By New Pathway -May 15, 2019 – Victor Hetmanczuk

From May 18 – 27, 2018, Canada-Ukraine Foundation held its 6th medical mission in Ukraine. The mission worked in Odesa and had as its goal to treat individuals injured in the ongoing war in Eastern Ukraine and conduct surgical master classes which would contribute to capacity building within Ukraine’s Ministry of Defense medical system. The mission was located at the Military Hospital Clinic Centre of the Southern Region.

Specifically, this project aimed to:

1. Provide soldiers and civilians with devastating injuries an opportunity for the most complex surgical reconstructions, to restore function, minimize disfigurement, and enable them to return to assume productive lives.
2. Save lives and radically reduce the number of casualties succumbing to their injuries due to inadequate primary trauma care.
3. Provide training to local surgeons, anesthetists, and nurses, and provide them with the requisite resources to achieve and maintain a global standard of primary trauma care and post-traumatic deformity reconstruction.

Thankfully, instability in the country and war in Eastern Ukraine didn’t overwhelm treatment capacity in Odesa, the medical mission was carried out as planned. Instability in the country and ongoing war did not directly threaten the safety of the teams during the mission. All postoperative complications have been minimal.

Emails were exchanged between CUF lead surgeon, Dr. Oleh Antonyshyn and Ukrainian surgeons Dr. Fedirko and Dr. Mazur who have both conducted follow-up procedures and continue to offer their services to all of our patients.

The mission achieved:

• Rapid intraoperative education of sophisticated health professionals (local Ukrainian plastic, ENT, maxillofacial and neurosurgeons, anesthetists, operating room staff), providing enhanced beneficiary skill to treat complex trauma and post-traumatic deformity.
• Enhanced beneficiary access to resources required to perform complex trauma and post-trauma reconstruction and in implementing primary trauma life support.

Direct Beneficiaries:

• Total # of direct beneficiaries (people directly trained, impacted, or influenced by the project): 139
• Total # of direct beneficiaries who were women and girls: 33
• Total # of direct beneficiaries who were men and boys: 106
• Total # of indirect beneficiaries: An estimate of 700 people were indirect beneficiaries.

Indirect beneficiaries:

• Medical professionals of the MOD of Ukraine and their patients and their families.
• Families of wounded soldiers and civilians.
• Medical students who attended lectures given by Dr. Oleh Antonyshyn and Dr. Todd Mainprize.

Gender Equality:

Gender considerations were taken into consideration as much as possible.

• The surgical team travelling from Canada was comprised of both men and women. All professions were represented by both genders, demonstrating that both genders are capable of being great nurses and doctors. We worked closely with both male and female colleagues based on their specialties. We tried to and believe that we did empower women to take on leadership roles in the hospital and within the medical department in the Ministry of Defense of Ukraine. One way this was done was through one-on-one training between our operating room nurses and their Ukrainian counterparts. Jodi Clements mentored a young Ukrainian nurse teaching her the more advanced responsibilities that she has in the O.R. with the permission of the Ukrainian head nurse.
• Patient recruitment did not differentiate between genders. Soldiers and volunteers injured as a result of the war, requiring the type of medical treatment our team is providing, were considered without preference for one gender over the other. There were very few females.
• Efforts were made to report how many female and male members were part of the training audience. Reporting has been segregated by gender.

While every effort was made to be as inclusive as possible, the reality remains that there are not as many women as men enlisted in the Ukrainian armed forces. Very few women are serving in active duty on the front lines and therefore are not injured as often. Ukraine still has a male dominated military culture where women are not looked upon as equals in many cases. CUF made every effort to empower the women with whom we did come in contact. By taking male nurses and female surgeons with us on our medical missions we wanted to show our Ukrainian colleagues that the stereotype of women being nurses and men being doctors, which is so prevalent in Ukrainian culture, could be successfully altered.

One of our female patients was a volunteer and the other was in her home when it was bombed in Luhansk. The patient whose home was destroyed lost one of her legs and had severe burns on her body. Her hands were affected to the point where it is very difficult.

This was CUF’s first medical mission to Odesa. A lot of preparation work was done including two advance visits to help prepare the hospital and make them understand CUF’s requirements for the mission. Many supplies were collected and purchased in Canada in advance of the mission. Unfortunately, our shipment of 25 large boxes filled with supplies did not arrive on time. Thankfully the team had enough supplies with them and were able to purchase other necessary supplies to make up for this shortage. We were fortunate that we did not have to turn away any surgery thanks to the flexibility of Dr. Antonyshyn and his team and the willingness of the Ukrainian team to help us find and share whatever we needed.

The mission began on a very positive note with the Ambassador of Canada to Ukraine, Mr. Roman Waschuk hosting a kick-off reception along with members of the Operation Unifier team. Over 150 attended the reception. This included various stakeholders in Odesa and many of our counterparts from the Odesa Military Hospital.

Operations took place from Monday to Friday with 3 operating tables running full-out for the 5 days straight. Both teams worked very well together and the mission was deemed a success by both teams. The head of the hospital has invited CUF back again for the same sort of “master class medical mission” whenever we are willing.

By New Pathway -May 3, 2019 – Victor Hetmanczuk,

Activity 4: Surgical observerships in Ukraine and Canada

Our previous missions made it abundantly clear that Ukrainian health professionals required a rapid introduction to global standards of trauma care. Involvement in international organizations which focus on surgical education and research is critical, and we therefore pursued Arbeitsgemeinschaft für Osteosynthesefragen Craniomaxillofacial (AOCMF) membership and training for two key surgeons.

The Arbeitsgemeinschaft für Osteosynthesefragen Foundation (AO Foundation) is an organization led by an international group of surgeons specialized in the treatment of trauma and disorders of the musculoskeletal system. Founded in 1958, AO fosters one of the most extensive networks of currently more than 16,000 surgeons, operating room personnel, and scientists in over 100 countries. Their mission is to foster and expand the network of health care professionals in education, research, development and clinical investigation to achieve more effective patient care worldwide. The AOCMF is the division of this organization which focuses on Craniomaxillofacial surgery (https://aocmf.aofoundation.org).

Observerships for 2 Ukrainian surgeons were carried out in Switzerland.

Two lead Ukrainian surgeons attended the AOCMF Principles of Facial Fracture Repair Course in Davos, Switzerland in December 2015 – Drs Igor Fedirko, and Dr. Ivan Pavliuk. Dr. Fedirko is the Head of the Maxillofacial Surgery Department at the Central Military Hospital Clinic in Kyiv where we carry out our surgical missions. Dr. Pavliuk is an associate and full time consultant in the same department. The contribution supports their registration, travel, accommodation and food expenses.

• Both surgeons were supported in their applications to the AOCMF European Faculty.
• Admission to faculty impacts future educational development in trauma surgery in Ukraine:

1. The 2 surgeons can sponsor other Ukrainian surgeons for membership to AO and participation in AO courses;
2. This greatly facilitates the possibility of organizing and hosting regional AOCMF courses in Kyiv through local faculty (Drs Fedirko and Pavliuk) to educate other Ukrainian trainees.

Activity 5: Ukrainian Trauma Life Support Courses

UTLS is an intensive five-day course consisting of seminars, workshops, practical stations and simulations run in real time. There are 25 students at each course, allocated to five groups of four students and one group of five students. Students receive a manual, already translated into Ukrainian, 4 weeks prior to the start of the course and they are advised to study the manual carefully before attending the course.

Four separate courses were taught by six physicians and licensed paramedics as senior instructors and six Patriot Defence instructor assistants/translators. A total of 97 doctors completed the four course cycles. A total of 100 doctors were registered, however three doctors were forced to leave the courses early due to an unforeseen event (illness, deployment into the ATO). All 97 doctors received certificates of completion that are good for four years.

The goal of this project was to support those that are most severely and profoundly affected by the war in Ukraine, and to provide the requisite skills and resources to those who care for them. Specifically this project aimed to:

• Provide soldiers with devastating injuries an opportunity for the most complex surgical reconstructions, to restore function, minimize disfigurement, and enable them to return to assume productive lives
• Save lives and radically reduce the number of casualties succumbing to their injuries due to inadequate primary trauma care
• Provide training to local surgeons, anesthetists, and nurses, and provide them with the requisite resources to achieve and maintain a global standard of primary trauma care and post-traumatic deformity reconstruction.

All three objectives were achieved with unprecedented success. There is no other country or organization that has been able to implement a surgical mission of this magnitude in Ukraine, or that has had a similar impact on the future development of trauma management in Ukraine. Direct intervention by Canadian health care professionals in mitigating the devastation of war in Ukraine highlights Canada’s foreign policy and humanitarian efforts, and sends a powerful message to Russian aggressors. The unanticipated benefit is the regard that Ukrainian injured, medical professionals, and the population in general have for Canada. The Canadian surgical missions were reported in 148 news broadcasts, videos and publications within Ukraine, and the reception received by Canadian team members was exceptionally cordial and enthusiastic.

The degree to which the Canadian Surgery Mission influenced public opinion within Ukraine was highlighted by a surprise visit by the President of Ukraine and his delegation to the Kyiv Military Hospital while the Canadian Team was operating. President Petro Poroshenko awarded Medals of Merit to three Canadian team members who provided treatment for the wounded ATO warriors in the Main Military Clinical Hospital in the framework of the Ukrainian- Canadian joint initiative. They were as follows: Dr. Oleh Antonyshyn, Dr. Carolyn Levis and Krystina Waler.

In the course of the meeting, the Head of State noted: “Thank you for your care. It is very easy to stay at home and say that you do not care. Your arrival symbolizes that we are not alone in our struggle against the aggressor. You are a symbol of global support for Ukraine”.

The president expressed special gratitude to the people of Canada for helping Ukraine.

The second unanticipated outcome was the recognition of Canadian expertise in organizing and implementing trauma surgery missions by the international medical community. Launching a self-contained multidisciplinary surgical mission to perform surgery of this complexity in a foreign country is distinctly uncommon and has rarely been accomplished with any degree of success. Canadian Mission Team members have been asked to discuss and describe details of the development, organization, management and execution of international surgical missions in various forums: Department of Surgery assemblies in University of Alberta, Edmonton, University of Calgary, Dalhousie University, the University of Toronto Global Surgery Program.

Most notably, the successes of the CUF GPSF supported surgery missions have prompted other groups to explore possibilities for humanitarian projects in Ukraine. Members of the U.S. Army approached CUF to share the knowledge that we have gained. A delegation led by Col. Anne L. Naclerio, Deputy Surgeon General for the U.S. Army Europe, observed the CUF medical mission on Thursday, February 25, 2016 after which a meeting took place to discuss possible collaboration moving forward. Pending approvals, Col. Anne L. Naclerio hopes to run a medical mission to treat orthopedic trauma while training Ukrainian military medical professionals to do so effectively themselves.