While the government’s efforts to combat the pandemic in Ukraine have been harshly criticized and the media often fuels panic, the main resources Ukraine has, its people, are underestimated. The doctor’s profession in Ukraine has always been financially unrewarding, but the young generation still chooses it and helps people with a passion. Iryna is a vivid example of this generation.
“Today, some woman shouted from a hospital’s window loudly ‘I am alive!’” my mom told me during her first days at the Kyiv City Clinical Hospital #7 where Iryna works.
Panic has accompanied the pandemic from its very beginning. Unfortunately, instead of preventing it, the media often played for it, giving patients of my mom’s age not that many chances.
“The doctors are always lively. They never say anything bad to us. Iryna is very smiling. However, I only see her eyes as everything else is covered with the protective closing. She is under 30, but I feel like she has the experience of a 50-year-old doctor.”
Iryna is 27, which in pre-pandemic Ukraine would in the public’s eyes be considered as too young to be a doctor. She is from Ternopil Oblast, western Ukraine. She came to the Kyiv hospital as an intern in 2017 and continued as a physician in the first therapeutic department. Meeting her in the hospital during her lunch break, I understand what my mother meant by calling her smiling. Almost everything she said came with a smile.
“Many things depend on what people think”
As Iryna told me, it was her intuition and practice which taught her how to speak to COVID-19 patients. Then at the end of last summer, she too became infected, and it helped her to understand her patients better.
“Even though I had expected that I’d get infected, there was this thought in my head – how come? Why me? Also with practice, I started to notice that more and more patients have anxiety, insomnia. Some get depressed. So I realized that I should have to refine my skills as a psychologist. To follow the protocol for treatment is one thing. However, you also should provide moral support. You can prescribe everything right but not talk to a patient, and he or she would tune themselves negatively. And that’s it. Many things depend on what people think. If you agree to stick to a doctor’s recommendations, do breathing exercises, there will be positive dynamics.”
When asked where she got infected, Iryna laughs as the answer is somewhere on the surface. When it happened the hospital was not working with COVID-19 patients. A sorting department was open at the hospital only in summer. At that period it started to take patients with cases of pneumonia. It was only turned into a COVID-19 hospital in the middle of September when the number of infected in Ukraine started to increase.
“If the pneumonia was [COVID] negative, a patient stayed with us in the therapeutic department in a clean zone. It was so for some months. But in summer there were more and more COVID-positive cases – 8 or 9 positive patients a day.”
“Working with COVID-19 directly is safer for doctors”
Kyiv City Clinical Hospital #7. Photo: Olena Makarenko/Euromaidan PressParadoxically, as Iryna says, from the time the hospital turned into a COVID-19 unit, it became safer for them to work.
“Now, we know that we work with COVID-19 directly. We know that we should put on a respirator, overall, shield, etc. And we go to work in protection. Because earlier it could have been that a person comes with decompensated diabetes and you treat it, but in a week his temperature can increase. You do a test and it is positive. So you never knew it in advance.”
Before getting infected, Iryna had about 8-9 24-hour shifts a month.
“There were so many people in contact with you that you could not know who was that particular point of infection.”
“When I received a positive test I was like – I expected it will happen one day”
She only found out she was infected when she lost her senses of taste and smell. The test came out positive. Later, Iryna was hospitalized with bilateral pneumonia and isolated in the hospital she worked in. Although after isolation she could not wait to get back to work, the process was not that easy.
“When I got back after sick leave, our hospital started to take COVID patients. I put on an overall, walked for half an hour, and realized that not everything is so simple. I experienced breathlessness.”
Now Iryna has recovered. She was by no means the only one among her colleagues to get infected.
“Initially, I was not afraid to get infected. Yes, I stick to some rules, I do what I can do, but there is no guarantee that if I do this I will 100% not be infected. So when I received a positive test I was like – I expected it will happen one day. Therefore, probably I am not afraid to be infected for the second time as well.”
“The workday ends at 5 PM, but it never happens”
Iryna’s and her colleagues’ work days start at 8 AM. First, there is a short planning session where they discuss how the patients felt. Before lunch, they come to the patients and prescribe treatment. Then they go to what they call a clean zone to write down the details of what is happening.
“Our work day ends at 5 PM, but it never happens. No one goes home at five. When there was a big influx of patients we went home at least about eight or nine in the evening. Sometimes even later. During the lockdown, there were fewer patients. Now the numbers are increasing again.” (The conversation with Iryna took place a week after the lockdown was introduced in Ukraine from 8 to 24 January).
“We need to spread goodness around and it will multiply”
Moreover, after finishing a night shift, Iryna does not hurry home.
“I know that after a shift, at nine in the morning one should turn back and go home. But I can’t do it like this. I have to come to all my patients, talk to everyone, tell them what to do, and then I can go home. My conscience does not allow me to just go home.”
Giving her personal number to relatives of those who were hospitalized (like me) and to some other strangers was also her own initiative.
“I think that we need to always help people. And it will be returned to you. If you treat people badly, it will go back to you like a boomerang. We need to spread goodness around and it will multiply.”
However, Iryna adds with a smile that she gives her number to strangers a bit less now. She came to this decision after some night calls.
“It’s not hard for me to give my number. But not always do people understand that it is my own initiative, and you should not call me at night. Perhaps, I should have told them, only something urgent. But it turned out that it was not that that urgent.”
Even Iryna’s mother sometimes feels difficulties reaching her daughter by phone.
“How do I cope with it? I go home and cry”
Also, a negative attitude is something that even doctors as kind as Iryna can’t be protected from.
“I think in a doctor’s practice it is impossible to avoid bad words about you. It will 100% happen because there are cases where doctors and medicine are powerless and a person dies. In sorrow, relatives don’t really want to know why it happened. Not everyone can perceive adequately that there was a disease, the consequent risks. So who do they ultimately blame? Of course, the doctor.”
As Iryna describes, other reasons for patients’ discontent appear when people don’t listen to a doctor’s recommendations but follow the tips of some other people. Still, the doctor remains the person to blame if the patient’s condition worsens.
“How do I cope with it? I go home and cry,” Iryna says this still with a smile on her face, but gets more serious later.
“I had a tough period. My mother was infected. And it also was an emotionally critical period for me when we had a lot of hard patients. There were patients with non-invasive ventilation, intubated patients, plus relatives of some patients who were saying that you were bad. So I just went to my mother’s room and wept. It’s my nature, it’s easy to release emotions, and it gets easier. I think if I kept all emotions to myself, probably I would not have been able to have kept working with COVID-19 patients till now. It is very difficult. They can walk as usual today, but in the morning thrombo-embolism could happen suddenly and that is the end of it… And it is very hard to wrap your mind around it. How come? You just talked to a person, everything was ok, and this is it.”
Iryna says thrombo-embolism is the main problem they have with COVID patients. Still, every time they learn how to combat it better.
“It is better now, but morally it still weighs you down.”
“Antibiotics is the biggest problem”
In Iryna’s experience, information disseminated in social media often causes harm.
“Someone writes somewhere that he was treated by this, and others start to take it as well whether they need it or not. Many people came to our hospital already using antibiotics. Some were taking serious ones. Those which I would consider 10 times before prescribing. But someone wrote on Facebook that you can take it and people take it. And then you don’t know what to do as there is a high risk of antibiotic resistance. If it was my decision, I would only allow the sale of these medicines through a prescription in our country. Because our people buy antibiotics whenever they have an itch.”
Also, there are different kinds of myths that patients believe.
“There is always something new. You never know. There was a patient who said that persimmon cured her. Not that a doctor was observing her, that she was breathing oxygen, taking hormones. No one pays attention to this. But persimmon cured it. We got used to such things. But still, antibiotics are the biggest problem. Antibiotic therapy is not always what is needed.”
“One should be a doctor of one’s own free will, otherwise you won’t work here”
Despite the many difficulties Iryna is confronted with, she has never regretted choosing her profession, even if it has always been underpaid in Ukraine and the attitude towards doctors is non-rewarding. She spent her childhood in a hospital since her mother worked as a paramedic.
“I did not even consider other options. I did not think about what salary I would receive, what the attitude towards doctors is. I just wanted to be a doctor. One should be a doctor of one’s own free will, otherwise, you won’t be able to work here.”
All Iryna’s classmates from university stayed in the profession as well. All work in Ukraine.
“We have a family doctor, therapist, anesthesiologist, radiologist, surgeon, traumatologist, psychiatrist, narcologist, two neurologists, and dermatologist. I would not be afraid to recommend them to anyone.”
And Iryna’s general recommendations to people in times of COVID is simple – wear masks, be careful contacting others, consult a doctor, and don’t self-medicate.