“Usual algorithms stopped working:” Dnipro rehabilitation center restores war-wounded bodies

"The holes were in the shin, thigh, fingers…". The story of Borys

As we speak, Borys tries to make himself comfortable on the massive machine. His every movement is slow and smooth. A physical therapist who monitors the patient's condition helps to lie down correctly and fix the body. The session lasts a few minutes. After it, Borys leaves the apparatus just as carefully. His right leg is encased in several places with iron accessories — Yelizarov and external fixation devices, and the foot is also covered in metal. "The holes were in the shin, thigh, fingers…" the patient describes his injury.

35-year-old Borys never had combat experience, but when Russia launched a full-scale offensive in February 2022, he joined the ranks of defenders. In his native Dnipro, he left his beloved work, parents, and wife with a baby daughter Varvara.

"I could not ignore this situation," the defender explains.

Borys was in the motorized infantry troops. At first, he studied on the spot, then went to the front line with his comrades. The soldier received his mine-explosive wound near Vuhledar on August 27. For three days, Borys and his unit almost did not sleep. Russians used everything they had: artillery, mortars, and shells from helicopters. The defenders repelled the enemy's attack, and a mine landed when they cleared the landing. The mine shards hit Borys in the leg, arm, and head.

The defender lost the fingers on his right hand. The right leg was sewn into iron for recovery. The fragment stuck in the head was later retrieved, but most of Borys's face does not work.

"While I was lying in Kyiv, the bones healed, but the pelvis was fixed incorrectly. It turned out that the difference between the legs' length is several centimeters," Borys recalls. "The doctors had to break everything again in Dnipro. That's why I've been in these iron devices for so long."

He has been in the rehabilitation center for three weeks after his wife found this opportunity. Borys spends weekdays in rehabilitation at a medical facility, and his family takes him home every weekend.

"I even tried going outside on my own. The doctors said they would take me out on a wheelchair, and then they came and said I should try myself," the soldier shares with Rubryka. "Before that, I couldn't walk at all. I was taken to hospitals in a car and to the institution in a wheelchair. But, now, I will walk."

Fractures made by doctors are not healing as fast as those the soldier received back in August. According to doctors' forecasts, Borys says, he will have to walk with an iron device for at least four months. Two-year-old Varvara does not understand what's wrong with her father.

If you want to support Borys, you can donate funds for his hand's rehabilitation and a bionic prosthesis.

"So that neither I nor they lose heart." Story of Anatoliy

Before the full-scale invasion, 29-year-old Anatoliy was engaged in construction work. The man had combat experience: as a conscript, he was in the army in 2012-2013; in 2015-2016, he served in the anti-terrorist operation (ATO) zone, after russia started aggression in the east of Ukraine, in the airborne assault troops. On February 26, 2022, the defender returned to his unit.

Anatoliy fought in several areas for more than a year with his comrades. In the Luhansk direction, he received his injury at the beginning of spring 2023. On March 5, Anatoliy came under mortar fire while performing a combat mission.

"At that moment, I was alone. That's why I was the only one who suffered," the soldier recalls. "First, I was taken to Kramatorsk, where they provided first aid. They stopped the bleeding, and when I was more or less stable, they immediately sent me to the trauma department here in Dnipro."

As a result of the shelling, the defender lost a large part of his left hand. He did not dare to tell his family about it for a long time. The wife was the first to find out, then the parents. They took the news hard.

"I explained to them that nothing would change. I got the injury, and there is no point in grieving. We have to move on and live with what we have," Anatoliy shares.

Currently, the soldier is in a rehabilitation center. Anatoliy has a busy schedule. "I wake up at seven o'clock and have my blood pressure and other indicators measured. I take painkillers because the wound still hurts," the defender continues. "At eight in the morning, the first sessions begin. I  exercise the hand so that it works and the muscles do not stagnate. I work out for an hour and then have free time for breakfast and coffee. Then at one o'clock, I have my bandages changed and another class at two o'clock." 

The fighter says he feels fine. Every day, Anatoliy finds time to talk with his comrades. As he says, so that they nor he lose heart.

Painkillers help him sleep better because the wound has not yet healed. According to doctors' forecasts, it will take one and a half to two months to heal, after which Anatoliy hopes to have a prosthesis installed. The defender really wants to return to the front line.

"I will wait to see what rehabilitation will bring because the war is not over for me. As well as for the whole country. When I fully recover, I will return if possible."

"All cases are completely different"

An employee of the center is busy with each of the patients. They guide, help, and support. The doctor is always ready to pick up the fighter at any moment.

Physical therapist Daryna says that for her to work with a patient, only a couch and brains will be enough. "I will be able to figure out what to do with it," says the specialist. But modern equipment makes her work much easier. And it's more interesting for the patients themselves.

"Here, for example, is the apparatus that Borys used. When there wasn't one, I held the patient's leg with my hands and back. I had to move the limb alone, but now the operator does it," says Daryna.

Daryna used to work as a fitness trainer and was interested in rehabilitation. She went to study physical therapy to continue working with athletes. But the specialist liked this department during clinical practice, so she volunteered here after graduation. And when she received her master's degree, she got a job here.

"I no longer want to work with athletes. When we started helping the military, I realized that this is my life's work and my duty," says Daryna.

Rehabilitation does not deal with disease but deals with impaired functioning. The patient's activities depend on the injury, and an individual plan is elaborated, especially since all cases are entirely different. It is necessary to discuss with the patient what they expect from rehabilitation, perform testing, and prescribe an action plan.

"The patient with Yelizarov's device will leave the institution with it. But when the doctors remove it, he will have to come back," the physical therapist explains. "A patient with an amputation must leave us ready for prosthetics and have enough strength to stand on this prosthesis. If we are talking about the most acute period of the injury, then our task is to ensure that the person does not get worse and does not lose their muscle strength." 

Daryna says that over the past year, the usual algorithms for rehabilitation have stopped working because the patients arrived with unhealed wounds and multiple injuries, and they had the external fixation devices only for a few days. The doctors studied international sources and also attended several trainings.

"For example, if we previously knew this: a person with weak lower limbs or paraparesis can be given a walker; if it is hemiplegia or partial paralysis, we can give a cane," the specialist continues. "It is difficult to understand how to act when a person has a Yelizarov apparatus, an amputation, and nerve damage, so only one hand works. You have to think about what auxiliary means you can choose."

During this year, Daryna says, there were many different cases. But for each patient, an action plan was prescribed after leaving the rehabilitation center.

"We want the patient to leave us knowing their plan — to recover further or a plan to continue their life. A person cannot go through rehabilitation all his life. Sometimes you have to understand that if something cannot be restored, it can be compensated. Yes, you will not be the same as before the injury. Life will be different. But you have to continue to live, love, and go to work, make love, and have a personal life," says the physical therapist.

"It is necessary to see what is better for the patient"

A rehabilitation center for wounded soldiers was opened on the basis of the Department of Rehabilitation Medicine of the Dnipro City Hospital. Thanks to the RECOVERY program, it was possible to obtain additional equipment and increase the number of beds to 30.

"Everything you see now was done in three years," says Alla, head of the team and head of the department. "When we came here, we turned the physiotherapy department into a physical rehabilitation medicine department."

The specialist says that in 2016, the positions of doctor of physical rehabilitation medicine, physical therapist, and occupational therapist (a doctor who helps restore lost self-care skills, editor's note) have only appeared in the national classification of professions. At the same time, there was only one occupational therapist in Ukraine.

"In 2023, 244 institutions signed an agreement with the National Health Service of Ukraine, and the package of medical guarantees requires that at least three occupational therapists be included," says Alla.

It was never easy, says the specialist. In recent years, doctors have worked with respiratory rehabilitation (consequences of COVID-19), the nervous system, and musculoskeletal injuries. After February 24, 2022, everything changed.

"All the specialists here joined the work on acute rehabilitation to teach the defenders elementary things — how to dress, undress, eat, drink, and choose auxiliary means. Three or four days, and the defenders were moved somewhere else," Alla tells Rubryka. "When the hospitalizations were allowed, patients with metal structures, complex injuries, and frostbite appeared," says the head of the department.

There were several cases of military personnel coming in with a stroke suffered on the front line. Currently, medics have a waiting list, but military personnel is accepted first. The length of stay at the center varies: 14 calendar days and longer, and if there are combined major injuries — from 21. But there were cases when patients stayed for up to three months.

"It is necessary to constantly look at what is best for the patient. No matter how good we are, it is difficult for a person to be in a hospital. They always want to go home," says Alla.

When they leave the rehabilitation center, soldiers leave their signatures on the battle flag. Alla shows the flag left by one of the soldiers. The yellow part of the canvas is already filled with the signatures and wishes of the patients. Doctors think buying a felt-tip pen visible on the blue part is necessary.