Yulia’s Story: Taking on Deadly Risks to Deliver TB Care in Kharkiv, Ukraine

By The Global Fund

October 13^th, 2022

Despite living under constant shelling and bombardments over the last seven months, Yulia Malyk has continued working as a social worker in Kharkiv, Ukraine’s second largest city.

“We are constantly on guard here,” she says. “When I step outside I instantly start checking the spots around me for shelter in case of shelling. We were not prepared. No one can be prepared for this.”

Yulia provides community-based health outreach services to prevent, diagnose and treat people with tuberculosis (TB) through the non-profit organization 100% Life, one of the Global Fund’s partners in Ukraine.

Yulia walks past a building destroyed by the ongoing conflict in Ukraine while on her way to work in Kharkiv.

Everyone in the city, including Yulia and her 5-year-old daughter, have experienced near-daily missile and rocket strikes. Despite these dangers, Yulia regularly heads out on foot, traveling across the city to provide vital TB health services.

Yulia says health workers have suffered tremendously throughout the Russian invasion.

“Doctors have had to walk for three hours from their homes to the hospital under shelling to give [TB] medications to their patients,” she says. “Two of my colleagues from the TB program left. I can't blame them. And a missile hit the apartment of one of my other colleagues.”

Yulia’s Story: Taking on Deadly Risks to Deliver TB Care in Kharkiv, Ukraine

The ongoing conflict in Ukraine has had devastating consequences on the country’s health care system. More than 700 health facilities have been attacked, resulting in the destruction of 101 hospitals, 400 pharmacies and 100 ambulances, including three TB hospitals. Health care workers and patients have been displaced, injured and killed.

Even before the Russian invasion, Ukraine was designated a high-priority country in the fight against TB in Eastern Europe. The conflict has made the situation worse with disruptions to prevention, screening and treatment programs.

Services provided by social workers like Yulia are vital in protecting gains already made in the fight against TB and maintaining essential services.

Today, Yulia is at the Slobidsky District Probation Center where she provides free TB screening to people after they register with a probation officer. Yulia visits the center twice a week.

Yulia talks to Andrei Mashkovan, an outreach worker with a harm reduction organization, during her TB screening activities with people who were formerly in prison at the Slobidsky District Probation Center in Kharkiv.

People who have been in prison face an increased risk of contracting TB, as detention facilities are often overcrowded.

"After the person registers with a probation officer, they can come over to me and I ask them about their health, give them a form to fill out and I offer them to come for an X-ray,” she says. “When we establish that the person has TB, we also check their relatives and close friends. We try to reach out to everyone who has been in close contact with the person."

Later the same day, Yulia visits several locations across Kharkiv where humanitarian aid is distributed. The number of people in need of aid in Ukraine has spiked due to the conflict.

Georgy Berdnyk is one of over 100 people lining up for food next to the city’s central market. He's been standing in line for two hours when Yulia approaches him.

"I've been feeling weak and tired lately. It's hard to get out of bed in the morning," he says. "I'm not coughing, but I had tuberculosis in 2011 and I have not checked since then. So I think I'll go and get checked just to make sure."

They exchange phone numbers and set up an appointment for the following week when Yulia will accompany him to the hospital. Then Yulia moves to the next person in line. "We stand in these long lines, there are so many people, some are coughing. I hope it's not TB, but you never know," says Georgy.

After a long day of walking around the city, Yulia returns to her office in the late afternoon to call her patients with TB to check on how their treatment is going and to set up X-ray appointments.

Yulia phones patients with TB to check how their treatment is going and to set up X-ray appointments.

Yulia says she worries the conflict will further spread TB.

"Even if a person has never contacted anyone with TB, the stress, staying in closed cramped spaces in the basement or subway for a long time and poor nutrition causes a low immune system and raises the risk of getting TB,” she says. “Most likely in winter, we will have a sharp rise of new cases.”

Immediately after the Russian invasion in early March 2022, the Global Fund approved US$15 million in emergency funding to Ukraine, including support to Yulia and her colleagues at 100 % Life.

This funding is in addition to grants, catalytic matching funds and the country’s COVID-19 response – totaling nearly US$190 million in Global Fund contributions.

Yulia says that regardless of the conflict, she plans to stay in Kharkiv and continue her outreach work. "I moved to Kharkiv from my hometown after I finished high school and I instantly fell in love with the city. I don't want to leave, it's my home now.”