Ukraine: Learning to walk again

In eastern Ukraine, a partnership with local health authorities seeks to help people who need physical rehabilitation support to participate fully in society.

“By Christmas, you will be walking on your own.”

These words are shared with a new patient in Kharkiv, eastern Ukraine.

Ortho-prosthetist Rayner Erasmus explains in detail to 17-year-old Kamila, who lost her leg, and her family how to use her first prosthesis. He explains the complex first steps and all subsequent stages of physical rehabilitation. He shares that with her perseverance and courage, she will make great progress. Not only by adapting to the new reality of having to use a prosthesis but also in other areas of her life. The girl smiles shyly at these words. But she is more than convinced. She says she will make every possible effort.

This exchange is just a small part of a new physical rehabilitation project, where individuals with amputations receive the support, they need. It is a place where hope is renewed, and the confidence to regain independence is restored.

Physical rehabilitation from the inside out

Rayner Erasmus has been working here at the clinic since August. He came to Ukraine back in November 2023 after working with rehabilitation teams in other armed conflicts. He has been a fully-fledged resident of Kharkiv for a while. Here, the International Committee of the Red Cross (ICRC) recently launched a comprehensive rehabilitation program for people with amputations or other physical rehabilitation needs. The program was established together with the Ministry of Health and implements modern medical rehabilitation protocols in Ukraine. The University Clinic of Kharkiv National Medical University has an entire laboratory where patients are assessed, temporary prostheses are manufactured, and physical therapy sessions are held in the clinic itself. But the most important thing is that it is here that the first, sometimes timid, steps are taken after losing a limb.

“This program is important for Kharkiv because there is a lack of similar humanitarian projects or rehabilitation services for people with amputations in eastern Ukraine, both for military and civilians,” says Rayner.

Currently, this laboratory is divided into ‘mobile’ units – each of them being a shipping container, that can be transported by truck. Each container performs a different function, from initial assessments to producing the actual prostheses. While the renovation and arrangement of a fully-fledged physical rehabilitation department at the University Clinic are underway, prosthetist Rayner works in these containers. This is a temporary solution, but it is the only way he and the team of can help people in critical need right now.

“My typical day usually consists of seeing patients for fitting or adjusting prostheses or casting. Then, I work in the clinic with the physical therapists to train the patients in walking. Mostly, my direct responsibilities here are to conduct clinical assessments of people with amputations and the technical part of prosthetics,” Rayner says.

The program has focused mainly on lower limb amputations throughout 2024. Patients are identified through the University Clinic and then referred to rehabilitation services that include prosthetics, physical therapy, and psychosocial support.

“Temporary prosthetics are necessary to fill the gap between the amputation itself and the receipt of a permanent prosthesis, as sometimes it takes a very long time. So, after the wound heals, we start working with the person, doing physical exercises with them, and teaching to walk again after fitting the prosthesis. This way, we don’t lose a single day, which is critically important for us,” says Rayner.

The people for whom all this is happening

Shelling, a high level of mine risk, non-communicable diseases – the reasons why people arrive at the clinic as patients are vastly different. Patients undergoing rehabilitation differ in absolutely everything: their field of activity, profession, age, motivation. Some people want to start a family, while for others, it is essential to return to work. Someone else’s fundamental goal is to walk with their grandchild in their hometown again, holding their hand instead of being guided by a wheelchair. But there is only one thing that unites them all, like a thin, barely visible thread: the desire to have full functional use of their limb again.

“The most important thing is that people with amputations and disabilities can live a normal life, forgetting about the difficulties and problems related to their amputation and injuries,” says Rayner.

He calls his part of the work purely technical. But behind this technicality are simple dreams, hardly achievable without rehabilitation. His patients are both civilians and military. They come from Kharkiv or small villages elsewhere in the region. Among these patients, there are dozens of stories related to the armed conflict and its consequences. Those stories used to be isolated incidents, but today, unfortunately, they are the stark reality.

“We have patients with amputations, for example, due to health complications. As a result of the escalation of the conflict, they were unable to get medical care in their region quickly enough, which led to the loss of their limbs. However, the majority of my patients are military servicemen who were injured in the conflict. We are also currently working with a civilian girl who had her leg amputated due to shelling,” says Rayner.

Kamila is a student at one of Kharkiv’s universities and she is one who has a special task for Christmas. She studies psychology, loves sports, and is just starting out on her own. Only a few months ago, Kamila’s daily routine was no different from that of her peers. University, family, friends, leisure. Today, she needs to use a prosthesis. On the last day of summer, her reality changed completely. Kamila’s left leg was amputated below the knee in late August. An air bomb hit a park in Kharkiv, not far from where Kamila and her sister were resting after studying. After the incident, she got used to moving around on crutches, realized the need for a prosthesis, and dreamed of riding a bike again. But there was no despair. Not even in her mind. She still had so much to achieve in her life and so many milestones to reach.

The work on the prosthesis for Kamila lasted three days. Several examinations, taking measurements, casting, lamination, and shaping to make everything fit perfectly. Then, in mid-November, Kamila tried to wear it for the first time. A week later, she confidently took her first steps. This technological device with stickers all over it became a part of her new everyday life. A little different at first, but still filled with her typical activities, new plans, and dreams.

Mykhailo was admitted to the University Clinic in the summer. He started each day here with long walks around the territory. With crutches and overcoming stairs, but all in order not to forget how to move. He lost his leg on a military mission. While on duty, he stepped on a mine. Doctors had to amputate his leg below the knee. After the operation, Mykhailo never used a wheelchair. No matter how difficult or painful it was, he took crutches and slowly took small steps in his new life. He knew that no matter how hard it was, he would walk.

“Even though we speak different languages, Mykhailo and I seem to understand each other from the word go. He is very courageous, always friendly and smiling. He waited patiently for his wound to heal before putting on the prosthesis. I know that Mykhailo used to work with horses before joining the army, and he loved it. I would sincerely like him to return to his favourite pastime soon,” says Rayner.

But besides that, Mykhailo has another important goal – after everything he has been through, he dreams of having his own family. And now, wherever he is, he is accompanied by his girlfriend, who was by his side in every difficult moment of his life, with all the care and support necessary at the time.

Mykhailo was fitted with a prosthesis for the first time in October. Under the close supervision of Rayner in charge of making his new leg, a physical therapist, as well as the doctors of the University Clinic, who helped, gave recommendations, and were incredibly supportive throughout Mykhailo’s recovery. In a few weeks, he confidently walked the hospital corridors, still smiling, seemingly even forgetting about the prosthesis. And his girlfriend was by his side, as always. Here, in Kharkiv, in the middle of another autumn, Mykhailo is literally one step closer to his dream.

About the profession and personal choice

“I joined the ICRC at the end of 2016. My first mission was in early 2017 in South Sudan. Then there were Myanmar, Iraq, Libya, and Tunisia. Finally, I am now in Ukraine. I have seen many consequences of armed conflicts and human suffering. However, I chose this path because I wanted to change something for people. I understood there are many ways to do this, but I found my calling in helping them get back on their feet. This is what I felt from a young age. This is what I wanted to do. And this is where I see myself needed.”

There are no geographical boundaries for Rayner. He works wherever his profession is most needed. Regardless of the country’s situation, location, or climatic conditions. That is why there was no doubt in his decision to come to Ukraine. And in his daily work at the clinic, he has no regrets about his choice to become a prosthetist.

“My favourite part of my job is fitting prostheses. More precisely when a person first stands on two legs and starts walking. I am very excited to be involved in this process and understand that it makes people happy again,” he says.

At the time of this writing, Kamila, Mykhailo and more than ten other people have completed the full cycle of rehabilitation or are at different stages of it at the rehabilitation clinic. Rayner’s schedule continues to be filled with appointments for potential patients and various stages of prosthesis manufacturing. He understands that this work will continue for a long time. Sometimes, it seems that people come here just for prosthetics, but when they complete their rehabilitation, they get a little more: a good friend who knows something of the lives of his patients, who constantly jokes with and supports them.

In the prosthetic workshops, the task is finished long after the sun goes down. Hiding behind a ‘purely technical’ job, the ortho-prosthetist continues to make people a little happier here in eastern Ukraine, in Kharkiv. He does this by helping bring back their dreams, supporting them to realise their almost forgotten life plans and build new ones, even in such circumstances. But he is right where he is needed most.