The images will be forever etched in *Angela’s mind. Some things never leave you, no matter how much you want them to. The terrifying sights of the crowded refugee camps, the heart-wrenching sounds of children crying and worst of all, the stench. Have you ever smelled fear and desperation? It is lingering. Haunting. Constant.

Angela is an Aid Worker, who has witnessed some of the most horrifying atrocities known to humankind. Her humanitarian efforts have taken her all around the globe, including Jordan, Nigeria, Haiti, Iraq, Nepal, Afghanistan and Syria.

Angela’s voice is rich with emotion as she shares her overseas deployment experiences. There is much stress and trauma experienced by frontline workers, whether it be in disaster relief positions, like Angela, or in palliative care, homeless shelters, elder care, child and family support, police officers, animal care and mental health. 

For any frontline worker there is a risk of physical danger on the job as a result of hazardous living/working arrangements, as well as becoming emotionally impacted by stressful work. Caregivers who provide services to trauma survivors in particular are at high risk of developing mental health conditions known as Vicarious Traumatization, PTSD and Compassion Fatigue.

While each organization has its own unique set of training policies and fundamentals in place to psychologically prepare staff for what lies ahead, counselling and support needs might not be as apparent at first. This is partially because workers may not be aware of how emotionally impacted they are, and may withhold their feelings from their supervisors. Supervisors should be on the lookout for signs of emotional turbulence in their workers, so situations can be properly addressed and necessary changes can be made. 

Types of Stress Experienced by Frontline Workers

The stress experienced by frontline workers is constant. On top of the obvious stress of witnessing daily human suffering, workers may deal with frequent transitions, lack of privacy, uncertainty about work contracts, family and relationship issues, and their own existing health problems — issues that could worsen as a result of chronic stress. 

According to Angela, aid workers often have 16-hour shifts during deployment. Self-care becomes virtually non-existent. “You work, then sleep and restart the next day, with hopes that the next day will be a little bit better,” says Angela. Sometimes, deployment is as long as several months and by the end, one is left completely physically exhausted and emotionally worn down.

Frontline workers are at risk for what is referred to as Compassion Fatigue, Vicarious Trauma and Secondary Traumatic Stress. These terms are often used interchangeably and are a natural but disruptive by-product of working with traumatized clients. After all, the helping profession requires professionals to open their hearts and minds to their clients and patients. This very process of empathy is what leaves helpers vulnerable to being affected by their work.

Compassion fatigue can take a physical, mental, spiritual, and emotional toll on people who experience it. Social workers, for example, may experience compassion fatigue when the stories and experiences of the people they meet in therapy start to negatively impact their lives outside of work. 

Vicarious trauma happens when one is deeply emotionally impacted by stories they are exposed to. Their symptoms mirror PTSD, such as nightmares, flashback and panic attacks, without necessarily being exposed to direct trauma themselves.

See this video for a deeper look at vicarious trauma. 

Post Traumatic Stress Disorder (PTSD)

PTSD can occur when a person re-experiences the traumatic event, tries to avoid thinking about the event or experiences high levels of anxiety related to it. If left untreated, PTSD can even have physical manifestations such as gastrointestinal problems, sexual dysfunction, body aches and headaches. The human body holds onto trauma. 

PTSD is a very real problem. We take the example of the following study, which surveyed 472 individuals who worked in frontline positions in homeless shelters in 23 different organizations. Rates of PTSD were found to be at 33% of the population. Another study showed that one in 10 currently active emergency workers have symptoms suggestive of PTSD.  

Angela admits to suffering from PTSD in past deployments, which can occur as a result of direct exposure to trauma. Her condition went undiagnosed at first. This isn’t uncommon because those in the helping profession tend to become emotionally numb as a way of detaching from the pain of the horrors they are witnessing. It’s easier to switch emotions off than replaying the same disturbing image of a refugee child ripped from his mother’s embrace over and over again. Treatment can be delayed as a result, to the detriment of the worker and he/she may turn to negative coping mechanisms such as alcohol and drugs to numb the emotional pain. 

Apathy can also kick in. Angela recalls a particularly difficult deployment, when her team was anxiously awaiting the arrival of a group of Syrian refugees attempting to flee to neighbouring Jordan. To their dismay, the refugees were blocked at the border.  It was devastating to watch this desperate group of refugees come so far, only to have the hope of freedom dashed in an instant. The sense of despair was overwhelming.

Part of this despair came from being unable to help in the face of injustice. “We can never fully address the wrongdoings and suffering taking place and it leaves one a bit powerless,” Angela says, with a touch of bitterness in her tone. Enthusiasm for the cause is the light that keeps workers going. When PTSD occurs, that spark begins to fade, causing once-passionate and mission-driven workers to become apathetic or cynical.

Supports in Place

Are organizations doing all they can to ensure frontline workers are psychologically prepared for their jobs? Currently, there is security training, cultural sensitivity training, peer support and post-deployment counselling available to frontline workers.  Buddy systems have become particularly important tools, where peers can turn to each other for support and guidance when needed.

According to Angela, “more has been systematic in terms of support than in the past, but more has to be done.” One difficulty is that in order for workers to take advantage of certain services, they must a) recognize they are struggling and b) be willing to use the services at hand. In an ideal situation, workers have ongoing emotional support available to them at all times.

Angela also spoke of the extra burden women carry while working away from home. Family responsibilities, including child care and caring for elderly parents may weigh on them and just adds to existing work stress. Those with pre-existing mental health problems are more likely to be negatively impacted by their work. 

The reality of a frontline worker can be a difficult one. Their emotional well-being is constantly at risk. Having the proper support in place, as well as staff trained to recognize signs of emotional turbulence, can make all the difference in the world. 

*name has been changed for privacy reasons. 

Additional resources: 

http://scholarworks.csustan.edu/handle/011235813/871

https://www.ucalgary.ca/news/study-shows-33-workers-homeless-shelters-suffer-ptsd

By The PLC Team

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