White Coat, Black Art

Harrowing journey aboard medical train in Ukraine takes injured to safer areas

Canadian health-care workers are going to great lengths to care for Ukrainians on and near the front lines of the war that started when Russia invaded Ukraine on Feb. 24.

Canadian doctors, nurses among those caring for Ukrainians on and near the front lines of the war

A patient is loaded onto the first medical train operated by Médecins Sans Frontières (MSF) on March 31 in Zaporizhzhia. The specially converted two-carriage train took nine patients, ranging in age from three to 84, on its maiden journey. It has since transported dozens more to relative safety in cities like Lviv. (Médecins Sans Frontières)

As a retrofitted medical train pulled out of Zaporizhzhia, Ukraine, carrying nine badly injured patients to a safer location last week, Canadian American physician Dr. Daniel Schnorr could finally exhale. 

"After all the patients were on board, we were getting ready to leave and we did have an air raid … so the train was stuck for a little while," said Schnorr, who led the first mission of its kind for Médecins Sans Frontières (MSF), also known as Doctors Without Borders.

"But then, eventually, the air raid was lifted, and the train started moving, and everyone breathed a sigh of relief — and you're on your way. And once the train starts moving, it feels like you're already halfway there," he told White Coat, Black Art host Dr. Brian Goldman.

Schnorr is among a number of Canadian health-care workers going to great lengths to care for Ukrainians on and near the front lines of the war that started when Russia invaded Ukraine on Feb. 24.

"The idea of the medical train kind of arose because we noted that the trains have, remarkably, been able to run throughout the war from the beginning," he said.

After a security analysis, the group concluded that the trains are the safest mode of travel right now, despite the fact that the station the group departed from was bombed a few weeks earlier.

Medics Nataliia Kyniv, left, and Dmitry Mogilnitski, prepare supplies ahead of the first patients coming aboard. (Médecins Sans Frontières)

On March 31, the train departed with the group of patients — all suffering from blast injuries, and ranging in age from three to 84 — from Zaporizhzhia, in the country's southeastern region, and transported them about 1,000 kilometres west to the relative safety of Lviv. 

Making room for more injured

"When we first entered into the country, MSF was kind of fanning out, trying to figure out where we could have the most effect, where we could help the most people, where we could alleviate stress on the medical system," said Schnorr, who runs a small emergency department in eastern Arizona when he's not dispatched to a crisis zone. This was Schnorr's fifth mission with MSF. 

The city of Zaporizhzhia has been receiving people who have fled Mariupol, which has been under siege for weeks. As a result, hospitals there have many patients with grievous injuries that will require prolonged hospital stays, said Schnorr.

"They were anxious to try to move patients out of their hospitals because they're anticipating a lot more patients coming in the next few days to weeks."

WATCH | Dr. Dan Schnorr explains the medical train evacuation:

The railway staff modified the railcars so there's space for patients to lay down, as well as for things like oxygen concentrators, IVs and other medical equipment, said Schnorr. Parts just inside the entryway to the train were cut away to make room to manoeuvre stretchers so the sickest patients could remain lying down while transferred from ambulances. 

"We don't have the ability to take ventilated patients, or patients that are on medications to support your blood pressure. But we can take most other patients," he said.

Though the train will be able to take many more patients at a time in future journeys, for its inaugural medical evacuation, Schnorr said they selected a small number of patients who would need to be in a hospital for a long time, but were stable enough to survive a train ride that could be up to 24 hours, given checkpoints along the way.

On board were "nine patients, plus family members and caregivers and two cats," he said. 

A shirt with the MSF logo is seen through the window of the first medical train to transport severely injured patients to hospitals in cities further away from intense areas of conflict. (MSF)

Dr. Joanne Liu, a pediatric emergency medicine physician from Montreal, was also on the ground with MSF to help assess the patients in the days and hours ahead of departure.

"We talked with the parents to ask if they wanted medical evacuation or not," said Liu in a blog post she wrote for the MSF website. "The first mother said, 'I want my child to be medevaced because I think it is the only chance for my child to keep his legs.' And the child looked at us and said, 'I want to walk again.'"

'I just wanted to do the right thing'

Canadian nurse Laura Orsatti, of Peterborough, Ont., is working at a children's hospital in Kyiv. She travelled to Ukraine on March 9 and stayed for about a month, and is now on her second stint in the capital after a four-day trip home to see her family.

"I didn't want to be part of an NGO. I didn't want to be politically affiliated. I just wanted to do the right thing. So I decided to show up at the biggest children's hospital because I had that experience."

Nurse Laura Orsatti speaks to CBC News from Kyiv on March 17. (CBC)

Orsatti said she's seen a range of injuries stemming from the conflict, including one child with a bullet wound who'd witnessed his father being killed on the street, a one-month-old with shrapnel wounds, patients who have been buried under rubble and a child under 10 who had been raped in front of their mother. 

She also said she's been moved by the strength of the Ukrainians she's working alongside. "They want to provide the best care possible, and they're doing everything they can to save as many lives. It takes a lot of bravery. A lot of them … they don't get to go home to see their families, their houses are blown up. And they have to live here full time."

Hospitals have been frequent targets for the Russian forces.

Orsatti said her hospital in Kyiv has been shot at. Here, a bullet hole can be seen through the hospital's window. (Submitted by Laura Orsatti)

"You hear the sirens going off all the time. I hear the Russians flying above us," said Orsatti. The window of a room she was staying in at the hospital was shot at, she said.

Dr. Richard Hareychuk, a third-generation Ukrainian Canadian and optometrist in Oakville, Ont., has been active in the efforts of the Ukrainian diaspora in Canada to support their homeland since Russia annexed Crimea in 2014. He said he recommends that medical professionals who want to help on the ground in Ukraine do so through official channels.

Global Affairs Canada has advised Canadians to avoid all travel to Ukraine and the Canadian Embassy in Ukraine has suspended its operations amid the conflict.

A news release on the Ukrainian Health Ministry's website, translated to English, said that as of March 3, it had received inquiries from more than 500 doctors, nurses and paramedics from countries around the world, including Canada. Interested parties can register by filling out a questionnaire, it said, and hospital co-ordinators will help arrange deployment to the areas and facilities that most need help at a particular time.

That help is certainly needed, said Hareychuk.

MSF physician Dr. Daniel Schnorr, left, is pictured with Dr. Nataliiya Maidan and a Ukrainian rail staff member known only to MSF as Yurey. (Submitted by Daniel Schnorr)

"There may be a little bit of a question of, well, 'Why a medic? Why not more soldiers?' The fact of the matter is a properly trained medic in the field that knows how to stop someone from excessive blood loss can save lives." 

Nurses shortage   

At the children's hospital in Kyiv, Orsatti said she's noticed there are more doctors than nurses.

Schnorr said he's noticed the same thing. When putting together a team for MSF's medical train, he was unable to recruit any local nurses.

"I think there was a shortage of nurses before the war even started, like there is in a lot of parts of the world," he said. But Schnorr said he also suspects that some nurses may have left their places of work to move their children to safety.

His crew instead had one nurse from Belgium and a number of Ukrainian medical students working as nurses' aides.

Part of the MSF medical team gets ready for patients, selected because their injuries are serious enough to warrant long hospital stays but their conditions stable enough to survive an up to 24-hour train ride. (Médecins Sans Frontières)

Asked if he has sensed that he's personally in danger during the mission, Schnorr said he had some trepidation as the group entered the country.

"When our team went to Kyiv in the beginning of my assignment here, the front lines were not really stable," he said. Still, MSF has a really good security team, in which he places a lot of faith.

"I'm very conservative [about] safety when it comes to these things because I have two young daughters. So I felt comfortable that we had a plan in place to be able to make a contribution in a safe manner," said Schnorr.

"As time goes on, you become a little bit comfortable — and maybe that can be dangerous. You don't want to become too comfortable." 

On Wednesday, the MSF medical train evacuated patients from the Kramatorsk station in Eastern Ukraine. On Friday, the same station was hit with at least one Russian missile, killing dozens, Ukrainian authorities said.

Orsatti said she knows she could lose her life in Ukraine.

"I'm not scared to die. I'm scared my life won't mean anything; like, I haven't done anything that's worthwhile," she said. "I don't know if I believe in God or anything like that. But if, you know, I meet my previous family members, I want them to be proud of me that I did the right thing, and I tried, you know. And that's all I really want." 

Written by Brandie Weikle. Produced by Colleen Ross, with help from Brian Goldman.

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