REFUGEE HEALTH ALLIANCE

The first step to reducing work related stress is becoming aware of and understanding what you are experiencing, as well as realizing you are not alone in your experiences as is demonstrated by these stories:

“I was feeling feverish and generally exhausted. This was on top of the nausea and dizziness which I’d been ignoring … Too much stress applied to a physical body part will eventually cause problems and, if the warning signs are ignored, long-lasting damage may well occur. ...Before all this [working in a crisis situation], I had considered myself both physically and mentally a healthy person... And yet this did happen to me – throwing all of my preconceptions about health into question…. Unable to read the signs, a vicious cycle was established. I worked more and more, both fueled by the anxious adrenaline, but also to distract myself from it. I exercised less due to tension and fatigue…. It has now been more than two years since my crash and I count myself very lucky that I have been able to take a slow route to recovery….Please take just a little more time to listen to what your body tells you, bearing in mind what could happen if you ignore the small soft voice for too long.”
                                             - Robert Males, Doctors without Borders volunteer (full story here)

 

“The heavy workload and high responsibility combined with the constant exposure to difficult situations and the want to make as much of a difference as I can but without that always being possible…. added to the blocks of pressure falling on me bit by bit until my brain and body could no longer handle it...I don't need to worry about the problems across the globe if I don’t want to… and I don't need to worry about whether my actions have an immediate impact on someone's life being saved.… our focus is always on the people we are working with: our patients and their communities. It always will be. It's why we do it. To continue to do that, we need to look after ourselves too - something many of us neglect. It's been over two months since I got back and by having this break, by putting a simple change of lifestyle in place and with the help of MSF, I feel more 'normal' again.”
                                                - Emily Gilbert, Doctors without Borders volunteer (full story here)

 

As these stories demonstrate, experiencing burnout, compassion fatigue, and stress are all common and normal experiences for providers. Over time these experiences can wear us down and make it harder to do our jobs effectively. We are not weak because we have these experiences. In fact, it can be unhealthy and unrealistic to have an expectation to always be productive and heal every person we work with. Research shows that when we do not take care of ourselves, it becomes more difficult to take care of those people we want to help. Take time to consider how you behave when you are stressed as you reflect on the following explanations of these common experiences:

 

Burnout or Compassion Fatigue: “The Cost of Caring for Others” 1

• Profound physical, emotional, and physical depletion that takes place when helpers are unable to refuel and regenerate.

• Symptoms include exhaustion, head and body aches, increased psychological distancing from one’s job, negative thoughts, diminished ability to empathize and reduced efficacy as a result of chronic stress.

• Caused by the nature of the work, workplace stressors, workload, and factors outside one’s control.

• Further, compassion fatigue occurs when we take on the emotional burden of a patient's agony.

• See these links for information on burnout and compassion fatigue.
   

Moral Injury: An Injury to Core Values 2

• Damage to one's conscience or moral compass when that person witnesses, perpetrates or is unable to prevent acts that transgress one's own moral beliefs, values or ethical codes of conduct.

• Often occurs when people are unable to provide maximal care for individual patients due to limitations that are outside of their control.

• Can include witnessing or learning about these circumstances.

• Signs include guilt, shame, outrage, distrust, and isolation.

Want to know more about moral injury? Check this out.

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Vicarious/Secondary Traumatic Stress: Experiencing Others Trauma as Our Own 3

• As providers and volunteers, we often define ourselves by the people we serve and take on their stories of trauma. Hearing about another person’s trauma can make you feel as if you are experiencing the trauma yourself.

• In response to exposure to another’s trauma, it is common to even have PTSD type physiological, cognitive, and emotional symptoms (e.g., difficulty concentrating, intrusive imagery, exhaustion, irritability, poor self-care, wanting to leave the field, and feeling hopeless, helpless or discouraged).

• This experience can have a sudden onset and is especially exacerbated when you have had similar experiences related to the trauma of the individuals you are servings.

• Working with migrants can be extra difficult when you have had shared experiences with the migrants (e.g., being from the same countries, being an immigrant, having your human rights denied, having experienced trauma, rape, community violence, or abuse).
   

The fatigue and secondary trauma or stress symptoms you may be experiencing are actually intended to help us survive through difficult times similar to how the migrants we serve have adapted to survive the trauma they have persevered through. However, these experiences are not permanent and can resolve with time, talking with someone for support, and simple quick practices that help us live more balanced lives to be able to better take care of others (e.g.,  reminding ourselves: “I've done the best I can for what I could control and do based on the information and time I had today. I am proud of myself for getting through today”). Take time to feel compassion satisfaction in the fact that you are working very hard to help individuals who are struggling. Additionally, we can derive peace and strength through the resilience stories of the migrants we work with since their inspiring stories remind us how valuable and impactful our work has been for many. Now that you know the importance of self-care, the next step is to try one of the links highlighted in this paragraph or try some other resources under cellular applications, audio/video, CodeGreen’s website, or this great simple tip sheet.

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References

1 Based on Excerpts from the Compassion Fatigue Workbook by Francoise Mathieu

2 https://www.aaem.org/UserFiles/file/COVID-19CrisisModeBuildingResilienceHCWs2020-04-30.pdf

3 Pearlman and Saakvitne – 1995