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Interview with Khmelnytskyi Regional Oncology Center, Ukraine: Cohesion and unity during war

On 15 September 2022 GCR’s Director of Communications, Darien Laird, interviewed Moroz Vycheslav, Director of the Oncology Center and abdominal surgeon at the Khmelnytskyi Regional Oncology Center, along with Yurchishyna Svitlana, Head of Radiotherapy Department, to get a glimpse of how the war has affected their day to day cancer care.


Khmelnytskyi is approximately halfway between Kyiv and Poland’s border in Western Ukraine. At the time Russia invaded, the Khmelnytskyi Regional Oncology Center had the advantage of having just installed new radiotherapy equipment as hospitals in the eastern parts of Ukraine were under attack, their Center was able to treat incoming patients with a high level of care. As a consequence, their normal patient load doubled from 50-60 patients to 120-130.


Both the medical staff and patients have met the challenges with heroic stamina.

“This situation created cohesion and unity, the kind you would never have seen in peaceful times. This united the doctors from around the country, from all regions, from different kinds of institutions. Everyone united for the benefit of our patients in Ukraine” --Yurchishyna Svitlana, Khmelnytskyi Regional Oncology Center Radiologist.

She continued by affirming what so many Ukrainian teams have expressed, “These are our people. These are all our patients. We are all Ukrainian.”


During the interview, the Khmelnytskyi medical team shared how their Center has managed the challenges and what others can learn from their experiences in adapting cancer care during crises.


KHMELNYTSKYI REgional Oncology CENTER INTERVIEW

GCR

Can you tell us a little bit about how your work has changed, how the patients you've been seeing and just how your center has been impacted by the war?


Vycheslav, Director of the Oncology Center

Over this time period in our group, we created a more humanitarian focus, a more sincere focus to our patients. Because a lot of our patients started coming into the clinic whose homes were bombed, whose medical clinics were bombed, and they needed to receive qualified medical care in a safe, protected environment.


And at the start of the war, we had the honor of installing new radiotherapy equipment, which was timely because medical institutions in the eastern regions were taken by war and patients simply did not have a place to receive life saving care. And this level of radiotherapy equipment was only available at a few places within our country. Because of this, together we changed our typical workflows, changed and enlarged our professional responsibilities, and stood higher as professionals.


GCR

The fact that your patients are coming in with other emergency needs beyond just getting diagnosed for cancer, what are the main barriers that you are facing in your center that you'd like people to be aware of?


Svitlana, Head of Radiotherapy Department

A lot of people come to us directly from the train, in their pajamas, over which they put on a coat. They had nothing. They did not have their medical documentation, did not have clear medical diagnoses, or a full medical history. We had to make telephone calls to their doctors and get this information by phone. There were a lot of patients and we started working long hours, around the clock, with short breaks for sleep, so that we could restart their radiation treatments and resume medical care.


We had many patients in the first weeks of war who started treatment at one medical center and we had to scramble to continue their treatment. Many people had no place to go. Because of this we tried to keep as many people in our hospital until they could find a place to stay.


And other doctors at other hospitals tried their best to help us out, by contacting us, but many of our colleagues from Kyiv and Chernihiv and Kharkiv had been evacuated out of the country because of the war and we kept in touch with them by phone and they tried their best to give us the necessary information to care for their patients.


We were bombed and we had many air raids and we had to move our patients and our staff to the bomb shelters, and because of this, there was great fear and psychological stress among the patients and our staff.


Even though we were scared, we had to continue working and the doctors at our institution stayed behind, did not evacuate, and all of them stayed the whole time at their workplace.


Vycheslav, Director of the Oncology Center

We receive moral support and the support of [other countries]. And for this we are extremely grateful.


Svitlana, Head of Radiotherapy Department

And we have some new equipment, made by Varian, which is our newest tool, and we have gotten excellent online training and support from Varian’s European office.


GCR

That’s good. I'm glad that they were able to provide training because I think that right now is one of the big barriers, too, that doctors within Ukraine are not getting the professional training that they normally would get.


Svitlana, Head of Radiotherapy Department

We had received all the training, but once the first patients started coming, many from Kyiv, and some with rare illnesses, we had to learn all the nuances that the new machine could provide. The cancer hospital in Kyiv, the highest regarded center in the country, had their patients treated here and we had to learn new techniques to accommodate them. And we had many patients and Varian was very helpful with remote training and consultations with physicists and they gave us remote assistance online.


GCR

What are some of the lessons that you're learning as you've been going through this in terms of workforce, in terms of treating patients? Things that you want to share with other doctors in other countries who may also encounter humanitarian crises.


Svitlana, Head of Radiotherapy Department

We have had a lot of new experiences with a higher level of radiotherapy. We were using Cobalt therapy, and now we have changed over to the linear accelerator. And this is an entirely different level of radiotherapy. This is a much higher level of treatment than what we used to provide and the change came very rapidly, because many patients came from private clinics in Kyiv which stopped service after the outbreak of the war.


Vycheslav, Director of the Oncology Center

As a comparison, this would be as if you were used to flying on a broom and now we are flying on a Bombardier B-52.


Svitlana, Head of Radiotherapy Department

It was like riding a bicycle.


GCR

Good. I think that's a good analogy. And it's important for the radiotherapy community to know that there is a difference and it will help in these times where you do have to treat patients with specialized needs.


Svitlana, Head of Radiotherapy Department

Before the war, we had 50-60 patients getting radiotherapy, and now we have 120-130 patients. And they have gotten a very high level of quality care.


Vycheslav, Director of the Oncology Center

For the most part, many people did not get treatment because of a variety of reasons, and now that there is more access for modern radiotherapy, it has increased our patient volume. As a result of this, we plan to continue this level of care to improve our patient’s survival and outcomes.


GCR

How have you been able to, as a center, continue to boost the morale of your workforce, of your doctors, and also of your community around you and your own families? Because I know you are also personally going through all of this in your own homes.


Vycheslav, Director of the Oncology Center

When we studied medicine in the universities, we took the Hippocratic Oath, and this for us is motivating. And we put our professional lives at a level above our other duties.


We have 500 coworkers on our team and only 3 or 4 people left the hospital due to the war. Everyone here has a duty and is responsible for their work and does what they need to complete it.


GCR

Is there anything else that you think is very important? It may be a personal experience that you've had in your center or something that you want to make sure that the international community hears about your experiences.


Svitlana, Head of Radiotherapy Department

We want the world to know that Ukrainian doctors have a high level of professional skills which we continually try to improve. And we work to European standards. We work to NCCN standards. And we try to meet all international requirements for our Ukrainian patients.


GCR

Have you had a personal experience during this time that you think is important to share? Because it really shows how you've been able to overcome and continue to treat your patients with that high quality of service.


Svitlana, Head of Radiotherapy Department

Our first patient who had radiotherapy on the new machine, was a man with lung cancer. And then after completing radiotherapy, he went to battle at the front, because he was a leader in the armed services. He was in a division of the Armed Forces of Ukraine.


And after 2 weeks he returned to continue the second phase of his cancer treatment. And many patients, who completed therapy did not return home, but immediately went to the battlefield. We were amazed, but they went directly to help with the war effort.


And if the aggressor wanted to create divisions in Ukraine between the east and west, then what actually happened was completely the opposite.


GCR

What is it that you need most now from the international community? What can we do to support you and your center?


Svitlana, Head of Radiotherapy Department

And we want peace so much, because for me, as a director of a large radiotherapy department I would like to go out and see what a similar department and organization does in a different country and elsewhere in Ukraine.


Vycheslav, Director of the Oncology Center

And now that we have new equipment for radiotherapy, we want to develop therapy at the level of a regional center, with installation of new equipment, because we have a large need for these treatments. We now have this experience. We have long wait times for patients to receive radiotherapy. And for other care. This is a sign that we are providing professional care for complex conditions, and we are able to provide that care to current standards.


And we could effectively use this equipment to provide care. To have such equipment is costly despite the good management of our work. But we hope to get grant funding and programs or scholarships so we could share costs for such a high level of medical technology. This is difficult now, because the budget for the country in 2023 is mainly directed to the army and to the restoration of damaged buildings and cities.


GCR

It's been such an honor to listen to you talk about your workforce, your colleagues, your patients, share your experiences with your training. You have so much to share and we have so much to learn from you. So thank you so much. And our thoughts are with you. Even though you've learned so much during the war. We want this to end and that is where our hopes are for you and for your countrymen. Thank you.


Svitlana, Head of Radiotherapy Department

We want to thank you for taking the time to meet with us, that you showed an interest in us, and to share this story with others.


complete interview transcript

*with special thanks to Tim Korytko, MD, Chief of Radiation Oncology

Bassett Healthcare Network, Cooperstown, NY for providing the translation

KHMELNYTSKYI COMPLETE TRANSCRIPT.docx
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