Caring for Others

Caring for Others

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:

Website:

Home-based care handbook

Contents

Introduction

Section 1: Finding out about HIV&AIDS

Why is everyone so worried about HIV&AIDS?

What is the difference between HIV and AIDS?

Where does the virus live and what does it do to the body?

Why is there no cure for HIV?

There is no vaccine against HIV

How does the virus spread?

Blood

Semen and vaginal fluid

Mother to baby

How is the virus NOT spread?

How can a pregnant woman prevent HIV spreading to her baby?

Prevent re-infection

Get medication

Don’t give birth at home

Feed wisely

How can I protect myself from getting infected?

No sex

Stick to one sexual partner

Stick to a sexual partner of about your age

Use condoms

Take the test!

Talk about it

Who is the most at risk of getting infected?

Sexually active people

Babies

People who share instruments that have touched blood

What is safe sex?

Very safe

Safe

Unsafe

How will I know if I am infected and what will happen?

How long will I live once I am infected?

Stages of infection

What can I do to live positively?

Know yourself

Get support

Get the facts

Take special care of your health

Get medication

Live in hope

What are my rights as an infected person?

Informed consent before testing

Confidentiality

Treatment

Employment

Education

Knowledge and information about safe sex

What can I do to help in the fight against HIV&AIDS?

Don’t

Where can I get help and information?

Section 2: Common health issues and illnesses

Antiretrovirals

Combination therapy

Resistance

Side-effects

Alcohol abuse

Allergies

Signs and symptoms

What must you do?

Anaemia

Arthritis

Asthma

What must you do?

Bed sores

Bleeding

Light bleeding

Heavy bleeding

Blood pressure (high)

Bronchitis

What must you do?

Burns

What must you do?

Cancer

Chickenpox

Signs and symptoms

What must you do?

Choking

Signs

What must you do?

Cholera

Signs and symptoms

What must you do?

Colds and flu

Signs and symptoms

What must you do?

When must you get medical help?

Constipation

Coughs

Disability

Dehydration

Signs and symptoms

What must you do?

Rehydration solution

Rehydration solution dose (how much to give)

Diarrhoea

Signs and symptoms

What must you do?

When must you get medical help for diarrhoea?

Drowning

Fever

What must you do?

Food safety

Don’t

Headaches and migraines

What must you do?

Heart attacks

Signs and symptoms

What must you do?

Hepatitis

Signs and symptoms

What must you do?

HIV

Lightning strikes

Malaria

What must you do?

Malnutrition: undernutrition/overnutrition

Maternal conditions

Measles

Mental health problems

Causes

Meningitis

Mumps

Signs and symptoms

What must you do?

Complications

Pneumonia

Signs and symptoms

Rabies

Sexually transmitted infections (STIs)

Signs and symptoms

What must you do?

TB (Tuberculosis)

What must you do?

More about DOTS

Tetanus (lockjaw)

Universal precautions

Vomiting

What must you do?

When must you get medical help for vomiting?

Water

Make water safe for drinking

What must you do?

Worms

What must you do?

Section 3: Introduction to counselling skills

What is counselling?

Counselling is …

Counselling is not …

Why do people need counselling?

Your role in the counselling process

Stage 1: Help the person to tell their story

Stage 2: Help the person to consider their current options

Stage 3: Help the person to make an action plan

Stage 4: Help the person to commit to implementing the plan

Characteristics of an effective counsellor

Two poor counselling sessions

What are the characteristics of a good counsellor?

How should a counsellor act during a counselling session?

What should a counsellor avoid doing?

Counselling skills: Reflective listening

Step 1: Reflection of content (also called summarizing)

Step 2: Reflection of feelings—these may be explicit (i.e. clear) or implied (i.e. suggested)

Counselling skills: Asking questions

Some common errors in questioning

1.Asking too many questions

2.Closed questions

3.Leading questions

4.Questions that probe too deeply, too soon

5.Poorly-timed questions

6.“Why?” questions

An effective counselling session

Working with children who have been abused

The safety of the child

The health needs of the child

Disclosure and communicating with children

Disclosure

Why don’t children disclose abuse spontaneously?

Why don’t children make a full disclosure?

Child abuse accommodation syndrome

Things to think about before your interview a child

The interview

Feelings that children may find difficult to manage after abuse

Section 4: Taking care of yourself

What is stress?

Assess your stress levels

Identifying and assessing negative stress

Causes of stress

Effects of too much stress

Getting “hooked-in” and burning out

Signs of being hooked-in

Signs of burning out

So … what is “normal”?

Ways to cope with stress and care for yourself

Assessing how you manage stress

Debriefing support group

Relaxation exercises

Answers

Two poor counselling sessions (Answer)

An effective counselling session (Answer)

Contact list

Home-based care handbook

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 avaccine.
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 itdoesn’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:

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 anexperienced 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’tshow 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.