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Helping So Much It Hurts

 

Humanitarian workers witness our world at its worst. They work on the frontlines of natural disasters, disease outbreaks, and war—leading to chronic stress and emotional trauma. And yet their compassion for others is also what keeps them from caring for themselves.

Can a movement to bring mindfulness to the field address the aid industry’s silent mental health crisis?

By Grace Edquist

 

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The standard shipping container is eight feet wide, less than nine feet tall, and made of steel. It has no windows, no lights. It isn’t particularly warm, or comforting, or peaceful. It is utilitarian, carefully engineered to transfer from train to truck to cargo ship as it transports anything from car parts to bulk grain all over the world.

But on a brisk autumn day in 2007, on a UN military base in Afghanistan’s Badghis Province, a human rights worker named Marianne Elliott found another purpose for a shipping container.

It became her yoga studio.

“I couldn’t put my arms out, but I could practice,” she says.

Each morning, Marianne would wake up in her container-turned-shelter—at the time considered safer than staying on the UN compound—step into the bit of empty space between her small bed and the wall, and begin a round of sun salutations. She would breathe in, look up, and reach toward the sky she knew was just beyond the steel ceiling before folding forward. From there the sequence would depend on what her body needed—sometimes breath work, sometimes a vigorous vinyasa flow, sometimes a round of chanting. All followed by seated meditation. It gave her peace and clarity, not to mention a physical outlet to help her cope with the challenging work.

Her job at the time was to investigate the living conditions of three prisoners convicted of kidnapping a son of a prominent family in a nearby town. The townspeople suspected the three kidnappers of being in the Taliban, and there were rumors they were being tortured while in prison. Marianne’s work was emotionally difficult, her surroundings grew more dangerous daily, and it all took its toll.

“As conditions deteriorated, we weren’t really allowed to leave our compound at all, so you needed a way to keep yourself physically healthy, as well as a practice to help you process the emotional and psychological aspects of living and working under those conditions,” says Marianne.

Yoga was her answer, her lifeline. “It was saving my sanity, and really when you think about how many risks there were, and how I could have chosen other ways of coping instead of yoga, it’s not a massive exaggeration to say yoga possibly saved my life.”

Quote 5-And we're dealing with people

Marianne isn’t the only aid worker to practice mindfulness as a means of coping with the stress inherent in humanitarian work, but she is an early adopter of a growing movement to bring practices like yoga and meditation to the field. Now, a handful of individuals and organizations are at the vanguard of introducing these practices to the humanitarian industry as a way to prevent and mitigate the stress, anxiety, burnout, and increased risk of depression that aid workers often experience—but rarely discuss openly.

Humanitarian workers witness human suffering at its worst—disaster, disease, hunger, war—and wrestle with the gap between the horrors they see and the change they can realistically effect. In talking to aid workers who were on the ground in the aftermath of disasters such as the Ebola epidemic in West Africa, the earthquakes in Haiti and Nepal, and the war in Afghanistan, it’s clear the struggle to maintain balance in the face of trauma and suffering is a nearly universal issue throughout the humanitarian sector.

It’s more than just anecdotal; a growing body of research backs up claims of chronic stress and vicarious trauma. The Antares Foundation, a nonprofit based in the Netherlands, published a study that found 30 percent of international aid workers they surveyed experienced significant symptoms of PTSD once they returned from working in the field. The Guardian conducted a survey in 2015 of aid workers that utilize the newspaper’s Global Development Professional Network and found 79 percent had experienced mental health issues, and a full 93 percent felt these symptoms were work-related. Additionally, a 2013 report from the Office of the United Nations High Commissioner for Refugees found 47 percent of staff had difficulty sleeping (or slept too much) and 57 percent experienced “sadness, unhappiness, or emptiness.”

But traditionally, humanitarians report that these feelings are either not talked about, suppressed, or the tools given to them for dealing with these issues are insufficient or inaccessible. Clearly there’s a problem with mental health among this population, and it’s costing the industry in terms of worker retention, training, and efficacy. And with the growing body of evidence that mindfulness in the form of yoga and meditation can do wonders in reducing stress, anxiety, depression, and similar issues, the logical next step is to bring these practices to aid workers. The problem is: Can a population so used to caring for others allow the time and space to care for themselves?

Emmett Fitzgerald was in Haiti after the catastrophic earthquake of 2010, a disaster that killed over 200,000 people and displaced 1.5 million more. Initially he worked with an NGO as a manager of a camp of 25,000 people, coordinating things like child protection and water systems, before shifting to work through the UN transitioning people out of camps and back into permanent or semi-permanent homes.

When he returned to London in 2012, he already expected the same emotional and psychological challenges he’d had when returning home from aid work in the Congo six years earlier.

But even after six months of being back, he still wasn’t feeling himself.

“I really recognized I was struggling. I was suffering with what has become known colloquially among aid workers as burnout,” says Emmett. A friend recommended a four-day program on mindfulness for aid workers called the Contemplative-Based Resilience (CBR) Project, an initiative out of the Garrison Institute based in upstate New York. Emmett enrolled in a CBR course held in Ireland in May of 2014, hoping the training would help him process the mental and emotional fallout he was experiencing and better prepare him for future deployments. The course resonated, so much so that he stayed connected with the organization and became director of the CBR Project in late 2015.

Pull QuoteThe CBR Project, which evolved from existing work within the Garrison Institute and launched in 2012, describes itself as the product of a “growing recognition of aid workers’ need for psychosocial support and skills to strengthen their resilience.” It focuses on the “ABCs” of developing resilience: awareness, balance, and connection. The course is a forum for aid workers to talk honestly about the exhaustion and burnout they endure—something aid workers discuss among themselves but rarely in a formal setting, Emmett says—and find healthy ways to work through these issues and prevent them from occurring in the future.

“It was eye-opening to learn what was happening to me in terms of chronic stress,” Emmett says. “I had never been told that empathy is a finite resource. You can run out. As a normal, psychological response, you cannot give of yourself again and again and again without replenishing.”

Talking about the issues humanitarians face with both peers and professionals—CBR faculty includes licensed psychologists and certified yoga teachers—fosters a nuanced understanding of the mental health issues. “If you understand it, then you can define how to try and diffuse it,” says Dr. Ibie Mohammed, a two-time beneficiary of the course who has been involved with Médecins Sans Frontières (Doctors Without Borders) and Save the Children International and has spent time in West Africa following the Ebola epidemic. She also says that fostering connections with her fellow participants has helped her find a community with similar values and challenges. “It’s nice to know you are not on your own.”

But more than a forum for support, CBR aims to give participants real, useful tools for dealing with their stress. They discuss what their triggers are and the non-work activities they can turn to as an outlet. Many of the coping mechanisms one would traditionally use to deal with stress are either unavailable while working in the field due to safety concerns—such as going for a run or bike ride—or are unhealthy or risky, as is the case with three of the most prevalent stress-relievers among aid workers: drinking, smoking, and sex.

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Emmett Fitzgerald leading a session during a CBR Project course in November of 2015. Photo by Tombo Productions.

That’s where yoga and meditation come in. The CBR course introduces these practices as a means of adding another coping mechanism to the positive column. “Nobody’s going to leave after four days as a yogi or a meditation guru, but they will leave with a little bit of a practice,” says Emmett. “The key is not to say that this is the mechanism, it’s that this is one you can do even when you’re on lockdown, even when you’re just in your office.”

Framing the practices in such a way is especially appealing to the attendees who have no set yoga practice or who have never tried yoga or meditation before—a category Emmett himself fell into until taking the course in 2014. At the most recent training in November of 2015, about half of the 25 participants were completely new to yoga and meditation.

Now that he has a practice, Emmett says there was a noticeable difference in how he coped when he was in Nepal in mid-2015 after the earthquakes struck. “Having gone through the course, and then going back to Nepal, it was obvious to me that there was a change for the better,” he says. “It was apparent in my own awareness of where my stress levels were at … when it’s healthy to stay, and when it’s healthy to step away.”

The early success of the CBR Project is a promising sign of how these kinds of trainings can better prepare humanitarians prior to deployment, and the project is planning more courses for 2016, including several in the field. Based on demand from aid workers, those will most likely be in regions of West Africa impacted by Ebola and areas of the Middle East and Mediterranean affected by the crisis in Syria.

Emmett also says CBR will be partnering with larger aid organizations and academic institutions in 2016 to broaden the scope of its work and, hopefully, develop research that catches up with its anecdotal findings. Having data that backs up the claim that mindfulness can mitigate and prevent aid worker burnout could lead to more organizations adopting these practices.

Furthermore, Emmett notes the business case to be made here. Having the presence of mind to take a break and meditate or practice yoga not only makes you feel better, it makes you better at your job. Taking a break now could lessen the effects of burnout in the long run, which means aid workers stay in the industry longer, which in turn creates more efficient and effective aid agencies. It can save organizations time, money, and the most precious resource of all: its people.

“The more we can create these communities of people, the more we can support one another to take care of ourselves using these tools—that’s when the change will come,” says Emmett. “It’s when we create these small groups and they become the tipping point that make people believe, with their own eyes, that when you take care of yourself, amazing things can happen.”

The benefits of self-care are broadly recognized across populations and professions, but yoga and meditation are particularly suited to the unique needs of humanitarians working in the field. For one, these practices are discreet and unobtrusive, requiring little equipment, space, and time—reasons Emmett, Dr. Mohammed, and Marianne all found asana feasible in their challenging working conditions.

And although attending a class in a studio led by a teacher might not be possible while stationed in Nepal, or Haiti, or Afghanistan, the proliferation of digital resources has made remote practice not only possible, but easily accessible after deployment. When the Ebola virus epidemic struck West Africa in 2014, humanitarians Donna Williams and Nuran Higgins put together digital “mindfulness kits” for those working in the field. These kits contained audio of a morning and evening meditation as well as 30 days’ worth of short yoga classes, plus one day of pre-deployment and seven days of post-deployment sessions.

The connection to another human being, even if only digitally, provided a much-needed respite from the limitations placed on human contact during the epidemic due to Ebola’s high communicability. “People felt a sense of comfort knowing that there was someone with them every step of the way, every day,” says Nuran, who has worked as a humanitarian throughout Asia, Africa, the Middle East, and the Pacific over the past 15 years.

Assembling these mindfulness kits for the Ebola epidemic was the first joint project of Nuran and Donna’s, but both women have other projects they head up to bring more mindfulness to humanitarians around the world. Nuran launched an online resource called The Healthy Nomad in 2013 as a means of fostering connection and wellness in the aid worker community. The site and its offshoot podcast, called Emergency AIDio, are Nuran’s way of introducing mindfulness to a broader audience, something she felt called to do after yoga and meditation were great sources of comfort and inner strength when she found herself homeless in Australia at age 15.

“I didn’t realize how lucky I was to have a grounded practice,” she says.

Donna’s project, called Emergency Yoga and also launched in 2013, has a similar goal of helping humanitarians stay healthy in mind and body, but through short yoga videos. Donna, who completed her yoga teacher training with Eoin Finn in 2012, leads short yoga classes filmed by co-founder and fellow International Committee of the Red Cross staffer Nicola Fell. The classes are targeted specifically at humanitarians in the field and are themed around requests she receives, often for yoga in small spaces, at a desk, for stress relief, or while aboard an airplane.

“We’re trying to make yoga far more accessible to the person who otherwise wouldn’t be doing yoga,” Donna says. And she’s had tremendous response from her “students”—a collective that spans the globe.

“It still blows my mind when someone comes back from the field … and comes up to me and says, ‘You were my yoga teacher, thank you,’ but I don’t recognize them. I’ll ask if they’ve been to one of my classes [that I teach in Geneva], and they’ll say ‘No, through the videos. You were my teacher in Sudan, or Chad, or Syria.’”

That’s the power of these digital resources. You can be anywhere in the world, in any situation, and you can practice.

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And while the discreet nature of yoga and meditation play a huge role in its compatibility with humanitarian work, perhaps an even larger factor is the sense of clarity and inner peace the two practices bring—something that is desperately needed when working in the face of human hardship. Anyone who has attended even one yoga class is familiar with the words “presence,” “intention,” and “grounding.” Applying these concepts—being present in the moment, setting an intention, feeling grounded despite your surroundings—all help with processing your reality and tackling overwhelming circumstances. Along with the fact that, at some point, you get to go home.

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Marianne Elliott in Afghanistan’s Ghōr Province. Photo by Vincent Jalabert.

Marianne, the shipping container yogi, who has since written a book called Zen Under Fire and has created yoga videos and led virtual courses on yoga and mindfulness for peacekeepers, says yoga helped her reach an epiphany on how to reconcile the atrocities she witnesses and the limitations of her ability to solve all the problems before her.

“One of the most dreadful things about this work is that you’re confronted by a need that is much greater than your capacity. I was meeting with people who were telling me about horrible human rights violations. People whose daughters had been captured by warlords—just profound injustice. And often there was so little that you could do. You could report it. You could document it, talk to the police. But until the country changed there wouldn’t be really any real justice for these people. But yoga helped me in learning to just sit. Sit with all this suffering and bring presence to it,” she says.

“At first it felt like I was doing nothing for them. But then with time I saw that giving someone your full attention, seeing fully, being completely present emotionally and energetically, was actually something. It was doing something. It was bearing witness. And I feel that it was really with my meditation practice through yoga that I was able to do that without being overwhelmed by the pain, or feeling like I’d have an impulse to withdraw.”

Two of the greatest barriers to addressing and solving the humanitarian industry’s psychosocial challenges have been society’s general aversion to discussing mental health and what has been dubbed the industry’s “superhero complex.”

Luckily, much progress has been made on the former. Talking about emotions and how they affect our professional lives is slowly losing its stigma. The same applies to the practice of yoga and meditation. “Society is far more willing to acknowledge that this isn’t the crazy hippies of the ’60s,” says Emmett. If Wall Street execs and Silicon Valley whiz kids are into it, surely those who dedicate their lives to helping our world’s neediest populations can get behind some rounds of sun salutations, too.

Quote 4-At first it felt like

But there’s still this “superhero complex,” a particular issue that humanitarians face that potentially keeps them from recognizing their chronic stress and practicing the kind of self-care that could address, and even ward off, these feelings in the first place.

“There is a culture within the humanitarian sector that we need to be superheroes,” says Nuran. “This altruistic mentality that anyone who has an occupation serving others tends to put their own needs last. And we’re dealing with people in crises, so to complain that you’re tired from working 18-hour days and need a five-minute break seems unthinkable.”

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Nuran Higgins has been in Nepal since the earthquakes struck the country last year. Photo by Dr. Mausam Bohara.

Humanitarians tend to get into this line of work because they care for others, but also because they’re tough—they can handle the long hours, the harsh conditions, the danger. They thrive off it, even. And taking a break, no matter how short, can be perceived as a sign of weakness. That you don’t care as much as your colleagues do—or that you aren’t as good at your job. The long hours and aversion to self-care take on a competitive, almost performative, aspect, perpetuating a dangerous cycle.

But if the industry can acknowledge this cycle and the damage it can inflict, therein lies the hope for progress. Signs of improvement are beginning to appear at a systemic level—an important indicator for real change. The International Committee of the Red Cross is partnering with a mindfulness specialist and an as-yet-unannounced app in 2016 to bring meditation to all its staffers for free. The Core Humanitarian Standard on Quality and Accountability was established in 2014 and outlines nine commitments that aid agencies and individuals should adopt—one of which touches on the need to support staff.

The number of individuals dedicated to this cause continues to grow, as well. Nuran, Donna, and Marianne are joined by such activists as Brendan McDonald, who has created an online petition calling for staff welfare to be a top priority at this year’s inaugural World Humanitarian Summit, taking place May 23–24 in Istanbul, and Alessandra Pigni, a licensed psychologist who created Mindfulnext, a website dedicated to “building resilience, preventing burnout” at a structural level in the aid worker sector.

Most of these websites and organizations didn’t exist just five or ten years ago; their mere presence is a sign things are starting to change.

It’s about hitting the sweet spot that Marianne says is at the intersection of doing good and being well: “When we practice wellness on all levels—physically, emotionally, psychologically—we can actually do good. I found that when I wasn’t taking care of all those pieces, and I had the best intentions but I had some stress or anxiety, those emotions would show up. On the flip side, if we take care of ourselves and do the practices that keep us well and get the sleep we need, we really can do good.”

Grace Edquist is an editor at Wanderlust Media. 

Are you a humanitarian who has experienced chronic stress or practiced yoga or meditation in the field? Share your story in the comments below.

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Posted on January 11, 2016