Ukraine Medics Gird for Surge in Amputees

LVIV, Ukraine — Vladyslav Tkachenko grimaced, grabbed a wooden balance rail and slid carefully forward. Then he lost his balance and his metal leg, fitted with his old combat boot, hit the ground. Undaunted, he stood up again and pushed forward, staring determinedly at his reflection.

“In his mind he is already back there, with his comrades,” said Viktoriia Olikh, a prosthetic specialist, hovering behind him. She helps Mr. Tkachenko, 25, with a limb that he hopes will take him back to the battlefield.

Mr Tkachenko lost his left leg on the second day of the Russian invasion of Ukraine when an artillery shell blew it off and tore his right thigh, leaving a web of dark red scars. He is among the first in what Ukrainian doctors fear could turn into a devastating wave of amputations as Ukrainian troops push to reclaim territory and intensify fighting in the east.

That expectation has led to an international effort to bolster the supply of prosthetic limbs in Ukraine. But Nagender Parashar, owner of a prosthesis company in Kiev, is concerned. “There are already hundreds of them. The numbers are frightening,” he said, referring to the number of Ukrainian soldiers who have lost limbs.

“We are about to lose many more lives and limbs.”

Mr. Parashar, who came to Ukraine from India in the 1990s, studied computer science before starting a prosthetic import business. Dissatisfied with the quality of the imports from China and eager to hone his craft, he began to disassemble and reassemble state-of-the-art German and Japanese artificial limbs. Today, he not only supplies caps for foreign-made limbs, but also makes his own parts, including hydraulic knees, at a factory in Kiev.

Ukrainians have acquired expertise in the science and art of prosthetics out of necessity. After Russia took over the Crimean peninsula in 2014 and war injuries multiplied, the conflict prompted many to seek training at top institutions around the world.

But producing prosthetic limbs, a complicated and high-tech undertaking, is expensive. The Ukrainian government, which funds health care in the country, is struggling to keep up with costs. As a result, some denture manufacturers have gone out of business. Others, such as Mr. Parashar’s company, are still waiting for payments.

Nevertheless, said Mr. Parashar that he is expanding production at his factory in Kiev and switching to double and triple shifts.

International volunteers are also helping to fill the gap.

Antonina Kumka, a Ukrainian-born Canadian, founded the Ukraine Prosthetic Assistance Project after the conflict in Crimea began in 2014. With the support of the American charity Prosthetika, she connects Ukrainian doctors with specialists around the world via video conference. She also encourages prosthesis manufacturers abroad to make donations.

“We don’t want money to send patients abroad — we need them to donate components,” she said. “The specialists in Ukraine can do it here. It costs less and it is better for the patient.”

But many patients, including Mr. Tkachenko, remain wary of Ukrainian prosthetics. He worries that the local doctors are working slowly to finish his prosthetic limb because they help him for free.

“I thought I would come here, and then one to two months later I would be back in the fight,” he said. “But I see now that it’s going to be a long process.”

Mrs. Olikh has tried to explain to him that he has to be patient, that his body needs time to heal. The area where a limb was amputated changes shape and size in the months following a traumatic injury, a process she said she needed to allow to end naturally.

Hoping to encourage him, Ms. Olikh handed him a hydraulic knee from Parashar for him to inspect. It would be added to his metal leg, she said, once he was more stable. He poked and poked at it.

The type of knee didn’t matter, he said, as long as it helps him achieve his goal of “going back to my brothers and fighting.”

SOURCE – www.nytimes.com

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