In response to the growing need for comprehensive support for wounded who have been seriously injured in the war zone, a modern rehabilitation hub is being built in Kyiv. This project was implemented thanks to the cooperation of the Center for Saving Lives, the Association of Osteo-Integrative Prosthetics and the Esculab Laboratories network.
“Our center was created to provide our military with the best possible assistance in recovering from severe injuries. We provide not only physical rehabilitation with the help of modern equipment, but also psychological support,” said Vyacheslav Zaporozhets, director of the Center for Saving Lives charitable foundation.
According to him, the project is unique in that it uses not only the most advanced technologies for physical rehabilitation, but also creates conditions for social adaptation and moral recovery of the military.
“We want every wounded soldier who has undergone amputation to be able to return to a full life,” emphasized Mr. Zaporozhets.
In his turn, co-founder of the Esculab laboratory, Serhiy Dyadyushko, also noted the importance of the work for the veterans’ recovery.
“The network of laboratories “Esculab” is not only about business. We are honored to be a part of this project. Our participation is not limited to financing; we are also actively involved in the process of education and training of specialists, which allows us to maintain a high level of services provided at the center,” he emphasized.
The center will be equipped to the highest standards, including anti-gravity walkways and group exercise spaces that allow patients to feel comfortable and safe during their rehabilitation.
The rehabilitation center is being built on a 500-square-meter area and includes a modern walking laboratory, a wrestling room, a cardio zone, a strength training zone, a dental office, two physiotherapy rooms, a meditation and sleep room, an occupational therapy kitchen, a mini shooting range, locker rooms and showers, etc. The center can accommodate 30 patients at a time.
The project is part of a larger initiative aimed at creating a network of similar centers across the country to ensure access to high-quality rehabilitation services for all victims.
“Eskulab is a network of medical laboratories of international quality of diagnostic tests based in Lviv and has one of the largest networks of branches in Ukraine. The network includes more than 100 sampling points in the cities and towns of Lviv, Ivano-Frankivsk, Chernivtsi, Zakarpattia, Khmelnytsky, Ternopil, Rivne, Volyn regions and Kyiv. “Eskulab provides patients with the opportunity to take tests at their place of residence and receive highly accurate results. In February 2020, Esculab Medical Laboratory underwent a voluntary assessment of its measurement capabilities in accordance with the requirements of DSTU ISO 10012:2005 “Measurement management systems. Requirements for measurement processes and measuring equipment” to confirm technical competence and received a Certificate of Conformity of the measurement management system. Today, Esculab performs more than 820 types of laboratory tests.
You can learn more about the initiative to build a rehabilitation hub in the video on the Experts Club YouTube channel here:
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Experts Club hosted a training aimed at psychological rehabilitation of people affected by the consequences of war. This training was part of a larger project organized by the Experts Club in cooperation with the NGO Club of Experts and the ADONIS network of centers. The initiative aims to support and restore the mental health of people who are under stress or have been victims of psychologically traumatic events.
According to Maksym Urakin, founder of the Experts Club, the rehabilitation course will consist of 8 trainings in three stages. The first stage focuses on the diagnosis of stress and post-traumatic conditions using internationally recognized methods, such as the Impact of Traumatic Events Scale (IES-R), the Trauma Screening Questionnaire (TSQ) and others. The next step is art therapy, where participants have the opportunity to work with qualified psychologists, and the final stage is to evaluate the results and develop further recommendations.
“Our goal is to show that recovery is possible, and every affected person can find support and a path to recovery,” – emphasized Maksym Urakin.
Inna Prysyazhna, training leader and psychologist-consultant of the ADONIS medical centers network, emphasized that art therapy uses primarily creative methods, such as painting, sculpture, composing poetry, fairy tales, etc.
“All this is used to express inner feelings and fears. This not only improves mood, but also helps participants find inner harmony and self-confidence. Art therapy does not just treat, but provides tools for self-help and self-realization. It promotes the development of skills that allow you to better cope with everyday challenges,” the psychologist notes.
The project is funded by the Experts Club project’s own funds. In addition, the initiative actively interacts with the media and social networks to raise public awareness of PTSD and the importance of psychological rehabilitation.
“Experts Club is an analytical center with its own video studio and educational center. The art therapy project is implemented in partnership with the Institute of Psychology.
The Ministry of Veterans ineffectively managed the activities of the subordinate centers, as a result of which they provided assistance mainly to other categories of citizens, numerous violations in the activities of the centers were revealed to the amount of 4.6 million UAH.
As the Accounting Chamber reports on its website, this is evidenced by the results of the audit of the effectiveness of the use of state budget funds aimed at the implementation of measures for the rehabilitation and re-adaptation of victims of the Revolution of Dignity, the anti-terrorist operation and the repulsion of the armed aggression against Ukraine.
“Yes, due to the lack of approved standards and protocols for psychological rehabilitation, the victims were treated in sanatoriums with physical therapy, phyto tea and mineral water, spending an average of 13.4 thousand UAH per person per course,” the chamber quotes Deputy Chairman of the Accounting Chamber Andrei Maisner.
Meisner notes that the services of psychological rehabilitation were provided by sanatoriums, which did not meet the established criteria: “psychologists without higher education in specific areas of vocational training, the premises of the institutions are not designed for persons with disabilities, etc.”.
In general, the auditors point out that in 2019-2022 the costs for psychological rehabilitation were reduced in 2.7 times (from 623 to 232 million UAH), while 1.8 times increased the amount of funds for spa treatment (from almost 338 million UAH to 624 million UAH). At the same time for four years 62.5 million hryvnia were not used and returned to the state budget.
“This happened because of overestimating the average cost in the planning of expenditures and allocation of allocations among the administrators of the lower level of funds. And also because of the delay of the Ministry of Veterans with the approval of the procedure of formation, maintenance and access to the Registers of providers of psychological rehabilitation services for veterans and members of their families. Another reason for the return of funds is the participation of these individuals in a large-scale war,” the auditors emphasize.
In addition, the Accounts Chamber emphasizes that the Ministry of Veterans has not developed and approved standards for the provision of psychological rehabilitation services. While providing assistance the psychologists did not use international protocols as none of them are implemented in Ukraine. As a result, the victims received substandard services, and the state budget spent UAH 178 million ineffectively.
The military aggression of the Russian Federation and active hostilities gave a powerful impetus to the development of the direction of rehabilitation in Ukraine, but the war showed the need to develop approaches to the rehabilitation of military traumas, according to the participants of a roundtable on topical issues of medical and psychological rehabilitation held at Interfax-Ukraine on September 5.
“We started building a rehabilitation system in Ukraine since 2014, but today there are problems that have not yet been resolved. The rehabilitation system depends on many things, including money, because rehabilitation is quite an expensive thing,” Executive Director of the Ukrainian Association for Stroke Prevention (UABI), doctor of physical and rehabilitation medicine Maryna Huliayeva said.
Huliayeva said that in “those clinics that do not have multidisciplinary teams for rehabilitation, rehabilitation is at a low level, the lack of specialists leads to the fact that the process and quality of rehabilitation care is hindered.”
Commenting on the rehabilitation packages, according to which the National Health Service of Ukraine (NHSU) contacts clinics under the Medical Guarantee Program, the expert said that “most of the package is spent on a patient who is already stabilized, but the issue of acute rehabilitation is hung.”
“Unfortunately, it happens that the stroke unit does not have a physical therapist in staff, but there is one in a rehabilitation department. Therefore, there is not enough staff for acute rehabilitation, where major complications are prevented,” she said.
Huliayeva said that, in particular, the military and patients with military traumas should also be examined by a specialist in physical and rehabilitation medicine, but there are no such specialists in military hospitals, so these patients are consulted by civilian doctors.
“I think that such medical care should be developed within the framework of the financing of the Armed Forces of Ukraine. Military doctors are ready to cooperate, we advise military hospitals, we come once or twice a week, we accept them for a rehabilitation package, we work with them,” she said.
At the same time, Huliayeva said that the approach to the rehabilitation of the military should take into account the purpose of rehabilitation, which depends on the severity of traumas.
Huliayeva believes that to develop the rehabilitation of the military, a decision is needed at the state level, “to introduce those positions [in the area of rehabilitation] in military hospitals that were introduced into civilian medicine.”
According to Huliayeva, in addition to introducing rehabilitation into military rehabilitation, it is necessary to develop palliative medicine, as well as rehabilitation at the outpatient level.
In turn, Vadym Kerestey, head of the rehabilitation direction of the ADONIS medical group of companies, also said that the war gave a start to the development of rehabilitation medicine, but if “civilian rehabilitation medicine develops, then rehabilitation in the military in hospitals stands still.”
“Unfortunately, there is a catastrophic lack of specialists. They do not open positions for physical therapists, ergotherapists and other specialists who are part of multidisciplinary teams. There are no such rehabilitation teams in military hospitals that could provide high-quality medical care specifically for the military, who often have severe polytrauma,” he said.
The expert said that “military hospitals are overcrowded with patients with severe traumas, but there are not enough specialists.”
“It is important that the military introduce the position of physical therapists in military hospitals. Perhaps the subcommittee of the Verkhovna Rada, which deals with rehabilitation, could initiate this, so that positions of doctors of physical and rehabilitation medicine could be opened in the military structures,” Kerestey said.
Commenting on the development of rehabilitation in military medicine, Kerestey also noted the importance of rehabilitation goals.
“Rehabilitation terms vary from several weeks to several months, since different patients may have different goals of rehabilitation. For some, this is a return to the ranks of the Armed Forces of Ukraine, for others, at least self-service,” he said.
He also believes that at present in Ukraine “the number of qualified doctors of physical and rehabilitation medicine is very small, they are sorely lacking.” In particular, according to Kerestey, currently in Kyiv “there are about five to six rehabilitation high-quality rehabilitation centers where patients can be treated, starting with intensive care units,” the rest of the centers in Kyiv can only work with already stabilized patients, and things are much worse in the regions.”
“Rehabilitation requires equipment, but it is not the main thing. It is important that the department has specialists: psychologists, ergotherapists, physical therapists, their assistants,” he said.
At the same time, Yehor Prokopovych, head of the Department of Physical and Medical Rehabilitation at Kyiv City Hospital No. 6, said that this clinic has enough specialists of the required profile. At the same time, in connection with the war, the hospital also accepts military personnel for treatment.
“Before March 2022, our hospital accepted [for rehabilitation] only patients with stroke and for rehabilitation under the orthopedic package. Since March, the hospital has been included in the list of hospitals that provide rehabilitation to the military, and we had to reorganize something in our work. For example, we did not know that narcotic analgesics could be prescribed in rehabilitation, that there could be patients with colostomy, with concomitant traumas, that they could have complications that we did not foresee in rehabilitation. We had to learn how to treat in rehabilitation and pneumonia, and cystitis, and urethritis, and much more,” he said.
Prokopovych said that before the war, the department had mainly “patients aged above 50, and now they are young patients who have severe injuries.”
The expert also stressed the absence of “the NHSU package for military rehabilitation.”
“We code them as ordinary neurological patients, and since the beginning of the war we have not received any clarification from the NHSU regarding the military,” he said.
“We see a big push in the field of rehabilitation, but there are practical problems. For example, this is the transfer of a patient from us to another medical facility, building codes or equipment. For example, now we need two devices for the rehabilitation of the military, one of them costs about EUR 10,000, the second is EUR 14,000,” he said.
For his part, commenting on the issues of psychological rehabilitation in wartime, psychiatrist and psychotherapist Yevhen Voronkov said that “not everyone has PTSD, but many people suffer from PTSD and complex PTSD.”
“It is necessary to distinguish between PTSD in combatants and in the civilian population who suffered from the consequences of the occupation, violence, bombing. In many cases, people turn to the general psychiatric service, but this is a level of disorders that no psychiatric services are adapted to in reality,” he said.
At the same time, according to Voronkov, psychiatric education is currently focused on the treatment of severe mental illness, and not the treatment of conditions “that require individual and long-term, but mainly psychotherapeutic management with some medication component and pharmacological support.”
Voronkov believes that there are specialists in Ukraine who can be qualified to work with a person in war conditions in a psychotherapeutic sense, including in the direction of PTSD, “but they are not trained in public structures, they are trained as part of international projects, most of them work individually or in small teams.
“Some of our psychotherapists work with those who have returned from captivity, have received severe injuries. But these are only a few of the therapists who are involved in the work. There is a problem in training military psychologists or psychologists,” he said.
The expert said that the psychological rehabilitation of patients in wartime requires a conceptual development, since “this is a new situation in such a mass plan, it is only six months old.”
“Neither the structure nor the characteristics of these patients is clear. There is only a general understanding of what to do with it. And it is clear that patients need to be distinguished: one thing is those who were in the occupation, the other is the military, the third is children, internally displaced persons, and so on. It will be a large complex, for which, I believe, the psychiatric service is not ready,” he said.
In addition, Voronkov said that “there are no systematic studies of the military on PTSD.”
“Such studies require a pool of patients, besides, PTSD does not occur immediately, it is a delayed syndrome. A burst of PTSD can manifest itself in its most real forms several months after traumatic situations. Sometimes it is weeks, but more often after months we can see the formation of specific PTSD. It is difficult to work with such patients, this is a very difficult contingent not only for rehabilitation, but also for treatment in an acute condition,” he said.
At the same time, Voronkov said that the developments that were made by foreign specialists in the course of local military conflicts of past years may now be ineffective in Ukraine, since “it is necessary to take into account huge transcultural differences, in psychology the transcultural aspect is very important.”
“Severe PTSD is a very serious disease. Doctors are not adapted to work in such conditions, it is impossible to train such specialists in advance,” he said.
In turn, the head of the Department of Nephrology and Renal Replacement Therapy of the National University of Health Protection, Professor Dmytro Ivanov said that the Ukrainian Association of Nephrologists, based on international experience, prepared recommendations for rehabilitation in the specialty of nephrology.
“They relied on world experience, because there are military conflicts, and there is an array of information to form recommendations,” he said.
At the same time, according to Ivanov, about 600 out of nearly 10,000 Ukrainians, who were on dialysis at the beginning of the war, left for the EU countries.
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The relevant committee of the Verkhovna Rada on the health of the nation has supported the draft law on attracting foreign medical rehabilitation specialists (No. 7422) to provide medical care.
According to the bill, for the period of martial law and for 6 months after its completion, the procedure for attracting foreign medical workers and rehabilitation specialists to provide medical care is simplified.
Currently, this procedure takes at least 6-9 months.
The bill provides for the involvement of specialists from different countries, except for citizens of Russia and Belarus.
Austria will accept up to 100 seriously wounded women and children from Ukraine for treatment and rehabilitation, Austrian Chancellor Karl Nehammer said.
“Yesterday I spoke with Ukrainian President Volodymyr Zelensky and Prime Minister Denys Shmygal. I offered to accept, treat and provide rehabilitation for up to 100 seriously wounded women and children. We will continue to help as much as we can!” Nehammer wrote on Twitter on Wednesday.
