Prof Oleksii Korzh
Head of the Department of General Practice-Family Medicine (Kharkiv Medical Academy of Postgraduate Education)

17-05-2022 Kharkiv during the war

Ukrainian troops prevented the encirclement of Kharkiv and displaced the Russian military from its neighbourhood. In recent days, Russian troops near Kharkiv, with rare exceptions, have not tried to maintain their positions in the face of counterattacks by Ukrainian forces. Russian forces have focused on conducting an orderly withdrawal of their units, instead of trying to hold positions near the city.

For several days now, Russian troops have not been shelling Kharkiv at all. At the same time, air strikes in Kharkiv region continue. Retreating, the Russian military mine the territory of Kharkiv region. There are active hostilities there. The enemy is retreating. The retreat is accompanied by mining absolutely everything: residential buildings, forest belts, roadsides, using different technologies, including remote mining.

In Kharkiv, the only genetic plant bank in Ukraine was destroyed because of Russian shelling. It was one of the largest in the world and it survived World War II. However, the Russians burned it completely. More than 160,000 varieties and hybrids of plants from around the world were stored there. There have been only a few such banks in the world. The seeds were stored in special storage facilities. They were being prepared for sowing and since March the employees had to sow a collection of plants.

More than ten UN agencies are working on a master plan for the reconstruction of Ukrainian Kharkiv, which has been shelled by Russian troops for more than two months. Experts assume that Russia will be defeated.

The master plan is being developed by the English architect Lord Norman Foster. He believes that this is an opportunity to combine the legacy of the past with new technologies necessary to create the city of the future.

“This is an opportunity to make the city even more majestic in the future than it was in the past. This is an opportunity to make it more dynamic and more advanced in terms of trends, technology, industry – everything that makes the city beautiful,” Lord Foster said.

10-05-22 Kharkiv during the war

Kharkiv business is learning to work during the war. Despite shelling, coffee shops reopened, medical centres accept patients, hairdressers serve customers, and couriers deliver pizza under artillery shelling.
In the first weeks of the war in Kharkiv you could only buy food. Now each district is like a separate city: some do not even have grocery stores, which work, others have cafes, beauty salons and private clinics.
The market of cosmetology services is also coming to life. There are several salons and private cosmetologists in the city, where you can do almost any procedure – from depilation to Botox injections.
Kharkiv citizens have access not only to cosmetology, but also to large-scale medical procedures. There are several private clinics in the city with a wide range of services: from laboratory tests to removal of benign tumours.

Many potential clients of cafes, beauty salons and clinics cannot visit them yet. The reason is not only that people are unemployed and have no money to pay for services. Even those who have savings often cannot get out of their neighbourhood. Taxis are expensive, they are used only in case of emergency. Therefore, until public transport resumes its work in the city, most enterprises, large and small, will stand idle.
The city authorities call on entrepreneurs who evacuated from Kharkiv during the war not to wait long and return to the city. The city is already negotiating with international investors that will help restore Kharkiv’s economy. The mayor of Kharkiv recommended that entrepreneurs make arrangements for the future life in Kharkiv after the war: make plans, create business projects.

04-05-2022 Health care system of Ukraine under conditions of war

During the war, the Ukrainian health care system not only survived, but continues to develop. To date, our hospitals continue to carry out the most complex emergency operations, planned transplantations, the blood service is actively working.
The war has revealed weaknesses in all spheres of public administration, and medicine is no exception. One of the most painful lessons was the lack of full-fledged bomb shelters at medical institutions.
Basements, which with great reserve were called shelters, often turned into mass graves during massive shelling. The lack of an autonomous ventilation, water supply system and strong ceilings makes them unsuitable even as a shelter for healthy people. There is no need to talk about the long stay of seriously ill patients in need of therapy.
Now many hospitals located in cities without hostilities have already been equipped with basements. In case of emergency, doctors will even be able to perform operations there, but this is not the level necessary for full-fledged work. It will be necessary to work on it after the end of the war.
Also in the future, it is necessary to create and constantly monitor the reserve supplies of medicines and other necessary means, which at a critical moment were lacking in Ukrainian hospitals. And in connection with the threat of the use of chemical weapons, the issue of providing means of protection not only for military but also for civilians has become acute.
The same applies to vaccination. The long stay of a large number of people in confined spaces (basements, subways, shelters), as well as getting injured with subsequent infection, leads to the development of dangerous diseases affecting unvaccinated people. We need to return to a clear regulated vaccination calendar not only among children, but also among adults. This will protect citizens from possible consequences of natural or man-made disasters, as well as reduce risks during hostilities.
The system of remote access to medical care needs to be improved, as well as planning for emergencies. In such cases, the major hospitals throughout Ukraine should have a sufficient supply of medicines, the required number of beds and doctors ready to work in the event of force majeure.
In addition, medical facilities in towns most affected by the war should become a separate point in the post-war recovery of the health system.

The main challenge to the system after the end of the war will be the issue of medical personnel. The organisation of work at the local level will require new management decisions, which will not be restricted to the search for specialists. The latest technologies will have to be introduced to compensate for the shortage of personnel.

27-04-2022 – Health care system of Ukraine under conditions of war

The Ukrainian health care system was not exemplary even in peacetime. The war had every chance to destroy the system finally, but instead pushed the government and local experts to find effective solutions, thanks to which medicine in the country not only survived, but also continued to develop.
To date, 347 health care institutions have been damaged in Ukraine, 36 of them have been destroyed. In addition, 78 ambulances were destroyed.

Surviving hospitals often have no electricity and water supply, and if they are located in towns captured by the invaders, there are also no supplies of the necessary medicines. Doctors have to work on-site, replacing sterile operating rooms with basements and bomb shelters. In some towns, medical staff do not leave the hospital, which has become their second home, around the clock.
There is an outflow of medical personnel from areas of active hostilities. Most of the doctors in Ukraine, as well as around the world, are women, many of them have children. While fleeing from shelling, they were forced to evacuate to the western regions of the country or abroad. Among medical staff who remained, many were mobilised to help soldiers on the front line.
As a result, there are a number of towns and villages that are regularly bombed, without properly functioning hospitals and the necessary number of doctors. At the same time, most of the population living there today are elderly people who are in need of medical control of chronic diseases.
When the military administration encourages residents to evacuate, it is important to realise that this is done not only because of the direct threat to life due to shelling. Such decisions are made also on the basis of an assessment of the health situation in the region.

Access of citizens to medical care in the occupied territories is a big problem today. After capturing a town, the invaders are unable to meet the basic needs of the population either in terms of food or health care.
In those regions of Ukraine where there are no active hostilities, a number of steps have been taken for the normal functioning of medical institutions.

In particular:

  • When martial law is in effect, access to primary care is not connected with declarations, signed with family doctors. Citizens can contact any primary health care doctor or an outpatient clinic. Appointments to specialists are not tied to a medical institution either.
  • Patients with cancer are sent for treatment to other cities and regions and this process is devoid of a bureaucratic component. They don’t need to collect certificates and register at a new location.
  • The procurement system for hospitals has been simplified. Thanks to the well-coordinated work of the Ministry of Health and volunteers, medical institutions are equipped with both medicines and food in full, and sometimes beyond measure.
  • There are no problems with financing either. During the hostilities, the procedure was simplified by dividing the planned annual sum into 12 months, thus saving hospitals from unnecessary bureaucratic delays.
  •  Ukrainian military doctors have extensive experience in conducting complex operations and treating seriously wounded soldiers since 2014-2015. Knowing about such successful treatment, foreign doctors have come to Ukraine over the past 8 years to exchange experience.

20-04-2022 – Work of Kharkiv doctors under conditions of war
Healthcare institutions in Kharkiv have not stopped working since the beginning of Russia’s full-scale invasion in Ukraine, all of them work under martial law.
Hospitals do not perform scheduled operations, but if a patient needs urgent care, on which his health or life depends, and his condition can become severe, the full range of health services is provided.
Inpatient departments are about half full, there are not more patients than before the war. Hospitals provide emergency surgeries, childbirth services, chronic diseases and outpatient treatment. Now hospitals are equipped with almost everything necessary. Consumables and medicines are available. Humanitarian aid is constantly provided.
There are not enough staff because some medical workers have left, and some can’t physically get to work. That’s why doctors help each other and learn to do work that they didn’t do in peacetime.
In addition, after the introduction of martial law, polyclinic doctors were transferred to work on-call shifts and provide remote counselling. All polyclinics have on-call medical offices, where family doctors and specialist doctors provide the necessary assistance. Healthcare institutions also vaccinate against coronavirus, vaccine preventable diseases and conduct necessary tests.

Besides, medical teams travel to bomb shelters or subway stations to examine people and provide them with the necessary medicines. They do not set aside lonely and elderly citizens, if possible, examine them at home, deliver the necessary medicines. A system of communication, interaction and exchange of information between all medical institutions has been established. Doctors are ready to provide maximum medical care to all those in need and do everything that depends on them.

12-04-2022

Primary care professionals have been on the frontlines of the russian invasion, especially in eastern Ukraine even while continuing to work in ambulatories and clinics.

The whole process of family doctors’ work in Kharkiv and Kharkiv region has been reformatted in the name of security: after the imposition of martial law, family doctors have been transferred to the mode of duty and remote counseling.

Therefore, those who can, our family doctors consult online or by phone. Those who need a personal appointment, come by prior arrangement with their doctor. Everyone is separated in time so that there are as few people as possible in the building of the clinic at a time. Those who do not have visits in the offices should always be in touch with patients, advise people through Viber cameras, other messengers or communication channels.

Family doctors are learning to be both psychologists and sub-specialists, because there is a lack of both. With the beginning of the war, the number of patients decreased in all doctors, and the following pattern emerged: those patients who remained have a much easier attitude to treatment of somatic diseases.

If we talk about chronic diseases, there is a sharp increase in patients with hypertension, who are sensitive and negative to stress, and in general with diseases of the cardiovascular system, including young people. Moreover, experienced patients complain that the drugs they have always taken do not remove the symptoms, their action is simply not enough.

Fear, anxiety, panic, in which people are currently around the clock, have the strongest impact on patients with kidney disease, gastrointestinal tract, coronary heart disease, diabetes. People with thyroid disease are very prone to stress. But, by and large, any somatics now easily turns into psychosomatics and becomes more complicated. We see this every day: unfortunately, the number of neuroses, depressions and hysterical syndromes has greatly increased.

In addition to medical work, postgraduate training of family physicians at the Department of General Practice-Family Medicine of Kharkiv Medical Academy of Postgraduate Education continues using distance educational technologies. Teachers of the Department give lectures remotely, as well as conduct interactive seminars.

Distance learning is the most optimal form in the system of continuing medical education during the war, as it helps to solve a number of problems arising for a certified specialist due to different approaches to work and study, in particular, in case of partial separation from work or the impossibility of separation from work (the difference between workers shifts and duty schedules for trained doctors, etc.).

Distance learning demonstrates its flexibility through the skillful combination of various types of distance learning technologies: without the presence of a teacher in the case of mastering the theoretical part of the course, with the partial presence of a teacher during practical and seminars in parallel with traditional teaching methods.

Postgraduate education of primary care physicians during the war  caused a change in approaches to the organization of the educational process, methodological training of teachers to implement innovations, facilitation of adaptation to learning, search and justification of forms, methods and technologies of distance learning.

06-04-2022

The medical system of Ukraine has switched to military rails so that Ukrainians do not suffer from the lack of medicines and price increases.
Today, the provision of health care comes from several sources. Basic health care services are provided by health facilities and hospitals to patients both after injuries and after polytrauma, as well as to those patients who received medical care during peacetime, in particular those with chronic diseases and cancer.

Military logistics has been created. Its one direction with medicines and humanitarian supplies goes from west to east of the country, and in the opposite direction there is transportation of patients with serious diseases who have lost the opportunity to receive the necessary treatment due to hostilities.
Significant assistance is provided by international partners supplying medicines in the form of humanitarian goods, which are immediately redistributed to health facilities with the most critical need.
There are separately formed packages of medicines, which in case of opening of humanitarian convoys are transferred to those territories where the invadors do not allow transportation by conventional logistics routes.
Regarding prices in pharmacies – the resolution of the Cabinet of Ministers of Ukraine defines a list of goods and certain medicines for which daily price monitoring is established. The State Service of Ukraine on medicines and drugs control provides monitoring.

Since 24 February 2022, 274 hospitals have been shelled in Ukraine, 13 have been completely destroyed – they are not subject to restoration, 70 ambulances have already been destroyed by shelling and mines, 6 medical workers have been killed, 20 have been seriously wounded. Medical assistance teams are shelled and kidnapped, as was the case with the ambulance brigade of Kharkiv, which went with humanitarian goods to occupied Vovchansk.

30-03-2022

As a result of hostilities in Kharkiv, 1,410 infrastructure facilities were destroyed, most of which are multi-storey residential buildings.

Thus, since the beginning of the war, 1,177 residential multi-storey buildings have been destroyed, 53 kindergartens, 69 schools and 15 hospitals were also damaged by shelling. People have moved to schools, kindergartens, bomb shelters, basements, subway stations.

This morning, Russian invaders shelled a polyclinic in the Osnovyansky district of Kharkiv, where the humanitarian aid delivery center is located. Four people were killed and three were injured. There is no military facility nearby.

On the morning of March 27, in the basement of a house on Saltovka, a 28-old Kharkiv woman gave birth to a girl weighing 2400 grams and 50 centimeters tall. The child was healthy with an Apgar score of 7-8. The 404th emergency medical care brigade delivered the baby.

Long queues are formed daily near pharmacies. At the same time, many medicines are not available now and Kharkiv citizens (especially the elderly) ask for help from volunteers, who, if possible, always respond and get the necessary pills. Hospitals continue to work, and doctors actively answer residents’ phone calls.

Utilities workers promptly eliminate the consequences of accidents caused by shelling – localize defects on in-house heating networks, replace pipelines damaged by shelling, as well as repair, inspect and put into operation boiler houses. Sometimes there is no Internet, but it is usually restored within three days.

The horrors of the war united the Ukrainian nation. In Kharkiv, hundreds of people of different occupations have become volunteers. Businessmen deliver the humanitarian aid within the city and respond to any written requests from the residents.

23-03-2022 

Since the beginning of the full-scale invasion, Russian troops have destroyed almost one thousand buildings in Kharkiv, most of them are apartment buildings.
972 buildings, including 778 high-rise buildings, were damaged.
The regional civil defence administration reported that damage in the region was done to:

  • 30 kindergartens;
  • 9 hospitals in different districts of Kharkiv;
  • emergency medical centre;
  • boarding school for children with visual impairments;
  • Kharkiv regional centre of children’s and youth creativity;
  • Karazin Kharkiv National University.

Everything is done to ensure the normal functioning of health care and the provision of medical services. Kharkiv region received 17 cars for emergency medical care from volunteers.
Interruptions in the supply of medicines occur only in towns where military operations take place. At least three wholesale drug warehouses were damaged as a result of shelling by Putin’s troops – in the towns of Irpin and Mila, Kyiv region, as well as in Kharkiv. But at present there is no shortage of medicines in the country.

Medical care courses have been opened at the Southern railway station in Kharkiv. Those who attend first aid courses are taught to help people with cardiac arrest, heart attacks, strokes, severe bleeding resulting from traffic accidents or injuries. Participants also get basic knowledge of how to deal with stranglement, drowning, epilepsy, burns, frostbite, injuries and other life-threatening situations. At the end of the course, all its students receive certificates.

18-03-2022 

Kharkiv and Kharkiv region were among the first areas, which were attacked by Russia. From the beginning of the war the Russian army invaded towns and villages on the north-east of the region, and Kharkiv appeared under the heavy shelling. A building of the Kharkiv region administration was destroyed by a missile strike on 1 March.

The Russian army probably expected that it would be met with flowers, bread and salt. Instead it faced a fierce resistance of the Ukrainian army and ordinary people, who, to put it mildly, don’t wait for them here, but resist on every centimeter of the Ukrainian land. Russia would like Ukrainian citizens evacuate by the proposed corridors to the Russian borders. This definitely won’t happen, people will never go there. That’s why Russia simply destroys the city so that it doesn’t exist anymore. Russians are constantly shelling living districts, where there is no military infrastructure or plants. A lot of children are killed.

During the war against Ukraine Russian invaders caused damage to 117 hospitals, out of which 7 cannot be restored. Besides, they shelled 43 ambulances and continue to do so.

Josep Borrell, High Representative of the EU for Foreign Affairs and Security Policy, condemned the Russian shelling of civilian objects in Kharkiv, the second largest city in Ukraine. “The shelling against civilian infrastructure yesterday in Kharkiv violated the laws of war. The EU stands unwavering at the side of Ukraine in these dramatic moments.” the EU foreign policy chief wrote on Tuesday, 1 March 2022 in his Twitter.