PEER COUNSELLING - A HOLISTIC PSYCHO - SOCIAL REHABILITATION APPROACH SHIVJEET SINGH RAGHAW, Peer Counsellor
Department of Rehabilitation, Indian Spinal Injuries Centre,New Delhi
Life almost came to a standstill for me on 23rd July 1980. While on my early morning jog some hooligans attacked me with sticks. I sustained serious injuries. There were more then fifty stitches on the scalp, left elbow was fractured, so were 3-4 ribs. But it was the fracture in the region of 5th-6th cervical ( neck ) vertebrae that changed the course of my life. This injury is termed as " Spinal Cord and a person is completely or partially paralysed below the level of injury.
The consequences depend on the site and severity of the injury. There is no cure for it any where in the world. One has to lead a wheel chair bound life, completely or partially dependent on others for day to day activities.
Today when I look back, I wonder is it really possible that I have come all this way in my wheel chair, despite all odds. How did I manage it? Who made it possible? Practically every body has helped in reaching this stage. But above all this was made possible by my parents, three brothers and sister. It is their love, care and help that left hardly any moment of despair and developed in me self-confidence and will power. One really needs complete unflinching support of the family and there can be no substitute or an alternative to it. I always use to wonder why most of the people with spinal cord injury were not as lively and confident.
I found that mostly the parents and other members of the family had the will to take care, but didn’t have the right understanding of the after effects of spinal cord injury. Neither the individual nor the family had any idea about the management after spinal cord injury.
They were totally depressed suffering with complications such as pressure sores, incontinence, acute constipation and other related problems. It is due to lack of proper training about management and rehabilitation at various hospitals and even few of the specialized centres for spinal cord injuries.
It was then that I decided to take up Peer Counselling as a hobby. During last 10 years have been able to successfully counsel and teach many a people with spinal cord injury about the management and Rehabilitation. It greatly helped them in their reintegration into the main stream. Presently I am working as " Peer Counsellor" at Indian Spinal Injuries Centre, Vasantkunj, New Delhi. I talk to people with spinal cord injuries and their families to help them in their rehabilitation. The focus being on Medical, Physical and Vocational Rehabilitation , so as to achieve maximum Psycho-Social & functional restoration.
WHO IS A PEER COUNSELLOR ? A Peer Counselor is one who is very well-rehabilitated Spinal Injured Person, possessing good communicating skills. Who also has a fair knowledge about physiology and anatomy of the human body and psychological aspects of human behavior. One does not qualify to be a peer counselor merely by being a w/chair user after SCI.
Patient sustaining an injury to the spinal cord undergoes significant changes in host of behaviors, e.g. the ability to relieve pressure on the skin and the ability to ambulate. The disability will change the patient’s need as well as the way to fulfill these needs. But the new behaviors will not occur until the patient has learned them.
Effective learning would be not only to acquire those skills but also to use them at appropriate time. When the patient enters the ward after SCI, family and the individual are not aware of what is in store for them. After coming out of the initial spinal shock, individual need to know what has happened to him/her. When would they start walking again, why they do not have control over their bladder and bowel.
They want to know when they would be al all right and would be out of the hospital. All these and other related issues need to be addressed with emphasis on future prospects. A Peer counselor can provide a lot of Psychological support to the patient and can help him/her in coming out of the depression phase and can advise the patients about the coping mechanism from his personal experiences and also of those who have been counseled in the past.
Rehabilitation is an on going process and requires to be comprehensive. Each component has to be covered systematically .There are particular steps in the process of rehabilitation such as Psychological rehabilitation, Physical rehabilitation, Vocational rehabilitation, Social rehabilitation and sexual rehabilitation. Each is of immense importance for successful rehabilitation. Medical and physical rehabilitation are critical in functional independence and the others then help reintegration of people with spinal cord injury into the main stream.
What ever is done on the Medical or Vocational front will be nullified without proper Psycho-Social rehabilitation. One has to be very well-prepared psychologically before leaving the hospital. Peer Counsellor is the ones who can better appreciate, understand and recognize the requirements in individual cases.
Peer counsellors can communicate much more effectively with SIPs and their immediate family. Patients learn to identify with the Peer Counsellors. Almost all people with spinal injury who received Peer counselling are of the opinion that they accepted their disability in the real sense only after their interaction with other SIPs. Talking to a well-rehabilitated peer SIP makes the patients realize that their inability to perform certain physical activity does not at all mean an end to leading a meaningful life.
They would be far more receptive to the vital need of rehabilitation. SIPs would be more open to a peer counsellor than anybody else about their fears & reservations and of their acceptance by the family and the society after they leave the hospital. They would be more at ease with a peer counsellor while discussing their anxiety about sexual dysfunction and problems in managing their bladder & bowel, etc. Rehabilitation would be more convenient and practical with peer counsellors acting as the link between the SIPs and the other members of the rehabilitation team.
