Position: Nurse Counsellor
Starting date: March 2017
Duration: 6 months renewable
I. Mission Context: Médecins du Monde (MdM) is an international humanitarian organisation whose mission is to provide medical care for the most vulnerable populations, the world over, including France.
It seeks to stimulate voluntary commitment from doctors, other health care providers, and from those whose expertise in other fields is needed for its activities, to enlist all competent support required for the achievement of its projects, and to seek at all times to encourage close working relationships with populations in its care.
For 20 years, Médecins du Monde has been involved in Harm Reduction, and is recognised for its work in this area, in France and internationally.
MdM has been involved in Harm Reduction programmes relating to HIV/AIDS since 1987 in France, and since 1990 internationally, in Russia, Serbia, China, Afghanistan, Georgia, Myanmar and Vietnam.
In Sub-Saharan Africa, Médecins du Monde has been working to improve access to voluntary counselling and testing; the prevention of mother-to-child transmission and access to antiretroviral treatment; as well as the decentralisation of treatment and healthcare.
Since 2009, MdM has chosen to target the highest-risk groups (particularly people who use drugs and sex workers), who are hardest hit and for whom no prevention or treatment services had been developed.
Following a needs assessment carried out in 2009, MdM implemented a harm reduction project among drug users in the in Dar es-salaam, Tanzania, in September 2010.
Today, this project includes a training and resource centre and aims to become a model project for national and regional harm reduction activities. In the same perspective, MdM have stated working in Kenya from 2013 and in Cote d’Ivoire in 2015.
Harm reduction (HR) policy: Harm Reduction is a set of policies, programmes and practices aimed at reducing the risks associated with psychoactive drug use for people who do not have the capacity or will to stop using. It helps drug users, their families and the community.
The harm reduction approach focuses on injection-related risks and on the individual, rather than on drug use. Debates on harm reduction began when the threat of the spread of HIV among drug users was recognised.
However, similar approaches have been used for a long time in many other contexts and for different types of drugs. Harm reduction complements practices aimed at reducing overall drug use, in that it is based on the acceptance of the fact that many people in the world continue to use drugs despite preventive or repressive measures.
It recognises that people who use drugs do not always have the ability or will to stop and shall be able to protect their health and their rights despite their drug use.
This approach is thus based on the principles of public health and on a commitment to respecting human rights. It is based on the understanding that it is preferable for a person who uses drugs not to inject, but that if a person does inject it is better to use sterile equipment in order to avoid harmful consequences.
Program Presentation: Kenya is one of the 10 countries in the world with the highest number of injecting drug users (with an estimated 130,000 drug users, of which between 18,000 and 30,000 are injecting users). HIV prevalence in Kenya decreased from 14% in the mid-1990s to 5-6% in 2006.
It is estimated that 1.5 million people are living with HIV, and that the prevalence rate among adults is 6.3%. A 2004 study of 156 IVDUs in Nairobi found an HIV prevalence of 36% (68% in women) and a prevalence of the hepatitis C virus (HCV) of 42% (48% in women).
In Kenya, drug use is heavily stigmatised by the population and healthcare professionals alike, which further marginalises people with drug dependency problems.
Drug users risk being detained for the use or possession of drugs, or even injecting equipment, which in turn increases the risks and vulnerability faced by people in relation to HIV and HCV.
MdM wants to centre its action on groups at high risk of infection, particularly drug users, by allowing them access to comprehensive harm reduction program including HIV and hepatitis prevention, testing, counselling and care, needle and syringes exchange programs, condoms, health education, etc.
MdM’s harm reduction project in Kenya aims to strengthen the capacity of Kenyan actors (voluntary organisations, healthcare professionals, etc.) and to become a model project for the country.
In the long term, it also aims to support the development of a regional approach, particularly with Tanzania, in order to introduce common training sessions and advocacy activities.
II. Task and Responsibilities
As a member of the medical team, she/he will ensure the following responsibilities in close collaboration with the outreach workers and other team members.
1. Perform daily medical activities in the Drop in Center (DIC) and during the outreach activities
- Prepare the medical records and sort patients depending on degree of gravity and refer to the clinic urgently if needed,
- Treat minor ailments and refer to the Kenyan health public system as necessary,
- Perform nursing care in assigned position: take vital signs of the patient before consultation, carry out wound care/dressing, provided hepatitis B vaccination, etc.
- Provide medication to patients based on accurate medical prescription according to national and international guidelines and protocols,
- Prepare and participate in the mobile Medical outreach clinic, and deliver quality medical care and referral,
- Participate to the inventory of HR program pharmacy and contribute to the pharmacy reports,
- Ensure correct IPC (Infection Prevention Control) practices (hand washing, disinfection and sterilization of medical equipment properly done, and Universal precautions measures) are implemented and follow up effectively in the DIC by the MdM staff and within MdM supported and integrated HR program facility,
- Ensure that Waste management rules are in place and well observed.
2. Perform specialized Harm reduction and counselling activities for patients
- Provide pre and post-test counselling and perform HIV, HCV, HBV, Syphilis or other tests in adequacy with national and MdM requirements and SOP,
- Organize proactively individual counselling sessions (VCT, ART, TB management, Methadone) for patients on request or as referred by outreach workers,
- Set up a strict follow-up and tracking mechanism of those patients,
- Pro-actively involve family members, relatives and friends of the patient if required, taking prior patients’ agreements,
- Regularly consult outreach team to discuss on individual cases as the need arise.
- Initiate decision making process to refer patients to specialist services if required in collaboration with the line managers,
- Ensure patient confidentiality and respect patient decisions in line with his medical status,
- Organize proactively collective support groups (PLH, ART, Partner, Methadone etc.) on a regular basis in collaboration with other staffs.
3. Collection of data and input for the monthly report to your line manager
- Maintain confidentiality of patients files and keep the clinic data well organized according to MdM Ethics and confidentiality standard and recommandations,
- Update patient’s files on the time set by the medical team,
- Collects daily activity data collection and fills in the appropriate forms (data collection register/form, etc.) and database,
- Prepare monthly report (monthly activities, information updates on outreach situation, challenges, solutions etc.) and weekly reports.
4. Perform other duties upon request
- Participate in weekly meetings and other program related meetings,
- Participate in field assessments on request,
- Perform cash managment for cost related referral,
- Promote skills and knowledge transfer to other MdM staff, eventually replicating the contents of attended trainings.
5. Input to improve the management of Harm Reduction activities and advocacy
- Participate on rotation basis in the training/sensitization sessions implemented within the program and give input for the development of training schedules and materials,
- Contributes to the development of new IEC materials, including creativity workshop and focus group discussions,
- Participates on rotation basis in advocacy meetings and give input for the elaboration and implementation of advocacy strategy,
- Other duties on request and needs of the program.
6. Ensure the security of team members
- Observe MdM collective and individual security protocols, including wearing of professional protective equipment,
- In case of security threats and related concerns, follow immediately the MdM security process.
7. Demonstrate an ethic and professional practice
- Respect beneficiary confidentiality and their dignity ,
- Respect and promote MdM’s policies and report to your line manager any non-compliance of policies amongst the team members,
- Address needs and requests in a professional way,
- Always interact with beneficiaries within the set framework,
- Always interact with beneficiaries with mutual respect and their consent.
8. Demonstrate willingness to improve professional competencies and abilities
- Demonstrate motivation at work,
- Demonstrate willingness to improve own knowledge and skills by participating actively in any training sessions, capacity building activities,
- Participate in the different activities that are common to all team members,
- Respect each team member’s positions, work and speciality,
- Adapt to special situations or demands from the line manager.
III. Functional links
Line manager n+1: Assistant Program, Harm Reduction
Line manager n+2: Program Coordinator, Harm Reduction
She/he will work in constant coordination with outreach department.