Labor of Love in Haiti: Aid Workers Face Crisis

Dr. Siddharth Ashvin Shah, a physician with Greenleaf Integrative Strategies who has worked with disaster-impacted populations in South Asia, said ​“survivor guilt” is common but typically counterproductive, even harmful.

“The people who are doing the work,” Shah told ITT, ​“often see themselves as so much better off than the people they’re responding to, the intended beneficiaries, that it almost feels wrong to be feeling hurt inside, or not being able to handle it.” He added that in Haiti, the shock of the earthquake is compounded by ​“extreme deprivation and poverty before the disaster,” further complicating the delivery of aid.

Some of the tensions peek through in the media coverage. Médecins Sans Frontières surgeon Paul McMaster’s anxious dispatch from Port-au-Prince hints at the emotional pressure of attempting the impossible in the face of logistical gridlock and infrastructural breakdown:

It is unspeakably frustrating to think there were two [dialysis machines] on the cargo plane, which has been turned back from Port-au-Prince airstrip three times in as many days, most recently on Tuesday night….

I’ve never seen the kind of devastation I’m seeing in Haiti, despite having flown in to many emergencies. We’re seeing the kind of daily casualty numbers you expect to see in a war. In some areas the city is absolutely destroyed. And it’s always the most vulnerable who suffer most. Whenever I leave our makeshift clinic, I see so many people begging for surgery, for even the most basic medical help.

At the Zanmi Lasante hospital (a branch of the pioneering medical group Partners in Health) in rural Cange, outside Port-au-Prince, the Wall Street Journal describes the devastation felt by humanitarians who worked to build the country before the quake and have seen their accomplishments crumble around them:

We are all asking ourselves, ​‘Why Haiti?” says Marie Flore Chipps, a project manager and daughter of co-founder Father [Fritz] Lafontant.

She, like many here, represents the extraordinary measures taken by Haitians in the quake’s aftermath. Ms. Chipps drives to Port-au-Prince daily and returns with the wounded. On Friday, she collected eight nuns who were living in a field.

Ms. Chipps had begun to believe that the country — cursed with a history of poverty, sickness and environmental despair — was finally marching toward prosperity. Roads were getting built. Health was improving. Businesses and agricultural projects were sprouting.

Now, Ms. Chipps says, ​“We are just living. But we don’t know why we are living.”

The issue of ​“secondary trauma” and indirect post-traumatic stress (explored previously in a post by Kari Lydersen about PTSD among soldiers) have become a focal point for the humanitarian relief community. Global conflict and widespread environmental catastrophes like the Asian Tsunami are pulling more ordinary people into life-and-death struggles, blurring the line between victim and helper. In Haiti, many local and grassroots non-governmental groups were severely damaged by the quake, so their staffs may suffer both primary and secondary trauma as they work to repair their communities.

The workforce tends to self-select for the steeliest personalities. ​“I think the very people who are ready to take on that harm unto themselves are the most ready humanitarian workers,” Shah said, ​“and they often don’t see [the harm] themselves.”

Shah’s recent research on aid workers in India revealed that most workers reported at least occasionally experiencing symptoms such as sleeping problems, or feeling as if they were ​“reliving the trauma experienced by my client.”

Underlying the emotional burden is the neurosis and self-conscious anxiety of survivor guilt.

In the context of a mass disaster, workers and responders are among the survivors. They may push themselves to work excessive hours, neglect sleep and hunger, and suppress grief, possibly to pay for the fact that they were fortunate enough to survive. They may not feel as though they deserve to live, but they continue to work in order to pay homage to the casualties. Professional social workers are typically taught the pitfalls of the rescue fantasy, in which an unconscious force motivates a helper to work against great odds to symbolically repair intrapersonal pain.

Ethnicity and culture factor in as well, as these patterns may especially affect ​“organizations that have workers who are ethnic minorities, female, of low [socioeconomic status], and from traumatized communities.”

The trauma isn’t just a personal problem. Emotional instability and overwork can undermine organizational cohesion and impede aid operations.

According to the Antares Foundation’s guidelines on stress management for aid workers, the social impacts could include:

over-involvement or over-identification with beneficiary populations or, conversely, callousness and apathy towards beneficiaries, self destructive behaviours such as drinking and dangerous driving, and interpersonal conflict with coworkers or with family members.

Ultimately, after workers return to their communities, it may take months to readjust.

But rather than ​“pathologize” these challenges, trauma experts encourage organizations to develop a healthier workforce culture. For instance, setting up a ​“buddy system” could provide critical peer support for staff under high-stress working conditions. Training workers to cope with stress can blunt trauma on the ground, and psychological monitoring during service can prevent crisis.

Shah notes that disasters can also produce ​“post-traumatic growth,” as the spiritual fulfillment of aid work fosters overall mental wellness. Similarly, by partnering with survivors — for example, engaging local communities in rebuilding efforts — aid workers can gain a more balanced perspective on the limits and potential of their labor.

For now, though, the disaster’s monstrous aftermath places the world’s focus squarely on the desperate needs of Hatians. As the relief process stabilizes, the people driving the recovery effort can get ready for the long haul by strengthening the way they value themselves — as workers and as survivors.