"It is important to see the situation from the point of view of the affected people and communities"

Bhava Poudyal, originally from Nepal, works as a regional mental health and psychosocial specialist in Bangkok, Thailand.

Can you please describe your background and role at the ICRC?

I started working for the ICRC in 2010 as a consultant in Nepal. Between 2012 and 2019, I worked as a delegate in Azerbaijan, Sri Lanka, and Tajikistan. Since 2019, I have been based in Bangkok as the regional mental health and psychosocial specialist. 

How did your career at the ICRC start?

Prior to joining the ICRC, I had worked in the humanitarian sector for 15 years in low- and middle-income countries, providing support to victims of trauma, ranging from natural disasters to conflicts. I started my career at the ICRC in by designing, implementing, and evaluating a new programme to help the families of missing people in Nepal.

What does your day-to-day work involve?

Right now, as regional advisor, my main role is to develop strategies and programmes to help delegates to analyse and adapt to new cultural environments. I talk to delegates in different countries about their programme plans for the coming years. We brainstorm and strategize; sometimes we need to design a new programme and sometimes we just need to tweak an existing one. I also examine training proposals in terms of the content/materials developed by delegates, and I communicate and cooperate with specialists from different departments.

What is the most rewarding part of your job?

I enjoy all aspects of my job, including assessing and developing solutions, thinking outside the box and being creative. I like capacity-building activities, particularly those for field officers and grass-roots service providers without a psychology background, as we often work in contexts where there are no psychologists to support affected people and communities. I also love being able to measure outcomes and evaluate the effectiveness of programmes.

Can you tell us more about your work on programmes?

We are very client-focused and aim to help people in whatever way best suits them. After a traumatic event, some people do not wish to examine their experience but prefer instead to learn how to manage their distress and focus on the “here and now”, in order to get on with their daily lives. If that is their choice, we help them to achieve their goal. Other people want to process their trauma and learn from their experience. If that is what they prefer, we try to help them with that task.

We focus on different areas, including providing support to victims of violence and the families of missing persons, providing care to front-line workers and integrating mental health into the work of our physical rehabilitation centres.

For example, our victims of violence programme has a two-pronged approach: it aims to build the capacity of health facilities and capacity at the community level. We try to look at both angles in order to improve services for victims of violence, including sexual violence, in the context of armed conflicts, and to ensure a continuum of care.

We also work to integrate mental health into the work of centres that treat patients wounded by weapons and those requiring physical rehabilitation. People who have had limbs amputated - a traumatic experience in itself - face a lot of existential worries. We try to help them to deal with their current situation, stick with their physical rehabilitation process, and work out what they want to do in the future.

Can you tell us a bit more about how you adapt your programmes to different cultural settings?

When you enter a new environment, you spend the first few months talking to people to understand how they think and how they attribute meaning to different kinds of experiences. You try to identify people’s help-seeking behaviour, who they might turn to and what measures could be effective. You might look at the role of religion or culture in how people express their distress, and the importance attributed to healing and well-being.

In many cultures, people do not discuss mental health and those with mental health issues are often stigmatized. It is therefore important to see the situation, including the problems that arise and the type of help required, from the point of view of the affected people and communities. We need to understand how people create meaning and how they perceive their traumatic experiences. To start a dialogue, it is important to take into account the cultural context and to establish a culturally sensitive framework. It is not possible to apply a single, uniform approach – perhaps one learned at university – in every country.

Can you describe a memorable experience?

It is hard to pick just one. However, I do remember something that happened while I was working in Azerbaijan with relatives of people who had been missing for 20 years. The families were still very much affected by their experience and going through the grieving process. In one of our support group meetings, people had been asked to create something to honour the memory of their missing loved ones. One mother brought in a chocolate cake that had been her son’s favourite. She had stopped baking after his disappearance two decades previously. The support group had allowed her to talk about her son, and she wanted to share her son’s favourite cake. It is truly memorable to see these kinds of reactions.

Do you have any advice for psychologists who would like to work for the ICRC?

The ICRC generally requires a minimum of a master’s degree in clinical psychology and two years of international experience. I would also encourage applicants to gain knowledge of cross-cultural psychology because it is very, very important in our work. It would also be very useful to read up on and become familiar with international consensus guidelines, such as the IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings, the WHO Mental Health Gap Action Programme (mhGAP) and the ICRC Guidelines on Mental Health and Psychosocial Support.