From curing Chernobyl liquidators to treating covid patients: the fight against the pandemic in a Ukrainian regional hospital

Special Envoy to Kharkiv (Ukraine)The Regional Clinical Dispensary Specialising in Radiation Protection in Kharkiv, Ukraine's second city, had specialised in treating liquidators who decontaminated Chernobyl nuclear power plant after the 1986 accident. Now there are only covid-19 patients. It is an old Soviet building with forty-year old wooden furniture, wallpaper on the walls and nurses in bonnets. They are suffering the impact of the fourth wave, with a record number of deaths and infections since the beginning of the pandemic, in a country where only 33% of the population has been vaccinated with two doses. President Volodymir Zelenski offered a payment of 1,000 hrivnias (€35 euros, equivalent to 5% of the average monthly salary) for getting vaccinated, but it hasn't made much difference: most people do not trust vaccines. On the street most people do not wear masks and are only required to do so in enclosed spaces, such as bars and restaurants, where they often, but not always, ask for a covid certificate. According to official data, 108,000 Ukrainians have died of covid: that is 2,500 per million inhabitants (slightly more than in Spain, with 2,011 deaths per million).

All 170 beds in the center are intended for covid patients, including 12 ICU beds. Staff, dressed in protective equipment, work in silence, concentrating on their work, and the atmosphere is calm. In the ward there are six patients on non-invasive ventilation, some lying on their sides to make breathing easier and covered with blankets; in the ICU next door there are four patients and two free beds. And they have an isolated box in case a non-infected patient arrives in a grave condition. All those admitted are elderly and the doctors explain that they had other previous illnesses. The vast majority were not vaccinated.

Dr. Oksana Sedenkha, a young intensivist, tells us how they are treating the patients: more or less the same as in the hospitals in Barcelona. In Ukraine they are already using molnupiravir, an antiviral not yet available in Spain. The results are also similar: 40,000 infections and 205 deaths per day on average in the last week. The staff admit they are tired: in the worst moments they knew what time they would start work in the hospital, but not when they would be able to leave.

On the ward for the most mildly ill there are three men in one room, lying on beds, immobile, with oxygen support. There is a strong smell of disinfectant. The doctors explains that they have not run out of oxygen at any time, although they admit that in the smaller hospitals they may have had problems. Rooms are small: there is barely room for three beds, and the patients' belongings are in bags on the floor. No visitors are allowed: at the entrance to the hospital, relatives bring them food in bags marked with the patient's name and room number.

The pandemic arrived in Ukraine somewhat later than in Spain or Italy. For Oksana Sedenkha, the worst moment was October last year, when they did not have enough space in ICU and had to choose which patients would have a chance to survive on a ventilator. Another of his colleagues remembers last spring's surge more starkly, because he had many young patients in critical condition. "We follow international protocols, we work as a team from the different specialties and when we have doubts we talk to colleagues from other countries to share the experience," says the doctor.

No preparations for war

Irina Prigov, oncogynaecologist and director of the hospital, tells ARA that, despite the fact that the city is only 45 kilometres from the Russian border, they are not taking any special measures in anticipation of an invasion. The facility, like all Soviet-era facilities, has bunkers dating back to the Cold War. In medical schools, regardless of their speciality, all doctors are trained in war medicine and there are plans to mobilise them with the military, but so far they have not been activated.

There is concern in the country about healthcare reform, which Volodymir Zelenski's neoliberal government is considering. It envisages cuts and closure of healthcare centres, but it has been put on hold by the pandemic. Victoria, a 23-year-old teacher from Kiev who prefers not to give her last name, says she is more worried about this than the war: "Health reform is a real genocide, there is rampant corruption and in hospitals they make us pay for everything: when my mother was admitted for covid symptoms we had to pay for medicine and if we didn't pay the staff, they didn't even come to take her temperature". Igor Halychansky, a cardiologist at hospital number 8 in the capital, does not deny it outright: "Emergency drugs are always available; for the rest, it depends".