Today is the day of consultations.

First, Victor and I set of for the grand Presidential palace, a dignified building faced with thick columns with large administrative wings in a wide street guarded by armed militia. We entered the nearest wing and were electronically tested by grim guards, bags examined, my camera and tape recorder confiscated (returned later), but strangely not Victor's less suspicious-looking camera, which made it possible later to take photographs.

We followed a secretary along the tall corridors of power along the first floor. The President occupies the second floor. Then on to the secretarial ante-room to be ushered into a larger tall-ceiling room. At a tidy imposing desk sat Professor Dr. Fedir Burchak, political legal advisor to the President of Ukraine. A tall slim elderly man we exchanged courtesies and introduced ourselves and explained why we were here. We talked and listened intently for the next hour.

Dr. Burchak explained the present crisis. In the Union of the Soviet Socialist Republics raw materials came from one place, parts were manufactured in another place and assembled in a third. When the Russians departed in 1991 one or two of these aspects of manufacture collapsed and factories closed resulting in massive unemployment. This resulted in a low tax base and in an inability for government to raise taxes for public expenditures.

Half the economy is in an untaxable shadow. The Union of the Soviet Socialist Republics was a system of strong central control supplying the needs of the people at an artificially low cost but with no freedom of thought or action, suppressing personal initiative. With the withdrawal of Russia, Ukraine, now an independent state, had to face the reality of world markets with much higher prices, which at present Ukraine cannot pay, hence the scarcity of goods especially the expensive medications and medical supplies which were once available.

Ukraine is politically a wealthy country with rich black soil, minerals and an agreeable climate, but its problem is its geopolitical positioning, being flanked by strong neighbours on its long frontiers and who are acquisitive of its resources.

The American Association of Physicians and Surgeons had written to Dr. Burchak inviting officials of the government of Ukraine to a symposium in Atlanta on 11th January 1997 to introduce the principles of a free market medical economy.

A flying hospital with an operating theater, a twelve bedded ward and surgical support faculties had recently visited Ukraine and performed 380 operations. This was organised by Operation Blessing International centered in Virginia Beach, Virginia.

After years behind an iron curtain Ukraine was now slowly emerging and desired to make the right contacts. This meeting was friendly and courteous and ended with photographs with our only camera.

Outside the Institute of Social Sciences we met a small man, compared to Victor and me, full of energy and enthusiasm, Professor Dr. George Drannik, head of the department of clinical immunology and allergology of the Ukrainian State Medical University. Driving through the streets of Kyiv he pointed out the great buildings of State, power and history. A magnificent city.

We arrived at the Institute of Urology. On the 6th floor was the department of Immunology. In the immediate area were the Institute of Nephrology and Transplantology and the building housing the laboratories. Under construction was a building to be the Institute of Pediatric Urology and Nephrology. The buildings shouted their need for care and repair. The paths were pot-holed and overgrown. Yet one was only aware of the courtesy and friendliness of all whom we met. We sat down in the professors busy office.

Dr. Drannik said that there were no accurate figures of the effect of the radiation of the accident of Chernobyl. Some try to find the true figures, while others speculate. The true figures would be higher but he was convinced that as the years go by the number of children affected will rise and the pathology will transmit down the generations. Future generations are now programmed to be born sick. It has been observed that each rayon (district) developed its own pathology, peculiar to itself. Radiation has caused a disruption of the immune syndrome so that pneumonia (say) would present not with classical symptoms, but with unusual symptoms. In 1989 the incidence of disruption of the immune system was investigated in different areas.

Area Percent of Population with disrupted immunity

Chernihiv                   80.9    This population was asymptomatic
                                    but their position was precarious  

Poltava (in the east)       78.6    Yet, this was considered a clean 
                                    area.

Zaporozhye (in the south)   78.3    Subjected to polluted air due to an
                                    aluminum factory and nuclear plant leaks. 

Rivne (in the west)         66.7    Subject to chemical plants and a nuclear 
                                    power plant, also received fallout from 
                                    Chernobyl   

Kirovograd (in the south)   34.1    Subject to uranium ore mines.  The 
                                    radiation is higher yet disruption is 
                                    lower, probably due to adaptation 
                                    to natural rock radiation over 
                                    generations.  

A similar city in the USA would have a disruption of 10%. It is necessary to repeat these investigation for yearly comparison, but the investigations cannot be afforded. Disruption of the immune system has been caused by the radiation from Chernobyl, but other causes should be added such as the affect of chemical fertilizers, stress and distress, poverty and even the uncertainty of Perestroika. The whole truth about Chernobyl has not been told yet.

Most of the people who were affected by the initial big dose of radiation and its effects combine and act synergistically with the effects of environmental pollution and stress. The dose of radiation in the air and food is not known.

The definition of health in Ukraine applicably to the above case is if a person has not gone to the doctor for six months.

Studies on the immune system are first clinical examination and secondly, blood analysis.

A clinical study was performed in 1989 in 1000 people who were outwardly healthy and living in Kyiv since the accident in 1986. People came to Dr. Drannik's clinic in a state of panic about themselves and their children. What could I tell then, he said. Out of 1000 people, 700 had symptoms on questioning. The results were collected.

Symptom/Sign              Percentage of 700

Fatigue                       90.6     
Sleepiness                    80.9
Anxiety, fear                 80.9
Enlarged thyroid              20.0
Slight pyrexia                64.0
Sore throat                   65.0
Herpes simplex                38.0
Myalgia                        6.4 
Headache                       6.0
Loss of weight                 0.64
Hepatomegaly                   0.64
Splenomegaly                    0

This symptom complex was determined by Dr. Drannik as the increased fatiguability syndrome that is similar to the chronic fatigue syndrom described and registered in the USA as a new disease. These syndromes are like in the fact that a disruption of immunity is developed at such people in both cases. And they are differed in the thing that the chronic fatigue syndrom is believed to be caused by an unrecognized virus, but here in Ukraine the increased fatiguability syndrome is caused by a combination of Chornobyl radiation, stress and ecological pollution. It is not known which makes the major contribution.

Immune competence is determined by blood examination for T cells. T helper cells, T suppresser cells, B cells and natural killer cells which defend against malignancies and viruses. Also immunoglobins and circulating immune complexes are assessed. Macrophages are counted.

This unit needs modern equipment to get this information more efficiently. There is some degree of inaccuracy in the present methods but the results are still high.

The disruption of immunity at people who are practically healthy but complain of the increased fatiguability syndrome, according to the 1989 clinical study, sometimes is like the disruption of immunity at the AIDS (Acquired Immune Deficiency Syndrome) patients.

Chlamydia infection is a major problem which can be connected with disruption of immunity, especially in the young. Infection of the urethra, prostate and vagina with chlamydia results in infertility. Babies are being born sometimes with chlamydia infection at such infected people.

If the patient has no immune deficiency or allergy, then they are advised to have a high standard of hygiene and to filter the drinking water.

If the patient has ingested radioactive dust or food then the excretion of radionuclides is increased with activated charcoal granules or tablets - three tablets three times daily for up to ten days.

The immunity can be improved with bovine thymus extract, oral, nose drops or injection, sold as Thymogen, Thymosin etc.

In Russia experiments are being made with the extract of cultivated animal bone marrow cells. Also stem cells from the liver of the human embryo have been injected in patients with immune deficiency syndrome and leukemia with benefit.

Finally studies are being performed using interferon and alpha 2 interferon which is cheaper.

The overall solution is to teach the principles of immunology to students and inform the population. A modern rehabilitation centre should be built to study immune deficiency diseases and where poor patients can be examined and treated free.

This Institute is the only centre in all Ukriane studying immune deficiency diseases. Much more knowledge is needed. Dr. Drannik would like to visit other centres of immunology in the USA and UK to learn and pool his knowledge.

The study of the increased fatiguability syndrome is too expensive for Dr. Drannik's department. He has many patients for study but no funds. Like many others in Ukraine he has not received a salary for several months.

In Odessa there are more than 500 new patients each year with AIDS and increasing following narcotic injections.

Medical consequences of the Chornobyl disaster could be roughly classified in the following way ("the Chornobyl syndrome"):

Group I Radiation causing genetic damage resulting in congenital abnormalities

Group II Radiation, distress, and environmental pollution causing immune abnormalities

a) Immune deficiency or AIDS-related, that is, no virus e.g. the increased fatiguability syndrome

b) Auto-immune disease-lupus erythematosis, Hashimoto's disease.

c) Allergy

This intense meeting was immediately followed by a car drive to the Institute of Social Sciences, a shabby but solid building, to meet Dr. Yuri Sayenko, deputy director of the Institute, a very tall slim bearded man with the expressive hands and face of a poet or a Moses. The long narrow study was divided lengthwise by a long narrow black desk, overlooked by a picture of Taras Shevchenko, 19th century national poet and reformer. Dr. Sayenko is responsible for the study of the sociological and health affects of the Chernobyl accident and for the collection of the statistics.

He opened by saying he was moved by our interest in their problems. He delivers many lectures on the Continent, all listen by no one acts.

The affect of Chernobyl is covered with mythology. It is imperative to obtain facts but different organizations publish differing statistics. It is widely not understood that there are three phenomena to be observed.

Group I In zone 1, the forbidden or dead zone, there are 500 to 1000 people all over 50 years who realise where they are living, but are unconcerned and do not want to leave their land.

Group II In zone 2, the relocation zone, there are about 24,000 adults and children who will not move. This is a dying community and they are given no government help with buildings, roads or any public expenditure.

Group III These are the people who were evacuated and resettled in clean areas but the relocation was done with Soviet KGB methods in the Stalinist deportation style, not unlike Hitler's deportation of Jews. 75% of the people over 50 years want to return and die in their land. People over 50 years have difficulty resettling while children resettle well.

Any study of the Chernobyl problem involves considering the effects of physical illness, social disturbance, environmental pollution and economic poverty.

These are great psychological problems besides physical health. There is a high level of fatalism. People know they are contaminated, but there is a strong denial of the effects. The higher the level of education, the greater the fear. The less educated see the trees in leaf and think all is well.

Those in group I are the middle to lower educated people

Those in group II are the lower educated because the more educated teachers, doctors and administrators evacuated. Strangely, it has been observed that the very highly educated are fatalistic like the lower educated.

The Chernobyl nuclear power plant engineers and administrators tend to be fatalistic.

There are two groups of Chernobyl engineers. The first group of 500-600 engineers evacuated from Chernobyl to Kyiv after their first high dose of radiation. These are now all invalids. But the second group who remained in Chernobyl and made the nuclear power plant operational again say they are in perfect health!

The firemen or liquidators who dealt initially with the accident and who have survived could not adapt to society again. The divorce rate doubled, although it is now stabilised. The alcoholism and suicide rate increased. Many do not care what they eat or drink. It is difficult to distinguish and separate the effects of economic and other problems.

People are not angry bitter about the accident, all they want is stability. One can be happy even in prison because at least it is a stable environment--an inmate knows where he will be the next day. The old USSR was a stable environment and people knew their boundaries, now they don't know.

In 1992 9% of the population wanted the old system back. Today 30% would like the old system to return. At present these is no physical, mental or spiritual goal, no five year plan of any sort. The people are drifting. After World War II there were leaders for the people to follow, now no one leads. The official unemployment rate is 0.7%, but in reality it is 35%--it depends on how one defines the employer's offer to take some time off, like half a year without pay! Many have had no pay since June 1996. Survival is by the following methods:

1. Growing vegetables, fruits, eggs, honey on a dacha (cottage) plot and bartering the produce.

2. Running a private business usually crushed by taxes

3. Becoming a handyman

4. Work through international connections and being paid in US dollars.

The future outlook is regarded as hopeful by up to 80% of the population. Up to 6% have the hope that a strong leader will arise from somewhere or they are waiting for a political party to get them out of the crisis.

The Ukrainians are a combination of Aryan tribes who united as a nation when they reached north of the Black Sea and Kyiv became their capital. They are separate and different to the Russians and Mongolians. Ukraine and especially Kyiv is the place of origin of the Slavic race.

There have been three influential injections into Ukraine. First, the Slavonic Ukrainians, the secondly the Germans, Catherine the Great was German and only spoke German and finally the French influence during the Napoleonic period.

Ukrainians regard Ukraine and nowhere else as their land and their home. The Russians, on the other hand, regard wherever they are situated as their land and home. Courtesy to foreigners and visitors is a feature of the Ukrainian character while a Russian wants to teach a visitor his way of doing anything. Poles resident in Ukraine make the most patriotic Ukrainians.

The problem with Ukraine even to this day is geo-political. It is surrounded by strong nations grasping at it's rich black soil and minerals and ripping the country apart, while the whole history of Ukraine is one of poor leadership. At present Russia is claiming Sevastapol, the Crimean city and port for themselves.

Victor and I were collected by an ambulance donated by Whitehall, Dublin and transported on a three hour journey to Chernihiv to Dr. Natalya Zenchenko's ninth floor flat of a concrete block.

Dr. Vasiliy Pasechnik and Dr. Anna Yakubova arrived followed by Victor Ostrik, an administrator and teacher in the Rehabilitation Centre and his wife Halyna who is a neonatal paedeatrician and responsible for all paedeatric care in the city of Chernihiv. Photographs were handed round showing the opening of the Centre for Medical and Social Rehabilitation on 19th June by the British Ambassador, Roy Reeve, and the mayor of Chernihiv, Vitaly Kosich. We sat down to a table groaning with cold meats, pates and fish. Throughout the meal there was a succession vodka toasts and increasingly noble speeches. The third toast is to the ladies, all ladies. The fourth toast is always to the men, all men. The fifth toast is to love, the fifteenth to universal love, the twenty-fifth is unmentionable and the last is for the horse to carry one home.

Halyna Ostrik looks after the newborn in the birthing house or obstetric hospital. She said only 10% of newborn are totally healthy in Chernihiv and it was confirmed by all present that only 1% of all school-age children are totally healthy. Chernihiv was subject to radioactive iodine fallout in the early stages and the population did not evacuate like some villages so the thyroid cancer incidence has been steadily increasing in the city since 1992, now the highest incidence in the world.

Too tired to keep awake, too tired to sleep.