Western prosthetics fill the gap in a war-torn Ukraine
Vadym Maznichenko, a 30-year-old construction worker, lived a regular life in the suburbs of Kyiv, when in summer of 2014 he was drafted to war in eastern Ukraine. He returned after several months, having lost his leg and hand. He could not get a prosthetic hand in his native Ukraine then, and laughs loudly when I ask about the artificial leg the state provided him.
“It broke in less than a month,” Vadym says. “They used the old methods for a new limb.”
The war in eastern Ukraine, supported by Russian troops, took over 9,000 lives, and, through traumatic injury, affected 20,000 more, according to a recent report by the United Nations. Some of those disrupted lives, such as Vadym’s, are becoming whole again.
Vadym was given the chance to join a NATO program. Since June 2015, the United States has offered rehabilitation for up to 24 Ukrainian servicemen through a program in medical facilities based either in the United States or Germany. This includes medical rehabilitation and prosthetic fittings that would be impossible for soldiers like Vadym to receive in Ukraine. Now he is at Walter Reed National Military Medical Center in Bethesda, MD, where he has been treated for the last half year. There he got three types of leg prostheses and a bionic hand, which he jokingly uses to scare visitors.
The US supported Vadym’s rehabilitation to the tune of nearly $150,000, Vadym says. The sum was unfathomable for regular Ukrainians. Officially, the average annual salary in the post-Soviet country is less than $2,400. That is why many veterans returning from the Donbas conflict zone rely either on volunteers or the state for medical help.
The state couldn’t help Max Klokun, 25, who went to serve in Donbas as a volunteer during the first months of the conflict and lost his leg. As a volunteer, the law has not initially recognised him as an active duty soldier; it took him a year and a half to prove in court that he lost his leg in the conflict zone instead of somewhere else. Max could have been left without a prosthesis for up to a year and a half, had he not met a doctor from western Ukraine named Oleg Savchuk. As of December 2015, Dr. Savchuk has singlehandedly organised obtaining just as many prostheses abroad for veterans as the entire Ukrainian government has; each donor has paid for six veterans. This information was given by the former Minister for Social Policy – Pavlo Rosenko.
Ukrainian officials from different departments claim there is no need to send wounded warriors abroad and that the state can provide for them. That is why the state budget pays for treatment only in the most difficult cases. Right now, there are eleven soldiers the Ukrainian government has sent for treatment abroad.
In fact, the veterans themselves are not so certain Ukraine can provide for them. Four of Dr. Savchuk’s patients had to have their prostheses completely remade. For this, he found an expert in Poland, collected donations, organised travel visas for the veterans and helped locate the appropriate limbs.
“The problem is that our prosthetics are still Soviet. You should get used to it if you want a prosthetic for free. But how can one get used to pain in a limb or a prosthesis that is five centimeters shorter than necessary?” says Savchuk. “Our artificial limbs weigh approximately four and a half kilos; the Polish ones are less then one and a half.”
Ukrainian state prosthetics lag behind many other countries’ industries. The problem is not about money or quality professionals, according to Leszek Kloszewski, a Dutch prosthesist who works in Poland with Dr. Savchuk. He thinks that Ukraine, a country which until recently experienced peace (since its independence from the Soviet Union), has not developed the appropriate procedures for limb recovery.
“Medical procedures in Ukraine end with amputation. In the Netherlands, after an amputation takes place, the patient is sent to a rehabilitation center to come out with maximal ability. As a prosthetist, I am an important person in the team. Rehabilitation takes months.”
Volunteer assistance of those like Oleg Savchuk or Leszek Kloszewski is not included in official statistics. Nobody knows the number of veterans taken abroad by volunteers, philanthropists, foreign NGOs and governments. This makes it difficult to understand the real number of veterans who need prosthetics. Official statistics mention about 467 people.
“We have passed a lot of laws and over one hundred legal changes. There is a law regarding volunteers already. We do a lot of work, but there is always a procedure. It is just bureaucracy and everyone has to deal with it,” says Arthur Derevianko, head of the State Service for Veterans and ATO Participants.
Vadym Maznichenko is grateful for Ukrainian doctors’ efforts, but the system in his homeland is still not ready for modern rehabilitation, like in the West, or for dealing with new postwar challenges. Treatment centres in Ukraine, converted from Soviet health care facilities, mostly still have old equipment and programmes. The few precious rehabilitation teams which exist have participated in trainings conducted by foreign experts on how to deal with post-traumatic stress disorder (PTSD) and war injuries. State institutions welcome foreign support, but they still fight among each other about responsibility, accusing each other of creating bureaucratic barriers. This is one of the reasons why the system has been so slow to improve.
“The system has to change,” Vadym says. “The equipment is old; the people are old. Rehabilitation looks like a Soviet line, where you wait for your turn to pass physical procedures. Then you have ten minutes of procedures with magnets. My gym in Ukraine was designed for those with spinal disabilities and had neither a running track nor a trainer for me. The guy in charge there was inviting veterans for a smoke after every exercise.”
In the United States, Vadym learned about occupational therapy and now has devoted himself to it. He dreams of studying occupational therapy there and bringing it home. But before he does that, he has headed back to the war.
“First, I want to go to different checkpoints, from Donetsk to Luhansk, to support the guys. I want to show that being disabled is not the end. I want to tell them how to act if something like this happens to them. When it happened to me, no one showed me the way; I learned everything myself.”
Since the beginning of the military conflict in Donbas, 210,000 soldiers have been mobilised, according to President Petro Poroshenko. Up to 30,000 more were hired on a contract service this year because of higher salary initiatives. It is still possible that additional waves of military draft will be necessary. The Ukrainian Ministry of Defense has plans for reform, moving toward a contract army. So far, the most important decision was to raise soldiers’ salaries; their pay will be no less than $280 a month. The president has promised to end the war in a year; then Ukraine will meet all of its veterans.