Sustaining Love and Care

1
Sustaining Love and Care

• A Model of Staff Support for a Grassroots
  HIV/AIDS Organization in Tanzania
• Leslie Snider, MD, MPH

2
KIWAKKUKI
ANTARESI
2008
3
Antares Foundation Mission

• to improve the quality of humanitarian
  assistance and overseas development through
  advice, training and support.

4
Antares Model of Support
5
Factors Underpinning Antares Guidelines

• Stress is inevitable in humanitarian aid work
• Staff members, managers and agency are
  inter-dependent and all responsible for good
  stress management practice
• Stress management should be instituted in
  organizational policy as 1) proactive, 2) routine
  and 3) responsive measures
• Principles are applicable to everyone with
  tailored support for national and international
  staff

6
Who are the Staff?

• International and National NGO Staff
• International staff
• National staff located elsewhere in country
  (South Sudanese staff working in Darfur)
• Local staff working in the area where they live
• Volunteers
• National staff comprise the majority of staff in
  international organizations

7
Adapting our Model to Organizations.

• Working in long-term development
• With stable staff members
• With limited resources
• With their own values, beliefs and ways of
  understanding and effecting support
• Without access to a professional mental health
  referral base for all staff

8
HIV in Tanzania, Kilimanjaro Region
9
Kiwakkuki
Kikundi cha Wanawake Kilimanjaro Kupambana na
UKIMWI
10
Kiwakkuki Background

• Founded in 1990 around the global theme of Women
  and AIDS
• Formally registered as an NGO in 1995, currently
  planned for a Trustee
• Goal To accelerate womens access to
  information on HIV and empower them with skills
  needed to fight HIV and AIDS in their families
  and communities at large.

11
Activities

• Empowering women made a big difference in the war
  against HIV/AIDS in Kilimanjaro
• Broad-based activities
• HIV/AIDS Awareness Raising
• Home-based care for PLHA
• Support to orphans and other vulnerable children
• Voluntary counseling and testing

12
40 Staff Members
13
The Challenge

• Organization began work in Moshi municipality
  then gradually spiraled out adding volunteers to
  cover 6 districts
• Membership now stands at 5,064
• 100 groups of volunteers in the region

14
2,300 Volunteers
15
The Collaboration

• Volunteers providing critical support in dire
  conditions which HIV/AIDS has created in their
  daily context.
• Difficult and distressing work, done in
  ill-afforded spare time for volunteers who have
  other family or job responsibilities
• Work for both staff and volunteers is manifestly
  stressful
• Need for a structure to offer support to the
  women carrying out this vital role would make a
  significant contribution to their mission

16
2004 Assessment Findings

• Tremendous success and growth
• Increasing interest from volunteers, but also
  increasing numbers of beneficiaries with no end
  in sight
• Fear of the organization in keeping up with the
  demands of the pandemic
• Organizational culture, demands of clients and
  ever-increasing workload conspired to create high
  stress levels

17
Culture of Volunteerism A Double-Edged Sword

• The basis of Kiwakkukis success
• Very hard working and dedicated staff who
• Dont take lunch breaks
• Dont take holidays
• Have a poor balance between work and life duties

18
Stressors and Supports

• Working conditions
• Organizational structure management problems
• Lack of skills training
• Accumulated stress
• Lack of personal coping and perceived support
• Lack of communication (technical social)
• Secondary traumatization

• Religion
• Sharing
• Singing
• Laughing
• Friendship

19
Early Response of the Organization to Staff
Members

• Lunch breaks
• Holiday schemes
• Workplace policy for staff affected by HIV/AIDS
• Salary increase
• Family days opportunity for staff to bring
  their family members to learn about HIV/AIDS and
  the work they do

20
2008 Assessment Findings from Work/Life
Questionnaires

• Work Assessment
• Good communication among all Kiwakkuki members is
  of fundamental importance
• Some stress management measures are now in place
  (group activities, stress management education,
  improved available resources such as staff
  manuals).
• Recommendations from respondents
• Formalize systems (i.e., the method for giving
  out work)
• Improve assistance with travel arrangements
• Ongoing stress management training

21
2008 Assessment Personal Circumstances

• Kiwakkuki members live in extremely difficult
  circumstances
• Some living on low income some with HIV/AIDS
• Overwhelming majority experienced or witnessed
  extremely traumatic situations
• Challenges working in this social context
• Many beneficiaries with problems too great to
  address as a whole.
• Large geographic working area, transportation
  difficulties
• High expectations about the work from the
  community
• Chronic lack of resources

22
Antares Principles Matrix

• According to each principle
• What are you doing?
• What are the gaps/needs?
• What is your action?
• Findings
• Need for more education and support, regularly
  organized and placed within daily routines
• Need policies, systems and resources (manuals, HR
  resources, trainers)
• Barriers lack of funds, large volunteers,
  difficult work and travel conditions

23
Two Streams of Assistance

• Organizational Consultation
• According to Antares Principles
• Longer-term process
• Importance of prioritization
• Inter-Collegial Support
• Skills based training
• Able to institute rapidly with all members

24
Stream 1 Organizational Consultation

• Prioritizing Actions!
• Exercises and dialogue helped staff to understand
  where they had informal (and sometimes formal)
  measures already in place
• Screening informal assessment of potential
  volunteers done through training
• 3 Priority areas preparation training,
  monitoring ongoing support, end of assignment
  support

25
Preparation Training

• All staff and volunteers need an orientation to
  Kiwakukki, to clarify expectations and reduce
  disappointment/rumors about what to expect.
• Opportunities for staff and volunteers to
  participate in professional development training
  and conferences within and outside the country
  were seen as valuable staff support initiatives.

26
Monitoring Ongoing Support

• Want to develop a way of monitoring ongoing
  stresses
• Discussed a mid-assignment briefing or debriefing
  to be able to identify and address emerging issues

27
End of Assignment Support

• Particularly important, as staff members express
  a fair degree of distress when project funding
  cycles and their positions end.
• Want to improve their exit planning with staff
  for their life beyond Kiwakkuki. Exit interviews
  important both for the person and for Kiwakkuki
  to learn.
• Exit interviews also provide a chance for
  Kiwakkuki to better understand reasons for
  reasons for attrition of volunteers in order to
  develop effective support strategies.

28
Next steps

• Appointing a key holder of the principle for
  action
• Short time frame to realize some progress (3
  months)
• Venue for addressing these issues in ongoing way
  (every other Friday alternating with
  professional literature day)

29
Stream 2 Inter-Collegial Support

• Builds upon other natural interventions in place
  talking friend
• A structured method of peer consultation for
  problem-solving
• User-friendly method for staff and volunteers at
  all educational and skill levels
• Opportunity to be together and share
• Engages the expertise of the peer group, building
  confidence

30
The 5-Step Method

• Present the problem (5 minutes)
• Questioning (10 minutes)
• Group formulates the problem (5 minutes)
• -Presenter restates their problem
• Advice from Group (10 minutes)
• Presenter Evaluates the Process (5 minutes)

31
Things to Remember

• Ongoing group of equals (peers/colleagues)
• Stick to the time and structure
• Everyone takes a turn mutual learning
• Can ask about effect on the person (how they
  feel, how they are coping)
• Person does not have to accept the advice!
• Supportive Be careful in questioning not to
  blame person for the problem or their handling of
  it.
• Confidentiality!

32
(No Transcript)
33
(No Transcript)
34
(No Transcript)
35
(No Transcript)
36
Follow-On

• Groups should be from the same location in order
  to continue
• Presenter chosen at the end of the consultation
  for the next meeting
• Comfortable, quiet and private location must be
  identified
• Regular meeting time working within members time
  constraints arranged

37
Lessons

• There is a need for support for local, HIV/AIDS
  development organizations staff, volunteers and
  beneficiaries
• Organizational structures and policies are
  essential, but should be introduced in
  achievable, step-wise fashion
• Practical peer support and consultation skills
  can be rapidly implemented and scaled up

38

• A dragon was pulling a bear into its terrible
• mouth. A courageous man went and rescued the
• bear. There are such helpers in the world, who
• rush to save anyone who cries out. Like Mercy
• itself, they run toward the screaming. And they
• cant be bought off. If you were to ask one of
• those, Why did you come
• so quickly? he or she
• would say, Because I
• heard your helplessness.
• Jelalludin Rumi,
• 13th Century Afghan Poet