Ukraine Doctor’s War Dispatch: Horrific Criminal Acts

Irina Voloshyna – Ukrainian Doctor

[Music]
Marianne O’Hare: Welcome to Conversations on Health Care . This week, we welcome
Ukrainian physician and family medicine professor, Dr. Iryna
Voloshyna, on mounting challenges providing care in her war - torn
country.

Dr. Iryna Voloshyna: So, my patie nts have no any possibility to obtain life - saving
medication, normal food, and usual human facilities.

Marianne O’Hare: Lori Robertson joins us from FactCheck.org . And we end with a bright
idea, improving health and wellbeing in everyday lives. Now , here a re
your hosts Mark Masselli and Margaret Flinter .

Mark Masselli: It’s been a little over a month since the world watched in shock and
horror as Russia invaded Ukraine. Over 10 million Ukrainians have
been displaced, and 3.5 million people have fled the cou ntry. The
World Health Organization says the only real solution is peace.

Margaret Flinter: Here to help us understand is Dr. Iryna Voloshyna. She is a professor
in the Family Medicine Department at a state medical university in
Southeastern Ukraine, which is not too far from where some of the
most intense fighting has been occurring. She also serves on the
board of the nonprofit Academy of Family Medicine of Ukraine.

Mark Masselli: Well Doctor, thank you so much for taking the time to be with us.
Maybe you can just share with our listeners where you are at the
moment and how is your community holding up at this time.

Dr. Iryna Voloshyna: Hello everyone. Dear colleagues, thank you for invitation. And first of
all, I would like to express my appreciation for your attention, and
ensure that I am in safe place now. I cannot say anymore. Everything
is much worse than you ever can imagine. A nd horrible mass murder
of children [PH], population in Ukraine , military, disruption of our
country, violence , t hat is now r eality in Ukraine. My native communit y
ha s suffered so much from Russian military occupation, who totally
blocked cities with population over 100,000 people . So, my patients
have no any possibility to obtain life - saving medication, normal food
and usual hu man facilities.

Our Ministry of Health, international partners and volunteers try to
help as much as they can, but more than a month we cannot stand to
block communities , even [inaudible 00:02:36].

Margaret Flinter: Well, Dr. Voloshyna , as a medical schoo l professor, I know that you
must have trained so many physicians and maybe other health care
workers as well throughout the country as primary care providers.
What are you hearing from them? What are the stories that you are
hearing from your former train ees?

Dr. Iryna Voloshyna: Actually, you are absolutely correct. We have in Ukraine more than

Irina Voloshyna – Ukrainian Doctor

23,000 registered primary care doctors and twice more family nurses.
Me and my colleagues from Academy of Family Medicine of Ukraine
really trained lots of them, a nd now we have an extensive network of
medical professionals who give now strong support for our patients
st
and coordinate lots of humanitarian packages. Before 21 of February
I was fully engaged in educational pro jects , and I am proud to
represent profess ional society of family doctors in Ukraine. And in this
March we had to provide a big [inaudible 00:03:50] with invitation of
my primary care colleagues from [inaudible 00:03:56 ] medical
universities, but our plans were criminally interrupted.

So, now I g ive warm greetings to all my colleagues, primary care
physicians in Ukraine. Most of them for example, my PhD student
st
Vand [PH] is back home now in Kyiv . Before this 21 February we
started absolutely new project for Ukraine called Vaccination And
C hemist ry. I was in frontline of this project. So we have ab s o lutely --
doctors have peaceful profession, but now we should take weapon
and fight with enemy.

Mark Masselli: Dr. Voloshyna, your world, as you just said, changed so much from a
month ago. I am just w ondering how your morale and how your spirit
of your fellow citizens is holding up. You know, we listen to President
Zelensky talk and feel that sense of strength and independence from
his voice, but we know you are also living in very difficult times. Sha re
with us a little bit about your sense of the morale and spirit.

Dr. Iryna Voloshyna: My last course I have been taking called the Stress Management, and
WHO organized ToT training for future trainers. So I am a trainer of
stress management, and you know , now I understand all necessity of
such courses like mental health care, stress management. So our
morale state is quite strong. We try to be close to each other on social
network, networking groups. For example, I have -- I joined the group
of my course from medical university doctors, and we discuss lot of
medical questions . We support each other. So, our morale stays quite
strong. But I worry very much about my patients and about our
doctors who are staying now in totally blocked and occupied
territorie s. It is completely awful situation . There is humanitarian
catastrophe, and it’s real genocide because people completely lost
even food.

Margaret Flinter: Well, Dr. Voloshyna, we have been following of course the World
Health Organization reports that ther e have been 31 documented
attacks on health care facilities with both injuries and deaths. I think
we all were horrified by the attack on one of the maternity hospitals
in particular. And I thought health care was usually spared. I wonder
as your hospitals themselves are being hit, you know, life - saving
places, critical moments, are you feeling that we are on the verge of a
collapse of your country’s health care system?

Irina Voloshyna – Ukrainian Doctor

Dr. Iryna Voloshyna: Actually our health care system was built in very quick attempts, a nd
we already have completely digitalized medical system. We have
digital medical records. It was, to my mind, one of the best system
even in Europe because I am in close communication with my
colleagues from European countries, but believe me, our health care
system for last five years was completely rebuilt. Lot of fantastic
doctors joined the team. Now, we have a lot of problems with
digitalizing because of very simple issue. In lot of our districts we even
have no electricity , and that is a big problem because you have no
electricity, you have no Internet. So, I am very grateful for example to
Elon Musk who gave us Starlink , and I hope that we can join our
medical electronic system to this Internet system.

And regarding the collapse, I cannot say that w e are now on collapse
level, but we urgently need to make more communication and give
more rights, not only Ministry of Health, because there are so many
requests from medical hospitals, from other little medical, even
individual doctors, individuals who c are about their patients. So, even
our Ministry of Health with international partners, are not sufficient.
So, I would ask to engage our NGO. We have a lot of NGO who can
support our medical system and I would ask every international
partners in terms of s upport of our medical system to make good
communication and support in different ways.

Mark Masselli: Well, Dr. Voloshyna, that was a wonderful overview of the system. I
think there is some comfort in a very difficult situation. I know how
advanced Ukraine was in digitizing its records, and we know the NATO
leaders are meeting and hopefully more supplies will be coming into
the health care system, as well as to support the security of the
country. We understand even before the war your country had a very
hi gh rate of TB, in fact one of the world’s highest burdens of
multidrug - resistant TB. We know infectious disease spread during
mass movements of people. What can you tell our listeners about this
part of the crisis that you are dealing with?

Dr. Iryna Volos hyna: Mark, you raise a very important issue, because really even before
this February the rate of TB in Ukraine was six times more than in
European Union countries. And it is my message to European
countries who have allowed now for our people to live in your
communities, I kindly ask you to open your medical system for
examination of Ukrainian displaced people . Because in terms of TB ,
there is a very simple rule. As faster as you diagnose and recognize TB,
as faster you get recovery and result and this pe rson will be absolutely
safe for society.

I know that those three million Ukrainian people who move d now in
European countries, it is very hard for them to get medical system and
examination in European countries. So, please give strong attention in

Irina Voloshyna – Ukrainian Doctor

terms of diagnosis of TB in Ukrainian people because even TB in
children is also quite high, and also multidrug - resistant of course. So, I
hope that you help us. You know the right kinds of medication. You
have this medication, so please help our people to trea t them.

Mark Masselli: Yes.

Margaret Flinter: Dr. Voloshyna, I think people really will hear that call. I want to ask
you about the people who remain in Ukraine and the supply chain. I
figure out how many thousands or tens of thousands of people with
diabe tes remain in the country. For the people who require insulin,
you have just described to us this situation where you have large
areas with no electricity . You have the issue of getting insulin , and
people with diabetes as an example. What is being done? W hat can
be done to maintain the vital flow of medicine that is really required
to sustain life?

Dr. Iryna Voloshyna: It is urgent question now, especially for some region, for several
region of the [inaudible 00:13:33 ] , for Chernihiv region because they
ar e very hard to get the insulin and other vital medical supplies. And
also for people with oncology disease, for example yesterday I
received several requests regarding oncology drug treatment, but we
can’t physically give to our people this medication beca use there is no
road, there is only military Russian soldiers who kill everyone who try
to bring any box to our people. That is awful situation. And I can say
that for example in non - occupied territories the situation is stable.
They receive enough amount of vital medical supplies and change the
game for our partners because in this month you can understand that
any of our medical factory was not efficient to produce medication. So
insulin and other drugs were kindly given from the partners.

I am sorry, th at’s my daughter.

Mark Masselli: No, that’s great.

And you know, really just thinking about the supply chain for
medicine, I also am just wondering about the basics of food and
water, whether or not nutrition is becoming an issue. Maybe tell us a
little b it about the nutrition, but also just the general health of young
people. I think we all worry, you mentioned earlier about some of the
training, first aid and behavioral health. What do we know about the
needs of young people as well?

Dr. Iryna Voloshyna: Our young people, our children suffer so much, you even can imagine
this. Actually, my daughter slept on the floor in the metro station in
Kyiv almost more than one week. Then we slept on the floor in our
bathroom. Every hour we have a notification of ale rt and we need to
go down to the metro. So, our Ukraine is even now and has such
scandal now. So any normal school lessons, any usual activity does

Irina Voloshyna – Ukrainian Doctor

not exist now in Ukraine, and I understand those parents who have
fought to let their children to go to safe place, but there isn’t any safe
place in Ukraine now, any.

And if we talk about food and water, I can say that even yesterday our
organization, our NGO , sent more than 30 cubic meters of food and
[ overlapping ] to region of Chernihiv because there is huma nitarian
catastrophe there. People even don’t have usual food, not even to
discuss medication. So there are lot of humanitarian crises in Ukraine
now. Even near Kyiv region for example, [inaudible 00:17:30 ]
completely destroyed, without mobile phones w e di dn’t know, and
we don’t have any information what is happening there now . But
when we receive even small request we try to react as quick as we
can.

Margaret Flinter: I think it goes without saying that it is hard to grasp the sheer scope of
this humanitar ian disaster. And I know, it seems to me virtually
everybody who’s in the occupied areas in particular, are living in a
state of trauma and responding as we know people do when they are
traumatized. Some people’s behavioral health status wasn’t as strong
t o begin with, right? I wonder how you and your colleagues are
working to maybe deploy additional help and support for people who
are experiencing serious behavioral health distress . You need to make
sure that you can triage a little bit, right, what kind o f health care
providers are available to take care of what groups of people . How
are you pulling people into this work to provide really mental health
care to people who are very traumatized right now?

Dr. Iryna Voloshyna: Margaret, the question of mental health is really acute. Now, in
Ukraine, I am not sure if our medical students who only gained their
diploma are experienced in giving mental health support. But I can say
that last three years the World Health Organization provided a series
of training as for primary care physicians in most, I think in most of
regions in Ukraine. I was one of the trainer. We have strong support
from our psychiatrist s and psychologist s . They are also quite
experienced. Our social workers also have been trained to mental
hea lth program, mental -- it is called Mental Health Gap, maybe you
know this guideline.

So we try to give our consultation to our patients according to this
guideline, but I know that the request s for example for retired homes,
from hospitals in small villa ges, are very, very high and intense in
terms of psychotropic education. For example, there are balms and
other medications which can be prescribed during acute stress and
psychological trauma, and for people in deep depression. So, of
course, we need to c ombine as pharmacological treatment as non -
pharmacological treatment as well. And I hope that we can give it to
our people.

Irina Voloshyna – Ukrainian Doctor

Mark Masselli: And just one last question. I would be interested to know prior to the
war , COVID pandemic was raging across Europe , and certainly the
Ukraine faced the same crisis. What can you tell us about the status
now in terms of the ability to assist people , or what the rate of spread
is at this point, or is it too difficult to assess?

Dr. Iryna Voloshyna: For us, because I even in the night send to my patient electronic
receipts and electronic referral to specialist for examination, so
system is working now. And o f course regarding – if we talk about
COVID as a disease, of course there is I think no -- it is not countable
at all, as well as the rate of vaccination. But before war, the rate of
commitment in vaccination in our country was quite okay. It was over
15% of target population.

Mark Masselli: Great.

Margaret Flinter: Well, thank you Dr. Voloshyna. You have truly given us a window into
the challenges you are facing, and our hearts and prayers go out to
you and all of your colleagues. And thanks to all of you for joining us
today. Thank you again, Dr. Voloshyna. We will thinking of you in the
days to come.

Dr. Iryna Voloshyna : Thank you very much for invitation.

Mark Masselli: Thank you.

[Music]

Mark Masselli: At Conversations on Health Care , we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award - winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. Politics.
Lori, what have you got for us this week?

Lori Robertson : Myocarditis , or inflammatio n of the heart muscle , is most often
caused by a viral infection. Research shows that infection with SARS -
CoV - 2, the Corornavirus that causes COVID - 19, increases the risk of
Myocarditis across age groups. But Myocarditis has also been
identified as a rare side effect of the mRNA Covid - 19 vaccines. Most
cases of vaccine - associated Myocarditis have been observed in
adolescents and young males ages 12 to 24 following a second dose.

According to a Centers for Disease Control and Prevention study,
post - vaccine Myocarditis is most frequent in males 16 to 17 years old,
with about 106 cases per million doses in the US. That study, and
others, have found that compared with classic viral Myocarditis , post -
vaccine Myocarditis appears to resolve faster, and have better clinical
outcomes, although investigations into potential long - term effects are
ongoing. Symptoms such as chest pain, shortness of breath,

Irina Voloshyna – Ukrainian Doctor

palpitations , or fatigue usually appear within a week of vaccination
and resolve within a few days. Case studies sho w that most of them
have recovered with rest and Ibuprofen .

No one in the US has known to have died from vaccine - associated
Myocarditis according to the CDC as of January 13. In contrast, as of
late February, there have been nearly 5800 COVID - 19 deaths am ong
people ages 18 to 29. However, the rare risk of Myocarditis continues
to be misleading leaders to argue that COVID - 19 vaccines are
dangerous , and that young males and children are better off without
th
them. The CDC concluded as recently as February 4 t hat the benefits
of both mRNA Covid - 19 vaccines far outweigh the risk of Myocarditis
even in younger males. A benefit - risk analysis estimated that for every
million males, these may be ages of 18 and 39 who were vaccinated
with the second dose, about 1800 and 1900 hospitalizations would be
avoided with the Moderna and Pfizer BioNTech vaccines respectively.

And t hat's my fact check for this week. I'm Lori Robertson , M anaging
Editor of FactCheck.org.

Margaret Flinter: FactCheck .org is committed to factual ac curacy from the country’s
major political players , and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you
woul d like check ed , email us at www.chcradio.co m . We’ll have
FactCheck .org’s Lori Robertson check it out for you here on
Conversations on Health Care.

[Music]

Mark Masselli: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Pregna ncy is
normally an exciting time for most women, but according to the
research , an estimated 10% of prenatal women experience some kind
of depression during their pregnancy, and many are reluctant to treat
their depression with medication for fear of harmi ng the fetus.

Dr. Cynthia Battle : In fact, a higher percentage are experiencing lower grade depressive
symptoms so they might not meet full criteria for a major depressive
episode. But they are having significant symptoms so they are getting
in the way of feeling good, and left un treated, those mild to moderate
symptoms can progress, in some cases lead to a more serious
postpartum depression.

Mark Masselli: Dr. Cynthia Battle is a psychologist at Brown University with a practice
at Women & Infants Hospital in Providence. She and her colleagues
decided to test a cohort of pregnant women to see if a targeted
prenatal yoga class, which combines exercise with mindfulness
techniques, might have a positive impact on women dealing with
prenatal depression.

Irina Voloshyna – Ukrainian Doctor

Dr. Cynt hia Battle : There was a typical kind of Hatha Yoga that would include physical
postures, breathing exercises , meditation exercises, and we enrolled
34 women who we re pregnant, who had clinical levels of depression.
They all had medical clearance from their prenatal care providers, and
they would come to classes and we measured their change in
depressive symptoms over that period of time.

Mark Masselli: Not only were women able to manage their depressive incidents, they
also bonded with other pregnant women during the program and
found additional support from their group.

Dr. Cynthia Battle : And the initial signs from this research are really encouraging. So we
found that women on average were reporting that they were
reporting much less.

Mark Masselli: A lar ger study with control groups is being planned with the
assistance of the National Institute of Mental Health.

Dr. Cynthia Battle : Women who are depressed during pregnancy, unfortunately do often
have less ideal birth outcomes. So, one thing we are interes t ed in
seeing is when we provide prenatal yoga program can it improve
mood, and then can we even see some positive effects in terms of the
birth outcome.

Mark Masselli: A guided non - medical yoga exercise program, designed to assist
pregnant women through d epression symptoms, helping them
successfully navigate those symptoms without medication, ensuring
healthier outcome for mother and baby, now that’s a bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masse lli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and health.

Marianne O’Hare: Conversations on Health Care is recorded at WESU at Wesleyan
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