Cracking heads open in Ukraine: a neurosurgeon’s story. Part 3

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
1 April 2010

Today, eighteen years after my first visit to Ukraine, Igor is one of the most successful and famous neurosurgeons in the country, practising modern neurosurgery which is directly equivalent to what is available in the West. The journey has not been easy, and his problems continue.

With the support of Academician Romadanov I was able to bring Igor to London to work with me as an observer for three months. It became a hospital joke that Igor rarely seemed to go to bed at night – instead he was to be found photo-copying my entire library of neurosurgical texts or filling one of the forty notebooks with which he recorded his visit. He would make diagrams and write notes on every operation and every instrument he had seen. He also used to write down everything I said, as though I were some kind of oracle. Whenever I suggested that I take him round London for a sight-seeing trip he would stand to attention, look at me with his most serious expression and declare:

“I am not here for entertainments.”

His devotion may have been at times embarrassing and unfashionable. It could certainly be tiring. But he was the ideal pupil.

Igor with patient 1

Igor’s increasing success, with more and more patients coming from all over Ukraine to consult him, inevitably made him deeply unpopular with the medical establishment.

As soon as I met Igor in the dark corridor of the Kiev Emergency hospital I realized that I was in the presence of somebody unusual. Most Ukrainian men are rather stolid and either reserved or bullying in manner, at least in public. Igor, by contrast, was as thin as a rake. He had large, piercing black eyes, and  was full of boundless, utterly determined  energy. His expression, often fierce and fanatical, could be suddenly transformed by a happy and child-like smile.

A western Ukrainian, an enthusiastic Ukrainian nationalist, his father was an engineer with an equally independent, inventive temperament. Igor had attended the local school in Novy Rozdil, the dormitory town south of Lviv, which accommodated the forty thousand employees of a huge fertilizer manufacturing complex (now all derelict). He had been, I believe, top of the class for everything and subsequently studied medicine at Ivano-Frankivsk and then worked as a doctor in Novosibirsk and Kiev. While in Novosibirsk one of his mentors had told him that if he wanted to make any progress in medicine he needed to learn English. So Igor listened to the BBC World Service and taught himself English. I had been the first English-speaking person he had ever met.

After working with me in London Igor returned to Kiev, shocked and excited by the immeasurable distance between Ukrainian and Western neurosurgery. “Everything must change!” he told me before he left “Not just equipment, but philosophy. Everything!”

When he got back to Kiev he learned that his patron Academician Romadanov had died and there was now a struggle for succession to his post among the many professors. It was not a good time to announce that Ukrainian neurosurgery was primitive and backward, but this is what Igor did. This was an act of remarkable insubordination, especially since his own immediate boss was one of the professors competing to be director of the Institute.

The next few years were very difficult indeed for Igor as he struggled to re-organize his department and his work along western lines. There was a long series of official denunciations, committees of enquiry and threatening phone calls. For a time he even feared for his life and felt obliged to sleep in a different place each night. How he coped with all this I cannot even begin to imagine.

Igor and Marsh workin gtogether

Eventually Igor’s department was fully equipped to a western standard

I felt that my naive philanthropy had caused as many problems as it had solved. Yet I could not very well abandon him. So each time that his ‘detractors’, as he called them, tried to close his department or sack his staff, I would do what I could to help. I took second hand medical equipment myself by road from London to Kiev. I brought some of his junior doctors to London to train with me, and tried to visit Kiev as often as I could to help him with difficult cases. I wrote articles for the Ukrainian press and in turn was denounced by all the senior professors in an open letter to then Prime Minister, Petro Lazarenko, accusing me of costing Ukraine millions of hrivnas and much human suffering with the advice I was giving Igor.

Eventually Igor’s department was fully equipped to a western standard – in large part courtesy of Roy Reeve the British Ambassador who allowed me to use the Embassy’s delivery truck from London to carry equipment for Igor. This included operating tables, more operating microscopes (crucial to modern neurosurgery and until then entirely lacking in Ukraine) and the entire surgical laundry from St George’s Hospital in London (the hospital laundry had been privatized and the stock of sterile gowns and drapes was to be thrown away – enough for 40,000 operations a year).

Igor’s increasing success, with more and more patients coming from all over Ukraine to consult him, inevitably made him deeply unpopular with the medical establishment. Even more important than my support was the growing army of supporters among his many patients. There was a limited degree of press freedom in the Leonid Kuchma era and it was possible for his supporters to mount publicity campaigns in defence of Igor against the succession of official commissions and investigations into his department. On more than one occasion Igor came to work to find that the entire staff of his department had been dismissed. But somehow he always managed to keep going.

As the years passed, however, Igor found his position in the Emergency hospital increasingly untenable. He came to the reluctant conclusion that he could only continue to improve treatment for his patients if he became truly independent. He had no interest in making money and still felt a real allegiance to the state medical system in which he had worked for so many years. But he decided he would have to try to establish a private medical practice – a somewhat revolutionary idea for Ukraine at that time. 

So one night, on the Hospital Director’s birthday, when it could be safely assumed that most of the hospital staff would be slightly the worse for drink, Igor and his team took a truck to the hospital and removed all his equipment. The legal status and ownership of the equipment (much of it having come from the West on a charitable basis) was uncertain and Igor had become increasingly worried that it would  be expropriated  by the hospital management. At the same time Igor and his doctors all resigned. So on the morning after his birthday the hospital director would have woken to find that Igor, his staff and equipment had all disappeared.

Igor spent the next two years working in partnership with a Lviv businessman, running a private clinic. The businessman, having initially made money felling trees in Kamchatka had somehow managed to obtain a loan of one and half million dollars from the European Bank for Reconstruction and Development. He had spent this on a rather strange, gerry-built complex on the outskirts of Lviv, comprising a small hospital, hotel and conference centre, and a large house for himself where he lived with his beautiful young wife. He was coming under pressure to repay the loan and hoped that Igor’s profitable medical business would enable him to do this. Igor, however, wanted to plough any profits back into the hospital and after a while the deal broke down.

The businessman died shortly afterwards leaving his beautiful wife and many debts behind him. Shortly before he died he told me that Igor was utterly impossible to work with. I fear that this might well be true, Igor ‘s mind being so utterly focussed on neurosurgery.

After that, Igor was unemployed for two years, although he managed to work ‘under the table’, in another doctor’s clinic. Finally, he negotiated a deal with, of all people, the SBU (as Ukraine's secret service is called), to rent space in their rather smart (by Ukrainian standards) hospital in central Kiev. Igor has made enough money from the clinic to buy his own equipment and equip his clinic to an entirely modern standard. He continues to live in the same modest apartment in Trojeschina where I first met him and has no intention of moving. The arrangement with the Lipska street hospital has worked well for some years, but  its future is now in doubt. It strikes me as typically Ukrainian, both whacky and pragmatic – a private clinic, run on essentially charitable lines, in the hospital that provides medical treatment to secret policemen!

It is difficult to exaggerate Igor’s achievement. Not only has he had to learn all the technical and clinical aspects of modern neurosurgery. He has also had to learn how to run his own business, to buy all his equipment and employ his own staff, with all the bureaucratic and human problems that that involves. On top of all that he has had to cope with the unrelenting hostility of many of the most senior doctors and medical administrators in Ukraine.

Neurosurgery is one of the most dangerous areas of medical practice. The careers of all neurosurgeons are punctuated by catastrophes when operations have gone horribly wrong. The problem for Igor is all the more acute since he knows that his competitors will not hesitate to exaggerate and exploit any bad results in his clinic – bad results which in the West would usually be considered to be inevitable.

It is all very Ukrainian – a complicated tangle of envy and  remarkable initiative, of sudden kindness  and ruthless competition. In the post-Soviet era Ukraine is struggling to establish a balance between private and public interest but the government has been weak and ineffectual and the recent economic crisis has hit Ukraine hard. The recent change of government means it is even harder than usual to know what will happen.

Igor with a patient 2

Igor’s increasing success, with more and more patients coming from all over Ukraine to consult him, inevitably made him deeply unpopular with the medical establishment.

Igor has not given up his plan of building his own hospital. Being something of a business genius as well as an expert neurosurgeon he managed to buy eight hectares of land on the outskirts of Kiev some years ago on a charitable basis at a very low price. But he has had to suspend his plans.

His contract with the SBU may well finish – it has come in for much criticism, mainly, I suspect, from jealous colleagues. However, he has recently opened a new department in Stryj in the west of the country, and is buying a second-hand MRI scanner. He remains the man I first met almost twenty years ago – utterly determined, a man of complete integrity, a passionate Ukrainian patriot, whose only interest is to treat his patients as well as possible.

The Hungarian poet Gyorgy Faludy wrote in his memoirs “Soviet Communism was like acid poured over metal. People made of base metal were destroyed, but people made of gold shone all the brighter.” As a visitor from the affluent, comfortable West, where life is so easy, I have come to understand on my many visits to Ukraine that  it is unlikely I will ever be put to the test and learn from what kind of metal I myself am really  made. I can only look with awe on what Igor has achieved.

The first part can be read here

The second part can be read 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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