In Turkey, Ukraine, and beyond, the necessity of trauma care

Watching news reports of the heroic relief efforts underway in Turkey and Syria following the devastating earthquake there, I can imagine the terrible weight of emotional trauma that so many people are experiencing right now because I’ve experienced it myself.

A dozen years ago, as a young doctor with a background in emergency medicine, I felt prepared to handle disaster response situations. But I was totally unprepared for the constant exposure to widespread suffering and death that I experienced while providing emergency medical relief after the 2010 earthquake that killed 220,000 people in Haiti.

I arrived in Haiti a few days after the earthquake and worked there for only three weeks. But after returning home to New Orleans, I was an emotional wreck. I cried all the time. Once I made an appointment to see a psychiatrist and began therapy, I felt an enormous weight lift from me. I recovered quickly after that.

Experiencing trauma of one type or another is not rare. About 60% of men and 50% of women have at least one traumatic experience in their lives. Women are more likely to experience sexual assault and child abuse, while men are more likely to experience accidents, physical assault, and combat, or to witness death or violence.

But more and more people are experiencing societal trauma. Mass shootings and incidents of police brutality top the headlines every week. Hurricanes, heatwaves, wildfires, and other climate-related disasters are striking more frequently and with greater intensity, upending lives and entrenching fear and anxiety among many. Covid-19 has taken an enormous toll on the mental and emotional health of the people of this country.

Yet few doctors are trained to deal with trauma. More need to be. They must be prepared to deal with the effects of traumatic experiences — their patients and their own.

In 2022, I joined a relief effort sponsored by the Swiss Foundation for Innovation to help clinicians in Ukraine provide lifesaving treatment to civilians living amid wartime danger and constant stress. I’d already seen how Russia was directly targeting civilian communities for attack, and recognized that Ukrainian clinicians needed specialized support.

My colleagues and I designed a virtual trauma care program for clinicians dealing with the constant threat of extreme violence. Faculty members from all over the world taught the course to dozens of Ukrainian clinicians connecting on their cell phones.

The program’s initial focus was on treating physical trauma. How do you help a pregnant person who’s been shot? What do you do if someone is on fire?

But I also remembered my experience with emotional trauma in Haiti. I imagined that the clinicians in Ukraine working so desperately to save the lives of their fellow citizens were experiencing the same things I had — or worse. I wanted to make sure they had support for dealing with the effects of not only of physical trauma but also emotional trauma, for their patients and for themselves.

We partnered with the Center for Deployment Psychology at the U.S. Uniformed Services University of Health Sciences to build into the program a component on emotional trauma. The university’s world-class experts provided instruction on trauma-informed mental health care at the end of every telementoring class session.

Participants told us how much they valued the mental health trauma component of the program. We were given frequent reminders that providers were experiencing the collective trauma of war, such as when our participants lost colleagues in a bombing at a rehabilitative hospital, or when we suddenly saw a decline in participation in the midst of an air raid.

The program has ended but, given ongoing demand, we plan to relaunch it soon.

Efforts like this are needed now and will be in the future in conflict zones and disaster areas around the world, as well as in the U.S. Training doctors about trauma and its effects on mental health should start in medical school and be offered through the continuing medical education system. Learning about trauma care needs to become a standard of practice.

For the program in Ukraine, we used the collaborative online learning model created by Project ECHO, a global telementoring network, as the backbone for the training program. It’s a flexible, highly interactive model used worldwide to bring specialized medical treatment and other types of expertise to remote places. The trauma care faculty could communicate in real time with doctors literally on the front lines of war to share not only best practices but also to receive new insights from those same doctors working in the field. It helped us create an ongoing learning community with clinicians working under extraordinary circumstances.

Although the program was designed for armed conflict scenarios, it can easily be applied to natural disasters, such as earthquakes or wildfires, to mass shootings, and more. The Swiss Foundation for Innovation is considering replicating the program in Turkey and Syria.

We live in traumatic times, and we don’t know when — or if — that will change. Whether it is the all-too-common occurrence of gun violence in U.S. schools and communities or the next global pandemic, the clinical workforce needs to be equipped to deal with trauma.

Now is the time to stand up virtual learning models that can empower health professionals to help their patients — and themselves — recover and heal.

MarkAlain Déry is an infectious diseases physician in New Orleans, chief innovation officer at Access Health Louisiana, and a maker of educational animations about infectious diseases, clinical trials, and vaccines.