Peer support needed for local Ebola workers | Toronto Star by Dr. Sarilee Kahn, Assistant Professor of Social Work at McGill University

Peer support needed for local Ebola workers | Toronto Star

He laughed with his colleagues as they discussed the stressors of fighting Ebola in their country. But the eyes of a Liberian man I’ll call William betrayed more complex emotions. “He lost his wife, his mother and two of his three children to Ebola,” William’s co-worker, Gladys, whispered to me later. “And still he comes to work each day to help prevent others from suffering the same fate.”
I met William, Gladys and their co-workers in late September 2014 when I travelled to Liberia and Sierra Leone to help set up a peer support project for local staff of an international non-governmental organization.

Since December 2013, Ebola has killed 11,000 people. In the shadow of the World Health Organization’s 68th World Health Assembly last week in Geneva, where its partners have been meeting to reflect upon the past year and set priorities for the next, it is important to remember that individuals like William and Gladys have helped stem Ebola’s tide. Their health and welfare matters, too.

All humanitarian aid work is stressful. Barbara Lopes Cardozo of the Centers for Disease Control in Atlanta and her colleagues have shown that both international and locally recruited aid workers are at risk of developing anxiety, depression, PTSD and burnout due to exposure to severe and prolonged stressors associated with their work. Mitigating factors include strong social support networks and management practices that build in time for reflection and relaxation — especially during emergencies.

But to local aid workers like William and Gladys — who survived years of violent civil wars — Ebola represents a new kind of stress. As Gladys told me: “At least during the war, we knew who the enemy was.” With Ebola, the enemy could lurk inside a handshake or a kiss on the cheek from a sick neighbour. It could hide in the sweat of the stranger in the shared taxi local staff took to work. And it could foment fear and mistrust within families. When Gladys gently rebuffed cousins who urged her to quit her job, lest she unwittingly contract Ebola and infect loved ones, they asked her not to visit.

As the WHO and its partners redouble the fight against communicable and infectious diseases like Ebola, meningococcal meningitis and dengue fever, local staff will continue to provide invaluable human resources, as they are recruited and trained in skills necessary to manage fast-spreading disease outbreaks. The challenge for international entities will be supporting and sustaining those teams over the long haul.

Implementing peer support is relatively simple and cost-effective. Combined with other best management practices, it can help mitigate stress for local staff. Our peer support trainees drew upon song, prayer and the simple human art of listening from the heart to support their colleagues. They suggested that peer support groups be implemented during normal work hours so the largest swath of workers might access them. They asked for additional training to help them identify colleagues who needed more intensive help. In those cases, a local mental health professional was engaged to provide that support.

The night after the training, Gladys’ beloved nephew succumbed not to Ebola, but to a chronic illness that had previously been managed successfully by the health system. That night, however, there were no hospital beds for non-Ebola patients. Two weeks after her nephew’s death, I spoke with Gladys by phone. She had returned to work, her motivation reaffirmed: “By the grace of God, we will beat back this devil.” And statistics show this has happened. Earlier this month, Liberia was declared Ebola-free.

As West Africa braces for new Ebola cases during the approaching rainy season, may the lessons learned from the fight against Ebola resonate this week with the WHO and its collaborating organizations. And may attention to staff welfare continue to be a priority. By the grace of God and human-to-human support we will beat back this devil.

Sarilee Kahn is an Assistant Professor of Social Work at McGill University and an occupational stress consultant to local and international humanitarian organizations.