The Shattering of Healthcare in Ukraine
I’m sitting in my emergency department in rural Emergistan. The sun is shining and my run of shifts winding down. However, the last few days have been hectic and a little bizarre, our work made more complex than usual by a recent drug bust and the associated heroin withdrawal that emerged within hours in those who had been taken into custody. We’ve sedated patients and ventilated patients and flow patients to other hospitals.
And yet it is, by international standards, an oasis of calm and normalcy. However strange or chaotic our shifts, there are absolutely no rockets or missiles incoming. On the local mountain roads there are no barricades, no idling tanks, no anti-aircraft batteries scanning the sky. We have no concern that troops will emerge from the woods or that gunfire will erupt. Attack aircraft will not streak across the sky; and the helicopters we call for patients will not be troubled by ground-fire.
It is a remarkable thing, to sit here in peace and quiet, giving the best we have to our patients in what is by all historical standards practically decadent ease. Yes, I know. COVID. Nevertheless we are well connected and well supplied. We have enough medication, enough bandages, enough blood and generally enough staff. The pandemic is winding down for now.
While storms sometimes affect our electricity we have generators. And while cell-signals and phone-lines can occasionally fail, they are almost immediately repaired. Our water supply is clean and consistent and the freezers in the hospital are full of food.
All day and all night, patients can come here. Young or old, sick or injured, the lights are on, staff is present and there is (for lack of a better word) plenty of stuff. And even as the pandemic has caused us endless troubles, most days we can give most people what they need most. Even the aged, the terminal, the demented are given the best possible care because we have this largess to offer.
I have thought of this all day as I have, between patients, viewed images of war in Ukraine. I have seen burning buildings, the shattered fuselage of aircraft, bleeding, weeping citizens outside of destroyed apartments, stretchers on which the wounded lay and the anxious faces of soldiers young and old, clutching rifles in hopes that perhaps this terrible thing might pass them by and have read of those who did no escape the madness and who fell defending their homes; or fell being dispatched to another country by the hubris of their leader.
In that besieged land which has seen so much suffering in the last century, all of the things that I can do even in my small hospital are slowly ebbing away as violence and destruction erupt.
What does this mean? Well, I’ve never practiced medicine in Ukraine but it is a modern nation. Nevertheless, for the forseeable future, heart attack victims may not get the treatments they need and strokes may just die. Children with life-threatening infections may not be transferred to needed specialists because it will be too dangerous. Necessary surgeries for serious acute, or chronic, medical conditions will be delayed, temporarily or permanently, as operating suites fill up with the wounded and their floors bear the thick, slick veneer of spilled blood.
God knows what will happen to those who are wounded and captured, or whose hospitals are overrun by invading soldiers. One hopes a sense of decency will prevail; but then, decency would seem to have prevented the entire affair to begin with if it were sufficiently present.
Surgeons and medics, nurses and firefighters will use what they have the best they have, and in the circumstances, young soldiers and the victims of bombs, rockets and artillery will take priority over much else.
What do I know from war? Nothing. I have never been to war. I know what I read and what I watch. But I know emergencies and tragedies. I know death and blood, cries and loss. I also know how precious lives and resources are in the best of times.
The COVID-19 pandemic has been a brutal reminder of what it means to give limited care to people when there is nothing to offer them. When there aren’t enough physician specialists, nurses, technicians or medics. When there aren’t enough beds or tanks of oxygen, ventilators or intensive care beds. When even pillows are in short supply.
This is especially hard on those in crisis; the young cardiac arrest, the old cancer patient hanging on, the pregnant woman with no care, the overdose with no hope.
It will be bad in Ukraine. Things normally handled easily will not be handled at all. Deaths unnecessary will become inevitable. The reaper will stalk the land, and the bodies will accumulate from things as acutely horrifying as automatic weapons and as mundane as infected kidney stones. And even those providing care will not be immune. White coats are not bullet proof or bomb-proof. Medical care for all its compassion is not tyrant-proof.
Every country faces crisis in its own way. But as hard as it has been for us, right now, it’s far worse for the citizens of Ukraine.
I’ll leave tonight and go to my safe home. I will not expect devastation or loss. I will celebrate my darling wife’s birthday this weekend.
But there, where death reigns down and enemies surround, the good, the normal, the hopeful are shattered.
Wars and rumors of wars shape so much. We study them, we prepare for them, we mourn them and we too easily celebrate them
In the end, though, the small people and small things, the daily necessities and gifts of modernity and civilization are destroyed.
God protect all those suffering, striving and dying in Ukraine.