Violent and traumatic events are a regular occurrence in many South Africans’ lives. The term 'continuous traumatic stress’ was coined by South African anti-apartheid health professionals in the 1980’s to explain the continuous nature of violence and trauma happening within the country. Although the political agenda may have shifted, many South Africans are still living within a context in which violent and traumatic events regularly occur. However, little is known about how health workers respond to continuous trauma within the South African setting. The Community Health Workers - within this study - are part of the South African health model called ‘Primary Health Care Re-engineering’ that is currently being piloted. The research was exploratory in nature and used a mixed methods design. Twenty three Community Health Workers who participated in the study were from two sub-districts within the Ekurhuleni district, Gauteng, Johannesburg. The research included two face to face semi-structured individual interviews. The first included qualitative questions and completion of the quantitative Stressful Life Events Screening Questionnaire (1998) to explore past trauma experiences. Over a seven month period, the participants were asked to document traumatic event exposure and responses through the adapted Life Events Checklist (1995) and personal journaling. At the end of this period, participants were interviewed again to explore their current traumatic experiences. Qualitative data were analysed through thematic content analysis and quantitative data were used to substantiate information from the interviews and checklists. Results show that Community Health Workers – within this study - have a high prevalence of exposure to traumatic events (directly experiencing, witnessing and hearing about). Prominent events included physical and sexual assault, transport accidents, fires and explosions. Media played a powerful role in exposure to events. Traumatic and unexpected losses were key experiences that need to be considered when working with trauma in the South African context. Acknowledgement of experiences (peer and external) is an essential element in developing support structures. These findings – from the context of Ekurhuleni, South Africa - contribute to exploring and understanding the experience of ‘continuous traumatic stress’ for Community Health Workers.

Researchers have found an overlap of psychological symptoms in victims of Post-Traumatic Stress Disorder and Continuous Traumatic Stress. Although the circumstances inducing the psychological reactions are different, the symptoms mimic one another without a clear cut demarcation, calling for practitioners to be cautious of contexts inducing psychopathology that is triggered through re-experiencing of past trauma when they are assessing and intervening with ongoing trauma-exposed communities. This study explored the subjective experiences of 15 local Non-Governmental Organization (NGO) administrators in Nigeria across 5 states, including the federal capital Abuja, about the intersectionality of their clients' persistent trauma experiences and their program planning and intervention strategies. The study leveraged complexity and organizational change models, using qualitative inquiry with open ended interview questions and purposive sampling. Questions probed administrators' modalities, orientations, and perceptions that inform organizational planning and interventions. Open-ended interviews of top local NGO administrators provided contrasting insights on current interventions. Data were collected and analyzed using constant comparative content analysis. Findings suggest that local NGO administrators currently lack the awareness and capacity to address their clients' psychosocial, behavioral, and mental health issues that are related to continuous, direct, and indirect violence. The study impacts social change by identifying gaps in current NGO administrators' efforts to reduce effects of violence and support peace in affected communities.