Page last updated at 11:01 GMT, Thursday, 22 May 2008 12:01 UK

Trauma risk for Burma aid workers

By Chris Hogg
BBC News, Bangkok

Red Cross volunteers carry an injured boy on 21 May 2008 (Image: IFRC)
Local volunteers have been bearing the brunt of the relief effort
For the aid agencies who have struggled for more than two weeks to get relief supplies to the victims of Cyclone Nargis, there is now a new factor that could compromise their ability to operate effectively.

Their staff are exhausted.

What makes this disaster different from others before is the fact that those trying to deal with this emergency have had to rely so heavily on local staff.

Burma's initial decision not to allow foreign relief workers in, and to prevent foreigners already in Burma from entering the Irrawaddy Delta, meant the international relief organisations were forced to tear up the rulebook and instead do the best they could with the resources they already had in place in the country.

Many of these Burmese staff are experienced operators who know the area well, but the pressure on them has been relentless.

One Burmese relief worker working with Christian Aid said she has been working non-stop since the cyclone.

"How can we take a day off when we know how many of our fellow citizens our suffering?" she asked.

The charity says its local staff feel all the responsibility is on their shoulders. Another relief worker lost his wife and three sons in the cyclone.

"He has not stopped working since the cyclone struck," his colleague said. "He has thrown himself into helping others as a way of coping with his grief."

'Shocked and numb'

Experience from other disasters suggests that people who identify more readily with the victims are at greater risk of developing psychological problems.

The symptoms of Post Traumatic Stress Disorder in one society might be quite different from those in other cultures, who might express stress differently
Dr Peter Salama,

Local staff, likely to identify more readily with the victims than those from overseas, are more likely to have higher rates of Post Traumatic Stress Disorder.

Those who deal with traumatic events like handling dead bodies also have a higher likelihood of developing psychological problems.

Research into the aftermath of the Kosovo war in 1999 suggests two groups of relief workers are most at risk of developing stress-related problems.

First time volunteers who may be wholly unprepared for the job, who do not know what to expect or who have unrealistic expectations of their ability to make an impact are the most at risk.

The other group is the more experienced experts from overseas, who travel from disaster to disaster and who as a result may have built up cumulative amounts of stress.

A woman looks for her belongings at her damaged home outside Rangoon on 21 May 2008
Staff who identify with victims could be more severely affected

Doctors say those facing extremes of stress often change their behaviour in an effort to find a new internal equilibrium.

"People feel shocked and numb, fearful and anxious, sometimes helpless and hopeless," said Professor Richard Williams from the University of Glamorgan in South Wales. "They feel guilty. Sometimes they feel angry."

As well as emotional reactions, there are psychological reactions to look out for, like poor concentration or poor memory.

Some lose confidence. Others feel they have to be over-vigilant. People regress into less mature patterns of behaviour.

"The key here is not that you have bad reactions, it's how quickly you get over them," the professor said. "If these feelings persist for a few weeks then it's worth taking much greater notice of them."

Although there has been a fair amount of research in recent years into the effects of severe stress on expatriate relief workers in disaster zones, there has been less work done on how local staff are affected.

Other studies have suggested that in Asia stress often triggers psychosomatic disorders - people start to display physical symptoms.

"We will need to look out for this when trying to help staff working in Myanmar [Burma]," said Dr Peter Salama, Chief of Health at Unicef.

"The symptoms of Post Traumatic Stress Disorder in one society might be quite different from those in other cultures who might express stress differently."

'Watchful waiting'

The Australian charity CARE International is already looking at how to support those of its staff who have been working in the delta for the last two weeks without a break.

A family sit in a tent on 20 May 2008 (Image: Unicef)
Survivors could also face stress-related difficulties, experts say
Its representative in Rangoon, Peter Newson, says they are aware these people will need a lot of psycho-social support.

"We have to be very careful, though, to tailor that support to the Myanmar [Burmese] culture in order to make it effective," he says.

That means encouraging them to talk to monks, to their families and to each other. In some cases writing down their experiences too.

"And that's not only important for our staff," Mr Newson said. "It will be important for the survivors in the delta too."

Dr Salama says when it comes to trying to reduce the stress on the front line staff, there are "common sense responses".

These include making telecommunications equipment available so it is easier to call home, setting up peer to peer networks so people can discuss with others what they have been through, teaching stress management techniques and creating a culture where people can talk more readily.

The doctors agree it is not unusual to experience some or all of the symptoms of severe or acute psychiatric trauma after dealing with a disaster like this.

But these days, according to Professor Williams, the approach that is often taken is to undertake what he calls "a month of watchful waiting or psychological first aid".

"We give people a lot of support, help them to return to a more normal set of arrangements as quickly as possible," he said.

"With that, most people will soon begin to recover and their stress levels will start to come down. If after a month they are still highly stressed then that is something to be taken more seriously."

As Burma agrees to allow more outside experts in from neighbouring countries, the pressure on the aid agencies' local staff should begin to ease.

But such is the scale of the disaster and the size of the task still to be done, the stress on front line staff and others will still be considerable for many weeks and months to come, making it all the more important that agencies have plans in place to recognise and deal with the problem.

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