Caring for Caregivers

Helen Sworn was shopping for groceries on a spring day near her home in Phnom Penh when she was

struck by a feeling of lightheadedness. She grabbed hold of the cart her mother was wheeling to steady herself. “You look gray,” her mother told her.

When she arrived home a few minutes later, Ms. Sworn’s legs felt wobbly, her arms refused to budge, and she’d lost her ability to speak. Ms. Sworn, who had spent eight years in Cambodia working for CARE, Tearfund, and other charities, was terrified.

“I wanted to go to the hospital, but I couldn’t say anything,” she says. “I was stammering.”

Over the next 18 months, Ms. Sworn visited doctors in Thailand and her native Britain and took tests for multiple sclerosis and brain tumors. Each test came back negative.

It wasn’t until Ms. Sworn spoke with a psychologist in Cambodia that she received a diagnosis that seemed to make sense. The psychologist identified Ms. Sworn’s temporary paralysis — which she used to experience as often as three times a week — as a symptom of “secondary trauma” resulting from working with street children and young women forced into prostitution on the streets of Phnom Penh.

Secondary trauma, also known as “vicarious trauma,” is one type of affliction that can strike nonprofit employees who work with troubled people. Employees at relief, development, and human-rights groups, in particular, may experience post-traumatic stress disorder from witnessing violent or disturbing events, or “compassion fatigue” after prolonged exposure to suffering. Workers hired locally in war-torn areas or areas hit by a major disaster are at highest risk because they experience trauma as both victims and people who care for others.

Symptoms of secondary trauma and compassion fatigue are similar to those of post-traumatic stress disorder: anxiety, depression, sleeplessness, and even the type of paralysis that afflicts Ms. Sworn.

Mental-health experts say the disorders are brought on, in part, by a feeling of powerlessness. When helping people facing extreme needs, “we take in all of their pain, all their struggles, and all their losses,” says Laurie Anne Pearlman, president of the Trauma Research, Education, and Training Institute, in New Britain, Conn. “And if we aren’t able to process that, it accumulates inside of us.”

Risks of Violence

Charity workers say there are a number of trends, including more-severe conditions in many countries, that make mental-health issues all the more pressing for aid workers. According to a recent study by the Center on International Cooperation at New York University, violence against aid workers nearly doubled from 1997-2001 to 2002-5.

While the center’s researchers say the increase isn’t as substantial as it seems — because the number of humanitarian workers has grown as well — several high-profile murders and kidnappings in Afghanistan, Iraq, Sri Lanka, and Sudan have shaken aid groups. At the same time, many experienced humanitarian workers who got their start in the late 1980s and early 1990s — when the field of humanitarian work became more of a profession — are planning to leave their jobs in the next few years.

Even individuals who have worked for years without experiencing trauma or burnout aren’t necessarily immune to problems. “Our level of resilience is not static,” says Lynne Cripe, senior technical adviser for staff support at CARE, in Atlanta. “Some people liken resilience to a muscle. You can strengthen it, but if you use it all the time, it can get tired.”

Many of the larger relief and development organizations, meanwhile, have created full-time staff positions in recent years to focus on the emotional well-being of staff members. These staff members help organize efforts to prepare workers for missions overseas and conduct debriefings when they return. Doctors Without Borders’ Amsterdam office, for example, employs three people who screen workers before they travel abroad and also provide counseling in the field in case of emergencies.

Staff members may also help organize charitywide efforts to educate people about stress. This month, Save the Children will start a pilot program to train staff members in Indonesia in coping techniques. If the effort works, the charity hopes to start the program in other strife-ridden places, such as south Sudan, and eventually in all the regions the charity serves, says John Fawcett, deputy director of staff wellness at Save the Children, in Westport, Conn.

The charity also deploys its staff members as part of a team, so that employees get to know their colleagues and feel comfortable turning to one another for support.

“Relationships are key,” says Mr. Fawcett. “If you’ve got good friends and good colleagues, you’re going to cope much better in an emergency situation than someone who is isolated from social networks.”

CARE has developed a pilot program that trains one volunteer staff member in each of its country offices in providing support to other employees. The project, which has so far started in 10 African countries, helps ensure that social support is tailored to the needs of individual offices and employees, says Ms. Cripe. The charity is also in the process of putting into effect new guidelines for responding to disturbing events such as the death of a staff member.

Finding ways to help workers who are themselves victims of a major disaster can be most difficult. Employees from the locality or country in which a humanitarian organization is working, who make up about 90 percent of most groups’ staff, are often barred from receiving government money to help rebuild their lives. “It’s almost a Catch 22,” says Mr. Fawcett. After the 2004 tsunamis in Asia, for example, “we had local Indonesian staff who were building houses for members of their community who weren’t allowed to build houses for their own families.”

Health Costs

While the emotional toll of nonprofit work threatens to drive some workers away from the profession, there are many people, like Ms. Sworn, who continue to work despite the mental and physical costs.

Since her diagnosis, Ms. Sworn has been able to reduce the frequency of her bouts with paralysis by taking antidepressants. But she still experiences episodes once every few months, she says. Even her daughter, 13, and her son, 9, now recognize when she is about to fall ill. When her husband is out of town, she says, they help her to a couch and then call a neighbor.

Ms. Sworn, who is now the director of Chab Dai (Joining Hands) Coalition, a group of Christian organizations fighting sex abuse in Cambodia, says that her own experience has made her more concerned about the mental-health needs of her Cambodian employees. She hopes to create a new position — the seventh at her small charity — for a Cambodian whose sole job it would be to counsel staff members at other aid groups about their employees’ mental-health needs. “This whole idea of caring for the caregiver is really ignored,” she says.