On the morning of Friday 01 April, Médecins Sans Frontières / Doctors without Borders (MSF) finalized its first medical train transfer of patients in Ukraine.
4 月 1 日星期五上午，無國界醫生在烏克蘭完成了首次醫療列車轉運。
Nine patients in serious but stable condition were transferred from a hospital in Zaporizhzhya, in the southeast of the country, to major referral hospitals in Lviv, on a dedicated medical 2-carriage train that MSF has developed together with the Ukrainian Railways. The patients were accompanied by a team of nine MSF medical staffs. This is the first short medical train, and a larger more highly medicalised referral train is being developed by the MSF team.
9 名病情嚴重但情況穩定的病人，由該國東南部的扎波羅熱（Zaporizhzhya）的一家醫院，搭上由無國界醫生與烏克蘭鐵路公司共同開發的兩節專用醫療車廂，被轉移到利維夫（Lviv）的主要轉診醫院，病人由 9 名無國界醫生組成的團隊陪同。這是首列短程醫療列車，無國界醫生團隊正在開發更大及更高度醫療化的轉診列車。
Dr. Joanne Liu, an experienced paediatrician in MSF’s Ukraine medical response team, recounts her part of the process, evaluating the patients and making sure they were all stable for the journey:
廖醫生是無國界醫生烏克蘭醫療應對小組一名經驗豐富的兒科醫生，以下為她講述自己在過程中所參與的部分──負責評估患者的狀況，並確保他們在旅途中都處於穩定狀態。
醫療列車啟程前，患者們的故事
On Tuesday 29 March, we went on a visit to Zaporizhzhya and met the regional health director. We said we wanted to hear from him if there are any things he needs from us. He said he’d heard a story about a train for medical transfer, and he was very interested. He said he had patients who needed to be referred.
3 月 29 日星期二，我們到訪了扎波羅熱，並和當地地區衛生主管會面。我們說，如果他需要我們提供任何東西，我們樂意聽取他的意見。他說他聽過一個關於醫療轉運火車的故事，他很感興趣，而且他有需要轉診病人。
We said: OK – let’s go and see your patients.
我們說：「好的，讓我們去看看你的病人。」
Most of the patients we saw had been wounded in, or while trying to escape from, Mariupol. One patient had big open fractures, and both legs on vacuum drainage. Fairly stable, but a very sick child.
我們看到大多數的病人都是在馬里烏波爾（Mariupol），或者在試圖逃離馬里烏波爾時受傷。 一名開放性骨折患者的傷口很大，雙腿接受負壓引流。這孩子情況相當穩定，但病情嚴重。
Of course, it makes sense to offload hospitals that are close to the frontline to enable them to have more bed capacity. But we needed to make sure we’d be transferring the patients to somewhere where they will get the same level of care, if not a higher level of care. And we just wanted to make sure this would be safe for everybody.
當然，在靠近前線的醫院減少留院的病人，以增加醫院的床位供應，做法合理。但我們需要確保患者會被轉移到可以獲得照護水準相同、甚至更高的地方。我們只是想確保這對每個人來說都是安全的。
We talked with the parents to ask if they wanted medical evacuation or not. The first mother said: “I want my child to be medevaced because I think it is the only chance for my child to keep his legs.” And the child looked at us and said: “I want to walk again”.
我們與孩子的父母交談，詢問他們是否想要進行醫療撤離。 第一位母親說：「我希望我的孩子獲得醫療撤離，我認為這是我孩子保住雙腿的唯一機會。」
孩子看著我們說：「我想再次走路。」
By then it was the end of the day and we had to leave to be able to pass checkpoints. So we said we cannot promise anything, we’ll see what’s possible. And the hospital director and many of the interns were there and they were insistent: “You NEED to get them out of here. They need to survive. This is our hope”.
到那時已經將近天黑，我們不得不離開，以便通過關口。 所以我們說我們不能承諾任何事情，我們會看看有甚麼可能性。醫院院長和許多實習生都在那裡，他們堅持說：「你必須讓他們離開這裡。他們需要生存。這是我們的希望。」
The next day, we came back, three of us, and we screened every single patient. Our key point was to consider for each patient – could this person sustain a 20-hours transfer where we don’t have ICU [Intensive Care Unit] level of care on this first short version of the medical referral train?
第二天，我們 3 個人回來了，我們對每一位患者進行了篩檢。我們的重點是考慮每位患者在沒有加護病房級別的醫療照護下，能否在首列短型的醫療轉診列車上，支撐為時 20 小時的轉移過程？
And then Thursday morning we came back early, to do another check on all the patients before doing the referral, to make 100 percent sure they were stable.
然後在星期四早上，我們早早回到醫院，在轉診前再次為所有患者進行檢查，以完全確保他們的情況穩定。
There was one patient, a three-year-old child with very severe abdominal injuries, who we thought would not be stable enough for the transfer. At one stage, the mother said: “My child is going to die during the transfer.” I’ve been a practicing paediatrician for the past 30 years, and what I told everyone is that when a mother tells you that, she’s never wrong.
有一名 3 歲的孩子，腹部的傷勢非常嚴重，我們認為他的情況沒有穩定到能夠進行轉移；期間，這位母親說：「我的孩子會在轉移期間死去。」
作為執業 30 年的兒科醫生，我可以告訴大家，當一位母親告訴你這一點時，她永遠不會錯。
We evaluated this child three times, together with the directors of the hospital. When we came on Thursday morning, the doctors were about to take the child back into the operating theatre, and we all came to the same conclusion; this child was not stable enough for the transfer. This decision took time, but it was a decision we all took together.
我們與醫院的負責人一起對這個孩子進行了 3 次評估。星期四早上我們來的時候，醫生正要把孩子送回手術室，而我們都得出了同樣的結論： 這個孩子情況不夠穩定，無法轉移。這個決定雖然很耗時，但這是我們大家一起做的決定。
I particularly recall a woman who had a blast injury in her face and had lost her right eye. We had asked her to send us a picture on Tuesday, as we wanted to assess her condition and we had to leave that evening to get back before curfew. And instead of sending us a picture with the injury, she sent us a picture of herself before the injury. And when we got back to the hospital the next day, the first thing she told us was: “I want to be beautiful again. For my husband. For my child.”
我特別記得一個女人，她的臉被炸傷，並失去了右眼。 我們請她在周二給我們一張照片，因為我們想評估她的狀況，而我們不得不在那天晚上離開，以便在宵禁前回家。她發給我們的並不是她受傷的照片，而是一張她受傷前的照片。第二天我們回到醫院時，她告訴我們的第一件事是：「我想變回以前美麗的樣子。為了我的丈夫。為了我的孩子。」
These stories from these few patients – this is the story of many thousands of people.
這些來自少數患者的故事，亦是數千人的故事。
The other thing that is amazing is the dedication I saw. For example, when we did the transfer to the train on Thursday morning, the ICU physician – not the interns but the senior boss of the ICU – came and did the transfer himself. He paid great attention to the boy with the severe leg injuries. It was him who lifted the stretcher onto the train, and waited there a while to check the patient was fine. And when he was finally satisfied, he looked at me and said: “I think my job is finished now. I'll hand it over to you.”
另一件令人驚嘆的事情是我見到的奉獻精神。例如，當我們在星期四早上轉乘火車時，加護病房的醫生，不是實習生，而是加護病房的高級主管，親自出馬幫忙轉移患者。 他非常關心腿部嚴重受傷的男孩。他把擔架抬上火車，再過一會兒又檢查病人是否安好。 當他終於滿意時，他看著我說：「我想我的工作現在已經完成了，接下來交給你了。」
執行編輯：陳品融
核稿編輯：林欣蘋
