How volunteers are spearheading Ukraine's COVID-19 response
Ukraine's volunteers mobilised with the outbreak of war in the Donbas. Now, during a pandemic, they are trying to hold up a collapsing health system — a task some say is more difficult than fighting militants and mortar shells.
They give doctors lifts to hospitals, they buy respirators and ALV ventilators, and they feed the homeless. A new wave of volunteering is sweeping Ukraine. In 2014, at the start of Russian aggression against Ukraine, it was the army and internally displaced people who most needed help; today it is medical staff and those citizens most hard-hit by coronavirus quarantine measures — in short, the poorest layers of society with the least protection. Why, once more, does it seem that the state cannot cope without a helping hand from volunteers?
Waiting for a Telegram
"In the distant past, I was a successful director. In the present, I'm a crazed volunteer who has never slept enough," began Lesya Litvinova when introducing herself to Hromadske Radio, an independent Ukrainian media network. These words are from 2015, when Litvinova was working in Ukraine's capital Kyiv, where she coordinated assistance efforts to displaced people from the Donbas region of eastern Ukraine. She then established her own foundation, Svoyi (Ukrainian: "Ours") to help patients in palliative care. She now receives requests for assistance from hospitals all over Ukraine. In short, after six years, Litvinova is still a volunteer. When comparing her activities back in 2014-15 to today's emergency, Litvinova says that obtaining much needed supplies has been more difficult during the coronavirus pandemic.
"Right now, everybody has problems getting the right equipment: we do, so do likeminded foundations, government agencies, and other countries. There are queues outside the manufacturers. Everywhere offers used equipment of uncertain origin, but that's a complete waste of money. You can buy a mechanical ventilator which was made in Korea 15 years ago, but it'll only work for a couple of days. There's a lack of these things worldwide. I got a call from a girl in Italy, from the Ukrainian diaspora, who had helped us out before. She said: 'we're at capacity here, could you let us use at least one oxygen concentrator, temporarily, from those which we gave you?' And I couldn't, because the borders were closed. And it really torments me. Many people have helped us out over the years, but now we can't help anyone," says Litvinova.
Litvinova's words contradict statements made by Ukraine's Ministry of Health, whose press releases repeatedly insist that:
"Ukraine is ready to receive and treat patients with COVID-19. We have wards for infectious diseases, about 12,000 hospital beds, 2,000 doctors specialising in infectious diseases, and about 5,000 other medical workers who work in these facilities."
Notices reading "no masks and antiseptics" have become a typical sight in Ukraine's pharmacies
In actual fact, the situation with medical staff in Ukraine's regions differs by region. On April 8, mayor of Kyiv Vitaliy Klitschko declared that 270 infectious disease doctors and more than 2,000 emergency doctors are currently working in the capital. But in the frontline Luhansk Region, the situation is the complete opposite. When Vostok-SOS, a charitable organisation working on humanitarian issues in Ukraine's East, interviewed the management of the region's hospitals, it was discovered that on average, hospitals in the Luhansk region are no more than 60 percent staffed. In settlements near the demarcation line, doctors are even rarer.
"First and foremost, there are not enough specialists with particular qualifications — namely in infectious diseases and resuscitation. For example, only one doctor of infectious diseases works on the infectious diseases ward of the Rubizhne City Hospital (which is now designated as a primary support hospital.) According to the chief doctor, for the department to function effectively during an epidemic, at least three such doctors would be needed for every 50 patients," reads the Vostok-SOS report.
Some regional hospitals in Ukraine have already contended with layoffs of healthcare workers. For example, since the quarantine period began, three nurses and five hospital attendants have already resigned from the infectious diseases department of the Ternopil Municipal Emergency Hospital, according to its chief doctor Yaroslav Chaikovskiy. He went on to explain, during the interview with public television and radio company Suspilne, that the employees had chronic medical conditions and did not want to put themselves at extra risk for their monthly salary of 4,000 hryvnia ($146). There are plenty more such cases. A doctor, two hospital attendants, and a nurse have resigned from the Koryukivka Central District Hospital in the Chernihiv Region. In the Khmelnitsky Region, two out of the three doctors from the infectious diseases ward of the Dunaivtsi Central District Hospital signed a letter of resignation.
Volodymyr Kurpita, the former director of the Ministry of Health's Centre for Public Health, gives a range of reasons for the dismissal of healthcare workers.
"It's a question of low wages, a lack of support from the state, and certain abuses. There may also be concrete reasons connected to employees' age or a lack of personal protective equipment. I wouldn't just say sweepingly that everything is great or everything is awful. There are some problems which you definitely won't solve in a day. They need to be resolved systematically," Kurpita remarked in an interview with oDR.
On April 2 a law entered force which, among other things, provides for additional payments to doctors involved in the fight against the coronavirus: up to 300 percent of their existing salaries. The exact size will be determined by the Cabinet of Ministers of Ukraine. However, the government has not yet publicly provided any calculations.
As of the morning of April 27, 392 new coronavirus cases in Ukraine had been recorded, 73 of which were medical workers.
Empty shelves and government reports
On March 23, the Specialised Anti-Corruption Prosecutor's Office (SAP) launched an investigation into negligence committed by the dismissed government of Oleksiy Honcharuk. According to the SAP, the Secretary of the National Security and Defence Council of Ukraine Oleksiy Danilov proposed that the Cabinet of Ministers limit the export of goods which could be necessary in fighting the pandemic. The government ignored Danilov's suggestion. For his part, former Prime Minister Oleksiy Honcharuk claimed that he only instructed his subordinates to look into the possibility of restricting exports, but did not dismiss the move outright.
Shortages began. Notices reading "no masks and antiseptics" became a typical sight in Ukraine's pharmacies. Meanwhile, on March 2 and March 6, several consignments of surgical masks were legally exported from Ukraine to Spain. The incoming government of Denis Shmygal voiced support for an export ban, but a week passed between the new prime minister's appointment of his cabinet and the formal introduction of the ban. By March 6, the shipment was already underway under the auspices of the new government.
Today, Ukraine imports its surgical masks and respirators from China. However, volunteers and doctors themselves say that there is simply not enough personal protective equipment. Lesya Litvinova told oDR that doctors in Kyiv and Ukraine's regions generally have to request their own personal protective equipment.
"It's about protective suits, respirators, shoe covers, protective guards. Not to mention the fact that hospitals are appallingly badly staffed as it is. This isn't just a problem which arose yesterday. And it isn't just about the absence of mechanical ventilators — it's about the absence of normal oxygen distribution (bringing oxygen pipes to the bed of every pneumonia patient — ed.). It's about the lack of decent beds in individual hospitals, their inability to correctly divide the premises into so-called 'clean' and 'dirty' zones (those with a lower and higher level of infection — ed.) And because most hospital buildings were inherited from the Soviet Union, they are pointlessly constructed and nothing smart can really be done with them."
As the BBC's Ukrainian service wrote in late March, for five weeks there were no centralised state procurements for equipment needed in the fight against the coronavirus. Aleksandra Ustinova, a parliamentary deputy from the Golos party, confirmed that on February 19, Honcharuk's cabinet instructed the Ministry of Health to purchase medical supplies worth 67 million hryvnias. But the ministry did not sign the procurement contracts. At the time, the head of the Ministry of Health, Ilya Yemets, was in conflict with Arsen Zhumadilov, the director of of "Medical Purchases," over appointments at the state-owned enterprise. On March 31 the Verkhovna Rada, Ukraine's parliament, voted in favour of Yemets' dismissal.
On March 23, a military aeroplane delivered coronavirus testing systems and personal protective equipment from China. The purchase was made with funds from big business. On April 2, another shipment was delivered. But the fact remains that not all these supplies reach the medical workers who badly need them — a fact which Ukraine's President Volodymyr Zelensky acknowledged on April 9.
"К нам обращаются — мы помогали. А обеспечивает ли государство, откуда я могу знать?"
The glaring gaps in the provision of personal protective equipment are often filled by volunteers. For example, in the city of Vinnytsia, five friends have come together to sew surgical masks.
"I had some bits of fabric. So a friend and I sewed 65 masks for ourselves, for our friends and relatives. There was some fabric left, so we wrote an announcement on Facebook. People began to call us, and write to us. I realised that there was demand, so we thought: why not help people at a time like this?" Viktoriya Lysyuk, a manicurist and volunteer, told oDR.
As Viktoriya is fond of making things by hand, she had plenty of fabric at home. Before she started sewing the masks, she consulted a doctor: are eight layers of gauze and two layers of cotton enough for them to be effective? Vinnytsia residents lined up for masks. So did organisations, including hospitals, a dispensary for radiation protection equipment, and the regional children's hospital. Military servicemen and border guards also turned up. Viktoriya did not ask whether the state also provided masks to the people who got in touch with her.
"They turn to us and we help them out. Does the state do anything... how should I know?" said the volunteer.
Over the course of 17 days, this group of volunteers sewed 5,200 masks which they distributed free of charge. The 1+1 television channel provided fabric for them. Work on the masks has since stopped: after Viktoriya's husband returned from a trip abroad, the family has to spend two weeks in strict self-isolation.
The Ukrainian NGO StateWatch collected data on the provision of medical supplies across 15 regions of Ukraine and drew some worrying conclusions in its report. According to these findings, just one to seven percent of hospitals surveyed were adequately supplied with biohazard suits, nitrile gloves, and respirators. For example, in the Ternopil Region only six percent of hospitals have enough biohazard suits to meet their needs, just 37 percent have enough shoe covers, and only 14 percent have enough respirators.
Together with the president's office, the company YouControl has launched a service which displays the level of supplies available to hospitals across Ukraine. Generalised data can immediately show how many medical facilities will be able to cope with the stocks currently at their disposal. For example, the Kherson Region has stocks of personal protective equipment to last for three and a half days, in the Ivano-Frankivsk Region for five days, and in the Rivne Region for 12 days. The best situation of all, according to the service, can be found in the Sumy Region, whose stocks will last for 108 days.
References to the difficulty in keeping medical staff safe can sometimes be found in official press releases. On April 9, for example, President Volodymyr Zelensky mentioned the situation in the Kirovohrad Region.
"In one of the hospitals in the Kirovohrad Region there are 20 infected doctors. This is just one example. Special equipment is only delivered to support hospitals, but every single doctor in each medical facility is at the forefront, and we must provide for each of them," remarked Zelensky, as cited by the press service of the office of the president.
On April 14, Ukraine's Minister of Health Maksym Stepanov reported that 172 doctors across the country had been diagnosed with COVID-19. But the data changes quickly, and the number of infected people is steadily growing.
Helping Ukraine's doctors during this pandemic has become the primary task of several large volunteer organisations, which collect and process requests from all hospitals in their respective cities. For example, the Kyiv Volunteer Headquarters counts as a member of its team Maksym Bakhmatov, an adviser to the mayor of the capital. The organisation has set itself the goal of raising 10 million hryvnia to spend on personal protective equipment for doctors. Volunteers are finding common cause with large businesses and attracting philanthropists. Companies are purchasing ventilators and surgical gloves for hospitals. There are also "non-monetary" initiatives: a chain of supermarkets has allowed social workers who show their ID to buy groceries without waiting in line.
The crisis caused by this pandemic should teach those who need help to speak more openly about their needs
In the large industrial city of Dnipro, the local volunteers' union has closely studied the requirements of their hometown. As well as providing personal protective equipment and other medical supplies, their list includes cooking pots and pans, plastic buckets, and clothes hangers for patients to use.
In the Donetsk Region, displaced people and veterans have come together to drive doctors to hospitals — an important move, given that passenger transport has been shut down across Ukraine due to the pandemic. Thus the Pidvesi_likar_Donechchina initiative arose, which includes about 25 volunteers from nine cities across the Donetsk Region. Its coordinator Boris Ovcharov, himself a veteran, told oDR that the regional administration and private donors have helped by providing money for fuel. At least 400 people are transported to hospitals every week under the scheme, including medical staff and patients who require haemodialysis. According Ovcharov, the region has since provided an alternative solution: buses for miners have been repurposed for the use of medical staff. However some doctors, who are used to travelling by care, must be persuaded to use these special forms of transport.
Ukraine's volunteer movement has expanded to address other social issues during this pandemic. These organisations are also very much in demand. For example, the Sant'Egidio Community, a Christian charitable fellowship which works with the poor, has launched the Do Not Spit campaign under the Ukrainian-language hashtag #не_начхати. Activists call on the public to help homeless people, and share the life stories of those who have ended up on the streets. The head of Sant'Egidio in Ukraine, Yuri Lifanse, says that the quarantine measures have primarily hit the homeless.
"In the blink of an eye, the scrapyards closed, public transport stopped, the public canteens, and the charity distribution points all closed. People were left stranded. The streets were seized by hunger. Gradually, people who worked in low-skilled jobs started to be fired. And when they were fired, they had no money left with which to pay for a stay at a shelter. And then there were even more people on the streets," explained Lifanse.
Lesya Litvinova believes that the crisis caused by this pandemic should teach those who need help to speak more openly about their needs. Medical staff must learn not to fear their bosses' anger, she stressed.
"Since 2014, volunteer movements have either evolved into fully-fledged public organisations or charitable foundations and are engaged in this kind of work systematically, or they have simply fallen to pieces, as it's impossible to simultaneously work in different directions for seven years. To get help from a charitable foundation or public organisation, one must at the very least first provide a letter signed by the head doctor outlining the hospital's requirements. And then when the amount is transferred, an official decision needs to be made and the sum allocated to the hospital's balance sheets. Just imagine: I am collecting large sums of money here. Very large amounts. How else can I report on whom it's going to and for what purpose?" asked Litvinova.
Ukraine's quarantine regime was recently extended until May 11. Every day, several hundred new coronavirus cases are being recorded in the country — for all the hardships they face, it may be too early for doctors and volunteers to relax yet.
Translated from the Russian by Maxim Edwards
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