Doctors Without Borders staff unload the first patients from a medical referral train which arrived in Lviv on 1 April. The medically-equipped train takes patients requiring evacuation for higher levels of care from areas near the front lines to hospitals further west which can provide the care needed. Ukraine, 1 April 2022. © MSF
Admitting patients onto Doctors Without Borders' first medical referral train in the town of Zaporizhzhia. We made the selection of patients with the management team of a hospital in the town of Zaporizhzhia, where the patients were first treated after leaving Mariupol. We transferred them to referral hospitals in Lviv. The idea is to take patients needing higher levels of care, but stable enough to endure a long train journey (up to 24 hours). Ukraine, 1 April 2022. © MSF
The next day, we came back, three of us, and we screened every single patient. Our key point was to consider for each patient – could this person sustain a 20-hour transfer where we don’t have ICU [Intensive Care Unit] level of care?
And then Thursday morning, we came back early, to do another check on all the patients before doing the referral, to make 100 per cent sure they were stable.
There was one patient, a three-year-old child with very severe abdominal injuries, who we thought would not be stable enough for the transfer. At one stage, the mother said: “My child is going to die during the transfer.” I’ve been a practicing paediatrician for the past 30 years, and what I told everyone is that when a mother tells you that, she’s never wrong.
We evaluated this child three times, together with the directors of the hospital. When we came on Thursday morning, the doctors were about to take the child back into the operating theatre, and we all came to the same conclusion; this child was not stable enough for the transfer. This decision took time, but it was a decision we all took together.
I particularly recall a woman who had a blast injury in her face and had lost her right eye. We had asked her to send us a picture on Tuesday, as we wanted to assess her condition and we had to leave that evening to get back before curfew. And instead of sending us a picture with the injury, she sent us a picture of herself before the injury. And when we got back to the hospital the next day, the first thing she told us was: “I want to be beautiful again. For my husband. For my child.”
These stories from these few patients – this is the story of many thousands of people.
The other thing that is amazing is the dedication I saw. For example, when we did the transfer to the train on Thursday morning, the ICU physician – not the interns but the senior boss of the ICU – came and did the transfer himself.
He paid great attention to the boy with the severe leg injuries. It was him who lifted the stretcher onto the train, and waited there awhile to check the patient was fine. And when he was finally satisfied, he looked at me and said: “I think my job is finished now. I hand over to you”.
This first, two-carriage medical train will be followed by a larger, more highly medicalised, referral train which is being developed by the Doctors Without Borders team.
