Tag Archives: burnout

Beyond Hope and Fear

Who out there shares my observation that there seems to be an awful lot of despair being expressed in the world at the moment, and that it’s not leading to much in the way of informed and inspiring action? Whilst I understand there have been exceptions – notably the Women’s March in the United States, UK and other parts of the world in January – I have felt that, in the UK at least, people appear to still be in a state of paralysis and shock following the tumultuous political events of 2016. And meanwhile Trump and Brexit march forward….

The discourse of fear that has apparently triumphed in both the UK and the US has prompted many to lose hope and feel powerless to change anything. The notions of ‘hope’ and ‘fear’ that guide much political change are discussed in an interesting article from the US based Berkana Institute, entitled ‘The Place Beyond Hope and Fear.’ The article was written in 2009 but is still relevant – even more so in fact – today.

One of the key messages from this article that resonates with me is that in order to resist a culture of fear we sometimes have to step back completely, so that we gain some perspective and clarity on the true nature of things – about what is going on right now, in our bodies and in our mind. This approach may be seen as a withdrawal – as the author acknowledges – but it is also a way of connecting with ourselves more deeply before responding to our environment. In doing so, there is the possibility of finding a response to events around us that is more compassionate and more understanding of what we see.

Parallels can be drawn here with the world of humanitarian and social justice activism. When faced with powerful political forces whose oppressive actions seem impossible to counteract, it is not uncommon for humanitarians to lose hope, and to withdraw. It is what I and many others have indeed done on certain occasions, and often with a heavy heart and a strong sense of guilt. This withdrawal has been called by another name – burnout.

Yet whether you are a seemingly jaded social justice activist responding to events in your own country, or a humanitarian or human rights worker responding to situations in Syria, Yemen, Nigeria, South Sudan or anywhere else, the decision to withdraw may be seen as more than just ‘giving up’, ‘shirking responsibility’, or ‘being selfish.’

As the author of ‘The Place Beyond Hope and Fear’ puts it:

I didn’t give up saving the world to protect my health. I gave it up to discover right action, what I’m supposed to be doing. Beyond hope and fear, freed from success or failure, I’m learning what right action feels like, its clarity and energy. I still get angry, enraged, and frustrated. But I no longer want my activities to be driven by these powerful, destructive emotions. I’ve learned to pause, come back to the present moment, and calm down. I take no actions until I can trust my interior state—until I become present in the moment and clarity emerges undimmed by hope and fear. Then I act, rightly, I hope.

There is something very relevant in this for aid workers. From my own experience of working on advocacy campaigns in the aid sector, I have seen that there is a tendency to engage in an ‘us and them’ rhetoric – where ‘we’ are the righteous and heroic and ‘they’ are the evil and villainous. Certain individuals – government officials, police, insurgents, church leaders, etc. – are often labelled as ‘the perpetrator’ in one form or another. Yet this labelling imposes a very black and white narrative on what is in fact always going to be a murky, complicated situation with complex characters involved; because that is the reality of life, where nothing is ever that clear-cut. This ‘us vs them’ mentality is not all that different from the language of fear that was so successful for both Trump and the Brexiteers, and which has had such a divisive impact on our societies.

I had an interesting conversation the other day with a Kenyan guy about how we deal with the judgements we make about people we disagree with. He was giving the example of people in his workplace who he realised were corrupt and how he had concluded that, when they lost their jobs, ‘they deserved it’. This is of course a natural judgement to make of someone who has committed what we see as a moral crime of one sort or another. Yet is it always healthy to see an individual only in those terms, whether it be as a corrupt person, an abuser, a perpetrator or any other such label?

We are all born into this world without any of these labels, and even though we may embrace or be ascribed many identities throughout our lives, they still do not necessarily reflect our entire personalities. Wouldn’t it help humanity, and help our ability to dialogue and debate the moral issues of the day, if we could see people in a more holistic manner that goes beyond this rigid labelling?

If we want to move beyond hope and fear, whether as aid workers, activists, or Joe Bloggs who is trying to make sense of the political upheavals of our time, perhaps the starting point is indeed to be present with our own emotions that are arising; to not dive into worrying about or reacting to the uncertainties of the future but to see what is happening in this moment. What do our reactions tell us about ourselves, and are these reactions helpful and conducive in bringing a change in attitudes or behaviour? This is not to say that anger has no place in taking action; indeed on many occasions it is the driver of social change but anger without a pause to listen and reflect can also lead to further hostility and division (think family arguments!) We do not know what the future holds; we in fact never know for sure, and sometimes the wiser course of action may be to rest in that uncertainty before leaping into a battle against what we think is going to happen.

This leads me to the next stage in building a more compassionate response. We need to commit to actively listening to others we disagree with. This requires that we release judgements which block us from discovering and understanding the other person more fully; just banging the table and calling someone ignorant or stupid is never going to move things forward. We can instead take on an almost innocent curiosity where we ask ourselves questions of ‘the other’ from a clean slate of non-judgement. Where does what they say come from? Is it from a place of insecurity that resonates with us on some level? Can we find compassion, and even common ground, by considering that person as more than just the labels we and others have assigned to them? They, like us, are in all likelihood individuals with the same basic needs and desires as us – such as health, love, financial security and freedom. Are we able to meet and understand someone on that basic level, even if our values appear diametrically opposed?

These are just the beginning stages, I believe, of stepping into a new way of being and learning that can guide us towards eventually taking informed and compassionate action in response to current political events. It is a long journey of change we have to embark on, but if we let go of judgements and the quest for a certain outcome, perhaps we can open ourselves to more possibilities than we’d ever considered before.

 

 

 

Who is the Aid Worker?

This is a question that has sprung up once again in aid/development debates, and one recent blog post arguing for ‘new words’ captures the issue very well. I have also been considering this question as I conduct research in Kenya. I have used the term aid worker in my research as I wanted to find an expression that could capture the diversity of people I was researching. To me it was the best term available to encapsulate all my research subjects – people working for international development, humanitarian and human rights organisations. But this by no means implies the term is sufficient; in fact it leads to a lot of confusion, for myself and others.

‘Aid worker’ is actually often associated purely with those involved in humanitarian interventions. So people have assumed that I am only interested in staff working for humanitarian organisations such as Medecins Sans Frontieres or the International Committee of the Red Cross. I’ve found myself having to explain that actually I’m just as interested in investigating the challenges of working on long-term development interventions; in talking to individuals who work on water and sanitation programmes or micro-credit schemes in rural settings, for instance. As what I wish to argue is that chronic stress may arise just as much from working in these sorts of settings as with short-term emergency operations in disaster areas.

But how can a human rights defender be considered an aid worker, some may ask? Well, as someone who has worked for both national and international human rights organisations, as well as development/humanitarian organisations, the easiest way to describe myself, when explaining what I do to people outside the sector altogether, is ‘aid worker’.

But of course this leads to huge misperceptions about what I do. The image of the heroic aid worker feeding a sick child or providing first aid to people fleeing war or violence is what everybody knows; yet I have never been directly involved in these sorts of operations, and in fact when working for human rights organisations there is often no assistance given whatsoever – it’s all about advocacy and raising awareness. But explaining that to an ‘outsider’ sometimes feels too clunky, too tiring….and sometimes one wonders, are they really that interested anyway in these finer details?

Furthermore, when we look at the actual job descriptions of aid workers, many are less on the operational side and more on the systems side of things – whether this be fundraising, M and E or strategy development. They are rarely doing the frontline work of regularly interacting and assisting ‘aid beneficiaries’ (another term that needs a serious overhaul). Yet as I’ve gone about my field research in Kenya I’ve been introduced to and interviewed a range of people who have offered themselves up as ‘aid workers’, who probably spend most weeks and months at their desks in an office in Nairobi, but who have a story to tell about stress and the challenges of the work.

This prompts a relevant question for my research; one which I feel inclined to ask my informants in the ensuing weeks – what does ‘the typical aid worker’ actually mean to people doing aid work?

This could be further expanded to ask more probing questions, like: What is the popular image they have in mind, and what is the real image that resonates more for them? At what point do people who enter the aid sector start describing themselves as an ‘aid worker’? And at what point does this concept of themselves get challenged by the reality they find?

The dissonance between the romantic image of the aid worker and the harsh reality of office politics, donor demands, unethical approaches and ineffective interventions can be a major challenge for people in the sector and, I think, a source of stress and contributing factor for those who burn out. This relates to a previous blog post I wrote about ‘moral injury’. The Headington Institute have a neat definition for this term and of another similar one, ‘wounds of the soul’:

They result from violations of deeply held beliefs about what is right […] when one must choose among “bad” options, [which] may force people to act contrary to their beliefs.

The writer at Headington Institute goes on to give other examples of moral injury within the context of humanitarian aid:

Inability to stop others from committing atrocities; carrying out management directives that violate personal values; witnessing random suffering caused by natural disasters; tolerating overwhelming injustice.

As the writer notes, these experiences can leave aid workers feeling full of guilt, shame and disillusionment – some of the hallmarks also of burnout.

So I feel it is true to say we must consider this term ‘aid worker’ and how we use it. Not just in the intellectual sense, but on a personal level too. Those working within the humanitarian/development/human rights sphere need to reflect on how they wish to see, and be, themselves. The narratives they, and their colleagues and organisations, build around their work may be serving to damage their own sense of self. What is needed in this work is not an inflated or exaggerated image of what one is expected to achieve in a world of extreme poverty and immense suffering, but confidence in the small and modest, but perhaps meaningful role, one can play in challenging opinions and changing lives.

 

 

 

Morals and Motivations in Aid Work

What motivates aid workers? And do motivations have any bearing on how aid workers experience stress? These are two among many questions I continue to grapple with whilst undertaking field research in Kenya.

Whilst family, friends and even strangers we meet at a party may assume that we are selfless heroes, ask aid workers about what motivated them to enter their profession and you’ll get a mixed set of answers. Some will flat out deny they have any altruistic motivations whatsoever and will argue that they are getting far more out of what they do than any so-called aid ‘beneficiary’ or ‘recipient’. The rewards for aid workers may be self-development, expanding one’s understanding of the world, exploring different cultural or social realities, or financial gain; because, much to the surprise of the stranger you meet at a party who asks you what you do for a living, aid work a lot of the time actually pays quite well.

Aid workers are often keen to debunk the popular image of humanitarian hero with purely altruistic intentions. A female development worker in Tanzania interviewed by Maria Erikson Baaz is quick to point out  the ‘egoistic will’ which drives her work (Baaz, The Paternalism of Partnership: A Postcolonial Reading of Identity in Development Aid, 2004: 90); and the aid blogosphere is full of snarky commentary (such as this one) that attempts to do away with false assumptions about heroic aid workers.

Aid worker motivations are nevertheless complex and cannot be easily categorised into the altruistic/selfish binary, as writers such as Sara de Jong (de Jong, ‘False Binaries: Altruism and Selfishness in NGO work, in Fechter and Hindman Inside the Everyday Lives of Development Workers: The Challenges and Futures of Aidland2010) and, most recently, Liisa Malkki, have highlighted. Malkki’s book, The Need to Help: The Domestic Arts of International Humanitarianism, which I have yet to finish, asks the question, ‘what is it we’re not seeing, and not being told, about the motivations of humanitarian workers?’ Her interest is particularly in the neediness that, she argues, often underlies a person’s decision to enter into this profession; a neediness to get away from home and find solace in a different community, or the neediness to live out a sense of obligation towards those less fortunate than oneself. She also notes that heroism, or some sense of self-sacrifice, were rarely the guiding motivations for the Red Cross humanitarian professionals she spoke to, although these factors probably had some influence. Many of her informants talked more about their ‘internationalist’ aspirations – the desire to travel and interact with different cultures, a sense of obligation towards the global south, whose communities were victim to the global north’s avarice and war-mongering – than a specific calling to a particular cause. Solidarity and a feeling of working together for a greater good were also important to the aid workers she interviewed.

What this indicates is that whether motivations are seen as selfish or altruistic, there is a moral undertone that guides a lot of people in this sector; aid workers do this work because they believe it is ‘the right thing to do’ in order to ‘share humanity’, to be part of this world and to take responsibility for the damage we are all causing to it.

I find this interesting as it relates somewhat to my own experience, and also to a term coined by a journalist interested in the trauma experiences of soldiers and of humanitarian workers; a term  which I’m going to adopt here – ‘moral injury’.

I was trying to think back to when I first felt this urge to enter the humanitarian sphere. There was one pivotal moment that particularly lodged itself in my memory, and that was seeing the aftermath of the earthquake Izmit which struck Turkey in August 1999. I was so horrified by what I saw on the news, and felt this strong desire to go and help. It was during that same summer that a friend from University had travelled to Cameroon to do voluntary work. When hearing her account of her experiences there when she returned, I remember feeling this urge to do the same, and also to do my volunteering in Africa.

So I left University with this determination to work abroad for a charity, but I didn’t really know what sort of work. I guess I had that ‘need to help’ that Malkki was talking about. Whether it’s a ‘neediness’ as she is implying in her book, I’m not sure. But it did eventually turn into an attachment to a particular cause and a moral imperative to take action – on the war in northern Uganda, on the post-election violence in Kenya, on the occupation in Palestine…and so on and so on.

Fast forward to 2016, and the plethora of questions and debates that have arisen around why aid workers suffer from stress and burnout, and how it can be prevented. And one journalist’s reference to ‘moral injury’, which caught my attention. The point he was raising, actually in reference to soldiers but with relevance for aid workers too, was that maybe we become damaged by disappointment and betrayal; because we start off in this work with a sense of moral obligation but can end up hugely disillusioned when we find out that our intentions are not always appreciated. Perhaps our organisation does not share our moral standpoint, or maybe the communities we supposedly ‘serve’ do not want us to be there. Or perhaps we feel betrayed because of something we should have done, but didn’t; or equally because of something we did do but wish we hadn’t. Sometimes we may end up questioning whether we’re doing any good whatsoever, and whether therefore our work is completely at odds with our moral obligation towards those who are suffering partly as a result of our governments’ policies. I remember leaving Palestine in 2011 with those very questions and wondering whether my presence there was appreciated, or made any difference. Perhaps no surprises what happened next – I’m undecided whether to call it a burnout, but it certainly resulted in a break from the sector and a difficult emotional period lasting over a year.

What do the mixed, changing and at times unrealised intentions of aid workers mean for how and whether they experience stress and burnout? I’m interested in exploring this here in Kenya, where I’ve spoken to a number of people, both Kenyans and expats, whose motivations do not point immediately to moral obligations, nor to purely altruistic intentions. Some have fallen in to this work without really planning it, some are in it for the opportunity to live abroad and be exposed to different cultures, and some are using it as a stepping stone to another career later on down the line. And of course there are indeed some who are passionate about what they do, and believe they can make a meaningful difference to people’s lives. I am not doubting that there are often caring intentions at play, but I am interested in exploring how different motivations are recognised and how they influence the behaviour and choices of aid workers. Sarah de Jong makes an interesting argument that altruism and selfishness may exist simultaneously and are not necessarily in contradiction to each other (de Jong in Hindman and Fechter, 2010: 37). I believe it is important to recognise this in order to understand fully why people enter the aid sector, how they change throughout their professional lives, and the reasons why some of them end up leaving for good.

 

Aid Worker Wellbeing: Reflections on the Guardian Survey and Steve Dennis case

This past week has seen a real shake-up in the aid sector. First last Monday the publication of the Guardian’s survey on aid worker wellbeing, which found that 79% of its 754 respondents claimed to suffer from mental health problems, including diagnosed depression, anxiety and post-traumatic stress disorder (PTSD). Then on Wednesday came the news that an Oslo court had found the humanitarian organisation Norwegian Refugee Council guilty of ‘gross negligence’ in the treatment of former employee Steve Dennis and others who were kidnapped by armed groups in Dadaab refugee camp in Kenya in 2012. Steve Dennis was awarded $500,000 in compensation plus costs.

Both pieces of news point to the same issue – that aid organisations are not giving nearly enough attention to the wellbeing of their staff, particularly those who are doing the frontline relief work in emergency areas, and that individuals are not getting the support they need when they experience serious stress and mental health conditions such as burnout and PTSD.

But before aid organisations quickly rush to demonstrate that they have all the right policies and structures in place to support their staff (I’m sure this is happening already, particularly given the legal implications of the Steve Dennis case) it’s worth reflecting on a few issues that are relevant but have not been so highly pronounced or exposed in these two pieces of news.

Which aid workers are being referred to in the Guardian’s survey? We are given little detail about who the 754 respondents are, except that most of them were female and expatriate. This in itself is hardly an accurate reflection of the broader aid sector, in which approximately 90% are nationals. I am also interested to know who these ‘aid workers’ were exactly. Only those working in disaster areas? Or development workers? They may not be exposed to the acute suffering that one witnesses in a disaster area, but are certainly likely to witness the human misery that arises from extreme poverty. Or human rights workers? They too are bearing witness to ongoing injustices. The survey did not make clear what jobs these 754 respondents were doing. For me this is of interest because the assumption is often that it is humanitarian workers who suffer the most from the work they do. And yet my own research is already demonstrating that you don’t have to be on the frontlines of war and disaster to suffer from burnout or post-traumatic stress disorder.

Can the causes of mental health problems be so easily defined? The main factors contributing to serious mental health conditions according to the Guardian survey were security incidents and the witnessing of human tragedy. Yet it is also becoming clear, in the Guardian’s own reports and elsewhere, that different people – women and nationals in particular – experience different challenges in this work. Given the Guardian’s own reporting on sexual assaults within the aid industry, a question we should be asking when addressing aid worker wellbeing is what specific challenges have women faced and what sort of support do they need? The same could be said about nationals. It is quite possible that some nationals are directly affected by the issues their organisations are working on; perhaps they are refugees themselves, or they or their family have been victims of domestic violence. These factors are important as mental health conditions cannot be fully understood unless we consider the individual’s background and identity and how these impact on their experiences in the workplace.

What are aid workers doing to address their challenges and difficulties? Both the Guardian survey and the Steve Dennis case may provide damning evidence that aid organisations need to be doing more to support their staff. And certainly the survey findings are pretty critical about the insufficient response given by aid organisations to staff who have suffered from mental health issues. But tightened security procedures, regular debriefings and staff counselling are not the only solutions aid organisations should be seeking. Staff themselves need to be considering what they must do to address the challenges they face in their work. As aid workers, we all like to moan about how our managers don’t have time for us and aren’t supporting us enough – and this may well be accurate a lot of the time – but are we also giving time and support to ourselves? In a culture that can often seem competitive and macho in its pressure to work the longest hours and be the most dedicated, what role can we play in caring for ourselves and stepping back, or seeking help, when we need to? With any big emotional challenges in our lives, it can be far easier to point fingers and blame situations or other people. It is harder, but just as important, to reflect on who we are and how we approach our work as possible factors in why we struggle in certain ways. As aid workers, our personal motivations, expectations and approach to work may say a lot about whether we eventually suffer disillusionment, guilt or burnout. And likewise reflecting on these and what needs to change within ourselves may help overcome some of our darkest moments.

These comments are not seeking to belittle individual experiences, nor undermine the serious mental health conditions that many are suffering in this work, including the staff of Norwegian Refugee Council who were kidnapped and those who responded to the Guardian survey. But I do believe we need a more nuanced approach to aid worker wellbeing that recognises that the challenges of this work are not simply related to security incidents and operating within conflict settings; I believe the experiences within the sector are far more complex. Nor are better security procedures or counselling services the only solutions. As the Guardian survey recognises, the culture within aid organisations must change. This not only means creating a space where it is safe and acceptable to admit you are struggling or not coping; it also means cultivating an environment in which people continue to feel valued and maintain a sense of purpose and meaning in what they do. This is the work of everybody – organisations and staff – who have an interest in reducing serious mental health and stress conditions and the resulting staff absenteeism and turnover; and who wish to encourage a spirit of humanity – not only in the field but also in the office.

 

 

The Role of Staff Welfare in Improving Humanitarian Practice

Yesterday saw the launch of three reports on humanitarian practice in Nairobi, and also saw me presenting on a panel for one of the reports. The panel was organised by the CHS (Core Humanitarian Standard) Alliance, a network of around 260 humanitarian organisations operating in 160 countries worldwide.   Its work focuses on ensuring the core humanitarian standards – nine commitments on quality and accountability – are mainstreamed throughout all humanitarian operations.

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A photo on display at the conference: MSF workers deliver food parcels to a remote mountain region in Nepal (Tatiana Kotova)

The CHS Alliance’s Humanitarian Accountability Report is entitled On the Road to Istanbul: How can the World Humanitarian Summit make humanitarian response more effective? In its 13 chapters, written by different experts from the humanitarian sector, 5 key themes are addressed, which the panel members, including myself, spoke to in our different capacities:

  • the role of principled humanitarian response in building trust and facilitating access
  • how standards can drive appropriate, effective and timely aid
  • strengthening national capacities in aid delivery
  • collective accountability and transparent decision making
  • good people management practices

This report launch coincided with two others – ALNAP’s State of the Humanitarian System report 2015 and Quality and Accountability Initiatives by the Inter-Agency Working Group on Disaster Preparedness in East and Central Africa. Whilst the content of these reports and the presentations given by the different speakers at yesterday’s event are all very relevant to the debates around improving humanitarian effectiveness, I will only touch here on the issue which concerns me most within my own area of interest – staff welfare. This was what I was discussing on the panel in the morning, and is an issue which was hotly debated on the margins of the global consultations for the World Humanitarian Summit happening in May 2016.

Sadly, I did not see these debates being addressed or given much attention in yesterday’s event, which was attended by around 80 regional and country directors and managers from various aid agencies, including UNOCHA, World Vision, Save the Children, Oxfam, Action Aid, Red Cross and Danish Refugee Council. The tendency of staff security, safety and welfare to be sidelined by what are seen as the bigger priorities of meeting the growing needs of populations living in crisis situations is nothing new. And certainly given the reality of today’s world crises and conflicts – creating higher numbers of refugees and populations in need of assistance – it is no surprise that humanitarian decision makers find it hard to consider their own health when having to make what often amount to life or death decisions affecting thousands of people.

Yet one issue highlighted in the ALNAP report on the State of the Humanitarian System  – the threefold increase in attacks on humanitarian workers since 2002 – demonstrate the huge risks, and the implications of these risks, for people working in emergency settings. In 2013, 151 humanitarian workers were killed, 171 wounded and 134 kidnapped. The majority of these were national aid workers, operating in their own countries. The increase in attacks are partly down to the changing nature of global conflict, with humanitarian workers now often being specifically targeted by non-state actors and armed groups. But as we’ve seen with the case of the MSF hospital blown up in Kunduz, Afghanistan, Western states are also responsible for flouting the laws governing armed conflict, directly affecting those engaged in humanitarian operations.

A photo on display at the conference: humanitarian workers on their way by helicopter to an IDP camp in South Sudan (Andrea Contenta)

A photo on display at the conference: humanitarian workers on their way to an IDP camp in South Sudan (Andrea Contenta)

As security risks to humanitarian workers are on the increase, so too is the likelihood of chronic forms of stress, such as post-traumatic stress disorder, for those working in the midst of crisis. My presentation at the CHS Alliance report launch highlighted two distinct issues arising from this reality, to be considered by humanitarian organisations. One was the need for organisations to understand the different cultural interpretations and ways of dealing with stress.   Staff welfare strategies, in terms of addressing problems such as stress, burnout or post-traumatic stress disorder, must acknowledge the diversity of the sector if they are to be effective. What is seen as stressful or traumatic for a white expat worker may be very different from what a Kenyan worker feels and experiences for instance. From the data I’ve collected so far in my research I’ve found that addressing the mental and physical health needs of national humanitarian staff is a major challenge. This is partly to do with inadequate support structures that privilege the expat staff, and partly to do with the very different cultural understandings of how personal emotional difficulties are talked about and dealt with. One important way of addressing this is to consider the right language to be used for addressing these difficulties. Trauma, for instance, or the more general term ‘mental health’ are still stigmatised words, not only in Kenya but in many other contexts.

Another issue I touched on in the panel discussion is related to the structures and culture of aid organisations. Some people, particularly national aid workers, have told me that there is a resistance to openly discussing vulnerabilities or difficulties in coping because people fear losing their job. This macho culture of working long hours, not really looking after yourself and not admitting that you’re not coping is so common in this sector and having the right support mechanisms in place is not enough to change this.

Instead, both managers and staff need to be asking themselves, how can they break down the stigmatisation around seeking help? How can they open up the space to allow for people to share their vulnerabilities and their personal insecurities? A major element that drives humanitarian work is compassion – compassion for the community in crisis. That same compassion can be lost when it comes to individual staff members looking after themselves or their colleagues. So a change in culture means cultivating an environment where staff can reflect on their emotional challenges and those of their colleagues, where they can realise they are not alone in the difficulties they face with this work, and where their personal problems are met with sensitivity and understanding.

These issues are of the utmost importance to people working in the humanitarian sector, as evidenced in various online discussions happening at the moment in the run-up to the World Humanitarian Summit next year. Yet so far there has been little recognition of the centrality of staff wellbeing to improving humanitarian practice; hence why it is not seen as a key theme to be addressed at the World Humanitarian Summit nor as an issue to be followed up in discussions such as those taking place in yesterday’s report launches in Nairobi. This is not to say that individuals, including those in the conference room yesterday, are not concerned about staff welfare. But addressing this part of humanitarian work remains far down the agenda of most aid organisations, and even more so for the donor agencies supporting those organisations. Humanitarian workers must continue to push the agenda of staff welfare within their organisations, and also at the World Humanitarian Summit in 2016. It should be an essential component in understanding how to make humanitarian action more effective and sustainable.

 

 

The Realities of a Life in Crisis

Watching Living in Emergency, a documentary film about doctors from the humanitarian agency Médicins Sans Frontières (MSF) operating in Congo and Liberia, reminded me of the profound emotional challenges and difficult decisions that are part of everyday life for many aid workers. The film tracks the lives of several doctors working in post-conflict Liberia and war-torn Congo, some of them located in remote areas with few resources to treat the hundreds of sick and wounded people who come to them for assistance. It addresses many of the issues I’m grappling with as I conduct my field research on stress and burnout among aid workers in Kenya, and which are important factors in remembering the human behind the humanitarian.

  • MotivationsThese are complex and not always what may be assumed. Whilst it’s easy to think that aid workers have purely altruistic motives – the wish to help others – sometimes they are fighting their own personal demons or pursuing a form of happiness they never achieved back home. In the film, one MSF veteran of 9 years mentions that some people do this work to run away from something, as was the case with him and his escape from life back home in Australia. A doctor who gave up his comfortable life in the United States to work in a hospital in Liberia claims, ‘It ends up being a selfish thing. Somehow fixing other people fixes yourself’.
  • Disconnection with home. The longer that aid workers are working in foreign lands, far away from the comforts of home, and the more they are exposed to immense and at times relentless suffering, the harder it becomes to relate to friends and family thousands of miles away. The Australian doctor in Congo claims he is essentially ‘homeless’ after moving around for so many years. The American doctor in the only free emergency hospital in Liberia’s capital Monrovia at the time, says, ‘If you’re going to talk to some of your friends about some of the stuff you saw, and you can’t describe the smells, the feeling of the heat on your body, the sweat running down your back, the smell of the pus that hits your nose and the unwashed bodies in a closed room…the smell of your own panic when you’re not sure what to do…you can’t share that stuff.’
  • Tensions between expatriate and national aid workers. Expat aid workers can often forget the privileges associated with their position, particularly in relation to their national counterparts. In the aid sector, the term ‘expat’ is often assumed to refer to a white person from the global north. Furthermore, the term ‘expat’ is conflated with ‘expert’ in the language of the aid industry. These assumptions are problematic for the aid worker from the global south, who is left on the sidelines of dominant white expat approaches to aid. In Living in Emergency, these roles are played out between the expat staff and national staff at MSF. In one scene there is an altercation between a Liberian doctor who is accused of being arrogant by his Italian colleague after disputing treatment being recommended by one of the expat doctors. In front of the camera he tells his Italian colleague, ‘Tell your doctors to talk to me like a doctor and not like a small boy. And don’t tell me I’m arrogant because I disagree with the diagnosis’. The different experiences of national and expat aid workers are highlighted again when some of the expat staff prepare to leave the country. A national staff member comments to his colleagues, ‘don’t get used to any expatriates. As they go, other people come’.
  • Inability to meet expectations of populations in need. As an aid worker, you can at times feel that people are depending on you massively to save their lives. Indeed sometimes this is the case – you are their only hope. What you decide may affect whether that person survives. And sometimes you have to say no, because you can’t meet everyone’s expectations – perhaps because of lack of resources, or because of the limitations of your organisation’s mandate. In my own experience, people have sought my help and I have not been in a position to give them the assistance they need. In one case, the person died as a result of not accessing the required treatment. Doctors at MSF have to accept this reality all the time. As the American doctor says, ‘you have to be able to live with wrong decisions. That’s really hard to do.’ An Italian woman working for MSF in Liberia comments, ‘I think we all have the same question and that is, what is our limit?’ A young Australian doctor on his first MSF mission and working in a remote village in Congo says, ‘I compare myself to others and I wonder whether another doctor in the same setting would have had the energy….to spend longer with that patient, sleep less that night, and got more work done the following day than I got done.’
  • Loss of idealism. Many aid workers start off their career with a determination to put an end to some of the injustices that they have seen on the news or read about during their studies. When they travel to the field they face realities that challenge the noble intentions to simply do good and help others. In the face of war or extreme poverty, and limited by lack of resources, the sort of help they had envisaged giving may not be possible. As an Italian woman working for MSF in Liberia says, there is a loss of innocence: ‘At the beginning I was feeling good about everything I was doing. Now I’m not feeling good anymore’.

These are some of the realities of a ‘life in crisis’, whether working for MSF or another humanitarian agency. They are also the experiences at times of development and human rights workers, who aren’t necessarily operating in emergency settings but who on a daily basis are faced with immense suffering and expectations that they are unable to meet. The guilt associated with these realities is felt by many and may linger for a long time.

And while for expats there are undoubtedly significant challenges to working far away from one’s home country, and at times it can feel like living in two very different and disconnected worlds, the national aid worker has their own unique struggles. They have no choice to leave the country after a year. The suffering they witness is part of their own society, perhaps their own family and friends, and will not end when the expat finishes their mission.

These realities have emotional consequences. How do aid workers maintain a sense of hope in the face of the struggles they encounter as they carry out their work? What is important and gives meaning in their lives when confronted on a daily basis with so much suffering and so many challenges? Searching for the answers to these questions is a part of my research and should also be considered by aid organisations and staff alike in the quest to address stress and burnout in the aid sector more effectively.

Stress in the Aid Sector: Who Suffers Most and Why?

Something in my heart snaps. My hands tremble and my eyes burn. For the first time since arriving here I cry. I cry for the dead boy buried in the cornfield. I cry for the hungry man beaten by the police. I cry for the little boy whose hopes of living with family have been shattered. I cry for the woman who will never recover from the wounds inflicted by her husband…

Miranda Gaanderse, relief worker in Rwamanja refugee camp, south-western Uganda (from Chasing Misery, ed. Kelsey Hoppe, 2014).

Why do some aid workers suffer from stress more than others? How do they cope with their emotional difficulties and what does this tell us about who they are and why they are doing this work? These are some of the questions I will be considering as I conduct field research in Kenya for my doctorate.

My research is inspired by my own experiences and those of my colleagues in the aid sector. Having worked in many different roles and in a variety of contexts – from villages at risk of demolition by Israeli authorities in the West Bank, to communities recovering from conflict and the tsunami in Sri Lanka – I’ve realised that stress and burnout is more complicated in this sector than one may originally assume. It is not merely the consequence of working in emergency or crisis situations, nor is it solely related to insufficient institutional support or the difficulties of working in unfamiliar settings, far away from family and friends. As mentioned in a previous blog piece there is a wealth of literature addressing the possible causes and symptoms of stress and burnout. However, whether it be in academic literature or in NGO/aid agency policy papers, we are told little about who it is specifically that suffers from stress and why. In particular I have found that there is an emphasis on the experiences of people operating in emergency settings – primarily relief workers – and on expats; with little attention paid to the reality that stress and burnout are also problems for other types of aid workers – such as development professionals or human rights activists, and nationals operating in their own countries.

The fact that there are so few studies about national aid workers is of particular concern, given that they make up approximately 90 per cent of the workforce.  They are often at the most risk from the work they do, due to their social proximity to the victims and perpetrators of human rights abuses and the state authorities responsible for addressing such abuses. They are also usually on lower salaries, with less benefits than their expatriate counterparts. They cannot simply leave the country when times get tough, nor do they have the same luxuries as many of their expat colleagues in terms of living arrangements and housing allowances.

Recent, and now increasing, reports of female aid workers being sexually harassed whilst on the job also highlights that women are at times faced with specific challenges and risks that are not fully recognised and no doubt are a serious source of stress.

Although these issues are receiving growing attention, this is not yet being translated into providing better advice and support that acknowledges the complexity of aid workers’ experiences. My research is thus aimed at highlighting that stress among aid workers can only be fully addressed by examining the diversity of personalities and identities within the sector and the influence of these elements on behaviour and experiences.

Motivations are particularly important here; I believe a deeper understanding of these may shine some light on why some people suffer from stress more than others. It is common for aid workers to be perceived as purely altruistic (particularly in the media and indeed by our own family and friends), or the complete opposite; in other words, motivated by what they may gain in terms of personal or professional development and status. Aid workers increasingly try to debunk the image of the altruistic hero by emphasising their primarily selfish motivations. My feeling is motivations are more complicated than this, and may be influenced by one’s background, upbringing and political beliefs. I’m interested to find out what role these motivations play in how aid workers approach and deal with the pressures of their job.

I also hope to reveal how one’s identity – whether this be class, gender, race, sexual orientation, culture or religion – influences the aid worker’s experiences. Whilst aid workers themselves share their experiences of the specific challenges of being, for instance a woman, or gay, far more analysis is needed to understand how these challenges contribute to stress and burnout in the sector.

It is my belief that understanding these issues is vital if organisations are to provide better staff care, and if aid workers are to make sense of the emotional upheavals associated with their jobs. I hope that my research, as well as this blog site, will provide opportunities to share experiences and reflect on how as aid workers we can understand ourselves and each other better.

The Role of Mindfulness in Aidwork

Using the terms mindfulness or meditation in the work setting of a humanitarian or human rights NGO can often feel inappropriate or irrelevant. In a sector that focuses primarily on caring for others, this method of self-care may seem at best of secondary importance, at worst in contradiction to the principles of selflessness that are associated with aid work. In the wider Western world, these terms also have negative connotations – of being hippie or ‘New Agey,’  therefore only understood and respected by people who have chosen a spiritual path. And a common accusation is that meditation is a navel-gazing exercise, which allows us to be detached from, or to escape, the realities of the world we live in but has no value in bringing any sort of change to those realities. This accusation can be found in, for instance, an article by Guardian columnist Suzanne Moore, which claims that mindfulness is all about self-help, but does nothing to change an unjust world. I would like to take issue with some of these assumptions about mindfulness and meditation, whilst also highlighting and attempting to address the uneasiness that exists towards the practice, both in the humanitarian and human rights sector and the wider world.

But first, what is mindfulness and how can it be distinguished from meditation? I see mindfulness as a practice, or exercise, that can be applied at any point in any day, no matter what we are doing. Meditation is one tool in which to practise mindfulness – a way of stepping out of what one is doing in the day, and dedicating 5, 15, 20 or 50 minutes to simply sitting and being present. Focusing on the breath is a common way of anchoring ourselves in that present moment. Mindfulness, whether through quiet, solitary meditation or otherwise, is an opportunity to transcend the endless chatter in our heads – the grievances about the past, the anxieties about the future – and simply focus on experiences as they happen, in the present. We can practise mindfulness without needing to meditate. The moment may be something as mundane as doing the ironing or as challenging as physical or emotional pain. Or the enjoyment of eating chocolate or walking in the woods. How often do we actually taste the food we are eating, when most of the time we are eating whilst working, or reading, or talking to others? How often do we actually feel our physical pain, when our instinct is to distract ourselves from it or be so consumed in worries about the possible future implications of the pain? Mindfulness puts us in touch with the immediate sensory experience, so that we are able to really feel what is happening, and acknowledge what that feeling is. It helps to deepen our awareness of all the thoughts, feelings and emotions that make up who we are, not only as individuals but as part of the human race.

Relating this back to humanitarian and human rights work, being mindful is a way of ensuring that we are not continuously led by our emotional responses. This is not to say that emotional responses to injustice, or human suffering, are not important. I think the problem that Suzanne Moore and others – including myself at times – have with ‘spiritual’ practice is the notion that it is too inward-looking, and makes robots out of human beings; real, raw emotions may in fact be lost in the search for authentic and transcendental enlightenment.

But mindfulness is as much about connecting with the outer world as it is with navigating our inner world. Both of these are important – we cannot help or show understanding to others if we are unable to help or understand ourselves. This is why compassion plays such an important role in Buddhist teachings of meditation. By exploring what is happening within, we can connect with deeper truths about human existence, consciousness and suffering that we so often overlook, ignore or avoid in everday life. Mindfulness also enables us to take a moment to watch the emotional reactions we have and guage whether they are helpful for us and for others. Anger and rage may be common experiences when working on issues related to oppression and injustice, but they are not always helpful. I have worked in settings where these emotions, displayed bombastically, provocatively and argumentatively serve to alienate the sympathisers to our cause as much as our opponents. Is that what we really want to achieve each time we disagree with something or someone we don’t like? Breathing in to and observing those emotions, instead of always getting lost in them, helps us to gain some clarity over how it is we really wish to respond, and what it is we really wish to convey when we react to human suffering. We are mindful not only in observing our thoughts and emotions, but also in putting those thoughts and emotions into action, for a particular effect or outcome. This is why it is an essential tool to bring into all that we do.

The debate over the relevance of mindfulness in aid work and activism is far from over, and in fact has only just begun, as more and more people take up the practice as a means to relieving stress and burnout. Whilst I try to practise various forms of mindfulness in my everyday life, I also continue to ask myself certain questions about its scope and use in the sector I work in. How can it help aid workers interact more effectively and compassionately with people around them? What role can it play in the quest for social justice? Is it merely a practice for the privileged or can it have meaning for the communities served by aid workers? Perhaps some readers have experiences to share that can help answer these questions.

Burnout in the Aid Sector: Debates and Emerging Issues

Burnout is a term that has become increasingly popular among the helping professions. Described by its key researchers as the emotional exhaustion and development of negative attitudes towards oneself and others that occurs among individuals doing ‘people work’  it is now increasingly recognised as a widespread problem within the aid sector. Within this sector, burnout is equated with mental and physical exhaustion, emotional detachment and insomnia arising from operating in challenging environments, heavy workload and insufficient social or organisational support. Concern has also been raised over its impact in terms of high staff turnover and absenteeism.

However the causes of burnout among aid workers are not clear or straightforward. There is a misguided assumption in much of the academic literature and public debates on this issue that chronic forms of stress such as burnout and post-traumatic stress disorder are associated with working in insecure or dangerous environments. This assumption fails to capture who exactly the aid worker is and how their unique circumstances – the personal values, choices or expectations that influence their work – may have an effect on their experience of stress. In addition, the humanitarian workers featured in most of the studies of stress and burnout in the sector are expatriates, whose emotional challenges are often associated with the specific pressures of living away from home in unfamiliar settings. Only a limited number of studies examine stress among national aid workers operating in their own countries (for some exceptional examples read Ager et al, 2012, and Cardozo et al, 2005).

A recent online consultation by PHAP (Professionals in Humanitarian Assistance and Protection) was a promising step towards putting the issue of stress and burnout and improving staff welfare in the aid sector firmly on the agenda of the UN at the World Humanitarian Summit next year, alongside a petition calling for the same. Among the rich and impassioned debate among approximately 170 aid professionals who joined the consultation online, a couple of issues emerged that reinforce the concerns I’ve outlined above. One is that we need to recognise that the emotional difficulties of this work do not only affect those doing the frontline interventions. Aid work means many things to many people; within my own professional experience this has included being a programme officer, human rights defender, researcher and campaigner. None of these roles fit traditionally within the humanitarian worker mold, but the emotions they provoke are not dissimilar due to the implications of repeatedly bearing witness to immense suffering and the horrors of mankind.

Not only is the call for better staff welfare too often focused purely on those working in emergency settings, it is also focused too often on expatriate aid workers. Yet, as acknowledged at the PHAP consultation and by others, national aid workers make up approximately 90 per cent of people operating within the aid sector.  They are often the ones exposed to more danger and risk due to their social proximity to communities their organisations are assisting and the fact they receive less security benefits and privileges – such as R&R packages and evacuations – than their expatriate counterparts.

Another important issue to emerge from the PHAP consultation is the aid sector’s organisational culture, which prevents the issue of staff welfare being widely discussed. In a sector that is constantly battling to get funds for its programmes, and where the public image is so focused on helping others, staff care costs are seen as a luxury. The fact that many organisations are not providing enough support or services for people suffering from chronic stress or burnout is obviously a major concern. However, so too is the fact that staff themselves are not admitting they are having difficulties. It’s quite possible that as aid workers, we all know someone who has suffered from chronic stress. But the signs are not always obvious. Aid workers and others within the helping professions are quite good at their emotional labour – a term described by Arlie Hochschild, the person who coined it, as ‘the management of feeling to create a publicly observable facial and bodily display’. In the case of aidworkers, amidst witnessing and responding to human rights violations and humanitarian catastrophes, showing one’s own vulnerability at times feels self-indulgent, or a sign of weakness amongst one’s far tougher colleagues and managers. Marianne Elliott provides some good examples of this in her account of her experiences working for the UN in Afghanistan. As does Kathleen Rodgers in her research into staff at Amnesty International.

Where there is a culture of suppressing difficult emotions it’s hard to know what the best response or form of support can be. Self-organisation among aid workers – seeking out support groups (please refer to my Resources page) – and opening up the discussion among colleagues, is in my view as important as putting pressure on  managers to take more responsibility in duty of care. As another humanitarian blogger has noted, we need to bring our burnout and our breakdowns out of the closet. Staff support and welfare interventions should certainly become more of a priority for aid organisations wishing to address staff burnout and turnover. But we as aid workers should also be willing to engage more directly with our own emotional needs and those of our colleagues. After all, this is part of the compassion that lies at the heart of all humanitarian work.