Odesa is a port city on the north-western shore of the Black Sea. In peacetime, the ‘sea pearl of Ukraine’ is popular with tourists who flock to its waterfronts and beaches and stay to be charmed by its splendid architecture including the pastel-hued façades of neoclassical and art nouveau mansions and the most beautiful opera house in all of Europe.
In wartime it is a strategic prize, for whoever controls Odesa, controls the Black Sea.
Located just 200 km west of Kherson, the city of Odesa has been the target of shelling and air strikes since the Russian invasion began. Air raid sirens ring out daily, and the list of civilian casualties keeps growing longer. During December, attacks on the energy grid plunged the city in darkness.
In April 2022, the Angels team in Ukraine together with Ukrainian stroke associations started running weekly Zoom calls for stroke physicians caught in the war – an initiative that would later gain a formal agenda and the support of the ESO’s Task Force for Ukraine. The opportunity for sharing their experiences and feeling a sense of community was embraced by stroke doctors around the country, including Dr Oleksandr Kartashov, the head of the intensive care department at Odesa Regional Clinical Hospital.
Located in the Suvoroskiy district in the north-eastern part of the city, Odesa Regional Clinical Hospital is a comprehensive centre and the leading stroke centre in the Odesa region under the direction of the chief director Dr Yurii Gulchenko. When Angels first started working with this hospital in 2016, they found an entire team of stroke champions already in place – Dr Kartashov himself, Dr Volodymr Kolesnyk, head of the neuroradiology department, and Dr Iryna Hubetova, head of the neurology department, who was later replaced by Dr Olga Velychko.
In 2016 Angels consultant Lev Prystupiuk visited Odesa for simulation and training workshops that marked the beginning of a new trajectory for stroke care at this hospital.
The numbers tell the story. Twelve patients underwent thrombolysis in 2016, and the median door-to-needle time was between 60 and 70 minutes. In 2017 and again in 2018, over 30 patients underwent thrombolysis, and in 2019, after simulation training by Angels consultant Maria Sheverdina, that number doubled to 63. Since 2021, over 200 stroke patients have been given a second chance at life at Odesa Regional Clinical Hospital, with door-to-needle times of between 20 and 30 minutes.
Dr Kartashov traces his personal experience with acute stroke treatment to 2010, a time when the attitude towards thrombolysis in Ukraine was tentative at best. He was on night duty when a female patient was admitted with signs of stroke. After ruling out other contraindications, Dr Kartashov decided to perform thrombolysis but although the treatment was successful, as a result of the perceived risk he was obliged to write many reports explaining his actions. “Winners are not judged, but I was,” he comments drily.
The event did however turn out to be a turning point for the hospital.
In 2019, the hospital won its first ESO Angels gold award, but while its performance continued to improve, entering data into RES-Q took a back seat for the next two years. That was, until war broke out and, on a Zoom call in April, Dr Kartashov listened with intense interest as Dr Yuriy Flomin, one of the leading stroke experts in the country, urged doctors to share stroke treatment data with RES-Q.
Centres of excellence like Odesa Regional Clinical Hospital deserved to have their results recognised, Dr Flomin said.
Once recorded in RES-Q, these results did indeed tell an extraordinary story of stroke care quality at the hospital and recognition soon followed. For the period April to June 2022 – a time when hospitals in Ukraine were becoming strategic targets – Odesa Regional Clinical Hospital won its second gold award,
How can you work when you know an attack could come at any minute, Maria asked Dr Kartashov at the time. He replied: “What else can we do, except to continue to work and hope.”
So they carried on working and hoping, and for the period July to September, as the frontline moved nearer to the city and rocket attacks claimed dozens more civilian lives, Odesa Regional Clinical Hospital won its first diamond award. And in the quarter ending in that dark December, they added a second diamond to their crown.
If war and stroke teach us anything, it is that life is precious. This is why Dr Kartashov says, “It is so important to give our patients the chance not only to live, but to really stay alive.”
