"They Don't Care"

Understanding Compassion Fatigue, Apathy, and Structural Burnout in Tanzanian Workplaces: An unpacking for volunteering in low resource settings.

By Pearl Sakoane-Nogi

“This would never happen in my country.”

“The people seem so cold.”

“Why are they so rude?”

“No one here looks like they care.”

“They don’t comfort patients the way we do back home.”

“They’re ignoring suffering right in front of them.”

“They’re so slow don’t they see it’s urgent?”

“No one smiles or welcomes us. It’s clear they don’t want us here”

“They don’t explain anything.”

“They just left that woman, child, or client alone.”

“They seem angry with each other too.”

“Why do they act annoyed when we ask questions?”

“If they hate the job so much, why do they stay?”

“They shouldn’t be in this profession if they don’t care.”

“They’re so hardened it’s scary.”

These criticisms are honest. They may even come from a place of intention, wanting to understand, and wanting to protect mothers, vulnerable people and do the right thing. But let’s take it a little further.

You are stepping into a space where staff are carrying full-body exhaustion, generational trauma, ethical injury, and deep cultural layers of “coping and tolerating” that have been shaped by economic scarcity, understaffing, and a long history of being under-resourced and overlooked. We all really need to sit with this.

This piece explores WHY Tanzanian workers may appear “cold” or “uncaring”. It does not excuse or harmful behaviours. But it provides the context needed to understand the emotional landscape you are walking into so we can all affect change.

Compassion Fatigue 

in 

Low-Resource Contexts

Compassion fatigue is not just burnout, it is the erosion of empathy after prolonged exposure to suffering without adequate tools, support, or relief. These are not just words, this is a true psychological phenomenon.

Psychologists Charles Figley and Francoise Mathieu describe compassion fatigue as the point where the nervous system shuts down emotional availability to protect itself.

Most people have heard the term “compassion fatigue,” but very few understand what it actually means in practice,  especially in African low-resource healthcare settings.

Compassion fatigue is a medically recognised psychological condition backed by decades of research.

Compassion fatigue is defined by trauma psychologist Dr. Charles Figley (1995) as:

“The cost of caring for others in emotional pain.”

It occurs when a person is repeatedly exposed to suffering, trauma, loss, violence, or crises without enough emotional recovery time or structural support.

This constant exposure overwhelms emotional systems, causing the brain to protect itself by shutting down empathy, blunting emotional responsiveness, and creating detachment as a survival mechanism.

Francoise Mathieu, a leading global expert, expands this:

“Compassion fatigue is the convergence of burnout, secondary traumatic stress, and moral distress; all happening in the same human body.”

In other words, the worker still wants to care,  but physiologically cannot access the emotional bandwidth anymore.

Most volunteers feel something is off but cannot name it. Here are the observable behaviours you will see in Tanzanian hospitals that are classic signs of compassion fatigue:

Emotional Blunting

• Flat facial expression

• Minimal verbal interaction

• Lack of visible empathy i.e unaffected by others’ pain or tears 

• Monotone voice

• Inappropriate responses to a tense situation i.e making jokes, laughing 

• Generally appearing ‘unbothered’

This is not cruelty.This is true emotional numbing,  a protective neurological response.

→ Irritability or Sharpness

• Snapping at colleagues

• Frustration when asked questions

• Impatience (especially with students or volunteers)

Research by Hooper et al. (2010) shows compassion fatigue increases irritability scores significantly in nursing populations.

→ Task-Focused Over People-Focused Behaviour

Staff focus intensely on procedure, protocol, and tasks because tasks feel safer than emotions.

You may see:

• Prioritising charting over comforting

• “just getting through” the patient load

• Limited explanations to mothers or patients

This is cognitive survival.

→ Emotional Withdrawal From Patients

• Reduced eye contact

• Limited physical comfort

• Detached or “cold” communication

Flarity et al. (2013) found that compassion fatigue reduces patient engagement behaviours by up to 40%. This is not “developing country” specific. This is a human limitation.

Depersonalisation

Patients become “cases,” “beds,” or “conditions.”

This language is not disrespect,  it is a coping mechanism to manage overwhelming emotional load

→ Physical Exhaustion

• Leaning on surfaces

• Slow movements, no urgency

• Micro-breaks during procedures

• Deep sighs, glazed eyes

• Forgetfulness between tasks

Compassion fatigue is embodied.The body shows what the spirit is carrying.

→ A Sense of Hopelessness or Futility

• “Hii ndiyo kazi.” (This is the work.)

• “Tunajaribu tu.” (We are just trying.)

• “Hakuna njia nyingine.” (There is no other way.)

Repeated exposure to unfixable suffering creates a resigned worldview.

Secondary Traumatic Stress (STS)

Exposure to trauma that is not your own.

In Tanzania, this can look like: • Witnessing preventable deaths • Seeing suffering caused by lack of infrastructure, finances, food security and/or resources • Hearing distressing stories from neighbours, family, clients, students, victims, or patients on a continuous basis • Handling personal or professional crises without adequate support or training

Studies show workers in high-trauma environments score ~34% higher in STS symptoms than the general population. (Bride et al., 2007)

STS is common across:medical staff, police, teachers, NGO workers,hospitality workers, social welfare officers, counsellors, immigration officers, journalists, and even customer-facing staff.

→ Burnout

A state of severe physical and emotional exhaustion caused by overwhelming workload and chronic stress.

Across Sub-Saharan Africa: • 60–75% of nurses report major burnout • nurse-to-patient ratios can reach 1:20 or worse • public-sector staff in education, social services, and law enforcement report similar overload patterns

The WHO notes that workers in low-resource settings, across all sectors, experience burnout at nearly double the global average due to: understaffing, low pay, lack of tools, inconsistent management, and relentless demand.

Burnout depletes emotional capacity and greatly increases the risk of compassion fatigue.

→ Moral Injury

This is psychological distress caused when workers know the right thing to do, but cannot do it because the system blocks them.

So how does it show up across work placements?:

Medical/Emergency placement Examples:knowing a patient needs monitoring but you have 30 otherslacking equipment to deliver safe carebeing unable to act in an emergency due to resource shortages

Social Work/NGO/Government placement Examples:lacking funds to assist a family in crisisbeing forced to ignore cases due to overwhelming caseloadsbureaucratic or political constraints that prevent ethical action

knowing a child needs psychological support but there is no counsellorovercrowded classrooms preventing proper teaching

Research shows moral injury increases emotional withdrawal by up to 70% (Williamson et al., 2018), because workers live in constant ethical distress they cannot resolve.

Moral injury occurs when a professional knows the right way to care, but cannot deliver it due to environmental conditions beyond their control.

African psychologists point out that moral injury is often misinterpreted as “apathy”, especially by outsiders.

“Apathy is not the absence of care, it is the scar tissue of repeated heartbreak.”, Adapted from Dr. Chinyere Felicia Priest, African psychiatry scholar

Over years, the heart learns that caring hurts.So it shuts down.

Sociocultural Expectations: Emotional Reserve as Professionalism

If you want to understand the culture, understand that many Tanzanian workplaces, especially hospitals, professionalism is equated with stoicism →  meaning showing completely controlled unemotional  calm, and showing very little (if any) emotion, especially during stressful situations. 

From Maasai warriors (Morani) to Sukuma agricultural traditions, emotional endurance has been historically valued as a sign of strength.

A widely cited Kiswahili saying captures the ethos:

“Mwanamke ni uvumilivu.”, A woman is endurance.

Care workers (particularly female) internalise their feelings and belief that showing emotion equals weakness.

To a Western volunteer, this looks like apathy.To a Tanzanian staff member, this looks like competence and showing up professionally.

Post-Colonial Labour Psychology: Why African Staff Withdraw

African scholars such as Achille Mbembe, Ngũgĩ wa Thiong'o, and Frantz Fanon describe how colonial labour structures trained African staff to:

• Follow rigid hierarchical orders

• Suppress emotions

• Avoid questioning supervisors

• Prioritise compliance over care

• Survive rather than thrive

And so people did what they were told in order to survive, until it became the norm. This created workplaces where, speaking up about unsafe conditions is discouraged, staff are blamed for systemic failures, emotional expression is punished, workers detach to survive.

This detachment is mistaken for “rudeness” or “not caring” by volunteers, who come from systems where emotional validation is an expected part of patient care.

Economic Burnout: Poverty Shapes Behaviour More Than Personality

Many Tanzanian staff carry: financial exhaustion, long commutes, dual or triple jobs, family responsibilities (supporting siblings, elderly parents, children), salary delays, no conveniently accessed mental health services.

A manager who snaps at a staff may have; walked 1.5 hours to work, skipped breakfast, been shouted at by a client, worked 3 nights in a row, lost two cases, and still needs to go home and cook for a family of seven.

You cannot separate behaviour from circumstance.

Workplace Apathy as a Symptom of Powerlessness

African philosopher Ngũgĩ wa Thiong’o describes apathy as a “response to the futility of resistance.”

If you cannot change a system, you learn to detach from it. Eventually, emotional withdrawal becomes a rational adaptation.

But We Must Tell the Hard Truth: Staff abuse, Obstetric and Medical Violence DO Exist

People are not imagining it.

Like many countries, there are well-documented issues of:

• Harsh language towards staff,  patients, children, labouring women

• Unacceptable incompetency 

• Unnecessary and unreasonable force

• Neglect of pain, harm or psychological distress

• Rushed or uncommunicated procedures or plans

• Shaming of others in lower positions or who can’t speak up

• Discrimination against poorer people, particularly women

And let’s be honest: this is unacceptable.

But understanding the causes allows us to respond more constructively than blame or judgement.

So Why Then, Do Volunteers Trigger Emotional Tension

Simply because: Volunteer’s  presence highlights the system failures staff have normalised.

This can unintentionally trigger feelings of:

• Shame (“We know our system is broken.”)

• Defensiveness (“Don’t come here and judge us.”)

• Sadness (“You have support and respect that we never received.”)

• Resentment (“You will leave. We will stay.”)

So Do Tanzanian Staff Care?

Yes.

Deeply.

Painfully.

Silently.

But their caring has been reshaped by emotional exhaustion, cultural expectations, professional conditioning, generational trauma.

And So How Volunteers Should Respond (Without Excusing Harm)

Understand it will be hard

Systemic issues take years to break. And only do when everyone contributes to their role (including volunteers) effectively.

Observe before judging

Give yourself one week to watch patterns before drawing conclusions.

Identify systemic, before personal causes for faster solutions

Always ask: “Is this a personal problem or a system problem?”

Advocate gently

Use curiosity, not confrontation:

“Nurse, is there anything I can help with here?” “Is this the normal protocol in this ward?”

Model kindness

Your presence softens environments more than you realise.

Protect patients when necessary

If you witness harm, alert your supervisor immediately.Silence protects no one.

Maintain humility

You are here to understand first, in order to help.

See staff through a trauma-informed lens

If someone is unkind, ask: “What pressure is this person carrying today?”

The Bigger Picture: Love As Resistance

African scholar Dr. Pumla Gqola writes:

“To care deeply in a hardened system is an act of rebellion.”

Many Tanzanian professionals continue to show extraordinary love, even when the system does not love them back.

You are not entering a cold system. You are entering one that moves for it’s own challenges.

Compassion fatigue and apathy among Tanzanian staff are not moral failings. They are survival strategies inside a system stretched beyond human limits. We can do better to arrive with empathy for staff AND for patients, without excusing harm on either side.

Understanding this landscape does not make the work easier, no not at all. But it makes your presence wiser, more grounded, and actually meaningful to the people whose world you are entering.