1. project Background 

Even before the war, there was a gap in eastern Ukraine between poor, backward rural populations and rich, modern, high-tech cities. The war widened this economic and social gap. Younger people have fled the rural areas close to the combat zones, towards Europe or the cities of the West. What remains are mainly elderly people who, despite the danger of being close to the front line, remain attached to their land and refuse to be evacuated to the west. The rural populations living close to the combat zones in the Kharkiv, Donetsk and Sumy regions are particularly suffering from the devastation caused by more than two and a half years of war. The daily bombardments have destroyed civilian infrastructures (schools, hospitals, houses), as well as energy structures (water, gas and electricity) and communication routes (destroyed bridges, mined and/or damaged roads). These rural populations are thus deprived of access to medical care and are living in a critical humanitarian situation. With no means of transport and very few economic resources, the vulnerable elderly and/or disabled living in these half-ruined villages cannot get to the hospitals in the neighbouring towns that are still operational. For these reasons, our mobile clinics are primarily aimed at this vulnerable rural population. The National Health Cluster (led by the WHO), in which we participate, encourages us to fill this humanitarian "gap", while of course complying with safety protocols (our members are trained in first aid and follow a mine risk education course offered by Handicap International in Kharkiv).

2. Concept and objective

Overall objective:
To contribute to improving access to primary healthcare for vulnerable populations in Ukraine.
Specific objective:
To ensure the regular provision of primary healthcare and improve the continuity of care for vulnerable people living in the border and rural areas of Soumy oblast.
Activities:
1. Primary care:
The mobile clinic provides regular primary care (monthly by default) in the homes of people with disabilities or reduced mobility identified by the Hromadas social services.
Medical consultations include:
- Medical interview
- Auscultation
- Taking of vital signs (blood sugar, oxygen, pulse, respiratory rate, ECG)
- Interpretation of medical tests
- Nursing care (wound disinfection, dressing application/replacement, catheter application).
- Prescribing and administering medication

2. Referral to emergency care:
If the patient's state of health is ‘critical’ and requires urgent treatment by hospital services, the doctor calls 112 and requests the intervention of emergency medical services. The medical team provides emergency care to the patient until help arrives. The doctor closely monitors the patient's condition in hospital. When the patient's condition has stabilised, at the request of the hospital and with the agreement of the patient's family, he or she is transferred home. The doctor determines the frequency of visits (weekly or monthly) depending on the patient's state of health.

3. Medical transport for secondary care :
If the patient's state of health is ‘stable’ but requires hospitalisation or a specialist consultation, the medical team organises hospital appointments and medical transport for disabled or reduced-mobility patients. A special relationship has been established with the Saint Pantelemon secondary care hospital in the town of Soumy, to facilitate rapid care for patients, as well as the Soumy and Kharkiv regional oncology hospitals.