Curiosity ~ Lucidity ~ Humanity
Dear Friends and fellow travelers,
I am presently in Ukraine to support and work with my neurosurgery friends and colleagues in Dnipro and then to participate in the Annual Ukrainian Neurosurgery Congress in Kyiv. I am here with my good friend and neurosurgeon, and well-seasoned traveler, with whom I have been in Ukraine several times.
After more than 30 hours in transit from Boston, I arrived in Chisinau, Moldova. From there, I took a 15-hour bus ride to Kyiv, the Ukrainian capital, followed immediately by another 14-hour bus ride to Dnipro, to the southeast.
Life in the countryside appeared quite normal.
Upon arrival, I was met by my friend and host, Dr. Andrii Sirko, Chair of Neurosurgery in the Mechnikov Hospital, the second largest in Ukraine. Since Dinipro is only 50 miles from the front, Andrii’s hospital receives most of the casualties of the war, both military and civilian. However, it also continues to receive the regular flow of people who need hospital services daily.
Andrii and his 14-year-old son took Russ, who had arrived in Dnipro a few hours ahead of me, for an excellent lunch of exquisite Ukrainian specialties, such as borscht and various types of dumplings. The restaurant had a good number of patrons.
Andrii then showed us what he called “The worst and best of Dinipro.” The worst were the sights of terrible damage to buildings by Russian drones and missiles. One was a massive building only a few blocks from Andrii’s apartment that had been struck many times, and most recently within a few weeks. The factory made machine parts, some of which were used for missiles. There was also a massive residential complex of at least 10 stories that was abandoned after missile strikes that resulted in massive casualties. We then visited the other side, a large, beautifully maintained park along the Dnipro River with weeping willows, geese, ducks, peacocks, larger carp in the water, someone on a hydrofoil board, a few sail boats, many families and couples strolling, and other people lounging and picnicking under beautiful trees on large pink cushions. Sunny and warm, and so tranquil. Meanwhile, Andrii was constantly on his phone, dealing with new, challenging trauma cases that were arriving at various hospitals, including the Mechniokov Hospital.
The TV news was full of discussions about Trump’s and Putin’s demands that Ukraine surrender a major portion of its land for a false peace, and the people’s refusal to sacrifice themselves to the egos of those men. Thus, despite a country at war, life in Dinipro appeared normal as people strive to maintain an element of normality. Such a contrast. Such a challenge.
Today, Sunday, Andrii and his wife and 14-year-old son will have a family event at their countryside house. His wife and son regularly go there on weekends. However, Andrii rarely goes because he works almost constantly. Being in the countryside serves many purposes. Andrii’s wife is a passionate gardener who grows an abundant amount of fruits and vegetables. However, it is also essential for their son, who has difficulty sleeping in the city with the constant attack alarms, especially after the missile attack on the factory near their city apartment. However, he can rest peacefully in the countryside.
As I was about to go to sleep, the warning sirens went off, indicating potential threats of missile attacks. There was nothing to do, so I went to sleep to catch some well-needed rest after more than 60 hours in transit from Boston to Dnipro. I slept well. However, this morning I found out that last night was the largest attack on Ukraine of the war, involving more than 1,000 missiles and drones. A map with tracks of the missile attacks last night is below. However, none landed in our immediate area. However, others were far less fortunate.
This graphic shows the origins of 1,100 missiles and drones, their trajectories, and sites hit during a single night while I was in Ukraine. Note that the trajectories are not straight, which makes it far more difficult to hit a missile or drone.
This morning, it is sunny and balmy, quiet and calm as we await a call from the hospital to go see some interesting neurosurgical cases.
Life goes on, and I am well.
- Damien
Dear Friends and fellow travelers,
Several issues I hope my dispatches address include my impressions on:
1. The feeling on the ground about the war.
2. The effects of this war on urban infrastructure, the personal psyche, and our physiology.
3. The dedication and neurosurgical skills of my friends and colleagues here.
4. Can some of the neurosurgical techniques my colleagues in Puerto Rico and I developed be applied here?
Because I am in Ukraine, I will restrict my discussions to Ukraine. Although many other catastrophes are raging worldwide, they are better discussed in separate or comparative essays.
Since the war began, there have been no air flights into, out of, or within Ukraine. This has led to the proliferation of buses to carry all the necessary travelers, including military personnel, throughout the country.
The night and morning of the massive attack on Ukraine, which I previously reported, the Mechnikov hospital received more than 60 injured patients, 25% of whom were military casualties. However, every day, the injured are delivered to the hospital for care. But one must recall that, before the war, the hospital was operating at full capacity. When the war began, the number of neurosurgical staff decreased by 30% for various reasons, and the patient load increased by 60%. It’s simple math: everyone must work constantly, just to provide reasonable health care, and it appears that all the staff do so as a fluid team.
Sunday at 8:30 AM and 1:30 PM, the day after the most massive air strikes on Ukraine yet, the sirens of Dnipro blared. For all I could see, life went on as usual. I was sitting in an outdoor café, and it was full, including 3 birthday parties. However, there were often clear sounds of drones and missiles, and from 12:30 to 1:15 AM on Monday, there was a large number of drones and missiles, roaring like jets, flying right overhead. Again, they went elsewhere. Many were the Iranian Shahad large drones.
What was surprising about this last attack was that no sirens went off before the sounds of the drones and missiles manifested themselves. Andrii said that sometimes the alarms go off only after the explosions occur. Not all systems are perfect, or most are not even close.
There is a curfew on all except emergency traffic at night. Therefore, the city is unusually quiet, and all unusual sounds stand out. Thus, one has to be a good sleeper not to hear the sound or to be awakened and then lie awake listening for the sounds of the next attack. As I mentioned earlier, my host’s son only sleeps well when he is outside the city and away from the anxiety of drones and missiles.
Of course, night attacks are intentional to instill anxiety, fear, or terror, and the lack of sleep. These are all attempts to weaken the enemy.
Within the past few weeks, in the neighborhood where Andrii lives, its power plant was significantly damaged, but remains partially operational. This means his apartment has electricity only for 2 hours per day, but no one knows when the electricity will be provided. Therefore, he has batteries that get charged when there is electricity, which supply constant electricity for his refrigerator/freezer and basic house electrical needs. He estimates that, due to the extent of damage, full power will not be restored for 2-4 months.
That day started at dawn with my return to the hospital to join Andrii and his colleagues in their daily activities. The day started with three meetings involving his residents and staff, then the hospital’s principals to keep everyone up to date on the status of hospital affairs, and then neurosurgery-specific plans for the day. There were the usual rounds of all patients in the neurosurgery beds, and time with individuals who would be admitted and others who were coming for status reports. Of course, neurosurgery operations are going on all the time.
The massive patient load is seen by patients in beds crowded in hallways as densely as possible. However, the level of care appears excellent. For those of you familiar with hospitals, this may not be new or interesting, because this is generally a common routine in hospitals, with the major difference in patient load. Regardless, it is interesting to see how different hospitals work.
As Monday came to an end, I was watching a brain surgery until less than one hour before my departure for Kyiv to attend the Ukrainian Neurosurgery Congress. I then took a taxi to the bus station. Just as the last time I was leaving Dnipro in December 2024, when I arrived, the sirens blared. However, since it was departure time for my bus, I boarded it, which contained mostly soldiers, either coming from or going to another front, and we drove off into the darkness.
I felt that a bus moving in the darkness would not be targeted. Into the night, we drove northwest with a scheduled arrival in Kyiv of 5:30 AM. From the bus station, it was a 15-minute walk to the small hotel where I had booked a room. Along the way, I saw several tall buildings with massive numbers of windows blown out. I immediately showered and then took a 15-minute walk through a large park to reach the Hilton Hotel, where the neurosurgery conference was being held.
So, here I sit in Kyiv, beginning another event, listening to excellent presentations on neurosurgical techniques. Fortunately, I was informed that I do not have to give my lecture today, but tomorrow.
- Damien
Dear Friends and Fellow Travelers,
Yesterday, at about 6:30 PM, I was being introduced for my lecture and was walking to the lectern. Yet again, the air raid sirens began to wail. I got to the podium and gave my presentation. I guess I have adapted. The talk went well and was followed by some good questions and a lot of interest.
After the lecture session ended, I walked with some friends and colleagues to a restaurant in a large park. As we were walking, the sirens began to wail again. One friend said it was more likely that a missile would hit the Hilton Hotel that we had just left than the restaurant where we would eat. As the sirens continued, so did the car and bus traffic and the pedestrians, and in the park, a group of 20-plus people continued to dance without breaking step.
Dinner was with 25 selected individuals from the meeting and involved a wonderful selection of dried meats, excellent fresh vegetables, pate, whiskey, Ukrainian stuffed pancakes, wine, and conversations.
The rest of the night was quiet.
- Damien
Dear Friends and Fellow Travelers,
This will be my last dispatch from this trip to Ukraine. Late this afternoon, I will take a 13-hour bus ride west to Chisinau, Moldova. Hopefully, the border crossing process, which once required me to sit on bus waiting for 5 hours to cross, will not delay the bus for too long, so I can catch my 6 AM flight to Vienna and onwards to home.
This neurosurgery meeting has been intense, running from 9 AM to 7 PM and now in its fourth day. The presentations have been followed each day by an excellent meal with my friends and colleagues. The first was a welcoming reception for all the participants in the National Historical Museum with an exceptional exhibit of a unique Ukrainian artist, Ivan Marchuk. The next, in a rustic restaurant in a large park, a 20-minute walk away, for about 25 people. The final social event for all participants, in what of all ironies, was called the Caribbean Club. A band with a singer played. There was good finger food, wine, and whiskey (no rum). Although I know this is a beautiful city, there has not been any time for tourism on this visit, perhaps after the war.
There have been air raid alarms every day and every night, and as I wrote earlier, when the alarms blare, during the meeting, no one budges. Rather, we stay seated, and the talks go on. Because I do not check the warning app on my phone related to the alarms, I do not know the location of the strikes. I only hear the specifics of the attacks if the events were particularly devastating. But throughout the day and night, drones and missiles continue hitting Ukraine.
The walk from my hotel to the conference center is through a large park with lush greenery and colorful flowers. Early the other day, on my way to the meeting, I sat in an outdoor café having a coffee. The sky was blue, the temperature balmy, the air clean, and all was quiet and relaxed. I guess this is what happens when one adapts. As I have written, life must go on. As usual, the rest of the day was non-stop, interesting lectures.
At one dinner, the conversation amongst a few of us turned to politics. Anger was expressed at Obama because when Russia entered and occupied Crimea, he told the Ukrainian President, “Crimea is all Russia wants. It will stop now and not try to take any more of Ukraine.”
The question was raised of what Russia might have on Trump that makes him pander to Putin. Great anger was expressed against Zelinsky. As a former actor, he is seen as pandering to the audience and surrounding himself with sycophants who do nothing but praise him, and is disliked for his belief that he is the best at everything, needs no advice, and is the ultimate source of all good ideas.
Another conversation involved the issue of corruption. It has been broadly accepted that corruption is rampant in the government. The problem of corruption is so significant, with so much money disappearing, that there is almost no money to support the public healthcare system and to pay more than minimal salaries. The society is suffering.
Are the corrupt people holdovers from the earlier communist regime, for whom that was just the way it was, and there was no reason to change? There was support for this belief, to a degree. However, it was also agreed that there is a group of entirely new individuals who have found corruption an easy source of benefits with low risk of being busted. Zelinsky was faulted for not doing enough to resolve the problem.
Clearly, there is a lot of ground to cover before meaningful progress can be made.
Everyone in Ukraine, but especially in urban areas, is threatened. Officially, you are told that when an alarm of a pending missile threat sounds, you should immediately go to a shelter. But one can not always find a shelter. And what if you can? Do you go each time there is an alarm? The reality is that one cannot always go to a shelter. Even if one did, how often can one go? Going with each alarm creates its own traumas. I, too, learned merely to continue doing what I am doing and accept that death may be imminent. But even this last thought no longer enters my mind when the sirens blare.
Due to the frequency of the attacks, typically announced by sirens, people find sleeping difficult. I mentioned this previously, the son of one of my friends can only get real sleep when he is outside of the city. This is life during this war. Apparently, clean and healthy living, but war nonetheless.
The Ukrainians are strong and believe they can or will withstand whatever they must. Have they suffered? Everyone I have met has suffered some loss. The death or injury of a friend, a family member, or other loved one, or one of their fellow citizens. One of my friends has not seen her husband or brother, who have been on the front line for more than three years, since they left for the front. She also rarely hears from them because phones are not allowed because they give away one’s location, leading to a rain of hell.
Although strong, please do not scratch me, because, while I am whole and will withstand all they throw at me, I am very fragile inside, perhaps just holding things together, but it still hurts. There is often a tear being withheld, forming, or rolling down a cheek.
A day ago, Russian drones killed more than 20 senior villagers who were clustered to collect their pension checks from the postman. A few days before, three drones struck a stable, killing all the horses. While only horses, three strikes at the precise spot indicate intention. This appears to be part of a terror campaign by which the Russians hope to get the people to turn against the Ukrainian government and to make concessions to the Russians. However, it appears the attacks only reinforce Ukrainian opposition to the Russians.
On another front, the average age of Ukrainian soldiers is 45. No one 25 years old or younger can be conscripted, although they can volunteer to serve. The belief is that the Ukrainians want to preserve their youth so they can move the country forward after the war. Until very recently, no male under 25 years was allowed to leave the country in order for them to be available for conscription. However, new legislation was enacted to allow them to leave if they want. Although no one knows how many may have gone, many who chose to leave did so to get their educations elsewhere. Nevertheless, I have heard another reason for not conscripting younger males. The rationale is that the attitudes and beliefs of Gen Z males would not allow them even to be trained to be good soldiers.
In response to knowing I was coming to Ukraine or that I am here due to my dispatches, some have written, “Stay safe,” “Be careful.” But these are such relative concepts. Everyone in Ukraine, but of course, especially in urban areas, is under threat, although, as I will mention, even in isolated areas and small villages, no one is really safe. My first experience with a potential threat was one night last December, in Odesa. At about 3 AM, 300 or more missiles and drones flew directly over me. They made a horrendous noise, and it was very disconcerting, knowing they could easily have rained down on me. Fortunately, none did. However, other people, less fortunate than I, probably suffered. I made an informed decision and am comfortable with it.
My neurosurgery colleagues are dedicated to doing all they can. However, they also suffer trying to repair those who lost a limb, an eye, face, part of the brain, or have their quality of life, or life itself, diminished. Nevertheless, they are tireless, and it is an honor to be with them as they learn, develop novel techniques when they are forced to improvise and develop new procedures, or work without many basic materials.
I tell people here that virtually everyone I know supports their cause. This provides enormous positivity. I also must state that the lack of support from the US is not due to us but to others.
Those who do not support this struggle of the Ukrainians to maintain their freedom and independence know nothing about being under constant or even brief threat. Few have ever been under attack or threatened, or faced real fear, except perhaps not being able to buy the newest model iPhone, or suffered the anxiety of not knowing whether they have secured a ticket to a concert by their favorite performer.
While not a clinician, I am here to offer what I can. Even my physical presence here is helpful. Only two non-Ukrainians are physically participating in this conference, although a few are participating virtually. I am also here to offer support in talking about and offering training in several novel clinical nerve repair techniques my colleagues and I have developed. I have also been asked to provide advice about the management of challenging nerve trauma cases. I offer what advice I can. Whether my professional work develops into a larger collaboration is an open question. It is clearly hard to conceive of starting a new clinical project under such challenging circumstances. However, I hope I may be laying the groundwork for moving forward in the future.
One may be surprised that restaurants and bars, markets, upscale and thrift stores are full. But life must go on. Operas and orchestral pieces are played, poetry is read publicly, bread and toasters must be made, fields plowed, planted, and crops harvested, beds changed, clothes washed, and kids dressed, taken to school and educated, one has to call a plumber for a problem, the plumber must put gas in their car, we walk in the park, sit quietly, and have a coffee. Life goes on. But, underlying all this is the constant stress. One must come to terms with one’s realities. I, too, must learn to do so with my life.
Everyone here is scarred to some degree, personally or through a loved one, friend, or fellow countryman. They endure because they must. We all must do what we can if we have something to offer.
While it is acknowledged that the US is the only country that can help bring an end to this war, the sentiment has been expressed by some here that the Biden administration did not have the courage to provide Ukraine what it needed long ago to slow the onslaught and the taking of so much Ukrainian land. But, there is still hope that the US will come around before it is too late. The problem of Trump’s waffling is very problematic.
MAGA and MAHA people, et al, know or think nothing about the real issues so many others face. For them, what happens here in Ukraine stays here and is not a real problem. They are not under any direct or even indirect threat. They do not yet understand the dangers they are creating by their selective blindness. Here, the threats are real and constant. Life and the future are threatened.
I recall when I was 17, I went to Germany for the summer to do an apprenticeship in tool and die, the art of making machine parts. It is a skill that has benefitted me throughout my entire life. Upon returning, my mother asked me, “What was your experience?” I boldly said, “I experienced everything.” To this, she said, “No, you experienced many things. There are many more experiences to come.” She was so correct. We can always learn, as I am still doing in Ukraine.
Sadly, there is no end in sight to this current travesty. This is a terrible ongoing struggle. I have been fortunate to have had the opportunity to experience Ukraine with a group of open-minded and dedicated people in a society struggling desperately to survive the onslaught of a massive enemy without adequate outside support. If Ukraine falls, so will other countries, because Ukraine will no longer provide the buffer against further encroachment. One way or another, we are all linked to the resolution of this problem. This has been intellectually, professionally, culturally, and socially an excellent experience. I will definitely return, hopefully under far better circumstances.
Now I head to the bus station to exit Ukraine via an overnight bus, and then fly home. Therefore, this is my last dispatch from Ukraine for this trip. I hope to have provided you with some of my experiences, insights, feelings, and those of people I was with along the way. Thanks for joining me.
- Damien