Over the 1 year and 3 months, Ukrainian people, and especially Ukrainian medical community, keep resilience in this awful full-scale Russian invasion of our country. Due to our brave defenders, Ukrainian Armed Forces, we have the opportunity to live and work. Also during last months all regions of Ukraine experienced horrible missile attacks of Russian invaders.
Today, the medical community of Ukraine is experiencing perhaps the most difficult time since World War II. The war with Russia forced Ukrainian doctors to once again recall the theory and practice of military medicine knowledge, the principles of sorting the wounded and providing emergency medicine on the battlefield, applying the principles of tactical medicine in daily medical practice, etc.
But how difficult the circumstances could be, there is always exists opportunity to unite and mobilise all possible efforts to keep resilience and try to do the best we can. In this article, we want to tell you about four Ukrainian doctors from different contexts, who demonstrate how they have united their efforts to offer the best care for their patients. You’ll read examples of the continuation of family practice, care for refugees, collecting and distributing humanitarian aid, providing Casualty Care Training, working as a volunteer, helping both militaries and civilians, and how they have used different methods such as participation in International Forum on Quality and Safety in Healthcare and telemedicine project to scale and spread their ideas.
So, we want to introduce you four Ukrainian doctors: YD, family physician from Brovary, Kyiv region, RZ, the director of Salutas Medical Centre from Lviv, OV, family physician and volunteer from Lviv and AB from Lviv. We want to share with you their reflections and thoughts about this difficult time of the war:
‘First of all, said YD, I have an honour and priviledge to serve for my patients, especially for the most vulnerable categories, such as elderly patients, refugees from the regions of Ukraine, who were directly suffered by the war. As usual, we have many patients with chronic diseases such as coronary heart diseases, diabetes mellitus, hypertension, etc. But in this time of the war, especially in this terrible period of Russian missile attacks and air alarms, we observe increasing amount of patients with anxiety, depression and other mental health problems. So, as a family doctors, we have a lot of work in this difficult time.
Many of my colleagues deliver medical care at the forefront line of a battlefield. We have many wounded warriors and also civilians in our hospitals. Many of colleagues works as a volunteers delivering medical care as a mobile teams to the most vulnerable patients who lives in the regions which are directly suffering by the war.
The most important lesson for me, continued YD, is the ability to have the active attitude and the importance to be open for the others.
How difficult the circumstances could be, it is always possible to find a creative and helpful solution. For example, at the beginning of the war, due to help of Professor Ian Leistikow and Duncan Jarvies, I made a couple of the videoblogs about the experience of mine and my colleagues during this difficult time, and put this on BMJ YouTube Channel sharing the true information about the Russian invasion of our country.
And, of course, I was taught to praise every minute of my life and try to live more meaningful. Thanks God and our brave Armed Forces, we have this opportunity.’
‘Providing continuous care, said OV, implementing principles of evidence-based medicine into this new routine, while keeping chronically ill patients under supervision and supplying them with necessary drugs all the while supporting Ukraine’s defenders to the best of our abilities, for as long as possible. This is the reason why I had to flip my life over and apply all my skills and knowledge to work with and support the Ukrainian defense forces in their medical needs. At that moment it was essential to keep our heads cool and our hearts warm. As a medic, I understood that we need to work not with secondary consequences but to find and eliminate the cause. So yes, we doctors need to treat wounded warriors and civilians as best as we can. But we also have a role in helping to win the war and stop this senseless destruction of human health.
Strong fighters are an incredibly valuable piece of weaponry, quite frankly priceless in my opinion. To reinforce them means to win the war. That’s why we made a decision to empower Ukrainian defense forces medically with proper individual first aid kits (IFAKs) and combat trauma medic backpacks.
Today, 9 months later I can see that it was an important and right choice.Because these IFAKs and combat trauma medic backpacks have saved many lives and wounded soldiers being brought into hospitals have been helped on the battlefield with these IFAKS and backpacks. The ‘plan–do–study–act’ cycle is extremely useful today in Ukraine.
In collaboration with World Congress of Ukrainians and their initiative ‘Unite with Ukraine’ I am actively organising and procuring proper equipment for combat medics on a front line. The length of the front line where the Ukrainian armed forces defend against the attacks of the Russian invaders is approximately 2500 km long. The 1300 of those km experiences constant, relentless, round the clock daily shelling and active battles.
It is paramount that we adhere to the concept that there should be no compromises—only best medical supplies with proper training on their use. The types of injuries experienced in battle require very specific supplies but it gives a chance to survive before a medical care. Our goal is now not only to stop the war as soon as possible but to win it and save lives of Ukrainians from Russian barbarism.
To avoid another pandemic in the world—the pandemic of indifference—it is vital to be brave and speak up, continued OV. Truth and knowledge are the only way to keep going the right path. As healthcare professionals we continue to implement standards of quality and safety in Ukraine even at war because it is our way to win and show the difference. While Russian leaders send their badly trained and ill-equipped soldiers to die on our soil, we cherish the lives and health of each and every one of our brave defenders. Providing good medical care is another way of showing how our view on humanity differs to that of the Russian aggressor.
‘Since the beginning of Russia’s full-scale invasion of Ukraine, said RZ, the ‘Salutas’ Medical Centre has been working non-stop to provide medical and psychological assistance to patients from all over Ukraine. Doctors from the occupied territories are employed in the medical centre, continuous necessary medical assistance and support is provided to people who have lost medical documentation, online consultations of patients with various pathologies are held.
Everything what we do, said RZ, should be with adequate strategic planning to be ready for the extreme situations.
We should be able to provide emergency care, have a well-trained staff, sustainable customer relationship management system, reserve of medications, etc.
And also we should provide a high-quality medical care not depend of different extreme situations, even during the war.
It includes the ability to make decisions quickly, supporting staff and patients, flexibility and openness to communication.’
‘At the beginning of the full-scale war it was quite difficult to continue the medical education process, said AB. But I with my colleagues found the ways to renew the study. All foreign students of our university were evacuated abroad and after 2 weeks (approximately 14 March) the medical education process was remotely renewed. Also we have opportunity to establish different trainings of first aid and medical care in the condition of the war.
It was very important to organise and provide Tactical Combat Casualty Care Trainings according to massive haemorrhage, airways, respiration, circulation, hypothermia algorithm that help our healthcare workers and medical students and also people without medical education to be able to provide first aid in this difficult time of the war. It was a great project that united the efforts of many volunteers and also teaching staff of Lviv National Medical University and other doctors across the city.
Also together with the Vice-President of World Federation of Ukrainian Medical Associations, member of the American College of Surgeons (ACS) and the National Association of Emergency Medical Technicians, Roksolyana Horbova were organised remote trainings on the issue of haemostasis (27 February 2022), and subsequently certified courses All Hazards Disaster Response Tactical Combat Casualty Care-All Service Members and Pre-Hospital Trauma Life Support, as well as a series of trainings with her colleagues from the American Burn Association and the ACS committee on Trauma, attended by physicians, interns and students from across of Ukraine. Also we established communication and collaboration with foreign companies (eg, from the USA), helping to deliver for free telemedicine equipment for our hospitals and clinics across the country (eg,’burn navigator’ device, equipment by RealWear, etc). This telemedicine equipment provides access to remote consultation between the doctors in different locations and helps to perform high-quality medical care. Also I have an honour to receive as a humanitarian aid two ambulances by our friends from Poland and Germany which were drived and delivered to our hospitals from the border by myself.
As the President of the World Federation of Ukrainian Medical Associations, said AB, I with my colleagues established the cooperation with the World Medical Association collecting and managing the medical supply chains for both our brave defenders and civilians. It is included the most needed medications for our hospitals on the home front and also for the healthcare workers at the front line of the battlefield. It is high-effective expensive antibiotics, anti-inflammatory medicine and painkillers and lots of other goods of medical purpose, tactical medical backpacks, IFAKs and tourniquets. Dummies were also sent to practice resuscitation measures in case of a tense pneumothorax and bleeding.
Also I keep in touch with Ukrainian doctors abroad who help me to collect and manage the humanitarian aid for our Ukrainian healthcare settings.
And finally, I have an honour to represent the Ukrainian Medical Community in Bremen at the 126th meeting of the German Medical Society and at the 73rd WMA General Assembly which was held on October 2022 in Berlin, Germany. It was a great opportunity to share the true information about the awful war in Ukraine due to the Russian invasion. We experienced a powerful support from our colleagues all around the world. Also WMA Resolution in support of medical personnel and citizens of Ukraine in the face of Russian invasion was adopted. So, I try to build the bridges of communication between Ukrainian medical healthcare workers and our colleagues abroad.
The situation with the war dramatically changed priorities, concluded AB, forced to concentrate on other points!
And this made it necessary to study new aspects of medical care that are not characteristic of peaceful life. This is also the search for new contacts, new logistics, faster decision-making!
The most important challenges were simultaneous multidirectional tasks that caused tension in the work and the need to quickly switch between tasks and areas of work. Education process, managing with humanitarian aid, providing casualty care trainings and communication with the foreign partners—all these areas needed my attention and efforts.
Only the awareness of the importance of the moment and the responsibility to many partners in the process forced me to work at the limit of possibilities! It was also important to support each other in achieving goals!
And the belief in victory and the desire to speed it up made it possible to achieve high results!’
‘And also there is one more important thing that I want to reflect on, continued YD. Its about a sense of belonging to the world medical community, to be able to connect and communicate with our foreign colleagues, sharing our ideas and perspectives and learning from their experience and wisdom. For example, last summer, 20 June–22 June, I with my colleagues had a brilliant opportunity to take part in International Forum on Quality and Safety in Healthcare in Gothenburg, Sweden. It was a great time of learning Quality Improvement and Patient Safety from the colleagues all over the world, interesting and helpful communication with the leaders in healthcare and esp. sharing true information about the war in Ukraine. Also we had the session about the resilience of Ukrainian health and care workers in this difficult time of the war. Four Ukrainian doctors from different contexts demonstrated how efforts can be united to offer the best possible care for the patients. The examples of holistic approach in family medicine at war, care for refugees, dealing with humanitarian aid, providing trainings in line with TCCC, working as volunteers and other different methods such as videoblogs to scale and spread good ideas were demonstrated. The session was moderated by Professor Ian Leistikow, Inspector and Advisor, Dutch Health and Youth Care Inspectorate from Netherlands, who gave the idea about the videoblogs about the resilience of Ukrainian healthcare workers at this difficult time of the war. Especially, we want to express our gratitude to Professor Ian Leistikow, who kindly invited our delegation to Sweden and performed an extraordinary job at keeping us welcomed. Equally we are grateful to Dr James Mountford, England for his active attitude in supporting us and providing really kind and friendly atmosphere at this amazing Quality Forum. The understanding of great support of international medical community gives us a lot of hope that we will spread among our colleagues at home. We were deeply touched by the solidarity and support of Ukraine by our foreign colleagues’.
Thanks to the information received at the Forum, continued RZ, an idea arose on the basis of the ‘Salutas’ Medical Centre to organise a project of a telemedicine platform to provide medical assistance to patients from the occupied territories, victims of military operations, soldiers for whom the provision of quality medical services on the spot is generally unavailable.
This initiative was supported by the president of IHI, Kedar Mate, who involved specialists in the field of providing medical services, in particular representatives from Scotland, who were happy to help.
Specialists of psychiatric care in Denmark also joined this initiative, who agreed to help with PTSD and provide psychological help to victims, soldiers, persons from temporarily occupied territories and all Ukrainians affected by military actions who need it.
The goal of the project is the implementation of a telemedicine platform with various devices in the ‘Salutas’ Medical Centre, the creation of mobile field teams to provide medical, psychological and psychiatric assistance to patients from all over Ukraine. We plan to involve doctors from the ‘Salutas’ Medical Centre in Lviv and Ivano-Frankivsk, as well as family doctor YD from Brovary, in this project.
We hope that this first experience of implementing a telemedicine platform will provide an opportunity to improve the quality of providing medical care to all those in need in Ukraine in this difficult time for the country and will allow us to preserve the principles of quality and safety of providing medical services to the population of Ukraine’.
‘While supporting the military and the defenders of Ukraine, continued OV, we as healthcare leaders must also not allow ourselves to forget the civilian populations that are suffering from the consequences of Russia’s devastating imperialist ideology and politics. Caring for the health and well-being of our patients during war time is complicated to say the least. Yes, safety precautions, medical equipment, keeping critical infrastructure like hospitals operational is expensive, but our highest cost is the thousands of lives of Ukraine’s bravest and brightest, the tears of their mothers and loved ones, and the once happy childhoods of millions of Ukrainian children that were snatched away from them without ever including them in the discussions that would decide their futures.
The understanding that the world has our backs, and that international society does not help Ukraine out of fear or pity, but rather because they are able to think critically—this gives us hope. Consistent peaceful protests on the streets of every major city in the civilised world is the best testimony that we as human beings still have a bright future on this planet.
We together will end up on the right side of history as it is not right to remain silent while you observe such atrocities and evil, no matter where on this planet it is taking place. The pandemic of indifference is the greatest threat that the modern world faces today. I encourage you to continue these actions of support towards Ukraine, the Ukrainian people, our territorial integrity and our freedom.
Acknowledgments
Prof. Dr. Ian Leistikow, Erasmus School of Health Policy and Management (Erasmus University Rotterdam), Dr. James Mountford, Director of Quality at Royal Free London NHS Foundation Trust.
Footnotes
- Twitter @Yaroslav Diakunchak
- Contributors All authors contribute to this article (every author wrote about his experience)
- Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Source: https://bmjleader.bmj.com/content/early/2023/05/02/leader-2023-000764
