The Unseen Emotional Cost of Standing on the Frontlines During a Crisis
Photo courtesy of Sri Lanka Foundation
Sri Lanka has been hit with one of the worst natural disasters in its history due to the impact of the cyclonic storm Ditwah. With over a million people displaced and over 400 people dead, approximately 330 people still remain missing according to a report by the World Health Organization.
While flood waters in many parts of the country have receded and relief efforts are underway, Sri Lankans continue to respond to the needs of those affected with remarkable speed and solidarity. Amid all the noise and chaos, there are a group of people who have been on the frontlines from day one, braving unpredictable weather conditions, contaminated flood waters, the continuing risk of landslides and many other hazards, with the sole intention of saving lives and providing comfort. Those are our first responders; the military, police, lifeguards, ambulance crews, first aiders, medical staff and volunteers. They are the first on scene and the last to leave when a disaster of any kind strikes, often working long hours, with limited resources in treacherous terrain. Our first responders are the backbone of Sri Lanka’s disaster response system. While they work tirelessly and silently providing essential services including search and rescue and retrieval, a pressing question remains: who supports Sri Lanka’s first responders as they support the nation?
A first responder involved in disaster response often comes face to face with raw human suffering. Continuous exposure to death and devastation while putting one’s life on the line repeatedly comes with an emotional and psychological toll, no matter how experienced or skilled one is. Maintaining a constant state of alertness in rapidly changing conditions with minimal safeguards has a cumulative impact on the entire human body, with an overactive stress response operating in the background. Witnessing pain and suffering first hand, hearing stories of loss and grief and also knowing that everyone cannot be saved can bring about feelings of helplessness, powerlessness and also prompt one to confront one’s own mortality. The expectation to push through in the service of a larger purpose and one’s duty while repeatedly being exposed to trauma and suffering along with the stigma around help seeking in uniformed cultures comes with a profound cost; long term vicarious trauma, compassion fatigue and burnout.
Vicarious trauma occurs when a person is repeatedly exposed to and empathetically responds to traumatic experiences of others. Directly witnessing a difficult event like a landslide burying a group of people directly in front of you or even hearing about similar stories as a part of one’s work can cause secondary trauma reactions in first responders. Intrusive thoughts, changes in mood and sleep, emotional numbing, disconnection from others and hyper alertness are some signs of secondary traumatic stress while feelings of cynicism, along with questioning the meaning of one’s occupation and life, are common reactions as well. Physiological reactions like headaches, fatigue, digestive problems and reduced immunity are also common signs of secondary traumatic stress. There are significant social and occupational costs like impaired performance, interpersonal conflicts and poor staff retention in services, which then increases the burden on the country’s health and economic systems.
Similarly, compassion fatigue can be understood as the emotional cost of caring for others or their emotional and physical pain. This develops over time and often affects healthcare workers like Emergency Medical Technicians, doctors, nurses, counsellors and other rescue workers, including those who care for animals in the context of a disaster. Reduced feelings of empathy, feeling easily overwhelmed while working, neglecting one’s own self-care, increased skepticism, irritability, withdrawal and isolation are some indicators of compassion fatigue. Burn out is a syndrome brought about by excessive, unmanaged workplace stress which can over time reduce one’s efficiency and efficacy, cause depletion in energy and one’s passion for work, and create almost a sense of apathy towards work. There is also the risk of developing mental health problems like Post-Traumatic Stress Disorder (PTSD), anxiety, depression and other stress related issues due to work related hazards and stress.
An Emergency Medical Technician (EMT) attached to a state run ambulance service said, “They don’t care about our wellbeing; they continue to remind us that we are earning merit according to Buddhist beliefs by helping people and therefore should just keep doing our job”. The EMT added, “There are days we come across over ten deaths on emergency call outs and respond to countless suicides and yet our employers do not see the need to have a support system in place for us”. The EMT also stated that their training did not cover self-care and that they are not encouraged to seek support. A medical officer on the frontlines mentioned having to leave the field of emergency medicine and intensive care as there was no support available especially after a difficult resuscitation or after having witnessed a traumatic death. “I would sit in a corner in the doctor’s room and cry as there was no access to immediate support,” said the medical officer, when asked about existing systems in place to support healthcare workers. Those involved in water rescue, first aid services and other emergency services also do not have mechanisms in place for debriefing, peer support or advanced psychological support. A gaping hole exists in our system where there is an obvious lack of institutional support and post response follow up for our frontline workers. In order to have a sustainable disaster response mechanism in Sri Lanka, we must care for our first responders in order for them to be able to care for us when it matters the most.
There are a number of strategies and approaches that can be embedded into organizations and institutions responsible for disaster response as long term mechanisms to minimize the risk of burn out and other mental and physical health consequences first responders may face as occupational hazards. An example from my time working as a pool lifeguard in South Australia was the availability of a free Employee Assistance Programme (EAP) staffed by qualified mental health professionals for both personal and work-related assistance. There was also access to immediate debriefing sessions after an incident involving an in-water rescue/first-aid. Ambulance services in many developed nations have trained peer support workers within easy reach for paramedics to access. Workshops on resilience, self-care, managing stress and critical incidents for first responders are also approaches that the government can take to ensure long term wellbeing while also including these vital aspects in training curricula for emergency and healthcare workers. Post-disaster mandatory debriefing is also a practice that the state can include into existing systems for reflection and learning.
We have been responding to one calamity after the other with very little breathing space over the past decade and while we do possess a collective sense of resilience, our emergency service personnel carry a deep sense of purpose as to why they do what they do, which in turn enhances resilience and strength. Our first responders will continue to show up when needed, they will approach danger, guided by a sense of duty and a deep sense of love for their motherland. However, their willingness to serve should not be mistaken for limitless capacity and the hidden emotional, psychological and social cost of being on the frontlines is not something we should be taking for granted. Psychological support for our first responders and healthcare workers is no longer a luxury, it is a necessity. It is an ethical imperative as a nation that we protect those who serve us.
