Prelude to Medic Work in Ukraine, part 3

#2:  "Do Not Harm Enemies Who Surrender: Disarm them and Turn them over to your Superior"

- From the United States Marine Corps Common Skills Handbook, Core Principles of the Law of War

January 2023

I've spent the first year of the war filling out applications to every medical NGO that has operations in Ukraine. At long last, it looks like I'll be accepted for a volunteer deployment to Ukraine as a Paramedic, this spring. I'll spend my last two months in Africa hiking up the hill to the "cell spot", in order to do interviews and process onboarding paperwork for Ukraine.

Our rural West African clinic is busy today. Dozens of men, women, and children wait outside the clinic; this is the only free medical care available within 3 days' walk. They chat, share food, and migrate patiently along with the shifting shade of the mango tree as the day progresses. Each evening at the local teahouse, the village men gather around a shortwave radio to listen to BBC. Major news, and a favorite topic of today's conversations, is the war in Ukraine. The general anticipation that Kiev will fall within a few days has turned out to be wrong. Right now, much of the world is rooting for the underdog in this fight. I'm hungry for more details, but information is limited in our remote village.

Local disease outbreak history here includes Ebola and measles, so we are careful to arrange as much social distancing as possible for our waiting patients. No inside waiting room. In any case, conditions are far more sweltering inside the clinic than outside. Last night a thunderstorm gave us an early taste of the coming monsoon season, and humidity remains high. We have no fans, but we open the windows and doors to maximize airflow.

In the crash room we currently have a pediatric patient whose initial presentation would stir panic in the heart of any seasoned US doctor or paramedic. She is 3 years old, limp, listless, dehydrated, semi-conscious, with a racing pulse and raging fever. She might be a critical case in the US, but for us, she's a run-of-the-mill kid with Falciparum malaria. We see several similar cases each week, once the rains start. We'll trial a dose of oral ACT (Artemisinin-based Combination Therapy- malaria has become resistant to many single-drug therapies, so a combination of drugs is now needed). If she doesn't throw it up, she'll almost certainly be stable and sleeping comfortably within an hour or two. If oral drugs don't work, we'll give her intravenous antimalarials, which pretty reliably yield a similar positive outcome. Without antimalarial drugs, she would be in grave danger. Falciparum is the most serious strain of malaria, and it is the country's leading cause of death. Rapid treatment is key. Our door-to-antimalarials time is less than 10min for most serious cases. 

While caring for the girl with malaria, we are serenaded by the continuous crying of a 3-day old girl, brought in for a well-baby checkup by her mother. The heat, high patient load, and cries of the newborn are conspiring to create a fairly trying day. As soon as possible, we frontload the newborn. She is mom's first baby, and the pregnancy and birth were uncomplicated. The baby is a bit feverish to the touch. When we undress her, we discover she has a severe cord infection, and is dehydrated and tachycardic. We evaluate options for transport to higher care. The nearest hospital with a neonatal ICU is a 2-hour bike ride away, down very rough roads. Our motorcycle ambulance has already left town with another serious patient. I send a runner out to search for any bikes in town.  

We start an IV. Our care options are limited; we have no oxygen, and the infant is too young for us to safely dose with a starting load of antibiotics. As I watch her, her breathing speeds and slows, and her limbs go blue, then return to pink when I stimulate her. With each episode of slowed breathing, the blue cyanosis spreads further, until it rings her mouth. I pat her feet and bounce her gently, and her breathing and color improve. I look up to see that the village Chief has entered the room. Generally we are respectful with the Chief, but this time I order him loudly: "I need a motorbike to the hospital for this baby immediately". 

Ten minutes later a driver, mom (still recovering from birth), and I are stacked three deep on a bike, headed down the steep, slippery hill to town. We jolt over ruts and splash through puddles. I can't imagine how hard this ride must be for mom. She holds the infant and I monitor baby's breathing, vigorously tapping her feet each time the cyanosis creeps back. I'm afraid to try using a bag-valve mask to breathe for her during this bouncy ride. It's easy to over-inflate a newborn's lungs, even under good conditions. My plan is to promote awakeness and breathing through tactile stimulation, and to give her mouth-to-mouth if she goes into complete respiratory failure. That way I can fill my cheeks with air and control the air volume she gets on this bouncing bike.

We settle into the long, familiar ride. The roads are very bad. Riding like this is probably the most dangerous thing we do here, so it's nice to focus on something else. I figure I'll fare better in a crash if my body is relaxed, not tensed. I alternate between watching the infant's breathing, tap-tapping her feet, and looking at the greenery passing by. I wonder what is happening in Ukraine right now. My favorite song, "Whistled By", is playing on repeat in my head. I imagine the patient is a trauma patient, the rig a beat-up, ad-hoc ambulance, and the roads the morass of the 'Rasputitsya' mud season. 

The news has been featuring stories of kidnapped Ukrainian children being spirited off to Russia. I find these stories particularly ironic, given that there was no shortage of unwanted street children in Russia during my exchange program time there. Shouldn't Russia see to them, before stealing extra children from Ukraine? I recall living in Vladivostok, and helping serve daily soup and bread to street kids after my Russian classes were over. I worked with several dedicated, kind-hearted Russian volunteers. I got to know a couple dozen of the kids pretty well. Some of the teenagers were my peers. They had their own peculiar street ergot, so I didn't always understand all of the stories they told me about their lives. But I understood enough to know that these kids didn't have the luxury of justice, or of choosing right over wrong. For them, the strong devoured the weak, and that was it.

A few denizens of Vladivostok must have seen me often enough with the street kids to think I was one of them. One day, enroute to class, and being a day-dreaming teenager, I stopped to admire a sailboat at anchor in Golden Horn Bay. I stepped a short distance off the sidewalk to do it, into a used car yard, and for a better view I used a toe placed in the chain link fence to boost myself up a couple feet. As I gazed at the bay, I imagined exploring the world on that boat. 

I heard a little click. I looked to my left. I took in many things quickly. A hundred meters away was a trailer. On its porch stood a large man in soiled work clothing. His shoulder held open a storm door, and he was rising up, having apparently just clipped something to a bolted chain on the deck. 

What he clipped was a lead, attached to an enormous black rottweiler mix. 

The dog was silently, teeth bared, making for me, at top speed. His sprint was low, fast, filled with rage and deadly intent, and a chain bounced along the ground behind him. He had already covered half the distance to me. I had a split-second debate: try to climb the fence and hop over, or try to retreat beyond the reach of the dog's chain, before he reached me?

Seeing as time was not on my side, I went for the option that involved the aid of gravity. I pushed hard off the fence, leapt back and sideways several steps, and then the dog was closing on me. His teeth flashed towards my leg, and I kicked out and rolled backwards over my right shoulder. Arms over my face I rolled several more times, backwards and away from him along the line of his chain. I rose and ran backwards several more steps, but as I looked at him, I saw he had reached the end of his chain. He jerked at it, snarling, spittle flying. As I rolled, he had seized my left pant leg and torn the lower half clean off. Miraculously, the skin of my calf had suffered nothing more than an abrasion.

I looked up at the man. He stood, arms crossed, watching. The dog was very large and I was fairly certain it would have torn my throat out if able. I was also fairly certain the man had seen me, quietly opened the door, and let his dog loose on me. I was worried about the dog's lunging pulling out the bolt that restrained him, but I was far more worried about the man's intentions. He was large, and very possibly armed. I strutted away nonchalantly, showing no fear. But as soon as I was out of view, I ran as fast as I could for friends and safety. 'Well', I reflected, 'there's an accidental taste of life as a Russian street kid for me.'

Over my years of travel, I have developed a habit of rating a culture by how it treats its street kids and stray animals. I've been to places where the stray cats come up and bump your legs, and roll over to show their bellies for caresses.  But not in Russia- it has some of the wariest street kids and strays I've encountered anywhere. I've never been to a place with so many mutilated animals wandering the streets- tail-less cats, nose-less dogs. What will this country do to an enemy in a war? The Katyn massacre, mistreatment of civilians and POWs... that behavior from our ally all got white-washed during WWII. Now we have cellphone cameras, satellite imagery, and social media. What will we see from this post-tech-revolution European war? 

I relax on the back of the motorbike, comfortably filled with deep thoughts that don't involve the possibility of crashing. The baby girl keeps breathing, and we transfer care to the Neonatal ICU in town. After two weeks of hospitalization for sepsis and acute liver failure, she is discharged with an excellent long-term prognosis. It's been a good day.

Prelude to Medic Work in Ukraine, part 2

#3:  "Do Not Kill or Torture Prisoners"

- From the United States Marine Corps Common Skills Handbook, Core Principles of the Law of War

Late January 2022 

Things are mostly packed and ready for the yearly journey to Africa. More and more frequently, my daily work occurs with "Comprehensible Russian" podcasts and Ukrainian news playing in the background. Included in these is Bellingcat's investigative series on Flight MH17. This Malaysian Airlines flight was shot down by a Buk surface-to-air missile in 2014, as it passed over a then-freshly-ignited conflict area in East Ukraine. 298 civilian passengers died in the crash.

My old favorite Russian songs of my teens have been resurrected as workout tunes. When the war starts, I'll come to be surprised at how many of my favorite bands make the risky move of coming out as anti-war. And what about the Russian friends I danced with? Will they protest the war? It will remain a lingering mystery- even in 2021, my letters to Russian acquaintances have begun to go unanswered. I'm probably just writing to the FSB now.

A favorite of mine, "Prosvistela" ("Whistled by") comes on. I realize I've never paid enough attention to the lyrics to understand them. I listen now, and pick out a confusion of something falling on the table, a hug, heaven, being prisoners of the motherland. It doesn't really make sense, so I finally google the meaning. It turns out my favorite song was written by Yuri Shevchuk, after a visit to soldiers fighting in Chechnya. Scarred by the horrors he saw, Shevchuk penned an unsubtle composition about a grenade falling into an armored personnel carrier. Everyone inside is killed, but in heaven they reunite with friends, find freedom and happiness, and reflect on the meaninglessness of the war. I'm shocked that this song, which blended seamlessly with the teeny pop discoteca sounds of my youth, had such a deep and dark meaning. You can here it here, and my translation of the full lyrics is below: Prosvistela/ "Whistled By", DDT https://www.youtube.com/watch?v=inG69xYWROw

The music draws me back into memories of Russia. I'm 16 again, and it's my first week in southern Russia. My host family doesn't speak a word of English, which is tremendously exciting for me. I've chosen Russian because I believe Russia will cause trouble one day, and I'll want to know Russian very well. Complete immersion is the best way to learn. I'm constantly thumbing through the heavy Russian-English dictionary I carry everywhere in my backback (no Google Translate or Kindle app in 1998!). Everything- "I'm hungry", "Good morning", "Where is the bathroom?" requires a consult with the book. Unfortunately I had an orange juice explode in my bag on the plane, and the dictionary remains decorated with tiny black mold stains for the year-long duration of my visit. Every morning I select 50 new words and write them down three times, in order to commit them permanently to memory.

During my first few days, southern Russia sees an oppressive August heat wave. My host family retreats to the beach, and I promptly become very ill with food poisoning. My host mother wisely sees me through with a treatment of two shots of heavily salted vodka, followed by bed rest.

By the time my second week in Russia rolls around, it is time to return to school. I'll be accompanying my host sister to the equivalent of a K-12 public school. At 14, she is two years younger, and immensely more wordly than I. "Irina" (name changed for her safety) has it all planned out: on her 15th birthday, she'll try Ecstasy; on the 16th, she'll lose her virginity. At the end of her 16th year, she'll enroll in college, preparatory to Law School. I'm placed in Irina's grade, and she helps me understand the lessons, which are of course all in Russian.

The heat wave, if anything, has grown more intense on our first day back at school. The class swelters, as the teacher conducts what I come to realize is a surprisingly in-depth review of World War II history. My host sister knows far more than the average American college student about 20th century European wars. I half-follow vaguely familiar battle names and dates, thumbing through my trusty, moldy dictionary.

Before math class, I join my host sister and her friends outside, politely declining their proffered cigarettes. Sweating and swatting at flies, we seek refuge under the only shade available, but don't stay too long. They must not have taken out the trash since spring; the air stinks of rotting meat.

We return to class, math this time. Suddenly, a woman comes in and draws the teacher from the room. A growing wave of whispering begins: "Samo-ubitsvo!" I feverishly flip the pages of my moldy dictionary, seeking this new term which has caused such a stir.

It means "suicide".

In the next two hours, I will be introduced to the real Russia, and the reality that, in most of the world, the strong devour the weak. In the next week, at 16 years old, I'll build two key emotional foundations. One is for dealing with Americans who turn a willful blind eye to the evils of the world (as with many future ugly international realities, my American compatriots cope with the alien violence and ugliness of this first day of Russian school, by simply refusing to believe in it). The second foundation is for recognizing and navigating the special mix of 'anything-is-possible and nothing-is-real', which underpins every twist of the marionnette strings, by which the Russian government controls the Russian population.

Our math teacher comes back inside, and acknowledges that there's no chance of us paying attention to the lesson. He releases us, and we join the entire student body outdoors. Kids from age five up through sixteen form a ring around the shade tree, where we had smoked earlier. The body hanging in the tree was discovered shortly after we left. The next group of smoking girls looked up when it dripped on one of them. It had probably been hanging, twenty feet up in the large oak, for the entirety of the hot weekend.

I saw my first body at age 14, when I discovered my mother had passed away from a mixture of cancer-induced hypercalcemia and pain medications. That was a peaceful and expected relief from pain, and I closed her eyes with more relief for her than grief.

This second body was much messier. At each of his slow rotations, his face was visible above us. It was plum-purple and bloated, and an impossibly swollen tongue stuck obscenely from his mouth. The military showed up with a pickup, and made a great show of obtaining his passport and reading his name out loud, then showing the passport around to the group of students. One of the soldiers then told the circle of assembled students to back up. He jabbed me in the abdomen with his AK when I was slow to respond. My host sister came to my rescue, saying I was "an Amerikanka, I didn't understand". I really wished she hadn't done more to make me stand out; even at sixteen I instinctively understood that what what happening here was outside the bounds of rule of law. Anything could happen. Being an American was crappy protection.

The soldier who had climbed the tree to get the dead man's passport proceeded to tie a rope around the waist of the corpse. The crowd of students parted to allow a pickup truck to drive in. One arm covering his nose, the soldier in the tree reached out and sawed though the rope around the corpse's neck. The circle of students, small and large, stood immmobile, barely glancing at the soldiers' AKs. They gazed upward, rapt, wordless. Neck-rope severed, the dead man described a slow-motion arc backwards. His torso came to an abrupt stop at its perigee, impossbily purple face now upside down, and oriented our way. An unexpected amount of what looked like black, clotted blood gushed out of his mouth and into the pickup bed below. I felt fortunate that my parents had enrolled me in many dissection and veterinary classes in grade school. Today's scene was no way to introduce oneself to the ugly side of mammalian biology.

The soldier in the tree undid a hitch, and slowly lowered the body, now essentially hanging upside-down, into the truck. With no further formalities, the soldiers left the scene and classes resumed. Being sixteen, abroad, and not having experienced the aftermath of a grisly suicide at school before, I accepted this as the normal process here. I told my dad about it next time we talked, and otherwise went on with life, and my observations of this very-different-from-American culture. It was ironic, comparing the complete lack of response from the Russian school system, to what would have happened at home in America. A scene like that on the grounds of a US school? The school would have been closed for a week, mandatory counseling for all the students! But, this was Russia. Counseling? Compared to watching the body of one's mother slowly destroyed by cancer, this really wasn't a big deal. As long as you're lucky, healthy formative-years coping mechanisms get built, and life goes on.

Only in retrospect, listening to Bellingcat and Prosvistela, did I begin to appreciate some of the political undercurrents of that day. Even in Russia, where life can be cheap, the man in the tree, so long ago, was probably not just a suicide. The army had taken far too much care to make sure all the students watched, and to make the name on his passport known. The man in the tree must have been someone... a political dissident, a rebel, an enemy of the mafia. He must have been someone worth making an example of. My dad, of course, believed every word of the story. The convenient denial of the other Americans- the other Exchange Program students and managers- was the first of many, many times that I would cope with this failing of my own culture. Outgoing President Obama would sum it up well in a 2015 speech: "If the American public cannot, or will not, differentiate fact from fiction, than we are in deep trouble".

Well, I'm just one member of that public. But, at sixteen, I surely appreciated my first lesson on what the breakdown of rule of law does to a society. My eyes and mind were wide open. I had expected that Russia would be challenging, romantic, sweet, and world-changing for me. It was all that. It was also ugly, corrupt, and violent.

So, twenty years later, when it came- Russia's wholesale violation of the Law of War in Ukraine, violation of "Do not kill or torture prisoners"? It was absolutely no surprise. Not after what I saw during my year in Russia.

Learning the structure and nature of Russia's ugly parts, and how to recognize their equivalents in other societies (including my own) was the greatest lesson of my time in the Russian exchange program.

Prelude to Medic Work in Ukraine, part 1

#4:  "Collect and Care for the Wounded, whether Friend or Foe"

- From the United States Marine Corps Common Skills Handbook, Core Principles of the Law of War

Early January, 2022

Grey clouds threaten to deliver a rare winter snow to my Western US mountain home. I hasten to relieve the springs of my old prius from their burden of medical supplies boxes- freshly donated by a local nonprofit partner. The collection of just-expired dressings, sutures, syringes, and IV sets are sure to save a few lives in West Africa over the coming year.

One by one, I lug the boxes in, adding them to the growing stack of supplies in the corner of my living room. Mission accomplished, I sprawl onto the couch to endulge my news-junkie compulsions. It's early January 2022. The US legal system continues to weigh in on vaccine mandates, and our societal pandemic response settles ever more firmly into dysfunction, setting the stage for future airborne disasters. But that's no surprise; the same thing happened after the Spanish Flu. As far as mainstream media goes, Trump has been tucked gratifyingly out of sight, as social media platforms and news outlets explore ways to navigate tech-revolution misinformation. Income-inequality fuels populism, while changing population dynamics fuel political extremism. All of these things together are making it feel a little bit like the 1920's and 30's. I turn on some Louis Armstrong and imagine I'm living in Huey Long's Louisiana.

Putin continues to insist that his military buildup along the borders of Ukraine is a mere exercise. Everyone else continues to do the convenient thing, which is to take him at his word. I listen to NY Times interviews, where dismissive Ukrainians refuse to be cowed by these latest Russian antics. Their tendency to replace hard 'Gs" with a soft "H" reminds me of the southern Russian accent I acquired, living near Sochi as a teenage exchange student. My time there was punctuated by the "Chechen" apartment bombings. Rumor has it, these were actually an FSB plot, orchestrated by then-Prime Minister Putin, in a bid to coalesce ordinary Russians behind him. Russian officials who raised the issue of a possible FSB plot? They developed a habit of dying under suspicious circumstances, and nothing was ever proven. The ensuing Chechen war cemented Putin's popularity, and made the new Chechen leadership into his puppets. Through lies, support of opposing fringe movements, and engineered political theater, Putin progressively undermined Russian society's ability (and will) to tell truth from fiction. Russia is the world's leader in government-by-disinformation. Since the 2016 debut of the Trump campaign, I have been hearing American echoes of Russian propaganda techniques every day.

Outside, the snow has started. Curled around a cup of Earl Grey, thousands of miles from European troubles, I mull over what the future may hold. I compare Putin's antics- his increasingly bold meanderings, first into Georgia, then Crimea- with the expansionist European strongmen of the 1930s. I don't dismiss the military buildup around Ukraine. Not at all.

That night, in my dreams, I shelter from bombs in the basement of a Ukrainian hospital. A chimeral Russian army sweeps, inevitable as gravity, through my Ukrainian dreamscape. They are certainly nothing like the real Russian army will turn out to be, because they mostly follow the Law of War. They fight only enemy combatants; they don't target civilians. Under a stern-but-fair Russian occupation, my dream-self works as a doctor-POW in the hospital, treating Russian soldiers and Ukrainians injured and taken prisoner in the fighting. Through this work, I gather intel and supplies for the Ukrainian resistance. The isolated case of true villainy is a Russian officer who attempts a rape; the hero is a second Russian officer who covers for me after I confront the villain and shoot him in a struggle over his firearm. Physically, the hero quite resembles Liev Schieber's Defiance character, Zus Belski, and it's all very romantic. In the end, I convince the Russian officer to join the Ukrainian resistance, the Russians are forced out by a NATO contingent, and all ends well for the Ukrainians. It's a very vivid dream, and I wake in the morning with Ukraine stuck indelibly into my subconscious.