Under Pressure: How IOM Doctors and Psychologists Are Working Together to Cure Hypertension

"Let us first measure your blood pressure" — this simple medical procedure is offered every day to everyone who comes to the IOM mobile clinics. Just a few minutes after, the doctor is better informed about the real state of the one’s cardiovascular system than patients themselves who complain about other symptoms such a headaches, nausea, difficulty breathing and a constant fatigue. Without consultations and medical examination, it is challenging to link these conditions to hight blood pressure and diagnose hypertension at the early stages. More and more often, people attribute these symptoms to chronic stress caused by the war and displacement and try to cure them on their own without addressing the cause of the disease. The IOM mobile medical teams, working in 12 regions, are making efforts to change the situation encouraging patients to take action for comprehensive and systematic treatment and disease prevention. 

"In the past, I did sports, so I didn't have any particular health issues and rarely visited doctors. Now, it turned out that I have high blood pressure," says Borys, a pensioner who was displaced from Nikopol and found shelter in the village of Mamalyha in Chernivtsi Region. In his hometown in Dnipropetrovsk Region, he had a family doctor and plenty of pharmacies nearby. Now, the nearest medical facility is at least five kilometres away. When Borys noticed redness in his eye, he did not attribute it to high blood pressure, but still decided to use the opportunity and get a check-up at the mobile clinic of IOM's implementing partner, UK-Med. He got his blood pressure measured, and ultrasound made. After the hypertension was diagnosed, Borys was prescribed with treatment and received medication for two months.  

Eight years of the armed conflict in eastern Ukraine that turned into the full-scale invasion, as well as the pandemic, have caused elevated stress. As result, cardiovascular diseases not only remain the main cause of mortality in Ukraine but are diagnosed among patients 10-15 years younger than usually. Increased pressure on the health-care system, difficulties in accessing health services in frontline and rural areas, as well as mass displacement, prevent people from getting timely examination to detect a disease at the early stages. High blood pressure creates an additional burden for the heart and blood vessels increasing the risks of heart attack, stroke, heart failure, and other diseases. At the same time, those displaced who already experience issues with the cardiovascular system need to register with a family doctor and stay in long queues at the medical facilities in their new places, where doctors cannot quickly find time for everyone and help prevent the disease. 

“If hypertension is not treated for a long time, it can seriously harm person's health, even making the one incapable of working. The majority of people who turn to us have low income. Although some of them knew about their disease and even took medicine, they had to stop treatment due to lack of funds. Others simply did not have a family doctor or did not know that the state covers the cost of certain medicines or that some of them can be obtained for free with a family doctor's prescription. In the mobile clinic, we provide the most-often prescribed medicines for arterial hypertension,” says the family doctor Iryna.  

The chronic stress and deterioration of the emotional state are other reasons that cause the widespread presence of hypertension and the development of its acute states. Ukraine’s Minister of Health Viktor Liashko estimated that about 15 million Ukrainians may need psychosocial support after the war. Therefore, IOM mobile clinics address the disease both on physical and a deeper, psychological, level. People can receive mental health aid and stabilize their emotional state with support of mobile clinics. After an individual session with a psychologist who works in each medical team, it is possible to continue therapy with specialists using the IOM emotional support hotline, employing 30 psychologists, psychotherapists and psychiatrists. 

"We visit the rooms of shelters where displaced people live. Often, a quick scan shows high blood pressure or heart problems. Having heard this from the doctors, people are more willing to agree to talk about the cause of their stress and how to deal with it. We even do relaxation exercises together. At our second or third meeting, the displaced people say that they feel better," says Olha, a psychologist at the mobile clinic. 

As psychologists explain, alarming news, regular air alarms, feeling anxious about the loved ones and difficulties adapting to new living conditions are often the most common issues that might lead to cardiovascular diseases among those displaced. Six months ago, Iryna was displaced leaving her own home in Melitopol and ending up in a kindergarten transformed into a collective centre in Chernivtsi. Here people live in shared rooms with a minimum personal space and comfort. As the Government of Ukraine has lost control over Iryna’s hometown, she does not know how much time she will have to spend in her new place. “I understand the difficulties that people who live here face. All of them feel stressed because they lost something due to the war. I had an argument with the neighbours, and I got very stressed,” says Iryna. Due to emotional exhaustion, she has got allergies and increased blood pressure and was able to stabilize her condition after turning to the IOM’s mobile clinic. 

“Timely prevention and a regular use of medicines can significantly improve the quality of life for people with hypertension. Prevention is both an easy and a difficult task: you need to keep a close eye on weight, limit alcohol consumption, try to quit smoking, and most importantly, move more! If displaced people can make this a part of their lives again, the risk of hypertension will significantly reduce," says the family doctor Iryna.   

According to IOM, every third displaced person in Ukraine needs medicine and medical services. Since the start of the full-scale war, this number has not change drastically. The IOM mobile teams, consisting of family doctors, junior medical staff, cardiologists and neurologists, started working in Ukraine two months after the outbreak of the full-scale invasion. Since then, the teams received almost 120,000 patients, out of which near 65 per cent with symptoms of hypertension and other cardiovascular diseases received consultation, information and medication to normalize blood pressure.  

Text and photos by Maksym Petrov, IOM Chernivtsi