Employees of global NGOs can present particular challenges to assistance companies charged with their care. Workers posted to major capital cities present few issues; but it is those stationed to the more remote parts of the globe, often isolated in resource-poor settings, that require experience and a collaborative approach if medical concerns are to be well managed. Assistance companies well versed in this category of client can offer much at every stage of deployment: from when posting is being considered, to returning home following a significant placement abroad.
Ensuring that there is a good fit between the worker and the posting abroad is the first thing to be considered. There are several aspects to this. Some concern the candidate and the nature of the job abroad. The chief concern of assistance companies, however, is the safety of the employee, given their past medical history and where they are to be placed. If the individual is taking regular medication, for example, it must be established whether or not the tablets can be sourced locally. It’s not just a question of being able to buy certain drugs, but whether they can be trusted to contain the correct active ingredients.
It’s well known that the fake drug industry is rife in many countries, often associated with medication bought on the internet. Drugs prescribed by doctors in many countries can also be affected: medications are thought to be counterfeit at least 10 per cent of the time, leading to many thousands of deaths annually. Even if the supply of medication is trustworthy, employees should consider whether the proficiency of local healthcare facilities is adequate for their needs.
An eLearning course, or pre-deployment medical lecture, is useful in detailing such medical issues that are likely to be important
A good medical assistance provider will have a strong working knowledge of medical capabilities around the globe and will be able to advise if a particular condition can be reviewed locally. Often, a shared-care approach is taken, where the worker’s home consultant sees the patient when they visit home, and the local consultant is seen in ‘outpatients’ at other occasions. If there is no reliable medical excellence locally, then a regional centre may well need to be used. For example, if in a resource-poor setting in the Far East, one of Bangkok’s world-class hospitals could easily provide the necessary expertise for regular hospital follow-up.
Medical pre-travel advice given by assistance companies is of great value for those working for NGOs. Clearly, if living in remote locations, a working knowledge of the sorts of local diseases that might be prevalent is essential. For those living in tropical areas, mosquito-borne illnesses are good to avoid. If malaria is present at post, taking anti-malarial medication is essential, but this should be supplemented by trying to avoid being bitten by mosquitoes in the first place as many other important illnesses are also spread by mosquitoes.
An eLearning course, or pre-deployment medical lecture, is useful in detailing such medical issues that are likely to be important. Other pre-travel advice would include food and water safety as well as the necessary immunisations that should be taken. Assistance companies can help prepare NGOs in other ways too. Some companies have a security capability that can be of vital importance in keeping the employee safe in potentially risky environments. As part of this, preparing the worker with a pre-travel security briefing is important.
If the employee has a psychological diagnosis, consideration should be taken to how counselling or consultations with a psychologist should be carried out at post. Receiving face-to-face consultations in remote settings has always been a challenge, as even if there are therapists, they are sometimes insufficiently skilled and often less than proficient in the language of the worker – an issue of particular importance in talking therapies. Assistance companies can now facilitate virtual online consultations with a native counsellor via a computer or smart device. Internet availability can be surprisingly good in the most desolate of regions, but if there are difficulties, a satellite phone and a counsellor prepared to give phone consultations can also be easily arranged.
As psychological reasons are often cited as contributing to unsuccessful postings abroad, the effects of being overseas on the employee immersed in a novel culture are receiving increased scrutiny. As is well known, initially the new culture is found to be fascinating but, with time, a feeling of isolation (and often irritation) can occur as ‘culture shock’ sets in. Being aware of these psychological issues early is helpful as culture shock can lead to anxiety and depression in some cases. It is best to be forearmed with solutions to these common problems: good assistance companies can help with this.
Assistance companies can facilitate regular check-in sessions as the posting progresses. The purpose of the contact is not to mollycoddle, but rather to review how the employee is coping with the profound change and offer help if needed. This can be accomplished in a variety of ways, from simple phone calls to the use of apps on smartphones. The degree of anonymity provided to the employee may well have an effect on the answers provided: as some employees fear that certain issues (especially psychological) may influence future job prospects, dealing with third parties might well facilitate fuller responses and allow for earlier intervention when needed. Even the occasional use of wellbeing assessments, simple to administer, may well alert the assistance company to the need for additional support, nipping the problem in the bud.
When medical difficulties arise at post, a collaborative approach between the assistance company and the employee is best taken. It’s not just prudent to involve the patient in decision-making to increase buy-in, but it is simply wise on a practical level: the NGO employee has often been in the field for several months; they know what is possible in their remote location, and the best way to achieve it. This local knowledge is usually very helpful when accessing the nearest medical facility. It is the assistance company’s medical team who must then contact the clinic, review any results, and determine whether further treatment elsewhere is required. For example, cuts and scrapes may well be adequately treated in fairly basic clinics, but if the diagnosis is potentially more serious, assistance companies must evacuate the patient to regional centres of excellence so that an authoritative diagnosis and treatment plan can be carried out.
Sometimes referring a patient to a slightly better in-country hospital would only add delay to receiving definitive treatment, rather than immediately going to a centre of excellence out of country
Some NGOs have a policy to use in-country medical facilities before patients are transferred regionally. This is not only for financial reasons but flows from a desire to use the local healthcare system like a national would. While honouring this intention, it is still an assistance company’s responsibility to advise if evacuating out of country would be preferable. Sometimes referring a patient to a slightly better in-country hospital would only delay receiving definitive treatment, rather than immediately going to a centre of excellence out of country. This sort of knowledge is only gained by experience, so having an assistance company whose bread and butter is helping those in complex situations is potentially life-saving.
Just as there are often difficulties adapting to the new culture at post, reverting to the home culture can be equally as problematic. This reverse culture shock can also be smoothed by regular contact with an assistance company alerted to its existence. For those employees who go from posting to posting, buffeted by the winds of diverse cultures, special care should be taken. With preparation, experienced help when difficulties arise, and pro-active attention, good assistance companies allow NGOs to perform their important work in the world’s most challenging environments.