One year after training at Yale, Ukrainian physicians are applying new approaches to mental health and pain care and sharing their knowledge with colleagues at home.
How do you treat insomnia when sedating medication may not be the best option, because ongoing air raids require a person to be able to wake quickly and get to safety?
Dr. Olena Nikolenko, a psychiatrist and psychotherapist at Ukrainian Mental Clinic, working with anxiety and depressive disorders, PTSD, OCD, addictions, and chronic pain, says that sleep became a particularly important area in the context of the war. Considering the specific challenges presented by recurrent threats, she wanted to expand her knowledge of non-pharmacological approaches to sleep management and learn additional ways of supporting patients living under prolonged and unpredictable stress.
Her interest brought her to the observership at Yale School of Medicine and Yale New Haven Hospital, organized by Doctors United for Ukraine in partnership with Nova Ukraine and supported by Yale’s World Partnership Fund. In October 2025, Nova Ukraine sponsored two Ukrainian physicians, Dr. Olena Nikolenko and Dr. Maksym Tkachuk, selected to participate in a four-week program, IMPACT-UA (Improving Pain Management and Mental Health Treatment in Conflict Territories: Ukraine).
A year later, Dr. Nikolenko has incorporated techniques she learned during the Yale observership into her everyday clinical practice:
“Anonymized composite case: female, 34 years old, Ukraine.
The patient presented with persistent sleep difficulties in the context of increased anxiety and prolonged stress. Her main complaints were difficulty falling asleep, nighttime awakenings, and increased anxiety around bedtime.
The key challenge was the presence of a real external threat due to recurrent nighttime attacks. This significantly limited the use of sedating medication as a primary strategy, as the patient needed to remain able to wake up and respond to potential danger.
Based on the knowledge gained during the Yale program, the treatment approach incorporated non-pharmacological CBT-I strategies, including a consistent wake-up time, a structured bedtime routine, and stimulus control.
The patient subsequently reported a greater sense of control over her sleep and symptoms, reduced overall anxiety, and fewer nighttime awakenings.
For me, this case illustrates the practical value of the training: even when an external source of stress cannot be eliminated, evidence-based behavioral strategies can give patients concrete tools to improve sleep and regain a sense of control.”
Other participants also quickly integrated the knowledge and skills gained through participating in clinical rounds, interactive seminars, and interdisciplinary case discussions and exploring approaches ranging from PTSD and trauma-informed care to pharmacology, regional anesthesia, cryoablation, and neurolysis.
Putting Yale Training Into Practice and Sharing Ukrainian Wartime Expertise
“Over the course of roughly six months, more than 600 service members with various upper- and lower-extremity injuries are treated in the operating room where I work. These patients are dealing with both acute and chronic pain. In most cases, they are young men who sustained limb injuries on the front line, directly during combat. The skills I gained in the U.S. and brought back with me were put into practice immediately,” says anesthesiologist Dr. Maksym Tkachuk.
At Yale, Dr. Tkachuk was able to observe how care was organized across the operating room, acute and chronic pain services, and the systems responsible for coordinating patients through different stages of treatment. “The program was structured to give us a look at very different aspects of how care is organized at a world-class hospital,” says Dr. Tkachuk. “This experience strengthened my motivation, which I was able to bring into my work with patients in Ukraine.” Moreover, upon return, he began conducting training sessions with interns and residents and plans to continue sharing what he learned with other physicians.
With more than eight years of clinical practice and specialization in ultrasound-guided regional anesthesia, Dr. Tkachuk emphasizes that programs like this are important for international exchange of clinical knowledge. Ukraine has developed unique expertise in treating military trauma that few countries in the world can match. During the program, American specialists also learned from their Ukrainian colleagues about how hospitals function with limited resources and staff shortages, how physicians manage large numbers of complex trauma cases, and the approaches to treatment developed during the war.
Dr. Yevgeniy Mayr, assistant professor of psychiatry at Yale School of Medicine and a member of DU4U, echoed the importance of this two-way exchange. “The program that we have developed for our visiting psychiatrists aims to promote knowledge sharing in the practice and delivery of mental health services, including pain management and addiction care, which have become a mounting need within the civilian and veteran population since Russia’s full-scale invasion of Ukraine,” said Dr. Mayr in an interview with Psychiatric Times. “Likewise, our visiting colleagues have also shared their unique perspectives and provided us with lessons in resilience and adaptability through their own practices in helping their patients during wartime.”
Strengthening Ukraine’s Healthcare Through Medical Education
Nova Ukraine’s support for the Yale observership was part of the broader Ukraine Without Pain initiative, which works to expand professional education and develop better approaches to acute and chronic pain care in Ukraine. Its impact is difficult to capture in a single number—a doctor may bring a new technique into everyday practice, share it with a resident or colleague, and gradually influence how a clinical team approaches treatment. In this way, knowledge gained during four weeks of training can continue to spread long after the program ends.
“I have already shared information and clinical approaches from the program with my clinical team. I am also preparing future internal and external educational activities that will allow me to share this experience with a broader professional audience,” says Dr. Nikolenko. “One educational opportunity can become a resource for many more people.”
