DOH RCCE Guide - English (For Print)
DOH RCCE Guide - English (For Print)
DOH RCCE Guide - English (For Print)
@DOHgovph | @unicefphils
doh.gov.ph | unicef.ph |
covid19.healthypilipinas.ph
COMMUNICATING
WITH COMMUNITIES
ON COVID-19
Guide for community health workers,
volunteers, and social mobilizers
APRIL 2020
#WeHealAsOne | #BeatCOVID19
TABLE OF CONTENTS
Purpose of this Guide 1
Importance of Community Engagement During a Health Crisis 1
How People Might React During a Health Crisis 2
Your Role is Important 3
How to Talk to People in the Community 4
Protect Yourself and Others While on Duty 6
Key Messages 7
Communicating in Difficult Situations 19
General Tips 19
Screening 20 REFERENCES
Preferencing 21
Triaging 22 COVID-19 – NOVEL (new) CORONAVIRUS: KEY TIPS AND DISCUSSION POINTS
For community workers, volunteers and community networks. IFRC, WHO, and UNICEF.
Admitting 23
Counseling 24 COVID-19 Infection Prevention and Control (IPC) Guidelines for Home and Community Settings (draft).
Deciding 26 Department of Health, UNICEF, and WHO.
Notifying 27 Interim Guidelines for Home Quarantine. Department of Health.
Anticipating 28
Grieving 30 Interim Guidelines for 2019-nCoV ARD Response in Communities. Department of Health.
Communicating in Specific Situations 31 Interim Guidelines on Disposal and Shipment 2019-nCoV ARD Human Remains. Department of Health.
Case Management 31
Interim Guidelines on Preparedness and Response to the 2019-nCOV. Department of Health.
Contact Tracing 33
Home Quarantine 34 Mental Health and Psychosocial Support for Staff, Volunteers and Communities
Safe and Dignified Burial 36 in an Outbreak of Novel Coronavirus. IFRC.
This document will be updated based on the evolving situation and needs of frontline World Health Organization Representative Office for the Philippines (2020). Communicating with patients
with suspected or confirmed COVID-19. The COVID-19 Risk Communication Package for Healthcare Facilities
workers on risk communication and community engagement. (1st ed., p. 5). Retrieved from: http://healthypilipinas.ph
2 Explain that all bodies will be prepared for a safe and dignified burial,
whether or not they died of COVID-19.
3 Listen to the family’s concerns. Help the family to contact a religious leader if
requested. Help people understand the situation Ensure two-way communication
and take actions to protect themselves between people and service
4 Discuss with the family that while tradition is important, everyone must find a and others from COVID-19 providers
way to respect the dead and observe burial rites without putting themselves
or anyone else in danger of catching COVID-19.
5 Remind the family that they may ask questions about the process.
Ensure that treatment, surveillance,
6 DO NOT act as a member of the personnel handling the body. and quarantine services are
understood, and meet the needs of
communities.
DURING A CRISIS a. Listen to community members, answer questions, and help them to stay
calm. Express concern and sympathy.
An epidemic may draw the following mixed reactions from the public which
hamper efforts to control the further spread of the virus if not addressed. b. Prepare the family for what they can expect during the quarantine. Explain
that everyone must observe the 14 days of quarantine for their own and their
community’s health and safety.
how the family can signs and symptoms of severe how to contact BHERT
communicate with disease to watch out for:
family members in the
quarantine center Adults: Difficulty breathing,
shortness of breath
DISTRESS MISTRUST & DOUBT STIGMA Children: Difficulty breathing,
from being isolated and on efforts to control the against people or groups inability to drink or breastfeed,
grief from losing loved ones spread of the virus associated with the spread of lethargy, unconsciousness,
COVID-19 convulsions
e. DO NOT raise expectations about the food/non-food items that a family will receive.
d. DO NOT take on the role of the contact tracing officer. DO NOT burden the 3 Monitoring and addressing rumors and misinformation
family or community by asking them to recount the details of the events
that took place over and over again. 4 Listening to, acknowledging and empathizing with
people’s feelings and concerns, and pointing them to
mental health resources when needed
3 After the surveillance visit or initial contact tracing visit
5 Improving self-efficacy and recognizing people’s efforts
a. Work with the family and community to coordinate any additional visits in to cooperate
such a way that communities are not over-burdened by outsiders and visitors.
6 Building trust and promoting cooperation in the
b. Follow up with the households and ask people if they have any questions government’s overall response
they did not feel comfortable asking at the time of the visit, but which they
might want to share privately.
HOME QUARANTINE
Who is under monitored home quarantine:
Any person who traveled to Any person who traveled to Any person with symptoms
areas with COVID-19 areas with COVID-19 such as fever, and dry cough.
transmission and/or had close transmission and/or had close
contact with a confirmed case contact with a confirmed
and does not show any signs case and with mild
and symptoms within 14 days symptoms within 14 days
after travel or exposure. after travel or exposure.
Help discharged patients, who were tested negative and are under or completed
1 Use phrases that convey compassion 14 days of self/home isolation, in reintegrating into the community by explaining
to community members that they no longer have COVID-19 and addressing
community concerns, fears, and stigma.
b. Link surviving family members to other services such as mental health and
I hear what you Maybe we can discuss psychosocial support (MHPSS).
are saying ... possible solutions ...
CONTACT TRACING
1 Before the surveillance team or the contact tracing team arrives
I understand that In this situation, your
you are worried ... reaction is normal ... a. Help the family stay calm. Explain that what is about to happen is a
standard procedure and no one is in trouble. This is being done to limit the
spread of the virus so it would be helpful if they told the truth.
b. Remind the family that they should feel free to express their concerns or let
you know if they are feeling uncomfortable with the questioning.
I am concerned With your consent,
about you ... we would like to …
c. Explain that everyone who has had contact with someone who has or may
be infected with COVID-19 must observe the 14-day quarantine for their
own and their community’s health and safety. Make it clear that this does
not mean they will all contract COVID-19.
...
c. DO NOT act as an ambulance team member.
4 If you don’t have the answers, tell them you will try
to get an answer and return to them. Consult reliable
sources of information such as the DOH website,
DOH Facebook page and the PH COVID-19 Health
Workers Viber Group.
c. There are cases of violence that may have not been reported during this
critical time. Inform people that reporting and referral services are
continuing amidst the COVID-19 situation.
1 Depending on your task and where you are stationed, there is a prescribed
personal protective equipment (PPE) for you. COMMUNICATING IN
2 Wash your hands with soap and water for at least 20 seconds or if unable to SPECIFIC SITUATIONS
do so, clean your hands with at least 70% alcohol, before and after wearing
PPE.
CASE MANAGEMENT
3 Wear, remove, and dispose of your PPE properly according to protocols.
Ensure that personal details remain confidential and are only used for case
4 Never recycle or reuse disposable PPEs. Clean and disinfect reusable PPE management purposes by authorities. Unauthorized disclosure of private and
between use. confidential information about a patient’s medical condition or treatment is
punishable by law.
5 Always put on PPE before touching or coming in close contact with a patient
who is or may be infected. Here's what you can do when you are notified that a sick person has been
reported in your area and when an ambulance has been dispatched.
6 Change PPE immediately if it becomes contaminated or damaged.
1 Before the ambulance arrives
7 Do not adjust or touch PPE during patient care.
a. The sight of an ambulance in the community and health workers in full
PPE can be a fearful experience. Listen to the family’s concerns and help
them to stay calm.
b. Help community members understand that the sick person has not yet
been confirmed to have COVID-19. This will only be confirmed after testing.
What you can do: Notice: am I letting everything get to me? Is all this
analyzing really about something else? Like how sad this is, how powerless I
SPECIFIC MESSAGES
feel, how puny our efforts look? Under these conditions, such thoughts are to
1 ABOUT THE SITUATION
be expected. But we don’t have to let them suck us under. Can we notice them,
and feel them, maybe share them?
a. COVID-19 is a pandemic and the government has declared
And then ask ourselves: can I step into a less reactive, more balanced place Code Red Alert Sublevel 2, which means that the COVID-19 virus is
even as I move into the next thing? spreading in communities.
c. This situation not only poses serious health threats but also
disrupts social and economic activities including work and school
attendance, delivery of social services, transportation, business, and
production and delivery of goods and services.
d. People are generally distressed and need support during this difficult time.
Droplets that come from an infected person when he/she talks, sneezes,
What you can do: Remember what you can do: you can hear what she’s
and coughs. The droplets may enter another person’s mouth, eyes, and
concerned about, you can explain what’s happening, you can help her prepare,
nose directly or indirectly when another person touches surfaces where
you can be present. These are gifts.
the droplets have settled.
What you can do: Talk to them about what you are worried about. You can
decide together about what is best. There are no simple answers.
But worries are easier to bear when you share them.
b. The most common symptoms are fever, dry cough, and tiredness. Few
patients experience aches and pain, nasal congestion, runny nose, and sore What you fear: I am afraid of burnout,
throat. Symptoms may appear between 1 to 14 days after exposure to the virus. and of losing my heart.
What you can do: Can you look for moments every day where you connect
with someone, share something, enjoy something? It is possible to find little
pockets of peace even in the middle of a maelstrom.
c. Not all people infected with the virus will show symptoms, but they can What you fear: I’m worried that I will be overwhelmed and that
continue to transmit the virus. I won’t be able to do what is really the best for my patients.
d. Most people who are infected with the virus recover at home without having
to go to the hospital. They will just need supportive treatment for the What you can do: Check your own state of being, even if you only have a moment.
symptoms. If one extreme is wiped out, and the other is feeling strong, where am I now?
Remember that whatever your own state, that these feelings are inextricable to our
e. Some people develop severe symptoms like difficulty in breathing and need human condition. Can you accept them, not try to push them away, and then decide
hospitalization. In some cases, the COVID-19 virus can cause pneumonia what you need
and even death.
ANTICIPATING
WHEN YOU’RE WORRYING ABOUT Treating a Caring for the sick Using the Changing a diaper
cut or wound Toilet
WHAT MIGHT HAPPEN
You know, many people find themselves in the same boat. This is a hard
situation. To be honest, given their overall condition now, if we need to put
them on a breathing machine or do CPR, they will not make it. The odds are
just against us. My recommendation is that we accept that he will not live
much longer and allow him to pass on peacefully. I suspect that may be hard
to hear. What do you think?
NOTIFYING
WHEN YOU ARE TELLING SOMEONE
c. When outside the home, wear a mask and keep at least a one-meter distance
from others. Avoid touching your eyes, nose, and mouth. Hands get in contact
with many things that can be contaminated with the virus. Yes I’m his daughter.
I am 5 hours away.
d. If you have been to areas with local transmission or had close contact with
someone who has or may be infected with COVID-19, inform your local
health worker and stay at home for 14 days, without any physical contact I have something serious to talk about with you. Are you in a place
with anyone at home (home quarantine) whether or not you are showing where you can talk?
symptoms. If you experience shortness of breath within the 14-day
quarantine, call your nearest local health worker or local COVID hotlines.
Well, let’s pause and talk about what they would have wanted. Can you tell
me what they considered most important in their life? What meant the most
to them, gave their life meaning?
B AR AN G AY HALL
Thank you, it is very important for me to know that. Can you say more
about what you mean?
I can see you are frustrated. I will ask my boss to come by as soon as
ZZZ they can. Please realize that they are juggling many things right now.
If you experience mild symptoms such as fever or dry cough, call a health I’m hoping that’s not the case. And I worry time could indeed be short.
worker and self-isolate for 14 days. If your symptoms worsen or if you’re having What is most pressing on your mind?
difficulty in breathing, immediately call your Barangay/City/Municipality
COVID-19 hotline for assistance and proper medical attention.
b. Practice physical distancing with family members who are sick and
How can you not
have underlying illnesses or the elderly.
let me in for a visit?
c. When going to public spaces, such as grocery stores and drugstores,
wear a mask and avoid touching your nose, mouth, and eyes. Make sure to
The risk of spreading the virus is so high that I am sorry to say we cannot clean your hands before wearing and after disposing the mask. Wash your
allow visitors. We can help you be in contact electronically. I wish I could let hands with soap and water afterwards.
you visit, because I know it’s important. Sadly, it is not possible now.
d. Remind every member of the household to: frequently wash their hands
with soap and water for at least 20 seconds; observe sneeze and cough
etiquette; handle food safely and properly; and wear a mask and practice
physical distancing when going outside the home.
COUNSELING
WHEN COPING NEEDS A BOOST,
OR EMOTIONS ARE RUNNING HIGH
From the information I have now and from my exam, your situation is serious
enough that you should be in the hospital. We will know more within the next
few days while in our care, and we will update you regarding your condition.
a. Ensure that the sick person stays at home during the home
quarantine period unless there is shortness of breath or the overall I imagine you are scared. Here’s what I can say: because he is 90, and is
condition gets worse. If this happens, seek medical attention. already dealing with other illnesses, it is quite possible that he will not make it
out of the hospital. Honestly, it is too soon to say for certain.
b. Confine the sick person in their own room. If this is not possible,
ensure that they practice physical distancing and always wear a mask.
It is so helpful for you to speak for them, thank you. If their medical condition 500ml
did get worse, we could arrange for hospice (or palliative care) to see them 2 tsp. water
where they are. We can hope for the best and plan for the worst. liquid bleach
e. Use mask and gloves to avoid direct contact with body fluids or
TRIAGING contaminated items in their immediate environment such as bed linens.
WHEN YOU’RE DECIDING WHERE f. Serve meal trays by the bedroom door for the sick person to pick up.
A PATIENT SHOULD GO When done, retrieve the used utensils and dishes using disposable
gloves to avoid contamination. Wash your hands with soap and
water or alcohol-based hand sanitizer afterwards.
Why shouldn’t I just
go to the hospital? g. Do not share utensils, dishes, and drinks with the patient.
Our primary concern is your safety. There is a possibility for you to get sick
even more in a hospital, whether it be from COVID-19 or other illnesses, if you 4 PREGNANT WOMEN
didn’t need to be hospitalized in the first place. The safest way is to call the
DOH Telemedicine hotlines or your BHERT to confirm your condition with a
a. Currently, there is no evidence showing the impact of COVID-19 on
medical professional. It will be faster for you and others
pregnant women and unborn babies.
b. Wear a mask during feeding and wash your hands with soap and
water before and after touching your breasts and your baby. Clean I am worried about this
new virus. What should I
and disinfect surfaces that you have touched.
be doing?
c. If you are too unwell to breastfeed your baby, you can express and
store breastmilk. Ask an adult caregiver to give it to your baby using
You are right to be concerned. Here’s what you can do. Please limit your
a spoon or feeding cup whenever needed.
contact with others—we call it physical distancing. Then you should pick a
person who knows you well enough to talk to doctors for you if you did get
really sick. That person is your proxy. Finally, if you are the kind of person who
would say, no thanks, I don’t want to go to the hospital, you should tell us
6 LOCAL OFFICIALS AND LOCAL EMERGENCY and your proxy.
HEALTH TEAMS
d. Ensure that frontline workers have access to PPEs, disinfectants, I don’t want to come to the end of my life like a vegetable
transportation to and from areas of work, and relevant training. being kept alive on a machine. [in a long term care facility
or at home]
e. Support families that were separated brought by isolation or treatment
for COVID-19 and those who have lost their loved ones due to COVID-19.
I respect that. Here’s what I’d like to propose. We will continue to take care
of you. The best case is that you don’t get the virus. The worst case is that
f. Explain safe and dignified burial protocols to families of people who
you get the virus despite our precautions—and then we will keep you here
died of COVID-19.
and make sure you are comfortable for as long as you are with us.
How come the politicians c. Implement measures to prevent or limit the spread of the virus within
got tested? your group such as modifying religious rituals/practices and postponing
or canceling mass gatherings or meetings.
d. Inform your members who had a family member who died of COVID-19
about the safe and dignified burial protocols. If the protocols violate or
I can imagine it feels unfair. I don’t know the details, but what I can tell you is are not consistent with your group’s beliefs and practices, discuss with
that was a different time. The situation is changing so fast that what we did a the health workers to agree on how to meet the safety standards.
week ago is not what we are doing today.