Easing Pain in a War Zone: CRNA Reflects on Medical Mission to Ukraine

Mark Haffey, MSN, CRNA, APRN, FAANA, said he’s always felt a strong need to help others. He’s been on several medical mission trips, and his most recent took him to Ukraine this past September with the organization Global Care Force. 

Although prior to the trip he had concerns, he was reassured when he learned Global Care Force had done 10 previous trips to Ukraine and had taken steps to make everything and everyone would be as safe as possible. He was also prepared to work in austere conditions thanks to his training as a Certified Registered Nurse Anesthetist (CRNA). 

CRNAs are advanced practice registered nurses who are highly skilled anesthesia providers. They safely administer more than 50 million anesthetics to patients each year in the United States. They practice in every setting in which anesthesia is delivered, including being the only anesthesia provider in over 80% of rural healthcare facilities. They are the only anesthesia providers who are required to have critical care experience prior to entering a nurse anesthesiology program, training Haffey found invaluable to this trip. 

“As CRNAs, we are trained to be adaptable,” said Haffey, who’s been an AANA member since 1999. “We’re also trained to be independent providers and learn how to adapt to whatever conditions that we are in. Our ICU training as critical care nurses provides us with advanced assessment skills and critical thinking skills. That background, as well as the education and training I acquired in anesthesia school, prepared me to provide care in a setting such as the one I was in in Ukraine.”

The Global Care Force Team in Ukraine.

Haffey arrived in Ukraine by way of Poland, flying into Krakow with the 13-person team of physicians, paramedics, physical therapists, and other medical personnel from Global Care Force. From Poland, they took a 20-hour train ride to Kyiv. 

“It was a modern train, but there wasn’t any air conditioning. It was easy to complain, but then one of our Ukrainian leaders showed us a picture of what the train station looked like back when Russia’s initial assault began,” he said. 

She explained that when the war began, their train car — which was designed for 40 people — would have 100 people crammed into it who were desperate to get out of Ukraine and to safety in Poland. They were mostly women and children, since men were required to stay back and fight. 

“There was no room to move for those people. At that point, I realized I had no right to complain about there not being any air conditioning on the train. When the war broke out, people were just thankful they had some kind of transportation out of the country,” he said. 

From the time he arrived in Ukraine, Haffey quickly had to adjust to his new reality — a reality Ukrainians have been living with since Russia invaded their country in February 2022. 

“Being there made me understand war isn’t just something that we see on TV. I realized very quickly, ‘This is real and I’m in a war zone.’” 

On his first night, at a hotel in Kharkiv, he was awakened by an explosion at 11 p.m. The hotel shook. The air raid alerts on his phone went off. Over the course of the night, seven missiles were launched on the city. The missile defense system shot down six and one got through. 

“This is what Ukrainians deal with on a daily basis, but when I saw people at our clinic the next day, they were so thankful that we were there. They were trying to smile. They really shouldn’t have anything to smile about, yet they were trying to show their appreciation,” Haffey said. 

He continued, “Many patients would spend all morning preparing meals before their clinic visits, in order to make sure we had lunch. They didn’t have any money, and they grew all their own fruits and vegetables. That patients were giving their few resources to take care of us spoke an immense amount to me. They gave what little they had to make sure that they were showing some form of gratitude to us. It made me realize the importance of our team being there to serve them.”

Patients in Ukraine wait to be seen at a clinic run by Global Care Force.

The Global Care Force team wasn’t there to perform surgeries since most of the hospitals in Ukraine are being used mainly to treat soldiers, pediatric patients, and the critically ill. Many healthcare practitioners were pulled into the war effort, meaning medical clinics closed and general physicians aren’t available in small towns. Global Care Force provides primary care at clinics, mostly in small villages. 

Haffey, who was the only CRNA on the team, assisted with primary care. Thanks to additional training in point-of-care ultrasound (POCUS), he provided needed ultrasounds for patients who were concerned their abdominal pain could be related to tumors. 

“With ultrasound, I’m not able to truly assess for function, but I can do a basic diagnostic ultrasound to help these patients. There were patients who had tumors, and I would make sure that they were taken to a hospital where they could get further care,” he said.

Mark Haffey performs an ultrasound on a patient in Ukraine.

Haffey’s ultrasound skills proved useful, as did his experience in pain management. He provided sphenopalatine ganglion blocks (SPG blocks) to patients who came to the clinic complaining of having headaches for weeks. 

“SPG blocks basically anesthetize the nerves that cause the pain that they’re feeling. Doing these blocks and seeing them feel relief because of the skills that I’ve gained as an anesthesia provider was crucial,” he said. 

The Ukrainian physicians on the team had never seen or heard of an SPG block. Haffey was able to teach them pain management techniques as well as ultrasound techniques they can use in the future. 

Haffey encouraged other CRNAs to look for opportunities to volunteer, whether it’s overseas or at home. 

“One of the things that makes CRNAs who we are is that we are patient advocates first,” he said. “And we’re not just patient advocates for patients here in the United States, but everywhere. The compassion that we learned as nurses is the same compassion that drives me and other CRNAs to make a difference in others’ lives.” 

He said volunteering and going on medical mission trips is also an opportunity to let people know who CRNAs are and what they do: providing the best possible care for their patients. 

“The physicians over in Ukraine had no clue what a CRNA was when I first arrived. By the time I left, they all knew what a Certified Registered Nurse Anesthetist was.”