General practice in Ukraine: 'COVID doesn't seem scary right now'

Ukraine GP and educator Dr Pavlo Kolesnyk explains how dedicated staff have maintained healthcare services in the face of medicine shortages, threats of Russian missiles and staff burnout.

Refugees head for the border in Uzhhorod, Ukraine
Uzhhorod, Ukraine (Photo: SerhiiHudak/Ukrinform/FuturePublishing/Getty Images)

‘Can you imagine managing diabetes patients without insulin?’ asks Ukrainian GP Dr Pavlo Kolesnyk, speaking over Zoom from his apartment in Uzhhorod, Ukraine.

Dr Kolesnyk, a family doctor and general practice trainer with over 25 years of experience, says he is worried for patients, with medical supplies becoming ever harder to obtain following the outbreak of war and the subsequent disruption to supply chains.

Listen to the full interview now on the Talking General Practice podcast

The invasion has seen his city - nestled at the bottom of the towering Carpathian mountains - receive large numbers of refugees from other parts of Ukraine. He says most of them are heading towards the borders with EU member states Hungary and Slovakia. Reports suggest that Uzhhorod's population of 100,000 has tripled in size.

‘We try to cope with the number of patients and for now we are dealing with this, but the main problem is the lack of medication. There is no system of delivery for some pharmaceutical medications, which is a bit broken here because of the war. So imports are not being provided in the usual way.

Medicine shortages

‘Clinicians also have to take care of the new population arriving [which has] different requests. For example, some people came from central Ukraine and they have a lot of thyroid problems because of the close connection with the Chernobyl zone, so many of them have hypothyroidism.’

Dr Kolesnyk describes a helpless feeling of knowing what drugs to prescribe patients, but being unsure if pharmacists will have them in stock. And when there is supply, he says those who have fled their homes are having to make difficult decisions.

‘People are arriving sometimes without money, or without access to their salaries, or no salaries…So they prefer not to spend money on medications, which are really needed…that’s why we really need more money, more donations to buy some extra medications to provide them for free. We give out a lot now, but it is not enough.’

Unsurprisingly he says the war has distributed the usual rhythms of family medicine in Ukraine, which is provided in outpatient clinics. Dr Kolesnyk, the World Organisation of Family Doctors (WONCA) representative for family medicine in Ukraine, says that a third of patients he now sees are refugees, but admits it is probably higher in other areas.

Staff burnout

Dr Kolesnyk describes what it's like providing care to patients amid the regular wail of warning sirens. Uzhhorod, on the western edge of Ukraine, has not been a target for Russian bombs as yet - but its residents remain on high alert. ‘Today, for example, we had an early morning wake up because of the sirens - and a few days ago I had it in the middle of my working day where I had to go with my patients to the bunker. So patients are waiting [for care],’ he says.

The Ukrainian GP is working double hours to manage the current pressures facing his clinic - treating patients, volunteering in shelters and organising drug deliveries. He says healthcare workers across the country are doing the same, and all at a time when their pay is being reduced to cope with the costs of war.

‘It's exhausting, every day is exhausting and you know, these alarms every night, every morning, every day. It interrupts your day or night. You hear this sound and you have to go down to the bunker to shelter somewhere. This is leading to a very huge burnout of our staff.’

Trainee doctors, or 'residents', are currently being used to reinforce the healthcare workforce in Uzhhorod. Hotels and temporary accommodation are reported to be fully booked, with an estimated 10,000 people crossing into Slovakia each day.

Trainee doctors

Dr Kolesnyk, who works at Uzhhorod National University, says trainees have been drafted into shelters across the city to staff ‘medical points’ and triage patients. He says: 'In the 15 shelters we have residents. Usually they are not responsible personally for the population here, they observe other clinicians at work.

‘But now they have an opportunity to learn in practice...where they are responsible for a small community, and they are the first person to take care of patients, for example recommending medications. It can be called the system of gatekeepers, with residents dealing with the easy problems and referring to the other clinics, or to the hospitals.'

Although they are helping to lift the burden on more experienced clinicians, it’s been a baptism of fire for the trainees, according to Dr Kolesnyk, who says that ‘lullaby sessions’ have been set up to provide support - and the opportunity to discuss cases and share concerns.

‘We call them lullabies because from the first days I realised that residents could feel a bit helpless with their lack of practical experience and needed some support. So we set up Google meetings for them which are free to access. They feel the psychological support, they feel united…as a part of the team [and assure them] that we are all together and everything will be okay.

COVID on hold

‘It's a lullaby because, you know, you always calm down your baby when he or she is going to sleep. Here, we also have the same purpose,’ the family doctor says.

In a society recently dominated by COVID-19, Dr Kolesnyk admits that the war has somewhat distracted Ukranians from their concerns about the virus, with the usual safeguards like masks and social distancing forgotten for now.

‘We have a joke here [where we say] let's talk about the pandemic situation instead of the war. COVID-19 doesn't seem very, very scary right now…it's impossible to think [about safeguards] when there are 50 people [living together in a gym], or when people are in bunkers and there’s a risk of bombing. People don't care about masks anymore.

‘But we are aware of the risks and we are aware of the [spread] of COVID-19 in the shelters…we try to isolate, if possible, but I am really worried about a big [wave] of COVID-19 among chronically ill patients, and about access to hospital care.'

Medical donations

He adds: ‘I hope to God it will not happen. But if it does, we could overload our hospitals with COVID-19. And what will happen with all the other needs and purposes? So, I prefer not to think about it, but really it is a very high danger.’

Even when Dr Kolesnyk arrives home at night he is reminded of the migration of people from conflict zones, hosting relatives from Kyiv. The apartment now houses 11 people in total, but he jokes that he still has free rein over the garden.

More than 3.7m items of medical supplies have now been given to Ukraine by the UK, according to the government, with items including vital medicines, wound packs, and intensive care equipment donated by the NHS. Medical Aid Ukraine, supported by a contingent of UK doctors, has also raised around £65,000 which will go towards medical aid procurement.

But the Uzhhorod family doctor emphasises that donations are still desperately needed. He says: ‘Definitely we need medication. Also donations will help us very much because we have had a lot of donations [but they are] less each week.’

How to donate

To find out how to donate to support Dr Kolesnyk, email gabor.peter1954@gmail.com.

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