Dr. Damian Jacob Sendler is a New York City and Chicago-based physician-scientist specializing in neuropsychiatry and public health research. His current research examines how trauma impacts physicians working in Poland and caring for Ukrainian refugees. We spoke with Dr. Sendler about these findings and their implications for medical practice worldwide. Simply put, Dr. Sendler believes that the most important lesson from his latest research is that public health care systems can rapidly adapt to an unpredictable migrant crisis if health care workers are dedicated. In addition, the government must provide an organized system for documenting and housing refugee arrivals. Furthermore, national collaboration is required to coordinate patient transfers between healthcare facilities. These measures, according to Sendler, ensure the successful process of providing health services to refugees.
Dr. Sendler’s research demonstrates how the Polish healthcare system is organized to assist those arriving from Ukraine with various health problems. He says that the most critical care needed by Ukrainian patients is psychological and surgical. There is also an increasing influx of pregnant women from Ukraine who requires obstetric care. We sat down for an interview to discuss these critical topics and delve deeper into his research and thoughts on how the war in Ukraine will shape how physicians practice medicine in the twenty-first century.
Damian Jacob Sendler knows what it’s like to be a fighter in the medical field to make the change. After graduating with an undergraduate degree at NYU, he worked as research biologist at Harvard and then went on to study medicine and public health at the Medical University of Lublin in Europe. Dr. Sendler understands how the intersection of medicine and science operates. These experiences are significant now that he is attempting to figure out how to provide adequate care to all Ukrainian refugees arriving in Poland.
He believes that resilience will help Ukrainians maintain their sovereignty and mental sanity in the face of the current atrocities. However, there is more to identifying the factors that can assist Ukrainians in regaining their footing and developing their country into a more prosperous and Westernized nation.
The story of Ukraine’s struggles resonates with Dr. Sendler, born in Poland, a country with a long history of conflict. The Polish people are incredibly resilient. Many Poles had to emigrate and build their lives worldwide during the diaspora, prompted by two World Wars and the Soviet occupation that ended in the late 1980s. According to Dr. Damian Sendler, there are many ways for Ukrainians to be strong and achieve their goals as long as they accept the premise that most Poles believe in: never give up. Poland has played an essential role in enabling Ukrainians to achieve their objectives. Millions of Ukrainians would not have a safe place to escape the war in their country if the Polish people did not support them. Poland has generously supported medical needs and educational programs for school-aged children and adolescents. These efforts have strengthened the Ukrainian resistance, allowing Ukrainian men to stay in their homeland and fight for their freedom. At the same time, their children, wives, and mothers relocated to Poland to continue their lives and support the front-line fighters through various initiatives.
Based on his professional interests and responsibilities, Dr. Sandler’s primary focus in clinical practice and research has been on recognizing how the arrival of migrants from Ukraine affects the government-run public health system in Poland. Dr. Sendler has been very interested in understanding access to health services in such traumatic events. He believes this is such an important topic because there are many lessons to be learned from this experience. Furthermore, this knowledge could improve access to health services in various global settings where political and environmental factors may limit access to medical care.
Poland is not a wealthy country. Its public health system is plagued by various systemic issues that are frequently intractable due to a lack of funding. However, Dr. Sendler believes that the public health system contains many hidden gems despite the challenges. Dr. Sendler thinks that one of the most significant benefits of the Polish public health system is providing medical services to everyone. Of course, there is a private sector where wealthy patients can afford to pay for top-tier care. However, according to Dr. Sendler, the best medical care is still provided at university hospitals that are still publicly funded. As a result of these factors, most Polish patients have access to advanced therapies regardless of their ability to pay.
The most serious issue confronting the Polish healthcare system is a lack of specialists to care for patients in need. According to Dr. Damian Sendler, the issue is that Poland has not produced an adequate number of medical school graduates in the last decade or so. And physician salaries have been so low that many have chosen to relocate abroad, primarily to the United Kingdom and Scandinavian countries, to practice medicine. Consequently, the number of practicing physicians has steadily declined yearly, and Poland is currently experiencing a medical provider shortage.
Poland’s healthcare system faces numerous challenges. The first challenge is to keep a public health system where patients have adequate access to health care. The next challenge is having enough staff in Polish hospitals. And the new challenge is how Poland will adapt to the massive influx of new patients in the form of Ukrainian refugees fleeing war, given that Poland is still struggling to meet the needs of its patients. According to Dr. Damian Jacob Sendler, all of these factors are highly problematic because there are only so many resources that can be allocated at any given time. Nonetheless, he claims that the Polish healthcare system has proven to be very efficient in accommodating a constantly increasing census of patients, which now includes not only Poles but also Ukrainians.
According to Dr. Sendler, the most difficult part of Polish medicine is dealing with the overwhelming number of patients seeking treatment for everything from obstetric and gynecological care to psychiatric services. Meeting those expectations presents numerous challenges. Furthermore, bilingual physicians are desperately needed to care for Ukrainian patients. Given these circumstances, Dr. Sendler believes that we must closely document how Poland is adapting to these new challenges to learn from this experience for future events in which we may need to improve the public health delivery system on the fly.
Dr. Damian Sendler believes that the situation in Polish medicine is a learning opportunity for everyone. He claims that no other country has ever had to accommodate millions of refugees requiring immediate medical care in a matter of weeks. According to Dr. Sendler, Poland has made numerous outstanding efforts to accommodate people fleeing the conflict in Ukraine. First, Poland granted Ukrainian refugees legal status within days, allowing them to pursue higher education, health care, and employment. Second, there are many changes in delivering health services to Ukrainian refugees, such as allowing Ukrainian-trained physicians to temporarily practice medicine in Poland to relieve strains on the Polish healthcare system. Third, children were allowed into classrooms as soon as they arrived in Poland to give them the gift of learning, recognizing that isolated children are at risk of developing psychiatric problems that would be difficult to resolve. Finally, Dr. Sendler claims that the model of providing health services in the Polish healthcare system has undergone significant changes. These changes include accommodating a diverse range of patients with different health problems, including cases of war trauma, which Poland has not dealt with in a long time.
Given these circumstances, Dr. Sendler began research to understand better how the public healthcare system can change its operations to accommodate patients fleeing war. He believes that documenting how Poland can become an effective healthcare system in the face of these challenges will be a learning experience for many others to follow if similar events occur elsewhere in the world.
Why is Poland the most important place for health research right now? Dr. Damian Sendler says Poland is a crucial research destination because of the unprecedented influx of Ukrainians seeking shelter and assistance after fleeing the war. This situation has put the Polish healthcare system under unprecedented strain. Dr. Sendler adds that Poland is the country to watch right now if you want to learn how to scale up any given healthcare system 10 to 20-fold to help people. “There has never been a situation like this in recent memory, with literally millions of new people fleeing the war into a single country as refugees in a matter of weeks. And the Polish healthcare system’s tenacity is inspiring. Keep in mind that our healthcare system is nowhere near as prosperous as Western European countries, and it is unrivaled by the American healthcare system. Despite this, our doctors have bravely cared for a large number of new patients as well as complicated emergency cases brought from Ukraine during an active conflict. This highlights the significance of this level of work for anyone involved in public health research, epidemiology, social health care policy, etc.,” says Sendler.
We then discussed the implications of the public healthcare system and its efficiencies and areas for improvement. The Polish public healthcare system, like any other in the world, is intended to benefit the general public. Other examples of public health care systems include the NHS in the United Kingdom. Furthermore, we must recognize that there are no barriers to seeing a doctor under public healthcare. In other words, healthcare is a necessity rather than a luxury that people receive. Dr. Damian Sendler says that growing up in Europe, he always valued the ability to visit a doctor without worrying whether or not his health insurance would cover the cost. The cost of treatment is not a question that the average Pole considers. Whether you are a working adult, a dependent child, or a retiree who has worked and paid taxes to the government, you are entitled to healthcare. Dr. Sendler says that there are no perfect healthcare systems, and the public system is not without flaws. He adds that the main issue is allocating funds, including specialized care.
Despite having a lower average GDP than many other countries around the world, particularly in comparison to the Western world, the Polish healthcare system is efficient. Dr. Sendler believes Poland will be a model public health system due to developing new ways of adapting existing healthcare infrastructure in response to unprecedented events. Furthermore, the COVID-19 pandemic is far from over. So, when considering all of these challenges and how the Polish healthcare system has handled them, Dr. Sendler believes that Poland has done a remarkable job handling the COVID19 pandemic and refugee crisis. Sendler says: “given the physician shortage, our accomplishments are impressive. Seeing these courageous healthcare workers manage all of the current pressures is breathtaking, and I believe they are a model for others to follow.”
It is worth noting that Poland has effectively mobilized its healthcare system to assist refugees. In addition, the government appears to have coordinated an effort to establish a temporary legalization structure to document Ukrainian migrants and provide them with access to various social services. Indeed, Poland had no choice but to adapt to the new circumstances. Dr. Damian Sendler says that, unlike many other countries, Poland was the destination for Ukrainian refugees escaping war. Sendler adds that Poles are extremely friendly and “couldn’t sit back and do nothing…. We are a country that has witnessed so much pain in the past that we probably understand what is going on in Ukraine better than anyone else on the planet. The conflict erupted so quickly and with such ferocity that tens of thousands of people were forced to flee within days.”
Let us not forget that this conflict has forced millions of children to flee their homes. Dr. Sendler says that Poland has a great responsibility to be a model neighbor, assisting people simply attempting to flee the terrible destruction and loss of life. Sendler says: “That is, without a doubt, the story of Poland and the countless lives lost over centuries to preserve our country’s integrity. It also serves as a model for others to follow. Consider how patriotic Ukrainians are to fight for their country against a superpower like Russia. That is unprecedented and admirable, and I believe it is critical to be a part of this mission to assist Ukrainians in surviving this bloody period in their history. And we must remember that it is Ukraine today, but it could be Poland or Germany tomorrow. We simply do not know the extent of this conflict or where it will lead, so this is an opportunity for our healthcare system to truly learn from these experiences and adapt if new situations arise. And hopefully, that will never happen.” There is a lot of recognition of threats to Poland, and Sendler acknowledges the fears are real among Poles.
It is worth noting that the Polish healthcare system will change in response to global events to adapt to new realities. We asked Dr. Damian Sendler if Polish healthcare workers are concerned about Russian retaliation. Dr. Sendler said decisively: “That is a question I believe all doctors in Poland and Europe are thinking about. Forecasting is difficult. In the history of Polish medicine, we had never faced a challenge like this. Because Poland has been through many wars, including two World Wars, we have had the unfortunate experience of caring for people during invasions and mass casualty deaths. Since Poland was last occupied, everything has changed. Poland is a modern country with cutting-edge medical technology. At the same time, we face the same medical provider and resource shortages as many other countries.”
Dr. Damian Jacob Sendler believes that various population-level challenges exacerbate these fears among healthcare workers. Sendler adds: “We have an aging population that requires access to healthcare services 24 hours a day, seven days a week. In addition, as a result of the war, the flood of Ukrainian refugees has added a few million new patients to our census, which is unprecedented. So, from the public health standpoint, it will be important to document how the Eastern European public health care system responds to these challenges. As the conflict in Ukraine began, we were able to overcome these obstacles relatively quickly. However, there is a distinction between improvising a response to a challenge and effectively administering health services in such a scaled-up fashion over an extended time. And our hospitals are being built only to meet the needs of the current Polish population. Therefore, any added patient volume creates unprecedented strain.”
Another issue that must be addressed methodically is the mental health crisis. And there’s been a mental health crisis in Poland for quite some time. The situation is even worse for the mental health of children and adolescents. Millions of Ukrainian children have arrived in Poland, scarred by war and suffering. There’s also the issue of not having a permanent address and living in a country with a different language and customs similar but not identical. And it will be a transformative time for Poland to adapt and demonstrate to the rest of the world that it can resolve these challenges. It will also be interesting to see how the rest of the European Union reacts to these challenges and assists Poland in catching up in terms of medical assistance. Dr. Damian Sendler believes it is impossible to predict what will happen in months or even years. He says: “This is a once-in-a-lifetime opportunity no other country has had. There are millions of refugees, and it is difficult to predict how our healthcare system will cope. However, I am confident that we will provide excellent medical care to these people, as we have done for centuries to Polish citizens.”
What does it take to create a public healthcare system that can support the massive arrival of new refugees? Dr. Damian Sendler says that this is a difficult question to answer. This is Poland’s first experience with a project of this magnitude. Nobody had any idea what would occur in Ukraine. No one in Europe expected a conflict, especially given the ongoing COVID 19 pandemic. Instead, Poland is currently dealing with two massive health crises, creating an unprecedented situation in terms of public healthcare.
The first crisis was the COVID 19 pandemic, which was especially severe in Poland. The second crisis is the influx of refugees who require immediate medical attention. We’re not just talking about people who have been injured by shelling or other types of physical trauma. We’re also discussing the psychological effects of war. Poland is unprepared to deal with these issues on such short notice. No country can do so effectively. According to public health and epidemiological research, preparing for such challenges can take years. So Poland’s adaptability is quite remarkable right now. There’s an overwhelming desire to help.
The most difficult question is whether this adaptability can be sustained over time. Even if the Ukraine conflict ends tomorrow, many cities in Ukraine are destroyed or dangerous due to the number of buildings that have been bombarded, necessitating a thorough assessment of safety to occupy. Poland must brace itself to maintain this level of preparedness and ensure that its healthcare facilities can adequately care for millions of new patients in the coming years.
Another significant issue afflicting Ukrainian children and adolescents is the mental health crisis. The experience they must go through is brutal. Even before the war, Poland could not meet the demand for mental health services for children and adolescents. Sendler says: “I am confident that we will be able to scale up and effectively adapt to these challenges. I am incredibly proud that we will be able to accomplish this within the framework of the public health care system.”
Recently there have been a lot of medical missions traveling to Ukraine to help refugees. We asked Dr. Damian Sendler whether he thinks Poland needs a similar support system? Sendler says: “Outside medical assistance is highly valued and needed. I believe that specialized mental health care, such as telehealth, could be executed most effectively. Small children may not be able to communicate in any other language than Russian or Ukrainian. And this is the most difficult challenge facing our healthcare system. Because the Polish, Ukrainian, and Russian languages are somewhat related, I believe it helps our physicians communicate, or at the very least find interpreters, much faster than if providers arrived from other countries where the language is entirely different. There is plenty of room for people who want to come and contribute to developing a support system. We also need the European Union to help fund medical equipment and medical supplies. It is also critical to invest in infrastructure to provide mental health services to people returning from war zones.”
Lately, we’ve seen a lot of images of trauma coming out of Ukraine. What is the role of Polish medicine in helping alleviate these struggles? Dr. Sendler says that this is an unprecedented act of war in Europe and that he “believes it will take months or years for us to comprehend the scope of the devastation and trauma fully. The images of suffering and potential atrocities in which civilians are slaughtered daily. That alone creates an entirely new reality for Ukrainians, Poles, and the rest of Europe. Consider how difficult it will be for Ukrainians to return home and simply resume their lives after the war. Widespread destruction and suffering include attacks on public health and medical institutions, cultural centers, universities, and public schools.” It will be challenging to return to normal life. Moreover, Ukraine has to deal with more than just establishing or re-establishing the numerous institutions that allow any country to prosper while retaining its sovereignty and way of life. It is also important to consider those who this situation will impact.
What is truly horrifying about this situation is that multiple generations of Ukrainians—people of all ages—have suffered unimaginable pain.
Dr. Sendler adds: “I am frequently asked about my thoughts on how we can address the mental health needs of Ukrainians. While children may require more assistance than adults, when the magnitude of the problems that exist and affect patients of all ages is considered, this is not the case. Poland must prioritize the most critical support areas for all people, especially alleviating post-traumatic stress.”
A significant issue in public health is how to resume everyday life in Ukraine while Russian forces continue to destroy health facilities. Without adequate medical care, it is impossible to re-establish normal daily routines. Ukraine will rely on the rest of Europe, particularly Poland, its closest ally, to ensure that Ukrainians have access to all advances in modern medicine that are freely available to Poles but have been eradicated in Ukraine. And this should be taken into serious consideration to accommodate and plan for the re-establishment of Ukraine’s public healthcare system. It will be a complex project.
What do healthcare workers in Poland think about the entire situation happening in Ukraine from a public health standpoint: the idea that there are just so many new people becoming patients within the Polish healthcare system? Dr. Sendler says that one thing is certain: “all healthcare workers in Poland agree that this situation necessitates a coordinated response. Most people, I believe, are still shocked by what is happening on our neighbors’ land just across the border. You’ve probably seen images of Polish healthcare workers mobilizing to transport vulnerable Ukrainian patients into Poland to stabilize and assist them. In addition, most pregnant women can not safely give birth through the Ukrainian healthcare system. So these are all critical aspects that we are still trying to process and understand to be more helpful as medical providers.”
What is more unusual is the speed with which the attack has occurred—and attempting to figure out how Poland and the rest of Europe can assist Ukraine in rebuilding once this nightmare is over. Ukraine has a strong medical and nursing workforce. After such a horrific attack, the challenge now is to keep these people up to date on their medical knowledge. When we consider this situation, so many questions arise. Most importantly, we must consider how long Polish medical facilities can handle such a large influx of new patients. The Polish healthcare system is set up to serve many patients. Sendler says: “We have a large elderly Polish male and female population, and we, like many other countries, face a healthcare provider shortage. Polish people are still in shock, but we respond as quickly as possible and provide as many support services as possible. Our medical facilities have adapted rapidly to meet this challenge. However, we must consider how long this will be sustainable. The Mayor of Warsaw has recently addressed this issue in numerous media interviews. It served as a timely reminder of the long-term viability of any crisis response, particularly in the healthcare system. And this is something that bothers me greatly. And I’m hoping we can find solutions quickly. Polish healthcare workers will undoubtedly do everything possible to assist Ukrainians in remaining healthy and recovering from any health problems that existed before the outbreak and necessitated ongoing medical attention. Poland must, however, consider how we can do this effectively over time. And this necessitates both international assistance and government guidance.”
When asked about what he likes and appreciates about the Polish healthcare system, Sendler says: “What I like best about the Polish healthcare system is its availability to all patients, regardless of financial circumstances. A common misconception about healthcare in Eastern Europe is that it is scarce and ineffective. Because our healthcare system receives less financial investment, Eastern European medicine is smaller than the Western European healthcare system. Because Poland is significantly poorer than its Western counterparts, healthcare spending, including physician salaries, is considerably lower. Despite these constraints, our healthcare system fulfills its responsibilities to provide adequate primary and specialized care per Western standards.”
Sendler says that the Polish healthcare system addresses the needs of the Polish people and is capable of providing a wide range of health services that can quickly meet nearly 99 percent of the needs of the average Polish citizen. He adds that Poles also have a similar diet, lifestyle, and predisposition to develop similar diseases and disorders.
There is still a lot of work to improve healthcare access, especially in rural areas. Poland must concentrate on producing many specialists who can deal with Poles’ various problems. Furthermore, Poland must work to increase the country’s physician population. Poland does not currently have enough providers to see everyone as soon as possible. This is one of the issues in many European countries, where it takes a long time to see a specialist for specific problems that your general practitioner cannot address, and no one should have to wait for three, four, or five months for specialized care. There are solutions to this problem, such as encouraging medical students to specialize in high-demand fields like psychiatry and increasing government funding for medical school positions.
Since Dr. Sendler has the perspective of a Polish-American person who has seen a lot of cross-comparison between Poland and the US regarding medical education, we asked him about his opinion on the strength of the Polish medical education system compared to the United States.
Dr. Damian Sendler: “Medical schools are free, which is the most significant advantage of the Polish medical education system. Tuition, except for books, room and board, and personal expenses, is waived for anyone who meets the admissions requirements for medical school. In that sense, coming from a low-income family gives you the advantage of receiving an advanced education that will place you in one of the most noble professions in the country. Therefore, I believe that the free education premise is critical. And without a doubt, it encourages people to enter the field because they know that any type of educational loan will not harm them or limit their desire to pursue primary care. Our medical education curriculum in Poland is modeled after the American system. A systems-based training model, for example, is now used in many medical schools. For example, the Medical University of Lublin has spent several years developing an integrated curriculum in which students can learn anatomy, physiology, pharmacology, and biochemistry while working through specific organ systems. The United States inspired this model of physician education. This learning model allows you to understand a single body system from multiple subject-based perspectives simultaneously.”
Over the last two or three years, the Polish government has made significant investments in increasing the number of spots in each incoming medical school class. As a result, Poland can produce more doctors to meet demand. Simultaneously, the government has increased the number of residency positions to ensure that every graduating medical student has a job. In addition, Poland has an LEK medical licensing exam similar to the USMLE steps one, two, and three. And this is yet another outstanding advancement in Polish medical education, ensuring that every graduating physician has the high level of knowledge required to care for their patients. Future investments will be made in medical simulation to teach medical students how to be effective providers, which has seen unprecedented growth in implementation and execution across all Polish medical schools. Sendler believes that Poland may be one of the few countries obsessed with the medical simulation that genuinely provides educational standards that outperform many others.
We have talked about the role of medical simulation in training medical students in Poland. We asked Dr. Sendler about what he thinks are applications of that technology in different specialties and improve patients’ health outcomes.
Dr. Damian Sendler: “As a first-year medical student, I had the opportunity to participate in medical simulation. It was an amazing experience for me. I had a fantastic time working with amazing mentors and hardworking medical students. And every scenario we practiced on one-of-a-kind mannequins and medical equipment was extremely high-tech in terms of replicating what you see in clinical practice. That experience is influential because it forces you to think like a doctor and teaches you how to work in groups where corrective actions can be implemented early on. As your education progresses, you become a much more knowledgeable healthcare provider. The old medical school model was based on reading books and taking exams. Then, as first-year residents, newly minted doctors were given real-world job responsibilities and training in whatever specialty they desired. The advantage of medical simulation training is that you can become that resident right away, gradually increasing your responsibilities as you learn to make decisions about your patients. Being a doctor is a demanding profession. To understand how to best arrive at a diagnosis and provide appropriate treatment to your patients, you must consider various data points, including clinical data and social and cultural factors. And developing a treatment plan is one of the most challenging aspects of a doctor’s job, especially when your treatment is based on a diagnosis you make. So the assumption is that if you make the correct diagnosis, you will be able to treat it correctly. However, this is not always the case. According to existing research, 30% of all medical decisions made worldwide are revised as more clinical data becomes available. It’s easy to understand why, given the circumstances of the diagnosis. For example, if someone has infection symptoms, you may diagnose an infection but prescribe an ineffective antibiotic against the bug you’re trying to treat. And the beauty of medicine is the ability to reflect on whatever diagnosis you made and the treatment plan you prescribed, then revise it to help your patients based on additional diagnostic labs and imaging and refine the cause of symptoms.”
Dr. Damian Sendler says that the best part about being a doctor is constantly learning to be a better and more effective clinician. Physicians demonstrate an incredible level of humility in perfecting their craft throughout their careers. Moreover, physicians must attend continuing education courses throughout their careers to stay current on the most recent and cutting-edge methods of diagnosing and treating their patients. This is especially true in medical simulation, where your knowledge as a first-year student is limited due to your inexperience with medicine. However, as you progress through your training to the second, third, and fourth years and beyond, students continue to hone their craft of practicing medicine.
Dr. Sendler adds: “When I reflect on my own medical school experience, I remember starting out knowing nothing about anatomy or physiology. Then, through hard work and genuine intellectual curiosity, I began developing an understanding of how all puzzle pieces of medicine fit together and appreciating how patient management should be best executed. Medicine is advancing at a breakneck pace. There have been numerous clinical practice updates. The medical simulation will be crucial in assisting future physicians in staying current with the latest knowledge and technologies to care for patients effectively. In addition, the medical simulation will remove the barriers to becoming effective communicators in connecting with your patients, listening to their concerns, and arriving at the appropriate diagnosis and treatment plan through data collection and differential diagnosis. Finally, one of the advantages of medical simulation is collaborating with other team members, such as emergency technicians, nurses, and specialists. This experience is critical in ensuring that we can work as a team to provide our patients with the best care possible.”
We began talking about the role of medical simulation in training physicians of tomorrow. We asked Dr. Sendler about his views on how the Polish healthcare system will change thanks to challenges imposed by the war in Ukraine. Sendler believes there is no effective way to prepare for the Polish healthcare system’s challenges. He adds: “Consider how the Polish healthcare system has changed due to the new challenges posed by the arrival of Ukrainian refugees. Take into account the massive impact these events will have on our medical education system. These circumstances will necessitate changes in how we train healthcare professionals for their future careers. We must invest time in preparing our medical students to deal with situations in which they must provide care under extreme conditions. I am aware that the medical school I attended has already implemented these levels of training for physicians, EMTs, and other medical providers for them to be effective caregivers during times of war. And that’s something we need to work on more now, not just because it’s a valuable skill to have, but because it’s a necessary skill to have in the future, especially for a country like Poland.”
Extrapolating from that thought process about medical simulation and preparing medical students for what’s about to change how they practice medicine, we asked Dr. Sendler about some concerns he sees occurring in the near future. First, Sendler says that Polish medical students currently enrolled in medical schools and completing their training, whether in their first year of study or their final year before entering residency, are filled with fear and uncertainty. The uncertainty stems from the fact that no one wants the war to spread into Europe and affect Poland and the rest of the continent.
Dr. Damian Sendler: “We can see what’s happening in Ukraine. Given Russia’s aggressive territorial expansion and military activities that have shifted from targeting military targets to civilians, the future is uncertain. The heinousness of the images that our people are witnessing is unprecedented. I’ve spoken extensively about the toll that this war will take on millions of people’s mental health. Consider the healthcare workers who will be forced to relive months and years of trauma as the patient population grows. Veterans, civilians, and government officials who have been traumatized and harmed by war comprise this new patient population. And we must consider more than just how to prepare these young people to deal with these exposures, who are frequently unprepared for life events as traumatic as we see them unfolding. We frequently think about how we can best prepare the next generation of effective medical providers in terms of clinical skills, the ability to make diagnoses, develop appropriate treatment plans, and carry out their responsibilities as physicians. However, we must also consider their ability to deal with the stress and demands of the job. Of course, they will want to provide the best care possible for these patients, but that will not always be possible because our patients’ outcomes will be determined by a great deal of physical and mental trauma that they will arrive with. Then there’s the language barrier to consider and how we’ll communicate with Ukrainian patients. Connecting with fellow citizens is one thing because there is no language barrier, allowing us to express ourselves truly. But how do we do that when our patients may not be able to communicate effectively with us? Translations and having a translator present will inevitably detract from developing a therapeutic alliance between the provider and the patient. We don’t have the best answer right now, but I believe we’ll be able to address those concerns and develop training protocols for tomorrow’s doctors.”
Dr. Sendler has published research that discussed exposure to trauma among healthcare workers in the past. And specifically, he has examined how Post Traumatic Stress Disorder develops among physicians who work in different specialties and have to deal with the trauma caused by their profession. And he talked about sort of the strategies that can be employed to alleviate the trauma and about the shortcomings. We asked him what he thinks will influence how we approach the subject of delivering health services during traumatizing events. Dr. Damian Sendler says that the study looked into Post Traumatic Stress Disorder in healthcare workers. The publication’s goal was to truly understand what types of events in everyday practice cause traumatizing events and how these experiences limited the doctor’s ability to provide adequate care. And he has investigated this using meta-analysis in the context of physicians working in organized healthcare systems where there are no other external factors causing trauma, such as war. Sendler adds: “Now that we are faced with this new reality, it has become an important topic to investigate. There have been research publications from war zones, including Israel, where attitudes toward post-traumatic stress disorder symptoms among healthcare workers have been examined. This study is significant because it provides a narrative understanding of what a doctor thinks about when they have to go to work, knowing that there may be a bombing that affects their patients and them personally.” What distinguishes Poland’s situation from Ukraine is that Poland remains a safe country, but there is a risk of things going wrong and in an unpredictable direction.
Dr. Sendler adds: “We must be effective providers while also acknowledging that what is happening in Ukraine could very well happen in Poland in days or months, depending on Russia’s military strategy. Hopefully, none of these scenarios play out. However, watching the news in Poland exacerbates those fears. We must also be realistic about the risks. Therefore, we must be flexible in educating our medical students in the future to prepare them for these situations. We must be able to provide them with the mental fortitude to recognize that risks exist but that they must live in the moment and be the best doctors they can be. At the same time, we must teach them resilience so that fear does not prevent them from providing effective care if the situation deteriorates and affects Poland.”
There is currently a lot of public discussion in Poland about what would happen if Poland was the next target of this war, which could spark a Third World War if NATO gets involved. Everyone is becoming aware of these threats. The providers of tomorrow will face these potentially dangerous circumstances and have to learn how to adapt quickly and seek external resources as needed.
We will keep in touch with Dr. Damian Jacob Sendler to continue covering his research on the Ukrainian war and how it affects healthcare workers in Poland.
