Mental health: Looking after our field staff

Before getting to the field

For all staff recruited to work overseas with Médecins Sans Frontières/Doctors Without Borders (MSF), we provide comprehensive preparation training. Although this varies from country to country, for field workers from Australia and New Zealand it is known as ‘Welcome Days’. The psychosocial component addresses topics including stress management, self-care, ways of coping, short- and long-term responses to trauma, managing unexpected events and burnout. 

“We talk to new recruits about the challenges of international aid work by acknowledging that this work is stressful and that it is completely normal for people to have hiccups along the way. We prepare our field workers for a marathon,” says Dr Kaz de Jong, a clinical and health psychologist, head of the Staff Health Unit for MSF based in Amsterdam. 

“We also train our managers on how to stay healthy, how to keep their teams healthy, what support mechanisms are in place, how to address burnout, what to do when teams are exposed to critical incidents, and generally on identifying the biggest stressors in MSF,” adds Dr de Jong. “We offer practical exercises around scenarios, including how to talk to someone who is working too much or how to deal with conflict.”

In the field 

Field staff may at times feel overwhelmed by working away from home, family or personal pressures, dealing with change, relationship challenges and job demands.

The most common challenge for field workers while on assignment is striking a healthy balance between work and leisure. At times, our staff are required to be on-call 24/7 and this can be particularly taxing. Considering this, MSF ensures that food, laundry, and general cleaning is taken care of. Although simple, providing this support ensures it is easier for field staff to make the most of available downtime. 

Dr de Jong says planning is one of the most important things field workers can do to keep their mental health in check. “It sounds strange because most people know us as an emergency organisation. But the fact is, in an emergency you can—and should—plan. If you plan your work, you know what you achieve, which in turn gives you a positive motivator and energy. Planning also means you work to a limited number of hours.” 

Eating well and often, maintaining regular exercise and steering away from alcohol are also key to maintaining a healthy balance. Some people struggle with the transition from being at home, with outdoor exercise, equipment, and resources on offer, to arriving in a high-security context where movements are limited. But Dr de Jong recommends getting creative with exercise in the field.

“When I’m working in the field, I regularly participate in ‘insanity exercises’—whether that’s exercising for 28 minutes by participating in a series of strength or stretch exercises,” he says. “I remember regularly participating in ‘fit club’ with the whole crew on board one of our search and rescue ships. Everyone knew to meet on the front deck every day at five o’clock. It was a great team activity that kept us healthy on the inside too! 

“Now with technology, you can play interactive games. I’ve played golf, had Zumba lessons, yoga with staff in the project… anything is possible!”

The impact of COVID-19

The COVID-19 pandemic has introduced layers of additional stress for field workers. “We have had staff who couldn’t get home for a funeral, or to attend the birth of their child, due to airport closures or other travel restrictions,” says Dr de Jong. Add to that days, if not weeks, of isolation brought on by quarantine measures in place. 

Uncertainty as a result of the novel coronavirus has become prevalent for MSF’s locally hired staff, often living and working in difficult contexts. Some staff are concerned about the future of the projects they work in, while some cannot work at all because they have risk factors. And others are taking on additional responsibilities because there is less capacity to get international staff to the field. 

“The reality is difficult,” adds Dr de Jong, “We’re briefing everyone going on mission with the real picture – for example, it might be that you can’t leave the project… along with tips on how to maintain good health if that is the case.”

Looking after ourselves and each other

After months in the field, staff are often tired and have many new encounters to reflect on. They also need to work on reintegrating back home and work out how to make changes to the way they look at life after witnessing the suffering of others. 

“You can only recognise that things aren’t working as they should be when you know the signs and symptoms. Recognising signs and symptoms in yourself means you’re also able to recognise it in others,” says Dr de Jong. “It comes back to shifting our thinking around mental health and acknowledging that if you have difficulties, or anyone else around you does, however big or small, that’s okay, and you can do something about it.”

De Jong says having open conversations is a good start. “For example, you might approach a colleague by asking: ‘Hey, it doesn’t look like things are well with you? You’ve changed? You look so sad lately? I hardly see you anymore. You seem withdrawn?’”

Asking these open questions rather than making abrupt assumptions like, ‘Hey, you must have post-traumatic stress disorder!’ is far more encouraging, says Dr de Jong, because poor mental health usually starts with mild symptoms.

Every operational section has a psychosocial unit—and all field workers are encouraged to use the support—whether they have general questions or need help because they’re feeling unwell. In addition to this, MSF Australia provides all field workers with access to psychosocial support prior to getting to the field, while on assignment and once they have returned home.