July 18, 2008
Ukrainian President’s Doctor Reveals Details of Treatment for Poisoning
Olha Bohomolets, President Viktor Yushchenko's doctor at the time of his poisoning in 2004, has spoken about the details of the illness and the treatment. She confirmed that there was no doubt that it was caused by dioxin. It was perfectly proper, she said, to put a dermatologist in charge his treatment in Switzerland. The following is the text of the interview Bohomolets gave to Mustafa Nayem entitled "Olha Bohomolets: Why I didn't tell the truth about the president's illness", published on the Ukrainian website Ukrayinska Pravda on 16 July. Subheadings have been inserted editorially:
Ukrayinska Pravda is continuing its own investigation into the circumstances of the sharp deterioration of [President] Viktor Yushchenko's health in September 2004, in the framework of which it is ready to set out the viewpoint of all the persons involved in it.It is already obvious now that the start of the intrigues around the investigation of the case of the poisoning of Viktor Yushchenko was given by the president himself and his entourage, who made public the official theory of what happened without being in possession of the results of the forensic expert analysis.
Common sense suggests that the actual fact of possible dioxin poisoning should have been the main secret of the inquiry. But instead of that, a myth was born that everyone took it upon themselves to explain, apart from the ones who engendered it - the doctors.
Unfortunately, Viktor Yushchenko himself is also guilty of this, since no doctor has the right to divulge a medical secret without the patient's consent.
Meanwhile, one detail stands out in the story of Yushchenko's treatment - all the doctors in charge of the medical observation of the president or dealing with his treatment, even if very well- known in their basic speciality, are nevertheless dermatologists. The role and personalities of the few toxicologists remain phantasmal to this day.
Three weeks ago the head of state's former personal doctor, Olha Bohomolets, consented to talk about her vision of what happened. It was she who prepared Yushchenko before he mounted the rostrum of the Supreme Council [parliament] to be sworn in as the country's president in January 2005.
The editorial board is also conducting negotiations about an interview with the president's current doctor, Rostyslav Valikhnovskyy, who promised to meet with a correspondent from Ukrayinska Pravda as soon as he gets permission from his patient.
[Nayem] Tell me why did you decide to talk about your patient at precisely this time?
[Bohomolets] It's simply that my patience had become exhausted to such an extent that I can no longer keep silent. But I had no right to violate the law of medical secrecy. The staff and patients of the clinic who at one time had seen Mr Yushchenko there several times are asking me why I am keeping silent, why I am not telling the truth. And this made me ask permission from my former patient to breach medical ethics.
It was my personal initiative. Mr Yushchenko never asked me to comment on his state of health. Now I've received permission, and so now I can tell you everything I know.
[Nayem] Were you given recommendations on Bankova [street where presidential secretariat is housed] about what to say or not to say during the interview?
[Nayem] In 2004 did you support Maydan [Kiev's Independence Square, heart of the Orange Revolution that swept Yushchenko to power] and vote for Yushchenko at the election?
[Bohomolets] Yes. I was on Maydan in 2004 as a doctor. And I gave help to everyone who needed it regardless of their political convictions. I have always been, and still am, opposed to the division of Ukraine for any reason. We are identical.
[Nayem] When did you get to know Mr Yushchenko?
[Bohomolets] In December 2004, some time in late December. I was phoned by Mykola Yefremovych Polishchuk [presidential adviser for medical issues] and asked to be in the clinic at a set time. Later he brought Mr Yushchenko to the clinic.
[Nayem] Did just the two of them come, or were they accompanied by anyone?
[Bohomolets] No, there was no-one apart from the security.
[Nayem] Did Mr Yushchenko come himself, or was he brought in on a wheelchair?
[Bohomolets] No, he came independently, and walked to the second floor.
Yushchenko's bravery and affability
[Nayem] What precisely did the future president want from you as a doctor?
[Bohomolets] There were various tasks presented to me at various stages of treatment. Right then in December I was asked to try to stop the skin process that the patient was developing and to remove its manifestation.
Later, when I became the president's personal doctor, I continued independently to carry out local treatment and I also monitored the conduct of the general treatment that was set in the Geneva clinic. I also received letters from people proposing treatment methods, poultices and jars - I analysed them and made conclusions about their advisability and possibility of application.
I received recommendations and was in constant correspondence with Geneva. I reported what I had done, how the illness was proceeding and what procedures had been carried out, in order subsequently to take correct decisions collegially.
[Nayem] Did Viktor Yushchenko himself talk about his illness or make any assumptions?
[Bohomolets] Understanding the status of my patient and my own, experiencing simply respect for the enormous courage of Mr Yushchenko, I didn't ask any questions which were not directly relating to my work. During the operations I tried to distract the patient and talk about something cheerful.
The only thing that Mr Yushchenko said about his illness was the time of the appearance of the skin rash. In his words, it appeared at the end of September, the beginning of October. Prior to that, in his words, there had been no rash.
[Nayem] Do you remember how the president behaved during treatment?
[Bohomolets] When entering reception, Mr Yushchenko greeted the staff and patients. He was always affable.
People behave in various ways on the operating table. There are some people who are brave and some who are not. Just imagine that all your body and face is affected, that everything hurts, and, after all it's not just pimples, it's cysts and wounds... [ellipsis as published], and it's very painful!
But Mr Yushchenko never complained. Sometimes he was simply falling asleep from fatigue, and sometimes the reverse: he would even tease me.
What is more, apart from the medical issue, there was also a purely aesthetic one. I have treated many children and adults with development flaws, when a person does not look like other people. And I know how hard it is to look in the mirror and understand that you are different and can't do anything about it. It's something that breaks some people forever, while others continue to fight, live and work, understanding the differences between form and essence.
[Nayem] How were the procedures conducted, for example during official visits?!
[Bohomolets] Exactly the same, only without an operating table. In the hotel after the end of the whole working programme, when everyone was already sleeping, I would unfold a mini-operating table.
On official visits we would take three to four shirts a day, because the bandages would not hold out, they would be saturated in blood and the shirt had to be changed after each bandaging to prevent his jacket from being saturated.
Treatment did not affect ability to work
[Nayem] You say that Viktor Yushchenko was undergoing constant treatment, including pain-killers. Might his illness or therapy affect his ability to work and ability to take appropriate decisions?
[Bohomolets] I see what you mean. Mr Yushchenko took pain- killers without sedative effects, i.e. not containing narcotic substances and not influencing activity of the brain. I did not see any signs in him of lack of balance or slowdown or any inadequacy in decision-making. He was always benevolent and adequate; he didn't like speaking with the use of notes. He analysed all the information himself, managing to do it even when being bandaged.
What is more, I was surprised by the life force. Before me was someone who was very ill, who had wounds all over his body under his shirt. But Mr Yushchenko went out to the rostrum with a smile and spoke about our country's fine prospects.
One evening, during a scheduled visit with a working rota of six a.m. to midnight, I complained of tiredness. Mr Yushchenko said: Olya [diminutive of Olha], what are you complaining about? You don't yet know what the rota would have been, had I been healthy.
And so, when I looked at the president standing on the rostrum of the Bundestag or the US Congress, I thought if the people sitting in the hall could knew what his body looked like - all covered in wounds, bandages and drainage-tubes - they would probably have listened to him on their feet, bowing to his courage to live for Ukraine, forgetting about himself.
[Nayem] Tell me, in December did you receive Mr Yushchenko in the clinic, or did you go out somewhere as well?
[Bohomolets] Yes, only here. In 2005 I was also going to the secretariat. In December I also went to the dacha several times. At that time Mr Yushchenko simply could not come to us because of his busy schedule.
[Nayem] I was told that it was the dacha of Oleksandr Tretyakov [former unpaid adviser to Yushchenko].
[Bohomolets] Possibly, but I didn't know that, and I didn't see anyone there apart from Mr Yushchenko and members of his family and service staff.
[Nayem] I know that you had some sort of conflict when black and blue spots appeared on Viktor Yushchenko's face after the inauguration.
[Bohomolets] Amazing... [ellipsis as published] I don't know anything about my conflict with Mr Yushchenko! There was a certain change in colour, but it was caused by the patient's illness and the processes taking place in the skin. Apart from that, the formation of cysts led to haemostasis in the skin - they occupied the whole space and pressed on blood vessels, which intensified the cyanosis, i.e. the darkening.
[Nayem] At that time were you able to determine what precise processes were taking place in the patient's body?
[Bohomolets] I knew perfectly clearly that my patient had a skin disease, and a reaction of the skin covering to an intoxication whose cause was unknown to me. Therefore, it was not simply an illness that suddenly appeared and could be treated, but a pathological process, i.e. an illness that was at a certain stage of development.
Unfortunately, it was impossible to carry out any medical procedure that would radically improve the exterior, since every day new elements were appearing. I personally found talk about why the president was not dealing with his external appearance very hurtful, since every day we were winning back literally millimetres of skin on his face and body.
For example, laser polishing could not be done, because new cysts were constantly appearing, and no external application could halt that process.
My job was to create a foundation so that in future Mr Yushchenko would look better. And today you can judge the correctness of that approach.
In December I saw erosions, little wounds and little scabs. It was explained to me that they had appeared in the place where a trial laser procedure had been conducted.
Later [Swiss] Dr Sora told me that they had carried out a trial laser procedure on Mr Yushchenko in Geneva on several sections of facial skin. Two weeks later wounds still remained there. And I had to heal them in order at least to be able to put on some make-up, since, when there are open wounds, make-up cannot be applied to avoid infection.
Rashes covered Yushchenko's entire body
[Nayem] Now, when the president bathes in an ice-hole, traces of the disease are not visible on his body. Were they there at the time, or was it only his face that was affected?
[Bohomolets] At the time of our first meeting in December there were rashes in his underarm areas, on his neck, face and ears. Later they appeared on the scalp, on his chest, back and legs. With every month they occupied more and more space. The peak of the rashes came in March-June 2005, when there was virtually no unaffected area on his body.
[Nayem] Was the rash on the face and body identical?
[Bohomolets] The rash was identical all over the body, but with special features of flow that depended on the location. Such deep cysts as there were on the back and thighs could not have been present, for example, on the scalp or face. That's because the skin there is held very close to the bone, and cysts the size of nuts cannot physically develop in those parts.
[Nayem] Could it not have been a manifestation of various diseases?
[Bohomolets] No. The clinical initial phase was identical everywhere.
[Nayem] Why did traces of the illness finally remain only on his face?
[Bohomolets] In actual fact, there are these small scar changes all over the body. How the skin reacts and how regeneration takes place, i.e. the restorative process, is another matter. The scars are gradually regressing. It's happening quicker on the body.
The skin on the face has the largest quantity of sebaceous glands, and there were more cysts there, since the process taking place in the organism was connected precisely with the sebaceous glands. Throughout the illness only the palms and soles of the feet were free from rashes. They are the places where there are no sebaceous glands.
[Nayem] As a doctor, were you familiarized with Yushchenko's case history? Did you see any documents?
[Bohomolets] In December I was not shown the case history. But I never had any need to receive that history. I had my own case history.
[Nayem] But before you start treatment, you have to know what you are treating a patient for.
[Nayem] What were you treating Viktor Yushchenko for?
[Bohomolets] In December I was treating Mr Yushchenko for the skin manifestations that I observed. With the help of the relevant medical procedures that could accelerate the resolution of the pathological process that I observed in the patient. It was draining the cysts and healing the wounds.
[Nayem] What was your preliminary diagnosis for Viktor Yushchenko?
[Bohomolets] A reactive (that is, connected with affect of some exogenous, external toxin) change to the skin in the form of a diffuse acne-like rash, single and multiple cysts.
At the time he came to me, Mr Yushchenko had neither clinical manifestations of herpes nor other skin diseases. I have photographic documentation that, if necessary, I can present and prove that clinically at that time in December Mr Yushchenko did not have any of the above-listed dermatological diseases.
[Nayem] Let us look at it from another side - did you personally carry out any analyses of the patient in your clinic?
[Bohomolets] Not in December.
[Nayem] I don't quite understand. Viktor Yushchenko was not an ordinary patient, and you could not have failed to realize the responsibility placed on you. How could you have embarked on treatment without carrying out any preliminary analyses?!
[Bohomolets] For the start of treatment there was no need to conduct any clinical analyses. I'll explain it to you in simple terms. You've crumpled your shirt. It's of no importance to me where you crumpled it and with what. I take an iron and iron it. If you were injured and were losing blood, what would you prefer: for the doctor to stop the bleeding or start finding out when and how it happened?
[Nayem] But after all, you decided on some treatment for him and probably gave the patient some medicines and he was taking something.
[Bohomolets] Not in December.
[Nayem] Then what did the treatment consist of?
[Bohomolets] In December it was carrying out exclusively operational procedures of low invasiveness at the level of the skin and subcutaneous fat cells. When someone has a new formation - in this case of a cyst - it is painful and needs draining. This means that the cyst is lanced, drainage tubes are applied, bandages are put on, time passes while the cavity becomes clean and then the wound heals.
[Nayem] But did you give him some pain-killers?
[Bohomolets] We used only local anaesthetics. If we're talking about systemic treatment, in December Mr Yushchenko was already undergoing the systemic treatment that was set for him in Geneva. Pain-killers were a component part of that course of treatment, since the pain was colossal. Nobody can live with constant dreadful pain.
[Nayem] But even if you were using local means, you should have known the reaction of his organism to those medicines. When taking up treatment, you should have understood all the risks. Were analyses really not conducted even for that?
[Bohomolets] There is no need to make additional analyses for this. We did a test for sensitivity in order to find out whether the patient had any allergies. For this a tiny button is inserted into the forearm by an insulin needle. And that's all.
[Nayem] Let's try again. Do I understand correctly that absolutely no analyses were carried out on Mr Yushchenko in your clinic?
[Bohomolets] Not in December. But later, here in the clinic, I took samples of blood, skin, cyst content and even hair. But I did not carry out any studies apart from ordinary urine and blood analyses. I handed over all the samples in sealed containers that were signed and packed by me personally to a senior person.
[Nayem] Who was that?
[Bohomolets] The chief of the presidential guard, Pavlo Alyoshyn.
[Nayem] Were you told why you were taking the samples?
[Bohomolets] No. I was tasked by Dr Sora with putting blood samples from Mr Yushchenko in special containers. It's difficult to imagine the use of those samples for anything other than additional research. The blood was cooled in special vacuum flasks and taken to the airport, since the level of laboratories in Ukraine does not allow for additional research needed for the patient.
[Nayem] Where else did Viktor Yushchenko undergo treatment in Ukraine?
[Bohomolets] Nowhere. Only with me in the laser medicine clinic at 17 Shevchenko Boulevard. Dr Sora, who came to Ukraine, carried out the necessary treatment at our base as well. At that point Mr Yushchenko was not looked after even in the 4th [medical] directorate. Neither did he go there when he was already president.
[Bohomolets] It was his decision. Mr Yushchenko did not go there until certain personnel rotations were made.
[Nayem] He didn't trust the doctors who were there at the time?
[Bohomolets] It's hard for me to read the president's thoughts. There was a rather serious situation: irregular heart rhythm. When I diagnosed it, I said that he had to be treated as an in-patient. Mr Yushchenko categorically refused. Nevertheless, I insisted, and we went to the 4th directorate.
We had to take the necessary consultants there from outside and also check the results of the analyses and cardiograms by telephone with the Geneva clinic. From Geneva they confirmed that the arrhythmia was a possible toxic manifestation of the influence of dioxin on the heart. We managed to arrest the attack quickly and the following day we already flew out on a foreign visit.
[Nayem] The operations that you carried out are some of the 24 that have already been mentioned?
[Bohomolets] No. In Geneva operations were carried out under general anaesthetic, and I took part in some of them. The operations that I myself did in Kiev took place under local anaesthetic, and there were considerably more of them: several hours two or three times a week. That is much more than 24.
[Nayem] In what way did the operations in Geneva differ from what you did?
[Bohomolets] In principle, not at all. There were differences in the volume of intervention and the type of anaesthesia. The point is that the cysts on the patient's body were very deep, and it was simply impossible to drain them under local anaesthesia. Apart from that, fatty tissues were removed in Geneva, since after conducting studies on various tissues, it was proved that the highest concentration of dioxin was found precisely in fatty tissues.
[Nayem] Who carried out those operations?
[Bohomolets] A group of doctors from Geneva under the leadership of Dr Sora. There were about five or six surgeons, including me, working simultaneously on the operations, in order to drain the maximum number of cysts in the minimum amount of time. There were no other specialists from Ukraine.
[Nayem] Who was with Viktor Yushchenko in the hospital during those visits?
[Bohomolets] Only me. Mr Yushchenko is not fluent enough in English to be asked how he felt as he recovered from the anaesthetic, and explained that another blood analysis had to be done. All the time that I was working there I was with him in the hospital round the clock.
[Nayem] Did someone check what you took with you on the visits, what you were doing to him?
[Bohomolets] Yes. My case was always under observation and monitoring. It was either carried by me or with the security guards. And the list of medicines was available for verification.
[Nayem] You say that it was impossible to carry out such additional analyses in Ukraine. What do you mean: is there not such machinery in the country or are the laboratories simply not certified?
[Bohomolets] As far as I know, the laboratories are insufficiently equipped to carry out toxicology studies at the highest level of complexity.
Concilium agreed treatment
[Nayem] Tell me what is your educational?
[Bohomolets] In 1989 I graduated from the therapy faculty of the Kiev Medical Institute and in 1991 I got a clinical registrarship in dermatology. In 1993 I presented my candidate's thesis on allergic dermatosis. In 1994 I took a course in dermatological pathology at the Bernard Ackerman Institute in the USA and in 1997 a course in ecological dermatology at Pennsylvania University, also in the USA. In 2003 I presented my doctoral thesis on the theme of blemishes in skin development. Apart from medicine, I have a degree in psychology.
[Nayem] From the side the impression is being created that Viktor Yushchenko throughout his illness was being permanently treated only by dermatologists, people who in effect were putting his external appearance back to normal. For both you, Rostyslav Valikhnovskyy and Sora the primary qualification is dermatology. But who is treating the president for what happened to him?
[Bohomolets] Are you familiar with the concept medical concilium? There is one senior person, and that person gathers all the people he needs to take the correct decision. These conciliums in Geneva were attended by a cardiologist, a toxicologist, a traumatologist, an anaesthetist and all the necessary specialists.
[Nayem] But why were they all headed by the dermatologist Sora rather than, say, a traumatologist or a toxicologist?
[Bohomolets] Here it's not a question of who is a doctor by specialization. The question is how far a specialist can think systemically. Dr Sora is a dermatologist with a world reputation, who gathered the best international specialists.
If you are a journalist on political affairs, does that really mean that you cannot write professionally on another topic? After all, you have a basic competence. And the main thing is to have talent, ability and a desire to get to the bottom of the situation.
[Nayem] But once again, you knew him as a dermatologist. You didn't know him as a toxicologist.
[Bohomolets] Other people were toxicologists. I repeat yet again - the basic manifestations of Mr Yushchenko's illness were dermatological. The main thing that worried the patient was the changes to his skin and a non-dermatologist could not deal with them. And, correspondingly, what worries the patient should determine which doctor is in charge.
Let us say that someone has a trophic ulcer on his foot, but its cause is diabetes. One dermatologist will treat the ulcer before gangrene sets in, and another will say: My dear fellow, you need treatment for diabetes.
Because, on seeing the trophic ulcer, he will clearly understand that if the patient does not lower his blood-sugar level, the ulcer will never heal. And an endocrinologist will not deal with a trophic ulcer at all, just as a toxicologist will not deal with multiple cysts on the skin.
No doubt that dioxin was the cause
[Nayem] OK, let's accept that. But who was the specialist treating Yushchenko specifically for the dioxin poisoning?
[Bohomolets] The concilium. After all, there is simply no experience in treating such poisoning. There was no doctor who could have come and said: I've had 10 exactly similar patients. This is what I did for them and they got well. What is more, there are no natural antidotes or medicines against dioxin. That is why treatment was sought collegially.
[Nayem] During your stay in Geneva did they talk with you about the causes of the illness, or was it only the official theory of dioxin that was current?
[Bohomolets] There were no other theories. There was discussion at the conciliums of the schedule of change in the concentration of dioxin in the blood. After an operation was carried out a fatty depot was removed and a repeat analysis was made.
Since, on the basis of an examination of various tissues, it was proved that there was no dioxin in the skin. There are changes in the skin, but the substance itself is not present there, since it acts indirectly and there is a chain reaction. The biggest concentration of dioxin was in the fatty tissue. And that fatty tissue was simply removed mechanically to reduce the content of dioxin in the organism.
After that, the doctors met and discussed the dynamic of the analyses. There were between five and eight specialists. There was an anaesthetist, a cardiologist, a traumatologist and a pathologist, because as a consequence of the intoxication there were temporary changes in various organs.
For example, there was a bursitis - a build-up of liquid in the articular sacs. Both of Mr Yushchenko's elbow joints were affected. The doctors insisted on doing a puncture and I insisted on not doing it. As a result I stood up for therapeutic treatment for three weeks, and I succeeded in two weeks in removing the liquid by local procedures in Kiev.
[Nayem] In Geneva were you shown the full case history of Viktor Yushchenko?
[Bohomolets] The full case history? No. I never saw it, and I didn't need it - I had my own case history.
[Nayem] During the collegium of doctors was the theory of dioxin poisoning adopted definitively, or were there doubters?
[Bohomolets] No, nobody cast doubt on the diagnosis.
[Editor's note: Part 2 of Mustafa Nayem's interview with doctor Bohomolets was posted on Ukrayinska Pravda on 17 July. Nayem asked Bohomolets unprofessional questions about various diseases whose symptoms in Navem's view looked similar to Yushchenko's condition during the period in question. Bohomolets insisted that Yushchenko had been poisoned with dioxin and rejected Nayem's allegations that Yushchenko could have had pancreatitis, suffered from side effects of cosmetic surgery, overdose of hydrocortisone, could have had rosacea, lepra, etc. Bohomolets also said that she had not been paid for treating Yushchenko and that the traces of dioxin poisoning are likely to remain on Yushchenko's face forever. No further processing of part 2 of the interview is planned.]
Originally published by Ukrayinska Pravda website, Kiev, in Russian 16 Jul 08.
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