A team of eight doctors from Ukraine on the frontlines of wartime medical care is currently spending a month training at Yale New Haven Hospital. The doctors are working to develop new standards of care for Ukrainian soldiers and civilians experiencing chronic pain.
Dr. Roman Smolynets pulled up his phone to show a photo of a young soldier in Ukraine, fitted with a pair of prosthetic legs.
“This patient, after the injury, he lost both legs,” Smolynets said. “And so he suffered from huge pain. He had this headache, neck pain, because the wave from the bomb thew him a couple of meters.”
In the photo, the man’s playing the guitar with a smile – a fact that makes Smolynets proud, as his anesthesiologist.
The patient, and hundreds like him, were sent from the frontlines to one of Ukraine’s largest hospitals, First Medical Union in Lviv, which operates the UNBROKEN National Rehabilitation Center.
Smolynets, 27, heads the pain center at the Lviv hospital comprising 3,000 beds. He said he’s studying multiple ways to manage chronic pain without opioids “because a lot of these patients receive opioids after the injury, and so when patients come to us, I try to not continue.”
Learning through observation
The other component of the doctors’ visit, observing Yale’s research, is critical to the group of Ukrainian physicians, who are tasked with establishing a research center for pain management in their country.
Among that group is Dr. Bozhena Andrushchyshyn, 28, chief of the psychiatric unit at Saint Leo the Great Mental Health Center in Lviv. The unit opened this year to treat tortured Ukrainian prisoners of war.
“They have chronic pain due to repeated beatings in the captivity,” she said. “Concussions, head injuries.”
Andrushchyshyn treats them for depression and post traumatic stress disorder (PTSD), but first they need to be treated for chronic pain so patients can respond to psychiatric treatment, she said.
“If a person has chronic pain, he cannot focus on his psychotherapy,” she said. “I can prescribe a lot of medications for sleep, but he will not sleep if he has chronic pain. So we need to treat chronic pain first.”
That’s why the care is interdisciplinary, involving wound care, anesthesia, psychiatry and rehabilitation. The Ukrainian doctors attend clinical rounds, seminars, and case discussions alongside Yale clinicians.
Their visit is part of a program: Improving Pain Management and Mental Health Treatment in Conflict Territories: Ukraine ‘IMPACT-UA,’” and is paid for by Nova Ukraine and Doctors United for Ukraine (DU4U), with support from the Yale Office of International Affairs.
The program ties into Ukraine Without Pain, a national initiative that supports reform in pain care across Ukraine through physician training, hospital support and public health research. More than a half of the Ukrainian population has PTSD, according to Nova Ukraine.
“This observership is critically important not only for each participating doctor, but for the development of the entire field of chronic pain treatment in Ukraine,” Oksana Gologorskaya, vice president for medical projects, Nova Ukraine, said in a statement.
“Since the start of Russia’s full-scale invasion, this issue has become one of the country’s biggest medical challenges. The number of people suffering from severe pain caused by complex trauma and amputations — both military members and civilians — has grown dramatically because of the war,” Hologorska said.
The program is led by DU4U.
Dr. Yevgeniy Mayr, assistant professor of psychiatry at Yale and director of education at DU4U, oversees the month-long training.
“Ukraine has a solid health care system, at the same time, there is some residual thinking and practicing from Soviet times [that] Ukraine is actively making an effort to revise,” he said.
“The U.S. is in a position because we're a well resourced nation, and we're not in a time of war, it is easier for a person to come and spend time with us and learn a more Western standard of care pertaining to conditions that are relevant to the Ukrainian population, and what Ukrainian clinicians are currently seeing.”
