Interview with Miss Emma

Miss Emma is counselor with the child health department at the Korle Bu Teaching Hospital. She provides psychosocial support for parents with children living with HIV. Much of her work is focused on helping mothers disclose HIV to the children, supporting children to adhere to their anti-retroviral therapy drugs, and supporting adolescents to navigate life’s challenges.

PROFESSIONAL INFORMATION

What do you do?
I work at the Counselling unit. We do retro screening…ie HIV counselling for all our clients/patients that come in. Preamp post counselling (give them the information; they tell you what they know; you correct them on any wrong perception; do the test; relay test results) this helps allay the fears of the individuals taking the test. Help individuals accept the test results. Counselling on nutrition (what to feed the children).  Help Voluntary counsellors with information. Psychosocial care and support (involves the patients in the ward, cancer patients. It includes playing with the patients, doing music therapy, reading therapy, colouring/panting to help patients express their feelings. Helps us to be able to single some children out who are having problems and try to counsel them and direct them appropriately.

An example of a child who benefitted from the psychosocial support system
A 15year old child, who used to be very involved in the therapies but showed up dirty and quiet during one session. I spoke to her and gathered she lived with her grandma. I engaged her grandma and came to the bottom of her problem and gave counsel to her grandma to help her deal with the child. This helped improve the disposition of the child and the grandma too. 

Walk me through a busy day in this unit.
Wednesdays are busy days because they are clinic days. References are made to us from the pharmacy, maternity. We help the new patients to make their folders and follow them up till the end. Counselling the patients who come for their drugs one on one I necessary. We also trying to form a teenage group for children around the ages of 13, 14 who are supposed to go to the fevers unit but don’t fit in well there. We have discussions with them and upgrade their information for children whose condition has been disclosed to them and counselling for the parents of those whose condition has not been disclosed.
 

PARENTING

hat is a tactful approach to deal with children apart from beating and shouting? 
Compromising with the child (meeting halfway). A little pampering and a little straightening. Bargaining and using reinforcement- negative and positive. A little punishment. Give children information so that they can understand their situation more.eg a child who does not want to take his drugs can be told the need to take them and given a reason – like so you can play with your friends – to motivate him to. However, be mindful of the amount of information to share with a children dependent on their maturity level. Solicit the ideas of the children concerning the issues at hand. 

How do I know my child is mature? 
Interact with your child, and pay attention to their contributions. Have time with your child and give them information to guide and ease their growth. Draw closer to your children, so that they are not afraid of you

What is the first thing you say to a child you are going to make aware of his condition? 
You begin by telling him he is sick. Encourage them to take their drugs. Show them movies about people suffering from the same illness and discuss the movie. Gradually ease the children into the information until you finally them what they are suffering from. Tell them the difference between HIV virus and AIDS and educate them about the immune system and the need to take their medicine. Make the process fun for the child. 

How do you help a child stay discreet about their condition? 
Tell them not to tell others and tell them why, to avoid stigmatization. 

A NURSE TELLS HER STORY: COUNSELLING CHILDREN AND PARENTS AFFECTED BY HIV

How did this setting start?
It started in 2009. A group came to fix this place up when HIV started and some nurses were sent for training in Isreal, I was one of them. On our return, we decided to run psychosocial support services in addition to the wards. After one year, we realised it was interrupting with our work. So we decided to get one person here and I volunteered. So we used to schedule other counsellors to come. We also used to go for refresher training. So when Korle-Bu was short of nurses, nurses trained in child health stopped coming to help because they were swamped. I stayed because I was passionate about it. So I decided to go to school and study psychology. I didn’t get a study leave so I was working and schooling simultaneously.

I was then put on night duties so I used to doze off a lot during lectures.one year to completion, I along with three other nurses applied for study leave again, and defended our claim well, so we were granted the leave. So I left this place in the care of another psychologist, Antwi who also loved to stay, and Noami. On completion, I came back here to continue. I had another opportunity to go to Israel in 2013 for an international programme concerning psychosocial support for HIV/ AIDS. When I returned I told my supervisor I wanted to pursue that direction and I made a presentation which pleased him along with other doctors, nurses and the team which were to be involved eg pharmacy. However we had a problem with funding.

In Israel I noticed they had medical clowns who joked with the children and could help the nurses de-stress and this impressed me so I wanted to so the same thing here. Some doctors made some contributions and a few collared people and I started out on my own. Initially, I started with the wards but I realized that the workload was too much. I used to go to the wards to play with the kids, talk and counsel those who had been there for a very long time. My head of department was very interested in what I was doing so she gave me the encouragement. But as time passed, climbing the stairs all the time (I’m lift phobia) became tedious due to aging. So I asked to be assisted by a national service personnel.

I got a new help every year but I later requested for those with a psychological background. Moreover, it got to a time the clinical psychologist did not visit the unit any longer. I met one of them, about three years ago, and told them about the unit and what I have set up and they have been of tremendous help to me. They help me with psychology issues and bereavement etc. Now, we go on the wards and cases are being referred to us; the system is working for us. It is our aim now to get a permanent clinical psychologist.

What are you not able to do because you do not have a clinical psychologist?
If we have them, they can work on the wards. When the wards send cases here the prognosis is very poor. We are not supposed to wait till the death of a child before we call parents. In cases like that, [where the kids have terminal diseases/ have been on the ward for too long] the parents are given counsel before the child leaves, so they (the parents) are aware and bereavement is not a shock to them. So the psychologist could do the counselling whiles I do the testing and other duties.

What are your current challenges?
We don’t have enough toys and stationary

Why do you still do this despite the challenges?
I still do this because I love this and I’m really passionate about this and I’m picky about the nurses that come here- I want those who love children . I am looking forward to someday setting up an NGO which deals with the psychosocial aspect of HIV AIDS for children. Freda, is helping me now. She loves children as well.