This episode of “Ukraine Through the Eyes of Others” features Henry Thomas Marsh, a renowned English neurosurgeon and pioneer in the field, with strong professional connections to Ukraine.
In this interview, Henry Thomas Marsh discusses his work in Ukraine, his experiences as a surgeon, and the challenges of providing medical care in conflict zones. He also reflects on how his long-standing commitment to Ukraine, particularly in the medical field, has shaped his views on healthcare, democracy, and global issues.
The conversation explores the role of healthcare in democracy, the impact of the war on Ukraine’s healthcare system, and the broader implications of Russia’s aggression. Dr. Marsh also touches on his motivations for supporting Ukraine and the importance of maintaining hope in the face of adversity.
In your book Do No Harm, you describe your first visit to Ukraine. Was it a deliberate choice to highlight how some British people perceive Ukraine?
Not particularly. It was more about portraying how much life is shaped by random events and chance. If I hadn’t gone to Kyiv on that visit, my life would have turned out very differently. It was a year after Ukraine gained its independence. The economy was in a terrible state due to the dislocation caused by the fall of the Soviet Union. I knew Soviet medicine was far behind the West, but I didn’t realise how much — it was about fifty years out of date. The hospitals were largely empty, with nothing happening. The factories were closed, I could see chimneys with no smoke rising from my hotel window. It felt like everything had come to a halt.
Nevertheless, when I visited the famous Neurosurgical Research Institute, where I was giving lectures, there was still that old Soviet mentality of “We are the equal of the West”. I met professors who proudly told me about their various departments, emphasising how this was Europe’s most prominent specialised neurosurgical hospital. Yet, my eyes saw something completely different — an empty, lonely facility. From my studies of the Soviet Union, I was already familiar with disinformation, or, as Trump might call it, “false facts”. Lying and dishonesty were ingrained in the Soviet system, and I found it quite ironic.
When asked if I wanted to see anything else, I said I’d like to see how trauma was dealt with since there didn’t seem to be any routine surgery happening. In the Soviet system — and it’s still the same now — routine elective work and emergency work were separated, unlike in Europe, where hospitals do both. I was taken to the emergency hospital in Troieshchyna (a large residential district in Kyiv — ed.), where the conditions were even worse. There, I met a very enthusiastic young surgeon — the only person on that visit who openly admitted, “Everything is terrible here.” Long story short, this young surgeon got the permission of Academician Romodanov (a prominent Ukrainian neurosurgeon and neuro-oncologist, credited as a founder of neurosurgery in Ukraine – ed.) to come to London and study with me. He stayed for three months.
Based on that, I decided to forgo holidays with my family and began travelling to Kyiv once or twice a year to help. On more than one occasion, I even drove from London to Kyiv with second-hand operating equipment, including microscopes, which are fundamental to neurosurgery but were absent there. This continued for many years. Ukraine gradually improved; the economy got better, and so did medicine overall.
In your book, you describe the interiors and exteriors of Soviet hospitals. Could you elaborate on the Soviet healthcare system and its architecture? Do you think their design was a deliberate choice?
Yes. In the Soviet Union, hospitals were designed to appear large and impressive, similar to factories in the West, but often lacked functionality. This reflected the “Potemkin village” mentality — creating a façade to pretend things were better than they were. It was part of the dictatorship’s narrative of a worker’s paradise, masking reality.
Potemkin village
A Potemkin village refers to a deceptive facade, where something appears impressive or functional on the surface but is hollow or fake underneath. The term originates from a legend about Russian official Grigory Potemkin, who allegedly built fake villages to impress Empress Catherine the Great during her 18th-century visit to Crimea.Additionally, there’s a cultural tendency, described as “Russian gigantomania,” to build massive structures to assert equality with or superiority over the West despite underlying inefficiencies. This stems from a deep-seated psychological conflict and denial of inadequacies compared to the West.
Russian gigantomania
Russian gigantomania is the tendency to create enormous structures and projects as displays of power and prestige, often prioritising size over practicality. Rooted in imperial and Soviet history, it reflects ambitions to showcase dominance and grandeur.Does that hospital’s dark and depressing design affect the patients and the staff who work there?
There’s some research, but common sense suggests that natural light, views of trees, and quiet, softened environments benefit patients and staff. Many hospitals lack these features due to the flawed design process. The key to a successful building is an informed client, but in healthcare, patients have no influence, doctors focus solely on treating illnesses, and managers lack understanding. As a result, architects often design hospitals as purely functional machines, with long corridors and minimal attention to creating a humane environment.
Hospitals should be designed with the patient’s well-being in mind, incorporating light, greenery, and calming environments to aid recovery. Using charitable funds, I transformed an empty balcony into a roof garden for patients in my London hospital. While I can’t scientifically measure its impact, it’s extremely popular among patients and staff. However, such features must be planned initially, as retrofitting is difficult. Unfortunately, patients are often overlooked in hospital design, and medicine is still frequently viewed as a purely technical exercise, disregarding how patients feel. This outdated approach fails to prioritise the human aspect of healthcare.
You mentioned Russia’s obsession with gigantic architecture. Many historians and researchers of that totalitarian architecture era say it was done deliberately to make humans feel small.
Yes, the state is this massive monolithic structure. But of course, the state is a nomenclature, and all these human beings are busy grabbing everything and suppressing everybody else. Again, in the Soviet Union, they made excellent rockets and weapons, but healthcare was a low priority — except for those at the top of the system, who had access to better hospitals.
In the Soviet Union there was the almost impenetrable Iron Curtain — no possibility to travel or exchange ideas and experiences. How do you think this affected knowledge, particularly within the medical system?
In the early years, I saw cases where young Ukrainian neurosurgeons, after training in England, were fired upon returning to Ukraine because their modern knowledge threatened their superiors. This reflects how medical systems mirror societal structures, and the Soviet Union’s hierarchical nature profoundly influenced its medical practices.
Though things are changing, significant reforms are needed, particularly in postgraduate training, which remains chaotic and overly dependent on individual professors. Unlike the U.S. and Europe, Ukraine lacks a standardised system, allowing some to claim expertise without proper training. War, though terrible, often acts as a catalyst for change. Historian Margaret Macmillan, known for her works on the First World War and her book War, highlights how conflicts reshape societies. While the current war in Ukraine is a nightmare, it has driven positive changes, such as reducing corruption.
Margaret MacMillan
a Canadian historian specialising in international relations and 20th-century history, renowned for her insightful analysis of war and diplomacy.What positive changes are you seeing in the Ukrainian medical system and society?
I’ve always been impressed by the strong sense of self-help, family bonds, and friendship in Ukrainian society. People rely on each other when the state isn’t there to help. The war has united Ukraine, achieving the opposite of what Putin intended. There’s less corruption now, though still too much, and the oligarchic control over the economy needs to change. Inequality remains a big problem in Ukraine, as it does in the U.S. and the U.K.
In an interview, you mentioned being a fan of Ulana Suprun, former Ukrainian Minister of Health, and the reforms she was trying to implement. What made them resonate with you?
The foundation of any effective healthcare system is primary care, especially the family practitioner model. Countries like Norway have strong systems where the family doctor is the gatekeeper, ensuring efficiency. Research from Norway showed that people who had the same doctor for over a year were 25% less likely to die, had fewer hospitalisations, and needed fewer emergency calls. This continuity of care makes healthcare more equitable and efficient. Ulana Suprun’s focus on strengthening primary care in Ukraine was the right approach. I haven’t spoken to her or others in detail, but I imagine specialists may see Ulana’s reforms as a threat since they limit the number of patients they see, which impacts their earnings. Patients may also resist, wanting direct access to specialists. Many Ukrainians in England complain about how hard it is to see a doctor there, while in Ukraine, they can get multiple opinions quickly. However, the opinion is often more reliable when you visit a doctor in England.
How do you think the role of doctors in wars changed?
Psychologically, doctors always have to balance compassion with detachment. With war surgery, you’re treating young people with horrific injuries caused by human cruelty, not bad luck. Maintaining that balance is more distressing and challenging, which could lead to burnout or compassion fatigue.
Do you think the concept of responsibility changes during a war, even for doctors working in civilian conditions?
I often discuss the importance of doctor-patient communication. Doctors hold tremendous power over patients, and there needs to be more recourse in Ukraine if things go wrong. In contrast, countries like New Zealand and Sweden offer automatic compensation for medical mistakes, avoiding court battles.
I encourage medical students to try to understand what being a patient is like. When you’re young and healthy, it’s hard to imagine the fear, pain, and vulnerability of being ill. Treating patients with kindness and respect makes the work more rewarding. Small acts, like helping a patient with their coat or holding their hand, can make a huge impact. Patients don’t always expect kindness, but it builds trust and improves relationships. However, the more you care, the more it hurts when things go wrong, making it a delicate balance.
How do you assess the international medical community’s response to the full-scale invasion of Ukraine?
I’ve heard stories about many wounded Ukrainian soldiers being treated in Western hospitals, but whether there’s any coordination, I’m not sure. I suspect it’s all just individual initiatives by hospitals and doctors. We should help Ukraine as much as possible. I recently bought a four-wheel-drive Jeep for some military friends. Having come to Ukraine to save lives, I’m now providing equipment for the army.
There’s been a lot of talk about organisations like the International Committee of the Red Cross trying to maintain neutrality and failing to address the real issues in Ukraine.
It’s a difficult situation. During the Second World War, the International Committee of the Red Cross had to cooperate with the Nazis to care for Allied prisoners, even though Russian and Ukrainian POWs often starved. As for neutrality, I believe doctors should treat everyone, regardless of their side. For example, if a Russian or North Korean soldier is wounded, they should be treated. It’s crucial to treat prisoners well, as many Russian soldiers are told they will be tortured if captured. The Ukrainian army must adhere to the Geneva Convention and treat prisoners with respect.
In your book, you mentioned technology and how it’s changing neurosurgery. How do you see the future?
Paradoxically, technological progress in neurosurgery has meant less surgery. There are now better treatments than open surgery. One of the biggest challenges is glioblastoma, a primary brain tumour that almost always leads to death despite treatment. It’s not a surgical illness, but new forms of immunotherapy could offer hope. While there’s a lot of research, progress has been slow. Brain implants from Elon Musk’s Neuralink (a neurotechnology company that develops brain-computer interface devices that connect the human brain directly to computers – ed.) show promise in functional neurosurgery.
Thinking of the amputees and spinal injuries from the war, I hope there will be further progress in connecting electrical wires to the brain to bypass spinal cord injuries or linking prosthetic arms to muscles electrically. There’s remarkable progress in this area, but it’s costly. I visited the Superhumans Centre (a Ukrainian rehabilitation facility providing prosthetics, rehabilitation, and psychological support for soldiers and civilians affected by the Russian invasion – ed.) in Vynnyky outside Lviv, which was fantastic. The Pinchuk Foundation funds it and features state-of-the-art prostheses, mainly from Germany, purchased commercially rather than donated. Ukraine will have a whole generation of injured men and women who will need help for years to come. Additionally, the country will have to address widespread post-traumatic stress disorders, much like veterans from America’s wars in Vietnam, Iraq, and Afghanistan.
The Pinchuk Foundation
is a private philanthropic organisation in Ukraine, founded by businessman Viktor Pinchuk. It focuses on education, healthcare, culture, and fostering Ukraine’s integration into the global communityYou mentioned the healthcare system in the UK and your background there. Before 2022, do you think the UK fully understood Russia’s threat?
No, it didn’t. Russian oligarchs had moved into London, especially in Chelsea, and were involved in money laundering, with British lawyers helping them. People preferred not to see what was going on, partly because the Conservative government had a corrupt relationship with Russia, which was funding them. This has changed with the new government, but despite Brexit, Britain has always been strong in the EU in opposing Russia. It’s part of the British tradition of supporting underdogs. We don’t like bullies.
There’s a good organisation in London called the Ukrainian Institute London, which I support and is trying hard to keep Ukraine in the public eye. But the situation with Israel is not helping, and there’s a sense of Ukraine fatigue. It takes a lot of deaths now to get back in the headlines. It sounds cynical, grotesque, horrible and very sad. However, I see no sign of weakening support for Ukraine in England.
The Ukrainian Institute London
is a cultural and educational centre that promotes Ukrainian culture, history, and current affairs in the UK. It offers events, lectures, and exhibitions to foster understanding of Ukraine and its role in Europe and the world.Do you see an admiration for Russia from a cultural standpoint?
The BBC classical music program still plays Russian music, which frustrates me. Many people think the great 19th-century novelists have nothing to do with what’s happening now, but that’s not entirely true. Interestingly, as new generations of immigrant families in England reach adulthood, there’s growing awareness of the evils of colonialism. More books are being published, not asking whether the British Empire was good or bad but highlighting its awful aspects. Russia is the last of the great 19th-century colonial empires, and under Putin, still has that mentality — something we’ve mainly lost in Britain.
Do you currently see the influence of Russian disinformation and propaganda in the UK?
There are rumours that Russia partly funded Brexit. While it’s unclear whether Russian misinformation had a significant impact, Brexit was certainly in Putin’s interest. Some argue, like with the American elections, that while there were Russian bots and influence, it probably didn’t make much of a difference. However, Russia has undoubtedly tried. Recently, the head of British internal security, MI5, gave an interview stating that Russia is actively campaigning to disrupt life in Britain.
What kind of approach do you take when you write articles about Ukraine?
I write about myself and tell stories about what I see. When Rachel (Rachel Clarke, British palliative care doctor and writer – ed.) and I were here two years ago, we were perfectly safe, but as we arrived at the central railway station, there were enormous explosions. Rachel, a former journalist before becoming a doctor, was skilled at exploiting the situation and did live interviews with several UK media channels. It made us appear as courageous English doctors being bombed by the Russians, which got a lot of publicity. That’s the kind of thing that works.
If someone asks you why you chose this cause and have stayed committed to it, how do you respond to the question, “Why Ukraine?”
I do it because it’s incredibly important. It’s about European values, and I feel I’d be betraying my friends here if I stopped coming. Despite my family not liking it, they accept I must do this. I can be helpful by lecturing and teaching, and I hope it helps. The students enjoy my lectures and it’s rewarding for me.
You talk a lot about civilised values and democracy. We started this conversation by discussing healthcare systems. What is the healthcare system’s role in building democracy?
It should be universal and free, not commercial. A small commercial sector can exist, but there needs to be a robust government system where everyone receives equal healthcare, regardless of wealth or social status. That’s the goal. In practice, it’s impossible to achieve ultimately, but it’s what we should aim for.
What do you hope for for Ukraine, and for the world in general?
It’s hard to see how Ukraine can regain occupied territories without significant military aid from the West, which I don’t think will come. What Ukraine needs is guarantees, unlike the Budapest agreement, that once borders are established, Ukraine will be safe, and Russia can’t invade again. That likely means joining NATO. The threat of NATO could deter Putin.
But NATO is hesitant. Many are cowards, unwilling to take risks. Everything involves risk, like surgery — if you don’t act, no one is saved. Without NATO, peace with Putin is dangerous. This war is not about land; it’s about Putin’s regime surviving. A free, democratic Ukraine is a threat to his power. If Ukraine can become free, why not Russia?