by Sara Peebles
volunteer writer for Angels in Medicine
Copyright © 2024 Sara Peebles.
Photos courtesy of Philip Van Benthem.
Global Outreach Doctors, better known as GoDocs, is an international relief agency that provides health care and crisis response in developing nations and all around the world. Shortly after the Russian invasion began in February 2022, GoDocs sent a humanitarian aid response team to Ukraine. This mission team included doctors, nurses, and paramedics. GoDocs provided ambulances as well as a trauma stabilization point in Southern Ukraine near Mariupol, in the Donetsk oblast (province). This facility treated around 95 patients per day with severe injuries.
Philip Van Benthem is the Country Director of the GoDocs Ukraine mission. Since April 2023, he has led a team of medical professionals providing emergency treatment as well as giving paramedic training to the Ukrainian military and local government agencies. With a background in international relations, Van Benthem has traveled all over the world and has worked in some of the worst areas of modern conflict, including Syria and Iraq.
Paramedicine is a healthcare profession in which highly trained medical professionals, known as paramedics, provide emergency medical care, treatment, and transportation to patients in out-of-hospital settings. While often confused with emergency medical technicians (EMTs), paramedics have more advanced education, a broader scope of practice, and a higher level of responsibility in patient care compared to EMTs.
Challenging Oneself
Van Benthem was led to paramedicine by a combination of two things: a calling to serve others, and a drive to seek out the toughest endeavors and adventures he could find to challenge himself. He found that emergency medicine was “the one thing where my speed, my performance, and my knowledge could have the greatest impact on someone’s life. It could literally mean the difference between life and death, as cliché as that is.”
What would draw someone to a war zone? Why Ukraine? Van Benthem said, “Not only does a conflict like this challenge our bodies, but it challenges… what we’re made of. It challenges our souls… It is the highest concentration of people in the most dire situations. It’s a place where someone like me, my skillset, has the greatest impact.”
Van Benthem’s work for GoDocs was not his first mission in the war-torn country. “I was in Ukraine at the very beginning of the war, working for a small NGO doing medical evacuation,” he said. “After two or three months I came back to the United States and I just kept looking for the right opportunity to return in that context, and luckily when the position at GoDocs was posted, I threw my name in the hat, had some friends vouch for me, and I got it.”
The Nature of the Work
But the risks he was facing were immediately obvious. “It was just an unfortunate reality of how the job became open,” he said. “It was open because the previous Country Director, Pete Reed, was killed while in Bakhmut. So, it was important for me to come in and carry on his legacy.”
In the beginning, Van Benthem said, the team was relatively small, because they essentially had to start from scratch, but it was high impact. They ended up with about five country staff members and three to five volunteers at any given time. The GoDocs team provided several areas of service, including frontline medical evacuations of soldiers and civilians wounded by the war and, more importantly, the mission’s training element.
“In my opinion, that’s the most important part of this,” he said. “As a paramedic, I can only help one person at a time, whereas with the training element, I can teach 30 people at time to save themselves or their countrymen, especially in a traumatic injury like an artillery shell or a bullet.”
The Need for Speed
Speed is vital in such situations. Van Benthem said, “Stopping hemorrhage in the first three minutes is critical. Without hemorrhage control, even having a well-trained paramedic four minutes or five minutes away, it’s too late.”
The GoDocs team worked at a stabilization point (also known as a stab point) about three kilometers from the front line of the war, which is the first place an injured soldier will be brought once he is evacuated from the front line. The GoDocs team provided training to the Ukrainian medics and doctors working at the stab point, showing them different modalities and tools. The GoDocs team quickly also began working as clinicians and mission critical members of the stab point staff because they were constantly overwhelmed with casualties from the fighting.
The injuries they saw were mostly from shrapnel secondary to artillery and drones. The team saw that the role of drones in warfare continues to expand, which is a terrifying but very real fact. Drones carry explosive munitions with deadly accuracy. They cause terrible injuries; men are torn apart, with chunks of flesh and limbs missing. The team treated many burns and gunshot wounds as well. Van Benthem noted that this all speaks to the horror and inhumanity of war, with pain as a constant part of existence for the soldiers.
Unfortunately, the stab point team usually could not consider pain management. Hemorrhage control had to be their primary focus, along with the other types of potentially fatal battlefield injuries, such as tension pneumothorax and airway injuries. If the team had time and seasoned medics available, they would provide pain management when they could. However, the unfortunate reality in this conflict is that many medics have been killed, so to find an experienced one is difficult.
Van Benthem had not envisioned that the team would be working as both trainers and front-line clinicians. He questions whether this was the best use of resources, but he knows the team made a positive impact. It was tough work, but they did everything possible to mitigate danger and protect their people, considering the proximity to the conflict front line. But this work is inherently dangerous, and everyone knew this ahead of time.
GoDocs hemorrhage control training was vitally important because, unfortunately, they were seeing solders applying tourniquets incorrectly almost all the time. Since hemorrhage can be fatal within three minutes, this can have dire consequences, whether a soldier is applying the tourniquet to a friend or to himself. The team trained many soldiers, and they included civilians in the training sessions as often as they could. (Since the battle lines haven’t moved since the end of Kharkiv offensive, the number of civilians who have remained in the area is relatively small.)
The Donetsk paramedics work closely with members of the Donetsk police department, and the police quickly took on a rescue role. When emergency services could not respond to calls close to the front line, the police would go. The police quickly became clinicians themselves and, with help from paramedics, became self-teaching, and were soon well versed in trauma care, tourniquets, wound packing, chest seals, and chest decompressions. Van Benthem noted that this was a civilian-facing side of their work that the team was proud of.
The Benefits of Training Soldiers
However, the training the team provided to Ukrainian soldiers had the greatest impact and led to the most rewarding experience for Van Benthem during his time in Ukraine. In the beginning of the mission, Van Benthem and his deputy developed a comprehensive training program focused on trauma care, tourniquets, and wound packing. They trained groups of soldiers for eight to 16 hours with much repetition and sent them off, hoping they would remember what they learned in that dire moment when they needed it.
Four months later, Van Benthem was at the stab point working with his crew and checking on his team. Late in the evening a flurry of soldiers came in, all wounded. Two soldiers walked in on their own accord. They had tourniquets on their arms, and one of them was missing an eye, but they were walking.
He recalled, “One of the soldiers kept pointing to me and was speaking to me and he was very emphatic about something, and I didn’t know what because I couldn’t understand him because I don’t speak Ukrainian. And I finally had my interpreter, I said, ‘what is he saying?’ And she spoke to him, and he said that he knew me.”
Van Benthem didn’t remember him, but the soldier was persistent. “He said, ‘No, I know you, you trained me over the summer on how to do tactical medicine.’ …He was really excited, and he started pointing to the tourniquet on his arm, and his arm was all mangled up and it was bloody, and he clearly had a pretty bad injury to it. …he was saying, ‘Did I do a good job, how did I do, is my tourniquet tight?’ Sure enough, it was applied correctly, and I said, ‘Well it’s obviously working, because you’re still alive!’ “
He was gratified by the recognition from the soldier. “The work that we put in, sometimes you just build a thing or teach a person and you send them off into the ether and you have no idea if it works or not, you just have to wonder if it made that difference. And here was that tangible proof that the work I did had a tangible effect. Because here this guy is, he’s alive, he’s going to go home to his family, maybe with his arm, or maybe without it, but he’s going to go home. And that was because of …the eight hours I taught him.”
In his leadership role as Country Director for GoDocs, he notes, “You need to have the soft skills to make this happen.” What are these skills? Effective communication, empathy, active listening, emotional intelligence, teamwork, adaptability, problem-solving, and cultural competence, which are essential for building trust, rapport, and strong relationships with patients and colleagues.
“You can be a bookworm or a policy wonk or an outstanding clinician, but if you don’t have the soft skills to go and shake someone’s hand, look them in the eye and tell them you’re going to follow through with the promise and the commitment you’ve made, none of that matters…It’s our ability to connect with another person. To build those bridges, build that trust. I have that, and I’d say, more than my skills as a paramedic, that’s something I thrive in the most.”
The Need for Money
Although GoDocs is no longer in Ukraine due to fundraising challenges, the mission continues. They handed off much of their work to a partner organization that hired the GoDocs staff and took over their work. However, this organization is also small and struggles to keep the doors open. There are many small aid organizations in Ukraine that need support and funds.
For Van Benthem, the biggest challenge he faced during the mission was the lack of money. “Our ambulances run on gas, our lights use electricity, and our bodies need food. This all requires money. Not thoughts and prayers, not a big box of donated supplies.”
He noted that people seem to have an inherent need to feel tangibility in a donation, such as seeing someone holding an item that they donated or made themselves. But this doesn’t pay the bills; cash does. Ukraine is flooded with material donations going unused because of problems with logistics. Some material things are needed, such as specific equipment, but cash is what is needed most. Money is what pays for fixers and interpreters and fuel. Humanitarian aid organizations can do without a lot of creature comforts, but they can’t do without these necessities to continue operations forward.
Inspiration
When asked about who inspires him, Van Benthem recalled a child he helped 10 years ago who showed great strength and magnanimity, something he loves and tries to emulate. “I was doing a humanitarian mission in Syria in 2014 and… we had a little girl, maybe 8, 9 years old, who was shot in the head by ISIS…
“Everyone thought everything was lost, but she was still alive. She was still alive, and she had purposeful movement showing cognition, even with this bullet in her head. And she kept fighting to pull out her endotracheal tube. And I rushed her to the border, you know, trying to breathe for her and keep her sedated, and I rushed her to the border, to Turkey, so she could get some more definitive care. And she fought and survived the entire way….
“That’s the kind of stuff that I admire, like that bravery, and it can be in all forms. You can be the tallest, toughest guy on the planet, or you can be an eight-year-old girl that won’t quit.”
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