DNIPRO, Ukraine — Mechnikov Hospital is so old it treated wounded soldiers during the Crimean War in the 1850s.
Yet the medical center in central Ukraine, just 60 miles from the frontline, plays a critical role in the current Russia-Ukraine war, where traumatic brain injuries are all-too-common. With a bit of help from some U.S. doctors, Ukrainian neurosurgeons are conducting state-of-the-art operations with cutting-edge equipment.
When Ukrainian troops suffer life-threatening head injuries — and many do — this is where they want to come as fast as possible.
"At Mechnikov Hospital, our rules say we need to start surgery in the first two hours after admission," said Dr. Andriy Sirko, the head of neurology who handles the most complex cases.
That's much faster than in many hospitals, especially those intended for civilians. Dr. Sirko has honed this process with some 2,000 war-related operations he's performed since Russia first attacked Ukraine in 2014. Most of those surgeries have come since Russia's full-scale invasion three-and-a-half years ago.
The huge number of casualties, and the severity of the wounds, forced Dr. Sirko and his team to develop ways of rapidly handling brain injuries, most of them now caused by Russian drone strikes.
"We implemented a new strategy, which we call early and comprehensive surgery," he said during an interview in his cramped office.
Traditionally, a soldier with multiple brain injuries might endure several separate operations over many days. This could involve drilling a hole in the skull to relieve pressure from brain swelling, removing shattered skull fragments, and delicate repair work on damaged blood vessels.
At Mechnikov, all this may be done in a single surgery.
"In one operation, we perform all stages," said Dr. Sirko.
And to finish up, a partly missing skull can be replaced with titanium mesh and screws, he noted.
A risky location
Proximity to the frontline means all this work may be done the same day a soldier or civilian is injured. But this has become more challenging.
A decade ago, wounded troops could be flown to the hospital by helicopter. That's no longer possible because helicopters are now too vulnerable to Russian attack. The Russians also use drones to hit vehicles, which means injured soldiers sometimes have to wait until nighttime, when it's considered marginally safer to drive from the front to the hospital.
The hospital itself is not entirely safe. A Russian missile crashed just outside the gates last October, shattering glass and shrouding the hospital, inside and out, in a cloud of dust and debris.
Dr. Sirko's 27-year-old son, Dr. Bohdan Sirko, who's also a neurosurgeon, was operating on a wounded civilian at the time.
"It was big bomb. There was a whistling of air. I never felt this before," said Dr. Bohdan Sirko. "When I opened my eyes, I was thinking, 'OK, maybe I'm dead.'"
The blast knocked down one of the nurses, but everyone survived — and he successfully completed the surgery.
A hospital from the Russian Empire
This hospital in the central city of Dnipro was established in 1798. It's now a campus with several buildings, and it proudly boasts that one of them — still in use — treated injured Russian soldiers in the Crimean War, which ended with Russia's defeat to Britain, France and the Ottoman Empire in 1856. At that time, this region was part of the Russian Empire.
Walking the crowded halls today is to travel through a time capsule from the Soviet Union.
The main colors are dull gray and drab brown. Chairs are scarce and worn bare. The elevator groans as it strains to reach the next floor.
Then you peak inside an operating room.
"What I was amazed by is that they had so much more capability than what we had in Iraq and Afghanistan," said Dr. Rocco Armonda, a U.S. neurosurgeon. Dr. Armonda is also a retired U.S. Army colonel who spent more than a decade serving in the Middle East and at Walter Reed National Military Medical Center outside Washington.
He operated on hundreds of U.S. troops with traumatic brain injuries, learning and pioneering new techniques over the course of those U.S. wars.
He describes Mechnikov Hospital this way: "It's like you transported Walter Reed within an hour of the frontline. They're so close to the battlefield and doing amazing, heroic work. Just for comparison, two days in Ukraine is equivalent to the worst month that we had in Iraq."
Dr. Armonda, who's now at Georgetown University Hospital, has traveled to Mechnikov three times in the past two years. He assists on operations and hauls basic supplies to the hospital. He's also helped it acquire multi-million-dollar equipment.
This includes an angiography machine, which provides ultra-high resolution views of blood vessels in the brain, as well as advanced surgical microscopes.
He's most impressed by what Ukrainian surgeons learned long-distance from Americans, and from their own war experience at home.
"They took it one step further. They took devices that we would use to treat a civilian aneurysm emergency, and they applied it to wartime injuries," he said. "So their devices got much better over the 20 years since we were in Iraq and Afghanistan."
In short, he added, "I was teaching them some things. But I think I was doing a lot more learning than teaching,"
Work that never ends
In his office, Dr. Andriy Sirko pulls out a plastic bag with shrapnel he's removed from the brains of patients. He pours the contents on his desk.
An olive green piece of metal is the size of a credit card. The serial number on the shrapnel is clearly visible. The patient, Dr. Sirko said, survived and is doing reasonably well.
Then he displays a tiny pellet, the size of a pea. This patient died, he explained. War is random.
Outside his office, the hallway is now filled with patients and their family members waiting to see him. He has six more surgeries planned for the week.
NPR's Hanna Palamarenko contributed to this story in Dnipro, Ukraine.
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