Roman Fishchuk, 35, is an ear, nose and throat specialist (ENT) at a hospital in the western Ukrainian city of Ivano-Frankivsk. Since Russia invaded Ukraine on February 24, he has found himself volunteering in any way possible including consulting patients through a hotline. He warns that many of the war’s “indirect” victims will be those who were vulnerable before the war, and can no longer access medical care. This is his account.
Before the invasion, I performed hearing tests for newborns and adults, examined patients and conducted research work at a state hospital in Ivano-Frankivsk. As CEO of the hospital’s clinical trials unit, I would oversee clinical trials, manage patients’ visits and communicate with the state regulator.
Earlier this year, we asked the international companies conducting clinical trials – there are about 250 active trials in the country – to develop plans to minimise the impact on patients if Russia invaded Ukraine.
Participating in a clinical trial is, in many cases, the only option for patients in Ukraine to access innovative treatment or therapy, and regular check-ups for conditions such as cancer, multiple sclerosis, Crohn’s disease and other life-threatening and disabling conditions. Unfortunately, companies didn’t take the threat seriously so we tried to put some plans in place.
In times of peace, the Ukrainian healthcare system suffered from underfinancing and other issues, but people got help one way or another and every year, services were improving. Our hospital in recent years has made strides in organ transplantation, primary care and digital health, for example. But the war changed everything for all Ukrainians.
Chaotic first days
The first days of the invasion were chaotic. For five days or so I was at the hospital almost 24/7. I was on standby in case any wounded people arrived, but the hospital also became a base of operations where I helped coordinate medical supplies and blood donations for our facility and elsewhere.
We had to discharge non-critical patients, and most face-to-face consultations are now too dangerous given the risk of an air raid.
Clinical trials have been greatly disrupted. We can no longer see clinical trial patients at the hospital, but we call them on a regular basis and deliver medication to their homes. But soon, the supplies will end, and companies have not come up with solutions for future deliveries. The worst part about this is that it is the patients who will suffer the most.
‘Tell me what to do?’
Since March 10, I’ve been a volunteer with the 24/7 hotline initially set up by the Ukrainian health ministry for the COVID-19 pandemic, and now adapted for our present needs.
Since many people have relocated and medical facilities have been destroyed, disrupted or stopped functioning, there is a need to help people who have lost contact with their family doctors, specialists, nurses and social workers.
In a four-hour shift, I can answer anywhere between 10 to 20 calls, and most last for 10 to 20 minutes although some are much longer.
Generally, I receive calls from patients or their caregivers and the issues range from palliative care needs to where a child can go for an operation. About half of the cases are urgent and serious.
As a doctor, I never expected to speak to so many people who risk dying a senseless death as a consequence of war. Some of these calls have affected me deeply.
On March 10, a woman in her 80s called from Kyiv. She lives alone in an apartment building and said she did not have any relatives. Her left leg was amputated many years ago and her right leg has ulcers and requires medical care. Before the war, people came to her home to treat her and assist with groceries, cooking, cleaning and washing because her mobility is very limited.
After the war started, no one has answered the phones of the medical facilities she called and she has not heard from the people who took care of her.
When she called, she sounded stressed and helpless. “Tell me what to do,” she said.
She can’t buy medication and must rely on others to buy it for her. She told me that a volunteer called her to say they would bring more to her. She asked how to use the ulcer medication that she had at home. I explained what to do, then I searched for the details of an operational medical centre in Kyiv for her to contact and ask if it could send someone to check on her. I told her to call again if she had trouble contacting the centre or using the medication.
Abandonment
From her and others who call the hotline, there is a real sense of abandonment.
In normal times, there are so many options for how to help this woman in Ukraine, but speaking to her made me feel sad and helpless. The options now are very limited. I feel angry at the Russians who have brought so much suffering upon the Ukrainian people.
One woman who called was diagnosed with breast cancer and had her surgery scheduled for February 25, but now she does not know when she can get an operation.
Around the country, planned surgeries have been cancelled. Only urgent cases are admitted to the hospitals where it is still possible to accept them.
Another call was from the daughter of a man in Kyiv who has stage four gastrointestinal cancer. To ease his pain, he requires palliative care, which he was getting before the war, but since the invasion, his daughter has not been able to get hold of anyone at the place that was providing the medication and care. His daughter has tried to access care from other facilities but has not been successful – people either don’t answer calls on the landlines and mobile phones she dialled, possibly because they have fled or are too overloaded to answer the phone or when they do answer, they say home visits are not possible at this time.
It is difficult to comprehend that this is the situation in the capital of the country where the infrastructure should be among the best. I cannot imagine the conditions where bombardments and fighting are happening daily. I don’t have words to describe Russian attacks on civilian infrastructure including maternity hospitals in Mariupol and just outside Kyiv in Zhytomyr.
Another call came from a woman in the Dnipropetrovsk region in central-eastern Ukraine. Her son, in his late twenties, was wounded in the head by a bullet a week ago and was admitted to a small district hospital about 40km (25 miles) from the regional centre, Dnipro.
He was connected to mechanical ventilation and is being kept alive by medical devices in the intensive care unit.
The woman goes to see him every day. She speaks to him in the hopes that he can hear her voice.
She desperately wants to help him but the doctors at the hospital told her that if they try to move her son from intensive care to a better-equipped hospital in Dnipro where neurosurgeons can treat him, he will die. Before he can be moved, he must be properly assessed but this can not be done where he is.
The woman is torn. No one is willing to transport her son to a place where there may be a chance to save his life. She called various hospitals that transport patients but all refused to move him because the risk that he will die during the transportation is too high. There was little I could tell her. I listened and gave her contact details for a few more facilities to ask.
These are the unseen medical challenges and horrors Ukrainians are facing today.
As a doctor, it is heartbreaking to listen to people cry and hear their desperation as they ask for any assistance. Those who cannot access medical care have been left behind in the panic caused by the war.
I try to stay calm and reassure people that we will do everything to direct them towards help. I tell them that they are not alone. The help we can provide on the phone is limited but we do everything we can.
Not alone
In the initial days of the war, patients at our hospital were frequently moved to the basement during air raid sirens. But the sirens became so frequent that the conference room and the physiotherapy department in the basement were refitted as intensive care wards and patients in a critical condition have been relocated there for now.
Sandbags now block the windows on all sides of the hospital and access to it is very limited, with only urgent cases admitted. The basement has been prepared to receive the wounded and for triage. Only a few patients have been transferred from central parts of Ukraine but with increasing attacks in the west and the growing number of wounded people in the rest of the country, this will definitely change.
Already, the victims of this war are beyond count. Those who have been directly hurt are in their thousands, and those who will be affected indirectly – who will suffer and die due to neglect and not being able to access healthcare – will be greater still.
It is vital that clinical trial participants resume their participation – for many, these trials can save their lives or improve their quality of life. Unfortunately, the companies that did not have risk mitigation plans did not do their homework after 2014 when Crimea was annexed, and the war started in the east. That was a small version of what is happening today.
As a doctor, a patient is at the centre of all my efforts. That is why I am trying to find ways to help, although in some moments I feel helpless because I can’t provide people I talk to with what they need and I fear for what will happen to them in the future. But I want to lift their hopes at least a bit and help them understand that in facing their struggles, they are not alone.
