Fieldwork gives development workers the unique opportunity to interact with and to experience the hardships of those who they aim to help. Making the transition from Western comforts to harsh realities in the field is difficult. But for many workers, the real challenge begins when they return home.

Research on this topic is scarce. Most studies have focused, perhaps justifiably, on stresses experienced by local communities in post-conflict and other high-risk situations. However, experts who deal with the effects fieldwork can have on development workers have found that these workers experience a number of problems after returning from high-stress environments where Western cultural norms and sensitivities are ignored and atrocities are commonplace.

"Depression, anxiety, alcohol abuse - those problems turned out to be much more prevalent than post-traumatic stress disorder," said Barbara Lopes Cardozo, a psychiatrist at the Centers for Disease Control and Prevention in Atlanta. "It's a much broader issue when you work in those settings in emergency situations. There are a number of stressors field worker have to deal with."

Lopes Cardozo has done some of the most extensive work detailing mental health problems in development workers, including a study of workers returning from Kosovo. Her studies found that while PTSD was less prevalent in expatriate populations working in the region than it was in native populations, other problems like depression and alcoholism were more common in foreign worker populations.

These problems are complicated by the fact that few organizations have networks to assist workers with the transition back home, experts said.

"It's only in the past 10 to 15 years that we've really started thinking about mental health in conflict and humanitarian crises both among the populations and health professions," said Dabney Evans, a lecturer in the Hubert Department of Global Health and executive director of the Institute of Human Rights at Emory University. "They're going to need the same kind of clinical treatment similar to a person who has experienced torture. [This includes] therapy, maybe medication. It's the same mental health issue even if the way it's experienced is different."

Few organizations have systems in place to get workers medical assistance once they return home. Most don't track the health of returning field workers. The Peace Corps, one of the world's largest humanitarian organizations, is one example.

Other organizations are more proactive. InterAction, the Washington-based umbrella organization for more than 150 international aid groups, has a program that helps workers with the transition back to Western life.
Even those organizations that recognize the need for more assistance for aid workers returning to the field acknowledge it is difficult to create programs that address symptoms experienced by workers coming home.

"There's no official program," said Lynn Sibley, a clinical associate professor at Emory University's Lillian Carter Center for International Nursing. "We're trying to … build in an orientation to try and prepare students for what they're going to do as a group."

The Antares Foundation, a group based in the Netherlands, is working to change this. The foundation is currently developing good practice guidelines for managing stress in development workers preparing to leave for and returning from the field. It has developed an eight-point action plan for aid organizations to create a policy to recognize and mitigate stress; screen workers for symptoms; prepare and train workers before they enter the field; monitor workers on an ongoing basis; provide ongoing support; provide support in a crisis; create a support network for returning workers; and provide ongoing support as workers integrate back into their lives at home.

The guidelines are expected to be applied by individual aid organizations in a way that best meets the health needs of their workers.

"The principles and indicators are intended to apply to both international and national staff, office and field staff, recognizing that adjustments may be necessary to take into account the unique needs and characteristics of each group," the guidelines state. "They constitute a tool for learning, reflection and planning rather than a set of rigid rules or solutions that are applicable under all conditions."

Antares is also working with the CDC to raise awareness about mental problems in aid workers. Each year since 2001, the two organizations have hosted meetings and conferences centered around the theme of street and humanitarian workers. These gatherings take place in Amsterdam.

The two groups are now working to create workbooks to help aid organizations create stress management programs. They are also working with NGOs to create pilot programs.

Despite these steps, dealing with worker stress will continue to be a challenging issue for aid organizations, according to the CDC's Lopes Cazdozo.

"There's a number of principles in those guidelines," she said, but "you cannot prevent everything even with a good support system in place. If there is an issue, [aid organizations should] be more proactive in providing some help."