Dr. Vadim Gushchin, MD, Surgical Oncologist and Director of Peritoneal Surface Malignancies at the Mercy Medical Center, talks about the difficulty of treating cancer patients in the Ukraine during a war.
Interview conducted by Ivanhoe Broadcast News in July 2022.
What is your connection to Ukraine?
GUSHCHIN: Well, a few years ago I was invited by one of my friends to go over to Ukraine. It was 10 years ago to share my expertise with Ukrainian oncologists. Before that, I had never been to Ukraine, strangely enough. I was born in Russia, Soviet Union, and I never visited Ukraine for some reason. It was my first time being there. I ended up in this area of Lugansk, which was annexed by Russia in 2014. I actually was in the middle of this happening in 2014. We were about to open a cancer center that was supposed to show the American way of treating cancer patients. Russian forces went in and the idea was put to rest, basically. The investors left this region of Ukraine. The doctors fled to either Russia, to Georgia, to other safer parts of Ukraine. So, everything disappeared. But I noticed that patients did not disappear. The patients of the cancer center, the cancer patients, still have to be treated. At that time, I thought that it crossed my mind that it was a problem for patients to get treated and a problem for oncologists who left in the occupied region with no resources, no connections to the previous country. It’s like, how do they function? These thoughts resurged in February 2022 when the war started. And by that time, I spent considerable time talking and teaching surgical oncologists from Kyiv. We went to conferences. We set up programs in peritoneal surface malignancies. We tried to figure out how to provide excellent care with limited resources they had in Ukraine. We published papers together. My friends came here to Mercy to see how we treat patients. I visited Kyiv two years ago or three years ago for a conference. It was a lively exchange of ideas. I got to know the surgeons there. It was very personal when the war started. I found myself texting them, how were you are? And are you safe? What are you doing? The first couple of weeks of the war, I couldn’t work. I couldn’t function. I was checking my text messages at night, the news. It was pretty difficult for me. I can’t even imagine how difficult it was for them to survive and provide patient care.
Are your friends still in Kyiv?
GUSHCHIN: Yes, they are.
Are they still practicing and treating patients?
GUSHCHIN: Correct.
Have you been in touch with them? And can you tell me what they’re saying?
GUSHCHIN: I’ve been in touch with them with text messages. I was devastated. As a human being, and as a Russian, that my country invaded Ukraine, I’m very confused, obviously, by this. I was asking how safe they are, how are their families, what they do with their families, how they go to work. I mean, how do you wake up and go to work when there is bombing going on? How do you check on your patients? How do you provide care for your patients? This kind of intellectual curiosity of putting myself into their shoes let me think, why don’t we just write up our experiences, shared experiences with my friends, what they did during the first few weeks of the war? Because as you pointed out, people get used to it. They forget what they did and how they did it. I was interested in these raw feelings, what they were going through as physicians who have responsibilities to take care of themselves, to take care of their patients, to take care of their families, what they do. Because I don’t know. Maybe you can be in this situation yourself with, like, flooding or war or something, social unrest, I don’t know. I just want to know what was in their heads. That’s how we framed our paper and that got published in The Lancet.
What are they doing when bombs are flying and you’re trying to treat patients? What do you do?
GUSHCHIN: First, they had to take care of their families because nobody knows what they have to do. We just recounted their thoughts, what they were thinking, and what they were doing. First of all, they solved the safety issues for their families. They sent them away and safe places, so they don’t need to worry about them and focus on what they’re doing professionally. So, this is theme No. 1 that we teased out from our conversations. The second important thing is whether they serve in the military, or they continue to treat patients. It’s a war time and they are men, and they have military obligations. The question is, can a doctor or surgeon shoot another human being, even if it’s an enemy? So, it’s a difficult dilemma. Again, you don’t think about it, but they had to. Everybody decides on their own. Then, they needed to understand how safe it is to bring patients in the hospital and how safe it is to provide high level of care in the hospital because if what if there is no electricity? What do you do? They provide full range of cancer care with radiation oncology, and what if there is no electricity and the treatment is terminated midway? So, what would you do? The patient is stuck in the machine, for example, or you cannot finish the surgery because there is no way to do that. So, they had to understand what they can and cannot do. It’s another challenge. They decided to outsource high acuity care to safer places or to send patients to Europe. For example, pediatric oncology is very emotionally involved, and there are a lot of players there. You have to not only treat the child, but also the families around. It’s a big production. A lot of safety issues. So, they decided to, the first days of the war, to send patients, pediatric patients somewhere else. How do you provide the documentation about that? What do you put there? It’s a big problem. You need to go child by child, patient by patient. And you need to reinvent this all over again. So, it’s not that kind of problem they were solving. That’s how there was a lot of influx of help from abroad, a lot of support. But how do you prioritize what equipment or supplies you need? Where to ask for? What to look for? How to utilize different supplies from different countries with different, like, marking? How are they compatible? Those are questions they needed to solve first days of invasion.
I know you were talking about sending some patients to Europe and outsourcing to bring people in, right?
GUSHCHIN: Right.
What do you do? And in my mind, I’m thinking patients that are just too sick, that have to stay in place. I mean, is that a consideration, too?
GUSHCHIN: Yeah. That’s what you saw in this video. You saw patients and health care providers were hiding together in the basement of the hospital, and they’re trying to coexist, survive, and figure out what kind of chemotherapy they can continue, what cannot be continued. But No. 1 priority probably was being safe. That’s why they’re crowded in the hallways of the basement, which we’re not supposed to house any patients or there are few services. But you probably saw somebody singing and playing guitar, and kids are there. They’re not crying. They’re surrounded by the family or friends. So, they did what they could.
What is the status now? Have you talked to your friends there recently? And how are they operating now?
GUSHCHIN: Well, it depends on where the patients are. So, there is active war zone in several cities. There is business almost as usual in other cities, like in Kyiv and in the western part of Ukraine. On the surface, the care is being provided. However, war does not make anybody stronger. It does not make anything easier. There is only detrimental effect on oncology care as far as war is concerned. Oncology care is much more than doing an operation or providing treatment. It’s a lot of social support. When everybody’s attention is pointed towards just mere survival and air raids and bombing still going on. I heard it on the news as I was driving here that several cities were bombed. I just don’t envy patients, oncology patients, how they are going through the treatment. It’s usually several months-long treatments, if not years-long treatments. Even if the basic of the medical care is provided, the rest of the support is very thin. When patients are shipped to, for example, safer places in Europe, it’s not fun to be away from the family and social supports, even in the best health facility in the world.
Why did you decide to publish this in The Lancet? What information is important in your mind and your colleagues’ mind to get out, not only to other doctors, but to the public?
GUSHCHIN: Well, I think it is important to understand the war affects all areas of human life. Then, when it comes to oncology, it puts oncology on the back burner because everybody’s interested in trauma surgery or saving lives. But cancer does not go away, and these patients suffer. I focused on the oncology health care providers who are very highly trained. They need a lot of support and infrastructure and safety to be the best physicians that they could be. During the war, some of them are just lost. They just don’t know what to do because they require a lot of technical supports, safety, and social support to do their job correctly. So, cancer care, modern cancer care is a complex endeavor, and it’s so easy to disrupt it. Whether it’s a war or social unrest or a natural disaster, it’s very easy to disrupt it. That’s what it taught me.
END OF INTERVIEW
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