A thread on burn-out in global health.

Having been engaged in global health for nearly 2 decades, I suspect high rates of burn out was a big issue before this pandemic.

Rarely discussed and most people suffer silently.

Global health (pre-Covid, at least) involved a lot of travel, and a crazy lifestyle (living off suitcases, meetings, conference calls at crazy hours, need to attend social events). This is initially exciting for young people, but not ideal for stable relationships & families.

The next big issue is global health work is inherently political - dealing with the constant politics, putting out fires, endless negotiations, competition, inter-agency rivalry etc. comes at a personal cost.

Job security is another constant stress: folks working in global health agencies are always nervous about their contract getting renewed, or the prospect of getting laid off.

Movement between agencies is very frequent. Imagine changing jobs every 3-4 years and the toll it takes.

Some global health agencies constantly requires staff to raise funds - they live grant to grant (contract to contract). This is like being on soft-money in academia, and is akin to being on a treadmill that cannot be stopped.

In some agencies (especially global health NGOs), there is a relentless need (or pressure) to compete for every single funding opportunity, no matter what. You get one grant, and even before you can begin to execute that project, you are asked to write the next grant.

Global health agencies are often very hierarchical - there is a long ladder to climb and it is not easy, especially for women, and people of color. Sexism & racism are well documented.

I suspect lack of autonomy is a big reason for burn-out: younger staff are told what to do, and they don't necessarily feel in control of their work.

Things can shift quickly: they can get moved from project to project with little warning. Hard to get a sense of closure.

Intra- and inter-agency rivalry is an issue. If two agencies do not see eye to eye, but still need to cooperate, the staff involved feel conflicted and stressed.

Even within an agency, new staff can get polarized among existing rival groups and feel like they need to pick sides.

I am not sure about access to mental health and counseling services for folks working in global health, but I suspect it is not easy to access them, and confidentiality is always an issue. Word gets around quickly. So, many suffer in silence until it becomes impossible to bear.

Now, with the Covid-19 pandemic, everyone is working flat out & remotely. While travel stress might have eased, other new stressors are in play - from job lay-offs & salary cuts to working with small children at home.

I am worried about high rates of burn-out post-Covid, if this issue is not explicitly anticipated and addressed.

Would like to hear thoughts on how to mitigate burn-out in global health, especially during this crisis. Thank you.