“You’re in ‘threat’ mode most of the time”

21 August 2023

We hear from Dr Alistair Teager, consultant clinical neuropsychologist with the Manchester Centre for Clinical Neurosciences (MCCN) at Salford Care Organisation about his time working at the National Rehabilitation Centre in Ukraine.

As a result of the war in Ukraine, there have and continue to be a lot of traumatic injuries. The World Health Organisation (WHO) and the Ukrainian government committed to developing a National Rehabilitation Centre to meet this increased need, and invitations to apply to join the humanitarian mission were sent out across the world.

In my role, I work with people with traumatic brain injuries and spinal cord injuries and have experience of developing services in these areas. I was involved in coordinating the acute psychosocial support at Salford Royal following the Manchester Arena Attack, that also stood me in good stead. A colleague from Stoke Mandeville (England’s National Spinal Cord Injury Centre) emailed me to see if I would be interested. After checking with our very supportive management team, applying and interviewing, it was a quick turnaround to get out there and get started.

Going out there for the first time was quite daunting, but it helped alleviate some of the anxieties I had about what it might look or feel like. It was reassuring to know we were well away from the frontline, but when you have to download an app that alerts you when there are air raids going on somewhere and that you need to head to a bomb shelter it can feel very real, even if it’s incredibly unlikely to be anywhere near you. Effectively, you’re in ‘threat’ mode most of the time, and this is exacerbated by the understandable stresses associated with trying to work flat out to achieve as much as you can in the time you have out there.

The remit was quite broad. From the psychology side of things, there was a lot around trying to upskill members of the Ukrainian multidisciplinary team in core skills such as goal setting and having difficult conversations with patients, but then more specific training around psychosexual needs, cognition, and emotional difficulties. In addition to this, we also did a lot of work to identify and procure equipment for use at the centre, which included things like cognitive tests, values cards, and iPads for the psychologists to improve their ability to provide quality care.

Settling in

We decided to move hotels in January so that we were in the city, meaning that we could go out more, be that for coffee, meals, for walks, or even to the gym. It also meant we had better access to the internet, which made things far better from a professional side of things with regards to working from the hotel, but also being able to connect with family and friends back home, stream things we wanted to watch.

This was such a good move overall as I think we all got a better sense and had a better experience of Ukraine and its culture as a result.

Being a part of a multinational team really helped, and our band of interpreters were amazing, not least for helping us communicate with professionals and public alike, but also arranging cultural trips, recommending places to eat or drink, and sharing their vast knowledge of the country and the effects of the war.

I think for me I also needed to practice what I preach, so I tried hard to get into a good routine around sleep, trying to eat well, do exercise, connect with others, and set boundaries around what work I was doing where and when. Giving myself permission to not do something was vital, as you really risk burning out working in and living in a warzone, and trying to liaise with your team back home to ensure things can run as smoothly as possible in your absence.

In terms of highlights, professionally it was so nice to see how valued our work was. It can sometimes be difficult to gauge where there are linguistic and cultural differences, but I think as we came to the end of our ‘mission’ in March, it became really apparent how grateful the Ukrainian team were for our presence, let alone the training and support we had been providing.

From a personal perspective, I really feel like I got a good sense of Ukraine and I loved going out for coffee and food with or amongst locals, and immersing myself in some Ukrainian traditions like the saunas, communal dinners, and many, many toasts. Everyone we met was just grateful for what we were trying to do and putting ourselves in danger to do so.

The people we saw were all victims of war, and very few spoke English, although they were often keen to talk about football when they could. It’s difficult to get your head around just how omnipresent the war is.

So many people have had their lives disrupted or been displaced. It was really heartening to see how the Ukrainian psychologists went about their work, and how valued it seemed to the people they were working with. It also, however, gave me a better insight into some of the differences between Ukraine and the UK in terms of clinical training.

In the UK, there is a funded, standardised pathway to train in clinical psychology, whereas in Ukraine it is currently more idiosyncratic and so the variation between what people have knowledge and experience of can be vastly different. That, to some degree, was where we came in, as we wanted to train the National Rehabilitation Centre team in evidence-based practice, but with such limited time sometimes it was a case of talking about core skills such as goal-setting and having difficult conversations, and making recommendations for the local psychologists to access more comprehensive training in things like cognitive behaviour therapy (CBT), eye movement desensitisation retraining (EMDR), and clinical neuropsychology.

The future

Since finishing my work in March, I have continued to be involved to some degree, but I’ve also had to try to protect myself and maintain some “distance” as well.

I’m back to working in acute neurorehabilitation and outpatient neuropsychology and trying to build our stroke rehab and spinal cord injury services further.

I’m reengaging with clinical research within MCCN, as we’ve also recently had some funding to evaluate MeloTM, a new digital health technology looking at supporting staff working with challenging situations to manage behaviour, so we’re in the process of trialling that on some of our neurorehabilitation wards, with the hope that it could be used more widely in the NCA and further afield in the future.

Alistair Teager with Ukraine team.jpg Alistair in Ukraine with a new feline friend.jpg Alistair in Ukraine.jpg Alistair delivering training in Ukraine.jpg Alistair with colleagues in Ukraine.jpg

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