Helping humanitarian aid workers.

Fawcett, John (Ed.). (2003).

Stress and trauma handbook: Strategies for flourishing in demanding environments. USA: World Vision. vi + 272 pp. ISBN 1-887983-52-X.

John Fawcett has been involved in humanitarian work for over 15 years. He is a consultant for both Christian and secular non-governmental organizations (NGOs), advising in the areas of staff support services, security preparation, and stress and trauma management for frontline humanitarian workers. Fawcett is a New Zealander, with extensive experience in overseas postings, and currently lives in Phnom Penh, Cambodia.

It has been five weeks since I had a decent night's sleep ... The
refugees just keep on coming, even at night when the roads outside are
in the hands of the rebels. They come crying, cradling their dead and
dying children, dragging their exhausted parents or aunts or brothers.
Some have lost limbs to the arrogant drunkenness of the jungle children.
Most of the women and girls have been raped, many more than once. The
air is thick with dust or mud.... At times I wonder if I have malaria or
something worse ... OK, let's go. Another day in paradise. Dutch aid
worker, Angola 2000

This book is written for those involved in the overlapping sectors of mission and aid work. It is a most welcome and essential resource for helping those involved in demanding humanitarian settings, such as the refugee camp in the above account. Organizations, leaders, staff, and member care workers will be both enlightened and challenged by the evidence-based conclusions (via research and expert consensus) that are consistently presented throughout this book.

The core of these conclusions can be summarized in this way: healthy organizational practices are paramount in protecting staff from the detrimental affects of stress. These practices include improving management/leadership capacity, team/group cohesion, and support/care structures. Yet the goal is not just protection, but rather fostering personal growth--flourishing. And as Fawcett emphasizes repeatedly throughout the book, "One of the most effective ways both to protect and to flourish is to maintain excellent social relationships within and outside the work environment" (p. 5).

This book weaves together research findings on the adjustment of aid workers (primarily from World Vision), personal vignettes, critical analyses, and helpful checklists/inventories. The authors write clearly, which is important for many in the mission/aid sector who do not speak English as a first language. Overall it is a practical blend of material from the fields of organizational development and human resource management, and a well-reasoned appeal to cultivate consultative leadership styles, clear objectives, ongoing skills, and supportive social relationships.

The book is divided into three parts. Part One overviews the nature and physiology of stress, along with stress in field settings. It also addresses the potential hazards of becoming addicted to exciting/endorphin-inducing assignments ("aid junkies"), caffeine-dependent, chronically tired, and becoming the well-meaning but judgement-impaired folks who make excessive self-sacrifices for the sake of the mission.

Part Two contains three chapters that review and assess trauma prevention, occupational stress, and social support for front-line staff. The main findings from two important studies of stress in humanitarian work are presented, as is a helpful model of stress in the organizational context. The need for intentional member care is seen in the findings of one of the studies, in which 30-50% of field staff scored in the moderate to high risk range on standard measures of depression, PTSD, and burnout. Post-traumatic "growth" is a welcome perspective in this section, rather than solely approaching struggles from a vantage point of disorders/deficits.

Part Three is full of recommendations to help strengthen and renew workers. This section covers about half of the book, and brings the conceptual and research contributions from the previous two parts to bear on the support and management of mission/aid workers. Good relationships, personal spirituality, self-care, organizational practices, issues for local/national staff, and crisis preparation are covered.

The editor--who wrote much of the book--and the authors, are committed Christians, who know this mission/aid field well. They do a good job of periodically referring to their Christian worldview and values in a way, which would not alienate most non-Christian readers. This is a very important point, as books like this are still few in number, and also of much relevance for the secular aid community. For those in the Christian mission/aid sector, however, there are still plenty of explicit faith-based comments to instruct and inspire. "The vision for Christian agencies ... cannot be purely a minimalist, damage-limitation exercise. The vision needs to incorporate hope for the reign of God--creative spaces where colleagues may flourish, where the hope for the communities that are established is Shalom, and where people, whether staff or beneficiaries, Christian or otherwise, are recognized as image bearers of the living God" (p. 103).

In addition to its many outstanding contributions, the book has a couple limitations. First, and in spite of my comment in the previous paragraph, the book misses the opportunity to include/integrate the faith-based literature with the more secular-based literature in the human resource field as applied to humanitarian work. An example of this is seen in one author's "extensive and comprehensive" review (25 pages) of the professional psychological literature. Here, the subsection on "Christian Humanitarian Work" contains but 12 references. This is perplexing, given the wealth of material that has been published the last 20+ years. Both Christian and secular sectors have much to contribute to each other, and practitioners/people of peace are needed to serve as bridges between the faith and secular-based NGOs. A second limitation is that there is no index to help categorize and access the wealth of material throughout the book.

Fawcett shoots straight with his readers and the organizations that they represent. In different ways and through different authors, he calls upon organizations to change. He is far more encouraging than confrontational in his endeavor to get helpful information and tools into the hands of the mission/aid community. An additional and refreshing feature of this book is that it is fundamentally a book about living, not just a book about stress. It is filled with hope for the improved well-being of both service providers, who often sacrifice so much, and service receivers, who often suffer in such horrific conditions. As Fawcett expresses right from the start, "humanitarian work is, after all, a celebration of life, not homage to death and despair" (p. 1.).

Reviewed by KELLY O'DONNELL, PsyD.