From Kyiv to Harvard and back

Ali Dzhemiliev was a first-year medical student in Crimea in 2014 when Russian invaders forced him to leave the region for a school in Kyiv. Much worse was still to come.

Eight years later, as Russian tanks rolled into Ukraine in February 2022, Dzhemiliev was already a doctor, but still completing his residency in surgery. The days ahead were an ordeal. “It was a new challenge for all of us to conduct and continue our surgical education in wartime,” he said.

Dzhemiliev lived close to Bucha, a city north of Kyiv now infamous for Russian atrocities against civilians. As the invasion intensified, he headed west, eventually joining the staff at a hospital near Ternopil. For 2½ months, he slept in the wards, ate the same food as patients, and performed surgery, often at night.

In May, Dzhemiliev heard about Harvard’s Scholars at Risk program from the nonprofit Global Medical Knowledge Alliance. “Being a passionate physician-scientist, I was eager to learn from the best scientists in the world in order to improve healthcare in my homeland,” he said. “And being a person who suffered twice from Russian aggression, this program seemed like a fantastic opportunity.”

He arrived in Boston in December, one of five Ukrainian physicians accepted by Harvard and two of its affiliated hospitals — Mass General and Brigham and Women’s — for Scholars at Risk fellowships ranging from two months to a year. In response to the crises in Afghanistan and Ukraine, and with support from President Larry Bacow’s office, the program, which welcomes academics, writers, artists, and practitioners from danger zones around the world, has expanded in recent years beyond its usual annual class of four to six scholars, according to Director Jane Unrue.

WHO reported in January that there have been more than 700 attacks on Ukraine healthcare facilities since the war began, leaving more than 100 people dead.

While Dzhemiliev is here for a yearlong fellowship in colorectal surgery, the other four doctors visited with the shorter-term, urgent goal of bringing ideas and materials back home. This approach distinguishes the cohort from the typical Scholar at Risk, according to Mark Poznansky, a professor at Harvard Medical School and an infectious disease specialist at MGH who has helped coordinate efforts by area physicians to assist their colleagues in Ukraine.

“There’s optimism about what will happen next, but also a feeling that there was a trajectory that was interrupted by war, which I think is different from Afghanistan and some of the other trouble spots in the world where people are up against an absolute wall,” Poznansky said. “There’s something unique about Ukraine that is generating this remarkable optimism that this could be done.”

To be a doctor in Ukraine comes with grave occupational hazards. The World Health Organization reported in January that there have been more than 700 attacks on healthcare facilities since the war began, leaving more than 100 people dead. Still, doctors and nurses have persevered, providing care out of basements, toiling through air raids and missile strikes, and adapting to water scarcity and power outages.

According to Ukraine’s Ministry of Health, more than 13 million people — almost half the country — will need psychological help, with levels of post-traumatic stress disorder climbing rapidly.

Veronika Patsko, a Kyiv-based oncologist, said that disruptions to routine care mean that she’s seeing patients with more advanced disease. In addition, with so many health centers damaged, nonfunctioning, or looted of equipment by Russian forces, more people are seeking treatment at her hospital, where patient numbers have increased 70 percent since the war began.

“There are a lot of cases that became advanced because of the lack of medical care,” she said. “And we really have a lack of drugs, chemotherapy drugs, targeted therapy drugs, there’s not enough to cover all those who need them.”

Vadym Vus, a family physician, volunteered on mobile teams, including on the frontlines, before traveling to Boston. He said he’s been motivated by the work of the psychiatrist Viktor Frankl, who documented his experiences as a Holocaust survivor in “Man’s Search for Meaning.” The first to die in the camps were those who believed the war would be short, Frankl wrote. Next were the people who thought it would never end. Those who managed to put time out of mind were most likely to survive.

“You must fill your head with a different type of work,” said Vus, who returned to Ukraine last month. “The first week of the war, I didn’t know what to do. I started to prepare humanitarian aid for refugees. In the second week, I started to teach our nurses in our rural clinic. In the first month, I understood that I must train military doctors, not only in our region, but in Kyiv [and beyond]. I don’t know how long this war will be, but we must work every day and think about how to help.”

Dzhemiliev is part of a team developing a mobile app that creates a network of consulting physicians, both in Ukraine and elsewhere.

While much of the focus in Ukraine has been on physical wounds, Sofiya Hrechukh, a psychologist from Lviv, said mental health needs are getting worse. The use of antidepressants has doubled from their level before the war, Hrechukh said. According to the Ministry of Health, more than 13 million people — almost half the country — will need psychological help, with levels of post-traumatic stress disorder climbing rapidly. Even Hrechukh admitted to feeling survivor’s guilt, which is driving her to push her training to extremes.

“I’m relatively safe, so I’m trying to help people every day, every free minute I have,” she said, “but I still feel guilty for not having those issues and just basically for being alive.”

During their time at Harvard, the Ukrainian scholars have engaged in a whirlwind of activity, shadowing their local colleagues and gathering texts and manuals to send home. Education has been a major theme, with fellows helping develop apps, instructional videos, and online courses that share cutting-edge knowledge and best practices, not just for physicians, but also for nurses and medics.

The chaos of the war has thrust physicians into roles outside their specialties, Dzhemiliev noted. To help, Dzhemiliev is part of a team developing a mobile app that creates a network of consulting physicians, both in Ukraine and elsewhere. Through the app, when a doctor runs into an unfamiliar situation, he or she can take a photo of a patient or attach an X-ray and send it to the network, which prompts responses from experts.

“Every physician has questions sometimes and if he has no senior colleague in the hospital at the moment, he can ask about it [in the app] and — if it’s surgery — all the surgeons will be notified that somebody needs help,” Dzhemiliev said.

As they return to the war, the fellows hope to build on the progress they made at Harvard, including through efforts to improve surgical education and develop psychiatric subfields such as women’s mental health and neuropsychiatry. “Every day, the question for me is what useful thing today I will see and do for our country, for our training team, and for my rural practice,” said Vus. “What do we need to take and what don’t we need to take?”

Even amid chaos and deep uncertainty, Hrechukh is confident that Ukraine’s health care system will emerge from the conflict stronger. “We’re going to build a better system,” she said. “It’s going to work.”