The Pharmaceutical Journal Vol 267 No 7179 p911-936
22-29 December 2001

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Christmas miscellany summary

A humanitarian aid journey to Ukraine

In retrospect, the most challenging part of the journey I took to Ukraine earlier this year to provide humanitarian relief was getting there and back. I was charged with procuring medicines for a dispensary in Vinogradev in the Transcarpathian Oblast (county) that provides free dispensing for the poor of the area. Vinogradev is in the very west of Ukraine and the people there are more ethnic Hungarian than Ukrainian. This part of the country is close to the borders of Romania, Hungary, Poland and Slovakia and over the years has been subjected to various countries' rule. It is possible for someone to be born, grow up, marry, and die in four different countries.

The people are for the most part Roman Catholic, with a small proportion of Greek Orthodox. There is a huge population of Romany people for whom the aid is mostly destined. I went as part of a Rotary Club party from Yorkshire under the aegis of Caritas, a Catholic charity which has the means to enter Ukraine. Ukraine is not on the tourist agenda of most Westerners, and an invitation from an individual or organisation is essential to gain a visa to enter the country.

The journey out

The journey was to be made by three 25-seater buses, plus a 40-ton articulated lorry, travelling from Hull to Zebrugge, and then across Belgium, Luxembourg, Germany, Austria, Hungary and finally into Ukraine. Little did we know as we loaded the buses with the donated aid at our depot in Yorkshire, that the most taxing part would be keeping the buses running. But keep them running we did, although one bus had to be abandoned in Belgium and another had a serious fuel leak coming through Hungary (we managed to repair this with the help of a passing Rotarian). Our journey involved much boring travelling and I will not dwell on it, suffice to say that every day brought a new challenge — would the buses start or wouldn't they? We saw many things along the way, and the sight of a procession of teenage prostitutes in every lay-by from Debrecen (Hungary) to the Ukrainian border was among the most memorable.

Our arrival at the border was met with some trepidation as we had heard many tales of the bloody mindedness of the border guards. The Caritas part of the convoy had gone on ahead (because we were holding them back with the constant breakdowns) and we heard that they had spent 23 hours at the border. We left Hungary, crossed the River Tizsa, and entered Ukraine at Côp. Four hours later we were on our way — it's not what you know, it's who you know, and one of the Rotarians from Uzgarhod had done all the work with customs in advance. After having a drink and a meal at a border brothel, we were on our way — complete with a police escort, which magically melted away the traffic. The roads in Ukraine were not the best: the pot holes are legendary.

Arrival at Vinogradev

We arrived at Vinogradev at about 10pm on 17 April. Members of the group were spread around the Catholic community for lodgings, and we were at the Caritas compound. Others were lodged at the parish house. All meals were taken at the parish house, and we were ferried back and forth by Father Tiomy, who we called "Father Schumacher" because of his handbrake turns and quick driving. Every one of the Rotary team had a specific job to do, be it driving, navigating, mechanics, or as in my case, pharmacy. I have never driven on the continent, so I was excused from driving — my part started on arrival at Vinogradev.

Before making the journey, I had consulted the Royal Pharmaceutical Society, the Home Office and the Ukrainian Embassy about the transport of medicines to Ukraine. From every one of them, I received sound advice, and I must thank Helen Darracott at the Society especially. We had asked Caritas in Ukraine what they wanted in the way of medicines and they sent back a long list, some of which I had never heard of. What, for instance is a hepatoprotector? I had been given £1,000 from Skipton Rotary Club and £500 from central Rotary funds to spend on medicines.

Wholesaler, Freemans of Harrogate opened an account for me, and the medicines I packed and travelled with included:

• Diazepam 2mg, 5mg, 10mg
• Diazepam 5mg, 10mg rectal tubes
• Paracetamol 500mg
• Aciclovir 200mg, 400mg, 800mg
• Erythromycin 250mg
• Carbamazepine 100mg, 200mg, 400mg
• Cefalexin 250mg, 500mg
• Ranitidine 150mg
• Loratidine 10mg
• Omeprazole 20mg

Vasiliy, the local pharmacist, was overjoyed with my selection. There was quite a lot of paperwork to go through to get the medicines over to Ukraine. I had to supply to the Ukrainian government in Kiev all the active ingredients of the various preparations, their batch numbers and expiry dates. To be safe I also included the product licence, manufacturer, source and my registration number.

The next morning we set about unloading the two buses and the lorry with enthusiasm and soon all the aid was stored away safely in the Caritas warehouse. Besides the medicines, I had brought our old dispensary computer, a 386, with monitor and an Epson FX80 printer (donated by Free Computers for Schools, a Rotary charity) and two of us set them up in the dispensary. We could not unpack the medicines because they had not received customs clearance from Kiev (and still had not when we left). NDC Healthcare had donated a complete Alchemist system (software and dongle), and my assistant and I had loaded it on to the computer in Dewsbury before it was packed for shipping in the UK. It was a gratifying moment when we plugged in all the cables and switched on — it worked first time.

Dispensing session

Vasiliy dispenses for the poor of the area (mainly Romanies) on two afternoons per week, and the next day was to be one of the sessions. Vasiliy's English was a bit weak, although much better than my Hungarian, so what passed in the dispensing session were my own impressions, and I could not quiz him about the nuts and bolts of the operation.

On Friday morning, a couple of us worked in the dispensary, and it was the coldest dispensary I have ever been in. We went to familiarise ourselves with the Alchemist system and how we could best adapt it to their use. I ruled out label printing as Vasiliy's patients could not read English, but the printer could provide a useful word processor. Vinogradhev was a central point and people came from all over the district to have their prescriptions dispensed. From early on people were congregating outside the pharmacy. We were of course unable to help — we did not speak the language, but I could understand some of the prescriptions that were thrust at me. They were written in Roman characters, as opposed to Cyrillic, and were in Latin. We eventually got the Alchemist program working as we wanted. I turned off all the bells and whistles, such as low cost alert, and set to writing a set of simple instructions to get Vasiliy going.

At 2pm Vasiliy arrived — he reminds me of Council member Andrew Burr, and is much given to hugging me. He really is pleased with the aid we have brought. He got ready for the dispensing session by putting on his white coat and placing a metal box on the counter. This box was for people to put donations in if they could afford it, and some did so.

In July, 2000, two Rotarians from our district had been out to assess the situation, and they reported back that there was very little in the way of medicines. However, when I went into the dispensary, it was quite well stocked. A German charity had just delivered supplies. But Vasiliy only had these medicines — when he ran out, there was no telephoning Ukrainian UniChem; he had to rely on charities to supply more. Vasiliy was only the second pharmacist I have ever seen who arranged his dispensary in pharmacological order, and it made for added complications, but he seemed to cope; at least he could see what classes of medicines were needed.

The patients came in and handed their prescriptions through a small window — Vasiliy had no contact with the public, except through this window, but it did not put him off and he counselled the patients through it. I was unable to determine the course of events that led the patient to the window with their prescription, but knowing Caritas, there was probably a free doctor at a clinic somewhere.

Vasiliy did everything we do when we receive a prescription: deciphered it, (even Ukrainian doctors have abysmal handwriting), checked if he had it in stock and finally dispensed it and handed it over with a little patient counselling. One major difference was that if he didn't have the item in stock, he would substitute it with the nearest that he did have. The majority of the prescriptions were for cardiovascular disorders, with a sprinkling of "rheumatics". I only saw one prescription for a psychoactive medicine although Vasiliy had a whole shelf of Anafranil and Prothiaden.

As each patient handed in their prescription, Vasiliy would enter the details into a book, if he wanted to see what a patient had had before, he had a long search through his past notes, and it was this aspect of the computer system that would let him search more quickly. I noticed that some people came "on spec" without a prescription, but with the box they had had dispensed the last time they came, or even just the name of a medicine written on a scrap of paper. Sometimes Vasiliy would dispense their request, and sometimes he would not — like a request for triazolam!

I could not understand what happened to the prescriptions after he dispensed them, but I did notice that if he did not have a particular product, and he could not substitute, he would cross off those items he had dispensed and hand back the prescription, perhaps for another time. If the product was in a patient pack, then Vasiliy would write the instructions from the prescription on the box. BAF printers in Leeds had given me a small supply of blank labels, designed for the printer, and now Vasiliy was able to write the instructions on the labels and stick them on the box. If he had loose tablets, ie, decanted from a bulk supply, he would fold them in a piece of paper and write the instructions on the paper. This was not done through laziness — indeed Vasiliy made an intricate paper package with which to hand over the tablets. For the past two years, I have been collecting empty plastic tablet bottles from my customers and I was able to give Vasiliy a huge bin liner full of empty bottles.

We thought we would have plenty of time to show Vasiliy the computer, but there was a continuous stream of people between 2pm and 5pm. However, Vasiliy was so taken with the computer that he stayed an extra hour while we went through the basics of the Alchemist system. It is a good job that Hungarian uses a basically Roman alphabet, because if the Cyrillic alphabet was used, the system would not be of much use.

As I have said, I consulted many agencies before I went, with regard to the conveyance of medicines, and they all said the same thing — recycled medicines, samples and returned medicines are not acceptable, and any medicines donated have to have at least one year of shelf life left on them. Freemans helped me make sure that these conditions were met.

The journey back

Our journey back was just as eventful as the journey out — the alternators on both buses failed, meaning that the buses were running on batteries only. We had three sets of batteries in each bus with another one on charge in the lorry. We were pulled over by the police in Germany for going too slow on the autobahn and collecting a two-mile long line of lorries, but when we mentioned the magic words "humanitarian aid" we were sent on our way.

Eventually we arrived in Belgium and were given the location of the third bus that was abandoned on the way out. A Belgian Rotarian had towed it to his scrapper's yard and stored it. The bus still had its load of aid on board, and we unloaded it into the empty lorry (well half-full lorry — we stocked up with beer in Luxembourg). When we saw the aid that we had had to leave behind, we could have wept. During our stay in Ukraine, some of us had visited the Children's hospital in Uzhgarod, and although clean and tidy, it was obvious they had little equipment. In the Belgian's yard, we unloaded boxes of sheets, blankets, a microwave (they used a very slow hot plate to heat feeds), stretchers, dressings, a refrigerator: it went on and on. The presence of all this aid made us determined that we would return and give it to the hospital.