Many Rheumatologists in Ukraine Become Refugees Amid Chaos

On the morning of February 24, rheumatologist Olena Garmish woke at 5:50 AM from the blasts of rocket fire in Kiev, Ukraine, and saw the explosions through her window

She described that next week to Medscape Medical News: air sirens 20 hours a day, fearing death 24 hours a day, and growing food shortages.

Garmish, executive director of the Association of Rheumatologists of Ukraine, said she continued working at a Kiev hospital until March 4, but then had to leave the country with her children and has traveled to two other countries since. Now she is looking for employment abroad after 22 years as a clinical researcher and practitioner.

“We lost our jobs and rheumatology practice,” she said. Now, she says, she provides online consultations to patients as much as she can.

As air strikes continued Tuesday in Ukraine’s capital city and elsewhere throughout the country, rheumatologists are among citizens forced to upend their personal and professional lives and make the best decisions they can to keep themselves and their families safe.

Roman Yatsyshyn, MD, professor at Ivano-Frankivsk National Medical University in Ivano-Frankivsk, Ukraine, and vice president of the Association of Rheumatologists of Ukraine, told Medscape Medical News that many rheumatologists, like Garmish, have been forced to close their practices and flee the country. The hope is that the moves are temporary, he said.

He said rheumatologists there are having very different experiences depending on their proximity to the shelling.

Dmytro Rekalov, MD, PhD, who has been a practicing rheumatologist for 20 years, said he has had to relocate – he hopes temporarily – to western Ukraine.

He told Medscape Medical News that the battles are about 40 km (25 miles) from him.

“I have a small private rheumatology clinic in Zaporizhzhia [in southeastern Ukraine]so if they invade our city, I’ll have to close my clinic and find another place to live and to practice in. “Zaporizhzhia is home to the largest nuclear plant in Europe, a facility that came under attack earlier this month.

Doctors from areas under siege have been forced to move to quieter locations and consult with patients remotely, Yatsyshyn said.

“Moreover, all doctors are actively volunteering, helping refugees, and supporting our military at the front,” he said, adding that medications are in short supply.

“We express our sincere gratitude to the world and European medical communities for their help for Ukraine at this time. Medicines and medical devices come to Ukraine from many countries around the world every day,” Yatsyshyn said.

Yatsyshyn said the Ministry of Health of Ukraine is coordinating delivery of medications.

“However, there is still a need for an uninterrupted supply of basic antirheumatic drugs, cytostatics, glucocorticosteroids, analgesics, and nonsteroidal anti-inflammatory drugs. We will be grateful if such help will continue to come from our colleagues,” Yatsyshyn said.

In most cases, he says, rheumatologists stay in touch with their patients via social media and apps, Skype, and Zoom.

“We have also created professional and patient groups in chat rooms,” he said. “There, we can respond quickly to current issues in different regions. If necessary, we send medicines in case of their absence or danger in certain regions of the country. Rheumatologists have set up a joint group for online counseling and exchange.”

Some rheumatologists have been retrained as emergency physicians, he said. In areas with less military activity, rheumatologists continue to treat patients at their practices. In places where it is relatively calm, rheumatologists consult not only local patients but also migrants from other regions affected by the war, Yatsyshyn explained.

The Association of Rheumatologists of Ukraine continues its activities, he said.

“We monitor the problems of our colleagues, their relocations, security, and the opportunity to work. In close cooperation with the Ministry of Health, we monitor the provision of necessary medicines to our patients. We are very grateful for the help of our colleagues from European associations, the United States, pharmaceutical companies, medical centers, universities, and volunteer organizations. “

“We have two other big requests to the entire medical and scientific community,” Yatsyshyn said. “To suspend the membership of all Russian medical communities in European and world associations (including EULAR, EUSTAR, Lupus Academy, ACR, British Society of Rheumatology, and others) with a ban on attending international forums just as almost all sports and art organizations in Europe and the civilized world have done. “

The second request, he said, is “to close the sky over Ukraine to stop killing children, civilians, destroying Ukrainian memories, and to destroy Ukrainians as a nation. We pray for this to all the conscious world.”

EULAR, the European Alliance of Associations for Rheumatology, said in a statement, “EULAR has stood for peace in Europe and globally, and for improving the lives of people with rheumatic and musculoskeletal diseases, for 75 years. We are committed to the tradition of humanity and peace and are deeply concerned about the general situation of the people in Ukraine. We will do our utmost to contribute to alleviate the suffering. To this end we are urgently exploring options together with other biomedical partners. Please also help to support the people in Ukraine, eg by donating to UNHCR (the UN refugee agency) or ICRC (International Committee of the Red Cross).

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick

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