The usual way to do medical mission work is to go to a less-developed country and treat sick people. We realized that we could go to Central America or sub-Saharan Africa, perform surgery for a week, and help 25, 30, or perhaps even 40 people. After we left, their overall medical care would not be improved. Through Baylor Health Care System's Faith in Action Initiative, we have chosen instead to obtain used medical equipment and ship it to hospitals in medically underserved areas in foreign countries that need the equipment. We then help the local doctors set it up and learn how to use it. This can positively affect the medical system.
Surplus medical equipment in the USA often has little or no commercial value. When US hospitals replace equipment, manufacturers frequently take the old equipment as a trade in, but this is not the same as trading in a used car when buying a new one. The auto dealer can sell the car, so it has a monetary value. The medical equipment manufacturers often cannot resell used high-tech medical equipment because hospitals in the USA do not want to buy used equipment that is obsolescent by our standards. The trade-in is little more than a discount; the manufacturers often discard or even destroy the old equipment. While used medical equipment may not have a monetary value, it still has a useful value since only a portion of its useful life has been used up. Often the manufacturer or the hospital is willing to donate the surplus equipment to be sent to a medically underserved area. This concept is by no means unique with us, but we prefer this strategy because it can upgrade the practice of doctors in medically underserved places and help untold numbers of people. We have worked in Mexico, Romania, and most recently Ukraine.
THE HISTORY AND CURRENT SITUATION OF UKRAINE
From 800 bc to ad 700, the Scythians, Goths, Bulgars, and Khazars overran the area that is present-day Ukraine, a name that means borderland in the Old East Slavic language. From ad 880 to the middle of the 11th century, Kievan Rus produced the “Golden Age of Kiev” and shaped the Ukrainian, Russian, and Belorusian cultures and languages. Kievan Rus adopted Byzantine Christianity in the 10th century. St. Cyril and St. Methodius, two brothers who were also Orthodox monks, developed the Cyrillic alphabet used in several Slavic languages. Kievan Rus fell to the Mongols in 1240. Subsequently, the area was occupied by Poland and Sweden. Peter the Great defeated the Swedes and absorbed Ukraine into the Russian Empire in the early 18th century.
The early 20th century saw important changes for Ukraine, beginning with World War I and the Russian Revolution, which led to the downfall of the tsars and the establishment of the Soviet Union (USSR).
Despite being dominated by foreign powers for centuries, Ukrainians historically have been nationalistic, and many resisted communism even though Ukraine was a founding member of the USSR. The famine of the winter of 1932–1933, called Holodomor or the “winter of Ukrainian genocide,” caused millions of Ukrainians to die of starvation. The word means literally “death by starvation,” or “killing by hunger.” Many scholars contend that Joseph Stalin and the Communist Party of the USSR orchestrated this tragedy to force Ukrainians to adopt collective farming.
On September 29 and 30, 1941, Nazi Einsatzgruppen troops killed 33,000 people, mostly Jews, in 2 days at a ravine in Kiev named Babi Yar (Figure 1). An additional 100,000 people were killed there over the ensuing months. An estimated 5 to 8 million Ukrainian civilians died in World War II.
Figure 1.
Babi Yar.
In the famine of 1946–1947, Soviet authorities confiscated 2.5 million tons of Ukrainian grain to export to Russia during a drought and the general wartime collapse of agriculture; 1 million Ukrainians starved to death. Stalin and the communist government of the USSR planned and accomplished this atrocity also.
Vladimir Lenin once lamented, “If we lose Ukraine, we lose our head.” The Ukrainian Steppe is a fertile agricultural area and was the “breadbasket,” producing much of the grain for the USSR. The eastern part of Ukraine contains rich supplies of coal and iron ore, produces large quantities of steel, and is a heavy equipment manufacturing area. Former Russian president and now prime minister Vladimir Putin seems to agree with Lenin's assessment today.
Ukraine became independent on August 24, 1991, with the dissolution of the Soviet Union. It has both a democratically elected president and a parliament with a prime minister. The tension between Viktor Yanukovych and Viktor Yuschenko in the election of 2004 led to the nonviolent “Orange Revolution.” The conflict resulted in part because Putin coveted the return of Ukraine and helped manipulate the election. Viktor Yanukovych, Putin's puppet, was accused of poisoning Yuschenko, terribly disfiguring his face. The dishonest election led the people to rise up in protest in cold December weather in Kiev's Independence Square.
The Dnieper River divides Ukraine into east and west. Ukrainians are especially nationalistic and independence minded west of the Dnieper. Those in the western part of Ukraine speak Ukrainian and want to become a part of the European Union and NATO. Those in the eastern part of the country, including Crimea, speak Russian and lean more toward an alliance with the Russian Federation. The vote in 2004 clearly showed this division, with the “red oblasts” (states) and the “blue oblasts.” Sadly, Ukraine and the rest of the former Soviet states are suffering heavily from the current economic situation.
Kiev is the capital of Ukraine and is a beautiful city with many fine churches and other lovely buildings. It suffered heavy destruction in World War II but has been rebuilt. Ukraine comprises 233,089 square miles, nearly as large as Texas, and has a population of about 45 million. It has the second largest land mass in Europe, second only to European Russia. It is bordered by Russia, Belarus, Poland, Slovakia, Hungary, Romania, and Moldavia. Even though Ukraine is considered to be in Eastern Europe, the geographic center of Europe is in Ukraine.
We have concentrated on working in the Donetsk oblast of Ukraine. It has significant needs and is relatively easy to reach. Donetsk is in the eastern part of Ukraine near the Russian border and is a center for coal mining and heavy industry. Metropolitan Donetsk has a population of over 2,000,000 people and is the capital of the Donetsk oblast and the Donbass region.
Ukraine is not a backward country. The Soviet T-34 tank, considered one of the best tanks in World War II, was designed and built in the Kharkov Tractor Factory in eastern Ukraine (Figure 2). Soviet intercontinental ballistic missiles and nuclear weapons were developed and built in eastern Ukraine. The world's largest airplane is being built currently in Ukraine. Frequently I reflect on the fact that when I served in the US Air Force in the early 1960s, at least one of the SAC B-52 bombers at our base may well have had Donetsk as a target. Now we are going there for benevolent purposes and I am studying Russian.
Figure 2.
Soviet T-34 tank, designed and built in the Kharkov Tractor Factory in Ukraine.
Health care was not a high priority for the Soviets. The ordinary Ukrainian hospitals are poorly equipped and maintained. They remind me of the “Old Parkland,” the one on Maple and Oak Lawn in Dallas where I trained when I started at Southwestern Medical School (Figure 3). The hospitals' current condition and equipment often are not as good as Parkland's was in the 1940s and 1950s.
Figure 3.
Old Parkland.
The Stryker Corporation, one of the largest and best manufacturers of laparoscopic and arthroscopic equipment in the world, donated laparoscopic equipment that it had taken back in trade. While the equipment may have been 3 or 4 years old, it was light years ahead of anything the Ukrainian hospitals that we visited had. We have shipped equipment to several Ukrainian hospitals and then have gone there to work with the surgeons to set it up and help them understand how to use it. Because of lack of time and resources, we don't teach laparoscopic surgery, so the surgeons have to arrange for courses on their own.
MISSION WORK IN UKRAINE: FACILITIES AND ACTIVITIES
A couple of years ago, Liz Eaton, a friend and a nurse educator in obstetrics at Baylor University Medical Center at Dallas, introduced me to the director of labor and delivery, Kristine Debuty, RN, who donated several retired maternal obstetrical monitors. We shipped them to Ukraine, and Liz and Kristine went with us to teach a course in maternal obstetrical monitoring for the obstetricians and obstetrical nurses in Ukraine.
We offered the first course at a hospital named Petrovsky #14 (Figure 4). In keeping with good Soviet practice, the hospitals in each district are numbered. There was good attendance for the course and it was a complete success. The course pleased the chief of obstetrics, Dr. Gritsenko Anatoliy Vyacheslavovich, so much that he took the group to a champagne and caviar lunch at his home.
Figure 4.
Entrance to Petrovsky #14.
The facilities in Petrovsky #14 are old and showing wear (Figure 5). The hospital has a single x-ray machine, which is both antiquated and inadequate (Figure 6). At least at the Old Parkland we had World War II surplus US Army field portable x-ray machines! Many Ukrainian hospitals have no x-ray equipment at all. The cardiac intensive care unit had four beds and only one cardiac monitor (Figure 7), which I suspect Florence Nightingale brought over from England during the Crimean War. What happens to the patients with a cardiac event who don't draw the long straw?
Figure 5.
A waiting area in Petrovsky #14.
Figure 6.
The x-ray department in Petrovsky #14.
Figure 7.
The equipment for the coronary care unit in Petrovsky #14.
The hospital in Dobrepolia has running cold water for 2 hours in the morning and 2 hours in the evening but never has running hot water. Imagine being sick in a hospital that doesn't have hot water! Dobrepolia doesn't provide sheets for the beds and budgets only $1 per patient per day for food. The chief of surgery told us that the surgeons at Dobrepolia make $100 per month. The cost of living is somewhat less in Ukraine than in the USA, but not that much.
The hospital in Gorlovka, a city of 275,000 people 60 km northeast of Donetsk, has more equipment for high-risk obstetrics (Figures 8–10). At one time they had maternal obstetrical monitors, but the monitors are no longer operational. They had one ventilator for preterm babies, but it functions for no more than 24 hours at a time. None of the hospitals we visited had laparoscopic equipment, and their operating room equipment was old (Figure 11). They did have cool scrub caps (Figure 12).
Figure 8.
A nurse with a wooden fetascope. The flared end is placed against the mother's abdomen, and the examiner's ear is placed against the other end to hear the baby's heartbeat. It looks a lot like Laennec's original stethoscope from 1816.
Figure 10.
Kristine Debuty showing the contrast between the old and the new in a hospital in Gorlovka.
Figure 11.
An oxygen tank sitting outside an operating room with tubing piping the oxygen into the operating room. Fire codes would not allow such a set up in the USA.
Figure 12.
Ukrainian scrub cap.
My limited Russian language ability helped. I opened the first session of the class on maternal obstetrical monitoring with the self-deprecating joke that one who speaks three languages is trilingual; one who speaks two languages is bilingual; and one who speaks only one language is American. The woman doctor who is chief of gynecology said, “No, Ukrainian.” This is not quite true, since most Ukrainians speak at least two languages, Ukrainian and Russian.
The visits to the hospitals took twice as long as expected because of the need for translation and the wonderful hospitality of the Ukrainian doctors. After every tour we had to sit down for tea and chocolates and conversation. It's tough duty, but somebody has to do it!
We visited the Children's Hospital in Gorlovka, a Donetsk suburb, and gave an otoscope to Dr. Natalie, the chief of pediatrics. She was really happy to have it. She told us that she would be the only pediatrician in the entire city who had one! How do you diagnose and treat sick children without being able to examine their ears? The otoscope cost us $35. The children's hospital has pictures of nursery rhyme characters painted on the walls. One said, “Praise good doctors.” Our escorts said, “The only joy in these hospitals is in the pictures on the walls.”
We visited Petrovsky #15, built by the Soviet Union as one of its premier spinal injury hospitals. Today it is a deteriorating place where doctors treat the bedsores that people with severe spinal injuries get so frequently. There is essentially no rehabilitation for the patients. Remember Christopher Reeve, “Superman”? He died of infection from pressure sores after a spinal injury. This hospital has none of the special beds, vacuum-assisted closures, growth factors, alginates, silver compounds, collagenase debriding compounds, foams, and other newer but expensive therapies that we use routinely in the US for wound care. They construct makeshift orthopedic frames from bent pipe bolted to regular hospital beds so that paraplegics can have a trapeze to help them move themselves (Figure 13). Forget about motorized wheelchairs and specially equipped cars to make the patients more mobile and independent. The doctors there have only operative treatment to offer, and they do it reasonably well. The patients have a bleak future.
Figure 13.
A makeshift orthopedic frame.
We met with Dr. Alexander Bratanov, a founding member and vice president of the Ukraine Medical Association for the Donetsk region. The association is not a governmental agency, but was organized during Soviet times to advocate for the medical profession and patients. I asked him if it was not dangerous to oppose the Soviet government and he answered “da” (yes). He had been a governmental official and was helpful in getting equipment through customs.
Our next concern was the Karlovka Rehabilitation Center for Children, “the orphanage from hell,” where kids nobody loved or wanted—“throwaway kids”—live. Often they come from the street, and some had been drug users or prostitutes. They run away from the orphanage when they want to, especially in the summer when the weather is warm. The police pick them up and bring them back, and the bitterly cold weather helps keep them there in the winter. The institution has little money; donations help pay for the coal to heat the buildings.
Valentina Alexandrovna, the manager of the center, begged for help with tears in her eyes and showed us some things that people have done for them. My wife, Margie, “adopted” the center 4 years ago. On our first trip there, the beds looked like rejects from a gulag. The kids had put cardboard in their shoes to keep the snow from coming in through the holes in the soles, and they lacked warm jackets to protect against the bitterly cold Ukrainian winters. Margie collected and bought shoes, clothes, and jackets (Figure 14). She raised funds for food, new beds, and exercise equipment for the kids and much more (Figure 15). This helps them feel that they are valuable individuals. Last year a 9-year-old boy took Margie by the hand and showed her what he had in his drawer. It was merely a pillow. It may have been the very first thing that belonged just to him. Even though they did not speak each other's language, there was no problem in discerning his gratitude.
Figure 14.
Shoes collected for the orphanage.
Figure 15.
(a) Before and (b) after pictures of the children's beds at Karlovka. Four years ago, the beds were sagging and uncomfortable. Margie raised money for new beds, with drawers underneath for the kids' personal items. Each pair of beds has a bedside table and there are wardrobes for the kids' clothes.
Oleg Bahkishev went to the center to work with the kids; teach Bible, life skills, and antidrug lessons; work out with them; bring them food; and develop a relationship with them. He was going once a week, but Margie raised funds to pay for his transportation twice weekly, and Valentina donated a classroom for Oleg to use. Oleg spoke animatedly of his dreams for a true rehabilitation institution for these kids.
Valentina has changed from being skeptical to supportive to loving Margie. A friend made beautiful necklaces to give to women in Ukraine, and Margie let Valentina pick from several. She picked an attractive one and tears came to her eyes. No one had ever done anything thoughtful just for her. Last year Margie took a box of Christmas presents for her. Valentina said that this was just the second time in her life she had received a gift. The first time was the gift from Margie the previous year. The communist legacy hangs over Ukraine like a pall.
The Karlovka orphanage has come a long way. The changes at Karlovka have given the kids a new view of life. Margie's efforts have helped change the faces at the Karlovka orphanage from glum and expressionless to smiling and hopeful. It is heartwarming to see kids who have no hope in the world being happy and having optimism for the future because someone cares for them.
CONCLUSION
When the gastroenterology lab at Baylor University Medical Center acquired new gastroscopes and colonoscopes a few years ago, the old scopes were destroyed. One day they were good enough for one of the top hospitals in the world, and the next day they were worthless. They could have made a big difference in places like Ukraine that need medical items. In the USA, we recycle plastic milk bottles but throw away equipment that could save lives. Commendably, Baylor Health Care System leaders are now aware of the problem, and likely this will never happen here again. Baylor has donated infant warmers, incubators, maternal obstetrical monitors, operating tables, hospital beds, combination labor and delivery beds, high-tech mattresses, and much more—enough to fill a container that we are in the process of preparing to ship to Ukraine. Dr. Don Sewell has been appointed director of Baylor's Faith in Action Initiative to accomplish this new work.
Doctors, hospital administrators, and manufacturers must become more aware of the needs and opportunities that can be met at little personal expense. We are the richest country in the world; surely we must do what we can to help those who are less fortunate. When you learn of medical equipment that is being replaced or retired, see that it gets to a place that needs it and will use it. You will be saving lives and raising the standards of medical care in places that need it desperately. Baylor's Faith in Action Initiative will be happy to assist.
Figure 9.
Delivery tables in a hospital in Gorlovka reminiscent of the obstetrical department at the Old Parkland in the 1960s.