The life of a Colombian doctor in the war in Ukraine – Health
The Russian invasion of Ukraine began on February 24 of this year and only a few days later various international medical and humanitarian organizations sent personnel to support and care for the population. Five sections of Médecins Sans Frontières (MSF) were present in several cities, developing strategies to resolve the work of the health system and strengthen health care in the country.
In this regard, EL TIEMPO spoke with Diana Galindo, a Colombian doctor who works with the French section (OCP) of the organization and was present helping the population from the first days of the conflict.
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Did you come to Ukraine because of the war?
I belong to Doctors Without Borders and some sections of the organization have been present in Ukraine for several years. MSF is already present in the territory with programs focused on the treatment of chronic diseases. In Donbas, specifically, we were present in 2014 and 2015. Activities were focused on regular health access projects and this made it easy for us to get there quickly when the conflict started this year. Everything was fine – administratively, we knew the population and understood how the health system works in the country.
How long did it take to get to the country?
Everything started on Thursday, and on Monday the first teams had already arrived in Ukraine. We are five sections and each has its own specialty. The two sections already present had the advantage of having certain health programs, but they had to stop them in order to quickly adapt to the needs of the moment.
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When the war started, what was your job?
I am in the French section and we deal with specific issues such as trauma, physiotherapy, rehabilitation and mental health. We are currently running rehabilitation programs and supporting the Ukrainian healthcare system, which unfortunately does not include physiotherapy as we know it. There are almost 120 physiotherapists, which is not a lot for a country at war. So in MSF France, we focused on rehabilitation support, military surgery and military trauma, because everything that was classified in Ukraine as “military trauma” was sent to other European countries. They had not developed this type of skill and with the war the casualty rate was huge.
How is the medical exercise with the war wounded?
It’s a very long follow-up because after you’re broken or amputated, there are months and months of procedures. They have to go to the operating room, fit the external fixator or readjust an amputation, remodel it, etc. And until that happens, they have to do physical therapy. You can have a patient who needs physical therapy for three months or one who requires years. Additionally, those who have amputations then need a prosthesis and also need support through long-term programs that include a mental health component. as it is not easy for these people to deal with how these injuries were caused or to accept that they will have a new need for disability.
And what about patients who have other diseases?
Several sections also work in mobile clinics, which are like the health brigades we know in Colombia, because the health system – especially in the first few months – completely collapsed due to the military effort to treat the wounded, which caused the paralysis of primary care. So there was an effort by all sections to make mobile clinics both in IDP sites and in more remote locations. We tried above all to reach people who stayed in their homes and were old. We also reached territories that were occupied. By the time the Russians withdrew, we went to take care of these populations that had not received medical care for months or weeks.
Mental health is the first thing affected in war. How do you operate in this field?
As for mental health, in Ukraine they don’t have much experience with war trauma. Everything that is mental health is very pathological. If you feel bad, you will be diagnosed as ‘depressed’, hospitalized and given six months of anti-depressant treatment in the hospital. They do not have a focus on psychological therapy because their training has historically been that way. So in that sense we see significant added value from our side and we focus a lot on integrating mental health into all the activities we do.
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Healthcare staff can also be emotionally affected, what about them?
The mental health care and counseling we provided was for the general public, but we also had a pillar focused on health professionals. In many places, we made a psychiatric brigade for the population in the morning and in the afternoon, for example, we treated people from the hospital. It was by their choice. Many times we would arrive at the hospital and ask the staff how they were doing or what they needed, and they would say, “we need psychologists, first for me and then for the patients, because I can’t take it anymore.”
We see significant added value from our side and focus a lot on integrating mental health into all the activities we do.
How is mental health care prioritized if so many need it?
The need for mental health was very telling. The type of consultation done by our psychologists – as well as the national ones – was quite strong, so we focused not only on treating the population but also on caring for carers. Many of them were close to burnout. And this is that during the first months, with the adrenaline, you think that the situation will not last and you do your best, but there comes a moment when you can’t anymore. Fortunately, we quickly integrated this type of care into our operations because there were so many people willing to drop it all. In some places we saw the staff leaving the post, the hospital.
Supply of health supplies was undoubtedly affected, how was this resolved?
Huge imports were made. I had never seen so many shipments arrive in one country. Never. There was a complete shutdown of supply chains. Medicines could not enter the country through the common chain, and many of the medicine factories they owned were in war or occupation zones, so they stopped working. All NGOs, such as the World Health Organization (WHO), brought many supplies into the country. Imports were made by other means, and we managed to balance the difficulties a little. The situation is much better now, but there are always certain drugs and certain molecules that are a little difficult to find. At the very least, we on our side are trying to keep a close eye on the drugs that are most sensitive and that we are sure are needed because the healthcare system in Ukraine no longer has them.
In the midst of war, how do you evacuate the wounded and vulnerable population?
Two sections of MSF joined forces to evacuate two different types of population. The first were wounded from the war, mostly civilians, although not necessarily wounded, they could also have other illnesses or be decompensated. We had an old train available, which helped because what we did was take apart the chairs and put in stretchers and hospital beds, including intensive care beds. We had two trains. One was for intensive care, which had about 20 beds with everything arranged: a respirator, an automatic syringe, everything necessary, and the second train was a little lighter, so to speak, because it was assigned to people who were not easy. to move.
And who was traveling in this lighter train?
Ukraine is very large and has a good railway network; So we took advantage of the fact that it was available to us and what that did was we also put a vulnerable population on that second train. What we mean by vulnerable population are mainly people who live in nursing homes in areas near the border line or people who have lived in shelters and who suffer from some kind of mental or chronic disability. When the conflict broke out, these people were trapped in these places because they are not easily mobilized. We put them on the second train and evacuated them from cities that were close to the border line or that were close to nuclear reactors or bombings and left them in quieter areas in the west or in the center of the country.
How are health claims other than those arising from war handled?
We have had many requests for basic care and primary health care. Here we have to think about diabetes, hypertension, hypothyroidism, as well as sexual and reproductive health, because although many women have moved, many others have remained in the country, and at this point a large number of health personnel are women who have remained in their posts , because it was a war effort that was necessary. We integrate this into health teams and focus them on mental health care, chronic disease and sexual and reproductive health.
Do your actions, outside of the war, contribute to the health system in Ukraine?
Yes, the idea is also that this is an opportunity for the healthcare system in Ukraine to reinvent itself and have strengths in mental health or physical therapy. We also did this with the aim of leaving something in the country, so we hope that after the disaster, a little of our long work will remain.
How is the healthcare system in Ukraine?
When it comes to primary health care, things are improving slightly. We have all adapted to the changes that they themselves (Ukrainians) are making and contribute where we can add something more, added value. Note that the situation depends a lot on each city. If you are in Kyiv, you will find certain health services. Obviously, the topic of surgery was saturated, but in general you could go to the doctor, go for an examination, with a longer waiting time than before. On the other hand, if you go to a city like Nikolaev, you won’t find anything unless it’s extremely urgent. One thing is certain, all western regions have saturated systems and this is a problem that the Ministry of Health in Ukraine and NGOs have been trying to solve.
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