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Life in Emergistan

Life in Emergistan

The Shattering of Health Care in Ukraine

Leap, Edwin MD

doi: 10.1097/01.EEM.0000827640.20053.5b
    Ukraine, war, international EM:
    Kyiv, Ukraine, Feb. 28, 2022.

    I was sitting in my rural ED, the sun was shining, and my run of shifts was winding down. The past few days had been hectic and a little bizarre, the ED's work more complex than usual by a drug bust and the associated heroin withdrawal among those taken into custody.

    We sedated patients and ventilated them and flew them to other hospitals. Yet I realized our hospital is, by international standards, an oasis of calm and normalcy. However strange or chaotic our shifts, we never see incoming rockets or missiles. No barricades or idling tanks are ever on the local mountain roads, no antiaircraft batteries scan the sky. We're never concerned that troops will emerge from the woods or that gunfire will erupt. We never witness attack aircraft streaking across the sky, and the helicopters we call for patients are never troubled by ground fire.

    It is remarkable to sit in peace and quiet, giving patients our best, which by all historical standards we do with decadent ease. Yes, COVID has been difficult in unprecedented ways, but we are well connected and well supplied. We have enough medication, bandages, and blood, and generally enough staff, and the pandemic appears to be winding down for now.

    We have generators when storms affect electricity, and cell signals and phone lines are repaired almost immediately when they occasionally fail. Our water supply is clean and consistent, and the freezers in the hospital are full of food. Patients can come here any time of day or night: The lights are on, staff is present, and we have plenty of stuff, for lack of a better word. Most days we can give people what they need most of the time, even as the pandemic has caused us endless trouble. We have this largess to offer.

    I've thought of these facts as I've viewed images of war in Ukraine. I've seen burning buildings, the shattered fuselage of aircraft, and bleeding, weeping citizens outside destroyed apartments. I've seen men and women carrying stretchers on which the wounded laid.

    Cameras have focused on the anxious faces of young and old soldiers and volunteers, clutching rifles in the hope of death passing them by for now. I've read about those who did not escape the madness and fell defending their homes and others who died far from their families after being dispatched to invade another country thanks to the hubris of their leader. All of the things that I can do, even in my small hospital, are slowly ebbing away in Ukraine as violence and destruction erupt in that besieged land that has seen so much suffering in the past century.

    Only Devastation is Certain

    Heart attack and stroke patients in Ukraine may not get the treatment they need, and those with severe strokes may even die. Children with life-threatening infections may not be transferred to needed specialists because it will be too dangerous. Necessary surgeries for serious, acute, and chronic medical conditions will be delayed, temporarily or permanently, as operating suites fill with the wounded and their floors bear the thick, slick veneer of spilled blood.

    Ukranians fleeing from Irpin' to Kyiv where they were evacuated by the Kyiv Territorial Defense Battalion.

    Who knows what will happen to the wounded and captured, to the patients whose hospitals are overrun by invading soldiers? Hopefully a sense of decency will prevail, but then again, a sufficient amount of decency could have prevented the entire affair in the first place. Surgeons, medics, nurses, and firefighters will use the best they have, but young fighters and the victims of bombs, rockets, and artillery will take priority over much else in these dire circumstances.

    What do I know from war? Nothing. I have never been to war. But I know what I read and see. I know emergencies and tragedies. I know death and blood, cries and loss. I also know how precious lives and resources are in the best of times. The COVID-19 pandemic has been a brutal reminder of what it means to give limited care to people when there is nothing to offer them, when there aren't enough physician specialists, nurses, technicians, and medics, when there aren't enough beds, tanks of oxygen, ventilators, and intensive care beds, when even pillows are in short supply.

    Limited resources are especially hard on those in crisis: the patient with cardiac arrest, the cancer patient hanging on, the pregnant woman with no care, the overdosed patient with no hope.

    Things are terrible in Ukraine. Tasks normally handled easily will not be handled at all. Unnecessary deaths will become inevitable. The reaper will stalk the land, and the bodies will accumulate from things as horrifying as automatic weapons and as mundane as infected kidney stones. Even those providing care will not be immune. White coats are not bulletproof or bomb-proof, nor is medical care tyrant-proof. Every country faces crisis in its own way, and it's difficult for us because of the pandemic, but it is far worse for Ukrainians right now.

    I can leave my job and go to my safe home without expecting devastation or loss. I will celebrate my darling wife's birthday this weekend. But in Ukraine, where death rains down and enemies surround, the good, normal, and hopeful are shattered. War and rumors of war shape so much: We study them, we prepare for them, we mourn them, and some too easily celebrate them, but the people and small things, the daily necessities, and the gifts of modernity and civilization are destroyed in the end.

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    Dr. Leappractices emergency medicine in rural South Carolina, and is the author of the column Life and Limb ( and a blog ( Read his past EMN columns at

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