Importance of Counselling in Community Outreach Programme

Role of a patient - counsellor in outreach programs

In a screening eye camp, the patients undergo various clinical examinations and finally the ophthalmologist advises for (Fig. 3.1).

• Cataract surgery
• A pair of spectacles
• Medicines
• Specialty treatment in base hospital

The medical team attending the screening eye camp should have a place for counselling and a counsellor is a part of the medical team. The patient counsellors have a very high degree of accountability in terms of:

• Patients’ satisfaction
• Surgery acceptance rate
• Spectacles acceptance rate
• Specialty referral acceptance rate
• Surgery follow up acceptance rate

The productivity of the camp in terms of number of admissions, acceptance of spectacles and specialty referrals highly depends upon the counsellor’s communication skills.

Responsibilities of a patient - counsellor in eye screening camps

In the camp, at the final stage of examination, the patients are guided to counselling area for persuading them to follow doctor’s advice. The counsellor who attends the camp has the following responsibilities.

• Collect the patients after final examination to counselling area with the help of a volunteer
• Refer to the details of diagnosis made and what the doctor has advised to improve vision
• Interact with patients and build up a trust on counselling
• Explain the nature of eye problems and what kind of action should be taken
• Clarify the doubts regarding treatment
• Explain the need for spectacles to correct the refractive errors
• Educate the patients about cataract, duration and method of surgery, benefit of intraocular lens and future benefits
• Get the consent from the patients or relative for surgery
• Ensure that the patients with cataract are admitted for surgery
• Enquire about history of any systemic illness such as hypertension, cardiac problems, diabetes in patients admitted for surgery. To motivate such patients to obtain fitness certificate from a physician for surgery. To ensure that an attendant accompanies them
• Counsel the patients to come to base hospital if they require any specialty treatment
• Explain the likely consequences of not undergoing treatment in the base hospital for specialty problems
• Follow up the referred patients for specialty treatment

In-depth counselling at the campsite focuses on

• The details of diagnosis
• Cause of blindness
• Curative method
• Need for surgery in case of cataract
• Details of treatment or surgery at the base hospital
• Pre-operative and post-operative instructions
• Health education on primary eye care

Responsibilities of a patient - counsellor in base hospital

Counsellor is to continue the counselling in the base hospital also in different stages of in-patients services. More importantly, they should talk to the group of admitted patients just prior to surgery regarding the duration and type of surgery in order to reduce their fear and anxiety.

Counselling should be continued even after surgery in the ward regarding the post operative medication during their stay in the hospital. They should also talk to them how to maintain the hygiene to prevent any kind of infections after they go back to their villages. The counsellors have to be aware of the discharge details and follow up details. Usually follow up is done after 4 weeks of surgery.

The counsellors should make a point on the date and venue of follow up in the discharge summary for all the patients. During post operative stay, they should explain the importance of follow up which will help to attain a high level of follow up acceptance rate. The details which are collected at the time of follow up will help to ensure the quality of service and to provide necessary treatment on complications.

A day before discharge or at the time of discharge, all the operated patients should be grouped together and follow up counselling should be done. They should also insist on regular application of medications and emphasis on precautionary measures to prevent from infection.

Counsellor should also ensure that all the admitted patients are operated upon. If any one is not operated upon, the counsellor has to collect the valid reasons and record the information. Surgery drop out is one of the important factors which influence the cost of surgery.

The counsellor should be able to collect and submit the particular to outreach department after each camp. The medical records or case sheets are the main source of information. On the arrival at the base hospital, the counsellor should refer all the case sheets and categorise the information for report generation.

The following information should be collected for each camp to evaluate the quality and productivity of the camp. This also helps to match with pre-set performance indicators.

1. The number of patients screened on the camp day (includes defective and normal patients who attend the camp as out-patients)
2. Age and gender break up of outpatients
3. Diagnosis details (disease wise category of outpatients)
4. The number of patients advised for cataract surgery (the cataract condition may be early immature or mature stage. It is good to have immature and mature cataract patients noted separately)
5. Cataract surgery acceptance rate (number of patients advised for cataract vs number of patients admitted for surgery)
6. The reasons of patients for not accepting surgery
7. The number of patients advised for spectacles and spectacles acceptance rate
8. Patients diagnosed with specialty problems like glaucoma, retina, childhood blindness etc.
9. The number of patients attended the camp with eye defects (cataract, refractive errors and specialty problems together)
10. The number of patients required and advised for further medical intervention in the base hospital
11. The number of patients who agreed to come to the base hospital for specialty treatment
12. Details of patients operated on and discharged
13. The number of operated patients who attend the follow up camp and follow up acceptance rate (it should be furnished after the follow up camp is conducted)

All the above information is interpreted to monitor the performance of outreach activity in a very scientific manner. This significant role of counsellor helps to improve the total quality management of outreach eye care services.

Role of counsellor in school screening camps

This camp is fundamental to take up the school eye health scheme as one of the major outreach programmes. The active participation of trained teachers is encouraged for better results and follow-up. According to the number of school children (1 teacher for 100 children) the teachers are trained for 1 day to measure the visual acuity and to identify common eye problems.

This camp helps to identify refractive errors, squint problems, bitot spots and other minor eye ailments in school going children. The success behind the program is involvement of school management, teachers and parents. Teachers can continue the screening process in future also. Other than refractive errors, the problems which need base hospital intervention can be referred to paediatric clinic.

This is the place where all the school children are examined for any refractive errors or any other visual problems.
No.of school children screened: 100
Percentage of refractive error children: 4 – 6 %

The teachers can also play a role as counsellors. The objective of counselling in these camps is to convince the children to wear glasses when the glasses are prescribed for their distant vision. The counsellor should explain the importance of glasses and counsel them for annual check up by an ophthalmologist. Counsellor should talk to the parents of these children especially when the children are prescribed for glasses. Unless the parents get involved in this process, the children might not wear the glasses.

Any other eye problems in children other than refractive error are also examined in this school screening camp. The counsellor should be able to talk to the parents and the teachers regarding further management of such problems.

Counselling in work related screening eye camps

This is mainly to detect refractive errors among working population especially in weaving community, tailoring units and other areas where near vision is needed for their work.

When these outreach camps are held, both employee and the employer gets benefited. The quality of the work is tremendously improved because of the proper correction of the refractive error. Also the employee is happy because he is able to do his work without much eye strain.

The role of counsellor in these camps is to convince the patients to wear their corrective glasses and the type of glasses will vary according to their job of requirements. Counsellors can also counsel them for protective glasses especially in welding job, stone cutting work etc.

Counselling in diabetic retinopathy screening camp

New diabetic patients

In new diabetic patients the counsellor should create awareness of the systemic and ocular complications of diabetes to newly diagnosed patients with special emphasis on the prospects of diabetic retinopathy. She should counsel them regarding

• Strict control of diabetes
• Regular annual check up by the eye doctor
• Periodical check up by their own physician

The aim of counselling in these patients is to prevent onset of visual damage due to diabetic retinopathy.

Longstanding diabetic patients

In longstanding diabetic patients when there is an evidence of diabetic retinopathy, depending upon the stage and doctors advise, the counsellors should explain the patient very clearly about their visual condition and convince the patient for taking treatment like lasers etc. The prognosis of visual recovery should be discussed in detail with the patient in a positive way.

In conclusion the counsellors should motivate all the new diabetics to prevent the onset of diabetic retinopathy and in longstanding diabetes she should take the responsibility of making all these patients to accept treatment for retaining their residual vision through out their life.

Key points to remember

• This is the best place for the counsellors to raise awareness of the common eye diseases in the community.
• The art of counselling will be different in outreach camp activities. The language should be simple and the counsellors should be able to talk to them in their own simple language.
• Because of the crowd and lack of time the counsellor can use group counselling method.
• When the patients are not convinced for surgery they may end up with many barriers such as fear of losing of existing vision. The counsellor can help patient in decision making for surgery. He/she can also use patients who have been already operated to convince others about undergoing surgery.
• In paediatric eye screening camp, the counsellor should encourage 100% students to get enrolled in the camps. He/She should convince these students to wear glasses if they have refractive error and motivate the parents on this necessity.
• In work related eye screening camp, the counsellor should be able to convince to wear glasses especially for near vision.
• In diabetic retinopathy camp, the counsellor should give a clear picture regarding prevention of diabetic retinopathy by periodical follow up of these patients both by the physician and also by the ophthalmologist.
• For any specialty cases like glaucoma, cornea, retina cases, the counsellor should counsel them very clearly to get them to the base hospital for further investigations and specialty opinion.
• The counsellor must be responsible for communicating to the patients about the exact date of the one month follow up. She should be accountable for atleast 90% of patients to come for follow up after one month.

Student exercise

Write short answers

1. What is the role of counsellor in outreach programme?
2. Write the main responsibilities of counsellor in eye camp?
3. Write the main responsibilities of counsellor in base hospital?
4. Write a brief note on counsellor in school screening camp?
5. What is the role of counsellor in diabetic retinopathy?