Edited by Layli Sanaee and Anton Helman

“People who do this type of work talk about the rupture we feel on our return, an irreconcilable invisible difference between us and others. We talk about how difficult it is to assimilate, to assume routine, to sample familiar pleasures. The rift, of course, is not in the world: it is within us….The world is a hard place — a beautiful place, but so too an urgent one. … Once that urgency takes hold, it never completely lets go.”
― James Maskalyk, Six Months in Sudan: A Young Doctor in a War-torn Village

Working on a humanitarian project abroad can be among the most challenging and fulfilling experiences of an Emergency Physician’s career. Much has been written about pre-departure training and strategies for adapting in the field. Far less attention, however, has been given to the challenges of returning home. Among seasoned humanitarian workers, it is well known that re-entry can be the most difficult part of the journey.

I recently sat down with a colleague who returned from a long project in Afghanistan. She described the difficulties of reintegrating into work, friendships, and relationships. I too have faced significant struggles on returning home, and over time I have learned strategies that can make the transition smoother.

This EM Cases Global EM column explores some of the challenges of “reverse culture shock” after humanitarian work and offers practical coping mechanisms.

Understanding Reverse Culture Shock

The difficulties faced after returning home are often described as reverse culture shock or re-entry syndrome. While the symptoms are subjective, there are common themes shared by many:

Alienation – You may feel that no one truly understands what you’ve been through. Friends and colleagues may seem uninterested in your stories, or their daily struggles may feel trivial compared to what you witnessed abroad.

Materialism – Returning to a resource-rich setting can provoke frustration or anger. A well-stocked supermarket, or the way people spend money, may stand in stark contrast to the scarcity and suffering you witnessed abroad.

Shifting Values – Humanitarian work often alters one’s perspective. You may find yourself reassessing priorities, only to be surprised—or frustrated—when friends and family have not changed in the same way.

Medical Practice – The contrast in Emergency Medicine is particularly stark. Abroad, you may have treated patients with advanced disease and few diagnostic tools. Back home, you may face well-resourced environments where extensive tests are used to rule out rare disease. These differences can feel unjust and difficult to reconcile.

I recall returning from several months in a tent hospital in South Sudan to a busy community hospital in Toronto. In South Sudan, we had no labs, overwhelming patient volumes, and high mortality rates. On my first shift back in Toronto, we intubated a 94-year-old and arranged a helicopter transfer of an infant to a specialty hospital just kilometers away. The juxtaposition was jarring.

Effects of Re-Entry

Reverse culture shock manifests in many ways:

  • Excessive criticism or judgment toward your own society

  • Feelings of loneliness, isolation, or not fitting in

  • Clinging to your identity abroad and resisting adaptation

  • Depression, anxiety, and, for some, increased alcohol or drug use

These reactions are common—and normal. Recognizing them as part of the process can be the first step toward coping effectively.

Coping Strategies for Reverse Culture Shock

Over time, and with experience, I have developed strategies that have helped me and colleagues navigate the transition home.

1. Take a Break Before Returning Home

Instead of returning directly from the field, consider a decompression period of at least two weeks. This allows you to process your experiences, rest, and begin adjusting before diving back into work and daily life. After a project in Bangladesh, I spent time at a beach in Sri Lanka. It gave me space to recharge, reconnect with loved ones, and create a shared experience before returning home. These pauses—whether in a nearby safe setting or elsewhere—can help soften the transition.

2. Seek Psychosocial Support

Most major humanitarian organizations provide free psychosocial support for returning staff. Speaking with a trained professional who understands the unique stresses of humanitarian work can be invaluable. Colleagues with global health experience can also be an important support system. I recently met with a friend who had worked abroad; sharing stories was cathartic for both of us.

3. Share Your Story Through Teaching

While colleagues may not fully relate to your experience, many are curious. Giving a talk at rounds or sharing photos and reflections can serve two purposes: it educates and inspires others, while also giving you a chance to process and reframe your own experience.

Final Thoughts on Coping with Reverse Culture Shock

Global health work can be profoundly rewarding, but the return home is often underappreciated as a source of challenge. Reverse culture shock is real—it can leave you feeling isolated, alienated, and unsettled. But with preparation, self-awareness, and the right coping strategies, the transition can be navigated successfully. Recognize that your reactions are normal. Lean on support systems, take time to process, and find healthy ways to share your experiences. By doing so, you not only protect your own well-being but also carry forward the meaning and lessons of your humanitarian work into your life and practice at home.

References

  1. Aid Workers Humanitarian Support. Re-entry Syndrome. Retrieved Aug 26, 2025, from
  2. https://www.aidworkers.com/aid-jobs/career/re-entry-syndrome/
  3. United Nations HR Portal. After Your Assignment. 2015.
  4. https://hr.un.org/page/after-your-assignment
  5. Coles, S. One Person Can’t Save the World. The Walrus. Mar 31, 2020.
  6. https://thewalrus.ca/one-person-cant-save-the-world/
  7. Welch, C. Let’s Talk about Reverse Culture Shock. A Better World Canada. 2025. https://www.abwcanada.ca/19314-2/