The British brain surgeon who joined the fight against corruption in Ukraine

http://www.theguardian.com/world/2014/sep/12/henry-marsh-british-brain-surgeon-ukraine

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I went to Kiev in December last year. The hospital where I work is in the centre of Kiev and only a few hundred yards away from Independence Square where Maidan – the demonstration against Yanukovych and his government – was in full swing. I helped operate on a young woman with a large brain tumour and saw the usual long queue of patients with awful problems in the dark and windowless corridor outside my colleague’s cramped little office.

While in Ukraine I made many visits to Maidan. To get to it you had to push your way through the lines of thuggish berkut – the special riot police. They were in visored black helmets, carried truncheons and shields and guns, and wore smart grey and blue camouflage uniforms. But once you were through the police lines you entered an extraordinary place. The central square in Kiev was packed with people, many draped in the blue and yellow Ukrainian flag. The air was full of the smell of wood smoke from the hundreds of oil drum braziers and field kitchens handing out free food. Flags and banners were flying everywhere. There were hundreds of tents, each with the name of the village or town from where the demonstrators had come. There were street musicians and bands playing all along Kreschatyk, the central street in Kiev. The atmosphere – despite the sinister police – was cheerful, yet you could feel a very real sense of determination. “We’re here to stay” everybody said while chanting “Bandu het!” ( Out with the gang).

I work as a senior consultant brain surgeon at St George’s Hospital in London. I had first gone to Ukraine in 1992 to give some lectures. The conditions I found in the hospitals I visited were terrible – the Soviet Union had been good at making guns and rockets but not much else. Healthcare – apart from for those in power – had been a low priority and, to make matters worse, the Ukrainian economy was in a dire state in the wake of the Soviet Union’s collapse. I met a young neurosurgeon, Igor Kurilets, working in the State Emergency Hospital, who was burning with a fierce determination to improve things that most of his senior colleagues seemed to lack. It seemed a simple matter to help him and I took to driving to Ukraine with car loads of secondhand medical equipment – microscopes, operating tables, thousands of instruments –enough to equip an entire neurosurgical theatre. I soon learned, however, that the newly independent Ukraine had not lost its old Soviet habits; innovation and initiative and contact with the west, if not sanctioned by those in charge, were met with implacable opposition. Igor’s attempts, with my help, to do better for his patients, quickly ran into difficulties. There were endless enquiries and denunciations, and on several occasions members of Igor’s staff were sacked. At one time, following telephoned death threats, he even felt obliged to sleep in a different room each night. While his problems became ever greater, I felt I could not very well abandon him and I have continued to work with him, pro bono, in my spare time, ever since.

Igor eventually left the state system to set up his own private clinic, where he paid all his taxes, and bribes from patients were no longer required. Money and medicine are never far apart, and his transparent honesty and tremendous success (since patients flocked to see him) were seen by many as a threat.

At last, after more than 20 years, Igor’s position is reasonably secure. Since I first went there, healthcare in Ukraine has improved considerably, although by European standards the country remains very poor. But when I saw what was unfolding last winter, it seemed to me that the protesters against the Ukrainian government, and its closeness to Russia, were fighting the same fight Igor had been engaged in for so many years – a fight against corruption and arbitrary rule. Although Yanukovych had been democratically elected, the police and judicial system were so corrupt that this had little meaning. With his family and cronies he had quickly started to amass a personal fortune by embezzlement and intimidation, and this corruption had spread into every corner of Ukrainian life. Igor, for instance, had had to start paying regular bribes to the police and pharmacological authorities or face criminal prosecution for trivial infringements of unrealistic regulations. I visited Yanokovych’s notorious private pleasure palace at Mezhyhirya in March, when it was left empty and open to the public. Behind the 20ft high walls mounted with security cameras, there is a shooting gallery, a huge sauna surrounded by water gardens, a vast garage with its own petrol station and a six-litre Mercedes coupe parked outside ( the other cars had all been looted), as well as an enclosure with ostriches waiting to be eaten. And, of course, there is the palace and an airport. The way Yanukovych looted Ukraine is a perfect example of the “extractive” institutions (described by Daron Acemoglu and James A Robinson in their brilliant book Why Nations Fail) that lead eventually to the collapse of states and empires. Another country, which has similarly extractive institutions is Putin’s Russia.

I returned to London on a wintry Sunday evening with deep reluctance, but I had a long list of operations for Monday. Then, on Tuesday of that week, Maidan turned violent when the government tried to evict the demonstrators. We have all seen the extraordinary scenes on television of the berkut locked in battle with the demonstrators, in temperatures down to -13C; scenes that looked like medieval battles. I rang Igor the following morning.

“They are heroes,” he said of the demonstrators, his voice breaking with emotion “Heroes. Henry, you must come back!” I felt a surge of patriotism within me for the country that has almost become my second home, even though I do not speak Russian or Ukrainian.

“Yes!” I shouted in reply because I had suddenly remembered that my outpatient clinic for the next day had been cancelled and I was supposed to be attending a rather dull meeting where nobody would notice my absence. I was able to get the last ticket out on the morning flight to Kiev the next day, 12 December, and so was back with my friends in Maidan by lunchtime.

The atmosphere now was very different. High barricades of bags packed with snow had been built round all the entrances to the square, so that the place looked like a fortress. Demonstrators wearing hard-hats or army helmets stood guard at the entrances, carrying shields and staves. Ruslana, the famous Ukrainian singer, was haranguing the crowd from the stage. “Bez krovni,” she said over and over again and they chanted it back: “Bez krovni” – “without blood”. I spent much of the next few days wandering around Maidan, since my visit was unplanned and there was little operating to be done. I was exhilarated (and worried) by what I saw but, once again, I had to return to London, deeply reluctant though I was to leave Kiev.

I next returned in early March. Yanukovych had fled the country, leaving a blackened and scarred Maidan behind him. Over 100 people had been killed there, shot down by snipers on the roofs of the buildings just next to the hospital in Institutska Street. One of the steel lamp-posts behind which the demonstrators had taken shelter was drilled with bullet holes – on the side facing away from the camp. So much for the Russian claims that the demonstrators had been shot in the back by their own side. Maidan was now a sad and sombre place with candles and plastic flowers and photographs of the dead on every corner, surrounded by smoke-darkened buildings.

Before Ukraine became headline news, when I told people at home of my enthusiasm for that country, they usually expressed some surprise.

“It’s in Russia, isn’t it?” was the usual response. I would explain how Ukraine was roughly divided into east and west, the west looking towards Europe and the east towards Russia, but would add that nobody expected that Ukraine would go the way of Yugoslavia. Ukraine was different. I would also say that it was a very important country but I doubt if anybody believed me.

All this has changed. Russia has invaded eastern Ukraine and the problem now is about Russia’s place in the modern world. Putin has replaced the dubious altruism of communism with the mystical pan-Slavism that has been the traditional response of some Russians to the existential threat they felt Russia faced from the west (which now takes the form of Nato). In this perspective, Ukraine is seen as part of Russia’s ancient heritage, while Ukraine’s move towards the west is a betrayal of this heritage and needs to be punished. The Russian equivalent of English jokes about the stupid Irish are told about Ukrainians. I suspect the closest analogy with many Russians’ view of Ukraine is with the patronising, colonial attitudes many people in England had toward Ireland in the past. The Soviet Union was, after all, the last of the great Empires and Putin has said that its demise was the greatest geopolitical catastrophe of the 20th century. Putin wants Russia to be a Great Power once again.

Equally important – perhaps more important – is the fact that Putin runs Russia on the same extractive, corrupt principles as Yanukovych ran Ukraine, and the success of Maidan at his back door has been a real threat to his own system of rule. It seems that Ukraine will pay a terrible price – it already has in terms of lives lost or ruined – for Russia’s failure to escape its past. I will be back in Kiev in December. I do not know what I will find, apart from a list of patients with difficult brain tumours and other neurosurgical problems waiting patiently outside Igor’s office.

To buy Do No Harm: Stories of Life, Death and Brain Surgery by Henry Marsh for £13.59 with free UK p&p call Guardian book service on 0330 333 6846 or go to guardianbookshop.co.uk.