Melanie Cole, MS (Host): Welcome to a very special episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. And joining me today is Dr. Eric Larson. He's the Director of Psychology and Brain Injury at Northwestern Medicine's Marianjoy Rehabilitation Hospital. In response to recent conflicts in Ukraine, there's been an interest in brain injury and how best to treat patients with related trauma in the war-affected areas of Ukraine.

In March of 2023, Dr. Larson taught a five-day intensive seminar to prepare counselors in Ukraine to care for church members who have experienced neurologic injury or emotional trauma related to war. Today, we will be discussing the lecture series with Dr. Larson and three students who attended that series in Ukraine, Diana, Olya, and Zhenya. To translate for our guests today, we have Zhanna Rohalska with us. Thank you all for being with us. Dr. Larson, how did you become involved with the school in Ukraine? Why did you want to teach this course?

Eric Larson, MD: I met the director of the counseling program here at Marianjoy. He invited me to come and speak to the students. He told me a little bit about the program they have there. And when I heard about the important work they're doing, I thought it was an opportunity I couldn't pass up to try and share some of the things we've learned in Rehab Psychology at Marianjoy to people in other parts of the world where it could do a lot of good.

Melanie Cole, MS: I'd like to speak to the students now. Diana, how did you come to be in Dr. Larson's class?

Olya / Diana / Zhanna (English): So, all three of us are the students in the Ukrainian Baptist Theological Seminary. And how we came to know about this particular program is that Chris, whom Dr. Larson just mentioned, he presented to us as a course that we could take during our curriculum since we are starting for our master's degree in Christian counseling. So, we were very eager and excited about this opportunity, since it's extremely topical under present circumstances in our country, which is in the state of war.

Melanie Cole, MS: Dr. Larson, what were the topics you covered with the students during your lectures? Can you please speak about the neurologic injury or emotional trauma related to war? What's important to know about the relevant physiology and psychology to triage and treat survivors?

Eric Larson, MD: We reviewed materials from the National Institute on Disability Rehabilitation Research intended to train family members about what brain injury does and what they should expect from people who survive those injuries. I've always found that I learn best when I'm teaching, and I wanted to give that opportunity to the students. So, they logged into the National Institute of Disability and Rehabilitation Research website before the class began They studied some of the topics that we were going to discuss, and they did presentations themselves to their fellow students on those topics. Their presentations were outstanding, and they showed a quick mastery of the relevant research, but they also showed insights on how to apply it to their local settings that I could never do. We also wanted to take a look at the emotional impact of surviving trauma. The World Health Organization has developed a special curriculum on how to best help people immediately after a traumatic event. That curriculum is called Psychological First Aid. And we did some exercises to practice using those skills in the classroom itself. And there's been some very interesting stories about what's happened in the months that have followed.

Melanie Cole, MS: Again, I'd like to hear from the ladies, starting with Olya. How are you using the information Dr. Larson shared with you? Do you have examples of how you've been able to use the information to provide help to the community?

Olya / Zhanna (English): So, we have a large team that comes and visits the members of the military who were injured with brain injuries. We go in and we share this knowledge given to us by Dr. Larson with them, and it's extremely important because an average Ukrainian does not possess that knowledge. So, we work directly with the families, with the relatives, so that these Injured soldiers, husbands can come back into their normal lives, and we tell them about the degrees of severity, about the rehabilitation process, what's required, what's expected. Because once again, an average Ukrainian overall is not familiar with any of this. And also, one should point out that we live very close to a strategically important military site. So, we have to prepare our population of a local population for shelling attacks so that they are prepared and aware, alert, because these emergency situations can happen anytime.

Melanie Cole, MS: Zhenya, how are you using the information Dr. Larson shared with you? And do you have some examples of how you've been able to use the information to provide help to the community?

Zhenya / Zhanna (English): In the beginning of the war, I had an opportunity to leave and live in Poland. And at the same time, I worked remotely, as a freelancer for a Ukrainian company. And while living in Poland, I worked with females who were forced to leave their homes and relocate to Poland. So yes, I mostly worked with females. In working with these female refugees in the Refugee Center, I, of course, shared with them the information that we received from Dr. Larson. And, simultaneously, I would consult and help the women who reached out to me from Ukraine directly. Those were women who worked at my company or just women who were physically present in Ukraine. I would tell them about the brain injury symptoms and how to talk to such men, how to manage this injury. And some of the women that were in Poland, they would go back to Ukraine to spend time with their husbands, some of whom were still on the front line. And of course, this knowledge about brain injuries was supremely beneficial for them, because they actually observed how the men changed if they incorporated that knowledge.

Melanie Cole, MS: Diana, how are you using the information Dr. Larson shared with you? Do you have some examples of how you've been able to use this information to provide help to the community? And also, please tell us about how you applied what you learned about seizures.

Diana / Zhanna (English): In the first two years of the war, I worked for the charitable fund with internal refugees, so internally displaced persons. And we didn't just work with these people, but also compiled some educational projects. And I personally prepared this educational project on trainings for volunteers and how to cope with stress. So, that was partly my initiative. I remember during one of those trainings, which we conducted, during the break, an adult woman came up to me. She was in the military actually, and she was a physician working in the military. She had the experience being on the battlefield. And once she was actually hospitalized, and besides this, she was working on her master's degree and writing her thesis on brain injuries. So, what I did, I shared with her the information that Dr. Larson provided to us. I referred her to the sites. So, I gave her a lot of useful materials.

And another case was when I was on the public bus traveling, and I saw this man with his wife. And at first, there was nothing wrong, nothing strange. But then, after a few moments, he started behaving a little bit strangely. He was shaking all over, falling down. There was foam coming out of his mouth. For a little bit of time, he was still not with us in this world. He was in his world. But then, slowly, he came back, and I was providing him some of the first psychological aid assistance. So, yes, he slowly came back, the attack subsided, and we talked a little bit with him. He said that it was not the first time that it happened to him. His wife was aware of this, but it's the first time that she saw him like that. And she actually didn't know how to cope with this, how to manage this. He did receive some medical assistance in the past. He had a concussion, which he received at the battlefield. So, he understood, and I advised him that he does need to contact a specialist regarding this, and he understood that. And when the ambulance came, eventually, he did give his consent to go to the hospital. And if we're talking about myself, I think it's going to be very important for me personally from now on because my father recently was mobilized. He was recruited. He's at the battlefield. So, this knowledge will be useful for me in this aspect as well.

Melanie Cole, MS: Thank you for sharing that story. That must have been very scary. I have another question for the three ladies, and then I'm going to have a few for Dr. Larson, and then a final question for the ladies. So, this next one, we can start with Olya. What was the most valuable or useful lesson that you've learned from this lecture series?

Olya / Zhanna (English): So, first and foremost, what exactly is a brain injury and the fact that life does continue after it. However, this life is extremely different afterwards. And secondly is how to help this person be admitted and how to accept the fact of this brain injury for the family, how a family can accept this for themselves and how they can live with it, how they can cope because it impacts their lives as well. So, how can the family members live and coexist with this? Thirdly, it's how important it is to be close to this injured person to always be nearby because you never know how the recovery process will be, whether it will be very quick or it will take longer, so that's very important. So, there should be a balance. And of course, the ability to take care of oneself is also very important.

Melanie Cole, MS: That's so important. Zhenya, you're up next. What was the most valuable or useful lesson you learned from the lecture series?

Zhenya / Zhanna (English): The most valuable lesson for myself or something that I gained is that we don't have the fear of the unknown anymore, because most of the women that I worked with in Poland, they didn't know at all what to expect, what they were about to face. And this fear of the unknown was weighing the heaviest on them. They didn't know whether they should divorce those men, whether they should go back and see them, what they're about to see, what kind of challenges they had in front of them. So, this fear was weighing the most, and the fear was lifted.

Melanie Cole, MS: You are all so lovely, and this is such a great conversation. Diana, what was the most valuable or useful lesson you learned from the series?

Diana / Zhanna (English): I would say that the most valuable lesson for me was in terms of hands-on experience. Because at first, of course, we dealt with theoretical material. But then, Dr. Larson gave us an opportunity to practice and to kind of reenact those situations, where a person assumingly would be with a brain injury, and different reactions were in those people. And for me, it was important to have that kind of knowledge. And also, I didn't expect that I would have to utilize this knowledge so soon in real time, but I had to, because you never know who you will meet in real time. Like the example that I provided with the bus, you never know who's going to sit next to you. And the question that I asked Dr. Larson towards the end of this course was how do I conquer that fear that I'm not knowledgeable enough, that I cannot help in a good enough way. And Dr. Larson reassured me that you have the knowledge, use it. And I stopped being afraid. I know that God is with me, and God will help me to make the right decision in a stressful situation. So yes, I started applying the knowledge.

Melanie Cole, MS: Dr. Larson, as I understand it, outside of the class, you presented to a gathering of about 40 pastors from and around the country, including battle zones in the East. What did they need to know to help their congregants, especially those with traumatic brain injury? How did they respond to your presentation?

Eric Larson, MD: I wanted to give the audience an answer to their doubt. Like Diana said, they were concerned they didn't know what their congregations needed most. In my speech, I recognized that during challenging times, those who are alone sometimes lose sight of the good. They expect only further hardship than loss. I shared a story about a patient, who after a catastrophic injury, discovered that quality of life can still be found in unexpected places.

In order to make that discovery, he needed a community that anticipated a restoration he couldn't see. I suggested that we can meet that need by envisioning the unseen good. They responded graciously, but I could see their doubt remained. They wanted more knowledge. I think if they had the time, they would have liked to have gone back to school and taken my class. I assured them that the students who took the class will bring them whatever they need and additional knowledge about brain injury and recovery from trauma. But the most important contribution they could offer was to hold on to hope even when it seems unreasonable to do so.

Melanie Cole, MS: Diana, do you have any final thoughts you'd like to share on how these teachings have made an impact, the mental health toll of living in a war zone, being a healthcare practitioner, helping your community to cope with the uncertainty, and how best to help with fears and uncertainty as the people that you know navigate these healthcare challenges?

Diana / Zhanna (English): As I've already mentioned, knowledge is extremely important, both theoretical and hands-on knowledge. And for that, I'm extremely grateful to Dr. Larson that he was able to provide us with this needed knowledge. But of course, knowledge is one part. Unfortunately, there are many opportunities in Ukraine for us to apply this knowledge in real life in Ukraine. So, life itself provides us with a lot of opportunities to practice. And, yes, unfortunately, we are in the war in Ukraine and, yes, the knowledge that we received is very beneficial.

Melanie Cole, MS: Zhenya, do you have any final thoughts you'd like to share on how these teachings have made an impact? The mental health toll of living in a war zone, being a healthcare practitioner, helping your community to cope with the uncertainty and how best to help with their fears as they navigate other healthcare challenges.

Zhenya / Zhanna (English): I would like to thank Dr. Larson for all the materials that he provided us with. Those were invaluable for us. And they describe, of course, the causes, the consequences of brain injuries, and I would like to highlight also the fact that they were written in a very simple and user-friendly language. So, it was very easy to absorb that information and to study it, and to share it.

Melanie Cole, MS: Olya, last word to you, do you have any final thoughts you'd like to share on how these teachings have made an impact on you and your community? The mental health toll of living in a war zone, being in healthcare, helping your community to cope with that uncertainty and fears as you navigate what's going on over there.

Olya / Zhanna (English): First of all, I'd like to point out that it was important for me not to feel alone. I look for support, and that helped me become more confident, this training and being among peers. And I truly believe that this war will end one day. However, we lack the experts in this field of psychological support for people with similar brain and psychological injuries. So, we need to speak out and speak up about this in whatever we can, whenever we can. Kids in schools have to be educated, have to be prepared, universities, average Ukrainians, everyone has to be aware of this significant issue and challenge that we will for sure face in near future.

Melanie Cole, MS: Dr. Larson, last words to you. Because this has been just a fascinating, enlightening conversation, do you intend to continue this lecture series? And what would you like other physicians listening to this podcast to know about your experience that you haven't already shared?

Eric Larson, MD: I've talked with the director of the program and we're trying to make arrangements for me to come back this coming March. As the students have said, I think there's a need for more people to receive training on how to address these needs.

But the one thing that I feel like could be addressed further and that I only scratched the surface during these lectures is the idea of hope. And when you're working with people with brain injury, one of the most important things that you need to know as the provider is that you can't anticipate Improvement. The body heals, the mind recovers from stress The patients don't know that. They have no idea what to expect. You need to carry their hope as their clinician. I feel like that is a whole class in itself, and that's what I want to come back and address next time. The patients here at Marianjoy, I feel like, are the advance guard in The War for Hope. I feel like they have been through a tough experience. They know things get better. They can go out and spread the word to other people who have had injury, that there's better things to come. And I'm hoping that these students feel the same way. And I'm hoping that when I come back, I can teach more people of things to look forward to/

Olya / Zhanna (English): Yes, hope is the primary thing that gives us hope, actually, right? It's extremely difficult for us, so hope is sometimes all we have.

Melanie Cole, MS: I'd like to thank all of you for joining us today, sharing your stories, your experiences, and what you got out of this lecture series with Dr. Larson. Thank you so much for taking the time today to be with us. To refer your patient or for more information, head over to our website at breakthroughsforphysicians.nm.org/rehabilitation to get connected with one of our providers. And that concludes this episode of Better Edge, a Northwestern Medicine podcast for physicians. I'm Melanie Cole. Thanks so much for joining us today.