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Table of Contents
PERSONAL REFLECTION
Year : 2019  |  Volume : 17  |  Issue : 2  |  Page : 305-309

When resilience starts within the team: a case study of mental health and psychosocial support professionals during the Rohingya crisis in Myanmar


MSc, Resource-PSS, France, www.mhpssconsultant.com, France

Date of Submission16-May-2019
Date of Decision26-Aug-2019
Date of Acceptance23-Sep-2019
Date of Web Publication29-Nov-2019

Correspondence Address:
Pauline P Bubendorff
30 Avenue Praud, 44300 Nantes
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INTV.INTV_20_19

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  Abstract 


The author, a clinical psychologist who started her humanitarian experience in North Rakhine State, Myanmar ten years ago, coordinated mental health and psychosocial support (MHPSS) activities in Rakhine State during the latest crisis that led to mass displacement of Rohingya from Myanmar to Bangladesh. In this personal reflection, she describes how decisions related to technical management or coordination impacted team members and dynamics to such an extent that it seemed to contribute to team resilience. Based on her professional experience, field observations and team feedback, she proposes possible resilience building mechanisms which can be supported in any MHPSS humanitarian intervention. She hopes to confirm or open up perspectives on team support and staff care to humanitarian actors working with Rohingya communities around the world.

Keywords: gender, professional development, staff care, team resilience


How to cite this article:
Bubendorff PP. When resilience starts within the team: a case study of mental health and psychosocial support professionals during the Rohingya crisis in Myanmar. Intervention 2019;17:305-9

How to cite this URL:
Bubendorff PP. When resilience starts within the team: a case study of mental health and psychosocial support professionals during the Rohingya crisis in Myanmar. Intervention [serial online] 2019 [cited 2019 Dec 8];17:305-9. Available from: http://www.interventionjournal.org/text.asp?2019/17/2/305/271880




  Introduction1 Top


Between 2016 and 2018, I worked with a team of up to 70 Rohingya employees involved in MHPSS activities in Rakhine State. During that time, both national teams and expatriates like myself suffered multiple ordeals that impacted our lives and work. Team dynamics, morale, work motivation and satisfaction were constantly challenged – by the unstable political and natural environment, by changes within our organisation, by difficult moments in our professional and personal lives. After the attacks, violence and mass displacement in August 2017, we could have been devastated with what was lost, what we could not address, what we were unable to restore or protect.

Yet, despite the repeated attacks on its balance and the vulnerability its members experienced individually, this team seemed to bounce back systematically and even thrive at times. We took successive blows, which we managed to overcome with reinforced engagement, technical creativity and team bonding. This observation raised the following question: how do we build a team’s strength while its members are exposed as professionals and individuals? I hope this personal reflection echoes with other professionals’ experience and inspires them in return.


  Acting on the team’s gender needs and supporting organisational gender equality Top


‘When I arrived in North Rakhine State I attended a meeting to discuss issues of programmatic integration. There were no women. Zero local women in leadership positions, out of more than 40 people. The visual was astonishing.’

Amy, North Rakhine State Programme Manager in handover report

‘The mother told me, “What about your baby? How can you breastfeed on demand if you are working here with me?”’

Fatima, psychosocial worker returning from maternity leave, during a team supervision meeting in Sittwe

A few months before the October 2016 attacks, Amy arrived on the mission as North Rakhine State programme manager. As she also specialised in gender, she promptly decided to lead an informal survey with female staff members in her team, in order to assess their specific needs. While gender inequality at community level was already acknowledged by most employees, the report revealed scope for improvement on gender balance at organisational level. Urgent needs surfaced on female staff security during field nights. Key issues raised also included consistency in gender composition between the team and the service users and work adjustments for breastfeeding employees to secure coherence between institutional practices and international recommendations shared in our programmes.

After months of internal advocacy and perseverance, subsequent actions to support female staff protection and empowerment were taken. First, at field level they included accommodation policy, recruitment of female team leaders, gender-sensitive trainings and work adjustments for breastfeeding staff. Second, at mission level, they comprised a breastfeeding policy, advocacy for gender-sensitive programming and active contribution to gender minimum standards based on field suggestions for institutional improvement.

These actions were progressively achieved over two years, and Amy, who had launched this initiative, only saw a few outcomes during her assignment. However, each achievement led to positive feedback from the team, and contributed to stronger trust building and empowerment, especially for female employees. I felt that respect for their management and a feeling of belonging to the organisation increased from the moment there was more consistency between what female team members told service users and what they experienced as employees.

I also sensed that the fact we took action, based on women’s words and testimonies, gave them an importance that challenged culturally rooted gender inequality. It brought new hope that their needs and opinions mattered and could lead to positive change. Their self-confidence seemed to increase and female voices started rising more assertively in meetings. The impact transcended the scope of our team, when senior national managers from another department reached out to us, requesting assistance to promote female recruitment in team leader positions, as they had witnessed the benefit for our own team.

Awareness about gender balance started growing both within the national and expatriate team. The team had become stronger, because its members who had specific vulnerabilities and needs in this context had been heard and supported through concrete action. By engaging in policy design and review at local, national and international levels, not only had we increased our capacity to sustain this new strength beyond expatriate turnover and changes of context, but we also allowed our organisation to become stronger by addressing needs and working on gender equality at all levels for all teams.


  Supporting professional development and upgrading programme quality Top


‘The mother said, “No one ever listened to me before like you.”’

‘Before this training I asked her, “Sister, please don’t cry,” but now I tell her, “I can understand that you feel badly, you are free to cry.”’

‘The mother told me, “What I share to you, I believe that God is already listening, because I feel already better.”’

MHPSS team members, feedback during training supervision session in North Rakhine State

In my previous work experience, I had managed technical growth through trainings, technical meetings and field supervision. In Myanmar, we had a combination of large team size (around 70 psychosocial workers), extended geographical coverage (three townships including remote rural areas), limited technical background (staff’s restricted access to university), and acute levels of distress of service users.2 We felt these factors required more complex technical support needs to guarantee safe services and reduce risks related to turnover, with a team we had taken years to train technically.

Throughout the crisis, we took a holistic approach to professional development of the teams – our objective was to deliver technical support and develop the team’s skills in a safe, conflict-sensitive, culturally adapted, gender-equal and accessible way. We tried systematically to design a training process according to the team/context specificities. We sought to integrate field supervision and follow-up sessions and to ensure that verbal and written translation in local languages was provided. We used culturally adapted and context-relevant examples to illustrate theoretical content and designed training manuals/tools based on field training experience, including corresponding checklists for self-monitoring or supervision. We explored related online international training courses to validate knowledge acquired internally and reinforce existing and propose new self-care techniques.

The impact of our intense mobilisation on technical growth for Rohingya MHPSS workers exceeded our expectations in upgrading programme quality. Staff expressed their feeling of being valued in their existing knowledge; they felt understood in their needs and constraints and technically supported with respect. Pride and a sense of ownership of their specific role towards service users became a source of strength in the deteriorating context – the more acute were psychosocial needs, the more meaningful was their service. Besides this, technical growth allowed them to understand underlying psychological mechanisms at stake not only for the people they supported, but also for themselves and their surroundings. This gave some sense of control in a context of massive adversity. With this holistic technical support, we seemed to increase team members’ self-awareness of their own needs, resources and capacity to act for their own wellbeing. Simultaneously, having efficient tools to provide support and relief in their daily work was a precious defence against helplessness.

The attacks in late August 2017 brought brutal changes that impacted massively the team at both a personal and professional level. The conflict led to staff displacement and expatriate evacuation, and prolonged activity suspension brought funding insecurity, with waves of contract termination, including for senior managers who had been in the organisation for years.

The personal impact of contract termination in a constantly deteriorating context was considerable, and our initial approach to technical growth was incompatible with new context challenges. We struggled to identify what could make sense professionally for the remaining team, with such programmatic uncertainty and omnipresent insecurity.

We explored opportunities hidden behind this new set-up: team members were stuck at the office, but for once grouped in the same location; they could not access service users, but had day-long access to computers. Actions we had deprioritised in the last year due to the emergency could in fact become useful once access resumed. We identified such as actions as developing department visibility, ethical/responsible procurement through social business and use of durable/recycled materials, online training options for MHPSS lay workers with variable English language levels, field validation of the Myanmar translation of the World Health Organization Psychological First Aid manual. We split responsibilities amongst team members, according to technical skills, language or geographical requirements.

We frequently felt these actions were absurd compared to immediate needs, yet once again, secondary benefits on team morale were striking: we all kept our minds ‘technically connected’ instead of being overwhelmed by negative thoughts; we explored new learning opportunities which opened perspectives in the midst of hopelessness; as managers and supervisors we were consistent in our support, even when this meant preparing for improbable job applications. Based on team feedback, it seemed that engaging consistently in professional development, despite context constraints, had allowed to limit the team’s exposure to anxiety, protecting their feeling of belonging through continuous team work and building new strengths and resources that could be useful in the future.

There again, developing team strength and resilience through professional development relied on the full-time presence of psychologists in the field, regularly consulting the entire team. We explored specific technical growth needs and aspirations, both material and intellectual, creative ideas for the programme, while considering the team’s comfort zone in terms of work space, time, location, gender and ethnicity in the group, language, materials used, etc. The main challenge in such an adverse context was to keep professional development as a key objective on our radar and to suggest innovative approaches to address constant limitations.


  Protecting team members’ wellbeing and contributing to staff care needs Top


‘I think of death all the time. On the way here I thought about jumping off the bridge.’

‘When we have no freedom, there is no reason to live.’

Service users during individual counselling in Northern Rakhine

‘When the crisis stroke, I felt like I was all alone, lost in the middle of a big ocean.’

Psychosocial worker during training on suicidal ideation in North Rakhine State

Even prior to the crisis, psychological distress among team members was a source of concern. Although their work in the organisation provided some form of security, Rohingya MHPSS workers were frequently exposed to potentially traumatic experiences, combined with daily stressors linked to deprivations in their access to basic items, health and education services, freedom of movement, etc. The crisis brought further deterioration, with new stressors in their personal and professional spheres. As individuals, house checks, night visits, rumours and confirmed information of arrests, killings and gender-based violence were a source of constant fear. As employees, contract termination risk, specific threats on INGO workers and increased institutional tension brought further anxiety. Moreover, in their daily work, team members had to listen to detailed accounts of horrible experiences and to work with people in great distress and states of bereavement and depression, which could activate and aggravate the psychological suffering of the staff themselves. Staff care solutions were challenging, since national mental health specialists did not speak the Rohingya language, and they belonged mostly to the Bamar ethnic group which was perceived as an oppressor due to the conflict.

From the time of the October 2016 attacks, the security context deteriorated both in North Rakhine State and in Central Rakhine State. The situation in both parts of the state are markedly different: after the 2012 outburst of violence in Central Rakhine State, all Rohingya who used to live in the urban area of Sittwe were displaced and relocated to a vast government-controlled camp area outside the town. No Rohingya were left in urban areas and extremist Buddhist groups started being more visible, especially in Sittwe and Mrauk-U. In this particular context, insecurity in Central Rakhine State involved different types of stressors: explicit anti-INGO movements reappeared, new movement restrictions were imposed and unpredictable acts of violence triggered traumatic memories of the intercommunal violence outburst in 2012. Community tensions filtered within the organisation and the exhausting lack of funding visibility created further institutional tension.

As expatriate colleagues, our scope for action felt drastically restricted to address such levels of anxiety. Yet several actions seemed to have a key impact on our staff’s stress relief and perception of support. In Central Rakhine, Sarah, the programme manager, was prompt to analyse the impact of external and internal changes and decided to adapt the team’s work based on their perception of security. She facilitated daily meetings to ventilate and put words on the insidious surrounding tension. Her crucial role reached a climax when a young female team member brutally died. In the midst of professional pressure and context insecurity, she secured space and time for the team to decide how they wanted to mourn their colleague, and when they felt comfortable resuming their work.

Overall, we felt that we needed to take action to limit the team’s additional exposure to trauma and distress, based on threats which were under our control. One example was the initiative taken by Rob, a trainer psychologist in Northern Rakhine, who led an informal survey to assess the emotional impact of the institutional use of the word ‘Rohingya’. The results made us realise how the institutional denial of their preferred ethnic name created a negative emotional impact for a majority of Rohingya staff. We took action through internal and external advocacy to sensitise organisations who employed Rohingya staff on this issue.

Another example was adapting programme activities, according to the level of team support allowed by the context. In periods of highest insecurity in Northern Rakhine State, Amy had suggested implementing a rotation system whereby the staff could attend to personal needs one day per week, being aware, for example, that men’s presence during a house check drastically increased the family’s feeling of security. After the August attacks, when activity resumption started being discussed, we felt that resuming psychosocial counselling was unethical, given that the team was exposed to insecurity at all levels. We invoked ‘do no harm’ principles to protect teams from further traumatic exposure and suspended psychosocial counselling activities until minimum standards of team support and supervision could be met. Despite activity suspension, we pushed to recruit a former psychologist/programme manager to provide remote assistance to the teams, including informal support through daily phone calls.

Each of these actions seemed to have a high impact on team resilience: staff members reported feeling privileged that their manager had considered how the context evolution impacted their lives both at home and at work and took decisions accordingly. Several said they felt treated as equals by their management and coordination, a feeling that was incredibly valuable in times of widespread institutional tension.

Our connection to both the personal and professional impact of the context evolution actually increased the team’s commitment to work, while protecting team bonding, motivation and morale, and we seemed less impacted with sick leave and turnover than other departments. We were impressed with the degree of bonding between members of the Central Rakhine team, the way they faced their colleague’s death, and resumed work with unaltered energy and commitment.

In a context where staff care services were not available, it seemed that the full-time presence of mental health specialists at management and coordination levels contributed to building team resilience. Connection to evolving sources of stress or distress within the team was easier with field access, but we also experienced how remote assistance by a psychologist manager impacted positively staff’s feeling of support. We had worked on well known factors to restore, protect and promote wellbeing – through early detection of specific needs, identification of relevant resources and adaptation of actions to context challenges – and choosing to apply these in priority to the teams.


  Discussion – mobilising psychosocial skills beyond MHPSS intervention: a trail for resilience? Top


I was curious to explore whether before the crisis there were pre-existing factors, specific to this technical sector, which could have been predictors of the team’s strength and capacity to bounce back. Comparing my experience in Myanmar with work experience in other contexts, I wondered whether resilience mechanisms could be facilitated with MHPSS workers whose psychosocial support skills are so deeply rooted that they become a pattern beyond programmatic setting.

First, most Rohingya MHPSS workers who had been managed for years by mental health specialists had developed basic counselling skills (including empathy, active listening, non-judgmental attitude, respect for the person seeking support and confidentiality) to such extent that it was inherent in all their work interactions. I was amazed at the quality of communication of some MHPSS workers who spontaneously demonstrated these skills both in formal and informal settings. Besides this, I found such profiles across the whole organisation, from field workers to headquarter advisors, which meant that quality support and understanding was accessible at all levels of the team.

One example was the Northern Rakhine senior manager’s reaction when I announced the last minute cancellation of a field visit by my line manager, one month after the October 2016 attacks. While I was apologising and struggling not to express my frustration openly, he reassured me that they were managing, and although they were longing for this visit he could see how I would be more useful in Yangon, writing proposals that would secure funding to address the needs of their community. I hung up and realised that in a few sentences, he had reduced my frustration and guilt, acknowledged my skills and my meaningful presence in Yangon, and expressed his trust in our professional connection.

Another key skill possibly at stake in resilience building is MHPSS specialists’ capacity to connect and reveal hidden links between a person’s psychological suffering and their unmet needs, between needs and potential resources, between resources and constraints to take action. What I observed is that this skill, mobilised outside clinical settings, has an incredible impact. It guides mental health specialists joining a new team to connect more quickly to their team members, to build trust and ground team spirit. We used it to reinforce existing resources and explore new ones within the team. Quality connections among team members considerably limited communication challenges due to language barriers, geographical locations or cultural difference.

We also used it to ensure continuity and consistency with national teams on programmatic aspects, by sharing background information and technical justifications within technical documents. Links between the context and technical aspects/decisions were kept visible through comments in protocols, notes on PowerPoint presentations, trainer reflections integrated in training manuals and therefore accessible to all newcomers.

I noticed this connecting skill also became a precious asset for team management in an adverse work environment, including context insecurity, funding instability and/or inter-ethnic tensions. Our connecting skill contributed to limit or promptly address unspoken tensions, reactions of mistrust, misunderstanding, tension or aggressiveness.

A striking example of this is the Central Rakhine team’s reaction throughout the different phases of the crisis. The team was composed of both Rohingya and Rakhine staff members who worked in corresponding locations. Context insecurity and inter-communal threats and violence had forced Sarah to suspend joint team meetings. When these finally resumed, the first meeting was emotionally intense and team members from different ethnic groups expressed openly how they had worried for and missed each other.

The precious connection among team members from different ethnicities and between colleagues from different bases was actively supported by psychologists involved in management and coordination and became an incredible source of strength. By staying connected to what others in the team were going through, we decreased geographical, political or cultural boundaries that impacted so heavily our environment.


  Conclusion Top


In this team work in Myanmar, it seems that resilience building relied on the extensive use of both psychosocial skills by MHPSS workers and specialised skills by mental health specialists in aspects of their work that were not MHPSS interventions. Our experience in Myanmar confirmed the conclusions of the Google Aristotle project3: psychological safety, advocated for and supported by expatriate psychologists, was key to maintaining our team’s ‘productivity’ throughout the crisis. In addition, their full-time presence in the mission had contributed to multiple conflict-sensitivity factors such as prioritising ethical considerations, securing consistency between institutional and programmatic practices, creating and maintaining connections between all team members and considering the variable context impact on each team member.

In aspects like gender considerations, professional development and staff care, the resilience building process seemed to mirror common steps in therapy work. The ‘therapeutic alliance’ translated at team level into quality communication, connection, trust and support shared beyond hierarchical links among MHPSS team members.

Undeniably, individuals of various technical backgrounds are bound to possess and be able to mobilise similar skills as part of their personality or by learning through professional or personal life experiences. However, mental health specialists and lay workers engaged in MHPSS interventions constantly mobilise these skills in their daily work as service providers and reinforce them regularly through technical professional development. This professional practice allows a deeper anchor and conscious use of these skills to build resilience not only for service users but for the organisation these professionals work in.

As we have seen, adverse contexts can threaten these skills and impact MHPSS workers’ wellbeing as well as their psychosocial competencies. Research in staff care and the exploration of diverse means to evaluate, restore and protect MHPSS workers’ wellbeing and professional skills could be a further step to contribute to resilience building in humanitarian contexts.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

1This personal reflection reflects the views of its author and not the organisation’s position. Names of professionals have been replaced by pseudonyms.

2Based on programme data in Northern Rakhine, 99% of service users presented some form of psychological suffering and 52% explicitly reported suicidal ideation.

3https://www.nytimes.com/2016/02/28/magazine/what-google-learned-from-its-quest-to-build-the-perfect-team.html ; https://www.youtube.com/watch?v=UfGiCnhdU78






 

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  In this article
Abstract
Introduction
Acting on the te...
Supporting profe...
Protecting team ...
Discussion ̵...
Conclusion

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