Our last article followed UK-Med as they first approached the Polish/Ukraine border to assess the medical and humanitarian needs of Ukrainian refugees. UK-Med was the first UK medical organisation to cross the border into the Ukraine. We now have an update on their efforts to set up treatment centres and mobile primary care units for those needing medical attention.
In an armed convoy moving cautiously across the Ukrainian countryside, Dr Andy Kent, lead surgeon of the UK medical aid charity UK-Med, is sketching out plans with his colleagues about whether to push further into the war-devastated country to focus their support in hospitals or whether they can make the most difference by working with refugees on the border.
UK-Med, which provided prolonged support in the Sarajevo conflict in the 1990s and most natural disasters since 1988, was the first NGO to have crossed into Ukraine. It is a self-sufficient team whose primary function is as an Emergency Medical Team (EMT). The aim is to bring the care that’s needed by invitation, where it’s needed without having any impact on the local area, apart from what they deliver.
Dr Kent, 57, whose 'day job' is as a consultant orthopaedic and trauma surgeon at Raigmore Hospital, Inverness, spent 17 years in the army before joining the NHS. He is taking a practical and strategic approach, worked out at every spare moment.
He says: "My priority over the next few days is the Five Ps - prior preparation and planning prevents poor performance."
Crossing the Border into Ukraine
This week he and UK-Med’s Humanitarian Operations Director Tom Godfrey and Portuguese paediatric nurse and UK-Med Senior Health Advisor Teresa Afonso, have moved UK-Med’s base from the Polish border near Rzeszow to Lviv in Northeastern Ukrainian, where air raid sirens have now become a regular part of life.
The trip by armoured convoy into town (not named for security reasons) revealed a hospital well prepared for the anticipated influx of patients from eastern Ukraine, with 11 trauma surgeons, two operating theatres, and plenty of available beds. The UK-Med team heard that 120 injured had come into the town overnight, but after a meeting with the senior team they agreed their help was not yet needed there but they would stay in touch.
Flexibility is the key to planning in a conflict. Dr Kent says: "It’s clear across the country that the paediatric and maternal health needs are great. We are also considering setting up mobile health clinics inside Ukraine along the borders of the neighbouring countries."
Preparation work for the hands-on medical assistance was put in place in the first week of the conflict with Russia when Godfrey and UK-Med’s humanitarian director Dr Ram Vadi flew into Warsaw, linked up with Polish partners Polish Centre for International Aid (PCPM), set up a base in the Polish town of Rzeszow about an hour from the border, and began working out how best to focus their medical offering.
They crossed the border to check out a 30-bed hospital in the Rava-Rus’ka area near a major border crossing point which could be upgraded to 100 beds but found 60-year-old Soviet surgical equipment and only one surgeon. This hospital may form part of a primary care support strategy.
Dr Freda Newlands, an ED doctor from Dumfries experienced in humanitarian missions has joined the UK-Med team. She has visited a shelter for Internally Displaced Persons (IDPs) an hour or so south of Lviv - with a view to installing a mobile clinic to support the shelter.
Planning on How to Best Provide Care
As Dr Vadi explains: "One of the things we have learned is that we can support a structure, but people can’t always get here. But given the huge distances that people are travelling, if they are injured or require too long a wait, we would go to them. We’d move around in a car with a driver a doctor and basic medical equipment, to either stabilise a patient or transfer them.
"We’ve heard reports of people delivering on the border because there’s no services and of children passing away because of the cold. We can offer immediate services. If you need to do a delivery, you can do it in a vehicle. You can warm a child and provide some basic treatment with the aim of getting them to the hospital for any further care or surgical treatment they might require.
Much of UK-Med’s time to-date has been in meetings with a variety of key stakeholders, including the WHO, OCHA, and other EMTs in Lviv, to build a picture of the routes east from a security and needs perspective.
Drawing on a register of nearly 1000 NHS and international health experts, the aim is to build up to a team of 15-20 from UK-Med, working alongside a similar sized contingent from PCPM.
On the Frontlines
Dr Kent and two teammates arrived in Ukraine from Poland on foot, having begun their day wading 1.5 km through thick snow to cross the border manhandling bulky cases full of medical equipment. Two cars driven by local volunteers met them on the Ukrainian side took them to Lviv, where arrangements had been made for their accommodation.
"We met long, orderly lines of [refugees] waiting to pass in the opposite direction," muses Dr Kent. "It was quite surreal how subdued everyone seemed."
Their 'hostel' turned out to be an orphanage and temporary refuge for more than 100 IDPs. The crowded, noisy facilities with poor wifi made their work difficult so they found themselves a small flat from which to operate.
"We’re planning to stay out here for a minimum of 6 months given that the situation is so fluid," says Dr Vadi, gloomily. "It depends on how the conflicts play out, but all the signs are that the push from Russia is going to be much stronger, which means that more people will move from the cities. So it may be longer."
The needs are huge and urgent. Dr Vadi lists paracetamol, surgical drugs and equipment, antibiotics, infusion fluids, bandages, and swabs as items in desperate need. Even before the conflict the medical services in this part of the Ukraine were weak and underfunded.
To provide the necessary medical staffing and resources for a long campaign of support in a deteriorating situation UK-Med needs donations. Details of UK-Med’s emergency funding campaign for Ukraine can be found on www.uk-med.org.
Lead Image: T Godfrey
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Cite this: Rachel Pugh. Providing Medical Support on the Polish/Ukraine Border: UK-Med Update - Medscape - Mar 18, 2022.