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March 15-16 2024

How to take car of your patients in a country a war?

Updated: Dec 11, 2023

The ongoing conflict in Ukraine has not only disrupted lives but has also presented unique challenges for healthcare providers.

In her interview with Pr Michael Hofer, Dr. Yulia Vyzgha, a pediatric rheumatologist from Ukraine shares invaluable insights and challenges for providing healthcare to children with rheumatic conditions in a country at war.

Connecting with Displaced Patients: 

The first challenge Dr. Vyzgha addresses is the dispersal of patients due to the war. Approximately 30% are abroad, while the remaining 70% is still in Ukraine (with part of them who have moved to get refuge in « safer » regions within Ukraine). In the realm of pediatric rheumatology, where close physician-patient relationships are very important, maintaining contact becomes challenging. Telemedicine emerges as a solution, with online consultations being developed on-the-fly, adapting to the unique circumstances without national validation or recommendations.

Articular Examination in Virtual Settings: 

Conducting articular examinations in a virtual setup poses its own set of challenges. Dr. Vyzgha acknowledges that familiarity with long-term patients facilitates this process. However, the efficacy also depends on the parents' skills in performing tests, positioning the camera correctly, and capturing movements. The virtual setting, while not a substitute for in-person examinations, becomes more of an observational tool rather than examination.

Managing Teenagers in Telehealth: When dealing with teenagers, Dr. Vyzgha highlights the preference for having parents present during virtual consultations. However, recognizing the need to observe and assess teenagers' complaints and status becomes crucial, given the unique dynamics of this age group.

Challenges in Investigations, Especially Ultrasound:

Investigations, particularly ultrasound examinations, pose significant challenges. Dr. Vyzgha notes that this issue existed before the war, emphasizing the need for experienced physicians to perform these exams. Compounding the problem, received results sometimes do not align with the presented symptoms, adding complexity to the diagnostic process.

Treatment Hurdles and Delivery Logistics: The landscape of pediatric rheumatology treatment was already challenging before the conflict, primarily related to medication coverage and reimbursement. During the war, the delivery of medication becomes a logistical hurdle. Moreover, administering injections requires patients to travel to another national hospital. For those abroad, a unique arrangement allows them to receive treatment from a national hospital with the discharge of a Ukrainian doctor for a minimum of three months.

Impact of War on Families: Dr. Vyzgha sheds light on the profound impact of the war on families dealing with pediatric rheumatology. Chronic diseases are inherently challenging, and the war adds an extra layer of stress. Parents, already grappling with their child's chronic condition, find themselves becoming both caregivers and recipients of stress. Physicians, in this context, become part pediatric rheumatologist and part psychologist.

Insights from the JIR CliPS Project: 

The interview concludes with Dr. Vyzgha's reflections on the JIR CliPS Project. It becomes evident that real-life practice often deviates from guidelines. The project serves as a valuable tool for physicians worldwide, offering practical insights that bridge the gap between ideal protocols and the complexities faced in the field.

As a conclusion, Dr. Yulia Vyzgha's account provides a poignant glimpse into the intricate challenges faced by pediatric rheumatologists during times of conflict. From telemedicine adaptations to the logistical intricacies of treatment, her experiences underscore the resilience and adaptability required in delivering care amidst unprecedented circumstances.


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