The Cost of Caring

Compassion fatigue is real. Often referred to as, the cost of caring, compassion fatigue and it’s often accompanying companion, vicarious trauma, can take their toll even on some of the most seasoned first responders, healthcare providers and humanitarians. No one is immune.

From a personal standpoint, I have suffered the effects of compassion fatigue more times than I care to think about. It happens less frequently now because I have learned how to care for myself better while out in the field and I have learned how to use the resources and tools at my disposal. Still, most of us in the field are just one critical incident away from the clutches of compassion fatigue.

This assignment in particular has been challenging in ways I could never have anticipated. Just over a month into it, my mother became critically ill and I flew home to see her before she died. It was a crushing blow. It took everything I had just to get up in the morning. I had to think about whether going back to the project was the right move for me. I had to weigh the benefits and downsides. I needed to get out of my emotions and just look at it in a practical way. In the end, I made the decision to return, partly because I knew I would be busy and distracted and this would be good for me and partly because I had a sense of obligation and wanted to fulfill my commitment to the project, even though no one in the organization would have blamed me if I had not. I just knew staying home, as winter approached with its cold, dismal weather, would only serve to exacerbate my grief and depression. I knew I would start feeling bored and useless within 2 weeks and would regret not returning, so I decided to go back. In the end, I can say it was the right decision, at least at that time.

For this particular assignment, there is the every day stress of dealing with emergencies, ever-changing circumstances in the camp – flooding, Hepatitis E outbreak, SGBV*, external violence in the area and cholera. Then there is the weather, 100°+ most days and dry (this time of year). There are the health issues that come with environments such as these, malaria, acute watery diarrhea and the ever present threat of COVID-19, for which we are at high risk just by virtue of the fact we work in a hospital! COVID also takes out national staff, leaving staffing shortages which leads to a high work burden on everyone else in the hospital.

Even though I feel my decision to return was the right one, grief has taken its toll on me during this mission. In this particular context, there is usually a maternal death every 6 months or so, basically 2 per year. However, in the last months we have had more than our share of maternal deaths – one due to COVID-19 and four due to hepatitis E – and they weigh heavy on the soul. Although there was absolutely nothing that could have been done for any of these patients other than what we did, it is difficult not to feel weighed down by the sadness of a young life lost. This just adds to the burden of grief.

The unbelievable agony of listening to someone in acute respiratory distress, struggling for each precious breath, is not something I would wish on anyone. At the end of the day, it is difficult to put these kinds of experiences out of your mind and just rest. There is always the feeling of thinking you could have done more. In truth, we usually are giving way more than is required but ego gets in the way allowing us to think we had more control over the situation than we actually did. It isn’t a healthy way to cope; and at the end of the day, there is nothing heroic about working ones self into mental and physical exhaustion.

I am sometimes asked how I deal with all I encounter in the field. Short answer is, sometimes I don’t. Sometimes I am an epic failure at dealing with compassion fatigue, burn-out and vicarious trauma and it really takes its toll. I have the added burden of Complex PTSD that gets exacerbated during these times as well. Insomnia, anxiety, fatigue, forgetfulness, hypervigilance, agitation and being quick to anger are just a few of the things that are triggered. I has taken me weeks to finish this post because it has been overwhelming just thinking about it. However, during times when I am able to manage, what helps me through the most are a few small things. The first one is, I look for something good scattered between the trauma of the day. It may be as simple as a bird I have not seen before or even one I have but it is still rare, it brings me a lot of joy. Maybe the cook made one of my favorite foods and I am so grateful I could cry. Little things are huge in an environment such as this one.

I also prepare for assignments knowing there will be hard times. I pack essential oils because the smell of lavender or rose calms me and I have a little diffuser (thanks Augustine!). I have my wind chimes and just the sound of them makes me happy. I reach out to friends back home and sometimes this will help ground me. I don’t reach out to discuss how miserable I am but rather to hear about their lives and what is happening and to just hear about regular life and other peoples problems. It is a delightful distraction. I have a very select group of people on whom I call because they know exactly how to be with me – just normal! They know if I want to talk about anything here, I will, otherwise the don’t ask beyond a cursory, “how is going?”.

Now, with the promise of home less than 2 weeks away, I am savoring every minute of time here. The sweltering heat, the food – of which I am now tired of due to its repetition, not because it isn’t good, the patients, my staff, each birth, every challenge – all of it. I am in the home stretch and I can feel it and it has given me a second wind of sorts. Still, the exhaustion comes through the cracks at times and I know when I finally leave the project, I will be leaving a job well-done; it will be a welcome relief to my mind, body and soul.

*Sexual and Gender Based Violence

***For more photos from the field, you can follow me on IG @globalmidwife64 ***