Viktor had got a new job four months before the war. He had worked as an adult Orthopaedic surgeon for fifteen years and was offered a job as a head of trauma and orthopaedic department at the Dnipro’s Children’s Hospital – the largest in the region, and the only one in the city. He had completed some training in paediatric trauma but had a limited practical experience working at a specialist children’s hospital. Nevertheless, he saw this new job as an opportunity and a challenge that he wanted to face head on. He had felt a bit stagnant at his previous workplace and embraced the change wholeheartedly.
He had brought a team of young enthusiastic surgeons with him and got to work. There were a lot of things that needed changing and Victor was the right man for the job. Having experienced the Western healthcare model as a visitor to a few well-known American clinics, he understood full well the standards that they needed to strive for and the obstacles of the old Soviet system that they needed to overcome. It was a hard and daunting task, but he believed in the positive change, his team and the general direction that his country was taking – away from the Soviet-Russian corrupt dictatorship towards a European democratic state.
And then Russians decided to invade Ukraine and install their “Russian World” onto the young democracy. Viktor remembers those first two weeks very vividly. Dnipro is situated only about 100 miles from the Eastern frontline and all the city hospitals were overwhelmed with wounded soldiers and civilians. They were the only children’s hospital in the city and Victor and his colleagues had to deal with all the children that were coming through during those early days. The closest paediatric centre was in Kharkiv, which ended up being 20 kilometres from the frontline and hence within an easy reach of Russian artillery. In fact, Russian troops managed to enter the city, but were pushed off by the Ukrainians in the first weeks of the war. The Kharkiv Children’s Hospital had to be closed as most doctors and nurses had left the city, so the Dnipro Centre had to admit all the kids from there too.
Viktor remembers his first admission, a fifteen-year-old boy from Mariupol with a severe compartment syndrome due to severe injuries to his legs. He had been trapped under the rubble of a building which had been blown off by Russian artillery. They managed to save his legs and he was later transferred to the United States for further treatment and rehabilitation. Then, there were more, a lot more. He remembers following movements of the frontline according to where his patients were coming from. Things were moving very fast in those early days and people simply did not have time to evacuate. Some of them did not want to.
A lot of children were not as lucky and ended up loosing their limbs.
Very often whole families with various injuries were admitted simultaneously and that presented unique challenges to how they were to be managed. Viktor, with his unique expertise in both adult and paediatric trauma made an early decision to treat them all in one place without separating the families. That required an official license from the local health authorities, but those things were easy to sort out in those early days. There was very little bureaucracy when the enemy was at the gates of the city. Thus, they started admitting families at a family trauma ward where the adults and kids were able to stay together while their physical injuries were being treated. At least, their psychological ones were not getting worse by being separated from each other.
About a month later, humanitarian aid started coming in. The large bulk of it was collected and shipped by Viktor’s friends from the States whom he had got to know during his earlier educational visits. People really showed the best of humanity during those early months of the war, and apart from the valuable medical kit that there were receiving, it was very important for Viktor and his colleagues to feel that they were not being abandoned, that they were being supported by the international medical community. Except for their Russian colleagues, who chose to keep quiet at best, and publicly supported the destruction of Ukraine at worst.
And so, it carried on – Viktor and his colleagues were treating horrible blast injuries in adults and children 24/7. Because of the overwhelming numbers of patients, they could not afford to keep them for too long and became a “stabilisation centre” in the evacuation chain – they would provide initial fixations of bone fractures, debridement and washout of extensive soft tissue injuries, application of vacuum dressings. Patients were then sent up the evacuation chain to the Western Ukraine and abroad if necessary. It was a hard work, but nobody was complaining and none of the Victor’s colleagues left. There was a true team spirit and people were doing their best to support each other working towards the common goal of making wounded kids better, at least physically. During the first month of the war when the city was heavily shelled and there was a strict curfew many doctors stayed in the hospital with their families and that really made their bond even stronger.
“What was the hardest part of your job at that time?” – I asked Viktor. “Seeing severely injured kids, maimed for life and not being able to help, not understanding why they had to suffer like that”. Sometimes some poor kid was the only survivor with their parents and siblings all killed by a shell while they were in another room which was directly hit, or because they were sent to get something from a shop while their house was turned into a rubble by a Russian rocket. Those orphaned kids, sometimes not older than five or six were the hardest to deal with.
Blast injuries in children were the worst.
Surgeons’ priority was always to save limbs at all costs.
The war was undoubtedly taking its toll on every Ukrainian regardless of where they were. As the frontline was getting closer to the city and explosions grew louder and closer, Viktor realised that it was unsafe for his family to stay there. He put them on an “evacuation train” bound to Western Ukraine and on to Poland. He could not join them because of the never-ending work – no one in the hospital had breaks, or days off then. He could have taken them to Poland himself – as a father of three children he was exempt from the military draft and was allowed to leave the country, but he chose not to. He had to be where he was. His country, his people needed his expertise and leadership then, and he could not betray them.
In about six months things became quieter for Victor and his colleagues at the Children’s Hospital. The Eastern frontline became static and most families living there had been finally evacuated. Finally, Viktor was able to take some time off and go and visit his family in Poland. His kids were in Polish schools, started speaking the language and found friends and started integrating into Polish way of life. He clearly remembers that conversation with his wife – he needed to decide whether to take them all back with him, or to stay there himself. It was a clear choice that both he and his wife clearly understood then. There was no way around it and he was the one who had to make it. Victor did not hesitate, not for a moment. “We must go back. I need to be there. I hope you understand” – he told his wife. She did understand and started packing up. In a few days they were back at their home in Dnipro. Viktor remembers that moment very clearly as one of the times that he had to make a conscious decision to do a hard, but the right thing fully accepting and embracing its consequences. He is still convinced that he did the right thing, and that his kids would understand and appreciate his decision one day.
Viktor in theatre with his colleagues.
Epilogue.
I spoke to Viktor at the end of December, 2023 almost two years after the war had started. At work, it is a bit easier now that the Eastern frontline has been static and most of children who lived in the areas where the most intense fighting is taking place have been evacuated. Children living in bigger cities, like Dnipro and Kharkiv still get severely injured by Russian missiles and drones which overwhelm Ukrainian air defences, but their workload is nothing like it had been during the first months of the war. However, there are other challenges that Victor and his like-minded Ukrainian friends find quite hard to cope with.
People are getting tired of the war. Those who are not in the trenches or have no direct relatives who are, just want their “normal life” back. In Dnipro, and other bigger cities that are farther from the frontlines there is a sizeable proportion of population who do not feel an immediate threat to their lives and think that they could just return to their comfortable pre-war lifestyles without pulling their weight and helping the war effort as volunteers, or even showing any respect or gratitude to the people who are paying a very high price for their freedom of choice day in and day out. And there is an industry emerging to cater to those people – new bars, clubs, restaurants, and other “entertainment” joints open up every day and there is an appetite for more.
Unfortunately, there is another ugly aspect to this story called corruption. People want their “normal” lives back, and outside of missile attacks they do try and re-build it the best way they can. The truth is that for many it means that normality equals corruption penetrating all facets of their lives – some policemen have started taking bribes, council workers expect some “favours” for business projects to be approved, there is even racketeering and money-laundering gangs coming back from the 1990s. The Ukrainian society is beginning to be divided into those who sacrifice their lives and limbs to defend the very existence of it, or like Victor who have given up everything to help their fellow citizens to survive and heal their wounds, and those who try to get an advantage and personal gains out of the highly volatile economic situation and simply do not care about the suffering of their fellow men, women and children. This is highly upsetting for Viktor and his colleagues, not saying anything about those who come back from the frontlines with severe life-changing injuries. It is a very difficult situation, which sometimes makes Viktor doubt whether he had made the right choice after all.
“What makes you keep going now?” – I asked him.
“My patients, the kids and their families that we have been able to help. They are innocent; in wars, kids are always innocent. Adults will always mess it up, we are here to make sure that our kids will survive and build a better Ukraine in the future. This is what we are fighting for here.” – he answered.
“Do you remember any of your patients particularly well, any that have stuck with you for a long time, the ones that you felt that you made a real difference treating?”
“Yes, a few. There was this girl who was at her apartment block of flats here in Dnipro with her mum when it was hit by a Russian missile. They were in separate rooms – the girl suffered severe injuries to her lower limbs, and her mum got away with some scratches and bruises. They were admitted together, and we spent a long time, a few months trying to put the girl together. We managed to save her limbs and she had a full recovery. She was amazing, just looking at her photos, at what she had been through makes me so happy! I do not know where they are now, but I hope they are well.”
Horrific soft tissue injuries in the girl whose flat was hit by a Russian missile.
And the underlying bone fractures.
Multiple surgeries.
Multiple surgeries.
…resulted in a remarkable recovery!
No more surgeries and no more metalwork!
War is evil and it affects people in so many ways. One of the biggest challenges is to remain a human being, to continue to help your fellow human beings even if some of them do not appreciate it, to not take your eyes off the ball, not to forget why you did it in the first place, to remember your “whys”, even if you do not know how to. Having spoken to Viktor, and all the other Ukrainians that I have had a privilege to meet I have a total confidence in the future of their country – it is in safe hands!