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May 4, 1999

The Mobile-Ukraine Connection

by Edmund Tsang

The four medical researchers from Ukraine are charmed by the southern hospitality of Mobile, but their mission in the Azalea City is more serious. They are here to learn the Alabama Birth Defects Surveillance program, and they will be involved in establishing a similar system in Ukraine when they return home in June.

Last Monday marked the 13th anniversary of the Chernobyl disaster. The most heavily contaminated region from the nuclear accident covers 39,000 square miles (roughly the size of Kentucky), which includes the north-central part of Ukraine, and low-level radiation covers much of the rest of the country too. The long-term impact from the radioactive fallout is just beginning to be felt among Ukrainians, especially children.

Lyuba Yevtshock, M.D., a geneticist from the Rivne region of Ukraine, said she has seen the rate of thyroid cancer among children more than doubled since Chernobyl. Because radiation, even at low level, attacks the immune system, Yevtshock said in an interview last week that she has seen a rise in infectious diseases and increases in congenital heart disease and anemia among children.

Tanya Vihovska, M.D., a neonatologist from the Volyn region, said she has also seen an increase in birth defects after the Chernobyl accident. Birth defects increased not only in the heavily contaminated areas but also in regions with low-level radiation, Vihovska added.

“Because Chernobyl happened during the time of the Soviet Union, there is no data for comparison before and after Chernobyl,” said Natasha Yuskiv, M.D., a geneticist also from the Volyn region. “We don’t have an exact picture yet because our data is incomplete. Data are collected by individual researcher and sent to the health ministry, so only the minister of health has a complete picture. Even though we are familiar with our own region, we cannot speak about the whole Ukraine.”

“The Alabama birth defect monitoring system that we are learning here and will implement in Ukraine offers a great opportunity to find correlation, if any, between environmental factors and geographical location and birth effects,” Yuskiv explained. “It will also provide us with a mechanism to prevent further birth defects.”

“With the help of the knowledge we are acquiring here in Mobile, we will be able to see a real picture of birth defects spreading among our children under the permanent influence of radiation and environmental pollution,” Yevtshock added.

The three Ukraine physicians are joined in their visit to Mobile by medical information specialist Serhiy Lapchenko. “Our medical information system is highly developed in Ukraine except we use cards to record the data and we don’t have computers to keep our records,” Lapchenko said. “We can provide the information that our physicians need but it’s very time consuming. When I see how everything is computerized in America and how much information I can get through the Internet, I realize we could work much better if we have such equipment.”

“Some ten years ago we didn’t have any computers but the situation is changing,” Lapchenko said. “Now, every hospital and department have computers but they are not networked nor tied to the Internet. That will be part of my work when I return to Ukraine.”

When they return to Ukraine, the medical researchers will teach other physicians how to examine patients and to use a special form modeled after the Alabama system to track birth defects. “My task is to use the data collected by the physicians and set up a computer data base which will be sent to the world alliance for the prevention of birth defects as well as to the Genetics Department in the University of South Alabama,” Lapchenko said. “Without those ties to the world alliance and to Mobile, our program in Ukraine is useless. But that part of the work is very expensive.”

Wladimir Wertelecki, professor and chair of the Department of Medical Genetics of the University of South Alabama, said the cost of setting up the birth defect monitoring system in Ukraine will be provided by the United States Agency for International Development and the March of Dimes Birth Defects Foundation. “We are going to provide the computers and train their personnel, and we are doing this from the ground up,” said Wertelecki, who is also the secretary-treasurer of the World Alliance for the Prevention of Birth Defects. “The Ukraine system is going to be as good as any other birth defects monitoring system in the world. They have to join the International Birth Defects Clearinghouse, and that organization imposes a common standard practiced among all its members.”

When asked about his interest in birth defect monitoring and prevention in Ukraine, Wertelecki said, “I am interested in birth defects, period. To me, a kid is a kid and there are no Ukrainian kids or American kids.”

“But there are several unique factors in Ukraine,” Wertelecki added. “First, they don’t know much about birth defects in terms of data and monitoring. Second, Ukraine is thoroughly polluted with pesticides, heavy metals, and other industrial pollutants. In fact, Ukraine is probably the leading heavy metal producer in the former Soviet Union and in Europe, and they have virtually no clean water. Thirdly, there is a rapid population decline in Ukraine, which may or may not be related to environmental problems. Lastly, one-third of the country is radioactive.”

Wertelecki said the birth defect monitoring system set up in Ukraine will also serve as a birth defect care system. “Birth defect is the number one cause for infant mortality, here as well as there, and it is one of the leading causes in developmental disabilities, including mental retardation,” Wertelecki added. “With the Genome project (the project to map human genes), it is increasingly a possibility to anticipate and to prevent birth defects.” For example, spina bifida in infants can be prevented with 0.3 pennies worth of folic acid administered to the mother prior to pregnancy or during the first week of pregnancy, Professor Wertelecki explained.

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