COMMENTARY

Supply Situation Improved but Medical Challenges Continue in Ukraine

Miriam E. Tucker; Boris Mankovsky, MD, PhD

Disclosures

September 23, 2022

This transcript has been edited for clarity.

Miriam E. Tucker: I'm with Professor Boris Mankovsky, who's the president of the Ukrainian Diabetology Association. We spoke back in March just after the invasion. At that time, things were bad in terms of getting supplies. You had donated supplies, but they weren't getting to where they needed to go. What's the situation like now?

Boris Mankovsky, MD, PhD: First, thank you for this opportunity to speak with you, and thank you for your support. The situation is that in 3 days it will be 7 months of Russian invasion. It's really been a long time and the situation has changed, of course.

Regarding medication supply, I think it's much better for patients with diabetes. We have an insulin supply and we have oral hyperglycemic medication. We also have a supply of levothyroxine, which was a huge problem at the beginning of the war.

Now, the situation is much better because we have received humanitarian aid. We are grateful to the people, organizations, and countries that provided such help and also got regular routes of supply restored. That's why I think that now we don't have shortages — at least we don't have shortages in central and western parts of Ukraine. If we're talking about eastern parts of Ukraine, a place of crazy fighting with Russians, of course it's a different story. It's still a very difficult situation.

Tucker: Do you speak with colleagues in the east? How are they coping?

Mankovsky: Yes. Actually, I'm very impressed by their courage, determination, and their ability to cope in that situation — for instance, in a city like Kharkiv, the second largest Ukrainian city. If we're talking about a smaller city, really they're under attack and under shelling almost every day and still they continue working.

Of the physicians and nurses who originally left the cities, the majority of them came back. 'They're trying to cope and provide good care to patients with diabetes and all other disorders. They're really brave and they're doing their best.

Tucker: What about the delivery of care? I think you had mentioned that, starting with COVID-19, many things had gone online and virtual and not in person. Is that continuing?

Mankovsky: Absolutely. Yes. I think you probably recall that despite all the tragedies and all the horror of the pandemic, COVID-19 gave us new approaches to treating patients. During the war, we use that possibility. We have many consultations and treatment online, using Skype, WhatsApp, email, or another platform. Of course, we need to admit patients sometimes, but not in many situations. Still, the possibility to provide care remotely helps us very much in such a situation.

Tucker: What are your biggest challenges right now in delivering care to diabetes and other endocrine patients?

Mankovsky: Probably the biggest challenge is not medicine itself. The biggest challenge is unpredictability and danger of the situation. Even this morning, just a few hours ago, Russia declared a mobilization and so on. It's still a huge threat for the country generally and a huge threat for everybody in Ukraine.

This is why it affects our patients, because how can we demand a patient to follow lifestyle, diet, or so on if there is such a difficult situation in their life? This is why the everyday lives of our patients and our doctors are heavily affected, and of course, it affects the quality of care as well. It cannot be another way, I'm afraid.

Tucker: Do you feel that you are coping the best way possible in this situation right now?

Mankovsky: Yes, I hope so. Once again, it's my personal opinion, but I would like to say that I am very proud of all those people. In May, I was able to be present when the president of the country awarded some medical nurses. It's an experience I will never forget. I'm sure about this.

Those nurses were from very small cities and villages all around the country. As everybody knows, they lost limbs, they lost legs, they lost hands. Why? Because they stayed with their patients until the very end — the Russians hit them, and so on. I'm talking about civilian people. I'm talking about nurses who are not related to the army. It was unbearable. It was not possible even to watch, but you have to. That's why it's still tough. It's full-scale war.

Ukrainian President Volodymyr Zelensky (left) with Boris Mankovsky, Ukrainian Diabetology Association president (right), at an event in Ukraine honoring nurses who cared for the injured.

Tucker: I was going to ask you about that because the president came to honor these nurses. You were there and I presume that there were other physicians there. Do you think he has an understanding of the medical issues, and about diabetes in particular?

Mankovsky: Despite the situation and despite the war, it involved on-call nurses, but also it was the opening of the new medical center, which was built, of course, before the war. The formal, official opening happened just in May. For instance, in that center, we opened for the first time in Ukraine a cardiometabolic unit.

I took the chance to speak with the president for a few minutes, so I told him about this cardiometabolic problem and he listened. At least medicine is still in the focus of attention of the government, for which I was very glad.

Tucker: Thank you so much, Professor.

Mankovsky: Thank you very much.

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR's Shots blog, and Diabetes Forecast magazine. Find her on Twitter: @MiriamETucker.

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