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Cracking heads open in Ukraine: a neurosurgeon’s story. Part 1

Henry Marsh, an English neurosurgeon, tells the story of his twenty-year friendship with Igor Kurilets, a young Ukrainian who resolved to drag Soviet neurosurgery into the 21st century
Henry Marsh
30 March 2010

[Part 2]  [Part 3]

Igor is always waiting for me when I arrive at Borispil. He’s almost twenty years older than when I first met him. He has a few grey hairs now, and rather borrowing a colleague’s battered old Moskvich he has quite a respectable car of his own parked in the airport car park. But otherwise he has changed little. His is still the face of an intense and passionate student, though the years have now added a certain gravity.

dr Marsh and dr Kurilets

Igor Kurilets and Henry Marsh: two friends who spared no effort to modernise Ukraine’s medical system.

As I emerge through the automatic doors in the arrivals hall I will see him among the throng of leather-coated taxi-drivers and anxious relatives with their bouquets of flowers, as thin and enthusiastic as ever, bobbing and ducking through the crowd, trying to find me. And when we meet he will kiss me enthusiastically in the Ukrainian way, and I, in the English way, despite almost twenty years, will recoil a little awkwardly, and pat him clumsily on the shoulder and he will then insist on taking my suitcase and I will go through the motions of trying to take it myself.

In the past I would often have been soaked in sweat as I left the customs hall, having been worried that the customs officers would open my suitcase and find the drills and saws, perforators, braces, rongeurs and suckers– all the heavy metal kit and others odds and ends  required for cracking open people’s heads and operating on their brains which I usually bring out for Igor when I visit Ukraine. If found they would have required much explaining and probably large bribes.  But as the years have passed and Igor’s fame and reputation have grown, it usually turned out that he had operated on one of the customs officers, or members of their families, and that rather than demand exorbitant import duties they would usher me through customs with a friendly smile, by-passing the x-ray machines.

Then we will drive away from the airport, down the long avenue once lined with trees with white-painted trunks, now instead lined with advertisements for mobile phones. A new airport terminal is now to be built, so the trees have been felled. As we drive the twenty or so miles to Kiev the conversation is also always the same:

“And how are you?” he will ask me in his emphatic, broken English.

“Oh, well enough” I will reply, or words to that effect. “How are things?”

“This year we do 100 hundred operations each month” he declares, as though delivering a speech at a factory meeting. Each year the number grows – when I first met him he was only carrying out a fraction of that number. “It is like holiday for me when you come. I recharge my batteries”, he will add happily.

“And what about the latest investigation?” I will ask a little anxiously, knowing that Igor’s professional career – like so many things in Ukraine – hangs by a thread, and a thread whose thickness nobody knows.

“It is normal in this country” he will reply with a dismissive shrug: “If you are successful you must to be investigated.”

“And what happened?”

“There is no result. Twenty years of official investigations with no result!” he adds with a laugh, one which I know hides years of fear, uncertainty and broken friendships. The conversation soon turns to more practical matters, in particular the cost of spinal implants, which Igor now imports from America. This is a subject close to Igor’s heart (though not to mine). By the time we have exhausted this topic we have reached the outskirts of the city.

“And the economic situation?”

“It is disaster. But this is Ukraine, so nobody know what will happen.”

We will drive straight to the SBU hospital in the centre of the city, through an archway off Lipska Street, where crudely welded steel gates wobble open as Igor drives up to the guard’s window. This is one of the smarter hospitals in Kiev – built, after all, for the secret police. There is a large central square, with many trees, and a large blue-tiled tub, large enough to be a swimming pool but which was, I think, supposed to be a fountain. Ukraine is a land of contradictions and surprises. I would never have believed it if somebody had told me eighteen years earlier that I would end up helping a Ukrainian surgeon to operate in the hospital for the organization that was the successor to the blood-soaked Cheka and the NKVD. 

Nor would I have believed it if you had told me that once in the hospital I would be faced by a long queue of impoverished Ukrainians, not a secret policeman among them, almost all of them with terrible, often inoperable brain tumours, waiting patiently, often overnight, for Igor and me to decide whether we can save them or not.

Operation theatre in dr Kurilets's hospital

In the small operating theatre upstairs, Igor Kurilets has crammed in every piece of modern neurosurgical equipment

Nor would I have believed that in the small operating theatre upstairs, past the long and rather gloomy corridors, Igor has crammed in every piece of modern neurosurgical equipment – computer navigation, a counter-balanced microscope, suckers, ultrasonic aspirators, diathermy, nerve stimulators, boxes and boxes of microscopic instruments, not to mention all the glittering titanium spinal implants – everything that I myself have in London. Igor assures me – and I see no reason not to believe him – that he is better equipped than the prestigious Institute of Neurosurgical Research, the main state neurosurgical hospital with which he is in bitter competition. He competes with them for patients and for the money that they bring. In Igor’s case, this money is legal, since his clinic is a private one, run on a commercial basis although not for profit. In the case of the state hospital, it is illegal: all patients must pay doctors for their treatment, but ‘under the table’ as the saying goes, since in theory treatment in the state hospitals is free. And not only is Igor in competition with the Institute to provide the most modern, and safest neurosurgery possible  but he is independent and honest and legal as well. So he has many enemies.

Having entered the hospital we will walk to Igor’s small, cramped office, awkwardly passing all the patients in the narrow corridor outside, their eyes all following us as we pass.  I shake hands with Igor’s doctors, who have been waiting to greet me – I know them all well - and Igor’s office manager Tamara will then bring me a cup of thick black coffee. This has all become a familiar ritual.

“Let us see first patient” Igor will then say, and the clinic – although it is already five in the afternoon, begins. It will go on for many hours.

**

part II of the article is here

Part III of the article is here

Henry Marsh is a senior consultant neurosurgeon at the Atkinson Morley Wing of London’s St George’s Hospital. Geoffrey Smith directed ‘The English Surgeon’,a documentary film for BBC Storyville about Henry Marsh’s work with Igor Kurilets in Ukraine. Henry Marsh has set up a charity to raise money for his work with Igor in Ukraine. To find the film, and details of the charity, go to http://www.theenglishsurgeon.com/ 

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