Kiranbala
I have been working as a Nurse Counsellor in the ICTC, CIHSR since March 2019 and it has been a good learning experience. Here through this article, I would like to elaborate on the important role of a Nurse Counsellor in ICTC. Working in the ICTC requires collaborative support from all consultants in various departments of the Institute in which he/she is working in so also support from NSACS (Nagaland State AIDS Control Society) through DAPCU (District AIDS Prevention Control Unit).
The job requires the Nurse Counsellor to navigate through all the protocols and documentation in the department. He/she also need to generate reports according to the format laid down by NACO to be submitted to NSACS in the beginning of every month.
An ICTC Counsellor needs the trust of individuals/clients before counselling and initiation of ART. Unless trust is built, adequate information cannot be given by both sides as sensitive communication take place during the counselling. Confidentiality and respect for the privacy of the patients, now called clients, is of paramount importance during the counselling process.
One thing which every individual need to know, irrespective of their age i.e. adolescent or adult is - What is HIV &AIDS? What are the routes of transmission of HIV? What are the different risk factors which can lead to this infection i.e. HIV? If we know the danger signs, we will never try to go in that area. If we don’t know those signs, then definitely we will venture into areas which will put our lives at risk. Many innocent and young lives are lost because of HIV and AIDS. It is high time that we give awareness about it again. If we want to save our nation or world from this HIV and AIDS infection, like mass awareness is given for COVID-19 by different organization/civil society enabling the control of its spread by following protocols and decreased in numbers when protocol is maintained, a similar awareness can be done for HIV and AIDS to be controlled.
When I looked at the different client(s) and their family that I have counseled in the past, I feel there is a great need for awareness and teaching on HIV and AIDS again amongst all ages. Looking back to the last year’s1st wave/outbreak of COVID-19, different groups of organization, frontline workers, church organization etc. did their level best in giving awareness/education to different villages, community, etc. instructing all to follow certain rules and protocols for prevention of COVID19 transmission. “United we stand Divided we fall “was the proverb that came to my mind at that time. From every angle, all are trying their level best to orient common people about COVID-19. At the end of the year 2020, by God’s grace, COVID infection was coming down to almost nil, compared to the initial status in Nagaland and other neighboring states once proper protocols were followed. All the hard work done by different groups of people were not in vain and above all by God’s grace, it seems to have worked.
When we look at the route of transmission of HIV, which is not easily spread like COVID, we still see HIV infections in alarming numbers. If we don’t prevent its spread, it is going to slowly rule our country/world. If we don’t raise an alarm ourselves and to those around us, despite NACO’s efforts to help those who are in need of medicine and treatment (by making it available free of cost), the cases will continue to grow. All the Healthcare staffs who are involved in providing different levels of healthcare to HIV and AIDS clients, in their respective area of responsibilities, need to be involved in these awareness campaigns.
We need to start talking about it from the early part of our education i.e. from school where habit formation or information given on life happened. Teaching on “Understanding our Body” need to be given as well as ‘how we can or need to live life for a better future’, ‘understanding God’s creation and purpose of our life’ are some of the topics that come in mind that need to be included in the Health education for children in schools. The old saying ‘today’s youngsters are tomorrow’s pillar for the Nation’ is so needed to be kept in our mind. By saying this it doesn’t mean that there is no teaching going on in school or colleges but a compulsory chapter or lesson need to be taught on this topic. Making every young person understand the value of life is so important. Habit becomes a part of our life. So it’s time to ponder upon what habit our youngsters are learning or imbibing in this generation without realizing the consequences for tomorrow.
Now in this time/era, with much advancement in technology, young people should be doing much more to improve themselves through different websites. However, there is a negative impact of these easily available technologies if it is used in an unhealthy way. Healthy habits in most youth are affected adversely by it. For this reason, we need proper education on healthy habits for a better future which should include HIV & AIDS awareness. We are all aware of the saying “Prevention is better than Cure.” And to a great extent, we can prevent HIV and AIDS if we are aware of the routes of its transmission.
Medical facilities and opportunities, as compared to the older times, is much improved. Compare it to the time when people used bullock cart or walk for long distance, from one place to another, struggling to avail medical facilities. Now Medical facilities are freely available but failing to avail what is freely available due to:
I. Lack of awareness of the importance of regular medical checkup for pregnant women (to rule out various infectious diseases including HIV, Hepatitis B&C and other preventable diseases through early diagnosis and initiation of early treatment) and opting for home delivery in spite of the available facilities.
II. Self-treatment through Google or WhatsApp is detrimental to health.
Yes, I do agree that there are still many places where medical facilities are not available because of the difficult geographical terrains and even if available, accessibility becomes an issue due to poor or improper transport facilities besides financial constraints. Sometimes to get that free available treatment may also mean a costly affair due to these reasons.
On the other hand, even when treatment or medication is freely available, it is still not able to reach to the level where people understands the importance of health checkup for which we need awareness programs to be initiated. Lack of knowledge of the importance of availing medical facilities even when freely available for the people, where transport or money is not an issue, is also something we see amongst the people.
The failure of understanding the importance of health checkup (e.g. the reason for not going to the doctor during pregnancy for health checkup) from the assessment I have done on the clients in my Institute is not because of financial problem or transport problem but rather “I didn’t go for checkup because I didn’t have any health problem. I didn’t felt the need to visit hospital or doctor”. HIV and AIDS transmission could be prevented from mother to child by discussing with the doctor, clearing their doubts and by using safety measures to prevent its transmission. It is very important to understanding all the possible ways by which infection can be transmitted from mother to child and its prevention.
The lack of awareness also leads to a delay in its detection and a client is diagnosed with HIV and AIDS at a late stage where there are already opportunistic infections like T.B., Pneumonia which is very common in many HIV clients.
Annual Health checkup and health awareness program on HIV and AIDS, if it exists in different departments, will also help to convey the message and information on HIV and AIDS prevention and transmission. Not only this but it will also help to detect other health problem like diabetes, hypertension and many more. Off course it might need lots of planning, implementation and funding. But again “Prevention is better than cure” is always good to remember.
Clients and individuals detected with HIV and AIDS need to know the importance about understanding the infection and its consequences if treatment is not taken in time or adhere to once it is initiated. ART initiation is important why?? Not just initiating ART by any medical team but with an ICTC Counsellor in collaboration with a medical team. The individual who is going to take the ART medicine need proper counselling with the involvement of families which is very important for adherence to treatment. It is important for clients to be aware of different opportunistic infection that can happen and this can be initiated with discussion by the treating doctor. Proper adherence to treatment and follow up of treatment schedules, plays an important role in the control of opportunistic infections. Of course, there will be difficult situations but effort is needed on both sides for treatment to be successful.
There are many clients who have initiated ART treatment but when their health condition improves, they quit the treatment thinking they are healed and no further treatment is needed. Some of them also felt that they have received healing through certain prayer groups and stop their treatment but ultimately ends up with opportunistic infection leading to loss of life, which could have been prevented by proper treatment and adherence. Of course death and life is not in our hands but still, it could have been prevented to some extent.
On the other hand, there are clients who have been initiated on ART without proper counselling and education. This has led to negative outcomes and so proper Counseling plays an important role for better outcomes. There are conditions where treatment need to be started according to the client’s condition and safety but it is important at the same time to understand the importance, by the client, the “why” of the initiation and adherence of the treatment. Situation might be challenging at times as giving too much time on taking a definite decision by the client before initiation of treatment might encourage more infection - hence balancing this co-ordination is important between the health care worker and the client.
Understanding the possible side effects of ART is equally important as after initiating the treatment, if adverse effect occur, prior proper counselling will play a vital role in ensuring that the client does not quit the treatment but consult the doctor about it. I have come cross clients who quit ART treatment because of adverse effects and miss follow up with their treating Doctor (after initiating ART) thereby getting opportunistic infection and then losing their life as it was too advanced by the time they come to the Healthcare center. There are also many, who, after proper counselling and education, restart the treatment and are doing well. This emphasizes the importance of follow up after initiation of treatment. If follow up is done at the right time, any problem which arises during treatment can be detected at the right time preventing further complications and also will minimize the cost of treatment too (as treatment in the initial stage is always associated with better recovery time). “I might not able to share the difficulties each individual might go through in the initial stage when treatment is initiated, but later, after the body adjust to the new medicine it is always a blessing” is what some clients have shared.
When I ask some clients about their opinion regarding initiation of ART,’ how they feel or experience health wise’. Some clients state,” Before starting treatment I was feeling very weak, no energy, sickly, feverish. But after initiation of ART medicine all the problems went off slowly, so I feel fortunate to have started the ART at the right time.” On asking the clients whether they would like to share their experience with other clients they are willing and quite happy to do so.” I want to share this benefit with other friends, about getting free medicine and the improvement in my health and discontinuation of all the other intoxicating habits, staying healthy as I am experiencing now” stated one client.
Another thing which is important apart from ART initiation is life style modification which cover a vast area of habits that a person do in their lifetime e.g. food habit modification according to health requirement, exercise, etc. It’s not only medicine but other aspects of life are also equally important to maintain a healthy life.
Sharing the positive status of a client to a family member is important but it requires the consent from the client. This is important in order to plan the treatment as sometimes it’s difficult to face difficult situations alone (we need support from our own family which we can’t receive from others).Some clients stopped treatment as nobody was around from his family or friends to help them get the medicine from the ART center. This could be because of health or social issues like lock down as they have no support system with them. Every individual is unique and different so planning need to be done as per the client’s perspective. Understanding the patient’s situation and also the medical point of view will help to come to a good plan of treatment for the patient.
From my experience, clients do much better if they get all support from family members in different areas like physical, mental, social and spiritual needs but it is always done with the consent from the client respecting their views and ideas. It doesn’t mean that no family involvement means no improvement but sharing and supporting the client by the family members brings a better result as in life it’s difficult to be alone in times of crisis.
In summary, we need to improve and increase our awareness programs and health education by starting it from a young age. In spite of all the efforts from NACO- making medication freely available, awareness pamphlets, etc. why is HIV & AIDS still increasing day by day? We need to re-assess and see in which angle we need to stress upon for prevention. It should not only be the onus of the health care team but every individual in the society, community, organization, Churches etc. need to play a role. If we want to defeat or keep HIV and AIDS under control, like all are joining hands to fight against COVID-19, how about HIV and AIDS?
As the word of God says, “And let us not grow weary of doing good, for in due season we will reap, if we do not give up” - Galatians 6:9
The writer is PC BSc Nurse Counsellor, ICTC (Integrated Counselling and Testing Centre – National Aids Control Organization) CIHSR
ART: Anti Retroviral Therapy for HIV and AIDS
