As coronavirus infections hit Ukraine, a single shift for Dr. Oleksandr Molchanov now stretches to 42 hours — 24 of them in Kakhovka's hospital, followed by another 18 hours spent visiting tents set up to care for 120 COVID-19 patients.
While vaccination rates in Eastern Europe have generally lagged, Ukraine has one of the lowest in the region. But because of its underfunded and struggling health care system, the situation has turned dire nearly two years since the virus swept into Europe.
The country is setting records almost every day for infections and deaths, most recently on Tuesday, when 838 deaths were reported.
“We are extinguishing the fire again. We are working as at the front, but our strength and capabilities are limited,” said Molchanov, who works at the hospital in the city in southern Ukraine on the Dnieper River. “We are working to the limit.”
After his grueling shift, the 32-year-old doctor goes home to sleep and recover for two days. The next one may be even more challenging.
"The situation is only getting worse,” Molchanov said. “Hospital beds are running out, there are more and more serious patients, and there is a sore lack of doctors and medical personnel.”
The tents beside Kakhovka's hospital have 120 beds, and 87 of them are occupied, with more patients arriving every day. But Molchanov is one of only three doctors to care for them.
President Volodymyr Zelenskyy's administration inherited a health care system that was undermined by reforms launched by his predecessor that closed many small-town hospitals.
In those communities, people have to seek care in large cities. If the problem is severe enough that a patient needs an ambulance, the wait can be as long as eight hours.
“They are bringing patients in extremely difficult condition, with a protracted form” of COVID-19, said Dr. Anatoliy Galachenko, who also works at the tent hospital. “The main reason is the remoteness of settlements and the impossibility of providing assistance at the primary stages of the disease.”
Yulia Tymoshenko, a former prime minister who leads the opposition Batkivshchyna party, said she has traveled to many hospitals in Ukraine and found shortages everywhere.
“The mortality from COVID that is now recorded in Ukraine, is not just mortality; it is the killing of people by this government, which does not have oxygen, antiviral drugs, beds and normally paid medical personnel,” she said in parliament.
”There are no free beds in the country anymore — a new patient immediately comes to the bed of a discharged person,” Tymoshenko added.
Four coronavirus vaccines are available in Ukraine — Pfizer-BioNTech, Moderna, AstraZeneca and Sinovac — but only 21% of its 41 million people are fully vaccinated. The Ministry of Health reported that 96% of patients with severe COVID-19 weren't vaccinated.
Zelenskyy has promised every fully vaccinated Ukrainian a payment of 1,000 hryvnia ($38), about 5% of the average monthly wage, but widespread hesitancy persists.
Doctors say the vaccines are highly effective at preventing deaths and hospitalizations, and when infections in vaccinated people do occur, they usually are mild.
Oleksandr Kymanov, who refused to get vaccinated, ended up getting infected and was brought to the tent hospital in Kakhovka from the town of Rozdolne, about 20 kilometers (12 miles) away.
Connected to supplemental oxygen, he cited various falsehoods about the vaccine, saying it was “useless” and that “people still get infected and get sick.”
Doctors complain that vaccine falsehoods about containing microchips or that they cause infertility and disease is driving the COVID-19 surge.
“People believe in the most absurd rumors about chips, infertility and the dangers of vaccines, elderly people from risk groups massively refuse to be vaccinated, and this is very harmful and increases the burden on doctors,” Molchanov said. “People trust their neighbors more than doctors.”
The government has required teachers, doctors, government employees and other groups of workers to be fully vaccinated by Dec. 1. It also has also begun to require proof of vaccination or negative COVID-19 test results for travel on planes, trains and long-distance buses.
The regulations have spawned a black market for fake vaccination documents, which sell for the equivalent of $100-$300. A phony government digital app for smartphones is reportedly available, complete with fake certificates installed.
“COVID cannot be fooled with a fake certificate, but many Ukrainians learn about it only in intensive care,” Molchanov said.
The Ministry of Internal Affairs said 1,200 groups have been sent throughout Ukraine to verify the authenticity of medical documents. Police already have identified several clandestine printers who were creating fake certificates.
Doctors say the fake certificates make their job harder.
“We are working to the limit, but we are tired of fighting not only with disease, but also with stupidity," Molchanov said.