Most aid workers probably know somebody who has been through a form of extreme stress or burnout, and who has set themselves on the road to recovery by taking time out, seeing a psychotherapist or leaving their job. Of course many people don’t take any action, and become more and more sick. But what I’m interested in exploring here is who it is that chooses to step away from their work and seek help or take a break.
My research suggests that it is mainly female aid workers from western countries who take action. Out of the 125 national and international aid workers I spoke to in Kenya, a total of eight people described to me a specific and chronic health issue that they’d been diagnosed with. Six of these were European women, one was a European man and one was a Kenyan woman. This chimes to some degree with the Guardian survey of aid workers conducted in 2015, which found that approximately twenty per cent of their 754 respondents had suffered from PTSD and panic attacks, whilst forty four per cent suffered from depression. This is a far higher statistic than my own, but what’s important to note here is that the majority of the survey’s respondents were female, and identified themselves as international staff working for an international NGO.
The aid workers I spoke to with chronic health problems had all learned about their condition through seeking professional help of some sort; and in the case of the Europeans, this often occurred when they had left the field and were back in their home country. Some of these aid workers talked to psychotherapists, and some of them embarked on different forms of self-care such as yoga or meditation.
These opportunities to acknowledge one’s own health problems are few and far between when in the field. As one of my informants, a French woman working for an international humanitarian agency, told me:
“Not during the mission. I think that during the mission, when you’re in these sorts of situations, and when you have this kind of position, when you are in charge…no there is no space for you!”
This points to a working culture that many will be familiar with in the aid sector: one where emotions and feelings are pushed aside in the interests of caring for others. Where meeting urgent deadlines in the provision of food, shelter and other forms of assistance to people in need takes priority over the consideration of whether the aid worker themselves is coping. An Ethiopian man I met, who works for the UN put it like this:
“Fear comes in, nightmares at night when you sleep, I had actually about all these stories and some people had gone through real stuff. I’ve been kidnapped once, ambushed I think more than four or five times […] I always knew that if I don’t go what I’m going through, some boy or girl somewhere will either miss their meal […] or some boy or girl somewhere would not have education, […] kids will miss their vaccination or immunisation and these are the vital services that children need.”
But it is not only work-related pressures and working culture that are relevant in considering why many aid workers don’t acknowledge their own suffering and seek help. In the case of the 64 Kenyan aid workers I met, their approach to their job was in some ways different from their international counterparts, and this had implications for the degree to which they recognised and responded to stress in their lives.
It was clear from some of the Kenyans I spoke to that they did not wish to complain about a job which they felt fortunate to have, and which was enabling them to support their family. Most of the Kenyans I spoke to were married and had children that were either their own or they were looking after, and many had financial responsibilities such as paying school fees for siblings or other relatives as well. This was in contrast to the majority of people I met from western countries, who although were often in relationships and in some cases had children, did not share these extended family responsibilities. Self-care, and professional help, was thus easier to access for many international aid workers because they were more mobile and able to travel out of Kenya if needed, and had more disposable income. In addition, it was suggested to me by both Kenyan and European aid workers I spoke to that the reason that national staff didn’t take up counselling offered by their organisation was fear that doing so might threaten their jobs. As one Kenyan man I spoke to put it:
“I think we’re too busy to focus on such things or to look for counselling. I think there’s also this fear that the moment you approach HR that you need counselling services on your work, then it’s a sign of weakness or a sign of incompetence or something. At least that’s what I’d feel.”
There’s no doubt that a resistance to admitting to experiencing mental health problems in many contexts and for many people, whether from Europe, Africa or elsewhere. But in the aid sector there are extra factors worth considering – particularly for organisations attempting to provide psycho-social support to their staff. In a country such as Kenya, terms such as mental health or trauma are viewed somewhat suspiciously – as many of my informants told me. Alternative forms of therapy such as life coaching, yoga or meditation are certainly available, but they are fairly expensive – as is psychotherapy, if it is not paid for by the aid organisation. More reflection and creative ideas are therefore needed to ensure support for aid workers is accessible and relevant for all – both nationals and internationals.