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FOCUS: Russia-Ukraine War

Why Ukrainian Refugees In Poland Are Crossing The Border For Medical Care Back Home

Since the Russian invasion of Ukraine began, Poland has accepted the largest number of Ukrainian refugees of any country. But in spite of the aid that they have received, some notable gaps remain: including the Polish healthcare system.

Photo of an Hospital entrance in Warsaw.

Hospital entrance in Warsaw.

Zoriana Variena, Katarzyna Pawłowska

WARSAW — I was 18 years old and far from home, all alone in Poland. My stomach pains were intense. But at no point did I think of going to the Polish National Health Fund (NFZ) for help. Instead, I left and went back to Ukraine for two months, until I was able to recover.

It’s nighttime when I wake suddenly. Around me, there is only cold and dark. For a minute, my eyes are blinded by the light from my phone screen, which shows me that it’s 3:47 in the morning. I have a sharp pain in my stomach.

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Though it was difficult, I managed to raise myself up from bed. With every step, I forced my body to suppress the tension I felt inside. I went up to the cabinet and sifted through medicine my mom had sent me from Ukraine. The bottles were hidden in a shoebox.

I found some painkillers and rushed to the kitchen. I swallowed the medicine with a large gulp of water, and looked out of the window. Two street lamps illuminated the sidewalk in front of my apartment building. Further in the distance, I saw one of the most fear-inducing signs in all of Poland: “Clinic." And beneath it, "NFZ." In theory, this institution is responsible for all of our health in this country. But for me, and many other Ukrainians in Poland, it is instead associated with fear and desperation.

The vast majority of Ukranians that I have met here go back to Ukraine at the first sign of any health problems. We go back to get medical care.

That night, when my stomach began to hurt, I was still a student, and barely eighteen years old. I was in Poland by myself. It was the year 2016, and I was living in Warsaw. I made the decision to go back to Ukraine.

It all worked out, and in Ukraine, I was able to access medical care. After the ordeal, I returned to Poland, continued my studies, and got a job. And although I adjusted more and more to the realities of daily life in Poland, I didn’t change my habits when it came to my health. Whenever I experienced any type of health problem, I packed up my bags and left for my hometown, Kyiv.

As time went on, I heard more and more stories similar to my own — not just from people my age, but also those in their 40s, 50s and 60s. I began to wonder why this was the case. Why do we undertake such journeys, traveling 300, 800, or even 1000 kilometers, for routine medical tests?

Is it something cultural? Or maybe it's an increased trust in Ukrainian specialists? Do we simply need the closeness of family in such difficult situations?

My colleague, Katarzyna, and I, decided to investigate.

Translators urgently needed

The first and most important factor that comes to mind is the language barrier. It is present at every stage of the healthcare process: from making an appointment, to during the visit itself, while receiving care, when getting a referral, during exams and when specialists offer medical advice.

Walentyna, a 63-year old Ukrainian woman, has been living on and off in Poland for over a decade. She has never received medical care in the country. “I don’t know the language well enough," she said. “It scares me."

Rather than facing her fears, several months ago Walentyna instead suffered a bad toothache, until it was time for her to visit her family in Ivano-Frankivsk.

Katarzyna Frołowa, a 25-year-old Ukrainian acquaintance of mine, went to a Polish doctor for the first time ever a few years ago. She needed a consultation with a gynecologist — a traumatizing experience, she said. "At that time, I still had a limited knowledge of Polishs. Nobody there wanted to translate for me," she said. She added that the medical staff used terms that she did not understand, and that even the doctor treating her was impatient. Though the words were unclear, Frołowa admits that the doctor’s tone was very clear. “You could almost hear her saying, get out of here quickly and stop bothering me," she said.

A good level of understanding between patients and doctors is key.

“A good level of understanding between patients and doctors is key," said Tomasz Karauda, a pulmonologist at the University Hospital Clinic in Łódź, Poland, who specializes in internal medicine. “It not only allows the doctor to actually help the sick person, but it also builds a trusted relationship between the patient and the person who is treating them," he added.

Like Karauda says, the situation on this front, especially in clinics, is difficult. “Making a doctor’s appointment over the phone is out of the question if you don’t know the language," he said. "If a patient comes in in-person, then it’s definitely easier — they can point at something with their finger to make it clear what the problem is, or someone in line at the doctor’s office might be able to speak Russian or Ukrainian."

But he admits that even in-person situations can have their own issues: “It isn’t always easy. In these clinics there is a lot of pressure to do everything as quickly as possible. Many people don’t have the time to try and understand what is going on."

And even if the patients manage to make an appointment, “It’s not easy in the doctor’s office either," said Karauda. "In many cases, the doctor only has 10 minutes per patient, which includes understanding why they have come, going over their medical history, giving them an exam and then trying to assess the urgency of the treatment, and the type of treatment that is needed."

For him, it's unrealistic to do this in such a short period of time. “There are instances where people lose their patience or become irritated, and those who are actually sick are left confused," he said. They are then left with a difficult choice: “Either they get dehydrated by taking diuretics incorrectly,” for example, or “They don't take the medicine at all, or they don't go see a specialist in the first place."

Maybe an app could help? 

Of course, there are some ways for people to better understand one another. For example, online translators that patients have on their phones. But, when it comes to medical matters, online translators are not always able to help. I myself have been in situations where I tried to use a translation app to make my case in front of doctors, while other patients waited outdoors for care. My hands were trembling, I felt incredibly uncomfortable, and, what’s more, the online translator managed to convey words that had a completely different meaning in translation to the doctor I was seeing.

Ałła Majewska, the head of the Legal and Professional Support Center for Ukrainian citizens at the HumanDoc Foundation, says that translations over the phone, though helpful, are not available to everyone. “Some people who come to Poland have very old phones, sometimes without internet," she said. For older Ukrainians in Poland, medical care is often the most urgent, but they are less likely to have a phone and translation app.

These people, then, cannot benefit from LikarPL, an app released in March by the Polish Ministry of Health, which aims to improve medical advice for Ukrainian citizens. It claims to enable a quick diagnosis of the patient's health condition, as well as to facilitate communication between the patient and doctors who do not speak Ukrainian. By May, 3,000 people had described their health condition via the app before visiting a doctor. There have also been over 200 doctor visits using the app.

As I clicked around the website, I admitted to myself that it was a nice option to have available, but I wouldn’t use it myself. When I am at a doctor’s appointment, I want to be able to have a dialogue with the doctor, rather than simply writing down what is happening. Ukrainians also face difficulties, even with apps, because you can describe pain in many different ways. And understanding what the doctor is saying, what they recommend and what we have to do is another matter entirely.

Even though this app exists, there seems to have been an outreach problem. I checked with friends and on Ukrainian groups on social media, and, until I mentioned it, no one had ever heard of it.

In our hospital, we’re lucky to have doctors, nurses and orderlies from Ukraine.

Some people say that there are hospitals and clinics where translators are available. I haven’t heard of any myself, and when I asked people I know, once again, they said that they hadn’t been made aware of any either.

“In our hospital, we’re lucky to have doctors, nurses and orderlies from Ukraine, so we can always find someone to translate if we need it," said Karauda, the doctor in Łódź.

But it isn’t so simple at every medical facility. “Sometimes, there isn’t anyone who is able to translate what the doctor is saying to the patient, and vice-versa," said Ałła Majewska. "Try to imagine how stressful this can be."

Polish hospital

There are no legal regulations when it comes to translators in the Polish healthcare system. Every medical facility copes with the situation in a different way.

Google Street View

No legal requirements for translation

Along with Katarzyna, we checked government websites for information about translators. In the Public Information Bulletin of the Commissioner for Human Rights, released on May 13, 2023, we read that a big problem in the treatment of people from Ukraine is "the lack of provision and financing of the interpreter service by the National Health Fund." At the moment, "Hospitals have to cope on an ad hoc basis, and there is not always a person among the staff who knows Ukrainian," according to the commissioner's website.

There are no legal regulations when it comes to translators in the Polish healthcare system. Every medical facility copes with the situation in a different way. Some finance translators themselves, while others require that patients who need translation come with someone. The rest rely on the language abilities of their own personnel or on the patient’s relatives, who must act as their interpreters. But, since these are not professional interpreters, the quality of the translations can vary, depending on the linguistic capabilities of each person. This can pose a significant language barrier when it comes to patient communication, for example, and also has an impact on the informed consent of patients. Having a random member of staff translate can also violate patients’ medical privacy.

At the request of citizens’ rights activists regarding the need to provide interpreters in the health service, the Deputy Minister of Health, surgeon Waldemar Kraska, replies that there is no legal basis for the National Health Fund to cover the costs related to the participation of an interpreter when providing healthcare services to a foreigner. “It should be assumed that the language barrier in the case of patients from Ukraine is smaller than in the case of patients from most EU countries," he said. So, in essence, our two languages are similar enough, so there should be at least some understanding between doctors and patients.

But Karauda does not agree with the Deputy Minister’s statements. “It’s not about understanding something or not. When it comes to someone’s life and health, we have to be very precise, so as not to do anyone harm," he said. “In my office, I see older patients who came from Ukraine all by themselves. They don’t understand a word of what I’m saying, and couldn’t find any similarities between the two," he said. They often come in with dire health conditions, including one woman with untreated diabetes, he said.

“Somehow, we were able to communicate with this woman, and of course we helped her, using the means that we had available to us, but the help of a kind person or an interpreter would be very useful here. There is still misunderstanding, emptiness and sadness among these patients," he said.

Long wait times and confusion are rampant

I am not sure if something like the NFZ even exists in Ukraine. I have always gone to a family doctor, regardless of whether I am insured through my work or not. In terms of access to medical care, work does not play a role — it is only the place of residence that matters.

Ałła Majewska also brings up the problem that occurs with the PESEL, the Polish social security number, which is required in order to receive medical care in Poland. “Ukrainian women living in Poland tend to cross the border as is. They go to visit their husbands, to take care of sick parents and to check on the wartime situation with their own eyes. When they return to Poland, it often turns out that they have been deleted from the government register, and do not have a PESEL number," she said.

“In theory, there is a procedure that no one is deleted from the system until 30 days of absence, but the practice is different. After a few days of absence, many of my compatriots no longer have a PESEL number. And they have to make multiple attempts with the system until finally obtaining one," she said.

And then there are the legendary wait times that Poles have to go through before seeing a specialist, which can sometimes take several years. “In Ukraine, you can go through all of your medical tests and a doctor’s visit on the same day that you come to the hospital. If anything, you wait one day," said Majewska.

“In Poland, if you are 'only' experiencing back pain, for example, then you have to wait 10 months for a doctor’s visit," explained my acquaintance Frołowa.

“Unfortunately, this is how it is in our healthcare system. The lines are the same for everyone," Karauda said.

Psychological tolls 

Another important reason for the stress of going to the doctor in Poland for Ukrainians is the emotional and psychological cost that affects refugees who are far from home.

Ukrainian women — there are many more of them in Poland than men — can often feel lost and alone in the foreign country, especially when they are facing difficult health situations. The lack of support from close friends or family in times of illness or even hospitalization cause feelings of longing, sadness and isolation.

This also affects the decision these women make to seek medical care in Ukraine. Receiving care in their home country gives patients a sense of emotional connection and support, which is crucial in the recovery process, even during wartime.

Most women do not have the comfort to decide.

Ukrainian women in Poland can also be met with uncomfortable situations at the doctor’s office. Katarzyna Frołowa says that, after the Russian invasion had begun, her sister had gone to the gynecologist in order to get a birth control prescription. When Frołowa’s sister entered the doctor’s office for what she believed was a routine procedure, “she was unpleasantly surprised," she said, and chose to return to Ukraine to get treatment. “I can’t say that everything in Ukrainian hospitals is perfect, but to me, it’s absurd, that a Polish gynecologist can refuse to write a prescription for birth control on any grounds," Frołowa said. "And the abortion bans are from the Middle Ages," she added.

Ałła Majewska warns against oversimplifying the case of Ukrainian women traveling specifically for treatment in their country. “Most women do not have the comfort to decide. The women who came to Poland because of the war go home for various reasons," she said. These can include seeing their husbands, taking care of their parents and to see a doctor for preventative visits, rather than waiting until they have a pressing health issue to receive care.

Its not just Ukrainian women 

Concerns about costs, women’s rights to choose during pregnancy, and the quality of medical care have also caused a growing number of Polish women looking for prenatal care to cross into the Czech Republic.

Patrycja is one of them. While she gave birth in a Polish hospital, all of her OB-GYN visits took place abroad — her pregnancy had never even been registered in Poland.

“We know what the attitude of the authorities towards pregnant women in Poland is”, Patrycja told Gazeta Wyborcza,“I read stories of women who miscarried and were later harassed, treated as child killers. I was afraid of our doctors.”

After researching gynecologists in the Czech Republic, Patrycja found testimonies from Polish patients, who had spent their pregnancies crossing the border for medical visits. “I read that they perform prenatal tests very reliably there, and that, in the event of a fetal defect, it is up to the woman to decide what to do with the pregnancy”.

Aside from far fewer restrictions on abortions, Patrycja remembers longer, more thorough medical visits and shorter wait times. And apart from regular visits at a doctor’s office close to the Polish border, she also was referred for specialized testing to Ostrava. Even with these added costs, she admits that she paid less in the Czech Republic than she would have for private medical visits in Poland. She estimates having paid about a third of the price of private Polish gynecologists.

Polish women have also been crossing the border for in-vitro fertilization procedures, and others still have been specifically failing to register their pregnancies in Poland — mostly out of fear of potential legal or social consequences as a result of fetal deformities or miscarriages. Unlike in Poland, where all pregnancies are registered into the medical system, the Czech Republic does not report this information, which makes some Polish women feel a lot more comfortable about their medical security and family planning.

The fears of discrimination — even around uncontrollable phenomena such as miscarriage — have been arguably amplified by recent events covered in the Polish media. Last week, a 41-year old woman known only as “Ola” told Wysokie Obcasy that after miscarrying, police showed up to her home, even going so far as to search her wastewater systems for signs of the fetus.

What next? 

Is there something that can be done to help make the Polish healthcare system more accessible to Ukrainians?

In Karauda's opinion, the introduction of translators who could work with several hospitals over the phone would be useful. The same situation should apply to psychological help. Even though over a year has passed since the outbreak of the war, psychologists are still a much-needed resource for refugees.

“Translators and translators should be appropriately compensated for their services, because it is hard work that requires motivation, and since it is something that is much-needed, and if it's really true that our economy is functioning perfectly as we hear so often in this country, then maybe there is enough funding for this to occur?” he said.

In the back of their minds, there is always the war, the ruined home.

Ałła Majewska instead believes that rather than promoting translators, it would be better if Poland were to accept more doctors and nurses from Ukraine. However, she is still satisfied that both Poland and its health system have at least tried to support Ukrainian refugees.

Despite the difficulties, "There is so much that has been done for us," she said. In her view, the problem lies elsewhere. “Ukrainians didn’t arrive in Poland in order to seek medical care. They came here to protect their children from the war. They live in constant stress. Many of them have experienced trauma," she said. “They are alone, so they have to take care of everything themselves. And in the back of their minds, there is always the war, the ruined home, the old and ailing parents and the husband who is fighting on the front. Her own self and her health problems are often the least of her concerns."

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