Ukraine : The obstacles and challenges to the medical workers at wartime

A brief report from the medical workers’ conference held on 10 may 2024 in Kyiv, Ukraine.

A brief report from the medical workers’ conference held on 10 may 2024 in Kyiv, Ukraine.

The conference was organized by the “Be Like Nina” Medical Movement and date of the conference was related to the International Nurses Day (12th May). It was held in the conference space of the National News Agency of Ukraine (Ukrinform) and was livestreamed by both Be Like Nina and Ukrinform.

The event was attended by over 20 people from all-over Ukraine and between 20 and 30 people were joining it online at various moments. The participants were mostly nurses (from clinics and hospitals as well as schools and kindergartens). There were also two military paramedics (one soldier trained in first aid and tactical medicine and one physician-neurologist currently serving in the army) and one surgeon from the civilian hospital. Vitali Dudin from Sotsialnyi Rukh was invited as an expert on labour law and some more people from Sotsialnyi Rukh were in the audience. Ignacy Jóźwiak (from the Inicjatywa Pracownicza – Workers’ Initiative union from Poland) was invited as a delegate from the International Labour Network of Solidarity and Struggles and delivered a short speech.

As we read on the Be Like Nina website:

The event gave military and civilian medics the opportunity to share their problems and visions of solving them. For example, Iryna Prykhodko and Ilya Gorodchykov, spoke about the dedication of volunteer medics at the frontline, but noted that sometimes the supply is insufficient. Combat medics also spoke a lot about the characteristics of tactical medicine, which is a specialisation that should be studied separately. Their civilian colleagues, including the head of the Association, Oksana Slobodiana stressed that such training would be more appropriate as part of study for nurses than the programmes in their current shape. […] A kindergarten nurse, Oksana Danilova and her colleagues from schools raised the issue of the difference in salaries for healthcare workers in educational institutions. In this case, in the Lviv region, the doctors managed to get their salaries increased in the form of various bonuses. However, it is still not much more than the minimum wage and does not reach the 13 500 Ukrainian Hryvnias guaranteed to all nurses. Vitali Dudin, a lawyer of the Association and activist of the Social Movement NGO, stressed that such a difference in salaries is a violation of international norms guaranteeing equal pay for equal work. The same applies to Resolution No. 28, which allows hospital administrations to cut staff payments if they consider the costs to be too high. The doctors also spoke about problems with the certification of hazardous workplaces […] In particular, Antonina Shatsylo raised the issue of violations of safety rules for employees in X-ray rooms. She also spoke about the indolence of labour inspectorates. The medics stressed that the workload on nurses is constantly increasing, as inadequate working conditions encourage people to leave medical sphere [there is not enough people to work – translator’s note]. And yet, the state does not introduce guaranteed and adequate salaries that would encourage more doctors to work. In the end, the participants noted that so far, Ukrainian civilian and military medicine has been based on the dedication and sacrifice of doctors. However, the state must make systemic decisions not only to improve this area, which is key to people’s lives and health, but also for future victory and sustainable development.

The event started from the minute of silence to commemorate the medics who died while performing their duties in the frontline, which was followed by the National Anthem of Ukraine. The conference was divided into three thematic parts: the military medics and the frontline work, civilian healthcare institutions and general discussion on the problems faced by military and civilian medics and possible paths to solving them.

In her introductory speech, Ruslana Mazurenko (a nurse) described the ways the Covid-19 pandemic and later, the full-scale war put the medical workers in the spotlight and how these unfortunate events revealed their importance. She briefly referred to the history of military and combat medicine in Ukraine and their development following the events of 2014 and onwards. She also mentioned the problems met by the medical staff: workload, salary cuts, mobbing and on top of everything – war.

Military medics

Illia, a military paramedic told about evacuating the wounded at the frontline. His work depends a lot on the frontline situation and on the enemy’s tactics (according to his words, Russia does not follow any international conventions regarding armed conflicts). He stressed the importance of proper training as most of military paramedics, including himself, are not professional doctors or nurses. Illia himself was a soldier in 2014, he re-joined the armed forces in 2022 as and only then, after a short, basic training, was ascribed the medical tasks. His speech was followed with the audience’s remarks that doctors and nurses spend years on studying but they are unprepared, professionally and mentally, to war and frontline situation. Iryna, a professional military doctor with experience of work at a civilian hospital, also shared her testimonies. Illia and Iryna pointed to the importance of mental health and mental health facilities for the medics themselves. Psychological assistance for patients is a relatively new thing in Ukraine and there are no structured programs with psychological assistance for the medics. As for the military, there are some psychologists at the frontline but there is no structural frontline assistance. They also mentioned the constant technical needs, like cars (which keep breaking in the off-roads and under fire) to evacuate the wounded and power supplies (generators and power stations) as there is no electricity in the frontline locations, even in the built-up areas.

Maria Trufen, an activist supporting the military paramedics, shared her experience in finding the needed supplies. Apart from buying, it is often possible to find some second-hand equipment for free in some hospitals and clinics. However, the most popular requests are torniquets, special bandages and other items used for stopping the bleeding. Illia said that his military unit was well equipped both by the state and by the volunteers and sometimes they share their medical equipment with other units. He admitted though that a lot depends on particular unit and on soldiers’ personal and social networks. He also acknowledged that wherever you look, people fundraise for the cars. Then, the discussion moved to the state support and state finances versus the volunteering, personal donations and public fundraising. Despite the special war tax (1,5%) and omnipresent fundraisings, there is still not enough money for the equipment and the salaries.

Work conditions in public healthcare institutions

Nurses at schools and in kintergartens („educational nurses” – osvitni medsistry in Ukrainian) described their specific situation due to the fact that they are not within the responsibilities of the Ministry of Health and the Ministry of Education is also avoiding the responsibility for their work standards and no one knows exactly how their salaries are calculated. Tetiana Hnativ, a school nurse from the town of Chervonohrad (a coal-mining town in Western Ukraine [1]) shared her experience of struggle for improvement of work conditions, which included the pressure not only on the direct employers but also on the local authorities. At the moment, a school nurse with lower work experience earns 7 500 Ukrainian Hryvnias. They are not within the responsibility of the regional superintendent and have no one they could turn to or who would be responsible for their work and work standards on the regional level (like it is with the teachers). Their medical points are underfinanced, underequipped and on top of that they are not allowed to perform certain medical procedures or use certain kinds of medicines (in general, they have limited capacity even if they have a proper skills). Tetiana is also trained in tactical medicine and she is a part of the local grassroots movement in support of the military paramedics. One of their activities was providing a training for the local men before their enlistment in the army. It shows that there is a link between military medics and civilian medics and that these two groups do not function in completely different worlds.

Aleksii Turpyna, a surgeon fin the civilian hospital, mentioned the following made a remark that collective agreements, if they actually are in place, are outdated and involve outdated renumeration. Salaries are not only low but are also unequal between different staff. For example, he himself earns 16 200 Ukrainian Hryvnias and the nurses at the same hospital earn 10 200. There are also no incentives or longevity pays (neither for the doctors nor for the nurses). From time to time, doctors also have to undergo paid trainings (organized by private companies) in order to upgrade and update their skills. This upgrading is mandatory if they want to maintain their jobs. Hospitals also pay private companies for software and online platforms they use.

Svitlana Sydorenko (a nurse in a clinic) shared a story about her employer using different legal tricks in order to avoid pay raise. Having made the clinic dysfunctional and after firing some people, he founded a private clinic and left his job in the public one. Currently they are encouraged to shift to the part-time employment and the local administration refuses to talk to them. They have come up with suggestions for the local authorities to reorganise the facility and make it more functional but there was no interest in that. They are now in the court and the local authorities are using the public money to pay the lawyers.

Vitali Dudin from the Sotsialnyi Rukh (Social Movement) NGO referred the ongoing changes in the labour law and pointed to the ways they apply to the medical workers. He also stressed the need to organize in the unions, joining other professional groups in their struggles and overcoming the neoliberal status quo.

Ignacy Jóźwiak welcomed and greeted everyone on behalf of the International Labour Network of Solidarity and Struggle. In his short speech he referred to our fruitful cooperation with Be Like Nina over the last year, which included material and symbolic support as well as the Movement’s delegates participation in various events around the world and online. He also noted that the problem of law salaries and workload are also typical for medical workers in other countries and so are the problems related to privatisation and commercialisation of healthcare as well as joining different institutions and facilities which usually leads to layoffs and worse treatment of the patients. Importantly, these problems apply to many other professional groups and they are protested by the unions and social movements globally.

In the end Oksana Slobodiana read their statement in the form of, as she said – „101st letter” to the Ukrainian authorities. The statement identifies the main problems and recommends certain steps in order to overcome them. She also read a letter from the combat medic, currently in the frontline (one of the three power stations recently delivered by the International Labour Network of Solidarity and Struggles member organisations has been given to him).

The meeting was followed by informal conversations and networking.

The Ministry of Health was invited to the conference but did not show up.

Footnotes

[1] For many years, Chervonohrad has been a stronghold of union activity. The local Independent Union of Miners of Ukraine is still active there. However, most miners are in the army now, mines are gradually closed.