This article by Laura Payton is particularly timely.

Post-traumatic stress real threat to aid workers, diplomats
By Laura Payton

Published January 27, 2010


Adrienne Carter felt the earth shaking for months after returning to Victoria, BC, from Pakistan in 2005. A clinical therapist with Médécins Sans Frontières, she had been working in the country after a devastating 7.6-magnitude earthquake in Kashmir. It killed 80,000 people and left 3.5 million homeless. And she still remembers one of the aftershocks.

“One really big one in the middle of the night, it was pitch dark, and then you heard a horrible roar, like a mountain was falling down,” says Ms. Carter.


“And one of the things none of us knew was [whether] it was going to be falling on the side we were, because we were only a few feet from the ravine, or is it going to be falling down on the other side. And we didn’t know, literally, whether we were going to die in the next few minutes or whether we were going to be alive.”


The memory stayed with her even after she was back in Canada, with the shaking she felt making her wonder whether another earthquake was imminent.


“My friends and colleagues looked at me [like], ‘Are you crazy? There is nothing.’ But I felt that shaking.”


While many people associate post-traumatic stress more closely with the military, there’s a definite risk to those who arrive in the aftermath of a natural disaster or in the midst of an armed conflict. Aid workers, diplomats and journalists all see and experience things that will stay with them long after their return.


While both the Canadian International Development Agency and the Department of Foreign Affairs refused to provide the numbers of staff who have experienced stress or trauma following a return from a conflict zone or natural disaster, they say they do have support programs for staff exposed to such situations.


A spokesman for CIDA says the agency offers critical incident stress management services as part of its Centre for Workplace Effectiveness and Well-Being. The services include both group session debriefings and individual counselling.


“The services are also provided to immediate family members. These services are available to all staff working on the crisis in Haiti both in Canada and through a field mission in conjunction with DFAIT,” wrote Scott Cantin in an email to Embassy.


“The intention behind all Critical Incident Stress Management Interventions is to prevent, as much as possible, long-term impact on individuals. Early intervention helps in faster recovery from a critical incident.”


Ms. Carter, who has worked with MSF for a decade and specializes in trauma work, has already travelled to Kosovo, Sierra Leone, Nigeria and several Southeast Asian countries. She hopes to go to Haiti, where she would be counselling both MSF staff and the locals who go to them for help. Despite her hope to go, she worries about what aid workers and others are being exposed to there.


“It’s utter horror, seeing so many dead bodies, especially the first responders. People dying after they have been rescued, but with no medical help they’re dying in front of your eyes. That’s hard for the psyche to accept. A lot of people would have nightmares, cannot sleep, feel really distressed about it.”


On top of some of the more gruesome or violent memories they have to deal with, some will experience guilt over being able to leave.


David Morley, president of Save the Children Canada, has worked in international co-operation for 30 years. He still remembers feeling that guilt while working in Central America in the 1970s.


“It was really tough [work] and [the community group is] working away…and I’ve got my Canadian passport and I know I’ve got my ticket home, and it’s really hard. And you feel guilty, for sure.”


Mr. Morley says it’s also hard to work in developing countries and conflict zones, then to come back to so-called normal life in one of the world’s richest democracies.


“It’s like you’re on another planet,” he says. “I’ve worked in some earthquakes and civil wars, but nothing like [Haiti]. I just find myself…feeling sometimes like, ‘Does anybody know that we’re here?’ It is just hard to believe you’re on the same planet. So when you come home, it’s really tough.”


Ms. Carter says it’s also difficult when those who experience such horror can’t connect with friends over their experience.


“All of us found this when we come back from the field, that our friends, even though they’re very close friends, they can’t listen to it. It’s too much for them,” she says.


In the case of MSF, they have a peer support network that helps with the re-integration. Workers can often speak to others who have worked in the same region and in similar circumstances. They check in with the newly-returned person to see how they are sleeping, whether they’re preoccupied with what they’ve seen, and whether they’re having nightmares or losing their appetites, all of which could be signs of post-traumatic stress.


“Your soul is really trying to come to terms with the horrors that you have experienced and you need to give it time and some good care in order to normalize. This is not normal what they are seeing there,” says Ms. Carter.


Save the Children has about 180 staff in Haiti right now, and most of them are local Haitians. They’ve had to bear the hardest burden, working non-stop while mourning family and colleagues. Mr. Morley says he doesn’t yet know how the organization will help them, but that there will be services available once the emergency distribution efforts are over.


Some people, especially in the face of a disaster, throw themselves into their work as a way to cope.


“This is our job, this is what we have to do, and I don’t want to sound hokey but this is our vocation. This is why we’re here, this is why we want to be here, but then it can get overdone for sure,” says Mr. Morley, who tries to remember that it helps to celebrate small victories throughout the tragedy.


“Otherwise, you’re not in it for the long haul, because you won’t last,” he says.


“That’s so hard for us. When we’re there as aid workers, we’re there with a mission and we’re there to do it, and we leave before the job is done.


“[And] we get to live here. Most people around the world are envious about the stuff that we get to complain about because we’re able to live.”