Mission Kharkiv, supported by Direct Relief, sets new standards in cancer treatment amid the Ukraine war

In May 2023, Direct Relief reported on the work of a new NGO distributing donated cancer drugs in Ukraine amid the chaos of a major war.

Fourteen months later, Mission Kharkiv, based in the city of the same name in the east of the country, has become a solid healthcare provider and is receiving praise from international organizations for its pioneering role in this highly specialized field.

According to the Ukrainian Health Cluster organizations, “no one has ever administered a full course of chemotherapy in a besieged city,” says Ross Skowronski, who founded the organization 18 months ago.

“So it looks like, even though we are very small, we are the first NGO in the world to have achieved this,” he adds, somewhat amazed at how far the NGO with 15 employees has come in such a short time.

It’s not just because of the huge number of unique oncology cases being treated there – up from 700 patients last year to over 2,500 today. The final part of the chemotherapy cycle was providing niche therapy sessions for people struggling with a harsh new reality.

“Because our team members communicate with patients on a daily basis, we realized very early on that they and their families also need mental health,” said Skowronski, a mathematician who moved from Spain to his birthplace of Kharkiv shortly before the Russian invasion in February 2022.

A survey conducted among the NGO’s patients and their relatives found that 68% needed psychological support and 35% expressed a strong desire to attend the mental health sessions offered.

Working with large international organizations, the first two attempts to organize support both online and offline saw a high dropout rate among participants. “In Ukraine, there is obviously a very strong stigma around mental health,” said Skowronski. “What was interesting was that cancer patients felt disconnected from the sessions of very large organizations because they perceived this approach as corporatized and standardized.”

The elusive successful pilot project finally came about with the hiring of Ihor Prokopiuk, a Ukrainian psychotherapist living in Spain who has 16 years of experience working with terminally ill patients. “Regardless of the setting, this (group therapy) helps and offers a way to live differently,” Prokopiuk said.

“When you have really difficult situations, like cancer and then war, it is of course terribly difficult for people to cope, to find meaning in their lives and to stop wanting to hide every morning.” He also pointed to the deep-rooted stigma, attributing it to the use of mental institutions as a punitive measure by the former Soviet authorities, which often caused serious psychological damage to people: “These prejudices are now loosening, but Ukrainians are still very ‘specific’ in this respect.”

The pilot project in Kharkiv lasted two months and included a weekly two-hour online session for ten participants. The feedback at the end was extremely positive.

“Only one patient dropped out of the study, and the others reported that it was a life-changing and life-sustaining experience for them and expressed a strong desire to continue,” Skowronski said. “It seemed like we had finally turned this problem into a project on the mental health of cancer patients. Now we want to continue.”

According to the Ukrainian Ministry of Health, there are currently almost 1.2 million registered cancer patients in the country, and about 100,000 new patients are added every year. State-run cancer treatment is free, but in wartime conditions, specialty drugs are often not available in hospital outpatient departments, so patients have to find and buy them themselves. This is where Mission Kharkiv comes in.

The work is complicated by the fact that patients are scattered across Ukraine. The country stretches over more than 600,000 km2 (230,000 square miles), or almost the size of Texas, making it difficult to transport expensive medicines at controlled temperatures.

However, in the first months of the war, people from as far away as Lviv and other western cities came to war-torn Kharkiv and traveled more than 2,000 kilometers in dangerous conditions to collect their medicines.

Today, in addition to its bomb-proof, temperature-controlled storage bunker in Kharkiv, the NGO uses secure storage facilities in the cities of Dnipro, Kyiv and Lviv to facilitate collection for patients and their families.

One of the drugs Direct Relief supplies to Mission Kharkiv is trastuzumab. It is typically given three-weekly over several months to treat various types of cancer, often in combination with chemotherapy and other medications.

If she buys the drug privately, a single dose costs more than ten times her monthly pension, says 68-year-old Lyubov, who lives in the Lviv region. Thanks to the organization, she now either receives the drug there or it is delivered to her by courier in a cool box from Kharkiv warehouses.

“It’s a really good organization, they helped me a lot and their people really understand oncology,” said Lyubov. She says frankly that while the treatment won’t change her outcome, it will change her prospects. “It’s incurable, that’s the way it is. But for now, life goes on, completely normally.”

Of the several patients from the Kharkiv Mission with various oncological diseases interviewed for this article, it is striking that none of them thought about themselves when asked about the future. The focus was rather on the common good as Ukraine fights for its survival.

“I want there to be peace,” says Galina, a 68-year-old former sports school principal, also from the Lviv region, who has been supported by Mission Kharkiv since January 2023. “Everyone dreams that everything will be like it used to be, when you just went to work, there were no air raid sirens and everything was just peaceful.”

At the beginning of the year, Skowronski took a long overdue break and traveled to Pakistan. There he also contacted local oncologists to find out more about the situation in the South Asian country.

His findings opened his eyes to the fact that the expertise of the Kharkiv mission can be transferred to other countries that are struggling with the same problems as Ukraine: “Their electricity grid is pretty poor, there is a shortage of chemotherapy drugs, they face corruption and cancer data is not properly recorded.”

After 18 months of development for Mission Kharkiv, he believes they are now ready to launch something even further away, be it in Pakistan or elsewhere: “We have our standard procedures, we know how to build the bunker, we have corrected many errors that occurred and that we were not aware of. So now we have the experience and can repeat this in other countries.”

However, part of the oncology system is still missing in Ukraine. Another project in preparation is Mission Kharkiv supporting the Ukrainian government in collecting accurate data on where drugs are prescribed.

Although the Department of Medical Statistics records cancer incidence, it does not monitor drug prescriptions and dosage. As a result, public procurement is based on approximate data rather than actual demand.

“If we can do this (data collection) on a sustainable basis, we can fully complete the drug assistance project and hopefully the government can take care of it forever,” Skowronski said.

Mission Kharkiv is one of Direct Relief’s key partners in Ukraine. Since 2022, Direct Relief has provided the organization with over $40 million worth of medicines and supplies to care for patients across Ukraine.