Physicians on the Frontline – Help for Ukraine

Oleg Turkot, MD, Assistant Professor of Anesthesiology and Critical Care Medicine, Johns Hopkins Hospital

My colleagues and I began work in Ukraine in 2018 with care for women and children in maternity hospitals. When the war started, one of the biggest changes was the acute need for reasonable diagnostic equipment that may be usable in case of lack of power. Ukrainian anesthesiologists don’t have access to ultrasound or necessary training. So, we considered, “What can we do and what sort of impact can we make in a very short period with something that’s portable?” Ultrasound became our go-to modality. With help from the Butterfly Network, we were able to bring additional probes into the country with an initial goal to provide baseline training and have local trainers do the additional steps with further development on the ground. Plus, with Butterfly, we would be able to do virtual consults and develop things further to start expanding to new locations. Then obstetricians we worked with stated that now women can’t leave their houses without fear of being shot or shelled. Now, we have the ability to visit women at home. Ukrainian hospitals are structured with large steps; you don’t have the ability to move ultrasound machines between different portions of the hospital. Now, with portable ultrasounds, we’re able to take the machines where the patients are instead of, for example, bringing a patient up to the third story of a building where the higher up you go, the more chances a blast will blow out the windows and damage everybody inside. Because the items were so easy to transport, we’re actually able to bring them toward direct frontline hospitals, which often work in situations with no electricity. Surgeons are utilizing ultrasound to locate shrapnel, because CAT scanners are absolutely unheard of in any frontline hospital. Sadly, you can’t just give somebody a probe an automatically they do everything. We started with things that are lifesaving and tailored things based on individual skill levels. And just because somebody can view a relatively protocolized scan doesn’t mean they’ll be able to recognize every single piece. And that’s where provider-to-provider feedback comes in. We will text pictures, talk, and be able to compare what they’re seeing with likely what it is. And we use that as a continual educational model. Our goal is to train them to be able to identify items that can be lifesaving.

A significant portion of the patients come in with GSWs, shrapnel, and extensive burns. There’s also a significant displaced population. Toward Eastern Ukraine, you see a lot more trauma. Toward Western Ukraine, you tend to see more chronic illness that has been unmanaged for a couple months. I’m a Ukrainian-trained physician. I went through all my medical school there, and I never saw a single GSW. We’re a peaceful country. Nobody owns guns. The idea of working during your typical day and the building next to you blows up really never crossed most of our minds. Today, every major city in the country has had at least one or two rocket attacks. There’s also been a massive hit to hospital infrastructure. About one in six hospitals in the country, as of two days ago (May 16, 2022), has been attacked. One in 15 has been completely leveled to the ground. There are large parts of the country where there are no undamaged hospitals.

I think the biggest thing that most people in the US don’t understand is that Ukraine is a low-middle income country. Ukraine’s GDP per capita is possibly comparable to El Salvador. That’s where they started and that’s the level of funding they have. And yet, for example, their levels of maternal mortality are lower than that in the US. in Ukraine, there’s a shortage of equipment but a plentiful supply of people who are willing to work. They do a huge amount with very little. And that means that every single little bit that we give them pays dividends.

We are always looking for additional support. One of the important aspects that we find is that whenever there’s a large disaster, typically support happens immediately and then it slowly teeters off. If it’s possible to continue that support further, you’re able to go really far with those limited resources. The organization that I primarily work with is Kybele, and we would love support for the mission that we’re doing. A lot of US physicians want to come in and provide direct medical care. At this point, it’s not the highest priority and it’s not the thing that pays the most dividends. At the same time, providing education and allowing people in the country to work better really has been one of the cornerstones of our project from the beginning; small conversations, small changes in how people do things, allow people to take care of themselves, and that’s what creates sustainable change as compared to coming in for a week or two and doing 150 surgeries or taking care of a lot of people in a primary setting. If you compare that to creating just one new doctor who’s going to stay in the country, that’s going to be more important.

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