For Dr Dmytro*, who has worked as a cardiologist in Lviv for 13 years, few crosses are harder to bear than the death of a child – the loss of a patient whose life still lay before them – even when he knows there is nothing more he could have done.
But while all children’s deaths weigh heavily on his mind, the avoidable loss of Andriy, a one-week-old baby who died because of a shortage of X-ray machines, is one Dmytro still struggles to reconcile.
Andriy was born in Lviv in March with congenital heart disease, and urgently needed an angiogram, a specialist X-ray that allows a doctor to see a patient’s blood vessels. But with only one angiography machine shared between several hospitals in Lviv, and as the western Ukrainian city copes with an influx of people fleeing Russian attacks in the east and around Kyiv, waiting times for specialist medical equipment have risen. In Andriy’s case, the delay was fatal.
“It destroyed me as a doctor,” Dmytro says. “He should have lived; it wasn’t the condition that killed him. This is a kid who should go to school, make friends, play football. And it destroys you, especially when you understand what could have solved this problem – and that’s another angiography machine.”
According to UN agency the International Organization for Migration, more than 7.1 million people have been internally displaced in Ukraine since Russia invaded six weeks ago, and hundreds of thousands have fled to the relative safety of western Ukraine, which has so far been spared the brunt of the violence.
The result is that hospitals in Lviv – the largest city in the region and its unofficial capital – are under increasing strain as they become medical hubs for the entire country. As well as serving the everyday needs of its growing population and those wounded in fighting elsewhere, Lviv’s hospitals have also absorbed patients with chronic and complex conditions who have been transferred from hospitals in frontline cities such as Kyiv, Kharkiv and Mariupol. Hospitals in those cities have also been directly targeted. For this reason hospitals in this article cannot be named ; doctors are also referred to by their first names only for security.
And as Russia marked the start of its renewed eastern offensive with missile strikes that also targeted infrastructure in western Ukraine, there are fears the region could soon be further overwhelmed with its own casualties of war.
As medical departments shut down in the east, many doctors also moved west, bolstering the workforce in Lviv. But equipment was left behind or destroyed, and while Lviv’s hospitals have enough doctors to treat the new patients, in some cases they are finding themselves without the means to do so.
Dr Zoryana, who works at a children’s hospital in Lviv, says: “Patients with chronic conditions, congenital malformations, cardiac surgery patients, neurosurgery patients, injuries from war – all severe pathologies are now coming here, because we are now one of the only centres that can manage such patients.
“We lack particular supplies and equipment, because we are not used to having so many severe patients. And that’s a real problem at the moment.”
In Zoryana’s hospital, for example, there is only one monitor to measure the vital signs of patients in intensive-care units (ICU). “We have the doctors to do three major operations a day, but we cannot do that because we only have one monitor. So we are only doing one a day and then waiting until the child is quite stable to give that monitor to the next,” she says.
As she talks outside the hospital, ambulances with Polish and British number plates arrive, full of privately donated medical supplies: bandages, morphine, saline kits, feeding tubes. Yet the more acute challenge is acquiring specialist equipment such as the angiography machine, which cost hundreds of thousands of pounds, that could have saved Andriy’s life.
“Before the war, we performed around 30 angiography procedures each month, but in the past month, we had 66 patients,” says Dmytro. “If the [operating] table is busy, heart attack or stroke patients have a much higher chance of dying or having neurological deficits … An extra hour can increase the mortality risk by 20%.”
Dr Denis, who fled his home in Dnipro and is now medical director of anaesthetics and intensive care at the children’s hospital, a workplace that also doubles as his new home, says they need “specialist equipment: ventilator units, ICU beds, syringe pumps, high-level monitoring systems, ECMO [life-support] machines.”
But he adds that it is not just quantity, but quality, that can make the difference between life and death. Using old Soviet-era devices that were in storage can lead to missed diagnoses, riskier procedures and longer operating times.
Ukraine’s defence minister recently called on “partnering states” to upgrade the country’s Soviet-era weapons with modern ones used by Nato, in order to survive the new onslaughtin the east.
“If they will open the humanitarian corridors, we can’t even imagine how many casualties we will take just from one city,” says Denis.
“What we ask from Nato is not soldiers – close the sky [to Russian warplanes] and give us modern ammunition, machinery and equipment. We have enough people ready to be deployed. And we have a lot of weapons, but from the Soviet Union.
“It’s the same situation in hospitals. Give us modern equipment, and modern medical supplies. Our doctors are well trained, they can do a lot of high-level operations.”
But for some doctors, the biggest challenge is wounds that Nato-provided equipment cannot heal. “Every doctor must be a psychologist now,” says Dr Ivan, a fresh-faced graduate whose first day of work in the children’s hospital was the day before war broke out.
“People are emotionally closed, like a shell,” he says. “Maybe the worst thing is to see in people’s eyes, children’s eyes – nothing.”
* Only first names have been used to protect the doctors’ identities.
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