We all know that the COVID pandemic has taken a toll on healthcare workers. But how was their mental health before the pandemic?

Today’s guest, Dr. Rola Hallam, has opened 7 hospitals in Syria as part of her humanitarian work. Dr. Hallam shares with us that compassion fatigue isn’t really about compassion or fatigue, it’s more likely trauma from having large amounts of empathy.

Dr. Rola Hallam

Dr. Rola Hallam is an award-winning doctor, humanitarian, campaigner, speaker, social entrepreneur, and trauma-informed life coach.

She has been honored with several awards and is also the first Syrian TED Fellow and founder of CanDo — a humanitarian organization supporting frontline health and aid workers to save children’s lives in their war-devastated communities. She has helped build 7 hospitals in Syria, including the first ever crowdfunded hospital, together reaching over 4 million people.

An advocate for the protection of healthcare, healthcare workers, and civilians in conflict, Dr. Hallam has shared global stages with presidents, celebrities, and grassroots activists, and her work has been featured in media from the New York Times to The Daily Show, including two BBC documentaries. Her online talks have been seen over 11 million times, inspiring thousands.

Gabe Howard

Gabe Howard is an award-winning writer and speaker who lives with bipolar disorder. He is the author of the popular book, “Mental Illness is an Asshole and other Observations,” available from Amazon; signed copies are also available directly from the author.

Gabe makes his home in the suburbs of Columbus, Ohio. He lives with his supportive wife, Kendall, and a Miniature Schnauzer dog that he never wanted, but now can’t imagine life without.

To book Gabe for your next event or learn more about him, please visit gabehoward.com.

Producer’s Note: Please be mindful that this transcript has been computer generated and therefore may contain inaccuracies and grammar errors. Thank you.

Announcer: You’re listening to Inside Mental Health: A Psych Central Podcast where experts share experiences and the latest thinking on mental health and psychology. Here’s your host, Gabe Howard.

Gabe Howard: Hello, everyone. I’m your host, Gabe Howard, and calling into the show today, we have Dr. Rola Hallam. Dr. Hallam is the first Syrian TEDx fellow and founder of CanDo, a humanitarian organization supporting frontline health and aid workers. She has been featured in media from The New York Times to The Daily Show. Dr. Hallam, welcome to the show.

Dr. Rola Hallam: Thank you for having me. Hello.

Gabe Howard: You know, the pandemic has changed everything, and I’m required to say that at least once a month. That and the new normal. That’s a big thing that comes out all the time, the new normal. But one of the things that I don’t think that it’s really changed is the burnout and trauma that frontline aid workers have felt. I think they always felt trauma and burnout because it was a very stressful job and many, many hours and of course, life and death situations. But just because burnout and trauma as a frontline aid worker has always been a thing doesn’t mean that it can’t get worse.

Dr. Rola Hallam: Mmm. Well, I think you’re, you’re absolutely right in the sense that it has been a problem for a long time now. Burnout and health workers and aid workers and um, in many of the healing arts, let’s say, has, has been a long-standing problem for a while now. Um, we in medicine have the highest rates of suicide and mental health illness of, of any profession and that was pre-pandemic. So, you’re talking about a already shocking situation that has indeed gotten worse through the pandemic. The latest data from Medscape, one of the biggest surveys of health workers, showed burnout rates at around 60%. Um, and it varies by specialty and, and it’s worse in women than it is in men. But it was bad and it’s gotten worse. But here’s the thing is that we do call it burnout, but actually the recognition that it’s trauma is very low. Most of us, and I was one of these health workers and aid workers, I for years marveled, told myself and others, Wow. It’s amazing how un-traumatized I am considering everything that I’ve seen and that I’ve been through, only to fall into an abyss of burnout and trauma and realize that trauma had really taken up home in every cell of my body. So, there’s a disconnect, if you like, between the mental health and general health and state of well-being in health and aid workers and our perception of what it is that is causing this burnout. The so-called new normal. We’ve stress, chronic stress, toxic stress. You know, traumatic stress has become so normal that we don’t we poorly recognize it. And that is part of the problem.

Gabe Howard: It’s fascinating that you brought up that burnout and trauma are the same thing, because you’re right, I think people hear burnout and they think temporary, right? Oh, I’m so burnt out on my job. Right. But you’re going to have a great weekend. We’re going to go on vacation. We’re going to get dinner tonight. We’re going to relax in front of the television. We’re going to there’s all of these things that treat burnout. But if we actually look at it as traumatizing, you have been traumatized by your job, then I would think that the treatment modality would look differently. And I only say that because I just I can’t imagine someone saying I have been traumatized and somebody looking them right in the eyes and saying, you know what you need? You need a weekend at a bed and breakfast, a good glass of wine and a good book.

Dr. Rola Hallam: And, you know, I still hear that in medicine and I’m like and I kind of just occasionally roll my eyes and but most of the time I just have so much compassion and love for the fact that we are still trying to put plasters on profound wounds. And you know, to your point, I think burnout is a problem across many different professions. But I think what does make it different, if you are a health or an aid worker, is that we are subjected, we are witness to illness, to injustice, to repeated frequent chronic injurious events. Right? Um, I have witnessed children who are severely burnt when their school was bombed and dozens of them came into one of the seven hospitals I helped to build in Syria. That day is etched on my mind, body and soul. Um, I’ve had, you know, children who a child who died from a peanut allergy, a 20-year-old who had an overdose and we couldn’t resuscitate him. And w18-year-old who died at the end of my needle when I promised his mum he was going to be fine. Right. Every one of these incidents marks me. But because it’s my profession and because it’s our normal, we tell ourselves it’s normal, right? And we don’t pause. We don’t take a breath. We don’t do anything about each one of those and I think what happens is eventually they accumulate. All of these wounds eventually accumulate within us, and they will manifest in each one of us in a different way. Right? For some of us, that will be something physical. I developed chronic, chronic back pain. For some people it may be an autoimmune disease, some, you know, some other physical manifestation for someone, a mental or an emotional manifestation. But trauma is the underlying cause of for so many health and aid workers. But there’s such a poor recognition of that fact.

Gabe Howard: When it came to understanding burnout and trauma. As a frontline aid worker, one of the concepts that kept coming up over and over again was compassion fatigue. Can you explain what compassion fatigue is to our listeners?

Dr. Rola Hallam: Oh, my God. So, you’ve. You’ve just put your finger on. On one of my. It’s such a huge myth, right. Um, so just to give you a bit of context. So, I had for the last ten years been working as a doctor and a frontline humanitarian in the war in Syria. I was based in the UK and I would go and do medical missions in Syria and so I was going there every few weeks or a few a few months and treating patients and delivering medical aid and building hospitals and, and, you know, I thought it was going to be a few weeks, right? Um, and then it was going to stop. Maybe a few months, and then I was like, okay, it’s going to be a year. And then, um, nearly two years ago it was the ten-year anniversary and I was doing a BBC interview. And I was talking about another hospital being bombed and I just suddenly had this out-of-body experience. And I was like, what the F? Like, I can’t believe I am still talking about hospitals being bombed and doctors being bombed and schools being bombed and children being bombed. Like, I really just had this moment where I just was like. I felt like the world’s biggest failure. I felt like. Like everything that I was doing was useless, that I was useless. Um, I just suddenly felt out of gas, completely exhausted, completely overwhelmed.

Dr. Rola Hallam: And I kind of knew that I had to stop, basically, and I had to do what I hadn’t allowed myself to do, which was feel. I had to feel all the feelings in order to start to heal. And a lot of people told me, oh, yeah, well, you know, this is compassion fatigue, of course, it fatigues. And something about that didn’t sit with me. Right? Like I’m a Sufi and we call God the compassionate, the merciful. Rahman and Rahim. So, we call the infinite by compassion. And same in Buddhism, which I’ve studied a lot as well. Compassion is one of the four limitless qualities. So, I was like, hang on a minute. How come we say compassion is this infinite, indefatigable, and yet we say it fatigues? And I realized that what we call compassion fatigue is actually empathetic distress and that there is a world of difference between empathy and compassion and actually what most of us, including probably you and me and most of the listeners here practice when we when we witness someone else’s suffering is empathy, right? Like, for example, you see that child, you know, Alan al-Kurdi, he’s, you know, he’s, he’s drowned on the beach and what do most of us do? Oh, oh, no. Like we, we, we, we, we we’re repulsed, right? Like there’s, like, it’s almost like you’ve touched a hot plate.

Dr. Rola Hallam: It’s like there is a there is a pulling away. And we imagine that child as our own child and we’re repulsed. Right. And that is empathy. That is when we actually feel the same emotion as that who is suffering that emotion. And comparison. The hugest difference between empathy and compassion is that you are not feeling with that person. You are not displacing the suffering from that person, that the pain and the suffering stays with that person and you stay in an open-hearted connection with them. And so, you generate a motivation to support and to help. And here’s the biggest difference. Compassion feels good, whereas empathetic distress is painful. And I believe that that is what most of us practice. It’s why we end up turning away from the news. It’s why we end up being overwhelmed. It’s why we end up, you know, um, consumed by, by the news. And everything that happens is we’re not able to be in compassion. We get distressed by our continuous empathy signals until we disconnect. And that’s that becomes our survival mechanism. We disconnect.

Gabe Howard: When I consider all I’ve learned about trauma and compassion, fatigue and burnout, it makes me wonder are our frontline aid workers becoming less empathetic or caring? How is this impacting them and the role that they play in our lives?

Dr. Rola Hallam: And I think that any human has the edge of their tolerance and a point beyond which they are absolutely not their best selves. That is why it’s so critical that we all do the work on ourselves, especially if you are in a profession that has people’s lives in your hands. Right. And that’s why it’s so critical, you know, physician, heal thyself. We cannot heal the world if we are deeply wounded. None of us can. Right. And so, the emphasis for each one of us is to do the work on ourselves so that we can be that healing presence, so that we can be that spark, that catalyst of positive change in the world. And so, and I think that even is even more important if you are a frontline health or aid worker. Um, I kind of think of it a bit like, um, you know, the phone memory, right? Like you need to clear it out. Otherwise, your memory gets full and then you’ve blocked incoming messages and you can’t take any more photos. And it’s kind of the same. You. I feel like we all need to do a good spring clean periodically and clear out all the crap, all the old stories, all the things and emotions and feelings that we just need to feel to let go of and create space and bring that back, that lightness and that brightness so that we’re able to continue without either, like you said, becoming more callous, entitled, whatever, you know, distorted version of our, of ourselves are.

Gabe Howard: Obviously, I would not wish compassion fatigue on anyone. But I do have to wonder, is there a protective factor in all of this? Does it help frontline aid workers do their job and keep themselves? I’m going to go with saying, is there a protective factor in compassion fatigue?

Dr. Rola Hallam: Because of the job, like you said. Um. It becomes a protective mechanism to say, I am going to no longer feel that pain. And we’ve all encountered these health workers who are perfectly professional, but you can tell they are not really connecting with you. And I think that absolutely is a protective mechanism because it gets too painful in order to feel it day in and day out if we are not practicing compassion. And so, it does become a protective factor indeed, I think. But here’s the problem is that, you know, these walls that we build around our hearts in order to stop pain from coming in also end up stopping love and joy and care. And many of the clients who I work with talk about numbing. You know, they just feel numb. They don’t feel bad, but they just don’t feel anything. You know, that tells me that they’ve really encased their heart.

Dr. Rola Hallam: Um. And fortified it with heavy walls in order to stop that that pain, in order to essentially not feel the emotions, not feel the feelings. Right. Because society has told us that to cry is to be weak. And, um, and men don’t cry and strong women don’t cry. And, um, and so, you know, we all believe that bullshit, basically. And, and so, yes, I think it absolutely is protective up to a, up to a degree and up to an extent. But unfortunately, it ends up disconnecting us from ourselves and essentially ends up disconnecting us from each other. It makes our relationships suffer, our family life suffer. Um, it disconnects us from nature, from everything makes us it makes for a very lonely place and for a lonely, lonely person. And I think that is one of the sad facts of burnout and trauma and health workers, is that most of them, according to the Medscape survey, at least 30% of them feel unable to tell anybody about their mental health illness, including family and friends, and they suffer in silence. And that isolation, I think, is part of this disconnection that we’re talking about.

Sponsor Break

Gabe Howard: And we’re back discussing burnout and trauma as a frontline aid worker with Dr. Rola Hallam.

Dr. Rola Hallam: I’d like to add a note. To all of us, whether you’re a health worker or an aid worker, don’t belittle whatever you have been through and whatever pain you are feeling. There is always someone who has been through worse. And I kept myself trapped in my own pain and in my own suffering for so long. Because of that voice of shame that told me, what are you talking about? This, you know, you haven’t even seen the worst of it. Shut up and keep going. You know, like that voice of shame that if you have that, know that that’s the voice of trauma. Do not compare yourself to anyone else. Do not compare what you’ve been through to anyone else. We all need to have the utmost love, compassion, kindness and care towards ourselves. To just meet ourselves wherever we’re at. Because I assure you that’s going to make for such a better life for you and for everybody around you. So please, wherever you’re at, give yourself some love and kindness. It’s going to unlock not only healing, but your growth, evolution and transformation. So, we can all do with being better, better friends to ourselves. Because people’s lives are in our hands. And I think that one of the things that I’m now trying to drum, drum support on is if people’s lives are in our hands, we need to be in our optimal health like athletes, we should be in peak performance, right?

Dr. Rola Hallam: Like that’s the kind of doctor I want to go to. Someone who’s, you know, well rested, who’s, um, you know, uh, feeling enthused with their, with their life mission, who are jumping out of bed every day, skipping into work, thinking, hooray, I’m so happy to be a health worker or an aid worker and feeling motivated and energized and inspired. Um, and the sad reality is that most of us are being seen to by health workers, whether it’s doctors, nurses or otherwise, who are not feeling that. We most of us are being tended to by, um, exhausted, overwhelmed, drained, um, health workers who are so just stuck in survival mode. They are constantly firefighting, um, feeling like they have to sacrifice themselves in order for them to deliver on the, um, inadequate health care that they are providing. And that causes a moral injury. I can tell you, there is nothing worse than knowing you are providing suboptimal care for somebody. You know, like when you kind of look at a patient and you say, like, I would not want this care for my daughter or for my father or for my husband. And yet that is the situation you’re forced into. That is injurious in and of the ins in and of itself. And it doesn’t matter how much money you make or don’t make, um, because that that affects your body, heart and soul and will therefore ricochet across the care that we’re providing to the rest of society.

Gabe Howard: Can frontline aid workers feel value in their job? I mean, we’ve been discussing just so much trauma that you feel it makes me wonder, is there any positivity that they feel? Do they feel joy about their job? Do they feel pride in their jobs or do all roads lead straight to trauma, compassion, fatigue, burnout and so forth?

Dr. Rola Hallam: I think that most people who choose these vocations have had a calling. And I mean, I certainly know from me, you know, I feel like I was born a doctor. I remember, you know, being aged six and growing up in Damascus and playing with my siblings and my cousins and insisting on being the doctor, performing the lifesaving surgeries on Barbies and Sindys, you know, so I think for so many of us, it’s a calling. Um, and. Um, and therefore, when you are fulfilling your purpose and your the mission that you feel you are put on earth, there absolutely is fulfillment and joy and. And a lot of the time it’s in the it’s in the smaller things. So, for example, you know, my bio will tell you I helped to build seven hospitals and I’ve helped impact over 4 million people. That almost feels. Nothing, right? Like that almost feels neutral to me. But when I know that one of the hospitals that we built was crowdfunded by thousands of people around the world and that the build of that hospital brought so much hope to the doctors and nurses who we were gifting this hospital to that they called it Hope Hospital because of how much hope it brought them. Like that fills my heart with joy. You know, the fact that I know we brought so much hope to people who were in such devastating sadness and darkness. Um, so I think there absolutely is fulfillment and there and there is joy. Um, and it’s in those fleeting, fleeting smiles. Um, that that we all witness.

Gabe Howard: It almost seems like compassion fatigue is just unavoidable. I mean, you’re working with people whose suffering is continuous and unresolvable. The terminally ill, refugees. You all don’t show up when everything’s great. You show up when things are going poorly and people are suffering, people are dying. Is there anything that can be done to prevent compassion fatigue?

Dr. Rola Hallam: Oh, 100%, yes. And you know, and this is my message, and this is what I’m constantly drumming into my clients is that it is not an inevitability. It is only inevitable if we sleepwalk into it. Um, and, and continue to fail to learn from, from, from, from the problems and from the mistakes and from the issues and from the things that we’re not doing right. So, for example, one of the first things that I speak to my clients about is how everything starts with us. It all starts with you. We must learn that in order to save lives, we have to put the oxygen mask on ourselves first. Right. And that means prioritizing our own health, our own wellness, our own growth, our own transformation. Not because we’re selfish, but because it is our highest expression of our love and our compassion to make sure that if I am if I’m in my peak performance, if I’m in my best state, then I’m going to treat you and any other patients in the best way possible. And so, I really work with my clients to shatter some of the limiting beliefs that they have around, you know, what culture tells us about sacrificing ourselves and martyrdom. Right? Like a lot of us, especially women, um, and in so many religious traditions, you know, we’re told martyrdom is a good thing. And so, we do sacrifice ourselves and we learn to give, give, give and not receive.

Dr. Rola Hallam: And so, one of the first things I work with and this is one of the things that has been transformative for me is learning to receive. We are all energy. Everything is in motion and we can only truly give if we are receiving. So, one of the first things we must all learn is to receive. You know, that means receiving love, receiving support, receiving money. Just knowing that to give is to receive and is to give is to receive. It’s the same cycle as one and the same thing. And the second thing that I work on is on trauma and tension release. We can all learn how to regulate our nervous system, right? It’s normal for us all to go into fight and flight or even into a state of disconnection, you know, into one of these survival mechanisms. That’s normal. What isn’t normal is if we are unable to bring ourselves back into a sense of safety and security and we get stuck in one of those survival modes. And so, this is where learning various different techniques such as orienting, you know, orienting to your surroundings, different breathwork techniques that will help you to calm yourself after you have been, you know, uh, aggravated into a survival state. So that I teach is how do you calm yourself or energize yourself if you’re in a state of disconnection? And then the hugest one is compassion training. So, neuroscientists have now shown and demonstrated that compassion is a skill and therefore it can be learned.

Gabe Howard: Dr. Hallam, thank you so much for being here. I do want to ask, what about you personally? Trauma, compassion, fatigue and burnout? How has it impacted your life and informed your work?

Dr. Rola Hallam: So, for me, um, I think that two years ago, when it was ten years into the my work responding to the Syrian humanitarian crisis and the Syrian war, that was when really I fell into this big abyss that, um. Where I just felt I felt broken, confused, lost, trapped. Um, I felt like a failure. And I really was just questioning my myself and my purpose. Um, there were days when I couldn’t get out of bed. There were days when I could just only sob. Um, or when a rage would visit, and all I could do was just rage. Um, and I’d realized that, actually, you know, I had coped throughout the last ten years, through my action, through my work, through just, you know, um, doing and I created an organization called CanDo with very much that ethos in mind, right? Is that, you know, we can do something about the world’s problems. We can save lives. And, um, and indeed we can. Um, but I hadn’t, I didn’t allow any space to feel the feelings and, and that was eventually what I was forced to do. Um, and underneath that, I realized was so much grief, so much trauma my own, but also my family’s. We’d lost over 30 members of my family and the collective of my people. And, um. And you know what? Out of that valley of darkness, I emerged a warrior who’s now embodying the words of the poet Rumi.

Dr. Rola Hallam: And he says, Yesterday I was clever, so I tried to change the world. Today I am wise, so I am changing myself. And that’s now the work that I’m doing and I’m honored to do as a trauma Informed Life coach are supporting other frontline health and aid workers, therapists and healers to support them, to prioritize themselves and recover from burnout and trauma and get back to their energized inspired selves. Because God knows, God knows, we need more frontliners, more people who are willing and able to face illness and indifference and injustice and not just survive, but thrive. And I know that it’s possible. I I’ve taken myself through it. I’ve taken many people through it. And I and I know that that is what the world needs. And I feel honored every day to wake up and, you know, work with these incredible people who have witnessed so much and who have been through so much and who are doing the work to, um, get back to it. Um, and it’s an honor and a pleasure. It really is.

Gabe Howard: Thank you so much for being here. Where can folks find you and your work online?

Dr. Rola Hallam: Well, I would love to hear from you. And you can visit my website, DrRolaHallam.com, or drop me a line at Rola@DrRolaCoaching.com. And I’d love to hear from you.

Gabe Howard: Thank you so much, Dr. Hallam, and thank you to all of our listeners as well. My name is Gabe Howard and I am the author of “Mental Illness Is an Asshole and Other Observations.” I’m also an award-winning public speaker who could be available for your next event. My book is on Amazon because, well, everything is, but you can grab a signed copy with free show swag or learn more about me just by heading over to gabehoward.com. Wherever you downloaded this episode, please follow or subscribe to the show. It is absolutely free and hey, can you do me a personal favor? Recommend the show to a friend, a family member or a colleague. Mention it in support group, share it on social media. Hell, send a text sharing the show is how we grow. I will see everybody next Thursday on Inside Mental Health.

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