Feature

Coming Home: For Some Aid Workers, it’s the Hardest Part

By David Francis on 19 March 2009

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Members of the Darfur Program, jointly operated by the International Medical Corps and the Bridge Foundation, pose in front of a supply truck. Aid workers often report problems readjusting after returning home from conflict regions such as eastern Sudan. Photo by: International Medical Corps

Fieldwork gives development workers the unique opportunity to interact with and to experience the hardships of those who they aim to help. Making the transition from Western comforts to harsh realities in the field is difficult. But for many workers, the real challenge begins when they return home.

 

Research on this topic is scarce. Most studies have focused, perhaps justifiably, on stresses experienced by local communities in post-conflict and other high-risk situations. However, experts who deal with the effects fieldwork can have on development workers have found that these workers experience a number of problems after returning from high-stress environments where Western cultural norms and sensitivities are ignored and atrocities are commonplace.

 

"Depression, anxiety, alcohol abuse - those problems turned out to be much more prevalent than post-traumatic stress disorder," said Barbara Lopes Cardozo, a psychiatrist at the Centers for Disease Control and Prevention in Atlanta. "It's a much broader issue when you work in those settings in emergency situations. There are a number of stressors field worker have to deal with."

 

Lopes Cardozo has done some of the most extensive work detailing mental health problems in development workers, including a study of workers returning from Kosovo. Her studies found that while PTSD was less prevalent in expatriate populations working in the region than it was in native populations, other problems like depression and alcoholism were more common in foreign worker populations.

 

These problems are complicated by the fact that few organizations have networks to assist workers with the transition back home, experts said.

 

"It's only in the past 10 to 15 years that we've really started thinking about mental health in conflict and humanitarian crises both among the populations and health professions," said Dabney Evans, a lecturer in the Hubert Department of Global Health and executive director of the Institute of Human Rights at Emory University. "They're going to need the same kind of clinical treatment similar to a person who has experienced torture. [This includes] therapy, maybe medication. It's the same mental health issue even if the way it's experienced is different."

 

Few organizations have systems in place to get workers medical assistance once they return home. Most don't track the health of returning field workers. The Peace Corps, one of the world's largest humanitarian organizations, is one example.

 

Other organizations are more proactive. InterAction, the Washington-based umbrella organization for more than 150 international aid groups, has a program that helps workers with the transition back to Western life.
Even those organizations that recognize the need for more assistance for aid workers returning to the field acknowledge it is difficult to create programs that address symptoms experienced by workers coming home.

 

"There's no official program," said Lynn Sibley, a clinical associate professor at Emory University's Lillian Carter Center for International Nursing. "We're trying to … build in an orientation to try and prepare students for what they're going to do as a group."

 

The Antares Foundation, a group based in the Netherlands, is working to change this. The foundation is currently developing good practice guidelines for managing stress in development workers preparing to leave for and returning from the field. It has developed an eight-point action plan for aid organizations to create a policy to recognize and mitigate stress; screen workers for symptoms; prepare and train workers before they enter the field; monitor workers on an ongoing basis; provide ongoing support; provide support in a crisis; create a support network for returning workers; and provide ongoing support as workers integrate back into their lives at home.

 

The guidelines are expected to be applied by individual aid organizations in a way that best meets the health needs of their workers.

 

"The principles and indicators are intended to apply to both international and national staff, office and field staff, recognizing that adjustments may be necessary to take into account the unique needs and characteristics of each group," the guidelines state. "They constitute a tool for learning, reflection and planning rather than a set of rigid rules or solutions that are applicable under all conditions."

 

Antares is also working with the CDC to raise awareness about mental problems in aid workers. Each year since 2001, the two organizations have hosted meetings and conferences centered around the theme of street and humanitarian workers. These gatherings take place in Amsterdam.

 

The two groups are now working to create workbooks to help aid organizations create stress management programs. They are also working with NGOs to create pilot programs.

 

Despite these steps, dealing with worker stress will continue to be a challenging issue for aid organizations, according to the CDC's Lopes Cazdozo.

 

"There's a number of principles in those guidelines," she said, but "you cannot prevent everything even with a good support system in place. If there is an issue, [aid organizations should] be more proactive in providing some help."

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David Francis
David is a Washington-based journalist and former Devex fellow who now spearheads Devex's "Obama's Foreign Aid Reform" blog. He has written for the Christian Science Monitor, Pittsburgh Post Gazette, SportsIllustrated.com, San Francisco Chronicle, Foreign Policy magazine and the Washington Monthly. David holds an undergraduate degree from the University of Chicago and is working to finish his graduate degree at Georgetown University.

Comments

Coming Home for Aid Workers

Donna R. on March 19, 2009 19:00

This article appears at a timely moment, a moment when threats and attacks against aid workers are increasing daily. There was a time when the aid worker was sacrosanct, when the work was seen as detached from political agenda. This is ancient history and the truth of the matter is that we are more and more vulnerable either because we are seen as more easily available targets representing our governments or because we are now confused with a military insistent on doing "development" work, to name but a couple. In 2002 (as I recall), a group of international psychologists, funded through a grant from the U.S. Institute for Peace, was brought together by an American NGO, Psychologists for Social Responsiblity (PsySR.org) to begin to develop a common language for disaster psychology. One of the areas we began discussing was the psychosocial wellbeing of staff working overseas. Out of these conversations, another group hived off to dedicate itself to the question of staff care. This group holds bi-annual conferences, has met at the Joan B. Kroc Center, University of Notre Dame, and the University of Denver's Insititut for Disaster Psychology. Out of the first conference, we formed a group that has met monthly in Washington, DC for the past four years. This group is made up of staff from the major NGOs (CARE, Save the Children, Catholic Relief, World Vision, Mercy Corps etc as well as staff from the for-profit groups (ARD, Inc., IRG etc.) and public agencies such as USAID. The group's reason for existence is to share cutting edge information and techniques to protect the psychological health and safety of overseas staff to "tend the tenders' fire". We work closely with Headington Institute (www.headington-institute.org), InterAction (interaction.org), People in Aid (www.peopleinaid.org) based in the UK, Antares Foundation (www.antaresfoundation.org) based in Holland, the Centre for Humanitarian Psychology (www.humanitarian-psy.org) based in Switzerland; U.S. Government agencies such as USAID/DCHA, U.S. State Dept., Peace Corps, multi-lateral groups such as the World Bank, the UN etc. as well as many universities and research centers. Members of Helpers' Fire are known scholars and practiticioners in the field of staff psychosocial care. There is a ton of information available on the net on this subject. The main ones are psychosocial.org (a clearing house for all information); InterAction.org/staffcare; Headington Institute with its myriad of truly excellent manuals, training programs, and self-care tips and, importantly, People in Aid, which is only concerned with the management issues affecting overseas staff. These websites do contain papers, training manuals, book chapters dealing with the issue of staff re-entry. A good, quick reference on the topic is Helpers' Fire member John H. Ehrenreich, Ph.D.'s (Professor of Psychology and Director, Center for Psychology and Society, State University of New York) book The Humanitarian Companion (ITDG, 2005), which contains a chapter written by John Fawcett of Save the Children, and Amber Gray, independent consultant, entitled "Going Home-a journey of discovery". In addition, the last Helpers' Fire Conference held in Denver this past May and attended by representatives from most of the implementing agencies engaged in overseas humanitarian and development assistance, had a whole section dedicated to staff re-entry. Many of the larger organizations (i.e. Save the Children) and some of the faith-based groups (i.e. Adventist Relief) have formal re-entry support programs. Some even deal with the topic of re-entry during the deployment phase. As a Foreign Service brat, I remember re-entering the U.S. at the age of 15. Never having lived here before, it was an extremely traumatic crash and burn situation. I have lived outside the U.S. for long periods of time since then and each time re-entry is somewhat of an issue. However, since that first time those many years ago, the State Department has become wise enough to establish its Family Liaison Office (FLO), which has a program in place to ease returning staff and their families back into U.S. culture. I could go on and on to fill several books on the topic of staff care but would like to end here by inviting all who are interested in the management and provision of field-based staff psychological safety to please attend the next Helpers' Fire meeting. We meet once a month at Relief International, 2001 S St NW, Suite 700, Washington, DC. Our next meeting is on April 15, 2009 at 11 AM EST. Some members attend via phone in. For further information, please contact me, Donna Read, Staff Care Advisor, ARD, Inc. at dread@ardinc.com or Sharon Forrence, Konterra, at sforrence@yahoo.com. Thanks, Donna I

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