According to Williams, care workers can experience trauma-like symptoms, even if they weren't present for the initial trauma.
"Care workers sometimes experience their own personal trauma," Williams said. "They take on a lot of trauma from walking with other people. In studies it's almost as if they experience trauma that didn't happen to them."
Practices such as journaling that help to process and let go of that absorbed trauma are also crucial. For Elliot, the practice was meditation.
"Meditation helped me a lot in the presence of difficult, unpleasant emotions, to let them come and go again. I could see how when I was swinging between turning away from it or trying to put a boundary or barrier up, I got pulled into it, I was holding it, it was sticking with me. What the yoga practice and the meditation practice helped me find was to allow myself to be open, to feel it, but to keep moving, because it wasn't mine to hold."
"She's cracking up."
Self-care and burnout are considerations organizations need to take into account as well — especially those struggling with volunteer or worker retention.
"We need to take good care of ourselves, but in order to do that, there needs to be kind of organizational, cultural support for that," Elliot said. "Even when organizations put things in place, like a staff psychologist, it's very rare for people to use those because the culture as I experience it suggests that if you can't cope there's something wrong with you, that you should be able to cope."
Elliot shared a story from her Afghanistan experience in which workplace culture let her down.
Working as the sole international staff member in a remote office and living alone, she was a two-day-drive from the nearest office. One night, as she stayed in the compound alone, there was an attack. Large, rocket-propelled grenades were fired at the compound.
"They didn't land in the compound, but they were very close, very frightening," said Elliot.
Elliot spent a rough night in the bunker, and the next day, for the first time in her Afghanistan experience, she didn't go into the office.
"I just said, 'I'm at the end of my wits, I need a day in bed.'"
Later Elliot heard another co-worker saying that Elliot was not coping, that she was "cracking up."
"I felt so ashamed," said Elliot. "I look back now and I think, how dare they. (I had) no one to talk to, been through this very frightening grenade attack, no one calls me ... instead they gossip about me."
The culture of "if you can't cope, you're not cut out for it" needs to change, according to Williams. She said humanitarians need to pace themselves and organizations need to give them room to do so.
"If you feel like you want to be involved when you're 80, you have the time to go slow and nurture relationships slowly," said Williams. "There are so many things in our life that cause us to experience grieving (We need) to give people and their minds, bodies, spirits, emotions the space to run that course rather than just trying to be normal or better or fine."
A study published by PLoS One found that one factor that eased burnout among relief workers included more autonomy and control over their jobs. Those with strong support networks also reported less depression, anxiety and burnout.
Sara Bowers Posada worked in Afghanistan with Catholic Relief Services. She said she saw burnout in herself and in her colleagues.
"It definitely took a toll," Posada said. "We didn't have a way to support each other because we didn’t have a name for what was going on."
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