Dr. Laura Bukavina traveled to Poland earlier this year to provide medical assistance to people escaping the Russian invasion of Ukraine, which began February 24, 2022. Bukavina is Ukrainian and migrated to the US at age 10. She is currently a urologic oncology fellow at Fox Chase Cancer Center in Philadelphia, Pennsylvania. Bukavina spoke about her month-long experience in a Polish refugee center during the 2022 International Kidney Cancer Association: Europe meeting in Antwerp, Belgium in April. She sat with the KCA to discuss further how a such crisis can impact people with cancer.
What compelled you to take action, gather resources, and make the trip to help those affected by the war in Ukraine?
First and foremost, as a mother and as a physician I could not stand the idea of mothers alone with children crossing the border without any available help. The horrific images of refugees on the border for days, stranded with children, without any medical help due to the rapid escalation of the conflict as well as inability to quickly gather a response was my call to action. I knew that I could offer help, in the form of translating, medical supplies, or my medical training. Somehow, I could help. I could not stand on the sidelines, could not sleep thinking about how they were suffering, without doing something firsthand.
What services or help did you provide and to whom?
I traveled to Ukraine/Poland for one month in February and April, providing medical services at a refugee camp. [I and other volunteers] established a medical tent that we serviced around the clock to help refugees crossing the border from Ukraine to Poland. We managed everything from trauma to hypertension to hypothermia to diabetes. Although I am a urologic oncologist, my medical training in the surgical subspecialty and the frequent medical complexity of the patients in our practice prepared me well to handle this situation
In addition to working in the medical tent, we also repackaged medical supplies that were delivered to the border as donations to be sent to Ukraine and appropriate hospitals. We triaged medications based on the needs of individual hospitals as well as the resources required at the medical tent. There was no waste of any donation. In other words, anything we did not use or need or had surplus of made its way to Ukraine.
Did you see any/many people with cancer while you were in Poland?
There were many that had cancer. Some patients presented to the medical tent shortly after their surgery while still requiring IV narcotics and wound care. Many had interrupted their chemotherapy treatment. Some had effects of chemotherapy treatment and required strong anti-emetics, all amidst COVID, in a crowded refugee camp with no masking precautions.
What kind of medical assistance did they need most?
The majority of refugees required care for chronic illnesses, as many did not have access to medications – pharmacies were closed or had no medications – or did not bring their medications as they were being evacuated. Hypertensive crisis, hyperglycemia, and dehydration were the most common conditions. During the first few weeks many people were hypothermic due to cold temperatures and long wait times. Many people had panic attacks and required counseling in addition to medications to calm their nerves once they crossed into Poland.
What kinds of medical care was possible or not for the people you encountered?
Although we had a fully functioning medical unit with ultrasound machines, an observation unit, and life-saving medications, access to dialysis, for example, was limited. Furthermore, due to the rapid escalation of conflict, nearby European countries had not established protocols in terms of medical management and staffing. The hospitals were full to capacity and at the beginning of the invasion resources to continue cancer care were limited. However, as the time went on, many neighboring counties established guidelines, hot lines, and contact physicians, including telemedicine services, that patients could turn to and seek care.
Do you think people with cancer are uniquely vulnerable during a war or crisis?
Absolutely, cancer patients are not only more susceptible to the environment around them, including to infectious disease, but also due to the complexities of medical care required. Many cancer patients require not only frequent physician follow up but multiple lines of care such as chemotherapy, radiation, and surgery, further complicating an already difficult situation. Furthermore, many cancer patients are not able to wait 3-6 months to seek care and need to resume their treatment as soon as possible. This is very challenging during a war, when resources are scarce, and hospital systems are overwhelmed by high acuity admissions.
What can we do as cancer advocates to help mitigate risks to those who are most vulnerable?
Establishing access to care, and support through a network of physicians that are able to respond in situations of crisis like this is critical. Having an established “flow” of physicians across all specialties of cancer care, that can triage cancer patients that require immediate care is critical to optimize medical treatment for the most vulnerable.