A Colorado physician assistant has completed his sixth medical mission in Ukraine. Bob Downs, who is from the small town of Lake City, volunteers with the nonprofit Global Care Force. Laura Palmisano spoke with Downs in Ukraine about his experiences.
Palmisano: What part of Ukraine are you in right now?
Downs: Currently I'm in Kyiv, the capital.
Palmisano: Is that where your medical mission work took place?
Downs: No, that’s where all of our medical missions start. From there, we usually — at least on the last few trips — travel south to a community on the river called Mykolaiv. Then we usually go out into some of the smaller villages, out to the east of there. Those areas were occupied for seven to nine months. The roads are in such bad shape that it’s difficult for them to get any sort of medical care or get any prescriptions. That’s one of the interesting things about Global Care Force, they try, on a 60-day basis, to get back to some of the same villages. And, when we come, not only do we come with medical providers, but we also come with the medications they’re gonna need as well.
Palmisano: We previously spoke in June after your fifth medical mission to Ukraine. What number are you on now?
Downs: Number six. Just completing that here in December.
Palmisano: Why did you decide to go back again?
Downs:I really like working with Global Care Force and the idea of the continuity, trying to get back on a 60-day basis. So, that really attracted me right from the beginning, and I just felt like there was a need to go back again to kind of care for these folks. In fact, I got to see quite a few people this time that I had seen on my last trip in June.
Palmisano: And what changes have you seen over the past six months?
Downs: Out in the rural areas in the south and southeast of the country, when we first started going to those areas, a lot of the fields were mined, and there wasn’t a lot planted — because these are primarily agricultural areas. Over the last few trips, I’ve seen gradually where they’ve de-mined the fields and they’ve been planted again. In fact, when I was there in June, it was really quite beautiful. They had planted considerable crops — rapeseed as well as a lot of wheat. That section of Ukraine is, well, it’s pretty much the breadbasket of Europe — all of Ukraine, for that matter.
Palmisano: How many times have you been to Ukraine this year?
Downs: February, and then again in April, and then June, and of course here in December. So this will be the fourth trip this year.
Palmisano: Six months is a long stretch, what have you seen change for your patients?
Downs: It’s wintertime, and they’re bundled up. There’s still not a lot of electricity down in that area. In fact, even in the larger city where we were staying down south in Mykolaiv, this time there were a lot more power outages, and of course, we didn’t really trust the water coming through the tap, if you could get water. In that respect, things have been degraded a little more than they had previously. People are faring well, they’re used to that, especially out in the villages, where they’re used to being in a little more austere environment.
The thing I will say between June and now, it was nice to see some of the workers coming in, where they’re actually back to work in the fields. Because, again, those are agricultural areas, and that’s basically their livelihood down there.
Palmisano: What are you hearing from folks about how they feel about U.S’. support of Ukraine?
Downs: I think there’s a sense that perhaps relations with the U.S. government and Ukraine are a little strained right now. I get the impression that while people are very weary of the war, they’re also not very anxious to settle the war on Russia’s terms, necessarily. They feel there’s a certain unfairness to that, especially considering how the war unfolded.
Palmisano: On this sixth trip to Ukraine, what is different from previous experiences?
Downs: What I find, even in Kyiv, they’re rationing electricity. There are a lot of outages, although a lot of places were prepared for this, they have backup generators, that sort of thing. We’ve also been told for the first time on this particular trip, not to trust the water — in other words, not to drink the water from the tap, although we can probably bathe in it, but be very cautious. I know that there are folks that are slightly more unnerved. They seem a little tireder because the air raid alerts that they get are much more frequent, which disrupts the sleep and their daily pattern.
Palmisano: Were you near the front lines?
Downs: We were back a good little ways, but there was one village that we were probably within 20 kilometers of Kherson, where there is active fighting going on. I was doing a home visit in that village, and we could actually hear artillery in the distance.
Palmisano: How do you and your fellow medical providers stay safe?
Downs: Our team is involved in coordination through the Ukrainian Health Network, and we're connected with security forces so that we know what areas are very safe or safe for us to go into on a given day.
Palmisano: Let’s talk about the continuity of care you’re providing through Global Care Force.
Downs: Well, most of the medical ailments we’re dealing with are things like Type 2 diabetes, hypertension, cardiovascular disease, and a lot of arthritic complaints, as well as, basically post-traumatic stress. People are having difficulty sleeping, feeling very stressed, and somewhat anxious. Providing medications for patients until we can get back again is probably one of the biggest things, because you’ve got to remember, a lot of the roads were destroyed in these occupied areas. So, even getting to a village that’s say 20 kilometers outside of Mykolaiv can sometimes take an hour to an hour and a half. It’s very slow going, and most of the folks living in those villages, they don’t have the money to have a car or be able to have the gas to actually go into the larger cities where they can get to a pharmacy.
And right now, because the roads are in such bad shape, there is no public transportation to a lot of these rural villages.
Palmisano: You mentioned working at a refugee center. Where are these folks coming from?
Downs: This is at the two refugee centers in Cherkasy, folks that are recent arrivals from the front further east, where some of the fighting is going on and they’re fleeing that fighting. The government can put them up in these refugee centers to try and resettle them short term, and they provide them with a stipend, and we are there to provide them with initial medical care until they get themselves settled.
Palmisano: Have you treated refugees before?
Downs: Yes, each of the trips previously, except for the June trip, we had always traveled to some of the refugee centers in Cherkasyi, as well as other regions in Ukraine. In June, we didn't go back to those refugee centers because at that time there were not a lot of new people that had come, and the government had provided a lot of subsidies for those folks. We rather spend our time out in the villages seeing folks that couldn't get into larger areas.
Palmisano: What is it like working at the refugee centers?
Downs: Many of them had only been there less than a week. Many of them weren't sure where they were gonna get their medicines. They were very thrilled to see us.
There was also a mix of folks we had seen in the past there as well that hadn't been resettled elsewhere. But generally speaking, they were really excited about the idea that we were there, that we hadn't forgotten about them, and we were willing to take care of their basically general medical needs.
Palmisano: Are you planning another trip?
Downs: I am. I am scheduled to go back in March, so I'll be traveling with a former team member who lives in Colorado also, and she's a behavioral trauma specialist, and we'll be traveling together on that trip.
We won't be traveling I understand in January and February, which is very unusual for us because we do like to go back at least on a 60 day cycle. It's my understanding that there were some funding issues and also recruiting medical staff who would be willing to go back for those two months, as I understand it.
Palmisano: How do you raise the funds to go on these medical missions?
Downs: Usually through friends and folks that I know professionally. My wife will usually put a notation on Facebook that I'm going back as well. I have also a few very consistent, larger donors that are very generous in helping me get back. This last trip, we were a little bit short, so my wife and I were able to put up the funds ourselves.
We, of course, will be fundraising for the next trip for March. These missions typically are 13 to 15 days long, two weeks is about the amount of time that a working professional can probably get vacation time off to do a trip like this. And of course, it's difficult to get into the country. It involves a flight from the U.S. to somewhere in Europe and then into Krakow, Poland, and then about a 10 hour, 12 hour train ride into Kyiv. And then of course, usually a travel day the next day from Kyiv. So it really takes about three days to get here and three days to get back to the United States.
Palmisano: Are you mainly seeing civilians?
Downs: We are not seeing, generally speaking, any veterans or anything like that, unless they're no longer in the military. I mean, occasionally we will end up seeing a veteran, but generally speaking these are just general citizens that need primary care issues addressed like their diabetes and that sort of thing. Occasionally we will see a more acute problem, but it's something that is more happen chance and we happen to be there. We kind of take care of that as well.
Palmisano: Is there anything else you would like to add, Bob?
Downs: Yes, working in the villages is very interesting because the environment's much more austere. There is rarely any electricity in any of the small clinics. In fact, this December, if there was any heat, it was usually from a wood stove that they had going, prior to us going there.
So it's a little more austere working in that environment as opposed to working in the refugee centers where things are a little more comfortable, and patients, when they come see us there, they don't have to travel any distance. Most of them are coming down from their room as opposed to the village folks that are having to travel in.
Palmisano: How many patients are you seeing in a day?
Downs: It varies. When we're in the villages, we try and do two villages a day, an A.M. village, and then an afternoon village. And we're seeing anywhere from 30 to 50 patients in each village and in the refugee center. It's almost a three quarter full day when we're there and we're seeing, oh, I don't know, an average of 60 to 70 patients.
Palmisano: Thank you for your time, Bob.
Downs: Thank you. Thank you, very much.
