The first Ukrainian-American professional exchange took place in the fall of 1993. This was a spin off of \"Hands Across the Water\" that began with the New Jersey school system and Russia in an effort to improve relations between the countries through education. In 1991, Ukraine gained its independence and was offered the program. Teachers, nurses, doctors, business people, and other professionals were invited to live with their counterparts in their homes in Ukraine, which is one of the greatest learning experiences of the program.

My wife who is a reading specialist was offered a spot on the team, and I applied to the program as an exchange physician. Our Ukrainian delegation organizer informed me that I would be staying with an anesthesiologist in Kiev, the capitol of Ukraine. The doctor was Alexei. His father was the founder of the delegation in Kiev who coordinated our stay.

We flew into Frankfort, Germany, then met with the group in Moscow. The delegation of 84 teachers, nurses, and doctor left for four cities in Russia and I headed for Kiev. We were treated royally by the Ukrainians who were honored to have us as guests.

I visited two hospitals while in Kiev. The first was Maternity Hospital #4, at which Alexei was a staff anesthetist. My first impression was that this was a dark and nondescript place. We entered into an elevator that could only accommodate three people standing. How did patients that were unable to walk get into the elevator or up to the surgical suite? The second impression was that light was limited inside the building. There was a lack of light bulbs in the building. I later found out that as soon as the light bulbs were replaced they were stolen.

The doctors\' lounge was a simple room with a fold up cot for the on call doctor. There was a rotary phone on the desk, and the remainder of the furniture looked to be of 1950\'s second-rate hotel stock vintage. The medications were kept in a cabinet here that was about 2\' x2\' x6\', solid on three sides in porcelain, with a locked glass door in white painted frame. I remarked that the x-ray view box was not plugged in to the electric wall socket and was quickly told that there was no need since there was no x-ray machine in the hospital.

I was allowed to look at and read any document that I came across. However Alexei told me that the documents were all in Russian. This was in direct defiance of the nationalistic direction of Ukraine to become independent. But he laughed and stated that all the doctors were Russian educated and this nationalistic trend would not last.

I asked if I could sit in on an operation and the doctors were delighted, as this was a teaching hospital. They also had no objection that a still camera be brought into any observed activity. The next day a vaginal hysterectomy was scheduled and all the residents and myself gathered to witness the surgery. I got there early to watch induction of anesthesia by Alexei. Prior to the operation, Alexei showed me the modern anesthesia machine that was present in the hospital. However, it was not working.

The patient was brought into the surgical suite and placed of the operating table. I noted that the anesthesia arm board was simply a four-foot length of wood approximately four inches wide and was placed behind the patients back and kept in place by her weight. This was covered by white oilcloth for easy cleaning. The outstretched arm was secured by a piece of cloth. Induction was by intravenous medication. On a small stand next to the anesthesiologist was an electric hot plate with a chipped, rusted porcelain pot with a lid. This contained boiling water and into it was placed reusable glass syringes and metal needles. This was the method of sterilizing these appliances. The IV anesthetic was taken from an open mouth jar. An intravenous infusion was then started. Alexei removed the plastic tubing from his bag; the tubing was already removed from its container. After successful induction of anesthesia, Alexei took out a plastic endotracheal tube, cleaned it with a cotton swab saturated with alcohol and after intubation switched to gas anesthesia. I asked about this procedure and was told that these were the only equipment he had and if he autoclaved them he would destroy them and have nothing to use. Besides, there was no autoclave in the hospital for sterilization. i

Since there was no way of measuring the oxygenation of the patient, Alexei would remove the anesthetic mask from time to time and evaluate the color of the patients lips, ear lobes, and tip of the nose. If these parts were pink, it was assumed that adequate oxygenation was being administered Cadiac monitoring was done by routinely checking the carotid pulse and an occasional use of a stethoscope on the chest. Nurses were also being taught to become nurse anesthesiologists and occasionally Alexei would leave the operating suite for a smoke. The students were then in command of the administration of the anesthesia.

The vaginal hysterectomy was performed by two female surgeons who sat on wooden stools. The ten residents stood on wooden stools to observe the surgery. However, little of the procedure could be seen or photographed. The surgical table pointed towards an open window about ten feet away. The window provided more light and cross-ventilation in the operating room. An adjoining equipment room also had an open window. There was heavy construction being carried out approximately three blocks away. However, the possible contamination seemed to bother no one.

The surgical team departed after the surgery leaving Alexei, a cleaning lady and myself to arouse the patient and clean the room. With the patient still in stirrups, the cleaning lady, clothed in street clothes, wearing elbow length rubber gloves, a babushka with mask, an oil cloth apron, and rubber boots started to clean up the bloody surgical sponges and the floor. The surgical instruments were unceremoniously placed in a soapy bucket at the foot of the surgical table. This was not a stainless steel bucket but a common metal bucket! Alexei aroused the patient by applying cold water to her face, slapping the patient, and calling her name. We then wheeled the patient into an eight-bed ward; there was no post-recovery room.

I returned two days later to see how the patient faired. I could not communicate with the patient, however, she seemed to be doing well. The open ward contained six other patients with no semblance of privacy. There was one nurse in attendance. The urinary catheter was made of rubber and drained into an open vessel on the floor under each bed. The containers and the beds were old, chipped, and rusted. No monitoring equipment was seen in the ward. I took several pictures of this ward and gave ballpoint pens to all the participants. The nurse was delighted and the patients thought that this American was crazy; no one gave gifts to patients in a hospital. Food service was never determined.

Alexei\'s salary was about $13.00 per month. The salary of the surgeons was $25.00. They often were not paid! The salary of the nurses and other personnel were never learned.

Later I was taken to a 1200-bed hospital in another section of Kiev. It was supposedly the largest hospital in Kiev. On this trip an American school nurse joined me. After meeting with the director of the hospital, a short stocky surgeon about 50 years old, we were asked if we had any cimetidine. He stated that he could only get the product that is made in West Germany and only came in the dosage of 200 mgm. I thought that was an odd request but later learned that 25% of the males in Ukraine had ulcers. Because of the lack of cimetidine or similar drugs the principal method of treatment of ulcers was gastrectomy.

We were then taken on a tour of the hospital. Before embarking I asked if there was a cardiac cath lab, a GI lab, an intensive care unit, and a MRI. To all these questions the response was positive. However the MRI machine was across town and not readily available. On our tour, we tried to visit the various specialty labs but the director did not have a key to enter nor did he seem to know whom to call to gain entrance. We did see the intensive care unit. There was one patient in the unit, a comatose woman who was intubated with the diagnosis of acute asthma. The director of the critical care unit was friendly and showed us the special lab for the unit. As we talked through an interpreter in the lab, one of the technicians started to openly weep. She continued to do so the entire time. I later asked why she was emotional and was told that we were the first Americans that she had seen and was weeping for joy.

After the tour we thanked the doctor for his time. I was then told that Russian doctors were better at physical diagnosis then American doctors and did not require the many tests that we do to arrive at a diagnosis. I wondered to myself how many of the gastrectomies were done with the right diagnosis of the ulcers and how many solid tumors of the lungs they could hear. We gave the director $6.00 for his time and left. With his salary of $30.00 per month as director of the hospital, the tip seemed appropriate.

After our visit to Ukraine, exchange arrangements were made to bring some of the teachers from Ukraine to the US. However, after arriving in the US, many never went back. The program was quickly and unilaterally disbanded.

The cold war was always present in my life until 1991. When the opportunity came to travel to the former Soviet Union I jumped at the chance. Documents and movies had depicted the life of the people in the former USSR but to actually experience it was altogether different. In the United States, we do not have military personnel packing sub-machine guns in our airports or on the streets. Landing in one of Moscow\'s airports and seeing this scene gave immediate grim reality to the stories that I had seen and read about. Seeing people from Kazakhstan being kept in a holding tank at the airport was also unnerving. They were being held on the pretext of being rebels and without an internal passport.

Medical personnel are not held in high regard in the communist world because they do not produce any goods. A common bricklayer is more respected because he builds a wall, something that is physical and useful, whereas physicians and surgeons do not.

There is also the feeling of planned obsolesce in humanity. Retired people do not contribute to the economy, only take from it. This also applies to people with chronic and incurable diseases. Therefore it is not of high priority to spend a great amount of the gross national product on keeping people alive, especially if they do not contribute to the economy. If a person has wealth they can buy almost anything, including good medical care. It is not stated anywhere or written anywhere but one must experience the daily life of the Ukrainian people to know that this philosophy does in fact exist.

Learning the workings of a system require more that reading or researching. One must \"walk a mile in their moccasin\'s\". Therefore it was helpful to step back from our system to gain a true understanding of the life of the Ukrainian medical professionals. From what I had observed, the professionals knew what to do but did not have the resources to do it. Though it may be helpful to provide an exchange program for Ukrainian medical professionals to come to the US, I don\'t think they would be able to make a significant impact or change on their system upon their return given the current state of political turmoil.