A (Tele)Helping Hand

February 13, 2023 - By Cassie Myers 

On the morning of February 24, 2022, Russia invaded Ukraine. The ripples of this event were wide and far-reaching, and they hit Sol Savchuk, a fourth-year medical student at Stanford, with extra force.  Savchuk was born and raised in Ukraine, and still has family there. She remembers the day vividly, all the “shock and anger” it produced in her as well as countless others at Stanford (and, of course, around the world).

But Stanford students are nothing if not resourceful. So Savchuk, an active member of the Ukrainian Student Association, and many of her fellow students (including med students, computer science students, social workers, and others) took action. “We started to think practically about what we were in a position to do,” she remembers. They began with the facts: there were countless physicians, volunteers, and providers (at Stanford, and around the world) who wanted to help, and a population in Ukraine, displaced and often without working healthcare facilities, desperately in need of that help.

“We wanted to put those two together and become the middleman to help connect them,” she explains. The basic idea? Use US doctors and providers to provide telehealth services to patients on the ground in Ukraine.

And Telehelp Ukraine was born.

Telehelp Ukraine now has around 120 providers, with about 40–50 active on a weekly basis, and another 60–80 volunteers. It operates as a nonprofit organization with a board and advisers and various teams, including Operations, Social Media, Patient Outreach, Clinical Services, Health Navigators, Interpreters, Finance, Builders, Research, Writing, and more. Volunteers and providers began as a core Stanford group, but now come from across the country and around the world, in Ukraine, Canada, Australia, and Europe. Savchuk estimates that they’ve had 500 appointments since the beginning, ranging in specialties from endocrinology to mental health services.

But they had to start small.

As Savchuk and others on the team acknowledge, the logistical hurdles at the beginning were intense: “There were so many barriers to overcome, technological, linguistic, legal, cultural, and so on,” Savchuk states. Tran remembers other concerns, too: What protocols should they have for psychiatric emergencies? How could they translate medical documents in time for appointments? And how would they deal with inevitable no-shows, with patients who were  facing not only the normal bustle of scheduling but also power outages, displacement, and all the other horrors of war? The problems could seem astronomical.

But Telehelp Ukraine took on each problem as it came. They saw their first patient at the end of April, about a month and a half after the idea first materialized, and since then they’ve had what Savchuk describes as a “consistent flow” of patients. The majority of appointments are from Ukraine, but they also see patients from Poland and outlying regions affected by the war. Many patients (probably around 40 percent, Savchuk estimates) are seeking mental health services. 

But how does this system work for patients on the ground in Ukraine?

It starts with local outreach, with local organizations and information platforms informing Ukrainians of the service. Potential patients are directed to the Telehelp Ukraine website (available in various local languages) where they can schedule appointments as well as request specialties and leave relevant medical information.

The scheduling team then handles the next few hurdles, wrangling the availability of providers, translators, and medical interpreters as necessary, and scheduling (or re-scheduling) as needed. This can be the most difficult part, particularly in a time of war when access to Internet, electricity, and other basics are not guaranteed.

Most of our patients end up coming back at least once.

Relevant documents and photos are uploaded, translated, transmitted, and interpreted. Patients are texted appointment reminders, with volunteers standing by for technical assistance when the appointment rolls around.

Once the appointment is finished, providers and translators follow up with detailed instructions, treatment notes, next steps, and more. This can mean asking patients for additional bloodwork or imaging or requesting that they go get medications themselves (many are available over the counter in Ukraine that wouldn’t be in the US). “We're being creative around the local availability of resources, which varies from region to region,” Savchuk explains.

There’s no cap on follow-up appointments, either. “Most of our patients end up coming back at least once,” Savchuk says. “For mental health services, they often come back for regular therapy sessions, even 8, 9, or 10 appointments.”

Many patients said they felt heard and cared for, something that is especially needed during times of war.

Savchuk has been present as an interpreter at many mental health appointments, and remembers how affecting they are. “It’s weird when you meet these people who are really strangers to you, but you just feel like you can see your parent in them, or your loved one, or your sibling,” she says. “These stories could have happened to any of us.”

And there have been triumphs. Many telehealth providers were able to make significant diagnoses, even from thousands of miles away, that improved patients’ daily lives. Patients were able to seek out treatments for their symptoms and in some cases their pain was erased completely. “Telemedicine has a lot of limitations,” Savchuk acknowledges. “We're just trying to stretch it as far as it will go. But sometimes we're surprised by how effective it can be, especially in a zone of conflict.”   

Patient feedback has been encouraging. “Patients are very happy with the quality of care,” Savchuk says. “But they’re also just happy to know that the whole world stands behind them and supports them. That’s just as helpful.”

Tran agrees, calling the feedback “heartwarming.” “Many patients said they felt heard and cared for, something that is especially needed during times of war,” Tran says. “My favorite part of TeleHelp is how patient-focused the organization is. Decisions are thoughtfully discussed to ensure cultural sensitivity and patient benefit, and patients are contacted both immediately after the appointment and one month later to make sure their concerns were properly addressed. ”

Von Gerlach loves hearing directly from the patients as well. She’s been impressed by the power of telehealth, which enables them to connect people from all around the world and at essentially any time of day. “Everyone in the organization gets a lot of satisfaction knowing that we are helping patients every single day,” she says. And the connections telehealth makes possible are truly astounding: Von Gerlach remembers one young boy who needed a maxillofacial surgeon. Telehelp Ukraine found someone to help him and the surgeon and patient met for a telehealth visit.  

Tracy Rydel, MD, a clinical associate professor of medicine and clinical advisor for the organization, describes Savchuk as “the heart and soul” of the organization, but Savchuk, who moves almost immediately from “I” to “we,” is quick to include others in the description. “I'm really just speaking on behalf of a team of amazing, very dedicated and very hard-working people,” she says. “I’m very honored to be defined as the heart and soul of this but really the heart and soul is the entire team that made it all possible. There are so many moving parts, and I’m just very grateful to have them all on board.”

Savchuk also wanted to highlight how much support they’ve gotten from faculty and providers. They were crucial, Savchuk explains, to the program’s early days.  Faculty and board members got directly involved in many stages of the work, from supervising to guiding and advising. “Knowing how busy all of them are and how responsive and supportive and understanding and flexible they've been,” she says, “it's just been amazing.”

Von Gerlach is also quick to thank their “incredible” volunteers. “They dedicate hours and hours of their time every single week,” she enthuses, “and they’re hyperfocused on providing extremely high quality medical and mental health care.”

Rydel, who’s been a clinical advisor to the program since May 2022, turns the praise back on the students. “I must emphasize that so much work has been done by the students and I am lucky just to be involved,” she says. She also has deep personal connections to the project. “My mother is a Ukrainian immigrant, and I was raised deeply rooted in Ukrainian culture (church, community, holidays, and identity), so this was an important project for me,” she explains. “I felt rather helpless since I was unable to do more than donate money while living abroad, so investing some time in this meaningful endeavor has meant a lot.”  

Tran is also grateful for the learning experience. “I’m learning more and more about Ukraine and its culture,” she says. “During one of our meetings in November, multiple members had watermelons in their background zoom pictures. I learned that it was to celebrate the liberation of Kherson! The watermelon is a symbol of Kherson because of the ample watermelon supply in the region.” She adds, “It has been such a pleasure and honor to work with all the passionate, kind-hearted volunteers.”

So what’s next? Tran, Savchuk, and others have detailed ideas for further expansion, into more research and writing teams, providers in all medical specialties, and building stronger networks with local Ukranian providers. They show no signs of slowing down. In a way, their simplest message is the most moving: “We’re here for you.”

Savchuk and her team are prepared to help, no matter what comes next. She vows, “We will continue offering appointments for as long as there’s a need for them.”

Telehelp Ukraine is always looking for more volunteers, including providers and medical professionals as well as volunteers with no medical experience.  If you’d like to help, please click here to visit their website. A Telehelp Ukraine info session for providers will take place on Feb 27^th at 12 pm PST. If you would like to sign up for the mailing list to receive updates or RSVP for the info session, please fill out this form HERE.