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TABLE OF CONTENTS

Chapter I: All About Stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Chapter II: Coping with Stress and Self-Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Chapter III: Tips for Managers – How to Create A Supportive Workplace. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

Chapter IV: Mission Readiness and Coming Home.. . . . . . . . . . . . . . . . . . . . . . 32

Chapter V: Staff Support. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38

Resources: Where to Get More Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Self-Care ExercisesRelaxation Techniques. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Yoga Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Meditation Exercises. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Creative Exercises.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Relief Worker Burnout Questionnaire. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

Bibliography. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53

Journal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54

“I needed to mourn the

people I lost and all the

suffering children. It is

incredible, the way it

suddenly hits you after

the real threat is over.”

Hanaa Singer, former UNICEF Programme Coordinator in Burundi

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Chapter I

ALL ABOUT STRESS

What is stress? When we think of ‘stress’, a negative connotation usu-ally comes to mind, related to reacting under pressure. But stress isactually a neutral response that calls for reacting to any change, or aphysical and/or emotional challenge. These challenges or threats areconsidered ‘stressors’.

Stress is part of our daily life. From the moment we wake up in themorning, we are subjected to it. Positive stress prompts us to takeaction and can shift our thinking patterns to be open to new perspec-tives. It enriches our lives with anticipation and excitement. Stress isalso useful in the presence of danger. The body responds by releasing aflow of adrenalin and other so-called ‘stress hormones’, putting themind and body in a state of high alert, in order to ‘take flight or fight’.Harmful stress reactions develop if stress lasts too long, or is toointense, and the body’s resources become exhausted.

Some humanitarian workers are attracted to challenging tasks per-formed under difficult circumstances, and could be characterized as‘stress seekers’. Aid workers often thrive in demanding situations andare therefore very effective in their assignments. However, when theworker is consistently given the kind of extraordinary tasks that areinherent in humanitarian emergencies, their coping skills are oftenpushed to the limit. Emotions and tasks may begin to appear over-whelming. This is where measures need to be taken so that stress doesnot become ‘distress’.

Stress can kill! Stress demands that the mind, body and spiritrespond to change. A stress reaction can save your life. But too much

All About Stress

3

stress can make you sick. Stress can also kill! Stress becomes ‘distress’when it occurs often, is severe and lasts too long.

What is distressful for one person may not be distressful for another.People can differ greatly in the intensity and timing of their responses.The reasons include life experiences, cultural backgrounds, personalphilosophy, education, religious beliefs, age, gender, health and fitnesslevels, and self-esteem.

Do something about it!You need to manage your stress because itaffects your physical and mental health, and your ability to functionand interact effectively in the workplace, socially and/or in your person-al life. Spiritually, your resources can also be depleted. Common physi-cal symptoms can include high blood pressure, headaches, nausea,

SOURCES OF STRESS FOR UNICEF STAFF

Workload and/or ability to achieve work goals and objectives.. . . . . . . . . . . . . . . . . . . . . . 79%

Feeling undervalued and/or unable to contribute to decision-making. . . . . . . . . . . . . . . 56%

Status of employment contract. . . . . . . . . . . . . . . . . 60%

Political, economic and/or social situation in the country where they work. . . . . 56%

Relationship with supervisor. . . . . . . . . . . . . . . . . . . . .45%

Relationship with colleagues. . . . . . . . . . . . . . . . . . . 36%

—UNICEF Stress Survey 2009

Caring for Us: Stress in Our Workplace

4

fatigue, ulcers and back pain. The psychological effect can lead todepression and anxiety. Cognitively one can experience a lack of con-centration and memory loss. Behavioural changes may includeincreased drinking or smoking, irritability, verbal outbursts and changesin eating or sleeping patterns.

What are some typical sources of stress for UNICEF staff?Stress can come from external forces, and additional stressors are cre-ated from within. People who are drawn to humanitarian aid work areoften idealistic and altruistic, have high personal standards, are com-mitted to ‘making a difference’, and are oriented towards results in theservice of others. These very qualities make these professionals morevulnerable to stress when needs are overwhelming and resources arelimited.

Stress may be caused by the living environment, such as isolatedand remote locations, inadequate amenities and extremes in climate.Other factors include exposure to high levels of criminal violence,unsafe or militarized settings and unstable political situations. Negativecultural attitudes, such as those towards outsiders or women, add tostress levels.

The organizational environment isoften the greatest source of stress forUNICEF staff. Some managementstyles, such as micromanaging orauthoritarianism, can make the work-place extremely stressful. Long work-ing hours, an intense workload andthe insecurity of employment con-tracts can undermine the most dedi-cated and talented staff. On top ofthis, the demands caused by theimplementation of a variety of policies and procedures, inadequateplanning and frequent travel can lead to a build-up of stress.

All About Stress

5

Social and interpersonal discord can destabilize a working team.Conflicts with supervisors, dysfunctional colleagues, and troubles with-in the family or home are sources of stress and will be compoundedby a limited range of social and recreational options to relieve it. Being physically unfit, such as by having chronic or acute illnesses,allergies or injuries, can be a biological source of stress. If youhave previously experienced a traumatic event (being the survivor ofcriminal or political violence, rape, childhood abuse, etc.), or if youhave a history of anxiety or mood disorders or any psychiatric condi-tion, you are at a greater risk of being negatively affected by psycho-logical stress factors.

For internationals, compounded stressors include the separationfrom one’s home environment, the loss of community, and distancefrom family and friends. Frequent relocation also poses a challenge topartners/spouses pursuing dual careers, and impacts children whoneed to repeatedly change schools.

National staff members may be part of large extended families, whoare sometimes dependent on their income and caretaking. The politi-cal, social and economic problems in their countries may impact themas severely as the beneficiaries with whom they work.

THREE TYPES OF STRESS

Day-to-Day StressThe underlying stress caused by the normal tensions of life at the indi-vidual, professional, family and social levels is called day-to-day stress.It waxes and wanes with daily challenges. Relationships and tasks inthe workplace, personal life and health, and local conditions relating tosecurity and hardship all contribute to basic stress levels. With the aidof this booklet and other resources you may find helpful, you, the staffmember, will develop coping strategies that will decrease your level ofday-to-day stress.


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Cumulative Stress – It Can Lead to Burnout!Cumulative stress results from a build-up of personal and work-relatedstressors such as the repeated and unrelieved exposure to heavy andintense workloads, conflicts within the team and/or other relationships,the need to carry out repetitive and demanding tasks, threats to safety,political instability, the overwhelming needs of beneficiaries, feelings of

helplessness and beingoverwhelmed, lack of essen-tial comforts, and little or norest and relaxation over anextended period of time.

Cumulative stress is enveloping and subtle. Unmanaged, it will erodeindividual effectiveness, as well as the team and project goals.

Symptoms can easily be ignored in the fast-paced workplace. If a staffmember is experiencing unusual fatigue, appetite or mood changes,difficulty concentrating and making decisions, increases in risk-takingbehaviour or in the use of alcohol and/or nicotine, a sense of cynicism,or a loss of caring or feeling, they may be experiencing the harmfuleffects of work-related cumulative stress and are at risk of burning out.

If you are experiencing these symptoms in response to workplacestress, it is important to address the causes with your colleagues, apeer support volunteer or your supervisor. Failure to recognize stressproblems over time increases the risk of burnout for all staff.

The result of stress overload and lack of self-care can be burnout. Thisis a professional risk for those in helping professions worldwide.Professional exhaustion – feeling like you can’t take it any more – iscaused by not recognizing and dealing with cumulative stressors.

Each person will experience burnout in his or her own individual way.It will also affect colleagues, the team and the work itself. Burnoutsymptoms include feeling chronically tired, disillusioned or unmotivat-

All About Stress

7

ed. The staff member usually experiences a loss of objectivity in carry-ing out professional responsibilities, and difficulty making decisions.Increased irritability and unusual feelings of sadness are often present.

Test yourself to see whether you are at risk of burnout. It can be usefulto do this at regular intervals and keep track of your scores. This wayyou can monitor yourself and see whether your risk is increasing ordecreasing, and whether you are managing stress effectively (see page51, “Relief Worker Burnout Questionnaire”).

Traumatic StressTraumatic stress (or critical incident stress) is caused by witnessing orpersonally experiencing sudden or violent events that are very differentfrom our everyday experiences. Exposure to traumatic stress can causeemotional reactions such as intense fear, helplessness or horror.Examples of events that cause traumatic stress include witnessing orexperiencing hostage-taking, armed robbery, assault or any other act ofviolence, especially when this involves children.

Personal losses, a sense of mission failure, feelings of outrage and neg-ative media coverage are all aspects that can contribute to traumaticstress. Personal losses can include the death of a colleague, a lostsense of your own strength and resilience if you are injured or feel oth-erwise unable to cope, or a feeling of survival guilt if colleagues areinjured or otherwise affected and you escape unharmed. A team canexperience a sense of mission failure if their intense efforts haveproved ineffective in dealing with a crisis, or if they’re unable to savebeneficiaries. Feelings of outrage can be caused by anger at the per-petrators of the crisis, a sense of being unsupported by donors, or thebeneficiaries’ anger when they make the team a scapegoat. Negativemedia coverage, inaccurate reporting or media scrutiny can result inoveranxious supervision and concerns about one’s performance, whichcan push stress levels even higher.

People’s immediate reactions to a critical incident during or right


8

after it may leave them feeling as if they are strangers to themselves.Often the affected staff member is not aware that they have lost theirability to function effectively. Colleagues and supervisors need to pro-vide support as soon as possible, as intense reactions are common,and the distressed staff member needs help and protection. Usuallyreactions gradually decrease in the days or weeks following the event.However, similar reactions to those experienced originally may occur ifthe staff member is re-exposed to a similar event, or when theanniversary of the event is near. Many people are taken by surprise ifthey experience delayed reactions after a critical incident. In somecases, it may take weeks or even months before the staff memberfeels affected.

Strong reactions are normal, and can be the mind and body’s way ofhelping one to work through the experience. Step-by-step, one canrecover from the traumatic event and move forward. Emotional sup-port from loved ones and colleagues, with the addition of professionalguidance if needed, can make all the difference in the healing process(see Chapter II, page 17, “How to Cope with a Traumatic Event”).

WHAT IS POST-TRAUMATIC STRESS DISORDER?

Post-Traumatic Stress Disorder (PTSD) can develop as a result of wit-nessing or experiencing a traumatic event. PTSD is a serious condi-tion, and its impact is severe. The symptoms fall into three basic cate-gories:

1. Intrusive reminders of the event

2. Avoiding anything associated with the trauma

3. Heightened alertness and responses

To meet a PTSD diagnosis, a person needs to have a certain number ofsymptoms from each category. This disorder should only be diag-nosed and treated by a mental health professional who specializes in

trauma (see page 17, “How to Cope with a Traumatic Event”, wherePTSD is discussed in more detail).

HOW IT AFFECTS YOU: SYMPTOMS OF STRESS

Stress can affect you on all levels: physically, cognitively, emo-tionally, behaviourally, socially, and spiritually/philosophically.

Physically, stress often manifests as headaches. The body expressesits pains; you may have difficulty with sleep – too much or not enough;and a variety of stomach upsets may develop.Immediate physical reactions to a traumatic inci-dent include rapid heartbeat, dizziness, shivering,extreme fatigue or hyper-alertness.

Cognitively, memory may be affected, and youmay struggle with concentration. Following atraumatic event, racing streams of thought and impaired judgmentmay be experienced, as well as, in the longer term, flashbacks to theevent, disturbing memories or nightmares.

Emotionally, you may feel anxious, depressed and withdrawn.Immediate reactions to trauma include feelings of elation, being over-whelmed, nervousness, rapidly changing responses, or a deadening of

feeling or numbness.

Behavioural reactions include irritability,and a tendency to rely on ‘comfort’ foods,tobacco or alcohol to manage the stress.After a traumatic incident, outbursts ofanger or becoming easily startled are alsocommon. Immediately after the eventthere may be a need to talk about whathappened. You may also experience

All About Stress

9

extreme restlessness or try to isolate yourself from colleagues, friendsand family.

Social interactions can also be affected by stress, often as a result ofmany of the changes listed above. Irritability and outbursts of anger,withdrawal and substance abuse will clearly have an impact on person-al relationships as well as interactions with colleagues.

Stress can also affect you spiritually.You can experience a sense oflost values, cynicism or a lack of trust. Some people also encounter acrisis of faith, or alternatively flee into excessive religious practices.

Having knowledge of what stress is and being familiar with differentreactions to various stressors – from day-to-day events to critical inci-dents – empowers individuals and the team to manage whateverstresses they confront in the execution of their duties.


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“To start, you have to be very

self-disciplined, and understand

three basic things:You must take

breaks from the work; you must

have proper nutrition; and you have

to rest. I made a point of going out

every other day to see people for

dinner or to socialize. It is when you

become too isolated and inward-

looking that you have the begin-

nings of a serious situation.”

Ibrahim Jabr, former UNICEF Representative inthe Democratic Republic of Congo

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Chapter II

COPING WITH STRESSAND SELF-CARE

What is self-care? Self-care is what we do to manage our physicaland mental health, as well as nurture our philosophical/spiritual bal-ance on a day-to-day level. Self-care begins with you, the individual. Inorder to take care of yourself, it is important to make time for recre-ation and relaxation to keep a healthy balance between work and per-sonal life. Self-care helps us to maintain stability in our personal andprofessional lives, and helps us to keep functioning, with our sense ofhumour intact, in the midst of adversity.

Identify your stressors. In order to manage stress, you need to firstidentify the sources of stress in your life. This starts with being more intouch with how you feel, and more conscious of how people andevents affect you. Are your relationships with your colleagues a sourceof stress? Are you supported in your personal relationships? Are youaffected by the dirt, traffic, noise and pollution that may surround you?Do you feel under pressure to perform or meet deadlines, or feel over-loaded by work demands? Do you have enough time to do the thingsyou love, that help you to relax?

A number of psychological and social factors can make it difficultfor us to recognize and manage stress in our daily lives. Some of theobstacles include:

◆ Getting used to and adapting to stressful situations. While adapt-ability is a useful and positive characteristic, it can be harmful whenwe over-adapt to stress in our environment and relationships, and fail

to see how they may be harming us.

◆ The pressure of social norms, obligations and taboos canmake it hard to admit that something is causing us stress, even toourselves. While we may love our families, the demands of children,parents and partners can leave us feeling burdened and resentful.

◆ Feeling guilty about negative thoughts and feelings can cause useven more stress. Guilty feelings will also get in the way of allowingus to analyse what it is that we’re reacting to, and what is causing ournegative thoughts and feelings in the first place.

◆ When we pretend to ourselves that something is not upsetting us,this is called denial. At times we have so much pressure on us tothink, feel or behave a certain way that we are not able to see what iscausing us stress. Denial makes it impossible for us to tackle what iscausing us stress. Being honest with ourselves is difficult and takeshard work. Being in touch with how you really feel and acceptingyour feelings can take some practice, but this is an important step inreducing stress.

◆ Blaming others for our stress can be counter-productive. Whilemost of the causes of stress may be external, complaining aboutthem will usually result in an even more negative environment, andcan leave us feeling helpless and out of control. We need to realizethat it is our own responsibility to deal with the causes and symp-toms of stress, and take realistic action.

Identify the things that you can change. Once you’ve becomeaware of what is causing your stress and how you are reacting to it,you can explore ways of changing the situation. The best way to man-age stress is to simply avoid it; easier said than done! But we canstrive to eliminate as many stressors as possible. Identify which caus-es of stress you can avoid or eliminate, even if it may take some time. Itmay be that you need to limit interruptions, set more realistic goals or

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Coping with Stress and Self-Care

manage your time more effectively, so that you do not feel pressured,overwhelmed or irritated. Also look at ways you can reduce the inten-sity of your stressors. Perhaps take more frequent breaks, try rotatingyour tasks, or deal with the stressors over a period of time rather thanall at once.

HOW CAN YOU ALLEVIATE STRESS IN THE WORKPLACE?

Time pressures and deadlines can be adjusted if you are not caught upin a crisis. Learn how to manage your time well. Organize your work-space. Label all files and keep them where you see them. Create a spe-cific space for incoming mail, items to file and work that must be com-pleted for the day. Create a ‘to do’ list for the week with three levels ofpriority: high, medium and low. Start with the most important tasks,and break down the list into a manageable, realistic daily schedule.

Include time to answer calls, send and respond to e-mails, and attendmeetings. Avoid scheduling back-to-back meetings. Limit interruptions.Stick to the task at hand. Know your own limits. Do not over commityourself. Learn to say no! You may need an assertive attitude if thedemands on you are excessive. Although sometimes it may be impos-sible to confront an unreasonable supervisor, when the situation isappropriate, clearly and calmly express what you can reasonablyaccomplish in a given time.

If you are caught up in a conflict with your supervisor, and you cannotsolve the issue with him or her, you should speak to your secondreporting officer, usually your supervisor’s supervisor. If they areunable or unwilling to help, then you might consider approaching theombudsperson or human resources for mediation. Find someone youtrust and who will be supportive of your feelings about what you aregoing through.

Take ‘time out’ on lunch breaks. Leave your workspace and take a walkif it is possible. Avoid talking with colleagues about work-related prob-


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lems during breaks. If it is not possible to physically leave your workspace, take ‘mini-breaks’: Move your focus away from your computeror the task at hand, close your eyes for a few seconds, and focus on animage or a memory that you find uplifting or soothing. Or practice oneof the short self-care exercises listed on pages 43-50.

If your assignment is away from home and family, and in a place wherethere is unrest or crisis, stress will be even greater. Support colleaguesby listening to them: Find out how they are coping with their stress. Incase of security incidents, take time to share emotions and experienceswith each other.

HOW DO YOU MANAGE THE IMPACT OF STRESS?

You may also need to learn how to better manage the sources of stressthat you cannot avoid or have not yet been able to eliminate. Becausestress affects everyone on various levels – physically, emotionally,socially, cognitively, behaviourally, and spiritually/philosophically – youneed to develop and implement reliable strategies to cope in difficultsituations. Find the ways that work for you and put them into practice.Be flexible and creative: Some strategies will work better at differenttimes or under different circumstances.

Physically, a healthy lifestyle is the most effective way to handle stresswith energy and efficiency. Go to bed early and try to get enough sleep.If you’re having difficulties sleeping, make sure that at least you getenough rest. Lack of adequate rest and sleep add to stress levels.Exercise vigorously at least three times a week for 20 to 30 minutes.This is possible even in the most difficult of duty stations: Do calisthen-ics, run up the stairs, do sit-ups or jump rope. If you are familiar withmeditation, yoga, tai-chi or other such techniques, these can help youkeep your equilibrium. Eat regular, healthy meals whenever possibleand keep nutritious snacks, like fruit and nuts, and plenty of water atthe workplace. Avoid relying on alcohol, nicotine, sugar and drugs tohelp you manage stress: These only lead to further health problems,


16

which in turn are the cause of even more stress. Keep up the activitiesthat you enjoy.

Listening to or playing music can be very emotionally nurturing. It canalso be a great release to express your feelings through creative writ-ing, painting, drawing or keeping a journal (see the self-care exerciseson page 48 for some ideas).

Nurturing social interactions are also very important. Set aside familytime if you are with your family, and take the time to communicate withloved ones, as well as schedule leisure activities in your daily schedule.Nurture a mutually supportive relationship with a special colleague tohelp each other through your assignments. Develop a sense of ‘com-munity’ in your work group by organizing and participating in socialevents, including music, dance, sports, games, storytelling, picnics anddinners. If you have been faced with any sadness or losses on yourteam, it can be helpful and supportive to individual staff and the teamas a whole to follow local customs of mourning, or create your own rit-uals with your peer group to work through theselosses.

Give your mind a rest. Take a short nap if it ispossible, or meditate. At the very least, give your-self small breaks from the tasks you are workingon. Socialize with your colleagues during breaks,and do not focus on work and problem solving during mealtimes. Try toexamine things from a new perspective, and look for the positive ele-ments. Changes in perception and setting realistic expectations are cru-cial to managing much of the stress we experience in our daily lives.Keep a healthy sense of humour!

Changes in your behaviour may be necessary if you find that you areunder intense stress. Slow down your breathing by practicing deepbreathing exercises (see the self-care exercises on page 44). This willalso help reduce your heart rate. Make an effort to slow your speech,


17

especially when you’re angry or nervous. Adopt other healthy behav-iours, such as nutritious eating patterns and regular exercise, and limituse of alcohol, cigarettes, caffeine and other drugs. Identify things thatyou can change to help you to reduce stress, and implement them,even if only for a few days, to see whether they are effective.

To support the spiritual and philosophical aspects in your life, readtexts that comfort or inspire you; write in your journal; talk with yourfriends, family and colleagues. Focus on parts of nature and life thatyou admire, and let them uplift you. Attend ceremonies or services ifavailable, and meditate or pray, according to your religious, cultural orprivate beliefs.

The importance of managing stress cannot be over-emphasised. Pleaseexplore the various self-care exercises described in this booklet, whichcan be practiced in various situations and locations.

HOW TO COPE WITH A TRAUMATIC EVENT

Traumatic events (or critical incidents) are sudden, violent occurrencesthat claim or threaten life and are not part of the range of normalhuman experiences. Even witnessing such an event can be traumatic.During the incident, recognizing the signs of traumatic stress helpsto normalize the stress reactions, and is the first step to managingthem. These can include nausea, tremors, hyper-alertness, extremefatigue, headache, anxiety, fear, feeling unreal, numbness, intenseanger, difficulty making decisions, slowed thinking or racing thoughts,restlessness and a profound loss of trust. Most people’s responses totraumatic events are intense, and they typically overwhelm coping abil-ities. Remember, these are normal reactions to abnormal events.

Helpful coping skills in the moment include maintaining a positiveattitude and positive self talk: Tell yourself that you can cope with thesituation and that you will get through it. Consciously slow your


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breathing rhythm, and focus on the task in front of you. Rotate tasks sothat staff, including you, can take breaks. Keep in contact with col-leagues where possible. Take care of yourself and each other by makingsure that you have enough food, water and rest.

Shortly after the traumatic event, you may feel the need to talk toothers about what happened – what you saw and perceived with all ofyour senses, and what you were thinking at the time. Try to share yourreactions and how you felt – both emotionally and physically. Expresshow you are feeling now. Write down your feelings, or find other waysto express them, such as through drawing, poetry or even dance. Doself-care exercises including deep breathing, relaxation, prayer and/ormeditation. Plan quiet time and read, reflect and listen to or makemusic. Start doing some physical activities once you have regainedyour energy. Keep a healthy, balanced sense of humour.

In the longer term, some people may develop reactions to their trau-matic experience. Three common types are: hyper-alertness, avoidanceof reminders of the event and intrusive memories. These reactionscoincide with the three symptom clusters of Post-Traumatic StressDisorder.

Hyper-alertness is a protective mechanism to prevent a recurrence ofthe shocking event, and behaviour comes across as ‘jittery’. Your bodyis responding automatically to potential danger. This response can bemanaged by taking deep breaths. Understand that it is the body’s natu-ral reaction to protect you from a repeat of the incident. Assess if thereis any realistic chance for the incident to recur. If there is no real threat,take a deep breath, and let the apprehension go. If there is danger, takeprotective action. Keep breathing, and allow the trembling which oftenaccompanies these experiences to happen!

Avoidance refers to the way we tend to detach ourselves from painfulmemories, to protect ourselves from re-experiencing the traumaticevent. Avoidance also serves to block off painful feelings linked to the


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experience. If you are aware that you are avoiding people and placesthat are connected to, or in some way reminding you of the incident,ask yourself why. If your motivation is related to security, you mustmake the judgment to create safety or leave the area. If avoidance isabout not wanting to be reminded of unpleasant events, it is importantto find a way to make the traumatic event a part of your life, a part ofyour past that you can live with. Continually trying to avoid anyreminders of it will have a negative impact on your life: on your emo-tional and mental well-being, as well as on your social life. You need tofind a way to reflect on the event, and think about what it means. Thegoal is to incorporate the traumatic memory into your past. You mayneed professional help from a therapist or counsellor, and it can be along process. We may never completely get over a traumatic experi-ence, but we can find a way to put it behind us. Trauma changes us. Thequestion to ask yourself is: “in what way?”

Intrusion is the experience of reliving the original event, throughmemories while you are awake, as ‘flashbacks’, or in dreams. This re-experiencing is nature’s way to remind us that we need to spend sometime in reflection and on healing the impact that the trauma has had onour lives. To move forward, you need to reflect on what happened andre-conceptualize your life in some way. Take time to search for somemeaning in the event and embrace what you feel that you can learnfrom it.

Any sight, smell, sound, taste, touch or even emotion that is similar towhat was experienced during the trauma can trigger a physical, mentalor emotional reaction similar to the original. Our natural defence is toavoid the painful reminder, and change the focus of attention to some-thing else, which doesn’t help in the long run. Instead, calm yourselfdown with five minutes of deep breathing (if you are not in danger),and reflect on the source of the trigger while reminding yourself thatyou are in control.

It is important to try to integrate this experience into your life. If the

incident has challenged your sense of meaning and who you are, itcould be helpful to talk to a spiritual leader, counsellor, loved one ormentor to explore the meaning of the event and help you to incorpo-rate the experience. This guided processing will eventually result in areduction of the intrusive symptoms.

Some people experience strong reactions to a traumatic incident,some have no symptoms at all, and some go through a delayed reac-

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FIRST AID FOR POST TRAUMATIC STRESS

1. Comfort and console the distressed person2. Protect the person from further threat or distress, including

protection from onlookers, insensitive colleagues and emer-gency workers

3. Meet immediate physical needs, including shelter, and providepractical help

4. Facilitate access to phone, friends and family5. Facilitate some telling of the “trauma story” and ventilation of

feelings as appropriate, respecting the wishes of those whodo not wish to talk about it

6. Facilitate the regaining of some sense of mastery and control.Provide goal orientation and support for specific tasks.Encourage a return to routine, BUT guide the survivorsagainst throwing themselves each into a heavy workloadwhich will interfere with the natural healing process

7. Facilitate access to information about the event (what hap-pened, who is affected and how seriously, where they arenow)

8. Identify the need for further counselling or intervention andfacilitate access to systems of support and sources of helpthat will be ongoing. Offer access to a professional for coun-selling, including the Staff Counsellor.

9. Provide information about common reactions to trauma,including coping reactions and natural recovery

10. Express your appreciation for the staff involved. Small signsof care can make all the difference

—Adapted from: McNally, Bryant, and Ehlers (2003)

tion months afterward. These traumatic stress symptoms are perfectlynormal responses to abnormal events, and in most cases will lessenwithin a few days or weeks after the event.

The recovery period also varies greatly with each person. After atraumatic experience it is very important to take extra care of yourself:Get more rest and sleep; spend time in reflection; take time off if possi-ble, away from the area where the event took place; and take on lesstaxing work assignments and responsibilities until you have had achance to recover. You may find that you develop an appreciation foryour strengths in handling a crisis, as well as new goals, values andpriorities. If you allow yourself to process the experience effectively,you may discover that your personality will be enhanced and strength-ened.

If powerful symptoms continue and interfere in your daily functioningfor more than one month after the event, it is highly recommendedthat you seek professional help as soon as possible to help you withthe recovery process. If this is the case, contact the UNICEF StaffCounsellor (see Resources, page 41), who will try to link you to some-one in your area. You may also want to get in touch with your localPeer Support Volunteer.

STAFF VULNERABILITY AND RESILIENCE

Major support for critical incidents is very important. Team leaders andmanagers need to be aware of the individual circumstances and lifehistories of staff members that may make them more vulnerable tostress from these events. Typically, survivors who have experiencedpast traumas in support work or in their personal lives are more vul-nerable to being re-traumatized and to developing PTSD.

Some of the positive factors in the following chart increase resilience.In contrast, the negative factors listed may create vulnerability. Referto the chart to evaluate your resilience and vulnerability factors.


21


22

WHAT HELPS AND HINDERS STRESS MANAGEMENT

Positive Factors Negative Factors

Individual ◆ Good health ◆ Health problems

◆ Successful previous ◆ Extremely high self

crisis experience; expectations

development of ◆ Crisis seen as a threat

‘survival skills’ to personal competence

◆ Crisis seen as a ◆ Unresolved emotional

challenge reactions from previous

◆ Focus on solutions trauma or personal loss

◆ Supportive family/ ◆ Personal/family

friends/colleagues, no problems; additional

additional outside demands/stress

demands

Interpersonal ◆ Well-balanced ◆ Personal ties/identifi-

personality, able to cation with traumatized

accept/give support victims

within team ◆ Personality problems;

◆ Good communi- unable to accept avail-

cation skills able support

Community ◆ Existence of strong ◆ Leadership problems

leadership ◆ Poor/disrupted public

◆ Reliable public information

information exchange ◆ Close scrutiny by

◆ Well-planned, media and observers

practiced emergency

procedures

—UNHCR, 2001, p. 14

“An e-mail will not replace

a smile or a sense of

human caring! Every

manager needs to make an

effort to go out in the office

and meet face to face with

staff members.”

Rima Salah, former UNICEF Deputy Executive Director

24

Chapter III

TIPS FOR MANAGERS:HOW TO CREATE ASUPPORTIVE WORKPLACE

Stress is an occupational hazard in humanitarian service. Work atUNICEF is associated with specific stressors, such as intense work-loads, long hours, and sometimes conditions of hardship and dangerin the field. As a supervisor, you need to be aware of the impact ofstress on your staff as well as on yourself, and do all that you can tomake the workplace a supportive environment. Try to anticipate vulner-ability factors, and prepare to support your team’s ability to workthrough crisis situations and avoid breakdowns in personal and profes-sional functioning.

The first step as a good manager is to set a good example.Managers need to make a serious effort to put stress managementtechniques into practice, especially at times when work demands arethe greatest. In order to sustain your effectiveness, you have to followyour own advice and monitor yourself in order to support others to dothe same. Remember, the team will follow your lead.

MANAGING STAFF STRESS

Self-care starts with the individual. However, a manager’s style andwhether he or she creates a collegial and supportive environment hasa powerful influence on the staff’s sense of well-being and the team’seffectiveness.

Tips for Managers

25

As discussed in Chapter II, one of the most effective ways of managingstress is exercise, which is part of any healthy lifestyle. Depending onthe circumstances of location and safety, management can identify theresources available and support staff in taking advantage of what isaccessible. In emergency duty stations, it may be necessary for theoffice to provide equipment for exercise, appropriate for male andfemale staff. Nutrition can be a challenge at a remote location or in anemergency. Regular, healthy meals can be hard to come by. Considerassigning a team member to oversee hygienic food provision, as wellas enforce rest and refreshment breaks.

Fatigue and exhaustion need to be monitored in emergency situations.Managers should establish routines that allow for adequate rest nearor away from the site. Team leaders can delegate responsibilities andput a back-up system in place so every individual has routine, regularbreaks. This includes making sure that you and your staff use annualleave and R&R entitlements: Remember, these are rights, not privi-leges! Don’t forget that national staff often carry an additional burdenby supporting extended families directly impacted by the local condi-tions. Maintaining a balance between your professional and private lifeis important both for you and your staff. A brief respite can renew yourenergy and spirit. You will benefit personally and serve as a role modelfor others.

"I made a decision to send staff home at 6 o'clock

every day, not only for security reasons, but more

importantly for their well-being. I know that we

cannot be effective when we have problems at

home, and there needs to be time for everything:

time for work, time for family, time for oneself."

Dr. Jean-Michel Ndiaye, former UNICEF Representative in Cameroon


26

Implementing a ‘buddy system’ can enhance team functioning.Discuss with your staff how extreme fatigue and the lack of propernutrition, rest, breaks and exercise can adversely affect judgment andjob effectiveness. Pick a trusted colleague and ask that your staff do thesame, and then agree to keep an eye on each other. Share with your‘buddy’ your personal stress and fatigue signals, then ask them toremind you to stop for a snack or a breath of fresh air, or to leave andcall it a day after putting in too many hours on the job.

Create a sense of community by encouraging social events that nur-ture team building, as well as heighten the comfort and trust levelsamong workers. Ask your staff to organize social events including pic-nics, sports, dancing, music making, etc. Be a participant!

Brief staff new to the duty station to help ease them into the workenvironment. The “Global Template” is a useful tool to quickly design awelcome kit customized for your duty station, that can be accessedfrom the Learning Web. The only information you will need to add isduty station and country specific information on living conditions,security, health, infrastructure and key contacts. Designate a focal pointfor new staff to contact prior to their arrival, to answer any questionsthey may have. Once the staff member arrives, it is vital to have astructured protocol in place to make sure they receive all importantinformation. The global template contains checklists which are helpfulfor both HR focal points and newcomers.

UN staff - who may be separated from their families and partners- areas a group very susceptible to high-risk behaviours. When you speak of'stress' with your staff, underline the importance of safe sexual behav-iour. Protect your staff and yourself: Make sure condoms are easilyavailable.

A useful tool for managers is the UNHCR booklet, Managing the Stressof Humanitarian Emergencies (listed in the Bibliography, page 53).

Tips for Managers

27

LEADERSHIP STYLE

A supportive and responsive leadership style inspires loyalty andempowers the team. An effective manager practices open communi-cation that is sensitive to cultural issues and gender. It is importantthat workers be given the facts about a situation, have the ability tocheck out rumours and have their immediate concerns addressed. Setin place e-mail and telephone connections for staff to stay in touch withloved ones if they are separated because of their work

We all have individual communi-cation styles. Under stress, someof us become quieter and have atendency to withdraw, while oth-ers become more short-temperedand loud. These kinds of respons-es greatly influence the escala-tion or stabilization of yourteam’s stress levels, confidenceand emotions. If you are stressedand you shout at staff or humili-ate someone, your team’s morale will plummet. They will also losesome respect for you. Being calm and considerate under fire buildsconfidence and loyalty. Force yourself to speak slowly and clearly. Keepbreathing!

All members of your team, at every level, need to feel that their workhas been noticed and appreciated. Honour their resourcefulness andresilience. When there is an emergency and the workplace is chaotic, itis better to communicate sooner rather than later that what the team isdoing is making a difference. Acknowledging this and being accurate inyour comments helps boost confidence and positive energy.

Be visible in your leadership role and available in the middle of a cri-sis. Access to you is reassuring. Visit staff workstations when you can,


28

engage in positive exchanges, encourage them and offer constructivecomments. Your standards, the way you speak, your responses andyour behaviours will be closely observed by the people you work with.

Grief leadership is also a necessary skill for managers. The formalacknowledgement of loss enables staff to begin the mourning process.Staff will value the support of a culturally sensitive, timely and appro-priate response. Be aware that often there is a need among staff forceremonies or rituals to honour losses. If appropriate, do what you canto implement a service acceptable to all the religions and cultures rep-resented, and involve yourself. Refer to FAQs on the Staff Counsellingportal on the Intranet (see Resources, page 41).

SUPPORT AFTER A CRITICAL EVENT

In the immediate aftermath of a critical incident, it is important that allstaff be able to express themselves freely, in a safe environment. Theyneed to be listened to. Protect their privacy and make certain that theycan wash, have a meal, and change into clean clothes in a quiet andcomfortable setting. Ensure that staff don’t have to face their supervi-sor, colleagues or anyone from outside the team until they themselvesfeel that they are ready. Protect them from intrusive questioning andmedia attention. Listen empathetically. Encourage them to pick up nor-mal routines and guide them with a simple structure for carrying outtasks. Offer reassurance about the normalcy of any responses theymight be experiencing, and validate their personal stress managementtechniques. Support your staff in taking the one-day-at-a-time approach.

Remember to be culturally sensitive. It may be necessary to invite heal-ers, religious leaders or others from the local community to help yourteam in the aftermath of a traumatic event.

Peers usually come together spontaneously at the end of the day and

discuss its events. In the aftermath of a shocking event, defusingshould be organized in a protected environment in which all who wereinvolved can safely and confidentially share feelings and their experi-ences.

Everyone’s privacy must be protected in the group. Efforts should bemade to keep the discussion supportive. Expressions of strong feelingsmay leave other participants feeling anxious and vulnerable, soresponses should be guided and contained. Angry feelings expressedby ‘letting off steam’ are a normal reaction to a violent and upsettingevent. Communicate this to the group, but let them know that this isnot the time or place for any criticism of professional performance.Explain that criticism should be handled at a 'lessons learned' meetingscheduled for a later date, when the situation will be reviewed from adifferent point of view with the participation of all staff. Use the defus-ing meeting to focus on educating staff about acute traumatic stressreactions, which are perfectly normal. Since delayed reactions canoccur, managers should monitor stress levels in the weeks followingthe event. Underline that risky behaviours are common yet dangerousresponses to critical stress.

Tips for Managers

29

“We had debriefing sessions where we all

recounted our part of the incident and put the

picture together again. It is only when you

recollect all the missing points and talk about

them over and over again that you come to grips

with your fearful memories and get them out of

your system.”

Hanaa Singer, former UNICEF Programme Coordinator in Burundi

Managers should be able to easily recognize traumatic stress (seeChapter I, page 7). An additional tool is The UN Pocket Guide on StressManagement, which was distributed to all UNICEF staff.

If a critical incident was severe,support must be provided by atrained professional in a safe andnon-threatening environment. It isstrongly recommended that this bedone within 72 hours. This providesan opportunity to modify acutetraumatic stress reactions and helpmanage them over the long term.See Chapter II, page 20 for moreon Psychological First Aid follow-ing a traumatic event. Senior management is responsible for identify-ing local or regional trauma resources with the assistance of theUNICEF Staff Counsellor.

If you are worried or concerned about a particular staff member, youmay want to mobilize specialized support. If you have any difficultylocating appropriate professionals, please contact the Staff Counsellor;UNDSS also has a Stress Counselling Unit for support to all UN staff.Any critical incident involving UNICEF staff should be immediatelyreported to the Staff Counsellor and OPSCEN, which is open 24 hours aday (see Resources, page 41, for contact details).


30

We “need to create support systems

that will be in place before, during and

after deployment of staff; and that will

be fully sensitive not only to the phys-

ical security of those at risk, but also

to their mental and emotional health.

Exhausted, stressed, and

inadequately supported staff cannot

do their jobs effectively.They may

want, and try, to tough it out, but in

the final analysis, everybody is

damaged. It is encouraging to know

that much serious thought is being

given to this matter.”

Former United Nations Secretary-General Kofi Annan

Chapter IV

MISSION READINESS ANDCOMING HOME

PREPARING FOR INTERNATIONAL ASSIGNMENT

Preparing for a new a new field assignment is a long-term process.Many complex issues are involved, from organizational tasks to compli-cated emotional challenges that arise from mission experiences.

It can be useful to be aware of the various cycles of deployment stress.In the pre-deployment phase, from one to six weeks before departure,there is often some anticipation of loss by your loved ones and yourselffor all the things you will be leaving behind. You may experience somedetachment and withdrawal in the last week. If your family and partnerare not going with you, try to discuss any feelings of sadness, or fearsthey might have, to help them prepare for your departure.

Once you arrive at your new duty station, if the exotic ways of dress-ing, smells, language, climate and topography, behaviours and foodhabits are not familiar, it is normal to feel somewhat disoriented andconflicted. Everyone goes through some form of culture shock underthese circumstances. You may encounter difficulty conversing aboutsomething, or locating a needed item, and you may miss your supportsystem back home. You may feel frustrated, isolated and resentful, andend up getting upset at the people closest to you.

How can you handle all these feelings? Should you hand in your resig-nation and go home? Or maybe you just feel like mentally distancingyourself, by isolating yourself from your colleagues and their activities?With time and self-care, you can adjust and learn to live among all

32

Mission Readiness

33

these new experiences, and, like many internationally deployed staffmembers, thrive in your new environment. In the end, the key to ahealthy adjustment is exactly what you might not feel like doing. Goout and meet new people, interact, do new things, explore markets, trynew foods, listen to music, enjoy the local art and culture, or take walksor trips with colleagues and discover the region. Embrace the particularrhythms of your new home, while making self-care a priority. Keepingup with exercise, ensuring balanced nutrition, socializing with newfriends and relaxing will help you adjust to this new way of life.Communicate and celebrate signs of positive growth in yourself andyour family, if they are with you. Maintain regular contact with lovedones and friends back home, and share information about your days,work and adventures.

Culture shock can be very psychologically stressful as well as disorient-ing. Be aware that you can manage deployment stress and that feelingstressed under these circumstances is normal. Cultural adaptation isnecessary for a successful and happy life/work assignment experience.Accept the lessons that cultural adaptation teaches: Your culture doesnot possess the only way, right way, or best way of doing something.Be open to new ways of being.

If you do, you will enter the period of adjustment. Hopefully your lifeis beginning to resemble your normal state of being, even if it is in acompletely different part of the world, with different ‘props’ and play-ers. You are starting to feel at home. You are getting your sense ofhumour back. You are adjusting.

CULTURAL SENSITIVITY

You will need to respect local customs, practices and religions in yourhost country at all times. Attitudes towards gender vary from country tocountry. Research the code of appropriate dress in your new locationbefore your assignment, especially if you are a woman. It is a matter ofrespect and safety for you. Both men and women need to be aware of


34

cultural signals such as eye contact, greetings or tone of voice, whichmay mean something very different than in your own culture. Actappropriately out of respect for the host culture and your own security.

DEALING WITH SECURITY AND EMERGENCIES

Before leaving for your assignment abroad, familiarize yourself withsafety procedures pertinent to your new location. Review the trainingcourse Basic Security in the Field – Staff Safety, Health and Welfare (seeResources, page 42). Request that you be given a security briefingbefore leaving if it is not on your schedule.

Make sure your mission arrival details are sent and confirmed by theduty station. Get the name and the telephone numbers of the personwho is to meet you upon arrival. Once you get to your new assign-ment, request that you be briefed on security procedures by the FieldSecurity Officer as soon as possible. If you are in an emergency dutystation, use reliable strategies that are described in this booklet to copewhen circumstances are difficult.

PREPARING YOURSELF FOR HOMECOMING

Home leave for many staff is not always a restful vacation. It can bestressful if family and friends have expectations of spending a lot oftime with you after your long absence. If this is your only vacation timeduring the year with your partner and/or children, you probably need torelax, and you may need to be clear about setting aside time for your-selves as a family.

If you are returning home after your deployment, there are steps youcan take to prepare for an easier re-entry, and to help reacquaint yourselfwith your family and loved ones. You may experience an upsurge in yourenergy and activities before you leave for home. Include your childrenand your partner in planning your homecoming celebration.

Mission Readiness

35

You may experience a ‘honeymoon’ phase upon returning to yourhome culture, where excitement is the overriding emotion in seeingfamily and friends, having your favourite foods, enjoying familiaramenities, and taking part in celebrations to welcome you home.

But after this phase is over, there is often a period of ‘re-entry shock’.You may feel that you no longer belong in your home culture. You mayhave difficulty with your friends and family, feeling they are not reallyinterested in discussing your experience. Returning home may not bewhat you expect. Staff members often find readjusting to their homeunsettling, often even more difficult than it was adjusting to the newmission. At first, you may be suffering from jetlag, and be on a differenttime frame for food and rest as well as struggling with extreme fatigue.Take it easy. Don’t over-schedule activities. Keep up your self-care rou-tine. Eat well-balanced meals and be moderate in terms of alcohol con-sumption. Some people think about their experiences all the time; oth-ers numb out. You may find yourself being irritable or tearful, havingdifficulty concentrating, going through changes in appetite, feelingoverwhelmed by tasks and generally feeling mildly depressed. This isnormal! Individuals go through re-entry shock with different levels ofintensity and at different paces. This pattern is similar to entering yourhost country at the beginning of your international deployment. Spendtime with supportive people, and keep your sense of humour.

USEFUL ADVICE ON A SUCCESSFUL REUNION

Be aware that there will be a renegotiation of many relationships in thefirst few weeks at home. One of the most common adjustment difficul-ties is communicating the international experience. Share your storiesgradually. Seek out people who are genuinely interested. Get in touchwith others who have lived and worked abroad, as repatriates tend tounderstand each other even if they have lived in very diverse areas.If you were separated from your family while on mission, rememberthat it is natural to have some difficulties in re-establishing emotionaland sexual intimacy with your loved ones. It may take time and


36

patience. You, and they, may go through a grieving period over the lossof freedom and independence. You may be overwhelmed with the noiseand confusion of home life. You may feel that your family’s adjustmentswhile you were away exclude you. Your children may act distant, needyor angry, and you may feel hurt when they are slow to respond to you.Remember that your partner and your family are also going through theprocess of reintegrating their relationships with you and each other. Goslowly with the children and adapt to routines that are in place. Let thechildren set the pace for the family getting to know each other again.Make one-on-one time with each child as well as your partner. Relaxand enjoy each other. Challenges of separation and reunion can providenew opportunities for renewal in your relationships.

REINTEGRATION AND STABILIZATION

Give yourself some space to adjust. Practical matters may also needattention. Reintegration and stabilization usually occurs six to 12 weeksafter coming home. If you are physically unwell, see your doctor andcommunicate where you have been and for how long. Certain illnessescan take months to show up. If you are worried about the possibility ofbeing HIV positive, seek counselling to see if you should be tested. Ifyou continue having difficulties with sleep, flashbacks, anxiety, irritabili-ty, numbing out or any other aspects of critical incident stress, contact acounsellor specialized in Post-Traumatic Stress Disorder, or the UNICEFStaff Counsellor (see Resources, page 41).

Your many positive experiences may include personal growth, newfriendships, and an expansion of how you view your work and life. Youmay have changed your outlook and priorities. Keep in contact withyour colleagues. Consider a debriefing session, as it helps you reflecton your experiences and enhances self-understanding and personalgrowth. Slowly build up your level of activities. Keep self-care a priority.

“It is vitally important that a

trusted team member in such

extreme situations is trained

to monitor colleagues’ stress

warning signs, and to support

and counsel them.”

Nigel Fisher, former UNICEF Representative inRwanda

38

Chapter V

STAFF SUPPORT

THE PEER SUPPORT PROGRAMME

The Peer Support Programme has been designed to assist UNICEF staffmembers to better manage work- and family-related issues by mobiliz-ing the support of colleagues. Staff members are trained as PeerSupport Volunteers (PSVs) to support their colleagues at times ofadjustment, stress and trauma. The programme has proved effective inother UN agencies, and having been successfully tested in UNICEFoffices has now been rolled out as a global programme. While it is nota tool to solve all staff problems, it is an approach that can extend sup-port to a troubled staff member at times of adjustment and stress aswell as during emergencies. It also offers access to other helpingresources.

PSVs are not trained as counsellors and do not diagnose problems, ortry to solve them for the staff member. They lend a listening ear, andtheir role is limited to basic help, support and referrals. Part of theirfunction is to research and develop a working relationship with locallyavailable counselling facilities and other resources. All PSVs sign a con-fidentiality pledge, which binds them to keep all matters brought tothem in the strictest confidence.

The PSV is closely supported by the UNICEF Staff Counsellor in NewYork in coordination with the regional office. In the event of a criticalincident, he/she will act as the focal point between the office and theStaff Counsellor for arranging trauma management interventions. ThePSV should not need more than two hours per week to carry outhis/her activities, unless there is an emergency.

Staff Support

39

UN CARES - HIV IN THE UN WORKPLACE

The UN Cares programme (which replaces the HIV component ofCaring for Us and now serves the entire UN family) helps ease theimpact of HIV and AIDS on our staff. The Human ImmunodeficiencyVirus (HIV) weakens the body's immune system and, if left untreated itcan ultimately lead to the Acquired Immune Deficiency Syndrome(AIDS), a cluster of medical conditions, often referred to as opportunis-tic infections and cancers, and for which, to date, there is no cure.

Several hundred UNICEF colleagues are already living with HIV, andmany more care for people who have been affected, particularly chil-dren orphaned by AIDS. The prevalence rate among UN staff reflectsthat of the countries we live and work in - our workforce is not exemptfrom the impact of this epidemic. “Contrary to what people think, HIVtends to start among better educated people before it migrates to thepoor. The typical UN staff member is very much at risk,” says MartinaClark, UNICEF's Staff Well-Being Specialist for HIV.

Factors that influence staff vulnerability include higher disposableincome; frequent travelling or deployment without our partners; expo-sure to high levels of stress, which at times leads to an increase in risk-taking behaviours; and substance abuse, which impairs decision-mak-ing. All of these are compounded by denial that we are at risk.

Managing stress can help a person to make better, clearer decisions,and in turn help prevention efforts. Stress management is even more

“Whatever our role in life, wherever we live,

in some way or another, we all live with HIV.

We are all affected by it. We all need to take

responsibility for the response.”

- BAN Ki-moon, Secretary General


40

important for people living with HIV, as stress negatively affects theimmune system and increases disease progression. Fear of HIV is fre-quently cited by staff in all regions as a cause of stress.

In order to be safe, do not discriminate: Always protect yourself byusing universal precautions, particularly in emergency settings. Alwayswear latex gloves if you are around body fluids, and then dispose ofthem properly when you have completed your tasks. Cover cuts withplastic bandages. Wash your hands with soap and hot water for at least20 seconds after you have had contact with blood or other body fluids.Aside from abstinence, condoms are the only way to prevent HIV bysexual transmission. Condoms are available at the workplace and areincluded as standard issue in some travel/medical kits. Make sure thatif you will be travelling for your work with UNICEF, you are trained inbasic first aid and complete the training course Basic Security in theField: Staff Safety, Health and Welfare (see Resources, page 42) beforeyou travel.

Staff have the right to information on their entitlements, rights andbenefits regarding HIV-related issues, so that they can make informedchoices within a reasonable framework. Resource materials from UNCares on the 10 Minimum Standards for every UN workplace are avail-able through the UNICEF intranet, as well as at www.uncares.org.

41

RESOURCES

WHERE TO GET MORE INFORMATION

UNICEF Staff Counsellor

Three United Nations PlazaNew York, NY 10017Telephone: +1.212.824.6902 (work); +1.917.815.3843 (mobile)E-mail: [email protected]

OPSCEN

For abnormal situations that cannot be addressed locally and areurgent in nature, an OPSCEN contact and action point is available on a24-hour basis for all staff in the field and at headquarters. If OPSCENstaff cannot answer your questions, they will either put you in contactwith someone who can, or they will research and provide an answer ata later time. OPSCEN can be reached seven days per week:

Telephone: +1.212.326.7222Fax: +1.212.303.7924Satellite Phone: +1.870.763.090378E-mail: [email protected]

UDSS

A Critical Incident Stress Management Unit (CISMU) supports UN staff. Telephone: +1.917.367.9438 / 9439 or +1. 212.963.1593 E-mail: [email protected]

Stress Management Portal

www.unicef.intranet.org (look under: Human Resources - UNICEF andYou - Staff Well-Being Or: Staff Xchange - Staff Well-Being)


42

UN Cares: HIV in the Workplace

www.uncares.org United Nations HIV Hotline+1.212.963.4782

Basic Security in the Field – Staff Safety, Health and Welfare

The "Basic Security in the Field" (BSITF) and the "Advance Security inthe Field" (ASITF) courses are available on the internet in all UN lan-guages. The UN staff and consultants can easily access the BSITF learn-ing programme from any location by accessing http://dss.un.org/BSITF/,and http://dss.un.org/ASITF/ respectively. The Basic Security in the Fieldtraining is mandatory for all UNICEF staff, including consultants,regardless of level and whether they are serving at Headquarters,Regional or Country Offices. The Advanced Security in the Field trainingis mandatory for all UNICEF staff irrespective of level, including con-sultants, who are assigned or required to travel to, a location that is inPhase I or above.

For assistance with the training, click on the Help button in the onlinetraining. If you have any questions or enquiries, please do not hesitateto contact the UNICEF NYHQ Security Team at [email protected], oremail the DSS help desk at [email protected].

Caring for Us publications:

Alcohol: Manage or Abstain (also available in French)Dealing with Domestic Violence (also available in French)Building Resiliency

43

SELF-CARE EXERCISES

The ways in which you relax and ‘de-stress’ are as personal and variedas the factors causing the stress. The following techniques offer someideas of practices that can help you relax and enhance your copingstrategies. We suggest that you read them through, try them out andfind the ones that work for you. You may need a variety of techniquesto work on different areas of stress.

The exercises will become easier with regular practice, and you willfind that you will be able to make use of them at times when they aremost needed. The more you learn to relax, the easier it becomes to rec-ognize signs of tension in your body, and this, in turn, becomes a sig-nal for you to deal with the causes of stress.

RELAXATION TECHNIQUES1

Instant Calming Sequence

This is a technique that takes only a short time to elicit relaxation. Theexercise is based on recognizing the first signs of stress and respond-ing to them immediately.

Follow these steps:

1. In the face of the stressor, keep breathing smoothly and deeply.

2. Smile as soon as you feel stressed.3. Adjust your posture to its optimum: head high, shoulders

back and spine straight.4. Send a wave of relaxation through your body.5. Give yourself an affirmation and acknowledge the situation.

(For example, think to yourself: This is really happening, and I am dealing with it as best as I can.)

1 World Food Programme, 2001.


44

Deep Breathing

Deep breathing helps you relax and increases your energy level. Followthese steps:

1. Sit comfortably with both feet on the floor.2. Place one hand on your abdomen and the other on your

chest.3. Inhale slowly and deeply through the nose or mouth into

your abdomen first and then into your chest, pushing your hands out. Exhale slowly, letting the air leave with a slight sound.

4. Make sure your shoulders, jaws and tongue are relaxed.

Repeat this exercise at least five times.

Open Future

There are times in our lives when it is diffi-cult to be grateful for either our past or ourpresent. This is when we need to be carefulto remain open to the possibilities in ourfuture.

1. Sit in front of a vista, either a window, outdoors or a painting.2. Close your eyes and sense the vista in front of you.3. Imagine your vision extends through your closed eyelids into

the space in front of you, and into your future.4. Spend five minutes being grateful for the future possibilities

that await you.

Self-Care Exercises

45

YOGA EXERCISES2

Neck Stretch

Benefits: Stretches neck muscles, reducingtension in the neck.

Instructions:1. In a standing pose, exhale, gently letting your head fall to the

right. Hold the pose for two to three breaths.2. Inhale, slowly lifting your head back to the beginning position.3. Exhale, gently letting your head fall to the left side. Hold the pose

for two to three breaths.4. Inhale, slowly lifting your head back to the beginning position

again. 5. Exhale, gently letting your head fall forward. Hold the pose for

two to three breaths.6. Inhale, slowly lifting your head back to the beginning position.

Exhale, gently letting your head fall backward. Hold the pose for two to three breaths.

7. Inhale, slowly returning your head to the upright position. 8. Repeat the pose two to three times.

Tips: ◆ Keep your shoulders relaxed and down from your ears, with

your shoulder blades flat against your back.◆ Keep your arms relaxed.◆ You will feel a stretch in the sides, front and back of your neck.

Caution: Be careful if you have neck problems.

2 Dillman, 1999.


46

Arm Reach

Benefits: Loosens the shoulder joints and stretches the upper back.

Instructions:1. In a standing pose, inhale and put your arms in the air, reaching

towards the ceiling or sky.2. Exhale, allowing your shoulders to return to their normal

position, and drop your arms to your sides.3. Repeat the pose five times.

Tips: ◆ Keep your head faced forward, with your eyes looking straight

ahead.◆ You will feel a stretch in your shoulder blades.

MEDITATION EXERCISES3

Listening

Close your eyes, breathe deeply and regularly...separate from the chat-ter of the stream of thoughts which flow through your mind....

Sound surrounds in the busy world...but it also whispers of breeze andbirds and children playing....

As your mind begins to quiet and you relax...become aware of the vari-ety of sounds which surround you...there is no need to do anything butlisten...listen with your ears...listen with your heart....

Let your focus gently float among the sounds of the world...gradu-ally...flow inward...towards your centre...eventually you will not hearanything....

3 Adapted from work by Lucia Amsden; Tim Amsden; Debby Singleton; Bea Lovejoy; Carol Cole;William J. Rea, M.D.; Laura Sarna and Dale Leach.

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Stay there for as long as you comfortably can.

When you are ready, gently re-emerge...and ‘hear’ the sounds of‘now’...open your eyes...be ‘here’...back in the physical space that sur-rounds you.

‘Letting Go’ of a Stress

Sit or lie in a comfortable position...breathe slowly and deeply....Visualize a situation, or a person, or something that makes you feelanxious and tense....

As you do this, you might see a person's face...a place you're afraid togo...a situation you don’t want to deal with...or simply a dark cloud....

Where do you ‘see’ this stressful picture...? Is it above you...to oneside...or in front of you...?

How does it look? Is it big...or little...dark...or light...? Does it have cer-tain colours...?

Now slowly begin to shrink the stressful picture...see the stressful pic-ture shrinking until it is so small that it can literally be held in the palmof your hand....

Hold your hand out in front of you, and place the picture in the palm ofyour hand....

Now...imagine the stressful picture is so small it can fit on your secondfinger...watch it shrink from there until it finally turns into a little dotand disappears....

When ready, gently open your eyes...and smile!

(Often this exercise causes feelings of amusement, as well as relax-ation, as the feared stressor shrinks, gets less intimidating and finallydisappears.)


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CREATIVE EXERCISES

Emotion Word Poem4

A poem based on attracting emotion words. First, choose from the fol-lowing emotion words those that attract you: fear, ecstasy, anger,courage, panic, peace, despondent, numb.

Now choose one of the words. For example: ‘peace’.

What does peace say to you? If peace were to be an animal or object, what animal or object would it be?

Peace lives in a place that looks like _____________________________________.

Peace is _____________________________________.

Peace is like _____________________________________.

Record Your Awareness5

Awareness is really seeing something as if for the first time...seeingdetails you missed before...taking the time to fully experience:

what you seewhat you hearwhat you taste what you smellwhat you touch

SLOW DOWN...concentrate on the here and now. Think about how theenvironment influences your thoughts, moods and actions. Recordthese impressions in a journal.

Think about what’s important to you in life. Make a list of what youneed and what you want in your life.

4 Adapted from Dunne and Barrager, 1997.5 Adapted from Fürrer, 1982.

Write and draw your:

◆ Experiences and your reactions to them◆ Memories of significant events in your past◆ Dreams, hope, wishes◆ Fears and frustrations◆ Goals and plans to achieve them◆ Ideas and inventions

Personal History6

1. Create a personal pictorial history of different significant scenes,moments and symbols that have meaning to you in your life. Draw, oruse abstract colours, shapes or symbols, or create a montage usingimages from photographs, magazines or other media, on a large sheetof paper or in your journal.

2. Develop a comic book illustrating a sig-nificant time in your personal history withdrawings, dialogue and story.

3. Write a monologue or design a dance,expressing an important scene from yourpersonal history. You could perform themonologue or dance in private, just for yourself, or perhaps share thisartistic expression with like-minded colleagues or friends. For example:Ask a colleague to paint your ‘backdrop’ or ask a musician friend tocontribute their music making and ‘share’ your stories with yourfriends.

Self-Care Exercises

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6 Adapted from Dunne, 1995.


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Unique Outcome Stories and Transformations7

Focus on a problem that you are faced with in your life at this time. Ifyou could imagine yourself free of the problem, where would you beand what would you be doing?

Think about a time in your past when you moved in a direction thatyou prefer. What would be most helpful in taking a step towards atransformed life? What images, ideas or rituals might help you to clarifythe direction of the transformation?

Write the story as you would like to see it unfold.

7 Ibid.

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Self-Care Exercises

RELIEF WORKER BURNOUT QUESTIONNAIRE8

Test yourself to see whether you are at risk of burnout. Test yourselfregularly and keep track of your scores, to monitor whether your stresslevels are increasing or decreasing, and how well you are managingstress.

Name:

Date:

Instructions: Rate each of the following items in terms of how muchthe symptom was true of you in the last month.

0 = Never1 = Occasionally (less than one time per week)2 = Somewhat often (one or two times a week)3 = Frequently (three or four times a week)4 = Almost always (almost every day)

Do you tire easily? Do you feel fatigued a lot of the time, even when you have gotten enough sleep? ____

Are people annoying you by their demands and stories about their daily activities? Do minor inconveniences make you irritable or impatient? ____

Do you feel increasingly critical, cynical and disenchanted? ____

Are you affected by sadness you can’t explain? Are you crying more than usual? ____

Are you forgetting appointments, deadlines, personal possessions? Have you become absent-minded? ____

8 John Ehrenreich, 2001.

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Are you seeing close friends and family members less frequently? Do you find yourself wanting to be alone and avoiding even your close friends? ____

Does doing even routine things seem like an effort? ____

Are you suffering from physical complaints such as stomach aches, headaches, lingering colds, general aches and pains? ____

Do you feel confused or disoriented when the activity of the day stops? ____

Have you lost interest in activities that you previously were interested in or even enjoyed? ____

Do you have little enthusiasm for your work? Do you feel negative, futile or depressed about your work? ____

Are you less efficient than you think you should be? ____

Are you eating more or less, smoking more cigarettes, or using more alcohol or drugs to cope with your work? ____

TOTAL SCORE (add up scores for items 1–13): ____

Interpretation: No formal norms are available for this measure.Based on the content of the items, a score of 0–15 suggests the workeris probably coping adequately with the stress of his or her work. Ascore of 16–25 suggests the worker is suffering from work stress andwould be wise to take preventive action. A score of 26–35 suggestspossible burnout. A score above 35 indicates probable burnout.


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BIBLIOGRAPHY

American Psychiatric Association (APA), “Diagnostic Criteria for Posttraumatic StressDisorder”, Diagnostic and Statistical Manual of Mental Disorders, fourth edition, APA,Washington, D.C., 1994.

Danieli, Yael, ed., Sharing the Front Line and the Back Hills, Baywood Publishing Company,Inc., Amityville, New York, 2002, p. iii, iv.

Dillman, Erika, The Little Yoga Book, Warner Books, New York, 1999.

Dunne, Pam Barrager, Creative Journal, The Drama Therapy Institute of Los Angeles, 1995.

Dunne, Pamela, and Krista Barrager, Double Stick Tape,The Drama Therapy Institute of LosAngeles, 1997.

Ehrenreich, John H., “Relief Worker Burnout Questionnaire”, Coping With Disaster, MentalHealth Workers Without Borders [www.mhwwb.org/disasters.html], New York, 2001.

Fürrer, P. J., “Awareness”, Art Therapy Activities and Lesson Plans for Individuals and Groups,Charles C. Thomas, Springfield, IL, 1982.

International Committee of the Red Cross (ICRC), Humanitarian Action and Armed Conflict:Coping with Stress, ICRC, Geneva, 2001.

International Federation of Red Cross and Red Crescent Societies, Managing Stress in theField, International Federation of Red Cross and Red Crescent Societies, Geneva, 2001.

Lovell-Hawker, D., Effective Debriefing Handbook, People in Aid [www.peopleinaid.org],London, 2002.

McNally, R. J., Bryant, R. A., and Ehlers, A. (2003). Does early psychological intervention pro-mote recovery from posttraumatic stress? Psychological Science in the Public Interest VOL.4, NO. 2, 45-79.

United Nations, Mission Readiness and Stress Management, UN Office of Human ResourcesManagement, New York, 1998.

———, The UN Pocket Guide on Stress Management, United Nations, New York, 2004.

United Nations Children’s Fund (UNICEF), Managing Stress at Work, UNICEF, New York, 1999.

———, UNICEF Staff News, New York, March and December 2001, April 2004.

United Nations High Commissioner for Human Rights (UNHCR), Managing the Stress ofHumanitarian Emergencies, UNHCR Staff Welfare Unit, Career and Staff Support Service,Geneva (can be downloaded from the UNICEF Learning Web, see Resources, p. 41.), 2001.

———, Traumatic Stress Reactions: An Informative and Educative Guide for the Survivors ofTraumatic Events, UNHCR, Geneva, 2001.

University of Guelph, Queen’s University and WSAnet, “Right to Play”, Ready, Set, Go: AnInteractive Pre-departure Workbook for Going Abroad, WSAnet: Professional InternationalEducators from Ontario Universities, 2003.

World Food Programme (WFP), Managing Stress: Guidelines for WFP Staff, WFP, Rome, 2001.

JOURNAL

Use these pages to record your feelings and experiences, make notes,keep track of your progress in managing your stress, for creative exer-cises, and so on....

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Journal

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2009, 2nd editionThis booklet was authored and compiled by Lee Anne Fahey MacDonald andPenelope Curling, and illustrated by Anastasia Higginbotham. Originally publishedin 2003, it is also available in French, Spanish and Arabic.

table of contents - unicefunicefinemergencies.com/downloads/eresource/docs/3... · symptoms can...

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