our doctors still have more experience to deal with such complex injuries. we have quite well -trained specialists from various specialties , and doctors and rehabilitation specialists and mental health specialists worked in the same way with amputation even before the war began. however, now there is new challenges to which we are not ready to fully respond due to the fact that sometimes there is a lack of personnel potential, that is, the number of amputations of the upper limb has increased, we do not have enough prosthetists who are ready to perform high-quality upper limb prosthetics extremity e-e because the need has increased three times due to the fact that they were not in ukraine and due to the fact that the demand was much lower earlier, the same for rehabilitation specialists and for mental health specialists who had previously

worked with such patients but in the conditions of military aggression, the needs themselves have changed, something happened and the number of these needs has increased, that is why we are very glad that we have many friends abroad, experts who are related to the field and who also had experience in their countries -is military experience of combat trauma and work with it and now share this experience with our surgeons and with our rehabilitation specialists and, in particular, with prosthetists, mr. nazar, and you also have the same question, if you remember. will there be enough experience or is there enough at all of experience on here are the complex injuries that the doctors now have that they saw well, i actually agree with mrs. elena on the account of the fact that actually, well, the war has been going on for 8 years and there were

challenges, there were the same ones, well, combat injuries, but there were simply no proportions at all with with the ones we have now and the biggest er the biggest challenge is precisely to ensure this first wave this avalanche what a war is going on people are injured and we can provide them as quickly as possible unfortunately we can not just the biggest challenge here is a special thanks to american colleagues or anyone else who can just come and help. it doesn't matter if it's an operative intervention or it's a partition. for us, this help is actually very important, that is, it is the prosthetist who determines the most desirable level of amputation is so much i understand and it is important to properly prepare the patient for

how he should behave with his prosthesis in the future because a lot depends on this can you tell me about it about your work mmm yes well actually the level of amputation uh will be determined hmm not only the prosthetist, the prosthetist can give a recommendation on the functionality of the top prosthesis, which can be pressed to the level of the amputation, in other words, if the surgeon understands that he needs to perform the amputation in a different way, we we will already talk and discuss about where will be this border between medical indications and functionality on the part of

prosthetics. what are the special tests that can be performed, let’s say, which equipment will be the most functional prostheses for this or that patient, mr. nazar, and if we are talking about the prosthetics procedure itself, it is generally expensive. the procedure and please tell me how long this process is. i understand that it probably has several stages, eh, yes, in fact, the most, well, in ukraine, at least the largest cost of the prosthesis is the components themselves, that is , knees, feet, hands, elbows, that is, such things as they are bought er, well, they are carried out abroad, er , prosthetics itself and how it is performed.

let’s say it has several stages. the first stage is er, removing the plaster negative, that is, the hypoabsorbent residual limb on the cup and from well, so we have, let's say, the model already has a volume , and then it is formed, well, plaster positive is pouring out of it, it will be, let's say, a plaster model of cooks, it is processed, the zones that are tolerant to the load are loaded, and accordingly those on which are unloaded you can’t give a load, and then after that the actual competition receiver is formed. at first it is so transparent, it is a test in order to see how well the course fits in the receiver, is there a free place somewhere or vice versa, somewhere is there too much pressure let's put it this way, and all these things are taken into account during the construction and display of the prosthesis , and then they are already passed, actually, let's say such

static settings first, then dynamic ones, that is, first, how the patient stands, then he begins to walk, and this protest has many settings that with which you can achieve the best result, sir, for now. and how long does it take in general, i don’t know, two months, six months, a year, in fact, from the time of taking the measurement, well, on average, it takes somewhere around two weeks to make, well, to spend time on one prosthesis, it takes about one working week to make it qualitatively and let’s say so with all possible corrections and to be as fixed as possible on the result and on the comfort of the patient and so how can they be done there, for example, two in parallel, then in the average time it comes out of the other when the patient already

starts to walk in well let's say this more or less sure, less often that now we are talking exclusively about primary prosthetics, well, as of now, we did not have patients who would have prostheses because they are all fresh in their essence. and in fact, this is another challenge, it is that, let's say, you need to constantly shape this merchant, she will lose weight, she will change in size, and it will always be necessary, let's say, to adjust to supply and form sugars mrs. elena and here, nazar said that the most expensive part of this whole stage in all these prosthetics procedures are the components themselves. what can their cost be on

average ? the cost is quite different. but prostheses can cost up to a million for a complete set and higher, that is, it all depends on what the requirements are for the prosthesis. is it a bionic prosthesis? is it mechanical ? for ukraine, the prices are quite high, especially if we are talking about bionic prostheses and myoelectric prostheses, mr. nazar, what are bionic prostheses? please tell our viewers, because before introducing you, i talked about what you want to provide, the center wants to provide ukrainians are precisely bionic prostheses, how are they different and what kind of prostheses are they? well, if you

say hmm, it’s easier. northern prosthesis - it’s uh, we can talk about the one from the upper limb, in which this hand actually performs the function of the hand itself. it has a large number of grips, let's say. that is, each finger is moved separately by a separate, let's say, servo motor, and we can or the patient can even adjust the grip itself. well, this is how you could describe a bionic prosthesis. the fact is that it so let's say so is a more user-friendly term because that's exactly the reason the moment in which the patient

as he will control this prosthesis he will depend on. this is the final eee device final let's say the device that is standing is the same brush and already the methods of driving it into action this is already it will be electric or electric or you want any others i have information recently that was in the news, but for 4 hours made and established in the nezlamni national rehabilitation center of the first medical association of lviv, what exactly is this protest that can be produced in 4 hours and we already have such opportunities in fact in ukraine to independently manufacture prostheses so quickly and in this

way give people a normal life so this new technology was coming, our american colleagues brought with them technology that was well, you are interested, it went to the market in america in july of this year and it objectively simplifies and speeds up the manufacturing process prostheses but it applies exclusively to prostheses below the knee they are so far well this technology is limited only to prostheses below the knees and if we talk in 4 hours, then it was like that and let's say so american prostheses did it in a short time but in any case it is say this time from taking off the measure to making but all the same

the patient was still experiencing uh and we will go through certain stages of corrections and formation of functions and so on, mr. nazar, for today we can help a few people and return them to a normal active life thanks to prosthetics i mean what possibilities does the rehabilitation center have now well, in fact, it is not possible to give any unequivocal answer to this question for the reason that it is an individual production there are different levels of amputations. equally different levels of complexity, and if one prosthesis can be made in 4 hours, then with another, it is possible to not have time to do

it properly in two weeks, so it depends a lot. it will depend on what kind of patient it is, what complications it has, what kind of problems, and so on, ms. elena, i want to talk to you again about the psychological help and rehabilitation provided at the center unbreakable, who can receive it, who is already receiving it and how many people, in general, have applied for such help in the e-e center , first of all, that is why it is the first health care institution in which in a multidisciplinary hospital there is a psychiatric department, it was

created even before the hostilities, before the start of a full -scale invasion, that is why we worked in this direction, and before now it was separate, that a mental health center was created, and this direction is actively developing, because the needs are growing, you understand with each every day, both civilians and military people contact the center, and the center works with children. that's why the numbers are growing tremendously every day, and the mental health specialists, as part of the rehabilitation team, are starting to work with in the acute period, that is, directly from surgical departments when new patients arrive, when there is a request, when the attending physician also sees that there is a need for mental health specialists , e. a

mental health specialist is part of the general rehabilitation team, in particular, the team that deals with e-e patients who need prosthetics, but in principle, in any team, and stroke patients, patients with craniocerebral trauma with a spinal cord injury, i.e. any patients who need the consultation of mental health specialists, they receive it at the tmo. that is, everyone who wants to apply can apply for help. i understood correctly, since at the level of a hospital, if it is e- there is a need for psychiatric care at the outpatient level. for example, if a patient comes to us in a polyclinic department and is in a mental health center, we can provide

these services both as an outpatient and as an inpatient, that is, absolutely everyone who needs and who ended up in the first territorial medical association of lviv well, i know about the fact that, after all, you are more calculated on the fact that there will be appeals from military personnel and their family members, uh, we provide help to everyone who needs it, because you understand that now, not only the military have been affected , including those who need the help of mental health specialists, eh, there are a lot of internally displaced persons, there are many internally displaced people who are injured as a result of combat trauma, eh, for example, we had a family hm and during the anxiety, that is, the woman actually started hysteria. when they started to sort things out, mental health specialists were brought in. it turned out that they had just been moved and evacuated from kharkiv. the woman is

in one medical institution because the tmo includes several health care institutions. the child is in to another man in another department of the same institution . the connection is lost. it is impossible to contact. well, you understand accordingly what happens in the head of a person when he cannot understand whether his family is safe, so in order to help when it arises some kind of acute situation or to help a person in general to accept that situation, which is to adapt and respond powerfully to the challenges that are now facing all of us, it is very important to participate in a mental health specialist in the rehabilitation team, we provide a comprehensive rehabilitation service, that is, any what are the needs of the patient, in particular, in e-e from documentary health, they will be provided within the event and i want to return to prosthetics and once again the center of prosthetics in which reconstructive surgery will operate, the

scientific and experimental direction of regenerative of medicine that allows you to clone lost parts and areas of the body and print bone implants on 3d printers and transplant them into the affected area well, you know, now i have read all this and more. it seems like some kind of fantasy, how realistic is it and are there specialists in our country who can really there are already specialists in our country to deal with all this, of course, this area is developing in ukraine, and our specialists are also focused on obtaining additional competencies and providing this assistance, in particular , because i said that at our stage already to fully provide all assistance in the treatment of prosthetics and rehabilitation for ukrainians in ukraine , mr. nazar, i know that the first 3d implants

have already been printed on special equipment. it was during the presentation of the project and it was planned to print such 3d implants on 3d printers. bone implants in particular, you can tell thanks to such implants who exactly it will be possible to help and how many such implants it will be possible to print. those e-e parts, which are joints or bones or anything else that is inserted directly into the body e-e, this is a question. what, that is, when there is no

limb, that’s why i can’t give you unfortunately, not exhaustive information on the cost of endoprosthetics , because that’s more. the queen of surgery is clear, mrs. mrs. olena. please tell me. well, it’s possible, and mr. nazar says how many patients are currently in the queue prosthetists, the queues of our patients are different because we currently do not have a queue for the lower limbs, that is, we perform them very quickly and the prosthetists are competent, they cope with the flow a-a more questions about the upper limbs, i said that because of that is three times, that is, if earlier prosthetics of the upper limbs was 10%. now it is approximately 30 percent, and therefore the personnel potential specifically for the upper limbs is not enough for the promotion of the upper limbs. that is, these are specialists who in it is not enough for ukraine to respond very

quickly to that challenge now, and we are working in this direction, that is why we have a waiting list specifically for the upper limbs, uh, about 17 people are currently on the waiting list, that is, uh, at the rates of prosthetics that there is now, if there will also be one prosthetist to perform prosthetics, then for about six months, it is already a piece of paper, and please tell me when they plan to open the new rehabilitation center, which we talked about at the beginning of the construction of which is currently in progress as i said, the very concept is already working, so the question is only in the buildings, and i hope that in two years this new building will grow up, but this is also very much a question that depends on funding, and that's

why we are asking donors to join us caring people who want to see a completely closed cycle of treatment of rehabilitation and prosthetics of ukrainians in ukraine at a quality level ms. olena who are the main donors who are currently helping and doing everything possible i am talking now about funding so that the center opens and maybe so that now all those who need prosthetics get it as individual people who represent the business, basically you can say that it is people who represent the business simply bigger less big business e.e. companies also join companies that manufacture well, with prosthetics, for example, viko - they make components, they help us from this side , and the diaspora helps, uh, media

people help, singers, actors, that is, people who are simply involved in certain directions get involved of business mrs. olena, i want to thank you for being in touch with us today and remind our viewers that we were in touch with the deputy medical director for rehabilitation of the first territorial medical association of the city of lviv, the doctor of physical and rehabilitation medicine olena dolyna and in addition, i want to thank you, mr. nazar, for being in touch with us, technician of the protistist of the first territorial medical association of the city of lviv, nazar bagnyuk, thank you and remind our viewers what we said today about the rehabilitation center that started working in ukraine and in fact, during these months of the

full-scale invasion of russia on our land, we have increased the number of people who need prosthetics, and doctors say that such people will become more and more, because at the moment there is no single base that would collect demand for prosthetics in ukraine and we hope that this center will be able to provide help to as many people as possible and it was a program about health and i, iryna koval , want to remind once again that the air alarm continues on to the whole of ukraine, so please be vigilant, be careful and take care of yourself, once such a picturesque city of sviatohirsk, which was called the switzerland of donbas, today it lies in wars, it was subjected to numerous artillery fire and then

it was occupied until the ukrainian forces pushed out the russian troops, 90% of the people who lived in this city left it those who remained three and a half months of russian occupation and fierce battles left deep scars. 76-year-old yevdokia only went out again after a month of stay inside without going out day and night, you can't imagine how they banged like that, all the books flew to the side, they didn't kill how many people, many of your relatives broke into their houses, they killed them, talking about the occupiers, her voice drops a few tones, this is a sensitive topic. i saw very few of them, maybe a check five here is a lot now everyone is everything but there was almost no one anywhere nothing we didn't see everything there the humanitarian was also proved, i won't say anything volodymyr rybalkin took

the post of mayor after his predecessor cooperated and then fled with the retreating the new mayor fought against the russians as part of the territorial defense forces and says that he will never forgive what is happening, brothers, in fact , she is the aggressor and destroyer of the ukrainian nation, so there will never be such a relationship between ukraine and russia again, and more and more people are consciously switching to the ukrainian language in order to to forget any connection with russia, namysk has long been a city , its activities are ambiguous, some residents refuse to associate with us, but others, as people, have been suppressing anger and emotions for months, emotions overwhelm her when she describes how the garden of her paradise they broke the peace last year, they came to us to

do yoga, have you seen these orcs? they are just like monkeys with grenades in their hands. they just come, put a grenade and say that they have come to rescue. lyuda uses orcs, a ukrainian insulting word for russian soldiers. she admits that many of her neighbors do not share her opinion. hatred, suspecting that the majority of those who are still here sympathize with russia, they would not have come here if some had not been waiting for them, i believe that 80% of the population was waiting for them, a few hundred meters across the siverskyi donets river is the city orthodox monastery as part of the moscow patriarchate has been solving

the question of its loyalty for years the monastery was damaged this spring the monk said that the building sheltered 400 people in the basement but they refused to talk further and you are filming i say again please turn off the cameras is it true that i have many pro-russian people who support russian invasion i can't say the work of a monk neopolitical views on in the service of god you are so cultural monument attracted 300 thousand pilgrims and tourists on year a huge local industry is now destroyed by the war oleksandr has just returned to

sviatohirsk please he is seeing his four-star hotel for the first time in this condition he lost his business and home and no longer feels such ease in the city do you think you will ever rebuild it i think we need help our clients want it very much and we want it and sviatohorsk wants it, these inhumans

will not return here again, the threat at the moment is that the front line is not so far away, this is the first thing, they are ready for anything just to to satisfy the ambitions of its leader, the clearing of the ruins continues and the restoration of the city has already begun before the onset of winter, but it will take much more time to restore the deep split between those who are loyal to ukrainians and russians