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Health-care workers on humanitarian missions may experience a secondary traumatic stress that can be surprisingly debilitating
DAY AFTER WEARYING DAY in a rundown hospital in the town of Baraka in the Democratic Repulic of the Congo, Dr. Reine Lebel (PhD) tended to the mental wounds of those who had been assaulted by one of the simplest, most terrible weapons of war: rape.
"We saw about 350 cases in three months-girls and boys, women up to the age of 70, even some males-and it was too much for me," recalls Dr. Lebel, a Montreal psychologist who was dispatched by Médecins Sans Frontières (MSF) in November 2003 to set up a counselling program for rape victims in the Democratic Republic of Congo. "In 30 years of practice, I have heard a lot of awful stories, but after every day of this, it was really tough."
Although she managed to function "pretty well" until the end of her three-month Congo mission, Dr. Lebel said the stories she heard-of women getting raped by as many as 17 militia men, often while their husbands and children were being hacked nearby with machetes-"really kicked me out of balance."
Feeling "close to being agitated," Dr. Lebel said she made a conscious effort to try to get enough sleep, and regularly did breathing exercises to relax. Those were small acts of selfcare perhaps, in such extreme conditions, but for Dr. Lebel they spelled the difference between staying psychologically intact and succumbing to a still under-recognized occupational hazard known as compassion fatigue.
"One of the things I do is train new volunteers to protect themselves against compassion fatigue," says Dr. Lebel, who also works with the humanitarian aid agency CARE Canada. "So knowing what I know about it, I tried to make sure there was a balance between my work and relaxation time."
Defined as a stress response to knowing or helping a traumatized or suffering person, compassion fatigue manifests itself in poor self-care and extreme self-sacrifice. Signs of compassion fatigue include chronic overworking, agitation,...