Objective: Highlight a high-stress institution (USAID) taking responsibility to protect the psychosocial well-being of humanitarian aid workers and the parallels with efforts to promote clinician well-being; and identify potential solutions that are transferable to healthcare.

1. Working in Harm’s Way
Siddharth Ashvin Shah, MD, MPH

2. 2
Rajiv Shah, MD
Administrator, USAID
2010-2015

3. 3
Raj Shah
White House Principal Deputy
Press Secretary

4. 4

5. 5
Photo:U.S.NavyphotobyLt.j.g.MatthewStroup

6. 6
“I was always thankful and glad
when I could get back to my room
and take off my body armor and
say, ‘I survived another day’.”
– USAID Worker

7. 7
Michael
Dempsey

8. 8

9. 9

10. 10
“The main issue is heavy workload
and long working hours.
10-14 hours a day,
6-7 days a week,
60+ hours a week.
There is limited ability to detach from
work, and a shortage of US staff to
manage the workload.” – USAID Worker

11. 11
“Lack of gratitude and
appreciation among senior
managers and irritable managers
with aggressive expectations.”
– USAID Worker

12. 12
“There is a pervasive feeling or vibe,
of anxiety, due to the high pace of
work. Everything’s a crisis or an
emergency, and this is chronically
destructive, it’s toxic.”
– USAID Officer

13. 13
“People get ‘crispy’ after being
here too long.
This leads to damaged
relationships.”
– USAID Officer

14. 14
“This pressure cooker visibly makes
people act in unusual and
inappropriate ways:
shouting in meetings,
talking out loud to themselves,
walking in circles,
and so on.”
– Extracted from the USAID CPC Incentives Survey

15. 15
“The HR system has not a clue
about life in the field…”
– USAID Worker

16. 16
“I feel as though I am on my own.”
– USAID Worker

17. 17
Do you presently gain wellness or receive support
from the following sources? (check all that apply)
Friends
Family members
Hobbies/athletics
Personal practices that promote wellness
Colleagues associated with USAID
Pet(s)
Colleagues outside of USAID
Faith or spiritual community
Clinician or mental health professional
USAID Staff Care Center
State department programs
USAID programs other than Staff Care
No
71.52%
70.85%
49.29%
45.29%
28.92%
24.44%
19.51%
15.02%
9.87%
8.30%
5.61%
2.69%
1.57%

18. 18
What topics for training or coaching would you be
interested in receiving? (check all that apply)
72.49%
43.37%
69.58%
56.63%
51.46%
47.57
42.07%
38.83%
30.42%
29.13%
Nutrition and healthy eating
People management/leadership skills
Stress awareness and management
Mind-body techniques (such as yoga,
progressive relaxation, or breath control
Cognitive-behavioral coping techniques
Exercise
Contemplative spiritual techniques (such as
mindfulness or meditation
Self-care
Coping techniques used by the US Military
Safety and security awareness

19. 19
“Aid workers, basically, have a
pretty shrewd idea of what they are
getting themselves into when they
enter this career, and dirty clothes,
gun shots at night and lack of
electricity do not surprise them.”
– USAID Worker

20. 20

21. 21
Both Workforce and
Leadership Welcomed
Biopsychosocial
Knowledge About
Trauma

22. 22
Threat-Related Stressors Sustained
Felt there was
a risk
Occurred to someone
known to me
Personally
experienced
Caught in armed conflict
(or active combat operations)
60% 46% 35%
Captivity
(e.g. being kidnapped, abducted, held
hostage, prisoner of war)
78% 35% 3%
Sexual assault
(e.g. rape, attempted rape, made to
perform any type of sexual act through
force or threat of harm)
72% 37% 4%
Sudden, intentional/violent death
(i.e. homicide, suicide)
54% 53% 13%
Serious injury, harm, or death you
caused to someone else
(e.g. accidental, combat-related)
68% 36% 9%

23. 23

24. 24
Duty of Care
Is Changing

25. 25

26. 26
Time to Accept
Responsibility for
Stress Mitigation

27. 27

28. 28

29. 29
Protective
Organizational Culture
Explicit policies and practices that promote a
Stress Aware and Stress Responsive culture
throughout all levels of the organization.

30. 30
Commitment to
Implementation
Ongoing programs for all staff on mitigating
their particular work-related stress exposures
and caring for those negatively affected.

31. 31
Ubiquitous Responsibility
& Engagement
Holding the organization responsible for upholding
policies and procedures for wellbeing. Managers are
held to stress responsiveness as a job duty.

32. 32
Ongoing Monitoring
& Assessments
Multi-tiered monitoring of stress at the individual,
team and organizational levels. Findings to
be integrated back into policies and processes.

34. Thank You