Dr Muiris Houston: It’s hard being a patient in Ukraine

Looking for medical treatment in Ukraine? Chemotherapy infusion booked for this week? Need regular oxygen to help control your chronic lung disease? Don’t hold your breath – since the invasion by Russian forces, healthcare in our European neighbour has been torn apart.

As Russian military close in on the country's second largest city, Kharkiv, (the equivalent of Cork if Ireland had been invaded) we hear how the constant bombardment has driven all healthcare underground, with intensive care units now attempting to function in cold and damp basements. And in Mariupol, under siege for days, doctors are running out of oxygen and morphine with which to treat gravely ill patients.

According to MedPage Today, in the national paediatric hospital in Kyiv, the capital of Ukraine, cancer specialist Dr Lesia Lysytsia now lives in the hospital with her physician husband, Oleksandr, and her two daughters (aged 2 and 5).

The hospital tried to evacuate as many patients as possible to Lviv in western Ukraine and to Poland, but some patients can't be moved because they are on 24-hour infusions or are otherwise unstable, she said.

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Routine surgeries have been suspended. They cannot perform organ transplants. Dr Lysytsia and her colleagues cancelled three stem cell transfusions in the first two days of the war, because the donor marrow cannot be delivered from Germany and Poland. Most patients have been moved underground.

Since the fall of the Soviet Union in 1991, much progress had been made in securing health for Ukrainian people. According to The Lancet, the health system had undergone major reforms in financing and primary care. All 44 million citizens and residents of Ukraine are entitled to receive free publicly funded health services. Primary care, which under the Soviet Union was weak, is now delivered increasingly by family doctors and community paediatricians, making provision more efficient. The under-5 mortality rate ( a sensitive measure of the effectiveness of a country’s health system) has fallen by more than half-from 18.3 per 1000 live-births in 2000, to 8.4 in 2019. But challenges remain. More than 50 per cent of total health spending comes from out-of-pocket payments that increase inequalities in access to health services.

The World Health Organisation (WHO) and Ukraine sign biennial agreements aimed at improving healthcare. Ukraine has the fourth highest tuberculosis incidence and the second highest burden of HIV in the WHO European region, so efforts to ensure continuity for essential HIV and tuberculosis services are welcome. Vaccination coverage against Covid-19 in adults is low (at 33 per cent), and the threat of vaccine-preventable diseases is high due to chronically low routine childhood vaccination rates.

But the war has put an abrupt stop to progress. Of more concern now are patients like the boy who suffered shrapnel wounds to his neck during the shelling of Kyiv. "Due to the severity of the injury, in order for us to stop the bleeding the boy had to undergo surgery right in the admission department of the trauma centre of the hospital," paediatric surgeon Oleg Godik, told Time magazine.The boy is now in critical condition and on a ventilator.

"You can't go on a waiting list for oxygen," Dr Mike Ryan, executive director WHO, told a press conference as he explained the health consequences of a shortage of oxygen and medical supplies to treat patients. "In Ukraine, there are 2,000 people who need oxygen to survive and, in fact, if anything that number has gone up because we have people with injuries, people undergoing surgery who need oxygen, we've children with childhood pneumonia..."

A group of Ukrainian doctors working in the healthcare system here have collectively established Medical Help Ukraine, an initiative to urgently deliver medical aid from Ireland to support the ongoing conflict in Ukraine.

If you would like to contribute, you can visit the group's fundraising website gofundme.com