Ukraine is a country of innovation and resilience, as we have witnessed since Russia began its war for Crimea in 2014. Since the 2022 declaration of the expanded war and aggression, the health care system in Ukraine has been undeniably overwhelmed. Struggling to recover from COVID as the war erupted into full action Ukrainian cities are swamped with refugees, resources are still scarce and often fail to keep up with need, and health care providers are exhausted. Many foreign medical students and residents who were critical to the medical provider pipeline have left the country.
Treating physical and emotional traumas that were unimaginable before 2022 has become a daily experience, whether or not the providers and the system are prepared to cope. On every level, the system is overwhelmed and under-resourced.
Into this picture, the use of auricular acupuncture for physical and emotional trauma has claimed a tiny fraction of the health care pie. Acupuncture has been practiced on the fringe of western medicine in Ukraine for decades, but has never been an accepted medical procedure. Training programs for SuJok and limited body acupuncture existed in Kyiv and Lviv before the war but were not well received by the western medical establishment. Efforts with auricular and scalp acupuncture are beginning to find traction, however.
Both 5- and 6-needle auricular protocols for trauma and pain were introduced in western Ukrainian hospital and outpatient clinics in 2019. Battlefield Acupuncture was introduced beginning in May 2023 to a limited number of combat medics and medical providers for use in frontline situations, and has already proven its worth in hospital and rehabilitation practices. The use of scalp acupuncture was also introduced in May 2023 for soldiers debilitated by combat injuries and is emerging as a viable option in Uzhhorod for rehabilitation in hospital and outpatient clinics. As a direct result of relationships built over the past 5 years, in late June I was asked to support the formalization of auricular acupuncture into combat medic trainings.
How did this happen? I am a 2nd-generation Ukrainian-American (maternal surname is Simchak) and have visited Ukraine since 2004 when I sought lost family connections. In 2017, I travelled to western Ukraine with a group of western medical providers serving orphanages. Invited to speak at the Uzhhorod National University College of Medicine about use of auricular acupuncture for pain and addictions, my guest lectures drew more than 100 students, faculty, and providers. That interest propelled us to pursue opportunities to return, and in 2019 I was awarded a Fulbright grant to develop curriculum for auricular acupuncture.
Hosted by the Uzhhorod National University College of Medicine, the 14-hour training resulted in a certification and Continuing Medical Education credits. The curriculum was later improved and delivered again in August, 2022, and again revised and taught in May 2023. In June of 2023 the course was taught for the first time in Lviv, Ukraine.
More than 80 providers have attended the trainings since 2019, including 29 medical doctors, 21 psychologists, 22 rehabilitation specialists (physical therapists), 3 military paramedics, as well as 8 others who identify with some connection to counseling and therapeutic activities. Some attendees traveled over 21 hours by train and in addition to Uzhhorod and Lviv, participants came from Kyiv, Dnipro, Rivne, Mukachevo, Kharkiv, Odessa, Dubno, and Zhytomyr.
Three Ukrainian providers stepped forward as my co-trainers during the August 2022 training; a fourth joined us in May 2023. All have proven to be invaluable as coordinators for operations on-the-ground, co-teachers in classroom, and mentors for trainees in hospitals and rehabilitation facilities. Most importantly, they take responsibility to continue mentoring trainees, and extend follow-up treatments after the trainings with patients in hospitals and rehabilitation facilities who agree to become part of our on-site clinical experience.
This process of introducing auricular to Ukraine has met and overcome many challenges since 2019. Originally hosted by a College of Medicine, and now with a proven track record and more than 80 trained medical providers, we are able to make a larger impact as the need has never been greater.
In August of 2022 as part of our Uzhhorod clinical practice our team was invited into a regional hospital to work with 3 postsurgical patients (all soldiers) who were not responding to conventional physical therapies. Their injuries included nerve damage, local pain from amputations, phantom pain, emotional distress, anxiety, insomnia, nightmares, and digestive disorders. For 9 days our patients received auricular, scalp, and full-body acupuncture in addition to needles with electrical stimulation, guasha, tuina, and laser therapy. In 2 cases significant improvements were realized in substantially increased mobility and reduction of pain; the third patient, treated for only 2 days with the 5-needle protocol found improved sleep, reduction in anxiety, and more even emotions.
In May 2023, I returned to Uzhhorod College of Medicine and expanded the acupuncture training to include scalp acupuncture. My Ukrainian team helped update the curriculum for more relevant situations, identified clinical practice and training locations, and improved overall operations. One week before the official training began, we were given access to 2 regional public hospitals, both serving soldiers. In our first 2 days the 4 of us gained 16 patients, the majority of whom we were able to follow for the next 10 days.
Depending on their situation we performed 5-needle auricular, 6-needle Auricular Trauma Protocol, Battlefield with ASP needles, guasha, body needles with electrical stimulation, tuina, SuJok, and scalp acupuncture. By our 2nd week and the beginning of the official training program, we were working 2 hospitals and gained an additional 6 patients. We also began to treat patients from a local refugee clinic and by the end of the week were invited to the Regional Veterans' Hospital. My team and I separated into 3 different clinical locations after our daily lectures and trainees dispersed among us, depending on their interests.
Three of my co-trainers have become proficient in the fundamentals and practice of scalp acupuncture and 2 are using it regularly in hospital and private clinical practice. Their video documentation of patients' progress is very encouraging.
At the end of our May Uzhhorod training I travelled to Lviv with 1 of my co-trainers who is specializing in Battlefield Acupuncture. As a former physical therapist and currently an army paramedic and also a trainer of medics, he has a significant interest in relieving pain. In Lviv he introduced me to a number of practitioners at hospitals and rehabilitation facilities and from this effort came invitations to provide a new auricular acupuncture training to be hosted by a large regional hospital. Given announcements about pending military actions I decided to return quickly to Lviv and train as many more providers as possible.
In late June I returned to Lviv with an integrative medicine pediatrician and friend from Minnesota. Together with our team of co-trainers we certified another 28 medical providers in use of 5-needle auricular acupuncture for post traumatic stress disorder (PTSD) and addictions, the 6-needle Auricular Trauma Protocol, and Battlefield Acupuncture. This group included 5 medical providers with previous training in acupuncture and they were voracious for knowledge and community of practice. Unfortunately, we did not have enough time to build strong relationships for clinical practice in Lviv so our access to patients was more restricted until after the training, by which time our trainees opened their clinical sites for a handful of us to practice. Our new trainees have now opened more doors, and we expect the next training to include a robust clinical practice in local hospitals and rehab facilities. Immediately after the Lviv training, free PTSD clinics were begun within regional two regional hospitals and one community site for soldiers and their families. Graduates from all trainings since 2019 continue to support each other and share cases through monthly Zoom meetings.
Where do we go from here? We understand this is an uphill effort in Ukraine but a road fairly well known from decades of experience along similar roads in the United States.
Ukraine does not have a formal regulatory process for acupuncture, which leaves much of what we are doing in a gray zone. The practice is neither legal, nor is it illegal. One formal training program existed in Kyiv for a while, but it is currently suspended. Many acupuncture practitioners employ techniques learned through weekend seminars and workshops. Although proficient in technique, we understood from conversations and observations that our colleagues are working with only half the picture.
We witnessed significant interest among doctors and therapists in use of acupuncture for pain management and PTSD. By training more than 80 professionals to date, and most under the auspices of a College of Medicine, we have already achieved some leverage. I also see many opportunities to educate legislators and the medical establishment about the fundamentals and science of acupuncture methodologies.
Experience in the United States informs our goals in Ukraine. We have introduced the concepts of gathering patient satisfaction with treatments, outcome measures, documenting results, and establishing a system of training standards, and community acupuncture. Invitations have been extended to continue training in Uzhhorod, Lviv, Kyiv, and Rivne. We expect to continue the work in the next year by increasing trainings and clinical opportunities. We especially need approaches relevant to treating soldiers and civilians impacted physically as well as mentally from war, including use of acupuncture for acute and prolonged field care.