The focus of this time period has been the need for psychosocial support to staff within our projects.
In Manipur, the team struggled with an unexpected tragic event. Meanwhile, in Kashmir, increased tensions in the area caused a great deal of distress for the team there who are running a mental health counselling project.
For me, this meant my role saw a bit of a shift from being a manager to providing psychological first aid to the Manipur and Kashmir teams themselves.
Psychological first aid
Psychological first aid (PFA) is an evidence-based approach for responding to traumatic events, with the aim to reduce initial distress and foster coping.
It suggests that individuals may be impacted by such events, causing a wide range of reactions (emotional, spiritual, behavioural, etc.) that can interfere with coping. However, it does not pathologise these reactions and instead suggests that a supportive and compassionate approach to addressing an individual’s psychosocial needs can assist in recovery.
For me, providing PFA/psychosocial counselling, particularly in crisis situations, is one of the most rewarding aspects of my job as a clinical social worker.
It has been a shift being in a non-clinical role within the project, so it felt good to be able to use my clinical skills to support the two teams and to hear the appreciation for the counselling support.
Compassion and support
What I observed in both our teams was a great deal of compassion and willingness to support each other through a difficult time. I also noticed how important faith and religion are to the majority of our national staff in the two locations of these two projects.
Within MSF, we are committed to impartiality which allows us to provide assistance regardless of religious affiliation. However, for many of our staff, outside of working hours, spirituality is a source of strength and resilience in challenging times.
Finally, I was impressed by how each team continued to be committed to their individual projects, despite their own struggles.
In Kashmir, in particular, staff frequently spoke of their work with MSF as being incredibly meaningful. It seems to me that they recognise the importance of providing mental health counselling in the communities MSF serves and feel they are contributing positively to a difficult situation.
I felt extremely fortunate to have had the opportunity to support the lovely Kashmir team.
Outside MSF, I’ve had my own loss. Remember my sweet dog, Rudy, from my first post? She passed away in March. The pet owners out there will understand - our pets are cherished members of our families.
It was extremely difficult to say goodbye and not be with her when she died. I’ve had my fair share of tears since but I feel so lucky to have had the time I did with Rudy in my life.
It seems strange to switch gears from talking about loss and struggle to the project itself. However, a lot has been happening in the Manipur project in the last five weeks.
World Tuberculosis (TB) Day was celebrated on 24 March however our projects celebrated on 5 April with the inauguration of our new clinic in Chakpikarong and in Moreh on 6 April with a community event and football match! March saw a significant increase in outreach and health education activities on TB as we prepared for the events.
Changing HIV treatment
There are big changes coming to the project as we are gearing up to implement a "differentiated model of care for HIV treatment." Wondering what this means?
Within the current model, patients attend the clinic at the same frequency and see all health care providers (counsellor, nurse, doctor) regardless of their health needs. This means long waiting times and high patient volumes in the clinic.
In the differentiated model, a patient-centred approach is taken in which individual treatment plans will be developed based on a patient’s care needs. For stable patients, this means fewer clinic visits - with two clinical consultations a year (one doctor visit and one nurse visit) and two ART (antiretroviral therapy) pharmacy visits.
These changes will significantly reduce the barriers patients face to accessing care - such as the financial burden of travel and loss of daily wages due to clinic visits.
It is also a more empowering approach towards care which normalises the experience of living with a chronic disease.
On the clinic side, it will allow the team to focus more time and energy on the patients with complex medical and psychosocial needs.
Meanwhile, for the project as a whole, it will free up staff to engage in new activities focusing on “key populations” (high risk groups who are often underserved) such as the intravenous drug user population in Manipur.
It will be a big shift in how HIV care is delivered here in Manipur, however, I think this will be a positive change for both staff and patients.
Differentiated models of care have been used in a number of other MSF projects. For more information, MSF SAMU (https://samumsf.org/en/resources/hiv/differentiated-art-delivery ) has lots of great information on differentiated ART delivery.