1. Feature – Ukraine
Driving a hard road down
in Ukraine
Travelling through western Ukraine searching out old and interesting
anaesthetic apparatus.
Introduction
I am a regular visitor to Ukrainian health-
care establishments, and as an ODP I
have developed a keen interest in the
anaesthesia platforms and apparatus that
they use.
Many of the older ‘warriors’, like the
Drager portable battlefield machine in
Figure 1, which have served with distinc-
tion for many years at the Regional
hospital in Ternopil, are being gradually
relieved from frontline duty. Nevertheless,
many other interesting items still remain
on active service in some of the smaller
John Allwood SODP satellite and rural hospitals.
SODP West Middlesex University So, with some spaces in my diary, I
Hospital decided it was time to pursue my interest,
fuel the Lada and take stock. My long-
Abstract standing friend, Dr Yuriy Kuybida from the
John Allwood describes a trip in western anaesthetic department at Ternopil’s
Ukraine in search of interesting and regional hospital, made the necessary
unusual anaesthesia equiopment. contacts, and we headed towards the
Key words small town of Zboriv, 35km west of
Ukraine, anaesthesia equipment, Ternopil – Yuriy’s home turf.
Polynarkon
Reference
Driving a hard road down
Zboriv straddles the main highway linking
Allwood J (2008) Medical services in
Gereshk, Afghanistan Technic 5(5): 16-19.
Ternopil to Lviv, western Ukraine’s largest
city. The hospital that we were heading for
was originally built in the late 1800s as Figure 1: Drager portable anaesthesia apparatus
the town hall. Yuriy explained that over
the years it had also served as the local even involves occasional neurosurgery
jail. The last rogue had waved incarcera- work among its 1200 annual operations.
tion goodbye back in the 1950s, when the The hospital boasts a busy obstetrics
building was converted and became the wing, located within the old prison cells.
local hospital. Eventually, we were ushered into the
second floor theatre / ITU department of
Zboriv the hospital, where the tour concluded.
Meting up with Dr Volodymyr Gotsa, The concept of intensive care in small
head of anaesthesia, we started a tour town Ukraine is little more than the
of the hospital. We walked down creaky provision of a separate room staffed
but spotlessly clean corridors while with a dedicated nurse, methodically
Volodymyr explained that Zboriv under- checking vital signs. Electrically powered
takes quite a mixed caseload, which patient monitoring is not that common,
16 TECHNIC | VOLUME 5 | ISSUE 5 | DECEMBER 2008

2. Feature – Ukraine
legacy from the time when oscilloscopes
were considered all the rage.
The nearby theatre staff were busy
placing recently autoclaved surgical instru-
ments back into their cabinets. Volodymyr
drew back a screen revealing two pieces
of equipment of significant relevance to
the trip. First in line for demonstration
was a Polynarkon 2P and an excellent
example of an older generation of
portable anaesthesia delivery system. The
Poly 2 is a simple design, which incorpo-
rates bag and bellows plus standard
rotometers and an absorption canister.
The platform also has interchangeable,
though unemployed vapourisers for
ether and halothane, plus yolks for two
cylinders. In the unlikely event of you Figure 5: Dr Maryana Chorna using an R06
Figure 2: A freestanding Polynarkon 2P portable having to change the cylinders around
anaesthesia delivery system here, oxygen cylinders are coloured were attributed to ether usage,
coded blue and nitrous grey. It’s actually manufacturing of the RO9 ceased. The
unlikely that even the local clinicians get R06 then underwent extensive
much opportunity, as the machine is updating and is now heavily marketed
designed to function using room air and as the company’s flagship platform; it
cylinders of medical gas are in fact quite is available for 300,000 roubles. The
a rarity. Commonly, many of these older RO9 still remains very much in use,
Poly 2s, which can be seen, have had provided the ether stash is well
their bases removed and bolted onto the hidden. Here is an RO9 variant – the
sides of the newer electrically driven RO9H – in use recently for a sub-dural
machines, to provide a backup when haemotoma removal in Ternopil.
power is down. The one in Figure 2, Our visit to Zboriv became fairly protract-
however, is still in its original freestand- ed, and we benefited from some
Figure 3: Breeze 2 ventilator ing form. Rubbing shoulders with the traditional Ukrainian hospitality thanks to
Polynarkon was the Breeze 2 ventilator, Volodymyr’s drinks cabinet, resulting in us
which is a testament to maximum size, staying over night in Zboriv.
minimal capability design. From the
noises it emits when it spools up for Bukacivtschi
duty, you get this feeling that several Next day, we continued, shadowing the
hours of nebulised cpap wouldn’t go Dneister river’s meandering course
amiss to help it wheeze its way to its towards Bukacivtschi 150km away. The
operating optimum – see Figure 3. three-year-old Lada’s robust suspension
Unlike the Polynarkons, the breeze is a proved to be more than a match for the
bit of a rarity and its purpose confined to road networks’ uncompromising
either lengthy post-operative ventilation potholes. As a result of European super-
or patients needing respiratory support powers battling out opposing ideologies
with humidification. Day-to-day anaesthe- and territorial sovereignty rights, the
sia at Zboriv, as in many hospitals in land we navigated through has
Ukraine and the Russian Federation, is undergone frequent and bloody national
normally undertaken using the RO6 identity changes over the years. This is
manufactured by the Krasnograveets (Red underscored by the sheer abundance of
Guards) factory in St Petersburg. cemeteries accenting the landscape.
Figure 4: An older version of the Krasnograveets Zboriv’s older version is shown in Figure Other occasional signposts to history
R06 for ‘day-to-day anaesthesia’ at Zbrovia 4. Despite its plethora of dials on the front were Red Army memorials, typically the
panel, it is really nothing more than a ubiquitous T34 tank – now motionless
and the occasional ECG machine you do ventilator platform, as demonstrated by epitaphs to the defunct Soviet mother-
see, has in all probability arrived either Dr Maryana Chorna in Figure 5. land’s lost comrades who fell in the
courtesy of a lengthy transatlantic ride in The RO6 was superseded by the RO9 ‘great patriotic war’.
an aid container from the US or Canada, (Figure 6). However, due to several To someone more accustomed to
,
or is a veteran Russian-made machine, a instances of machine explosions, which witnessing zealous wheel clampers ply
TECHNIC | VOLUME 5 | ISSUE 5 | DECEMBER 2008 17

3. Feature – Ukraine
Figure 6: The R09, which superseded the R06 Figure 9: A rare example of an RO-2 respirator
medical and surgical caseload. A town on offer here. Alas Myron’s dual role
this size, would not normally host a diminished with the appointment of a
hospital or even a clinic, and instead dedicated surgeon a short while ago. He
would be reliant on the services of a showed us a Polynarkon 4 apparatus,
local healthcare provider known as a which normally resides in the small
Feldsher. ‘Feldsher’, which means ‘field operating theatre – see Figure 8. This
doctor’, was a term imported to the old equipment is used for the hospitals 300
Russian empire from Prussia. Nowadays, annual general anaesthetics. Again, it is
it means a multi-skilled health profes- free standing, but smaller and more
sional, whose level of expertise and compact than its predecessor the
training lies somewhere between that of Polynarkon 2. Although noticeably
Figure Outside Bukacivtschi hospital – complete a doctor and nurse. They crew the rural redesigned, its operating capabilities
with grazing horses and no parking problems ambulances, attend home births and are almost identical and again air is
provide vaccinations, as well as handing used for manual artificial ventilation.
out general healthcare advice and Volatile agents are not needed, as a
education. Due to the remoteness and rudimentary total intravenous approach,
winter conditions, when the snowfall using bolused thiopentone, is consid-
that can cut of the town, and the ered adequate for around 90% of
mercury can fall below –30 degrees anaesthetics. The remainder are under-
celcius, it was deemed prudent to taken using regional techniques.
maintain a year-round health facility at Next, in an adjacent room, which
Bukacivtschi, serving the local, mainly doubles as the ‘high dependency’ lay a
farming community. I was also informed fine example of a very rare RO-2
that during mid-winter when the local Respirator – Figure 9. Developed for
road conditions deteriorate, a horse and military use in the 1960s, it comes with
Figure 8: A Polynarkon 4, which is normally cart is often pressed into service as the quite an intriguing design history. The
used in Bukacivtschi’s small operating theatre local ambulance. (Perhaps we could RO-2 was manufactured from plans
persuade the estates management team obtained using cold war industrial
their trade, the sight of grazing horses to crew the clamper trucks if the espionage perpetrated against the
in front of a hospital provided an inter- ambulance service gets a bit Engstrom company by the KGB.
esting backdrop as we entered (Figure overstretched.) Apparently, Engstrom has corroborated
7). Without even a hints of hospital Myron has quite a colourful past I this theory.
parking scratchcards or permits, we learnt during our conversation. Until In many ways, it has several character-
parked next to a group of medics from recently, not only was he responsible for istics comparable with that of the old
nearby Roghatyn who were undertaking administering the patients anaesthetic, Bease pulmoflator, except with a
some outreach rounds. We were greeted but also looked after the surgery side of graduated plastic water funnel stuck on
by Dr Zinoviy Kuschinsky and Dr Myron things too, once the patient was uncon- its side, with which the user visually
Poyasnyk, the hospital’s respective chief scious. Such enthusiastic multi-skilling confirms inflation pressure.
executive and chief anaesthetist. They would raise many a directorate In theory, you can control volume and
led us on a we tour through the 35- manager’s eyebrow with interest at the pressure by manipulating the knobs,
bedded hospital, which has both a cost and manpower saving possibilities dials and bellows screw. In practice,
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4. Feature – Ukraine
nationally rated around 1960. It was one of the first
medical and positive pressure ventilators manufac-
nursing college for tured after the polio epidemics of the
a long-anticipated 1950s. This machine appears to have its
meeting with its roots in France, with the ID plates at
director, Dr the rear indicating it had been manufac-
Lubomir Bilic. tured by the R Pesty company in Paris.
Through Dr Bilic’s How it came to be in Ukraine was a
craft, care, dedica- complete mystery to everyone.
tion and So all good things must come to an
unbounded faith in end. After our fill of more first class
a competence- hospitality and some lengthy dialogue
based educational in the faculty dining room with Dr Bilic,
regime, he has came the moment to part company.
transformed the Time was pressing as I had a class of
Figure 10: A class of students in one of Ukraine’s finest training
institution into one students to take at the medical
esablishments in Chortkiv
of the finest academy back in Ternopil. We transited
training establish- the relatively pot hole free M14 for the
however, most of these are in need of ments in Ukraine. last stretch to Ternopil. Two hours later
repair and such fine control would be an The colleges establishment of around with class over and the chalk almost
exercise in futility. Its functioning param- 1200 students, and when we were there exhausted as I was, there was nothing
eters are defined by what still works the atmosphere was fairly hushed else left to do except grab some well
and it is pretty much limited to because many of the students were in earned cold ones with a few of the
providing airway support during resusci- the final stages of cramming for students. With the sun setting, a beer in
tation, as a kind of one size fits all large impending examinations. Chortkiv has a hand and some good company, a great
mechanical ambu bag. wide training remit; pharmacists and way to finally take the hard roads
dental technicians also receive their chequered flag.
Chortkiv tuition there.
After another local night stop we were The college boasts its own radio Thanks
back on the road zigzagging with more station and a well known English I would like to express my gratitude to
road-induced bump and grind on the language department where I was all my friends and colleagues in Ukraine,
longest leg of our trip towards the warmly received by Ivanna Zakharchuk for the courtesy and hospitality shown
small town of Chortkiv. This is another and her team. Ivanna has authored throughout my trip. We are now setting
town whose recent landmarks are Ukraine’s main medical English up a new project in Chortkiv, and are
dominated by World War Two. The language textbook and many of the well underway with an extensive
locality was an epicentre for the students’ timetables now include laryngeal mask trial at the regional
Holocaust and later in 1944 was on the English language studies. hospital in Ternopil using both conven-
frontline of some heavy fighting The concluding events of our tional and the new iGels courtesy of
between the retreating Germans and walkabout at Chortkiv saw us gravitat- Intersurgical UK. Ukraine is now
advancing Soviet tank armies. After ing towards the surgical training room manufacturing very good home-grown
making several unintended circuits of and a ‘face to face’ with the headline ventilator and monitoring equipment,
the town, we eventually found its act of our three-day tour. Standing which is not surprising given its global
proud amongt all the other training pedigree and reputation in the worlds of
paraphernalia, operating table and science and aviation.
instruments (which were also of great
interest) stood an absolute showstop- Further reading
per of a device (Figure 11). It is still If you found this article interesting
used to train students about the princi- then you may be interested in a more
ples of mechanical ventilation. in-depth and comprehensive review of
Unfortunately, even Yuriy was a bit anaesthesia delivery in Ukraine that I
sketchy over its history, although he did wrote: ‘A Toast to Morton and his
mention it was in use in a regional narcosis’, which appeared in the
hospital many years ago, before being October 2002 issue of Technic.
redeployed to Chortkiv. It looked as A more extensive selection of images
though it had been shipped straight which interested readers are welcomed
from a Pinewood film set after Baron to browse can be found at my image
Frankenstein had finished using it to website:
Figure 11: An Engstrom positive pressure reanimated his monster. This machine www.flickr.com/photos/johnallwood/sets/
machine, now used for training students is in fact an old Engstrom 150, built 72157601139419065/ CODP
TECHNIC | VOLUME 5 | ISSUE 5 | DECEMBER 2008 19