SCCM Member Efforts in Ukraine

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Rom A. Stevens, MD, FCCM, and Robert Kerr, MD, were planning to spend this past April sailing off the west coast of Alaska. The two retired Navy captains were looking forward to a relaxing escape, ready to soak in the breathtaking scenery of the last frontier. Instead, they found themselves in war-torn Ukraine, trying desperately to aid a country being decimated by ongoing Russian invasions.

“Ukrainian soldiers are giving their lives for our shared democratic values,” Dr. Stevens said. “We couldn’t go on vacation when people were dying, particularly when we had skills that could help save lives.” Dr. Stevens spent 36 years in the military and served, along with Dr. Kerr, in Afghanistan, Iraq, and Africa. During that time, Dr. Stevens was deployed to Ukraine. As deputy surgeon for the U.S. Naval Forces Europe-Africa/U.S. 6th Fleet, he participated in the exercise Sea Breeze, a multinational exercise with the Ukrainian Navy that allowed him to visit one of the country’s medical clinical centers and talk with hospital staff.

	Dr. Stevens and Dr. Olha Kitsnak, resident in anesthesiology and intensive care medicine, in the ICU at the L’viv Emergency Hospital discussing patient care.

He learned the country’s Cyrillic alphabet during that time, and he forged friendships with Ukrainian physicians. When a humanitarian crisis unfolded in Ukraine in February 2022, those friendships became more important. Dr. Stevens connected with a nongovernmental organization (NGO) and began planning a trip to Ukraine. Two months later, he and Dr. Kerr were on their way to Munich. From there, they traveled by train through Poland to L’viv, the largest city in western Ukraine.

“I went there because I had contacts in the hospital in L’viv, and Ukrainians were shipping a lot of their casualties from the Donbas front west to L’viv,” Dr. Stevens said. “We’d been in war zones before, and we knew the risks. We did not feel our security was threatened; in fact, we felt we were quite safe, but not all U.S. medical personnel would be able to make that determination.”

By April 7, more than 100 Ukrainian healthcare facilities and transport vehicles were attacked.¹ Those conflicts primarily occurred near the capital city of Kyiv, around Kharkiv, in the Donbas, and in the south near Kherson and Mykolaiv. L’viv, located more than 300 miles west of Kyiv, remained mostly untouched, Dr. Stevens said. “The hospitals in the eastern part of the country didn’t have resources,” he said. “Kyiv was never fully cut off from the rest of the country, so they were shipping patients by train to L’viv, where there was more capacity in teaching hospitals.”

Initially the two physicians lectured to physicians in English, sometimes with the help of Ukrainian translators. The lectures focused on their experiences in Iraq and Afghanistan and what Ukrainian clinicians could learn from them. “We had been to war multiple times and were aware of the lessons our medical military officers learned during almost 20 years of war,” Dr. Stevens said, “particularly around blood transfusion and treating combat injuries, which are different from civilian injuries.”

Dr. Stevens’ initial impression of Ukraine’s healthcare system was that it was very resource limited, with remnants of the Soviet healthcare system. Ukraine’s healthcare system began to reform when Ukrainian-American physician Ulana Suprun, MD, was named acting minister of healthcare in 2016, a role she held until 2019.

 

Dr. Stevens lecturing on whole blood transfusion to the physicians of the L’viv Emergency Hospital.

“In 2019 there was a change in government, and all ministers were replaced,” Dr. Stevens said. “They’re now on their fourth health minister since then. Then came COVID-19 in 2020, and in two years of COVID, most ICU patients on ventilators died. When they were clear of COVID, the war started. Because of this, the Ukrainian healthcare system has not made much progress reforming.” Dr. Stevens explained that some Ukrainian hospitals had modern ICUs and operating theaters, but many hospitals had not been renovated. Antibiotics and anesthetics are difficult to obtain, and the system overall is massively underfunded compared to the average country in the European Union. Many Ukrainian hospitals are surviving on humanitarian aid provided by the EU.

“The average salary of a resident is $125 per month,” Dr. Stevens said. “A board-certified anesthesiologist makes less than $500 a month. They often couldn’t afford join European professional societies or attend meetings because of the high cost of membership.” Dr. Stevens wanted to educate the healthcare professionals in Ukraine as best he could. He talked about the U.S. Department of Defense’s Tactical Combat Casualty Care (TCCC), which has become standard for the U.S. and many NATO military services. The focus of TCCC is tactical field care for treating combat casualties. U.S. and NATO soldiers carry individual first aid kits (IFAKs), which are deigned to treat the four life-threatening injuries (airway obstruction, tension pneumothorax, sucking chest wound, and uncontrolled hemorrhage) that could result in death in the prehospital phase of casualty care. Since 2014, many NGOs are distributing IFAKs to Ukrainian military units and instructing Ukrainian soldiers in TCCC.

Humanitarian efforts by NATO, the EU, Japan, Australia, South Korea, and other countries to aid Ukraine and its healthcare system have been admirable, Dr. Stevens said. But he believes that quick fixes will not help Ukraine in the long term. “Their healthcare and medical education systems need reform. They need to pay clinicians better, hire more nurses and ancillary staff, and improve undergraduate and postgraduate medical education. But those are projects for the future. It’s hard to accomplish meaningful reform while fighting for the existence of your country.”

Dr. Stevens returned to the Chicago area in July, where he works as an intensivist for Advocate Aurora Health. When he left for Ukraine in April, Ukrainian struggles were a popular topic of conversation in the North American and European media. When he returned to the United States in July, media coverage had dropped way off. “There’s a danger that people have forgotten about the Ukrainians when they need our support now more than ever, as the war drags on and winter approaches. Recently the Russians have begun targeting Ukrainian energy infrastructure in an effort to demoralize the Ukrainian civilian population.”

	Dr. Stevens and ICU nurse Katiya in the ICU at the L’viv Emergency Hospital with medications donated by the European Union.

Dr. Stevens thinks international medical specialty organizations such as SCCM can help provide needed support. An SCCM member since 2009, Dr. Stevens believes the educational knowledge developed and disseminated by SCCM can be valuable resources for Ukrainians. He has seen this firsthand. “The amount of educational material that SCCM provides is awesome,” he said. “The training that SCCM gives on point-of-care ultrasound (POCUS) really changed my approach toward critical care medicine. I used ultrasound skills extensively in Ukraine. Some Ukrainian intensivists understood the utility of POCUS quite well, and I was able to help improve their skills.” Dr. Stevens expressed his admiration for the Ukrainian medical personnel who continue to provide the best medical care they can to their population, despite the intrusion of the war on their lives and, in many cases, devastation of their cities, their homes, their hospitals, and massive loss of life. After the war, recovery will take years and a massive amount of funding, including treatment of posttraumatic stress disorder in civilians as well as in soldiers.

Dr. Stevens returned to Ukraine in September and October to lecture on whole blood transfusion at hospitals in Dnipro, close to the Donbas front, and in Rivne. He is now back in Chicago and is planning a trip to Ukraine in the spring of 2023 to teach POCUS with SCCM. His goal is to continue finding support for Ukraine until its healthcare workers receive—not just the resources—but also the education they need to thrive. “They need access to our journals and webcasts. These people want our help gaining new medical knowledge. They want to become part of the European Union and realize they have a long way to go to reach the medical standards of western Europe.”

SCCM's Efforts in Ukraine

As the humanitarian emergency unfolded in Ukraine, SCCM rapidly deployed support to critical care clinicians and patients. Partnering with Direct Relief, the Society helped coordinate the delivery of over 750 tons of emergency medic packs, insulin, oxygen concentrators, and wound care supplies. SCCM provided critical care educational resources, while also providing links to free education, including online modules from its Fundamental Critical Care Support: Crisis Management program. As conditions deteriorated over the summer, SCCM and Direct Relief expanded their support by partnering with two U.S.-based NGOs to provide 12 frontline hospitals $50,000 each to purchase needed supplies to keep their hospitals and ICUs operational. SCCM is planning to send a small group of members to Ukraine in the spring of 2023 to conduct in-person ultrasound training and to provide attendees with free hand-held ultrasound units paired with tablets preloaded with SCCM’s ultrasound training courses and reference materials translated into Ukrainian. Donations from organizations, corporations, and dedicated members make it possible for SCCM to respond in ways that are making a significant difference to patients impacted by this crisis. Access free resources in English and Ukrainian and read more about SCCM’s efforts in Ukraine at sccm.org/ukraine.
 

References

1. World Health Organization. WHO records 100th attack on health care in Ukraine. World Health Organization. April 7, 2022. Accessed August 26, 2022. https://www.who.int/news/item/07-04-2022-who-records-100th-attack-on-health-care-in-ukraine

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Posted: 11/21/2022 | 0 comments