Ukrainians evacuate childhood cancer patients, join convoy to visit Polish triage center

Dr. Roman Kizyma and Yuliya Nogovitsyna climbed into a car, the tail end of a medical convoy headed from Lviv, Ukraine, to the Polish border.

Boxes of medical supplies and basic equipment for each bus and ambulance had been prepared ahead. A police escort was ready to clear the red-light intersections along the 45-mile route.

There were 16 children, two in serious condition, and their families, most from Kherson, a city under Russian occupation. By this day in April, they’d spent more than a month in a hospital there with no way to leave the city. Medicine was running out. Only one doctor remained.  

Tabletochki, a charity devoted to supporting pediatric oncology patients in Ukraine where Yuliya is program director, hired eight cars with eight drivers. They switched license plates when they entered the city so as to not look as if they were traveling through.

Drivers paid Russian soldiers for passage.

“It was a risky operation, but there was no safer alternatives,” Yuliya said. "To stay in Kherson seemed more risky."

The trip from Kherson to Lviv, one of Ukraine's western-most cities, was 650 miles. The children stayed a week at the Lviv hospital to rest — from the long trip and their terrifying time under occupation — and waited for the next convoy.

Now, Roman and Yuliya were joining them on the last leg of the journey to safety.

“I felt that I’m tired and exhausted, and I can imagine how these families are tired and exhausted because children are not well,” Yuliya said. “… For a cancer kid, it is difficult to sit 12 hours in a bus. You can get nausea. You can just be bored. Or you can have headache or stomachache.”

From the first days of Russia’s invasion of Ukraine, Yuliya and Roman, head of the Pediatric Oncology Clinic at the West Ukrainian Specialized Pediatric Medical Centre in Lviv, have rushed to arrange the transport of children with cancer from all over the country so they could cross the border and continue treatment.

They’d seen photos and videos from the convoys. They’d talked on the phone with doctors who’d traveled with patients — sometimes as many as 70 at a time. They’d arranged the buses, ambulances. They knew about the children who fell into medical crisis along the way. Ones who needed an infusion. Others, a helicopter waiting at the border. The long delays.

The weariness of trips that seemed like they’d never end.

Roman and Yuliya, along with their colleagues, had already sent hundreds of children — ones with leukemias, lymphomas, brain tumors, cancers of the abdomen, and others with diseases so rare the only option was to evacuate them to the Unicorn Marian Wilemski Clinic. It’s the triage center set up by St. Jude Children’s Research Hospital and its global partners, a place for sick children to rest before they travel to other countries for continued treatment.          

But on this day in April, just before Orthodox Easter, Roman and Yuliya got to experience it themselves.

Roman had permission from the Ukrainian government to leave for a few days to travel as a medical escort with the convoy. Men otherwise are forbidden to cross the border in case they’re called to fight.

Yuliya joined him.

Dinner was waiting when they arrived, though it was almost midnight. The whole team welcomed them. St. Jude staff, local nurses, volunteers. Roman and Yuliya knew some of them. But every single person knew them. 

There had been no time to think about the heroism of their work, Yuliya said. But that's how they were welcomed.  

Roman and Yuliya finally took a breath, away from the air raid sirens and constant threat of missile attacks back home.  

“It felt here like a big, extended family,” Yuliya said. “You know, everybody was missing you, and everybody was waiting for you.”

Roman was emotional, too.

“Men in Ukraine, they don’t cry. No emotions,” he said, laughing. “It was emotional, of course, because a lot of people that we’ve never seen each other in life, but we created this kind of pathway of life, and you feel for these people sometimes more than people you see every day.”

Yuliya marveled at the organization, the whiteboards, the procedures — everything checked and rechecked. But for Roman, it was exactly as he anticipated.

“I witnessed how it worked, how they do the triage, how they do the testing, how they communicate, how they meet as a big team,” he said. “… It really works like a hospital. And it was created from nil, in the middle of nowhere in the forest where people really just have beer and relax.”

What he saw was a relief, really. He wouldn’t have added a thing.

The place was more like a summer camp than a distribution center. Children, some bald, chased each other and held plush unicorn toys. Even parents seemed relaxed. There was nothing to bother about. Everything was provided: food, a place to sleep, medical care, and transportation. Tenderness and love could be found in the smallest of moments.

Beyond witnessing the operation and visiting colleagues, Roman and Yulia strategized with St. Jude staff who were at Unicorn about how they might work together to support Ukraine’s pediatric oncology landscape in the future.

“I made some personal photos for me to have it in my memories forever,” Roman said.

In these few days of more reset than respite this spring, Roman and Yuliya could see the fruits of their hard work.

“I really don’t think anything similar happened in healthcare systems before,” Roman said. “Anywhere, ever, I’m sure.”

Still, it was hard to shake the extreme emotional highs and lows of the previous months. Moments replayed in their heads. The shock of the initial invasion and questions about what they’d do with patients. Should we treat them? Should we hide them?

The triumph of moving so many children to safety. The magnitude of everything they’d lost.

Just five days before the war started, Roman had opened a bone marrow transplant unit in the old hospital in Lviv, in a low-income country, as he put it. He’d overseen a national conference for hematology and introduced clinical trials of the first phase from the United States. He was the principal investigator, he said, one of the youngest in the world.

All of that evaporated — a lifetime’s worth of work — the instant the war began. Instead, Roman spent hours in the train station, waiting for children with cancer to arrive. He gathered strong men to carry them to waiting ambulances, sometimes more than one child at a time. 

Hundreds of thousands of people were fleeing Lviv. Roads were packed. Masses of people shoved to get on and off the train. Sometimes, Roman fell on the tracks in the rushing crowd with children still in his arms. The worst was five days in a row of trains. They just didn’t sleep at all. Some children arrived with fevers. Others were in pain. Some couldn't move.

If the children weren't carried from the railway cars, they could have died at the train station.

The scene looked to Roman like the chaos of a Hollywood movie.

Five or six times a day, he and other hospital staff carried children to bomb shelters as air raid sirens sounded. Staff and parents slept at the hospital, too, because 10 p.m. was the commandant’s hour – the martial law curfew. No one could leave.    

“So, it was emotional, and I came to the right place,” Roman said of Unicorn. “I was really stressed and depressed and tired of all of these events. … We just faced the necessity to step in. We didn’t run away. But it wasn’t a thing that we wanted. So, I felt like I am in a safe place.”

After a few days, Yuliya returned to Lviv. She spent Orthodox Easter with her husband and children. Roman visited his wife and three children in Slovakia before he returned home, too.

Yuliya and her family have temporarily moved to Lviv in a rented apartment from the capital city of Kyiv. Roman and Yuliya work together in the local hospital. And Roman's family is back from Slovakia.

Children no longer wait in crowded train stations to be carried to ambulances. But patients whose families couldn’t flee still must be treated. Doctors don't carry them to bomb shelters every time the air raid siren sounds. They take them instead to a corridor without windows.

The hospital has about six months of basic chemotherapy drugs and a pathway to procure more from Germany, though sophisticated diagnostics are no longer available. And doctors know the longer the war drags on, there’s a chance they’ll be called to the front to fight.

“We don’t know how to act in the future because these guys are shooting missiles in the big cities of Ukraine, so when you can just watch out of your window and see how the missile flies and strikes the residential building where like hundreds of people live,” Roman said. “And you cannot know, it may be your hospital.”

What’s next is a constant question.

Should Roman send his staff to Europe and the United States for training? What if 100 patients come in the next month, and he doesn't have enough staff to treat them and they fail? What if half of Ukraine’s population never returns either because of war casualties or that the brightest leave the country forever?

“We are desperate,” Roman said. “And we don’t know what we should do. Should we rebuild it or should we wait? Or should we leave the country because it is for nothing? We don’t know what else is prepared here for us.”

Still, Yuliya holds on to the thought that so many people are willing to help.

“I see these people, they work not for money and not because they were instructed to do some things,” she said. “Because they are so much devoted and committed to help children with cancer, to help Ukraine, to mend the wrong which was done. … Everyone considers these children to be theirs.

“So, they’re not Ukrainian. They’re just children with cancer who are to be helped, supported.”