"Medical Clinic on Wheels" physicians discuss project at The Chicago Group meeting (01/17/93)

"Medical Clinic on Wheels" physicians
discuss project at The Chicago Group meeting

by Theodora Turula

CHICAGO - The need for medical and dental care in Ukraine, especially preventive care, is acute. The "Medical Clinic on Wheels," an ongoing project that addresses this problem, was the topic of discussion at a meeting sponsored on November 21, 1992, by The Chicago Group. Featured speakers were Dr. Stephen Dudiak, project director, Dr. Roxolana Tymiak-Lonchyna and Dr. Andrew Melnyk.

Dr. Dudiak, a retired physician from Wisconsin, conceived this project shortly after the Chornobyl tragedy, but it was not until 1991 that he was able to obtain funding through the "Thoughts of Faith" Lutheran ministries in Wisconsin, and various pharmaceutical corporations. Two mobile clinics were built - one medical and other dental - with all the most advanced equipment and supplies to examine and treat children.

Dr. Dudiak told of the difficulties in dealing with local bureaucrats in Ukraine. In 1991 the country was still under Communist rule. As a result of official obstacles, the project was not able to set up in its original target areas, and finally found a home in Ternopil, which had been the third choice. Since the clinics are self-contained, complete with generators, they are free from any outside interference, and if their presence is not welcomed in any locality, they can simply leave and find a more favorable location, Dr. Dudiak noted. The program serves various purposes. The first is to provide ongoing medical and dental care to children of the Ternopil Oblast. In order to ensure that this care will continue after the volunteers leave, it is necessary to train local physicians and dentists to use the equipment and supplies. The vans, Dr. Dudiak explained, consist of two examining rooms, a small laboratory and a waiting room. Each room in the dental clinic has two complete chairs, and each of the medical clinic's rooms has side-by-side examining tables, allowing a volunteer and a local doctor to work together. The emphasis is on teaching.

The project also provides medical supplies and equipment to pediatric and obstetrical hospitals. Experts are sent along to set up the equipment and to train local individuals in its maintenance and repair. "Volunteers are the key to our success," Dr. Dudiak stated. It was also necessary to train personnel in calculating the correct dosages for the various drugs, so doctors will feel comfortable prescribing them.

Another aspect of the project's work is to provide educational tools, books, videotapes and instructors, to improve the level of medical education available locally in Ukraine. A building was set up in the city of Ternopil as a resupply warehouse for the medical clinics. Several rooms of this building were converted into lecture and study rooms, where doctors could review taped procedures and study other source material.

In conclusion, Dr. Dudiak listed some of the program's myriad accomplishments. Thirty-five volunteer medical and technical personnel traveled with the clinic and worked at various targeted hospitals. These enthusiastic dedicated individuals ensured the program's success, he underlined. Medical care was provided to 7,000 children, and 4,000 received dental care. Volunteer radiology experts showed the people how radiation had affected their countryside, since the government had concealed the extent of the damage.

Dr. Tymiak-Lonchyna, a dentist at Swedish Covenant Hospital in Chicago, spoke of her two tours of duty with the "Medical Clinic on Wheels" as an "emotional experience... all my years of study and work were rewarded." Within the clinic, a Ukrainian dentist worked alongside the volunteer, learning how to use materials on hand, so they could carry on the work when the volunteers left.

Dr. Tymiak-Lonchyna described the difficulty of imparting the need for disinfection, sterilization and general cleanliness. Medical personnel were required to wear scrub clothes, masks, gloves, glasses - even special shoes. She took the time to explain every step of the treatment and discuss alternatives. At first there was much doubt and hesitation, but once all the instructions were written out in Ukrainian, things began to run more smoothly, she said. Ukrainian dentists were amazed by the durability of fillings - theirs tended to crumble in six months. Dr. Tymiak-Lonchyna emphasized that dental care in Ukraine is dismal, and preventive care non-existent.

During her second trip to Ukraine this October, Dr. Tymiak-Lonchyna checked on the dentists she had trained previously. They were seeing 20 children per day and, most importantly, they were realizing that their treatments worked. The main purpose of Dr. Tymiak-Lonchyna's second trip was to talk with the proper authorities about introducing fluoridation of the city water supply. She came prepared with statistical data and plans for fluoridation programs. She also outlined a five-part plan for improving dental care in Ukraine, consisting of a public health campaign emphasizing preventive dentistry; fluoridation of city water; providing pregnant women with prescriptions for vitamin supplements with fluoride; construction of several toothbrush and toothpaste factories; and education of dentists in methods of preventive care.

Dr. Melnyk, chief of pediatric clinical genetics at Loyola Medical School described the critical medical situation in Ukraine today. Infant mortality is about 20 percent, meaning that one out of five newborns dies before his first birthday. Although the procedure exists for testing a newborn's blood for a whole battery of genetic disorders, blood submitted to the central Kyyiv laboratories is screened and the tests are computerized, many children are simply not tested. Children under the age of 1 are not operated on, so many disorders routinely treated in the West remain uncorrected.

Doctors, he explained, have a good grasp of medical knowledge, but modern equipment is lacking. Even in the Kyyiv hospital's neonatal unit, there is only one respirator for 10 to 20 infants. Microscopes are available, but broken bits of windowpane serve as slides. Since proper medication is lacking, doctors use whatever is at hand, often ineffectively. Patients distrust their own doctors, believing those from the West can effect cures. The first question, when a child is born defective, is: "Did Chornobyl do this?"

The "Medical Clinic on Wheels" is a proven success. The doctors, dentists, technicians and other experts who volunteer their time see the positive results of their work and become deeply involved in the project. Two doctors, Dr. Sonia Prokopetz from Toronto and Dr. Lydia Chapelsky from Ann Arbor, Mich., who had participated in the project, even traveled to Chicago for this special meeting just "for the sake of nostalgia," to reminisce and share some of their experiences.

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