Ruslan Baltaga - Receiving Patients in Moldova

When the Russian invasion of Ukraine began on 24 February, staff members at the Oncology Institute of Moldova jumped in their cars and headed for the border to collect refugees.

Our oncology institute was in the midst of the Covid pandemic and resources were already stretched thin for Moldovan patients. On top of this, there were longstanding shortages for routine cancer care. For head and neck cancers there was a 60-day waiting list for treatment; for breast cancer treatment, a two to three month wait; for radiotherapy, we could only handle 19 percent of the demand before the war.

Another challenge was the rapidly changing situation, as more refugees continued to arrive. The Moldovan Ministry of Health – after intense consultations with international partners and local actors – had to repeatedly update its policies on what cancer treatments it could afford to subsidise for the Ukrainian patients.

At one stage, the health authorities offered to fly these patients to designated treatments centres Europe. But many refused to travel due to cultural and language issues, and the fear of being much farther from home. What helped greatly was the Ministry of Health’s introductions to the International Organization of Migration and the Blue Heron Foundation. These two entities agreed to pay for initial assessments of Ukrainian cancer patients in Moldova, CT scans and biopsies, and any treatments that did not involve going on a waiting list.

In all, 300 cancer patients reached out to our institute. I am proud of how the team here responded.

Within the clinic, we were fortunate to have so many people willing to collaborate. Some were motivated by empathy, others by fear, afraid that

Moldova could be the next Russian target, so we had to stand together in solidarity with our Ukrainian neighbours.

As for lessons learnt, I believe we should have done more preparation in peacetime to expand capacity in Moldova’s cancer centres. To avoid the shortages of medications that we are now experiencing, we should have diversified our suppliers. At the start of the war, our medications were coming from Ukraine, Belarus and Russia. Then everything stopped. We couldn’t even get basic saline, or the price would be three hundred percent higher.

Another area that needs closer examination is preparing for the psychological toll a crisis like this takes on cancer patients. We can see some patients from Ukraine making erratic decisions. They are overwhelmed by the disease they are carrying and the devastation they have left, and we don’t have enough resources to handle their emotional turmoil.

We can all do better, but we need to look carefully at every aspect of how we responded to this crisis and to see specifically where we could improve.