The Tribulations of Ukrainian Doctors Saving Lives of Coronavirus Patients

"Supermen" and "Superwomen" in white robes have been saving Ukrainians' lives for two months from the novel coronavirus, COVID-19. We spoke to three of them to tell their stories. Kateryna Marushko, an anesthesiologist working at the Kyiv City Clinic Hospital No. 4, anaesthesiologist Oleksandr Bundyuk, who has been living for over a week in an Odesa hospital to save critically ill patients, and Olha Martynenko, the only infectious disease specialist at the central hospital in the town of Rubizhne, in the Luhansk region.

In order to keep our heroes and their patients safe, our photographer, Anastasia Vlasova, organized and coordinated photoshoots online. With her help and advice, doctors and their colleagues took photo diaries of their days at work and sent the photographs to Anastasia.

“I, indestructibly fulfilling the oath, may I be given happiness in life and in art and glory among all people for eternal times...”

A line from the Hippocratic oath that is no longer said.

***

Oleksandr Bundyuk usually works at the Odesa regional clinical hospital as an anesthesiologist. But now he’s in a different part of the Odesa region, as part of a “working medical fortification group”, and has been sent to a city hospital to assist.

“I like emergency cases,” says Oleksandr, when I asked why he decided to become an anesthesiologist. He adds that he likes to see a quick result: if there are emergency situations he solves them. Though he admits it doesn’t always work out.

Anaesthesiologist Oleksandr Bundyuk during a working shift as part of the “working medical fortification group” at a hospital in Podilsk, Odesa region. Photo: Oleksandr Bundyuk / Anastasia Vlasova for hromadske

Oleksandr and his team (four people) live on the hospital premises, from April 28, and for at least another two weeks – everything depends on the number of patients. Right now, they have nearly 100.

“We, volunteering, were told that people need help, and so we agreed without any problems. The hospital is on a strict quarantine and observation because of the serious epidemiological situation. No employees have the right to leave its grounds. And we’re under watch by the National Guard. We have organized spaces here and we can immediately determine who needs to be hospitalized, and who needs to be sent on...

We have hazmat suits, Level 3 respirators – everything. Do I feel safe? Time will tell. But this is the recommended maximum, which is why I don’t know what else you could think of. The most important thing is to keep the algorithm – to correctly wear and remove [hazmat] costumes. If doctors are getting sick that were in personal protective equipment (PPE), then that means that something was done improperly. 

Over the course of a day, I’ll put on and take off all of this ‘armor’ three to four times in a separate emergency room. We have very clearly delineated ‘clean’ and ‘dirty’ zones – what to do in what order, how to wash your hands.”

“We have hazmat suits, Level 3 respirators – everything.” Photo: Oleksandr Bundyuk / Anastasia Vlasova for hromadske

“We don’t have anything like ‘going out for a smoke’ and then putting [PPE] on again. The process of putting on the costume takes 15-20 minutes. You always get dressed in pairs – you help each other. Right now, we should have a sanitary nurse at her post for six hours. The sanitary girls can even put on diapers, if needed, because no one can hold out that long without a bathroom break, especially in the infectious ward, where there are over 30 nurses, and just try to avoid them all. We work as long as needed – if someone leaves, that’s -1 set of PPE, and tomorrow there already may not be enough.”

Oleksandr and his colleagues at the hospital go through the process of transferring between the “dirty” and “clean” zones of the hospital. They end up needing to go through this process 3-4 times a day. Photo: Oleksandr Bundyuk / Anastasia Vlasova for hromadske

“We have time to relax. It’s better to do everything as needed during the day and in the evening in order to sleep at night. We have a TV, internet, Facebook. We relax as much as we can in a hospital room. 

We’re saving our salaries and may even get a bonus. And the government also promised these 300% [bonuses] – the head doctor said we’ll also get them. But believe me, we’re not doing this for money.

I asked the mayor that medical personnel who are in constant contact with patients be given an additional one-off bonus. They promised they would give it.”

A bed in a hospital room where Oleksandr rests after his shifts. Photo: Oleksandr Bundyuk / Anastasia Vlasova for hromadske

You can have a bite to eat or some tea in the rec room. Photo: Oleksandr Bundyuk / Anastasia Vlasova for hromadske

“How did people react to us here? Well, now they don’t even let us go and tell us ‘What would we do without you here?’ As for the moral situation: yes, we have encountered this for the first time. It’s hard for medical personnel, seeing as everyone is sweaty, the respirator is pressing down. You have to be patient with all of these things, especially if you’re in diapers. But it’s hard for patients as well. When they see us in these hazmat suits, they think their own situations are bad. It's not easy. We cannot simply calm them down as usual and establish contact as it's done in normal life. But anyway we talk, think of something, and we want them to be happy. We talk with them loudly, in order for them to hear us through the costume. In the emergency room, for example, the [patients] that are stable, we mark as ‘seniors.’ They care about the others. We congratulate them when they do therapeutic breathing exercises. After all, we’re forcing them to lie on their stomach for 10 hours a day, with breaks of course, because the lungs are better ventilated that way. They lie with us the same way they would on a beach, basically. If they’re great, we promise that tomorrow we’ll transfer them to a different department. We joke with the men and women so that they take care of themselves and that they like each other, for everyone to be beautiful, shaven, and groomed. And they laugh at all that.

And we also very much ask them, for when they’re discharged, to tell everyone what they saw here, how we work and how everything really goes on, in order to make those that think the coronavirus is made up to finally open their eyes.”

READ MORE: Sweat, Disinfectants, and Rubber Suits: Exclusive Report from Ukraine's Most Coronavirus-Ridden Region

“When they see us in these hazmat suits, they think their own situations are bad. It isn’t simple.” Medical staff in a room at the infectious disease ward of the Podolske hospital in the Odesa region, Ukraine. Photo: Oleksandr Bundyuk / Anastasia Vlasova for hromadske

“It’s hard for medical personnel, seeing as everyone is sweaty, the respirator is pressing down. You have to be patient with all of these things, especially if you’re in diapers.” Oleksandr photographed his face, showing off the marks left by PPE after his work shift. Photo: Oleksandr Bundyuk / Anastasia Vlasova for hromadske

***

Olha Martynenko works as the head of the infectious disease ward in the Rubizhne central city hospital in the Luhansk region. She’d gone to med school in Donetsk, and then returned to her hometown.

In 2003, Olha was named as the head of that department. When the conflict in the Donbas began, connections to hospitals in Luhansk vanished. Olha became a freelance regional infectious disease specialist. She says that since the conflict began, only a total of 30 infectious disease specialists have been left in the region. In her hospital, out of the three doctors that should have been working in her department, she remains the only one.

Doctor Olha Martynenko, an infectious disease specialist, heads the infectious disease ward in the Rubizhne central city hospital in the Luhansk region, Ukraine. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

“When the pandemic began, we should have had three doctors and 13 nurses, but we had only me and five nurses. Another three students moonlighted. Our hospital was designated as the regional base for COVID-19 patients. Now we have five such reference hospitals, but even in March, they were bringing patients suspected of coronavirus to us from across the region. It was hard to organize our work. We ended up working evenings and nights – no one could admit patients aside from me. Now it’s easier – in April, four more nurses came to assist, my husband came – a doctor working half shifts. Now it’s easier.”

“Our hospital was designated as the regional base for COVID-19 patients. Now we have five such reference hospitals.” Photo: Olha Martynenko / Anastasia Vlasova for hromadske

Paramedic-disinfectants in the courtyard of the Rubizhne hospital in the Luhansk region, Ukraine. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

Four more nurses and a doctor joined the infectious disease ward in April. Prior to that, Olha was the only infectious disease specialist in the hospital. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

A sign on the door to the infectious disease ward at the Rubizhne central city hospital in the Luhansk region, Ukraine. It reads ‘We’ll stop it together!’ on the upper text, and ‘National Guard of Ukraine’ on the lower. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

“We calculated all of this back in January (I’m talking about how an infectious disease specialist thinks.) There hadn’t even been a single case in Europe at that point, but we had already submitted a report from the department stating that we needed PPE. And when it all started in Italy, we bombarded everyone with requests – the department, our MPs. And things happened. We got help. We held seven training sessions. We separated the rooms, put a conditional “patient” there and worked it all out. Then, of course, when this patient appeared for real, then we had to add a little bit – but we were already prepared.

The first patient didn’t have a confirmed coronavirus diagnosis, but the second, on March 18 – did.”

READ MORE: Why Ukraine's Frontline Doctors Still Didn't Receive Their Salary Bonuses, Despite State's Promises

Olha puts on PPE before going to see patients. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

Photos: Olha Martynenko / Anastasia Vlasova for hromadske

“Am I scared? Only idiots wouldn’t be. Fear can both demoralize and motivate. I support the latter. I tell my girls: ‘Don’t relax. You should be scared. Fear won’t let you slip up. This will help you track whether you’ve put everything on correctly or taken it off, in order to not get sick.”

Mandatory hand disinfection before seeing patients in the ward. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

Olha sees a sick patient in his hospital bed. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

“There’s no document that describes how to properly organize the work of a hospital. There are orders, but the technical details of ‘clean’ and dirty’ zones we came up with ourselves. I remember things from my university days, what we need to do during cholera or plague [outbreak]. Why did I become an infectious disease specialist? This is the only specialty that ever prevents your brain from drying out. [These] doctors don’t just work with patients – we have to have a strategic mindset. We’re like investigators in a manhunt: we’re not just interested in the patient, but also the contact vectors, infection sources – what to do in order to stop the infection from spreading. We considered all of these details. God willing, in order for no more of our medical staff to fall ill. In the Luhansk region, only one medical professional has fallen ill – and that was in everyday life, not at work.”

READ MORE: “The Government Has To Protect Us, or There Won’t Be Anyone Left To Protect The People”: Interview with Ukrainian Doctor

“[These] doctors don’t just work with patients – we have to have a strategic mindset.” Photo: Olha Martynenko / Anastasia Vlasova for hromadske

We have a saying in our department: “Not a step back, not a step in place, only forward and only together.

“I’m so grateful to my team – you should absolutely write about them. We’re all scared, but they trust me and we’ve gone further back-to-back. No one has quit, no one has had any hysterics. We even have a saying in our department: 'Not a step back, not a step in place, only forward and only together.' We’ve been working this way for over a decade. 

When we admitted the first wave [of patients], I said: 'Look at me – the way I do it, you do it. I’m not scared, and you shouldn’t be either.' Even though my own knees were shaking.”

During Victory in Europe Day, Olha and her colleagues added red poppies to their PPE ensemble. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

The medical staff of the infectious disease ward of the Rubizhne central city hospital with a grateful patient. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

“You won’t read about this disease in a textbook. We look for what doctors write from China, Italy, Australia, and Spain. But the decision is still only yours. That’s the sort of responsibility – you can’t even imagine it. First, you worry, and then you have insomnia.

Our first patients have been released. I arrived in the evening when I found out that the second PCR test for COVID-19 was negative. And I told my girls: 'There, healthy.' Without talking, we all start hugging each other. Everyone says different things, but you’re the only one who can make the decisions. And I’m just a single doctor, I don’t even have anyone to consult with. This isn’t a large town where you can gather a board of doctors. Then your professionalism wakes up. I draw strength from the moment when someone recovers. That means I’m doing everything right, and not for naught, and then I go to work once again in the morning.”

READ MORE: Kyiv’s Medical Workers Announce A Strike Due to Low Salaries

Nurses with marks from masks and goggles on their faces during a break from work in the infectious disease ward. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

Mask traces on Olha’s face after another working shift. Photo: Olha Martynenko / Anastasia Vlasova for hromadske

***

Kateryna Marushko works as an anaesthesiologist in the Kyiv city clinical hospital no. 4. She has five patients in the intensive therapy ward, one of which is undergoing artificial ventilation. Kateryna says that she’s one of those doctors that holds their emotions further away and tries to always stay collected. Her parents are also doctors, and their hospital is on quarantine. Because of the pandemic, Kateryna had to leave them.

“I work at one-and-a-half times the usual shifts. In a month this could be around 200 hours, that is one 24-hour period after three. Nothing changed on the schedule, and the number of doctors has increased – there are more hands. We don’t have enough nurses – we have one nurse for a 24-hour period, and this is very difficult.”

Doctor Kateryna Marushko, an anaesthesiologist, grew up in a family of doctors. She knows how to keep her emotions under control and to stay calm from childhood. Photo: Kateryna Marushko / Anastasia Vlasova for hromadske

“Our department was built out of boxed wards. They have separate exits to the street, and separate entrances inside the ward. Because of this, because we have patients suspected of having the coronavirus, and those with a confirmed diagnosis, between patients we have to change into a different PPE costume. If a patient is stable, then a doctor checks in on them four times a shift, and six-eight for a nurse – if the patient is stable and doesn’t require active observation. If it’s an emergency, then we may be there for up to two hours. It’s hard because everyone is sweaty in PPE, the goggles fog up, and your angle of perception changes. Respirators are on clips, so the back of our ears don’t hurt, but the respirator and face shields press down on your whole head. You need to know what to do even when you’re stressed. But we’re getting used to it.”

READ MORE: “I Got My Family Sick – All for $74 A Month” – Ukrainian Doctor With Coronavirus On Healing, Motivation, and Risk

Kateryna readies herself to check up on patients in the intensive therapy ward at the Kyiv city clinical hospital no. 4. Photo: Kateryna Marushko / Anastasia Vlasova for hromadske

Photo: Kateryna Marushko / Anastasia Vlasova for hromadske

Photo: Kateryna Marushko / Anastasia Vlasova for hromadske

“What do I do? Everything to help people breathe. The simplest version is with a mask and oxygen. The second stage is an oxygen mask, plus non-invasive lung ventilation – this is when we put on a hermetic mask [on the patient], which provides pressurized oxygen and opens alveoli which are poorly ventilated. And the more difficult procedure – artificial ventilation of the lungs. The patient has to be heavily sedated. Then a specialized tube is placed through the vocal cords directly into the person’s trachea. It’s angled through the mouth and stays in the trachea. From our side, we then hook it up to a machine that will supply oxygen and air to the lungs. We also have an ECMO (extracorporeal membrane oxygenation – ed.) – this is when we make an incision on the hip and insert two tubes into two veins. But unfortunately, we don’t have such a machine. But we have enough artificial lung ventilators.”

READ MORE: “I Started Talking About Coronavirus in January” - Ukrainian Doctor Treating Coronavirus Patients

“It’s hard because everyone is sweaty in PPE, the goggles fog up, and your angle of perception changes. Respirators are on clips, so the back of our ears don’t hurt, but the respirator and face shields press down on your whole head.” Kateryna with mask marks on her face after a shift at the hospital. Photo: Kateryna Marushko / Anastasia Vlasova for hromadske

“Our infectious disease ward is completely full – over 50 beds. Over the course of this pandemic, we’ve had four lethal cases: two patients over 80, and two had oncological pathologies. Telling people bad news is also part of our jobs, and it’s one of the most unpleasant. These emotions go through a doctor, it’s very hard to remain aloof.

There’s emotional exhaustion, of course, but somehow I manage to relax. It’s enough for me to go for a walk, just chat with someone. I also have a dog, but she’s at my parents' at the moment.”

READ MORE: Ukraine’s Parliament Sets Medics’ Status Equal to the Military, Insures Lives and Health

Reading an interesting book is another way to curb your emotions, especially when you have to tell someone bad news. Photo: Kateryna Marushko / Anastasia Vlasova for hromadske

Kateryna with her colleagues at the hospital. Photo: Kateryna Marushko / Anastasia Vlasova for hromadske

“I choose a colleague-like tactic with my patients. I explain to them that we are fighting this affliction together. I explain how to perform breathing exercises – the person exercises, and at the same time is distracted from other thoughts. We even give patients our work phone numbers, so that they could, in some cases, call us and say 'Something is bothering me, please come,' so that they don’t yell and bang things instead. We also stimulate conversations with their relatives, if their condition allows for it. Humor, of course, is the best doctor.

And here we have our small victory – a woman, 82 years old. She had a lot of related pathologies, but we transferred her onto artificial ventilation, treated her, and then we managed to disconnect her from the machine. Now she’s home with her family.”

During the pandemic, four patients have died in Kateryna’s department, but they saved the majority of them. One 82-year-old patient survived artificial ventilation and is already recovering at home with her family. Photo: Kateryna Marushko / Anastasia Vlasova for hromadske

For all the latest updates on the coronavirus in Ukraine, follow this link.