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Burn-Out: A Culture of Silence? - Part 2

Are We Adequately Recognizing Burn Out in the Aid Sector?

Hopefully you have read Part 1 of our 3-part blog series. In the first blog, we looked at some key definitions of mental health and burn-out, as well as some key statistics in the sector. We continue, in Part 2, with another important consideration of recognizing mental health concerns - looking at who or what regulates the international aid sector and what I mean by a culture of silence.

Please remember that this blog is an opinion piece and is for discussion and awareness only. The Grants House always encourages those suffering with mental health concerns to seek clinical help. No clinical help is offered or intended to be offered in this blog series.

Who is Regulating?

Consider this statement. The international development sector is one of the largest ‘fairly unregulated’ sectors in the world. Do you agree or disagree?

Regulatory bodies provide standards and oversee quality assurance, competencies, ethics, standards of practice and manage disciplinary issues. Most of us are familiar with those bodies that govern the medical, legal or engineering sectors. But who regulates the international humanitarian sector?

Thankfully, there are Associations that maintain benchmark standards and require their members (who work all over the world) to adhere to those standards.

Examples include inter alia CHS Alliance, The Core Humanitarian Standard (CHS), the Humanitarian Standards Partnership, the International Red Cross (along with previous iterations of Humanitarian Accountability Partnership (HAP) International, which focused on accountability to affected people, SPHERE and People in Aid). There are dozens of other associations and initiatives that provide different types of support for international humanitarian organizations and their staff. The CHS sets out Nine Commitments that organizations and individuals involved in humanitarian response can use to improve the quality and effectiveness of the assistance they provide. The International Red Cross also recognizes those that adhere to principles such as impartiality, neutrality, do no harm, etc. And of course, the media is usually swift to identify major issues in the sector.

Endorse, Shame or Blame

Surprisingly, most humanitarian organizations are self-regulated and joining one of the above associations is voluntary!

Those who do join as members are given an endorsement of the association in line with their respective codes of conduct and principles. However, members are often not subjected to any punitive system, other than dropping their membership, if they don’t keep up with the standards. If an agency strays too far or a staff breaches a code of conduct, it may become visible in the media - but that is more shaming and blaming, rather than regulating.

The absence of a regulatory body for humanitarian development is problematic, generally. Very importantly, when it comes to mental health issues, those associations take varying positions and we have only recently seen the discussion emerge (usually in relation to staff safety and security, which has been in place for many years). Therefore, who is preparing our international cadre of aid workers? And who is overseeing how humanitarian organizations monitor and respond to the health of staff throughout their active deployment?

Preparing Our International Aid Teams

Let’s first compare international relief workers with some other well-known front-line workers.

For example, we have no trouble agreeing that we don’t send firemen into fires without equipment – or soldiers into battle without weapons. So why would we send aid workers into conflict zones or emergencies without proper training or assessing their mental state to cope with it?

Ask yourself this - Does your agency track and regulate your staff conduct and service on a regular basis? Does it provide health check-ins? Are pre and post-deployment mental health services encouraged - and more importantly, is mental health (or well-being) 'normalized' for your agency culture? Most agencies would have no problem responding to these things positively but (a) you may not have considered it as a priority or (b) you may not have the capacity in your agency to respond adequately. Each agency has to make that inquiry into its own ability to respond effectively.

Some agencies have started to prioritize this aspect of their work - and I take my hat off to those who have done that. I know of some organizations that definitely do prioritize their staff work/life balance (or well-being) - but do they go as far as addressing the potential mental health concerns that arise from their daily humanitarian activities (especially overseas work); for their partners, their local staff and their international staff? Right now, there are tens of thousands of charities and in many, they are filling their ranks with energetic and idealistic young staff, interns and volunteers. There are tens of thousands of humanitarian workers abroad that are not even part of a secular or faith-based organization or a religious institution. In some cases, agencies or humanitarian groups (registered or unregistered) may not have careful controls put in place for vetting who we send out to the field.

Under Pressure! Not just another Queen Song.

From previous blogs, you may remember that I mentioned that agencies often recruit for culture fit, passion and commitment - people who share similar standards, who are adaptable and who work well under pressure.

But are young people, volunteers, new recruits – even seasoned professionals - really prepared to go overseas? Can they handle the long list of dignity, rights and justice abuses? Can they face the challenges to their emotions, and maybe their ethics too. Do they have support from their family or community while they are on the job (whether national or international staff). For those who are away from home, are we addressing their needs and ensuring they stay connected. Our international and national staff, and partners, face a high risk of mental health challenges - simply by implementing a project in a complex and high intensity environment. After all, they are put into unfamiliar contexts, sometimes vastly different cultures to their own - and often very far from their home and support structures.

I am aware of this every time I write a new proposal or get new funding for a project. I interact with hundreds of different staff all over the world and though they are all amazing people, I see the tell-tale signs of burn-out in many: cynicism, fatigue, frustration, impatience, over-worked, complaining and the list goes on.

Burn-Out is Not a Clinical Illness?

Let's turn our attention back to that insidious condition I mentioned earlier - what we often casually wave off as Burn-Out.

It's probably one of the most misrepresented or trivialized words, because we talk about it as being over-worked, frustrated, or exhausted. As I mentioned earlier, it is one of the least understood pieces of mental health and has not even been classified as a clinical illness. But ignoring it is tantamount to ignoring the concept of ‘well-being’ entirely. Let me explain.

I need a holiday

Over the years that I've been in the field, working on development and relief projects, I came to realize that people didn’t discuss mental health because -

(1) we don't diagnose it properly and there are few psychology experts who really understand the type of work that international aid workers do - especially related to cross-cultural adaptation contexts. This can lead to a high level of distrust and so people often don't seek out assistance.

(2) there is a perception that no one really wants to hear about it. If you are feeling bad, the last thing another tired and overworked colleague wants to hear is your problems – and if you did talk about it, then it might be seen more from the perspective of griping and commiserating with one another (the 'water-cooler' discussions). This is where we hear a lot of 'cynicism' being expressed too. People may not complain about their problems directly but rather, will criticize the sector, the organization, their managers or other people. It's another way of exhibiting frustration and discontent.

(3) the concept of burn-out is often trivialized and is not clearly researched and articulated. So it isn't seen as a mainstream science – but rather, more of a fringe discussion. and;

(4) being chronically tired and over-worked is often considered a 'badge of honour' amongst your peers. Humanitarian work is a calling and a career for many people - more than a 9-5 job. There is also the expectation on the part of our organizations that we need to get the job done. Most progressive agencies would recognize work/life balance - but there is also the ever present deadlines and pressing needs at the moment. Just ask around - or ask yourself - do you work outside of regular and agreed upon hours, consistently! If the answer is 'yes,' do you feel it is fair and balanced for you personally and professionally?

We're all affected differently

In all fairness to the health profession, Burnout is not an easy phenomenon to describe – it’s complex and different for everyone.

For myself, I’m certainly not someone who shies away from the tough jobs. Growing up, I was exposed to war, carjackings, revolution, suicide bombers, kidnappings and I was nearly hanged by local extremists in Algeria when I was 26, on my first deployment overseas, when they stormed our offices. I’ve experienced most of the unpleasantries that are thrown at aid workers. And because I was apparently good at dealing with these emergencies – the UN and NGOs decided to send me to a series of conflicts and emergency crises areas around the world. And I won’t lie – I loved every minute of it! But it comes at a cost and it will affect everyone differently.

My Personal Moment of Realization

For most of my career, none of my family or friends would ever think that I could burn out.

Over the years, I realized that what I was feeling was far more insidious than fear, stress or anxiety. And when I had my own sudden moment of realization, I began a journey of self-exploration.

Until that moment, I’d always said, I’m ok – it doesn’t bother me. I’ll get over it.” And I definitely didn't talk about it!

Who wants to admit weakness? I had a man shot in front of me in South Sudan, in 1998, simply because he wouldn’t deposit his pistol before going into a meeting with a regional representative of the Sudan People’s Liberation Army. I almost was shot myself, when a guard discharged his rifle accidentally and the bullet grazed over me. And my last visit to one of my favourite countries, Afghanistan, ended with a suicide bomber missing my car by 50m. That should have been enough to make many want to stay at home - but I love my work and I'm used to it, right?

In 2018, I did a school presentation in Whitby with a local MP, and a student asked me why I went into the humanitarian sector. In a sudden flashback, I realized that it was because of a woman in Saigon (Vietnam, 1973) begging outside of my primary school. Her face and hands had been disfigured by a napalm attack. I couldn’t understand it at that age but I decided back then that I wanted to change that kind of suffering in our world. The student said, “So you were an idealist, at our age? It must be so exciting to do what you do…and rewarding.” That young person set me on a journey of self-exploration from that simple observation.

My bruise is my badge of honour

I realized that the students, my family and friends all think of aid workers as some kind of “Indiana Jones,” because of our exciting travels to exotic places. Many of my friends and family live vicariously through me, listening to the stories and gleefully asking “where is Phil this time?” Does that sound similar to your situation?

But guess what - that external image didn’t match my internal one. Their perception of what I did – didn’t match my perception of my reality. People often think that humanitarian workers just get free trips to exotic countries and travel the world, spending donor money – so what are we complaining about? Of course, I've been to 115 countries now but quite honestly I've usually seen them at their very worst - when they are suffering and most vulnerable. And that leaves an indelible impression on even the thickest skin.

And while our friends and family see the glitter - we take the bruising and trauma, the exhaustion & over-work AND we wear those things as a badge of honour amongst ourselves - bruises and all! It's who we are - or at least, who we can become.

Culture of Silence?

My first signal that something wasn't quite right was when I would ask my colleagues a simple “how are you doing?”

Amongst aid workers, it is incredibly refreshing to hear someone say - “I feel great, rested and under-utilized.” Truthfully, in my humble opinion, it rarely happens! Instead, the response is often expressed in relation to being chronically tired, overworked, feeling under-appreciated, and frustrated at some time or another. How many of us can relate to working long hours, answering too many e-mails, not being appreciated or understood, not keeping normal hours (often because of time-zones) or dealing with challenging colleagues or managers? Of course, it is a continuum - a scale. And we must each assess ourselves on that scale. We're all at different places on that scale. However, as time progresses in aid work, it is increasingly easy to see the glass as 'half-empty' instead of 'half-full.'

Naturally this situation doesn't apply to everyone - I don't want to imply that it does. But I learned that if you observe a pattern of such responses, it might be leaning towards a signal of burning-out. And I use the term 'burning out' intentionally, instead of 'burnt-out.' In fact, we are all on that continuum and we want to control the sliding towards being burnt out.

Here is an unexpected twist in the burn-out continuum though.

Working at a high pace and in difficult contexts can be like a drug. And when it also folds into your self-perception or identity, reinforced by others and your own sense of self-worth, then it becomes a spiral of negative behaviour and external perception. As I mentioned a moment ago, some people may start to blame their external environment, their partners, their managers or the agency. And to solve that growing cynicism and negativity or a feeling of 'spinning your wheels', one might start seeking the next challenge - that next assignment which will be the panacea to whatever problem you happen to perceive. We used to call it ‘chasing the dragon's tail’ in relief work, as there were so many staff who just went from disaster to disaster.

In my case, if I became frustrated and my idealism was shattered by the logistical and bureaucratic nature of some of my jobs, I would be tempted to seek a new adventure and position - to put a salve on my internal wounds. But you know what? As I did, I felt less and less productive and accomplished each time. The grass looked greener elsewhere but it never seemed to live up to the hype after a brief honeymoon period at the new job!

One of the principal reasons is that we carry our mental health baggage around with us. It doesn't go away just because we change jobs or seek out a new environment. It might just be put on pause for a little while - like a distraction. We certainly don't want to confront the issues and we don't want to talk about them, for all the reasons I mentioned earlier. And it's a double-edged sword because agencies want tough and adaptable people - and yet we are all simply - human!

As a result, the international aid sector has mostly stayed quiet on these issues over the years - until recently. When something goes unspoken or overtly acknowledged, we might call it a ‘culture of silence.’ I don't want to imply that it is insidious or intentional - it is not! But there always seemed to be a larger majority of aid workers who just accepted the conditions for what they were - and kept on pushing forward. Staff may not want to talk about it and the agency may not know how to deal with it - so it becomes a culture of acceptance of the status quo. But the issues we do hear about may only be the tip of the iceberg.

Opening New Dialogue Post- Covid-19

If it’s possible to see a positive side to such a terrible time as the COVID pandemic, we might say that it has brought the discussion on mental health to our doorstep – in fact, to everyone worldwide. It has given us the possibility to frame uncomfortable and personal conversations about mental health, in a safe space. This has partly been driven by the media and partly by agencies like the WHO. My hat is off to them for making this possible.

Every day, during the lockdown, they had been discussing the issue of ‘anxiety’ caused by the lockdown measures. But - the messaging around anxiety is not new! It’s just heightened – it’s exaggerated - in today’s environment. But the positive thing is that ‘it IS being talked about more openly now.’

When the going gets tough? The tough get going!

As a recruiter for many years, I would say that aid workers have to be tougher, smarter, more flexible, adaptable, culturally sensitive, emotionally stable and ready to accept the unexpected. Boy – that’s a lot of expectation we put on aid workers right from the get-go – before we even send them overseas. On top of that, remember that they are away from home and away from their normal support structures, so they have to be resilient and able to cope. And often, they have to do it on their own! But does your agency have sufficient training provided and capacity to respond to staff mental health needs?

The strongest will stick it out the longest but they may suffer the most because of it.

Not all agencies are equal. Some take great care to provide suitable training for their frontline aid workers. However, I would argue, (in my opinion), that many do not. And a large percentage may not be able to pay adequate attention to their staff's mental health care.

When I started aid work, my deployment training was fairly negligible. What I remember is the trainers saying “Be prepared for anything - including being disabled in the field.” The trainers in my program - mostly hired consultants - made it clear that they didn’t want weak people going abroad and stress was not an option. But the problem we’re discovering is that people with a high degree of coping skills and tolerance for stressful environments will also suffer from being worn down over time. As a result, the strongest will stick it out the longest but they may suffer the most because of it.

In 1997, I was deployed to the horrors of the displaced and dispersed camps in Burundi, in the aftermath of the Rwanda genocide. In a short 9 months, I’d seen more suffering than I care to remember.

When the job was done, I was transferred to South Sudan for 2 years. The situation in South Sudan was a perfect storm of war, lack of rain, long famine and human suffering. And our agencies were working right in the middle of all of that! In fact, we had to pitch tents to sleep in camps under constant threat of aerial bombings and ground assaults, because the cities were overtaken by the North Sudan forces. We had to rely on the goodwill of the South Sudan forces to keep us safe and every day we were on the sidelines watching a population die by the thousands. Just another crisis in which aid workers are called to serve.

No time to breathe

As in many emergency relief efforts, every day was a race against time to save lives, as literally thousands of children and adults were dying from starvation. For most of us, we felt that we had no time to breathe.

Click on the video and listen to my voice in this interview I did with ITN News (UK) in 1998. Do you sense any disappointment in my voice? We were bringing food supplies in by small planes and air-dropping food from C-130's. And on the ground, we organized food distributions in the camps and coordinated supplies. And by the way – I had never done anything like that before and no one had trained me to do it.

That disappointment in my voice was due to the slow progress, logistics problems, bureaucracy and lack of international support. Operational Lifeline Sudan (OLS), while saving countless lives, was also a highly criticized delivery mechanism. But what relief efforts haven't been criticized, right? However, it was my first encounter with a bureaucratic aid framework that did not meet my high expectations and idealism (the two things that I took out to South Sudan with me). And I had no idea back then but it was also the first 'chipping away' at my passion and idealism - due to a breakdown of the system overall. Sound familiar?

When I left my post and went to the next one in Nepal, I didn't receive a debrief, no counselling and no offer of follow-up help. I don't blame the organization for that at all - it was simply not thought of as a priority or a need for someone like me. I was on my own again and taking my collective - though unrecognized - baggage to my next agency.

Message from The Grants House!
Grant proposal; Grant writing; Writing a grant proposal; grant writer; grants strategy
Philip Tanner, Grants Coach and Trainer. Founder of The Grants House

Look for Burn-Out: A Culture of Silence? - Part 3 in the next blog.

One thing this COVID pandemic has taught us - mental health and burn-out are real and it’s becoming more common to talk about it - and it's ok to talk about it! It doesn't mean that we aren't 'fit for purpose!' And as those 84% of aid workers who have continued working with untreated mental health issues begin to talk more freely about their experiences, will the Aid Sector be prepared to respond?

We are starting to realize that being able to discuss mental health openly means we are fitter than most! I've seen so much burn-out affect staff in the field and in headquarters, and I often see it amongst my Grants Acquisition colleagues - working long hours and on recurring deadlines, travelling to difficult and complex places, and often with program designs that impact the most marginalized people. My hope is that this blog may provide an opportunity, as a sector, to reflect deeply on the matter and to better support our most valuable resource - our committed aid workers!

I'm Dr. Phil Tanner, founder of The Grants House. I've been working in international development and humanitarian relief work for over 30 years and now I'm excited to pass along my experience to you in The Grants House proprietary training courses!

Don't forget to give us a thumbs up after you read this blog and let us know if you want to hear more about identifying and mitigating mental health risks and concerns within the international aid sector.

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@The Grants House, 2023


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