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

The meeting between President Petro Poroshenko and the Canadian team at the Kyiv Military Hospital

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/Structure/Pages/default.aspx).

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.