Report for Mandalay Care and Support (II) (23.5.11 to 26.5.

11) Objective:
1) To have updated knowledge and understanding on HIV/AIDS management including OI treatment & ART (for care givers including news care givers and RDM) 2) To enhance their counseling knowledge for HIV/AIDS clients.(basic counseling) 3) To strength their home base care activities for PLHA as much as possible

Post Test for Care and Support (1)

We care and support team, did post test for care and support (1) training with 30 questions and answer at the end of that training. All the care givers enjoy answering the 30 questions concerned with HIV and ART knowledge. Most care givers got 27 marks at least. Just now we reflected the answer of these questions.

Pretest for Care and Support (2)

All care givers freely write their knowledge about HIV/AIDS on the flit chat. They have a lot of knowledge about HIV/AIDS. In the pretest check list they write as follow: (1) (2) (3) (4) (5) (6) ART HIV/AIDS prevention TB and HIV co infection STI OI Side effect of ARV drugs

They can also explain detail of the above topics to Radana Myitta s care givers. So Radana Myitta s care givers can catch the care and support (2) training s outline can learns all topics smoothly. (Radana Myitta s care givers didn t attend care and support (1).)

Participants list
No 1 2 3 4 5 6 Name U Kyaw Kyaw Oo Ko Myint Thein Ko San Min Htwe Ko Aung Zaw Zaw Tun Ko Win Htet Ko Naung Naung Designation Care Giver(PDO) Care Giver(PDO) Care Giver(PDO) Care Giver(PDO) Care Giver(PDO) Care Giver(PDO)

7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25

Ko Han Htun Ma Yu Yu Maw Ma Kyi Pyar Nyein Ma Kay Khaing Soe Ma Saw Myat Nwe Ma Khin Myo Myat Ma Nwe Ni Ko Ye Lin Tun Ko Thet Naing Oo Ma Cho Phyu Ma Yin Yin Aung Ma Shar Hmwe Ko Khine Zaw Win Ma Phyo Su Han Ko Phyo Phyo Aung Ex Mon Win Ko Win Ko Aye Mon Win U Kyaw Naing

Care Giver(PDO) Care Giver(PDO) Care Giver(PDO) Care Giver(PDO) Care Giver(PDO) Care Giver(PDO) Health Promoter(R II) Health Promoter(R II) Junior field facilitator Senior field facilitator PDO Nurse PDO Nurse Care Giver(WJ) Care Giver(WJ) Care Giver(WJ) Yadana Myitta Yadana Myitta Yadana Myitta Care Giver(WJ)

Detail report for each day(23.5.11 to 26.5.11)

Date 23 May 2011 Time 9:00 - 9:30 Topic Welcome and Introduction Section report Dr. WYS introduce herself and introduce the attendances each other. Dr. WYS explain the general concept of the training. We care and support team, did post test for care and support (1) training with 30 questions and answer at the end of that training. All the care givers enjoy answering the 30 questions concerned with HIV and ART knowledge. Most care givers got 27 marks at least. Just now we reflected the answer of these questions.(post test C&S 1) All care givers freely write their knowledge about HIV/AIDS on the flit chat.(pre test C&S 2) They have a lot of knowledge about HIV/AIDS. In the pretest check list they write as Facilitator WYS

9:30 - 10:30

Pretest of training C&S(2) Post test/Review of C&S (1)

WYS

follow: (1) ART (2) HIV/AIDS prevention (3) TB and HIV co infection (4) STI (5) OI (6) Side effect of ARV drugs They can also explain detail of the above topics to Radana Myittas care givers. So Radana Myittas care givers can catch the care and support (2) trainings outline. (Radana Myittas care givers didnt attend care and support (1). 10:30 10:45 10:45 12:00 Tea Break IRIS By group description and interactive participation

Dr. WYS ask their knowledge status of IRIS. Most attendances can discuss some cases of IRIS.(cases from PDO & WJ) Dr. WY explains the detail facts of IRIS with power point presentations. In this section, Dr. WY explains what is IRIS, the patterns of IRIS and example of IRIS. In the group work, all attendances have to divide into three groups and discussed about the participation of PLHA in the HIV/AIDS prevention and care/support activities and its effectiveness. Then Dr. WY presents power point slides and interactive discussion about this topic. First all attendances and facilitators discuss about STI/RTI and their sign and symptom. Dr. WY explains the sign and symptom of STI and RTI and syndromic management for STI. Attendances can learned some photos of some STI symptoms. The participants from Yadana Myitta like all topics because they didnt know these topics before training. Most attendances like IRIS topics and they said they can guest the causes of dead patients on ART. They also like the photos of STI (all attendances and Dr.WY discuss the topics from Day (1) Dr.AMT prepares 10 questions and answers about HIV/AIDS knowledge. All attendances have 20 minutes to answer and then Dr. WLA explain the questions. Dr. WY helps as co facilitators. Most attendances didnt know child ART

WYS

12:00 13:00 13:00 14:30

Lunch Group Work Empowerment for SHG

WYS

14:30 15:00 15:00 16:30

Tea Break STI Group discussion and Interactive participation

WYS

16:30 17:00

Day (1) evaluation

24 May 2011

9:00 9:20 9:20 10:20

Reflection Problem solving with case study

WYS Dr.AMT/Dr. WLA

10:20 10:40 10:40 12:30

Tea Break Child ART

WYS

Interactive power point presentation

clearly. So Dr.WY explains about child ART with the topics of (1) when to start child ART? (2) What to start? (3) How to start? and (4) how to manage? This section is also new topic for CGs and so Dr. WY leads the discussion. In this section, the attendances can learn (1) what is occupational PEP, (2)non occupational PEP, (3) PEP regimen and management, and (4) what is PrEP? Again, this section is new topics and all participants have to learn first. In this section, the attendances can learn (1) What is failure and when to change second line? , (2) How to change? , (3) what to change? , and the knowledge of some second line drugs? Can see in Final evaluation WYS

12:30 13:30 13:30 15:00

Lunch PEP

15:00 15:15 15:15 16:30

Tea Break Resistant of ART

WYS

16:30 17:00 Day III Date 25 May 2011 Time 9:00 - 9:30

Evaluation Topic Welcome and Introduction

Dr. TTT explains the concept of the basic counseling training. discuss about psychological, social support What will do in two days? y let the participants to write down their expectations on papers and posted them on flip chart y pre test for their existing knowledge on basic counseling y explain about the objectives of the training so that the participants might be motivated to participate actively y explain about the agenda and asked what issue that the participants do not understand Pre and post test results Pre test 10 questions Attempt = 24 participants 10 marks= 1 9 marks= 13 8 marks= 5 7 marks= 3 6 marks= 2

Facilitator TTT

9:30 - 10:00

Expectation and Ground Rules Pre-test, Training overview and objectives of training

TRMA

Post test 10 questions Attempt = 22 participants 10 marks= 11

10:00 10:30

-What is counseling? -Relative concept of counseling

9 marks= 6 8 marks= 4 7 marks= 1 y can discuss well on what counseling is y what adherence is y communication and conversation between two persons y confidentiality is important y option exploring y decision making by client himself y doing in behavior change by client himself in BCC y not include counselors concepts and physical helpings y not an ordinary conversation or an psychological therapy y psychosocial problems are very complicated and delicate y a kind of building of a helping communication y have an objective y active listening y let the client to tell his/her problems y finding the options to solve the problems y exploring his/her occult strengths y leading to positive sight y example of a glass of half full water y health education is absolutely not a counseling y everyone cannot be started with counseling, some cases should start with HE y it is not blaming, investigation, deciding, directing, teaching, advising, promising, persuasion, arguing y some objectives are: for behavior change, could control well the feelings, could decide right decisions, live appropriately with environment, to explore occult strengths y four helping styles y confidentiality issues y disclosure issues y cultural and contextual issues y y y y y y y Active listening Open questioning Summarizing Briefing Optioning Mutual respect Understanding

TTT

10:30 10:45 10:45 11:30

Tea Break -Objectives of counseling -characteristics of effective counselors

TTT

y y y y y 11:30-12:00 Skilled helper model y

Value respect Cultural and contextual respect Boundary and limit keeping Know his limit Taking safe side of him TRMA

Explain about what the skilled helper is y A skilled helper could help a client to know: (1)what the problem is, (2)what he wants to do, what is needed and what he wanted to be (3) what his strengths are and what should he do to achieve them (4) how should he do to get good results or being better y y Example giving on skilled helper model Option giving exercise on skilled helper model

12:00- 12:30

Counseling environment

y y

y 12:30 13:30 13:30 15:00 Lunch Counseling skills

Discussion about the places where the counseling can be done It may be any place where the counselor and client feel safe and comfortable Brain storming of participants about how to decorate as if they have to have a counseling room How to prepare the counseling environment at hospital or any large room Ideas about some standard counseling rooms group work on listening and just hearing listening carefully can cope all the essence of a topic and can repeat or summarize well and just hearing cannot cope well and cannot repeat or summarize well group work on how good at listening on story telling it was obvious that listening carefully is quite difficult and repeat or summarize again is quite hard problems observer role is also important to evaluate the counselors quality of listening actively

TRMA

y y

TTT,TRMA

y y

y y

15:00 15:15 15:15 16:30

Tea Break Counseling skills

16:30 17:00

Wrap Up

group work on counselor, client and observer role play y firstly, counselor have to listen only and not to tell anything to client even a question y exploring about their feeling of being in each roles y then rotate the three roles let the counselors to ask some open questions to be obvious the problems y then exploring again about their feeling of being in each roles listening without having any chance to ask some open questions might be found difficulties in exploring clients all participants can discuss well about learned sessions on basic counseling Evaluation was made on three questions: y 1. What did you learn today? 2. What are useful in your work? 3. How does it get better?

TTT,TRMA

TTT

Day IV 26 May 2011 9:00 9:20 Reflection Dr. TMA take reflection from the participants for Day 3(25.5.11) y sitting in a circle and each tells that what was left in mind from previous day sessions all participants can discuss well and they can memorize the essence of basic counseling skills Dr. TTT present the concept of the problem solving y Counselors always has to find clients problems y Psychological, social, mental, physical and emotional problems y Sometimes bad desires evolved firstly due to problems y Problem tree analysis (1) emotions, complications, side effects at branches of a tree(2) main problem at trunk of a tree and(3) causes of problems at root of a tree y Exercise on problem tree with own cases y Four case presentations in problem tree exercise : (1) a man being scared after doing risk behavior (2) a youth who failed 10th standard exam (3) a young couple who didnt marry y TMA

9:20 10:20

Problem solving in counseling

TTT

yet and the girl got pregnant (4) a man who being felt with skin infection 10:20 10:40 10:40 12:30 Tea Break Problem solving in counseling (continued) Counseling steps 3 groups discuss for problem solving tree and present by each group. y Exercise on problem tree with own cases y Four case presentations in problem tree exercise : (1) a man being scared after doing risk behavior (2) a youth who failed 10th standard exam (3) a young couple who didnt marry yet and the girl got pregnant (4) a man who being felt with skin infection y y y y y y y y y y exploring the ethics which a counselor should have the most important issue is confidentiality boundary issues are also important value difference issues taking safe sides not to manipulate the client know the limits do no harm know the limits of the counselors themselves how to care oneself among counselors TTT

12:30 13:30 13:30 14:15

Lunch Self care and ethical issues in counseling

TTT TRMA

14:15 15:00

Role Play

4 groups prepared for role plays. Their role play topics are the topics from problem tree. 4 groups acted in role plays. Their role play topics are the topics from problem tree. y all participants can discuss well about learned sessions on basic counseling y post test for assessment of knowledge and skills what they have learnt during training and how they have developed after the training

15:00 15:15 15:15 16:30

Tea Break Role Play

16:30 17:00

Wrap Up, Post test

TTT

Final Evaluation on Basic counseling training at PDO, Mandalay

(1) y

What did you learn from the training? Basic facts that should follow and avoid during counseling

y y y y y y y y y y y y y y y y y y y (2) y y y y y y y y y y y y (3) y y y y y y y y y y y y y y y y y

Client centered approach Optioning Let the client to decide What is counseling? Practice makes perfect Listening is the most important skill Characteristics of a good counselor Helping styles Listening rather than questioning Listening Vs just hearing General counseling skills not only focus on HIV Counseling environment and setting Questioning skills Counseling leads to emotional support Welcoming is half cure of a client Problem tree analysis Counseling is never perfect Knowing self strengths and weakness in role play

what lessons will be useful in your work? Client centered approach Problem solving At home based care Being more confident in counseling Not only to client but also in daily social life Listening skills Counseling cannot be done to everyone Role plays help a counselor to evaluate the needs Empathy to a client No discrimination between counselor and client (e.g. sitting position and chair) Always learning Self care what should be done better? Review of lessons should be done very often Games or energizers after lunch Also want to get end stage counseling training Two ways discussion, brain storming and group works are very good for learning Less sitting lessons were better Want to get more training days (more than two days) More humors and stories Very hot in training room More practice sessions Pure counseling training more trainings concerned with counseling more role plays want to attend training at Sagaing (WJSH) more time on role plays exposure visits to other sites trainings always in PDO is boring so it is better in WJSH or other sites everyone should act as a counselor in role plays

y y y y y

some group members are selfish advanced counseling trainings ART counseling More facts about a good counselor in C & S III More for more practical sessions

Pre and post test results Pre test 10 questions Attempt = 24 participants 10 marks= 1 9 marks= 13 8 marks= 5 7 marks= 3 6 marks= 2 Post test 10 questions Attempt = 22 participants 10 marks= 11 9 marks= 6 8 marks= 4 7 marks= 1 Final Evaluation for Care and Support topics Most attendances like PEP topics, IRIS, child ART and second line ART, but they feel a little difficult in studying second line ART because it is new topics. They also like the questions and answers section by Dr.AMT and Dr.WLA. The problem of the training is that all attendances and facilitators face hot weather for the whole training days. All attendances propose to add more game in the training. We care and support team, also make score for care and support (2) training.(post evaluation) If the training is very useless, the trainees can mark score (1). (strongly)----------------------

If the training is useless, the trainees can mark score (2). ---------------------------------------If the trainees don t want to say anything, the score may be (3). -------------------------------If the training is useful, the score may (4). ------------------------------------------------------------If the training is very useful, the score may (5). -----------------------------------------------------All attendances give the score of (4). (25 attendances)

Prepared By: (1)Dr. Wut Yi Soe STO, C &S, BI-MM

(2) Dr. Thura Mg Aye T.O, PSS, BI-MM

Memories of C&S II, PDO/WJ, Mandalay