For the first time in many years of work, Nazar Borozniuk walks up to the ward feeling worried. He does not know what to say or how to start a conversation. Finally, he crosses the threshold and sees his new patient—the blue-eyed Marynka.
She is six years old, and she came from Kherson Oblast, where her house was hit by a russian shell, injuring her and her mother. Under shelling, her grandfather took her to Kryvyi Rih, where she received first aid and had her leg amputated. Later, Marynka was taken to Kyiv, to the National Children’s Specialized Hospital Okhmatdyt. News about a small patient with an amputation instantly spread around the hospital.
“A lot depends on the first contact with a child,” Nazar Borozniuk explains much later. “The adults can be clearly directed: what they should do and how, they understand why they need it, it doesn’t matter if they like you or not. With a child, you need to find the right approach—they must believe you for it to work out. With children, it is not enough to be a good doctor. You must be a psychologist and a good friend, too.”
Nazar wants to be a friend to his patients. He is 32, and he has been working as a rehabilitation specialist and a physiotherapist in Okhmatdyt for over eight years. His task is to return children back to active life after injuries and illnesses—including those resulting from the war.
Suddenly—nobody
On February 24, 2022, with the first explosions heard in Kyiv, Nazar decided to take his pregnant wife and young son out of the city. First, they went to Zhytomyr Oblast, but when it became clear it was too dangerous to stay, the family moved further to Ivano-Frankivsk Oblast.
Having safely settled his family there, Nazar stayed for a week to help at the local hospital sharing his experience with local doctors. But, as he confesses, it was too difficult for him there, in relative safety: he felt guilty for not being with his colleagues. He made up his mind to go back, so he packed his car trunk full of groceries and went to Kyiv while fighting was still going on around the city.
“When I got there, it seemed to me it was not my city. It was empty, with mostly military people walking the streets. It took me another day to get used to the explosions from Hostomel and Irpin. There were few patients in the hospital, and these were either severely ill children who could not do without medical assistance or wounded children who were brought there,” recalls the doctor.
There were enough doctors at the hospital, so until the end of March Nazar spent most of his time volunteering: he delivered groceries around the city, helped gather funds and bought everything needed for the territorial defense. He spent many nights at the hospital.
“It was hard. The patients were going down to the basement, the floor shaking from the hits, and us running to the reception and waiting in case a child had been wounded and would be brought to us. I remember us being happy every time the shelling ended without any new patients.”
The first war-wounded children Nazar saw himself were siblings—a brother with his sister from the city outskirts, with multiple injuries and their faces cut by shrapnel. Later, he recalls, there were many cases like that: children from Bucha, Irpin and the surrounding areas.
“You perceive war wounds differently. Before the full-scale invasion, I used to work with, say, broken legs or arms. But when such patients started to arrive—I couldn’t grasp it at first: a child with a mine-blast wound!”
After the liberation of Kyiv and neighboring Oblasts, the number of patients in the hospital increased. At the same time, the workload grew too, as Nazar works in the acute rehabilitation department—here, work with a patient often begins in the intensive care unit.
At the end of May 2022, Marynka was brought to Okhmatdyt.
A prosthesis that got a name
Nazar’s first meeting with Marynka didn’t last long. They got acquainted, and the doctor said they would learn how to walk again. Marynka looked him in the eyes and asked if she would ever run again. And, although Nazar replied, “Yes, you will be able to do anything,” he now confesses he was not so sure of that.
“We didn’t have such an experience before. In the eight years of war in Ukraine everybody already knew how to work with adults after amputations, but when it came to a child, I didn’t even know whom I should ask for advice,” he said.
Then, Nazar turned to Google for help, translating foreign scientific articles and learning from their experience. Pediatric prosthetics is a long process consisting of several stages. The first stage—after treatment and a long period of limited movement—the whole body must be prepared for exercise. Then, the patient must be raised upright and put on crutches. Simultaneously, they work on the stump to which the prosthesis will be attached; it must be formed and prepared for the prosthetics.
First, Nazar showed Marynka exercises for her back, and then they moved to the exercises for her stump—they had to desensitize it. After that, they worked on Marynka’s coordination and learned to balance.
“It was not an easy process,” the physiotherapist recalls. “Sometimes, we worked for five minutes and Marynka started to cry and said, ‘I won’t.’ We took a break and met again in about an hour. Sometimes we had to make three attempts in a day. And later, we made a deal: we exercise, and then we go play. If we don’t exercise, there is no play. I had to schedule additional time for play—you have to keep your word. It was teamwork done by psychologists, other doctors, and even the press service. Marynka’s first step on crutches was our first victory.”
“It was not an easy process,” the physiotherapist recalls. “Sometimes, we worked for five minutes and Marynka started to cry and said, ‘I won’t.’ We took a break and met again in about an hour. Sometimes we had to make three attempts in a day. And later, we made a deal: we exercise, and then we go play. If we don’t exercise, there is no play. I had to schedule additional time for play—you have to keep your word. It was teamwork done by psychologists, other doctors, and even the press service. Marynka’s first step on crutches was our first victory.”
At that time, Ukrainian children who had their limbs amputated because of the war received their prosthetics abroad. But the girl’s parents decided to go through the prosthetics and rehabilitation here in Ukraine. The prosthesis for Marynka was produced in Kyiv. It was prosthetist Oleksandr Stetsenko’s first experience working with a pediatric amputation. Marynka is the first child with a war trauma to receive a prosthesis in Ukraine.
But having the right prosthesis produced turned out to be only part of the process. After that, it was necessary to overcome the child’s psychological barrier and fear of wearing it. The doctors suggested the girl chose a name for the prosthesis. Marynka called it Kiesha. After that, the third stage began—to learn to walk correctly with “Kiesha.” At first, with the help of crutches, and later on her own. Then, she had a cosmetic prosthesis made for her to make it look as much like a real leg as possible.
At that time, Marynka received a lot of guests: from the US State Secretary Antony Blinken to the most popular dog in Ukraine, Patron. But most of all, the girl was waiting for “uncle Vova”—the president of Ukraine.
“Once, he recorded a video for Marynka where he wished her a happy birthday and promised to visit her. It became an additional motivation for her to exercise and learn to walk properly. And when they met, she was so excited,” says Nazar.
In the cabinet in Nazar’s office there is a souvenir in memory of the journey he has traveled together with his small patient—a cube with their photos. It is Marynka’s birthday present for the doctor. Now, the girl has gone back home to Kherson Oblast, but they still keep in touch. Marynka sends a video to Nazar: her running, jumping on the trampoline, or riding her bicycle with the words: “Look what I can do!”
They don’t say goodbye for long
We meet Nazar at his workplace, where he is just finishing his work with another patient—a 13-year-old boy. It is a small, bright room with a massage table in the center. Here, kids exercise with Nazar, chatting like old friends in between the exercises. Next to it there is a therapist’s desk with a flag of the Dynamo Kyiv football club. Nazar smiles and repeats from time to time: “Come on! You can do it.” Only he knows how much effort this positive attitude requires.
“Sure, your patient’s personal stories can’t leave you indifferent, but I try not to succumb to emotions, because it will affect my work. Now, I try to take it as it is: there is a problem, and we need to put in as much effort as we can to resolve it. When you are constantly working, there is no time for contemplation. But, I think, all these suppressed emotions will eventually overtake me after the victory,” Nazar says.
When things get complicated, his family and sports help; however, he admits he never learned to “leave his work at work.” Nazar also draws his energy from his colleagues and the fact that his work is noticed.
“These children are heroes. When you see their strength, it stops you from giving up, breaking down, or getting tired,” the therapist says, adding that after seeing and experiencing so much, he is most annoyed by the adults speaking about “being tired of the war.”
One of the things Nazar prepared for most carefully was dealing with phantom pain after amputation. He wondered how he could explain to a child that something that didn’t exist could hurt. But it turned out none of his small patients ever experienced phantom pain. Still, working with pediatric prosthetics poses other challenges. The main problem is that children grow so quickly.
“Hardly do we get used to the leg prosthesis, when it already needs being replaced, as it becomes too small and wearing it can cause pelvic misalignment, leading to many more health issues. Scoliosis can begin, because the child’s musculoskeletal system is still forming. In case of an arm prosthesis, it is important to constantly strengthen muscles of the amputated limb. In addition, the bionic prosthesis is quite heavy, so we must work not only with the arm, but also with the back and shoulders. Moreover, it is vital to consider the peculiarities of children’s psychology, to seek compromises, to motivate them to get a good result,” Nazar says.
Periodically, his patients come back for rehabilitation, prosthesis replacement, or prosthetic liner adjustments. He never says goodbye to any of them for long.
Translation — Olha Dubnevych
Copy Editing — Jared Goyette
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[The translation of this publication was compiled with the support of the European Union and the International Renaissance Foundation within the framework «European Renaissance of Ukraine» project. Its content is the exclusive responsibility of the authors and does not necessarily reflect the views of the European Union and the International Renaissance Foundation]
