How international aid workers stay resilient amid devastating loss

Nurse practitioner Patrice Gordon speaking with local children while in Bangladesh with the Canadian Red Cross.SUPPLIED

Of all the war zones and humanitarian emergencies that Patrice Gordon has experienced, the 2014 Ebola crisis in Sierra Leone is the one that impacted her the most.

Ms. Gordon is a nurse practitioner from B.C. who has been working with the Canadian Red Cross for the past 15 years. Two or three times a year she is deployed to places like Bangladesh or Syria to provide medical aid after natural disasters like earthquakes or in times of conflict or war.

In Sierra Leone, Ms. Gordon remembers wearing head-to-toe protective equipment and kneeling beside a young boy with Ebola as he experienced a seizure and then died. Under different circumstances – if it was a less deadly and less contagious virus – she could have given him intravenous medication to treat the attack. That sense of helplessness still haunts her.

“We were witnessing such horror and doing our best, but our best was not turning the tide,” she says.

Ms. Gordon and others like her willingly set aside their own safety and security to work in places where each day is filled with high-stakes, high-pressure crises. These aid workers are undoubtedly brave, but they are still human, and that kind of stress takes a toll on the body over time. To cope with the strain, they turn to practices like breathing techniques, quiet reflection and documenting the losses they have faced.

Processing trauma

Dr. Karthika Devarajan, a Toronto-based obstetrician, has worked on seven assignments with Doctors Without Borders/Médecins Sans Frontières (MSF). Recently, she returned from Afghanistan where she provided medical care in a field hospital and trained a team of local female doctors who are no longer able to attend medical school under the Taliban’s rule.

Dr. Devarajan says that most people won’t go to the hospital until they are in critical condition. This means that she is forced to perform very difficult surgeries with limited medical resources.

“That’s the most stressful thing, feeling that somebody could die in your hands,” she says.

There have also been times where war is being waged right outside the medical tent. Dr. Devarajan describes performing a Caesarean section in Yemen while in the next bed over someone was getting their leg amputated after it had been blown off.

Both Ms. Gordon and Dr. Devarajan have developed their own coping strategies over time. Ms. Gordon likes to find a quiet place in nature to sit in solitude at the end of the day so she can reflect on how grateful she is to be able to help people. Dr. Devarajan decides to simply trust that the excellent MSF security team will keep her safe and focus on how rewarding it is to be able to make a real difference in people’s lives.

Toronto obstetrician Dr. Karthika Devarajan on assignment in Afghanistan with Doctors Without Borders/Médecins Sans Frontières.SUPPLIED

Dr. Judith Andersen is a University of Toronto psychologist whose research has focused on how first responders react to stress. She has found that repeated exposure to the emergency situations police, fire fighters or medical providers face can have serious health implications.

Prolonged stress can cause physical symptoms like elevated heart rates, exhaustion, decreased appetites, frequent illness and difficult sleeping. Post-traumatic stress disorder (PTSD) is linked to conditions like heart disease and metabolic disorders. It also takes a mental and emotional toll.

“You may not be able to process the horrendous trauma that you’re seeing, and that feeling of helplessness engages the centres of the brain that are associated with low mood and depression,” Dr. Andersen says.

The good news is that many of these symptoms can be prevented or improved by using specific stress management techniques. Dr. Andersen taught first responders to control their heart rate through breathing exercises and connecting with a colleague who can help you become grounded during times of acute stress. She also recommends making time for physical exercise, taking short breaks at work and practicing mindfulness.

Dr. Andersen followed first responders for a month after teaching them those stress management strategies. She saw radical improvements in physical symptoms like a high heart rate and the ability to remain mentally calm and focused during stressful situations.

Letting go, without forgetting

The Red Cross and MSF have also taught their aid workers techniques to help manage stress. Dr. Devarajan says, “Sometimes, to ground myself, I just really pay attention to the way my foot feels in my shoe.” She says taking some time to write or talk about a particularly stressful situation is very helpful.

Ms. Gordon says that breathing and centring herself is a key way she manages internal stress.

“Sometimes there’s only time for one conscious breath and a quick visualization before you jump into the fray.” She likes to imagine a photo of herself with her three sons in the B.C. mountains.

Ms. Gordon also thinks it’s important to reflect on the good outcomes and try to let go of the hard ones. “Telling ourselves that we made things better by being there, even if we couldn’t fix everyone, is very healing,” she says.

But letting go doesn’t mean forgetting. Ms. Gordon has a little red book with the names of every person who came through the Ebola treatment centre in Sierra Leone – those who survived and those who died.

She says, “It’s a way of honouring the people that we lost, and also honouring our amazing success stories and the big hearts of all the people that we worked with.”

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