Johanna Schubert – AFE Blog – United Nations, Medical Services Division, New York, NY

“Choose a placement that fits your field of studies and interest, with any organization of your choice, in any country you want – as long as you’re reasonably safe.”

This was the basic instruction for a Rotary Peace Fellow, to choose an Applied Field Experience that will enrich and keep us busy over the summer trimester. Wow. There I was, sitting in front of my laptop in October last year, feeling like I had just arrived in North Carolina, and I was supposed to identify the perfect option for my professional development and future career somewhere on this planet– no pressure! And at the same time: What a privilege. Choose wisely! But what, with so many options?

Soon I figured out the main criteria for my choice of an AFE: I wanted to be of use (to the organization as well as to beneficiaries directly), learn something new, and find an organization that I would enjoy working with afterwards and that actually is employing new staff even in May 2018. After much deliberation, I decided to stay in my general field of expertise, Mental Health, but to challenge myself with a broader focus, applying Public Health methods and mechanisms that I had acquired at the Gillings School of Public Health, UNC, so far. So, I ended up applying to various organizations such as the International Medical Corps (IMC), UN Headquarters, the International Criminal Court, the World Food Program, UNHCR, WHO, and the World Bank, throwing my hat in the ring. In the end, UNHCR, WHO, and the IMC decided for me that I should work under the IMC’s roof, but on projects for their umbrella organization, the Mental Health Psychosocial Support (MHPSS) Working Group in Gaziantep, Turkey, at the refugee camps along the Syrian border. My focus would be to evaluate the provision of Mental Health Support to refugees, in specific the care taken of children and adults with cognitive disabilities. Also, the MHPSS working group wanted me to lead a consensus process on the definition of Mental Health terms in order to enhance communication and cooperation between agencies. It was great! I successfully negotiated with both Rotary and UNC (Thank you, Shai!) to convince everybody that I would be safe and could handle myself in today’s Turkey. I booked my flight and was good to go.

 

 

However, shortly before my departure, the Turkish government started to arrest even solely German journalists and aid workers in Turkey for allegations of espionage and conspiracy. Hmm. Slightly unsettling. Then, two weeks before my booked flight, my supervisor at the IMC called me to tell me they had to put all operations to a halt, as they had not received the necessary assurance from the local government in order to proceed with their work. It was possible that they would have to pull out of Turkey completely and abort all projects. The organization was very cooperative and friendly, however in the end the internship had to be cancelled.

What to do, at such short notice? Luckily, from previous work with the United Nations High Commissioner for Refugees in Geneva, 2010, I was still in touch with some of my colleagues, who were so kind to help me out immediately. Soon I received an offer from UN Headquarters, Medical Services Division, to support the Staff Counselor’s Office in New York City. They knew about my background in Stress- and Psychotrauma Prevention for Humanitarian Aid Staff and my qualification as a psychotherapist in Germany and therefore warmly welcomed me to their team for the summer to support their Mental Health Strategy, Occupational Mental Health Risk Assessments, as well as the Training Needs Assessment for UN Medical Staff worldwide. This offer was a wonderful opportunity, as it combined every part of my previous professional experience, with my newly acquired skills in Public Health Leadership.

 

 

 

 

 

 

“What we see is a new type of war veteran, the international humanitarian worker, returning from battlefields unable to escape the horrors seen there.” [1]

We all admire international professionals like our fellow Rotary Peace Fellows and all other committed Humanitarian Aid Workers worldwide for the fact that they dedicate their life to support the less fortunate, foster peace and mutual understanding, further the economic and infrastructural development of less-developed or war-torn regions.

But who takes care of the Peace Builders and Aid Workers?

Interestingly, for decades the world just assumed that they are invulnerable, immune against the atrocities they are witnessing in their jobs, like heroes in movies or on TV who simply shake off their experiences, crack a joke and live happily ever after. The British Army in WWI first recognized a condition called “shell shock”, when physically intact soldiers trembled uncontrollably for days or even weeks after traumatic experiences (recommended reading: Dr Jonathan Shay’s “Achilles in Vietnam: Combat Trauma and the Undoing of Character”). Since then, slowly but surely the world learned to recognize Posttraumatic Stress Disorder (PTSD) as a common consequence of extreme and existentially threatening incidents or experiences of loss. Today, International Organizations are much further realizing the impact, of not only traumatic stress, but also seemingly small or routine factors such as everyday work stress or the effect of bad management on employees’ mental and physical health. The UN, like many other organizations, now has been working on the improvement of psychosocial care for their employees in the cause of duty of care for several years now, the employer’s ethical and legal obligation to avert any foreseeable harm to their staff members.

Duty of care does not exclusively consists of basic security and physical integrity. And it is not only direct attacks on UN staff and premises such as the attack on the UN guest house in Kabul, 2009, or the bombing in Abuja, 2011 that can severely affect UN staff members’ mental health and wellbeing. UN duty stations all have their health and safety hazards immediately or progressively affecting employees’ health status. This Fall, the Medical Services Division will publish a major Mental Health Survey they undertook recently in order to find out more about the status quo of their staff members’ psychosocial wellbeing globally. The team used a comprehensive online assessment tool to screen for a number of risk factors and possible symptoms for Generalized Anxiety Disorder, Major Depression, Posttraumatic Stress Disorder, and Hazardous Alcohol Consumption. Over 15,000 staff members globally participated. For reasons of confidentiality and not to ruin the suspense, let me only say so much: The results will certainly show that the efforts to identify and tackle mental health hazards to staff are a good idea. My role in this project is mainly to serve as a qualified cold reader, also to prepare presentations on the results and support the core team finalizing the report for submission to the Secretary General, His Excellency Mr António Guterres.

 

 

Currently, my supervisor Dawn Straiton, the Staff Counselor’s Office’s Chief, is conducting Mental Health Risk Assessments at different duty stations in order to get first impressions of the different intra- and extra-organizational mental health hazards to the staff members. I am supporting her, identifying and appraising validated online assessment tools for a global assessment and risk-mapping to prepare the factual basis for targeted mental health risk management interventions.

In-between, I have tasks a little less gloomy and more exhilarating, and that is everything related to Chloe, the therapy dog.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From February until June 2017, she visited a number of different offices and received visitors at the Staff Counselor’s Office for stress relief! To the reader unfamiliar to the concept of Animal-Assisted-Activities and Therapy, this may sound surprising: UN staff petting and playing with a dog during working hours? Don’t they have more serious stuff to do? Actually: No. UN staff everywhere are under a lot of pressure and carry a lot of responsibility. Successful Stress Management is key for them to continue doing their job at the best of their capabilities, and pleasant breaks from war and humanitarian crisis are crucial to take a breath and avoid burning out in the long run. For people who are not opposed to dogs for allergic, personal, religious, or hygienic reasons, interaction with a dog can actually significantly reduce symptoms of depression [2, 3, 4, 5], anxiety [4, 5, 6, 7, 8], high blood pressure and heartrate [4, 8, 9, 10, 18], PTSD [11, 12] as well as chronic pain and fibromyalgia [11, 13, 14, 15, 16]. The positive effect of animals on human wellbeing is believed to be mainly mediated by an increase in oxytocin levels in the blood through physical contact and display of affection between the animal and the human individual [17, 18, 19, 20, 21]. Oxytocin is a neuropeptide and peptide hormone primarily related to social bonding and sexual reproduction, but increasingly found to be linked to various physical and psychological health benefits, such as decreased stress levels, reduced depression and anxiety in both humans and animals, as well as to more satisfying relationships in life [22, 23, 24, 25].

In a nutshell: Hanging out with Chloe the therapy dog is fun AND good for your health:

 

 

Last, but not least, my current most challenging task is the Training Needs Assessment for global UN Medical Staff. The UN provides clinics in remote locations providing emergency health care, occupational health support, medical evacuation and referral services to staff members and eligible dependents. For medical staff in general, the rapidly changing nature of their profession makes it crucial to participate in Continuous Professional Development. While it is not mandatory in all employees’ countries of origin, it is certainly desirable from an organizational point of view in order to provide UN staff, based in remote and underserved areas, with best-possible health care and to build local capacity, training national health care staff along the way. My job is to develop a comprehensive concept on how to incorporate systematic Training Needs Assessment into the Standard Operating Procedures of the Medical Services Division and ideally create tools in order to do so. The diversity of the staff members’ backgrounds, locations, resources and occupational demands make this an interesting puzzle to solve. My previous experience in hospital quality management back in Germany is of great help in this.

My brooding over my knowledge transfer flowchart was briefly interrupted last week by a fire alarm (“This is not a drill!”), causing the evacuation of the entire UN building, which went very smoothly. Nonetheless interesting how your perception of these incidents changes when you are studying for a FEMA certificate in Disaster Management at UNC Chapel Hill!

 

 

A highlight besides work was certainly my trip to the Rotary International Convention in Atlanta. I had been invited to lead a breakout-session on “Resilience in the Field”, stress management for Rotarians undertaking field projects. Of course, I was honored to contribute my expertise to the colorful and inspiring buffet of breakout sessions offered at the Convention. Almost 100 participants attended the session and I was incredibly happy that everyone was so interested and active, that we could collect a number of factors and suggestions how to make Rotary field projects successful and a positive experience for all concerned. Currently, I am analyzing the notes and group work results in order to provide the Rotary Foundation with written recommendations to hand out to interested Rotary Clubs.

 

 

 

 

What I have always loved about the Rotary Conferences is all the inspiring people you can meet and listen to. And this time, apart from amazing keynote speakers during the general sessions, I was most inspired by fellow Peace Fellows. To see what they have accomplished further down the road from where I am, the projects they are undertaking, NGOs they founded – there is no better energizer to strive for more impact and success on the path in the international field.

The day after my breakout session, I wanted to inhale some more of this spirit but came too late: The Session “A Day in the Life of a Peace Fellow” was completely full with 25 people waiting outside the door in vain. Encouraged by Beccah Bartlett, I then initiated a spontaneous breakout session next door as it would have been a pity not to serve all these very interested Rotarians who wanted to learn more about the program!

 

And of course, the fellowship of the Rotarian family is another factor that makes the international conventions so special:

 

All that is left from a summer that went by so quickly are three more weeks to finish up my work for the UN, say good-bye to New York and go back to North Carolina via Germany, where I will visit my family after eight months “on the way”.

Summing up, I have to say I was incredibly fortunate to have such a great “Plan B” for my AFE, which brought me in touch with a lot of committed professionals working behind the curtain to keep the UN staff in the field fit and sane for life as well as their job. I learned a lot about Occupational (Mental) Health administration for Peace Builders and feel encouraged in my strive to “help the helpers”, a concern of mine since 2009. I will continue my studies in Global Public Health Leadership with a new inspiration and energy, and all that’s left to say for now is

THANK YOU, ROTARY!

 

 

 

 

 

[1] Smith, B., Agger, I., Danieli, Y., & Weisæth, L. (1996). Health activities across traumatized populations. Emotional Responses of International Humanitarian Aid Workers. In: Y. Danieli, N.S. Rodley, L. Weisæth (Eds.), International Responses to Traumatic Stress (pp. 397-423). Amityville, NY: Baywood.

[2] Folse, E. B., Minder, C. C., Aycock, M. J., & Santana, R. T. (1994). Animal-assisted therapy and depression in adult college students. Anthrozoös, 7(3), 188-194.

[3] Souter, M. A., & Miller, M. D. (2007). Do animal-assisted activities effectively treat depression? A meta-analysis. Anthrozoös, 20(2), 167-180.

[4] Nimer, J., & Lundahl, B. (2007). Animal-assisted therapy: A meta-analysis. Anthrozoös, 20(3), 225-238.

[5] Berget, B., Ekeberg, Ø., Pedersen, I., & Braastad, B. O. (2011). Animal-assisted therapy with farm animals for persons with psychiatric disorders: effects on anxiety and depression, a randomized controlled trial. Occupational Therapy in Mental Health, 27(1), 50-64.

[6] Barker, S. B., & Dawson, K. S. (1998). The effects of animal-assisted therapy on anxiety ratings of hospitalized psychiatric patients. Psychiatric services, 49(6), 797-801.

[7] Barker, S. B., Pandurangi, A. K., & Best, A. M. (2003). Effects of animal-assisted therapy on patients’ anxiety, fear, and depression before ECT. The journal of ECT, 19(1), 38-44.

[8] Cole, K. M., Gawlinski, A., Steers, N., & Kotlerman, J. (2007). Animal-assisted therapy in patients hospitalized with heart failure. American Journal of Critical Care, 16(6), 575-585.

[9] Lasa, S. M., Ferriero, G., Brigatti, E., Valero, R., & Franchignoni, F. (2011). Animal-assisted interventions in internal and rehabilitation medicine: a review of the recent literature. Panminerva Med, 53(2), 129-36.

[10] Morrison, M. L. (2007). Health benefits of animal-assisted interventions. Complementary health practice review, 12(1), 51-62.

[11] Yount, R. A., Olmert, M. D., & Lee, M. R. (2012). Service dog training program for treatment of posttraumatic stress in service members. US Army Medical Department Journal, 63-69.

[12] Dietz, T. J., Davis, D., & Pennings, J. (2012). Evaluating animal-assisted therapy in group treatment for child sexual abuse. Journal of child sexual abuse, 21(6), 665-683.

[13] Marcus, D. A., Bernstein, C. D., Constantin, J. M., Kunkel, F. A., Breuer, P., & Hanlon, R. B. (2012). Animal-assisted therapy at an outpatient pain management clinic. Pain Medicine, 13(1), 45-57.

[14] Lust, E., Ryan-Haddad, A., Coover, K., & Snell, J. (2007). Measuring clinical outcomes of animal-assisted therapy: Impact on resident medication usage. The Consultant Pharmacist®, 22(7), 580-585.

[15] Coakley, A. B., & Mahoney, E. K. (2009). Creating a therapeutic and healing environment with a pet therapy program. Complementary therapies in clinical practice, 15(3), 141-146.

[16] Marcus, D. A., Bernstein, C. D., Constantin, J. M., Kunkel, F. A., Breuer, P., & Hanlon, R. B. (2013). Impact of animal‐assisted therapy for outpatients with fibromyalgia. Pain Medicine, 14(1), 43-51.

[17] Uvnäs Moberg, K. (2010). Oxytocin verbindet. Deutsche Hebammen Zeitschrift, 1(2010), 12-17.

[18] Beetz, A., Uvnäs-Moberg, K., Julius, H., & Kotrschal, K. (2012). Psychosocial and psychophysiological effects of human-animal interactions: the possible role of oxytocin. Frontiers in psychology, 3, 234.

[19] Chandler, C. K. (2012). Animal assisted therapy in counseling. Routledge.

[20] Rothbaum, B. O. (2013). Service Dogs in Military Medicine. Psychiatric Annals, 43(6), 291-291.

[21] Olmert, M. D. (2010). Made for each other: The biology of the human-animal bond. Da Capo Press.

[22] Amico, J. A., Mantella, R. C., Vollmer, R. R., and Li, X. (2004). Anxiety and stress responses in female oxytocindeficient mice. J. Neuroendocrinol. 16, 319–324.

[23] Guastella, A. J., Howard, A. L., Dadds, M. R., Mitchell, P., and Carson, D. S. (2009). A randomized controlled trial of intranasal oxytocin as an adjunct to exposure therapy for social anxiety disorder. Psychoneuroendocrinology 34, 917–923.

[24] Kirsch, P., Esslinger, C., Chen, Q., Mier, D., Lis, S., Siddhanti, S., and Gallhofer, B. (2005). Oxytocin modulates neural circuitry for social cognition and fear in humans. J. Neurosci. 25, 11489–11493.

[25] Uvnäs-Moberg, K. (1994). Role of efferent and afferent vagal nerve activity during reproduction. Integrating function of oxytocin on metabolism and behavior. Psychoneuroendocrinology 19, 687–695.