Prelude to Medic Work in Ukraine, part 3

Rule #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

It's been a year since Russia's "training exercise" turned into a full-scale invasion of Ukraine.

I've spent that first year of war doing my normal developing world medical work, while 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.

The history of local disease outbreaks 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 10 minutes 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 tap 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, baby, mom (still recovering from birth), and I are stacked four deep on a bike, headed down the steep, slippery hill to town. We jolt over ruts and splash through puddles. Mom leans back to make room for baby, and I commence an hour-long situp, tensed abs holding me and her up as I cling to the bar behind the seat to keep us from falling off backwards. I can't imagine how hard this ride must be, physically and emotionally, 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. 

Then 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 dog. 

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 jerked it away 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 big 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

Rule #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. An international Joint Investigation Team found that the missile originated from the Russian Kursk-based 53rd Anti-Aircraft Brigade, and it was fired from Ukrainian territory held by Russian-backed rebels. Three Russians and one Ukrainian national have since been given life sentences by Dutch courts, and Holland is in the process of taking Russia to the European Court of Human Rights for its role in the downing of MH17. 

My old favorite Russian songs of my teens have been resurrected as workout tunes. Later, when the war starts, I'll come to be surprised at how many of my favorite bands make risky anti-war statements. And what about the Russian friends I danced with? Will they protest the war? This will remain a persistant mystery. Even back in 2021, my letters to Russian acquaintances had 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 listen to it here, and a 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 to learn Russian, because I believe one day Russia will cause trouble, 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!). Communicating anything- "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, which lets me commit them permanently to memory.

During my first few days in-country, 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 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 worldly 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 shade of a tree, 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-ubitso!" 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 tug 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, after 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. The breeze spun him on the rope around his neck. 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. Overtly being an American here wasn't the best idea.

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 immobile, 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, impossibly 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 felt odd to compare 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, and mandatory counseling given to all 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 nature and structure 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

Rule #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 supply 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 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 way of replacing hard 'Gs" with soft "H"s 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 rally ordinary Russians to his cause. 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 military 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.

Ukrainian "Dragon Drone" destroys tank

 

Youtube video from the Sun shows Ukrainian "dragon drone" drop thermite on a Russian tank

Hurricane Helene produces hundreds of lighting strikes

 Really interesting perspective:

       

watch on Youtube

British Foreign Secretary David Lammy calls out Putin for Imperialist actions in fiery UN Security Council speech

                                                    Watch on Youtube

Fall Mushroom Foray in the Wasatch Mountains!

 

Here it is again… fall mushroom season in Utah!

This foray was to the Wasatch Front in early September. Even at 8,000’, it was pretty warm out, and I wondered if we would find anything.  Dry grasses and forbs crunch-crunched underfoot in an un-promising manner.

Then my footsteps fell silent as I approached a small stream. This moist micro-habitat, it turned out, was full of mushrooms! Great find!

Here’s some Cortinarius mushrooms, members of a very large genus which is identifiable by weblike remnants of a cortina on their stems. The cortina is a delicate structure that covers the gills, coming away as the mushroom matures. In the third picture below, a bit of cortina can be seen, still connecting stipe to cap.

 

Fungi are just about the only organisms that can decompose lignin, a key component of wood. If not for the vast amount of lignin-digesting fungi that inhabit the woods, we would be awash in dead and down logs in perpetuum. Chunky “brown rot”, below, is left behind by organisms that only consume cellulose. “White rot” fungus consumes both lignin and cellulose, leaving a pale residue.

Brown rot

White rot

 

Here is Lacterius deliciosa. The lacterius genus oozes white “milk” from their gills when damaged. In this case, deliciosa is a misnomer- this mushroom will make you sick.

 

Below is Sarcodon – the shingled hedgehog. An easy-to-recognize edible mushroom with a unique musky, minty odor. Some like it and some don’t. They are better young, becoming bitter when older. The hedgehog has teeth instead of gills or a polypore structure.

 

Below is a picture of Cryptospore fungus on a tree trunk. Beetles crawl into the fungal case to feed, and are covered in spores, which they carry to a new tree.

 

On the overhanging banks of the stream, hiding amongst mosses, were charming little bright orange Scutellinia scutelata “eyelash mushrooms”. Under a magnifying glass, these tiny orange cups are fringed by eyelash-like hairs.

 

Porcini bolete- the Utah state mushroom is a large, choice edible! It can be recognized by its polypore underside, reticulum on stem, and “penny bun” cap. It is mycorrhizal, often found under younger spruce trees.

 

The bolete was followed by a couple of rare finds: elven saddles! Top photo is a white one, and the black one in the lower photos may be a new species.

Interesting WaPo Story: Russia uses American Social Media personalities to spread disinformation in the US

Russia’s election influence efforts show sophistication, officials say - Washington Post

Ukrainian Drone Drops Fire into Treeline

 Check out this video, posted by Special Kherson Cat, of a Ukrainian drone dropping fire into a treeline:

https://t.co/uztFLP5aLh

Fringe Ecosystems: Ghost Grass and the Sonoran Desert

"One day, Ghost Grass will cover everything, and that's the way the world will end"

-Ser Jorah Mormont, quoting a Dothraki legend, Game of Thrones. 

 On a recent hike through the Sonoran desert, the warm air and fantastic shapes of the cactus around me made it easy to imagine I was diving on a tropical reef. At the same time, I had a strange feeling I was in Africa. Numerous acacia trees created classic Africa skyline sillouettes, and beneath them waved a sea of amber grass. The grass was fully cured, the air was 110 degrees, and monsoonal lightning storms were approaching. Minus the cactus, it looked just like West Africa during the harmattan/fire season.

 But, unlike many Sahel ecosystems, the Sonoran Desert is not fire adapted. It seemed like this impossibly combustible cocktail should have done in the slow-growing saguaros and other cacti long ago. Some research proved the resemblance to Africa wasn't coincidental; African and Mediterranean fire-adapted grasses have invaded the Sonoran Desert, threatening ecological catastrophe. 

 The real-world equivalent of Game of Throne's Dothraki Ghost Grass consists of a sinister trio: Cheat Grass, Buffle Grass, and Red Brome. For Western Deserts, the 19th-century introduction of these old-world grasses was, arguably, the most ecologically consequential event since the last Glacial Period.

 Adapted to Mediterranean and African conditions, inluding drought and wildfire, these grasses outcompete American species, such as sage and native bunchgrass. Cheatgrass, Red Brome, and Buffel grass create soil characteristics unfavorable for native desert plants. Drying out early into continous fuel bed, they carry wildfire across desert landscapes, where plant spacing used to prevent fire from spreading. Invasive grasses have spread throughout the West, from Texas to California, and the Dakotas to Arizona. Below, a field of invasive red brome fills in the spaces between saguaros.

The NPS publishes the guide, seen below, to identifying and eradicating Red Brome. The eradication options (hand-pulling bunches of grass, or five years of annual herbicide application) may work for individual homeowners. Unfortunately, the idea of implementing these on a large-enough scale to protect the vast stretches of Sonoran Desert which have been invaded by Red Brome is laughable.

Arizona and New Mexico are home to the southern fringe of many landscapes, including Ponderosa Forests, Pinyon-Juniper forests, and the Sonoran Desert. These fringe forests represent species inhabiting the southern end of their range- a range that is shifting northwards due to climate change. These days, the unhappy theme of each of my wildfire assignments here seems to be the complete destruction- by fire- of fringe ecosystems that were already stressed by climate change, pollution, and overgrowth, and competition with invasives. Natural forest succession cycles and climactic range shifts occur at too rapid a pace for nature's coping mechanisms to keep up. A forest that used to burn in a mosaic of 5-acre fires over 100 years burns today in a single, 500,000-acre blaze. No refuges for wildlife are left, the soil is baked to clay. When the rains return, no animals remain to greet it from unburned refuges, no green islands of trees are left to reseed the soil. Without roots to retain it in place, the soil is washed away into vast, destructive debris flows. 

 Fringe forests convert to fields of brush, deserts to fields of Ghost Grasses- and fire is the final catalyst.

Ukraine: Jogging in Circles and Red Viburnum Tea

Staying fit during winter in the Eastern half of Ukraine can be challenging. Fortunately I've worked out a combination of pilates and jogging around a UXO- and stray-dog-free circuit. Twenty laps equals two miles. The background noise of local air defense artillery at work has become easy to ignore. 

Winter is setting in in earnest; after a cold run, its a good time for a cup of vitamin-C rich Red Viburnum Tea. Crushed viburnum berries and honey are a traditional remedy for colds in Ukraine. The berries can also be eaten raw in small quantities or made into jams and pies. For example, the viburnum genus is large and widespread. New-world viburnums, also known as high-bush cranberries, were used by Native Americans as a vitamin-C-rich winter food.

Pensions are very small in Ukraine, so it's extremely common for pensioners to set up small tables on the sidewalk in town to sell home-grown produce. This time of year, a grandmother might sell butternut squash, jam, or jars of pickled vegetables. Some folks spend all afternoon sitting out in the cold, just to sell a few bunches of Red Viburnum berries. When in town, I try to buy from pensioners and small shopkeepers, rather than line the pockets of supermarket-owning "mini-oligarchs".

Viburnum is not just a common hedgerow bush here; it's a national symbol of Ukraine. "Chervona Kalina" ("Red Viburnum") is an old Ukrainian folk song (lyrics below). Its first stage performance occurred in the 1914 Stepan Charnetsky play "Sun of Ruin". Popularized by the play, it became the anthem of the Ukrainian Sich Rifleman unit, which fought for Austria-Hungary. In 1944, Chervona Kalina was made into an arrangement by Ukraine National Chorus director Oleksander Koshets. Koshets made "Carol of the Bells" famous in the US, during the Chorus's post-WWI world tours. The tours were intended to promote Ukrainian culture and garner support for the Ukrainian Independence cause, after the Bolshevik invasion. 

Chervona Kalina has been extremely popular with Ukrainian soldiers, both during WWII and the current war. It is effectively a second national anthem for modern Ukraine.

Here is a youtube link to a 2022 version performed by Pink Floyd Chervona Kalina, with Pink Floyd  

Chervona Kalina, lyrics:

In the meadow, a red kalyna

In the meadow, there a red kalyna, has bent down low ,

For some reason, our glorious Ukraine, has been worried so.

And we'll take that red kalyna and we will raise it up,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

And we'll take that red kalyna and we will raise it up,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

 

Do not bend low, Oh red kalyna, You have a white flower.

Do not worry, glorious Ukraine, You have a free people.

And we'll take that red kalyna and will raise it up,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

And we'll take that red kalyna and will raise it up,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

 

Marching forward, our fellow volunteers, into a bloody fray,

For to free, our brother - Ukrainians, from hostile chains.

And we, our brother - Ukrainians, we will then liberate,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

And we, our brother - Ukrainians, we will then liberate,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

 

In the field, of early spring wheat, there's a golden furrow,

Then began, the Ukrainian riflemen to, engage the enemy,

And we'll take, that precious, early wheat and will gather it,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

And we'll take, that precious, early wheat and will gather it,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

 

When the stormy winds blow forth from the wide steppes,

They will glorify, through out Ukraine, the Sich riflemen.

And we'll take the glory of the riflemen preserving it,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

And we'll take the glory of the riflemen preserving it,

And we, our glorious Ukraine, shall, hey - hey, cheer up - and rejoice!

Ukraine: How Long can a Tourniquet be left in place before the limb must be amputated?

Prospects for limb salvage after tourniquet placement has become a crucial matter for thousands of soldiers and their surgeons in the Ukraine war. Near-peer fighting conditions and lack of air superiority can create extended evacuation times for casualties. Drone threats to moving vehicles have become so pervasive that, in many areas, the last few miles up to the zero line area only traversable on foot. Beyond this zone, mud, bombing damage, UXOs, and the impossibility of road maintenance make vehicle evacuation slow and bumpy. Patients must often wait for nightfall to evacuate, and dawn-dusk day length at the height of summer on the Eastern Front is 17 hours. Today, almost two years into the war, high attrition rates amongst experienced frontline medics means loss of TCCC tourniquet conversion knowledge along the frontline. 

For medics and doctors in forward casualty collection and stabilization points, who are receiving tourniqueted patients after prolonged evacuations from a near-peer conflict area, assessing patient candidacy for tourniquet conversion (i.e. removal and replacement with a simple pressure dressing) or movement of tourniquet to a more distal location is a critical outcome-changing skill. Just as important as assessing limb salvageability is 1) readiness to manage acute complications such as acidosis and dysrhythmias, and 2) ensuring that timely transfer to higher-level care is available for potential medium-term complications, such as compartment syndrome and acute renal failure. 

Current TCCC guidance assumes that limb salvage becomes highly unlikely 6 hours or more after tourniquet placement. However, this guidance is unavoidably based on the extremely limited data pool available to date. Limb salvage after tourniquet placement is a young and weak science, which stands to benefit greatly from case reporting and retrospective studies originating from the Ukrainian conflict. If we look only at the small pool of my personal experience as a paramedic in Ukraine, several case examples of physician-directed conversions of tourniquets in place for over 6 hours have been performed, or given post-conversion management, by either myself or my immediate colleagues. Clearly, amputating every limb that has been touniqueted for more than 6 hours would result in unnecessary negative life impacts for patients.

Current tourniquet science is based on animal studies done in controlled environments, and a very small number of human case reports. Tourniquets are widely used in routine surgeries, but tourniquet use in traumatic wartime injuries is a completely different animal. The reality of warfare adds in a number of important and unforeseen variables, which defy efforts to cleanly categorize patients as <6 hours vs >6 hours:

1) initial tourniquet placement is likely to occur under extreme conditions. Often, the soldier placing the tourniquet has minimal medical training, may be physically and/or mentally exhausted (many Ukrainian soldiers have been deployed for nearly 2 years with little or no leave). He or she may be receiving fire and/or returning fire, and may be working in conditions of darkness, loud noise, and confusion. The soldier placing the tourniquet may have reduced fine motor control due to cold, exhaustion, or adrenaline, or may be injured themselves. Weather and fighting conditions may have led to heat exhaustion, dehydration, nutritional deficits, soaked clothing, icy gear, numb fingers, or cold injuries of feet and hands, and rapid assessment and tourniquet placement and/or other bleeding control measures may have to be performed over/through multiple layers of clothing and body armor. Tourniquet availability on the frontlines is limited and likely to consist of a mish-mash of tourniquet brands and styles. These factors often conspire to create "partial-tourniqueted" patients. Tourniquets may be tightened enough to slow, but not fully stop, bleeding and limb perfusion. Venous and capillary return may be cut off, without halting arterial inflow. 

2) Due to frontline conditions, time of original placement of tourniquets is frequently estimated, or missing altogether.

3) Environmental conditions and threats during evacuation may necessitate rapid movement and rough handling of the patient, which may lead to tourniquet loosening or temporary dislodgement. Poorly made or re-used tourniquets may stretch over time or fail, lead to placement of multiple tourniquets, and intermittent periods of reperfusion or partial reperfusion. 

4) Intentional attempts at tourniquet conversion may be made in the field. Due to fighting conditions, these field attempts may or may not be accurately recorded in the documentation that reaches field hospitals. Patient evacuation routes shift frequently, and patients may pass through multiple patient care teams, comprised of a cast of medical providers that shifts daily.

5) The tourniqueted limb may be subjected to a variety of physiological and environmental conditions, including varying levels of external cooling, varying states of patient blood loss and shock, and varying levels of resuscitative care received.

Due to these variables, Ukrainian doctors cannot rely on hard-and-fast rules such as the 6-hour tourniquet rule. Many tourniquets were placed with good intent, but were never necessary in the first place. Doctors are often forced to decide, based on clinical observations and professional experience, whether tourniquet removal is in the patient's best interest. Does the probability of limb salvage outweigh potential systemic risks to patients? Objective numerical values from blood testing can inform these decisions, if lab services are available. But more often, the critical time for this decision occurs at minimally-equipped forward field treatment points, and thus it must be made based on time of injury, exposure to weather, limb skin color and temperature, injury patterns, and overall patient presentation. 

Here is an interesting case report from Kragh et al, published in Orthopedic Trauma in 2007, which represents the realities of tourniquet placement in conflicts, as well as variability in limb salvage times. The patient, an American helicopter pilot in Afghanistan, was shot in the hand and received RPG shrapnel to one leg. Hemorrhage from the hand was stopped 1 hour after injury by a combination of one purpose-built and one improvised tourniquet. Bleeding recurred 6 hours after injury, and was stopped by tightening the tourniquet. The pilot lay in a snowdrift, with temperatures at -15C, for a half-day after injury. After that, he was insulated by blankets made from cut-out aircraft insulation. Evacuation was delayed due to an ongoing firefight, mountainous terrain, and inclement weather. The patient arrived at a forward surgical facility after 16 hours of continuous tourniquet placement. He had severe soft tissue loss, irreparable radial artery damage, and compartment syndrome. He underwent surgical debridement and irrigation, radial artery ligation, and 3 dorsal + 2 ventral hand fasciotomies, and the operating surgeon deemed hand preservation was questionable. Repeated surgical debridement and irrigation took place over the next month, first at Landstuhl, Germany, then at Walter Reed, before primary wound closure was accomplished. Several more surgeries and physical therapy followed, to correct pain and stiffness. By three years after injury, the patient had recovered sufficiently to use the hand for activities of daily living, and to return to piloting Chinook helicopters.

Nacreous Cloud Pics

More on nacreous clouds and pics taken during Winfly by my trusty little Olympus, which has survived mild freezing 3 times now! (think you'll like this, dad)

As explained during a sunday science lecture by Dr Terry Deschler, atmospheric scientist, nacreous clouds are formed of very small particles like chlorine which refract light very effectively. The angle of refraction is very localized so the brilliant colors in the clouds are constantly changing minute to minute as air currents flow through. Many of these are lenticular clouds- formed by a standing wave of cold air rising up over mountainous terrain. Air must be very cold to form nacreous clouds, so they're generally only seen at very high altitudes over mountains during cold times of the year when there's low-angle sunlight.

The chlorine in the clouds is actually breaking down ozone as we watch- chlorine combines with 03 to form ClO and O2, then ClO interacts further with O3 to form Cl and O2. Thus the chlorine is recycled in the equation and oxygen is formed from the breakdown of ozone.

Atmospheric chlorine comes from natural reservoirs such as acid clouds in the atmosphere. (Interestingly high-flying fighter jets experience etching of glass and metal due to atmospheric acid, and many commercial airliners needed scarred windows replaced in the months after the eruption of Mt Pinatubo released sulfuric acid into the atmosphere). The breakdown of CFCs has added to Earth's natural reservoirs of atmospheric chlorine and resulted in the ozone hole in the Southern Hemisphere. There is actually more chlorine in the skies over equatorial latitudes, but the chemical processes which break down ozone occur at high latitude. Ozone is produced naturally by O2 interacting with the solar winds. Therefore banning of CFCs means eventually the excess chlorine will be naturally cycled out and the ozone layer should reseal, but this will take several generations.

In the meanwhile we enjoy a beautiful pheonomenon with disturbing implications behind it.

TB and the Ukraine War

Not only does the current Russia-Ukraine pose unique risks of regional and global military escalation, it is also creating historic levels of population displacement and military mobilization of convicts, in one of the world's foremost multi-drug-resistant tuberculosis hotspots.

TB, or "consumption" is an ancient disease, closely associated with malnutrition and overcrowding. It is the disease that killed Chekhov, Chopin, Emily Bronte, Orwell, Kafka, Keats, Thoreau, and many others at the height of their creative years.

TB is caused by the bacteria 'Mycobacterium tuberculosis'. Mycobacteria have evolved a waxy coating which allows them to survive and reproduce inside macrophages, thus evading our immune system's first line of defense. Tuberculosis can remain latent within the body for many years, becoming active once the immune system is sufficiently weakened by factors such as malnutrition, diabetes, HIV, or smoking. A patient with latent TB has a 5-10% lifetime chance of developing active TB. Classic symptoms of active pulmonary TB include night sweats, weight loss, and a cough that produces blood-tinged sputum. Untreated, pulmonary TB eventually destroys the lungs in a "swiss cheese" pattern, and leads to patient death. TB bacteria may also disseminate throughout the body, creating a variety of symptoms, such as cutaneous nodules, engorged lymph nodes (scrofula), meningitis, and an array of internal organ problems. 

TB is the world's top infectious disease killer, and fully 1/4 of the world population currently carries latent tuberculosis. Infection rates vary locally, ranging from as low as 3% in some developed countries, to 90%+ in parts of Africa. Only patients with active TB can pass the bacteria on to others, and may infect 15 other individuals per year. Conflict and other social disruption events can have a major impact on spread. Firstly, conflict subjects individuals to physical hardships, such as poor nutrition, inadequate housing, and exposure to other infectious diseases. Second, conflicts displace populations, and lead to overcrowding, poor sanitation, and breakdown of healthcare systems. Studies suggest that war increases annual TB incidence up by up to 20%. The 2022 Russian invasion of Ukraine has resulted in the fastest mass refugee migration since WWII. In 2022, the world-wide number of displaced persons hit a new record of over 100 million souls.

Social disruptions do not have to be conflict-based to facilitate the spread of TB. Russia and other former USSR members have the developed world's highest TB rates, due to social disruptions that occurred during the decade after the fall of the USSR. The 1990's reversed a huge amount of Soviet progress on TB control, which had been achieved via xray detection, isolation, and treatment in sanitariums. Infection rates in Russia fell from 1910 levels of 400/100,000, down to a rate of 17.3/100,000 (in men) and 1.9/100,000 (in women) in 1990. But post-Soviet poverty and healthcare system collapse caused Russian TB rates to double between 1991-1998. During the same time period, incarceration rates tripled in most post-Soviet states. By the late 1990's, TB had become a raging epidemic within the overcrowded Russian prison system, with prisoner infection rates averaging 4,000/100.0000, and in some regions reaching 7,000/100.000.

Mycobacterium tuberculosis's ability to hide from the immune system means that treatment regimes, even for cases that are susceptible to first-line antibiotics, are lengthy. If, due to treatment costs, disruptions in health services, or poor patient education, a patient stops treatment early, evolutionary forces favor the growth of antiobiotic-resistant bacteria within that patient's body. This resistant bacteria can then be passed on to others, garnering new opportunities, with each unsuccessful treatment course, to become resistant to additional medications. The result is multi-drug-resistant TB, or "MDR-TB"- one of today's major public health challenges. Treatment regimes for MDR-TB last up to two years, may cause uncomfortable side effects, and have a significant failure rate. To reduce risk of MDR-TB, DOTS, or Directly Observed Treatment, has become the gold standard for TB treatment worldwide.

However, in post-Soviet states, corruption and economic woes interfered with successful TB programs. Physicians opposed DOTs, feeling that it threatened their already precarious livelihoods. TB medications were re-purposed and sold in markets by crooked pharmacists, or traded for other items by prisoners in treatment programs. Until fairly recently, antibiotics were widely available without prescription at pharmacies in both Russia and Ukraine. It was quite common to self-prescribe an inappropriate course of antibiotics, for example, for a viral cold infection. By 1998 20% of Russian prison cases were MDR-TB. As prisoners were released mid-treatment, this trend spread into the general population. Eastern Europe now accounts for the largest MDR-TB burden in the world. 

In recent years Russia, along with many former Soviet states, has resumed making progress on TB control. Between 2010-2020, Russian TB mortality halved, and general population infection rates fell to 45-50/100,000 (48% MDR-TB). WHO estimated 2021 TB incidence in Ukraine to be 71/100,000 (31% MDR-TB in new cases and 45% in relapse cases). In contrast, average 2021 TB incidence in the EU was 8.4/100,000 (33% MDR-TB). Thus, TB infection in refugee populations moving from Eastern to Western Europe is a major public health concern.

Despite progress within prisons, as well as amongst the general population, TB remains a major problem in Russian prisons. Russia has one the world's highest incarceration rates, with overcrowding and poor living conditions extremely common. A 2017 study estimated that 1 in 10 Russian prisoners have active TB, and that the majority of remaining prisoners have latent infections. A 2019 study found that Russia had the world's second-highest number of new active TB cases amongst prisoners (~13,000 cases, second only to 15,000 cases in Brazil). A 2-3 yr prison sentence leads almost inevitably to TB infection. 48% of Russian prison cases are multi-drug-resistant. Russia also has one of the highest rates in the world of "extensively drug-resistant TB", which is even more difficult to treat than MDR-TB. Russia's heavy reliance on convicts as soldiers, low health standards for enlistment, difficult frontline living conditions, unreliability of medication supplies, potential for injury or capture, and inter-mixing with and displacement of civilian populations all create a major risk for wartime transmission of TB, MDR-TB, and XDR-TB.

In the Ukraine war, post-Soviet health challenges are potentiated by the melange of convict soldiers, frontline conditions, and mass displacement of civilians. The result is a myriad of spread opportunities for the world's new diseases of disruption: MDR-TB, MDR wound infections, and potentially also novel respiratory viruses (think a new wartime COVID variant or a 1918-style influenza). 

Spread of MDR-TB is not the only concern. TB comes in a variety of strains. Interestingly, the prevalent strain in Russia is the "Beijing" type. The Beijing TB strain, first described in 1995, has unique proteins. These potentially make it more infectious and more resistant to treatments. A 2020 literature review of studies involving 7,000 patients found strong support for correlation between the Beijing strain and more unfavorable treatment outcomes. Despite global implementation of DOTS, TB incidence seems to be declining at only 1-2%/yr- far slower than math models predict. The reasons for this include prevalence of HIV coinfection, diabetes, malnutrition, drug resistance, crowding, and poor control infrastructure. Arguably, another reason is the spread of Bejing subtypes- which will also likely be further facilitated by the disruptions of the Ukraine war.     

There is hope on the horizon for TB control. A currently approved vaccine, the BCG TB vaccine, does not prevent TB, but it does serve to lessen risk of some severe forms of disseminated disease in children. Several vaccines designed to prevent pulmonary TB in all ages are currently under development. The most promising is M72. M72 was dropped by its original creator due to low profit potentials, but has recently been picked up by the Gates Foundation and has entered Phase III trials. M72 may be able to prevent pulmonary disease in 54% of infected adults. And for a disease that can take years to treat, and becomes active in 5-10% of patients, who go on to infect 15 other people per year, 54% prevention be a game-changing statistic.

WHO TB page
WHO TB Surveillance and Monitoring in Europe, 2023
The 2020 clinical update by the Global Tuberculosis Network
2020 Stanford-China study: Mycobacterium tuberculosis Beijing genotype strains and unfavourable treatment outcomes: a systematic review and meta-analysis
2017 literature review: Multidrug resistant tuberculosis in prisons located in former Soviet countries: A systematic review
 

Ukraine: Bradley IFVs taking on T90 tanks

 

Several videos have emerged this week, showing Bradley Fighting Vehicles successfully taking on advanced Russian T-90 tanks.

From Special Kherson Cat on Twitter, video of Bradley IFV vs T-90 in Avdiivka

Ukraine: Types of Missiles that Russia Commonly Fires at Ukrainian Cities

 

 

     

S-300 / S-400 a potent, long range, surface-to-air, anti-aircraft guided missile, S300 developed in 1978, S400 in 2007. Fully automated, or can be manually piloted. Launched form a command post, which include acquisition and guidance radar, transportation, and launch vehicles. May be used to intercept aircraft or other missiles. Possessed by a number of countries in Europe and the Middle East, and used in conflicts including Syria and Nagorno-Karabakh. Used extensively against ground targets in Ukraine. Image by By Tourbillon - Own work, CC BY 3.0, https://commons.wikimedia.org/w/index.php?curid=6714828. 

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Kh-47 Kinzhal hypersonic air-launched ballistic missiles, NATO name "Killjoy", entered service in 2017, design based on the older Iskander missile, uses standard ballistic missile technology at greater speeds. After launch, the missile rapidly reaches cruising speeds of Mach 4, and up to Mach 10 on a downward trajectory. Maneuverable, erratic flight path. Originally touted as "impossible to intercept" by Russia, Kinzhals have been used extensively in Ukraine, and a significant proportion of them were successfully shot down by Patriot air defense systems in 2023. They have also proven to be fairly inaccurate. Image from By kremlin.ru, CC BY 4.0, https://commons.wikimedia.org/w/index.php?curid=68926303

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Kaliber cruise missile, in service 1994, some models are capable of a supersonic terminal sprint, traves at ~70' over water, or ~150-350' over land, uses inertial guidance +terminal radar or satellite guidance, 

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Iskander mobile ground-launched, short-range hypersonic ballistic missile, NATO name "Stone", first launched in 1996, as a replacement to the SCUD missile, uses inertial guidance or GPS, depending on model, can be re-targeted midflight, uses evasive maneuvers and decoys during terminal flight, travels at an altitude of 20,000-160,000 feet. Used in Syria, Georgia, Nagorno-Karabakh, and Ukraine wars. In the summer of 2023, an Iskander was used to destroy Ria Pizzeria, a restaurant in Kramatorsk, Ukraine, frequented by journalists, aid workers, and military members. The famous Ukrainian writer Victoria Amelina was killed, along with a pair of 14-year-old twin sisters, and 10 others. Dozens were injured.

Image from Vitaly V. Kuzmin - http://www.vitalykuzmin.net/Military/ARMY-2016-Demonstration/, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=52213498

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Kh-101 / Kh-555 / Kh-55 family of air-launched subsonic cruise missiles, Nato name "Kent", in service 1983, inertial guidance with terminal radar/terrain map, capable of cruising at tree-top level, the original Kh-55 ran on a Ukrainian-made Sich motor, used in Syria and Ukraine wars

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Kh-22 "Storm" missiles. NATO name "Kitchen". Large, long-range anti-ship missile developed in 1962. Climbs to either 89,000' (high-altitude mode) or 39,000' (low-altitude mode), then hits top speed while dropping towards target. Guided by radio altimeter and gyroscope-stabilized autopilot. A 1,000kg shape-charge load results in a 16' wide, 40' deep hole. First combat use was in May of 2022 in Ukraine. Use against targets in civilian areas of Ukraine has been criticized due to low accuracy. Image by By Антон Бородин - Музей авиационной техники, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=10658517

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Kh-59 "Ovod" or "Gadfly" guided aerially-launched land-attack cruise missiles. Developed in the 1980's. Flies at about 22' above water, or 300-3,000' above ground, using a radio altimeter. Used in Chechnya and Ukraine.

	Cost #USD	Warhead Size	Warhead Type	Missile Length, Speed	Engine	Range, Accuracy	Launch Platform
S300	1 million	up to  143 kg	19,000-36,000 metal frag,s	~25'		up to 250 nm	vehicle-based
Kinzhal	10 million	480kg	Conventional or nuclear	25' Mach 10	solid-fuel rocket	300nm	Tu-22 Mig-31
Kaliber	1 million	500kg	Conventional or nuclear	~25' Mach 3	solid-fuel rocket or turbojet	up to 1300nm	Air, ship, or sub launched
Iskander	3 million	480-700kg	Cluster, thermobaric, EMP, frag, bunker busting, nuclear	25' Mach 7	single-stage solid propellant	300nm 3' - 100'	vehicle
Kh-101	13 million	400mg	conventional or nuclear	24' Mach 0.7	turbofan jet	3500nm 20-33'	bomber aircraft
Kh-22	1 million	1,000 kg	RDX or thermo - nuclear	38' Mach 4.6	liquid - fueled rocket	320 nm             300-900'	Tu-22  Tu-95
Kh-59	500,000	320 kg	Cluster, Shape-Charge Frag	18' Mach 0.8	2-stage rocket	60-160nm	Sukhoi and Mig jets

Notes: "hypersonic" missile is somewhat of a misnomer; nearly all ballistic missiles reach hypersonic speeds at some point during flight

"Kh" and "X" are both transliteration options for the same Russian letter, (X)

Info from Jane's Air-Launched Missiles