Camaraderie and community: Buffers against compassion fatigue among expatriate healthcare workers during the Ebola epidemic of 2013–16

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Aim: This study assessed the prevalence of compassion fatigue, compassion satisfaction and burnout among expatriate Ebola aid workers roughly 1 year after they returned from deployment. It also investigated methods by which care providers managed stress in the field and when they returned to their homes.

Methods: A convenience sample of medical care providers who were solicited by non-governmental organizations that deployed practitioners to work in the Ebola response were asked to complete an online Professional Quality of Life (ProQOL 5) scale. Of those respondents, one-third consented to sit for a key informant interview to validate the findings and explore aspects of stress management. Responses were calculated for the whole sample and then differentiated into groups based on professional role and years of professional experience. MANOVA and independent samples t-tests were administered. An inductive thematic analysis, which included open and axial coding, was applied to the interview data.

Results: Fifty-eight participants completed the scale; of those, 20 participants were interviewed. There were no significant differences between the interview and non-interview group ProQOL 5 scores. The whole sample scored in the lowest 25% quartile with regards to compassion satisfaction, but scored in the 50% quartile with regards to compassion fatigue and burnout. Within the sample, physicians scored significantly lower than the other groups with regards to compassion fatigue (p=0.05, 95% CI −0.03 to 8.56). Providers with 1–5 years of experience scored significantly higher on the burnout scale compared to standard quartiles presented by ProQOL (p=0.031, 95% CI −10.47 to −0.51). Six themes arose from the qualitative analysis that supported the ProQOL findings: Changes on return, Camaraderie, Satisfaction—self and others, Dissatisfaction—organizational, Seeking organizational support and Extreme situations.

Conclusions: The qualitative data from this study validated the ProQOL 5 findings that expatriate providers who worked in the Ebola response did not experience high levels of compassion fatigue and burnout 1 year after deployment. These results suggest post-traumatic growth among the study sample. Post-traumatic growth refers to one’s ability to recognize and embody positive changes in one’s life after witnessing or experiencing trauma. One would posit that providers with lower levels of compassion fatigue and burnout post Ebola may be exhibiting post-traumatic growth which, through its positive response to traumatic events, may decrease the likelihood of burnout. Providers with fewer years of professional experience were most at risk for high burnout scores, and physicians, as compared to the other professional groups, had lower scores of compassion fatigue. Providers described strong senses of community and camaraderie, coupled with the use of narrative methods as tools that helped them manage the stresses of caring for Ebola patients. It is likely that collegial support, despite witnessing excess death and working in the face of organizational dysfunction, buffered these providers against compassion fatigue and burnout.