Community health is a place where everyone has a syllabus and there is one no one discusses. A seemingly parallel curriculum was at play, one that is rarely discussed but also unavoidable and that was happening to me, working within the tough circumstances that most of us work with as a physician, ignored, but present all the time: the emotional work of caring about others.
A community health is a domain in which everyone is bound to have a syllabus and there is none that no one talks about. It was indeed another parallel curriculum which is never talked about but something inevitable and happening to me and all of us as a physician–which we all do as a physician–the emotional labor of caring about others that we all do but silently ignored all the time.
The emotional issues of the profession usually come unexpected to the community health extension workers. They exist in the lonely sorrow upon the death of a patient, the disappointment of a community overcome by its refusal to accept a health intervention and the impotence of even the most adequate care in the face of structural poverty. Often they are not part of classroom lectures, but this is what working in the frontline in the field of public health is all about.
Read more to learn about the way the community health extension workers are influenced by the experiences they have in the field in connection to their emotions.
This article examines the emotional cost that CHEWs experience and how they learn to deal with this and how learning how to be emotionally strong is as important as learning a medical procedure.
Understanding Emotional Labor in Community Health
Emotional labor can be described as the act of controlling feelings to satisfy emotional requirement of work. This translates into more than being polite or professional, as is the case with community health workers, it means empathizing in heart-breaking cases, maintaining composure in emergency calls, and being content with another person in their pain in a case where the health worker is experiencing pain, themselves.
Emotional labor is considered to be among the most significant and long-term aspects of the daily experience of a CHEW which is not directly taught.
- The weight of Witnessing Poverty
The extent of poverty in the area where the students work is one of the first surprises that students receive when they enter field during their practicums. It is not unusual to see homes that lack clean water, children with bloated stomachs because they are malnourished or expectant women as they deliver a baby without a skilled nursing assistant.
Emotional Response:
- Helplessness: Knowledge of what to do and possessing no means to do it.
- Guilt: Going home at the end of the day leaving the patients in the dire conditions.
- Over Identification: Having a sense of guilt in situations which they cannot help.
What they learn:
- The need to see, not only poverty as a condition but as a system.
- To play with very limited resources yet to give the best.
- To concentrate on small, everyday things which can make a difference.
CHEWs discover that strength to the soul has nothing to do with turning a blind eye to suffering, it has everything to do with standing with people through it.
- Facing Death for the First time
No educational presentation could ever prepare a student when a child dies in their arms or a patient breathes the last moment on an outreach. These experiences would leave lasting traces and they are usually unannounced.
Emotional Response:
- Shock and disbelief, more so on the first option.
- Numbness emotionally, intrusive memories or nightmares.
- Questioning of their purpose or competence
Coping strategies:
- Chatting with experienced peers that have entered the scene.
- Putting experience in writing in order to understand it.
- Rituals e.g. saying a silent prayer or having reflection.
With time, CHEWs come to understand that though death is painful and heart rending, it is also a part of life- and so, other times, the best treatment that they can provide is to just be there.
- When Patients Resist Help
A more annoying and confusing emotional issue is that patients or communities refuse to be helped. A mediocre medical regimen can prove resurrection to us, whether it is a parent who refused to immunize a child, a mother who concealed the symptoms because she was scared, one of the village elders refusing to attend a health talk, or an elder sister dismissing an encouragement to eat right, resistance can be personal-it is not.
Underlying causes may include:
- Traditional beliefs or fear of stigma
- Disbelief of the health care system
- Past negative encounters or misinformation
What CHEWs learn:
- Not to just take in failure personally
- To approach listening with no judgment and trust as time goes by.
- That kindness and perseverance tend to conquer people gradually.
These incidences instil humility, empathy and need to work alongside and not against communities.
- Carrying the Burden of Expectation
CHEWs are not only considered to be health workers, but are regarded as miracle workers in most communities. In hopes that they will deliver a medicine, solve bureaucracy, or offer financial support, their families expect them. In the instances when CHEWs are unable to provide everything, they might feel angered or disappointed.
Emotional pressure includes:
- Being held for systemic downfalls
- Feeling stretched thin
- Guilt when personal needs are not met
How they cope:
- Training boundaries on emotion and profession
- Paying attention on what they can control
- In search of sympathy with other people who share the burden
They, however, come to discover the boundaries of care-but even in the boundaries of care, compassion is important.
- Navigating Family Trauma and Violence
CHEWs also come across instances of domestic abuse, child abuse or sexual exploitation. Such scenarios called not only on medical expertise but also on bravery, confidentiality and emotional strength.
Emotional impact:
- Anger at unfairness
- Fear for the affected safety
- Ethical issues about reporting
Lived response:
- Supervisors quietly or consulting mentors
- Non confrontational documentation
- The reliance on community facilities in order to locate solutions that are safe
These experiences remain in the minds of CHEWs long after the completion of the practicum, greatly influencing their ethical direction and vision and increasing their empathy.
- The Silent Toll of Emotional Suppression
CHEWs are typically supposed to be strong- especially the ones in the cultures that stigmatize emotional expression. With time, the requirement to suppress emotion may lead to:
- Burnout
- Compassion fatigue
- Emotional downfall
What they eventually learn:
- That crying, yelling, blogging, or grieving doesn’t make them damsel weaklings
- The fact that professional sustainability is related to emotional health
- That opens up and shared vulnerably leaves room and room to make connections and healing processes happens
Peer support networks, which may be informal, become life line.
- Finding Support in Unexpected Places
Even though emotional coping is not addressed in the classrooms, CHEWs may get the support in unexpected manners:
Peer Support:
CHEWs reveal themselves to one another during debriefs following outreach programs or during dinner in student lodges. They go through the ups and downs, rejoice when there are success stories and comfort during the bad moments.
Mentorship:
Experienced CHEWs, nurses, or community members have much to teach beyond text books. They recount their own tales of failures, and strengths, and graces—and assert that one can survive.
Community Gratitude:
A little something as a simple “thank you,” a plate of food from a thankful patient, or the smile from a young child can become a source of rejuvenation. Tales of peace indicate that they are making a difference.
- Self care: The Unspoken Curriculum
As CHEWs advance in learning, it has been recorded that one would frequently initiate some form of self-protective routines and habits to ensure mental wellness. These may entail:
- Reflective journals to reorganize the feelings
- Exercises or walking to get rid of tension.
- Peace by praying, meditating or spiritual grounding
- Trying to listen to some music or dancing to find the joy again
- Even short-term breaks to restore
These are the things that are hardly taught yet they are so serious.
- Developing Emotional Intelligence Over Time
Every new emotional challenge enables CHEWs to evolve what psychologists’ term emotional intelligence: the capacity to acknowledge, appreciate and control their emotions as well as the emotional state of others.
They learn:
- Self awareness: Being knowledgeable of what pushes them
- Empathy: Touching and not merely empathizing with humans
- Emotional Regulation: Being still under pressure
- Social Skills: Being aware of how to create trust and eliminate tension
These characteristics mean that CHEWs become more than just technical workers, they become community leaders.
- Why Emotional Resilience Matters in the Long Run
It allows emotionally strong CHEWs to be more adequately prepared:
- To prevent burnout
- To stay understanding through years of practice
- In Being mature to deal with ethical complexity
- To be a role model to others in a healthy emotional behaviour
- In sustaining community trust
The best worker may become weak when it comes to emotion resilience. With it, even the limited resources can do a great contribution.
Institutional Gaps: What More Can Be Done?
Although CHEWs tend to acquire their own solution to working with emotions, learning institutions may assist them by:
- Adding mental health modules in school curriculum
- Helping to have group reflections, or journaling, as guided
- Development of access to student counselling service
- Promoting the culture of not feeling weak when one asks for help
The professionalization of emotional education does not eliminate the experience of living in it-but it can equip the students who go through it with more resources and less pain.
Conclusion
They are untold stories but a huge deal of emotion that a community health extension worker goes through. One of them (CHEWs) is the process of visiting mourning families, encountering resistance, binding and suffering silences, as well as discovering unfaded strengths; the emotional journey of CHEWs is as important in shaping them as any classroom lesson.
Such are the things, nobody ever tells you about–the things, though, that leads one right into the pulses of community health work. In every tear that cannot be heard and every doubt that cannot be expressed and every little victory that wordlessly comes by, CHEWs will not just be health workers they will be a healer, an advocate and a hope anchor.
It is not only humane, but critical to supporting the resilient, humane health system, to recognize and compensate their emotional effort.
