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Ukrainian Rural Doctors Visit Alberta

By New Pathway -Mar 6, 2018

The Calgary Branch of UCC organized a “Meet and Greet” fellowship on January 22, 2018 for three visiting medical doctors from Ukraine. The meeting was held in the board room of the Assumption of the BVM Ukrainian Catholic Church, who support cultural events. The University of Calgary had just held a 3-day course “Emergency Medicine for Rural Hospitals.” This was the 34th Annual Conference and was held at the Banff Park Lodge. The vision of this course was to provide clinical topics relevant to physicians, nurses and other healthcare professionals who practice in rural communities The Ukrainian Canadian Professional and Business Association (UCPBA) of Calgary co-sponsored this community event.

Bohdan Romaniuk, President of the UCPBA Calgary opened the meeting by welcoming the doctors and shared information about the Canada-Ukraine Foundation (CUF) and its President Victor Hetmanczuk and the phenomenal work that he and the organization is doing with help in Ukraine. The three doctors — Orest Kulenych from Ternopil, Vadym Vus from Rivne and Ihor Zastavnyy from Lviv region, had come to Alberta. Travelling and morally supporting the visitors was Victor Hetmanczuk. CUF has raised millions of dollars in funding for emergency medical assistance to Ukraine, especially to those affected by the war in the Donbas. Both Bohdan Romaniuk, and Victor explained the function of the Canada Ukraine Foundation and how it has been supporting medical help and doctors going to Ukraine to take care of the needs of patients and their families hurt in the war ongoing in Ukraine

Having visited our hospitals in Calgary, the three visiting doctors with amazement in their voices told those present how impressed they were with our Canadian system of healthcare. The availability of buses fitted with medical equipment and supplies that go to rural areas here in Alberta with help to those in need, including our STARS ambulance helicopter service. The sharing of ideas and support of medical staff was another important realization for them. Ukraine’s medical system differs from the Canadian one. The young doctors, and medical students present shared information. For example, the doctors who work in the villages are not allowed to do sutures, they send their patients to hospitals in the nearby cities, yet Danylo a first year medical student at U of C, learned to do them his first day in medical school.

Dr. Semkuley, who with his wife Elaine of Medical Mercy have been going to Ukraine for over 30 years with humanitarian help, compared experiences they had during their visits every May to villages in Western Ukraine and teaching the villagers to help themselves by building and renovating in their villages. Learning how they could improve their facilities on their own, not waiting for the government to help them. It has changed very slowly over the years and sometimes not. Dr. Ihor Zastavnyy mentioned that Ukrainians are starting to understand volunteerism, especially since the Revolution of Dignity and making positive changes by volunteering and organizing volunteer groups.

One of the doctors shared an experience of how it hasn’t changed. While attending to a patient when volunteering for ATO in Eastern Ukraine, a woman from the village learned he was from Western Ukraine and referred to him as Bandera “Banderivets”. She was apprehensive about him caring for her. He, in turn, said let me examine you and then you can judge me. She ended up telling him that she is immediately going to call her friends in Russia and Crimea and tell them that he was normal.

Most rewarding for those of us attending that evening was that we shared our love for Ukraine and wanting Ukraine to have the same level of healthcare that we in Canada are blessed with. In fact, within days Dr. Vadym Vus wrote the following: “Thank you very much for your warm meeting! We are already in our Motherland and it is pleasant to realize that your hearts are open to Ukraine. We will already extend the knowledge, experience and contacts that you have discovered for us. Blessing to your community and waiting to meet with you in Ukraine!” Vadym Vus.

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Canada-Ukraine Foundation’s Medical Missions in Kyiv: Part 3

By New Pathway -Apr 23, 2019 – Victor Hetmanczuk, Canada-Ukraine Foundation.

CUF’s team operates at the Ukrainian Military Hospital.
Photo: Adriana Luhovy

During the missions, we also provided training to military surgeons, surgical trainees and nursing staff at the Central Military Hospital Clinic (CMHCK). These Ukrainian medical personnel are already in the front lines treating war casualties in the country’s foremost trauma centre. All patient consultations and all surgical procedures were performed in collaboration and with the active participation of Ukrainian surgeons and anesthetists. The projected number of people that would be trained and have their surgical skills enhanced was exceeded. There was such a huge thirst for learning and knowledge from our Ukrainian colleagues that people were constantly coming and observing. Operating tables would have up to 20 people surrounding each of them at any given time.

Each of the 2 missions provided direct intensive intraoperative training to the CMHCK staff: 3 anesthetists, 3 anesthesia assistants, 5 surgeons, 3 surgery assistants/trainees, and 2 nurses. In addition to these 16 people, direct intraoperative training and teaching was provided to 65 visiting surgeons, nurses and medical students. Throughout the mission, military neurosurgeons, maxillofacial surgeons, ENT (ear nose and throat), trauma and plastic surgeons and trainees from Kyiv, Odessa, Lviv, Dnipropetrovsk came and went. In total, over the two medical missions, 81 people (many that observed the first mission returned to observe during the second mission) were able to enhance their skills through training obtained during the course of the medical missions.

The training was provided according to standards employed in Canada for Continuing Medical Education (CME) and resident training. Ukrainian health professionals actively participated in:

  1. Patient assessment, physical examination, radiographic examination
  2. Formulation of treatment plan and surgery preparation
  3. Discussion of options, variables, risks, and risk management
  4. Practical demonstration of requisite surgical skills
  5. Instruction in postop management of pain, infection prophylaxis, etc.

Resident teaching and training is vastly different in Canada and Ukraine, with the Canadian system being much more formal and defined in terms of teaching standards, methods, requirements for competence-based learning, availability of educational resources. One of the unexpected outcomes and legacies of these missions was the demonstration of resident training methods employed in Canada, and the enthusiasm with which local Ukrainian trainees responded to these efforts.

In an effort to maintain and develop this ongoing clinical and educational collaboration across borders, a decision was made to develop a Telemedicine Program. Experience previously obtained in developing live surgery demonstrations for International CME programs (Advanced Craniomaxillofacial Forums) and research of current technology and standards for two way videoconferencing through “Sunnybrook telemedicine” and “Ontario Telemedicine Network” facilitated the design of a telemedicine system that would optimally serve the patient care and educational needs at the Kyiv Main Military Hospital.

The Telemedicine system will be used to:

  1. Document relevant surgical cases performed by orthopaedic, craniofacial, hand and microsurgeons, and neurosurgeons at Sunnybrook Hospital
  2. Conduct combined surgical rounds and seminars featuring recorded surgical cases
  3. Perform remote clinical or radiological consultations

The equipment necessary to establish a telemedicine/ telesurgery link between Ukrainian and Canadian Trauma Centres was selected following presentations and quotes by Stryker Endoscopic Systems and Panasonic. Panasonic was chosen based on quality of product and best price. The system comprises 3 hubs:

  1. A portable OR cart with camera and video recorder. This will be available to any Sunnybrook OR performing relevant surgery. The recorder allows documentation of data from multiple sources: overhead camera, head cam, and computer (for CT data, and powerpoints)
  2. Telecommunications Hub at Sunnybrook Hospital
  3. Telecommunications Hub at Kyiv Main Military Hospital

Panasonic professionals came to Sunnybrook to teach Dr. Antonyshyn the most effective way to set-up and use the equipment. Dr. Antonyshyn shared this information with his Ukrainian colleagues.

The use of two-way videoconferencing and advanced information communication technologies to deliver examinations, treatments, clinical, and education services will allow Sunnybrook Health Sciences in Toronto and the CMHCK to collaborate, share knowledge and consult patient cases for years to come. Dr. Antonyshyn has the same implants, instrument sets and pieces of equipment that were purchased for the CMHCK (to create a centre of excellence in Craniofacial surgery) at Sunnybrook Health Sciences. Since our second medical mission, our colleagues have continued to use the new technologies that were purchased for them. Through telemedicine, Dr. Antontyshyn will continue to train his Ukrainian colleagues to use the new equipment, instruments and implants, that were donated to them, as efficiently and effectively as possible by consulting on specific cases and organizing viewings of his complex surgeries. Dr. Antonyshyn in Canada and Dr. Ihor Fedirko in Ukraine are both committed to using this educational tool for years to come.

Further refinement of these initial efforts and wider adaptation of Telemedicine through Ukrainian Medical teaching centres can potentially revolutionize training of health professionals and delivery of health care. This leaves a legacy.

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Canada-Ukraine Foundation’s Medical Missions in Kyiv: Part 2

By New Pathway -Apr 18, 2019 – Victor Hetmanczuk

Canada Ukraine Foundation’s medical missions, which were held in 2015-2016 at the Central Military Hospital Clinic in Kyiv (CMHCK), provided consultations and surgical reconstructions to patients with complex traumatic defects. The missions also aimed to deliver technology, equipment, surgical tools and supplies to create a centre of excellence at the CMHCK. The specific resource deficiencies that restrict delivery of primary trauma care and sophisticated trauma reconstruction in Ukraine were previously identified during two prior CUF-sponsored missions to the CMHCK and a country-wide needs assessment mission performed in April, 2014. This project’s objective was to provide the technology, surgical equipment and supplies, and the device training that ensure maintenance of global standards of care, during the course of surgical missions and in the future.

List of purchased equipment:

  • Complete sets of surgery instruments: (purchased in Canada)
  • Complete power system for bone cutting and shaping (purchased in Canada)
  • Complete Stryker bone fixation system with sufficient hardware and implants to perform surgery for 2 years (purchased in Canada)
  • 1 tourniquet to allow bloodless extremity surgery (purchased in Canada)
  • 3 reusable cuffs for the tourniquet (purchased in Canada)
  • Orbital implants (purchased in Canada)
  • Titanium meshes for bone defect reconstruction (purchased in Canada)
  • Suction drains (donated in Canada)
  • 3 cautery and haemorrhage control systems (purchased in Ukraine)
  • 8 bipolar cautery forceps (purchased in Ukraine)
  • 2 advanced surgical head-lighting systems (purchased in Ukraine)
  • 1 computer system to allow intraoperative visualization of patient CT and other Xray data (purchased in Ukraine)
  • 1 pantographic X-ray system (purchased in Ukraine)
  • 1 multi-use operating table (purchased in Ukraine)
  • 1 portable autoclave for sterilization (purchased in United States)

The capital equipment purchase made possible by GPSF generated a tremendous impetus for industry, institutional and volunteer donations of medical devices and disposables. Hospitals and medical supply companies contributed in-kind donations towards both missions (this includes but is not limited to Sunnybrook Health Sciences Centre, Trillium Heath Care providers and St. Michael’s Hospital in Toronto). Disposables (sutures, staples, gloves, gowns, drapes, medication, etc worth tens of thousands of dollars) were essential for surgery, and were sent to Ukraine in advance of each of the missions.

Some of the larger donations included:

  • Stryker Canada provided us with a grant for equipment and implants for the first medical mission valued at $152, 544 (as mentioned previously).
  • Calavera Surgical Design donated $37,500 worth of custom, molds, forming tools, and custom implants for skull defect reconstruction.
  • For each mission, Health Partners International Canada provided us with medications to support our mission that valued over $20,000 each.
  • $9,000 McGvath Video Laryngoscope
Calavera molds, forming tools, and custom implants

It is important to note that in addition to the purchase and delivery of the latest surgical technology, specific training in the direct application of this technology was provided during the course of both missions.

For example:

  1. Prior to this mission, CT scan images essential for surgery had to be anticipated and printed on photgraphic transparency sheets as hardcopy to be brought to the Operating Room on the day of Surgery. The Canadian mission installed a computer system with the necessary software in the operating room to allow sophisticated CT data visualization intraoperatively.
  2. Bone fixation systems were grossly deficient and most complications in fracture healing occurred as a direct consequence of inadequate fracture stabilization. The GPSF allowed delivery and implementation of state-of-the-art bone fixation systems which dramatically altered craniofacial fracture repair outcomes.
  3. Calavera Surgical Design system was specifically designed to facilitate rapid, efficient, durable and anatomically accurate reconstruction of skull defects resulting from gunshot and shrapnel wounds. This provided a very practical and readily adaptable solution for the neurosurgical services.
Canada Ukraine Foundation's Medical Missions in Kyiv. Part 1
Canada Ukraine Foundation’s Medical Missions in Kyiv. Part 1
Canada-Ukraine Foundation’s Medical Missions in Kyiv: Part 3
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Canada Ukraine Foundation’s Medical Missions in Kyiv: Part 1

By New Pathway -Apr 11, 2019 – Victor Hetmanczuk

Dr. Oleh Antonyshyn operates during CUF’s medical mission in Ukraine

Canada Ukraine Foundation has so far held six medical missions in Ukraine. This number includes two missions in Kyiv in 2015-2016 which were held at the Central Military Hospital Clinic in Kyiv (CMHCK) paid by the Canadian government through Global Peace And Security Fund (GPSF).

The main purpose of these two missions was to provide consultations and surgical reconstructions to patients with complex traumatic defects who would otherwise not receive treatment. The missions were carried out as planned and exceeded their targets.

The first surgical mission was completed Oct 21 – Nov 1, 2015. It was overwhelmingly successful:

  • 21 Canadian medical professionals participated, including 3 craniofacial surgeons, 1 neurosurgeon, 1 hand microsurgeon, 2 surgical residents, 10 nurses, 2 anesthetists and 1 hand therapist.
  • 90 patients with war traumas were seen in consultation. Ukrainian surgeons, anesthetists, nurses and trainees were actively engaged in the triage, management and preoperative assessment for each patient.
  • 93 surgical procedures were completed on 38 patients. Detailed intraoperative instruction was provided in a variety of trauma reconstructive procedures. 34 patients underwent hand therapy.
  • Ukrainian surgeons, anesthetists and surgical assistants actively scrubbed and participated alongside Canadian specialists in each of the 93 procedures. Three operating tables were run daily from 9 am – 7 pm for 5 consecutive days.
  • In addition to those scrubbed and directly assisting in surgery, medical professionals from across Ukraine (other Kyiv hospitals and other military hospitals in Lviv, Odessa, Kharkiv, Zaporizhzhya and Dnipropetrovsk) attended surgery for educational purposes. Ukrainian medical students volunteered their time and translated for both missions while being exposed to surgeries and learning opportunities they would have otherwise never had the chance to observe.
  • Patient population included 36 military men, one child and one civilian woman. Both the child and the woman were victims of war.
  • The value of services provided during the course of this mission was calculated based on the costs to the Ministry of Health if the same services were provided to Canadian patients in Ontario. The OMA Schedule of Benefits and the Ontario Ministry of Health Healthcare Indicator Tool were employed in determining these costs. During this first mission, the value of surgical services provided by Canadian professionals totaled CAD 489,578.10.

The second surgical mission to Kyiv was completed from February 18 – 29, 2016 at the CMHCK. It was extremely successful as well:

  • 21 Canadian Medical Professionals participated, including 3 anaesthetists, 3 craniofacial surgeons, 2 hand and micro surgeons, 6 OR nurses, 2 clinic nurses, 3 PACU nurses, 1 hand therapist. The President of Canada Ukraine Foundation, Victor Hetmanczuk, joined the team to observe.
  • 105 patients with war trauma were seen in consultation. Ukrainian surgeons, anesthetists, nurses and trainees were actively engaged in the triage, management and preoperative assessment for each patient.
  • 61 surgical procedures were completed on 40 patients. Detailed intraoperative instruction was provided in a variety of trauma reconstructive procedures. 39 patients underwent hand therapy.
  • Ukrainian surgeons, anesthetists, and surgical assistants actively scrubbed and participated alongside Canadian specialists in each of the 61 procedures. Three operating tables were run daily from 9 am – 7 pm for 5 consecutive days.
  • In addition to those scrubbed and directly assisting in surgery, medical professionals from across Ukraine attended the procedures for observation. The amount of time that each person observed or participated in the surgeries varied, based on their experience and particular educational needs or interests. Many of these people attended the first medical mission for observation as well.

As funding from the GPSF did not arrive in time to make many of the purchases, which were needed for the first medical mission in October, Stryker Canada was kind enough to loan CUF power equipment and bone fixation instruments, as well as provide us with an industry grant for implantable materials essential for the success of the first medical mission. Stryker Canada in-kind support was valued at $152, 544. The equipment, which was lent to us, was returned upon arrival back to Canada and the implants were left in Ukraine. The craniofacial bone fixation equipment (the equipment that Stryker had lent to us) was purchased in Canada in time for the second medical mission in February and remains at the CMHCK. 1 of 2 

Above: State-of-the-art surgical technology was utilized in reconstructing the most complex casualties of war: 22 yr old male with post shrapnel defect skull, forehead and brow. Pre-op CT scan showing massive skull/forehead defect. Post-op CT showing total skull and orbit reconstruction with custom titanium mesh. Pre-op patient photo demonstrates horrendous deformity. Post-op photo, day 3 post surgery, patient fully ambulatory, with restoration normal features forehead.

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CUF Helps Ukraine Develop Its Rural Medicine

By New Pathway -Mar 27, 2019

Victor Hetmanczuk, Canada Ukraine Foundation for New Pathway – Ukrainian News.

Canada Ukraine Foundation has been assisting Ukraine in various medical needs since 2014. The poor conditions of Ukrainian rural medicine have been in the spotlight for quite some time. When President Poroshenko announced in August, 2017, that Ukraine was going to invest into improvements of its rural health system UAH 4 billion (CAD 200M), it was time to start assisting Ukraine in this process. One of the ways to do that was to share the experience of Canada’s rural medicine with Ukrainians.

In September, 2017, CUF’s President Victor Hetmanczuk sent an email to the Acting Minister of Health Dr. Ulana Suprun to propose a project that would bring three rural doctors to the University of Calgary’s annual Emergency Medicine Conference for Rural Hospitals in January 2018.

The Ministry of Health sanctioned the trip in October, 2017. Candidates would be selected through an open contest. They had to work in villages, speak English and write a 300-word motivational letter why they wanted to attend the conference.

Out of 50 clean applications, in December, 2017, Victor Hetmanczuk from CUF and Deputy Minister of Health Oleksandr Linchevskiy picked three successful candidates.

CUF became the sole sponsor and organizer of the project, starting from Canadian visas, travel arrangements to facilitation during the visit. The total budget of the project amounted to CAD $ 14,400.

The Ukrainian doctors participated in the conference on January 19 to 21, 2018, in Banff, Alberta and were able to observe local hospitals and emergency services. As the conference’s sessions progressed, Ukrainian doctors showed genuine interest and asked questions of the main speakers and other participants.

The doctors also visited a hospital in Canmore, population 14,000, and a Community Mental Health clinic located in a shopping centre in Calgary.

At the University of Calgary campus, they watched a live demonstration of the Rural Videoconference Program. This is a series of weekly, one-hour educational sessions via video conference presented by clinical experts. There were over 60 sites connected for this session. Presenter was in Thunder Bay, Ontario. Each presentation was focused on evidence-based information that is directly applicable to rural primary care and hospital environments.

A one-hour meeting was held with the Director of the Continuing Medical Education program who explained to the Ukrainian doctors how the system works in Alberta.

The Banff Rural Hospital was next door to the conference venue, so participants had the workshops in a real emergency room. They also studied the STARS air ambulance system and visited the STARS mobile training bus, parked in the hospital parking lot.

It needs to be noted that Canadian rural hospitals are not equivalent to the Ukrainian ones – there is a big gap in infrastructure and services performed. Some topics at the conference were not applicable for the Ukrainian participants due to current state of affairs in the Ukrainian rural health system. But this gave the doctors valuable information on how the Ukrainian system needs to develop.

One of the participants, Ihor Zastavnyy, a general practitioner from Krakovets, Lviv oblast, noted that a plan needs to be formed for development of Emergency Rooms in Lviv oblast. He was ready to participate in trainings for rural doctors in emergency medical care. He also planned to implement changes at the Krakovets ambulatory based on the medical knowledge he gained at the conference.

A family doctor Vadym Vus from Karpуlivka, Rivne oblast, noted that at the conference he gained information that would allow him to raise the quality and lower the cost of services he provides. In Canada, he obtained numerous contacts for such future endeavors as medical staff exchanges, acquisition of medical devices and cooperation with professional organizations.

The Ukrainian doctors also had a chance to learn about the Ukrainian Canadian community and its history. They visited the Internment Museum in Banff and St. Vladimir’s Ukrainian Orthodox Church and Cultural Centre in Calgary. On one of the evenings, they had a meet and greet session with the Ukrainian Canadian Professional and Business Association of Calgary at The Assumption of the Blessed Virgin Mary Ukrainian Catholic Church. They also were hosted in a private home of a Ukrainian Canadian family for supper.

The long-term impact of the visit on professional careers of the Ukrainian participants and changes to the rural health in their villages is going to be monitored by CUF for at least three years. The participants have already started up an NGO group, Academy of Family Medicine of Ukraine. They are training other doctors about the ICPC-2 (International Classification of Primary Care) program. As events unfold, we will report the results.