Counselling assumes considerable significance for a doctor who desires to acquire the skill of performing the Non Scalpel Vasectomy (NSV) procedure and who would be delivering the NSV services under the national family welfare programme. It is most likely that the clients would ask him questions before undergoing the NSV procedure. Such questions may be like: Will NSV be effective method since it does not involve any cut and stitch, as told? Will it be reversible? How it is different from the conventional procedure of vasectomy? Does it cause any side effect? Etc.
Answers to these and other questions with necessary factual information in a manner that could facilitate his understanding and clarify doubts and fear, would go a long way in assuring him about the quality of care and making the NSV service delivery more attractive and satisfactory.
As a services provider, you may agree that our family welfare service delivery needs improvement for better quality of care. However, improvement in clinical and infrastructural facilities alone would not make much differences. Inclusion of non-clinical elements of quality of care like clients' perspective, need reduction, satisfaction, etc. are equally important.
Counselling has, therefore, been considered an effective means to integrate these later elements with the clinical elements and assure better quality of family planning services including the NSV, a new method for males.
Forthcoming conference of NSV Surgeons India
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DEFINATION
Counselling in family planning may be defined as a process enabling and encourage clients to make;
· Well informed
· well considered,
· and voluntary choices contraceptive methods.
Counselling is a client-centred approach to family planning service delivery that includes;
· an intimate communication between the
service - provider and client,
· factual information to explain advantages & disadvantage
of family planning methods,
· clarification of doubts and correction of wrong beliefs &
rumors about different methods available, and
· correct and continued use of the chosen method.
Counselling enables the service provider to understand clients' perceptions, attitudes, values, family planning needs, and preferences and provide services accordingly. However, it does not warrant the provider to resume the role of a counsellor in literal sense at the cost of his assigned role of service provider nor the role of an advisor or motivator for a particular method in order to avoid his encroachment upon the reproductive rights of the client.
While offering the NSV services with quality of care and implicitly aiming at its promotion as a new procedure to influence the birth rate, counselling should be used carefully. The clients should not conclude in the process that the other methods available in the national family planning programme are less effective, cause comparatively more side-effects or they are obsolete. In order to avoid such a critical situation, it may be suggested that balanced information, i.e. advantages and disadvantages of the NSV procedure as well as the other methods should be used wherever necessary but without inter-method comparison or intra-method comparison. If the client comes with the NSV in mind as his preference, the provider should not counsel him unnecessarily rather ascertain if he is aware of the advantages and disadvantages of the NSV vis a vis other methods, and if it is his own voluntary choice. If any supplementary information is necessary in addition to what he knows, that should be provided in a simple and understandable manner before performing the procedure on him.
PRINCIPLES OF COUNSELLING
While administering counselling, it is mandatory for the provider to adhere to the following principles;
1. Provider's role should be non-judgmental.
2. Client's individuality, problems, values, needs and preference should be honoured.
3. Client should have the benefit of exercising self-determination for a method.
4. Method and service related facts/important information should not be suppressed.
5. Confidentiality of personal matters shared with the provider should be promised and maintained.
6. Privacy to enable the client for free communication should be maintained in any given situation in which the provider performs the procedure.
Most often, the providers deliver the services under certain infrastructural/logistic as well as time constraints. However, skilled providers/surgeons using their personal efforts may make the given situation quite conducive to adhere to these principles of counselling and make the delivery of services more satisfactory.
In a camp situation also, the clientele for the NSV services swells, the skilled surgeons and complimentary staff can administer counselling to ensure maximum satisfaction to clients.
METHOD OF COUNSELLING
The method of counselling involves six steps, popularly known by the
acronym "GATHER". Each letter of this word signifies one particular
step. If followed in sequential order, these steps would facilitate the
process of counselling, economise time, and make counselling more effective.
These steps may be explained as under:
1. 'G' stands for "GREET": It is the first step to begin counselling.
The provider should greet the client like any respectful person and pay
due attention to his family planning needs.
2. 'A' stands for "Ask/Assess": It is the second step followed
to know what the client knows about the method in mind or the other method
and assess what additional information is necessary to make him well informed.
3. 'T' stands for" Tell": It is the third step followed to tell
about the method, remove associated wrong beliefs, myths, rumors, and
satisfy the queries raised by the client.
4. 'H' stands for "Help": It is the fourth step to help the
client take a decision or review the method, if any in mind in view of
the advantages and disadvantages.
5. 'E' stands for "Explain": It is the fifth step to suggest
that the client should be properly explained about the correct use as
well as continued use of method.
6. 'R' stands for "Return": It is the sixth step that stretches
counselling process upto follow up or necessary check up. It is generally
the post-adoption stage in which the client/acceptor returns to the service
centre and the service provider administers counselling in order to re-enforce
his motivation for continuous practice of the family planning method chosen,
values the decision, provides additional information, removes any fears
and guides or provides necessary services required.
This last step is more important for the NSV acceptor. When the acceptor returns after 3 months as per the advice for semen-test, he should be given due attention and guidance. His doubts or fears, if developed after the NSV procedure should be addressed to carefully and to his satisfaction. Any indifference to the acceptor in the post-NSV situation may jeopardize good prospects of the method in the very neighbourhood where he lives. If he is accompanied by his spouse in either situations, pre or post-NSV, she should also be counselled or her queries answered to her satisfaction.
REMBER! Counselling does not terminate when the client accepts a method or undergoes the procedure, its process completes when the acceptor returns to the service centre/provider for follow up and goes back home with satisfaction.
FACTS FOR EFFECTIVE IEC/COUNSELLING
· It is a new procedure of vasectomy that involves no incision
and stitches.
· The scrotum is punctured on both the sides to pull, cut ant tie
the vas.
· The man does not feel pain as the procedure is performed under
local anesthesia.
· The entire procedure takes a little time.
· It is a simple, hence convenient to men of any profession/occupation.
· It is fully effective male method of family planning.
· It is a permanent method of family planning for men.
· It is a safe method, hence no known long term side-effect are
reported.
· Possibility of pain, swelling haemotoma following the NSV in
some cases may not be ruled out. However, these are temporary. Doctor's
skill and immediate attention/follow up can prevent such minor side-effects.
· It is reversible by micro surgery known as vasovasectomy.
After vasovasectomy, the man becomes normozoospermic but reported pregnancy
rate is low.
· This procedure is performed currently both in urban and rural
clinics including camps by trained doctors only.
· To ensure full effectiveness of the NSV, the acceptor should
be told to positively return to the service centre after 3 months for
semen-test as advised.
· The acceptors of the NSV should be advised to use condom, coitusinteruptus
or his wife should use oral contraceptive, diaphragm or abstinence until
azoospermic test.
· The NSV does not affect adversely the man's normal health, ability
to perform sexual act, and manual work.
IMPEDIMENTS OF COUNSELLING
There are three major beliefs that operate in the minds of many service providers as impediments of counselling. They are;
1. Counselling takes time.
2. Counselling is a specialized activity of professional counsellors,
clinical psychologists, and psychiatrists.
3. Counselling is not feasible due to lack of privacy in most of the settings/service
centres.
1. The fact is that for a willing and motivated provider, counselling becomes as simple and intimate as his routine activity, so integrated with his main role that appears an activity inseparable from the clinical and paramedical activities. In most of the cases, counselling does not take unafordable or longer time.
If the client load is heavy, the display of effective IEC materials and use of audio-visual aids in the OPD or waiting places including camp setting, the time factor could be controlled to an afordable limit. The IEC materials should be for all types of clientele, literate, semi-litertate and illiterate.
2. True, counselling is a skilled activity but it could be learned and specialized by any enlightened/willing provider. It is not intricate or restricted to the counsellers, psychologists, psychiatrists or doctors. Any provider interacting with the client learn counselling as it is part of intimate behaviour, skilled communication and quality of care.
3. Wherever, privacy is a real constraint, the
re-arrangement of sitting of the providers in the OPD, clinic as well
as camp setting can considerably ensure the privacy for counselling the
client and confidentiality of his sensitive information shared with the
provider.