The Trauma Lines Blog

Association of Traumatic Stress Specialists

“Notes from the Field”

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Just as technology has evolved from typewriters to laptops, from high-frequency radios to cell phones, so have the mental health resources made available to international relief workers.

“Notes from the Field,” written by Francois de la Roche, is a first-hand story of how one certified traumatic responder’s career progressed right alongside his industry’s care for their members:

In the early 1980’s, when I started international relief work, we were still accepting hand-written reports, unless you brought along a portable typewriter as part of your personal kit. Cellular telephones didn’t exist, so if you were in an isolated field post, you depended on your high-frequency radio for contact with head quarters and the outside world. Living conditions varied widely, in most cases, where the work needed to be done, living conditions could be primitive, or as I recall with fondness “rustic.” We lived, ate and shared the life of the local population — including local problems as well as larger geo-political challenges affecting the communities we were serving.

 As part of our lives as international relief workers, there was an image of the rugged individual that we were suppose to maintain; and as part of that image, we were also expected to be able to “tough it out” in rough situations. It was one thing to be evacuated because an exotic disease or worse, but it was totally different if you were evacuated because you couldn’t “hack it.”

Being evacuated for stress induced or psycho-traumatic reasons usually meant the end of your international relief career. However, change came in the 1990’s when major international relief/development organizations started including a visit to the psychologist as part of the standard mission briefing and then at the end of mission during the debriefing. The purpose for these psychological reviews at the start and end of assignments was a targeted attempt to stanch the loss of qualified personnel after one or two assignments where stress was indicated as the reason for leaving.

Over the years, more emphasis was put on staff care in the international relief agency community. The added focus was based on models being used within the military, emergency response agencies — such as fire and police departments — and with large not-for-profits like the American Red Cross, where staff care specialists were imbedded within emergency response operations to deal with post-crisis trauma of personnel. 

Some international organizations (IO) and non-governmental organizations (NGO) started copying these systems and developed staff care specialists – those individuals who were trained in stress management and post-crisis trauma support at headquarter and regional levels. Still, some NGOs started training country level staff in stress management and post crisis trauma support, thus pushing down to the closest level to a crisis situation help for the NGO responders in need. 

The build-up of support systems to keep IO and NGO staff going, and to provide them with safe outlets and skills for stress management, and also to provide post-crisis support didn’t come because the job was tough. The world of the IO and NGO was changing.

In 1984, when I first went on an international assignment, there were maybe 200 or so NGOs — the main responders were still the United Nations (UN) and the Red Cross. By the mid-‘90s, it was not uncommon to have maybe 250 NGO’s plus the Red Cross and the UN operating in a single country.  Additionally, it was becoming more dangerous for NGO and IO workers in the field as emergencies and conflicts started getting more complex, and the work of the NGO or IO was being seen through different lenses by the various actors in an emergency or conflict.

Danger lurked everywhere for the NGO and IO worker, it was (and still is) common to read in the news wires about NGO and IO workers being kidnapped or killed by one side of an issue or the other, being injured or worse in vehicle accidents and of course you heard of the periodic suicide of a colleague.

When Iraq and Afghanistan were invaded, the perception that NGO and IO workers were extensions of their respective governments, along with military units getting involved in relief and development work, further blurred the world of the NGO and IO worker. 

All this complexity, blurring of roles, and life in general, having to take long breaks between assignments in difficult environments, it was no wonder that international relief and development workers got stressed out so easily, or worse, burned out and ended up changing their life styles and work objectives.

It was in April 2008 that I was invited by World Vision International to take courses in Critical Incident and Stress Management (CISM). I thought that was pretty cool, yet, I didn’t think that I would, within the next month, start practicing what I learned!

Upon my return from my post in Herat, Afghanistan, I ended up doing an individual intervention for one of my stressed out colleagues. In July, there came an opportunity to conduct a group debrief (CIGD) after three of my colleagues were near an improvised explosive device (IED) when it exploded. While it didn’t harm them physically, it did cause them some great stress.

Over the next months, would do several crisis management debriefings (CMB) and another individual crisis intervention (ICI). As part of my personal goals post-training, I set up a staff care plan for the World Vision (WV) Afghanistan Team, and ensured that staff care procedures, as well as CISM intervention requirements, were written into the WV-Afghanistan Security Plan — which included the hostage management and line of duty injury/death response plans.

In January 2009, I was again invited to attend further CISM training, this time it was for advance courses which included pastoral care, suicide intervention, along with CISM planning and administration. Whilst at the training, my trainer, Dr. Michael Hegenauer, Director of Staff Care for World Vision International, mentioned that it would be neat if World Vision could get one of its staff to apply to the ATSS for certification as a certified traumatic responder (CTR). True to my nature, I volunteered to apply for my CTR.

This was quite an experience collecting those materials to put into my CTR application — with my certificates both with me in Afghanistan and at home in Cincinnati, and my references being somewhere else in the world. But I did it, and after getting my sponsor, it took only about another sixty days before I got my letter from the ATSS saying that I had been approved for my CTR.

May 2009 was the start of a new period for me. I was actively being recruited for work in Sudan…which when I told this to my wife, she was ecstatic at the thought that I’d no longer be in Afghanistan.  She was also really happy when many years before I called her to let her know that I was no longer in Vietnam…so based on this experience I continued with the change process.

By the end of May, I was offered my new job in Sudan as the Country Director for International Relief and Development (IRD). Prior to my departure, one thing that I wanted to do was to help a WV colleague of mine to get her CTR. She was not sure that as a German Citizen she could be certified by the ATSS. Lo and behold in July, and after some really fun search processes for her CISM training certificates, she got her CTR! It made me feel really good about what I did for her, since she wanted to use this newly acquired skill set to help other colleagues through critical incidents and high stress situations.

Well, here I am in Torit, Sudan, writing this short piece on my experience in dealing with critical incidents and stress in the old days, as I wait to start a field assessment at first light tomorrow morning. When I first got to Sudan, I let the NGO Security Consortium know that I was an ATSS CTR and offered my services. Sure enough I would get plenty of opportunities in these first months of my assignment to practice my skills. So far I’ve done three individual critical interventions internally for my staff, and have done a group debrief for another NGO which experienced having some of its staff arbitrarily arrested and thrown into jail (something you do not want to happen to you in Sudan). I’ve been contacted by colleagues several times to provide them with individual interventions when they have been stressed to the breaking point. So, yeah, it’s been busy, but good busy. Oh, I do all this on my own time after work and on the weekends…

The way I see it now, there is no excuse why NGOs should not have a staff care plan that includes the ability by a member of the NGO team to be able to conduct CISM interventions as needed by the respective team. With so much need in very rough places in this world, the international NGO community cannot afford to have its staff burn out because the INGO community is not able to provide the needed immediate and medium-term crisis intervention that is so necessary to keeping its staff healthy. Maybe the ATSS would do well to seek out INGOs and invite interested international relief and development workers to train in CISM, get their CTRs and provide these services to a community in want of this type of help.  Could this be the wave of the future — keeping the members of the INGO community on the job longer, happier in their work and living a less stressful life…hmmm?

About the author:

Francois joined IRD as the Country Director for IRD’s Sudan operations on June 15th, 2009, after serving 31 years with the American Red Cross, CARE and World Vision in US based and international relief and development operations.

He has served in various leadership posts in Latin America, Africa, Europe and Central Asia, responding to complex emergencies which include the Sahel Famine Relief Operation, the Armenia Earthquake Response, the Sudan Emergency Operations, the Liberian, Sierra Leonean and Angolan civil war refugee operations, and the Hurricane Mitch Emergency Response.

After the September 11, 2001, Francois was named by the American Red Cross to lead the America’s Fund for Afghan Children, established by George W. and Laura Bush. He would again serve in Afghanistan in 2007 through 2009, and is now on his second tour of duty in Sudan. 

In 2008, Francois started his CISM training and work as Peer Support Provider.  He was certified as a Trauma Responder by the ATSS in April 2009. Prior to becoming an international humanitarian specialist, Francois grew up in Guatemala and France, learning to speak in this order – Spanish, French and English. He graduated from California State Polytechnic University, Pomona in 1973 with a B.A. in History and served 6 years as a Commissioned Officer of United States Marines during which time he participated in combat operations in Southeast Asia. He’s married, and happily so to his wife of 36 years, Bonnie and has two daughters, Aimee, mother of their grandchildren Damian and Sara; and daughter, Marie. Francois and family are based out of West Chester, OH.


Written by traumalines

December 29, 2009 at 2:45 pm

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