How to Adapt a Community HIV Program

Adapting a Community HIV Prevention program is more than simply advocating safe sex. It is a means of opening the lines of communication and helping community members apply preventative measures to their daily lives.




Step1
Research your community through outreach or needs assessment to determine the effectiveness of a particular prevention program. This process may require technical assistance and the recruiting and training of staff.


Step2
Sponsor community events, such as neighborhood potlucks or music festivals. The resulting camaraderie can help to make communication more effective.


Step3
Get the message across with peer education by staffing and training people who have a personal stake in the community. Employing community members to save the lives of their loved ones is a powerful tool.


Step4
Find ways to implement the notions of family, community and ethnic pride, such as through family counseling and language classes. Programs that address issues beyond HIV may draw more participants and bring community members closer together.


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How to Act if You Encounter a Bear

If you enjoy spending time in the outoors, especially camping or hiking, there's a chance you could come across a bear. Use these strategies to avoid a dangerous encounter.


Step1
Learn about different types of bears. Black bears can climb trees and sometimes attack in a predatory manner. Grizzly and polar bears are more likely to attack in self-defense.


Step2
Know how to identify bears. Grizzly bears are large and have a hump just behind their shoulders. Black bears are smaller and have rounded ears and a long snout. Polar bears are white.


Step3
Make some noise when you are in the woods, so you don't surprise a bear. Sing or talk loudly to let a bear know that you are coming and that you are human (not prey).


Step4
If you encounter a bear, don't run. Back away slowly and talk to the bear. Let the bear hear your voice but do not shout.


Step5
Play dead. If a bear attacks in self-defense and makes contact, lay face down and stay very still. If you do not appear to be a threat, the bear may leave you alone.


Step6
Fight back. If a bear makes a predatory attack, fight back as hard as you can. Once a bear find out you aren't easy prey, they may leave you alone. Scream, kick, punch, hit the bear with rocks or branches, or use bear spray if you have it.


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How to Assess the Three Stages of Heat Illness

Heat-related illnesses consist of three stages, ranging from relatively mild to life threatening: heat cramps, heat exhaustion and heatstroke, respectively. Recognize and treat symptoms as soon as possible, especially before earlier stages progress to heatstroke. These guidelines follow recommendations of the American Red Cross and the Center for Disease Control.

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Step1
Check for a cramping in the leg muscles or abdomen.


Step2
Ask the person whether he or she is feeling tired, has a headache or feels nauseous or dizzy.


Step3
Look for heavy perspiration.


Step4
Continue to next section to assess for heat exhaustion. Otherwise, treat person for heat cramps (see "Treat Heat Cramps," under Related eHows).

Heat Exhaustion


Step1
Look at the person's skin for a pale color and feel it for moistness.


Step2
Check for a weak but elevated pulse.


Step3
Watch for vomiting.


Step4
Continue onto next section to assess for heat stroke. Otherwise, treat for heat exhaustion (see "Treat Heat Exhaustion," under Related eHows).

Heat Stroke


Step1
Observe the person's behavior and temperament. If he or she appears disoriented or is acting out of character or exhibiting a strange personality, suspect heatstroke and treat immediately.


Step2
Take the person's temperature. If over 104 degrees F, treat immediately for heatstroke.


Step3
Look at and feel the person's skin: Is it hot and red? If so, suspect heatstroke and treat immediately.


Step4
Check the person's heart and respiratory rate. If either is elevated, suspect heatstroke and treat immediately (see "Treat Heatstroke," under Related eHows).


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How to Assess a Rib Fracture

Suspect a rib fracture anytime a person receives a blow to the chest and feels a great deal of pain at the point injured. Look for the following signs as indicators of the severity of the injury.



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Step1
Gently touch the area of the chest that received the blow. The injured person will complain of sharp tenderness at the point of the fracture if one or more ribs were broken.


Step2
Have the injured person take a deep breath or cough: Does he or she feel sharp, stabbing pain? If yes, suspect a fractured rib.


Step3
Look for the following additional signs and symptoms: deformity or discoloration around the chest area; shallow breathing to minimize the pain with each breath; an elevated respiratory rate. The presence of any of these signs may indicate a fractured rib.


Step4
Decrease movement on the side of the fracture using one of the following methods: Tape the factured side with four or five pieces of adhesive tape from the sternum to the spine; apply an elastic bandage around the entire chest; use a sling and swathe to immobilize the arm against the injured side; tape a stuff sack filled with clothes loosely to the injured side of the chest. See "How to Treat a Rib Fracture."


Step5
Administer ibuprofen, acetaminophen or naproxen sodium for pain.


Step6
Encourage the injured person to cough frequently, despite the pain, in order to prevent secretions from pooling in the lung causing pneumonia.


Step7
Evacuate immediately, monitoring for difficulty breathing. The injured person may be able to walk out if there are no signs of respiratory distress.

Serious Fractures and Flail Chest


Step1
Look for the signs of respiratory distress immediately after a major impact to the chest: rapid and shallow breathing; elevated heart rate; a bluish tint around the nose and mouth; no detectable breathing.


Step2
Look for the signs of a punctured lung: increased difficulty breathing; coughing up blood.


Step3
Place one hand on each side of the injured person's chest and observe the way in which the chest moves with inhalations. If one side of the chest rises during inhalation while the other falls, at least three ribs have been broken on the falling side of the chest.


Step4
Treat immediately if the person appears to have punctured a lung or has multiple fractures. The best treatment is to roll the person onto the injured side and place a rolled piece of clothing underneath the fractured area to support it.


Step5
Evacuate immediately, monitoring for respiratory distress. The person will not be able to walk out and must be carried on a backboard or in a litter, or flown out with a helicopter.

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How to Assess Lung Injuries

A lung injury can occur anytime a person receives a severe blow to the chest. Whenever you suspect a rib fracture, look for a lung injury as well.

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Step1
Look for signs of respiratory distress immediately after a major impact to the chest: rapid and shallow breathing, an elevated heart rate, a bluish tint around the nose and mouth, no detectable breathing. If any of these signs are present, suspect a lung injury.


Step2
Look for the signs of a punctured lung: increasing difficulty breathing, coughing up blood.


Step3
Put an ear to both sides of the injured person's chest and listen to the breathing: Can you hear air entering both sides of the chest? If air is entering only one side, suspect a lung injury.


Step4
Look for an open chest wound or an impaled object in the chest. If either of these is present, suspect a lung injury.


Step5
Treat immediately: Maintain an open airway, seal any open chest wounds, stop the bleeding, stabilize any impaled objects, have the person sit or lie in the position of greatest comfort (see "How to Treat Lung Injuries").


Step6
Evacuate immediately, monitoring for respiratory distress. The person will not be able to walk out and must be carried on a backboard or in a litter, or flown out with a helicopter.

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How to Assess Forearm Tendinitis

Tendons are the cords that attach muscles to bone. Tendinitis occurs when these cords become inflamed. Forearm tendinitis usually occurs with overuse or misuse of the tendon - a common injury for kayakers and canoeists.



Step1
Identify when the pain first began and the activity that preceded it. Forearm tendinitis usually appears the morning after participating in an activity that involves overuse of the wrists and arms.


Step2
Look for the following symptoms on the forearm: redness, swelling, warmth to the touch, pain when touched or moved, grinding sounds when the wrist or arm is moved. Suspect tendinitis if you observe any of these symptoms.


Step3
Treat immediately if you suspect tendinitis while camping or during other wilderness activity. (Evacuation will probably not be required.) Basic treatment involves rest, ice, taping or stabilizing the wrist, administering ibuprofen for pain, and elevating the arm. (See "How to Treat Forearm Tendonitis.")


Step4
Check for the following symptoms that might indicate a more serious injury, such as a fracture or dislocation: sudden and intense onset of pain, bruising, deformity, inability to move the joint, absence of a detectable pulse in the wrist, pain at one particular point, inability to move the fingers, or tingling or lack of sensation in the fingers. Evacuate to a doctor immediately if any of these signs are present.



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How to Arrange Hospice Care

The final stages of a terminal illness are emotionally and physically devastating to both patients and caregivers. Hospice provides critical at-home care and eases the burden for the whole family as they transition toward death. Knowing when and how to set up hospice care requires much thought and planning.




Step1
Determine if hospice care is appropriate. When a life-limiting illness no longer responds to cure-oriented treatments, hospice care can provide comfort and support to patients and their families. The patient, family and/or physician can initiate a hospice information or referral call.


Step2
Know what expectations the hospice will have from the patient and the patient's support system, and what kind of support and training program the hospice has for caregivers.


Step3
Research insurance coverage and payment options. Hospice care is a covered benefit under Medicare for patients with a prognosis of six months or less, and Medicaid covers hospice services in 41 states. Many private health-insurance policies and HMOs offer hospice coverage and benefits as well. Frequently, hospice expenses are less than conventional care expenses during the last six months of life.


Step4
Investigate the hospice. Find out if its accredited by a national organization like the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), Medicare certified, and certified by your state, if required. Also check it out with the Better Business Bureau (bbb.org) and/or the state attorney general's office and ask for references.


Step5
Verify that the hospice's policies and philosophy are a good fit with your family's medical, financial, emotional and spiritual needs. Ask about specialized services, billing procedures, planof- care document, designated caregiver requirement, flexibility with balancing the family's other responsibilities and the hospice's procedure for resolving issues. Also pay attention to the general level of concern and competence you observe when communicating with hospice employees.


Step6
Ask for help. Family members, friends, co-workers, clergy and people who belong to community organizations can all pitch in. Some can help with planning, and others can help with carrying out those plans and giving support.


Step7
Talk to the hospice about the challenging role of caregiver and find out how they will support you. You will be tending to the patient's constant physical demands, supporting his or her spiritual concerns and helping resolve unfinished business, in addition to dealing with health professionals, family and friends, and taking care of your own needs. Hospice can provide trained volunteers to offer respite care to give family members a break.


Step8
Be clear and firm about what you want when working with health professionals. Prepare lists of questions and concerns, and have all the information they may need ready when you call.


Step9
Get help as you and your loved one move into the final stages. Hospice offers a variety of bereavement and counseling services to families before and after a loved one's death. In addition, publications like "Journeys," a monthly newsletter to help in bereavement published by the Hospice Foundation of America, can help during this difficult time.

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How to Apply for Medicare

To apply for Medicare you must be at least 65 or disabled. You can apply at your local Social Security Administration office.



Step1
Understand that Medicare is a health insurance program paid for by the federal government that is designed to ensure that elderly people have medical coverage.


Step2
Determine if you are eligible for Medicare. You must be 65 or older, or disabled or suffering from chronic kidney disease if under 65. You or your spouse must have worked at least 10 years in a job that had Medicare coverage.


Step3
Know that if you are 65 or older and qualify, there is no cost for Medicare Part A, if you are eligible for or receiving Social Security.


Step4
Realize that if you are under 65 and qualify because of a disability, there is no cost for Medicare Part A if you have been receiving Social Security for 24 months.


Step5
Consider your right to purchase expanded coverage under Part B for $45.50 a month (1999 figure), which is deducted from your Social Security check. You will receive information about this with your Medicare card.


Step6
Recognize that if you are under 65 and receiving Social Security, you will be automatically enrolled for Medicare and will receive a card three months before your 65th birthday. If you are not receiving Social Security, you must apply for Medicare three months before your 65th birthday, or wait for the next general enrollment period after your birthday.


Step7
Call the Social Security Administration at (800) 772-1213 for enrollment forms, or go to your local office.


Step8
Bring your birth certificate, driver's license, proof of other insurance if you have any, and your social security card when you apply.


Step9
Be prepared to provide names of doctors, hospitals and clinics if you are eligible due to disability.


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How to Apply for Medicaid

To apply for Medicaid you need to contact your local social services department and show proof of your financial need for this assistance.



Step1
Understand that Medicaid is a state-run program that provides medical insurance for low-income people. Each state has different eligibility requirements and different application procedures.


Step2
Know that if you receive SSI (Supplemental Security Income) from the Social Security Administration, you will probably qualify for Medicaid.


Step3
Recognize that there have been recent limits placed on this program at the federal level, so the benefits are not as wide as they used to be.


Step4
Contact your local state Department of Social Services or Human Services. Your state may have a different name for this agency. It is the agency that provides food stamps and financial assistance. Call your county building and ask for the name of it if you don't know it.


Step5
Ask for a Medicaid application. You will need to complete it in the office.


Step6
Take your birth certificate, driver's license, pay stubs, Social Security card, proof of address, proof of other insurance if you have it and information about any bank accounts you have.


Step7
Be prepared to answer questions about your finances. Eligibility is based on your income level.


Step8
Ask office personnel for assistance if you do not know how to complete the form.


Step9
Request assistance at home if you would like to apply but are unable to leave home.