Adapting to the realities of war at Dnipro’s Mechnikov Hospital

Dr. Yuriy Skrebets and Dr. Ihor Yovenko with wounded soldier Andriy and wife Natalia, Mechnikov Hospital, Dnipro. Photo: uain.press/Marusia Lahuta  

Featured, Ukraine, War in the Donbas

“The first wounded soldiers arrived at our hospital on May 9, 2014. First one, then six more, then nine, twelve, twenty four, more and more kept coming… They came with open bleeding wounds, some had their hands and feet attached to their body with tape. It was a shock to all of us…” recalls Deputy Chief Physician and Surgeon Yuriy Skrebets.

In the four years of the Donbas war, Mechnikov doctors have saved the lives of over 2,500 Ukrainian soldiers. More than 2,000 employees and 500 doctors of the largest regional hospital in Ukraine have adapted their daily routine to the new realities of war.

On the verge of death

Deputy Chief Physician and Surgeon Yuriy Skrebets. Photo: uain.press/Marusia Lahuta

In 2014, it was difficult to understand that a real war had erupted in Ukraine, says Dr. Yuriy Skrebets. At the time, Chief Physician Serhiy Ryzhenko gave several interviews about the first soldiers arriving at Mechnikov Hospital. He asked Dr. Skrebets to prepare a list of wounded soldiers.

“There were so many of them… I took the lists and glued them together into a small book. The lists were very long, and I printed the names in small letters… ten, twenty, fifty names, in just two days! When they saw this list, our people realized that there was a real war in our country.” says Yuriy Skrebets.

The first months of armed hostilities were the most difficult for the doctors. They were obliged to re-think and re-build their approach to medical treatment.

“Combat injuries are completely different from civilian ones. A civilian may need to have his wound sutured, but a combat injury must be carefully examined and treated starting from the soldier’s foot to his waist; all internal tissues must be explored and properly operated due to internal injuries caused by fragments or bullets. If you have a small wound, it will heal normally, but if we apply the same treatment to combat wounds, the limbs will probably have to be amputated sometime in the future.” remarks the doctor.

Yuriy Skrebets admits that, at the end of July 2014, he thought the war would soon end.

“At the beginning of August 2014, one of our doctors, Artem Provalov was wounded at the front. Chief Physician Serhiy Ryzhenko, Head of the Dnipropetrovsk Regional Center for Emergency Medicine Radiy Shevchenko and I went to fetch him at the airport. At that time, we thought our boys were winning…. Then, a week later, the battle of Ilovaisk…”

Today, the most seriously wounded soldiers – those who are hovering between life and death – are brought to the hospital.

“If it’s planned to dispatch a wounded soldier to our hospital, we are informed about his injuries almost immediately. The medical coordinator and military doctors are in charge of relaying this information. Earlier, we didn’t have a clue of who or what kind of injuries would be arriving, but now we get information about most new arrivals, their injuries, and what treatment they’d received at the mobile hospital. We’re ready for anything!” explains Yuriy Skrebets.

Emergency Admissions, Mechnikov Hospital, Dnipro. Photo: uain.press/MarusiaLahuta

Soldiers (and other patients) are brought to the Department of Diagnostics where they are met by a team of doctors, while anesthesiologists remain on duty round-the-clock.

Severe trauma is treated by a neurosurgeon, surgeon, traumatologist and two anesthetists. If necessary, they perform anti-shock and resuscitation measures, apply prosthetics and artificial ventilation, or operate. The resuscitation room is situated at the entrance; ten patients can be admitted and treated at one time. There are three operating rooms on the first floor, and several more on the second floor, if needed.

“All assistance and diagnostic tests are provided on the first floor so that the wounded don’t have to be transported from one end of the hospital to the other. The main medical team also works here. In the first years of the war, the main office was decorated with flags, chevrons and letters, and volunteers were on duty every day. Today, they still work here, but they follow a fixed schedule.” says Yuriy Skrebets.

Letters to soldiers at Help Center, Mechnikov Hospital, Dnipro. Photo: uain.press/Marusia Lahuta

Will this wounded soldier be the last one?

Dr. Ihor Yovenko, Head of the Intensive Care Ward, Mechnikov Hospital, Dnipro. Photo: uain.press/Marusia Lahuta

All the soldiers who are brought to Mechnikov Hospital must go through the resuscitation room, situated on the ground floor. Dr. Ihor Yovenko is in charge of the Intensive Care Ward.

“Our servicemen are extremely strong. They’re different from other patients. We see it immediately. For example, a civilian may suffer from a banal household injury, and next to him lies a soldier. In the long run, the fighter recovers much faster; he is more positive and wants to recover and get back on his feet.” says Ihor Yovenko.

Doctor Yovenko has treated thousands of soldiers in his ward. He remembers his first patients very well.

“There were five or six men, soldiers and officers. They all had gunshot wounds. One had a small hole in the hip area. It looked fairly simple and complications were not apparent at first. However, a completely different clinical picture unfolded two or three days later. We realized that the soldier had serious intestinal injuries. This was the first time we’d seen such wounds. He was injured by a bullet with a displaced center of gravity. Fortunately, this officer recovered, and now lives and works normally. But then, he was on the verge…” recalls Dr. Yovenko.

However, these were only bullet wounds. Then, they began bringing in more difficult cases – men with torn limbs, heavily damaged internal organs; men in shock, with infected wounds. At every new arrival, the doctors would make the sign of the cross and hope these would be the last ones. But, they keep coming and coming…”

“Then, men started dying… We saw soldiers with sniper wounds that were impossible to treat… no chance of survival. The soldier might last one, two, sometimes three weeks… We looked into his eyes and the eyes of his relatives every day and realized that we couldn’t do anything. It was very difficult for everyone to understand that this was all happening in Ukraine, right in the center of Europe…” says the doctor.

Dr. Ihor Yovenko with patient in Intensive Care Ward. Photo: uain.press/Marusia Lahuta

Doctor Yovenko sighs and adds that the hardest thing is to lose patients and report their death to the family.

“All of us here – doctors, nurses, and medical staff – respect and love each soldier. It’s impossible to remain neutral or aloof. Only those who really feel responsible and are ready to help others have remained at the hospital.”

Dr. Ihor Yovenko is convinced that all the fighters need support and assistance.

“It’s a big help if relatives are with them, especially if they’re disabled. We had one 19-year-old boy who had an amputated leg and had lost an eye. It was very difficult for him to accept that he was disabled. He lay in bed, refused to get up, but we forced him to move around. Today, I see his photos in social networks. He has a prosthetic leg and does sports; he’s great! But, he never believed that he could return to normal life.” remarks Dr. Yovenko

“We have a lot of volunteer friends. For example, Tetyana Yuriyivna works as a doctor, has a private practice. Before and after work, she visits the patients in the intensive care unit, prepares food for them. She doesn’t want any publicity, hasn’t received any awards, but has been helping us for several years. Recently, we needed a very expensive drug. She bought it with her own money and delivered it to the soldier. Another lady visits us regularly; she’s a retired teacher and lives nearby. As soon as she hears the ambulance sirens, she runs to the hospital and asks us what to bring and how to help.”

After a stay in the intensive care ward, the soldiers are transferred to the surgical department.

“When they leave, we always tell them that we don’t want to see them anymore.” says the doctor jokingly.

“I’ll never let him out of my sight again!”

Natalia never leaves her husband’s side. Photo:uain.press/Marusia Lahuta

Andriy was born in Cherkasy Oblast where he worked as an auto mechanic. He enlisted because he couldn’t stand the fact that others were fighting for their country while the people in his village were only worried about daily trifles. He fought for six months. He was seriously wounded by a tripwire landmine near Avdiyivka, suffering from severe injuries to the eyes, lungs, liver, intestines, and head.

He was first operated at a military hospital near the contact line, and then transported to Mechnikov Hospital by helicopter. Andriy was unconscious, connected to a mechanical ventilator.

“It was very hard. We waited for two days: it was neither here, nor there. But, he came out of it…” says his wife, Natalia.

Natalia has been by Andriy’s side for several days. She lives in a nearby hostel that was organized specifically for relatives of patients. Natalia holds Andriy’s hand and refuses to let go. She says that she knew immediately that something had happened to Andriy.

“He called me three times every day. I started worrying when the calls stopped. I called him, but he didn’t answer. I knew something had happened. I must have dialed his number 180 more times… But, he was already on the operating table. I was informed about this in the middle of the night. An officer called me; then, they picked me up, put me on a bus and gave me a ticket to Dnipro. I cried all the way, but I don’t cry now. You have to be strong here.”

Andriy is out of danger. He speaks; he sits up, watches films, and plans to go fishing when he returns home.

“He even jokes with me. Before, he was so weak, but now he laughs. This means everything will be fine. But, I’ll never let him out of my sight again!” promises Natalia.

Treating not just the body, but also the soul

Dr. Svitlana Moroz. Head of the Center for Psychosomatic Disorders, mechnikov Hospital, Dnipro. Photo: uain.press/Marusia Lahuta

Soldiers often return home apparently healthy and fit, but in fact, they are seriously ill, says the Head of the Center for Psychosomatic Disorders under the Department of Neurology at Mechnikov Hospital, Dr. Svitlana Moroz.

“I examined a young man just half an hour ago. He’s been suffering for three long years. His mother forced him to come here. He’s got several disorders; he feels it, but has no one to talk to. After just five minutes of conversation, I persuaded him to stay and undergo some treatment.” says Dr. Moroz.

More than 90% of the soldiers who have seen active duty suffer from post-traumatic stress disorders (PTSD).

“As soon as a soldier is conscious, a psychiatrist and other doctors examine him. They draw up a psychiatric diagnosis and then perform a psychological examination. After that, we work out a treatment plan. We’ve treated 400 soldiers of the 2,500 that have been admitted and treated here… And, we’ve talked to all of them.”

Dr. Svitlana Moroz admits that when she started working with wounded soldiers, she did not fully comprehend the gravity of their problems. At that time, Mechnikov doctors were confronted with symptoms they had never seen before.

“The most difficult cases are soldiers that were held hostage and patients suffering from acute ear barotrauma affecting the central nervous system. Prisoners of war have lived through such stressful situations that it’s very difficult for them to return to normal life. First, we need to plan a “strong” period of rehabilitation. It can last two months. Then, many more years of work with a psychologist. Men that have been in captivity remain silent for two-three weeks… and only then do they slowly start talking.”

Dr. Moroz says that the worst thing that relatives can do when their loved one returns from the front is to question him and try to “explore his soul”. She advises families to immediately take the soldier to a specialist.

“The Heroes return home. They don’t want anyone to dry their tears. If they’re healthy, they’ll cope with the stress themselves. If not, then only a highly skilled specialist can help. Centers for primary diagnosis should be opened in Ukraine, where servicemen could have access to a complete examination, and then return to normal civilian life. After all, they’ve experienced horrifying situations, and after severe contusions or injuries, it’s very difficult for them to get used to daily patterns, such as banal skills of just sitting around and chatting. We’ve organized our own center at Mechnikov Hospital. We search for veterans and encourage them to come in for an examination. However, this should be changed at the legislative level. Complete medicals must become mandatory for every soldier in every region of our country.” explains Dr. Moroz.

Asked how the doctors themselves deal with psychological stress (after all, they’ve seen horrifying things in four years of war), Dr. Moroz says they try to help each other.

“I cried when we buried the wounded that we couldn’t save. I wept and chain-smoked although I’d given up smoking many years ago. We try to support and help each other. We’ve survived, but not one of us ever thought that we’d also need help.”

The soldiers don’t always remember us, but we remember each one…

Dr. Serhiy Ryzhenko, Chief Physician and Surgeon, Mechnikov Hospital, Dnipro. Photo: uain.press/Marusia Lahuta

At 6:00 a.m., Serhiy Ryzhenko, Chief Physician and Surgeon at Mechnikov Hospital, is at his desk. He has a lot of things to do – organize work, speak with the heads of different departments and the employees, make the rounds and talk to patients.

“I’ve spent many nights at the hospital. I’ve even installed a cot in my office. When so many wounded people started arriving, I knew that I wouldn’t get home. In 2014, we spent months and months in the hospital. We never look at the clock when it comes to saving a life. All our employees are ready to leave home and provide assistance at any time of night or day. Our people don’t work for money, but for results!”

The war has radically changed everyone’s life in Mechnikov Hospital. Some employees could not take the pressure and found work elsewhere. Dr. Ryzhenko makes a point of welcoming and speaking to each new doctor or nurse personally. He also tries to allot at least ten minutes to each employee in order to inform them about the basic principles of the hospital.

“Doctors shouldn’t think too much about building a beautiful life. They see real life on the operating table. Saving people is our biggest reward!” says Serhiy Ryzhenko.

He remembers clearly the story of each fighter that they have saved.

“The soldiers don’t always remember the time they spend in Mechnikov Hospital. But, we remember each and every one. After all, their stories are heroic examples of courage and recovery. Recently, at the opening of the exhibition about our hospital in Kyiv, I met Dmytro Kraslyansky, a soldier that we literally pulled from the jaws of death and set on the path to recovery. He survived despite very serious wounds. Dmytro was in a coma for several months, but now he walks and smiles… It was then that I realized I hadn’t lived in vain.” says the doctor.

Today, there are no locked doors in Mechnikov Hospital. Anyone can walk into the offices or wards and see what’s happening…

“This is important because people who need help should know that their relatives can come and see them and support them at any moment.” explains the chief physician.

Dr. Serhiy Ryzhenko hopes and dreams that the war in Ukraine will end soon. It is only then that he and his medical staff will take some time off, rest and relax.

Translated by: Christine Chraibi
Source: uain.press

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