Making a difference in times of war

Interview, Dr. Oleksandra Shchebet, Ukrainian neurologist

Oleksandra-Shchebet Dr. Oleksandra Shchebet

Dr. Oleksandra Shchebet is a young neurologist from Ukraine who used to run a private practice in Kyiv. Initially, like many others, she didn't anticipate that the tensions between Ukraine and Russia would escalate into a full-scale war. However, the reality became undeniable by February 24, prompting her to seek refuge in Lutsk, her hometown, where she had relatives.

In an arduous journey, she, along with her family, which included her grandmother and a three-year-old nephew, embarked on a nearly 24-hour drive without rest to reach Lutsk, located near Poland and the Czech Republic. Upon arrival, they secured a rented apartment. However, Dr. Shchebet was determined not to remain inactive. She dedicated long hours to working in a warehouse, where she received, sorted, and distributed food and medical supplies to frontline areas in Ukraine. During the initial phase, Ukraine faced a critical shortage of medications due to panic buying and delivery constraints. Dr. Shchebet played a pivotal role by serving as a key point of contact for doctors in various regions of Ukraine, coordinating the procurement of specific medicines from Poland or the Czech Republic to address this urgent need.

Later, through the global NGO, Health Tech Without Borders, she became involved in the development of a vital medical care chatbot designed to assist frontline combat medics, clinicians, and first responders in Ukraine. Currently working as a Clinical Research Coordinator at NSU Florida, Dr. Shchebet shared her insights on various issues in Ukraine, including the mental health crisis resulting from the ongoing war, in an exclusive interview with THE WEEK. Here are some excerpts:

As the war started last year, you and your family had to leave Kyiv for Lutsk. From that point on, you assumed responsibilities beyond your role as a neurologist. You were previously running a private clinic in Kyiv, but your duties extended far beyond that scope. Eventually, you returned to Kyiv while your family remained in Lutsk. Could you kindly share some anecdotes from that time, including the various activities you were involved in, such as procuring medical supplies? We would appreciate hearing more about that phase of your experience.

Many people were saying that the war was going to start. Personally, I didn't think it would happen because it is the 21st century, and we live in a democratic world. The situation was unclear, and we didn't know what to expect over there. To be safe, we had to leave Kiev, as we were not sure how long the situation would last. We chose to go to Lutsk, my native town, where I was born and had relatives.

I am not the kind of person who can just sit and do nothing. Even though I am a doctor with my private practice, I felt compelled to take action. Interestingly, on the evening before the war started, on the 23rd of February, I attended a psychiatric conference on mental health after Covid, but the next morning, the war had already affected people's mental health. The war officially began on the 25th of February.

Our friends from the Czech Republic brought a big truck filled with various supplies, including food, hygiene items, and medications. We had to make space to store these items and then distribute them to places where they were most needed. Thankfully, we found people who were willing to support us and offered us a big storage facility without asking for any payment.

This was in Lutsk, right?

In Lutsk, yes. We got a large storage space, approximately the size of 500 pallets. People from the Czech Republic and Poland—especially since Lutsk is close to the Polish border, around 70 kilometres away—started sending supplies. Our storage became a central point where we sorted the supplies before sending them to regions in need. Due to the ongoing conflict, Kiev was cut off from many regions, and the only way we could send supplies was through a challenging route, facing bombings and shootings. Initially, postal services weren't operational, so volunteers travelled by cars to deliver the supplies to different regions, including the eastern and southern parts of Ukraine. The journey that typically takes five hours from Kiev to Lutsk now took about 36 hours.

Despite the challenges posed by extremely high fuel prices, obtaining fuel for transportation was difficult for cars and ships. Nevertheless, many people showed their willingness to help by donating money, fuel, and offering assistance with cars. The organisation of all this aid required careful management. In late March, the charity fund Dzhmil was established after it became possible to register everything legally. At the beginning, Ukraine faced a shortage of medications due to panic buying and delivery restrictions. Doctors from various regions sought information about where to find specific medications, and through contacts in the Czech Republic and Poland, clinics and hospitals received available supplies in response to their requests. Later on, partnerships with European organisations, like Rotary Club Düsseldorf in Germany, facilitated the acquisition of expensive and rare medical supplies, including insulin for hospitals with shortages. Communication with funds in different parts of Ukraine made the distribution of supplies more manageable. When Kiev was finally liberated, I returned in late May, but my private practice remained inactive.

But you were doing tele-consultations then, right?

Yes, even to this day, I continue to provide medical assistance because my patients are now scattered all over the world. In the initial weeks of the war, people needed help but were uncertain about how to access it. Given my significant presence on Facebook, they began sending me messages seeking aid. This is how I managed to respond to their needs—through text messages, voice messages, and even video consultations, all while simultaneously organizing the supplies in my storage.

I distinctly recall a particular case in this context. A young girl reached out to me on Facebook, saying, "I have a 90-year-old grandmother. We are in a shelter right now, and it's being bombed." They were located outside Kyiv, close to the eastern front, and she explained, "My grandma is unconscious. What should I do?" Initially, I found myself at a loss for words because emergency services couldn't reach them due to the ongoing bombings. The girl, not being a doctor, was also helpless.

Based on the symptoms described, I suspected it was a stroke. Since physical help wasn't feasible, I provided the girl with psychological support. I spoke to her on the phone, reassuring her that her grandmother wasn't in pain, but rather in a deep sleep, among other things. Unfortunately, the elderly lady passed away within the next 12 hours. However, the girl later wrote to me and expressed her gratitude because she felt my support had been invaluable. She knew she wasn't facing the situation alone, and that's what I could do at that moment.

Sometimes people contacted with acute pain, such as backaches, headaches, or high blood pressure. I would ask if they had any medications nearby and advise them on what to take based on what they had available. If not, I would guide how to manage pain without medication. It was a challenging task, but primarily, what I did and what proved most helpful was offering psychological support. People found solace in knowing they weren't alone and had someone to talk to.

Were you handling a lot of PTSD, depression and anxiety cases too?

Initially, there was a prevalent sense of anxiety and acute stress. People were understandably disturbed, grappling with uncertainty and not knowing how to respond, resulting in heightened anxiety. As time progressed, we began encountering a substantial increase in cases of depression. Currently, we are observing a noteworthy prevalence of depression among the affected population. Post-Traumatic Stress Disorder (PTSD) started manifesting a bit later, as it typically evolves over time. Although not to an extensive degree, we are seeing instances of PTSD, particularly among the adults I work with. Interestingly, they often mention that their children are exhibiting symptoms akin to PTSD. Consequently, my colleagues specializing in child psychology and paediatric urology are now confronted with an increased workload.

What are the major issues you hear from people now?

Currently, a predominant concern among individuals is the prevalence of sleep disturbances due to ongoing air raids, particularly at night. This has disrupted regular sleep patterns for both adults and children, resulting in frequent nightmares and unsettling dreams. Virtually all my patients now report a noticeable decline in daytime energy levels, difficulties with concentration, and memory issues, all of which can be attributed to the poor quality of sleep they are getting.

Children, in particular, are adversely affected, as many of them express a lack of vitality for outdoor activities. The safety of going outside varies depending on the region in Ukraine, with many areas being deemed unsafe. Consequently, they find themselves sitting more than walking, leading to physical discomfort such as headaches and back pain. Additionally, the heightened levels of anxiety and depression have further contributed to these headaches.

What is interesting to note is the significant rise in chronic headaches, surpassing pre-war levels. Many individuals who had never experienced headaches before are now reporting severe headaches nearly every day. Addressing this issue has become a pressing concern for us.

You hold the position of a medical advisory board member within the international non-governmental organisation HealthTech without Borders. Your significant contribution lies in the development of a medical care chatbot designed to assist medical volunteers operating in the field.

I have a friend named Olga Gershuny, who is also involved in the HealthTech Without Borders. Olga has been residing in the Netherlands for an extended period and has a background as a nurse practitioner. When the conflict began, her strong desire to assist her homeland prompted her to seek ways to contribute. Together with a group of friends, we engaged in brainstorming sessions and devised the concept of developing a chatbot. This idea emerged from the recognition that many individuals on the front lines urgently required medical assistance, often provided by tactical medics who, while not always doctors, were primarily paramedics.

In response to this need, several individuals from European countries such as Poland and the Czech Republic, who possessed expertise in tactical medicine, began offering training courses to our warriors. However, these efforts proved insufficient. We recognised the necessity for a rapid and efficient tool capable of delivering concise instructions on how to respond to a variety of situations. This gave rise to the concept of the chatbot.

This chatbot serves both paramedics and civilians alike. For example, if you find yourself on the streets of Kyiv during an emergency and need guidance, you can simply open the chatbot, specify that you are a civilian, and receive instructions on providing appropriate first aid for various types of injuries and traumas.

My role was to translate the content from American and European standards into Ukrainian, ensuring that it would be easily understandable for people in Ukraine. Initially, the idea was to create this bot primarily for Ukrainians, but as the situation in the world is unpredictable, it has now expanded to be available in both English and Ukrainian.

Could you please share some touching anecdotes from the last one and a half years?

The entire situation seemed like a remarkable story because it pushed me beyond my comfort zone, and the usual medical protocols we employ for patient care didn't appear to be effective in this particular setting. As part of our charitable efforts, we dispatched humanitarian aid packages to internally displaced individuals who had relocated from the eastern to the western region of the country and were currently residing in shelters. When they requested medications for their chronic conditions such as hypertension or back pain, I not only included the prescribed medicines but also furnished them with comprehensive instructions on proper usage. Alongside food and hygiene essentials, I attached a personalised prescription.

To my astonishment, people expressed profound gratitude, not primarily for the food or other supplies, but for the prescription and the accompanying instructions. They felt a profound connection, despite never having met me in person. One woman even shared that reading my prescription gave her a sense of being cared for and understood on a personal level. This experience moved me deeply because it allowed me to convey genuine care and compassion to individuals, even in the midst of challenging circumstances.

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