Categories
Response stories

Holding the form-master accountable

Larisa has been using drugs for more than ten years and is HIV-positive. Having children, the woman has learned to use the drugs in a controlled manner and treats her health consciously.

At the beginning of May, Larisa and her son set off to one of the local lyceums to submit an entrance application form to the first form for the new study year. The woman had chosen precisely this educational institution because of its proximity to their home, and everything seemed to be going the right way. The secretary of the lyceum had already started checking and filing the documents as the future class teacher of Larisa`s son entered the office. The teacher appeared to be an old acquaintance of the woman, so she knew about her risky lifestyle. In the child’s presence, she started offending the client and informed her that “drug-addict” families would not be in her class as such people have no place in her “elite class”. Larisa decided not to continue the conflict rolling out in her child`s presence, leaving the educational institution upset.

The next day, the woman decided to turn to the REAct project. After hearing that, the documentator immediately intervened and promised to help. Larisa received psychological assistance and a consultation about the legal issues and offered to talk with the director of the lyceum about the situation that had arisen. Besides, the client received help compiling an official form regarding refusing to provide educational service.

Later, during the conversation with the documentator, the director of the lyceum apologized to Larisa and helped her to choose another class teacher for her child. Regarding the official response that the client received, the teacher who had refused the child`s education was reprimanded and given a disciplinary conversation.

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Response stories

Support after experiencing violence

Hanna asked the REActor for help on the phone. The woman reported that a client beat her. The man stole her money and ran away. Considering that they were outside the city, Hanna couldn’t call a taxi, so she decided to call an ambulance. Yet the ambulance operator refused to send the car as he did not see the necessity to do that. Moreover, he recommended Hanna in the future “to think with her head and not get drunk, because with such a profession she can even lose her life.”

Hanna realized that in such a condition, with a face beaten and in blood, in the dark time of the day and without money, she had no chance of stopping a passing by car. Being desperate, she decided to turn to a REAct documentator.

The documentator, Olena, and the coordinator, Yulia, personally collected Hanna from the place of the event and delivered her to the nearest ambulance station, where they stayed with Hanna all the time and supported her. The client was given first aid: her wounds were treated, and the stitches were put on the open wound on the head. Hanna refused to report to the police. She was later taken home and made sure to be safe.

In two days, the client met with an amicable psychologist who provided Hanna with a psychological consultation on living through the violence and fighting post-traumatic stress. The psychologist helped identify the problem and voice the feelings. After the session, Hanna was also offered some more free meetings to stabilize her emotional state.

Categories
Response stories

Assistance in the TB treatment resuming

Natalia is a pensioner who has a disability of the 2nd group. The woman has faced difficulties in the ambulatory stage in the local clinic during the tuberculosis treatment. In June, she was refused to receive the next portion of the anti-tuberculosis drugs, arguing that Natalia hadn`t undergone the intermediate diagnostics in the regional anti-tuberculosis dispensary located outside the city.

Unfortunately, the client did not have the financial means to do that, and because of her health condition, she could not realize this trip. Considering that the break in the treatment could have negatively affected the results of the fight against tuberculosis, the woman applied to the REAct project documentator. REAtor immediately contacted the medical worker who had refused Natalia and explained that the specialized transport that ran according to the schedule was possible to send the patient’s biomaterial to the dispensary laboratory.

Later, the documentator organized the sending of the necessary biomaterial, which made it possible to conduct the examination that supported the provision of anti-tuberculosis treatment. Thanks to the intervention of the documentator, Natalia’s treatment was resumed, and the woman was given all the necessary anti-tuberculosis drugs. With the help of REAct, the client received new hope for recovery and successfully overcoming this severe disease.

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Psychologist's advice Useful materials

How do we learn to negotiate when the conflict is inevitable?

People differ in their character, temperament, and other criteria and react differently to the situations they find themselves in. Even if a person is very peaceful, he cannot always avoid disagreements with others. We have different views, which can lead to difficult situations, especially conflictual ones. The term “conflict” can have many definitions, but they all emphasize the presence of disputes, especially in human interaction.

Unfortunately, key HIV communities in Ukraine face widespread rights violations, prejudice, and discrimination due to their membership in a vulnerable group. The REAct system has repeatedly recorded cases of improper treatment of community representatives, which led to severe conflicts.

So, today, we offer to figure out how to behave if a conflict is inevitable.

Remember! Conflict is not a tornado or chaos but a structured phenomenon. Quite predictable and manageable. There can be no winner in an interpersonal conflict. But avoiding a conflict whose time has come is also dangerous.

Being able to conflict is an art worth learning.

Do not avoid the dispute, do not attack and do not defend yourself, but behave psychologically competently in the conflict.

Below are several rules that may be useful to you in conflict situations:

Rule 1. Let the opponent speak without interrupting him. Sometimes, this is enough to resolve the conflict.

Rule 2. Show your opponent a genuine interest in what he has to say. Truth is not born in disputes but in discussions. And for this, you need to allow a person to express his position.

Rule 3. Always allow your opponent to save face. Even if he is 100% wrong, never point it out directly.

Rule 4. Show respect for your opponent. For this, it is enough to monitor your intonations and not allow any harsh statements.

Rule 5. Stay open and honest. Hints and innuendos only increase the conflict.

Rule 6. Do not look for the guilty. Blaming the opponent is the best way to start a protracted conflict without a chance to resolve it.

Rule 7. Admit that you, too, can be wrong. Admit it sincerely if the opponent’s arguments are reasonable and obvious. It is the most challenging thing to do, but a person who knows how to apologize is strong.


If your rights or the rights of your loved ones have been violated, you can always contact REAct specialists and get free help and support.

You can contact us by writing to us via:

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Psychologist's advice Useful materials

How to help children affected by the war: tips and advice

Due to the beginning of a full-scale war, many Ukrainians were forced to go abroad with their children. The children lost their safe, permanent place of residence, their room, bed, friends, communication, the usual street, and park. The children were already traumatized by the move itself. What is much worse is when the child was in the occupation, heard explosions and saw destroyed buildings, witnessed injuries or deaths, or lost their relatives. This considerable stress is reflected in the child’s sense of internal security.

Then how to help a child to cope with all this?

  1. It is necessary to remember that the adults around a child must stabilize their condition first. The child reads the anxiety restlessness impulses that you feel. They seek to have support, to see someone they can rely on. And if you are not in the resource, the child experiences traumatic events much harder. Therefore, stabilizing your condition is the task number 1. This will help you understand where to move next and how to help the little ones.
  2. Understanding how to talk to the child about the events they experienced is essential. You should definitely talk about it. If this is avoided, all the child’s experiences are “crammed” into the body and manifest as psychosomatic symptoms. It happens to everyone individually, but it is always highly unpleasant.
  3. Feel free to seek medical help in the country where you happen to stay.
  4. Write down the symptoms observed in the child: insomnia, sleep talking, anxiety, congestion, diarrhea, nausea, constant body scratching, sudden cough, fears, physical exhaustion, loss of orientation, etc. It is necessary to tell the doctor in detail what is happening to the child.

How to talk to a child about psychological support:

  • First, you need to realize that you are the mother (father or guardian) and are responsible for your child`s health.
  • Explain that you are eager to help but cannot do it as professionally as a specialist. For this purpose, there are psychologists and psychotherapists – specially trained people who help children survive a trauma.
  • It is not worth expecting your child to agree to go to a doctor or therapist after your first conversation. After all, the child`s psyche is traumatized, and they might no longer perceive anything apart from the trauma. It can be complicated, but you should speak without any pressure. Explain that you invite them to go together because you care about the child and will always find a solution to help them.
  • When a child loses their safe and routine life, their home, it creates a “void” that needs to be filled. If it is not done, the child’s psyche can be broken down. It can lead to the development of some mental disorders if you do not turn to help on time. Don’t delay. If you see that your child is not “ok”, in no case, postpone your visit to a specialist.
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Lawyer’s advice Useful materials

Introducing electronic prescribing

As the healthcare reform continues, further changes are being introduced to the standard set of treatment options. The information that a significant number of medicines will now be available only if a prescription is obtained in advance, and the introduction of electronic document management, including, among other things, drug prescriptions, raises questions and concerns among some of the project’s clients.

The declared reason for increasing the share of prescription drugs in total pharmaceutical sales is the recognition by modern medicine that these drugs have an increased risk of side effects, carry a risk of abuse or dependence, and therefore should be monitored by a doctor.

This may seem worrisome at first glance, but it should be kept in mind that many of the drugs available in pharmacies previously were formally considered prescription drugs as well. All medicines that were previously dispensed against a doctor’s prescription can now be purchased not only after presenting a paper prescription but also via an electronic prescription system. However, now that the new regulation is in place, in some cases, an electronic prescription will be routinely required instead of a paper prescription. Essentially, the list of prescription drugs has not changed significantly. Prescription medicines still include narcotic drugs and medications, some painkillers and sedatives, antibiotics, anticonvulsants, and hormones, as well as drugs for the treatment of heart disease, antihypertensives, and blood thinners, contraceptives, etc.

The current procedure for dispensing medications is regulated by the Rules for Issuing Prescriptions for Medicines and Medical Devices approved by the Order of the Ministry of Health of Ukraine, On Amendments to Certain Regulatory Acts of the Ministry of Health of Ukraine Regarding Prescribing and Dispensing Prescription Medicines and Medical Devices, No. 494, dated March 15, 2023.

Based on the above regulations, an electronic prescription is a medical document that is electronically generated by a prescribing physician in the Register of Medical Records, Referral Records, and Prescriptions in the Electronic Healthcare System based on medical records existing in this Register.

As per established procedure, prescriptions that primary care physicians are authorized to issue, including those for reimbursable medicines or medical devices, shall be dispensed by the designated physicians regardless of whether or not the patient has in place a signed medical services contract (the Healthcare Services Declaration Form) with the relevant physician.

In other words, no Healthcare Services Declaration with the family doctor is required to obtain an electronic prescription. Any physician who is responsible for treatment, such as a surgeon, therapist, cardiologist, or oncologist, will be able to issue a prescription for a prescription drug.

With the introduction of the electronic prescription service, there is no need to visit a doctor’s office every time to pick up a prescription for relevant medicines. This can be done, among other things, remotely. Medication prescriptions can be accessed on the patient’s smartphone.

As a reminder, it should be noted that under this arrangement, the cost of medicines or medical devices that were dispensed to a patient based on a prescription may be eligible for full or partial reimbursement out of public funds for business entities that are engaged in the retail sale of medicines.

All prescriptions must be issued to the patient for legitimate medical indications, provided that relevant data be entered into the primary medical record.

As per established procedure, prescriptions to be filled by pharmacies for patients shall be required for the following items:

  • Medicinal products that are subject to prescription and full payment by the consumer and/or via other sources that are not prohibited by law, except for public budgetary funds;
  • Reimbursable medicinal products and medical devices;
  • Medicinal products and medical devices that are dispensed on a preferential basis;
  • Medicinal products that are manufactured in a pharmacy setting.

After issuing an electronic prescription, the patient (or their representative, if applicable) must be provided with information such as the unique identifier of the electronic prescription issued and the confirmation code for relevant medicinal products or medical devices released by the pharmacy and prescribed under the e-prescription in question.

Upon request from the patient (or their representative), the patient has the right to receive paper-based information that is generated by the system and details such as the e-prescription identifier, confirmation code, and date of issuance, as well as information regarding the medicinal product or medical device prescribed. The information provided, as outlined in this paragraph, shall not be considered an electronic prescription and shall be used for informational purposes only.

Physicians may issue a prescription for a medicinal product in quantities required for a course of treatment, except for narcotic medicinal products that are dispensed following specific standards for a one-time dispensation of such products by prescription, as provided for in the Annex to these Rules.

Previously, narcotic medicinal products used to be dispensed only against a doctor’s prescription as well. Special prescription forms (Form No. 3) used for this purpose are printed on pink paper, numbered, recorded, and strictly controlled by healthcare facilities and pharmacies. All prescriptions for combined medicinal products containing narcotic drugs, psychotropic substances, or precursors in an amount that shall not exceed their maximum permissible limits are also issued on Prescription Forms No. 1 (f-1).

The digitalization of the process and e-prescribing of narcotic drugs is expected to strengthen control over the sale of these drugs. For example, only a doctor is authorized to enter information regarding a patient’s health status into the electronic healthcare system and make appropriate prescriptions, certifying these records with their e-signature.

The rules require that for combined medicinal products in original packages containing narcotic drugs, psychotropic substances, or precursors in an amount that shall exceed their maximum permissible limit, one package of such a medicinal product may be prescribed in one prescription, but not more than fifty tablets.

By way of an example, the regulatory requirement for the dispensation of prescription drugs can be cited. For Buprenorphine (0.2 mg tablets and 0.4 mg tablets), the maximum permissible amount of the drug per prescription is 0.017 g, whereas, for 2 mg, 4 mg, and 8 mg tablets, this amount equals 0.112 g. For Methadone (5 mg, 10 mg, 25 mg, 40 mg tablets), this amount is 1 g.

If anyone’s right to obtain a drug prescription or access medicines is violated, a complaint can be filed using the electronic form on the NHSU website at: https://bit.ly/3L9IUdM or the NHSU Contact Center can be contacted at the Toll-Free Number: 16-77.

Categories
Response stories

Addressing bullying in daycare

Viktoriia contacted the REActor for help because her child was being bullied in daycare. The little girl had repeatedly complained at home that other kids were constantly saying bad things about her mother, the teacher called her names in front of everyone, made her pick up and put away the toys other children had been playing with, and yelled at her. Viktoriia suspected being a target of mean-spirited comments and verbal abuse behind her back so she asked the kid’s grandmother to pick her up after daycare. But the last straw was when the kid complained to the daycare teacher that another girl was calling her names and hitting her, but the woman replied that it was all her own fault and blamed it all on her poor upbringing.

The little girl came home all in tears and flat-out refused to go to daycare again. The next day, Viktoriia visited the daycare center in person and discussed the situation with the teacher. The latter brushed all accusations aside and advised the client to adjust her behavior and take better care of her child because otherwise, the girl would grow up to be just like her mother. “Everyone knows perfectly well what kind of lifestyle you lead,” the teacher said as they were wrapping up the conversation.

The client was outraged and replied that her private life had nothing to do with anything and that she was a good mother and spent enough time with her kid. Some personal remarks were exchanged, and then the head of the daycare center joined in the argument to privately advise the woman to find another daycare for her kid given the negative attitudes shown by the parents of the other kids. Realizing that the situation was hopeless, Viktoriia got in touch with the REActor for assistance and guidance.

The REActor, Olena, and the project coordinator, Yulia, escorted the client to the psychologist’s office. The latter talked her through the necessary steps to take and gave her recommendations on how to behave in stressful situations and how to provide support and distract the child from negativity, as well as how to show love and empathy. Apart from this, a joint session with the child was suggested to properly explain the reasons behind the negative attitudes towards her and improve the situation for the future.

In addition, the project’s legal counsel gave Viktoriia an initial consultation over the telephone. The lady specialist explained what to do if her child is bullied, what parents are supposed to do if that happens, and where to seek help if necessary. Viktoriia received assurances of support and assistance in case she should encounter any legal issues. However, the client refused to file a complaint with authorities and chose to transfer her kid to another daycare center with a more child-friendly environment, but she agreed to receive further psychological counseling.

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News Reports

The impact of war on the rights of communities in Ukraine

In the first half of 2023, the REAct system documented a total of 2,027 cases of violations of the rights of key communities. Of these, 371 cases were related to the beginning of the full-scale war of the Russian Federation against Ukraine.

In 54 cases, the violators were the occupiers. Among the most common violations: deprivation/theft/destruction of personal property (20 cases), harassment and/or intimidation (15 cases), restriction of access to medical services (10 cases), and physical assault (9 cases).

For brief statistics on the impact of the war on the rights of communities in Ukraine for the first half of 2023, see the infographic below and the website at the link: https://react-aph.org/…/ukrayina-2023-pershe…/…

Remember that every person has the right to receive quality services and decent treatment. If you or your loved ones have suffered a rights violation, contact REAct specialists for free help:

Categories
Response stories

Support of the client in passing the military commission

Andriy contacted the REActor asking for support in getting medical care, as his pleas were denied by the military commissariat (Armed Forces Recruiting Office). The man reported being detained on the street by draft office personnel and taken to the commissariat, where the client tried to explain that he was severely ill and unfit for combat duty for health reasons (as he had stage 4 AIDS disease). The commissariat representatives replied that they had their physical evaluation board to carry out medical fitness assessments and that they would evaluate Andriy’s fitness for military service, even though he was willing and ready to provide relevant medical records and reports.

When Andriy showed up to undergo a medical, the doctors on the physical evaluation board would not even listen to the man’s health complaints and declared him perfectly healthy and fit for service.

Once all the facts were in hand, the REActor immediately headed to the relevant Territorial Recruitment and Social Support Center located in Odesa. In a conversation with the second-in-command officer, the REActor explained that Andriy was severely ill and had all the supporting documentation readily available. In addition, the man takes his ART regularly, is unable to function in daily life without medication, and his condition requires ongoing medical supervision and monitoring by an infectious disease specialist, which can also be confirmed and supported by appropriate documentary evidence.

The military recruiting office agreed to wait until the REActor and the client’s sister provided the necessary paperwork. The REActor called Andriy’s attending physician, who flat-out refused to provide the family with any Medical Certification of Illness, even though the client consented to this arrangement.

After lengthy discussions with the military recruiting office, the latter finally agreed to take the client to the regional AIDS center for a medical examination, which confirmed that Andriy was indeed suffering from AIDS and TB, and needed treatment. After that, the client was released, removed from the military conscription register, and recognized as unfit for military service for health reasons.

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Response stories

A social welfare office worker held to account

To birth her baby in safety, a pregnant PLHIV client moved from a war-stricken area where she was residing to a relatively peaceful city and obtained an IDP status certificate for herself. Once her baby was born, Inna found herself in a desperate situation and thought she would also try to get her baby recognized as an IDP. When she applied for this to the Social Welfare Office located in the area of temporary resettlement, she was denied this service because allegedly she was already a recipient of social assistance as a single mother.

When Inna questioned the case worker’s decision and mentioned her friend from another city who had the same status but was awarded a targeted child benefit, the welfare worker she was talking with framed her response rudely saying, “I’m the law here, and I decide who gets the support here and who does not,” and advised her to be thankful, even if just for the amount of money she was already getting.

Following this dispute, to see justice done, Inna made up her mind to seek help from the REActor. Once the client stated her case, the REActor offered free legal aid via an online platform. During the session, the legal counsel explained that the woman’s rights had indeed been violated in this case, as described below:

  • The living allowance paid to IDPs has nothing to do with accessing social assistance as a single mother;
  • Babies born to IDPs are eligible for IDP certification and financial support.

Next, with the client’s consent, professional legal assistance was provided to draft an official letter addressed to the Head of the Social Welfare Department in the city where Inna was staying, pointing out these procedural violations and asking for feedback.

The woman has now been contacted by a representative of this Department and invited to apply for getting an IDP status certificate for her baby. She received a verbal response to her letter and was informed that the employee who had refused her this service in violation of applicable policies and regulations had been officially reprimanded and made to undergo a re-credentialing process for an ad-hoc re-evaluation.

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Psychologist's advice Useful materials

Where to get strength and how to preserve internal resources?

The resources referred to here are the pillars of life that allow us to meet our basic life needs, such as survival, safety, physical comfort, social belonging, acceptance, as well as self-actualization. They affect our capabilities and determine what we can or cannot achieve. By and large, these resources define the amount of time needed for us to attain a certain goal.

Internal resources represent the physical and moral strength that we desperately need for our everyday life activities. So, let’s figure out where to draw your strength from and how to maintain your inner resources that are essential for living a comfortable life.

The first things to take care of are as follows: 

1. Learn how to manage your available resources.

For the time being (temporarily), stay away from situations that do not directly concern or affect you. For example, those associated with conflicts or conversations involving people around you: they are talking to each other, but not with you.

2. Don’t do things that are beyond your scope of reference.

Do not waste your energy arguing over something that is of secondary importance to you. Avoid disputes over minor matters. As often as not, arguments over non-essential issues involve a manifestly disproportionate effort compared to the satisfaction gained from winning them.

3. Look after your physical needs. Drink if you’re thirsty and eat if you’re hungry. If you need to take a walk or lie down for a bit, do that. However, it’s important to consciously ask relevant questions of your body, taking pauses and focusing on bodily sensations.

4. Get adequate rest and relaxation. Essentially, the body rests during sleep, whereas the brain recharges itself in “silent mode,” with no exposure to external stimuli. To ensure a good rest, reduce the amount of information you consume. There may be nothing but some ambient background noise in your immediate environment when you are resting. It’s best to make sure that no direct information (news, movies, books) enters the brain through your eyes or ears.

5. Avoid leisure activities that tire you out. For example, meeting up with people if you are overwhelmed with human interactions during the day. If you can walk instead of using public transportation, go for that.

The second thing to take care of is to learn how to save and accumulate your energy.

Once you have succeeded in sustainably maintaining your life energy (internal resources) for an extended period of time, you can consider taking gradual steps to build it up. To do this, follow the steps below:

  • Try to get new positive experiences on a regular basis, and look for relevant sources around you. Keep track of things, phenomena, or events that boost you up without tiring you out.
  • Find events, images, or scents that are pleasing to your senses in the world around you.
  • Select your social circle with great care. Surround yourself with people you find interesting and easy to communicate with. Reserve for yourself the right to say no to listening to other people’s complaints, giving advice, or actively participating in gossip and squabbles. Don’t be lazy and look around for people who share similar interests with you.
  • Take care of yourself physically, paying attention to your aches and pains, bodily “red flags,” signs and symptoms of nervous system fatigue, and seeking timely help and support when needed. Health is the foundation of everything, so don’t ignore your health problems.

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Response stories

Protecting kids from discrimination at school

The sister of a client with TB approached the REActor based in a friendly NGO, “100 Percent Life Ivano-Frankivsk” (Charitable Organization), asking for help in dealing with the situation in the school that her nephews attended.

Anna, the Project’s client, is currently undergoing inpatient treatment at a local lung disease center, and the school administration where her kids are enrolled has found out about this. On the basis of their mother’s diagnosis, the school’s administration began to discriminate against the minors on a regular basis. It even threatened to take steps demanding that the kids be removed from the family home. They argued that the “lack of adequate parental care and supervision due to their mother’s illness” required the children to live with their aunt.

Moreover, the school administration repeatedly questioned the health of the client’s children and tried to separate them from other students. On multiple occasions, threats and insults in this vein were made in the presence of the kids and their fellow students, thus negatively affecting both their psychological well-being and academic performance.

The REActor provided an initial legal consultation for Anna’s sister. Apart from that, together with the client’s sister, he drafted a letter to the school administration explaining the provisions of the anti-discrimination legislation and attached an evaluation report detailing the children’s living arrangements and the certification of good health. On top of this, the children were provided with psychological assistance and support by specialists from a friendly organization.

Once the letter was received by the school administration, they immediately discontinued the misguided practice and never again summoned the client’s sister to school or threatened the kids.

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Psychologist's advice Useful materials

How to help those who are experiencing acute stress?

An acute stressful situation is an experience where a person’s life is under threat. Those who find themselves in such a situation need psychological help and support. How should you act and what should you do if you have to provide psychological first aid?

There is a clear protocol on how to help people who have just experienced an acutely stressful event. It is easy to follow and can be used not only by psychologists but also by anyone involved in dealing with the aftermath of a traumatic experience.

Be sure to follow and respect the very important guidelines below while providing the necessary help and support:

  • Avoid arguments or disputes with the person you are helping, even if their opinion differs from yours. Do not try to bring them around to your point of view. This is not your job. Your job is to help a person who is experiencing an acute stress reaction.
  • It is essential to remember that you are helping someone who is particularly susceptible to suggestion. Every word you say can have either a therapeutic or traumatizing effect. Your task here is to mitigate the impact of a stressful situation. Therefore, be sure to avoid complicated language that can be confusing.

And now let’s focus on how to provide the psychological assistance needed.

  • The first step is for you to calm your own nerves. While providing the services, you must be in a state of emotional stability. Although you may be scared too, you have to get your emotions under control.
  • It is extremely important to not talk about the victim’s emotions. Your task is to “enable” completely different areas of their brain. Avoid using the following language and words, “Calm down,” “It’s all going to be okay,” “Everything shall pass,” “Things will work themselves out,” etc. This kind of language will make the person you are helping feel even more alone and lonely. They will not believe you.
  • Speak at a much slower pace than you normally do. For the person you are helping, the outside world has crashed down and collapsed, and nothing is stable anymore. Therefore, to offset that sentiment, you should try giving them a sense of support and confidence.
  • Use clear, short phrases, such as “Look at me. Do you see me?” This is a good place to start. The person is experiencing the effect of tunnel vision. It would help if you expanded that tunnel.
  • Establish rapport and give them a first impression that there is something else out there, other than the horror they have experienced. Introduce yourself.
  • Ask for their name.
  • Next, ask them where they were going, what they were doing, and what they were about to do when… (an air raid alert siren started going off, the gunshots were heard, and everyone ran for their lives – describe the situation). Bouts of acute stress can disrupt the continuum of life’s events. These questions create a single chain of events and restore a sense of continuity.
  • Repeat the answer after the person, clearly and concisely. Fill in the additional blanks if you know the situation. Without any emotions or extra details.
  • You also have to reactivate their thinking capacity, as well as restore their sense of control and self-worth. This stage will require your creativity. For example, you can ask them to count up the people they see or take a look at the numbers of the buildings around them. Example wording: “Help me out here, I do really need to find out the numbers of the nearby buildings, this one’s and that one’s, but I have poor eyesight.”
  • Then comes the process of “normalization.” Say, “All of the reactions you are experiencing (list those you can notice, e.g., feeling tearful, confused, anxious, devastated, scared, embarrassed, mentally sluggish, aggressive, etc.) are normal responses to an abnormal situation.”

A rare situation is when a victim is in a state of stupor. If the person “freezes” and does not respond, use your voice (say something in a confident and loud voice), and visual stimuli (wave your hand in front of their eyes). You can try giving them something contrasting (if there is an ambulance nearby, you can take a piece of ice and give it to them). Giving light slaps across the victim’s cheeks (as is shown in the movies) is not recommended. In a state of stupor, a person can hear and understand things but is unable to move.

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Response stories

Helping a client get back home

Being a sex worker with HIV-positive status and an internally displaced person from the occupied part of the Donetsk region, Yuliia stayed at the Kryvyi Rih Rehabilitation Center. Since the year before, she had been a client of the partner organization, linked to a healthcare facility for case management and ART, and enrolled in the CIRI intervention (accessing support for 12 months).

Six months after being started on the therapy, Yuliia suddenly cut off all communication with her case manager and doctor. After a while, the woman finally contacted the REActor over the phone asking for help. As it turned out, the client had decided to drop out of her rehabilitation program, believing that now she was well able to lead a life of sobriety without any outside help. The woman moved to another region and tried to find a job there, but after a short time, she returned to retaking drugs and quit ART.

Due to such drastic changes, Yuliia’s health suffered a major setback. To make matters worse, one evening, she was attacked by two unidentified men who beat her up and then raped her. As a result, the woman suffered severe concussions to the head and sought professional help from the local General Practice/Family Medicine Clinic. They turned her away, without even providing first aid service, arguing that she had no signed medical services contract (the Healthcare Services Declaration Form) with a local doctor. Next, the woman turned to the district police officer for help but was also refused help and advised to get back to the rehabilitation center.

Yuliia had neither the strength nor the money to return to Kryvyi Rih immediately. So she called up the REActor and asked for help. In the end, the client was brought home through everyone’s efforts. Yuliia was provided with psychological and emotional support, as well as primary legal aid services in a consultation format. She was also accompanied to the health care facility to resume ART. The woman also received medical care from an ophthalmologist, as her eyesight had significantly deteriorated due to the injuries sustained, and she was prescribed the treatment she needed. Yuliia decided against contacting the police to file charges. She is currently back in rehabilitation and continuing her therapy.

Categories
Response stories

Protection of client’s rights in the local dispensary

Viktoriia was being treated for lymphadenopathy; she was running a high fever and the lymph nodes in her neck were extremely swollen. She turned to her family doctor for help at a local outpatient clinic. During the consultation, the doctor advised hospitalization, but Viktoriia refused due to financial reasons.

After that, Viktoriia informed the doctor about her HIV-positive status. As soon as the words were out of her mouth, the man’s attitude toward the patient immediately changed, and he adopted a dry and curt tone of voice. When he stressed the need for her to see an ENT specialist as well, and Viktoriia asked for a referral and information on where she could get high-quality medical advice, the doctor replied, “How do you even expect to get a consultation with a diagnosis like this?” and mockingly added that the patient should be grateful that she was even talked to in “regular health care centers” and advised her to contact the AIDS center where “the likes of her” are treated.

Viktoriia was shocked by this attitude, but she had to get the referral, so she asked the doctor to provide a referral for the ENT specialist, rather than waste his time sharing unsolicited comments. The doctor replied that he was unable to help her out with this at that point because the computer system was not working. That being so, the client asked that the doctor then give her a paper-based referral note and enter the details into the database at a later point, because she knew from experience that this was standard practice. The doctor carried out this request, although with much reluctance, essentially hurling at her the slip of paper with the referral number, and told her to never come back.

Viktoriia was so rushed to leave his office as soon as possible that she did not even look at what he had written there. Once the woman left the office, she saw that the doctor had written the ICD code B20 with the note “AIDS patient” in the corner of the referral slip.

The client immediately returned to the doctor’s office and asked that he rewrite the referral. At that moment, the doctor was talking to a nurse, and the woman realized that they were discussing her diagnosis. As soon as they saw Viktoriia, they immediately stopped talking and the doctor disdainfully inquired if she had forgotten anything. The woman asked that the ICD code be removed from the referral, but was told no, “Doctors are supposed to know everything about their patient, especially this kind of data, this is a safety precaution.”

That same evening, Viktoriia got in touch with the REActor. The client was provided with legal advice and psychological guidance. The woman was also advised on how to proceed if the doctor and nurse disclosed her HIV status. Later, the paralegal and the REActor filed a complaint with the head of the primary health care center about the discriminatory attitudes experienced by their health care staff, violation of patient’s rights, and disclosure of confidential information. After that, they took up the matter with the head of the center and discussed the situation at hand.

The head of the health care center reacted promptly, and the family doctor was officially reprimanded and warned that disclosure of confidential medical information incurs criminal liability.

Currently, Viktoriia is being served by another family doctor, and her treatment is successful.

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Lawyer’s advice Useful materials

The issue of the implementation of the rights of representatives of key communities that took part in hostilities to receive the status of combatants

Since the outbreak of Russia’s criminal aggression against our country, many Ukrainian citizens from key communities have taken part in hostilities as part of regular army or local volunteer-based territorial defense units. In the latter case, some of those who resisted the Russian invaders did not always have enough time to get their combatant status properly documented and formalized in accordance with applicable regulatory requirements given the urgency of the combat situation that they were in.

However, even when the status of a serviceman of the Armed Forces of Ukraine is officially established, there are recorded cases when defenders who are PLHIV, after an extended stint in the harsh conditions of the war zone with no access to proper care, suffered a significant deterioration in their health, which prevented their further participation in combat activities and led to their discharge from the Armed Forces for health reasons. This makes it necessary to have their status as combatants officially recognized, as this recognition entitles eligible individuals to multiple benefits and social security guarantees from the government, including those related to medical care and treatment.

In accordance with applicable regulatory requirements currently in effect, special commissions were set up by the relevant agencies and entities associated with the Ministry of Defense and the Armed Forces to examine claims of recognition as combatants of the Armed Forces of Ukraine from individuals who had directly participated in efforts aimed at ensuring the defense of Ukraine, or protecting the safety of the population and the interests of the state in connection with the military aggression of the Russian Federation against Ukraine.

In practice, there are three ways to have the status of combatant officially recognized:

  • Upon request from the unit commander who submits supporting documentation for their subordinate servicemen via centralized procedure;
  • On personal application by a serviceman who independently collects and submits the necessary paperwork to the relevant commission;
  • On personal application by a person who is discharged from military service through a territorial recruitment and social support center.

So, let’s break down this procedure for eligible individuals who have been discharged from military service and are applying in person through a territorial recruitment and social support center.

The procedure for obtaining combatant status by an active serviceman of the Armed Forces of Ukraine who submits the requisite documents in person.

The first step is for the serviceman to submit a report to the commander of their military unit requesting that a set of required paperwork be provided to serve as the basis for granting them the status of combatant for the combat (service) missions carried out personally or as part of a military unit while participating in activities required to ensure the defense of Ukraine or protect the safety of the population and the interests of the state in connection with the military aggression of the Russian Federation against Ukraine.

On this basis, the commander of the military unit must make arrangements that the following documents be executed and released to the serviceman concerned through the personnel service (personnel centers):

  1. Proof of the applicant’s direct participation in activities required to ensure the defense of Ukraine or protect the safety of the population and the interests of the state in connection with the military aggression of the Russian Federation against Ukraine;
  2. At least one of the following documents is required as mandatory:
    • Extracts (copies) of combat reports;
    • Extracts (copies) of logs with details of combat operations (combat missions);
    • Extracts (copies) of logbooks;
    • Copies of materials associated with special-purpose (official) investigations into incidents involving wounds, shell shock, or injuries sustained.

These documents may be supplemented by other supporting documents, if available.

For persons who had been held as prisoners of war or hostages, materials of special-purpose (official) investigations into circumstances surrounding their being taken prisoner or hostage must also be provided.

Once the requisite documents have been received, the personnel service unit (personnel center) must notify the serviceman concerned of the address of the Commission that examines claims of recognition as combatants of the Armed Forces of Ukraine (hereinafter referred to as the “Commission”) so that they are in a position to independently submit the necessary documentation for consideration and decision-making.

The following documents shall be submitted by the eligible serviceman concerned for consideration by this Commission:

  1. A report (application) requesting that the related documents be reviewed by the Commission;
  2. Proof of the applicant’s direct participation in activities required to ensure the defense of Ukraine or protect the safety of the population and the interests of the state in connection with the military aggression of the Russian Federation against Ukraine;
  3. At least one of the following documents is required as mandatory:
    • Extracts (copies) of combat reports;
    • Extracts (copies) of logs with details of combat operations (combat missions);
    • Extracts (copies) of logbooks;
    • Copies of materials associated with special-purpose (official) investigations into incidents involving wounds, shell shock, or injuries sustained.

As noted above, other documents containing evidence and supporting the fact that the person in question was involved in carrying out the combat (service) missions personally or as part of a military unit (body, subdivision), institution or establishment may be submitted as well, whereas for persons who had been held as prisoners of war or hostages, materials of special-purpose (official) investigations into circumstances surrounding their being taken prisoner or hostage may be provided.

Other documents to be attached shall include the following:

  • Certified copies of the applicant’s Ukrainian passport pages with details of their last name, first name, and father’s name, passport issuance information, place of residence, and proof of Taxpayer ID Number or the front and back of the passport of a citizen of Ukraine in card format, and a document verifying the applicant’s place of residence;
  • Consent for the collection and processing of personal data;
  • Two color photographs on matte paper measuring 3×4 (cm).

Based on this, the Commission shall be required to do the following:

  • Once the serviceman’s report (application) along with the required documents have been received, register them in the book of records maintained for this particular purpose;
  • Within one month from the date they were received, review the documents submitted and communicate the decision made by the Commission to the applicant with an explanation of the procedure for obtaining a combatant certificate;
  • Through the relevant offices of the personnel service (personnel centers) responsible for the operation of the Commissions, make arrangements for a combatant’s certificate to be issued to the serviceman concerned in person or through the military unit where they are serving;
  • Through the relevant offices of the personnel service (personnel centers) responsible for the operation of the commissions, notify the Ministry of Veterans Affairs of Ukraine about the issuance of the certificate.

The procedure for obtaining combatant status by a person who is discharged from military service through a territorial recruitment and social support center.

The eligible person must submit the following documents to the territorial recruitment and social support center where they are registered as military service personnel:

  1. A report (application) requesting that the related documents be reviewed by the Commission;
  2. Proof of the applicant’s direct participation in activities required to ensure the defense of Ukraine or protect the safety of the population and the interests of the state in connection with the military aggression of the Russian Federation against Ukraine;
  3. At least one of the following documents is required as mandatory:
    • Extracts (copies) of combat reports;
    • Extracts (copies) of logs with details of combat operations (combat missions);
    • Extracts (copies) of logbooks;
    • Copies of materials associated with special-purpose (official) investigations into incidents involving wounds, shell shock, or injuries sustained.

As noted above, other documents containing evidence and supporting the fact that the person in question was involved in carrying out the combat (service) missions personally or as part of a military unit (body, subdivision), institution or establishment may be submitted as well, whereas for persons who had been held as prisoners of war or hostages, materials of special-purpose (official) investigations into circumstances surrounding their being taken prisoner or hostage may be provided.

Other documents to be attached shall include the following:

  • Certified copies of the applicant’s Ukrainian passport pages with details of their last name, first name, and father’s name, passport issuance information, place of residence, and proof of Taxpayer ID Number or the front and back of the passport of a citizen of Ukraine in card format, and a document verifying the applicant’s place of residence;
  • Consent for the collection and processing of personal data;
  • Two color photographs on matte paper measuring 3×4 (cm).

In this regard, the relevant social security offices of the territorial recruitment and social support centers shall be required to do the following:

  1. Once the eligible application along with the required documents have been received, register them in the book of records maintained for this particular purpose.
  2. Verify to make sure that the documents submitted contain sufficient evidence and support the fact that the applicant, personally or as part of a military unit, was involved in carrying out the combat (service) missions or intelligence activities, and that they comply with the requirements set forth in applicable laws and regulations that govern the procedure for granting the status of combatant;
  3. If needed, make the necessary inquiries to the military units where the applicants did their military service or to the relevant archival institutions;
  4. Once the set of required documents has been executed and released, submit it to the relevant Commission for consideration and decision-making.

Once that is done, the Commissions shall be required to do the following:

  1. Once the eligible applications along with the required documents have been received from the territorial recruitment and social support center, register them in the book of records maintained for this particular purpose;
  2. Within one month from the date they were received, review the documents submitted and communicate the decision made by the Commission to the appropriate territorial recruitment and social support center.

Once the Commission’s decision regarding the recognition of the claim has been received, the relevant social security offices of the territorial recruitment and social support centers shall be required to do the following:

  1. Notify the person concerned of the Commission’s decision;
  2. Make arrangements for a combatant’s certificate to be issued to the applicant in person;
  3. Notify the relevant offices of the personnel service (personnel centers) responsible for the operation of the Commissions that the combatant’s certificate in question has been issued.

In turn, the relevant Commission must inform the Ministry of Veterans Affairs of Ukraine about the issuance of the certificate through the relevant offices of the personnel service (personnel centers).

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Response stories

Bringing the family doctor to justice

Yulia is an HIV-positive woman who has a family and a full-time job in the public sector. When signing her general medical services contract (the Healthcare Services Declaration Form) with her family doctor, the client made a special point of stressing the confidential nature of her medical records and the need for keeping her HIV status undisclosed.

However, in a private conversation with another client, Yulia’s mother, the family doctor informed her about her daughter’s HIV-positive status. From that point on, the girl’s life turned into a “living hell on Earth” – she was completely cut off from her family and her own child, made to use separate dishes and bedding, nor was she even allowed near her child for a hug or a kiss. She was constantly humiliated and abused, with the other family members shaming her and lashing out at her over the HIV status non-stop.

Yulia decided to contact the REActor in a face-to-face setting to find out what remedies are available against this doctor for breach of confidentiality, as well as to get advice on how to improve her life and her relationships with family members.

During her appointment with the REActor, the girl was provided with counseling and information explaining her rights and responsibilities as an HIV-infected person. The REActor clarified for her the meaning of the terms “stigma” and “discrimination”, the liability for allowing those to happen, and for the disclosure of confidential health information, as well as laid out the possible options for addressing these issues. On behalf of the client, the REActor drafted a letter of complaint to the head of the primary care facility involved, describing the family physician’s unethical behavior and its implications for the victim’s family life.

As a result of the investigation into the complaint, the administration of the medical facility sided with the client and officially reprimanded the family physician, having her apologize for her unprofessional conduct. Apart from that, the administration of that medical center suggested that Yulia choose another doctor from among the pool of its specialists, but the girl refused and transferred to another primary care provider.

The REActor also offered to meet and communicate personally with her mother and relatives, as well as to provide consults involving the social workers from the AIDS Center to share objective and accurate information about HIV infection, along with specific lifestyle and treatment advice and guidance for HIV-infected people. But Yulia said she would take things from there and try her best to straighten out her family situation without any outside help.

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News Reports

Results of the implementation of the REAct system in Ukraine (01.01-31.05.2023)

87% of resolved cases regarding the violation of the rights of key communities – the REAct project continues to work actively, despite the difficult conditions.

In the period January-May 2023, a total of 1,472 appeals from 1,410 clients were registered. Of these, 1,277 cases were fully resolved.

Most often, men (57.5%) and women (41.6%) face violations of rights, manifestations of stigma, and discrimination in Dnipropetrovsk (370 cases) and Cherkasy regions (235 cases).

The main violators of the rights of representatives of key communities traditionally remain the employees of state healthcare institutions (696 cases), the police (163 cases), and the provided state social services (96 cases).

The largest number of appeals were received regarding refusals to provide assistance or services (1,005 appeals), cases of emotional (747 appeals) and/or physical violence (312 appeals).

92% of services were provided by documentators at the place of the client’s request. Among them, are primary legal assistance/support (65%) and psychosocial assistance (34%).

See the infographic for brief statistics for the first five months of 2023.

Remember that every person has the right to receive quality services and decent treatment. If you or your loved ones have suffered a rights violation, contact REAct specialists for free help: