Sami Bilal, Sohail Ali, Mowadat Hussain Rana.
Secondary traumatization in the caregivers - unique case of compassion fatigue in a relief worker.
Pak Armed Forces Med J Jan ;56(4):460-3.

The patient, 31 year old married male, on the afternoon of 8th October 2005 he came to his hospital to offer his services to help the staff on duty. He was instructed by the medical authorities to move to the helipad in a local air base, in an emergency state without any preparation or arrangements. In his medical kit he received a few dozen tablets of pain killers and some bandages. He continued to work with same spirits over the next two weeks. He worked day in and day out with the wounded, mutilated, broken bodies of humans, dead and alive. He helped in the rescue efforts by digging out dead bodies, helped in their burial and helped in tending the wounded. Over the next few days, maintaining the same routine, he started to develop physical fatigue and tiredness, and had difficulty in going to sleep. He became fearful of the after shocks which continued to rock the ground. Outbursts of anger became a constant feature of his routine, and as a result he also became quarrelsome with his colleagues. All these complaints made him unable to perform his duties. In face of such adversity from nature, he himself was trapped in a persistent state of physical and emotional fatigue. It was in this unbearable state of mind and physical exhaustion that, suddenly, the ordeal for him ended and he was instructed to report back to base hospital in Rawalpindi. At his first psychiatric interview, he reported chronic fatigue, multiple somatic complaints, disturbed biological functions, strong guilt and self blame against a background of a "pervasively depressed mood". He had lost compassion - he had lost trust of colleagues and seniors - he indulged himself in medication with benzodiazepines, and he had isolated himself socially. Based on a detailed history and psychiatric assessment he was diagnosed as suffering from "Secondary Trauma".

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