DAVID GURA, HOST:
When Russia invaded Ukraine, Aleksandra Shchebet's life turned upside down. She's a neurologist who was forced to flee to the relative safety of northwestern Ukraine as Russia attacked her city of Kyiv. And she had to leave her patients behind.
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ALEKSANDRA SHCHEBET: My heart is broken, actually. I'm a good neurologist. And now I'm not able to help.
GURA: That was in March. NPR's Ari Daniel got back in touch with Shchebet to see how she's doing. He reports the neurologist is seeing patients again, but the war has transformed her practice.
ARI DANIEL, BYLINE: In early June, some 3 1/2 months after the start of the war, Aleksandra Shchebet decided to return home to Kyiv. It had gotten safer, and she missed her city. On the drive back, she passed by burned houses, shelled supermarkets and, in her words, wounds on the earth. She set up a new office just around the corner from where she used to work and began seeing patients five days a week again, including recently a 47-year-old woman who fled war-torn Chernihiv in northern Ukraine.
SHCHEBET: She couldn't sleep for months.
DANIEL: The woman found Shchebet and did a virtual exam. Now, Shchebet's trained to treat things like Alzheimer's, stroke, MS. But the woman explained that she'd been in the midst of a lot of shelling. Shchebet guessed her insomnia was probably related to stress.
SHCHEBET: She has lost some friends. She saw it, and it was, like, a tragedy for her. So, of course, she couldn't sleep because of that. The pictures of what happened was in her mind again and again before she went to sleep.
DANIEL: In her wartime practice, Shchebet had come to recognize these symptoms as the telltale signs of a particular mental health condition, PTSD.
SHCHEBET: Now we have a lot of cases when people saw in their own eyes how their friends, members of their families are dead or are wounded. Of course, it has its impact on psychic.
DANIEL: Ukraine has become a population in need of care. Shchebet says mental health disorders have increased. She estimates that 90% of her patients, which are all adults, are coming to her with conditions provoked by the war - insomnia, yes, but also anxiety and depression and chronic daily headaches and other pain caused by constant stress. Thing is, back in medical school and residency, Shchebet never trained to diagnose PTSD, and she wasn't alone. She says that since the war began, support for mental health professionals has poured in.
SHCHEBET: There are a lot of courses which were provided by foreign psychiatrists and foreign psychologists for Ukrainian doctors to help them to learn how to deal with these patients.
DANIEL: She also spoke with more experienced colleagues about how to make referrals to psychiatrists and psychotherapists, which involves assessing someone for PTSD. But when Shchebet started seeing patients in Kyiv who she thought might have it, she was worried.
SHCHEBET: What if it is PTSD, and I am not diagnosing it? That may impact quality of patient's life. I was afraid to miss something. You know, you can never be sure for 100%, never.
DANIEL: As those experiencing PTSD continue to seek her out, Shchebet gradually - and she says regrettably - got more confident at diagnosing it.
SHCHEBET: I am feeling sad, actually, because of how many patients with PTSD we have. If patients came to me and ask for help, I have to help. So I'm doing my best I can. There is always a risk that if I am saying, no, I'm not doing this, I'm not handling this PTSD, he'll walk away, and he will never go to doctor again. So I had to do this.
DANIEL: When Shchebet first returned to Kyiv, she found the work devastating.
SHCHEBET: I heard their stories about how they lost their wife or their husband or their parents. It is hard to listen to. And I know I can't help them, except that I can give them medications and say some kind words. That's all.
DANIEL: Shchebet was feeling herself burning out, so she worked with her own therapist to keep her emotions more distant to protect herself. Now she marvels at what she's grown accustomed to. For instance, frequently during an in-person appointment, an air raid siren goes off.
SHCHEBET: I'm saying that, now we have to go with you to the shelter. She or he is saying, OK, I got it.
DANIEL: Chabot continues her consultation in the shelter, usually alongside other doctors and patients who've also rushed to safety.
SHCHEBET: This might be a positive thing for the patients because they know they are not alone.
DANIEL: She doesn't think this time of intense challenge will last forever. So for now, she does what she can. That woman from Chernihiv, who Shchebet diagnosed with PTSD a few weeks back, is now receiving medication and therapy and is improving. Shchebet says the woman told her, I've started to feel the taste of life again.
Ari Daniel, NPR News.
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