St. Jude Global Provides Treatment for Children of War-Torn Ukraine

The whole purpose is to give these children “a chance at a different outcome.”

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The world changed on February 24th when Russian forces, on orders from president Vladimir Putin, stormed into Ukraine, bringing war to a sovereign European country that had posed no threat. Less than a month later — on March 21st — four Ukrainian children and their families arrived at St. Jude Children’s Research Hospital in Memphis. Between the ages of 20 months and 8 years old, each of the children is battling cancer, even as their native land burns under assault. They are among hundreds of Ukrainian cancer patients already touched by SAFER Ukraine (Supporting Action for Emergency Response), a program launched by St. Jude Global to provide safe passage and, ultimately, treatment for cancer patients no longer secure at home.

Dr. Asya Agulnik is director for both the Global Critical Care Program and the Eurasia Regional Program (founded in 2018) under St. Jude Global. The latter encompasses a dozen countries — prominently among them, Ukraine — in eastern Europe and central Asia. St. Jude Global’s network of more than 180 institutions in more than 60 countries existed prior to Russia’s invasion of Ukraine, but the web of care providers is being tested in ways Agulnik and her colleagues had never experienced before now.

“When the war started, our clinical and foundation partners called [to assess the issues],” says Agulnik. “Initially the problem was providing higher level care to some of the more complicated patients, because they couldn’t access the needed diagnostics and treatments. But when the situation on the ground deteriorated, it grew to many more patients and that led to the SAFER initiative.”

A pediatric critical-care physician, Agulnik arrived at St. Jude in 2016 (after three years at Boston Children’s Hospital) and found her calling with the extensive reach and impact of St. Jude Global. “I’ve always been interested in health disparities,” she explains. “As they apply to populations in the U.S. but also globally. I got a Master’s in Public Health [at UC Berkeley] and at that time was looking at disparities in health outcomes for children in rural Guatemala that were related to food insecurity and housing. That led me to St. Jude Global and the work we’re doing currently. It’s a combination of my clinical interests and my public-health interests.”

A critical — and compassionate — detail to St. Jude’s efforts for Ukraine: no child is separated from his or her family. At least one parent travels with the patient, whether to a facility in Europe, Canada, or all the way to St. Jude here in Memphis. The first group of four children to arrive at St. Jude included a total of 14 family members and a second group of four patients (on March 28th) brought 11 family members. The aim, of course, is to minimize trauma, both from the rigors of cancer treatment and the emotional scars of a mass exodus from a patient’s native country.

“This was the first situation like this since we had the network in place,” says Agulnik. “We have supported partners through other emergencies like Covid and the war in Syria. But this is unique in many ways. The war has an emotional and psychological toll for all of us involved, directly or indirectly. It motivates us to help, but it also makes it quite difficult.”

“The whole purpose is to give these children — if they remained in Ukraine, they’d most likely die from their disease — a chance at a different outcome.” — Dr. Asya Agulnik

Through the end of April, more than 1,000 patients (up to age 25) have registered with the SAFER program for treatment. How is each patient provided the best care? And how are the patients who travel to Memphis selected? Patients are first transported to the Western Ukrainian Specialized Children’s Medical Center in Lviv, where they are stabilized and then organized into medical-transport convoys to cross the border into Poland. It quickly became clear, though, that the number of patients exceeded the grasp of regional hospitals. St. Jude then partnered with government agencies and foundations to form the Unicorn Marian Wilemski Clinic in Bocheniec, Poland. A converted hotel is now serving as a triage center for Ukrainians with blood disorders or cancer. “Patient convoys arrive and are medically assessed,” says Agulnik. “Anybody who’s not clinically stable is sent to a [local] hospital. The rest of the patients are referred to hospitals all over Europe and some in North America, based on their medical needs and hospital capacity.”

Memphis is a long way from Ukraine, and by a few measures. The patients who make the journey all the way to St. Jude are chosen with great care. “Most patients prefer to stay in Europe,” notes Agulnik. “This is their first time outside [Ukraine]. It’s the farthest they’ve been from home, and many have family still in Ukraine. But some have families in the United States, or they may need a specific type of treatment. It’s a discussion with families about their relative needs, and the families’ preferences.”

As though battling cancer weren’t heavy enough, the Ukrainian patients must confront cultural, social, and emotional turmoil, made that much more challenging by news from their war-torn homeland. “I accompanied the first group,” says Agulnik, “and I think it was a combination of being very stressed and uncertain about what the future held, both for their family and their country. But they were also hopeful that this was an opportunity that they wouldn’t have normally. They were confident that they would get great medical care; that’s always our priority. It’s a combination of fear, anxiety, and hope. And it’s that hope we focus on. The whole purpose is to give these children — if they remained in Ukraine, they’d most likely die from their disease — a chance at a different outcome.”

Volunteer translators numbering in the hundreds have helped St. Jude and Agulnik emphasizes they’re as valuable for cultural translation as for the language barrier. She’s seen Ukrainian families adapt more quickly and smoothly than might be imagined in a study or lab trial. “Kids are very resilient,” she notes. “They just want to be kids, get a Hot Wheels toy, or a really cool pair of shoes they’ve seen. They don’t want to think about cancer treatment. We’ve done our best to support that, to be normal even though this is not a normal situation. It’s one of the pleasures of our job.”

The patients at St. Jude will remain here in Memphis “as long as they need to” according to Agulnik. With Russia’s attack ongoing, Ukrainians can gain refugee status, which eases — and potentially lengthens — their stay on foreign soil. “Many of these patients want to return to Ukraine,” stresses Agulnik, “when that’s safe and possible for them.”

St. Jude’s support of the Ukraine cause has caught the attention of friends in high places. First Lady Dr. Jill Biden visited the campus on March 25th, a chance to share word about the Biden-Harris Cancer Moonshot initiative, which aims to cut the death rate from cancer by 50 percent over the next 25 years. The fifth First Lady to visit St. Jude, Dr. Biden met the patients and families from Ukraine and learned about the reach of St. Jude Global.

Merely a few months since Russia’s attack, the numbers of St. Jude’s SAFER efforts are staggering. As of late April, the program had transported more than 400 patients — via 12 convoys — to the Unicorn clinic in Poland, then on to treatment centers in Europe or North America. (For pre-invasion perspective, St. Jude sees around 8,600 patients annually, most on an outpatient basis, including those contributing to ongoing research programs.)

“We’ve learned a lot from how brave these families have been, to do everything in their power to get medical care for their children. They’re here to get that care, and everything else is secondary. That motivation, that drive is universal. It cuts across cultures, and it persists despite the most challenging circumstances. It’s quite powerful.” — Dr. Asya Agulnik

Agulnik acknowledges the obstacles, some of them profound, as St. Jude looks forward with SAFER Ukraine. “It’s hard to make plans and develop plans with so much uncertainty,” she says. “You don’t even know what the next week will bring. We’re lucky that we haven’t had any significant clinical challenges. Our primary goal is to evacuate these children safely and continue high-quality medical care. We’ve been able to do that. The challenges are organizational and logistical.”

Patients learn from their doctors, to say the least. But doctors also find wisdom and inspiration from those under their care. Such has been the case since late February for Agulnik as she interacts with Ukrainian evacuees. “We’ve learned a lot from how brave these families have been,” says Agulnik, “to do everything in their power to get medical care for their children. They’re here to get that care, and everything else is secondary. That motivation, that drive is universal. It cuts across cultures, and it persists despite the most challenging circumstances. It’s quite powerful.”

It’s the unknown in Ukraine — When will Russia’s attack end? When can the country begin to rebuild? — that weighs heaviest worldwide. St. Jude Global cannot answer those questions, but with the efforts of people like Asya Agulnik, the days between now and the war’s end can bring compassion and, yes, healing. “This goes back to St. Jude’s original mission,” says Agulnik. “No child should die in the dawn of life. No Ukrainian child, no Russian child, no child in any country. Unfortunately, there are disparities in outcomes, especially with complicated diseases like childhood cancer. Stressors like war disproportionately affect the most vulnerable. It’s helpful to go back to that original mission.