Tag Archives: stress

What do Stress and Wellbeing mean to Aid Workers?

In the last few weeks I’ve been engaging in discussions that have put the question of how aid workers interpret stress and wellbeing at centre stage. In August I ran a stress management workshop with an Italian NGO in Kenya which was attended by Kenyan, Somali and European staff. Aside from that, I’ve been talking to various people who have an interest in or are working on providing stress relief for aid workers and social change makers.

The question of how stress and wellbeing is understood by different people is important because in a world that is flooded with information about ‘alternative therapies’ such as yoga and meditation, as well as the western psychotherapy models, we can forget the hundreds of cultural traditions around the world that have handled emotional difficulties and mental health problems in their own, localised way. We can also forget that what works for one culture or society may not work for another. And in the aid sector, where the majority of staff are nationals from the southern hemisphere, we perhaps therefore still have a lot to learn about what interventions (if any) are appropriate for dealing with work-related stress.

The tendency is to assume that standard psycho-social models are a sufficient mechanism for addressing staff mental health. But there is a counter-argument that suggests that Western models of trauma healing are not always appropriate, nor healing, for some individuals from post-conflict countries. This has been argued in various literature (for instance, here) and was a point made by an Italian doctor I met recently who was conducting a training for humanitarian workers in body, mind and spirit practices for stress, trauma and compassion fatigue. During the training she related how in previous trainings in Rwanda and Burundi, some of the participants had commented how traumatising they had found the counselling given by Western psychotherapists.

’Stress’ and ’counselling’ are pretty familiar terms in European and American societies. Whilst there is still stigma around issues of mental health – people don’t talk openly about their depression, for instance –  there is an assumption that stress is part of everyday life, and that chronic forms of stress affect some of us and require clinical intervention in the form of one-to-one counselling.

The personal perception of stress and the way one deals with it is, in many ways, culturally and socially rooted. Whilst many NGOs provide some form of counselling for their staff, it would seem that ‘talking therapies’ are not necessarily the answer for a lot of aid workers.

Here are a couple of quotes from my data:

“There are those of us like me who come from nomadic background which thinks that talking about it is…is being a bit of a sissy. But, there are those of us that come from that culture of expressing yourself and you can see that people do grieve with each other, with different cultures.”

Somali UN worker (male)

“They pay for our counselling…but since it’s not so African to go for such things, most people don’t go for…debriefing. You can go during your R and R but nobody seems to ever get to it […] We as Africans we handle our stress differently – everyone has their own issues so why do you think yours is bigger? […] I think people just learn to handle their stress on their own, in case it’s there. Because for one we don’t open up that much, and especially here in Kakuma who would you open up to, especially if stress is work-related [….] basically you have to learn to handle your stress by yourself.”

Kenyan humanitarian NGO worker (male) (Kakuma)

Stress is not only culturally rooted; it is a gendered concept too. In the stress management workshop I recently ran, the Kenyan women remarked that stress in their society is largely seen as a women’s issue and associated with marital pressures, and with being of the ‘weaker sex’. This not only denigrates stress to the female experience, it also sends out the message that men do not suffer from stress, and therefore should certainly not talk about it.

I have been wondering about self-care practices too. ‘Self-care’ is in itself a dirty word for some aid workers. If it’s not seen as a bit ’new age’ or ‘hippy’, it’s seen as self-indulgent and completely at odds with a sector supposedly focused solely on helping others, not oneself.

There is a growing interest in yoga, meditation and similar self-care practices as a means to relieve stress, build resilience and encourage deeper self-awareness and compassion among aid workers and other social change makers. Regular yoga and mindfulness practices have certainly helped me in the last few years; the way I approach my work as a human rights defender has been transformed by following a daily practice that cultivates presence and a more mindful response to my own emotions and to the challenges around me.  And I continue to explore these further as a means to engage more fully in the world as well as to bring inner wellbeing.

But can these sorts of practices be adapted, and adopted, in African cultures? Are there traditions within African cultures which in fact use some of these practices already but give them a different name? I’m conscious that here in Kenya, for instance, trying to impose yoga or mindfulness as a stress relief tool may be seen as an effort to convert people to Hindu or Buddhist religions. Yet some of the techniques used in both these practices can probably be found in many other ancient cultures, including in Africa.

There are examples where the use of yoga and mindfulness have been introduced in different cultures, among aid workers and the communities they serve, with positive results – as this video from a woman who worked in Afghanistan suggests. Capacitar training also uses yoga, tai chi and other practices for trauma healing in communities that may be otherwise unaware of these traditions.

Self-care needn’t require a commitment to these increasingly popular practices however. As this blog by an Afrofeminist writer eloquently describes, there are many ways of practising self-care without having to devote oneself to yoga, and without necessarily having to completely change one’s lifestyle. Spending more time with family and loved ones is  important for aid workers and any other social change makers; because one of the big symptoms of stress and burnout is social detachment and disengagement, triggered by repeated exposure to the brutality and injustice that represent the darkest elements of human behaviour.  After such exposure, it is vital to seek out community and friendship. This can restore one’s faith in humanity and help cultivate compassion in a working environment that can be susceptible to ‘compassion fatigue.’ This video by the Headington Institute provides some advice to aid workers on how to maintain relationships with loved ones as a means of self-care.

Stress and how one responds to it is in some ways a complex matter. In the aid sector, both the individual and the organisation need to listen more – to themselves, to their staff, and what forms of support and healing are appropriate. It could take some time before aid agencies  go beyond a ‘one size fits all’ approach to staff care, but in the meantime there is a lot aid workers can do to help themselves. The starting point is that old adage, ‘Know Thyself’. What is your body trying to tell you and are you willing to stop and listen?

 

 

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.

 

 

 

Finding Purpose and Managing Expectations in Aid Work

There’s been a fair amount of debate recently regarding people from the western world who travel to the developing world (particularly Africa) with high ideals of saving lives and leave feeling disappointed or worse, depressed. First there was the ‘Linton Lies’ debacle where a white British woman’s published book describing her experiences as a volunteer in Zambia, and the neo-colonial language she used in the book, were challenged through the social media hashtag #LintonLies.

Then this week an anonymous aid worker wrote about the depression they suffered after working for an international NGO in an unnamed African country. Both individuals have drawn criticism for having white saviour complexes. Their stories also raise important issues about whether aid organisations – working with volunteers or paid professionals – make the appropriate decisions in who they send on these ‘missions’ and whether the people sent are sufficiently prepared for the working environment they will find themselves in. The criticisms levelled at these individuals, and the concerns their stories prompt about institutional responsibilities – whilst certainly worthy of attention – are not the focus of this blog post.

There is an overriding theme that emerges from the stories of these individuals which I find particularly interesting right now, and that is expectations. How do personal, organisational and societal expectations feed into aid workers’ sense of, or indeed loss of, purpose? This question is as legitimate for national aid workers from developing countries as it is for western aid workers from privileged backgrounds.

Aid workers often enter the sector with high morals and ideals about saving the world or humanity. And there is certainly nothing wrong with wanting to play a role in improving the lives of others, or ending social or economic injustices. The reality of the work though can be far from what aid workers had in mind. Not only this, but aid workers are often juggling the huge expectations from their organisation, from their organisation’s donors, and from the populations receiving the organisation’s assistance. Feelings of guilt and shame arise when as an aid worker you realise that organisational policies, poor management or insufficient – or worse, wasted – resources, mean that some of the communities you are assisting will not actually receive the help that is so urgently needed, and their lives will not change for the better through your interventions. Under these circumstances it is not difficult to wonder whether your efforts were worth it, or even necessary in the first place.

Kenyan aid workers I’ve spoken to have told me of how one of their major challenges is responding to the expectations of the communities they are assisting, particularly in poorer regions such as Turkana in northern Kenya where the needs are greater.  An organisation’s mandate to work solely on human rights protection, for instance, means little to someone in urgent need of food and water.The chances are that as an aid worker you will have to get used to saying no to requests for help far more than you can say yes. And the justification for saying no can at times seen unethical, unfair or unjust.

As noted in the Guardian’s Secret Aid Worker article, there are also work pressures that are not envisaged when entering into this sector; tasks and responsibilities that go beyond your job description. This includes the unspoken expectation that you will check your e-mails regularly outside working hours, including weekends. Or being told that it would be better if you delay your R and R (rest and recuperation) because you’re needed in the office, thereby resulting in you not seeing your family for another few weeks after having already been away for 2 months.

Much of what I’m talking about here has nothing to do with western aid workers with white saviour complexes. National aid workers are just as likely to have these same challenges; indeed many Kenyan aid workers I’ve spoken to have referred to them. One Kenyan female humanitarian worker told me how she travelled to Dadaab to conduct a training in the camp, 33 weeks pregnant and on a bumpy and unsafe road, because the colleague who was meant to be going had fallen sick and couldn’t make it. Another Kenyan woman working for an international humanitarian agency told me that she had to work over much of the Christmas period in response to a string of natural disasters and conflicts occurring in the region, requiring an urgent response. Her exhaustion from this episode resulted in what she called a ‘burnout’. This was dealt with partly by establishing a more disciplined working pattern, where at a certain time outside working hours she would stop checking and responding to e-mails and be called by phone only in an emergency.

But what I find particularly relevant for aid workers – and perhaps this is also the case for others in the ‘helping professions’ – is the role of personal expectations in one’s experiences. Many aid workers are driven by a shared experience of injustice, or by a desire to help others less fortunate than themselves. Their expectation is that they can make a tangible difference to people’s lives. Indeed this is also backed up by the agendas of their organisations, so often popularised through the media images of aid workers feeding hungry children or building shelters for refugees.

There is thus an emotional investment; a sense of responsibility – rightly or wrongly – for the wellbeing and survival of others who are suffering. There is also an expectation – again at times reinforced by one’s employers – that this responsibility towards others comes before responsibility to oneself. One Ethiopian UN worker I spoke to went as far as to say, ‘if I don’t go through 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…or kids will miss their vaccination or immunisation and these are the vital services that children need….’

Perhaps what is important in all of this, if aid workers are to continue their efforts without burning out, is for them to find purpose in what they do. The recent Secret Aid Worker’s story, along with many others from aid workers, highlight that loss of purpose is often a trigger for depression and burnout. But what is also important is having realistic expectations about one’s purpose in the first place. This requires aid workers to engage in some self-reflection about their role in helping others – and this should certainly include a willingness to recognise their privileged position and skewed view point in relation to the populations they are assisting, something that Louise Linton in particular was accused of failing to do. But aid workers should also acknowledge, accept and work within their limitations – whether these are down to organisational policies, the environmental context or simply being human.

 

 

 

 

 

 

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.