Tag Archives: expat aidworkers

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.

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.