Wars are complex and they lead to the breakdown of society, damage infrastructure, and have economic impacts. Although it is too early to tell what consequences will occur in the wake of the war in Ukraine, our healthcare system will likely take a huge hit.
Primary care professionals have been on the frontlines of the Russian invasion, especially in eastern Ukraine, even continuing to work in primary care clinics.
After the introduction of martial life, primary care doctors were transferred to working shifts on-call and provide remote counselling. All primary care clinics have on-call medical offices, where family physicians and specialist doctors provide necessary assistance. Primary care physicians also vaccinate against COVID-19, vaccine-preventable diseases, and perform necessary tests.
Kharkiv and the Kharkiv region where I live and work were among the first areas attacked by Russia. From the first day of the war, Russian troops have been barbarically destroying civilian infrastructure and exterminating civilians in Kharkiv. Residential buildings, hospitals, schools, and universities are still continually under air-strikes and bombing.
HEALTH CARE AND MEDICINES
The whole process of family physicians’ work in Kharkiv and the Kharkiv region has been reformatted in the name of security.
Consequently, our family doctors consult with their patients online or by phone. Those requiring a personal appointment attend by prior arrangement and are separated by allotted timescales so there are as few people as possible in the building at one time. Medical staff who do not have appointments in the offices can stay in touch with patients, advising them through Viber cameras, and other messaging or communication channels. Military logistics have been created. In one direction medicines and humanitarian supplies go from the west of the country to the east. In the opposite direction there are patients being transported with serious diseases who have subsequently lost the opportunity to receive the necessary treatment due to the hostilities. Significant assistance is provided by international partners supplying humanitarian goods (such as medicines), which are immediately redistributed to health facilities with the most critical need. There are separately formed packages of medicines, which — if and when humanitarian corridors open — are transferred to those territories where transportation by conventional logistics routes is impeded by Russian forces.
CHRONIC DISEASES
Family physicians are learning to be both psychologists and subspecialists because there is a lack of both. At the beginning of the war, the following pattern emerged: those patients who remained in the country had a more dismissive attitude to the treatment of somatic diseases. There is a sharp increase in patients with hypertension, who are sensitive and negative to stress, and in general with diseases of the cardiovascular system, including young people. Moreover, patients complain that the drugs they have always taken no longer remove or ease their symptoms as they are simply not enough.
Fear, anxiety, and panic are emotions that people are currently experiencing around the clock, and these have the strongest impact on those with kidney disease, gastrointestinal tract disorder, coronary heart disease, and diabetes. People with thyroid disease are very prone to stress. But, by and large, any chronic disease now easily turns into psychosomatic illness and becomes more complicated. We see this every day: unfortunately, the number of neuroses, depressions, and conversion disorders (a condition in which people experience symptoms affecting the nervous system that have no physical explanation) has greatly increased.
In addition to medical work, the postgraduate training of family physicians at the Department of General Practice/Family Medicine of Kharkiv Medical Academy of Postgraduate Education continues using distance educational technologies. Teachers give lectures remotely, as well as conduct interactive seminars. Postgraduate education of primary care physicians involves changing the organisation approaches to the educational process, the methodological training of teachers to implement innovations, the facilitation of adaptation to learning, and the search and justification of the forms, methods, and technologies of distance learning.
- © British Journal of General Practice 2022
