A harrowing journey aboard a medical train in Ukraine transports injured people to safer areas

As a modernized medical train left Zaporizhzhia, Ukraine, carrying nine seriously injured patients to a safer location last week, Canadian-American doctor Dr. Daniel Schnorr could finally breathe his last.

“After all the patients were on board, we were getting ready to leave and we had an air raid…so the train got stuck for a little while,” said Schnorr, who led the first such mission for Doctors. Sans Frontières (MSF), also known as Médecins Sans Frontières.

“But then, finally, the air raid was lifted, and the train started moving, and everyone breathed a sigh of relief – and you’re on your way. And once the train starts moving, you have feel like we’re already halfway there,” he said White Coat, Black Art host Dr. Brian Goldman.

Schnorr is one of a number of Canadian healthcare workers going to great lengths to care for Ukrainians on and near the front lines of the war that began when Russia invaded Ukraine on February 24.

“The idea for the medical train kind of came about because we noticed that the trains were able to run remarkably well throughout the war from the start,” he said.

After a safety analysis, the group concluded that trains are currently the safest mode of transport, despite the fact that the station the group departed from was bombed a few weeks earlier.

Doctors Nataliia Kyniv, left, and Dmitry Mogilnitsky prepare supplies before the first patients arrive on board. (Doctors Without Borders)

On March 31, the train departed with the group of patients – all with blast injuries and aged between three and 84 – from Zaporizhzhia in the southeastern region of the country, and carried them about 1,000 kilometers to west to the relative safety of Lviv. .

Make room for more wounded

“When we first entered the country, MSF was sort of spreading out, trying to figure out where we could have the most effect, where we could help the most people, where we could ease the stress on the medical system,” said Schnorr, who runs a small emergency department in eastern Arizona when not dispatched to a crisis area. This was Schnorr’s fifth assignment with MSF.

The city of Zaporizhzhia is hosting people who fled Mariupol, besieged for weeks. As a result, hospitals there have many patients with serious injuries who will require extended hospital stays, Schnorr said.

“They were eager to try and get patients out of their hospitals as they expect many more patients to arrive in the coming days or weeks.”

WATCH | Dr. Dan Schnorr explains the medical train evacuation:

Rail staff modified the cars so there was room for patients to lie down, as well as for things like oxygen concentrators, IVs and other medical equipment, Schnorr said. Parts just inside the entrance to the train have been cut off to make room to maneuver the stretchers so that the sickest patients can lie flat while being transferred from the ambulances.

“We don’t have the capacity to take ventilated patients or patients who are on medication to support your blood pressure. But we can take most other patients,” he said.

Although the train could carry many more patients at a time on future trips, for its inaugural medical evacuation, Schnorr said he selected a small number of patients who would need to be hospitalized for a long time, but who were sufficiently stable. to survive a train journey of up to 24 hours, considering checkpoints along the way.

On board were “nine patients, plus family members and carers and two cats”, he said.

A shirt with the MSF logo is seen through the window of the first medical train carrying seriously injured patients to hospitals in towns farther from areas of intense conflict. (MSF)

Dr. Joanne Liu, a pediatric emergency physician from Montreal, was also on the ground with MSF to help assess patients in the days and hours leading up to departure.

“We spoke with the parents to ask them whether or not they wanted medical evacuation,” Liu said. in a blog post she wrote for the MSF website. “The first mother said, ‘I want my child evacuated because I think it’s the only chance for my child to keep his legs.’ And the kid looked at us and said, ‘I want to walk again.'”

“I just wanted to do the right thing”

Canadian nurse Laura Orsatti, from Peterborough, Ontario, works at a children’s hospital in Kyiv. She traveled to Ukraine on March 9 and stayed there for about a month. She is now on her second trip to the capital after a four-day trip home to see her family.

“I didn’t want to be part of an NGO. I didn’t want to be politically affiliated. I just wanted to do the right thing. So I decided to go to the biggest children’s hospital because I had this experience.”

Nurse Laura Orsatti speaks to CBC News from Kyiv on March 17. (Radio Canada)

Orsatti said he saw a series of injuries resulting from the conflict, including a child with gunshot wounds who saw his father killed in the street, a month-old child injured by shrapnel, patients buried under the rubble and a child under 10 who had been raped in front of his mother.

She also said she was moved by the strength of the Ukrainians she works with. “They want to provide the best possible care, and they’re doing everything they can to save as many lives as possible. It takes a lot of courage. A lot of them…they don’t go home to see their families. , their houses are blowing up. And they have to live here full time.

Hospitals have been frequent targets for Russian forces.

Orsatti said his kyiv hospital was shot. Here, a bullet hole can be seen through the hospital window. (Submitted by Laura Orsatti)

“You hear the sirens going off all the time. I hear the Russians flying above us,” Orsatti said. The window of a room she was staying in at the hospital was knocked down, she said.

Dr. Richard Hareychuk, a third-generation Ukrainian-Canadian and optometrist in Oakville, Ont., has been active in the efforts of the Ukrainian diaspora in Canada to support their homeland since Russia annexed Crimea in 2014. He said he recommends that medical professionals who want to help on the ground in Ukraine do so through official channels.

Global Affairs Canada has advised Canadians to avoid all travel to Ukraine and the Canadian Embassy in Ukraine has suspended operations during the conflict.

A press release on the Ukrainian Ministry of Health website, translated into English, said that as of March 3, it had received requests from more than 500 doctors, nurses and paramedics from countries around the world, including Canada. Interested parties can register by completing a questionnairehe said, and hospital coordinators will help organize deployment to areas and facilities that need the most help at any given time.

That help is definitely needed, Hareychuk said.

MSF doctor Dr Daniel Schnorr, left, is pictured with Dr Nataliiya Maidan and a Ukrainian railway staff member known only to MSF as Yurey. (Submitted by Daniel Schnorr)

“There’s maybe a bit of a question of, well, ‘Why a doctor? Why not more soldiers?’ The fact is, a properly trained doctor in the field who knows how to prevent someone from losing too much blood can save lives.”

Shortage of nurses

At Kyiv Children’s Hospital, Orsatti said he noticed there were more doctors than nurses.

Schnorr said he noticed the same thing. When putting together a team for the MSF medical train, he was unable to recruit local nurses.

“I think there was a shortage of nurses even before the war started, as there are in many parts of the world,” he said. But Schnorr said he also suspects some nurses may have left their workplaces to get their children to safety.

Her crew instead included a Belgian nurse and a number of Ukrainian medical students working as orderlies.

Part of the MSF medical team prepares for patients, selected because their injuries are serious enough to warrant long hospital stays, but their condition is stable enough to survive a train ride of up to at 24 hours. (Doctors Without Borders)

When asked if he felt he was personally in danger during the mission, Schnorr said he had some apprehension when the group entered the country.

“When our team went to Kyiv at the start of my mission here, the front lines weren’t really stable,” he said. However, MSF has a very good security team, in which it has great confidence.

“I am very conservative [about] safety when it comes to these things because I have two young daughters. So I felt comfortable that we had a plan in place to be able to safely contribute,” Schnorr said.

“Over time you get a little comfortable – and maybe that can be dangerous. You don’t want to get too comfortable.”

On Wednesday, the MSF medical train evacuated patients from Kramatorsk train station in eastern Ukraine. On Friday, the same station was hit by at least one Russian missile, killing dozens of people, Ukrainian authorities said.

Orsatti said she knew she could lose her life in Ukraine.

“I’m not afraid to die. I’m afraid my life means nothing, I haven’t done anything worthwhile,” she said. “I don’t know if I believe in God or something. But if, you know, I meet my previous family members, I want them to be proud of me that I did the right thing, and I tried, you know. And that’s all I really want.”

Written by Brandie Weikle. Produced by Colleen Ross, with assistance from Brian Goldman.