Ukraine: First Shoot Down of an Enemy Helicopter by a Maritime Drone

 Ukrainian Defense Intelligence (HUR) announced today the first successful destruction of an aerial target using a marine drone. The drone, a Magura V5, is reported to have shot done one Russian Mi-8 helicopter with a SeaDragon missile, and damaged a second helicopter.

Ukraine: Refugees

 

EU Blocks Telegram Channels that Disseminate Russian Propaganda

MSN: Telegram blocks Russian State-Owned Media Channels in several EU Countries 

Fatalities from Armed Conflict: Three-Decade Trend (includes civilian and military)

Ukraine: Frostbite and Trench Foot Prevention and Treatment

 FROSTBITE AND TRENCH FOOT

Frostbite is injury due to formation of ice crystals within tissues. Adjacent tissues may be damaged by vasoconstriction, thrombosis, and inflammation, 

Determining the severity of a cold injury can be challenging during early phases. Initial signs and symptoms in severe frostbite may appear deceptively benign; conversely, mild cold injuries such as frostnip may present similarly to frostbite.

Prior to rewarming, frostbitten tissues are cold, white, hard, numb, and sometimes blistered. After rewarming, skin becomes blotchy red, swollen, and extremely painful. Blisters tend to appear within 4-6 hours of rewarming. Clear, serum-filled blisters indicate superficial damage, without residual tissue loss. Blood-filled blisters accompany deep tissue damage and likely tissue loss. Longer-term complications can include compartment syndrome, gangrene (usually dry, with a hard black carapace over healthy tissue), need for amputation, and long-term neuropathic symptoms. The full extent of frostbite damage may take several days to several weeks to become clear.

TCCC has four frostbite categories:

First Degree (Superficial): Superficial skin injury, pain on rewarming, numbness, hyperemia, occasionally blue mottling, swelling and superficial desquamation (after ~5 days)

Second Degree (Superficial): Partial thickness injury to skin, in addition to first degree findings, vesiculation of the skin surrounded by erythema and edema (appears around day 2)

Third Degree (Full Thickness): Entire thickness of skin extending into subcutaneous tissue, bluish to black and non-deformable skin, hemorrhagic blisters, vesicles may not be present, eventual ulcerations can be expected, area will likely be surrounded by 1st or 2nd degree injury

Fourth Degree (Full Thickness): Similar to third degree, but full thickness damage including bone. Area may be cold to touch and may feel stiff or woody.

Immersion Foot: Caused by prolonged exposure to moisture. Feet, especially soles, become water-logged, hyperemic, mottled, painful, and edematous, gradually progressing to blistering, hypoperfusion, ulceration, and gangrene if untreated. Treatment is re-warming and drying at room temperature. Pain control and debridement may be required. As with other cold injuries, persistent life-altering symptoms may occur. 

TCCC frostbite treatment protocols are as follows: 

***Treatment protocols in Ukraine will depend on local guidelines*** 

Address major trauma and hypothermia before focusing on frostbitten extremities. 

PREVENTION in patients: Ukraine conflict conditions and injury patterns can predispose patients to cold injuries, in several ways.

Field conditions: Immediately post-injury, it may be necessary to prioritize movement, cover, and returning fire over keeping patients dry and fixing damaged winter clothing systems. In Ukraine at present, Casualty Collection Point and/or field care is generally provided by personnel with auxiliary training, only at the Combat Lifesaver / EMT-Basic level. Due to large numbers of patients, and pervasive drone, artillery, and direct-fire threats, it is common for this Care Under Fire / Tactical Field Care phase to be extremely prolonged. Patients typically spend 6 - 48 hours, or more, on position prior to casevac. 

Nature of Injuries and Medical Interventions: Patients’ mobility, and their ability to protect their own limbs, may be reduced due to injuries and altered mental status (from medication or trauma). Circulation to limbs may be further impaired due to direct trauma, hypotension, shock, global hypothermia, and bleeding control measures. During early care phases, global hypothermia prevention is much more effective against cold injuries than localized hypothermia prevention. Hypothermia is particularly dangerous in trauma patients, as it combines with coagulopathy and acidosis to form a positive feedback loop (“the Lethal Triad”). Climate control systems may be inadequate or absent in transport vehicles and treatment areas (ideally you should be uncomfortably warm in the room where you treat a trauma patient). Preheat chemical blankets, and turn up the heat in the patient compartment while enroute to the AXP. Minimize opening doors and patient transfer time into the ambulance. Even the best care teams may allow a patient to become hypothermic while focused on performing advanced procedures. Remove clothing and blankets from the patient only long enough to perform essential exams and medical interventions. Consider using multiple blankets to “burrito wrap” the patient.

TREATMENT: Hospital / Prolonged Field Care Phase: The core of frostbite treatment is rapidly rewarming the frostbitten area in warm water (37-40 degrees celsius)  This should take 15-30 min if water is kept continuously at 37-40. (TCCC calls for 40-42 degree water; however recent studies have shown this causes additional pain without improving outcomes). The longer the tissue remains frozen, the greater the damage. A general rule of thumb is that if the patient cannot reach a hospital in the next two hours, field rewarming should be undertaken. However, NEVER THAW tissue unless it can be guaranteed that it will not re-freeze. Do not thaw feet if the patient will have to walk on them in the near future; thawed tissue is delicate and susceptible to trauma. Dry heat sources should be avoided; they may burn numb tissue. Avoid the temptation to prematurely end rewarming due to pain; rapid rewarming is more painful but produces better outcomes than slow rewarming. Liberal use of pain medication is highly encouraged during the rewarming process. The patient should move the affected part gently during rewarming.  Do not rub affected areas, or apply snow or oil. Leave blisters intact to prevent infection and deep tissue dessication. Preventing infection is paramount. The hospital may use vasodilators, anticlotting meds, NSAIDs, and elevation to encourage reperfusion.  Patients should avoid vasoconstrictors such as nicotine, and be monitored for electrolyte abnormalities. Acute, persistent pain will generally subside within the first three days, although intermittent nerve pain may continue for an extended period.

Previous Medical Spotlights

Blood Loss and the Lethal Triad

TB and the Ukraine War

Ketamine in War, Including Use in TBI Patients

Crush Injury and Compartment Syndrome

Frostbite

Joke: A Ukrainian Man Goes Before Saint Peter:

Saint Peter asks 'Where were you born?'

The man thinks for a moment and says 'Austria-Hungary, Lemberg.'

'Where did you go to school?'

'Poland, Lwow.'

'Where were you married?'

'The Ukrainian S.S.R., Lviv.'

Surprised, Saint Peter asks 'Where was your first child born?'

'In the German Reich.'

'And where did you die?'

'At home in Lvov, in the Soviet Union.'

Astonished, Saint Peter shouts 'My, you moved around a lot!'

'What are you talking about? I never left the city!'

Ukrainian Musician Plays Shedruk (Carol of the Bells) on a Traditional Bandura, Near the Front Line at Pokrovsk

 

Ukraine: Human Rights Watch Report Summary on Torture of Civilians by Russian Military in Izium

Human Rights Watch Investigators visited Izium in the fall of 2022, after the city was liberated by the Ukrainian counter-offensive. Multiple civilian residents describe being detained and tortured by Russian soldiers in the report.

NEWS ARTICLE: Human Rights Watch Report Summary on Torture of Civilians by Russian Military in Izium

Downing Drones with Radio Waves

 This British Ministry of Defense reports successful testing of its RFDEW. This platform can shoot down drones up to a kilometer away, using radio waves, at the cost of 10 pence per shot.

Ukraine: Incoming Artillery in Donbas

 

 

Ukraine: One of the Longest Armored Movements Behind Enemy Lines in History: The Raid of the 95th Brigade (2014)

 

During the Donbas War, elements of the Ukrainian Army reportedly made a 170km dash behind enemy lines, in order to resupply a cut-off unit. According to Potomoc Institute for Policy Studies historian, Dr, Philip Karber, this was one of the longest armored raids in history.  

Between 19 July and 10 August, units of the Ukrainian 95th Air Assault Brigade, reinforced with elements of the 25th Airborne and 30th and 51st Mechanized Brigades, conducted a 470 km raid, of which 170km was behind Russian and Separatist lines. All those who took part in the operation on the Ukrainian side were volunteers. The raid was successful, allowing for the creation of a safety corridor to evacuate Ukrainian units trapped behind enemy lines at the Russia-Ukraine border. 3,000 troops and over 250 pieces of equipment of the 24th, 72nd Mechanized, and 79th Air Assault Brigades. 

This was the first direct clash between Ukrainian and Russian troops of the Donbas War. The soldiers involved have been praised by military experts and historians for the skill and daring that went into the raid. 

Watch a youtube video from Battle Order, about the raid:

Volunteer Group Platsdarm is bringing fallen soldiers home, from both sides of the Ukraine Conflict

 Oleksii Yukov's volunteer group, Platsdarm, has been working in Eastern Ukraine since 2014. In this time, it has conducted respectful recovery of the remains of over 2,000 fallen soldiers, and returned them to their families in Ukraine and Russia. This provides crucial closure for families of those who went missing in the conflict. Prior to the Donbas war, Mr Yukov worked with groups that recovered remains of soldiers lost in WWI and WWII. 

Link to Voice of America video story on Platsdam:

Ukraine: Christmas Memorial Installation in Kiev

Christmas dinner table with empty chairs and soldiers' uniforms commemorates those who are dead or missing

 

Ukraine: Christmas Message from Dr. John Quinn

"To All of You and cross posting:

You are doing extraordinary work. Keep it up. We face gaps, challenges, and immense headwinds. It is critical that we keep our focus aligned on one shared mission: to reduce preventable morbidity and mortality among the Ukrainian warfighter, the volunteer warfighter, and all volunteers and medical support elements across the FLOT.

We all know the stakes. If we lose focus, people die. People are injured. Projects stall. Partnerships falter. And ultimately, we may lose. The fragmentation I’m seeing as I depart is a direct result of the enemy’s efforts to divide us. Do not let this happen.

Engage. Partner. Support. Do what you do best, what you know is right, and what is needed—always. If in doubt, ask for forgiveness, not permission.

Despite the challenges—financial, relational, and operational—you must persist. Do not give up. Do not surrender. Do not let the enemy win.

Wishing you all a Merry Christmas (whichever one you celebrate), Happy Hanukkah, and Happy Holidays. Stay strong, stay united, and stay focused.

With respect and gratitude, Slava Ukraine! -Quinn"

 -Message from Dr. John Quinn, an American physician who has been going to Ukraine since the start of the Donbas War. He has been instrumental in approval of blood products for prehospital use in Ukraine

Ukraine: Decent Documentary on Izium Occupation

 Documentary by Devin San Luis

Ukraine: Trench Candles and the Palmer Furnace

 Trench warfare and caving... two cold, wet, and dangerous activities, which have both inspired creative ways to stay warm.

Caver and hypothermia expert Jonathan Palmer invented the Palmer Furnace, for use underground. Cavers, especially expedition cavers, often traverse tight, wet passages, in caves which may have an ambient temperature in the 30's or 40's Fahrenheit. This is commonly followed by long periods of inactivity, sitting on cold ground, surveying new passage. This combination can easily result in hypothermia. 

Palmer's invention is a simple combination of a large trash bag and a candle. The person sits with the lit candle between their legs, and covers themselves, legs and all, with the trash bag. A small hole should be cut, so that the face is outside the trash bag, and the top of the head is inside. The bag traps air warmed by the candle, creating a cozy microclimate. Beeswax candles work best, burning for a long time at a high temperature.

In Ukraine, volunteers are making trench candles. This is an old technology, which was also used in WWI and WWII. 

Construction of a trench candle is simple. A tin can (1L paint can, cat food tin, etc) is filled with a spiral of cardboard, cut to the height of the can. A cardboard wick, cut an inch or two taller than the rim, is inserted. Melted was is poured into the tin, until full. The resulting candle will burn for 5-7 hours and produce quite a bit of heat. It can be used for light, warmth, and to heat food and drink. Trench candles with lids can also be boiled in water and used as re-heatable hot packs inside clothing.

Photo from How to Make a Trench Candle at Home

And here's a good video on Youtube, showing the trench candle-making process

News Story: Volunteers in Ukraine Make Trench Candles

Ukraine: Keeping my Helmet Warm

 

Ukrainian Drone hits airbase in Chechnya

 

Ukraine: Successful shoot-down of a Russian Missile during a recent attack on Ukraine's Power Grid

 

Ukraine: 3rd Brigade Interviews a Prisoner of War

 

Ukraine: Russian Submarine Missile Launch

 

This video reportedly shows a submarine missile launch, which targeted Ukraine in December 2024.

Ukraine: Monthly Salary over the Years

Right-hand column shows monthly salary in dollars.

 

Ukraine: The Cost in Dollars of Supporting Ukraine vs Letting Russia Win

 Elaine McCusker, Senior Fellow at the American Enterprise Institute, provides a cost comparison: 

~112 billion:  Cost to the US so far, to support Ukraine with weapons and other equipment (most of this money goes to US arms manufacturers

vs 

~808 billion: Projected additional US defense spending that will be needed over the next 5 years, if Russia wins the Ukraine war, including:

    - $88 billion for 270,000 more US service members

    - $31 billion to harden US facilities

    - $109 billion to increase US air combat capabilities

    - $28 billion for drone development

    - $173 billion in air defenses

    - $63 billion to enhance munitions production capability

    - $50 in shipbuilding

    - $185 in additional training and exercises

    - $33 billion in spare parts stockpiling

    - $10 expanding special operations forces

    - $36 billion expanding space and cyber systems

The full article is available in Foreign Affairs magazine here: The Price of Russian Victory: Why Letting Putin Win Would Cost More than Supporting Ukraine

Ukraine: IAEA vehicle hit by Russian FPV

IAEA Director General Raphael Grossi reported significant damage to the vehicle, and called the strike "unacceptable". There were no injuries. 

Ukraine: Eliminating Enemy Surveillance drones and Shaheds

Over four months in 2024, drones of the 3rd Assault Division aerial defense units brought down dozens of Russian Lancet, Orlan, Zala, Supercam, and other drones. 

Paths of Russian aerial attack assets on 28 Nov 2024. Yellow triangles indicated Shahed drones, other colors are missiles.

 

 

Ukraine: Medical Evacuation Under Fire

 

Ukraine: Soldier survives 24 days with a tourniquet in place

 

This injured Ukrainian soldier was pinned down by enemy fire for 24 days. A tourniquet on his left arm

saved his life. After evacuation to a military hospital, the limb was amputated, and prognosis is good.

Ukraine: Maryinka, Donetsk Oblast, before and after the full-scale invasion

 

"A Testament" - Poem by Borys Humenyuk, MIA

Today we are digging the earth again

This hateful Donetsk earth

This stale, petrified earth

We press ourselves into it

We hide in it

Still alive

We hide behind it

Sit silently in it

Like little children behind their mother’s back

We hear its heart beating

Its weary breath

We are warm and comfortable

Still alive

Tomorrow we will die

Maybe some of us

Maybe all of us

Don’t take us from the earth

Don’t tear us away from our mother

Don’t gather our remains from the field

Don’t try to put us back together again

And — we beg you — don’t erect crosses

Monuments or memorial slabs

We don’t need them

Because it isn’t for us —

You erect these monuments for yourselves.

Don’t engrave our names,

Simply remember:

On this field

In this earth

Ukrainian soldiers lie

And — that is all.

We don’t need funerals

We know where our place is

Simply cover us with earth

And move on

It would be nice if there was a field

Where rye is swaying

A lark flies overhead

And — the sky

The endless sky —

Can you imagine the grain a field

Where warriors are lying will yield?

To remember us, eat the grain from the field

Where we laid down our lives

It would be good if there were meadows there

And many flowers

And a bee under each flower

And lovers who come in the evening

To weave wreaths

To make love till dawn

And during the day, let new parents

Bring their young children

Don’t keep children from coming to us

But this will be tomorrow

Today we are still digging the earth

This cherished Ukrainian earth

This sweet, gentle earth

And with a soldier’s spade we write as one

On its body

The last Ukrainian poem of the last poets

Left alive

- Boris Humenyuk, currently MIA

Click to text excerpt below to link to Luke Harding's full Dec 2023 story in The Guardian:

"A year ago, the poet Borys Humenyuk sent a final message. For 24 hours, he and two fellow Ukrainian soldiers had been under relentless Russian fire. Shells rained down on their trench outside the eastern city of Bakhmut. “We’re running out of ammo. Down to the last bullet,” Humenyuk said over a crackling radio. Those were his last words.

Humenyuk had volunteered to relieve a group of exhausted service personnel at “zero”, the hottest part of the frontline. Now, he explained, he was wounded in the shoulder and unable to drag his injured comrade to safety. “We are stuck,” he reported. By the time an evacuation team reached the trench in the village of Klishchiivka, Humenyuk had disappeared ...." 

-Luke Harding, the Gaurdian

Ukraine: How to Improvise a Nasal Atomizer!

 

From Brown Emergency Medicine Blog

Ukraine: Good Documentary on Modern Trench Warfare from the Daily Mail

 

YEMEN: Super-simple drone made of sticks and a motor

 

Shared on Twitter by CNA Analyst Samuel Bendett

Ukraine: "The Russian Military Medicine Experience in Ukraine" from CNA

 

CNA (the Center for Naval Analyses) is an independent, federally-funded think tank based in Arlington, VA. This November 2024 CNA publication details some very basic analysis of the Russian military medical operations in the Ukraine war. 

"We Need a Medic! The Russian Military Medical Experience in Ukraine"

On his podcast, Samuel Bendett interviews one of the paper's authors here.  Bendett is a CNA analyst, and his podcast usually focuses on drones and technological developments. 

Ukraine: Holodomor Remembrance Day: 23 Nov 2024

 

The text at top reads "Hammer and Sickle - Death and Hunger"

Today Ukraine observes Holodomor Remembrance Day. It's traditional to light a candle at 4pm and put in in the window, to remember to Stalin's engineered famine of 1932-33. An estimated 3-5 million Ukrainians died in the Holodomor.

Countries in blue recognize the Holodomor as genocide.

Ukraine: "Hazelnut": the New Russian Missile

 

On 21 November 2024, Russia hit the city of Dnipro, in E Ukraine, with a new type of missile. The missile traversed the distance from its "Cabbage Canyon" Caspian Sea launch site to Dnipro in 15min. Thirty minutes before launch, Russia used to the ICBM launch protocol to notify the US. Initially, based on flight characteristics and damage assessments, it was mis-identified as an RS-26 Rubezh Intercontinental Ballistic Missile.

Further evidence revealed that it was not a Rubezh, but a new type of missile. The "Oreshnik" ("Hazelnut") is a Russian medium-range missile, capable of carrying a nuclear warhead, but apparently not capable of traveling the 5,000km minimum needed to meet ICBM definition. Various military experts are currently estimating a possible range of 2,000-3,000km. Ukrainian intelligence assessed that the missile traveled at Mach 11, and was equipped with 6 individually-guided conventional warheads, each with 6 submunitions. Putin claims that "there are currently no ways of counteracting this weapon" The same claim was made of the Iskander, which has subsequently been shot down mulitple times by Patriots. So far, Ukraine has intercepted in extraordinary 80% of all missiles fired from Russia. Mach 11, if true, would put the Oreshnik on the upper limit of current hypersonic capabilities- very hard to intercept. On-the-ground reports indicate that explosions persisted in Dnipro for 3 hours after impact. 

The Oreshnik constitutes a significant escalation. It has the potential to negate air defenses around key Ukrainian locations. It is impossible to know the target until moments before impact. It is also impossible to know whether the payload is conventional or nuclear, although Russia already routinely uses nuclear-capable missiles, including Iskanders and KH101s. While the Oreshnik may not have the range to reach the US, Western Europe would be well within range, and is not equipped with commensurate land-based medium-range missiles that could hit launch sites within Russia.

Ukraine: US authorizes use of ATACMs and Storm Shadows on interior Russian targets

 This week has seen the first use of US ATACMs missiles, as well as British Storm Shadows, on non-frontline targets within Russia. 

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.