Photo: Glenna Gordon/IRIN Counsellors can be affected by clients' emotional reactions to HIV-positive test results
NAIROBI, 21 May 2010 (PlusNews) - The Kenyan government has won praise for a national door-to-door HIV testing drive that aims to test 80 percent of the population for HIV/AIDS by the end of 2010, but once-enthusiastic counsellors are beginning to show signs of burnout.
Weighed down by the heavy "counsellor's kit", thousands of volunteers walk or cycle long distances in heat or rain, sometimes dealing with difficult clients and having to ask uncomfortable questions.
"At times one wonders whether to discuss HIV testing or to help families deal with matters at hand; how do you deal with a family that tells you they haven't eaten for days, or where a member is bedridden or one whose house is flooded?" asked Judy Nyambura, a counsellor with the national NGO, Liverpool Voluntary Counselling and Testing Care and Treatment (LVCT).
"Other times, we encounter drunkards, idlers and criminals, making personal security a concern; burnout is obvious when one is overwhelmed by the field."
Feelings of frustration
"As a normal human being, when you start off the day with such clients, you may get frustrated or fatigued and may find it hard to support any other client soon after," Nyambura added.
For Joseph Otieno*, a counsellor for a Kenya Medical Research Institute-US Centres for Disease Control programme based in western Kenya's Siaya District, the job can be as frustrating as it is rewarding.
"Some appreciate my work, welcome me and I take them through the procedures and get to test and explain the results," he said. In other instances, families, and men in particular, were reluctant to be tested.
"I have encountered clients who tell me off, claiming that we [health workers] are there to spread HIV using the 'pricks'. Others say, 'when I am sick I will go to hospital', or 'I am too old to get HIV'.
"At such times, or when clients skip appointments for no good reason, I feel tired and worked up... It is the same when you wake up to get a series of HIV-positive results at the start of the day - you get stressed and feel like not going on," he added.
Dealing with discordance
Particularly difficult is dealing with married couples - one of the main targets of the drive because of the rising rate of infection among them - especially when one tests positive and the other negative.
"Discordance is a challenge to a counsellor... you need more time with the couple to have them understand the result," said Maryanne Wanjiru, who heads a team of 15 counsellors and 20 community health workers in an LVCT home-based care and treatment programme in the slum of Kawangware in the capital, Nairobi.
"There are issues of acceptance, they may blame each other; we do not wish the family to break up," she added.
Funding problems
In an April 2010 article in the British medical journal, The Lancet, Nicholas Muraguri, head of the National AIDS and Sexually transmitted infections Control Programme, is quoted as saying Kenya has fewer than two-thirds of the counsellors needed to meet the goals for this year, and is struggling to pay them.
"We try to budget to pay for them but it is not sufficient," he said.
In an interview with IRIN/PlusNews, Muraguri acknowledged that a counsellor's job was not an easy one: "Door-to-door testing is very involving and there are challenges where HIV is very high," he said. "It can be stressing through physical stress such as counsellors walking long distances."
Caring for carers
According to LVCT's Lucy Njuki, when the emotional or physical stress of the job is overwhelming, counsellors are urged to seek guidance from their supervisors or their peers. Every week, LVCT counsellors meet their supervisors to go over any issues they feel they need help with; counselling is available.
Kenya's national testing guidelines recognize that home testing and counselling "can be challenging not just for the client, but also for the service provider". They recommend steps be taken to prevent burnout, including support supervision by senior counsellors, refresher training and group meetings, and appropriate support services.
* Not his real name
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