Anatoly Kazmirchuk, Ukraine Armed Forces Medical Forces Commander
Over 70 percent of soldiers get back to war zone upon recovery after treatment for wounds and injuries
14.10.2024 09:10
Anatoly Kazmirchuk, Ukraine Armed Forces Medical Forces Commander
Over 70 percent of soldiers get back to war zone upon recovery after treatment for wounds and injuries
14.10.2024 09:10

We meet with Anatoly Kazmirchuk at the National Military Clinical Center, where he began his professional career as a senior resident back in 1997. Currently, Mr. Anatoly is the commander of the Medical Forces, who not just knows the inner workings of the military medical health care system, but took part in the construction of this system. Ukrinform was the first to interview Mr. Kazmirchuk as the Armed Forces Medical Forces Commander. He was talking about how the system works amid war, how many soldiers return to the ranks upon recovery after treatment for wounds and injuries, the reasons why just 10 percent of combat medics have a background in medical education, how the evacuation of the wounded from the Kursk region takes place, the ways to solve the problem of medical personnel shortage, in addition to many more topics.

THERE HAS BEEN NOT A SINGLE INSTANCE WHERE A MEDIC LEFT HIS COMBAT POSITION

- Mr. Anatoly, you were appointed to command the Medical Forces by a presidential decree issued on 19 November 2023. What kind of legacy and challenges you were left with?

- I would like to start by saying, that prior to my appointment to this position, I was heading the Central Military Hospital, and, of course, we were a component in providing medical evacuation services to military personnel. Therefore, the hospital that I headed provided training to medical and nursing teams, to forward surgical groups, and forward surgical detachments that were immediately involved in rendering medical care, not only within the walls of the hospital, but also in the war zone. Actually, the system created by all representatives of the medical service worked and continues working in a pretty well coordinated way, in my opinion. This is the experience, painstaking work and blood of our colleagues at war.

At the same time, obviously enough, as in the work of any other service, there were some bottleneck issues that occasionally slowed down progress. But I will reiterate it again: this does not mean to say that this service did not work. Unfortunately, we know of instances where military units, for some reason or other, left their combat positions and went elsewhere. So, where we talk about the Ukraine Armed Forces Medical Service, I cannot give you a single example where either a surgeon, or someone from middle-level or junior medical staff said: "Sorry, I'm burnt out, I'm tired, I won't provide medical care". This is probably yet another testament to the high level of professionalism and responsibility for the lives of our army men, which are characteristic of our medics.

- What tasks do you set to the Medical Service now?

- The main task for the Ukraine Armed Forces Medical Service is precisely to preserve, to the maximum degree possible, the life and health of servicemen and, in case of an injury or trauma, to provide conditions for the servicemen to receive all the required amount of medical care, at all stages of medical evacuation. Unfortunately, the current war is an "epidemic of combat trauma." After all, life and health of own and his comrades depend on how quickly and timely medical care will be rendered to a soldier who needs it.

- What do you mean?

- Military personnel, who have already served, gained a certain amount of experience, which they, upon recovery from wounds and returning to the ranks, can share with their comrades serving alongside them.  This would make it possible not to look for a new mobilization resource, but to use the trained personnel already available. After all, everyone knows that an army man, contracted or called up under mobilization,  is supposed to undergo a basic military training course at a training center, which includes training in military medicine among other things. Unfortunately, the number of hours allowed for the training course in military medicine is limited to 13, which we consider insufficient.

In response to these challenges of the reality, we initiated an online video course on tactical medicine, which presents a Tactical Combat Casualty Care (TC3) training program, based on the MARCH-PAWS algorithms. Despite our (initial) skepticism, we can see that it is popular, especially among TC3 instructors. Some of the skills presented in this video are also suitable for being taught to military personnel undergoing basic military training, for example, First/self Aid during an in-progress firefight (hot zone/direct-threat area) and Tactical Field Care (TFC) when lo longer under effective hostile fire (indirect threat-area).

Indeed, this video format is only designed for the learning and final fixing of the knowledge and skills already acquired, but this is how we make the acquisition of knowledge and skills more accessible for each serviceman.

Furthermore, our task of priority is to make sure that each and all of our servicemen are trained, both called-up soldiers and combat medics. In particular, we are now piloting a second-level instructor course in order to improve quality control of the basic military training insofar as it pertains to tactical medicine.

TRAINING IN MILITARY MEDICINE FOR CALLED-UP PERSONNEL SHOULD LAST AT LEAST 20 HOURS

- How long should such training preferably last, in your opinion?

- World standards require longer training – up to 40 hours. We allow 13 hours, which is why we are insisting that, due to the realities of war, the time of training in this discipline should be increased to at least 20 hours.

- What prevents increasing the time of training for beginners?

- This is a complex problem. We submitted proposals to the General Staff to increase the number of training hours in pre-hospital care to 20 hours. We are currently eagerly awaiting the implementation of these changes.

JUST 10 PERCENT OF COMBAT MEDICS HAVE AN EDUCATIONAL BACKGROUND IN MEDICINE

- How important is training in knowledge and skills in pre-hospital care?

- We are saying all along and try to convey this, that a serviceman who has joined military ranks must be trained in rendering first aid to himself and his comrades. After all, even if a soldier going into combat carries an individual first-aid kit but lacks appropriate knowledge and skills, he will not be able to use it as appropriate and, unfortunately, will be helpless to help himself or others.

About 10 percent of combat medics have a medical educational background, but completely different rules work on the battlefield. It is about saving lives, not about treatment. That is why we are saying that a trained solder is saved soldier.

For example, there are instances where, in an area of indirect threat, the necessary manipulations are not carried out, such as assessing the feasibility of applying a tourniquet to a wound where it would suffice to apply a pressure bandage, without the need to relocate the tourniquet or place it higher above the wound.

Because of these cases, it was decided to introduce training in tourniquet relocation into the basic military training program.

OVER 70 PERCENT OF THE WOUNDED RETURN TO THE RANKS UPON RECOVERY AFTER TREATMENT

- What is the percentage of those military members who get back to the war zone upon recovery after treatment for wounds and injuries?

- The data in our possession suggests that over 70 percent of wounded soldiers return to the ranks after treatment. These is according to average statistic data. After all, you should understand that this percentage may differ from one sector of the frontline to another. We can say that these 70 percent of military personnel is exactly what makes the core, the backbone of our Military.

- Why is the shortage of combat medics so persistent, despite they are actively trained?

- It is not a secret that the combat medic is deployed in the war zone. In addition to carrying a backpack with the medical kit and trauma supplies they use in rendering the necessary care, combat medics perform the duties of ordinary military men in full combat gear. That is, a combat medic works alongside his comrades on the battlefield, so this is a very vulnerable category of servicemen, who are currently not subordinate to the Medical Service of the Medical Forces Command. Instead, they are subordinate to the units of the Armed Forces’ branches and subdivisions. In other words, a military unit is responsible for manning its medical service with combat medic, while we are responsible for specialized training.

- But it is your Command who is responsible for training them…

- Yes, the Command is responsible for providing medical support and supplies, as well as for everything related to the training of these servicemen. At present, such specialists are being trained at the Armed Forces’ School of Tactical Medicine.

- Tell us more about this School, please.

-- The School of Tactical Medicine provides over 75 percent of the Armed Forces requirement for combat medics. The School of Tactical Medicine now trains combat medics according to international standards.

Currently, there is a need to transform the School into a Tactical Medicine Training Center under the Armed Forces Medical Forces Command, with building its capacity in line with its core tasks.

We are hopeful that this will enable to increase the amount of training for senior combat medics at company-size units (batteries) in line with the needs of the commanding staffs of the Armed Forces’ branches and arms, as well as to provide advanced training courses for instructor-officers at training units (centers) of individual branches and armed services, focusing on ​​tactical medicine of the first (classes in tactical medicine during basic combined military training and combat paramedic training) and second (specialized training for combat medics) levels. Moreover, this will allow us to compile standard curriculum for personnel providing pre-hospital care, for marksmen-paramedics, combat medics, instructors specializing in tactical medicine of the first and second levels.

- Do combat medics undergo training abroad?

- Some combat medics are sent for training abroad. The training of combat medics both in our country and in NATO countries takes place according to approved uniform programs. That is, at present, there is no such thing that one center provides training in one way and another in a different way. All these programs are unified, although with some distinctions depending on the specifics of the special tasks performed by defenders.

- Do you cooperate with civilian medical universities in this matter? Aren’t they supposed to take on part of the burden of training?

- These are two different domains in that a combat medic is not a medical worker, actually, and so training of combat medics goes beyond the competence of civilian medical universities. Once we have talked about medical universities, we should talk about the need to restore (or set up anew) military training units attached to civilian universities, which are currently referred to as Disaster Medicine and Military Medicine Sections. The restore process is painfully slow, hampered by the shortage of professional staff for this role. But we have found a solution. Certified medics who did not undergo military training at a civilian university can take a crush two-month officers’ training course at the Ukrainian Military Medical Academy to get license and obtain the lowest officer rank Junior Lieutenant of the Medical Service. In less than five months since the course was launched, it has already graduated around two hundred officers. This made it possible to partially reduce the shortage of qualified personnel, but so far, unfortunately, there is still a shortage of healthcare professionals in certain medical specialties.

- Which specialties?

- Traditionally enough, these are surgeons and anesthesiologists. The same is with paramedical and nursing staff, especially in surgery: operating theater nurses, blood transfusion specialists, etc.

- What potential solutions do you see for addressing this staff shortage?

- Where the talk is about medical university graduates, it is not a secret that, over the time of the full-scale war, quite a few doctors exited Ukraine, a certain number of doctors have not registered with the military enlistment authorities in recent years. So this category of people need to be checked thoroughly and given appropriate positions in the Armed Forces that are relevant to their educational background, so that it doesn’t happen that, for example, a certified doctor is assigned to a position of marksman-paramedic or machine gunner.

If we talk about the paramedic and nursing staff, it is definitely necessary to intensify cooperation with the medical colleges that graduate these specialists, to advertise service in the Medical Forces. The preferable option would be to get these specialties trained at an educational institution focused on military medicine. We do not have institutions of that kind in our country so far, to my regret.

NEARLY 70 PERCENT OF ARMY MEN SIGN UP REMOTELY FOR MILITARY-MEDICAL EXAMINATION

- Currently among the Armed Forces, there is a trendy topic such as digitalization, and one of the tasks set to you is to ease the life of a soldier who sustained a wound while on active service. Has it become easier for an army man to collect the necessary medical papers, health certificates, applications, etc.?

- Over this year, through joint efforts with the Ministry of Defense and the General Staff, we were able to achieve many pioneering changes in this respect. There is a well-founded argument that the Ukrainian army is an “army of papers”. Because previously, a soldier had to carry a pile of papers in hands, go through all the relevant authorities possible just to get an appointment with a specialist doctor, meaning the need to spend time waiting in long queues. The man came in, waited a long time in line in front of the door to see a doctor. This could not but cause indignation and rightful anger among patients, because it's really inappropriate where the injured or wounded soldier had to spend all day waiting in long queues. So we have done quite a lot of work with chiefs of medical services attached to army units. We have empowered them to get a soldier signed up for a military medical examination or a routine examination in health care establishments, without the need for him to leave the military base.

Currently, nearly 70 percent of servicemen eligible for military-medical examination sign up remotely for an appointment with a doctor.

To this end, a medical information system network has been created within the Armed Forces. We have very ambitious plans to get it implemented to full extent in our institutions by the end of this year. All institutions run by the Medical Forces now have in place electronic medical information systems, and we have created some two thousand workplaces in our institutions. These are two thousand specialists who enter all information about a serviceman into this electronic system.

For example, a physician examines a patient and, using an electronic key, makes all records electronically. In the same way, upon completion of an examination, laboratory analysis or X-ray survey, the physician no longer has to write a conclusion by hand in illegible handwriting, but enters the resulting data electronically.

This system is also beneficial in that it enables a certificate of illness to be compiled based on the diagnosis that has already been previously determined and entered into the database. 

Similarly, whereas previously, a serviceman, for example, had undergone a military-medical examination and, according to its results, was found to be needing a sick leave from service, he had to be released from a medical institution with a certificate of epicrisis, to visit his military unit and submit a report to his commanding officer. Currently, all Armed Forces units have in place and employ an electronic filing system.

That’s to say, right away on the day a soldier is released from hospital, the military unit he is assigned to receives a relevant certificate. And it is automatically notified that the serviceman, for example, has been granted medical leave. So the soldier goes on leave without the need to return to his unit, because an electronic copy of his medical leave certificate had been sent there. Where continued treatment is needed, he has to submit a relevant referral from the military unit, which can likewise arrive via e-mail.

Now we are doing everything possible to make sure that the information system employed by the Armed Forces Medical Service is fully compatible with the [civilian] healthcare information system. After all, the Single Medical Space system has been set up in place in Ukraine. Furthermore, the electronic medical information system needs to be implemented in all healthcare units of the Armed Forces of Ukraine in order to simplify the flow of electronic medical records at all stages of medical evacuation.

- Do you think it’s possible to get the Armed Forces Medical Service fully digitalized as scheduled by the end of 2025?

- We will do our best. But this will require additional workplaces equipped with all necessary office equipment, gadgets, etc. Like I said before, two thousand workplaces have been set up already, but about one and a half thousand more are needed to enable the system to operate to full capacity and efficiency.

I would like to highlight once again the importance of achieving full interoperability with the civilian electronic healthcare information system, because the outcomes of medical examinations conducted by one or another medical institution are indispensable for soldiers’ treatment at the following stages.

In his context, it is worth of mention that the Supreme Commander emphasizes the principle of people-centeredness, meaning organizing the health system around the comprehensive needs of people rather than individual diseases. A soldier who sustained a wound or injury or is sick should be the focus of attention for the Medical Service. All the conditions favorable for him must be set in place so that he receives the full amount of treatment prescribed, undergoes follow-up rehabilitation, gets recovered and ultimately returns to the ranks. A program aimed to save health and life of soldiers on the battlefield, initiated by the Armed Forces Chief Commander, is currently being implemented in the Armed Forces.

The program aims to achieve the following objectives: improving the quality of medical care rendered to the wounded immediately on the battlefield, ensure that evacuation of wounded casualties from the battlefield is timely and safe as much as circumstances allow, using ground robotic platforms among other things. Another important need is the provision of specialty equipment for safe evacuation of the wounded. We are currently paying a lot of attention to the training of combat medics and improving the quality of training for all personnel involved in tactical combat casualty care.

WE HAVE BEEN ABLE TO ACCUMULATE A SUFFICIENT STOCK OF INDIVIDUAL FIRST-AID KITS

- Let's move on to a sensitive topic such as provisions. Prior to your taking the Office, there was a loud uproar over the low quality of the tourniquets provided to the military. What is the situation like currently with provisions for the Medical Forces? To what extent are combat medics and medical teams provided with what they need to ensure they do their best?

- Never have I seen a chief of an institution or a physician who would say they are fully provided with everything they need. This is a never-ending process, a persistent issue, and it would be untrue to say that it can be resolved right away, once and for all. Given the situation as it is now, it’s critical that, as you rightfully said, the means used to save soldiers’ lives are of high quality.

We have set a priority to ensure soldiers are provided with high-quality, certified first-aid kits and components that meet international and NATO standards. To date, we have managed to accumulate a sufficient supply of first-aid kits and components.

WHERE LOW-QUALITY TOURNIQUETS ARE FOUND, WE USE THEM FOR TRAINING PURPOSES

- Would it be true to say that tourniquets or first-aid kits of substandard quality no longer find their way to the Military?

-  Frankly, there is a problem where tourniquets or individual military first-aid kits of much lower than high quality reach our units. Why? Well, some part of these supplies get there bypassing the centralized supply system. What I am talking about is that -- we all know and are grateful to the Ukrainian citizens who have been and will continue supporting our Armed Forces – it sometimes occurs that those low-quality individual first-aid kits or tourniquets are bought from a dubious manufacturer.

In order to tackle this issue, the Medical Forces Command have set up mobile medical supply teams to do periodical checks of the availability of the sufficient amount of individual protective means, their compliance with standards.

It is often the case that relatives and friends buy and send these protective equipment to a military serviceman. Why was it so? This was due to issues relating to the writing off of individual first-aid kits. We have known of this problem for a long time, and this year, we have been able to get the write-off procedure for such items simplified. They are no longer classified as inventory items, but as expendable items. With that being said, there are now fewer cases of low-quality components in first-aid kits, including tourniquets, being discovered. Regarding the quality of tourniquets, the tourniquets that are supplied to us as part of financial and equipment aid packages are fully compliant with the EU and international quality standards.

TACTICAL EMERGENCY EVACUATION AND TOURNIQUET SYNDROME

- The quality of tourniquets aside, what is the focus of you attention?

- Let me briefly touch on another problem. Unfortunately, nowadays it is not always the case that the rule of the "Golden Hour" can be observed. Everyone knows it. The enemy deploys a wide diversity of weapons. We, unfortunately, have to admit that it sometimes occurs that evacuation from the place of injury to the nearest appropriate place of medical care can take several hours: it can take 10 hours, 15 hours, even longer than a day. The problem is that, where a tourniquet is applied, and the wounded soldier is not trained in tourniquet conversion/relocation, the probability is high that the affected limb will be amputated. We are paying great attention to this matter. It was the Ukrainian military who initiated changes to the tourniquet conversion procedure. NATO member countries, too, amended these procedures, enabling the conversion to be made by a properly trained soldier or a combat medic, in addition to medical personnel involved in the final evacuation stages.

Sad to say, due to problems with the time of evacuation of the wounded, we often talk about the tourniquet syndrome. This, of course, is not a problem because of the medic who rendered care in due time, but because of the impossibility of taking the wounded casualty out of the affected area in a timely manner. That is why we are talking about the persistent shortage of armored medical evacuation vehicles, about the possibility of evacuating wounded casualties from the affected area using various [robotized] ground platforms such as drones, for example. In Ukraine, there are so far no such platforms manufactured on a production-line basis, but we know that, in certain locations, such platforms can be used to bring ammunition to the line of battle and to get back carrying a wounded casualty.

- How widely are such platforms used currently?

- Regretfully, there is no massive use, only a few exist as technology demonstrators and have already proved to be effective.

THE FLEET OF ARMORED AMBULANCES MEETS A LITTLE MORE THAN HALF OF THE REQUIREMENT

-- What is the situation like right now with the availability of medical evacuation vehicles?

- Pitifully enough, the adversary, acting in disregard of all the existing international conventions, does not stop short of shelling and bombarding both ambulance vehicles evacuating casualties from the battlefield, and healthcare facilities, deploying first-person-view (FPV) explosive drones, artillery projectiles and precision glide bombs for these attacks. That said, the need for armored ambulances is pretty acute. In Ukraine, armored vehicles such as Kozak-5MED, for example, are manufactured, albeit not in mass production numbers. Basically, we receive armored vehicles from international partners, which is what provides us with buoyancy and allows us to stay afloat, if I may say so.  But, I reiterate it, the need for armored evacuation vehicles is quite critical.

- Are you looking at the possibility of setting up something like an armored ambulance capability coalition to tackle this shortage?

- There is a system that sets out the requirements of not just the Armed Forces Medical Service, but of the Armed Forces in general. Indeed, this system encompasses our requirement for armored vehicles among other things, and this is precisely what enabled us to receive over a hundred such vehicles this year alone. But this number, regrettably, does not suffice our requirement. I reiterate it once again: the adversary is hunting for them. Where there is talk about medical vehicles that meet relevant criteria for emergency evacuation, we receive such vehicles from individual NATO countries.  Thus, for example, a shipment of M-113 armored ambulances arrived this year. This represents a significant support for our combat medics during casualty evacuation.

- Do international partners help in the rehabilitation of our army men?

- There is a very high requirement for rehabilitation beds in hospitals. Healthcare institutions run by the Ministry of Health, with which we closely cooperate and share a common medical space, carry out the major part of the rehabilitation treatment. This is because the number of beds available to our institutions within the Armed Forces is limited due to the focus placed on the treatment of the wounded and sick. That being said, we came up with a proposal last year to set up five rehabilitation centers with an aggregate capacity of 2,000 beds. We have engaged some of our partners to help in this project. Locations in several different regions have been selected. For example, a new boiler house in one such location was completed a few days ago, and a lot of equipment was delivered, for use precisely in rehabilitation treatment. And I can tell you that our servicemen, who have learnt about this, currently refuse to go abroad for treatment, because this allows them to remain in their home country, see their families and friends while at the same time undergoing high-quality rehabilitation treatment. To add to this, these centers are being created to meet the standards for inclusivity and accessibility: there are equipped ramps, elevators, doors, etc. Where we hear soldiers saying they would like to undergo treatment in Ukraine, we consider it to be a success in itself.

- But some of our soldiers are sent for treatment to foreign countries, aren’t they?

- Yes, a certain number of our servicemen are currently undergoing treatment programs abroad. For you to understand the mechanism of selecting patients for treatment abroad, I would say that they undergo initial treatment in hospitals in Ukraine, in civilian hospitals, and the Ministry of Health is mandated to select a healthcare institution that suits a patient’s treatment needs. This category of servicemen are contained in a database, and foreign partners, without seeing the identities of individual patients, select some of them for treatment that pertains to specialization of the clinics involved. This represents a highly valuable aid to our healthcare system.

JUST 2% PERCENT OF CASUALTIES ARE EVACUATED BY AIR

- Let's get back to the topic of evacuation. Do you cooperate with Ukrzaliznytsia [Ukraine’s railroad monopoly]? How closely?

- Unfortunately, we cannot use the air medical evacuation. We know that our airspace is unsecured, vulnerable to attacks, and that is why we organized the evacuation by rail transport beginning in 2022, in a joint project with Ukrzaliznytsia. We managed to create wagons equipped for patients in need of resuscitation care, for lying patients and for lightly wounded patients. This makes it possible for wounded casualties to be evacuated from all currently active operational fronts. Ukraine's experience of war-waging, and of emergency medical evacuation in particular, prompts our partners to think about alternatives to air evacuation. After all, just two percent of casualties are currently evacuated by air, with evacuation by surface transport accounting for more than 50 percent.

HEALTHCARE INSTITUTIONS IN KURSK REGION DO NOT RENDER MEDICAL CARE TO WOUNDED UKRAINIAN SOLDERS

- In the context of the Kursk offensive operation by Ukrainian forces, would it be true to say that evacuation of wounded casualties from these territories takes place according to the same unified procedure that you’ve described?

- Yes, it’s true. Evacuation of the wounded, injured and sick patients from this Theater takes place in accordance with the same procedure that applies to any other battlefield in Ukraine.

- Are local healthcare facilities engaged for this purpose?

- No. Initial medical care is provided at patient stabilization stations deployed out there by the Medical Forces and medical subdivisions of branches and armed services of the Armed Forces and the Defense Forces of Ukraine. The evacuation then proceeds to civilian hospitals in front-line areas, where our military doctors and medical personnel work alongside their civilian counterparts, then proceeds further into deep rear regions.

MILITARY MEDICAL BUDGET FOR FY2025 WILL BE SAME AS THIS YEAR

- Now that the defense budget for next fiscal year is being formulated, could you tell whether the military medical budget for this year suffice for your needs? Has the FY2025 budget request for the Ministry of Defense been formulated already?

- Of course, I will not reveal specific numbers. However, if we look at the beginning of the full-scale invasion by the Russian Federation in 2022-2023, in addition to budgetary funding, which is never sufficient, we received a record high amount of humanitarian aid. This aid was diverse, encompassing equipment, medicines, protective gear, individual first-aid kits, tourniquets, stickers and suchlike. And when, at the end of the year, we analyzed what we received through centralized and decentralized supply channels thanks to charitable organizations and equipment assistance from international partners, we saw that the requirement for medical care is very high. What I can reveal is that the military medical budget for the next fiscal year will not exceed the amount of funding allocated for this year.

- What is the current situation like with prosthetics care for soldiers with limb loss? After all, sometimes we see appeals for donations to people in need of prosthetics.

- Nowadays, there is ongoing national program on prosthetics, allowing a patient with limb loss to get a pretty high-quality, modern artificial replacement. Moreover, the prosthesis components produced locally in Ukraine meet international quality standards. There are prosthetic enterprises run by the government and non-government owners, providing prosthetics care while the patient with limb loss is still undergoing treatment. And the patient is empowered to choose between alternative preferences. Whereas in the past everyone wanted to get prosthetic care at a foreign-country clinic, then now orders are increasingly often made here in Ukraine. It's the same technology, it needs maintenance, and so there is little point in traveling abroad to change same for the same. As before, the problem remains persistent with prosthetic care for patients with high amputations, given the limited capacity and abilities of the prosthetics industries in Ukraine and, perhaps, also elsewhere. After all, a prosthesis is difficult to install where there is a high amputation. Needless to say, here in Ukraine, unfortunately, there are soldiers who underwent high amputations. The artificial limbs that are recommended to them are, of course, expensive, and the national program simply cannot absorb such expenses. Funds are sometimes raised by public organizations. That is, this is currently a common problem for the state apparatus. I am hopeful that this issue will be able to be resolved in the near-term future.

- You maintain a hotline of communication. How often do citizens call it? What questions are asked most frequently?

- The hotline was launched in order to be as close as possible to the problems of servicemen and their families. It has been active for about half a year now. The questions asked most frequently by members of military units are concerning medical care and support, provisions of various kinds, organization of new units, military medical examination etc. Citizens’ appeals are mainly about medical care and treatment, i.e. about where a serviceman can get a treatment, where the nearest place is to undergo a military medical examination, how to get a decision sooner, where to complain about a military-medical board.

In addition to hotline communication, we are trying to establish contacts with public organizations focusing on military healthcare issues. We have designated coordinating persons specializing in various fields, who quickly respond to potential crises reported by volunteers; we try to hear and be heard.

- My final question is about you plans for the coming year.

- Well, you know, for every Ukrainian citizen, the plan No. 1 is for the war to end with our victory and as soon as possible. And, of course, our Medical Service must be ready to face whatever challenges may come in providing high-quality medical care. I mean to say that the work related to personnel, skill management and training must continue. Because we all understand, that it will be very difficult without properly trained personnel. This is also about the search for new methods of treatment, transition to the latest technologies, teamwork with partners, medical supplies, expanding the possibilities for patients to get treatment abroad. We can talk about this for a very long time. It would not be fair to say that our service is functioning effectively until there are no current work problems left in all areas of activity, until all of them are solved, because we have all the necessary resources in place -- human, professional, material and technical -- to achieve this goal.

Interviewed by Iryna Kozhuhar

Photo via Pavlo Bagmut

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