Tag Archives: stress

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.