Preparing humanitarian workers for disaster response: a Red Cross/Red Crescent field training model

 

Over the past decade, humanitarian operations have become increasingly complex, with multiple actors, new roles for the military, new and evolving standards and guidelines, new terminologies, new products, a variety of coordination platforms, changing donor roles, challenges in accessing populations in need and chronic conflicts and anomalous climate patterns leaving communities more vulnerable than ever. These developments have generally not been matched by sufficient practical training to equip those engaged in delivering humanitarian relief and assistance with the skills they need to do their jobs. Projected future challenges may well create fresh new complexities.[1]

The skills needed for disaster response

Teams deployed in emergencies are required to initiate rapid assessments and implement appropriate interventions within days of a disaster. Coupled with the need for a rapid response in conditions of extreme physical and mental stress, aid workers must adapt to and deal with unfamiliar demographics, cultures, political environments and climates. This further complicates the task of implementing relief activities that are relevant, timely and well-targeted.

The skills sufficient 15 or 20 years ago are no longer enough to succeed in today’s complex humanitarian environment. A new approach to training and skills development is needed, not least to respond to the greater demands of donors and stricter professional accountability measures.[2] This must be matched with a complementary level of institutional commitment and financial investment, aimed at improving the efficiency of humanitarian operations.

The ability to rapidly adapt to changes in culture, working and living conditions, language and professional practice and standards is a fundamental prerequisite for aid workers. For many this can be very unsettling. The most successful tend to be those who have had relevant prior experience. Aid workers must be able to coordinate, build and work in teams and interact with communities across sectors (health, water, sanitation, shelter, nutrition, security, gender, the environment). This is essential during the early post-disaster phase. Aid workers need to understand the links between sectors, and how these links impact upon overall health and wellbeing. Finally, effective disaster response in emergency public health requires the ability to communicate effectively with many stakeholders: a mother, a deputy health minister, a local nurse and field officers, often through interpreters.

The need to modify training methods

Much humanitarian intervention training is classroom-based, coupled with role-playing and table-top simulations. The background of many participants (highly specialised, lacking cross-cultural experience and effective communication skills, lacking practice in community entrance techniques and basic household interview skills) can leave them overwhelmed and barely able to cope in real deployments. Completing a classroom training course does not necessarily qualify people for complex humanitarian operations.[3]

In 2007, the Norwegian Red Cross and the International Federation of Red Cross and Red Crescent Societies (IFRC) developed a field-based training model focusing on humanitarian response in disasters. Five Field Schools were conducted (in Kenya in July 2007 and November 2009, Belize in May 2008, Cambodia in December 2008 and Fiji in June 2009). A total of 140 people were trained, and each training mission was overseen by on average 15 facilitators. The settings selected for the field training missions were all remote rural communities with high rates of morbidity and mortality resulting from poverty and disasters. The thematic focus throughout the training has been on public health in emergencies, using a holistic approach encompassing water, sanitation, emergency shelter, nutrition and psychosocial support.

The Field School training concept

The Field School is a unique form of training, consisting of total immersion in a mission environment. The Field School has a focus on ‘learning by doing’, while participants are mentored by experienced facilitators on a 24-hour, seven-day-a-week basis. A practical two-week modular curriculum mirroring Red Cross/Red Crescent disaster response forms the basis of the approach. The mission places participants in conditions of physical and psychological stress similar to those they are likely to experience in the early stages of deployment to major disasters. Male and female participants, representing a diverse mix of international, regional and national Red Cross/Red Crescent staff, are chosen against specific selection criteria, and are required to complete a pre-course paper outlining their expectations, aims and objectives. Participants are also required to complete pre-course reading aimed at providing theoretical knowledge across response sectors.

Field School facilitators have extensive humanitarian field experience, as well as the proven ability to coach, mentor and support personnel in working environments. The facilitators promote continuous active learning and demonstration, coupled with a culture and ethic of true community participation. Facilitators are constantly challenged to sharpen their own pedagogical skills, and to be flexible, responsive and creative in meeting the learning objectives of participants.

Preparation for the training

In the planning phase for the Field School, an assessment team undertakes a scoping mission with the host National Society of the country in which the training is to take place. A recent external review has emphasised the importance of thorough preparation and site selection criteria to guide this process.[4] Community meetings take place with the authorities and the target population to inform them of the aims and expected outcomes of the Field School. Once common understanding and acceptance have been achieved community contacts are followed up by the local Red Cross Branch to further clarify any outstanding concerns. This also contributes to addressing community expectations, and planning for what the Field School will ‘leave behind’ as a contribution to these communities.

The training

Learning objectives are articulated in a defined but flexible curriculum. Participants are divided into small teams of five to seven people, and are required to engage with communities in a ‘real’ disaster response. No classroom presentations are used.

The participants assess, plan, train local volunteers and implement short-term interventions, which have included disease prevention and health awareness activities. This work takes place in close partnership with local branches, volunteers and communities, thus simultaneously building local capacity. Improving communication skills and learning how to build trust with local counterparts are integral components of the curriculum. Participants set up a secure operational base including infrastructure – water, sanitation, telecommunications, shelter and logistical arrangements – and deal with day-to-day problems. From this base, and with real-time mentoring, teams are required to undertake community meetings and engage in focus group discussions to identify priority needs. The Field School offers a unique chance to coach participants and practice communications with a variety of counterparts, often through interpreters and under stressful conditions.

While engaged in the mission, the field teams manage budgets and work to tight deadlines. They also use existing disaster response tools, guidelines, manuals and templates, including communicating with simulated task forces and the media. Security awareness and simulations are also included in the curriculum. Where possible, the Field School links with ongoing activities in the area managed by the authorities, local Red Cross branches, the Ministry of Health and NGOs. These have included food or relief item distributions, health services and coordination meetings. Active coordination with other actors in a community is key to a successful intervention, and one of the hardest tasks for teams under time pressures and stress.

An additional component pioneered in all four training courses has been the field-testing of various relief and medical products, including rapid malaria tests, inflatable rafts, solar cells, rapid set-up latrines, shower tents and water purification systems. This component is seen as a vetting process to enable better decision-making in selecting appropriate technology for the field.

Training outcomes

The impact of the training on participants is monitored closely throughout the mission by the mentors, as well as through formal written evaluations. These help facilitators to fine-tune the training as it progresses. Results to date, confirmed through post-training follow-up and a review of the Field School concept, indicate that, while participants acknowledge some of the difficult personal and professional challenges of the training mission, they have been able to incorporate the skills they have acquired into their work in subsequent missions. The three most highly rated aspects of the training are the ‘how to’ skills acquired, multi-disciplinary learning and working with local volunteers in the communities. In addition, the mix of international, regional and local participants with diverse backgrounds was cited as contributing to learning through the exchange of experience and the opportunity to see different perspectives. Most participants also cited teamwork as a key enhanced skill, including greater appreciation for non-mission-related activities that improve productivity and team cohesiveness.

Benefits to the communities 

Communities are encouraged to highlight concerns and challenges in their daily lives. All assessment findings and plans of action developed for training purposes are provided to the local Red Cross/Red Crescent Branch, to guide ongoing activities and possible future programming. Based on the data gathered from the assessments and presented to the host National Red Cross/Red Crescent Society, and in some cases the Ministry of Health, inputs have been provided to the community following the training. In Belize, for example, community water tanks – highlighted as a priority need – were installed to help with water storage in the dry season. In Cambodia, a building was renovated as the Red Cross Branch office in the district where the assessments took place, and over 70 volunteers were trained in disease prevention and health promotion. The plans of action developed by the Field School participants were later presented to the Australian Red Cross, which subsequently supported a Cambodian Red Cross water and sanitation project in the district where the Field School was run.

Ethical issues

The involvement of poorer communities in learning processes has posed ethical challenges to all the Field Schools. The training mission by definition entails elements of trial and error, and raised expectations are also a factor. The recent review of the Field School emphasises the need to be ethically correct towards the communities involved, i.e. to be aware that foreign presence always creates expectations. The needs of the community must never be ignored, not even in a training situation.

Although the facilitators offer close guidance to ensure safe practice and control for errors, ethical dilemmas remain a daily agenda item during the training. Some ethical issues were addressed by providing a field equivalent of informed consent. Such measures will vary by country and district, and need to be prioritised throughout the planning and implementation phases. Consideration of future potential Field School locations needs to include and be synchronised with post-training follow-up projects in these locations.

Conclusions

Humanitarian aid continues to evolve from ad hoc assistance into a science that requires skilled and specialised personnel. Those engaged in the delivery of aid need not accept that they can only learn the skills they require during actual operations, possibly at the expense of delivering optimal services to stricken communities. The recent external review confirms the benefits of the Field School concept. The Field School has demonstrated that it can build upon classroom-based training, adding a practical layer through total immersion in disaster operations: a form of internship for humanitarian workers. Participants learn to apply combined theory and skills, use appropriate tools and communicate effectively with communities and among themselves. This holistic multi-disciplinary approach is uniquely possible in the type of mission environment the Field School provides.

The methodology can be applied to other sector training as well, through the development and adaptation of existing classroom-based training modules and coaching by facilitators. The modular curricula can be modified to address longer-term community-based disaster preparedness and development. The Field School concept could expand and become more effective through partnerships with other humanitarian organisations, applied research groups and academic institutions. It can also be used to field-test new concepts, devices, products and approaches before deploying them in actual emergencies.

The Field School is an appropriate and successful training medium for developing the field skills of disaster response workers to an adequate and effective level. An improved response to disasters requires more coordination and collaboration among humanitarian organisations and academic institutions to further validate such approaches and gather further evidence. Mainstream tools can then be developed and adopted to improve disaster response outcomes overall. Whilst the Field School model has addressed many of the gaps in the humanitarian working environment by focusing on developing the skill sets of humanitarian aid workers, a commitment is needed to the parallel development of policies, standards, guidelines and equipment for disaster response.

Hossam Elsharkawi (hossam.elsharkawi@redcross.no) is Emergency Response Coordinator, Health in Emergencies Advisor, Norwegian Red Cross. Hakan Sandbladh is a former IFRC Senior Health Officer. Tammam Aloudat (tammam.aloudat@ifrc.org) is Senior Officer, Health in Emergencies, IFRC. Andree Girardau is Field School Manager. Ingrid Tjoflåt is Associate Professor of Nursing, University of Stavanger, Norway. Cecilia Brunnström is a Red Cross Consultant and Delegate, and Field School External Review Consultant. The authors would like to acknowledge the contributions of the facilitators who have assisted in developing and fine-tuning the Field School model, including M. Fisher, A. Koestler, A. Marschang, R. Munz and M. Ververs, as well as the Kenyan Red Cross.

[1] International Federation of Red Cross and Red Crescent Societies (IFRC), World Disaster Report 2009: Focus on Early Warning, Early Action; Humanitarian Response Review, An independent report commissioned by the United Nations Emergency Relief Coordinator and Under-Secretary-General for Humanitarian Affairs, OCHA, 2005.

[2] ‘The Effectiveness of Disaster Training for Health Care Workers: A Systematic Review’, Ann Emerg Med. 2008. 52(3):211-22, 222.e1-2.

[3] Aidan J. Byrne et al., ’Review of Comparative Studies of Clinical Skills Training’, BEME Rapid Review, 30:764–767, 2008.

[4] C. Brunnström C, ‘Field School: External Review’, Document posted on Disaster Management Information System Web, DMIS. Contact authors for copies.