CHERNIHIV, UKRAINE – In April 2022, hours after Russian troops withdrew from the northern Ukrainian city of Chernihiv, humanitarian aid workers with the Association Internationale de Coopération Médicale were met with scenes of destruction.

Scenes of devastation, including damaged infrastructure and improvised graves, marked the city, according to Dr. Christian Carrer, co-founder of the Association Internationale de Coopération Médicale, or AICM.

“Since the beginning of the fighting, we were the first NGO to bring medicines and food to a population that had resisted the unthinkable. Many hospitals were devastated and hundreds of thousands of patients from the surrounding villages no longer had access to healthcare.”

Little did his team realize that this was the start of a unique relationship with hospitals in this frontline region bordering Russia and its ally Belarus. While continuing to deliver medical supplies and other essentials to Chernihiv city and region, AICM, supported by Direct Relief, has also been expanding one of its most innovative projects in Ukraine.

For the past two years, AICM has been working not just to restore destroyed ultrasound capacities in Chernihiv’s hospitals, but to rethink the paradigm altogether, providing fast access to specialists in other locations and slashing treatment timeframes.

The key to this is a portable ultrasound probe called Butterfly, designed by French doctors in 2021 for the company Santé Intégrale. Coupled with a smartphone or tablet, the handheld device enables medical staff to comprehensively screen patients anywhere, including in an ambulance, with real-time imaging on their phone or tablet screen.

Images can be shared with specialists in the regional capital for further examination and guidance on referrals if needed. This is a game-changer in Chernihiv, which is about the size of the U.S. state of Maryland and had a pre-war population of around one million. Tens of thousands fled for safety after the war began, especially young families, leaving many elderly people isolated in villages with limited access to medical care.

With bus services to Chernihiv city sometimes running just once a week, the Butterfly affords great savings in time and expense for patients whose local medical station can be up to 65km (40 miles) from the nearest hospital, said Oksana Logvynchuk, the director of 14 state-run ambulatory medical centers across the region.

A Pocket-Sized Lifesaver

The probe also proved to be a lifesaver for some patients, revealing serious issues during regular check-ups.
“This way we manage to catch many things before they get catastrophic,” said Logvynchuk. “Previously, there were delays of 2 weeks to 3 months when patients were sent for ultrasound screening. Now, it usually takes 2-3 days.”

“This was a discovery for us and we jumped on [the possibilities],” said the doctor, praising the device as a force multiplier in medically underserved areas. Currently, 130 doctors share a dedicated Telegram group – patient confidentiality is of course still paramount – where pathologies and paths of treatment are discussed by experts in a particular field.

Fifteen local doctors under her supervision have been trained so far. Another 20 are in line for training as this component of the project grows steadily, as do overall hospital capacities in Chernihiv, despite the constant military pressure on the region. All hospitals have air raid shelters in their basements.

Multiple Applications

AICM began the Butterfly project in 2022 in conjunction with its French partner, distributing 47 units in Chernihiv with accompanying training of scores of medical staff. Direct Relief supported the project’s expansion this year with a $110,000 grant to supply 25 more probes and conduct training. In addition to the units provided to AICM, Direct Relief also conducted a 2023 training that equipped first responders with ultrasound training and portable devices.

The device, which is designed in France and manufactured in China, can quickly detect situations like internal bleeding and is used in such specialties as cardiology, oncology, nephrology, and endocrinology. It also enables preliminary screening at busy health facilities, freeing up larger stationary ultrasound equipment for more detailed analysis.

At Chernihiv’s impressive Medical Center of Modern Oncology, the Butterfly is often used for essential but simpler tasks like measuring stomach liquid levels, a key indicator of oncological conditions, said medical director Dmytro Tsvir. “But it also has applications like establishing the presence of tumors.”

“It has been useful in many diagnoses,” agreed Nataliia Serhiichyk, medical director at the Regional Children’s Hospital, where three donated Butterflies are in service. “We have one that is jointly used by four doctors and they all want one now,” said Serhiichyk, who recalled the device’s effective use by two surgeons trying to extract an air-gun pellet moving around inside a boy’s knee.

‘Risky Bet’ That Paid Off

AICM, which is based in the east-central Ukrainian city of Poltava, began its ultrasound project in Chernihiv by donating four stationary machines from an American donor, but that was not enough. It then worked with its French partner to deploy the probe as close as possible to patients in small local medical stations.

“It was a risky bet because family doctors had never used such devices,” said Dr. Carrer. “But we were helped by the specialized hospitals of Chernihiv in oncology, pediatrics, cardiology, and surgery.”

Therein lies the success of this project, he believes. “The war brought to the medical network of this region a fundamental social element: solidarity. There is no more hierarchy or rivalry between specialists and general practitioners. They now work together for their patients.”

In 2023, AICM also donated three of the probes to the state ambulance service in the Poltava region. Funds allowing, it plans to roll out the project there and in other Ukrainian regions in the future.

Direct Relief has supported health services for Ukrainians with over $1.4 billion in medical and financial assistance since February 2022, including through partnerships with organizations like AICM and the Society of Critical Care Medicine.