Dahleen Glanton | Atlanta | July 3
Chicago Tribune – While the military has made some strides in dealing with stress-related issues, public health officials, including doctors at the federal Centers for Disease Control and Prevention in Atlanta, are just beginning to address the mental health problems of aid workers. After recent attacks on workers in Afghanistan and Iraq, there is a need for support services in the field and at home, health officials said.
In the days when he was volunteering in Afghanistan, Dr. Brigg Reilley and a few other humanitarian aid workers used to sit in a circle on the floor in the Doctors Without Borders compound and talk about the tragedies of war.
With pillows propped against the wall, a single light bulb hanging from the ceiling and comfort food–usually a local trail mix–in the middle, each of them shared stories of what they had seen and heard that day while delivering medical services to people in need. Then they had to decide if it was worth the risk to go out again the following day.
“Things were changing in Afghanistan, and we had to make decisions day to day. . . . There is a price for going out, but there is a bigger price for not going because so many patients are depending on you,” said Reilley, an epidemiologist who spent October and November in Afghanistan and works as a program officer for Doctors Without Borders/Medecins Sans Frontieres in New York.
While the military has made some strides in dealing with stress-related issues, public health officials, including doctors at the federal Centers for Disease Control and Prevention in Atlanta, are just beginning to address the mental health problems of aid workers. After recent attacks on workers in Afghanistan and Iraq, there is a need for support services in the field and at home, health officials said.
“In the last five to 10 years, our work has . . . become much more dangerous,” said Dr. Barbara Lopes Cardozo, a psychiatrist and epidemiologist with the CDC. “In the last few years, situations like Iraq and Afghanistan have become very volatile. When people are killed, it is horrible for the families and friends, but it also affects the whole aid community. People feel much more vulnerable, and it has an effect on their mental health.”
Though there has been little research on the topic, Cardozo said that a recent study reported about 10 percent of aid workers are diagnosed with post-traumatic stress disorder, while 30 percent show some symptoms of the illness, such as anxiety, flashbacks and trouble sleeping. A CDC study conducted in the Serbian province of Kosovo last year showed high incidence of anxiety, depression and alcohol abuse among aid workers, she said.
This year, the CDC and other agencies intend to launch a long-term study of post-traumatic stress disorder and other mental-health issues related to aid workers. More than 300 workers are to be assessed during the next three to five years to determine how to best deliver services in the field and provide support when the workers return home.
Stress syndrome affects GIs
A study this week in the New England Journal of Medicine found that 1 in 8 U.S. soldiers who fought in Iraq reported symptoms of post-traumatic stress disorder.
Western military interventions in the 1990s altered the way civilian relief workers deliver humanitarian aid in war-ravaged countries. Once considered neutral parties, aid workers, particularly Americans and other Westerners, have become targets of insurgents attacking civilians to send a political message.
Several aid organizations evacuated workers and suspended operations after 12 people, including two Red Cross workers, were killed in a suicide bombing outside the International Committee of the Red Cross headquarters in Baghdad last October. Relief work was curtailed again in May, when five workers from Doctors Without Borders died in an ambush in Afghanistan.
According to James Guy, executive director of the Headington Institute in Pasadena, Calif., relief workers are exposed to traumatic stress in various ways.
While trauma is experienced directly through life-threatening events, such as shootings and kidnappings, workers also experience vicarious trauma through working closely with victims as well as hearing stories and seeing images of their suffering.
“All of it has a significant impact on relief workers in ways that are normal and expected. Chronic stress leads to burnout and fatigue, but the indirect trauma catches them off-guard,” said Guy, whose organization provides care services to aid workers. “But we have found that people are hardy and resilient. They just have to understand that they can recover when the wind gets knocked out of them emotionally.”
Those late-night talks in Kandahar helped Reilley and his colleagues cope in the field.
“By talking, we shared information that might help the team security, but it is also very therapeutic,” Reilley said. “Afghanistan has us all in shock, and there’s a lot of stress involved with what we do now. A lot of people are there because they feel they must help, but we are not cowboys, and we are not foolhardy. We have to weigh the risks we are taking against the benefits we are providing.”
Visiting aid workers tend to bond with their native-born colleagues, said a State Department official who recently returned from Iraq. Up to 90 percent of aid workers may be native-born. When these people are attacked or injured, the visitors feel grief.
Seeing friends die
“What people seem to forget is that these were very good friends who were killed. Seeing people close to you die, people who are well-meaning and altruistic, affects everybody,” the official said.
Doctors Without Borders workers are debriefed as they prepare to return home and are questioned again once they arrive, according to Jennifer Vago, field human resources officer for the humanitarian group. A peer support network also is available to those workers, who are paired with others who have gone through similar experiences.
“For most people, re-entry is a shock,” said Vago, a registered nurse who has gone abroad on several Doctors Without Borders projects. “They have been living in a place where life is tenuous and may not always be so safe. And they are living with people who have so little, just struggling to get by.
“To come back to the U.S. and walk into a grocery store or shopping mall just overwhelms people sometimes. To flick on a light or sit in a living room and read in the evening makes them realize how much is taken for granted here.”