When crisis has become a normality: life of a doctor in Ukraine

Dr Iryna Rybinkina in Ukraine.

Dr Iryna Rybinkina worked in the NHS for nearly 20 years but when war broke out in Ukraine, she returned to her home nation to coordinate aid for healthcare workers through the Smart Medical Aid charity. Here she shares why she does this and what she’s learnt along the way.

Words: Catherine Levin, Editor, Emergency Services Times

There is a determined intensity to Iryna who talks to me via WhatsApp video from Lviv in Ukraine. She is a cardiothoracic anaesthetist who, just prior to war breaking out, had moved her family from the UK to start a new life in New Zealand. She explains why she decided to return to Ukraine. “When the first rockets flew into Ukraine and I saw this on social media, I felt numb. I was too far away to do anything. I had to go back.”

With her husband and young children safe in the Netherlands, Iryna travelled on to Ukraine and set to work making a difference through the Ukrainian-Dutch charitable foundation, Smart Medical Aid. This is a team of medical practitioners, volunteers and specialists with experience of emergency and disaster medicine that has been operating since 2014.

Making connections in among the chaos

She is very well connected in the medical community, with contacts around the world. She shares what it was like, “In the first few weeks it was chaos. Logistical routes for aid were broken. What I did with my organisation was to look at getting supplies, anything that we could get through to our warehouses and out to the hospitals where they could be used.”

It is impressive that Iryna can call up the Minister of Health or the Minister of Defence. “I’ve always been very direct. I could pick up the phone – I found the numbers of Ministers via people I know – and I would just call, introduce myself and offer help. I had that network.”

I ask her why people would listen to her, let alone government officials and ministers, and she responds, “No one could say no. I had my professional reputation, but really I was just determined to cut the bureaucratic chains of communication and establish contact.”  She pauses to reflect on this experience, “Who am I to call them? I am just a simple doctor. But it was the right thing to do.”

Responding to demand

She is clear that her role is one of supporting the health care system and saving as many lives as possible. Smart Medical Aid has 15 staff operating in the western region of Ukraine. They treat the distribution of medical aid as a logistical exercise that requires detailed project planning. “We don’t just give stuff to hospitals. We ask them what they want, and we give them that.”

As the horror of the war in Ukraine revealed itself through western media, people naturally wanted to help and some that came through donations of equipment. The urge to do good is welcomed by Iryna but she said it can also be a burden when equipment ends up not being used because it is obsolete, broken or simply in the wrong place.

It’s clear from talking to Iryna that the needs of hospitals in Ukraine are very specific; not only to individual hospitals but areas of the country and at particular times. There is no one size fits all approach when it comes to providing relief for healthcare in war torn Ukraine. In the initial stages of the conflict, Iryna says that people just wanted to help, but in specialist area like hospitals, it has to be more nuanced and demand led and that is where she is today.

Making use of donated ambulances

We talk about how ambulances are used during the conflict, and she describes how ambulances are repainted to avoid identification as they are seen as targets by the Russians. Fighters who are injured during the conflict are taken to stablisation centres on the front line where there is very basic medical facilities prior to being moved to somewhere safer. Iryna is providing equipment to these locations.

There are enthusiasts and organised groups who have driven ambulances to Ukraine and want to donate them for the war effort. Iryna says they arrive without medically trained staff or equipment and often end up in the wrong place. “For some reason, people think an ambulance should come to a hospital, but this is does not work for us,” she says, going on to explain that the emergency services operate separately from hospitals.

Directing ambulances to places of need

As the conflict has gone on, ambulances are now allocated to areas of need and are used for evacuation purposes. To be of most use, ambulances need to meet certain criteria including being less than five years old, left-hand drive and in good working condition. She says that reconditioned ambulances that come from countries like the UK can be used, but only in certain evacuation areas.

“We communicate directly with the area where we are donating equipment and we listen to them. They may say don’t put any equipment in it, we just need a vehicle to carry casualties. In other cases, we are asked to send an ambulance full of bandages because they have completely run out.”

I ask if she still wants donated ambulances from the UK and she says yes, they will repaint them, fix them and put them to good use. “We lose a lot of ambulances every day, if they last for two days, we are very happy.”

Looking ahead to winter

As the conflict continues, Iryna’s work evolves, and the needs of the charity are changing. It is a massive logistical exercise that is now helped by working with another Ukrainian charity called Razom, as they seek to deliver the greatest impact with the donations they receive. She is already planning for the winter.

Iryna will eventually relocate her family to Ukraine – she misses her children greatly and she asks herself in her quieter moments why she is doing this. “Being a doctor is my identity,” she explains and that’s the reason why she’s done this. She knows the answer is because she had to, it was the right thing to do and because of her selflessness she has done a huge amount of good.

Iryna is speaking at The Emergency Services Show on 21 September.