How Ukrainian oncologists fight

Andriy Beznosenko

— On February 24 this year, I met like most Ukrainians at home. Explosions rang out. I live on the right bank of Kyiv. That's why I heard the explosions at the Gostomel airport, at the Vasylkov airport, in other places, when rockets flew by. Then there was an alarm, it was about four o'clock.

The first thing I did was to move the children and family to a safe place.

Actually I was at the Institute around six in the morning. Because, at that time, there were 450 patients in inpatient treatment, and they received treatment.

In addition, there were more than two hundred medical and service personnel in the night shift.

There were forty children in the pediatric oncology department who were either after surgery or after chemotherapy.

Or before the operation - they were preparing. There were also patients of both adult and child age - after bone marrow transplantation. One child was after all the procedures preceded the transplantation, which was supposed to take place on February 24. —

— What depends on me, in order to ensure the safety of patients and staff of the Institute.

Most patients were discharged home within the first two days. These are those who live in the West and in the Center of our country. They got there by train, bus or other ways.

Patients from Kharkiv Oblast, Mykolaiv Oblast, Kherson Oblast, Zaporizhia Oblast, Donetsk Oblast – there are more than 50 people - they stayed with us for up to two months. They had nowhere to move.

Then we transferred them to the West of our country, and they also continued treatment abroad. —

Andriy Beznosenko

— We centrally evacuated children to Lviv, under the leadership of the Ministry of Health, the "Zaporuka" charitable foundation, Natalia Onipko - I thank them once again, and I will thank them every time.

Then the border crossing and treatment in Poland, Germany, USA.

Many countries responded to children's oncology.

At that time, you may remember, the train stations were full, and it was impossible to get anywhere.

That is why we and the management of Ukrzaliznytsia agreed on a separate train - because our children cannot stand or sit all night on the train on the way to Lviv. They are limited in movement.

They are forced to be either lying down or in another position.

That is why we put the patients with their parents in the railway depot, not at the station.

When the train was already arriving at the platform, the carriage with the children did not open, and other citizens did not get on it. —

Andriy Beznosenko

— Those who remained, they remained to live in the Cancer Institute. We made a shelter in the basement, for almost fifty beds. We provided new mattresses, linens, a strategic supply of water, Wi-Fi, coffee and food.

There were both hospital staff and patients who could not go. Because their cities were either under occupation or already bombed. These are Chernihiv region, Gostomel, Irpin, Bucha.

These are the regions that were under occupation and there was nowhere to return. We all lived at the Institute for more than two months, until our Armed Forces repelled the Russian troops. Only after that we started spending the night at home, and planning our life during the war in a different way.

There were not enough "hands", not enough staff - even to physically move the beds into the basement. Doctors helped. Volunteers helped, when the nurses did not have time, they even set up drips. Two weeks after the start of the war, we decided to continue treatment. After all, no cancer centers were working, and patients remained in Kyiv. —

— There were many temporarily displaced people and they needed help. We had a stock of drugs, we started to provide chemotherapy, drip drugs. It was both a day hospital and a full-time hospital.

Everyone was engaged in this: oncologists, pediatric oncologists, and oncological surgeons. Also, nursing manipulations were often performed by doctors.

From that time until today, we work as a general care hospital - regarding surgical care. These are both civil injuries and civil surgical disasters, these are also acute diseases of the abdominal cavity. Therefore, in addition to oncology, civilians also turn to us. We help around the clock - for more than six months. After all, we have enough competence and experience to do this - along with oncology. —

Valeriy Zub

— Indeed, Chernihiv, Chernihiv Oblast is one of those regions that was encircled and under occupation from the first days.

It was very difficult for the medical industry to work in conditions of such full-scale aggression. I want to say about the Chernihiv Cancer Center, the institution was under constant shelling.

All those patients who were being treated in that period, were transferred to a shelter in the first days. Treatment continued there in the first days. It was decided to transfer all patients, as well as the staff who remained in the institution - into a separate room, which was the most adapted and fortified. And the patients remained there. Some - up to the complete liberation of Chernigov. —

— There was a need to continue the treatment of complex forms. This was especially true for those patients who needed to continue to undergo another course of chemotherapy.

A decision was made to open a separate department - a separate structural unit of the cancer center. In the district center of Nizhyn - where was the simplest logistical solution. Where most patients could be referred.

A department was opened, where our doctor - an oncologist, who organized all the work there, was sent. In order to provide treatment with chemotherapy drugs, we contacted all oncology centers, in two or three days, we collected the medicines that our cancer center had for the future. The treatment of patients who were in Nizhyn and in other cities continued. During the shelling, the computer tomograph was damaged, and the generator completely failed.

The CT scanner was unable to work after that. There was a fire in the cancer center, this happened as a result of the impact of shrapnel and mines. The same thing happened with the linear accelerator, the roof above it was damaged during the shelling. The cooling system of the linear accelerator was also damaged.The buildings of the cancer center came under fire, many windows, doors, and the roof of the premises were damaged. There were no direct hits, but damage was caused by mortar fire and shrapnel. If we talk about the state of oncology care, I want to say that the oncology service has withstood the challenges that have arisen these days. —

— In the first days there was chaos and misunderstanding - what to do, how to work?

But literally in the second week - all institutions that were not under occupation began to accept - in addition to their own patients, there are also patients from other regions. In some regions - the increase occurred by 30-50%. There was no refusal to accept patients from other regions.

Perhaps the biggest challenge was organizing the logistics for our patients. We had to develop such a route so that it was clear: where to turn when the patient arrived in another place. This mainly concerned the displaced persons. We had to tell them where the treatment is carried out, where the medicines they need are available.

This is what had to be done in those first days. This was probably the most difficult. Thanks to our foreign partners, a corresponding site was created. About 30 European cancer centers were involved. They were ready to treat our patients for free. We provided information about these clinics as quickly as possible. Accordingly, those patients who have already gone abroad, or who were going to go abroad, They had information, and therefore could turn to these medical institutions, where treatment of relevant pathologies was carried out. —

— For almost nine months, we have been in the territory where active hostilities are taking place - since February 24, 2022. During the war, the enemy randomly fires at populated areas and destroys vital infrastructure.

In the Mykolayiv region, medical facilities were affected. As a result of the military aggression of the Russian Federation, 13 such institutions were damaged in April. The microdistrict, where the cancer center is located, is a sleeping area in the eastern part of the city. Many medical facilities are concentrated there. On April 4, the territory of our cancer center came under fire. Fortunately, the workers were able to hide in the bomb shelter and were not injured by the explosions.

Although both the windows of the cancer center and the cars parked near the facility were crushed by the blast wave. Patients also suffered. More than ten wounded were on the territory of the facility. They were brought in on stretchers and cars to the reception department of the oncology center for medical assistance.

Our radiological building, which was in the final stage of major repairs at the beginning of February, was damaged. With new, modern equipment and fully ready to receive patients. Not to mention the operating room - a fragment of a cluster projectile flew into the window. —

Andriy Hanych

— Good day. I am Andriy Hanych, head of the radiology department Mariupol oncology dispensary. Since childhood, I dreamed of being a doctor. My mother worked as a nurse in this department, therefore, since childhood, I was a frequent guest there, and the question of choosing a professional education was no longer an issue at all.

Today, I am a radiation oncologist with more than twenty years of experience and have been the head of the radiology department for two years. At the beginning of 2014, our department was designed for 50 beds and provided oncology care to the citizens of Mariupol and residents of seven adjacent districts with a total population of about 700,000. After the occupation of Donetsk, our branch remained one of two branches -in the entire Donetsk region (together with the radiation therapy department of Kramatorsk).

Annually, we treated more than five hundred patients with the most diverse geography - these were both patients from Mariupol and from the territories occupied at that time. Even from neighboring regions - Zaporizhia and Luhansk. It should be noted that despite the outdated equipment and almost zero funding from the administration, thanks to the considerable altruism of the staff of our department, we actively used modern technologies: 3D visualization and radiation treatment planning, 3D printing, developed devices for precise positioning of the patient in the coordinate system of the radiation therapy apparatus.

In 2021, outpatient chemotherapy was launched on the basis of our department with the only hematology beds in Mariupol at that time. Therefore, at the beginning of the full-scale invasion of the rf in February, we were a department which was in very difficult situation, but which had a reasons for further development.

It must be said that we were not ready for war. On February 24 in our department about 40 patients were treated, most of whom were local residents who were treated on an outpatient basis. But there remained 16 patients who were not local and who were physically unable to reach their homes. In a few days, relatives came for four patients, so there were 12 patients left in the department - 5 men and 7 women. —

— Meanwhile, events unfolded very quickly and after a few days the city was without gas, heat, light and water supply, there was a complete lack of communication. In such conditions, our main task was to ensure the viability of patients. We cooked food on the fire. We provided water, obtained by melting the snow that fell in March.

The temperature was below zero in March, so that was our rule constant availability of two teapots or thermoses with boiling water on the tables in the department - the water has run out or cooled down - immediately boil a new one. We didn't have any backup generator, and there was an ordinary household generator brought by the family of our nurse, that transferred to our department after a projectile hit their house.

We tried to restore power to our equipment with this generator because, among our patients were those who are not recommended to take breaks in radiation treatment, because of the biological properties of their tumors. But the power of the generator was not enough and we only had 7 liters of fuel. Therefore, it was decided to use the generator exclusively for boiling water, when the fire is not lit, and for recharging the lanterns.

A hospital was deployed in the main building of the oncology dispensary, in which aid was provided to a large number of wounded civilians. The department had prepared a rather large amount of dressing material, which we handed over to the hospital till February 24 by my order. It should be said that out of almost 250 employees of the dispensary, only about a dozen were working at that time. I am proud of my friends – surgeons-oncologists, Eduard Mostov, Vlad Sayenko and Mark Doroshenko, the three of them provided surgical care in the hospital around the clock, under artillery fire.

In addition to these three surgeons, two nurses and two or three junior nurses remained in the dispensary. I consider them real Heroes. Meanwhile, the front line in the city came close to our hospital. During the artillery shelling, the patients and I hid in the canyon with the radiation therapy devices - there are quite dense walls and no windows, unfortunately, our department is one-story and has no basement. —

— One night there were a lot of wounded, so I stayed overnight in the hospital. When I returned in the morning, I saw that the window in the ward where I spent the night was damaged by shrapnel and debris. Having made a tour of the department, we found several more windows damaged by shrapnel.

It became finally clear that further stay in the branch building is dangerous. Only then I managed to convince the patients to evacuate, because until then they felt relatively comfortable and safe. I had neither a moral nor an administrative right to expel them by force. I managed to negotiate with the hospital management to allocate a bus to evacuate our patients.

The patients were evacuated in the afternoon on March 9. Indeed, this evacuation turned out to be very timely. Because two hours later, when I was taking wood from the fire after cooking food for the sick, our branch came under an air strike. The first hit was a missile, with a direct hit on the branch building a few meters from me. The second blow was an aerial bomb that hit near the maternity hospital, next to which our department is located. This blow had devastating consequences - almost all doors and windows were damaged, a huge hole in the ceiling. It is scary to imagine what would happen if the patients stayed in the department.

I lived in the department for another week in order to ensure that the equipment was preserved as much as possible. —

Andriy Beznosenko

— During air raids, hospital staff, doctors and patients were sheltered.

But air alarms last for hours. In order not to waste time, my colleague and I looked for stories of cancer treatment - during the war. In particular, in professional scientific oncology journals and mass media. It turns out that there have been quite a few wars in recent history. In Yugoslavia, in Iraq, in Afghanistan, in Syria, in Libya - but does not have any professional medical description - what happened to cancer patients during the war.

How did the oncology care management process work. It was not a lack of information, but an information vacuum. It was not there at all. Therefore, through our contacts, through the united oncology community, we collected first information. Then analyzed. Then with colleagues from Stanford and Harvard universities published in the most popular scientific medical journals. —

— In order to record what is happening, to predict the future of cancer care during wartime, in order to show the professional oncology community what is happening with us oncologists. And what is happening with our patients. After all, if we don't describe it, no one else will do this.

Why is this important? Because we inform our colleagues about working conditions in which they have never worked. And they don't know how to work. Get information from the mass media that the shelling took place, who died,how air defense works - of course, this is important. But it was important for us to convey professional information to our colleagues, how to be the Ukrainian oncologist - during the bombing of Kyiv, Mariupol, Kramatorsk, Mykolaiv. —

27.06.2023, Taras Zozulinskyy

NGO "NABU" and its head, human rights defender Andriy Petryshyn participated in the preparation of this journalistic investigation.

This material was funded by The European School of Oncology (Italy) 

 https://www.eso.net/