Working with individuals and communities is an essential part of maintaining supportive service networks that enable the guarantee of human rights and the building of peaceful relationships in all societies. However, it brings challenges, especially for professionals working with survivors of trauma, different types of violence and abuse. Even if you are not directly involved, you may be affected by what you hear, see or experience while helping.
Working directly or indirectly in humanitarian contexts means that practitioners, actors or facilitators are exposed to processes of re-traumatisation and re-victimisation, as well as to significant psychophysical burdens that put them at risk of exhausting their internal resources if they do not take sufficient care of themselves. Emotional reactions can build up over a considerable period. Witnessing the pain and suffering of others can lead to emotional numbing, negative coping strategies and even emotional crises. While working in such contexts it is entirely normal to experience psychophysical and emotional distress, it is urgent to address comprehensive measures to deconstruct the idea that self-care is only a personal practice reduced to implementing a series of mental strategies and some healthy habits.
In contexts of violence and humanitarian crises, self-care, to be possible, must be based on a network and system of affective care that sustains it; that is, a network of interconnections and relationships in which support, dialogue and collective support allow the situations and ideas that interfere with common care to be questioned.
1. Understand the systemic meaning.
Frontline workers often provide guidance on self-care and healthy coping strategies to the people they help. However, they often neglect their own self-care. The first step is to recognise the impact of this work on the mind, body and spirit.
Talking about self-care involves recognising the cognitive, emotional, socio-cultural, spiritual and biological mechanisms that allow us to perceive and experience the world the way we do. In the communities I work with, self-care is established as an experience that is constructed based on cultural, emotional, physical, mental, environmental, social and economic situations that allow individuals to experience favourable conditions for confidence and the creation of secure relationships.
Security and confidence play a fundamental role in providing people the reflective capacity and physical mechanisms needed to activate and sustain routines that allow them to deal with discomfort and psychophysical overwhelm. Stress, depressive and anxiety disorders, eating disorders, sleep problems, concentration disorders, irritability, states of sustained hypervigilance and various types of psychosomatic symptoms are conditions reported by managers, facilitators and practitioners working in community processes and in humanitarian crisis contexts. These symptoms cannot be treated in isolation but require comprehensive intervention in strategies for self-awareness and emotional management based on the strengthening of neurocognitive, spiritual and biopsychosocial tools according to the needs and differential characteristics of each subject, as well as the intersectional conditions based on race, gender, social class and ethnicity that enable or limit access to resources for self-care.
For many people working in contexts of violence and trauma, the body itself becomes a stage for battles and constant alertness, which is why it is necessary to promote tools of mindfulness that allow each person to be their own safe space, to name and manage thoughts and emotions related to emotional overload.
2. A relational definition of self-care.
The promotion of self-care practices has traditionally been limited to the individual level by assuming that skills must be developed in each individual so that each person learns the tools of self-control and self-management; from this perspective it has been assumed that in the community and institutional contexts of humanitarian workers, policies must be integrated that allow people to access healthier work spaces. There are organisations that give mental health days off to their members or employees, others promote recreational, artistic or sports days, others pay their employees for some sessions of therapeutic help, and we could mention many other measures.
All these measures are important, but it can be overlooked to understand that self-care also depends on the ways in which power and communication structures within communities, groups and organisations, and on the conditions for decision-making and conflict resolution in teams. There is currently no single definition of self-care accepted in the literature. Definitions may vary according to the following aspects: what motivates self-care behaviours; who participates in self-care; and to what extent health professionals are involved.
The definition of self-care has evolved enormously over the past decades. In the 1970s, definitions of self-care focused mainly on aspects related to health or illness. In relation to health, self-care focused on health promotion and disease prevention. In relation to illness, self-care involved being aware of symptoms and their severity and making decisions about treatment options. This definition evolved in the 1980s to include an emphasis on independence. In 1983, the World Health Organisation defined self-care as "actions taken by individuals and groups, with the intention of achieving the promotion and restoration of health, the prevention of disease and the minimisation of illness". Furthermore, in this decade, self-care began to include caring for others, especially in the context of emergencies.
In the 1990s, the WHO defined self-care as "what people do for themselves to establish and maintain health, prevent and cope with disease". This definition encompasses hygiene (personal and general), nutrition (type and quality of food), lifestyle (physical activity, leisure, etc.), environmental factors (living conditions, social habits, etc.), socio-economic factors (income level, cultural beliefs, etc.) and self-medication.
In recent years, the definition of self-care has evolved to include rehabilitation and all those conditions of communication, strategic planning, assertive communication, types of leadership and possibilities of corporal, emotional, relational and social awareness that need to be developed not only by each person but also by the groups of people that conform the organisations and teams. In summary, it is necessary to understand that self-care practices are made possible because of the combination of the individual level (habits of mental, spiritual, emotional and physical life) and the collective level (habits of communication, listening, conflict resolution, decision-making and life project).
3. Self-care as an ethical imperative.
As a helper, it is vital to pay extra attention to one's own well-being to be emotionally and physically able to help others. It is also necessary to promote spaces for collective well-being.
If front-line workers do not help themselves, how can they help others? From an ethical perspective, it is imperative for "helping professionals" to engage in self-care as they are susceptible to burnout and impairment, which might affect clinical work. Self-care can then be viewed as a form of preventing participants self-harm, as reviewed in the various codes of ethics of mental health professionals. In fact, ethical practice requires helping professionals to monitor their physical, psychic, and spiritual state to ensure the provision of competent and adequate services to clients. Just as it is the responsibility of workers to engage in self-care, it is also the duty of organizations to support their staff in this process, as a form of accountability both towards staff and beneficiaries.
Esta nota fue hecha en el marco de mi trabajo con una ONG dedicada a fortalecimiento de sistemas de salud.
Te abrazo y te espero en nuestros espacios terapéuticos.
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