There is something unusual about public hospitals; sad and angry faces, the medicinal smell to sinister thoughts that easily come to mind every time you hear people in one corner break down. One needs a strong heart to work within these walls. Yet at times, such cries come from counsellors’ rooms, especially those that deal with HIV testing and counselling.
In places where counselling is still valued, the counsellor will have a one on one session with each client before delivering the results.
Rachel Buteme, a counsellor with AHF Uganda Cares, says counselling is a core element in the universal model of healthcare that deals with a client on a psychological but mostly personal level.
She says since a number of HIV positive patients first live in denial, she has personally dealt with many showing up to prove that their previous positive result was not a mistake.
“You have to get them to accept the situation and later tell them about the medication. The whole process involves getting into their personal life and understanding their story,” she says. Yet as every counsellor tries to understand each client in order to find ways of helping them, they unknowingly leave themselves psychologically exposed. Buteme says counselling may be important but has been largely ignored both at workplaces and policy level. “We are a forgotten category of health workers that is rarely defended or even remembered,” she says adding that although it is advisable to handle only five sessions a day, many find themselves almost doubling that number.
And of course, with every session, a counsellor interacts with real stories, contradicting beliefs and questionable decisions by their clients, yet as by their ethics, they are not allowed to be judgmental. “One time as I counselled a young man who told me that he was in a relationship with a school boy,” says a one Musa, a counsellor.
According to his Islamic faith, he has no reason to even listen to a gay person, yet as a counsellor, he does not only listen but advise them on the importance of practicing safe sex.
Buteme says matters become complicated when they have to deal with children that were not born with the HIV virus. “There are times we address children between 15 to 17 years that are sexually active,” she says, adding that of course, most of the time it is easy for counsellors to assume that the said client was raped or abused, yet when they discover they are simply active with multiple partners, they are heart broken.
“Such cases stay with you. Even when you go back home, you will think about this young girl and whether she truly understands the implications of her decision,” she says.
Over the years, the biggest documented challenge therapists and counsellors face has been exhaustion stemming from various emotional hazards and job overload.
Herbert Kimala, a counsellor since 2010, says while doing their job, they tend to focus on their clients’ wellbeing and the fact that they work for long hours, they are exposed to high levels of stress. “You will deal with many people and most of the time, forget to deal with your own problems,” he says.
Counselling being a compassionate service, the care they give most of the times gets clients attached to them.
“When you deal with a client, they will want to always get services from you because they believe you understand them. It becomes personal,” he says adding: “You may deal with a child, you see them come from the worst stages and when they start getting better, they die.”
He notes that this leaves many of them frustrated. Sadly, he has had to deal with many of such situations, people whose lives have been shuttered by a positive result to those whose families put all their faith in him but still died. “While doing our job, we usually tell people it will be fine as long as they take their medication but when they die, their families take you for a liar,” he says.
“In a month, you will carry out 60 sessions and they are likely to break or harden you,” says Buteme. She adds that some counsellors have made HIV and the clients a new normal that they can freely test people or handle blood without even using gloves.
“… you end up being indifferent when you disclose a status to a client. Sometimes you see them cry after receiving their results and for you that is normal,” she says.
Of course, even the normality of working with clients all the time cuts on the socialisation with the outside world; “There are times patients think you are infected too and thus start making relationship advances,” says Buteme adding that at times, it becomes hard to tell them you are not infected because that may force them to reject your care in future.
Musa says the years he has been working as a counsellor, have made him question humanity because some people are highly dishonest.
“I have talked to respectable women that are married and have multiple partners. Some do not even have any remorse even after revealing that they have infected their partners with HIV,” he says.
He says most of the time, one partner is hell-bent on seeing another partner’s positive result and yet as a counsellor, when the two show up for testing, the confidentiality bars you from disclosing results.
“With confidentiality, you will find a client in a bar with about two young women but because he knows that as a counsellor you cannot out him to the unsuspecting girls, he continues with the reckless behaviour,” says Musa.
“Such information and situations most of the times forces them not to have friends and lose trust in people, Musa says adding that a number of male counsellors do not trust women and resort to staying single.
Counsellors and therapists do a job where their biggest weapon is their own awareness. Much as they learn and practice self-regulating skills to suppress their own baggage, most of the times they need interventions.
Rachel Buteme, a counsellor with AHF Uganda Cares, says it would be nice if counsellors get time off in form of retreats to fully refresh. “At the moment we get days off but even then, clients will still call you to make inquiries or ask for advice,” she says.
According to Patrick Tayebwa, a counselling psychologist at Serenity Centre, the practise has a guideline where every counsellor should have a supervisor.
Tayebwa also recommends personal counselling, which is more of a process of self-discovery and growth, but above all, he says peer supervision could also be good. “Some may not feel comfortable talking to counsellors they know but that is when they should use the help of supervisors to recommend someone,” he says adding that every counsellor or therapist needs a person watching over them.