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Risks and responsibilities in the field
- 1. Risks, Realities and Responsibilities in the Field Carol Etherington, MSN, RN, FAAN Associate Director, Community Health Initiatives, Vanderbilt Institute for Global Health
- 2. Essential Questions Where are you going? Why are you going? With whom are you going? What is their history and what is their hx in this site? What will you do? How will you do it? How will you know the impact of what you did; what / who will follow
- 3. Before you go, be sure that ….. you are clear on the organization’s goals and objectives for the mission, and have received an orientation you have attended to medical requirements you have A LOT of information about the place/and the culture (your responsibility!) you have talked w/ family and friends so they have a reasonable understanding of where you will be and what you will be doing you know who will meet you upon arrival; have the address, phone number w/you in the local language.
- 4. Essential Issues Geography and Climate Housing and Work Sites Food, Diet, Drink, Meds & Paraphernalia Transportation Work Related Stressors Professionalism, Socialization and Judgment
- 5. http://www.environmentalgraffiti.com/news-stormy-weather-monsoon-season-around- world?image=9 GEOGRAPHY & CLIMATE Darfur Camps / Chad: CE
- 6. HOUSING & SITE LOCATIONS of WORK …and for those caring for the people who reside there Living in tukuls, or under ox carts creates unique challenges for the people
- 7. FOOD, DIET, DRINK,MEDS & Paraphernalia http://www.bing.com/images/search?q=phtographs+of+unusual+food& view=detail&id=BF1AB1A7B4CCFE5A29109A60D29991A19DF8B0A 6&first=1 Don’t be afraid to try new things, use common sense along with your curiosity.
- 9. TRANSPORTATION – Likely the most dangerous element of your trip Public transport to avoid when possible: matutus, put puts, rickshaws, chicken buses, Use great care in driving/riding in autos, bicycles, motorbikes, camels Use experienced, and preferably licensed drivers rather than drive yourself in questionable circumstances
- 12. WORK RELATED STRESSORS/RISK FACTORS Proximity to conflict or risk of conflict erupting Endemic tensions; local politics Expectations of patients Inadequate equipment Lack of procedural knowledge (local) Too little/wrong type of security Inappropriate mix of personal/social issues
- 13. WORK RELATED STRESSORS Internal tensions and conflict (project or team) Lack of self confidence/ too little training for the job Overly confident/eager to try new skills and assume roles Differences of opinion about how to achieve effective and efficient outcomes Witnessing disparities between ex pat/national staff
- 14. Witnessing extreme need e.g. illness or poverty Cultural/Social barriers Blurred professional/personal boundaries Lack of trust/confidence in project leadership Accountability without control or authority to make change Too few staff; too many <>ineffective use of resources
- 15. Considerations of National Staff in some settings Face more risks than expats Live with multiple stressors Likely impacted by the same traumas, medical or psycho-social issues as patients/consumers Understand social stigmas and issues particularly related to gender and religion,
- 16. Considerations related to the 3 R’s AWARENESS and ATTENTIVENESS COMMUNICATION – VERBAL & NON-VERBAL CULTURAL COMMON SENSE PERSONAL RESPONSBILITY
- 17. Define it. Look it. Live it. PROFESSIONALISM in work & social setting/s http://www.bing.com/images/search?q=inappropriate+dress +in+work+place&view=detail&id=D75BE77EA8BC046AE90 96B4BF9B8FE502E9002CE
- 18. TYPES of VICTIMIZATION Physical Assault: kidnapping, aggravated, death threat, intimidation Property Crime: robber, armed robbery, burglary with & w/o person present, theft, vandalism Sexual Assault: Sexual Battery, Attempted Rape, Rape Death: Illness, accident, suicide, homicide
- 19. Mistakes to avoid • …. wearing and carrying expensive items; e.g. jewelry, cameras/electronic gadgets where they are clearly visible • …. wandering with a map &looking lost - go into the nearest shop/restaurant for assistance • …using suspect transport methods which can be dangerous for locals and tourists; use a metered taxi • ...if using trains (try not to at night), sit in a car where there are other people; keep luggage in sight if possible • …. hiking into remote and rural areas without a clear plan and people who know where you are; use guided tours if available and go in daylight hours.
- 20. Additional Considerations look at locals to determine what is appropriate dress popular tourist destinations are often favored sites of pickpockets and in some places, terrorist activities if driving, know where there are gas stations/locations/distances between towns and villages . FIND OUT BEFORE YOU START where are the best places to stop have an understanding of police protocols/reputation
- 21. No relationship, no drink and no good time is worth the risk of losing your dignity, your position, your well-being or your life. Practice a prevention lifestyle & use good judgment …..
- 22. Kristoff…… BUT, don’t be so cautious as to miss the magic!
Editor's Notes
- Hello and welcome to this sessionon risks Realities and Responsibilities in the Field. My name is Carol Etherington and I am pleased to have this opportunity to share some thoughts on this topic with you. In this format of v/o ppt. there are challenges to adequately covering any material but topics such as these are particularly challenging because there are of course no universal truths and because the opportunity to hear directly from students about their experiences is absent, I would welcome you to contact me if there are any questions or elements about this presentation that you would like to address further.
- No matter howbusy before your departure these things are essential for your to attend toask who will meet you at the airport. Culture shock can be severe—especially during your first time at the airport of a developing country. You may feel overwhelmed by the crowds and taxi drivers hawking their services. Typically, a driver or a representative of the organization will be waiting for you with a sign bearing the organization name, or you’ll receive instructions on which taxi or car to take. Keep in mind that you can’t just go to a telephone and make a call without first getting local coins and knowing the language. Important: Make sure you know the name your organization goes by among the locals, as well as the address and local phone number of the place where you wish to go.
- Though we cannot cover these areas in a comprehensive manner, they are primary ones to consider when working in global health sites, particularly those that we are focusing on today which are very resource constrained.
- Before you go -study the area where you will be at the time you will be there; planning for work in the Sahel vs. SE Asia in monsoon season. Know yourself and ask what you may need.. Most organizations give you lists; if they do not talk with people who have been with them before to get the real sense of conditions at the time of your visit AND what the mode of transportation may be. Know ahead of time how much walking you may be doing and in what conditions
- This is a well built TUKUL in a refugee camp; you may live in something akin to this which many expats do or you may live in a more elaborate house; whichever, do not necessarily expect running water or indoor toilets. Do not expect ample supply of toilet paper or anything other than collective, group kitchens. You well MAY have them but unless specifically told, don’t expect them. IN some instances you may live in the same compound as local persons but typically expats do not – for security reason and do allow space between your private life and patients whom you may see in clinic, there is a strong rationale for separate living residences. Do be mindful of problems unique to your area – in some cases scorpions that love to live in your boots and shoes; in others, e.g. the wetter areas lots of critters would love to come share your nice cozy dry space. If you are sharing housing, whatever type, please do remember that everyone’s lifestyle may be different but there is a responsibility to be respectful of space in terms of noise, clutter, cleanliness and crummy attitudes. We’ll speak shortly about how shared living spaces can add to cohesion or toxic stress for teams of people living and working abroad.I would suggest regarding your living spaces that within a very short time of your arrival that you really familiarize yourslef wiuth the setting. ; in you r own space howver samll, check beds and under beds; know who has access to the area and who has keys
- Think in terms of insects – DEET is essential; Find out what things are available to you on site e.g. simple meds, hygiene items, types of foodsUnless you are going with an extremely well equipped medical organization, you would be advised to take at least a minimal amount of basic first aid and otc meds. PX you DEFINITELY WANT TO HAVE SUFFICIENT AMOUNT and also a small supply of some basic comfort food –e.g. peanut butter, small cans of tuna, dry soups and bouillon cubes are easy and very nice to have along. Be concsious of what you are eating and follow the basic guidelines of peel it, boil it or don’t eat it in some places. Here is a slain goat that I was, once it was roasted, enjoying until a spoil sport team member said I never eat goat – WHY/ do you have any idea what the goats here eat? That said, you can really go overboard with your fears and not enjoy some very delicious meals – as in everything use some sense and moderation. I just heard a quote form Julia Child the other day – do everything in moderation, including practicing moderation.Think about computer safety – removbe senstive data before you go; decline requests for others to use your computer; routinely run checks for viruses.Take luggage and backpacks that are not designer stuff; in fact just take the simplest of things to reduce your risk of theft and to reduce emphasizing that you are a have among have nots. It makes snese to choose things that you will take and then leave there as you depart; also take practical things that may become real icebreakers in your work e.g. crayones and paper for children, small keepsakes or knickknacks that you can give to someone at the end of your tour of duty/your mission – I take a number of things from Nashville –everyone has heard of it and it seems personal to people.
- There are looming water crises in many areas of the globe and most certainly in SSA; land grabs , conflicts or outright wards are likley in the future over water. Be VERY conscientious about how you use water – for your own personal hygiene and for cooking. Try to ensure the organization you are with is using every conceivable means to collect (rain barrels), conserve and demonstrate good water usage. Remember too that it isn’ t just the lack of water you want to be concerned with, it is the quality of the water. MAKE SURE you know the source of the water you are drinking or how your food has been washed and prepared !!!! Just an aside here about working with populations who gather at wells, particularly the women – it is an amazing place to build relationships and to learn much about the lives of the people – true, you have to be there long enough to be trusted and “allowed” to come to the well with the others but it is, for all the drudgery and back breaking work, a place where you can mainstream into the community.
- Don’t drive after dark; know ahead a of time what your destination is and where there are places along the road that are recommended stops for gas or bathroom breaks. In general the expectation that you will avoid using local modes of transport is unrealistic if you are in a place for any given time – you just have to constantly remember that this is the highest cause of injury and death, bar none for expats/internationals working on foreign soil – always be thoughtful about your choices.
- In a lot of places, local people are accustomed to seeing NGOs and GOs driving around in their gas guzzling Land Rovers. They are typically essential to getting a job done especially in complex situations; do keep in mind however that the local people, while r=perhaps grateful for your presence, fully recognize that a tank of gas would feed their family for a month.In some instances they are literally lifesavers and in this case, side by side are the two things used as ambulances in at least on of the Darfulr camps.
- It is not likely as a representative of Vanderbilt or another academic institution you would be on a student or work related mission that is in a conflict area – though many of you may well find yourself there by choice if you later work with an NGO like Doctors Without Borders, International Medical Corps or other humanitarian agencies. Conflict zones bring on special stressors and it is essential to be familiar with all the protocols and security rules which will be reviewed with you bytthe organization. More likely however, you could find yourself in a place that will have tensions and/or volatile issues that can escalate –keep your ears open and remain informed.
- a lot of people come home from an assignment and even if in a sever hardship zone, they will often cite team dynamics or issues with supervisors and peers as being the most stressful aspect of their experience. Be prepared for things to NOT be as they are in your home environment ; be flexible and recognize that one reason you wanted to do this was to be exposed to new and different experiences. Also, keep in mind that time will pass differently in different setting and people work differently, and at a different pace than you are likely accustomed to in the U.S. – enjoy that and learn from it. Just because YOU have a short time there and 1) need to get your data or 2) need to a major difference so you can feel gratification – those things are understandable but they are YOUR needs and not necessarily the need of the population you are working with.
- These are all important issues to consider – how you will deal with them . It isn’t in the scope of this presentation to address these in the like of way that I would like but please do remember that these are the types of issues that can enhance and detract from your experience.
- They are at risk for a variety of issues: e.g. politically in some places, working with the “westerners”, or simple resentment and jealousy. Not uncommon for persons, especially health personnel to take a job with a higher paying NGO, UN or whatever, and when they leave not be hired back by the local MoH. That is one of the responsibilities in going to resource limited places – it is incumbent to understand their local system and infrastructure. It is fairly easy to decimate a fragile system with few resources in the rush to set up one’s own program or project.While many local/national staff forge deep bonds and friendships with those with whom they work, they become very savvy and ‘holding back’, knowing that time and again people are coming – and inevitably, they are going. Do not expect people and do not push to embrace you, confide and trust you in a short period of time – they need to take care of themselves and part of that sometimes means putting up boundaries. Do not personalize that; respect it and be patient in gaining their trust and respect. If you are doing to a place that has been involved in conflict, disaster, or has a high rate of illness and death due to disease, remember that the people with whom you are working even if they are healthy have experiences the same kinds of things as the patients in your clinics and hospitals. You can expect them to work in a professional way but remember they are doing so with a different personal history that you have. In some settings, it is appropriate to ensure that there are some kinds of formal or informal support mechanisms in place for national staff who are dealing with very difficult circumstances. Always be aware of cultural norms in the place where you are working and make it your business to know what is appropriate about working on the holy day, or men and women riding together in a vehicle, or serving an alcoholic beverage in an “after work” event.
- Having a heightened awareness and attentiveness to your surroundings and what is happening in those surroundings, along with thoughtful communication, using common sense about cultural issues and setting a high bar for yourself in terms of personal responsibility in work and in social settings will - reduce your risks for many unpleasant, even dangerous situations things and enhance your experience immeasurably.
- There are many who go abroad and somehow leave their day to day judgment at home. If ever it is important for any of us to
- Where there is poverty, there is opportunism - it's as simple as that.If you are carrying computers, cameras etc. at least put n backpack or handbagIf you do get lost, go into a place -- a shop or restaurant where you might receive assistance If the locals say something is dangerous – believe them!
- Everything in moderation, including moderation. (Julia Childs)
- And then come home with a plan and ideally some activities to look forward to. It can be difficult to re-adjust and even disorienting for the first few days trying to explain what you just experienced is challenging for you and for those listening. Remember, you have vivid memories and the emotions attached to them, but they have no context. Be patient with them and enjoy that you have a place to come home to.