African Health Sciences, Vol. 8, Suppl, 2008, pp. S44-S45
Resilience in MSF and its Personnel
Annick Filot and Carla Uriarte
1 MSF Belgium 2 MSF Spain
Code Number: hs08066
Médecins Sans Frontières (MSF) is an independent international medical humanitarian organization that delivers emergency aid in more than 70 countries to people affected by armed conflict; epidemics; natural or man-made disasters; or exclusion from health care. There are 19 sections, of which 5 are operational. In this workshop we will be representing the Belgium (MSF-OCB) and Spain-Greek (MSF-OCBA) operational sections. (When referring to MSF in this abstract we refer to the OCB and OCBA psychosocial units approach)
In emergencies and their aftermath, MSF provides essential health care, rehabilitates and runs hospitals and clinics, performs surgery, battles epidemics, carries out vaccination campaigns, operates feeding centers for malnourished children, and offers mental health care. When needed, MSF also constructs wells and dispenses clean drinking water, and provides shelter materials like blankets and plastic sheeting.
Through longer-term programs, MSF treats patients with infectious diseases such as tuberculosis, sleeping sickness, and HIV/AIDS, and provides medical and psychological care to marginalized groups such as street children.
MSF staff is very diverse and is the basement of our work in the Psychosocial Care units. The diversity of our staff has multiple sides; the main ones are individual, professional, cultural and social backgrounds. Inside this population, at the given moment, we have staff working, in their own country (6000 national staff) and staff working out of their country (900 expatriates from at least 25 nationalities) on 3 to 12 months contracts. Both subpopulations will have common and specific stress factors and resources to consider.
Working in a humanitarian organization is inherently stressful. Indeed, the nature of MSF is to work close to human suffering in, often, extreme psychological and physical conditions. Adjusting to the environment, facing up to potentially traumatic events, the proximity to human suffering, the lack of means to support the population in need like we would like to, difficulty in stepping back and giving space to oneself, the urgent pressure of the needs, team living, violence, poverty of the beneficiaries, are potential common stressors for all MSF staff. The national staff is, in a lot of places, chronically exposed to the stress linked to their socio-economico-political context and/or to the the stress associated to their survival after natural disasters. In the other hand, the expatriates experience the stress of remoteness from familiar systems to which they belong. A major difference between the two populations is the choice they have or not to be where they are and to leave it or not.
MSF Resilience Model
To speak about resilience we have chosen the definition given by Bonnano as the capacity to, in the face of loss and trauma, maintain relatively stable, healthy levels of psychological and physical functioning. So it would not be the capacity to recuperate from a disorder but the ability to not have one. To present the relevant resilience factors, their indicators and how MSF promotes and supports them, we have modified the stress model to organize the information:
The resources we believe are most relevant for MSF staff have been gathered into a questionnaire. We have designed it in order to assess the importance of all these resources by contexts, and to analyze trends to help us promote those perceived by international staff as most relevant. It is not designed to be an academic instrument, but to use in a trend report. In MSF we have been passing the questionnaire since March, although validations and data analysis will not be possible until the second half of this year.
For MSF teams in the field, external resources can be grouped as:
For example, in a on going war emergency, with teams working many hours on end, few tangible resources and strict security norms constraining personal liberty, interpersonal and individual resources become most important.
In missions where the context is stable, and the activities are programmed and planned (ie. HIV/AIDS projects) organizational factors might gain more importance, such as rotation, access to ARV medicaments, etc.
Internal Resources for MSF staff can be:
So for us, the effectiveness of these resources varies greatly from mission to mission, and to person to person.
Resilience Promotion and Intervention in MSF
As part of the organizations policy some operational sections have created units with the mandate to support the organization and it's staff in preventing and managing mental health problems in the field team members. In MSF OCB and MSF OCBA units we agree in the need to promote resilience at the individual, interpersonal and organizational level. In order to accomplish this we carry out the following activities:
© Copyright 2008 - Makerere Medical School, Uganda
The following images related to this document are available: