How to support staff deploying on overseas humanitarian work: a qualitative analysis of responder views about the 2014/15 West African Ebola outbreak

Abstract

BackgroundResponding to health crises overseas can be both rewarding and distressing for staff involved.ObjectiveWe interviewed UK staff involved in the 2014/15 Ebola response to identify experiences that positively or negatively affected them.MethodWe conducted qualitative telephone interviews with 30 Public Health England (PHE) staff and 21 non-governmental organisation (NGO) staff who had deployed to West Africa.ResultsThe main motivations for deploying were for moral reasons and personal development. Families were largely supportive of deployment, although family tension was apparent. Pre-deployment training was largely viewed positively. Common stressors included dealing with death and suffering as well as concerns about contagion, while uplifting aspects included seeing patients improve and receiving thanks from community members. Communications with home were largely satisfactory, although participants commonly self-censored their communication. Inter-organisational tensions caused stress, particularly for PHE staff hosted by NGOs. After deployment, loss of motivation and being avoided by friends and family were common.ConclusionHighlighting the personal benefits arising from deployments, as well as their moral value, may help to increase volunteering. Efforts to improve the support given to responders should focus on identifying how to better support families, preparing all staff members for dealing with death and the risk of contagion, providing opportunities for staff to more frequently experience the uplifting aspects of deployment, resolving inter-organisational difficulties, and educating others about the low risk posed by responders on their return.Highlights of the articleWe interviewed 51 medical and laboratory staff sent to West Africa during the 2014 Ebola outbreak, to understand what factors were stressful or uplifting.Common stressors included dealing with death and suffering as well as concerns about contagion. Uplifting aspects included seeing patients improve and receiving thanks from community members. After deployment, loss of motivation and being avoided by friends and family were common.Preparation and support for staff should consider these issues.

A Systematic, Thematic Review of Social and Occupational Factors Associated With Psychological Outcomes in Healthcare Employees During an Infectious Disease Outbreak

“…Perceived threat or lack of safety have also been shown to be predictors of poor wellbeing in disaster responders and emergency personnel 39,40 and more recently were noted as important concerns in a qualitative study of staff deployed to Africa during the 2014/15 Ebola outbreak 41 . Again, specialised training may help to minimise the amount of risk felt by employees and thus lead to more positive outcomes.…”

“…through loss of housing/income or reduced contact with family 40,44 . However, there has also been much research suggesting that humanitarian work can have a positive impact on life: qualitative research involving relief workers and healthcare workers who have responded to disasters and disease outbreaks has suggested that 13 they experience positive effects such as personal growth, a greater appreciation for life and a sense of achievement 41,45 . It may be useful for preparatory training packages and interventions to encourage healthcare workers to focus on the potential positive impact of their work or to consider coping strategies which may help them to see the positive effects of working in a crisis.…”

The psychological impact of quarantine and how to reduce it: rapid review of the evidence

“…They also often have catastrophic appraisals of any physical symptoms experienced during the quar antine period. This fear is a common occurrence for people exposed to a worrying infectious disease, 41 and might be exacerbated by the often inadequate information participants reported receiving from public health officials leaving them unclear of the nature of the risks they faced and why they were being quarantined at all. Ensuring that those under quarantine have a good understanding of the disease in question, and the reasons for quarantine, should be a priority.…”

Reflections on the ebola public health emergency of international concern, part 2: The unseen epidemic of posttraumatic stress among health-care personnel and survivors of the 2014–2016 Ebola outbreak

“…[12] With focus squarely on containing the outbreak and dealing with the immensity of the task at hand, many fail to notice the associated emotional and psychological toll. [34] Posttraumatic stress disorder (PTSD) is defined by Diagnostic and Statistical Manual of Mental Disorders, 5 th edition as a specified constellation of emotional and behavioral responses to traumatic events.…”