When choosing a venue for the January get-together where the three districts of Khmelnytska Oblast will celebrate becoming Ukraine’s first Angels Regions, one of the chief requirements will be a sturdy and capacious bomb shelter. Though Khmelnytskyi is located in the west of the country, the war has been edging closer. A nuclear power plant near Netishyn in the most northern district of the oblast was recently targeted by russian missiles and drones.
There will nevertheless be a great deal to celebrate.
This jarring reality brought about by a 1000-day-old war makes it all the more remarkable that Ukraine is among the first countries in Europe to convert Angels Regions.
When the 100 Angels Regions strategy was launched at the start of 2024, consultants Lev Prystupiuk and Tamara Zabashta knew that their regional conversion process would have to address the needs of a population fractured and exhausted by two years of Covid and three years of war. Security was part of the reason why they decided to start with Khmelnytskyi – it was, or at least appeared to be, at a safe distance from the war. But even more than that they wanted to focus their efforts on a region that needed help fast, Tamara says. “Not much attention had been paid to this region and we felt we could help a lot of people there.” And as they soon found out, Deputy Director of the Department of Health in Khmelnytska Oblast, Tetyana Kosovska, would be a powerful ally.
Khmelnytska Oblast consists of three districts or administrative raions – in order from south to north, Khmelnytskyi Raion, Kamianets-Podilskyi Raion, and Shepetivskyi Raion. The stroke network consists of 10 hospitals, evenly distributed across the territory but all at various stages of their stroke care journey, and a central EMS.
For a region to become an Angels Region, hospitals, emergency services, local authorities and public educators all have to work together towards a shared goal – to make their community safe for stroke. But in Khmelnytska Oblast, the pandemic and then the war had worn away at the connections that bind a society together and across the region people were struggling with exhaustion from air alerts disrupting their sleep and their work.
Lev and Tamara set out to rebuild a community in which everyone felt supported – by the authorities, by Angels and by each other. Their goals were to create a community of hospitals, cooperate with local health and educational authorities, and instill a culture of teamwork in the region. Working methodically, they identified the main challenges and drew up an action plan for each, then broke it down into an integrated program of scheduled meetings, trainings and follow-ups across four quarters. These included emphasizing the importance of quality monitoring in round table discussions and regional training sessions; providing training on fast-track systems for stroke patients to address hospital admission delays; training to support decision making, and introducing measures to improve community awareness.
Lev and Tamara wanted everyone in the region to work together, and they practised what they preached. They drew up a spreadsheet that detailed the activities for each month, but didn’t divide up the duties. Instead, they worked as a team, ticking the boxes as they went.
Quarter two was the most challenging one, Tamara says. The Khmelnytskyi group was split into two for the Angels Initiative stroke simulation training in Kyiv and Lutsk, in addition to neurologist training, RES-Q trainings, an EMS simulations, and consultancy visits to all 10 hospitals. They also got to participate in national events such as the Ukrainian Stroke Medicine Society’s Stroke National Conference and the Schools for Young Neurologists.
The minimum criteria for Angels Regions status is an ESO Angels gold award for every hospital and EMS. In Khmelnytskyi like elsewhere, some hospitals started out with an advantage while others had some catching up to do. But Lev and Tamara, mindful of teamwork, deliberately steered clear from singling out hospitals for their awards status.
“It wasn’t a case of this is a gold and this is a diamond hospital or this is Lev’s hospital or mine,” Tamara says. “Our priority was to become a ‘gold region’, and for everyone to achieve it together.”
Every team needs a cheerleader and health Deputy Director Tetyana Kosovska was both enthusiastic and proactive about Khmelnytskyi’s three districts becoming the first Angels Regions in Ukraine. Her good leadership made it easy and she was a regular participant in the program, Tamara says. “She really understood the deepest sense of this work.”
Khmelnytskyi Raion and Kamianets-Podilskyi Raion were first to attain Angels region status, with Shepetivskyi Raion to join them as soon as the quarter four results are official. But the region has achieved something even more profound and worthy of celebration: The campaign to become an Angels Region has strengthened their community with the knowledge that they can count on each other for support.
