Will chatbot heal us? – talk with Daryna Dmytriievska
Meet the fellows of Vidnova Fellowship — an individually designed program for civil society actors from Ukraine that enables them to continue their work and broaden their network with other European and Ukrainian partner organizations.
Daryna Dmytriievska is a family doctor from Kyiv. She worked in the medical primary care field for more than five years. However, she’s also an activist and loves to work in communications: encouraging trustful relationships between doctors and patients, discussing complex topics and developing ethical communication in medicine. Her goal is to improve the medical services and evidence-based medicine in Ukraine. She created several communication channels (on Telegram and Facebook) where she shares helpful information with patients. Besides that, she has created a chatbot that covers primary medical care. It helped more than 5,000 users to treat common cold and COVID symptoms.
I fled Ukraine at the beginning of March 2022 with my friend and colleague, with whom we created the chatbots. We ended up in Germany, where we began to discover the local medical system and further explore it through exchanges with other colleagues and various conferences about health support. As quickly as we realised that our ideas could be beneficial here, we learned about many restrictions that are in place in Germany — such as data privacy needs for specific licences and practices. While looking for opportunities, we came across the Building Bridges project, DontBePatient. I contacted them when I became a Vidnova fellow, as their NGO dealt with patient communication. This is how I became a part of their team. I immediately understood the challenges they were facing in communication with Ukrainian refugees.
Where are you based?
I’m based in a small town near Hamburg, Uelzen. I ended up in the village with my daughter and my mother.
What is your story of leaving Ukraine?
We left Ukraine on the 3rd or 4th day of the Great War. I wasn’t in Kyiv when the war started. I visited our relatives with my mum and daughter for several days. We knew that we needed to get out. We crossed the border with our kids, and for the first few days, we lived close to Warsaw with a kind family who opened their doors. We moved further when we understood Poland would soon be overwhelmed with Ukrainian refugees. Our friend from Hamburg helped us find a place. Our kids haven’t witnessed many traumatic events but were stressed about leaving their homes without properly understanding why it happened and when they would be back.
Do you remember the moment you realised something was going on?
I woke up on February 24th very early, around 5 a.m., a bit nervous. I heard no explosions because we were in a small town far from Kyiv. I remember that we were nervous in the days leading up to it. We talked about it with my friends. I planned to go to the Medical University that day to talk about the transgender community, one of the topics I educate on, but in the morning, I saw all the messages. I was alone with my kid and our elderly relatives. Only I could get food, water and money to help us survive. It was scary. If I weren’t with my child, I might have stayed in Ukraine and volunteered, but I had to leave because my daughter was only seven years old.
Now she is attending a nice school in Germany and learning the language. I can’t say she’s alright with that: she’s lost her identity. I lost mine as well. I realised I had nothing left in Ukraine. We’re in a safe place now, which matters a lot, but I can’t continue doing what I was doing before. I can’t be a doctor in Germany because I don’t have a licence. I can’t educate others because I don’t have a name. I need to start from scratch. Vidnova was a big step for me in that moment: it helped me regain at least a part of my identity. I knew right away that Vidnova was something I needed.
I got the information about the fellowship from my former boss and decided to use this opportunity to continue my work on LGBTQ+ education and human rights. The program for social activists is a perfect match.
What’s your background in activism?
Five years ago, as a family doctor, I registered for training in Kyiv, focusing on transgender people. I learned about Ukrainian laws around the topic, the transition protocol and the different roles in this process. This event evoked my desire to support and help this community directly. I started to work in the field and fight my bosses in the clinic because they were very transphobic, homophobic, and “everything” phobic. But I fought them, and we won. I had a lot of patients. And my LGBTQ+ patients, in addition to good medical care, often needed appropriate, sensitive and engaged communication. Trans people need medical involvement and some documents about the transition. I worked a lot on this topic with different organisations and hosted lectures for other doctors.
Two years ago, together with my colleagues, I created an NGO, Medical Leaders, aiming to foster changes in the medical system in Ukraine. Last year, we launched an educational project for doctors on transgender issues, supported by the British Embassy. We conducted focus group research among doctors about their thoughts on LGBTQ+ rights in the medical field while fully aware of aggravated situations around human rights and confidentiality in Ukraine. This has resulted in a series of educational videos about the transition in Ukraine: the process itself, rules that apply and guidance for communication between transgender people and doctors. We hosted several trainings throughout the country. One of these was supposed to take place in March 2022. Unfortunately, it never happened. Sometimes, doctors are very stuck in this classical mirroring relationship. They don’t want to listen to LGBTQ+ activists. They need to listen to other colleagues as they think that if other doctors are working with LBGTQ+ people, they should also consider it. I’m one of the few doctors in Ukraine who openly works with LGBTQ+ people. We have some other doctors ready to work, but usually, they aren’t outspoken about it. I trained most of them.
I often use my videos as a reference when trans people and doctors have questions about the transition. It has a huge impact. In these videos, we describe different steps from the perspective of a family doctor, a psychiatrist, an endocrinologist, and a person who went through the transition experience. I see the value of setting an example around this topic as other doctors approach us to learn from us.
Recently, I was at the Summer school of the European Professional Association of Transgender Health with specialists from different countries who dedicate their careers to doctoral and scientific research, setting the standards of care for the transition process. None of these findings are translated or available in our country. Many doctors in Ukraine know that if they have questions about transgender health, they can approach me.
Do you also offer some kind of psychological help?
I’m not a psychologist, but I plan to specialise in sexology because, for now, we don’t have good specialists in Ukraine, especially for the LGBTQ+ community. I often find myself challenged when talking to an LGBTQ+ person, a teenager who defines themself as a trans person or the parents of an LGBTQ+ person. Sometimes, I talk to parents, usually moms, about what to do next and how to help their children. This is the only kind of emotional support and encouragement I can offer. Those who need psychological help often don’t ask for this support.
Who is your Telegram chat for?
The Telegram channel is not exclusively about transgender people. Of course, sometimes I publish information related to the topic, but since the beginning of the war, the channel has been almost empty. Initially, I created a chatbot limited to dealing with the common cold and COVID-19. It asks about symptoms and advises according to evidence-based medicine.
While further developing it, I’ve learned that some topics and questions are in demand that can’t be integrated into the chatbot. For example, during the COVID pandemic, there was a lot of fake news about antibiotics, so I wrote many articles about these topics and shared them on my Telegram channel. This reduced the time I spent chatting with every patient because I wrote the articles specifically for them. My patients later shared that the chatbot and the Telegram channel decreased their anxiety and nervousness when they experienced various symptoms.
How do you imagine the outcome of your participation in the fellowship?
For me, it’s about becoming a part of this medical ecosystem in Germany and expanding my network and knowledge. I need to find new contacts and combine our experiences because it makes it easier to implement different projects when you’re connected. I don’t know if I will stay here. I need to receive my diploma to practice.
And can you share your idea of what the project could be about?
It could be about providing care for HIV-positive people: Ukrainian refugees in Germany who need to get tested and be informed. I chose this idea because, in Ukraine, I worked a lot on the HIV topic as a primary care doctor and as a lecturer. After one of the Vidnova meetings in Berlin, I talked to several participants. One of them is in Berlin and working in this field as well. Since then, I have put together some thoughts and now understand what to do next.
Is there anything, in particular, you want to share about your fellowship and host organisation?
I’m very happy with my organisation because when I informed them about my project idea, they were very supportive and eager to help. They offered resources for Google advertisements and an office if I needed to host conferences or meetings. In addition, they agreed to let me do this project under the umbrella of their organisation. My idea fully aligned with the scope of work and mission of their NGO. Moreover, they have indicated their interest in expanding my project in case it’s effective. Many Ukrainian people in Germany need help and informational support, and the organisation needs people who can assist Ukrainian refugees. So they were quite excited.
What do you do after work?
Now that I’m considering starting a medical practice in Germany, it’s almost impossible to have free time, but I found a family doctor, and we became friends. He said they need help in the clinic because they have Ukrainian refugees who don’t speak German and have different fantasies about how they should be treated and how the system should work. They are now trying to find a way for me to help them in the clinic and communicate with Ukrainian refugees. This would be a big step because I need to get my diploma approved and learn German well to be a part of the medical system. I am very far from that at the moment, so if I could work as an intern in this clinic, it would be nice.
What would you call yourself for now? What is your role?
If you are a doctor, you’re always a doctor, even if you don’t have official rights to practice. On the other hand, I love communication. I wanted to work on this topic in Ukraine because we have good doctors who cannot communicate properly with patients. In the future, I want to do something to improve this aspect of medical care in Ukraine. I want to talk to people and doctors, take Ukrainian doctors, and show them good European examples. This is very much related to human rights and tolerance. A doctor who can talk to transgender people without misgendering or discriminating against them can communicate respectfully with any patient. I see myself in the future as more engaged in communication management in medicine, but the practice will remain with me forever.
How do you take care of yourself as a doctor?
We never take care of ourselves (laughing), but we know how to do that. We can control some processes. However, regarding our mental health, when I understood that I have big problems with stress, I went to a family doctor and told them that I have this problem, the reasons and the outcomes, and I asked what I should do to treat myself. They were surprised I was already doing what was needed, such as sports and travelling, but sometimes you need someone to help you. That’s always a hard question.
Do you feel and want to stay where you are?
I don’t feel that Ukraine is safe for my kids, nor will it be okay for them for a long time, even when Ukraine wins. My kid is very anxious and sensitive, and I will do everything she needs to be happy and healthy. Most of my decisions are based on that, so I will stay here for a long time. Even if I want to return because I have a big part of my identity and family there, I know it’s not an option for a few years. It also depends on my opportunities to stay here and all the projects I work on — the companies and fellowship.
I want to thank Vidnova for the opportunity. I’m not new to projects, but this project is mainly about humanity, love, and care — which is very important to participants now.
