Journal of Human Security | 2015 | Volume 11 | Issue 1 | Pages 19‒25

DOI: 10.12924/johs2015.11010019

ISSN: 1835-3800

Research Article

Human Security Workers Deployed in Austere Environments:

A Brief Guide to Self-Care, Sustainment, and Productivity

Thomas F. Ditzler

*, Patricia R. Hastings

and Abigail D. Hoeh

Department of Psychiatry, Tripler Army Medical Center, 1 Jarrett White Rd, Honolulu, HI, 96859, USA;

E-Mail: [email protected] (ADH)

Joint Chiefs of Staff (JCS) Surgeon's Office, United States Department of Defense (DOD) , 1400 Defense

Pentagon, Washington, DC, USA; E-Mail: patricia.r[email protected]

* Corresponding Author: E-Mail: thomas.f.ditzler[email protected]; Tel.: +1 8084331246

Submitted: 15 September 2014 | In revised form: 24 December 2014 | Accepted: 15 January 2015 |

Published: 14 April 2015

Abstract: Since the early 1990s, the human security movement has sought to expand the

concept of security beyond the traditional military defense of national borders to focus on the

intra-state security needs of populations at the individual level. Specific initiatives frequently

address problems of population health, ethnic conflict, religious extremism, human rights,

environmental or natural disasters, and other critical issues. For expatriate human security

workers in the field, the environment may present meaningful challenges to their wellbeing and

productivity. This can be especially so for those who have relatively more experience in

academic, business, or administrative settings, and less in the field. The authors' goal is to

illuminate practices that have demonstrated their efficacy in enhancing wellness, sustainment,

and productivity for human security and other humanitarian and development workers deployed

to austere environments. The content represents a synoptic consensus of best general practices

and guidance from a range of resources comprising United Nations agencies and activities,

national and international non-governmental organizations (NGO's), private volunteer organ-

izations (PVO's), national military services, and international business concerns.

Keywords: humanitarian; human security; non-governmental organizations; population health;

private volunteer organizations

1. Introduction

From its beginnings in the early 1990's, the human

security movement has engaged a stunningly broad

constellation of challenges. Human security workers

may represent disciplines of anthropology, interna

under a Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0/).

tional relations, environmental science, ethics, health,

engineering, economics, law, or other professional

fields. For those who engage in human security work

in the field, environments are often austere. Workers

may confront their mission in the context of civil strife,

limited or depleted natural resources, endemic disease,

meager or absent health care, unsafe transportation,

inadequate public health assets including water and

sanitation, and other critical infrastructure. Research on

psychological distress among such workers indicates

that chronic exposure to such environmental stressors,

including the suffering of others, is associated with

negative mental health outcomes, including depression,

anxiety, and "burnout" characterized by long-term ex-

haustion and diminished interest. These outcomes are,

in turn, associated with decreased work satisfaction

and productivity [1]. To effectively meet the challenges

of these environments, workers require strong support

from their sponsoring organizations; the best prepa-

ration emerges from a transparent and interactive

agency-worker partnership that embraces a shared re-

sponsibility for mission outcome. Specific agency-based

support should include pre-employment screening of

potential workers, provision of mission-specific edu-

cation, training, and ongoing worksite support in the

field. Whatever the specific activities of the agency,

planning for success should include thorough worker

preparation in self-care and sustainment. Specific skills

typically include healthy practices of personal hygiene,

diet, physical fitness, cultural adaptation, socialization,

and development of effective stress management strat-

egies. These skills are mission-essential for all deployed

workers. The advantage of healthy, self-sustaining work-

ers is reflected in greater mission success, improved

job satisfaction and increased worker longevity [1].

2. Pre-Deployment Issues

If being engaged a new organization, workers are ad-

vised to contact current or former workers familiar with

the organization to learn as much as possible about its

leadership style and general culture, to get a clear

understanding of screening, hiring, and field support

procedures as well as vacation or leave policies and

access to health care.

Many experienced workers make a "deployment

book" to leave at home with an appropriate person.

The content typically includes relevant personal infor-

mation that someone else would need to contact the

worker. At the very minimum this should include names

and contact information of key deployment agency per-

sonnel at both the home office and in the area of

operation (AO), copies of the ID page of the worker's

passport with several other recent pictures of him or

her, and a letter of instruction on what to do if the

worker is ill, detained, or missing. A more substantive

document might include copies of required author-

izations and permissions necessary to permit another

to carry out legal, business, financial or other personal

responsibilities on the worker's behalf, such as a power

of attorney.

In addition, it is important for the worker to con-

duct a thorough background study of the AO. There is

no single best way to organize the effort, but areas of

focus often include the region's history, geography,

social organization, political institutions, spiritual sys-

tem(s), health care, transportation, important social

customs and traditions, and language. Learning some

of the local language is an obvious advantage in any

environment. In situations with one principal language,

workers can pursue pre-deployment study. There are

many government, academic, and commercial sources

available in a range of media.

Unfortunately, many of the languages of the field

environments human security workers engage are

not commonly spoken, or the number of languages or

dialects commonly spoken precludes the acquisition of

meaningful skills. This is especially so in settings in

host communities with a large number of refugees or

internally displaced persons. A properly vetted local

translator is a necessity, and can also serve as a

cultural informant to provide useful information on a

range of issues related to important customs, tra-

ditions, and social conventions. For workers attached

to organizations already in the AO, translation and

related language issues are usually managed by the

sponsoring agency. In the absence of a translator, the

pre-deployment language practice mentioned above

can go a long way in facilitating productive social ex-

changes. It is a truism that workers' level of wellness,

comfort, security and productivity can be largely

predicted by their working knowledge of the culture

around them.

3. Health Preparation

Health authorities recommend that basic preparation

include a comprehensive pre-deployment medical ex-

am, a review of routine personal medications, and

consultation on medications indicated for potential

medical threats in the AO [2]. A dental exam is also

considered good planning. It is worth noting that even

in otherwise sophisticated military organizations, dental

problems are a common cause of evacuation from the

field. Hormonal changes may predispose females to

gingivitis, making a dental exam more important than

many may realize [3]. For routine maintenance medi-

cation, seasoned workers often take a supply that

extends two months beyond the scheduled deploy-

ment. In preparation for work in arduous environ-

ments, the basics of nutrition would advise keeping a

healthy weight with a BMI of 19‒25, and eating a

balanced diet including grains, fruits, vegetables,

milks, and meats/proteins. Women need more iron,

calcium and folic acid. If unable to secure these nu-

trients on a reliable basis, it is best to discuss possible

supplements with a health care provider.

4. Equipment

Proper fit and comfort of personal gear is an important,

but easily neglected aspect of self-care. Most military

and camping equipment items are sized for males and

may need to be modified for females. Injuries to the

lower back and legs of female soldiers are twice those

of men [4]. Jumping from relatively low heights can

cause knee and hip injuries. Women are more prone to

stress fractures of the hip and leg. Females involved in

extreme athletic endeavors can have similar problems

due to low body fat, loss of menstruation, and hor-

monal changes which can weaken bones and pre-

dispose to stress fractures [5]. One of the factors con-

tributing to these types of injuries may be equipment,

which is not typically designed for females. [6]. A

female may have difficulty carrying the same load in

the same way as a male, often because she has a

shorter back. The best backpack for females is often

one that has adjustable shoulder straps, a chest strap,

and a waist belt to place some of the bag's weight on

the hips. Because a female's shoulders may not be as

broad as a male's it is often beneficial for a greater

amount of weight to be placed on the hips.

Ankle injuries are also more common in women

than in men. If at all possible, women should select

boots made for the female feet. Females have higher

arched and semi-curved feet. In contrast, the male

heel and ankle is typically wider due to the pull of the

calf muscles and musculature [7]. Before deploying,

women should ensure that foot-gear is well broken in.

Also, a supportive sports bra can make long treks much

more comfortable and decrease back and shoulder

pains. Most females with field experience would advise

a pull over the head sports bra to lengthen its use, as

harsh washing can break or rip the eyelets used to

fasten a regular bra.

5. Safety and Security

Among seasoned humanitarian workers there is a com-

mon saying: "if you don't have security, you don't have

anything". This aphorism is especially true for emer-

gency workers responding to large-scale natural or tech-

nologic humanitarian disasters, or those who are work-

ing in areas of armed conflict or other general social

strife. Clearly, workers deployed to these areas are in

exceptional circumstances, and security measures are

unique to each environment. Typically, security practices

involve responses reflecting the collaborative efforts of

the supporting humanitarian agencies/organizations,

the host government, and in some instances, military

personnel or civilian police (see Appendix A for more

information about physical security in high risk areas).

In stable environments, unavoidable hazards, threats,

and vulnerabilities require a clear and consistent risk

management strategy. The most effective security

plans start with detailed background knowledge of the

AO; there is no substitute for situational awareness of

the environment and culture. Below are a number of

principles, precepts, and practices that have demon-

strated their utility in maximizing collective security

and wellness for program leadership and workers.

• Safety and security is everyone's concern at both

the organizational and personal level. A useful aph-

orism is: "have the plan, know the plan, carry out the

plan".

• Safety plans and rules must be communicated to

all; acceptable and unacceptable risks must be clearly

defined along with procedures for exceptional cir-

cumstances (e.g.travel at night, traveling alone, etc.)

• Ensure that safety and security issues are an

integrated part of administrative and supervisory

meetings. This will reify the expectation of shared

security vigilance among colleagues

• Have clear contingency plans for special threat

situations including severe weather, important infra-

structure failure, civil disruption, or other security

conditions

• Communication practices are critical and should

include standardized training for communication

equipment, procedures and terminology.

• Know relevant local laws and customs, especially

about what to do in cases of a vehicular collision,

pedestrian accident, or inadvertent property dam-

age. Especially in rural tribal settings or areas em-

bracing transitional justice, the customary response

may be harsh.

• Do not defer routine vehicle maintenance, and

ensure that all vehicles have up-to-date maps on

board along with serviceable mobile communications

equipment.

• If possible, have secure vehicle parking and main-

tain an environmentally appropriate medical kit on

board.

• Personal wellness is a large part of safety. In

addition to physical fitness, adequate sleep and ap-

propriate nutrition, workers can increase safety for

themselves and others by abstaining from recre-

ational drug use, and moderating alcohol.

• For those concerned about the need for emergent

medical care or the possibility of rapidly deteriorating

security conditions, consider rescue and evacuation

insurance (see Appendix B for more information on

several well-known firms).

6. General Hygiene in the Field

The routine conveniences of daily hygiene materials

and practices may be much less available in the field.

Important hygiene practices to maintain are: dental

care, regular bathing, hydration maintenance, avoid-

ance of simple sugars, and abstaining from alcohol

and tobacco products. Fluoride toothpaste is advised

in most cases. In the absence of toothpaste, table salt

or baking soda may work well, or use a cloth and

water to wipe over each tooth surface to help avoid

debris build-up.

Ideally, all workers should have access to a way to

wash every day to avoid disease, parasites and skin

infections. Showers are preferred to baths to avoid

urinary tract infections (UTIs). Minimal requirements

for bathing are: a secure environment, at least one

quart of water, soap, and proper drainage. If no

shower facilities are available and water use is restricted,

commercially available wet-wipes can ensure a minimum

level of hygiene until a shower is available. Wet-wipes

may also be used as toilet paper if this comfort is not

available.

A common hygiene problem for workers (and for

women in particular) is difficulty urinating in environ-

ments with less than optimal privacy or in situations in

which it could be dangerous to disrobe. In responding

to this, workers may sometimes resort to strategies

that are sub-optimal for peak performance and health.

For example, some may decide to voluntarily minimize

fluid intake to avoid urination, which could increase

the likelihood of UTIs. If one will be away from any

medical facilities it may be practical to have an

antibiotic prescribed for use if needed. In addition to

increasing the likelihood of a UTI, water restriction

can cause dehydration. Voluntary water restriction

may not be subjectively perceived as dangerous to

the individual owing to the belief that the sensation of

thirst will automatically cue them when it is time to

hydrate. In reality, anyone with a clear sensation of

thirst is already dehydrated. Controlled studies

indicate that among women, even mild dehydration is

associated with headache, lowering of mood, in-

creased fatigue, increased perception of task difficulty,

and impaired concentration [8‒10]. More severe

restriction can also lead to heat injury including heat

exhaustion or heat stroke, which can be fatal. The risk

of heat injury may be increased in very dry environ-

ments in which the sensation of perspiration may not

provide a clue for fluid loss [11]. Urine retention also

increases the likelihood of bladder injury in the in-

stance of blunt impact or deceleration injury (e.g. fall,

or vehicular mishap) as the pelvis or abdomen can

more easily traumatize the distended bladder. Fluid

intake is critical to peak performance and, though this

may be considered in hot environments, it can be

problematic in cold regions where women can face

the danger of cold exposure because of the need to

disrobe more fully to urinate.

It is not unusual to have some change in menstrual

period length or flow in a physically or emotionally

stressful environment. Women are encouraged to have

enough sanitary supplies for at least 30 days if resupply

is predictable and longer if resupply is not assured.

Some external irritation may occur in hot environments,

but cornstarch or a thin layer of petroleum jelly may

improve comfort. Pads can also be used if stress incon-

tinence may be an issue. For women who use tam-

pons, cardboard applicators are usually a better choice

than plastic because plastic applicators can cause

micro-abrasions in the vaginal mucosa and are not bio-

degradable. Both tampons and pads can do double

duty when used as dressing or to occlude bleeding

sites.

7. Climate Issues

It has long been known that a high level of physical

fitness is a key element in worker safety and produc-

tivity. As a practical matter, physically fit workers are

less likely to get sick or injured; and they recover more

quickly when illness or injury occurs. In addition, active

physical conditioning helps workers to acclimatize to

the environment. This is especially important in envi-

ronments of extreme heat or cold including desert en-

vironments, where daily cycles of extreme temper-

atures are common. Caution is advised when exercising

in very hot or cold weather as chance of injury tends to

increase with temperature extremes. In general, wom-

en do not tend to perspire as quickly or easily as males

[12]. The way the female body adapts to heat relies on

the principal of a smaller total body mass combined

with the larger surface area to body mass ratio. This

explains why women will often do better than men in

hot topical (wet) environments, but not as well initially

in hot desert (dry) locations where perspiring can make

a difference in acclimatization (US Army Public Health

Command, 2010). Also, women typically have lower

finger temperatures and higher rates of peripheral vas-

cular disorders that could make them more susceptible

to peripheral cold injury.

8. Social Acculturation and Gender Roles

The process of adaptation to a new and sometimes

jarringly different social environment has traditionally

been referred to as "culture shock". Hopefully workers

will have availed themselves of basic background in-

formation about the work environment and the proc-

ess of cultural adjustment. In many areas, traditional

gender role expectations may place meaningful con-

straints on working women, even if they are expats in

a humanitarian role. Expat female and male col-

leagues in these areas are well advised to have a

clear understanding of culturally acceptable inter-

action in a shared space.

Customary dress is often conservative for both men

and women. This may involve covering the limbs, (i.e.

long pants for males and long sleeves and long pants

or long skirts for females), and often includes covering

the hair for females. These modes of dress can make

one's job more difficult physically and emotionally. For

example, if acceptable clothing comprises a full-length,

dark colored robe, heat may become a meaningful

problem. Likewise, covering the ears can decrease the

ability to hear the spoken word or localize other

sounds. Full facial coverage can also impair peripheral

vision and the ability to see what is near ones feet. In

some areas, women wear tight fitting shorts under

their skirts to ensure if there is an inadvertent move-

ment of the skirt that their upper legs will not be seen.

Norms for behavior may not allow male or female

workers to talk to the opposite gender. Females may

not be allowed to be in the company of males who are

not a relative; in some instances, a male aid worker

may put a local female at risk by speaking with her or

being in her company. Age can also be a difficulty with

regard to the youth of a country adapting to foreign

languages more quickly than adults and change the

dynamics of a family or clan if the younger children or

adolescents are acting as interpreters.

Body language can be a powerful force for good or

ill. In many circumstances, there are subtleties that

must be briefed to those going into an area. It is espe-

cially important to be aware of norms about physical

touching, and in many cultures there a certain gestures

that are best avoided. Other normative communication

issues might concern gaze behavior. In many western

cultures, looking another person in the eyes is often

considered a sign of sincerity; in many other settings it

may be considered rude or aggressive. Also, the social

expectations of gaze behavior may be different de-

pending on the gender of the speakers. Similarly, ask-

ing about another's spouse or family may be viewed as

friendly or intrusive. It is worth noting that many cul-

tures also have strong customs, traditions, and social

rules governing the processes of gift giving; once

again, a little cultural homework can go a long way.

This is especially so if the host country is also accom-

modating refugees or internally displaced persons,

where multiple standards may apply.

9. Emotional Self Care

This skill set has been variously referred to as stress

management, resiliency, personal wellness, mental

health, emotional well-being, psychological hardiness,

and other terms. Research confirms that humanitarian

workers, especially those responding to large scale

disasters, have high rates of subsequent psychological

distress. These frequently include a range of mood dis-

orders, anxiety disorders, and in some instances spir-

itual or philosophical problems, sometimes involving

loss of hope or purpose [1,13,14].

Although the field work of human security workers

may not routinely engage the magnitude and com-

plexity of career disaster responders, the cumulative ef-

fects of their work can still be emotionally challenging.

Whatever the specific mission, it is clear that evidence

from a number of studies reveals the most common

source of psychological distress is the persistent ex-

posure to the suffering or deprivation of others (An-

tares Foundation, 2012; Brunette, 2011). An important

but less striking source of strain may include separation

from family and friends, physically demanding work,

different language and working through translators,

unusual foods, crowding and lack of privacy, different

social customs (especially concerning gender roles),

harsh climate, or a lack of accustomed comforts. Over

time the otherwise fairly ordinary inconveniences can

produce an emotionally corrosive effect sufficient to

compromise general wellness and productivity.

Based on a review of the literature, Blanchetiere

[14] proposed that causes of stress may be thought

of under four general headings: 1) situational factors,

including personal security, health risks, and demands

of the population; 2) job related factors, comprising

living conditions, cultural change; workload, colleague

relations, and job security; 3) organizational climate,

involving program roles and expectations, manage-

ment style and worker support; 4) personal risk fac-

tors, incorporating poor self-care, psychological vul-

nerabilities, unrealistic expectations and motivation,

and lack of experience. The sources of stress, there-

fore, are complex, interrelated, persistent, and idio-

syncratic. The key to management lies in having in

place an individualized self-care program focused on

health maintenance and increased comfort. The plan

embodies the worker's aggregate knowledge, skills,

experience, beliefs, behaviors, plans, and attitudes that

contribute to the maintenance of well-being. Effective

plans begin in the pre-deployment phase, during which

the worker reflects on the personal values, goals and

expectations they attach to their efforts. These insights

can help to identify the substance of their motivation

and facilitate the earnest assessment of their particular

strengths and limitations that shape specific self-care

plans. Below are some self-care ideas that have proved

useful for many.

• Monitor your mood, and establish mutual support

relationships; share your thoughts and feelings with

trusted coworkers at appropriate times.

• Make a point of planning an exercise schedule

and stick to it. Because the operational tempo may

be high, it is important to block out specific time to

ensure you maximize the advantages of a regular

physical care regimen.

• Real time electronic communication (social media,

FaceTime, Skype, etc.) can facilitate a sense of con-

nectedness with home.

• Keep a log (diary) of thoughts, feelings and ac-

tivities; this often helps in processing your activities

and may later provide an instructive source of re-

flection on your experiences.

• Sharing humor can provide welcome relief from

the stress, but it is important to keep things positive.

If the tone turns negative or angry, it can com-

promise trust and erode the collaborative spirit.

• Personalize your living quarters with photos, sig-

nificant keepsakes, and other reminders of home; it

helps maintain a sense of continuity and attachment

• When possible, seek recreation away from the

work area.

• Even if you will not be on site for an extended

period, it is generally a good idea to unpack your

bags to lend an element of order and predictability

to your personal environment.

• Be careful about the use of alcohol; the pressures

of field work can potentially lead to an unhealthy in-

crease in consumption. Recreational drug use is

clearly contraindicated.

10. Coming Home

As the mission winds down, workers are often invig-

orated by thoughts of returning home to their family,

friends and customary lifestyle. They may reflect on

their endeavors, and the relationships they have

developed with colleagues and those they sought to

help. Workers often look forward to having time to

consider what they have learned and accomplished,

and to sharing their experiences with others. Indeed,

being part of a team with a shared goal in service to

others can be a great source of healthy pride. How-

ever, there is often sadness about departing.

Sometimes the feelings can be surprisingly intense.

Departing workers and those they served all benefit

from making adequate time to get closure, and saying

goodbye or making plans to stay connected. In some

circumstances this may involve a communal activity or

formal event; in others, it may be more personal.

Whatever form it takes, the departure process reifies

the value of what has been done and acknowledges

the contributions of all.

On returning home, workers embrace the challenges

of reconnecting with their previous world. Especially for

those who have less experience in foreign placements,

or who have been away for a longer time, the process

can be surprisingly disquieting. Although formal re-

search is scarce, comments of field workers from

diverse missions reveal a number of common themes

that may emerge for returnees. Below are some of the

most frequent of these with some advice from human-

itarian mission leaders [13].

• As a returnee, understand that the homecoming

may be less eventful and rewarding than you had

imagined.

• Once home, get lots of rest. Jet lag only lasts a

few days, but returning to the pace and activities of

home may require some adaptation. Give yourself

time to adjust; don't try to do too much too fast.

This is especially important if you are returning to

work.

• Family and friends can be problematic if their

need for your attention inadvertently overburdens

you. It may be necessary to diplomatically explain

your need for some undisturbed time.

• You may want to talk a lot about your expe-

rience and find that others are simply disinterested,

or that they don't seem to connect with the mag-

nitude of what you have experienced. They may be

much more interested in telling you what has hap-

pened for them during your absence.

• In other cases, you may find the questions of

others to be intrusive. You may experience anger or

frustration with those who seem insensitive or un-

sympathetic to what may have been a life changing

experience for you.

• These contradictory feelings, while troublesome,

are part of the readjustment process; as a general

rule, try to be at least as understanding of yourself

as you would be of someone else in your position.

11. Conclusions

A large and expanding body of research clearly

validates the critical role of individual worker wellness

in the success of human security field missions. From

pre-deployment planning, through mission responsi-

bilities in the AO, to the return home, both workers

and agencies clearly benefit from a thoughtful plan for

self-care. The rewards of worker self-sustainment can

be measured in terms of both mission success on the

ground and long term worker wellness. Hopefully the

authors' efforts will provide some useful guidance on

how to approach the process.

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Appendix A: Security Planning Resources

Rogers, C., & Sytsma, B. (1999). World Vision Security

Manual.

Van Brabant, K. (2000). Operational security

management in violent environments. Overseas

Development Institute.

Adventist Development and Relief Agency. Guidelines

for Developing a Security Plan. Retrieved from

http://www.adrasouthpacific.org/site_data/109/assets

/0038/2161/Guidelines_for_Develpoing_a_Security_

Plan.doc

Appendix B: Rescue and Evacuation Resources

Rescue and evacuation insurance through Global

Rescue (globalrescue.com)

International Medical Group (imglobal.com)

Adventure Sports Insurance

(adventuresportsinsurance.com)

International SOS (internationalsos.com)

Appendix C: Aid Worker Training Resources

All resources accessed on 23 December 2014

http://www.jhsph.edu/research/centers-and-

institutes/center-for-refugee-and-disaster-

response/education_training/HELP/

http://www.goinginternational.com/

https://www.icrc.org/eng/resources/documents/misc/

help_course.htm

http://www.who.int/hac/techguidance/training/course

s/en/

http://reliefweb.int/training

http://www.disasterready.org/about

http://www.sphereproject.org/blog/free-online-

humanitarian-training-resources/