A SURGE OF WARTIME BRAIN INJURIES IS CHANGING LIVES—AND OFFERING LESSONS

DNIPRO, Ukraine—Oleksandr Biliaiev was hit by a cluster munition in the early weeks of the war in Ukraine that left him with 11 pieces of shrapnel in his head, and unable to walk, talk or feed himself.

While those physical effects are improving, the mental-health problems that often come with traumatic brain injuries still plague the former soldier.

Beyond the loss of life and limb, doctors say the brutal explosive power used by Russia and Ukraine has resulted in an epidemic of TBIs not seen since at least the Vietnam War. That’s left a growing number of civilians and soldiers experiencing psychological problems, including depression, insomnia and aggression.

U.S. medical professionals are now helping their Ukrainian counterparts deal with the physical and mental-health fallout, while also trying to learn from Ukraine’s experience.

“Ukraine is a unique situation in that it is modern warfare by organized militaries with modern weapons,” said Elkhonon Goldberg, a New York-based neuroscientist and author. “This is what makes the current Ukraine conflict potentially so valuable in terms of research.”

Goldberg is among a number of American doctors who have provided Ukraine with information and tools to diagnose and treat TBIs.

The Department of Veterans Affairs has hosted more than 100 Ukrainian doctors for trauma training sessions, where it says the psychological fallout from TBIs was a big component. Members of the American Psychiatric Association have separately visited Ukraine to train civilian and military professionals.

Modern warfare is leading to more brain injuries, American doctors said, because improvements in medical care, and armor, are keeping more people alive who might have died in past conflicts.

Aside from physical effects, mental-health problems often follow TBIs because of damage to nerve endings in parts of the brain related to behavior.

U.S. doctors want to learn from Ukraine to improve treatments back home. From 2000 to 2022—a period including engagements in Afghanistan and Iraq—about 458,894 U.S. service members were diagnosed with a TBI during training or in combat, according to an Inspector General evaluation of the Defense Department’s management of TBIs. The report, published last March, found a lack of consistency in implementing policies and procedures to determine the care needed for sufferers.

The issue gained attention last year when Robert Card, a U.S. Army reservist, killed 18 people in Maine. Card had a TBI that likely played a role in his change of behavior, according to an analysis by Boston University for Maine’s chief medical examiner. The 40-year-old had served as an instructor at a hand-grenade range, where he was exposed to thousands of blast waves over a period of years, it said.

The war in Ukraine is likely resulting in a large number of TBIs because both soldiers and civilians are being exposed to a high volume of blasts. Russia alone has fired millions of artillery and tank shells since its 2022 invasion as well as thousands of missiles.

Biliaiev is one of the victims. The former artillery man has damage to the prefrontal cortex of his brain, its so-called personality center, which has caused apathy and lack of concentration, said Sergiy Sievtsov, his clinical psychologist.

Sievtsov received training from the U.S. group Goldberg put together, which also provided him with diagnostic and cognitive rehabilitation methods that the Ukrainian said has aided Biliaiev’s recovery.

U.S.-developed apps have helped Biliaiev regain his memory, ability to focus and speech, enabling him to help his wife with some household tasks such as basic cooking and cleaning. One program built on the 34-year-old’s love of soccer by testing his memory of players and jerseys, allowing doctors to track improvements in his reaction time, attention and visual and verbal memory.

Biliaiev is on an anonymized database of TBI cases compiled by Ukrainian psychiatrists that they, Goldberg and other U.S. doctors are studying. The database allows them to compare each patient’s symptoms and response to treatment.U.S. medical professionals say they are learning about how to deal with such injuries and associated problems when the battlefield is at home as opposed to the foreign wars America has fought in. That includes how to prepare service members for the psychological effects of seeing their own country being destroyed.“We also can better understand just how challenging it is for a country’s healthcare system to manage the injuries of war for both veterans and civilians during an active war,” said Dr. Steven L. Lieberman, the VA’s deputy undersecretary for health.

Despite some progress, Biliaiev is often still depressed, according to Anna Stasiuk, his wife and full-time carer. “Sometimes he says things like, why didn’t the bomb kill me, why did I survive,” she said.

Biliaiev struggles to sleep and sometimes doesn’t want to get out of bed. He hears ringing noises in his ears. A gentle, good-humored man before the war, Biliaiev was aggressive toward his wife when first in hospital, she said. Biliaiev said he doesn’t remember this but is ashamed of it.

Biliaiev has a full schedule. He attends sessions with a speech therapist, a psychiatrist, a psychologist, a military psychologist, an occupational therapist and a physical therapist, and has sessions at a local gym with a trainer. He takes up to nine different medications a day, including antidepressants.

His most effective carer has been his wife, he said. Medical professionals say such support is important. In interviews the couple often caressed and kissed each other.

“She is better than any doctor,” he said.

Part of the American Psychiatric Association’s training in Ukraine has been to teach those close to an individual with a TBI, such as partners and children, to understand what has happened to that person.

“When a person shouts at them for a trivial or seemingly no reason at all, a spouse or child has difficulty understanding why this is happening” and can blame themselves, said Dr. Joshua Morganstein, the chair of the APA’s Committee on Psychiatric Dimensions of Disaster and a former psychiatrist in the U.S. Air Force.

The VA has also made psychological health first aid a key part of its training, said executive director Dr. Tamara Campbell. Here people are taught to see the signs of mental-health problems at an early stage, and when to seek help, similar to how people are taught to recognize and deal with early signs of strokes or heart attacks.

Physiatrists say the complexities of brain injuries make them hard to treat, and that the related mental-health effects and post-traumatic stress are often difficult to untangle. That adds to the challenge for Ukraine, where the World Health Organization says 9.7 million people are estimated to be at risk of developing a mental-health condition or already living with one.

Ukraine “was not prepared for the amount of injuries they were seeing,” said the VA’s Lieberman. Still, “we learn more from them than we ever thought we would,” he added.

Ievgeniia Sivorka and Isabel Coles contributed to this article.

Write to Alistair MacDonald at [email protected]

2024-04-27T03:01:54Z dg43tfdfdgfd