Thousands of Ukrainians living near the contact line in the Donbas find themselves literally cut off from the outside world. In these conditions, perhaps, it is most difficult for lonely elderly people who are left alone with their problems – without medical care and social support. This story is about those who still come to people’s aid and how the situation regarding access to medical services in the region looks like today.
“I realise that people are left alone, without children, without help. Therefore, even though I have four appointments precisely fixed every day, if someone else needs help, I will see them, even though it takes me more time,” says Zoya Ivanivna Honcharova.
By profession, she is a paramedic, and worked previously as a nurse in an outpatient medical facility. She provides assistance to residents of Donbas villages thanks to EU funding through the EU COVID-19 Solidarity Programme for the Eastern Partnership. The programme aims at mitigating the impact of the COVID-19 pandemic, as well as contributing to the longer-term socio-economic resilience of vulnerable groups in Armenia, Georgia, Moldova and Ukraine. The programme is implemented by the ‘People in Need’ organisation in partnership with the Netherlands Helsinki Committee (NHC) and AFEW International (AFEW) together with the Red Cross.
Since the beginning of the year, mobile medical teams of the Ukrainian Red Cross Society – a doctor and a nurse – have been coming to the villages of Popasna and Novoaydar districts of the Luhansk region. Also, thanks to the EU project, a home health care nurse is constantly taking care of people: this is one of our protagonists, Zoya Ivanivna. It is her responsibility to monitor the treatment of elderly people, and to help them with household chores.
‘Guardian Angel’ for lonely seniors
Now the woman’s working day begins with calls from her charges, elderly residents of Triokhizbenka (Luhansk region), who ask questions about treatment or ask to bring some products from a local store.
In total, she works with 20 seniors – 4 mandatory visits a day. But, she says, in the case of “unscheduled” requests, she never refuses.
Requests are of a different nature: from the need to sweep the floor, to have a haircut or help with cooking dinner. Although the project is officially aimed at the over 65s, in reality, Zoya Ivanivna’s youngest wards are 70 years old. And mostly people are aged between 85 and 92.
“Just imagine: a bed-ridden person who cannot serve themselves. Sometimes it’s hard for them even to walk around the room. It happens that today a person feels fine, and tomorrow you come – he or she is already lying down, unable even to lift their head,” – explains the things the home nurse.
Zoya Ivanivna regularly brings seniors groceries from the store and the necessary medicines, and pays for communal services. In addition, it is mandatory to monitor treatment and medical services directly: temperature and pressure measurement, saturation check, sugar level control.
If there is a serious problem, a doctor from the Red Cross mobile brigade is always available, providing her recommendations by phone and deciding what to do next with a patient.
Mobile communication in the village is not always available – there are failures. But locals know the hills where you can go to ‘catch’ a signal in case of need, such as calling a doctor.
Among the main difficulties, Zoya Ivanivna still notes transportation – her charges live in different parts of the village, and not all the roads are asphalted. In good weather, she rides a bicycle, in other cases, she has to walk many kilometres through the mud.
At the same time, there are often few problems with face-to-face communication: “I know how to get along with elderly people. We always come to a consensus over all issues,” she laughs. “Although, sometimes, you have to go to the store two or three times – the same person forgets to order something. But it is an old person, I’m not angry at all.”
How Red Cross mobile medical brigades work
Along the contact line, medical personnel are scheduled to visit remote settlements four times a month – on Saturdays. In total, the medical team, doctor Tetiana Manina and nurse Tetiana Hotsman, alternately visit five villages. Among them is Kriakivka in the Novoaydar district.
Here, instead of a first-aid station there is a former store building in the very centre. The only room with surviving windows was expressly equipped for such meetings. It is heated with firewood, while electricity is “borrowed” from people living in the neighbourhood.
The walls are decorated with children’s drawings, handwritten philosophical quotations and a large paper with photographs of doctors’ appointments.
The last entry in this notebook was signed by four pensioners from the village of Koliadivka. People call Tetiana Manina “a doctor from God, to whom you can turn at any moment – around the clock.” They also note the “kindness and compassion to patients” of nurse Tetiana Hotsman.
For the arrival of the mobile brigade, a small queue of local pensioners is gathered on benches at the entrance, eager to get a doctor’s consultation and generally check their health. The number of patients depends on the epidemiological situation in the region: during lockdowns, no more than 10 people were invited, in normal times, it could be up to 25. The emphasis is on elderly people who find it difficult to get to the central outpatient clinic.
According to doctor Tetiana Manina, local residents are most often concerned about cardiovascular diseases. In general, they come with a variety of problems. Here they measure temperature, pressure, blood glucose and saturation, and it is also possible to do an electrocardiogram and ultrasound. Doctors also monitor the condition of patients with COVID-19 – both in the acute and post-acute stage in cases of long COVID, where symptoms can persist for months.
One of the patients, 64-year-old Valentyna Profatilova from Kriakivka, says that during the appointment she managed to do a cardiogram and measure her blood pressure. The woman has hypertension and, from time to time, heart problems.
“Even if we need to have testing – they can take blood samples and take them to the laboratory. Sugar is checked, treatment is prescribed… There is so little here and it is very expensive to get to Novoaydar. On our pensions, we can’t often go there for an examination. Therefore, we really need these doctors,” she explains.
74-year-old Kateryna Kriakovtseva also underwent an examination and took medication for her seriously ill husband. He is not able to come to the appointment personally – he has a group 3 disability suffering from diabetes, and moves with great difficulty. The woman says that she does not go to doctors often, but they know very well about her husband’s problems and from time to time they go to visit him at home.
After the appointment, as a rule, the medical brigade pays visits to patients who find it difficult to move due to their age or illness.
“Sometimes we come to a person in an acute condition, for example, having cerebral circulation disorder. Not everyone wants to be hospitalised, we have to deal with such problems. If necessary, we can contact the family doctor, redirect to the central outpatient clinic,” says Tetiana Manina.
Zoya Honcharova monitors compliance with the doctor’s recommendations after consultation. Elderly people sometimes find it difficult to navigate prescriptions and medications, while, for treatments to be effective, timely medication intake and correct dosage are important.
One of the ‘in-home; patients, 76-year-old Nina Korzhavina from Kalaus (part of Triokhizbenka), meets the medical brigade on the threshold of her house with a smile. She was notified of their arrival by her dog’s loud barking, who immediately calmed down when he saw a familiar face – Zoya Ivanivna.
“I have chronic diseases, and I recently buried my husband. It’s all hard,” said Nina Korzhavina, who also recently suffered a heart attack.
But she recovered quite quickly, according to her doctors, and her situation is now under control. Zoya Honcharova visits her once a week – helping around the house and “keeping her finger on the pulse”. The medical team comes less often, when necessary: they do an ECG, compare indicators, give recommendations.
Local residents really appreciate the work of the mobile medical brigades, because there are no medical facilities at all in many localities. For example, from Kriakivka, the central outpatient clinic is located at a distance of 60km, in Novoaydar. There is another outpatient clinic, smaller, in Triokhizbenka – 6km from the village.
Maria Lanina, a person with group 1 disability, says that their family doctor lives in Muratovo (about 17 km from Kriakivka) and his one or two visits a week to the Triokhizbenka outpatient clinic is indeed the closest help. But even there, the villagers have “very limited access” – due to the lack of transport. In other cases, the doctor, who has 2,000 patients throughout the district, arrives only for emergency calls.
“A social bus runs to Novoaydar now on Wednesdays. Otherwise, one needs to hire a car – 170 hryvnias, if four people are onboard. If you don’t find fellow travellers, you pay 600 hryvnias yourself,” Maria explains.
As for COVID-19, everyone is sent to Novoaydar for inpatient treatment. If a mobile team on duty suspects a virus, according to nurse Tetiana Hotsman, the information is immediately transmitted to the nearest outpatient clinic. There the patient will be tested for free, or, in severe cases, doctors come to the home.
“This mobile brigade is our salvation” – these words were repeated many times by different patients.
After overhearing from a conversation that the project expires at the end of December this year, patients waiting for an appointment at the makeshift first aid station of Kriakivka were alarmed:
“Maybe they will extend it after all… We only live by it. We need them to be, anyway. Because without them, we will all go to the dogs,” says 65-year-old Liubov Dolmatova.
The woman adds that there is simply nowhere else to turn, for them the project is like a “magic wand”. Even on the phone, the doctor answers at any time – advising, suggesting what to do. But Liubov Ivanivna also comes to a personal appointment regularly: in the winter she was seriously ill with COVID-19, now she constantly monitors saturation, does a cardiogram.
“They do ultrasound and cardiogram – they do everything if necessary. They even take blood for cholesterol and hormones if one needs. I did so in the summer – they transported samples to the laboratory in special boxes. So that a person does not go there, does not spend money. Because it is very far and expensive,” adds a resident of Kriakivka.
According to doctor Tetiana Manina, the project is needed primarily because it makes health care more accessible. People have an opportunity to control their blood pressure, their cardiogram indicators. There is no need to go to the central outpatient clinic, and there is always feedback even over the phone.
But one of the most important goals of the project is still to support elderly people who are left alone with their problems.
Author: Svitlana Popova
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