With more and more practitioners becoming involved in the provision of care in humanitarian settings, the issue of secondary trauma experienced by personnel when exposed to stressful and emotional circumstances has been exposed. Often the health of these aid workers are sacrificed in the line of duty, affecting their physical and mental health, and policy must be put into place to help prepare workers for such environments and treat them effectively when they do experience poor health.
We've taken an exclusive extract from our upcoming publication, A Field Manual for Palliative Care in Humanitarian Crises (December, 2019), highlighting the importance of care that is informed on this issue to ensure medical workers can provide essential aid without damaging their own health.
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Why Trauma Informed Care?
By The Rev. Denah M. Joseph, BCC, MFT and Jessi Humphreys, MD
Our fellow human beings are going through intense suffering, and those of us working in humanitarian crises are likely not only to be moved by compassion but also to be traumatized by the exposure to such intense suffering. This is especially true in global health, where providers routinely and selflessly promote the welfare of others, and in doing do, can suffer unexpected harm.
It is common and temporarily adaptive to proceed as if we are immune to this intensity of suffering and trauma, to focus on the immediate needs of the day, and set our own wellbeing aside. While this may be effective and even necessary during a shift where your primary attention is required for applying tourniquets and avoiding bullets, this is not sustainable practice for practitioners who wish to continue in the field of humanitarian medicine. Nowhere are healthcare providers as subject to as many varied forms of stress and trauma than in humanitarian crises.
The practice of medicine exposes providers routinely to suffering and trauma even outside of crisis situations. In responding as we aspire to, with empathy and compassionate action, we recognize that vicarious or secondary trauma is invariable. The construct of trauma exposure syndrome provides a useful model for addressing the mental health sequelae for providers following trauma both during and after their work in the field. Trauma response is increasingly recognized as a normal response to an abnormal situation, and may be less pathologized among healthcare providers than thinking of themselves as suffering from a psychiatric disorder such as depression.
The special circumstances of caring for those in mass humanitarian crises must lead us to re-examine and re-define what exactly we can hope for in terms of burnout prevention and resilience promotion under these intense and extreme circumstances. Unique, non-normative experiences in humanitarian crises can lead to a variety of maladaptive behavioral responses including complicated grief, substance abuse, risky sexual behavior, and numbing and dissociation. These experiences are associated with and can lead to more complex stress response syndromes including burnout, depression, trauma exposure syndrome, and anxiety related syndromes.
These syndromes impact providers’ professional and personal lives, their ability to provide care to patients, as well as to care for themselves, their families and loved ones. Addressing this is an ethical issue, as we have a moral obligation to ensure we are not sacrificing our own on the altar of caring for others in great need. It is also an imminently practical issue, as we have an interest in ensuring our healthcare work force continues to function and provide quality care in humanitarian crises. The prime directive of being a first responder is not to become a victim yourself. We have the opportunity to be at the forefront of this movement, to recognize the risks to teams and individuals, and develop best practices in protecting providers.