Empathetic Healthcare (SCORA x CBSD)

ASSA-ALEXANDRIA SCORA X CBSD

Empathetic Healthcare MANUAL

INDEX 02

ASSA-Alexandria Mission & Vision

03

Small Working Group Introduction and Message

05

Medical Ethics Introduction and Its' Four Pillars

07

SCORA: Female Genital Mutilation Survivors CBSD: Persuasion Skills

15

SCORA: Family Planning Counselling CBSD: Communication Skills

24

SCORA: Sexual Exploitation Survivors CBSD:: Psychological First Aid for GBV Survivors

29

SCORA: Child Abuse CBSD: Crisis Management

35

SCORA: Post-Partum Depression and Obstetric Violence CBSD: Emotional and Intellectual Intelligence

43

SCORA: Dealing with people living with HIV / AIDS CBSD: Maintaining Trust

49

SCORA: Comprehensive Sexuality Education including Sexual Dysfunctions Counselling CBSD: Intercultural Dialogue

ASSA ALEXANDRIA Alexandria Students' Scientific Association (ASSA) is a non-political, nonreligious, non-profit organisation run by medical students in the Alexandria Faculty of Medicine. ASSA is officially recognized as a scientific association by the administration of Alexandria Faculty of Medicine – Alexandria University since 1969.

ASSA does not belong to the students’ union or follow its activities by any means.

Our mission is to qualify medical students and empower them with a sense of social responsibility to achieve community welfare. ASSA aims at improving medical education and increasing the awareness of medical students about public health issues as well as providing them with a fruitful impressive social life inside the faculty through carrying up different activities based on the purpose of serving medical students and enhancing their role in community service and through this mission.

ASSA supports the values of teamwork, devotion, friendship, respect and passing the knowledge and experience to newer generations who will exert their efforts to accomplish the same mission.

ASSA is a full member of the International Federation of Medical Students’ Associations–Egypt (IFMSA-Egypt) which itself is a full member of the International Federation of Medical Students’ Associations (IFMSA). ASSA is registered in Alexandria Faculty of Medicine since 1969 and its operational office is located on the 5th Floor – Academic Building – Alexandria Faculty of Medicine – Khartoum sq. – Alexandria – Egypt PAGE 02

MESSAGE FROM THE SWG Hello, our beautiful readers and healthcare workforce, It gives us joy, happiness and excitement to be writing this message to be you, to share a year of deviation, work and determination to equip you all with all the utmost tools to use in your prosperous careers.

The true message of this manual is to actually provide empathy above all else, empathy can never be separated from medicine, to provide equal, accessible, available and quality healthcare, always.

Beyond technical words and difficult phrases, we want you to know that you have the ability to make a cold, scary and anxiety-filled hospital, warm with just your attitude, words and actions of kindness when treating all people regardless of any form of status they may have.

This collaboration between SCORA (Standing Committee of Sexual and Reproductive Health and Rights including HIV & AIDS) and CBSD (Capacity Building Support Division). It couldn’t have been more perfectly paired to provide you with the soft and heavy knowledge about how to encounter almost all difficult circumstances in healthcare, ethically, quickly and empathetically.

We hope you enjoy reading it and aid you in all your endeavours.

Love, Small Working Group PAGE 03

SMALL WORKING GROUP SWG Coordinators

Mirna Hussein CBSDD

Tokka Shaban LORA GA

Dina Abdelhamid LORA

SWG Members

Bavly Naim

Heba Attia

Nourhan Galal

Nesma Soliman

Rodina Nagi

Amr Nabil

Wahy Adel

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MEDICAL ETHICS Medical ethics are extremely important in guiding clinicians and other healthcare workers not to cause harm while providing the needed services.

Medical ethics describe the moral principles by which healthcare professionals must conduct themselves.

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FOUR PILLARS OF MEDICAL ETHICS Beneficence

Non-Maleficence

This means that all medical practitioners have a moral duty to promote the course of action that they believe is in the best interests of the patient.

It states that a medical practitioner has a duty to do no harm or allow harm to be caused to a patient through neglect.

How? it requires that the procedure is provided to do good for the patient involved

Autonomy This means that a patient has the ultimate decision making responsibility for their own treatment.

Autonomy also means that a medical practitioner cannot impose or force any form of treatment on an individual for whatever reason – except in cases where that individual is deemed to be unable to make autonomous decisions.

Autonomy is important because, in order for a patient to make a fully informed decision, they must understand all risks and benefits of the procedure and the likelihood of success.

Justice In the context of medical ethics – is the principle that when weighing up if something is ethical or not, we have to think about whether it’s compatible with the law, the patient’s rights, and if it’s fair and balanced.

The health care provider must consider four main areas when evaluating justice: Fair distribution of scarce resources Competing needs, Rights and obligations Potential conflicts with established legislation.

It also means that we must ensure that no one is unfairly disadvantaged when it comes to access to healthcare.

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FEMALE GENITAL MUTILATION SURVIVORS SCORA EDITION Female genital mutilation/cutting (FGM/C) is “any partial or total removal of the external female genitalia or any other injury of the female genital organs for nonmedical reasons.” it is a cultural practice that predates the Abrahamic religions, although some proponents claim it is rooted in Islam, (which is untrue and prohibited by Islam and all other religions as well) Girls who do not undergo mutilation/cutting can face community shaming and diminished marriage prospects.

Types of FGM Type 1: Clitoridectomy refers to the partial or total removal of the clitoris and/or the prepuce.

Type 2: Excision is when the clitoris and/or the labia minora are removed.

Type 3: Infibulation occurs when the vaginal opening is sealed by cutting and repositioning the labia minora and/or the labia majora, with or without the excision of the clitoris.

Type 4: All other damaging procedures are done to the female genitalia for nonmedical reasons (e.g., pricking, piercing, incising, scraping, cauterization)

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Physical effects of FGM

Psychological effects of FGM

Short term: Severe pain Excessive bleeding Bacterial or viral infection Injury to the surrounding area, including swelling Not being able to urinate or pain during urination (dysuria)

Short term: Shock and sadness Feelings of isolation Anxiety Depression

Long term: Chronic vaginal and pelvic infections Continued difficulties with urination (or completely emptying bladder) Genital scars such as cysts or keloids Pain or lack of pleasure during sex Infertility due to chronic infections

Long Term: Post-traumatic stress disorder (PTSD) Anxiety Depression

Trauma stems from both the mutilation/cutting itself as well as, having to recount the experience to others.

When the healthcare workers, react with shock or disgust when discovering a woman's FGM/C, women can feel afraid, embarrassed, and stressed, as a consequence, women may simply no longer be willing to discuss their FGM/C with their doctor.

Women who have undergone FGM may also experience: 1. Isolation Women report that they are unable to discuss their FGM/C with friends, doctors or partners because of the stigma surrounding the practice.

Women also said they are “missing out” on important experiences, particularly in intimate relationships. This comes out when friends share their own positive sexual experiences.

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2. Frustration and confusion Women may not necessarily know how FGM/C affects their physical health, having undergone genital cutting at a young age, women said they did not know what was “normal” in the context of their health, and they may not know that the several negative physical symptoms they are experiencing are a result of cutting.

Women who are aware of how FGM/C affected their health report feeling a sense of resignation where they feel there is nothing they can do to improve their symptoms.

3. Anger Women, who have undergone FGM/C also report feelings of anger, particularly at family members who have violated their trust.

What happens when survivors realize that not everyone has been cut? Women and girls with FGM/C may not even know that their vagina looks different than anyone else’s, or that their cutting is “abnormal.”

The sudden realization that their condition is actually harmful genital mutilation/cutting – rather than the way all women are – comes as a relief to some and a shock to others, when healthcare providers react with disgust to seeing FGM/C in a patient, this moment of self-discovery can stir feelings of shame and stigma, Of course, not all women realize they have FGM/C in a clinic, for some, this turning point in their lives comes when listening to a classroom lecture, watching a documentary about FGM/C, or hearing family members tell stories about cutting

How can you discuss FGM with your patient?

Female genital mutilation/cutting (FGM/C) is an enormously sensitive topic for some women, while others are comfortable talking about it, and some women want to treat the symptoms.

While others see FGM/C health consequences as a normal part of life so, as you would with anyone else, pick up cues from your patient as to how she feels about living with FGM/C through verbal and body language of the patient.

Does she feel ashamed? Indifferent? Comfortable or nervous discussing health consequences?

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DO

Use the same words your patient relies on to describe her experience with FGM Ask if your patient is willing to talk about their FGM Limit the number of providers in the room when examining her.

Use a nonjudgmental tone when discussing health consequences.

Keep an open mind about how your patient feels about life with FGM. Ask if your patient would like to be accompanied by family members.

Make FGM care a recurring part of your patient's routine visits in order to help her overcome her embarrassment.

Explain why some requests may not be legally or ethically possible (i.e. infibulation following FGM/C is outlawed in Egypt).

Give referrals to specific mental health services or other specialized physicians such as adolescent gynaecologists and urogynecologists.

DO NOT

Use the word "mutilation" with your patient.

Insist on discussing FGM if the patient doesn’t want to.

Invite other providers from the practice in the middle of any form of physical examination.

React with shock and horror.

Assume all patients are necessarily unhappy living with FGM/C. Some may see consequences such as painful periods or infections as a normal part of life.

Discuss FGM with family members in the room unless the patient brings up FGM first.

Assume the patient will bring up FGM/C care during visits.

Assume your patient will seek out these resources on her own.

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How to handle a case of a pregnant patient with FGM/C? The more severe the cutting, the greater the risks to labour and delivery.

The risks associated with FGM during pregnancy: Excessive bleeding/post-partum haemorrhage Obstructed labour (with Type II and Type III) It may require cesarean sections Prolonged labour Episiotomy Perineal trauma/tears Increased risk of stillbirth or perinatal death, though this is rare if your patient has undergone FGM/C and is pregnant: Use prenatal visits to talk about how FGM/C could affect delivery.

Start the conversation on how FGM/C could affect labour and delivery with patients who are not yet pregnant but plan to become pregnant in the near future.

Ask your patient if she had any complications from FGM/C during past pregnancies.

Manage labial tears among women with FGM the same way you would with women without FGM.

What is Definbulation Deinfibulation is a procedure that you can perform to improve symptoms resulting from Type III FGM/C. It is a "vertical incision made along the anterior surface of the infibulated scar until the urethral meatus, and eventually, the clitoris, is visible."

Deinfibulation can prevent obstetric complications among women whose vaginal openings have been sewn shut (Type III FGM).

Some patients consider deinfibulation culturally unacceptable, fearing their partners may reject them or worrying their vaginas may feel “open” after the procedure has been performed. You should discuss the risks and benefits of the procedure with the patient preoperatively.

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Deinfibulation should be performed during the second trimester of pregnancy or during the first stage of labour. Some researchers recommend performing deinfibulation before pregnancy.

Perform deinfibulation before an episiotomy, if needed during labour and delivery.

PERSUASION SKILLS CSE EDITION As a healthcare worker, you have the responsibility to educate and boost your patients' health and lives, and to do so, you have to develop your persuasion skills to convince your patient to take the right action that would inflict on them and their future.

Communication To persuade someone, you have to establish good communication with them.

This will give you a hint about your patient’s background and the right approach to convince him\her with the treatment regimen, change of behaviour…etc, and also gain your patient’s trust for further steps.

Use the appropriate vocabulary that your patient can understand, welcoming hand gestures and good eye contact.

Remember the only way to know your audience is by talking to them

Emotional intelligence Handling a patient could be very sensitive, emotional intelligence is crucial to avoid triggering your patients and when used for persuasion, it also helps you to tailor your persuasive method to suit every different person and situation.

Learn to read your patient’s feelings, tone of voice, the will to maintain eye contact and hand gestures to adjust your method accordingly.

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Active listening L i s t ening well i n v o l v e s b e i n g a t t e n t i v e a n d r e s p e c t f u l i n your conversation w i t h others, bef o r e y o u c a n p e r s u a d e s o m e o n e , y o u w i ll often need to know a n d understand t h e i r c o n c e r n s o r a r g u m e n t s .

G i v i ng the oth e r p e r s o n t i m e t o s p e a k a n d s h a r e t h e i r t houghts will make th e m feel valu e d a n d c a n c o n t r i b u t e t o b u i l d i n g t r u s t . It will also allow you to u n d erstand the i r m o t i v a t i o n s , w h i c h i n t u r n w i l l h e l p y o u form more effective p e r s uasive arg u m e n t s

Logic and reasoning M a n y effective p e r s u a s i v e a r g u m e n t s a r e b u i l t u s i n g l o g ic and reasoning sk i l l s . B efore yo u c a n p e r s u ad e a n o t h e r p e r s o n t o b e l i e v e in an idea or c o m mit to an a c t i o n , t h e y n e e d t o u n d e r s t a n d w h y d o i n g so would be a lo g i cal choice .

T o s how them t h i s , y o u w i l l n e e d t o r e a s o n w i t h t h e m u s ing facts that support y o u r view. Sta r t s e t t i n g a p o s i t i v e m i n d s e t w i t h a t r u t h t h at has to be argued, u s e positive app e a l i n g l a n gu a g e a n d m a k e s u r e t h a t t hey understand they h a v e the freed o m t o s a y n o .

A l o gical mind s e t a n d g o o d r e a s o n i n g s k i l l s w i l l h e l p y o u to form convincing p e r s uasive arg u m e n t s

Negotiation N e g otiation is o f t e n a c r u c i a l p a r t o f s u c c e s s f u l p e r s u a s ion. In many cases, th e person you a r e p e r s u a d i n g w i l l b e u n w i l l i n g t o c o o p erate unless they b e l i eve they a r e b e n e f i t i n g f r o m t h e d e a l . Y o u m a y n e ed to be able to fa c i litate a com p r o m i s e t o pe r s u a d e t h e m t o p a r t i c i p a t e.

T o d o this, you w i l l h a v e t o un d e r s t a n d t h e i r n e e d s , f i n d a way to meet those n e e ds and nego t i a t e a n a r r a n g e m e n t t h a t p l e a s e s b o t h sides. Negotiation sk i l l s ta ke pract i c e b u t c a n b e a s i g n i f i c a n t a s s e t w h e n you are trying to p e r s uade a stu b b o r n p a t i e n t .

F o r example: i f a p a t i e n t i s n o t w i l l i n g t o f o l l o w a t r e a t m ent regimen, try to m o d ify it acco r d i n g t o t h e p a t i e n t ’ s l i f e s t y l e , c l a r i f y t h e pros and cons of th e s e modifica t i o n s a n d m a k e s u r e t h e p a t i e n t u n d e r s t ands it clearly and a g r e es with it.

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Interpersonal skills Part of being persuasive is being genuine, natural and at least a little charismatic.

People are more likely to agree with someone they like, so improving your interpersonal relationships is one of the best ways to become more skilled in persuasion.

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FAMILY PLANNING COUNSELLING SCORA EDITION Family Planning (FP) is having the desired number of children and when you want to have them by using safe and effective modern methods.

Advantages of family planning Mother Enables her to regain her health after delivery.

Gives enough time and opportunity to love and provide attention to her husband and children.

Gives more time for her family and own personal advancement.

When suffering from an illness, gives enough time for treatment and recovery Children Healthy mothers produce healthy children Will get all the attention, security, love, and care they deserve.

Father Lightens the burden and responsibility of supporting his family.

Enables him to give his children their basic needs (food, shelter, education, and a better future).

Gives him time for his family and own personal advancement.

When suffering from an illness, gives enough time for treatment and recovery.

Family planning counselling Family planning counselling is defined as a continuous process that you as a health care professional provide to help patients and people make and arrive at informed choices about the size of their family.

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Informed choice is defined as a voluntary choice or decision, based on the knowledge of all available information relevant to the choice or decision.

To allow people to make an informed choice about family planning, you must make them aware of all the available methods, and the advantages and disadvantages of each where they should know how to use the chosen method safely and effectively, as well as understand possible side effects.

Always remember that family planning counselling is not a type of lecture from you to those who have come to you for help.

In the process of family planning counselling, there should be mutual understanding. You should show respect to the patient who has come to see you and deal with their problems and concerns about contraception in a straightforward way.

Types of family planning counselling Individual counselling Individual counselling is a process through which clients work one-on-one with a trained mental health clinician in a safe, caring, and confidential environment.

You will find that in most cases individuals prefer privacy and confidentiality during communication or counselling with you. It is important to respect the needs and interests of a client by finding a private room or place where you can talk with them.

Couple counselling Couple counselling is when you give a counselling service to a couple or partners together. This is particularly common when they are thinking of using irreversible family planning measures, such as voluntary surgical methods.

Important principles and conditions necessary for effective counselling ● ● ● ● ● ● ● ●

Privacy — find a quiet place to talk.

Take sufficient time.

Maintain confidentiality.

Conduct the discussion in a helpful atmosphere.

Keep it simple — use words people in your village will understand.

First things first — do not confuse by giving too much information.

Say it again — repeat the most important instructions again and again.

Use available visual aids like posters and flip charts, etc. page 16

What are the most important characteristics of a counselling role?

The most important characteristics are: ● ● ● ● ● ●

Respect the dignity of others.

Respect the client’s concerns and ideas.

Be non-judgmental and open.

Show that you are being an active listener.

Be empathetic and caring.

Be honest and sensitive.

Important things to consider: You need to remember these guidelines when you are counselling for family planning, but there are additional considerations because family planning is a particularly sensitive issue.

Many people have strong ideas about family planning, but some of the ideas they have may be based on myths or misinformation.

You need to be respectful and welcoming when sharing ideas, and demonstrate commitment to the necessary values and principles of family planning.

Try to find out your clients’ views by encouraging them to talk.

Do not ask them direct and judgmental questions such as: ‘Are you one of those people who believe that modern family planning is forbidden for religious people?’ Such questions sound critical and can make people feel inferior, or may make them mistrust you because they may ask themselves, ‘Why should I believe this person when all my relatives share my belief?’

Always try to understand, and be sensitive to, cultural and psychological factors that may affect clients in your village adopting and using family planning methods.

For example, there may be opposition to the idea of controlling the size of the family from some cultures and religions.

This means that you should have good scientific knowledge of all the contraceptive methods, and understand the practical part of family planning methods.

Also, you should be prepared to answer questions comfortably and without embarrassment about contraceptive myths, rumours, sexually transmitted infections (STIs), and reproductive and personal concerns. page 17

The three-stages of counselling - General counselling The first contact usually involves counselling on general issues to address the patient's needs and concerns.

You will give general information about methods, and clear up any mistaken beliefs or myths about specific family planning methods. All this will help the patient arrive at an informed decision on the best contraceptive method to use.

During this session, you would also give information on other sexual and reproductive health issues, like sexually transmitted infections (STIs), human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), and infertility.

- Method-specific counselling In method-specific counselling, you give more information about the chosen method.

In this case, you can explain the examination for fitness, and instruct on how and when to use the given method.

You will also tell the client when to return for follow-up, and ask them to repeat what you have said on key information.

The BRAIDED approach The acronym BRAIDED can help you remember what to talk about when you counsel clients on specific methods. It stands for: B Benefits of the method R Risks of the method, including consequences of method failure A Alternatives to the method I Inquiries about the method D Decision to withdraw from using the method, without penalty E Explanation of the method chosen D Documentation of the session for your records. page 18

- Return/follow-up counseling Follow-up counselling should always be arranged.

The main aim of follow-up counselling is to discuss and manage any problems and side effects related to the given contraceptive method. This also allows you to encourage the continued use of the chosen method unless problems exist.

Also, use this opportunity to find out whether the patient has other concerns and questions.

COMMUNICATION SKILLS CBSD EDITION Communication is the act of developing meaning among entities or groups through the use of sufficiently mutually understood signs and symbols.

Accordingly, they conceptualized communication as involving concise steps in a concise communication chain:

Types of communication Examples are : Gestures, body language, facial expressions, eye contact etc. Nonverbal communication also relates to the intent of a message.

Examples are voluntary, intentional movements like shaking a hand or winking, as well as involuntary as shaking their legs.

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The speech also contains nonverbal elements known as paralanguage, e.g. rhythm, tempo, and stress. It affects communication most at the subconscious level and establishes trust. Likewise, written texts include nonverbal elements such as handwriting style.

To have total communication, all non-verbal channels such as the body, face, voice, appearance, touch, distance, timing, and other environmental forces must be engaged during face-to-face interaction. Written communication can also have non-verbal attributes. E-mails, webchats, and social media have options to change text font colours and add emoticons, capitalization, and pictures in order to capture non-verbal cues into a verbal medium.

Non-verbal behaviours are multifunctional. Many different non-verbal channels are engaged at the same time in communication acts and allow the chance for simultaneous messages to be sent and received.

Non-verbal behaviours may form a universal language system. Smiling, crying, pointing, and glaring are non-verbal behaviours that are used and understood by people.

Such non-verbal signals allow the most basic form of communication when verbal communication is not effective due to language barriers. When verbal messages contradict non-verbal messages, observation of non-verbal behaviour is relied on to judge another's attitudes and feelings, rather than assuming the truth of the verbal message alone (people assume they are lying).

Verbal communication Verbal communication is the spoken or written form of a message.

Barriers to effective communication Barriers to effective communication can distort the message or intention of the message being conveyed. This may result in failure of the communication process or cause an effect that is undesirable.

These include filtering, selective perception, information overload, emotions, language, silence, communication apprehension, gender differences and political correctness.

This also includes a lack of expressing "knowledge-appropriate" communication, which occurs when a person uses ambiguous or complex medical jargon or descriptions of a situation or environment that is not understood by the recipient.

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Physical barriers Physical barriers are often due to the nature of the environment. An example of this is the natural barrier which exists when there is an obstruction or barrier between two or more people communicating in a certain setting as a clinic.

System design System design faults refer to problems with the structures or systems in place in an organization. Examples might include an organizational structure which is unclear and therefore makes it confusing to know whom to communicate with. Other examples could be inefficient or inappropriate information systems, a lack of supervision or training, and a lack of clarity in roles and responsibilities which can lead to staff being uncertain about what is expected of them.

Attitudinal barriers Attitudinal barriers come about as a result of problems with staff in an organization. These may be brought about, for example, by such factors as poor management, lack of consultation with employees, personality conflicts which can result in people delaying or refusing to communicate, and the personal attitudes of individual employees which may be due to lack of motivation or dissatisfaction at work, brought about by insufficient training to enable them to carry out particular tasks, or simply resistance to change due to biased attitudes and ideas.

Ambiguity of words/phrases Words sounding the same but having different meanings can convey a different meaning altogether. Hence the communicator must ensure that the receiver receives the same meaning. It is better if such words are avoided by using alternatives whenever possible.

Individual linguistic ability The use of jargon and difficult or inappropriate words in communication can prevent the recipients from understanding the message. Poorly explained or misunderstood messages can also result in confusion. However, research in communication has shown that confusion can lend legitimacy to research when persuasion fails.

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Physiological barriers These may result from individuals' personal discomfort, caused—for example—by ill health, poor eyesight or hearing difficulties.

Psychological barriers: Certain attitudes can also make communication difficult.

For instance, great anger or sadness may cause someone to lose focus on the present moment. Disorders such as autism may also severely hamper effective communication.

Bypassing It is when the sender is expressing a thought or a word but the receiver gives it a different meaning as when using abbreviations.

Multi-tasking and absorbency With a rapid increase in technologically-driven communication in the past several decades, individuals are increasingly faced with condensed communication in the form of e-mail, text, and social updates. This has, in turn, led to a notable change in the way younger generations communicate and perceive their own self-efficacy to communicate and connect with others.

Fear of being criticized This is a major factor that prevents good communication. If we exercise simple practices to improve our communication skills, we can become effective communicators. For example, reporting a case to a senior physician can be overwhelming, so practising and preparing beforehand could be a good initiative for medical students and new residents.

Gender barriers Most communicators have been raised with different societal mindsets and expectations on how they should act or communicate in different settings based on their assigned gender.

Noise In any communication model, noise is any interference that disrupts the chain of communication.

Environmental noise that physically disrupts communication, such as standing next to loudspeakers at a party, or the noise from a construction site next to a classroom makes it difficult to hear the professor.

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Cultural aspect Cultural differences exist (tribal/regional differences, dialects and so on), between organisations or at an organisational level – where companies, teams and units may have different expectations, norms and idiolects. Families and family groups may also experience the effect of cultural barriers to communication within and between different family members or groups.

For example words, colours and symbols have different meanings in different cultures. In most parts of the world, nodding your head means agreement, and shaking your head means "no", but this is not true everywhere.

Communication to a great extent is influenced by culture and cultural variables.

Understanding cultural aspects of communication refers to having knowledge of different cultures in order to communicate effectively with cross-cultural people.

Cultural aspects of communication are the cultural differences which influence communication across borders.

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SEXUAL EXPLOITATION SURVIVORS SCORA EDITION What is Sexual Violence?

Sexual violence refers to any sexual act or attempts to obtain a sexual act, or unwanted sexual comments or acts of human trafficking, that is directed against a person’s sexuality using coercion by anyone, regardless of their relationship to the victim, in any setting, including at home and at work.

What is Rape?

Rape is the term that is commonly used for the first type of sexual violence mentioned above (forced/coerced intercourse).

Rape can be defined as non-consensual sexual penetration, however slight, of any part of the body of the victim with a sexual organ, or of the anal or genital opening of the victim with any object or any other part of the body.

The invasion is committed by force, or by the threat of force or coercion, such as that caused by fear of violence, duress, detention, psychological oppression or abuse of power, against such person or another person, or by taking advantage of a coercive environment, or committed against a person incapable of giving genuine consent.

Marital Rape: Sexual intercourse is forced on a woman by her husband, knowingly against her will or vice versa.

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Guiding Principles and Rights of Survivors • Dignity and respect to the survivor • Self-determination • Highest attainable standard of health • Non-discrimination • Privacy and confidentiality •The right to know what information is being collected from them

Basic First Line Support to Sexual Violence Survivors Listening: attentively listen, without passing judgement.

Inquiring about needs and concerns: assess and evaluate their various needs and concerns (e.g., financial, emotional, physical, social, etc.).

Validating their concerns: assure them that you understand and believe them.

Enhancing safety: discuss a plan to protect them from future harm if the violence reoccurs.

Providing support: help them access information, social support and services.

PSYCHOLOGICAL FIRST AID CBSD EDITION Gender-based violence ( GBV ) can be described as any form of violence (physical, sexual, psychological and/or financial) against an individual on the basis of their gender.

The majority of GBV survivors are in fact females, irrespective of their religious, cultural or social background.

Multiple factors may contribute to that fact mainly faulty cultural or marital customs and behaviours that marginalize women.

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How to provide PFA to GBV survivors?

With the aim of providing instantaneous support and preventing any exacerbation of the case, one must be aware of the proper steps as not following them correctly, may result in some easily avoidable negative consequences.

Just like its provision the steps of PFA must be RAPID… 1. Reflective Listening 2. Assessment 3. Prioritization 4. Intervention 5. Disposition

1. Reflective listening Nothing can be more reassuring to a GBV survivor than feeling heard, understood, and not blamed.

Sometimes all that a person needs is to be heard and be allowed to vent without being interrupted or advised, the best we can do is just listen compassionately with all our hearts without arguing or jumping into providing solutions.

The worst mistake to be made in such a situation is underestimating someone’s story or not valuing what they have to say.

2. Assessment Here, and after you have listened to all that the survivor has to say, you start assessing the situation on multiple bases; the first of which is severity, and is as follows.

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Next we check the domains of distress which are:

3. Prioritization Now, we start prioritizing, where we decide on what kind of help to provide the survivor first.

This is done according to what is known as “Maslow’s Hierarchy of Needs” which states the human needs in order, that are known to affect our behaviour and these, we need to try to satisfy respectively.

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4. Intervention After having worked on tackling the survivor’s needs, we start intervening and the approach varies drastically according to the case and state of the survivor, who may be stable or not.

If unstable, we usually steer away from providing any proactive cues and get back to just listening actively. Most importantly, we try to convince the survivors out of any impulsive actions which they may regret later as they are not out of proper thinking, but rather just hurt.

If stable, the survivor here is calm and is open to accepting and considering what you have to say. First and foremost, you always have to reassure the case that there is always hope and there is always something we can do. Then, you start working on containing their stress and anxiety and their reasons then try to correct the misunderstandings if any and reframe the situation into a more positive one.

5. Disposition Now, and after you have done all of the above if the person is stable you let them leave and assure them you’ll be there anytime for them.

However, if the person does not seem to be okay, you seek help be it medical, financial, psychological etc.

Last but definitely not least, it would be great if you could teach a couple of the survivor’s family members or friends how to deal with them to help them feel supported and improve faster.

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CHILD ABUSE SCORA EDITION What Is Child Abuse?

It’s defined as “any act or failure to act on the part of a parent or caretaker which results in death, serious physical or emotional harm, sexual abuse or exploitation, or an act or failure to act which presents an imminent risk of serious harm on a child.”

What are the Major Types of Child Abuse and Neglect?

1. Neglect: It can be defined as the failure of a parent or other caregiver to provide for a child’s basic needs. It takes many forms; essential nutrition or shelter, lack of medical or mental health treatment (especially when it’s life-threatening), education, and emotional needs.

2. Physical Abuse: It is a nonaccidental physical injury to a child; punching, beating, kicking, burning, shaking, throwing, stabbing, choking, hitting either with bare hands or with other objects.

It can lead to minor bruises, severe fractures or even death.

3. Emotional abuse: Any repetitive behaviour that affects a child’s emotional development or sense of self-worth: constant criticism, threats, rejection, and withholding love, support, or guidance.

4. Sexual abuse: fondling a child’s genitals, penetration, incest, rape, sodomy, indecent exposure, and exploitation through prostitution or the production of pornographic materials. Added to that as well, human trafficking is a form of modern slavery and includes both sex trafficking and labour trafficking.

5. Parental substance use: It ranges from permitting a child to use alcohol or other drugs even indirectly to the mother’s use of legal or illegal drugs or other substances during breastfeeding or pregnancy and manufacturing, selling, and distributing drugs or alcohol.

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Signs and Symptoms of Child Abuse

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What to do if you suspect, or if a child discloses or shares the abuse?

Act on the suspicion quickly.

Keep the best interests of the child in mind, and protect the child from returning to the abusive or neglectful situation.

Write down what you have been told and by whom, your observations and what you did.

Reassure him/her that it was right to do so, as he/she may have mixed feelings and/or feel loyalty to the abuser.

Try to learn as much as you can about the situation, and find out if the child is experiencing ongoing exposure to the abuser but do not interview the child about details. That is the responsibility of Child Protective Services.

Contact Child Protective Services and report the situation and provide identifying data and your contact information.

Consider referral to a mental health professional for assessment/treatment of any psychological or psychiatric problems.

CRISIS MANAGEMENT CBSD EDITION Generally, A crisis is defined as any unexpected event that happens during the time of a project/activity/event that may lead to unfavourable results and could cause any harm to the goal of an individual, a group, or an organization. In the context of psychological first aid, a crisis is defined as “a perception or experience of an event or situation as an intolerable difficulty that exceeds the person’s current resources and coping mechanisms.”

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During a crisis, coping mechanisms that are usually effective can fail, leading to ineffective decisions and behaviours. A person in crisis may experience a wide range of emotions, like confusion, anxiety, fear, anger, and, most importantly, vulnerability.

Perceptions often are altered and memory may be distorted.

Types of Crisis Developmental crises: A developmental crisis is one that results from a normal life change, like puberty, marriage, and retirement These are changes that are normal parts of life. As one learns to cope with their situation, developmental crises can be successfully transitioned through.

Existential crises: An existential crisis is one that is related to things such as life purpose, direction, and spirituality. A midlife crisis is one example of a crisis that is often rooted in existential anxiety. Someone with an existential crisis may question their purpose in life or the direction they want to take.

Situational crises: Situational crises are sudden and unexpected crises due to sudden or devastating events. They are the result of unexpected traumas, like car accidents, experiencing a flood or earthquake, or due to illness. The unexpected nature of these events further adds to the stress a person experiences.

Sociocultural crises: Sociocultural crises occur when an individual or members of a community stop conforming to the values and interests embedded in the social structure of that community. This may involve discriminatory practices based on age, race, sex, sexual preference, or class distinction Mental Illness crises: Mental illness crises may occur when an individual living with a mental illness experiences a severe acute exacerbation of their symptoms. The crisis may occur after exposure to a stressor, or it can occur suddenly and without warning.

In the context of sexual and reproductive health, examples of situational crises include gender-based violence and obstetric violence.

Sometimes, developmental and situational crises can occur simultaneously, which can further compound the negative effects of unexpected traumas.

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Fink’s Crisis Model Fink’s crisis model is a four-stage model that examines a crisis as an extended event with sufficient warning signs that precede the event. It recognizes that the actual crisis event begins with a trigger during what he refers to as the acute stage. This stage is characterized by the crisis event and resulting damage.

Stage 1: Prodromal (Pre-Crisis) This is the warning stage. The event hasn’t happened yet and you may not even recognise that it could happen. This is the time when you want to assess the impact an actual crisis could have.

Stage 2: Acute (Crisis) This is the crisis itself. Detrimental events will occur, which can result in damage. Ignoring the situation is not an option. In this phase, controlling the situation is the way to go, in order to minimize damage. That way, you can move on to the clean-up stage faster.

The acute stage is the shortest of the four phases.

Stage 3: Chronic (Clean-Up) This is sometimes referred to as the clean-up phase. If there are no negative effects from the acute phase, this stage passes quickly. If there are negative effects, this is the time to clean them up i.e. correct the negative effects. Failure to respond properly to the initial crisis can prolong the clean-up phase or make it last indefinitely.

Stage 4: Crisis Resolution (Post-Crisis) This is the turning point where you can turn a challenge into an opportunity. This is the phase where you can make changes that prevent the crisis from recurring.

Stages of a Mental Health Crisis The stages of a mental health crisis are divided a little differently, in that there may not be a known trigger. All stages of a mental health crisis involve negative effects on a person’s wellbeing. This is different from Fink’s model, where not all stages come with negative effects.

Stage 1: The initial threat or triggering event occurs in this phase. The person faces something they perceive as threatening to them, which leads to increased anxiety.

However, there may not be any triggering event. Yes, a crisis can happen without a warning. To lower the level of anxiety (fear), the person may employ coping mechanisms which can help them manage the situation. For some people with strong coping skills, the threat disappears and there is no crisis.

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Stage 4: If the problem is not resolved in the second or third phase and new coping skills are ineffective, the individual may be overwhelmed with anxiety. This leads to panic and despair, which are hallmarks of this phase. The individual may experience confusion, depression, or attempt violence against themselves or against others.

Crisis Management In order to keep things concise, we will discuss general crisis management here. For more information on the management of a mental health crisis, refer to the Psychological First Aid section. However, keep in mind that these stages can also apply to a mental health crisis, once its acute phase has passed. Mitroff’s model divides crisis management into five stages: 1. Signal detection: In this stage, people try to identify warning signs that a crisis is about to occur. Preventive measures are then taken.

2. Probing and prevention: Here, people actively search for risk factors that can lead to a crisis or triggering events and then take steps to reduce them.

3. Damage containment: If a crisis has already occurred, actions must be taken to limit its spread. The goal here is to end the crisis or stop it from doing any further damage.

4. Recovery: In this stage, after the crisis, efforts are made to return to normal operations, or how everything functioned before the crisis 5. Learning: Once the crisis has passed and recovery has been achieved, people analyze the crisis as a whole to evaluate how they have managed it and what they’ve learned from it.

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OBSTETRIC VIOLENCE AND POSTPARTUM DEPRESSION SCORA EDITION Obstetric violence A type of violence can be physical, sexual, or verbal abuse, bullying, humiliation, coercion, or assault against labouring women by medical professionals.

This form of gender-based violence violates human rights, and evidence-based medicine, and inhibits respectful and high-quality maternal care.

Obstetric Violence (OV) violates women’s rights and inhibits Respectful Maternal Care (RMC).

The Eastern Mediterranean Region (the Region or EMR) ranks the second-worst globally on reproductive and maternal health with urgent progress needed for women’s empowerment.

Types of obstetric violence: (specifically in EMR) Type 1: Physical Abuse a. Overuse of routine interventions b. Hitting c. Insufficient pain medication

Type 2: Non-Consented Care a. Hierarchical care and limited decision-making power b. Limited information for decision-making and consent c. Unconsented routine interventions

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Type 3: Non-Confidential Care a. Lack of physical protection of patient confidentiality b. Overcrowding

Type 4: Non-Dignified Care a. Verbal abuse b. Dehumanized care

Type 5: Discrimination a. Personal characteristics b. Language

Type 6: Abandonment a. Lack of companionship b. Neglect

Type 7: Detention a. Culture of bribes and Informal payments

Actions to avoid using and are considered forms of obstetric violence by healthcare workers Routine and non-selective episiotomy Lie to the patient as to her dilatation or fetal vitality to appoint cesarean due to trips or private appointments Appointment and making the elective cesareans with 36 weeks before prolonged holidays Making the cesarean of a 5-month-old fetus due to miscalculation of pregnancy time Women in labour with family planning and authorization for tubal ligation, with scheduled cesarean due to interactivity and the doctor refusing to do the procedure.

Tie the legs to the gynaecological table during normal delivery.

Elective cesarean delivery forging indications that are not real (fetal macrosomia, meconium, circular cervical, maternal narrow basin, among others) Performing perineal shaving and fleet enema antepartum Keep the woman in labour in a prolonged fast without clinical justification

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Obstetric emergency care appointments without the doctor’s introduction and being impatient not to allow the patient to utter her complaints Not allowing the skin to skin contact after the birth of vigorous and healthy babies for being in a hurry to examine them Not allowing the patient to choose the best position for delivery Physical examination without privacy and exposition of the patient to other patients and accompanying person Refer to the patient using the bed number, the pathology, centimetres of dilatation, parity and not using her name Discrimination concerning the ethnic group of the woman in labour Rude assistants and angry health professionals Exposition of names and diagnoses of the women in labour in panels in the halls

Quote

"I still feel so upset to be reminded about what happened. That second ‘Sir’ [the doctor] came to me and from the very first moment stared at me and rudely asked me to keep my legs in ‘the correct position’ [for him] to check [the progress of the labour]. I did as he asked. Oh god!

How terrible! That was the moment I felt the most severe pain during the entire labour – when he was checking me. I had no control and screamed.

Then that doctor came close to me and pinched me on my shoulder, asking [me] to push, but I was weak. Then he slapped me on my thighs vigorously. Other staff around him kept silent"

Post-Partum Depression Baby Blues Forty to 80% of all new mothers may experience the baby blues within the first 10 days following birth.

While a new baby can bring immense joy to a family, families also experience stress, fatigue, and difficulty adjusting to a new routine and responsibilities.

Postpartum depression Perinatal depression or postpartum depression (PPD) is a mood disorder that can affect women during pregnancy and after childbirth.

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Mothers with perinatal depression experience feelings of extreme sadness, anxiety, and fatigue that may make it difficult for them to carry out daily tasks, including caring for themselves or others.

The difference between the baby blues and postpartum depression

Baby Blues Signs and Symptoms

Mood swings Anxiety Sadness Irritability Feeling overwhelmed Crying Reduced concentration Appetite problems Trouble sleeping They last only a few days to a week or two after the baby is born

Post-Partum Depression Signs and Symptoms Depressed mood or severe mood swings Excessive crying Difficulty bonding with the baby Withdrawing from family and friends Loss of appetite or eating much more than usual Inability to sleep (insomnia) or sleeping too much Overwhelming fatigue or loss of energy Reduced interest and pleasure in activities she used to enjoy Intense irritability and anger Fear that she's not a good mother Hopelessness Feelings of worthlessness, shame, guilt or inadequacy Diminished ability to think clearly, concentrate or make decisions Restlessness Severe anxiety and panic attacks Thoughts of harming yourself or the baby Recurrent thoughts of death or suicide Untreated, postpartum depression may last for many months or longer.

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Do(s) and Don’t(s) when talking with a parent who may be experiencing PPD?

DO

- You can say helpful phrases such as: “Being a new parent can be an incredibly wonderful and incredibly overwhelming experience and it is normal to feel both.”

“We know that PPD is common in many women after giving birth so talk to all the families I work with about this.”

- You can help by reducing her sense of isolation and shame and encouraging her to believe a better future is possible - To reassure the parent that being concerned about PPD does not make her/him an unhappy or bad parent

DO NOT Quote

- Avoiding assumptions.

- Avoid judgmental tones or assuming he/she has PPD before screenngs and assessments are complete - Ask mom or dad if she/he has been screened for PPD by anotherhealthcare professional or judge for her not seeking help: - Mothers might be unable or afraid to seek help from family, friends or certified healthcare professionals specialising in mental health for any of the following reasons: Unable to disclose their feelings to partners, family Women denied that they were experiencing depression and tendency to minimize symptoms is a normal part of motherhood Lack of knowledge about postpartum depression Lack of transportation, cost of the care and child care Fear of stigma and sense of shame Fear of being unfit mothers Fear from their baby may be taken away from them

"[My postpartum depression] gripped my heart to such an extent that I didn't even have the desire to try to overcome it. I mean, I was flattered by it. I was devastated by it. And it wasn't the ‘baby blues.’ And I was told it was the ‘baby blues’ at first. And so then, what was wrong with me was even worse. I thought, "Well then I must epitomize failure if I can't even get past this. ... [I want other moms to know that] it has nothing to do with your love for [your children]. … Pay attention to the feelings that you're feeling and talk about them and ask your doctor.

Find out what medicine's available. You don't have to be miserable.”

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EMOTIONAL (EQ) AND INTELLECTUAL INTELLIGENCE (IQ) CBSD EDITION Intelligence has been defined in many ways and linked to higher-level abilities (such as abstract reasoning, mental representation, problem-solving, and decision making), the ability to learn, emotional knowledge, creativity, and adaptation to meet the demands of the environment effectively.

The two essential types of intelligence Emotional Intelligence Intellectual Intelligence

What is Intellectual Intelligence?

Intellectual intelligence is the ability needed to perform various mental activities. The more intellectual the person is, the higher his/her ability to deal with problems related to spatial, numerical, and linguistic abilities.

What is the difference between Intelligent and Intellectual?

Both intelligence and intellectual refer to our mental abilities.

The main difference between intelligent and intellectual is that an intelligent person is able to learn and understand things quickly and easily, whereas an intelligent person is able to think and understand things, especially complicated ideas.

What is Emotional Intelligence?

It is the capacity to detect and comprehend your emotions, as well as the impact your emotions have on those around you. It also affects your perspective of others: understanding how others feel assists you to have better relationships.

Emotional intelligence is considered one of the great tools that humans use on an everyday basis yet people are still unaware of its nature and how to develop it as well as they may not associate emotions and intelligence with one another, but in reality, they are very related.

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The four key components of emotional intelligence

1. Self-Awareness: Being conscious of your own feelings and your thoughts about them.

It allows you to be familiar with your strengths and weaknesses, which allows you to work on these areas and eventually perform better.

2. Self-management: The ability to regulate one's emotions and impulses. So, you become less likely to become too angry or jealous and to make rash, reckless decisions. It’s characterized by the comfort with change, honesty, and the ability to say no.

3. Social Awareness: The ability to take the perspective of and empathize with others from diverse backgrounds and cultures, to understand social and ethical norms for behaviour, and to recognize family, school, and community resources and supports.

Empathy in particular is the second-most important element of emotional intelligence; is the ability to identify with and understand the wants, needs, and viewpoints of those around you.

4. Relationship management: The ability, through inspiring others, managing conflicts, fostering teamwork, and other competencies, to move people in the direction you desire.

How to Improve Your Emotional Intelligence Observe how you react to people: Look honestly at how you think and interact with other people. Try to put yourself in their place, and be more open and accepting of their perspectives and needs. examine how your actions will affect others before you take those actions.

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Look at your work environment: Do you seek attention for your accomplishments?

Humility can be a wonderful quality you say that you know what you did, and you can be quietly confident about it.

Give others a chance to shine: put the focus on them, and don't worry too much about getting praise for yourself.

Do a self-evaluation: what are your weaknesses? Have the courage to look at yourself honestly – it can change your life.

Examine how you react to stressful situations: the ability to stay calm and in control in difficult situations is highly valued – in the business world and outside it. Keep your emotions under control when things go wrong.

Take responsibility for your actions: If you hurt someone's feelings, apologize directly – don't ignore what you did or avoid the person. People are usually more willing to forgive and forget if you make an honest attempt to make things right.

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DEALING WITH PATIENTS LIVING WITH AN STI AS HIV/AIDS SCORA EDITION Dealing with patients living with a Sexually Transmitted Infection (STI) such as Human Immunodeficiency Virus (HIV)/ Acquired Immunodeficiency Syndrome (AIDS) is a skill that any doctor needs. As medical professionals, it is our job to care for every aspect of the patients’ health.

Thus, ensuring the patient has a healthy and correct perspective of STIs, themselves as a person living with one and how to deal with it falls on us.

To be able to help such patients, you need them to be open with you about many things most people consider to be private and/or personal.

Because of that, it is very important that you show them that you are a person whom they can trust and build rapport with them. Doing all that starts from the moment they enter your office, where you need to establish a safe environment for them there (a safe space).

Creating a safe environment To create a safe environment for the patient, you need to make them feel safe and comfortable. You might find it at times helpful to remind the patient that, as a doctor, you are not here to judge anything about them be it big or small as that will reassure them and may make them more comfortable opening up to you.

Never forget the patient’s autonomy. If the patient isn’t comfortable talking about a specific thing, then they shouldn’t, don’t ever push them to answer any question.

It is important for the patient to understand that taking a sexual history is a conversation, not an interrogation.

Having created a safe environment, it becomes time to take the patient’s history.

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Sexual History Taking When dealing with STIs and patients possibly having them it is important to set a few rules for yourself: 1- Explain to the patient any and everything you’re going to do before you do it. No matter how obvious it may seem to you, the patient probably might not be normalized with this procedure.

2- Ask permission before doing anything. About to talk about sensitive subjects? Ask permission. Want to take notes while asking questions? Ask permission. About to do a physical exam? Ask permission.

3- Explain to the patient that any personal questions or physical examinations aren’t an intrusion but are to help provide them with the best healthcare.

4-Listen to the patient until they’ve finished talking and don’t interrupt them.

While taking a patient’s history, a good way to guide your conversation and help you remember all the information you might need to ask about is by remembering

Partners: The number, gender, risk factors of patient’s sex partners and if they’ve had any new sex partner.

Practices: Sex practices like types of sex or drug use

The 5 Ps

Past history of STIs: such as symptoms, STIs testing, and partner's STI history.

Protection from STIs: Abstinence, or not having sex, number of sex partners, condom use, the patient’s perception of their own risk and their partner’s risk, and STI testing.

Pregnancy intention: Contraception use and wanting to have (more) children, when, and prevention until when.

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If, through taking the patient’s history, you find that the patient is at risk of an STI infection, be sure to encourage and recommend testing and give positive feedback about prevention methods that the patient is willing or able to use.

STI tests may be part of a routine screening or specifically when the patient shows signs and symptoms of an STI. It is recommended that those at high risk of getting an STI do routine screening such as people: with an STI infected partner, with more than one partner, practising unsafe sex and using IV (Intravenous) drugs.

While taking a patient’s history, it is really important that you understand the patient clearly and that the patient understands you clearly as well.

Importance of Sensitive Language Good communication not only gives you and the patient a better understanding of the situation but also is the main factor in building rapport with the patient and being effectively able to establish a safe space.

You can’t know what the patient is comfortable with unless they communicate that to you and you pick up on it clearly, these are some things you might want to keep in mind concerning communication with the patient:

The 5 Ps

Maintain eye contact with the patient as much as possible Acknowledge them (proper greeting, less focusing on the computer screen/paper on the desk...etc.). This helps establish good rapport and form a human connection between the doctor and the patient Sometimes if a patient is embarrassed to talk about a certain subject they can be vague. Be attentive so you can be sure that you don’t need more clarification by asking questions with a simple 'yes' or 'no') to initiate the consultation and only use close-ended questions (Yes or no questions) if you need clarification on a specific point.

Always pay attention to the patient’s body language, eye contact and tone of voice as they can be indicative of important things that they might be too afraid or embarrassed to say outright like for Use neutral terms like “person” or “partner” unless they give you the information themselves.

Make sure the patient understands any medical terms you say and you understand any slang or colloquial terms they use to leave no room for error or interpretation.

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Quote “Imagine someone living a double life and trying to hide, their health, so you can see two different personalities, someone trying to be very strong, trying to do lots of hard work for them to survive, in their own world. There is that other side where they’re totally scared [then] depression will start to kick in, high level of anxiety as well, and fear, and so you can imagine what their mental health status would look like”

MAINTAINING TRUST CBSD EDITION As a medical professional you need to be able to build and maintain trust with your patients.

You’ll often have to bring up and deal with subjects that your patients might be insecure about or consider deeply personal or private (eg: an STI or a form of sexual dysfunction).

Patients are more likely to open up to you if they trust you. This leads to greater patient autonomy and shared decision-making.

High levels of trust have been associated with many benefits, including greater acceptance of recommended treatment and adherence to that treatment

Elements of Maintaining Trust - Competence in knowledge People generally trust those who show more competence in their work and seem to know what they are doing. The same applies to patients trusting doctors.

Thus, it’s important to: PAGE 46

Always be self-evaluating and always be keeping your knowledge and skills up to date and relevant to your role and responsibilities.

Seek advice and/or refer your patient whenever necessary.

Work with your team to ensure the best for the patient, caring for the patient never was and never will be a competition. . Competence in social/communication skills Patients need to feel they are actively heard and given information in an honest non-judgmental way to trust their doctor. Here are some ways you can show that to the patient: Showing signs and gestures that you are listening to the patient like nodding at them understandingly or making an “mhm” gives them the feeling they are being listened to attentively.

Mirroring a patient’s mannerisms and behaviours puts you and the patient, during the conversation, on the same level which makes them feel more at ease around you.

Paraphrasing what the patient says after they are finished is a good way to show that you were listening carefully.

- Honesty Medical professionals who are dishonest with their patients often lose credibility and the trust of their patients. Therefore, it’s important for the doctor to be honest with the patient.

Even if it’s difficult or the short-term results don’t look good, it’s been shown time and time again that it’s always better for the patient in the long term to be always honest and direct with them.

- Confidentiality and caring When sharing private or sensitive information, the patient needs to be sure they can trust their doctor with this information.

That’s why you always need to assure them of confidentiality and take the necessary measures to maintain it, such as:

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Make sure conversations with patients are not heard by the public eg: make sure the door to the office is closed and don’t raise your voice when talking about the patient’s specific problem.

Do not leave any personal information of the patient where anyone can see it (on your desk, for example).

Do not post patients’ personal information online even if you redact the name as people can still guess.

- Showing respect Medical professionals are expected to treat their patients with respect.

Judging a patient or patronizing them will undermine the trusting relationship between them and their doctor.

You must find a balance between not using medical terms or sounding too technical with the patient and dumbing down the information so much that it sounds condescending or patronizing.

You must also respect the patient’s beliefs and choices if you want them to respect your medical opinion.

Patient autonomy is one of the most important things to keep in mind as it’s respecting the patient’s freedom and ability to choose what is best for them in their own opinion.

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IMPORTANCE OF CSE IN MEDICAL AND CLINICAL SETTINGS SCORA EDITION Comprehensive Sexuality Education (CSE) is a curriculum-based and ageappropriate process of teaching and learning about sexuality in all of its aspects, including cognitive, emotional, physical, and social.

It aims to equip children and students with knowledge, attitudes, skills, and values that empower them to realize and actively take care of their health and wellbeing and develop social relationships based on respect

-Key Concepts and Characteristics of CSE According to the UN International Technical Guidance on Sexuality Education (ITGSE), key target groups for CSE are divided into four age categories: 5 to 8 years old, 9 to 12 years old, 12 to 15 years old, and 15 to 18+ years old.

Lessons may be skills, attitudinal, or knowledgable. The topics and learning objectives covered are adapted to suit each age group and come from eight concepts: 1. Relationships: Some of the topics covered here are relationships with families, friendships and romantic relationships, and tolerance and inclusion.

2. Values, Rights, Culture, and Sexuality: Lessons and key objectives under this key concept may discuss how sexuality relates to values, human rights, culture, and society.

3. Understanding gender: Topics under this key concept cover gender equality, stereotypes and bias, and gender-based violence, among others 4. Violence and staying safe: Violence, consent, privacy, and safe use of technology such as phones and social media are covered here.

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5. Skills for health and well-being: Topics covered here discuss decision-making, communication, refusal, and negotiation skills, as well as finding help and support. Lessons here aim to help children and young adults navigate peer pressure and find help if needed.

6. The human body and development: Lessons and key objectives here may talk about sexual and reproductive anatomy and physiology, puberty, body image, and menstrual hygiene.

7. Sexuality and sexual behaviour: Topics under this key concept include sex, sexuality and the sexual life cycle, sexual behaviour and sexual response 8. Sexual and reproductive health: Pregnancy and pregnancy prevention and HIV/AIDS and other STIs, plus their stigma, treatment, and risk reduction, are some of the topics under this key concept.

To illustrate how lessons change depending on the age group, let’s examine a lesson under the key concept of relationships.

A lesson about families for children aged 5 to 8 might describe different types of families and how to respect them. The same lesson for young adults aged 15 to 18 may assess how family members’ relationships may change when a family member discloses sensitive information.

Why is CSE Important?

In the big picture, comprehensive sexuality education (CSE) covers a broad range of issues relating to both the physical and biological aspects of sexual and reproductive health, as well as its emotional and social aspects. When provided correctly, it can provide accurate and affirming information to young people, which supports the efforts of parents and teachers. It can also help reduce the impact of some of the negative or inaccurate messages and stereotypes often perpetuated by society and encourage openness around conversations about sensitive topics.

Due to the many misconceptions and taboos that exist around sexual and reproductive health, many young people receive confusing and conflicting information, during an already confusing time, as they make the transition from childhood to adulthood.

The knowledge and skills acquired by youth from CSE programs empower them to make responsible choices that protect their health and well-being.

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What Approach Should I Take When Offering CSE? Comprehensive sexuality education can be conducted in both formal and nonformal settings. However, the information offered must meet certain criteria, in that it should be: 1. Scientifically accurate 2. Step-by-step and Gradual 3. Developmentally and age-wise appropriate 4. Curriculum-based 5. Comprehensive 6. Based on a human rights approach 7. Based on gender equality 8. Culturally relevant and context-appropriate 9. Transformative 10. Able to develop life skills needed to support healthy relationships When conducting CSE for children and young adults, care must be taken first to establish a safe space in each session.

Setting ground rules at the beginning of each session is one way to do that. As a healthcare provider, it is important to establish connections with the person/people so that they feel comfortable asking questions and participating.

Give chances for problem-solving by encouraging the discussion of information, and, if disseminating information to a large number of people, encourage dialogue circles. Most importantly, however, be sensitive to the individual needs of each person, stay friendly and positive, and always remain a good listener.

Sexual Dysfunctions Persistent, recurrent problems with sexual response, desire, orgasm or pain that distress or strain one or both partners in the relationship are known medically as sexual dysfunction.

Sexual dysfunction is prevalent in both men and women, occurring at any stage even if the person enjoyed sexual intercourse before and had no issue during it, at any point, the level of sexual desire, arousal and satisfaction can change.

Therefore, the healthcare worker can establish a healthy trustful, safe and judgement-free environment and encourage the patient to do the following:

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Communicate openly with the other partner: open and honest communication is the foundation of healthy and pleasurable sexual activity with respect, trust and empathy.

To learn more about sexual dysfunctions, sexual pleasure and communication and ask the healthcare worker any questions or fears regarding it.

Be as honest as possible and specific (if comfortable of course) in stating signs and symptoms like pain, irritation, burning sensation and etc.

Communicate with the healthcare worker in the patients’ most comfortable words and phrases regarding the subject, whether verbally or through writing.

Get support where If it helps, ask the other partner to come with them to the appointment. If the patient prefers, they could ask the partner if they would ask the question for them, either on the phone or in person.

It is perfectly ok, to change physicians if the patient does not feel they are comfortable, can communicate or share their experience with the current physician and seek out another physician or specialist.

Our role as healthcare workers is to reassure and normalize sexual dysfunctions, talk about them according to the patient’s consent if they agree to talk about them and, finally, treat them with different options according to the patients’ capabilities and preferences.

Having any form of sexual dysfunctions, should not be a communication barrier and it is completely normal and both partners can still have a healthy sexual relationship.

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INTERCULTURAL DIALOUGE CBSD EDITION According to the Council of Europe, “Intercultural dialogue is an open and respectful exchange of view between individuals and groups belonging to different cultures that leads to a deeper understanding of the other’s global perception.”

Therefore, it is a discussion in which all parties, be it people, associations or families, have equal rights to represent their beliefs, values and customs.

The importance of intercultural dialogue?

“Dialogue can defuse tensions and keep situations from escalating” Mr Ban Kimoon, United Nations Secretary-General.

No doubt that intercultural dialogue brings close extremists that would otherwise conflict.

It aids in maintaining harmony and “shared-living” not only on a political or international scale but on a personal scale as well. Every person has a different upbringing with a different background and in turn, grows up with different values and beliefs. If we are unable to discuss and explore the different ideologies in our society, prejudice and hatred will have the upper hand.

Intercultural skills Self-disclosure Behavioural Flexibility Interaction Management Social Skills

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Factors of intercultural dialogue

Intercultural Sensitivity This is the ability to express and receive a response that leads to cultural acceptance and respect.

No one can deny that the first step to understanding is acceptance, one cannot understand a culture or an idea if they do not accept its existence and respect it and the same goes here.

One of the most common mistakes when it comes to intercultural sensitivity is stereotyping; from food to clothes and accents all are unacceptable, and down below is a model by Milton Bennet that shows the six stages of cultural sensitivity.

Studying these stages enables us to have a greater acknowledgement and acceptance of others’ perspectives.

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