symptoms include tiredness and lack of energy. Teenage girls sometimes suffer from anaemia during their periods. |
|Arthritis |
|Arthritis is sore and inflamed joints. It usually happens in older people due to wear and tear, but can affect all age groups. There are many |
|causes and treatments. |
|Asthma |
|People with asthma sometimes find it difficult to breathe and often also have an irritating cough. Asthma is caused by a chronic inflammation |
|of the breathing tubes. The inflammation sometimes causes the airways to narrow and makes it more difficult for air to move in and out of the |
|lungs. |
|People who have a family history of asthma are more likely to get it but it can also be caused by environmental things such as pollens, |
|certain chemicals or animal fur. |
|What must you do? |
|See a doctor who will do special breathing tests on you. There are many very effective treatments for asthma, and many people grow out of it |
|later. But don’t ignore asthma. Some people have it very mildly, but it can become so severe that it becomes a killer. |
|Bed sores |
|Bed sores are chronic (long lasting) open sores that people get when they are so sick that they can’t move around enough in bed. If you’re |
|caring for a bedridden person, you must turn them every hour to make sure they don’t get bed sores. Wash them every day too. If they have bed |
|sores, keep the sores clean and keep pressure off them, and don’t let them get infected. |
|Bleeding |
|Bleeding is when blood escapes out of your blood vessels. It can go into tissues in your body or into body cavities (this is called “internal |
|bleeding”), or it can go out of your body. |
|Your body has natural defences to stop bleeding. Damaged blood vessels constrict and blood pressure drops. This means that less blood flows |
|with less force. Blood also clots as it comes into contact with air. This seals the wound. You must help to stop the bleeding. There are 3 |
|steps: |
|Put pressure on the wound to stop blood flow and allow clots to form. |
|To reduce blood flow, lift up the injured part so that it is higher than the heart. |
|Put the patient in a rest position. If the bleeding isn’t from the head, the patient must lie down with their feet raised about 30 cm. (You |
|could put cushions or pillows under their feet.) |
|You can do all of these things at the same time. |
|Some wounds aren’t dangerous (for example, a small cut or graze). Others are more serious, such as a stab or gunshot wound. |
|Always wash your hands with soap and water and put on gloves before you treat any wounds. (See Universal precautions.) |
|Light bleeding |
|Wash the wound well. Running water helps to clean out all the dirt. |
|Clean it with antiseptic. Wipe away from the wound. |
|Cover with plaster or dressing if necessary, but put it on loosely so that air can get in. |
|Heavy bleeding |
|For big or long wounds, stabbing wounds, wounds in the neck, chest, stomach or head or bullet wounds, get medical help. In the meantime |
|Lie the person down in a rest position with the bleeding part higher than the rest of the body. |
|Don’t try to clean the wound. Put a clean dressing or bandage on the wound. Press down hard on the wound until the bleeding stops. If the |
|dressing gets soaked with blood, don’t take the dressing off because it may disturb the clots that are forming. Add a new dressing or bandage |
|on top of the blood-soaked one. |
|If you can’t control the bleeding, wind a bandage or strip of material round the arm or leg just above the injury. The bandage must be between|
|the injury and the heart. You must only do this if you can’t stop the bleeding, because it can be dangerous. |
|When the bleeding is under control, bandage the wound. Make sure you don’t bandage it so tightly that you restrict circulation. |
|Blood pressure (high) |
|High blood pressure, or “hypertension”, means that the pressure in your arteries is higher than it should be. Often there are no symptoms. |
|(Some people get symptoms such as headache, dizziness, shortness of breath and blurred vision.) It is a very dangerous condition, and can |
|cause a heart attack, stroke or kidney failure if it is untreated. Usually, hypertension can’t be cured, but by taking medicine every day, it |
|can be controlled and reduced to a safe level. |
|Bronchitis |
|Bronchitis is an inflammation of the tubes that carry air to your lungs. Acute bronchitis is usually caused by an infection. If the infection |
|is bacterial, you will need antibiotics, but if it’s a virus, antibiotics won’t help. People often get chronic bronchitis because of living in|
|a very dusty place, working in mines or, most commonly, because of smoking, and it is often associated with emphysema, which is a disease of |
|the lungs. |
|What must you do? |
|Don’t smoke. |
|Avoid dusty and smoky occupations and places. |
|Burns |
|Burns can be very serious, especially if they are deep or cover a very big area. They are especially dangerous for babies and children. |
|Get medical help for any burns that are |
|Bigger than a baby’s hand |
|On the face, neck, private parts or on a joint |
|What must you do? |
|Stop the burning: move the person away from the fire. If their clothes are burning, cover them in a blanket or carpet. This will stop air from|
|getting to the fire and it will go out. |
|Cool the burns down by pouring cold water over them. |
|Look out for shock. |
|Cancer |
|Cancer is a tumour or lump that grows in a particular organ: cells grow and multiply in an uncontrolled way that isn’t normal. Sometimes the |
|cancer spreads to other organs. |
|Cancer isn’t one disease. It is a group of more than 100 different diseases with many different causes. It can affect many different tissues |
|and organs, and it can have many different forms in each body area. |
|Get medical help. Untreated cancer can lead to death. |
|Chickenpox |
|This is a mild childhood viral infection that you get about 2 to 3 weeks after coming into contact with an infected person. |
|Signs and symptoms |
|Many small, red, very itchy spots form on the back or front of the body and then all over. |
|They turn into pimples and then blisters. |
|Finally they form scabs. |
|There is sometimes mild fever. |
|What must you do? |
|Bath every day in warm water with soap. |
|Don’t scratch, and use cool cloths or an antihistamine cream on the itchy spots. |
|Treat any infected spots. |
|Choking |
|Choking is when food or something else gets stuck in a person’s mouth or throat and stops their breathing. |
| |
|Signs |
|Choking usually happens when someone is eating, or talking and eating at the same time. They will suddenly stop talking and may make choking |
|noises. They may just open and close their mouth or reach for their throat. |
|What must you do? |
|If you can see what is choking the person, try to pull it out. Let them vomit if they want to because it may force out the thing causing the |
|choking. |
|If you can’t see what is choking the person, hit them hard 3 or 4 times on the back between the shoulder blades, using the heel of your hand. |
|It might make them cough out the thing causing the choking. |
|If it is a child, lay them on their stomach and over your knees with their head hanging down. Hit them on the back. |
|If it is a baby, hold them upside down by the feet. Hit her gently on the back. |
|Cholera |
|This is a very serious bacterial infection that can lead to death if you don’t get quick treatment. It is spread through water infected with |
|cholera from faeces (poo). Cholera is very infectious and usually happens in epidemics (when lots of people get it at once). |
|Signs and symptoms |
|Severe diarrhoea, and poo looks like water after cooking samp |
|Vomiting |
|Serious dehydration |
|What must you do? |
|Get medical help straight away. You will be given antibiotics and maybe put on a drip to give you fluids to treat the dehydration. |
|Colds and flu |
|Colds and flu are common viral infections. Antibiotics don’t help, and the body usually fights it on its own. There is no way to cure colds or|
|flu but you can do things to treat the symptoms. |
|Signs and symptoms |
|People many have some or all of the following: runny nose, cough, sore throat, fever or sore joints. |
|What must you do? |
|Drink liquids and get lots of rest. |
|Take medicine to lower the fever and take away aches and pains. |
|Body protector foods, such as oranges and garlic, help the immune system to fight the virus. |
|When must you get medical help? |
|If a cold or flu lasts for more than a week |
|If you have a fever and cough up lots of phlegm |
|This could mean that you’re getting bronchitis or pneumonia. These are bacterial infections and you may need an antibiotic. |
|Constipation |
|Constipation is when you go to the toilet but can’t pass faeces (poo). You can prevent constipation by exercising regularly and eating food |
|with fibre and roughage such as vegetables, fruit and cereal. There are medicines (laxatives) you can take when you are constipated. |
|The number of times we poo generally gets less with age. |
|Coughs |
|A cough isn’t itself a sickness. It is a sign of another sickness in the respiratory system, which could be anything from a cold to TB |
|(Tuberculosis) or Pneumonia (see below). |
|Disability |
|A disability is when one or more parts of a person’s body don’t work the way they should. |
|A physical disability is when someone’s legs, arms, neck or back doesn’t work properly. Some people with physical disabilities use crutches or|
|wheelchairs to get around. |
|Here are examples of a sensory disability: A person may have poor sight, or be blind. They could have poor hearing or be deaf. They may have a|
|problem with speech or not be able to talk at all. |
|People with a mental disability may not be able to think and work as fast as other people. |
|People with disabilities have the same rights as all other citizens. They can live a normal life. People with disabilities often have problems|
|because society isn’t well organized to deal with disability. For example, people in a wheelchair can’t get up steps. |
|Disabled people are often discriminated against. Many people believe that disabled people are stupid and can’t work. People mock and tease |
|disabled children. Disabled people are often victims of emotional, physical, financial and sexual abuse. |
|Disabled people are fighting for their rights to health, employment, education and transport. |
|Dehydration |
|Dehydration is when you don’t have enough water in your body. You get dehydrated when your body loses more water than it takes in. It is like |
|your body is dry inside. |
|People get dehydrated when they have bad diarrhoea and vomiting, or when they are too sick to eat or drink. |
|Anybody can get dehydrated, but it is most dangerous in babies and children. Many babies and small children die from dehydration. |
|Signs and symptoms |
|[pic] |
|What must you do? |
|Act very quickly! |
|Eat if you feel like it. |
|Drink often. Have little amounts to drink even if you vomit. |
|Drink a rehydration solution. |
|Get medical help if the dehydration doesn’t get better. |
|Rehydration solution |
|1 litre clean boiled and cooled water; ½ level teaspoon salt; 8 level teaspoons sugar |
|[pic] |
|Rehydration solution dose (how much to give) |
|Drink sips of this drink every 5 minutes, day and night, until you start to urinate (wee) normally. An adult needs at least 3 litres a day, |
|and a small child at least 1 litre. Drink even if you vomit. (See Vomiting, below.) |
|Diarrhoea |
|Diarrhoea is when you have very loose or watery faeces (poo) and have to go to the toilet often to poo. Many things cause diarrhoea, but the |
|most common causes are not eating healthy food, tummy infections and infected or polluted water. Many small children die from diarrhoea every |
|year, but with prevention and correct treatment, many deaths could be avoided. The biggest problem with diarrhoea is that you get dehydrated. |
|It is untreated dehydration that causes death in so many children. |
|Chronic (lasts a long time) diarrhoea is often caused by malnutrition and is also a symptom of AIDS. |
|Signs and symptoms |
|Very loose or watery poo |
|Dehydration |
|What must you do? |
|No matter what the cause of the diarrhoea, you need to prevent dehydration (see Dehydration, above). |
|Eat as much food as you feel like, and drink often. |
|When must you get medical help for diarrhoea? |
|If the diarrhoea lasts more than 3 days in an adult and 1 day in a small child |
|If there is dehydration and you are losing water faster than it can be replaced, or if you can’t keep the fluids down |
|If there is blood in the poo |
|If there is vomiting as well, take medicine to stop vomiting |
|If the vomiting and diarrhoea don’t stop, get medical help. |
|If there is a fever as well, take medicine to bring down the fever |
|Get medical help if the fever and diarrhoea doesn’t stop. |
|If the diarrhoea looks like the water after cooking samp, get medical help. It could be cholera. |
|Be careful of anti-diarrhoea medicines. They may stop the diarrhoea, but they don’t deal with the cause of the problem. |
|Drowning |
|Drowning is when water enters the lungs. You can die in a few minutes. Children and babies can drown in the bath or in a bucket of water. |
|Get medical help. |
|Get the drowning person out of the water. If you can’t swim and it is deep water, use a rope or stick to get them out. |
|Carry the person out of the water, face downwards. Their head must be lower than their body. This helps the water to run out of their lungs. |
|Don’t push her stomach because it can cause vomiting. Vomiting can be dangerous because the patient can choke on the vomit. |
|Fever |
|Fever is when you have a body temperature that is higher than normal. Normal is 37(C. |
|Many different illnesses cause fever. A few examples are colds and flu, bronchitis, hepatitis, malaria, pneumonia and tuberculosis. Fever is |
|usually just one sign. You need to look for other signs and symptoms too. |
|What must you do? |
|Fevers, especially high fevers, can be very dangerous. Children under 4 years get high fevers very quickly and they can have convulsions |
|(seizures). |
|Always take steps to lower a fever. |
|Uncover and remove clothes to be as cool as possible. Fresh air and a breeze help. It is very dangerous to wrap someone up in blankets and hot|
|things. |
|Take medicine to lower the fever. |
|Drink lots of water to stop dehydration. (See Dehydration, above.) |
|Take cool baths or use cool clothes. Change the clothes often to keep them cool. |
|Continue doing this till the fever goes to below 38(C, or sponge the person with cool clothes or sponges. |
|If the fever doesn’t go away, get medical help. |
|Find out the cause of the fever and treat the cause. Look for other signs and symptoms. Take the temperature 4 times a day and write down the |
|time and the temperature. This will allow you to get an idea of the fever pattern because many very serious illnesses have fever patterns. |
|Make a note of when the fever comes, how long it lasts and how it goes away. |
|Food safety |
|Germs often get into food, because we can’t see them. There are always germs around us, but here are things we can do when working with food |
|to keep germs away: |
|Do |
|Keep food covered to stop flies from sitting on it. |
|Store food in containers that can be sealed. |
|Wash your hands with soap and water before touching food, and after touching animals or going to the toilet. |
|Buy food in small amounts unless you have a fridge to keep it fresh. |
|Keep all surfaces, walls and floors in the kitchen very clean. |
|Wash all utensils, plates and cups in hot soapy water. |
|Wash all fruits and vegetables before eating them. |
|Keep pets and other animals away from food. |
|Don’t |
|Don’t eat undercooked or raw chicken, meat, fish and eggs. |
|Don’t drink water without purifying it if you aren’t sure that it is safe. |
|Don’t buy canned food if the can bulges, has dents or is leaking. |
|Don’t buy or eat cracked eggs. |
|Don’t buy food that has passed its “sell-by” date. |
|Don’t re-freeze food after it has been defrosted. |
|Don’t eat prepared food if it has been standing for longer than two hours. |
|Don’t use cracked or chipped plates and eating utensils (knives, forks, spoons). |
|Don’t reheat food more than once before eating it. |
|Headaches and migraines |
|Headaches can be caused by many things. They may be simple headaches that go away after a short time. Headaches often go together with fever |
|and they may be a sign of a more serious illness such as meningitis (see Fever, above and Meningitis, below). If the headache is very bad, it |
|may be a migraine. Migraines are very sore, but they aren’t dangerous. |
|What must you do? |
|Lie down in a cool, quiet and dark place and rest. |
|Different things work for different people. You can try putting a cloth soaked in warm water on the back of your neck. Other people find it |
|helps to put a cloth soaked in cold water on their forehead. Keep a bowl of warm or cold water close by so you can warm or cool your cloth. |
|If the headache doesn’t go away, take pain medicine (e.g. aspirin). |
|Heart attacks |
|Heart attacks are one of the commonest killers, particularly of men. It is caused when the blood vessels to your heart are obstructed and the |
|heart muscle dies. |
|Signs and symptoms |
|Severe chest pain that comes suddenly where you feel as though you’ve got a heavy weight on your chest and you can’t breathe properly. |
|Pain down the left arm |
|Collapse |
|What must you do? |
|Get medical help urgently. |
|Hepatitis |
|Hepatitis is an inflamed liver. There are many causes, and many types of hepatitis, called Hepatitis A, B, C, etc. |
|Hepatitis A is spread from faeces (poo) to mouth through infected food or water. Hepatitis B is spread when infected blood from one person |
|gets into the blood of another person. Hepatitis can also be spread through sexual and other close contact with an infected person. |
|There are vaccines for some types of hepatitis. |
|Signs and symptoms |
|There are many signs depending on the type. Here are a few examples: |
|You do not want to eat or drink. Seeing or smelling food may make you vomit. |
|Sometimes you have a fever. |
|Sometimes you have a pain on your right side, near your liver or lower ribs. |
|Your urine (wee) turns dark yellow. Sometimes your poo turn whitish. |
|Sometimes, children have no signs, but they can still pass the hepatitis on to others. |
|What must you do? |
|Get medical treatment. Hepatitis is a virus and you will not get an antibiotic. |
|Practise good personal hygiene and sanitation. |
|HIV |
|See Section 1: Finding out about HIV&AIDS |
|Lightning strikes |
|Lightning is a very powerful burst of electricity that sometimes hits the ground. When there is lightning around, follow these instructions: |
|Go into a house or building or car. |
|Don’t go under a tree. |
|Don’t use the telephone or metal things. |
|Don’t take a bath or shower or swim. |
|If you’re in the bush and there are no buildings around, then |
|Lie down on the ground far away from any trees. |
|Malaria |
|Malaria is an infection of the blood that causes chills and high fever. It is spread by mosquitoes. Only some types of mosquitoes carry |
|malaria, and they only bite between dusk and dawn. Malaria is only a problem in some parts of South Africa. But malaria is very serious and |
|must be treated immediately because you can die. |
|What must you do? |
|If you have been in a malaria area and have high fevers for no other reason, have a blood test for malaria. |
|If you have malaria, you will be given medicine and if it is serious, you will stay in hospital. |
|How to prevent malaria |
|Take preventative medicine if you go into a malaria area. |
|Get treatment so that you don’t pass the malaria on to others. |
|Don’t get bitten by mosquitoes. Sleep under a mosquito net and stay inside between dusk and dawn, or wear clothes that cover your body. |
|Mosquitoes breed in water that doesn’t move. Get rid of water from broken pots and cans. Kill mosquitoes. |
|Malnutrition: undernutrition/overnutrition |
|Overnutrition is when you get too much food. This can lead to obesity (being too fat) and many health problems. |
|Undernutrition can take many forms. |
|One type is marasmus, where you don’t have enough of all types of food. The person is very thin and underweight, but may have a “pot belly”. |
|Kwashiorkor is another type where the person doesn’t get enough protein in the diet. A child with kwashiorkor is very miserable and often has |
|swollen feet, hands and face and peeling sores. |
|Maternal conditions |
|Maternal conditions are in the top 10 killers in Africa. It is about sickness and death related to problems of pregnancy and during |
|childbirth. Pregnant women need to go to have regular check-ups and it is important to have medical help available to deal with problems |
|urgently. |
|Get urgent medical treatment if there is |
|Bleeding |
|Swollen legs and face and difficulty with being able to see near the end of the pregnancy |
|Long delay once waters broken and labour began |
|All pregnant women must go to antenatal clinics for regular check-ups and monitoring. This is an important way to prevent problems. |
|Measles |
|This is a serious viral infection most common in children. It is especially dangerous in children who have poor nutrition or TB (Tuberculosis)|
|(see below). |
|Measles can kill. Prevent measles by getting children vaccinated when they are 8–14 months old. |
|Mental health problems |
|Mental health problems are very common. Research in South Africa and elsewhere shows that around 1 in 5 people who go for general health care |
|need mental health assistance. Mental health problems can happen to anyone and there are many causes. One of the problems is that there is a |
|lot of stigma about mental health problems, so people are afraid to admit that they have a problem and they don’t talk about it. Also, many |
|health workers don’t recognize problems or give support when it is needed. This means that often problems get much worse. Sometimes, the only |
|way that a person gets help is when they get completely out of control and become violent. Others get help after they have attempted suicide, |
|rather than long before they get to this state. |
|But there is lots of treatment available. |
|Causes |
|There are many causes of mental health problems: |
|In South Africa, there are victims of all sorts of awful violence, such as women abuse and rape, child abuse and hijackings. We know that the |
|mental health consequences can be much worse than the physical ones. There are also victims of wars and natural disasters who require mental |
|health care and support. |
|Your nervous system works by sending chemical messages very quickly between your nerve cells. Many mental illnesses are caused by chemical |
|messages that are not balanced. |
|Examples include depression, psychosis, panic disorder, stress and schizophrenia. |
|The Department of Health wants to assist as many people as possible who are either not receiving care or who are being stigmatized because of |
|their mental health problems. Its messages are |
|Mental health problems can happen to anyone. |
|Help is available. |
|Don't isolate people with mental health problems. |
|Meningitis |
|Meningitis is a very serious infection of the membranes lining the brain. It is most common in children and is often a complication of another|
|illness such as Measles (see above) or Mumps (see below). Signs are fever, very bad headache and stiff neck and back. Get medical help |
|immediately. |
|Mumps |
|Mumps is a childhood viral infection that you get about two to three weeks after coming in contact with an infected person. |
|Signs and symptoms |
|Fever |
|Pain when you open your mouth and when you eat |
|Swelling below the ears, under the jaw that usually goes away in about 10 days |
|What must you do? |
|Take medicine for pain and fever |
|Eat soft nourishing food |
|Complications |
|Mumps is more dangerous in children over the age of 11 and adults, who might get a very sore swelling in the belly or testicles (in men). Men |
|can become sterile (i.e. they can’t make babies). Get medical help is there is any sign of Meningitis (see above). |
|Pneumonia |
|Pneumonia is an acute infection in your lungs. Once bacteria, virus or fungus get into the lungs, they usually settle in the air sacs where |
|they grow in number. This area of the lung becomes filled with fluid and pus as the body attempts to fight off the infection. |
|People often get pneumonia after they have had another respiratory problem, such as Measles whooping cough, Colds and flu, Bronchitis or |
|Asthma (see above). Babies and older people also get it after any other serious illness. Pneumonia is also common in people with AIDS. |
|Pneumonia is serious and must be treated. Many people die from pneumonia. |
|Signs and symptoms |
|Chills and high fever (sometimes babies and old people have no fever) |
|Quick, shallow breathing and sometimes wheezing |
|Cough with yellow, green and bloody phlegm (what you cough up) |
|Chest pain (sometimes) |
|Cold sore on the face or lip |
|Get medical treatment immediately. |
|Rabies |
|You can get rabies if you get bitten by an animal that has rabies. Animals with rabies usually die within 5 to 7 days. In humans, the first |
|signs of rabies happen in about 3 to 7 weeks, but you can get them earlier or later. If you think someone has been bitten by an animal with |
|rabies, get them to go for medical treatment immediately. You can treat rabies if you start treatment before any sickness starts. Once the |
|person gets sick, there is no treatment and they will die. |
|Sexually transmitted infections (STIs) |
|STIs are passed on from an infected person to another person during sexual contact and when body fluids are mixed. Some STIs, such as HIV, can|
|also be passed on through infected blood, during birth and by breastfeeding. |
|Untreated STIs are very dangerous. They can lead to infertility and lifelong problems, such as pain in the abdomen and cancer. They cause |
|problems in pregnancy and you can pass them and other health problems on to your baby in childbirth. |
|They are an open door to HIV&AIDS. A person with an STI is more likely to get HIV if they have sex with an HIV infected person. |
|Signs and symptoms |
|Some STIs have no signs. If you had unprotected sex, you may have an STI even if you have none of the signs. But some of the signs are |
|Ulcers, sores or blisters on your genitals (private parts) |
|Discharges from your private parts (penis or vagina) |
|Some infections have only mild symptoms and few signs and if not treated these may clear. However, the person is still infected and |
|infectious. |
|What must you do? |
|Most STIs can be treated and cured. Get a test immediately from a clinic or hospital and get advice and treatment. |
|Wear a condom (or get your partner to wear one) and take care not to spread the infections to other people. |
|TB (Tuberculosis) |
|TB is a chronic (long lasting) and very contagious (it spreads easily) bacterial infection. You often get it in your respiratory system, but |
|you can also get it in other parts of your body. |
|You’re at high risk if |
|You live or work closely with someone with TB |
|Your body systems are weak or you have poor nutrition |
|You have AIDS |
|Signs and symptoms |
|Chronic cough, especially after waking up |
|Mild fever in the afternoon and sweating at night |
|Pain in your chest or upper back |
|Loss of weight and you get weaker |
|If the TB is advanced |
|Coughing up blood |
|Hoarse voice |
|What must you do? |
|TB is curable, but many people die from untreated TB. If you have any signs, go for a test immediately. You will have a skin test and an |
|X-ray, and health workers will examine the phlegm that you cough up. |
|If you do have TB, take care not to infect others. |
|Try to sleep in a separate room. |
|Cover your mouth when you chough; don’t spit on the floor. |
|Take your medicine exactly as the health worker tells you. |
|You will usually get at least 3 medicines to take at the same time. |
|TB takes 6 months to a year to be cured. Don’t stop taking medicine just because you feel better. |
|Once you start treatment, you’re infectious for only a few weeks. But if you stop the treatment early before the TB is completely cured, you |
|can get resistance to the drugs so they will not work properly on the TB. |
|To prevent this from happening, people use DOTS (Directly Observed Treatment Strategy) where somebody watches you take your medicine to |
|monitor that you do it. |
|Get everyone you live with to be tested too. If anyone in the family develops any of the signs of TB after a test, take them for another test.|
| |
|Get BCG vaccinations for the children. |
|More about DOTS |
|Community DOTS supporters are volunteers. They are trained in knowing about TB and talking to and dealing with TB patients. They also give the|
|TB patient their medicine for 6 months. These supporters have a box to keep the medicine for each patient they work with and a supply of green|
|cards to record the details of the medicine given. The patient decides who their supporter will be. |
|Usually the community health committee helps to identify people who should be trained as DOTS supporters. |
|Tetanus (lockjaw) |
|You can get tetanus from a germ that lives in faeces (poo). It enters your body through a cut in your skin. Wounds such as dog bites, gunshot |
|and knife wounds, holes made by dirty needles, injuries from barbed wire and punctures from thorns and nails can all lead to tetanus. Deep or |
|dirty wounds are very dangerous. Signs of tetanus are that it is hard to swallow, your jaw gets stiff and you have convulsions (fits). Tetanus|
|is very dangerous and you can die from it. You need to get medical treatment quickly. There are vaccinations against tetanus, but always keep |
|wounds very clean and have good personal hygiene. |
|Universal precautions |
|Universal precautions are the steps everyone should take to protect themselves from infections spread through blood and other body fluids. |
|Protection from infection |
|Universal precautions are about protecting people from infection. When you meet people, you have no idea if they are infected with a disease. |
|You can’t see by looking at people. As a health care worker, you will come into contact with body fluids. And many diseases, such as Hepatitis|
|(see above) and HIV&AIDS, are spread by body fluids. Because you can’t see infection, you need to treat everyone as if they have an infectious|
|disease. |
|To be safe, everyone must treat all body fluids as if they are infected. This means all blood, open sores, wounds, grazes and other body |
|fluids—such as saliva (spit), mucus and phlegm, urine (wee), vomit, poo and pus. Here are some basic safety rules to follow: they are |
|universal precautions. |
|All these things help you to prevent infection: |
|[pic] |
|The water and disinfectant clean surfaces, equipment, your hands and the wound. |
|If you or the injured person has any cuts on the skin, the gloves protect both of you from direct contact with body fluids. |
|If you need it, the face mask and protective eye wear protects your face from contact with body fluids. |
|The resuscitation mouthpiece protects you from coming into contact with saliva (spit) in mouth-to-mouth breathing (resuscitation). |
|The dressing protects others from coming into contact with body fluids from wounds. |
|Always practise universal precautions when you help somebody. |
|Vomiting |
|Vomiting can be a sign of many different types of illness. It may be a simple problem that gets better on its own in a day or two. Or it may |
|be a sign of a more serious problem: |
|It may be an infection and the person may have diarrhoea as well. |
|It may be food poisoning caused by spoiled food. |
|Many sicknesses with high fever or very bad pain can cause vomiting, for example, tonsillitis, urinary infection, Malaria (see above), |
|Headaches and migraines, or Hepatitis (see above). |
|What must you do? |
|Sip a cola drink to help settle the stomach. |
|Eat if you feel like it. |
|Take a vomit control medicine if the vomiting doesn’t stop quickly. |
|Drink liquids and watch out for Dehydration (see above). |
|When must you get medical help for vomiting? |
|If there is dehydration that you can’t control. |
|If there is very bad vomiting that lasts for more than 24 hours. |
|If there is violent vomiting (i.e. it spurts out) that is dark green or brown and smells like poo. It could be an obstructed gut. |
|If there is pain in the stomach and bad constipation (see Constipation, above). It could be an obstructed gut. |
|If you vomit blood. It could be an ulcer. |
|Water |
|Water is essential for life. Without water you will die. Your body needs lots of water every day to keep going. But water can be dangerous: it|
|can carry disease. If you don’t know that the water is safe, don’t drink it or use it before you treat it to kill germs and make it safe for |
|drinking. |
|Make water safe for drinking |
|What must you do? |
|Here are 3 options: |
|Use tap water (and don’t let it stand), OR |
|Boil water and let it cool before drinking it, OR |
|Mix 5 ml (i.e. 1 teaspoon) bleach (e.g. Jik) in 25 litres water. Let it stand for at least 2 hours, but preferably overnight, before drinking |
|it. |
|[pic] |
|Worms |
|There are many types of worms and other living organisms that live in your intestines and can cause disease. You can sometimes see the bigger |
|worms in the faeces (poo) of an infected person. There are many worms that can live in your tummy that you never see in your poo. |
|Some worms are spread from poo to mouth or from the anus to mouth if you scratch your anus and then put your hands in your mouth. Some worms |
|can also enter your body through your bare feet. You get some worms if you eat meat that isn’t properly cooked. |
|What must you do? |
|Treat worms with worm medicine. |
|Always wash your hands with soap and water after going to the toilet and before preparing food. |
Section 3: Introduction to counselling skills
This section introduces you to some basic counselling concepts, such as listening and questioning techniques. It also gives guidelines on working with children who have been abused.
Please remember that this doesn’t equip you to be a professional counsellor. To make a comparison: if you’ve done a first aid course, you aren’t qualified as a doctor. However, you can splint a person’s leg before helping to move them to hospital, where a doctor will set the broken leg. “First stop counselling” is about offering people “emotional first aid”. Your job is to be a listener and a shoulder for the help-seeker to cry on if necessary and, in the case of children, to take the necessary action to protect them. In many cases you will refer the person to a professional or an organization who can offer them the help and support they need (see Contact list at the end of this handbook).
What is counselling?
Counselling is …
… a bit like holding up a mirror to yourself. For example, a mirror will show you what the expression on your face is like and the objects that are behind you. Counselling helps you to see things about yourself and your situation, but it doesn’t take any action or make any changes. The changes and the action need to be implemented by you for yourself.
Counselling is not …
… a way to hand your problems over to someone else to “fix” for you. However, in some circumstances, counsellors do have to take action. For example, if a child tells a counsellor that they are being abused, the counsellor must take action and must not expect the child to solve the situation on their own. Make sure this difference is clear to the participants. Telling the counsellor is the child’s way of asking for help.
Counselling is a process that helps an individual to consider all sides of a potential choice before the choice is made. Counselling also helps the person to modify, reinforce or even abandon the choice, when consequences are undesirable or harmful. Counselling isn’t just giving advice, but rather getting the person (the one being counselled) to make decisions for themselves. However, offering advice on how someone can cope with problems is also part of counselling.
In the counselling process, the helper expresses care and concern towards the person with a particular problem, in order to facilitate that person’s personal growth and positive change through self-understanding. Counselling usually involves a relationship between a concerned person and a person with a need, and is more often a person-to-person relationship, although it may involve more than two persons, depending on the nature of the problem. Counselling is designed to help individuals to understand and clarify their views on life, and to learn to reach their self-determined goals through meaningful and well informed choices, and resolve emotional or interpersonal problems.
Why do people need counselling?
At some time all of us have faced problems that we couldn’t solve effectively by ourselves. Below are some of the reasons people may need counselling:
• They haven’t had the opportunity to learn the skills needed to solve certain problems; they don’t know how to go about solving them.
• They feel apathetic about solving their problems; they hope they will go away, even if they do nothing.
• They don’t have the confidence to solve the problems on their own.
• They are too anxious, angry, sad, frightened, etc., to be able to solve their problems—they feel helpless and powerless.
• They are confused, or the problem looks as though it can’t be solved.
• They realize they need to make changes in their lives, but are frightened to change.
• They don’t have someone they trust or that they can talk to without being judged.
• In the case of children, they may not have the maturity and life experience to manage or cope with challenges without the help of a counsellor.
Counselling involves an interactive relationship with the aim of helping individuals solve problems relating to themselves, others, situations and events. It is also about developing self-understanding with the aim of being a happy, fulfilled and effective member of society.
For these reasons, many people can benefit from going to counselling. Seeking counselling isn’t a sign of weakness or stupidity. Rather, it can help people to develop new skills and knowledge that will help them to take better control of their own lives.
Your role in the counselling process
The following four-stage process is more appropriate for working with adults than with children. (For information about working with children, see Working with children who have been abused, below.)
Stage 1: Help the person to tell their story
What happens: the person is filled with details and feelings about a problem when approaching the counsellor. These need to be spoken about: What happened? What did they try to do or decide not to do? What do they feel about what happened?
Your role is to help the person gain clarity. Often emotions and a jumble of details make the person telling the story sound vague and confused. It may become clearer through digging deeper into the person’s background/home/other situations that relate to their problem. Together, you must come to a joint understanding of the person’s experiences, feelings and behaviours. There may be a few different problems, but what are the most important ones?
Stage 2: Help the person to consider their current options
What happens: the person needs to think about what possible actions could be taken now to improve the situation. Often, they think “I can’t do anything. The situation is hopeless.” However, there is usually an option, even if it isn’t ideal. The person needs to start thinking in a creative and enterprising way.
Your role, after the core problem has been clarified, is to help the person to brainstorm ways of dealing with it. Sometimes the person has a blind spot about a problem, or needs help in listing the pros and cons (the good and the bad) of a particular solution. Your role is to help them think “outside the box” and provide information on ways to get help that they might not have considered (e.g. specialists, organizations, government departments or medical personnel).
Stage 3: Help the person to make an action plan
What happens: after listing ideas and potential solutions, a concrete plan for future behaviour should be formulated, otherwise the solution will remain a thought and not something that becomes a reality. A set of steps could involve reporting something to the police, visiting a clinic, making an application for something, for example, and following up on these actions afterwards.
Your role is to help the person to make a decision and then a plan to put the decision into action. What are the logical steps that could be taken? What daily or weekly goals does the person think they could attain and stick to? At this point, they could write these things down, with your help.
Stage 4: Help the person to commit to implementing the plan
What happens: the person must be mentally prepared to commit to the actions that will lead to the constructive changes they want. This is because a list or plan isn’t helpful unless the person is determined and prepared to put it into practice.
Your role is to help the person make a firm commitment to following through on the decisions. When will “x” be done? What will be done to overcome obstacles to doing x? All (or most) of the action will be taken by them. Usually, you, the counsellor, commit to meeting them again at a later stage, to see how they are doing and to offer on-going emotional support. Sometimes, if something has to be reported by an adult on behalf of a child, or if mediation is required, the counsellor will make a firm commitment to that action.
Characteristics of an effective counsellor
Below are two counselling sessions to show how a counsellor should NOT behave. As you read, jot down what you think the counsellor is doing wrong. Compare your answers with those in Answers at the end of the handbook.
Two poor counselling sessions
Scene 1
|Counsellor: |This has been such a busy day for me. So much to do and so little time! Eish! (yawning and looking out of the window). |
| |So tell me quickly now, what’s your problem? |
|Client: |Well, since my parents died last year, I’ve been staying with my auntie and I am not feeling happy. |
|Counsellor: |(wagging a finger) Well, you know, there are always problems when you have to take on someone else’s children, because |
| |you adolescents don’t give us adults an easy time. You’re very lucky to have someone to give you a home. Now your |
| |friend Zizi was telling me yesterday that she lives in a shack and has to do sex for food. You’re better off than she |
| |is, so you should be happy. I hope you’re grateful to your auntie. |
|Client: |Oh yes, I am very grateful but it’s just that I feel she doesn’t like me and resents having me there. I feel miserable |
| |and very uncomfortable all the time at home. |
|Counsellor: |Well, she probably does resent you. You can’t really blame her for that. You’re another mouth to feed and it looks as |
| |though you eat a lot. |
|Client: |(upset and getting up to leave) I know I’m overweight, but that doesn’t make me deserve what has been happening in my |
| |life. I’m going now. |
Scene 2
|Counsellor: |And what happened then? |
|Client (male): |Well I told her that I had HIV. |
|Counsellor: |(looking shocked, gasping) Haaa! You didn’t! |
|Client: |Yes, I did! |
|Counsellor: |No! No! No! That is completely wrong! How could you do that? |
|Client: |Well I wanted to … |
|Counsellor: |(interrupting the client while he is still speaking) You wanted to end the relationship. And you were too scared to |
| |tell her. So you told her you were HIV-positive because you thought that she would end the relationship. That’s what |
| |you wanted isn’t it? |
|Client: |(looking confused) Er, um, no. That isn’t what I wanted. I just thought it would help our relationship if I was honest |
| |with her. |
What are the characteristics of a good counsellor?
• Be trustworthy and have integrity—don’t take advantage of your clients.
• Show warmth, genuineness and empathy (i.e. able to put yourself in the shoes of another person).
• Be able to build relationships and a good rapport with your clients. This is especially important with children, when you need to show that you’re interested in the whole child and not just the problem.
• Be approachable so that the client feels comfortable being with you.
• Be positive and encouraging.
• Communicate well.
• Care about yourself, and be able to de-stress.
• Always strive for more knowledge and be prepared to learn.
• Offer a supportive, caring and comfortable environment in which people can talk.
• Be able to build relationships with people.
• Show a genuine interest in, and respect for, people from all walks of life.
• Have patience, understanding and the ability to listen non-judgmentally.
• Use objectivity and tact—don’t express your personal opinions.
• Be able to motivate and inspire people.
• Be able to facilitate communication in groups of people.
• Have good organizational and planning skills.
• Be able to work effectively with other professionals and community agencies.
• Enjoy working with people.
• Respect and keep strict confidentiality.
How should a counsellor act during a counselling session?
• Be quiet most of the time; let the other person talk.
• Listen, listen and listen some more to the other person.
• Listen to yourself. How do you respond to the messages you’re getting? What do your responses tell the person you’re counselling?
• Use all your senses to get the total message across:
o Listen actively: make culturally appropriate eye contact; nod; say things such as, “Mmm”, “Go on”, “I understand”, etc.; ask questions.
o Use your ears to listen to words and the emotional meaning behind them.
o Read body language: is the person sitting very straight and stiff; are their arms crossed over their chest in a defensive way; do they look relaxed?
• Don’t let the discussion deviate from the problem at hand. For example, when a client feels uncomfortable discussing a subject, they might move from the point to avoid the uncomfortable subject.
• Help the person sort out which issues are important, and which aren’t so important.
• People don’t see things in the same way. Find out how your client sees the situation by listening carefully. Don’t assume that you know what they feel or think.
• Your facial expression is important—keep your face relaxed, nod your head, etc. Don’t show that you’re shocked by what the person says, even if dreadful details are revealed.
• Be aware of your body posture and movement—be relaxed, open and ready to help.
• Pay attention to the tone and pitch of both your voice, and that of your client.
What should a counsellor avoid doing?
• Don’t block the client’s emotions by saying things such as
“Don’t cry.”
“Anger is witchcraft—the Bible says so.”
“When you see what other people have to go through, you can just count your blessings!”
Instead, allow the person to work through their emotions.
• Don’t generalize or trivialize by saying things such as
“All teenagers think their parents are unreasonable”
“It can’t be as bad as all that!”
Instead, you should take the person’s concerns seriously.
• Don’t moralize by saying things such as
“Abortion is so wrong! Even if you were raped that is no excuse to murder an unborn child!”
“If I was in your shoes I’d leave that guy!”
It isn’t helpful to impose your own values and morals on the person, because what is right for you isn’t necessarily right for the other person.
• Don’t falsely agree (if you don’t feel the same way about a generalization that the client has made)
Client: “All men are insensitive and selfish.”
Counsellor: “Yes.”
(Wrong response—especially if this counsellor is happily married to a sensitive and generous man)
Instead
Client: “All men are insensitive and selfish.”
Counsellor: “In your experience it must seem that way.”
(Right response—the counsellor is acknowledging the reality of the client’s feelings and circumstances without agreeing that all men are insensitive and selfish)
Acceptance of another person’s viewpoint doesn’t necessarily mean agreement with it.
• Don’t reassure glibly by saying things such as
“Everything will work out, don’t worry.”
“He won’t die yet. I’m sure he’ll live for years!”
It is possible to be hopeful, but you don’t know if things will definitely work out well. When things don’t go the way you said they would, the client will stop trusting you. If you’re sensible and realistic, you will be more helpful to the client.
• Don’t guess answers by saying things such as
“The reason why she’s acting that way is because she is simply jealous!”
“The only solution is to try harder.”
Telling the client what you think the answer is, isn’t helpful. Assist the person to arrive at their own answer.
• Don’t tell the person what to do by saying things such as
“You must go to the principal and tell her that…”
“You have to disclose to your partners that you’re HIV-positive.”
Help the person decide for themselves. You aren’t the expert in this person’s life, nor do you have to live with the consequences of the decision. The client does!
• Don’t move away from what the person is telling you
Client: “When he came home that night he said he was going to leave me. I was shocked.”
Counsellor: “Tell me about your support network.” Or “What were you wearing at the time?”
Deal with the content the person has presented. Don’t ask irrelevant questions.
Counselling skills: Reflective listening
Reflective listening is a tool to allow a counsellor to show empathy. In other words, trying to stand in the client’s shoes and see how they experience the situation.
This isn’t the same as sympathy, which involves showing pity for another person. Reflection is a crucial skill that helps the people being counselled to feel that you’re “walking beside them”, and that you’re trying to see the situation through their eyes. It helps you to show empathy for clients.
Counsellors should show warmth and caring but they should not show pity, because pity makes a client feel inferior and helpless.
Reflective listening involves restating the main things the person has said in your own words, without adding anything new, such as your own thoughts, opinions or conclusions.
In doing this, you become a “mirror”, helping the person to see their feelings and situation more clearly.
Step 1: Reflection of content (also called summarizing)
In doing this, you reflect the “story” the person tells you. This skill is useful, particularly during Stage 1 of the counselling process, because
• It tells the person that you’re listening and want to understand.
• It allows you to check that you’ve got it right and actually do understand. The client can tell you if you don’t.
Don’t talk about the person’s deeper feelings yet, because
• Reflecting the person’s deepest feelings may be too threatening at the beginning of counselling.
• You may be unsure of the true, underlying feelings or conflict. These feelings might emerge later and should be reflected then.
Example 1
|Client: |For a year, my boyfriend has been drinking and then getting violent. Yesterday he hit me again. I am worried about my |
| |children. I’ve complained and threatened to leave. He promises to change. I’ve laid a charge of assault. I even went to |
| |stay with my mother for four months. What can I do? |
|Counsellor: |You have been subjected to your boyfriend’s drinking and physical abuse over a long time. You’re concerned about the |
| |effect it is having on the children. You have unsuccessfully tried three different approaches and are now looking for |
| |help in reaching a new decision. |
Step 2: Reflection of feelings—these may be explicit (i.e. clear) or implied (i.e. suggested)
When the person begins to feel fully understood and comfortable, they will usually progress to the next stage and reveal—explicitly or implicitly—how the situation is for them. Then you can start to reflect the person’s feelings.
The “safer” a client feels with a counsellor, the more they are likely to share their deeper feelings, but these may not always be obvious to them. When you reflect feelings, you help the client understand what is going on deep inside.
Example 2
|Client: |I like school and I want to do well so I can study further and get a good job to look after my family. But since my |
| |parents died, there is no money and I have to miss school often to look after the small children. I am in charge of the|
| |house now and have to take responsibility for lots of things. My school work suffers because I don’t have enough time |
| |for it. I often feel angry with the children and then I feel guilty because I love them and want the best for them. I |
| |feel caught because I can’t do the only thing that will help me and the family deal with our problems in the long term,|
| |and get out of the poverty. |
|Counsellor: |You feel frustrated and very disappointed by what is happening in your life. Things aren’t going the way you expected |
| |and planned. You also feel resentful and angry towards the children because you feel that they are causing the problem |
| |for you and holding you back from reaching your dreams. At the same time, you feel the love and protectiveness of a |
| |parent towards them. You feel stuck in a situation and feel as if you will never be able to change it. |
Remember! The point of reflection is to
• Stay “where the person is” at that moment.
This means you must not jump ahead of the client.
In example 1, jumping ahead of the client would be you saying: “So if you leave him permanently do you think he will follow you and still hit you?”
• Stay with their feelings.
This means exploring the feeling the person is expressing right then, rather than suggesting other feelings.
Not staying with the person’s feelings in example 2 would be you saying: “But when you care and provide for the children, it must also give you good feelings—satisfaction that you’re doing what is right and good for them.”
• Move at their pace.
This means letting the client tell the story without you pushing them ahead to the next stage. There may be details and information that they will not have a chance to express if you rush.
• Allow them to work through their feelings.
This means not going on to discuss a second or third feeling until the first feeling has been spoken about in depth.
In Example 1, the client would probably want to work through the “worry” about her children. Once that has been done, the counsellor can encourage her to talk about another feeling (maybe fear for her own life, or disappointment in the justice system, or feelings of helplessness and hopelessness—whatever the client identifies). These feelings need to be discussed before the counselling session moves on to what could be done about the situation.
You need to practise reflective listening. To help develop these skills, you could (in the beginning) start most of your responses with: “You feel…”, or “You felt…”
Example 3
|Client: |I never want to have a boyfriend. My father left us and my mother’s life has been very hard all on her own. My sister’s|
| |boyfriend has lots of other girlfriends too, so she is always unhappy. |
|Counsellor: |You feel afraid that a boyfriend will let you down and cause you unhappiness, because men have had this effect on other|
| |members of your family. |
Example 4
|Client: |I hate going to meetings at the school. The teachers and other parents always look so smart and sound so clever. |
|Counsellor: |You feel uncomfortable at school functions because to you, the other parents and teachers seem superior. |
Later, you may start your responses by using different words:
|“From your point of view …” |“From where you stand …” |“It sounds like …” |
|“In your experience …” |“You’re saying that …” |“For you it’s as if …” |
|“That was … for you” |“It would seem as though …” | |
Example 5: (reflecting feelings and content at the same time)
|Client: |I really don’t know what to do! I’ve just found out I’m pregnant! I’m only fourteen. What am I going to do? |
|Counsellor: |You feel helpless because you’re going to have a baby at such a young age. |
| |You feel (identify the feeling) because … (identify the context or situation that is leading to the feeling). |
Counselling skills: Asking questions
Questions are an important part of the counselling relationship.
They can be used by the counsellor to get information about the other person’s ideas about his problem and his past, and to clarify information and feelings. If you use questions well, you gain information; but if you do it badly, you do the opposite and get in the way of communication.
Effective use of questions in the counselling situation is a skill that you need to keep practising.
|Closed questions require a short direct response such as “yes” or “no” or other short answer. For example: “Are you tired?” or “How old are |
|you?” |
|Leading questions lead the person to answer in a certain way. For example: “Don’t you agree that all people should disclose their HIV status?”|
|It is hard people to answer “no” to this kind of question and they will probably say “yes”, even if they disagree. |
|Probing questions explore things more deeply. For example, “What did you feel about your son after your granddaughter told you he sexually |
|abused her?” |
|But take note: probing questions are an important part of counselling. But they can make clients feel uncomfortable if they don’t want to talk|
|about certain matters. Clients should not be pushed to discuss sensitive issues before they are ready. They must trust you first, and then |
|they might mention the more sensitive issue themselves. |
Children may feel a lot more comfortable with non-verbal ways of telling you things—for example they may draw a situation, or act it out with a puppet—or even through role-play.
Some common errors in questioning
Here are six traps to avoid:
Asking too many questions
This will probably make the client feel they are being interrogated, and they may become defensive. Control of information and direction now lies in the hands of the counsellor, instead of in the hands of the client: it’s as if the counsellor is saying, “I’m the one who is qualified to decide what information is important here!” This attitude disempowers the client.
Use questions only when they have a purpose, i.e. to focus, expand and deepen the counselling process.
Closed questions
Closed questions require a short, direct response, usually “yes” or “no”. Sometimes they require another short answer. They prevent an in-depth response and block the sharing of feelings. For example:
“Do you feel your marriage is unhappy?” (Yes)
“Do you have stomach pains?” (No)
“Where do you live?” (Durban)
There is place for some closed questions that help provide important background details. For example
“Do you have an adult caregiver at home?” or
“How old are you?”
may be relevant to the client’s situation. But if a client says
“My mother died last week and my father is very sick”
the counsellor should not follow this comment with a closed question such as
“Do you feel very sad?” or
“How many brothers and sisters do you have?”
Open-ended questions are the more useful in counselling—they encourage the client to explore their experiences, thoughts and feelings, without being channelled towards a particular response by the counsellor. Here are some examples of issues explored through open-ended questions and closed questions. Compare the amount of information you can get from the two types:
|Closed (limited information) |Open-ended (more information) |
|Do you want to get divorced? |Tell me about your feelings concerning your marriage at the moment. |
|Are you getting enough healthy food to eat? |What do you usually eat at home? |
|Could things change? |Describe how you think things could change. |
|Did you scream and run away? |What was your response to the situation? |
|Is there a problem at work? |Explain what happens at work. |
|Have you experienced symptoms of AIDS-related diseases? |Please tell me about your recent and current state of health. |
|Are you going to negotiate for safer sex with her? |How are you going to talk about having safer sex with her? |
Leading questions
This type of question puts pressure on a person to answer in a certain way. For example:
“You must have felt angry when she came round to see you, weren’t you?” or
“Don’t you think sex before marriage is very wrong?”
These types of questions often show how the counsellor is thinking, rather than how the client is thinking and feeling.
|Remember! |
|The client’s thoughts and feelings are more important than the counsellor’s. |
Questions that probe too deeply, too soon
Show sensitivity to people. Don’t ask a probing question right at the start of a session, before the client has relaxed, developed rapport with the counsellor or decided the counsellor can be trusted and confided in. Later in the session, questions that probe too deeply could cause anxiety in the person about issues they aren’t ready to talk about. The client could feel that the counsellor is being intrusive and invasive.
Poorly-timed questions
Ensure that you don’t ask questions out of context or move the conversation in a different direction when the person has not yet finished talking about something else. Timing is something you will learn with practice.
“Why?” questions
“Why?” questions usually don’t help much in the counselling process. Often, the person doesn’t know clearly why a particular emotion is felt or action was taken. To gain insight into behaviour it is often more useful to ask “How?” questions.
|Remember! |
|The above points are guidelines—not strict rules. Sometimes when questioning you might feel it is right to follow a gut feeling rather than |
|sticking rigidly to the rules (for example, when the safety of a child is concerned). |
|Tone of voice and non-verbal expression are also important. When asking a question, using a loud, angry, indignant or shocked tone of voice is|
|unhelpful and even harmful. For the client’s sake it is important to sound warm, concerned and calm. Control your body language so that you |
|appear relaxed, “open” and interested. If, for example, the counsellor’s hands are on her hips or she is lolling in her chair, the client will|
|not feel confidence in her. |
An effective counselling session
Below is a script of an effective counselling session.
• Find the correct place in the script for the labels below. (Labels 1 and 2 have already been done for you as examples.)
• Write the label in the correct place on the script.
Compare your answers with those in Answers at the end of the handbook.
Labels
1. Client made to feel welcome
2. Stage 1: Helping the client to tell the story (bracket the whole stage on the left hand side of the page)
3. Stage 2: Helping the client to consider current options (use brackets)
4. Stage 3: Helping the client to make an action plan (use brackets)
5. Stage 4: Helping the client to commit to implementing the plan (use brackets)
6. Confidentiality mentioned
7. Closed question (appropriate here)
8. Open-ended question
9. Probing question
10. Non-judgmental
11. Reading the client’s body language
12. Reflection of content (there may be more than one example)
13. Reflection of feeling (there may be more than one example)
14. Summarizing
15. Providing relevant information
16. Offering appropriate ongoing support
Session script
|Counsellor: |Good morning, Buhle. How can I help you? |
|Client |I have a problem. |
|Counsellor |Sit down and tell me about it. Whatever you say will remain private between us |
|Client |(Silently bites her lip and stares at the floor. She is sitting with her arms crossed.) |
|Counsellor |(leaning forward) I am listening, Buhle. Can you tell me what is bothering you? |
|Client |(starts crying) |
|Counsellor |Some things feel so heavy that it is difficult to find words. Take your time. |
|Client |I don’t know what I’m going to do. |
|Counsellor |You’re in a situation where it is hard to make a decision? |
|Client |Yes. You know I am the head of my home? |
|Counsellor |I heard in the community that your father left many years ago and that your mother died in February, |
| |leaving the younger children in your care. |
|Client |We never have enough food. There are five of us. But my sister, Khanyi, says she is going with the taxi |
| |drivers now. They have money and she can get money from them when she sleeps with them. At the weekend we |
| |had meat and vegetables for the first time since Ma died. But Khanyi! She is only 13 years old! ... HIV |
| |killed Ma and it will kill her too. |
|Counsellor |So you children are starving. Khanyi’s solution has given you all good food for once, but it has brought |
| |another big worry to you as well. You don’t want to lose her the same way you lost your mother. |
| |(Counsellor continues to support client by reflecting content and feeling) |
| |10 minutes later … |
| |So if I hear you correctly, there are two main worries for you at the moment: the children are hungry and |
| |you want to find a way to feed them; Khanyi’s behaviour is putting her at risk and you want to protect her.|
| |Which worry is the biggest for you? |
|Client |The food. |
|Counsellor |Let’s work on that first. What ways have you thought of so far to improve the financial situation at home? |
|Client |Zama (he is 12) got work at the shop. He was doing cleaning on Saturdays and got R15 for the morning. But |
| |last month they told him not to come back. We don’t know why. We also planted some spinach and pumpkins. |
| |But the neighbour’s goat ate most of the plants. |
|Counsellor |So you have been trying to make things come right, but other problems have got in the way. Did you know you|
| |can get a grant each month from the government? |
|Client |Yes, I heard there were grants. But how do I get this money? How much will they give me? |
|Counsellor |You make an application at Welfare and there should be R200 each month for each child under 14 years. That |
| |would be … let me think … R800 for Khanyi, Zama and the two little ones. First, though, you have to prove |
| |you’re in need, and also who you are. You have to produce an affidavit and show your ID numbers, which are |
| |on your birth certificates. What documentation do you have for you and your brothers and sisters? |
|Client |I have a birth certificate and so has Khanyi, but I do not know about the other three children. What is an |
| |affidavit? |
|Counsellor |(Counsellor explains and goes through the options with client) |
| |10 minutes later … |
| |Now what are your decisions? Let’s make a list … |
|Client |5 minutes later … |
| |(reading from her list) I must look at home to see if there are birth certificates for the three other |
| |children. If there aren’t any, I must apply for birth certificates at Home Affairs. Then I must get an |
| |affidavit at the police station. When I get the birth certificates I’m going to go to Welfare and apply for|
| |the grants. Then I’ll have to go and fetch the money once each month. |
|Counsellor |That’s good. Let’s see now, when are you going to do each one of these things? |
|Client |I’ll look tonight for the birth certificates, and tomorrow I’ll write up the affidavit and bring it to you |
| |to check before going to the police station in the afternoon after school. And this weekend I’m going to |
| |speak to the neighbour about either tying up his goat or helping me fix the fence between his garden and |
| |ours. I’m a bit scared to go to him alone, so I’ll ask Mrs Khuzwayo to come with me. She is the chief’s |
| |wife. |
|Counsellor |It looks as though you will soon have the food problem under control. Well done! In the meantime, you could|
| |get food parcels from Social Welfare, because you will have to wait while the grant applications are |
| |processed. However, we have not yet considered how you think you might protect Khanyi. |
|Client |No. I’m worried that even if we get food money she won’t stop going with those men. |
|Counsellor |What do you think is motivating her? |
|Client |(sighing) She says she also wants to buy a cell phone and nice clothes, and she gets more money if condoms |
| |aren’t used. |
|Counsellor |So what we must also do now is decide when we will meet again to discuss what you can do to help Khanyi. Is|
| |Thursday afternoon at 2:35 okay for you? |
|Client |Yes, that’s fine. I will also tell you then what I have managed to do so far with the documents and |
| |applying for the grant. |
Working with children who have been abused
The safety of the child
How safe is the child? When counselling children, it is important to find out because children are dependent on others—sometimes on the abuser—to provide for them. You need to find this out before counselling begins. You might need to take action to protect the child and there is no point in providing counselling if the child remains in an abusive situation. You may need to contact other services to assist in providing safe care for the child. (See Contact list at the end of this handbook.)
The health needs of the child
What are the child’s health needs? If the rape is recent, both a forensic and health examination of the child may be urgent—especially as HIV testing and ARVs are provided for victims of sexual abuse. However for ARVs to be effective they have to be provided within 72 hours—so counsellors need know about this and be trained to ask the appropriate questions. It is important for counsellors to know that the risk of ARV infection is present even without penetration. For example, in the following scenario
The rapist pulls down the victim’s jeans and in doing so, the zipper grazes the child’s stomach. The rapist ejaculates prematurely (as many do) on top of the child stomach. If he is HIV+ this may be enough to infect the child.
So a counsellor needs to talk to the child about all injuries and how they happened.
Furthermore, children are at risk of other sexually transmitted infections. (Sexual offenders are usually sexually irresponsible and therefore high risk for multiple infections.) And girl children are at risk of pregnancy. A health examination may be necessary for these reasons.
Disclosure and communicating with children
Many people who have been sexually abused feel strong emotions such as embarrassment, shame, guilt, fear and anger about the abuse. For these and other reasons disclosing sexual abuse can be a very difficult thing to do, especially for children. Many never disclose at all. The way we facilitate and respond to disclosure can make it easier for children to talk about what happened to them, or it can make it more difficult. The following notes will give you some ideas about how you can help children and their families disclose sexual abuse.
Disclosure
• Disclosure is often not spontaneous, that is, it doesn’t happen automatically or on its own.
• It often begins when there is some other discovery, e.g. a urinary tract infection, or when a friend discloses the abuse.
• Disclosure is often only partial.
Why don’t children disclose abuse spontaneously?
There are several reasons why a child may not want to disclose, for example:
• The child feels shame, guilt or embarrassment.
• The child is physically or psychologically threatened by the abuser.
• The child wants to protect others.
• The child is trying to protect her or himself.
• Economic pressures—for example, the child’s family might depend on the abuser for money and the child might be afraid that their family won’t get this money any more if they disclose the abuse.
Why don’t children make a full disclosure?
• Children may only disclose what they think is relevant (important). They may think certain events aren’t significant.
• They may think the person to whom they are disclosing will respond negatively.
• They may fear punishment.
• They may only remember some aspects of the abuse at a time.
• The way the interviewer tries to get the child to remember the abuse might not work for the child.
• The child may think that the person to whom they are disclosing won’t believe them.
Child abuse accommodation syndrome
Sometimes children retract (withdraw) their disclosure, saying that the abuse didn’t happen after all. This is called child abuse accommodation syndrome and there are many examples of it in the research on child abuse. It is likely to happen when
• The person the child disclosed to did not believe her.
• There has been a strong negative response to the child after the disclosure.
• The disclosure has seriously upset the child’s life and this disruption is more painful than the abuse itself.
• People have put pressure on the child to retract the disclosure.
Things to think about before your interview a child
There are some factors that make it more or less likely that a child will disclose abuse to a particular interviewer. Think about these when planning an interview with a child:
• Gender: some children can’t talk about sexual issues across genders, no matter how skilled the interviewer. So for some children, it is better for a boy to talk to a male interviewer or for a girl to talk to a female interviewer.
• Age: in some cultures, you may not discuss sexual issues with older people.
• Language: children may not have the language to describe their experiences or feelings. They may also be uncomfortable using certain words.
• The physical setting: if the abuse happened in a particular place, for example, at school, the child may not feel comfortable talking about the abuse in that place.
• Perceived differences in status: sometimes children find it difficult to talk to adults, especially those in roles of authority, such as teachers.
• Other issues: think of any other issues that may influence the interview.
For the above reasons, it is sometimes helpful if an older peer supports and helps a younger child when they disclose abuse. However, this must be done with the guidance of an older person who is trained, and, in the end, the adults in the school environment are responsible for supporting children when they disclose abuse.
Preparing your space (where you will have the interview)
Is the space where you will interview the child child-friendly? Think about the following things:
• Seating: are there cushions or floor coverings (mats or blankets) that the child can sit on?
• Allow for spillages and accidents: a mat may be more practical than fixed carpeting, especially if the child is young and upset.
• Barriers: are there any barriers between you and the child? For example, if you sit at a desk and the child sits on the other side of the desk, the desk becomes a physical barrier between the two of you.
• Pictures: what is on the walls? Do these things make the environment friendly and welcoming for the child?
• Play material: are there a few things for the child to play with?
• Aids to talking: are there things such as crayons and paper that might help the child to express what happened?
Arrange that there will be no distractions or interruptions. Switch your cell off, take the phone off the hook, and put a “busy” sign on the door and insist others respect it.
Preparing yourself
• Find out about the child’s background:
o How old is the child?
o How mature is the child?
o What is the child’s cultural background?
o What is the child’s main language?
o What state might the child be in?
• Dress appropriately. Don’t wear distracting clothing or jewellery. Don’t “power dress”; instead, dress in a child-friendly way.
The interview
a. Starting off
• Observe the child carefully but don’t make lots of eye contact—this might frighten them.
• Ensure that you’re at the same physical level as the child. It usually helps to sit on the floor with younger children.
• Greet the child.
• Make sure you know/learn the child’s name and what they want to be called.
• Make sure the child knows your name and what to call you. If possible, wear a name badge.
• Ensure that the child is physically comfortable.
• Spend time establishing rapport (a friendly feeling) with the child.
• Explain what you’re going to do, and why.
• Explain your role.
• Ask the child’s permission to go on.
b. During the contact
• Use simple language without talking down to the child.
• Show the child you’re listening with your body. For example, face the child, lean slightly forward, nod regularly to show that you understand what they are saying.
• Adjust your voice and tone. For example, talk quietly, calmly and sympathetically.
• Be aware of your facial expression. If you frown the child may think you don’t believe her. If you look shocked the child may feel judged. If you look angry, the child might think you’re angry with her. All of these things will have a negative impact on what she tells you.
• Observe the child’s responses and behaviour.
• Let the child guide you.
• The child may need something to drink.
• The child may need something to hold.
• Focus on strengths and not just on the abuse or negatives.
• Praise the child where appropriate but don’t overdo this!
• Ask open-ended questions, requiring more than a yes/no answer.
• Try to avoid taking notes. If you have to, explain why and ask the child’s permission.
• Don’t jump to conclusions. Go slowly and don’t rush the child.
• Check your conclusions with the child.
• Accept that talking may be difficult for the child. Allow silences and pauses.
• Invite the child to ask you questions. Answer the questions honestly and simply.
• If possible, give the child some choices even if these are very simple.
c. Ending the contact
• Explain what will happen next.
• Check on the child’s immediate safety needs.
• Don’t make promises such as “everything will be better now”. Sometimes things are worse for the child after disclosure.
• If you have to share information with others, explain to whom and why to the child.
• Explain your ongoing role. You’re likely to need more than one session.
The role of the child’s caretaker in the interview
• Ask the caretaker for information that will help you establish rapport with the child.
• You might need to include the child’s caretaker while you’re establishing rapport.
• Don’t allow the caretaker to interrupt and offer explanations.
• Give the caretakers time to talk to you on their own. Explore their concerns and needs. Answer their questions honestly but also explain the child’s need for emotional safety and confidentiality. Give them your contact details and details about the case in writing. Remember that by taking care of the caretaker, you’re taking care of the child.
Things to remember
• Keep to commitments that you have made.
• If you need to change appointments or other arrangements, communicate directly with the child and explain why the change has to be made.
• Remember that you’re a model of appropriate adult behaviour for the child.
• Never share information outside the necessary circle of role-players.
|Touch |
|Some traumatized children seek (look for) touch as a way to reconnect them to others. But some children are very anxious about and |
|cringe away from touch. You must respect this, because if you insist on touching the child, they will be further traumatized. However,|
|some children may build up such a resistance to touch that it may put their future adult relationships at risk. This should be |
|addressed through therapy and with the child’s caretaker. |
Feelings that children may find difficult to manage after abuse
Children may have a number of feelings that they find difficult to manage after abuse. You can’t wish these feelings away. They are a natural response to what the child has experienced.
These feelings may interfere with the child’s ability to cope at school, at home and in other contexts. Therefore, they need help in expressing these feeling safely. However, they may not be able to label their feelings or discuss them openly. You will have to observe their behaviour to see and understand how they are feeling. Then you can help them to work out what practical strategies they could use to deal with these feelings.
Below we will look at some of the feelings children may find difficult to manage.
a. Anger
Children may be angry about why the abuse happened to them. They may find it difficult to express this anger without hurting themselves or others. Helping them acknowledge anger and express it safely may be important.
b. Depression
Children may feel as if their life is over. They may not be able to sleep or to eat. They may appear withdrawn and unmotivated.
Encourage the child to be physically activity, but don’t force it. Life/future planning may be helpful. Medication for depression should be used with great caution with children.
c. Guilt
Children may feel that they are responsible for what happened to them. Simple reassurances aren’t enough. Try to help the child express the reasons behind their feelings of guilt. Make sure that you discuss the issue of responsibility logically. You may have to do this repeatedly.
d. Poor self-image
Children may feel that their body is ugly because of what happened. They may also try to harm themselves physically. Encourage them to take care of themselves and give appropriate positive reinforcement when it is appropriate. Encourage the caregiver of the child to help with self-care.
e. My body is not mine
Children may completely or partial reject their body—“it is not mine”. Encourage them to identify normal body issues, for example, when they are hungry, or need to go to the toilet. Help them to learn ways of relaxing. Encourage them to take care of their bodies.
f. “Anxiety”
Children find it very difficult to acknowledge that they are anxious and they can’t label anxiety properly until they are teenagers. They may describe it as always feeling scared that something will happen. Or they may have nightmares or difficulty concentrating at school. Encourage them to discuss their fears. Sometimes practical suggestions help, for example, encouraging them to always walk with a friend or to share a sleeping space.
g. Early sexualization
Sometimes a child feels that they only have value through their sexual behaviour and may become quite seductive. Encourage the child to express what they are feeling and discuss responsible sexual behaviour with them, without lecturing.
Section 4: Taking care of yourself
This section aims to equip you with the skills and knowledge to be able to identify signs and causes of stress in yourself, and to take appropriate action to cope. Remember you can’t care for other people if you don’t take care of yourself. The section looks at what stress is, helps you to measure your stress levels, and offers suggestions on how to manage your stress.
What is stress?
Imagine yourself in a stressful situation. What do you feel? Maybe you feel one or more of the following: tight stomach; rapid breathing; pounding heart; sweating; flushing; tense muscles; shivering; dry mouth. Perhaps you can add to this list.
These physical sensations are normal when someone is stressed. They are caused by the release of the hormone adrenalin from the adrenal glands that are situated just above the kidneys.
Adrenalin prepares the body for the “fight or flight” response—i.e. either to grapple with the threat or to run away from it. The brain is prepared for quick thinking and the body for immediate action. This makes good sense if someone is about to run a race, write an exam or cope with a sudden crisis. We sometimes hear of people who get superhuman strength in extreme situations. But if someone’s system is flooded with adrenalin too often and for too long, they can become sick.
Health consequences known to be linked to excessive stress are heart attacks, strokes, stomach ulcers, high blood pressure and a weakened immune system.
Assess your stress levels
The following questionnaire will help you to assess your stress levels:
1. Read the statements below, and for each one, choose the option that applies to you (“often”, “sometimes” or “hardly ever”). Tick the appropriate box on the right.
NB: There are no “right’ or “wrong” answers—only answers that correctly describe you.
2. This self-assessment sheet is private. No one else may look at it unless you wish them to.
3. Keep this assessment sheet in a safe place. After a few weeks, fill it in again, to see how much progress you have made in managing your stress.
|Statements |Often |Sometimes |Hardly Ever |
|1. I find myself sweating a lot | | | |
|2. My mouth feels dry | | | |
|3. I cry or feel the urge to cry | | | |
|4. I am aware of my heart beating fast | | | |
|5. I snap at people | | | |
|6. I am disorganized in my work and/or my life | | | |
|7. My stomach tingles (“gets butterflies”) | | | |
|8. I eat either too much or too little | | | |
|9. My sleep patterns are disrupted | | | |
|10. I find it hard to concentrate | | | |
|11. My memory fails me | | | |
|12. I drink alcohol or take medicine to help me cope | | | |
|13. Making decisions (even small ones) is difficult | | | |
|14. I feel very tired without having done physical exercise | | | |
|Column subtotal: | | | |
|Total/42 for all three columns: | |
4. Score yourself:
In each box where you have ticked “frequently”, write 3.
In each box where you have ticked “sometimes”, write 2.
In each box where you have ticked “hardly ever”, write 1.
Add up your total for each column.
Add the totals from the three columns together.
5. Interpret your score:
Total: 14–20:
Your stress level is low. Whatever you’re doing to cope at the moment seems to be working.
Total: 21–31;
Your stress level is uncomfortable. You need to do something to reduce it.
Total: 32–42;
Your stress level is too high and you’re approaching burnout. You need to do something urgently to address your stress, and perhaps seek outside help too.
|NOTE: this test and its interpretations are not 100% accurate. Results might be affected by various factors. For example, a person might have |
|a dry mouth as a result of medication they are taking, rather than as a direct result of stress. Also, someone might be eating less due to |
|being on a weight-loss programme, or finding it difficult to concentrate due to being in love. |
|Regardless of your score, if you’re worried about your stress levels, it is a good idea to consult your doctor. |
Identifying and assessing negative stress
Stress isn’t always negative—it can sometimes serve a useful purpose. The right amount of short-term, acute stress can help you focus and perform better. It can motivate and help people attain difficult goals. For example, you may feel that same good stress at work if you’re primed for an activity that you can accomplish right then and there.
However, excessive and ongoing stress makes people
• Disorganized (leading to time-wasting and other problems)
• Unable to think straight or rationally
• “Go blank” or be very forgetful
• Clumsy or feel unable to move
• Unable to focus or concentrate
• Exhausted
• Nauseous
• Incoherent
Some people need a crisis (high stress level) to get them going, but others find even a small amount of stress is counterproductive. Where do you think your individual, optimum stress-to-performance points are?
Think about how stress affects you and fill in your own curve on the blank graph on the next page.
Causes of stress
Life is stressful for South Africans. Here are some of the stressors (not including work-related pressures) that we face. Perhaps you can add to this list.
General stressors
• Insufficient salary
• Increase in the interest rates
• Unemployment and/or poverty
• High level of general crime
• Fear of being hijacked
• Fear of rape
• Bad driving on the roads
• Political intimidation
Personal stressors
• Bad relationships or divorce
• Maintenance battles with ex-partner
• Own children taking drugs
• Own children going through turbulent adolescence
• Worry about being infected with HIV
• Nursing family and friends dying of AIDS
• Colleagues or boss being difficult
• Transport problems
Effects of too much stress
Getting “hooked-in” and burning out
People whose work involves helping and caring are at risk of being “hooked in” by those they assist. This includes psychologists, social workers, doctors, teachers and other professionals, as well as people who do voluntary caring work, such as home-based carers, LifeLine counsellors or hospice helpers. Someone who frequently gets “hooked in” is going to feel stressed and is likely to burn out quickly. It is therefore important for care workers to recognize the signs, and to do something about how they are responding to their work. If they are going to cope, helpers must take responsibility for their own feelings.
Signs of being hooked-in
1. Low-level hook-in
• The helper feels a strong emotional response to the client, such as irritation, pity, or grief. The helper spends a lot of time thinking about the client and “takes the job home”.
2. High-level hook-in
• The helper is overwhelmed by the suffering of the client and the feelings that the client’s suffering evokes. The helper actually experiences client’s feelings.
• The helper is fiercely angry towards those who have caused the client’s suffering. The helper wants to hit back at the perpetrators and hurt them.
• The helper wants to go much further than the extra mile to help the client and feels powerful and elated when help seems to be effective.
• The helper starts to become less effective, because the need to help others becomes more important than the client’s need to be helped. The focus has shifted from the client to the helper.
Signs of burning out
• The helper becomes ineffective in their role. Strong emotions and thoughts are not properly sorted out in their head. The helper’s behaviour can be counter-productive.
• The helper shows the physical, emotional and behavioural symptoms of ongoing, intense stress (this could include stomach pains, weepiness, disorganization, etc.).
• Eventually, the helper stops caring about the clients and their feelings and has nothing left to give.
So … what is “normal”?
As a home-based carer, you must expect to feel emotionally affected by the situations you face. Clearly, anyone who is unmoved by the suffering experienced by others—especially children—has lost the ability to feel human compassion. Such a person is therefore not suitable to be a helper. Carers do their jobs because they care. But they must constantly check themselves for the signs of unhealthy stress and of being hooked in, and take action, before burnout spoils their own lives and their chances of making a positive difference to others.
|Important! |
|People who have suffered trauma in the past (rape, assault, abuse, bereavement or anything that hurt them deeply) have to work through their |
|past emotional and psychological pain. A counsellor can help them with this process of “unpacking”. Someone who has been raped will experience|
|a lot of stress when trying to help other rape survivors, unless their personal rape issue is dealt with. The new survivor’s trauma will |
|simply reactivate the helper’s past trauma, and the helper will inevitably pay attention to her own feelings instead of to the client’s. |
|The most stable and effective helper is a healed helper! |
Ways to cope with stress and care for yourself
The table below lists ideas for stress management and self-caring.
1. Fill in the blank spaces on the left-hand side with ideas that are not already on the list.
2. Tick ideas that you currently practise.
3. Choose 4 ideas that you aren’t already practising. In the right-hand column, write down when, where and how you’re going to implement them.
NB: Keep this list in a safe place and check and update it regularly.
Assessing how you manage stress
|Stress management |
|1. Don’t take caring problems home with you. | |
|2. Decide how much time you can give per week, and then allocate specific | |
|times in which to do your caring work. | |
|3. Admit and accept that your power, influence and resources are limited. | |
|4. Focus on what you are doing instead of what you can’t do. | |
|5. If you are religious, use your religion to support you. | |
|6. Learn to say “no”. | |
|7. Form a debriefing support group. Participate regularly in support group | |
|meetings. Talk out your angry, painful and frustrated feelings. | |
|8. Make a list of resources, organizations and contact people you can | |
|access, or to whom you can refer people in need. | |
|9. Join or develop local community networks that offer you support and | |
|solidarity. | |
|10. | |
|11. | |
|12. | |
|Self-caring |
|1. Have a quiet time of meditation/prayer at a set time every day. | |
|2. Eat a healthy, balanced diet. | |
|3. Exercise at least three times a week. | |
|4. Do at least one thing each day that gives you pleasure. | |
|5. Do a physical and mental relaxation exercise once a day. | |
|6. Do something to allow yourself to have a laugh once a day. | |
|7. Develop/maintain other interests and activities. | |
|8. Allow enough time for sleep. | |
|9. Invest time, love, focus and fun in your relationships—these are your | |
|lifeline and your support base. | |
|10. If you’re depressed, seek professional help. You can phone Life Line 24| |
|hours a day (see Contact list). | |
|11. Work through your own issues and past traumas, so you can cope with | |
|people trying to survive similar situations. You might need professional | |
|help to “unpack” certain issues. | |
|12. | |
|13. | |
|14. | |
Debriefing support group
A debriefing support group offers people who have stressful or emotionally upsetting work the chance to get together and talk about their thoughts, feelings and actions. The idea is that after talking through and sharing what they have experienced, the participants will feel better and will be less likely to “take the job home” with them.
Debriefing support sessions can be run in different ways. They can develop a life or character of their own, due to the personalities of the people who participate. The most important thing is that each person feels helped. Participants can acknowledge how the others feel, even if they don’t have solutions to the problems raised. Often there are no solutions anyway—that is why the work is difficult. What is important for each person is to know that the group members have listened, tried to understand, and have “held hands” through the hard times. Sometimes a group member can ask a question, make a comment or even a suggestion that can help a participant to see their situation in a new light, or even to get an idea about how to go forward.
The session time can include happy moments too. For example, a group member might have an update on a tough situation they shared the previous week. Maybe the life of someone they have been helping has been positively turned around. Remember that the names of the people being helped must not be revealed.
Guidelines on how to run a debriefing session:
1. The group should meet regularly and for a set time (e.g. once a week for one hour). Punctuality should be observed.
2. The meeting place should offer privacy (e.g. a room where the door can be closed and people can’t be overheard).
3. There should be a reasonably small number of participants; six or seven people is about right. If it is larger than this, not everyone will get a chance to share.
4. Arrangements should be made so that there are no distractions, interruptions or noise outside.
5. Everyone’s cell phone must be switched off during the session!
6. The participants should be seated comfortably in a circle, so that everyone can see everyone else.
7. Everyone should be given a chance to speak and to participate in any discussion.
8. There should be a chairperson who runs the session, making sure each person has a chance to speak. Members can take turns to chair.
9. All information revealed in the support group—either what members reveal about themselves or about the people they have helped—must remain absolutely confidential. People will not continue to be open about themselves if anyone talks outside the group. Members must not divulge the names of people they are helping as this will be a breach of that confidentiality.
10. Three things that are not allowed in the group are dominating, criticizing and withholding:
• Dominating happens when one or two people talk for a long time and other people don’t get a chance to speak.
• Criticizing happens when someone has just revealed what they thought, felt or did, and other group members say “How could you have done that?” or “You shouldn’t feel that way!”
• Withholding is when people in the group just sit there and don’t participate. They let everyone else do all the revealing and speaking.
What is the process?
1. The chairperson makes sure the people in the group know each other. If a new person joins, everyone must re-introduce themselves and very briefly state who they are.
2. The session is opened in whatever way the group prefers (song, prayer or ice-breaker).
3. The chairperson asks someone to start. Participant no. 1 will mention an incident that she experienced as distressing. She will briefly state
• What happened
• What she thought
• What she felt
• What she did
• What the worst thing about this incident was for her
4. When the participant has finished, the chairperson will invite each other member of the group in turn to ask a question or make a comment on what was said.
5. Each person must attempt to comment thoughtfully and sensitively. The chairperson must make sure that each person comments briefly, and that the focus remains on the participant who has revealed the incident. (Other group members aren’t obliged to comment on every occasion, but everyone has to participate at some point during each session.)
6. When everyone has briefly spoken, the chairperson will invite participant no. 1 to comment again. She can ask for assistance from the group if necessary.
7. When the cycle has been run for each group member in turn, the debriefing session has ended.
Relaxation exercises
Deep breathing
• Lie on your back and bend your knees slightly. Close your eyes or gaze at the ceiling in an unfocused way. Rest one hand lightly on your stomach.
• Take slow, deep breaths, allowing your hand to rise and fall with each breath. Don’t stain to overfill your lungs.
• When you have developed a smooth rhythm, start counting your breaths. As you exhale, silently count “one”. Continue counting up to 4, and then start at one again. You may become so relaxed your mind wanders and you lose track. When this happens, just start at one again.
Progressive muscle relaxation
Sit comfortably on a chair, or lie on your back with your knees slightly bent and your arms comfortably at your sides.
• Take a deep breath, right down into your abdomen. As you exhale, let your whole body begin to relax.
• Curl both hands into fists, tightening forearms, biceps and pectoral muscles. Hold for 7 seconds and relax. Notice the feeling of relaxation in your arms and chest.
• Wrinkle your forehead. Hold for 7 seconds and relax. Notice the feeling of relaxation in your forehead.
• Simultaneously frown, squint your eyes, pinch your lips, tighten your jaw and hunch your shoulders. Hold for 7 seconds and relax. Notice the feeling of relaxation in your face.
• Gently arch your back and take a deep breath into your chest. Hold the position as well as your breath for 7 seconds. Relax as you breathe out.
• Take another deep breath, and press your stomach out. Hold the position as well as your breath for 7 seconds. Relax as you breathe out. Notice how it feels to relax your back and stomach.
• Now flex your feet and toes. Tighten your buttocks, thighs and calves. Hold for 7 seconds, then relax.
• Lastly, point your toes, while tightening the buttocks, thighs and calves. Hold for 7 seconds, then relax. Notice what your legs feel like when they really relax.
• Briefly scan your whole body, checking for any places that still feel tight, and relax them. Lie for a few minutes, feeling a deep sense of relaxation.
Body check-in
From time to time during the day, pause in a quiet spot and close your eyes. Allow your breathing to slow and deepen. Scan your body for any tight muscles, sore joints, tiny aches and pains, or small twitches. Focus on each area for a moment, as you exhale slowly and allow the tension or pain to melt away.
Special place
You can create a safe and peaceful place in your imagination, a place where you can go any time you need to relax, even if it’s just for 30 seconds.
Start by taking a slow, deep breath. Close your eyes and continue to breathe slowly and deeply, letting your whole body relax with each breath. Now let your imagination roam freely to look for a special place where you can feel calm and relaxed. It can be indoors or outdoors, a place where you have been, or a place you have never seen.
When you’ve found your place, allow yourself to really bring it alive. Be aware of what’s above you and what’s under your feet. Notice what’s in front of you—the colours and shapes. What do you hear? What do you smell? Touch something in your special place and notice its texture. Notice the temperature, the feel of the air.
Now imagine you’re comfortably sitting or lying in your special place, feeling deeply relaxed. Take a slow breath, way down into your abdomen. Feel your whole body becoming heavy and calm. See what’s around you, hear what’s around you, feel what’s around you. Let it all wash over your senses until you’re at peace.
Once you have imagined your safe space, you can return to it any time you’re feeling stressed.
Answers
Two poor counselling sessions (Answer)
Scene 1:
• Not making the client feel welcome or important
• Making the client feel as though she is a burden on the counsellor
• Being judgmental
• Jumping to conclusions (assumes the client is giving the aunt a hard time)
• Taking sides (counsellor appears from the start to be sympathizing with the aunt instead of empathizing with the client)
• Not paying attention to the person’s feelings
• Moralizing
• Breaking confidentiality (Zizi’s story should not be revealed to anyone else)
• Comparing the client with others
• Insulting the client by referring to her weight
Scene 2:
• Showing shock
• Passing judgment
• Criticizing; running the person down
• Finishing the client’s sentence for him—assuming what he was going to say
• Not trying to see the client’s actions through the client’s eyes
• Not listening to the client
An effective counselling session (Answer)
|Counsellor: |Good morning, Buhle. How can I help you? |
|Client |I have a problem. |
|Counsellor |Sit down and tell me about it. Whatever you say will remain private between us. |
|Client |(Silently bites her lip and stares at the floor. She is sitting with her arms crossed.) |
|Counsellor |(leaning forward) I am listening, Buhle. Can you tell me what is bothering you? |
|Client |(starts crying) |
|Counsellor |Some things feel so heavy that it is difficult to find words. Take your time. |
|Client |I don’t know what I’m going to do. |
|Counsellor |You’re in a situation where it is hard to make a decision? |
|Client |Yes. You know I am the head of my home? |
|Counsellor |I heard in the community that your father left many years ago and that your mother died in February, |
| |leaving the younger children in your care. |
|Client |We never have enough food. There are five of us. But my sister, Khanyi, says she is going with the taxi |
| |drivers now. They have money and she can get money from them when she sleeps with them. At the weekend we |
| |had meat and vegetables for the first time since Ma died. But Khanyi! She is only 13 years old! ... HIV |
| |killed Ma and it will kill her too. |
|Counsellor |So you children are starving. Khanyi’s solution has given you all good food for once, but it has brought |
| |another big worry to you as well. You don’t want to lose her the same way you lost your mother. |
| |(Counsellor continues to support client by reflecting content and feeling) |
| |10 minutes later … |
| |So if I hear you correctly, there are two main worries for you at the moment: the children are hungry and |
| |you want to find a way to feed them; Khanyi’s behaviour is putting her at risk and you want to protect her.|
| |Which worry is the biggest for you? |
|Client |The food. |
|Counsellor |Let’s work on that first. What ways have you thought of so far to improve the financial situation at home? |
|Client |Zama (he is 12) got work at the shop. He was doing cleaning on Saturdays and got R15 for the morning. But |
| |last month they told him not to come back. We don’t know why. We also planted some spinach and pumpkins. |
| |But the neighbour’s goat ate most of the plants. |
|Counsellor |So you have been trying to make things come right, but other problems have got in the way. Did you know you|
| |can get a grant each month from the government? |
|Client |Yes, I heard there were grants. But how do I get this money? How much will they give me? |
|Counsellor |You make an application at Welfare and there should be R200 each month for each child under 14 years. That |
| |would be … let me think … R800 for Khanyi, Zama and the two little ones. First, though, you have to prove |
| |you’re in need, and also who you are. You have to produce an affidavit and show your ID numbers, which are |
| |on your birth certificates. What documentation do you have for you and your brothers and sisters? |
|Client |I have a birth certificate and so has Khanyi, but I do not know about the other three children. What is an |
| |affidavit? |
|Counsellor |(Counsellor explains and goes through the options with client) |
| |10 minutes later … |
| |Now what are your decisions? Let’s make a list … |
|Client |5 minutes later … |
| |(reading from her list) I must look at home to see if there are birth certificates for the three other |
| |children. If there aren’t any, I must apply for birth certificates at Home Affairs. Then I must get an |
| |affidavit at the police station. When I get the birth certificates I’m going to go to Welfare and apply for|
| |the grants. Then I’ll have to go and fetch the money once each month. |
|Counsellor |That’s good. Let’s see now, when are you going to do each one of these things? |
|Client |I’ll look tonight for the birth certificates, and tomorrow I’ll write up the affidavit and bring it to you |
| |to check before going to the police station in the afternoon after school. And this weekend I’m going to |
| |speak to the neighbour about either tying up his goat or helping me fix the fence between his garden and |
| |ours. I’m a bit scared to go to him alone, so I’ll ask Mrs Khuzwayo to come with me. She is the chief’s |
| |wife. |
|Counsellor |It looks as though you will soon have the food problem under control. Well done! In the meantime, you could|
| |get food parcels from Social Welfare, because you will have to wait while the grant applications are |
| |processed. However, we have not yet considered how you think you might protect Khanyi. |
|Client |No. I’m worried that even if we get food money she won’t stop going with those men. |
|Counsellor |What do you think is motivating her? |
|Client |(sighing) She says she also wants to buy a cell phone and nice clothes, and she gets more money if condoms |
| |aren’t used. |
|Counsellor |So what we must also do now is decide when we will meet again to discuss what you can do to help Khanyi. Is|
| |Thursday afternoon at 2:35 okay for you? |
|Client |Yes, that’s fine. I will also tell you then what I have managed to do so far with the documents and |
| |applying for the grant. |
Contact list
Here are some useful contact numbers. Add to this list with your contacts in your area.
|Alcoholics Anonymous |0861 HELP AA (435-722) |
|Ambulance |10177 |
|Child Line |0800 055 555 |
|Clinic (local) | |
|Department of Health |0800 005 133 |
|Fire Department (local) | |
|HIV & AIDS Helpline |0800 012 322 |
|HIV 911 |0860 448 911 |
|Life Line Counselling |0861 322 322 |
|SANCA (SA National Council on Alcoholism and Drug |0861 322 322 |
|Abuse) | |
|SAPS (Police) |10111 |
|Stop Gender Violence |0800 150 150 |
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2. Stage 1: helping the client to tell the story
1. Client made to feel welcome
2. Stage 1: helping the client to tell the story
1. Client made to feel welcome
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