INTRODUCTION

It has been over 2 years since the biggest conflict since the Second World War has been going on in Europe, caused by the Russian invasion of Ukraine. This war caused global consequences, changed the world order, and forced more than 6.3 million Ukrainians, mostly women and children, to leave their homes to seek salvation abroad (mainly in neighboring European countries). There were many doctors among the refugees; however, some GI specialists remained in Ukraine. The war dramatically changed the established order of things and created uncertainty in the lives of every Ukrainian. Anyway, the first shock has passed, and the country is gradually accepting the reality of a long war. In these conditions, Ukrainian gastroenterologists continue to work and develop their careers. In addition to the understandable difficulties caused by the war, many opportunities opened for Ukrainian doctors and scientists thanks to international support. In this article, we asked four young Ukrainian gastroenterologists how they proceeded to develop their careers in war conditions and adapt to the new reality.

ARTEM NEVEROVSKYI

War changes everything! Your life, your people's lives, your perception of vital values, and your health—everything changed. Before the Russian invasion of my country, I thought I had a precise and quite successful career development plan. Finishing my Ph.D. thesis, conferences, fellowships, patients, and students… And suddenly, you woke up to the sound of a deadly missile flying over your house.

Nevertheless, war doesn't cause any pauses for health conditions, so people continue to get sick. Moreover, due to the enormous stress and mental trauma, we have been facing an increasing number of patients with GI pathology, both functional and organic. This is a great challenge to manage such health issues, especially for internally displaced patients from temporarily occupied territories. So, we have an undeniable need for education now. Even higher than before. Fortunately, most international professional gastroenterological associations, including the UEG, have been helping Ukrainian physicians. A lot of my colleagues took part in free online and on-site educational activities. International support means a lot to us, and it helps us overcome this challenging period of life.

As a university teacher, I also face additional problems in organizing the educational process for my students. Nowadays, I am responsible not only for their knowledge and clinical skills but also for their lives. Air alarms during classes, forced migration, living in occupied regions, and mobilization for the army have changed the way we educate students. One of our clinics was damaged during the Russian missile attack, 30 min before the lecture. However, even with these obstacles, young people are not led astray from the path of becoming doctors.

Unfortunately, no one knows what lies ahead, whether we will be alive tomorrow or not, whether we will have any career tomorrow, or whether the day after tomorrow or not. Could we stop, wait, and just hope? Of course, no. We must continue our work, education, and self-improvement. I think saving human lives is the biggest praise, and thanks to international society, we can do that more efficiently. For now, that is the main part of my career development.

STANISLAV KRAVCHUK

Career development requires planning and a certain level of stability. It is obvious that, in terms of war, it is difficult to be expected.

Even before February 24th, like many young progressive doctors, I felt frustrated about the development of a medical career in Ukraine and planned to go abroad. Well, I put in some effort and received two offers to study in the US and UK on a full scholarship in 2022. This period coincided with the beginning of the war and large-scale support for Ukraine throughout the world. Many of my colleagues went to study at the world's best institutions. Unfortunately, because of the war, the men could not leave the country, so the training had to be postponed indefinitely. For me, as a person who highly values personal freedom, it was difficult to accept the impossibility of free movement and the exchange of experiences.

In the beginning, there was hope that it would all pass quickly, and many tried to “play with fate and luck” and somehow ride it out. However, after 2 years, you gradually get used to the war and realize the new reality that it will last a long time. At this moment, it is necessary to gather strength and learn to manage this chaos by learning the most necessary hard and soft skills to bring victory closer.

In my case, ultrasound became such a skill. In the fall of 2022, I managed to get special permission to take a short trip abroad and visit the UEG Week. I spent almost the entire week in the ultrasound training area and discovered a lot of new things for myself. Already at home, with a team of colleagues, we organized a training team “Ukrainian POCUS Society” to teach Ukrainians to perform point-of-care ultrasound (POCUS). It is extremely important to use this technology in conditions where other diagnostic methods are not available (as is often the case during wartime). I like teaching POCUS very much. I think that in times of war, everyone should do what they can with the resources they have.

In the end, I want to note that, compared to the existential threat of the war, all career crashes pale. Many brave Ukrainian GI doctors were required to postpone their careers and join the army; some even performed as combat medics on the battlefield because of the circumstances. The world, as well as Ukrainians, should realize that this is a new reality of the long war and we must unite for the sake of preserving democratic values, including in medical societies.

IRYNA TVEREZOVSKA

The war completely changed my life. I used to live in Kharkiv city, right near the eastern border. When the war started, I decided to find a safer place for me and my little son in western Ukraine. Fortunately, I found a hospital where I currently work as a practitioner in a new city. Before the war, I started doing my PhD research, but due to circumstances, the university needed to switch to distance education, and it had a substantial impact on the duration of my studies. I had to wait. Happily, I can already work at my university online as a teacher and continue my clinical practice at the hospital.

Beyond any doubt, the war has a negative influence on the educational process. Studying medicine is not possible without practice, live master classes, and real communication. We often lack that in terms of hybrid learning. Currently, we teachers are in the process of transformation and adaptation to the new reality. We also need to pay special attention not only to the typical curriculum but also to emergency and war medicine.

However, thanks to the international community, Ukrainian doctors have opportunities to attend fellowships, conferences, and study abroad now. For example, I completed a 2-week UEG Clinical Visiting Fellowship in July 2023. It was such a valuable experience for me to immerse myself in the work of one of the most powerful GI centers in Europe, both as a practitioner and as a scientist. It is very important in terms of the exchange of experience and motivation to teach at home.

I am sincerely grateful for the great support of Ukrainian doctors in the international professional community. We had unique access to the latest guidelines, conferences, and fellowships. It is very important not to miss the opportunity to study, and I hope many colleagues have used it. It would be great to have more programs for scientific and clinical cooperation. I am sure we have a lot to learn from each other. Also, it is a great boost for striving for a high level of professionalism, developing Ukrainian medicine, and learning languages.

ANNA BEZPALA

Since the full-scale war began, I haven't changed my residence or workplace. However, my perspective has changed drastically. At this critical time, we must go above and beyond to make a positive impact.

I now confidently recognize that my career extends beyond gaining new knowledge and skills or conducting research. It is also about advocating for patients and empowering them.

At my workplace, we advocated for patients to international societies and companies, resulting in a year's supply of medication being provided to children with rare liver disease and inflammatory bowel disease. While not all our communications were successful, this has been my driving force for the past year.

The war has made it difficult for patients to access healthcare and medication, resulting in delayed diagnosis, flare-ups, and complications. For a young GI fellow, it also means a reduced learning pace, the range of diagnoses and clinical situations to deal with, and the number of examinations to perform. Thanks to international support, I had the opportunity to attend many educational events through the UEG Community as well as my colleagues.

Many doctors have already been drafted into the Ukrainian Armed Forces, and it is our duty to support them in the first place.

I believe the International GI Society can further empower young GI doctors by engaging key stakeholders, including patients and patient organizations, and assisting in communication with pharmaceutical companies regarding critically needed drugs. Addressing patients' needs directly can reduce the burden on doctors and prevent them from burnout. The role of the international GI society is hard to underestimate, as it plays the principal role of a platform where we can communicate about our needs in the best possible way and foster cross-border clinical collaboration.

CONFLICT OF INTEREST STATEMENT

The author declares no conflicts of interest.