Diaspora Helps Fix Ukraine’s Crippled Healthcare

New Pathway.

On April 21, the UNF Hall on 145 Evans Ave. in Toronto hosted the event “Enlightenment through Medicine. Transformation of Ukraine through medical education”, organized by the Ukrainian Canadian Congress (UCC) and presented by Renata Roman and John Holuk, coordinators of UCC’s initiative Ukraine Appeal. The presentation featured Dr. Ulana Suprun, Director at the Patriot Defence initiative and Director of the School of Rehabilitation Medicine at the Ukrainian Catholic University; and Dr. Volodymyr Golyk, Academic Director at the School of Rehabilitation Medicine.

In her introduction, Renata Roman, Vice-President of the Ukrainian Canadian Congress (UCC) who leads the Ukraine Appeal Medical Advisory Group, stressed that, in Ukraine, healthcare now is in critical condition. She listed several Canadian initiatives that have attempted to reform Ukrainian healthcare over the years, such as the Children of Chornobyl foundation and its Dzherelo Children’s Rehabilitation Centre in Lviv and the Ukraine Paediatric Fellowship Program, and also an exchange program that brought two Physical Therapy students from Ukraine to the University of Manitoba 20 years ago. One of those students, Lesya Kalandyak, now runs the major neuro rehab clinic in Lviv Military Hospital, which has become the centre of neurological rehabilitation for the military in all of Ukraine.

Dr. Ulana Suprun’s Patriot Defence project, which provides first aid kits to the Ukrainian military and law enforcement and participates in medical sector reform, is another success story. Dr. Suprun explained that Enlightenment through Medicine is a program which aims to use education to transform the medical system, and through medicine, the whole of society in Ukraine. She said that one of the most transforming and important parts of changing medicine and society is to have new professions and to provide education that teaches the most current standards of medicine. Education is an integral part of the Patriot Defence initiative which trains soldiers how to provide first aid and has developed into training combat medics how to give trauma care on the battlefield and in civilian life. The Ukrainian Catholic University in Lviv, with the help from its donors, has launched the School of Rehabilitation Medicine which will provide Master’s programs based on the Canadian model to prepare both physical and occupational therapists. Before the specialists graduate from the Master’s programs, the School is going to teach short term programs to help Ukrainian doctors and currently practicing physical therapists in the most modern rehabilitation methods.

Dr. Suprun stressed that the recognition of the need to develop rehabilitation medicine is based on the experience derived from the years of Canadian and Western humanitarian and medical aid to Ukraine: “We performed an assessment of the medical system to identify what’s needed – we are not guessing from a distance what’s needed in Ukraine, but taking into account unique societal, cultural and psychological aspects of the people that we are trying to help.” She explained how Patriot Defence developed the program of training the Ukrainian military and law enforcement personnel during the war in the Donbas. At the very beginning, the most pressing need was to provide first aid kits and teach soldiers how to use them to save lives on the battlefield. In two years, the initiative trained over 25,000 soldiers and have provided those trained with over 21,000 Individual First Aid Kits (IFAKs). But, “we later found that the soldiers were dying during the evacuation period. So we re-evaluated everything and came up with a new idea – let’s start training combat medics and providing them with tactical backpacks which can save four soldiers’ lives and keep them alive for several days before they get evacuated. And then we heard stories where the soldiers were dying after they came to the hospitals – the doctors in the hospitals weren’t trained in trauma care. So we repeated our assessment of medical care in the ATO, updated it in August 2015 when we visited 22 different hospitals along the front line of the ATO zone and assessed what they needed. We developed a Ukrainian Trauma Life Support course – a 6-day course to teach doctors how to keep the soldiers alive in the first few hours after being brought into the hospital. To date we have trained over 150 military and civilian doctors.

Because many soldiers and doctors we have trained are now being demobilized, we decided to recruit the doctors who completed the Ukrainian Life Trauma Support course and create our own medical corps. We are going to send them two weeks at a time to the hospitals in the ATO zone so that they can help save the soldiers and civilians injured in the ATO. We also organized two international conferences, one in January 2015 and another one in March 2016, where we invited the Ukrainian military personnel that are involved in tactical training and international experts in tactical medicine, and discussed the organisation and implementation of tactical medicine, how we can help each of the different Ukrainian security forces to adapt it into their own training system. At every stage of our programs, we look back at whether we are doing the right thing, we ask our students to give us feedback on our teaching methods. There are things that we changed from the beginning – one of those things was handing the IFAK’s individually to each soldier. At the beginning it was necessary since there was no logistic structure in place, but in time we realised that once those soldiers went home, they took their IFAKs home with them. We changed our methods, still handing the IFAKs out individually, but now putting them officially on the list of supplies in the battalions.”
Lack of emergency care is not only a problem for the ATO zone but for the whole of Ukraine.

Patriot Defence is providing first aid training to Ukraine’s new police. This training is sponsored partly by the Canadian and Australian governments. The initiative trained all of the new Kyiv patrol force (2,000 new police officers) and provided first aid kits for each of them and for their vehicles (220). According to Dr. Suprun, the situation with emergency care is quite grave in Ukraine: “There are no paramedics in ambulances in Ukraine, only doctors that don’t have much training. In Canada, you have paramedics who can pick up the patient and keep them alive long enough to get them to the hospital where the doctors give them definitive treatment. The response time is on average 8 minutes and they get to the hospital by about 20 minutes. In Ukraine this takes on average 48 minutes. Kyiv is a city the size of Toronto. Toronto has 41 ambulance stations while Kyiv has 14. And those 14 stations have only a couple of ambulances that they use. In Ukraine, a doctor takes six years to get trained, a paramedic takes only three years. So we can train two paramedics in the time we train every doctor – just the schooling of the doctor without any clinical work. If we do that, we can double the number of available ambulance stations. The stations can be equipped with the ambulances that you, Canadians, are sending over to Ukraine with UCC’s Ambulance for Ukraine project. You can make a huge difference by providing that ambulance to a trained professional and we can train those professionals. It’s an excellent combination.”

To explain the gravity of the situation with emergency care in Ukraine, Ulana Suprun showed the gathering a heart-wrenching video of a man who was hit by a car in Kyiv and died because of the lack of care. On that night, when time was precious, the ambulance took a long time to arrive and when it came the doctors did not have the basic skills of how to clear airways – the man choked on his own blood. The relatives of the deceased man agreed to publicize the video to attract attention to the problem.

The development of understanding of what Ukraine needs in medical terms led to the realization that there is very little rehabilitation in Ukraine as we understand it in the West. As Renata Roman, herself a physiotherapist, put it, “If I ask in Ukraine in a room full of people how many of them have even been to a physiotherapist, barely one would say yes.” In Ukraine, rehabilitation is a very short period of time spent in the sanatorium resting after an injury. Dr. Suprun is now involved in the Ukrainian Catholic University’s School of Rehabilitation Medicine which will offer physical therapy and occupational therapy educational programs, the first of their kind in Ukraine.

Dr Volodymyr Golyk, the academic director of the School of Rehabilitation Medicine, who is also a neurologist, originally from Dnipropetrovsk, made a presentation of that program. He described the planned transformation of the current Ukrainian system of sanatoriums into a Western-style rehabilitation medicine system. Dr. Golyk also explained the progress of the project that has been achieved in the past year and the project’s ties with its international counterparts in Europe and North America.

That night at the UNF Hall had an educational purpose, but, as the UCC President Paul Grod put it in his greeting, there is also a need for the Ukrainian Canadian community to actively raise funds for the projects that help reform Ukraine’s crippled medical system. The event was sponsored by the Ukrainian Catholic Education Foundation.