International Critical Incident Stress Foundation, Inc.
International Critical Incident Stress Foundation, Inc.
By: Grace Wolbrink
The purpose of the paper is to present the author’s adapted, One-on-One, Physiological First Aid, CISM response in working with an island nation’s first responders and trauma survivors at the onset of the global pandemic. This island is home to over 30,000 people from 112 nationalities, where people spoke one or more of the five dominant languages.
There is no definitive “Survivors Guide to Pandemics”. So how does a mental health practitioner render the best CISM response while working solo, in a foreign country, at the onset of a global pandemic? The COVID-19 crisis is ongoing, and we are co-experiencing it.
Fresh off the plane, like kids in a car on a family vacation, medical providers pressed their noses against tinted van windows. We watched in awed amazement at the island’s picturesque beauty. Amidst the stout green mountains and variegated blue waters, we followed the serpentine road, now void of cars, past the jagged metal fence at the edge of town. Only months prior, thousands of tourists swarmed the area enjoying its vast beaches, duty-free shops, ethnic restaurants, and carnival celebrations. Only today, behind that jagged metal fence stood two men holding garden shovels – but they had not been gardening; they were digging fresh graves.
In dealing with a pandemic, it’s important to learn about the culture and the community we are serving. To identify how unemployment, starvation, pandemic fear, and other social factors impact community life and organizations. On the island, void of government assistance, people are forced to find work in a country dependent on global tourism during an international crisis.
The jolt of catastrophic hurricanes further intensified the physical, psychological, and economic impact of the pandemic and mandated lockdowns. The waking nightmare of hurricanes past are prevalent in daily life. Frayed structures, missing rooftops, abandoned homes, and boarded windows heralded the haunting memories of devastating storms. Their images and daunting memories plague survivors as if it happened yesterday.
“I can still see it”, lamented the property owner of an oceanfront hotel. Thieving winds and ripping rains shattered its fourth-floor windows. Impenetrable darkness swallowed terrified, screaming guests, now barricaded in hotel bathrooms. In a violent game of tug-a-war, storm vs human, the manager and his teen-aged son wrestled guests to safety. Amidst torrential rains and howling winds, looters scaled the exterior walls threatening rape and physical harm to anyone trying to stop them.
“Now this. Hurricane season. During COVID all I could do was sleep. Now I just stay awake. At least during the hurricane, other countries help with food and supplies. Now people have no food. There is no help.” Natural disasters bring foreign aid to regional survivors. Pandemics stretch the economy’s marginal resources.
Third world conditions and quarantine mandates further challenged people’s cultural and spiritual beliefs. For the first time in the island’s history, cremation happened because of COVID. Revised hospital policies separated patients from their loved ones. Immigration laws barred undocumented residents experiencing COVID related symptoms from necessary medical services. The island’s first responders stated that more people died because of COVID, than from COVID. Pandemic induced fear, stress, depression, unemployment, and homelessness. These are the true killers of human life.
Resources in Short Supply – “First hurricane, now COVID.”
The simple phrase “I don’t feel well” signified that a small legion of COVID testing teams, driving government marked vehicles would be summoned to someone’s home. Masked nurses, wearing white, hooded, PPE gowns knocked on the doors of an employee calling in sick. Socially shunned, test recipients are treated like lepers instead of people. Bouts of depression and fear from their experiences still haunt them.
When the government first lifted the bans on social gatherings, people were afraid to worship inside. The next Sunday morning, congregations socially distanced in church courtyards and on city streets. Outside, people listened. Inside Priests and Ministers preached.
Skill Sets – Smile and Wave
Colorful shops lined narrow, cobbled streets and oceanfront boardwalks. A wave and a smile ripples into more waves and smiles. Masked employees scanned vacant streets. A female security guard peered through a tinted window. Older women sat on a black, rod iron bench. Younger women gathered around them. A place where conversations were shared, and information was gleaned.
Compassionate Presence Strengthens Resilience
George Everly Jr. Ph.D., ABPP’s pioneering work in Psychological First Aid provided the foundational theory and skill set for my work on the island. His emphasis on the power of compassionate presence, of being present, and of listening without judgment became the cornerstone of human connection in a time of physical distancing and social isolation. Below is my adaption of these basic, yet powerful principles.
1. Observe
The formal structure of CISM incorporates a team approach to crisis responses. Because of the organic nature of my work and being a solo provider in someone else’s country, I looked for people who were likely to talk with me as opposed to those who might be in crisis. Business owners, employees, and beach goers became my primary focus. Add a smile and a wave, it shows you care and is a starting place for person-to-person interaction.
Since I was new to the country and its customs, I did not approach anyone showing visible signs of distress or grief unless escorted by a community member.
2. Establish Trust
Be approachable. Establish predictable routines when you walk around or visit places to create visibility. Identify a few neutral, or even unconventional, meeting places where people can find you. Again, this helps to establish trust as you build relationships.
On the island I frequented First Responder stations and targeted community-based locations. A few of favorites included: the metal folding chair in a vitamin shop. Joining the women around the black, rod iron bench in front of the name brand clothing stores, and on beach chairs or sand along the ocean. Walking through town or along the boardwalk, I smiled and waved.
Be present. Join with people. Your eyes communicate approachability.
3. Listen
Be present, listen without waiting for your turn to talk. Listen without judgment. Normalize people’s feelings and emotions. Do not try to fix a person or a situation. They are not broken, just in transition. The use of cognitive reframing also fosters resilience and is strength empowering.
4. Support
Identify community resources. Be available. Help when possible. Provide or clarify information.
The list of community resources on the island was short; a four-bed hospice facility, an eight-bed nursing home, the community mental health offices, a domestic violence shelter, and a hospital.
On the island I provided information about COVID related symptoms, hospital protocols. I also offered suggestions on coping with the effects of anxiety, depression, loss of purpose and quarantine isolation. People asked me to take their temperatures, to explain what a fever was, and to watch movies from cell phones. I dropped bottles of water off to artists along the boardwalk. The most important thing is to be yourself, to be creative, and to have fun. Most of us appreciate being treated like a person.
5. Record the Day’s Victories
At the end of the day, write down three or more victories or things you are grateful for. Affirm the power of your version of a smile and a wave. Compassionate presence is powerful and transformational, even when its impact seems unclear. Focus on victories, they become easier to identify and to acknowledge the success within ourselves and others.
Here are a few of the victories during my time on the Island. People no longer wanted to commit suicide. Women learned to identify the signs of human trafficking in a place where there are no helplines or resources. People smiled and waved.
Aspects of this article have been changed to protect the integrity of the people who so courageous shared their stories.
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