Dnipropetrovsk hospital marks 20th anniversary of Ukraine's first neonatal ICU (04/02/06)

Dnipropetrovsk hospital marks 20th anniversary of Ukraine's first neonatal ICU

by Alexander Kuzma

DNIPROPETROVSK On February 17 doctors and former patients marked the 20th anniversary of Ukraine's first neonatal intensive care unit at Dnipropetrovsk City Children's Hospital No. 3. The ICU inaugurated a new discipline in Ukrainian medicine, enabling doctors to treat premature babies and infants suffering from low birth weight, underdeveloped lungs and severe congenital defects at a time when other Ukrainian hospitals considered such cases hopeless.

"Prior to 1986 such children were not even counted as live births, as doctors had no way of stabilizing their condition or giving them a chance for survival," said Dr. Alexander Buyalsky, the director of the neonatal unit. Since that time, doctors at the children's hospital have made dramatic progress in saving the lives of thousands of children.

Dr. Buyalsky recalled many difficult trials and tribulations during the first 10 years his unit was in operation: "For the first 10 years we struggled without appropriate technology, and we only dreamed of the kind of equipment we have used more recently."

In 1997 the hospital received its first large humanitarian shipment from the New Jersey-based Children of Chornobyl Relief and Development Fund. The airlift was made possible by a major grant from the Monsanto Foundation, and it brought the first advanced pulse oximeters, ventilators, infant warmers and cardiac monitors. The hospital staff considered the aid so precious that it retained the services of a local Ukrainian army brigade to unload the cargo and to guard against any diversion.

Within the first year since the aid arrived, the Dnipropetrovsk hospital was able to reduce its infant mortality by 46 percent, while at the same time taking on children with lower birth weight and more complex pathologies.

CCRDF's first in-country director in Ukraine, Inya Bonacorsa Chehade, helped to build the partnership with Dr. Buyalsky and his staff, monitoring its utilization of donated items. Under the Monsanto grant, the fund brought three doctors from Dnipropetrovsk to the United States for an intensive training program at the acclaimed neonatal unit at St. Barnabas Medical Center in Livingston, N.J.

Four years ago the Dnipropetrovsk hospital appointed a new medical director, Dr. Ihor Makedonsky, a gifted young surgeon who was trained at the Boston Children's Hospital as well as at a Swedish pediatric center. Dr. Makedonsky trained his staff in a number of unique procedures to correct severe birth defects affecting the urinary and gastro-intestinal tract. He also invited foreign doctors to come to the Dnipropetrovsk City Children's Hospital No. 3 to teach his colleagues how to perform minor transplants that could repair clubbed hands, retrofit missing organs and correct other disfigurements.

Dnipropetrovsk is known as one of the most industrialized and most polluted cities in Ukraine, and its location on the Dnipro River also draws contaminated water from Chornobyl, Cherkasy, Kyiv, Dniproderzhinsk and other pollution sources upstream. The city has earned the dubious distinction of having one of Ukraine's higher rates of birth defects, and many local women struggle with difficult pregnancies that often result in premature deliveries. Dr. Makedonsky and his staff pride themselves on combating these illnesses with growing confidence, and they are determined to further improve their infant survival rates to achieve Western levels.

Until recently, most Ukrainian hospitals were allowed to discount newborn children weighing less than a kilogram, artificially inflating survival rates that were already unacceptable at 23 deaths per 1,000 live births. Ukraine's infant mortality rate is substantially better than the abysmal rates in Central Asia. Kazakh families suffer from mortality rates of 63 per 1,000. Armenia stands at 39 deaths per 1,000; Azerbaijan's stands at 75, and Tajikistan at 113, but Ukraine has a long way to go to reach the West European standards set by France and Finland at 5 per 1,000 live births and Denmark and Austria at 7 per 1,000.

Over the past year the Dnipropetrovsk hospital has received a new infusion of technology with the help of a major grant from the Ukrainian mobile telephone giant UMC. In October 2005 UMC donated over $266,000 to the Children of Chornobyl Relief and Development Fund following a nationwide campaign and phone-athon celebrating the company's 10 millionth mobile customer. The fund used these donations to purchase a new ultrasound, cardiac monitors and other diagnostic instruments that are expected to greatly improve the hospital's ability to identify and treat birth defects and to improve survival and recovery rates.

With the UMC grant, the fund has also purchased a Canadian "urodynamic" diagnostic system to help Dr. Makedonsky and his chief of surgery, Dr. Alexander Hladky, to perform even more delicate operations on infants and small children who suffer from incontinence or from obstructions of the intestines, bowels and urinary tract.

"These operations can mean the difference between a life of self-denial, dehumanization and shameful seclusion from society, and a life full of joy and enrichment," said Dr. Makedonsky.

In the case of one of his proudest successes, a former invalid who underwent such an operation just received a full scholarship to study with the youth ensemble of a major East European ballet company. The Dnipropetrovsk hospital's reputation has grown to the point that patients from as far as St. Petersburg and Vladivostok have come to Dr. Makedonsky for treatment.

The neonatal unit has also benefited from a new state-of-the-art Viasys Bear Cub respirator that CCRDF installed with proceeds from a benefit concert last May featuring the Ukrainian Eurovision winner and popular recording artist Ruslana.

"We've invited Ruslana to come visit our neonatal unit in February or March so that she can see for herself the babies whose lives she has helped to save," said Dr. Makedonsky. "As of the end of January, we have used Ruslana's respirator to strengthen the tiny lungs of 21 newborns who could not breathe on their own." At the rate of six or seven babies per month, the respirator is expected to save nearly 500 babies in the next six years, and doctors believe the respirator will continue to operate well beyond that time.

Currently, the Dnipropetrovsk neonatal unit has 12 beds for its patients with the most acute needs. Many other Ukrainian hospitals suffer from a lack of basic equipment such as pulse oxymeters and respirators, often forcing doctors to make painful choices as to which critically ill newborn will be placed on artificial ventilation, and which will have to survive without it. To spare doctors the anguish of such choices, and to save more lives, CCRDF has installed modern neonatal equipment in 10 of its partner hospitals, including those in Chernihiv, Rivne, Lutsk, Ivano-Frankivsk, Odesa and Chernivtsi.

"We still need a great deal of additional equipment to manage our large patient load from across Dnipropetrovsk province (oblast)," said Dr. Makedonsky. "Our most urgent need is to modernize our Newborn Pathology Department, which still uses incubators dating back to the 1960s." His other great dream is to renovate the Department of Rehabilitation, where young children and babies who suffered various injuries during delivery or early childhood can undergo specialized, long-term treatment. Under the direction of Dr. Natalia Krasovska, the rehabilitation unit is currently housed in a building that dates back to the early 1900s and is in desperate need for reconstruction.

To further improve his facility, Dr. Makedonsky and his staff have turned to local businesspeople and government officials for support. "Even with the lack of needed economic reforms in Ukraine, Dnipropetrovsk remains a very prosperous city with a lot of industry and pockets of great wealth," Dr. Makedonsky noted. "There is no reason for our children not to have the best medical services available. UMC and the Children of Chornobyl have set a good example for our local leaders to follow."

On January 10 the Dnipropetrovsk Philharmonic hosted a special benefit concert for the children's hospital and a local cosmetics company, Bon Jour, donated $5,000 to the Dnipropetrovsk City Children's Hospital No. 3 to help purchase new equipment for its surgical ward. The wives of two local business leaders have also volunteered to organize a women's charity auxiliary for the hospital.

Western aid has helped to forge some vital improvements at this hospital, and perhaps more importantly, it has stimulated a new awareness within the local community that even greater improvements are possible. As the Dnipropetrovsk hospital continues to achieve greater successes, it is hoped that local and national leaders will start taking greater responsibility for the quality of care and for the long-term wellbeing of Ukraine's children.

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For more information on the UMC and CCRDF joint campaign to improve conditions at the Dnipropetrovsk City Children's Hospital No. 3, or to aid other hospitals in Ukraine, readers may call the Children of Chornobyl Relief and Development Fund at 973-376-5140 or send e-mail to info@childrenofchornobyl.org. Tax-deductible donations may be sent to CCRDF at 272 Old Short Hills Road, Short Hills, NJ 07078.

Alexander Kuzma is executive director of the Children of Chornobyl Relief and Development Fund. He is currently based in Kyiv.

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