Inverness medic anticipates increased support needed for Ukraine
Andy Kent expects there will be UK specialists heading out to help and train surgeons in Ukraine for some time to come given the on-going conflict
Staff from Raigmore Hospital expect their involvement in supporting Ukraine to continue for some time following the invasion by Vladimir Putin's forces.
Without any sign of an end, the fighting continues and longer-term the impact from the conflict will see countless lives affected.
MFR News has again heard from Inverness medic Andy Kent after his most recent spell in the war-torn country.
Initially, back in late February/early March, Andy was involved with UK-Med and FCDO (Foreign, Commonwealth & Development Office) in setting up surgical training in Dnipro and a field hospital further east towards the Russian border.
The facility was initially staffed by a team from Raigmore, including Andy's colleague Angus Watson and Hamish Hey, but that has now since been handed over to a Ukrainian medical team.
"We're only a small drop in the ocean, but we offer training to enable and support them", said Andy
"With front-line medics, one of our physicians from Raigmore Dr Claire Vincent deals with critical care by training ambulance technicians.
"They offered some of this training in Sumy and Kharkiv which are still seeing a lot of bombing and civilian trauma.
"With plastic surgery and limb reconstruction, given its specialist nature, that's something that is best in the university in Lviv where we can bring the surgeons there to learn.
"This is something that's going to need to continue for many months, but we're already seeing the benefits of that."
Within the university in Lviv, in the west of Ukraine, there is now a training course teaching ortho-plastics to help those with limb injuries in the war.
UK-Med has committed to an 18 month programme initially, and it is now about trying to sustain that and keep the momentum to keep this in the spotlight.
"It's amazing how many civilians have actually crept back towards Dnipro", said Andy
"There were around 10 million displaced people, but as the Russian advance sweeping through the country has failed to materialise some have started to return.
"Bizarrely there were more bombings going on, but some people had realised the alternative of living in displacement camps wasn't acceptable to them."
Given the nature of the war, with artillery blast casualties, in Dnipro the UK-Med team has also trained staff to deal with limb and shrapnel injuries.
A plastic surgeon and an orthopedic specialist are helping train staff with reconstructive work - as the demand remains huge and the medical teams from the UK are stretched.
"The geography of Ukraine surprised me, because obviously there's no air traffic, so travel has to be by road or rail", said Andy
"For example a rail journey Lviv to Dnipro would take upwards of 24 hours and they're not the most comfortable.
"Road carries certain risks and there are still a number of roadblocks - plus fuel is an issue too.
"UK-Med did rely on the rail network, but clearly that's being used for munitions, and the infrastructure in a target for Russian bombs.
"There's a bit of a choke point near Dnipro, with casualties being evacuated by road, and then it's a case of getting them to the relative safety of Lviv.
"With some on ventilators, they can't be transferred 24-hours by train from Dnipro.
"Dealing with cases remotely, sending images and using modern media can help, but you have to grasp that those on the ground are struggling to maintain supplies and equipment.
"UK-Med has been trying to improve the standards of equipment they have, getting it shipped out to where it's needed most, from specialised dressings, to even X-ray machines."