Joe Elia:
What is the situation of clinicians in Ukraine, and what can we do to help them?
You're listening to Clinical Conversations. I'm Joe Elia, and I'm joined by cohost Dr. Ali Raja, an emergency physician from Mass. General Hospital and Harvard Medical School.
Our guest was supposed to be Dr. Andriy Huk. He's the chief of the Department of Endoscopy and Craniofacial Neurosurgery at the Romodanov Neurosurgery Institute in Kyiv. However, he's unable to join us -- because there's a war going on.
And so, we have been joined by Dr. Roxolana Horbowyj, who is in Philadelphia and has been involved with the American College of Surgeons' program called Stop the Bleed, which is really about trauma and not about the situation in Ukraine, right now, but here she is, with us, and we also have Dr. Serhiy Kareta, a neurologist from the city of Chernihiv, who is not in Chernihiv, right now. He's evacuated to a safer place. So, we welcome both of you, and thank you for being here.
Ali Raja:
Thank you, Dr. Horbowyj, Dr. Kareta. Thank you for joining us, Dr. Kareta, especially given the fact that you just evacuated to western Ukraine. Can you tell us a little bit about what it was like before your evacuation? We know that this has been such a stressful time, but how are your colleagues doing? How is the hospital? How are the physicians? How are you doing?
Serhiy Kareta:
Well, we discharged most of the patients that we were able to discharge, and we basically only have those who cannot be discharged, and the hospital receives a lot of trauma and a lot of injured patients, you know, from the battlefield basically, and it's one of the hospitals. It's not the only hospital that receives the injured. It's a large hospital, but the patients that were previously hospitalized there, they were all gathered on a single floor, which is a therapy department -- so all therapeutic specialties -- and then another floor for all surgical specialties, and all the other floors of the hospital, and all the other rooms of the hospital, were freed for incoming injured patients.
So, it's taking a lot of trauma. It's taking in a lot of trauma patients, mostly civilians, mostly civilians. The arrangement is that only the critical staff is in the hospital. So, we don't have all the physicians. We don't have all the nurses and staff in the hospital. It's just the critical staff, like heads of departments and those on call, you know, and we rotate. Same in the ICU departments, which is done in case the hospital gets hit so that we have our personnel preserved, and we can continue to function.
Joe Elia:
Of course. Now, Dr. Raja and I are both based in Boston, and yesterday, there were marches here in support of the people of Ukraine. Could you tell us if we could get clinical supplies to you, right now, what supplies would be most valuable to what are you trying accomplish?
Serhiy Kareta:
I think, yes, you can get supplies, but not to all parts of Ukraine. For example, you can probably, most likely, get supplies into Kyiv, which is not surrounded, but there is heavy fighting going on north of the city, west, north, and east of the city, but there are still ways to get into the city. So, medical supplies, it's possible to get medical supplies into Kyiv, and it may not be possible to get medical supplies into Chernihiv, at the moment, because it's basically surrounded, and there's heavy fighting going on between Kyiv and Chernihiv. So, that would be extremely risky, and there are several places in Ukraine that receive most of the refugees and most of the trauma patients.
That would be Kyiv, and that would be Dnipro, which is in the central part of the country, and a smaller city of Poltava, which is kind of north and east of Dnipro, and they receive a lot of patients from Kharkiv, which is the worst-hit city at the moment. So, Kyiv, Dnipro, and Poltava -- three locations in Ukraine where it is possible to get medical supplies to, and those are the places that receive most of the injured patients.
Those are the locations, three locations at the moment, and it is possible to put all of those supplies through the western border from Poland, Slovakia, Hungary. I think it's possible, especially Poland, because Poland has been really cooperative through all of this, and they're helping a lot. I'm sure they would be happy to assist us with any kind of, you know, medical line, supply line, or whatever.
Ali Raja:
Thanks, Dr. Kareta. Dr. Horbowyj, you're a surgeon, an intensivist. You're Ukrainian-American. You've been in and out of the Ukraine for decades, working with trauma surgeons, and you've been an advocate for and a leader of the Stop the Bleed program over there. I know you've been in constant touch with a number of physicians in the Ukraine, right now. What are they seeing? What are you colleagues seeing? How much has care been disrupted? What have you heard from the folks you know so well?
Roxolana Horbowyj:
Oh, thank you, so much. So, yes, I've been also teaching the National Association of Emergency Medical Technicians course on PHTLS, Prehospital Trauma Life Support, as well as the TCCC -- all different levels of that -- since 2014, as well as other courses, like RTTDC, the rural trauma course and team, quite intensively, through 2019 and being there up to six times, two weeks at a time, sometimes, and so, that's really helped the Ukrainian military along with many other people who have done similar training, you know, increase their skills with these courses, and staying in touch with them, really hundreds of people, they're continuing to do their work. They're standing for Ukraine.
They are very resolved that they will win, and we all believe that they will. They give examples, for example, of paratroopers being deployed from the Belarus area and the wind being so strong that rather than them landing in Ukraine, they were blown back into Belarus; and targets throughout Ukraine that the Russians set for firing and bombing got covered with snow, and so, there's a lot of belief in their abilities, and so, people, depending on when you speak to them, their condition may have changed from yesterday to today.
So, for example, a person, one of our instructors, an incredible physician in Vinnytsia, which is quite central and a bit to the west of Kyiv, she's been participating with us in instruction things, and yesterday, you know, it was quiet, right, and then yesterday, they bombarded the airport, and so, the conditions change from moment to moment, and so, they're doing their best. They are massively overwhelmed, the hospitals. I just heard from the Lviv Western Medical Military Center, they're doing what they can.
So, all help, well, at all levels, from the population side, tourniquets, and I'm very grateful DoD has provided some guidance about improvised tourniquets, which we've now implemented, and in our teaching, we've figured out what seems to be a reasonable, effective way to create and use improvised tourniquets. They are in need of tourniquets, all, you know, the first-aid IFAK type of things, with NPAs, needles, all reusables, and then for things that are not consumables, instruments for general surgery and especially vascular surgery and orthopedic.
So, I've had lists from all over, really, the country that the key things that I'm always asked for are general surgery instruments, vascular grafts -- 8 millimeter by 80 is their choice -- back wound dressings, bipolar generators, and forceps, orthopedic instruments, especially ex fixes, rods, pins, those kind of things, because, as you know, bombs have not only internal injuries to the lungs and all air-bearing areas but also amputations and broken bones, and so, that has its classic scenario that needs to be dealt with, and as Serhiy has also said, they're targeting civilians as well as the military, and so, 40 million population, you know, we need a lot of things, and when hospitals get bombed and those resources get destroyed, when train lines get disrupted and bombed, humanitarian aid is destroyed. So, but those are the key things, vascular, ortho, general surgery instruments, and consumables.
Serhiy Kareta:
My suggestion would be that we need to address the basic stuff, you know, the very basic stuff, the basic medications, antibiotics and you know IV lines, you know, the basic stuff, because they use a lot of that, and my other suggestion would be to contact those key hospitals in those key cities, Dnipro and Kyiv, and probably Poltava. Those are the cities that are receiving most of the trauma patients at the moment, and ask them directly exactly what their need is. So, we're not just guessing about what may be needed, but we could probably, and I'm sure we would get a very specific list of things of what the actual need is.
Roxolana Horbowyj:
I have done that. So, the things that I listed for you are the things that have come from those hospitals. The list that I actually provided, Serhiy, is from Mikala, who's in Chernihiv, and those are the things that he said that they needed, and there were very similar lists from Kyiv. I mean, you know, globally, those are, to get it down into four categories, right, it's consumables, which is all the basic stuff, the three types ofÉas far as surgery goes, those three types of instruments, and you know, the items that I listed, those are directly from the Kyiv Trauma Hospital, just from Sunday.
And that's what we are trying to provide, and also, the President of the World Federation of Ukrainian Medical Associations here in the US, and we have a little bit of a global network throughout the world, and we're on a WhatsApp group, and so, that is helping a lot to focus the supplies. For example, someone needed a drug for multiple sclerosis in Kyiv, at the oblast center there, on Saturday, when it was yet calm, or Friday or Saturday, and so, from Switzerland, we were able toÉor Greece, I think, we were able to get that within a day or two. So, we are constantly honing in on needs that we know because we're in constant communication with people who can still, you know, have access to communication.
Joe Elia:
And Dr. Kareta, I wanted to ask you about the morale of the staff.
Serhiy Kareta:
There's a lot of fighting spirit there. People are not giving up. No. No.
Joe Elia:
That's so good to hear.
Serhiy Kareta:
No way. People are just, people expect to fight until this is over.
Joe Elia:
Yes. Are people getting sleep, food?
Serhiy Kareta:
Well, you kind of get used to it. We actually had some trouble waking up some of the staff in the middle of the bombardment 6 or 5 days after the start of it, and we had to roll them over and tuck them under beds, if we couldn't take them to the basement, so, well, you know?
But there is going to be a humanitarian catastrophe in those cities that are surrounded. This is true, and there's already a lot of strain in such places like Chernihiv or Sumy, which is way east of the country, or Kharkiv. This is becoming a real problem. There is a shortage of food, and there is a shortage of basic medical supplies, basic things, like flu medicines, antibiotics, you know, the very basic stuff. There's already a shortage of that in the cities that are on the frontline or those that are surrounded. So, there is a brewing humanitarian catastrophe in that part of the country. It is simply a matter of days before it gets really bad.
Ali Raja:
We just wanted to ask about how we can help. We have an audience of many, many clinicians from around the country and from around the world, many of whom are looking to help, and some of whom already are, but many of whom are looking for ways to help. We've talked about donating medical supplies, and Dr. Horbowyj, whatever you think in terms of the contact information, we'll post that with the podcast, what else can all of the clinicians around the world, listening to this podcast, do to help you? How can we help you?
Serhiy Kareta:
If I may, I suppose we need a single body that would collect all those things and then somebody distributing them on-site, depending on the needs in specific places, and not just random donations here and there.
Roxolana Horbowyj:
So, I can speak from the US. We are scurrying and have scurried and are really, I think, Serhiy would know this, quite organized. There are several major NGOs and professional organizations that are Ukrainian and including the ACS [American College of Surgeons], who are in close communications, who are constantly being updated with needs. There are shippers in place that ship humanitarian aid from the US to Ukraine to Poland, which is where, you know, we've been able to ship most. Some, we're trying to ship into Kyiv. I don't know if that's possible now.
We are, you know, organized, and there have been an outpouring of support from all sorts of community members, clinicians, everything. So, Serhiy, please know that it's not just what someone thinks or makes up, or you know, because, I mean, from where you are, you may not know, but the information is, for right now, at least, is flowing, and other countries have offered the shipments as well. So, not only like Nova Poshta is here, Neolit, which is a name of a shipping company that are, these are traditional shippers, right? There are other non-Ukrainian shippers that have stepped up, and Ukrainians are steadfastly resolved, and so, we're just pulling all the stops, all the plugs, to push anything that we can. Clinicians and everyone can very much do, in addition to providing, you know, those things that I've listed, and I'm glad to share the Ministry of Health's needs list with you.
Joe Elia:
I will post that, Dr. Horbowyj, with this podcast.
Roxolana Horbowyj:
If I may, a very important thing that everyone can do -- and I think something that could be incredibly effective and has been helpful -- is to remember we're trying to stop the carnage; and that is to lobby for stop the oil and provide a no-fly zone, provide the defensive military aid that Ukrainians so much need because theirs gets destroyed, as well, and consumed, you know, and so, that, you know, anyone can do, but that's so critically important.
Serhiy Kareta:
A no-fly zone over Ukraine is extremely important, and it's really urgent because that's where most of the carnage comes from.
Joe Elia:
We want to thank you, Dr. Horbowyj, and Dr. Kareta, for being with us, and I hope this interview will bring help where it's needed. Dr. Kareta, especially, I want to applaud you and your staff for your bravery against the Russian invasion.
That was our 284th clinical conversation. It comes to you from the NEJM Group and the writers and editors of NEJM Journal Watch. The executive producer is Kristin Kelly. I'm Joe Elia.
Ali Raja:
And I'm Ali Raja. Thanks for listening, and more importantly, thank you for doing what you can to help the brave clinicians in the Ukraine, taking care of their people.