The Challenges of Winter Are Over, But the War is Absolutely Not

UK-Med Hosts Trauma Care Pathway Conference in Kyiv

In May 2023, 454 days after the invasion of Ukraine, UK-Med convened a two-day conference in Kyiv with the purpose of bringing together 116 people from across the Ukrainian health sector, responsible for treating people with complex traumatic injuries as a direct result of the war. Also attending were representatives of the Ministry of Health, and international and national NGOs and organisations; most of whom are health professionals who have also been working in Ukraine.

Attending the conference was Dr Serjii Dubrov, the First Deputy Minister of Health, who thanked Ukraine’s partners in his opening speech, welcoming the UK-Med conference and suggesting that, ‘We are doing quite well in terms of provision of care in all the occupied areas of the country, but we have to keep improving our knowledge, we have to learn fast, learn from colleagues who have more experience. So I’m deeply convinced that this event is going to be useful to get new knowledge and skills to improve the quality of health care to the wounded people in Ukraine.’

Also attending was Ms Denise Brown, the United Nation’s Resident Co-Ordinator, and David Wightwick, CEO of UK-Med, who in his opening speech talked about how, ‘The unrelenting nature of the conflict and sheer scale of casualties is something that will challenge and erode everyone within the health system. This is especially true when we talk about trauma. It needs to be addressed and understood as a whole system.’

When a team within UK-Med first began considering the value of convening a conference, it immediately became apparent that it could only be held in Ukraine. ‘In a time of war, you have to hold an event such as this as close to the conflict as possible, to ensure you’re taking the clinicians out of the field for as little time as possible,’ explains Jane Cocking, who organised the conference. A humanitarian professional with more than thirty years’ experience, she was pleased with the event’s success. ‘A lot of its value wasn’t what happened in the conference but the informal networking and discussions that went on in the breaks – which we deliberately made as long as possible so that people had enough time to network. It was very dynamic and vibrant. You could feel the energy in the room.

‘In terms of the cost of organising it (there was no conference fee, and UK-Med funded the cost of the Ukrainian delegates’ travel and two nights’ accommodation), relative to the scale of the international response it represents a miniscule amount of money. But the impact it could have on the quality and nature of the care that people will experience as a result is hugely significant.’

The packed two days were split into main conference talks and breakout sessions. In his presentation, Dr Andriy Vilensky, medical director of the newly formed centre, Superhumans, located in Lviv, estimated that 10,000+ Ukrainians will need prosthetics and rehabilitation as a result of the war. He talked about the multi-disciplinary focus of the centre and presented a roadmap of the patient’s journey through the centre, reflecting on some of the current issues. ‘We understand that we have a lack of experience in multidisciplinary teams which would include experts on rehabilitation and prosthetics, expert psychologists. The training of such teams is very important because it could speed up the rehabilitation and lead to better outcomes.’

Mariana Svirchuk of Unbroken, Ukraine’s National Rehabilitation Centre, began by thanking UK-Med for the organisation’s support since the beginning of the war. ‘It’s very easy to be resilient if you have support. People who come in and say, okay, you can do it this way or that way’. At the beginning nobody knew what would happen and how the war would be. But when the front line stabilised, everybody understood that we would need to be resilient, and to treat Ukrainians in Ukraine.’

With the conference comprising a roughly fifty per cent split between Ukrainian and international attendees, it was very much a two-way flow of information. ‘A year ago, Ukraine had a health service where its doctors had been trained for civilian work – car crashes, agricultural accidents and so on,’ says Vince Vial, UK-Med’s country director, who’s been in Ukraine for the last four months. ‘But they’re now having to deal with blast injuries, bullet wounds, often multiple wounds in different limbs at the same time, meaning they’ve quickly had to turn themselves from being civilian surgeons to full on war surgeons, and that’s a very different thing. So the coming together to share everyone’s diverse experience was invaluable.’

Another of the conference’s key aims was to shine a light on the need for more international focus on healthcare in conflict situations. ‘In war, no sector has the money it requires, and donor governments are constantly under pressure to give money to a complex variety of needs. But when it comes to the treatment of trauma, there’s also the perception that this, and secondary health care in general, is very expensive per person, and it can be an area that’s neglected,’ suggests Vince. ‘And it’s true that it is expensive, but it’s also vital; and not only for the short-term health of the people effected by war. Yes, put starkly, without it people will die. But also, looking at Ukraine’s long-term recovery, a lot of the people receiving these injuries are young and economically active, and if we can help in ways that mean they are able to work in the future and are not long-term disabled, then that will have a significant net benefit.’

The Practicalities of Improving Patient Outcomes

In terms of looking at the trauma care pathway, particularly with reference to ortho-plastic care*, the conference had three main areas of focus:

The Importance of Getting the Basics Right

As Dr Ram Vadi, UK-Med’s Health Director explains, ‘If, for example, you have a complex blast wound, then the most important thing is to begin by making sure it’s absolutely bacteriologically clean. The cleaning can take a long time, and often there’s a temptation to do that quickly, then move on to closing it. But unless you’ve really done the basics right, you’ll end up with an infection further down the line and more surgery may be needed during the patient’s recovery. It’s difficult during times of crisis such as this to remember the basics we all learnt in our training, but it’s something we need to stress and ensure to get right for the sake of our patients.’

Infection Control, Antimicrobial Resistance

The second area of focus was the importance of ensuring that infection prevention and control (IPC) is being integrated into all stages of work in the secondary healthcare system, and how it is the responsibility of all those in direct contact during the patient journey to ensure that it is being done in a safe and preventative manner to limit life-threatening or life-altering infections from occurring. In that same regard, when infections do occur, that they are diagnosed and treated appropriately to prevent antimicrobial resistance. Antimicrobial Resistance occurs when bacteria, viruses, fungi and parasites change over time and no longer respond to the medicines we currently have available, which makes infections harder to treat and thus increases the risk of disease spread, severe illness and possibly death. This can spread cross border and is a key threat we must mitigate to protect others.

Integrated Rehabilitation

The third key area of discussion was the importance of considering the prospective rehabilitation needs of a patient right at the start of the process. As Ram explains, ‘If there’s been a severe injury to a leg, the old-fashioned way of thinking was that it’s treated and it heals, and then the patient goes onto rehabilitation. But if you wait until then to start considering the issues, this doesn’t necessarily secure the best outcome for the patient. Instead, if you begin considering the rehabilitation needs at the commencement of the surgical process, you can start the rehabilitation process much earlier on, helping to avoid the loss of vital muscle function etc during the first stages of treatment, while also considering other elements of rehabilitation, such as mental health and wellbeing of the patient and are therefore able to provide a more holistic recovery.’

Despite the ongoing intensity of the war, during the two days of the conference, hosted in the centre of Kyiv, everything went extremely smoothly.

‘We feel the conference as a whole achieved its aims of bringing together representatives of the Ministry of Health and other national and international agencies to share experience of work over the past 12 months,’ said Vince in summing up, ‘and to discuss what the priorities should be to improve capacity and expertise in Ukraine for war-related trauma injuries.  It was really inspiring to be amongst so many dedicated clinicians, all working so hard to save lives and improve the long-term quality of people’s futures, giving them the best chance of hope and maximising their sense of independence.’ 

* Orthoplastic surgery is a multidisciplinary approach that uses a combination of orthopaedic and plastic surgery principles for treating musculoskeletal problems. An example is limb salvage where soft tissue and bone are involved.

All photos by Vasyl Churikov

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