With Ukraine certainties are few.
A family flees a village in Mykolaiv district,
Ukraine, 7 April. Photo: AAP.
We cannot predict how far the mass
destruction will spread, nor for how long. We cannot confidently assess the
chances of a diplomatic fix or even a nuclear escalation.
Beyond the catastrophic effects of
bombs and artillery on human life, this war will have an insidious impact on
millions far from the battlefields.
The shaky public health and clinical
care systems in Ukraine, a country that struggled to prosper after the collapse
of the Soviet Union, are now being crippled.
Damage to surgical supplies,
electricity, clean water, food, supplementary oxygen, medications, hospital
records and IT systems has been so extensive that hospitals and clinics near
the front lines have been abandoned, the staff relocated.
The
stress experienced by frontline medical and nursing staff is visible. We see
the scenes of heroism, as doctors and health workers continue to care for the
sick and injured in those underground shelters.
Then comes the damage less easy to
see — the effect of the sanctions and embargoes imposed on Vladimir Putin's
regime.
As a war waged by alternative means,
there is no question that they are designed as a response offering less carnage
than the West’s direct military involvement. But they carry huge
implications for ordinary Russians.
Read more:
- Should pharma companies go further in the boycott of
Russia?
- Ukraine docs treating tumours to trauma in hospital
basement
There is also the global issue of
food. Across the Middle East and parts of Asia and Africa, some 800 million
people depend heavily on Russian and Ukrainian wheat.
And you can throw in the other
dynamics. Inflation, an economic illness afflicting those least able to adapt,
is expected to spread rapidly in the coming months.
But
there has always been that dark truth when it comes to war. Medicine benefits
as a by-product of its horrors.
The familiar example that comes to
mind is the rapid developments in plastic surgery after the First World War,
much of it through Dr Harold Gillies, the New Zealand-born otolaryngologist,
and his revolutionary use of tubed pedicled flaps.1
A paper published in the New
England Journal of Medicine at the beginning of the COVID-19 pandemic,
listed just a few other examples.2
The authors (both doctors) referred
to George Washington who successfully inoculated his army against smallpox.
This helped to demonstrate the value and efficacy of a public health
intervention which can be marked as one of medicine's greatest achievements.
There was also the US army physician
Dr Walter Reed who elucidated the epidemiology of typhoid and yellow fevers
during the Spanish–American War.
Then comes penicillin, another
medical wonder. Alexander Fleming’s chance discovery in 1928 that the mould
penicillium appeared to kill bacteria was publicised around the world at the
time, but then it lingered untapped for a decade.
It was only in 1941 when the US
government responded to the imploring of Oxford researchers Howard Florey and
Norman Heatley about what this drug could do, and created a system to produce
and deliver it in industrial quantities.
In their paper, the authors described
this as an undertaking on the scale of the Manhattan Project.
They
add “By D-Day in 1944, there was abundant penicillin for wounded soldiers, and
by 1945, both service members overseas and civilians at home had ready access
to the drug.
“The requisite scientists,
laboratories, and production facilities would never have joined together in
peacetime or through private industry alone.”
Other therapies, such as chloroquine
and radioisotopes, have similar histories, they say.
The sudden acceleration of medical
progress through war usually benefits most those of us who only experience
conflict as distant history, read about rather than suffered.
I think of how many lives penicillin
has saved — it runs to millions, of course.
But ultimately your heart can’t escape
what war does to the individual life.
The following comes from Sasha, a
long-serving health worker with MSF.
He's talking about the Russian attack
a few weeks ago on Mariupol, the city where he was born that has been so
severely battered.3
Read more from Professor Stephen
Leeder:
- Should we reopen schools or not? It’s more
complicated than that
- Is Big Tobacco’s move into medical devices all bad?
“In the beginning, things almost
seemed more or less normal, even though we knew that nothing really was normal
anymore," he wrote on the MSF's website.
“But then the bombings started and
the world we had known existed no more.
“Our lives became weaved between the
bombs and missiles falling from the sky, destroying everything. We could think
of nothing else, and we could feel nothing else.
“The
days of the week stopped to have any meaning, I couldn’t tell whether it was
Friday or Saturday, it was all just one long nightmare. My sister tried to keep
count of the days, but for me it was all a blur.
“In the first few days, we managed to
donate some of MSF’s remaining medical supplies to an emergency department in
Mariupol, but [then] the electricity and phone network went down.
“How can one describe one’s home
becoming a place of terror?
“There were new cemeteries all over
town, in almost all neighbourhoods. Even in the little yard of the kindergarten
near my house, where children should be playing.
“Each day is like losing your whole
life.”
I am grateful to Dr Peter Arnold,
OAM, for his editorial assistance and suggestions.
References:
3. MSF: Ukraine: how long will this
disaster continue?; 24 March 2022
