How community counseling turned the tide of HIV/AIDS in Africa

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How community counseling turned the tide of HIV/AIDS in Africa

  1. 1. HOW COMMUNITY COUNSELING IN THE 1990’S TURNED THE TIDE AGAINST HIV/AIDS IN AFRICA: WRITING HISTORY TODAY. MacDonald Chaava Feb, 2014
  2. 2. How Community Counseling Turned the Tide 2 In the darkness, a candle • In the late 1980s and early 1990s the heart of Africa was very dark because of HIV/AIDS • In the most unlikely place, lessons from the most unlikely programs began to turn the tide • One community at a time, many communities • Zambia, Uganda, Zimbabwe, Kenya, Nigeria, Ghana, Tan zania…
  3. 3. How Community Counseling Turned the Tide 3 What History Will Say o The story of HIV/AIDS would have been written differently because there was no cure, no hope o More people died than necessary o There was no short-cut; no easy path o Community counseling turned the tide in the 1990s o The credit goes to a small hospital in rural Africa for thinking out-of-the-box
  4. 4. How Community Counseling Turned the Tide 4 Testing and Counseling • A snap survey of hospital inpatients HIV status concluded: • • • • • We Have a Problem!! Thinking out of the box: start to warn people through counseling Start Testing and spread the word Testing and counseling for individuals was established Train health workers and prepare counselors Rotate counselors to handle increasing workloads
  5. 5. How Community Counseling Turned the Tide 5 Testing and Counseling for Individuals • Tens of health professionals including Clinical Officers, nurses, para-medical staff trained as counselors in hospital • Local teachers from primary and secondary school trained as HIV/AIDS counselors
  6. 6. How Community Counseling Turned the Tide 6 Increasing Workload • Men, women, children of all ages diagnosed, many • • • • admitted to hospital Some sick at home in the villages Some are critical, come to hospital, are admitted, begin to clog the system More loved ones waiting on the sick Hospital grounds become overcrowded
  7. 7. How Community Counseling Turned the Tide 7 Find out What People Want • A simple survey determined where patients wanted to die: At Home, NOT in the hospital • Explains why people want to die at home • Preparation for transfer of counseling model from case management to community counseling • Offer by donors to build a hospice turned down
  8. 8. How Community Counseling Turned the Tide 8 Patients Want to Die At Home; Not in Hospital! • A simple Social worker’s survey determines where • • • • patients want to die, and Why At home they are in familiar surroundings At home they are surrounded by loved ones At home the loved ones can watch over their sick ones and also do field work At home, all the extended family members can come at any time
  9. 9. How Community Counseling Turned the Tide 9 Patients Don’t Want to Die in Hospital! • A simple Social worker’s survey determines why patients • • • • • don’t want to die in hospital In hospital they are surrounded by strangers In hospital it means all their loved ones must leave home to watch over them Loved ones cannot do their field work; there will be no harvests In hospital, only few of the extended family members can come at any given time “People go to hospital to get well, not to die”
  10. 10. How Community Counseling Turned the Tide 10 Counseling for Communities! • Practical lessons learned from ongoing leprosy • • • • • rehabilitation are tried out in the HIV/AIDS work Birth of Home Based Care: Transfer of care from Hospital to Household The problem with HIV/AIDS is defined as an intricate social dynamic that can only be unraveled through an equally sensitive culture-centric approach Community counseling started Integrated multi-sector approach to HIV/AIDS established with Chikankata Hospital as the hub AIDS Training for international participants took root at Chikankata Hospital
  11. 11. How Community Counseling Turned the Tide 11 Why Community Counseling Works • Provides space for people to identify themselves as a • • • • • • • • community Allows people of various tribes (ethnic groups), age, and gender to think together Provides safe spaces for community members to speak their minds Provides a place where people cannot be “wrong” Provides a place where every voice counts Provides a place where people can laugh at themselves without feeling ashamed Provides spaces for community to process what is going on Creates space for community members to be accountable to one another by mutual agreement Helps community to look HIV/AIDS in the face: the stigma, the loss, the orphans, the widows, the faith, and so on
  12. 12. How Community Counseling Turned the Tide 12 How Community Counseling Works • Counseling is based on relationship • Trained facilitators enter relationship with community • Facilitators help community to begin a journey together • Entry of facilitators into community is by invitation, recognizing role of community leadership • Entry is preceded by enrollment of leaders, explaining why this journey is important • Facilitators use a strategic framework built solidly on relationship • The framework for community counseling begins with relationship building, extends into problem identification, exploration, action, and review
  13. 13. How Community Counseling Turned the Tide 13 What was apparent • Anecdotal evidence showed that community counseling • • • • • • was well received Communities were willing to do this Faith groups did not separate people, instead strengthened the bonds of community Community counseling reduced the friction within community Community conversations were very well attended Community conversations generated immense talk at funerals, at school, in church, and around the fireplace and in bedrooms Community conversations brought hope of a new sun-rise
  14. 14. How Community Counseling Turned the Tide 14 The Facilitator Is not a leadership, political, or religious position • Has knowledge and skill-set necessary to drive the • • • • • community counseling process Knows to respect the relationship with community A typical community counseling facilitator is a member of the community Is trusted by the community Is recognized by the community as their voice Is the conscious of the community, reminding of commitments made by the community
  15. 15. How Community Counseling Turned the Tide 15 Why History will look back at the 1990s as the Turning Point • Community counseling helped many across Africa to face their fears and overcome their inhibitions • Faith Based Organizations, Governments, NGOs, and Community based organizations took up HBC and components of counseling • The Community counseling model was rapidly taken to scale across Sub-Sahara Africa, Thanks to the Salvation Army
  16. 16. How Community Counseling Turned the Tide 16 What I discovered about my African heritage (1) My first week in England I might have been at the bus station waiting for a bus with the bus schedule in my hand, and yet, I probably turned to the guy standing near me and asked, “What time is the bus coming?”
  17. 17. How Community Counseling Turned the Tide 17 What I discovered about my African heritage (2) • You see, it was not about the bus… or the schedule… it was about relationship: I wanted the guy to know me, I wanted to know him so that if we met again we would greet and say, Hi! I know you! I am your friend. • Generally the people I did this to, hated it. They probably did not want to be known by me. They did not want to know me except as the figure who stood near them.
  18. 18. How Community Counseling Turned the Tide 18 What I discovered about my African heritage (2) • In my African heritage, I tend to value relationships, trust, care, love… • I am always conscious of relationship. It is hard work not to relate with people; it is hard work just standing there with all the strangers without looking into each other’s eyes and wondering or asking, “Do you have a mother who loves you? Are you okay today? Can I be your friend?”
  19. 19. How Community Counseling Turned the Tide 19 HIV/AIDS makes people lonely: Community counseling counters by building relationships Across Africa you heard sayings like these: • You are my brother/sister; I may not know you, you may not know me • Ubuntu • I am, because you are • You are not alone; it will be okay • No one should die alone • No community should stand alone • The Answer Lies Within • You can build highways and freeways; people will continue to walk the byways
  20. 20. How Community Counseling Turned the Tide 20 And the Verdict: History We have to wait until history is born in 2028! THE END

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