An article written by Ukrainian journalist Kateryna based on two interviews in Kyiv and the Kyiv region with Dmytro (not his real name), head doctor of a hospital, and Boris, director of a rehabilitation center. Both interviews were done in December.
Russia’s ongoing war against Ukraine has shifted the lives of Ukrainians irrevocably on personal and societal levels. As Ukraine closes in on one full year of war, people have had to adjust to an aggressive new climate, reconstruct their habits and work schedules, and mentally acclimate to a harsh new reality. State juridical, medical, economic and even educational systems likewise have had to shift to the rails of military law, wherein one of the biggest pressures within the context of active warfare falls on medical institutions.
Hospitals all over the country have reorganized their work due to an increased volume of war-induced injuries among both the civilian population and the army. Civil hospitals have opened military departments or even shifted their specialty to treatment of the injuries received at the front line.
“Among all the patients we have treated in the last 10 months, the predominant diagnosis is a mine blast injury. Open and hidden shrapnel wounds is the most popular damage among the civilians and the military. It could have been thought that war implies bullet injuries, however this is the rarest case in this war,” shares Dmytro, a head doctor of one of the hospitals in the Kyiv region.
“Mine blast injury is a result of an explosion, it is an indirect trauma. Depending on the scale of the attack, be it an artillery, a rocket, mine, or a drone attack, the shells and parts of the destroyed object or building fly with a high speed within five to 30 meters. Moreover, it affects not only those inside or near the object attacked. Parts of the glass from a broken window destroyed by a shock wave can likewise cause this type of injury. Unfortunately, such traumas are very common and we receive patients with these wounds on a daily basis.”
The treatment is predominantly surgical, often including amputation. Before the war, amputation and the surgical removal of the external objects was treated in a special surgical department. In the last year, the hospitals have had to extend this department and call in for more medics to perform this treatment.
“Since April we have been sending our medics to surgical and amputation educational courses. Doctors of dermatological, venereal, rheumatological, and cardiological departments are being trained as anesthesiologists, surgeons, neurologists, and rehabilitologists”, shared Dmytro.
Neurology is another vital medical department in a war state. Most injuries affect the nervous system and after the surgical removal of the shells or an amputation, patients require a great deal of neurological treatment as well as psychological assistance and a respective period of rehabilitation.
The director of a military rehabilitation hospital, Boris, noted, “The patients who end up with us after the surgeries usually don’t need just one type of treatment. They often come with several traumas at once. We treat patients with hydrotherapy, including hot baths and swimming. We do physical training and professional massage to restore the nerves in a patient’s body, orthopedic treatment, and a course of psychotherapy.
“Nearly all of the patients suffer from post-traumatic stress disorder. It is very important to offer them a full complex of treatment and make sure the patient can come in a good mental state. We start treatment with a mandatory psychological assessment. If the trauma was received in a direct attack, a patient was pressed by a wall, or stayed under the rubble in a narrow space, we have to correct our treatment to eliminate narrow-space tubes during the hydrotreatment or physical exercises.
“When it comes to the soldiers, many associate the vibration of the massage equipment or the vibration from water bubbles during the hydrotreatment with the vibrations of the ground during explosions. It is important to consider such psychological traumas as well.”
Psychological rehabilitation of both soldiers and civilians is of a high importance. Civilian injuries often go hand-in-hand with the loss of a loved one or neighbor and a lack of living space. People suffer from shock and have visionary and auditory flashbacks. Injuries of the military are likewise often accompanied by the loss of brigade members and near-death experiences; they might result in survivor’s guilt and make adjusting to civilian life nearly impossible. Special care is needed for those fighters who, due to an amputation or a serious surgical intervention, won’t ever return to the front line.
Moreover, PTSD is developed not only by people who were physically injured. The constant sound of explosions, stress, and fear affect Ukrainians on a daily basis. “Treating the symptoms now is crucial and is the third biggest segment in Ukrainian medicine in the last year after neurological and orthopedic treatment,” Boris said. “However, we also understand that psychological trauma is ongoing; the war is still going on and we have to be prepared to continue receiving and treating patients from PTSD years after the war ends.”