Helping the helpers

Lisa Lim Ah Ken was in Mauritius and Sri Lanka when we asked her to write about how psychology has informed her work with aid organisations, so the 'interview' was carried out by e-mail exchanges. This highlights one of the points she makes about the difficulties of communication in her role.

How did you first get interested in psychology?
As a child I remember puzzling over why adults often say one thing but do the opposite! My family lived in Mozambique for over 20 years of my life and I schooled in the UK, but my parents are of Chinese origin with Mauritian nationality. I was a very confused child and teenager and struggled to understand others and fit in anywhere. A few years ago it finally dawned on me that before I could understand others I would really have to understand myself. This sparked my interest in studying psychology.

How did you set about studying it?
When I was living and working in the UK I started an Open University sociology degree. Although the course was great, it didn't give me the answers I was looking for and I shelved my interest in psychology for a few years. When I joined the aid sector I decided it was time to take the subject seriously and I started a distance learning degree with the University of South Africa. I chose to study with an African university rather than a European one. As well as mainstream Western theories, the course also studied issues such as HIV and AIDS counselling in an African context, anthropology of African worldviews and community psychology in the context of aid work. I wanted to be able to relate what I was learning to people I was working with.

How did you get into your job?
I was busy with a career in the private sector and was working in Sri Lanka during the December 2004 tsunami. I felt compelled to join the relief effort as many friends were indirectly affected. By that point I had become disillusioned with my work in the private sector, so it was no hardship to drop it. I joined the UN in Sri Lanka in 2005 and started working in administration, then moved to Indonesia and then Pakistan to support the earthquake relief effort during 2005/2006. I had already started my psychology studies and found my work relationships becoming richer and more interesting as I started understanding myself better. I decided that I wanted to work more directly with people and saw a rare opportunity in 2007 for a staff welfare officer with another organisation. I applied and got the position.

What does your work consist of?
As a staff welfare officer I travelled to programmes in countries such as Darfur, Liberia, Democratic Republic of Congo, Senegal, Zimbabwe and Cambodia, to provide support to the organisation's employees. The organisation provides relief to vulnerable populations through different types of programmes, for example by digging wells and boreholes to reach deep, underground water for communities who suffer due to persistent drought. Aid staff are often exposed to vicarious trauma and develop stress due to the harsh conditions; working at extreme temperatures for long hours in insecure locations. There is often a constant heightened sense of danger due to the political instability. Living quarters are basic at best. Lack of sleep, physical and mental exhaustion, culture shock, poor diet, unrealistic workloads and curfews which restrict freedom of movement are just some of the challenges staff face daily.

Staff needs are varied and usually tied to the context, culture and period. My services were usually requested by the country director, based on their perception of team problems. These could be anything – for instance, high levels of absenteeism, negative team dynamics, staff falling sick or caught in a traumatic situation (such as carjacking). Sometimes the reasons were more practical, such as needing a health and safety assessment. I usually found that the actual needs were quite different. A lot of the time I also discovered that underlying, chronic issues, such as staff disempowerment, lack of cultural understanding (by the organisation and expatriate staff), poor communication patterns and chronic stress, were at the root of anxiety and complaints.

After an assessment I would recruit a local psychologist from the area and spend some time inducting him or her into what we could and couldn't do given the organisation's policies. We would then work together to design interventions tailored to the unique needs of the team and delivered in contextually appropriate and meaningful ways. Examples might be regular, individual or group counselling sessions; group workshops over several months to develop communication skills, learn to manage stress or learn to listen empathically; and longer-term strategies to deal with organisational causes of stress. I would work with a country for one week to three months, sometimes going back for follow-up work.

What did you enjoy about the job – and what did you find more difficult?
I really enjoyed its uniqueness: while some needs are common across all teams, others are specific to the team or environment. I loved the fact that the job offered me the opportunity to work and get to know people from different cultures, with very different worldviews to my own. Being exposed to people's different interpretations of experiences enriched my understanding of the world and of myself. Being able to support people who work tremendously hard, under extremely challenging situations gave me a sense of accomplishment – I felt I was contributing to the relief effort by looking after its workers.

The intense travel was exhausting. I travelled to over 12 countries in two years and sometimes found myself waking up in the morning unsure of which country I was in! Aid workers often put their lives 'on hold' and go home after several years in the field to find that the world has changed. Readapting to a routine life can be very stressful. E-mail and Skype have been a godsend for keeping in touch with friends and family.

Setting and maintaining boundaries is a challenge. I work with and share a house with my team-mates, so inevitably people often want to offload to me during the evening or weekends. It was difficult for me to be gentle yet firm in maintaining my own 'time out'.

I was the only person in my role, so there was no one who really understood my challenges, my findings, or the work I was doing. I was fortunate that there was a very experienced analytical psychologist working for the organisation and he became my mentor and supervisor. Unfortunately, it was always a challenge and frustration for me to try and demonstrate the benefits of the role in a tangible manner. Despite the evidence of high levels of turnover, burn-out and chronic stress in several of the programmes, the role was terminated a few months ago. I'm now working for another organisation in Sri Lanka as a project manager on a rights-based project.

Does your training prepare you for your work?
My psychology studies and the training provided by my supervisor were essential. I was able to apply principles of the person-centred approach. Respect and empathy are crucial to earn trust in a multicultural context. I was a 'foreigner' talking to people about issues which were often sensitive, personal and could potentially be used against them. Unconditional positive regard was important for people to feel empowered and safe enough to be able to talk openly. The psychosocial support worker is often perceived to be in a position of power, and congruence was important for people not to feel that they had to say things just to please me. In many of our programmes, staff face incredible challenges. Without a deep belief in people's ability to overcome their challenges by themselves, I would undoubtedly have felt a need to 'save' everyone and impose my own solutions on them.

None of my training however, prepared me for how lonely the role can be. I soon learnt that due to confidentiality needs and the kind of personal information people shared with me, I would never be able to make close friends with staff. At first this was difficult because, landing in a strange (and potentially dangerous) country immediately made me feel like I needed to bond with team-mates. However, I learnt to rely more on my supervisor, my family and friends back home for emotional comfort and reassurance.

What sorts of people do you work with? What have you learnt from them?
I work with all sorts of people and learnt that Carl Rogers was correct when he said that people have an innate ability to survive and to strive towards actualisation. I also learnt that the human spirit is a magnificent thing. I have been humbled and inspired by the people I work with. They taught me to look at the world through positive eyes.

Most of the people I've worked with have been from collective cultures and they taught me a lot about the strength of a shared existence. I firstly found people intrusive, but soon came to appreciate how wonderful it is to share, once I overcame my ridiculous notion of ownership. People would go out of their way to help and support me, making me want to do the same thing. 

How do you cope with professional development?
I study by distance learning. It continues to be a real challenge, lugging my 15kg of books around the world and coming back to an assignment after a hard day's work. Eventually I will have to take a break to focus exclusively on my studies. Experience, however, is also a very important aspect of my professional development, and, thanks to my supervisor, I continue to grow in areas such as self-awareness and the ability to interact meaningfully with clients.

More generally, what does psychology contribute to aid work?
It's critical, but this has not dawned on organisations yet. For years the aid industry has been throwing money down the drain with ill-designed programmes which do not take people's real needs into account and which can destroy people's lives. A complete lack of respect and empathy for programme beneficiaries causes waste and destruction. Blueprint programmes designed by Europeans and Americans are rarely beneficial to people in Africa or Asia. Without talking empathically to those who need the help, it's impossible to truly understand how best to help them. The aid industry is slowly waking up to concepts such as participation and inclusion, but not nearly fast enough. Community psychology, for example, is a great way to merge the aid sector with psychological principles to ensure that programmes are effective, efficient and make a real, lasting, positive change.

A lot more also needs to be done to support aid workers. They are often portrayed as hardy, army-type people who travel around the world saving lives, but they are not robots.

Many people are attracted to this field of work because they project their own unsatisfied needs for nurturance and healing on the beneficiaries. They then become unrealistic in their attempt to 'save everyone'. Other people take on this kind of work because they may be running away from dealing with the challenges of 'normal life'; the intensity of aid work can be quite addictive. Whilst a large proportion of aid workers are young and unattached, there is a fair number that are older and have never been through the 'normal' stages of life (or are stuck at a particular stage), such as having children or being in a committed relationship – some suffer from depression and many drink heavily and regularly. Psychology can help people develop a more realistic approach to aid work and can help workers at all stages of their career.

Presumably cultural and diversity issues play a big role?
Eighty to ninety per cent of aid workers are 'national' – that is, they are hired and live/work in their own countries. Their needs are often different to those of expatriate staff. A good example of the difference is the provision of trauma counselling for staff who have been involved in a serious incident. Expatriate staff are usually provided with counselling by a trained person and flown back home for an agreed period of recovery. National staff are also provided with a counsellor (a foreign person who doesn't speak their mother tongue) and they get time off work. However, many cultures do not use and cannot understand counsellors, so the debrief is not helpful to them. Some cultures have a taboo about speaking to psychologists, and the staff member could actually be stigmatised. Furthermore, national staff may live in the same area where the trauma occurred, so going 'home' for them may not bring much relief as they are constantly reminded of the incident. Organisations are yet to invest in research which identifies more appropriate methods of providing psychological support to their national staff.

What does the future hold for you?
I intend to continue working in this sector for another year or two and then focus on my career in psychology. I need to have a cut-off plan because aid work is exhausting and I don't want to get to the stage where I've burnt out and become disillusioned with it. Eventually I'd like to contribute to my own community back home, and hopefully my experience in aid work combined with improved skills in psychology will enable me to contribute in a way which is meaningful.