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Veteran care and rehabilitation in Ukraine remains flawed

WORK FOR THE SAKE OF RECOVERY: The immediate treatment of wounded soldiers is only part of the process of their recovery. Long-term rehabilitation is required.
WORK FOR THE SAKE OF RECOVERY: The immediate treatment of wounded soldiers is only part of the process of their recovery. Long-term rehabilitation is required.

Having interviewed several Ukrainian soldiers who were injured in battle, NV journalists concluded that the existing military healthcare system remains unprepared to offer comprehensive rehabilitation to our veterans.

In peaceful life, Kyiv resident Roman Ivanenko, 46, was working in the film industry. He even had a chance to work with future Ukrainian President Volodymyr Zelenskyy when the latter was still an actor.

Movies, work, and all other aspects of civilian life ended in one moment for him. Ivanenko became a combat engineer in Ukraine’s 53rd Mechanized Brigade after the Russian invasion in February 2022.

However, his tour of duty war didn’t last long. In August 2022, Ivanenko came under tank fire near Bakhmut, Donetsk Oblast. Fortunately, his comrades-in-arms were able to evacuate wounded Ivanenko from the battlefield.

“Three surgeries, a damaged spleen; I was transfused with three liters of blood, followed by a [induced] coma,” Ivanenko describes the beginning of his recovery.

When he regained consciousness, the first few days he moved around in a wheelchair.

Read also: Ukrainian soldier triumphs with prostheses, reveals inspiring rehabilitation journey

But gradually the engineer began to walk and even returned to military service. However, later he had to undergo another course of treatment.

Finally, according to the decision of a military medical commission, the soldier was deemed unfit for service and discharged.

Ivanenko says his treatment dragged on for a long time after that. He was treated in five medical institutions in one and a half years. Although there is progress, because at first the former sapper couldn’t even walk well and could barely communicate, his recovery continues.

There are many more people like Ivanenko in Ukraine. Some experts believe tens of thousands of soldiers already need rehabilitation, while their number may grow to 2 million in the future. Even now, far from the point of maximum strain, Ukraine’s military healthcare system faces serious challenges.

Natalia Zarytska, who in 2022, together with other spuses and mothers of the defenders of Mariupol’s Azovstal established the Women of Steel NGO, speaks of rehabilitation in its modern Ukrainian version with skepticism. She is convinced there has been a change of concepts: rehabilitation in Ukraine simply means “hospitalization,” i.e. to address acute symptoms of an injury or illness.

Zarytska cites the example of her husband, who after being released from Russian captivity was placed in a hospital with atrocious conditions: there were no facilities even to have a wash.

The doctors took tests only from some of the soldiers in their care, but even they got strange results.

“How can HB [hemoglobin] level be 131 [high] on the second day after release if it was preceded by seven months of starvation?!” Zarytska asks with indignation.

“They didn’t properly record the signs of torture and injuries, issued useless pieces of paper to the guys. What are we to do with them next?”

She believes that medical rehabilitation should ultimately lead to patients making the best possible recovery—not end with some certificate about the treatment they had.

Now, if a wounded soldier’s blood, vision, and hearing indicators decrease, doctors say “what do you want after what you’ve experienced?”

“And that’s all [they had to say], any complaints are ignored,” Zarytska says.

“We must do something about it.”

Oleksiy Mozhovyi, 32, a resident of Vyshneve just outside Kyiv, has already undergone medical rehabilitation several times. But he describes his condition as deteriorating.

Mozhovyi got to the front right after the 2014 Revolution of Dignity. He fought near Donetsk Airport, in the village of Pisky, where he was concussed. With the beginning of the full-scale war, he returned to service, where he sustained another concussion.

The soldier admits that concussions had a cumulative effect as he now stutters a lot and has other related health problems.

“We need to help fellow soldiers and war veterans, because their numbers are growing, and many of them have the same problems as me,” Mozhovyi says.

Ukrainian Health Minister Viktor Liashko assured NV he understands that the country needs rehabilitation programs for those who suffered in the war. His team considered the Israeli model for veteran rehabilitation to develop a similar approach for Ukraine. It turned out that in order to launch comprehensive rehabilitation cycles, it’s necessary to have at least 3,500 beds in specialized hospitals for multidisciplinary teams of doctors and therapists to offer comprehensive treatment. Later, the ministry revised this number to 7,800.

The department kicked off this program in June 2023. They identified the so-called “cluster hospitals” in all Ukrainian regions, which had surgery, traumatology, and stroke units, and instructed them to establish rehabilitation departments with 30-60 beds and hire the necessary staff. The ministry, for its part, guarantees payment from the state budget for rehabilitation treatment cycles.

The amount ranges from UAH 17,000 ($439) to UAH 42,000 ($1,086) per injured person, depending on the severity of the injury and rehabilitation cycle, the minister says.

“This was a successful decision, as most of the cluster hospitals already have rehabilitation departments, rehabilitation multidisciplinary teams, and receive funding under the medical guarantee program,” Liashko continues.

The minister assured NV that the department plans to evaluate the program in June 2024 to analyze its effectiveness.

Over 230,000 patients, both civilian and military, received rehabilitation care last year, Liashko added.

On the ground, however, everything isn’t always as the minister describes.

Problems arise even where they seemingly shouldn’t exist. For example, with equipment.

According to Zarytska, freed Azovstal defenders had cases when the hospitals where they were undergoing rehabilitation had no opportunity to professionally check their eyesight due to a lack of equipment, or, in the absence of an MRI machine, performed surgery on soldiers who have 17 shrapnel fragments embedded in their bodies.

Vitaliy Nadashkevych, head of the Poland Helps Ukraine charity foundation, also pointed out that Ukraine lacks, for example, microsurgical microscopes for brain surgery. Such a device helps not only cure patients, but also facilitate their further rehabilitation. That’s why the foundation purchased these microscopes for hospitals in Zaporizhzhya, Kharkiv, and Lviv.

To a certain extent, these equipment shortages can be addressed by the existing program financed by the European Commission, which allows the transportation of severely injured patients for treatment to EU countries.

“It’s completely free of charge for Ukraine and for those undergoing similar treatment,” Liashko explained.

Our best days lie ahead

The Health Ministry, of course, can improve the system of rehabilitation of the wounded veterans, but problems with rehabilitation begin even before the soldiers get to specialized facilities.

After the end of a treatment cycle, the soldier must undergo a military medical commission, which decides what to do with him next. The commission may send him back to service, to his military unit, or refer to a further medical examination to determine his condition. Another option is medical leave for further treatment and rehabilitation.

At the same time, according to last year’s study by the Pryncyp (Principle) human rights center for servicemen and veterans, most soldiers don’t receive information about rehabilitation, which is why they have to look for it on their own. Almost 70% of them used their own funds for medical treatment.

The process doesn’t become easier after obtaining a medical examination conclusion. Veterans then face challenges such as obtaining financial assistance, a war-disability certificate, and benefits.

Such bureaucratic problems have already become significant at a time when the number of people who need treatment and rehabilitation exceeds thousands. What will the state system of veterans’ assistance turn into when the flow of patients increases many times?

At the same time, there is another aspect, namely Ukrainian soldiers and war victims need not only medical rehabilitation, but also psychological one. The latter still looks like an impossible task.

Oleksiy Solovyov, deputy secretary of Ukraine’s National Security and Defense Council, predicted in early 2023 that millions of civilians and hundreds of thousands of soldiers would need psychological assistance.

“We’ll definitely build this system,” he said.

“But we also face the problem of qualified doctors. This is a very difficult profession, and not many people go into it. Foreign specialists cannot be involved here, because the work of a psychologist, psychotherapist, psychiatrist is primarily a conversation with a person. Therefore, building this system is a task we embrace ourselves.”

A year has passed, but the system Solovyov talked about seems far from being in place.

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Read the original article on The New Voice of Ukraine