Maria* still remembers the day that could be fatal for her and her unborn baby. A pregnant resident of non-Government controlled Makiivka got involved in a car accident and seriously injured pelvis, which made impossible the option of natural childbirth. Her family was unable to pay for medical care of risky pregnancy and frantically moved to the Ukraine-controlled front line city of Krasnohorivka. In the city that is still regularly shelled, there was no way of providing a pregnant woman with a qualified assistance. Maria turned to Pokrovsk Perinatal Center where UNFPA Health service delivery point for victims of gender-based violence is based. Here a woman was performed with cesarean section, provided with medicines. Later, healthy mother and baby were both discharged.
‘They came to us totally desperate. Prenatal care of such pregnancy requires a lot of medicines, surgical tools and postoperative remedies. They got all needed from UNFPA medical kits’, says Ivan Tsyganok, the head of Pokrovsk Perinatal Center.
Pokrovsk Perinatal Center has become one of the 15 medical institutions in Donbas that got UNFPA medical kits within the framework of the project "Response to acute humanitarian issues (sexual and reproductive needs) of the most vulnerable women and adolescent girls in eastern Ukraine".
‘Each kit contains all required tools, medicines, medical equipment for providing obstetric and gynecological care. There are kits for post-rape treatment, post-exposure prophylaxis, contraception, natural and complicated childbirth, miscarriage treatment, treatment of sexually transmitted infections and complications arising from abortions. A kit for complicated childbirth contains all necessary ranging from sterile medical costume to equipment for reanimation measures to provide qualified care, perform obstetric and gynecological surgery in all circumstances, even during an emergency, such as an earthquake or war. One kit allows to perform 105 surgery and it weighs nearly 1100 kilos’, says Bohdan Pidverbetskyi, the UNFPA Reproductive Health Project Officer.
Pokrovsk Perinatal Center provides service for one-third of Donetsk region, settlements along the contact line. However, despite a significant load, in 2018 the center received only Hr 7800 from the city budget for medicines procurement. According to Ivan Tsyganok, in 2019 the situation with funding slightly improved, but anyway most of the center’s needs are covered due to UNFPA humanitarian aid.
‘Last year we have 1200 childbirths. Treatment of one patient in critical condition could cost Hr 120 000, caring for a premature baby - from several to tens of thousands hryvnias. Partially, relatives cover it, but not everyone has financial capabilities. It is a great amount of money and such cases are not rare’, tells us Tsyganok.
Pokrovsk Perinatal Center has cooperated with the United Nations Population Fund in Ukraine since 2017. One of Health service delivery points was opened there, that works in the area of reproductive health, HIV prevention, prevention and treatment of sexually transmitted infections, prevention of unwanted pregnancy and emergency care for victims of rape. Since then shipments are systematically and provide the needs of the health care facility sufficiently.
‘We got 96 boxes in December. Everything has a certificate of quality. I forgot when I used low-quality suture kits last time. Now we work only with Vicryl. While its price in the pharmacy is Hr 146, we receive plenty of it’, says Tsyganok.
Besides a Health service delivery point in Pokrovsk (HSDP), with support of the United Nations Population Fund 16 similar HSDP were opened across Ukraine: 5 - in Donetsk oblast, 5 - in Luhansk oblast, also in Vinnytsia, Kryvyi Rih, Kharkiv, Mykolaiv, Odesa, and Kherson. Every point, that provides medical and psychological care, has high-quality medical equipment, all essential medicines and a qualified medical staff working there.
According to UNFPA’s statistics, only 32% of victims of physical and/or sexual violence ask for help. Only 1% of them come to see a physician. This happens because of victims’ fear of publicity. However, all HSDP provide confidentiality. Moreover, most of them have a separate entrance to cabinets.
Medical examination on the contact line
From May to December 2019 UNFPA with the support of Central Emergency Response Fund (CERF) implemented the project "Response to acute humanitarian issues (sexual and reproductive needs) of the most vulnerable women and adolescent girls in eastern Ukraine”, providing obstetric and gynecological care to local residents, living along the contact line. According to Bohdan Pidverbetskyi, over 19 000 people were examined during this period. Three UNFPA medical mobile teams included a gynecologist, family medicine doctor, nurse, and social worker, worked according to the timetable. Locals knew about examinations in advance due to TV, radio, social media and reports of local authorities. Each team was equipped with portable electrocardiographs, ultrasound examination devices, portable obstetric chair, lamp, panel screen, and express tests. During the project implementation period, the mobile teams provided preventive healthcare in 253 settlements.
‘For sure, such service was popular’, says Bohdan Pidverbetskyi, the UNFPA Reproductive Health Project Officer. ‘Along with reproductive health issues, other issues could be examined. Medical mobile teams provided free tests for glucose level, hepatitis B, C, HIV/AIDS, and syphilis. Ultrasound examination device was especially demanded. Besides ultrasound examinations of the urinary system, screening of the hepar, pancreas, spleen and thyroid gland was provided. According to healthcare departments’ data, about 1500 medical workers left the area along the front line that led to a lack of staff. Especially, gynecologists.’
In the cases when hospitalization was required, the mobile team’s staff transferred all patients' data to local health care authorities and gave recommendations and required medication in place. Special attention was paid to people with disabilities. Medical mobile teams conducted examinations of immobile people at the place of residence.
Reproductive health amid a pandemic
As COVID-19 spreads globally, Bohdan Pidverbetskyi emphasises the effectiveness of the UNFPA medical kit 11 for medical staff working with infected people.
“It contains a sterile medical costume, goggles and other protective supplies, used during surgery for people living with HIV. There are also antiseptic chlorhexidine solution, intravenous fluids, and Quinine - a medicine used to treat malaria, is also effective for coronavirus treatment. WHO recognizes it’, says Pidverbetskyi.
Ivan Tsyganok, the head of Pokrovsk Perinatal Center assures, now it is hard to predict what could be useful in work amid a pandemic. But staff of the center has already prepared these kits, just in case, he says.
‘UNFPA activity is essential and crucial. And what is the most important - people see that it works.’
*Name changed to for privacy and protection
