Each semester, when Gernot appears at the beginning of the third modular period, it is a sign that soon the peace students would leave their laptops, their books and most importantly, their comfort zone. He has been one of the key actors in the development and transformation of the field training component of the MA Program in Peace Studies at the University of Innsbruck. Therefore, one rainy morning of March I visited him at the Austrian Space Forum to know more about his perspective as an experienced aid worker and paramedic on healing, the main topic of this volume. Additionally, we talked about the transformation of the peace students’ training offered by the Red Cross along the years. The Interview was conducted by Alexa Cuello.
MPM: What is the first thing that comes into your mind when you think about healing?
GERNOT GRÖMER: When I hear the word healing, I think I focus boldly on its somatic parts: when people have physical injuries and when they are healing those injuries. However, this encompasses both the physical aspect as well as the person’s attitude towards healing. I believe that healing is the result of an attitude, of how much the person wants to be healed and that means how much the person can take care of him or her-self accepting that he or she has been injured.
The process of healing is a multiphase one I would say. On the one hand, an injured skin heals no matter what you do, except that you treat it very badly. On the other hand, there are certain injuries, from the medical perspective, for which you need an active participation of the patient to heal them. There is a specific rehabilitation process, for example, for a joint to move again and build muscles around, but there are also other long term consequences that need to be taken care of after a serious injury. If you had a traffic accident the healing part is much more complex than just the skin growing together again. An accident can change your brain structure and how you perceive pain because you have gone through an extraordinary event and you have experienced physically how your brain deals with danger for instance. I think, therefore, that healing starts already at the point before the actual action happens. Just as your immune system is trained to deal with threats, the way we are trained to deal with pain has an influence on the healing process as well.
I believe that healing is the result of an attitude, of how much the person wants to be healed and that means how much the person can take care of him or her-self accepting that he or she has been injured.
We [paramedics] talk about a phenomenon which we call cultural fear treatment and we also talk about it in the frame of the peace studies. Basically, we deal with pain in the way the healing tradition of our culture socializes it or treats it. That means, and there are many studies that back up this, that the amount of painkillers that a patient might need depends obviously on the kind of injury he has, but also on which culture he comes from. Every paramedic knows that if there is a patient from Scandinavia who had a ski accident and broke for example a leg, he needs less pain-killers than people from other cultures for instance. If the patient is wearing a uniform, like soldiers do, he needs less pain killers because a soldier is not supposed to cry or complain about his pain.
So, as I see it, we start with the healing process before the accident happens, with these mechanisms that are developed in us according to our attitude and culture. It is a matter of whom and what have made you the person you are and there isn’t too much control you can have about that. There are a few choices you can take as an individual on how much you accept an injury but this is overwhelmingly influenced by the way you have been socialized by your family, your past, your culture, your society.
MPM: In what consist then the approach of the paramedics taking those elements into account?
GERNOT: I think there are two dimensions of this. The first one is that knowing how dealing with pain depends on the culture you are coming from, we take everything seriously. However, we might have a prejudice in the back of our mind: “well, he is just a complaining and crying baby” with a particular person complaining about a small injury or so. Hence, we teach our staff to ‘swallow’ whatever prejudices that might emerge at that very moment. Instead, we try to think that we are living and working in the ‘here and now’ meaning that if a patient feels pain we do something about it, no matter if the injury should be painful or not. Normally, we use a pain scale, ranging from zero to ten. Zero is not pain; ten is the most unimaginable pain you ever had in your life. That is a subjective measure and the way we administer drugs to cope with the pain is depending mostly on that subjective perspective, but then it eradicates the cultural prejudice of the paramedic.
There are as well objective measures that we can use as a measure to complement our assessment in a way but in the end pain though is generated at the place of the injury, is perceived and interpreted in the brain. Thus, many of our tools to treat pain do not work at the point of the injury but at the brain level.
We understand that the physical pain caused by the injury is only one part of the story, so we are also looking at the psychological side meaning that, at certain point, we also know that giving a pain-killer is only one part of it. Also, providing a sense of security and safety, the sense of being as comfortable as we can offer and, sometimes, simple things as offering a blanket to a patient so he or she can cuddle into it are essential elements of our intervention. In other situations, we also refer the patient to psychological support or to post-traumatic support. That is something we have learnt only I wouldn’t say recently but I would say within the last 10 or 20 years. There has been a paradigm shift in that sense, so 20 years ago, when I started to do this, it was ok to tell the patient to “just tough it out”.
Now, we understand that is not the proper way. It is the easiest way but it is not the most efficient way in the healing process. For instance, one visible sign of this paradigm shift is related to how to deal when a person dies. When you have a close relative family member dying unexpectedly of a heart attack, the family is shocked and grieving. 20 years ago our first reaction would have been to offer pills to the close relative members, and I really mean it in the right way, to dump their emotions and overcome the first phase of the mourning. We discovered 15 years ago, that that is actually a bad idea, because you are taking away an important part of the mourning process by dumping or suppressing all those emotions and feelings. So nowadays, we tend to let them mourn as deeply as they want to and offer them support but not drugs any more, with some exceptions of course. We still have them in our arsenal for very rare cases in which we might need them but it is a very uncommon thing.
We try to think that we are living and working in the ‘here and now’ meaning that if a patient feels pain we do something about it, no matter if the injury should be painful or not.
In circumstances like that, there are a few things which I think are still valid that can help you to structure the grief. As strange as this might sound but of course it helps a lot if the person is spiritual or religious, because then they have their rules: for example open the window to let go the soul or cover the mirrors of the mourning house with some blankets or cloths like in my culture.
When you are working with secular people, and someone just died, we need to start the digesting process right in the minute when we say “I’m sorry but your husband died.” Our first rule is to make clear to the relatives that the person is dead. This might sound very obvious and a simple thing to do but it is not. I experienced several cases where for example imagine a couple living together for 50 years and then he or she dies, we would tell to the person surviving her or his partner “we are sorry but we are stopping now the CPR, your husband is dead, we are sorry but he is dead now”. I have had cases where the partner would say “ok that’s a bad thing but would he be able to go to work tomorrow?” Therefore, to grasp the magnitude and the gravity of the situation, we need to speak in very clear words, no matter how hard it might be, but making it absolutely clear that this person is not going to stand up again, that she or he is dead. That is something you have to learn and train, because we tend to phrase it out in metaphors like “he’s not amongst us anymore” or “he’s gone to a place where we all will go some day” and that will not help the person, we need to say clearly: “this person is dead now”.
At the beginning, when we started this changing process, there were many of these tough-it-out personalities among our paramedic staff. Many of them were thinking ‘oh this left extremist liberal approach!’ while others were thinking “I’ve been a paramedic for 30 years I don’t care about this sweet stuff”. That has changed and there are reasons for that. The cultural awareness training is only one part of the training, we also include training elements that you can use at your advantage (as paramedic) to make your work more easily and more efficient. Let me give you an example; let’s start with one very strong stereotype we have here in Austria. We have let’s say a very large family and somebody gets injured and it is a very common thing that you arrive and you see 10 or 15 people who have been called before the ambulance has been called, because you first called the uncle if the grandpa has a heart attack and then you called your sister, and then they all arrived at the place, they are nervous and screaming, it’s chaos! In former times, these tough-it-out personalities among paramedics would have pushed them away screaming “everybody out of the room!” and it would have been a total disastrous situation.
Nowadays, we teach our people that those families are surprisingly well structured. If you are able to identify the head of the family and if you gain that person as a partner, then you have an ally, and they can give clear commands to the rest of the family, if he or she says “get out of the room” then probably the family will do so. If the person says “carry the bags, move the table, make some space,” they will follow the commands and the important thing is that that person does not lose the faith because is still in control of the situation. So suddenly, he is your deputy and you can have 15 more assistants. Once you realize that, you can use this to your strategic advantage for the sick of the patient and once they accept that, the family realize they have a role and everything works better.
MPM: Did the training of a different audience like the peace students influenced that shift in the approach?
GERNOT: Yes! First of all, it has certainly broadened my perspective, because there are so many countries and cultures involved in the training! Many more than we usually have in our everyday activities at the Red Cross. That is one part. The second part would be, something I really highly appreciate, that there is not only the willingness to learn and participate of the students but also that there are many natural talents among them to play the roles of patients within that frame. In that sense, that is a collateral benefit for us, I would say. It is not only a fun aspect, because the exercise is performed lively, but it is also our laboratory, where I can apply my magnified glasses, under very controlled conditions, where I am able to observe the people, their roles within a giving context and bringing their own culture. Therefore, I have to say I learn many things each time that then I can apply in my other teaching activities with young paramedics.
MPM: How has the training to peace students evolved with the years? I imagine that the beginning was something very different from what it looks like now.
GERNOT: When I was approached to hold the first courses more than a decade ago, it was for me like a luxury first aid course, because we had more resources than usual, and we were told to give to the students some privileges that in other courses attendants don’t have. Once I learned about the story behind the peace studies, which I didn’t know very well in the first courses, to be honest, our first reaction within the teachers group was “ok this is a rare thing” (laughs). It was not so much on our radar before, and it has some, I would say to be honest ‘esoteric connotations’ and an emergency management is anything but esoteric of course! You have blood pressure, numbers, drugs, procedures, all straightforward.
So, back then, I chose to accept that and I said “well just let’s make the best out of it, because I like the people”. From the very beginning the people were very likeable and had a huge amount of social competences.
I think the machinery that the people go through here from an educative point of view is really about learning how to stay operationally in time of crisis in a meaningful way.
Later in time, it took me like at least five or six years until I realized how much of a strategic approach was behind the didactic concept of the Peace Studies and why things needed to be done in a certain way. I also realized that things are not given, but things need to evolve with time and then I reached the point when I said “ok, I’m choosing to take a role now in trying not to influence but trying to help evolving the course”. Therefore, the way we do the course now is very different from the way we did it many years ago obviously. I also accepted that the medical part, the bits and pieces of doing CPR are important elements because you need to know that but it is not the only important thing. That is the point when we realized that is also about staying structured, focused and balanced in a time of crisis, where people are screaming and there are lots of blood around you. I hope that barely anybody in the Peace Studies would have to be in situations like the ones we do for real. But I know that almost everybody from the course would not fall apart. I think the machinery that the people go through here from an educative point of view is really about learning how to stay operationally in time of crisis in a meaningful way.
MPM: What would you like to see in the future regarding the field training?
GERNOT: What I hope for the future is a stronger integration of the teaching elements of the field parts. We are now more in a sequential order, which make sense in a way. You start with the ‘easy part’ with the Red Cross and then you go to a more complex situation with the army. However, I could imagine that in the future, and I am not sure if it is going to be in five or ten years or never, but I would like to see a more flowing transition from one element to the other, where you don’t really see that you are switching from one organization to the other anymore. I would argue for a smoother transition in between the steps and a less compartmentalized work in the future.
- Featured Image: © Bernhard Stolz