Medical armored personnel carrier. Medical cross on the armor of an armored vehicle against the background of the flag of Ukraine at exhibition ARMS AND SECURITY - 2021. Kiev. Ukraine - June 18, 2021.

Sutures for Ukraine: The Medical Case for City Diplomacy

By Vrushab Gowda, Leslie Appleton, and Jesse Ehrenfeld

The war in Ukraine has brought nothing less than an unmitigated humanitarian catastrophe. Health care infrastructure has been deliberately — and systematically — targeted by Russian forces since the very outset of the invasion. Hospitals have been bombed, internal displacement has uprooted providers from their communities, and rail lines have come under sustained bombardment from cruise missiles, hindering the resupply of frontline towns. All of this has exacerbated the demands on an already fragile health care system, which strains to keep up. The Ukrainian people urgently need practical solutions.

Enter city diplomacy. In parallel to official channels of federal aid, American cities can play a decisive role in supporting their Ukrainian counterparts under threat. An “Adopt-a-City” campaign could leverage preexisting ties within a sister cities context (like Los Angeles and Kiev, if approved), which can be bolstered and intensified. Where these relationships do not exist, they can be created. New York could “adopt” Odessa. Atlanta, Kharkiv. Houston, Dnipro.

City departments of health would take center stage throughout all of this. Unlike howitzers, ammunition, electrical grids, and water supplies, medical aid is readily portable across international lines and can be concentrated in urban settings. An “Adopt-a-City” platform would provide a unified vehicle for channeling it, permitting American cities to render material and infrastructural assistance alike.

This can take the form of a public-private partnership, in which cities can bolster their excess supplies with contributions from local vendors, regional supply chains, and area health care facilities. Vanderbilt University Medical Center did just that; earlier this year, it served as a focal point coordinating state, municipal, and private resources for transfer to Ukraine. This should be replicated. Supplies ranging from basic PPE and essential medicines to durable medical equipment should be collected, sterilized, and packaged for transport.

This represents more than just an outlet for offloading excess capacity; it is an ethical imperative. It also has a precedent – earlier in the COVID-19 pandemic, Chicago and Austin, sister cities of New Delhi and Pune, launched fundraisers to purchase medical equipment for their Indian counterparts during a deadly surge. This should be scaled and broadened.

Apart from physical hardware, “Adopt-a-City” participants can share their human capital just as well. Municipal public health authorities can offer institutional know-how on sanitation and disease control — crucial insights when hepatitis A and cholera threaten the devastated cities of the east. Likewise, physicians can provide telehealth services to Ukrainians lacking access to specialty care. The “Adopt-a-City” program could moreover serve as a central node for pooling funds from local residents who may otherwise donate to separate charities that may be several degrees removed from impact on the ground.

An “Adopt-a-City” approach would furthermore be unencumbered by the bureaucratic red tape which may constrain federal initiatives, as well as the need to contract with third-party vendors during acquisitions. In other words, this program would place medical equipment directly into the hands of Ukrainian providers and health care officials, as opposed to infusing cash into Ukrainian ministries, through several organizational layers, and only then to purchase medical supplies on the open market, at a time when global supply chains are stretched to their limits.

By cutting out the middleman, the “Adopt-a-City” campaign would move faster than traditional channels of foreign aid and obviate the need for oversight to guarantee that funds are appropriately spent. It would moreover serve as a force multiplier to the myriad NGOs and private individuals who have personally organized consignments of health care supplies. These ad hoc arrangements would instead be systematized and brought under more coordinated planning.

All of that said, “Adopt-a-City” stands to supplement, rather than supplant conventional aid delivery at the highest level; even at scale, the volume of aid could not rival that at the federal government’s disposal. Nonetheless, it would serve as a critical adjunct to existing efforts, and one that can offer a blueprint for allied nations to emulate. It will provide our Ukrainian partners with the tools they need for survival, perseverance, and ultimately, for victory.

Vrushab Gowda, MD, JD is an internal medicine resident at UNC.

Leslie Appleton, MD, MPH is an internal medicine resident at UNC.

Jesse Ehrenfeld, MD, MPH is President-Elect of the American Medical Association Board of Trustees and the Joseph A. Johnson Jr., Distinguished Leadership Professor of Anesthesiology, Surgery, Biomedical Informatics & Health Policy at Vanderbilt University School of Medicine.

Vrushab Gowda

Vrushab is a JD candidate at Harvard Law School and MD candidate at the University of North Carolina. He has previously served on the masthead of Harvard Journal of Law and Technology, as a research assistant to Deputy Dean I. Glenn Cohen, and clinical student within the Center for Health Law and Policy Innovation. Vrushab's scholarly interests focus on the legal, regulatory, and ethical dimensions of digital health products.

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