What is the problem?
Full-scale Russian aggression affected the Ukrainian population's access to essential medical services. Their cost has increased, logistical obstacles have arisen in some regions, and infrastructure has been damaged. This is especially true for residents of remote parts of Ukraine. In addition, strong emotional outbursts and stress negatively affect women's reproductive health.
What is the solution?
UNFPA, the UN Population Fund in Ukraine, has created special services for sexual and reproductive health — mobile gynecological teams and gynecological offices with barrier-free access.
Mobile gynecological teams work in 22 regions of Ukraine, and 86 barrier-free gynecological offices operate in various settlements. Both services provide inclusive, free, and confidential services. In particular, barrier-free gynecological offices are equipped with inclusive examination chairs.
A mobile gynecological team has been operating in the Kyiv region since October 2022. It was created on the basis of the municipal non-commercial enterprise of the Kyiv Regional Council, Kyiv Regional Perinatal Center.
How does it work?
A mobile gynecological team typically consists of an obstetrician-gynecologist, a family physician or therapist, a nurse or midwife, and a driver. However, they work in shifts, so, in particular, in the brigade in the Kyiv region, there are two drivers, six doctors, and midwives. At other times, doctors perform their main work in the perinatal center.
Doctors of the mobile team examine women and advise them on a wide variety of issues: regarding the optimal means of contraception, age characteristics, nuances of women's health in the pre-and postpartum period, opportunities to get pregnant or, on the contrary, terminate a pregnancy, if there are reasons for it and infections and sexually transmitted diseases.
They leave early in the morning so that people don't have to wait
A modern ambulance equipped with a mobile gynecological chair is ready to leave the building of the regional perinatal center as early as 7.45 a.m. every morning on working days. Gynecologist Oleksandr Mykytenko says that at first, the team went at 9 a.m., but it took too long to get there due to Kyiv traffic jams. So they decided to start earlier so that people in the villages could get the services they needed faster and go further to work, to their children, or to take care of the household.
"I always try to come earlier, prepare the car for departure, and I also need to load consumables. The one-way road can sometimes reach 190 kilometers," says Volodymyr Smolyar, the driver of the mobile brigade. He has been an ambulance driver since 1996, so he knows the local roads well. Smolyar is very grateful to UNFPA for the new car because most of the perinatal center's fleet is from the 1990s.
Oleksandr Mykytenko, a specialist with 40 years of experience, works in the Kyiv Regional Perinatal Center's inpatient department, performing various operative interventions.
"The work in the brigade is different — it is an outpatient appointment, but if you know all the work in a hospital, then when you see a woman at the reception, you already know what to offer, what the treatment path should be, what age-related changes are taking place. What can be treated at home, how long should it take to see a doctor, what can be bothersome, and so on," says Mykytenko.
What services does a person receive?
Today, Rubryka joins the brigade on the trip to the village of Panfyly of the Yahotyn community of the Boryspil district, one hundred kilometers from the capital. Along the way, we will find out exactly how the reception of patients usually takes place.
Natalia Lysenko, a midwife of the mobile team, says: "First, we survey the patient, enter all the data into a tablet, then take blood for glucose."
Next, the doctor examines the woman in the chair. A special advantage of the team is that the gynecologist conducts a routine examination and has a portable ultrasound machine.
Mykytenko conducts an ultrasound examination of almost all clients of the mobile brigade. He explains that not everything can be felt with the hands, and it is better to ensure that everything is normal with the device's help or to detect a pathology inaccessible for a regular examination.
"For example, yesterday during one of the examinations, I did not feel pressure with my hands, but with the help of the apparatus, I saw a cyst nodule," says Mykytenko. "That's why I perform such an examination on almost all women who come to us."
Usually, it is possible to receive up to 20 people per day. For some, it takes ten minutes, and for others, much more if a person needs consultation and clarification of the following treatment steps.
"We try to work until the last patient. However, to provide high-quality services, the optimal number is 20 people. If more, I may not see something due to fatigue. We had several cases when we did not have time to accept everyone, but there is a way out: the village should apply again, we come a second time and accept the rest of those willing to be examined," says the doctor.
Based on the examination results, each patient receives a medical opinion on her health, if necessary, and recommendations for additional examinations.
Doctors say that sometimes it turns out that women do not even know about the existence of the Kyiv Regional Perinatal Center, so the team explains that here you can get a wide range of services from obstetrician-gynecologists, surgeons, neonatologists, therapists, geneticists, anesthesiologists, and related specialists.
"If we detect a pathology, we do not intimidate people," Mykytenko explains. "We understand people's busyness, but at the same time, we advise that you should not neglect yourself. It is worth solving the issue with the family and the household and allocating time for further examination and treatment. We can immediately prescribe the necessary tests, for example, for tumor markers."
Cooperation with a family doctor
The team can also refer the woman to a local family doctor. For example, if there is a need for an additional examination or the prescription of certain drugs. The doctor of the gynecological team cannot issue an electronic prescription, but the family doctor has this option, to whom the woman will show the corresponding conclusion from the brigade.
Medical confidentiality is guaranteed
At the same time, the doctors of the mobile brigade emphasize that the information about the patient's condition or diagnosis contained in the advisory opinion is confidential and is not passed on to local medical workers.
Mykytenko adds that he sometimes offers local midwives to assist the team and thus learn something new for themselves. Some agree with interest, but most refuse, saying: "We all live here and know each other. Women are not ready to share everything. You are a visiting doctor: you came, discussed something with the patient, and left, and no one knows anything."
What is the benefit of the brigade for the residents of Panfyly?
Panfyly is a rather large village in the Yahotyn community with approximately 1,000 inhabitants. It is located not far from Yahotyn, on the highway Kyiv — Kharkiv. There are no logistical obstacles to obtaining medical services here, but there are others. Yahotyn does not have all the specialists and services women need, and a ticket to Kyiv costs 150 hryvnias — the economic factor deters some people. Many women have small children or a household they cannot leave for long.
For example, the first client of the mobile team during this trip was the mother of two-month-old Artem, a nurse at the Panfyly Outpatient Clinic, Oksana Motelyuk.
"It's easier for me to come here than somewhere further with a small child," says Moteluk. "I am very satisfied. The doctor explained everything to me and advised me on the issue I was interested in."
Lyudmila Parkhomenko, a nurse at the Panfyly General Practice Outpatient Clinic — Family Medicine, says there has been no gynecologist in the village for a long time. A family doctor and two nurses work in the outpatient clinic. Here you can make an electrocardiogram and test blood for sugar. Upon request, the family doctor can make an appointment with a gynecologist in Yahotyn. The dispensary does not have a specially equipped office, and the doctor and the driver of the mobile team bring a mobile gynecological chair from a car.
In general, the dispensary makes a very pleasant impression: the offices and restrooms have undergone high-quality repairs, considering the needs of patients with disabilities.
Today is the case when the mobile brigade visits the same village for the second time — however, already in a different composition. The women of Panfyly residents were very satisfied with the previous visit, says Parkhomenko. Many people came to see the doctors — there was a queue of one and a half dozen women.
"The doctor is very professional"
"Girls, the doctor is wonderful! Don't be afraid; he explains everything so well!" after leaving the office, Olena Yaskova smiled and addressed the queue. This cheered the women in the hallway, especially those a little confused by the fact that the doctor was a man.
Yaskova moved from Kyiv to Panfyly a year and a half ago. She learned about the planned arrival of the mobile gynecological team from the village chat, where everyone is informed about important local events.
"Our village is wonderful! Nature heals," the Yaskova smiles.
Her impressions of the visit to the doctor are only positive: "Everything went very well, and I am very grateful because, in Yahotyn, there is no ultrasound examination equipment that I needed. The doctor answered all questions immediately — it is clear that the person is very professional."
Yaskova says that living in Kyiv, she used to go to the doctor once a year because everything is more accessible in the capital. When she moved to Panfyly, she faced the need to pass a medical examination.
"I went to Yahotyn, but there was no equipment for my needs. Fortunately, a mobile team came to us, and I received this service," says Yaskova. "If only we had a mammologist. This is a request from all the village residents because there is no such specialist in Yahotyn. I believe that the work of this team is very important because the health of every person should be at the forefront."Patient Olena Yaskova and mobile brigade doctor Oleksandr Mykytenko
"This is a very useful project because not everyone has the opportunity and time to go to the district center"
Another resident of Panfyly, Lyudmyla Mysan, also says that when she worked in Kyiv, she went to the doctor for a check-up once every six months. Now she has a job in the village, and it turned out that she hasn't been to a gynecologist for almost two years.
Mysan says: "This is a useful project because not everyone has the opportunity and time to go to the regional center, and even more so to the regional hospital. Of course, one should put one's health first, but we, in the village, as always, you know, neglect all this. Therefore, I am very glad that such an opportunity arose. I am very satisfied with the visit: I recommend this visiting team to everyone! It would be good if doctors from other specialties also visited us."
Tetyana Dankevych learned about the upcoming arrival of the brigade from the family doctor, who offered to come for a check-up.
"It is perfect that doctors come and provide such services free of charge," says Dankevych. "I liked their excellent attitude. They checked and gave a referral to the Kyiv hospital. I will call back and come and check again there. I go to doctors mainly to undergo a professional examination. I am very grateful to the doctors for this visit."
Does it really work?
Timely check-up is a matter of health and even life
According to the observations of the doctors of the mobile brigade, their services are most often used by women aged 30 to 60.
Not all clients come with complaints, but doctors often detect certain pathologies.
"For example, yesterday, a young woman with cervical pathology came. She came simply for a professional inspection, we took a look, gave a conclusion, recommended not to delay the resolution of this issue," says Mykytenko.
The doctor emphasizes that sometimes this is a question not only of health but also of life, and this is the meaning of the brigade's trips. "We say to women: 'We have come to provide you with help, at least to guide you regarding the state of your health.'"
Timely detection of pathology is the key to more effective treatment, and if the process is neglected, sometimes there is a risk of some severe issues, like oncological diseases.
Mykytenko says that their equipment makes it possible to screen out certain pathologies. Still, if certain problems are detected, in most cases, for effective treatment, a woman will need deeper diagnostics with the help of special equipment.
The doctor explains: "We are looking at how much it is possible for us to find out the level of that pathology. If we can, we will direct you to treatment. If not, we recommend you undergo an additional examination for confirmation."
Visited a gynecologist for the first time in decades
Thanks to the team, women sometimes get to see a gynecologist for the first time in 20 years and sometimes even 30 years.
"Yesterday, we accepted a patient who had not been to a gynecologist for 20 years," says midwife Lysenko. "We did not find anything terrible, thank God, she was lucky, but we recommend that women go to the gynecologist every year because it is primarily their health."
Lysenko is glad that the services of the mobile brigade are in high demand:
"Here, women often do not have time to see a doctor because there is much work. They are very grateful to us because it happens that we detect pathology in time. That is, treatment will require lower costs. They are pleased that we helped, and we are pleased that we are doing such a good deed."
It is also useful for doctors and midwives
Other specifics provide flexibility
Mykytenko says that thanks to his work in the mobile brigade, he began to master ultrasound equipment more thoroughly. In addition, the specificity of this activity made him more efficient in his career. Midwife Lysenko uses the opportunity to improve her professional development:
"The specifics of work here are completely different from the maternity ward where I worked before, but I like it. I help the doctor and observe simultaneously: I see examinations and ultrasounds. It's something new for me, and it's important and interesting to me."
"This is a much-needed solution"
According to Mykytenko, the appearance of mobile gynecological teams is very timely. After all, people in any corner of Ukraine need to receive quality medical care free of charge. Actually, that is what medicine should be aimed at so that the country has as many able-bodied people as possible, which will boost Ukraine's economy. A healthy nation is the key to the development of the state, Mykytenko reminds.
"At this stage, when people do not have quality access to medicine for various reasons, there is no alternative to brigades," the doctor believes. "This is a very necessary decision."
Mobile gynecological teams and gynecological offices with barrier-free access work within the framework of humanitarian response measures of UNFPA, the United Nations Population Fund, with the financial support of the European Union (EU), the Ministries of Foreign Affairs of Denmark, France, and the Republic of Korea.
Photo by Mykola Tymchenko
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