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LVIV, UKRAINE – The big day is here. Oleh cautiously shifts his weight onto his new, German-made prosthetic left leg. It pinches slightly and is removed for some final adjustment before it is refitted to hopefully serve its wearer for years to come.
It’s been four hard months since the 35-year-old Ukrainian civilian was cut down by flying shrapnel as he entered his home in the eastern town of Bakhmut, the scene of some of the heaviest fighting in the almost 17-month-long war in Ukraine.
“I don’t know what [kind of projectile] it was – all I heard was whistling for a second,” recalls Oleh, who was taken to Dnipro, where the shattered limb was amputated above the knee. He was then transported on an evacuation train 500 miles (800km) across the country for treatment at the “Unbroken” National Rehabilitation Center in Lviv.
Unbroken’s head prosthetist Nazar Bahtiuk makes final adjustments (left) to the artificial limb fitted for Bakhmut resident Oleh. (Nick Allen/Direct Relief)
Oleh is among approximately 15,000 Ukrainian patients to pass through the center since the start of the war. It is located on the premises of the First Medical Union of Lviv, Ukraine’s biggest healthcare facility consisting of two hospitals for adults and one children’s hospital. As well as its prosthetics capacity, Unbroken has surgical and burns units and offers extensive physiotherapy and mental healthcare, all provided for free to patients.
“Our goal is to help Ukrainians remain UNBROKEN and get all the necessary help here, in their own country, near their families,” declares the website of the center, which is supported by the government, Lviv city, private donors and international organizations, including Direct Relief.
Next-Generation Care Under One Roof
Bright and modern, the center exudes positivity and pride at every turn: Portraits and the stories of former and current patients hang on the walls, artworks embody human fragility and resilience, and scarred but upbeat care recipients stop and chat as they wheel themselves in chairs or hop on crutches around the complex.
In addition to around 450 patients at the other hospitals and units, there are presently 39 patients living here. From their admission to receiving and learning to use the prosthesis can last a few months. This includes physical and mental health care, several weeks’ healing following any additional surgeries needed, up to three weeks of preparation of the prosthesis, and then fitting and adaptation. Around 160 people went through the whole process so far, with thousands more around the country also now needing care.
Patients with spinal injuries also receive treatment here, including individual care from social psychologist and life coach Pavlo, who is himself wheelchair-bound. “I coach them in how to live if you don’t have full physical function, moving from bed to wheelchair, using the bathroom, dealing with architectural barriers, how to do adaptive sports like bench presses.”
In an adjacent room, physiotherapist Maria works for the second day with Olha, a local woman who fell at home and broke her arm in two places, helping her regain full use of her hand through exercises. “There’s a big difference already; yesterday, I could only use two fingers. Today it’s all five,” Olha says.
Lviv resident Olha works with physiotherapist Maria to regain the use of her hand after an accident at home. (Nick Allen/Direct Relief)
At the end of the room, which is fitted with computers and a kitchen range where patients relearn daily activities, waits Mykhailo, who is missing a recently amputated leg. “I am not a soldier – I had an agricultural accident,” he tells visitors in English with a smile. His wife, still clearly shaken by the events, stands beside him.
However, around 90% of the patients receiving prostheses are military personnel, says head of prosthetics Nazar Bahtiuk, who has almost two decades experience in this field. He is one of only about 20 specialists in Ukraine, so it was a huge boost when he joined the team last year, says Solomiya Yakubechko, the head of Unbroken’s communication department.
Sculptor and prosthetics trainee Lyubomyr measures a plaster mold of a limb stump before pouring a plastic socket attachment. (Nick Allen/Direct Relief)
Bahtiuk also conducts training within the eight-person prosthetics team, which, as well as using imported components, makes its own socket fittings, starting with a plaster mold taken of the stump of the amputated limb. The team’s most recent addition, Lyubomyr, is a local sculptor who volunteered his skills in the casting process and has been in training for the past three weeks.
A Long Journey in a Changing Society
Resident patients have regular sports and social activities, including excursions to do archery, horse riding and bowling. As well as being fun group activities to build confidence and stamina, the outings have a crucial broader effect – of making the patients visible in public: “Our society needs to see them, understand that this is a man with a prosthesis, and accept them as part of that society,” says Yakubchenko.
Physical trauma is often accompanied by inner turmoil, addressed in the center’s large mental health department, where 11 specialists work. As well as psychological and psychiatric care it offers body therapy, which incorporates touch, breathing and movement techniques to address various mental and physical health concerns.
Another medium is art therapy, where patients are encouraged to express themselves and unlock mental obstacles through drawing. Patients who suffered trauma from injury, captivity and torture often resist the idea at first, asking why they need to relive painful emotions.
“If we don’t go through these emotions again, a big part of our potential can stay arrested,” explains psychologist and art therapist Orest Vasyliuk.
It can take several sessions for the therapy to take effect, he says, showing three colored chalk drawings done on successive visits by a Ukrainian soldier who was badly tortured during months of captivity. It is a powerful triptych: From angry stabbings on the paper with a red chalk stick in the first drawing to a personification of horror in the second, and then a burst of sunlight, nature and color – juxtaposed with a scream – in the third.
Three drawings done by a soldier in successive art therapy sessions show a shift in associations, from left to right, as the soldier participated in more sessions. (Nick Allen/Direct Relief)
A great sense of journey becomes apparent when visiting Unbroken. That journey doesn’t end with a successful skin graft or a new prosthesis but continues with new challenges and perspectives, some darker, some brighter. As one initially reluctant art therapy patient told Vasyliuk after he started to draw in his free time: “You opened my eyes to colors and then I started to see life more colorfully.”
Oleh from Bakhmut knows he has an arduous recuperation ahead of him but says he can at least contemplate that now, compared with the immediate aftermath of his injury. “At the beginning, it was…I don’t know how to describe it,” he says. “Now it is getting a little easier; I don’t have the depression of earlier. I know I must live, work, and build a family.”
Since the war’s start, supporting rehabilitation and recovery from war injuries, both physical and psychological, has been a core focus of Direct Relief. The organization has committed $15 million to specifically support rehabilitation and injury recovery efforts in Ukraine. Direct Relief has helped Unbroken procure rehabilitation equipment, develop treatment protocols, and train rehabilitation personnel.
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