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Physician Daryna Bahriy discusses her article “How Ukrainian doctors kept diabetes care alive during the war,” sharing how medical teams in western Ukraine adapted to protect vulnerable patients amid the chaos of conflict. Daryna explains how disrupted supply chains threatened insulin access, how doctors rapidly coordinated resource redistribution, and how patient education initiatives provided life-saving guidance in bomb shelters. She reflects on the importance of leadership, foresight, and humanity in medicine during crisis. Listeners will learn how health systems can prepare for instability, support chronic disease patients under extraordinary conditions, and draw strength from resilience and solidarity.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today we welcome Daryna Bahriy. She is an internal medicine physician from Ukraine. And today’s KevinMD article is “How Ukrainian doctors kept diabetes care alive during the war.” Daryna, welcome to the show.

Daryna Bahriy: Hello. Thank you.

Kevin Pho: All right, so why do we not start by briefly sharing your story and journey and then talking about why you decided to share this article on KevinMD?

Daryna Bahriy: Thank you. I am originally from Ukraine, where I trained and worked as a physician. I focus on internal medicine, especially on chronic diseases; I mostly work with diabetes. Medicine has always been not just about a career for me; it is about a calling. I worked in a regional clinic where I treated patients, where I educated them, and I organized some training so they could improve their life with this chronic condition.

Also, my passion was evidence-based medicine and preventive medicine, public health. That is what I worked on before the war. But on February 2022, everything changed. One day I was reviewing lab results, speaking with patients, and scheduling training. The next day, I was trying to figure out how to keep patients with diabetes alive during massive disruption, during air raids that shook our city. I now am living in the United States, and I continue to reflect on those experiences, and I would like to share.

Kevin Pho: All right, so why do we not go ahead and do that? You talk about that in your KevinMD article. Talk to us about what it was like during that time in Ukraine during the war and how it affected you as a physician. Tell us about your article.

Daryna Bahriy: Yes. So, thank you for the question. The days before the war felt like the calm before the storm. Everyone was talking about the possibility of war, but no one really believed it would happen until it suddenly did. I remember that morning. I believe everyone remembers that morning when we figured out, even that night, that it had happened.

We had a lot more patients at that time because people were fleeing from the most dangerous part of Ukraine to our region. I live in Western Ukraine, and it was as peaceful as it is possible to be peaceful in a war. So people were arriving, and insulin warehouses were destroyed. Usual distribution and medical chains had collapsed. We did not have enough medication; we did not have enough insulin. And people were panicking.

In those first days, medical teams across our region were trying to locate available stocks of insulin and other medication and build chains to relocate it to another clinic, to another city, to shelters, to relocate it where it needed to be. Humanitarian organizations gave us huge help, but coordination on the ground happened in real time, often under air raids. It was how it was.

We were also trying to teach patients to be peaceful, what to do in a situation when they were stuck in a bomb shelter, when there was not enough food, water, or medication. So they knew how to use insulin in this situation, how to keep calm, how to monitor symptoms, and what to do. If it became peaceful enough, they could go to a clinic and find insulin and find medication as soon as possible.

Writing this piece for KevinMD, it was both emotional and healing for me. I never thought that I was going to have this experience in my life, but it shaped me into who I am today, and I am really grateful to have this possibility to share my story with you and your audience.

Kevin Pho: So tell us what it is like for patients to, like you said, sometimes have to receive insulin in the setting of air raids or in the setting of being in a bomb shelter. You said as a physician that you had to give them advice in terms of how to manage their diabetes in that war setting. So what kind of advice did you share with them?

Daryna Bahriy: So first of all, it is to be calm. Panicking is not OK in any situation, and also, panicking increases the glucose level in the blood. We all know it. Also, we spoke about how to use insulin. If you do not have enough insulin and you do not know how much time you are going to spend in a bomb shelter, you need to use it carefully, a little bit. As long as you can keep your glucose level not in the normal range but in a not-critical range, you can keep going for a long time, but not in a perfect situation. Also with food, if you have no food, try to use a long-acting insulin a little bit, not fast-acting with no food. Also, drink water. If you have water, drink it in small sips so you can stay hydrated as long as possible.

Also, when it becomes safe, go to the nearest clinic to visit a doctor. A lot of patients came and they had been using one type of insulin all their lives. Right now, we did not have this insulin; we needed to use another insulin. And patients were panicking, and the whole situation was totally terrifying. No one wants to change insulin in one day because people had used it for ten years and it was safe.

We tried to keep them calm, explain how the action is similar, that it is OK for you to use right now. You can come back when it is going to be peaceful. We will find more. Humanitarian organizations are going to help us; they are going to send us insulin. To be honest, at the end when it became peaceful, a lot of people started receiving better insulin. We changed something. So people who used NPH insulin twice a day started to use better insulins, and they were even thankful for that experience, that they took this step forward to change something in their life and in their treatment.

Kevin Pho: Tell us what was going through your mind as you as a physician were treating patients in a war setting, knowing that your own life was at risk during that time. What were you thinking as you were seeing patients in the clinic? What was going through your mind?

Daryna Bahriy: I was thinking about my daughter, to be honest. Because I went to work and left her at daycare. It was an all-day air raid, and she spent a lot of time in a basement. This basement was never meant to be a basement for kids; it was a technical room.

Kevin Pho: And what continued to motivate you to go in and see patients in a clinic instead of spending time with your family and daughter during that time?

Daryna Bahriy: I understand I have no way to stay in a basement. I need to work. I need to help. It was heartbreaking that she stayed, but I did think that it was safer for her to stay there than to stay at home with me because at home we did not have a basement. It was not like a basement in the United States. It was a technical room. There were some supplies. It was never meant for people to live there or spend their time. So I understood that she needed to stay there for her safety. She did not understand the whole situation. She was just three years old. Her teacher gave us updates on what they were doing and how they were doing.

And I was still working because I understood the situation. I understood the patients. I understood that I needed to be here. I am necessary here. I am useful here. A lot of my coworkers that morning just left our city and went to the most dangerous part of Ukraine to give help, like surgeons and traumatologists. People, my coworkers, who I spoke with every day, they just left that day and went to that part to give help. That was the most necessary first help for the injuries of soldiers and people. So I understood that for them, it is the most stressful. For me, to stay here and work, there are air raids, but we are still working, we are treating, we are doing what we need to do in our place. Everyone was doing the same. My sister is a pharmacist, and she also was working all day. Her kids were at school, at daycare. So we all do what we do. And I understand that leadership is not from the top; leadership is local. From local doctors, nurses, volunteers. You just need to act to save lives, to be in your place.

Kevin Pho: So tell us about the health care workers who were among the casualties of the war. How many of your colleagues do you know personally that you have lost?

Daryna Bahriy: From our clinic, thank God, we did not lose any person. But my friend from childhood, we played together, we studied at different universities but were always in touch. He died on the first day of the war because he was a surgeon and he went to the most dangerous part to give help, and he died from air raids, from a drone. The whole team that was on the way to this place where they needed to be located, the whole team died in one moment.

Kevin Pho: So tell us what the situation is now. What is it like now in Ukraine for health care workers? The war has been going on for several years now. What kind of stories are you hearing from back home in Ukraine?

Daryna Bahriy: Right now, it is as normal as it can be normal during the war because there are still air raids. At the hospital I worked at, a small clinic in a small town, we do not have a basement. We do not have the possibility and staff to move everyone during air raids to a safe place. A basement is just impossible. So people stay, people stay working, still helping patients. Nothing changed.

But when you have a breakout, when we had in the winter before last year, we had a lot of time when we did not have enough electricity. And it was stressful because when you are going through an operation or through another medical procedure, it is just life or death to have electricity. It was stressful, but we are adaptive people. We just have some stuff to keep working. We have generators to keep having electricity, backup plans. Right now we are trying to handle it, but at first, it was hard. I wish we had prepared before. I wish we had backup plans before. I wish we had emergency delivery routes. I wish we had some stockpile of medicine. But right now, we are doing OK, as much as you can say OK in this situation. Because the situation is totally not OK, but people are working in their places and trying to do their best.

I know a lot of people who left Ukraine, and I am as well. I was working for one year during the war. Then I decided that for the safety of my family, for my daughter, we needed to leave because there were days where my daughter spent the whole day in a basement. It was heartbreaking. So we decided that we needed to leave. We came to the United States, and we are very grateful for this possibility to be here. I was working online with my patients, consulting. Right now, I am starting to prepare for the USMLE to become a doctor here in the United States.

Kevin Pho: You said that this whole experience about practicing in a war setting in Ukraine changed you as a physician. How did it change you?

Daryna Bahriy: You know, before, I do not know how it changed me, not just as a physician but also as a person. I will never be the same as before, for good or for bad. I do not know. I just became more peaceful. I have less great joy in life, but I am enjoying small peace in life right now. Before, I had dreams to become someone, I do not know, to be someone on the top. But right now, I understand that I do not need it. I do not need to be on top to change something, to matter. You just need to be in the place where you are, and it is the best you can do. It is very important. You do not need big stuff in your life to be happy. You do not need big supplies and everything at work, which I really wished for because we had a really regular hospital. We did not have a lot of stuff that I wished we had. Right now, I understand it is all not as important as it was for me at that time.

Kevin Pho: What is the message that you want listeners and readers of your article to remember? As we mentioned before, the war has been going on for years now. Sometimes that means it gets pushed back in the news cycle. Now, for those people who are listening to you now, what is the message that you want them to hear?

Daryna Bahriy: I want to say that adaptability saves lives. Protocols are important. They are very important, but flexibility is critical when everything changes. Leadership is local. You do not need a big title to change something. You just need to act. Communication matters, even from time to time, more than medication. You need to be in your place to support your patient, not just by medication, but by your humanity, your words.

And take care of caregivers. Doctors and nurses under stress also need support, or the whole system can collapse. And advice as a human: be grateful for your life right now. Enjoy your life. Feel everything that you have right now. Do not wait until some time to do something. Just live your life now.

Kevin Pho: Tell us the emotion that you are feeling for having to leave Ukraine under these circumstances. You were a physician in Ukraine, and you mentioned now you are in the United States studying for your USMLE in hopes of being a physician in the United States. Tell me the emotion that you are feeling about being forced to leave your home country.

Daryna Bahriy: To be honest, I feel guilty that I left. I feel guilty because I know that I could still be working, still helping in that place where I was. But our life is not only work; it is also family, and you need to balance between all this stuff. So the main emotion is guilt, and I am working on it. But I hope that I can improve my skills here. I will become a doctor here, and I am still going to help in Ukraine. I am going to work tirelessly with my colleagues, with the hospital where I used to work, to help them improve some stuff they have right now.

Kevin Pho: We are talking to Daryna Bahriy. She is an internal medicine physician from Ukraine. Her KevinMD article is “How Ukrainian doctors kept diabetes care alive during the war.” I am going to end with asking you just some take-home messages that you want to leave with the KevinMD audience.

Daryna Bahriy: Medicine is not just about treatment. Medicine is about leadership, foresight, and communication. It does not matter where you work, in a war zone or in a peaceful clinic, remember your leadership and your humanity are as much important as your prescription.

Kevin Pho: Well, thank you so much for sharing your story and perspective, and thanks again for coming on the show.

Daryna Bahriy: Thank you. Thank you so much for asking me. It was really nice to speak with you, and it was really healing for me to share this experience. Thank you so much, Kevin.

Kevin Pho: Thank you so much for sharing.