A. Staying healthy

This section highlights some simple precautions to minimise the chances that you will fall ill. Some suggestions may seem obvious. Unfortunately, many civilian experts on mission do not take necessary precautions, often because they are deployed at short notice or adopt an overly tough attitude and assume they are immune to microbes and mosquitoes.

Keeping these guidelines in mind throughout your deployment can help save your life.

1. General health advice

Food safety

If you consider and abide by the following rules before eating, you could eliminate the main reasons why crisis managers fall ill. The following recommendations apply to food vendors on the street as well as to expensive hotel restaurants:

Water safety

Contaminated water is the second main reason for people to fall ill during their stay in foreign countries. Follow some simple rules to prevent disease caused by unclean water:

2. Hygiene

The following notes on hygiene should go without saying, but there is no harm in reminding yourself of some of the most important basics. In certain situations it may not be possible to maintain the standard of hygiene you are used to at home. However, the following points are important for the prevention of infection and contribute to your general health and well-being.

Care of the body:

Care of hands and nails:

Procedures for the washing of hands:

Alcohol gel, hand sanitiser or antibacterial dry wash are effective at killing germs and worth using frequently. If hands are visibly dirty, then using soap and water is preferable.

Large numbers of germs are transferred when shaking hands and through touch. Respiratory infections as well as diarrhoea are caused by touching the face and mouth with dirty hands. Regular use of alcohol gel will reduce your risk of these common and annoying conditions.

Dental care:

Foot care:

Protective clothing:

3. Common illnesses: diarrhoea, fever and malaria

Diarrhoea

Diarrhoea is a common problem when travelling. To avoid getting diarrhoea, ensure that hand washing and hygiene are given attention and the source of water consumed is safe. Many diarrhoea attacks are caused by viruses; these are self-limiting and clear up in a few days. It is important to avoid becoming dehydrated. As soon as diarrhoea sets in, drink more fluids, such as bottled, boiled or treated water or weak tea. Dairy products should be avoided as they can aggravate diarrhoea.

The body loses water, salts (especially sodium and potassium), water-soluble vitamins and other important trace minerals through diarrhoea. In order to replenish some of these losses, it is recommended that you consume at least three litres within the first three hours and continuously drink fluids thereafter, especially oral rehydration solution in the correct dilution.

Evidence and experience show that antibiotics such as ciprofloxacin and azithromycin can reduce the frequency and severity of diarrhoea in about 7 out of 10 cases and can be taken as part of the medical kit. They can be especially helpful when work, travel or important engagements may otherwise be disrupted.

Be careful!

You should seek medical help if there is any blood in your stools or accompanying fever and vomiting. Diarrhoea that lasts for more than three days requires medical attention.

Fever

A high body temperature (i.e. 38.5 °C or more) should always be taken seriously, especially if you are in a malaria-prone area or have come from one in the past. You should see a doctor if a fever persists or is worsening. It helps to be aware of some important causes of fever. These include: meningitis (severe headache, stiff neck, often a rash that does not fade
when you touch it); acute bilharzia or katayama fever (often accompanied by wheezing and itching 20 or more days after swimming in an area where bilharzia is common, such as Lake Victoria or Lake Malawi); kidney infection or pyelonephritis (aching in the loins, often with nausea, shivering, and frequent urination that creates a burning sensation); typhoid (progressive fever and feeling increasingly ill – with no response to malaria treatment – usually accompanied by diarrhoea, sometimes by coughing and sometimes by a faint rash); blood poisoning (alternate shivering and sweating, often in the presence of an infected bite or other skin infection like a boil, or warm infected feet or legs). Heat stroke also causes high temperature.

Malaria

If you are in a malarial zone, this is an essential list of precautions:

Even if you take all these precautions, you may still get malaria. Whenever you travel, take your malaria standby treatment kit with you. Consult your doctor on the type of treatment kit and prevention tablets, since different drugs are needed in different parts of the world. If you develop a fever, sweats and chills, a bad headache or other symptoms that could be attributed to malaria, get tested as soon as possible by a reliable doctor or laboratory. If this is not possible, if you do not trust the result or if the correct treatment is not available, self-treat within 8-12 hours of the time your symptoms first started. In all cases you should put yourself under the care of a trusted doctor or other health worker as soon as possible.

Malaria kills more people than wars do.

4. Treating infections, parasites and bites

Infections, parasites and bites can turn nasty, so proper treatment is important. This section will offer you advice about what to do in case of an infection or bite and what medication to take. However, you should refrain from self-treatment unless it is impossible to reach a doctor and get medical advice.

Dengue fever

This is a mosquito-borne illness that can cause severe illness very rapidly. The Aedes mosquito, which spreads this severe flu-like illness, tends to bite during the day. Typical symptoms are high fever, severe headache, muscle and back pain, and feeling seriously ill. If you experience these symptoms, see a doctor, get a blood test (including a blood slide to rule out malaria), then rest, drink plenty of fluids and be patient. There is no cure, but expert health care can be life-saving if (rare) complications set in.

Dengue is spreading worldwide with amazing speed and is becoming as great or greater a risk than malaria in many areas such as South East Asia and South America.

Viral haemorrhagic fevers

Lassa fever, ebola and marburg are the best known of these rare afflictions. There are regularly cases of lassa in rural areas of West Africa. Most viral haemorrhagic fevers are spread by close contact with infectious cases, while some are spread by mosquitoes or ticks. If you are deployed in areas where known outbreaks are occurring, get specialist advice. Symptoms start with fever, headaches, muscle pain and conjunctival suffusion (redness of the eye/conjunctiva). Lassa may be treated by a slow intravenous infusion of ribavirin; however up until now, no effective cures have been found for ebola and marburg. Prevention consists of avoiding contact with infectious cases.

Pneumonia and respiratory infection

These are especially common at times of stress, tiredness and overcrowding. Symptoms are coughing, shortness of breath, fever and sometimes pain when breathing deep. If you experience these symptoms, seek good medical advice as soon as possible. Timely treatment with effective antibiotics usually shortens these illnesses. If you are deployed in a country where any currently severe episodes of flu or flu-like illness are known to be occurring in the area or in a world-wide outbreak, follow official guidelines carefully.

Skin and wound infections

In hot climates, even small cuts, grazes, bites and other wounds can quickly get infected. Use an antiseptic cream or powder. Cellulitis – hot, red skin spreading outwards from an infection or upwards from the feet and toes – can come on extremely rapidly. Start a high-dose antibiotic at once under medical supervision.

Bites from dogs and other animals

Clean bites scrupulously with soap and water. Get them looked at by a doctor or other trusted health workers. Bites often become infected and in principle you should start a course of antibiotics even if no infection is obvious. Make sure you have been immunised against tetanus. (That means a primary course of three injections in the past and a booster every 10 years.) If this is not the case, you will need a tetanus shot without delay.

Unless you are in a region known to be free of rabies, you absolutely must report to a good health centre at once if you are bitten. If you have been fully immunised prior to deployment, you will need two further vaccines. If you have not, you will need five post-exposure vaccines and probably also Human Rabies Immunoglobulin, which can be hard to get a hold of. Everyone deploying to a country where rabies is endemic should be immunised prior to mission.

Sexually transmitted infections (STIs)

These are very common among mission personnel and humanitarian workers for reasons that are usually obvious. The key rules are never to have unprotected sex (i.e. use condoms) and to avoid sex when alcohol has significantly blurred your decision-making. Also report any signs such as abnormal discharge, sores or genital warts. If in doubt whether you may have become infected, get checked out at the end of your mission as some STIs may cause no symptoms, but can cause infertility and other problems. Include an HIV test.

At the end of your mission

It is now considered good practice to have a post- mission medical checkup unless your deployment has been short or to low-risk destinations. If you have any unusual or persistent symptoms, including unexplained tiredness or weight loss, have these checked out by a doctor.

5. Dealing with climatic extremes

Altitude sickness, hypothermia and heat stroke can be dangerous. This section will instruct you on how to cope with extreme climate and altitudes.

Too high

Beware of altitude sickness, which can set in at any height above 2,000-3,000 metres. When climbing or travelling to heights above this, try to take one or two days to get acclimatised. Above 3,000 metres, try to sleep no more than 300 metres higher than the night before. Maintain your fluid levels. If you become short of breath while at rest, develop a persistent cough, experience a pounding headache or feel drowsy, return to a lower altitude as quickly as possible.

Too cold

Hypothermia can quickly set in with any combination of cold weather, high elevation, strong wind and being wet. To prevent this, wear several layers of loose-fitting clothing, with a waterproof outer layer, and cover head, neck and hands. Set up a ‘buddy system’ so that individuals can look after one another. Signs of danger include feeling intense cold, shivering, drowsiness or confusion. If this happens to you or your companion, warm up without delay by having warm sweet drinks, sharing warmth in a sleeping bag or having a bath with water up to 40 °C. Check for signs of frostbite (an aching or numbness, often in the hands or feet, with the skin feeling rock-hard and looking very pale or purplish). Do not drink alcohol.

Too hot

Working in high temperatures brings with it the risk of heat stroke or sun stroke. This is when your body’s cooling mechanism (including your ability to perspire) breaks down. In these situations, your body temperature escalates to 39 °C or above, you feel hot and dry, your pulse rate goes up and you may feel sick and confused. Get into a cool place at once, drink cold non-alcoholic beverages if you are able to, get sponged down, fanned or have cold water poured on your body to evaporate the heat. Get medical help, as this can be an emergency.

Useful websites include:

 

6. Mental health and stress management

Working in crisis management environments can expose you to stressful situations and conditions. You might be shocked to realise that a situation your colleague judges to be extremely stressful is one that you can handle like a walk in the park. It is only natural that different people react differently to stress triggers and that coping strategies vary from one person to another.

Experiencing stress in a crisis management environment can be helpful. It can focus your attention, increase your concentration and mobilise the necessary energy you need to achieve your everyday goals.

However, failure to cope effectively with stress may cause a decrease in productivity, prove detrimental to your functioning and affect the work of your entire team. Early prevention can stop the stress reaction from escalating into a real problem in the short- and long-term future.

This section will focus on three types of stress, namely cumulative stress, acute traumatic stress and vicarious trauma. It will provide you with tips on how to deal with both and take advantage of the resources at hand to speed up your healing process. Furthermore, you will find a section on post-deployment stress in Chapter 7.

Cumulative stress

Stress that builds up over time and that is not well managed can gradually lead you to perform less effectively. Some form of stress in missions is inevitable, but failure to address cumulative stress may lead to burnout.

What creates cumulative stress?

Every individual has different reasons for feeling stressed. Some can cope with stress better than others by consciously controlling their state of mind. This is a list of possible causes of cumulative stress:

How to recognise it

It is important to recognise indicators of cumulative stress. It may be a good idea for individual team members to share clues with their colleagues that will indicate when they are not handling their stress satisfactorily.

Possible indicators:

How to cope

Experience has shown that knowledge, especially through training prior to deployment, about cumulative stress, how to build up resilience, awareness of early-onset indicators and prompt action to establish coping mechanisms has had a positive effect on reducing cumulative stress and avoiding burnout. It is normal to experience cumulative stress during a disaster operation and most reactions to stress are considered normal behaviour. Cumulative stress may be identified and managed.

How to minimise cumulative stress

Some of the actions below may help reduce stress:

Acute traumatic stress

This powerful, acute type of stress is brought on by sudden exposure to a traumatic event or a series of such experiences. It is classically described as a set of normal reactions to an abnormal event. For example, these events might include:

There is no right or wrong way to react to these kinds of experiences and it is important to remember that strong emotional and psychological reactions can often occur in the immediate aftermath of a traumatic experience.

What are common reactions?

Emotional and psychological reactions may include the following:

Physical traumatic stress symptoms may include the following:

Steps towards recovery

Going through a potentially traumatic experience can often fundamentally challenge our sense of safety and meaning. We can often feel helpless and out of control. It is important that we take proactive steps to address these sensations as soon as we can:

Dealing with strong emotions

Allow yourself time and make yourself aware that you may well experience strong emotional reactions:

When to seek help for traumatic stress

Try to seek support from your natural networks (e.g. friends, family, colleagues) as much as possible during the aftermath of trauma. If this support is not immediately available or you do not have access to these networks, then try to find a specialist. As stated above, quite extreme emotional reactions to traumatic experiences are perfectly normal.

However, should you find that your functioning is profoundly affected and your reactions are taking a long time to subside or are even worsening over time, then you should seek professional assistance. This is especially true if:

If these criteria are present, you should make contact with a professional through your insurance provider or other medical networks. You may be in danger of developing post-traumatic stress disorder (PTSD), a severe and disabling condition that can be alleviated with professional help.

It is possible that your seconding organisation provides access to services to support you in dealing with stress or trauma. Be sure to inform yourself about all available services and how to access them prior to your deployment.

If you feel like you can no longer remain in the mission because of the trauma that you have experienced, do not hesitate to take the necessary steps to end your contract. There is no shame in leaving a stressful and traumatic situation.

Vicarious trauma

Vicarious trauma (otherwise known as secondary trauma) can affect anyone who is exposed on an ongoing basis to the suffering of others. Anyone, therefore, who works in crisis environments can be vulnerable.

You are particularly at risk if:

Common reactions

Vicarious trauma is a cumulative process that makes gradual changes over time to a person’s emotional, physical and spiritual well-being. Common reactions include:

Coping with vicarious trauma

Because vicarious trauma is such a gradual process, there is no quick fix for recovering from it. Some helpful strategies for dealing with vicarious trauma include the following:

7. Substance abuse

The high levels of stress that can form part of the daily work of civilian experts on mission can some times become a breeding ground for substance abuse. By substance abuse, we are not only talking about cases of drug overdoses or drunkenness, but rather about a long and complex problem of intoxication and addiction.

While addiction can cause serious health problems for civilian experts on mission, intoxication can pose safety risks as well as low levels of productivity in the workplace and increased absenteeism. While each type
of drug affects a person’s mind and body in different ways, there are general signs and symptoms to watch out for:

Physical evidence

Habits and moods

Absence from work

Work performance

How to deal with substance abuse

If you recognise the aforementioned symptoms in your colleagues, then they could be struggling with alcohol or substance abuse. The best solutions you can offer them (or seek out in case you are going through these problems yourself) are guidance, support and treatment. Some options include:

Addiction to trauma

If people have suffered early trauma in their lives or are repeatedly exposed to acute stress in adulthood, it is possible to become addicted to the experience (the term ‘adrenalin junkie’ may be familiar). Otherwise known as ‘repetition compulsion’, it refers to the need to persistently revisit disturbing experiences.

Clinical research suggests that this may represent an attempt to gain mastery over a previous trauma. It is also thought that the excitement of the risk acts as a distraction from feelings of loss and confusion that might otherwise prove overwhelming.

Common symptoms

If you are in the grip of repetition compulsion, you may experience any of the following. You may:

Responding to trauma addiction

In many ways, repetition compulsion needs to be treated like any other addiction. That may mean a period of abstinence in order to ‘detox’. It can be very helpful to take breaks from adrenalin-fuelled crisis environments to reflect on your experiences and talk through your reactions.

Addiction of any kind is a very isolating experience, which can usually only be fully resolved in relationships with others. If you are aware of difficult or traumatic experiences that you sense you have not come to terms with, it is important that you find someone to discuss this with.

Some people prefer to talk to one other person (such as a trusted friend, colleague or counsellor) but others find group support more helpful. However you do it, clinical experience indicates that dealing with past experiences can help people move on in their working lives with a renewed sense of purpose and engagement.

8. First aid

Knowing and applying simple first aid principles can save lives even when you only have basic equipment at your disposal. It is important to realise that first aid is a practical skill. In order to be effective it requires regular practical training. We strongly recommend that you attend a professional first aid course and possess a valid first aid certificate. As an alternative, you may take an online course, such as a first aid e-learning course offered by the British Red Cross. This is accessible free of charge at www.firstaidforfree.com.