“Architects” of a New Medical System
Dr Ulana Suprun, director of the NGO Patriot Defence spoke to us about how an emergency medical services system should work in Ukraine.
They have taught life-saving courses to the army, police, the Foreign Affairs Ministry, the Presidential Administration, youth organizations like “Plast” and schoolchildren. They are activists of “Patriot Defence” who have spent the last year conducting trainings in first aid to these groups and have thus, probably, saved the lives of more than one person.
Patriot Defence began its operations in May 2014. Since then, its activists have provided training in pre-hospital first aid to soldiers (over 30,000) and provided them with NATO-standard first-aid kits after the training. According to the organization’s director, Dr Ulana Suprun, “Patriot Defence’s” activities are aimed at creating a new and improved medical system. “The Day” newspaper asked Dr. Suprun about her organization’s vision for the new medical system and the results of its work.
“KNOWLEDGE AND SKILLS ARE KEY”
“We decided that it’s essential to train soldiers on how to provide aid in the battlefield,” recalls Ulana Suprun. “After working with them, we saw that there are too few tactical medics on the frontlines who are able to care for a person’s life prior to hospitalization. So we worked with the medics of the special service forces and that produced favourable results.
Then we saw that while battlefield medics are able to deliver the injured to hospitals, the injured perish there. So we decided that it’s necessary to also provide training to doctors on how to provide aid for specific injuries. In October of last year, our organization introduced a five-day course. So far, four groups of 24 doctors have completed it. The course is structured in such a way, that we take our trainers to a specific hospital, and train the personnel there to use the equipment they have. It’s not vital to have the most modern equipment or supplies. Knowledge and skills are key. Our instructors also conduct educational work in that they explain that the life of every soldier is vital and that we have to fight for each one.
What about journalists? How important are medical skills for those working the battle zones?
In the West, there are specific courses for journalists who are sent into conflict zones. They don’t only address medical issues, but how to behave in dangerous environments. Most important for a journalist is to know how not to become a target. In London, such a course for media professionals takes five days and costs five thousand pounds. We have adapted the training to last two days and it is conducted by British trainers who worked with journalists and diplomats before they were sent to Iraq. We teach how to behave on the approach to checkpoints, how to distinguish the sounds made by various weapons and the direction of fire. There’s also advice on what to wear.
At the beginning of the war, many Ukrainian journalists donned camouflage, but this is actually dangerous, because they cannot be distinguished from the military, and snipers can decide to take aim. Knowing these types of nuances saves lives. In addition to journalists, we provide specific training to cameramen, because there job is different. It’s important to understand that when a journalist is immersed in his or her work, they can get excited and their perception of reality can be altered. But battle conditions don’t allow for breaks in reality. You have to always be in top form.
“DOCTORS DON’T KNOW WHAT TO DO WITH NEW DRUGS”
Do our hospitals have enough materials to be able to save every life?
Providing first aid doesn’t require much equipment. You have to stop the bleeding, ensure breathing and determine if a surgeon is required. And then you can send the patient to a different department. You need to know procedures, but be able to use anything at your disposal.
We don’t want our courses to focus on the latest technology, but on the tools our doctors have at their disposal. We can’t take all Ukrainian doctors to see an emergency unit of an American clinic. Ukrainians work in Ukraine, so they have to manage in their own conditions.
Equipment in hospitals has improved significantly as of late. A lot of humanitarian aid has been received. Unfortunately, many doctors do not know what to do with the new drugs. There are many volunteers sending over things, but are not making the efforts to teach someone how to use them. If there’s an emergency, doctors don’t have the time to read instructions. They have to act. Unfortunately, there are no practical trauma courses in Ukraine.
“IN CANADA, EVERYBODY HAS FIRST AID SKILLS”
Generally speaking, how would you rate the quality of Ukraine’s medical system?
Paramedicine as such does not exist in Ukraine. According to international standards, this is not the kind of work that is done by doctors. Here, if a person is injured, the call goes out to “shvydka dopomoha” (literally, “quick” or “fast” aid) which can take up to half an hour to get to a patient. Doctors, nurses or feldshers (physicians’ assistants) are on duty at the “shvydka” stations. They are able to provide only very basic first aid.
In the western world, paramedicine is a branch of medicine. Paramedics are the people who support the lives of victims until they are delivered to a hospital. In addition, paramedics, not doctors, are on duty at the stations. In Kyiv, for a population of 3 million, there are 16 “shvydka” stations. In Toronto, with the same population, there are 41 stations. A paramedic arrives in 8 minutes at the latest. If a person’s airway is blocked, she will die in 10 minutes, so that kind of organization provides greater chances of saving her life. What’s more, in Canada, everybody has first aid skills: from the police to the firefighters.
We are already working on these kinds of courses of medical preparedness for all structures in Ukraine. At the moment, it’s important to change the system so that all the courses are standardized. We’re already supported in this by the Security Service of Ukraine and, beginning with this year, they have made tactical medical training mandatory for all their employees. Changes are also afoot at the National Guard and Border Service. The Ministry of Defense is also beginning this process.
Is it possible to reform the existing medical system?
Our goal is not to reform the system, but to build a new one. If the existing system is “ill” and can no longer exist, it’s better to create something new to replace it. If we are looking towards Europe, then we need to adapt to their system of providing aid. It’s not worth spending time trying to make the old system look different. If you take an old building and paint it, it doesn’t become new. In Ukraine, everyone’s used to being “firefighters.” We’re ready to react when something goes wrong. But nobody wants to be the “architect” who will design a system that will function properly. “Firefighters” arrive when something’s in the process of being destroyed. But if the system is properly constructed from the outset, then there will be no “fires.” We at “Patriot Defence” strive to be the “architects,” although this is more difficult. We are prepared to work on a new Ukrainian medical system that will be focused on the person, not the state.