Diary of a volunteer: On the front line of war

Part 5: The drums of war

Sunday 16 June, 2024

At 7am there is a knock on the door. By now, Vitalii’s silhouette has become familiar. He indicates that there is an evacuation starting - a patient needs to be collected from a triage point about 25km from the front line and our team is getting ready to pick them up.

My communications colleague Fran is behind me, shoes on and bag in hand before Vitalii has finished explaining. We are so keen not to get in the way. In silence, she slips on her Kevlar, and I wave her off as they depart before returning to my bunk.

It’s mid-morning now and the air is fresh. I’m keen to take a look around the town, to get a better understanding of how civilian life continues, layered between the humanitarian services and the military presence.

We joke to our chaperone that he must have been next on the babysitting roster for the foreigners; he laughs and happily leads us out of the base toward the town centre. He insists on walking a few metres behind us, scanning the road ahead and sky above. The surrounding area is like many Ukrainian towns; large government buildings and community spaces stand empty. Street art and murals decorate walls and bus stops. We pass a park and at the entrance is a memorial for all the local men and women who have lost their lives since the start of the war. The portrait of a young boy looks down at me from the wall, barely 14 he looks as if he is posing for a school photo.

In the park, we are alone. It is a sprawling space with wooded sculpture exhibits, old war memorials, tree lined paths and a huge children’s playground. It is around 10am on a Sunday morning and not a single child brandishes their make-believe sword on the huge wooden pirate ship. All the swings stand motionless and the roundabout creaks in the breeze. I know there are still plenty of people living in this city, and yet the streets and parks are a ghost town. Where is everyone?

There is some hustle and bustle in the hallway as a group are preparing for a trip to the local shops to buy supplies, and I ask to join them. As we’re leaving the gates of the base a crew is returning from a patient evacuation from last night. Our driver immediately stops, and all the team jump out of the car to embrace them, greeting them like brothers, or returning heroes. I’m reminded how dangerous the work they do here is, how they risk their lives to reach their patients, and the stamina required to work on the critically injured for hours on end, hunched over in a vehicle barrelling down bomb scarred roads at 140km per hour.

Christina accompanies the MOAS medics on a critical care evacuation

The town is busy. Old women do their shopping and children eat snacks on benches while countless men in military garb smoke and chat on the street. Outside the basic supermarket there is a Ferrari parked alongside our ambulance and a military truck marked out as ‘medic’ with a cross on each side made of masking tape. When we leave the shop, it’s raining and one of them, a stern tall driver called Kalenda, asks: “Do you like the rain?” I nod saying, “I love the rain”. He smiles back, “me too.”

I don’t know it yet, but this man will be the driver of the ambulance crew I will join later in the day. Together we will stand outside a secret military collection point in a torrential downpour, surrounded by the walking wounded, staring at a rainbow in the sky while our patient is being gently navigated into the ambulance behind us.

I’m the only Maltese left at the base now; my colleagues have both gone out with ambulances while I was shopping. Vitalii is sitting beside me in the rec room when the bombardments ramp up. The volume and frequency of the booming increases and I try to ignore it, but I can’t help thinking about how familiar that sound is. I’ve never been to a warzone before but how can this sound be pulling at my memory. I realise that this louder version of the soundtrack that’s been playing since I arrived at base, sounds almost identical to the Maltese fireworks that go off day and night as the festa approaches. I wonder if I’ll ever hear them the same way again. As I’m lost in thought an extremely loud bang startles me; it’s closer than anything I’ve heard thus far and is accompanied by a small shudder in the building. My eyes dart to Vitalii, who looks at me very seriously and says, “Christina, that was a door slamming”. His face breaks into a smile. I’m mortified and my face burns at my inexperience.

A patient evacuation

Finally, it’s my turn on a patient evacuation. The ambulance crews are made up of three people per team. One is a driver, whose focus is on arriving safely at the patient’s drop off location. They drive for approximately 10 hours at a time, often in the dark with no streetlights and damaged roads. The other is a paramedic, their responsibilities are mainly to the ambulance itself, ensuring stocks are full, equipment is functional, the patient is monitored, and all the paperwork is in order. On my crew this is the fresh-faced Babenko who I’ve had little interaction with till now.

The last person in each team is what makes MOAS so unique – a fully qualified, accredited and equipped anaesthesiologist. With me on ambulance MOAS 68, this is one of our youngest team members, Horb. I’ve been chatting with him across the day. Horb is friendly and open and I’m impressed by the way he switches between his light exuberance and focussed professionalism throughout the trip. The presence of this skill on board means that MOAS can transport the most extreme trauma patients while sedated and intubated, saving them from long transfers in excruciating pain, or an inaccessibility to onward services due to a lack of patient stability. In some areas, MOAS is called for 80% of the ‘red tagged’ patients, at the less busy areas it’s 70%. I ask what happens if a MOAS is not available for an intubated patient. Kalenda shrugs, “most of the time, they wait”.

MOAS medics display diligent patient care even as the ambulance drives at 160km per hour

Once we’ve retrieved our ambulance from its hidden storage location we are on the road, driving east, further toward the action. We will be going to pick up a patient at a discreet medical triage facility around 20km from the latest bombardments. It will take us around 30 minutes to get there and as we are driving it starts to rain. A rainbow comes out and the crew point out national landmarks as we speed along. A disused mine, too close to the action, a town abandoned in 2022 with inhabitants now starting to return, a water reservoir, and in the distance, a grey hazy scar cutting across the flat landscape – the front line. The crew tell me that it’s unusual to be driving in the daytime, and that at night you can see the flashes of explosions and the beams of aircraft torches in the distance.

Soon we’re driving through Kramatorsk, Donetsk oblast’s second largest town. It’s been bombarded throughout the war, an industrial city where strikes targeted factories and export lines. There are destroyed buildings at every block and the council buildings and community buildings have all their windows boarded up. The most infamous attack on Kramatorsk came in April of 2022 when a missile strike hit the railway station, killing 63 civilians, including nine children, and wounding 150 more. The attack happened while between 1,000 and 4,000 civilians were at the station awaiting evacuation following heavy Russian shelling. This is just one of many examples of the indiscrimination of the devastation and violence that has characterised the invasion.

Mutanka the small yellow doll

In a small nearby town, the ambulance turns off the highway into a maze of lanes, passing one last military checkpoint before coming to a stop in front of what looks like an abandoned building. Two stories high, with windows boarded and no signage in sight.

The good luck talisman of the ambulance I’m in, a small yellow doll called a Mutanka, sways gently in the silence and I notice some washing hanging to dry on a nearby tree. The MOAS 68 crew step out of the vehicle, and I follow. It’s only then that I notice a cluster of blood-soaked stretchers piled up against one wall, on another there’s a row of ancient wheelchairs. Dotted around are a few solitary figures, smoking under rusted awnings, all with limbs and faces bandaged, some clearly too short or small to indicate anything but amputation.

Kalenda and his good luck charm mutanka

We’re at the pickup location. I’m asked to wait by the ambulance with the driver as the medics go inside to arrange for the transfer. My eyes follow them through a heavy door and on the walls that line the corridor are countless pictures drawn by children with messages on them, mostly coloured in blue and yellow.

The rain picks up, but neither myself nor Kalenda make any effort to avoid the weather. We stand together waiting for our patient to be brought out and loaded into the ambulance.

The patient comes out with Horb and Babenko. The stark difference between the old, handheld stretchers rusting along the hospital walls, and our own shiny backboard on collapsible struts is alarming. The atmosphere on the ambulance is immediately different, everyone is focused on the patient. Babenko checks all the handover paperwork and fills in our own MOAS patient card before signalling to Kalenda that we can leave. We drive faster now, all eyes ahead on the road. Kalenda knows where he is going from experience and instinct; at the start of the war the Ukrainians destroyed all road signs and markers to make invasion more difficult for the Russian forces. He only uses the sirens when there’s traffic or at the many checkpoints we are waved through. Some soldiers at the checkpoints salute us as we speed past, a sign of respect for their fallen comrade and the humanitarian team fighting to save him.

The patient is 32 and he has a traumatic abdominal wound. In the ambulance he is wrapped tightly, none of his injuries visible above his dressings and hypothermia blanket. His resemblance to my partner makes me uneasy. He has already had emergency surgery and will be reviewed in Dnipro, our drop off location.

The crew respond to every change in our patient. Every beep or flash on the machines prompting a check, or adjustment. The patient is sedated and intubated, breathing rhythmically with the pulsation of the ventilator. He won’t remember this journey. I wonder if he can hear them murmuring as they treat him and maintain his sedation. They explain each step to me, reassuring me the noises or lights are only due to the movement of the ambulance, the shift in weight, the need for a little more sedation. They’re seamless. Efficient but not panicked, professional and caring.

We are driving between 140 -160km/hour, but the journey is smooth. All the while the team deftly tend to their patient. They have an innate ability to communicate his needs between them, indicating to one another when we need to slow down for a blood pressure check, avoid bumps when preparing perfusion, they are efficient, clean and professional but also caring and respectful. To them this is a brother, he is a hero. Horb tells me that they work on each patient as if the family is watching.

‘They think war is faraway’

Coming into Dnipro the traffic is worse, people are lazy about moving out of the way, the sight of ambulances must be so common now they can’t muster up any sense of urgency. Horb notices me getting agitated as we come to a stop behind a queue at an intersection, “They think the war is far away,” he says simply. He’s right, life even here is pretty unaffected, and in Kyiv you’d be forgiven for forgetting there’s a war on. The soldiers, civilians and humanitarian organizations in the Donbas are using themselves as a shield to protect this way of life, a physical barrier between the horrors of life under occupation and the normalcy of life beyond it, but it shouldn’t be so easily forgotten.

Relief and pride for MOAS teams as they drop their patient off at referral hospital

Kalenda is from Dnipro, so as we make our way through the city toward the hospital he talks of his family and life in Dnipro before the war. He says it’s strange to be so close to them on such a regular basis without being able to see them. Sometimes they come to the hospital in Dnipro when he is on a drop off, even in the middle of the night, just to wave at him from the barriers as he drives in and out, a cherished sliver of contact that sustains them all until they can be reunited.

Pulling up to Dnipro hospital, we are back to a medical system I can recognise. Signage directs us to ambulance drop off, and the A&E sign glows neon in the dark. The doctors and nurses are waiting for us as we pull up and I barely have time to bestow a silent prayer onto the patient before he is whisked inside. Job done the crew do not pause for breath, disposing of their waste, disinfecting the ambulance, prepping for their return.

I go straight to the hotel. It’s late, and we have an early start the next morning for our drive back to Kyiv. I sleep soundly this night. If there are air raid sirens, I don’t hear them. Nothing can penetrate the emotional and physical exhaustion of the weekend. I’m amazed by the stamina shown by our staff in the field, their ability to re-deploy, re-focus, re-commit, over and over again.