Eugenia was on call at her Maternity Hospital on the night of the Russian invasion. She remembers finishing an emergency Caesarean at midnight, then going to bed only to be woken up by a call to the Emergency Department about a new admission – an 18-year-old girl who was coming in at quite an advanced stage of labour. She delivered a healthy baby at 5:30 a.m. A paediatrician popped into the labour room and said that a bomb exploded on the 12th of April Street (named after the date when Gagarin, the first Soviet cosmonaut went into Space). That was the street where Eugenia lived with her family. That was her first taste of the war. The street is long, and her family was OK.
She stayed at the hospital till 4 p.m. that day as that is how the shift system works in their hospital – you do full 24 hours of emergencies first, then stay and do elective work straight after that. All the elective surgeries were cancelled on that day, but they had enough in-patients to worry about. There was a chaos of the war that everyone had known was coming but was taken by surprise when it actually happened. The city’s healthcare bosses told them to prepare to admit the wounded, a silly suggestion since the only doctors they had were obstetricians and gynaecologists, as well as anaesthetists who had spent most of their careers in Maternity Hospitals, and neonatologists, who had very limited experience with children beyond one month of age. Having separate Maternity hospitals was a relic of the Soviet healthcare system – somehow it had been considered a good idea to single out childbirth with neonatology and make them separate from other specialities. During peaceful times, it often necessitated inter-hospital transfers when things went wrong, as there was little capacity and expertise to treat serious complications in mothers. When the war came, they could not offer much in the field of combat trauma care – their surgeons did not operate anything above, or below the pelvis; their anaesthetists could not remember the last time that they had dealt with a major trauma, and their paediatricians could only take care of neonates. Eugenia, being the Deputy Chief Medical Officer of the hospital fought hard with the city’s administration against the nonsensical and potentially catastrophic decision to make them first responders in those early days of the full-scale invasion. She finally managed to convince them to leave the staff alone, and to carry on doing what they did best, i.e., taking care of women and their babies.
Eugenia remembers one amusing episode from those early days. By coincidence, her birthday fell on the second day of the invasion. They had booked a Spa Day with friends in a nearby city of Dnipro some time previously and completely forgotten all about it being overwhelmed with what was going on around them. Eugenia could not believe it when someone from the spa called her asking if they were still coming for her birthday! Situated only about 100 miles from the Eastern frontline Dnipro was being bombed quite heavily with a lot of its inhabitants trying to escape from the city in the first weeks of the war and yet that Spa was still open and prepared to host a birthday!
Those first days and weeks were chaotic and scary. The Maternity hospital is situated on the outskirts of the city facing the wrong direction – Russia and the region bordering it, which was occupied early during the war. The city of Zaporizhzhya virtually lost its surrounding territories then. There were a lot of refugees escaping their new Russian rulers with horror stories to tell. Some of them were heavily pregnant, and ended up in Eugenia’s hospital with their families as there was nowhere else for them to go. They would often give birth and stay around until they were fit enough to travel further west. The Hospital became a shelter for many refugees from the East. All the elective work was cancelled. Eugenia and her colleagues were only dealing with urgent gynaecological cases and pregnant women, the numbers of which declined sharply after the invasion, mostly because of the loss of territories that they had previously covered.
Hospital staff and patients lived together in the bomb shelter in the first weeks of the war.
An improvised “labour room” in the hospital basement.
Children of the medical staff and patients sleeping together in the bomb shelter during an air raid.
And then raped women from the occupied territories started coming in. Eugenia remembers each and every one of them. Their medical management was not that complicated, but their stories were hard to forget… There was one woman that Eugenia remembers particularly well. She was living with her eight-year-old who had severe cerebral palsy in a village which was occupied by Russians. Her husband had moved to Poland in search of a better-paid job some time before the war. They were not able to get out and ended up living under occupation. She was being raped by Russian soldiers every day before they finally managed to escape and get to Zaporyzhzhya. The woman was heavily pregnant and ended up under Eugenia’s care. Her disabled child required constant and complex care, which the nurses at the Maternity hospital were not able to provide. Eugenia remembers looking for a suitable place for him to go to while his mother was giving birth. They delivered a healthy child, who had Asian-looking face. At the time, a large proportion of the occupying forces were from the Asian parts of Russia. The mother did not want the child. Neither did she want her husband in Poland to know anything about it. She left to join him once she was well enough to travel.
Her child joined other children born from raped women. All the children’s homes and orphanages had been relocated to the Western Ukraine earlier as the city, being in the immediate proximity of the frontline and within the reach of Russian artillery was considered unsafe to have any children’s institutions. The Hospital became an orphanage and the only shelter for those poor little souls doomed to be unwanted and unloved by their mothers.
Eugenia sent me some photos which are too graphic to be displayed here. It took me some time to stop thinking about those images as I have never seen anything as grotesque and awful as that, and I have seen a pretty bad accidental trauma during my twenty-five-year career in anaesthesia and intensive care. What made it worse was realising that it was all caused by (in)human beings who look just like us on the outside but must have very different internal make-up. Or was it just humans, but with no rule of law, or societal pressures to control their animal instincts, which are actively encouraged to use rape as an instrument of war? This is a dark side of the war which everyone seems to want to avoid talking about, but it is very important to do so. Firstly, the World needs to know about the war crimes being committed by ordinary Russian soldiers who are being encouraged to use rape as a weapon in this genocidal war. Secondly, there needs to be more psychological help and support available to the victims, medical personnel treating them, as well as children born as a result of wartime rapes. The problem is not going to go away just because we choose to ignore it.
Life near the frontline is hard and dangerous. The city of Zaporizhzhya is divided by the Dnipro river in two halves – Eugenia lives on the right bank and works on the left one. The journey across the bridge takes a long time due to heavy traffic caused by road blocks and she drives along it every day mindful of the fact that a shell could land on it at any time.
There were problems with electricity as the city’s energy infrastructure was constantly targeted by Russians. At the beginning of the war, they only had one small generator for the whole hospital and had to ration their use of electricity – if a theatre was open, then everything else had to be switched off. Eugenia remembers a health care assistant running around the hospital and literally telling everyone to shut off all the lights elsewhere as an emergency Caesarean was under way. If they had to open two theatres at the same time, then torches had to be used in one of them. They sometimes delivered babies in a bomb shelter. The autumn of 2022 was very difficult. Then the hospital finally got hold of a high-powered generator and their life improved dramatically.
Eugenia performing Caesarean under a torchlight.
…and delivering a baby at the bomb shelter.
When not treating her patients, Eugenia stays cool during air raids and shellings – she just finds a “safe place” and waits it out. They all do. In contrast, visitors to the city, including Eugenia’s in-laws who have recently come for a short visit, panic, and try to run in search of a nearest bomb shelter. Eugenia shrugs it off – “There is no point running – you cannot predict where it is going to get you”. She says that this attitude is prevalent among those who has chosen to stay in their hometown. Currently, about 15 to 20 air raid sirens go off daily, and they ignore virtually all of them.
One of theatres with tiles fallen off the walls and cardboard instead of windows due to constant blasts nearby.
It does not always work – one of her colleagues and a friend, who is the chief medical officer at a rural Maternity hospital not far from the city was once on call when a C-300 missile landed not far from the building he was in. Air raid sirens never go off as there simply is no time for the air defence to detect and intercept missiles launched from a few miles away. He heard an explosion nearby, and instead of running for the shelter, approached the window to check it out. The next thing he saw after coming round was large concrete blocks around him – another missile hit the wall of the hospital earlier taking it down along with the floor and the doctor who was staring out of the window. He came out of it totally unscathed, having been protected by the concrete blocks which fell around him.
A newborn baby lying next to his mother at a postnatal unit of that hospital was not that lucky – he was thrown against the wall by the blast wave and could not be resuscitated. The mother survived and is now pregnant with another child. They are currently under Eugenia’s care at her Hospital. The mother’s mental health is in tatters. No one knows how to deal with her psychological state, there is no expertise available.
The rural hospital with its maternity wing missing after it was hit by a Russian C-300 missile. Photo: t.me/tymoshenko_kyrylo
An aftermath of the missile attack. Photo: Suspilne Zaporizhzhya (Suspilne Media).
There are shortages of the essentials, like oxygen and blood at the blood banks. Every time Eugenia performs a Caesarean, she thinks about the lack of oxygen especially if the baby needs it urgently. The problem with blood is even more pressing – an Obstetric bleeding could be catastrophic, and blood transfusion along with the surgical control is essential in treating it. All the donated blood collected in the city’s blood banks is prioritised for the numerous wounded treated in the general hospitals. There is simply none left for women in labour. Everyone working in the Maternity hospital knows their blood groups, which are all displayed on a special board in the theatre block. If blood is required urgently, medical staff with the same blood group give their own blood directly to the patient who needs it. Legally it is a grey area in Ukraine, so those doctors transfusing their own blood potentially risk their careers, or worse but what is the alternative? To passively observe their patients die of torrential blood loss knowing that there is a chance that they could have saved them? I tip my hat to those doctors and nurses donating their blood to their patients in those conditions. They also carry on working after blood donations despite weakness that follows blood donation.
A doctor is donating blood for a direct blood transfusion to a patient in an emergency.
And now it i Eugenia’s turn.
A lot of the hospital staff have left since the start of the war. It is a big problem for all the hospitals in Ukraine, but particularly those that are close to the frontlines. I asked Eugenia whether the thought of leaving has ever crossed her mind, and what keeps her there. She says that she would only leave if Russians occupied her city. “Why do I have to leave? This is my home!” I have heard those words many times before from the people who have made similar choices. It is hard to explain, and even harder to judge those who have made different choices, but all these stories, and Eugenia’s one are about individual choices and the ripple effects that they have on their families, people in their towns and cities, and the country in general.
Eugenia is currently involved in setting up a privately funded Women’s Hospital which will be based on the Western healthcare model, rather than an outdated Soviet one. She has been invited to Yale for a clinical observership recently and has come back energised and inspired to try and improve the healthcare model in her home country. She has managed to secure a funding from private investors, which was not an easy feat for a big construction project at a frontline city, which is constantly being shelled by Russian artillery, but she has done it! The medical centre is going to open in March next year and care will be free at the point of delivery. One person is making a big difference by making her choice to stay where she belongs and continue helping others.
Eugenia performing a Caesarean when the lights are on.