Lesova Polyana
Part II
Lesova Polyana VA Clinic is an old Soviet building on the edge of Kiev, built in the mid 80s for the Afghanistan war veterans. Coincidentally my father was one too, and perhaps he too was treated here once. Surrounded by ponderosa pine forest, Pusha Vodiza is a natural area with tear shaped lakes, civilized park and a wild forest, is punctuated by sanatoriums, summer camps, and private sector. The Lesova Polyana VA clinic is at once hidden from the eye, peaceful, and isolated.
The three story building has orthopedic, ptsd, trauma, and neurological inpatient wards on one side, and the patient rooms on the other. The building houses 150-200 people in its deteriorating walls. The bathroom on the first floor is out of the 80s, a wet rag on the floor in front of the sink, no toilet paper, no soap. The second floor bathrooms are for staff and cleaner, at least the floors are ceramic instead of dirty cement. They are locked with the hidden key after 4 pm when the procedures are done. The walls are currently decorated in a bizarre choice of Japanese anime style images of boys and girls in camo holding hands and kalashnikovs. Someone probably thought it was patriotic. I cringe.
There is a tiny store and a patient cafeteria. Downstairs the lobby houses billiards, chess, and table tennis- same exact games as I remember seeing growing up on Soviet army bases as a child. The temperature inside is cold and damp, there’s no ac or heating yet. The forest is all around the clinic, but it’s not recommended to venture outside into the open forest because the mines left over from the russians could still be there. The soldiers congregate outside to smoke, talk, and take walks around the perimeter. The floor on the main second floor is in disrepair, covered by the cardboard, a thin line of red carpet trailing over the paper to make it look more presentable for visitors. When I peek around I discover that inside every other smaller room on the first floor there is rubble rendering them out of commission in the deteriorating building. Yet everyone seems to adjust, go around, use what they can, and overlook the obvious lack of medical standart to make do with what they have. The rubble in one room, the donated high end rehab PT equipment in the gym in another, no one is surprised by these contrasts.
The two small rooms assigned to me for my private acupuncture sessions have sinks but no soap. I buy my own soap and bring a towel to dry my hands. At first I have to bring the electric heater from home, and move it from room to room until the director of the clinic personally brings me the three electric heating units to put in each room. When I ask for a sharps container I am given an old plastic bin from laundry detergent, still smelling like laundry.
The soldiers wait stoically for their appointments in the long hallways. There’s a sense of depression. Many of them disappear into their phones, still I can see they hope that someone behind the door will know what to do with their broken bodies and minds.
Almost each person I meet has a concussion. Many have repeated concussions after months of being stationed in the trenches during the continual artillery attacks. Some have been at war for years since 2014, their old brain injuries layering with the fresh ones. What it looks like is perennial inability to sleep, short term memory lapses, deminished capacity to function, disorientation, headaches, cold sweats, fatigue, and of course feelings of anxiety, grief, loss, anger, frustration, despair, the whole nine yards of trauma.
Their age varies - still boys, middle age, past their 50s. Many will go back to the active war zones as soon as they get patched up. The war isn’t soft on them and they are deemed more needed with their military experience than the fresh recruits. The military health committee will not be concerned with headaches and ear ringing, anxiety and lack of sleep, they tell me. They are only concerned with lack of feet or hands, severe stuttering, loss of speech, or obvious disability. Otherwise, in 21 days if you don’t have that, you kill probably be deemed good enough to return back for duty.
Who else but not us? said a big handsome desantnik, the equivalent of a navy seal, who thanked me for helping him and walked out of the clinic with a straight spine. It was such a reward to see this guy lay in a lounge chair with needles in his body drop into a restful sleep while I have played smooth jazz, Nina Simone, Armstrong, Miles Davis. The music transported these guys to sitting at clubs, in a time when they didn’t have to kill or be killed. They got acupuncture, listened to the music, cracked jokes, got quiet, and fell asleep.
The word spread through the soldier’s telephone that acupuncture mambo jambo really did help them sleep better. I saw the same people every day, some of them for 21 days straight with breaks on the weekends. And the new arrivals come in to test it out on themselves. They too mantra the same thing in response to my, What’s bothering you? They point to the head and say, a headache, I can’t sleep after this concussion, even with the meds. I have anxiety attacks, I have pain. I stutter. I don’t feel good. I am too aggressive. I can’t unwind.
The current law allows those on medical leave 21 days in one facility, followed by a review with the military health committee, after which they either go back to war, or go back home, or go back to another facility. My patients have only 3 weeks to stay here, with possible repeats later in a month or two.
What can heal in 3 weeks? To me it seems to be a bandaid. It’s a chance for the beginning of recuperation, for going through short courses of therapies, getting a few tests done, getting referrals to other facilities, but is it enough to heal a serious traumatic brain injury. That might take a year, two, of weekly work with neurologists and other providers. I worry many of these guys will fall through the cracks of the system that is not designed to address their needs, a system that is overwhelmed, imperfect, underfunded, and focused on acute care.
So I do my NADA ear acupuncture for PTSD for everyone first, then I add a few needles in the rest of the body. I am determined to get to them all in the limited time I have in the day and I make my decisions quickly. On the inside I try to breathe, to feel my feet on the ground, to keep my own body relaxed and efficient. I ignore the discomfort if neither of these things are happening. On the outside I joke, issue commands, whisper calmly to cajole the needle phobic, run up and down the stairs between my stations, look for my patients, and keep working until there is no one in line. I know that my own nervous system is not optimal to deliver the type of the ideal experience associated with acupuncture, a serene present space. No!!! This is my imperfect but concentrated -I am doing my best, fuck you!- to the putin’s regime. This is my own focused effort, my own warrior response to the destroyed lives and dignity of my people. My source of energy here is not a calm presence, it is a quiet rage.
If the soldiers had to gather themselves internally to face bombs and killings, the clinic staff have to gather themselves to face the soldiers. Everyday the clinic staff show up to treat countless lines of men in their suspended between war and civilian life facility. The staff are mostly women, the soldiers are mostly men. The care taking burn out dynamic is very real.
The clinic staff are young and old, paid and volunteer, of various cultural backgrounds just like the soldiers. They work in their rooms like they are in the trenches, disappearing there for long periods of time, only to run to the bathroom or walk hurriedly while talking on the phone, on the lookout for another patient.
Some have their lunch communally, having learned to pause for food and conversation to sustain themselves in the long run. After I have treated the staff -psychologists, neurologists, cardiologists, administrators, the director and her secretary, nurses, the pharmacologist- they begin to invite me to their lunches, making me plates and hot tea, teaching me to pause and take breaks too. I am grateful to be adopted into the family of these mostly invisible to the world yet determined and strong willed women, many of whom have their husbands fighting in this ugly war.
Some of them are so burned out they cannot maintain a conversation. Anxiously running through the corridors, juggling appointments, giving interviews to the countless press teams, taking the non stop professional training sessions on zoom, they can’t give themselves permission to stop, the weight of responsibility on their shoulders as their own rage sacrifices their happiness and vitality for the sake of these soldiers. I know I cannot help them to slow down and consider a plan b- a walk in the park, a dance, a vacation. They have heard and saw something that made them very, very determined to not stop until it’s all over.
In this war regime the clinic admin have suspended its usual formalities and allowed volunteer alternative practitioners to share the burden of caring for the armed forces. Over time I meet feldenkrais practitioners, cranio sacral therapists, a massage therapist, a mindfulness meditation facilitator, team of volunteer hairdressers, art therapists, sports coaches, emotional rescue animals and their trainers, bakers, and others who come to do their part. We exchange the understanding of people who are here for one purpose. I watch Irina, the petite Feldenkrais practitioner, work in the cold gym for seven hours straight, with one person after another, and I am so amazed that she is here-and the magic of Feldenkrais, one of my favorite somatic practices that teaches the body to move more efficiently, is available here, out of all places!
I have been in a Feldenkrais teacher training program for a year now, yet I have no time outside of acupuncture to share the method myself here. Instead I approach another Ukrainian teacher to come to the clinic and offer classes. Andrei comes, and I see him teach the method to a room of soldiers who have never heard of the method but sure, they will try it! They packed the room like sardines, laying on the floor head to head, and with many interruptions due to comings and goings and phone ringings and joke tellings by the time he was finished everyone was quiet and breathing freely, their nervous systems calmed down.
I do continue to take online modules while in Kiev though, in the evenings after work. It seems very surreal, to do slow Feldenkrais movements during air raid sirens. Still it’s probably the only thing that helps my back when it gets injured on a cold day working at the clinic.
My routine is soon established. I wake up at 8 am, make coffee, doom scroll through the news to make sure that there is no nuclear war, eat breakfast, take a shower, then at 11am I catch an uber to the clinic. I take ubers to avoid 1.5hr travel by several buses one way commute, which most of the staff at the clinic have to do every day. I am acutely aware that my American privilege is reflected in not getting paid, getting taxis, and eating out twice a day, and I am okay with that. I am also aware that I will leave in the next several months, and my colleagues will stay to continue what they are doing without replenishing their tanks with rest and safety.
I go to buy water at the tiny store upstairs, when I arrive, to keep hydrated. Then I head to the group session room, turn on the music, and bring the supplies. Usually several guys are waiting for me, more often than not all 7 chairs are full. The room is often very cold and I turn the heater on, surprised that they didn’t do it every morning. Then I start coming around to each person, taking their pulse, asking a quick recap of their complaints, doing the small talk, and making decisions about where to place the needles. Other folks would open the door to see if there is space, and often I’d ask them to go and wait downstairs at my small private rooms. After I have needled the first group I would go downstairs, needle the two more complicated patients waiting for me, then go upstairs to take the needles out from the first group, to restart the second wave that was waiting. Then I would go downstairs to take the needles out from the two patients to bring two more, and so on. Often those who felt relief would come almost every day for the 3 weeks of their stay, an unusual experience for my once or twice a week American acupuncture routines. I watched curiously for how quickly they responded to my daily treatments.
Sometimes the patients were above my skill level. Often these were complex brain injuries. I didn’t have the communication with their team, the information of their diagnosis and treatments to discuss with the other staff. They were men who were shaking, withdrawn, with pallid sullen complexion, slow movements, stuttering, cold sweats, fatigue, and sadness from being so hurt and changed. They were cooks, architects, political aides, basketball coaches, teachers, businessmen. They will not be able to return to their jobs, their lives, feeling like they have been feeling now. And I could see they were terrified of what happens next.
I was also aware that they were on the prescribed regiments of tranquilizers and psychotics, and that the effects of acupuncture was not considered to reduce the doses of medications. The facility was state run, which meant that the doctors were paid regardless the outcomes for the patients. They were overworked, and still had to do all the paperwork by hand. They offered the meds and short term therapy, and seemed to be too stretched, burned out, overworked, unmotivated to look for other methods of treating brain injuries. I was trying to piece together the picture of how the system functioned, or rather malfunctioned, but I could not do it while I was working at the clinic, it would have to wait. I could see that after the patients went through this facility they will most likely will have to seek private out of pocket care, look for volunteers to help them, or wait for the government of Ukraine to create long term solutions for TBIs, which currently did not exist from what I have started to understand.
I also knew that at least this facility did not have what they needed to help them fully recover. I saw that the best I can do is focus on bringing head injury specialists and their protocols and resources back from the States when I go back.
The Ukraine VA system will have to address the massive head traumas and long term recovery protocols, and it will take many different efforts to facilitate some kind of solution. Brain injuries take a long time to heal. The injured need constant weekly therapy for years. For now most severe cases most likely will fall through the cracks, people having to fend for themselves in search of proper rehabilitation. It was heartbreaking to see that I could not relieve their condition, it was simply too complex and needed time and other therapies. I tried to focus on those who got better, and had to let go of the ones who stopped showing up because they didn’t.
Ukraine is known for adopting quickly to various needs and situations, having gone through many trials and tribulations in the current battlefield as well as during other times of struggle. It’s a resilient society. It’s full of people who care, as well as people who can not anymore. I know that many do not believe in change in the Ukrainian medical system, but I also hope that these soldiers will get what they deserve.
Only last week Zelenskaya visited our clinic, following the visit by the Netherlands Minister of Defense. It means that funding will be coming, and it means changes like a new floor, additional salaries, jobs for new therapists, and perhaps-educational and other resources for treatment of traumatic brain injuries are coming too. But it would take time.
For now, the hospital is gloomy and very cold, the staff is patching trauma with drugs, and the patients take what they can get - the mix of IV vitamins and psych drugs, ten minute visits with a psychologist, magnet therapy, acupuncture, feldenkrais, physical therapy, and whatever else is there, really, depending on any particular day at Lesova Polyana.