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CUSAP 4th Life-Altering Mission in Poland – 27 patients, 32 operations, 105 procedures.

“Those suffering have absolutely no one to turn to. Ukraine is at absolute capacity,” says Dr. Antonyshyn, founder and head surgeon of the Canada Ukraine Surgical Aid Program (CUSAP).

Unfortunately, Ukraine’s overburdened healthcare system cannot alone handle the immense patient needs caused by the war. They need the help of international partners like CUSAP. The complex injuries referred to our group of highly-skilled medical volunteers require a multidisciplinary surgical team and the latest technology in facial implants.

During this 4th mission held in Czeladž, Poland, 52 Ukrainian patients were consulted, and 27 were operated on. During one week, the team performed 32 surgeries, which included 105 procedures: craniofacial, orthopedic and hand / peripheral nerve.

The surgical missions are specifically designed to address craniofacial trauma, soft tissue trauma, upper and lower extremity reconstruction and burn reconstruction. 

The heart and soul of these missions is the multidisciplinary team of surgeons, anesthetists, intensivists, nurses, administrative staff, and other specialties, including psychologists and an occupational therapist. This is a well-rounded team of incredibly skilled professionals who continuously volunteer their time and expertise to treat those severely injured in Russia’s unprovoked, genocidal war on Ukraine.

“It is such a privilege to be able to help these people. They deserve all the help we can give”, said Dr. Chris Graham, an orthopedic surgeon.

The hardest part of every mission is the goodbyes when we see patients being repatriated back to Ukraine. Over the course of their treatments, they become friends and family, leaving an impact on the hearts of each member of the team. The heartfelt gratitude of these patients leaves a mark that lasts a lifetime. “We had love. Now, thanks to you, we also have health”, said the wife of one of the patients.


Over the 4 surgical missions held in Poland – September 2022, November 2022, April 2023 and September of 2023:

  • 95 patients operated on
  • 110 surgeries performed
  • 331 procedures
  • 14 microvascular free tissue transfers

We are very grateful to all who continuously support CUSAP’s life-altering surgical missions. We would like to extend a special thanks to the two anonymous donors of $200,000 CAD and $75,000 USD, who supported this latest mission – thank you sincerely on behalf of the 27 patients who now have a chance at a better quality of life!

Our next surgical mission is planned for the early part of 2024. Please consider supporting this vital project of the Canada-Ukraine Foundation by donating at www.cufoundation.ca.


Background

Canada-Ukraine Foundation (CUF) was established in 1995 to coordinate, develop, organize and implement aid projects created by Canadians and directed to Ukraine.

Canada Ukraine Surgical Aid Program (CUSAP) is a humanitarian surgical aid initiative established by the Canada-Ukraine Foundation together with the Sunnybrook Health Sciences Centre in 2013 that provides life-changing care to patients affected by the war in Ukraine. The surgeries have significantly improved the quality of life of Ukrainians who undergo the operations.

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CUSAP missions restore hope for a better-quality life.

It has been nineteen months since Russia’s full-scale invasion of Ukraine started in an almost 10-year-long war. Thousands of lives have been lost, and thousands are forever changed by injuries sustained either on the battlefield or while simply waiting for a bus or turning in for the night. During the twenty-first century, in the heart of Europe, this is the reality of millions in Ukraine.

Surviving a mine blast or a missile attack is a blessing, but it is also the beginning of a long and painful journey to recovery. Veterans and civilians with craniofacial, head and neck, and orthopedic injuries who cannot be further helped in Ukraine are referred to the Canada Ukraine Surgical Aid Program (CUSAP), where a team of surgeons, anesthesiologists, internists, nurses, and support staff deliver complex, life-altering reconstructive surgeries and pre- and post-surgical care to give patients a chance to return to a normal life.

For a glimpse into the life-altering work of the CUSAP team, we would like to share the story of Pavlo, one of 286 patients helped since the program was established in 2014 by the Canada-Ukraine Foundation and the Sunnybrook Health Sciences Centre under the leadership of CUSAP’s head surgeon, Dr. Oleh Antonyshyn.

About a third of patients return for multiple missions as their injuries are so severe that their recovery is a multi-step process with many procedures performed by the multidisciplinary team of surgeons. Pavlo is one of such repeat patients. He sustained a mine blast injury on August 31, 2022. He was missing the midsection of his face with full exposure of his nasal cavity. Pavlo was referred to CUSAP and became a patient in November 2022, CUSAP’s second mission in Poland.

To date, he has undergone reconstruction of his nasal framework, followed by nasal reconstruction and lip reconstruction and revision. Between missions, he was operated on by Dr. Oleksandr Lompas, a Ukrainian surgeon, who joined several missions and operated alongside Dr. Antonyshyn and the Canadian team. Dr. Lompas managed Pavlo’s case in Ukraine and performed smaller operations to maintain his progress and prepare him for the more significant procedures on the missions.

Please meet Pavlo and see his progress with CUSAP…

Photos by Andrey Syrko

On Tuesday, September 26, Pavlo had another long set of surgical procedures done by the CUSAP multidisciplinary team to further reconstruct his midface with a forearm flap and bone and skin grafts.

As Pavlo nears the end of his recovery, there are many more who are only at the beginning. As the war continues and Ukraine fights to liberate its land and people from under Russian occupation, more veterans and civilians will need reconstructive surgical aid.

We are grateful for the generosity and steadfast support of our donors for enabling the CUSAP team to restore hope and change lives of hundreds of Ukrainians, like Pavlo, who have suffered a serious physical toll as a direct result of war.

To continue supporting the Canada Ukraine Surgical Aid Program, please visit www.cufoundation.ca. Thank you, Дякуємо, Merci.

Background

Canada-Ukraine Foundation (CUF) was established in 1995 to coordinate, develop, organize and implement aid projects created by Canadians and directed to Ukraine. Read more about CUF’s history on Wikipedia.

Canada Ukraine Surgical Aid Program (CUSAP) was established by the Canada-Ukraine Foundation together with the Sunnybrook Health Sciences Centre to help Ukrainians who were severely injured during the Revolution of Dignity in 2013 and the subsequent war in Eastern Ukraine in 2014. Since then, Canadian plastic surgeons have operated on 286 patients – civilians and veterans. The surgeries have significantly improved the quality of life of Ukrainians who undergo the operations.

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CUSAP Team Lands in Poland for the Fourth Surgical Mission.

The Canada-Ukraine Foundation is pleased to announce the fourth humanitarian surgical aid mission of the Canada Ukraine Surgical Aid Program (CUSAP), which will take place from September 17 to October 4, 2023, in Poland. 

Next week, CUSAP surgeons, internists, nurses, and support staff will travel to Poland to deliver complex and life-altering surgeries to Ukrainians injured during Russia’s attacks on Ukraine.  

Every CUSAP mission hopes to ease the tremendous burden on the Ukrainian healthcare system by lending the time and expertise of our highly skilled and dedicated volunteer medical professionals, who deliver surgeries as well as pre- and post-surgical care with integrity and compassion. 

Photos taken by Andrey Syrko

The Canada Ukraine Surgical Aid Program would not be possible without the help of our collaborators and the support of hundreds of donors. 

In addition to funding from the CUF-UCC Ukraine Humanitarian Appeal, we would like to express our gratitude to two incredibly generous anonymous donors, who contributed $200,000.00 CAD and $75,000.00 USD to fund the September 2023 CUSAP mission. 

It is the generosity of all our donors and supporters that enables the Canada-Ukraine Foundation to restore hope and change the lives of Ukrainians who have suffered a serious physical toll as a direct result of the war. Thank you, Дякуємо, Merci! 

To make your contribution and follow the latest news on CUSAP, please click hereCanadian donations are eligible for tax receipts from the Canada-Ukraine Foundation. 

Background

CUF-UCC Ukraine Humanitarian Appeal (UHA) was launched in 2022 by the Ukrainian Canadian Congress (UCC) and the Canada-Ukraine Foundation (CUF) to coordinate the provision of humanitarian assistance quickly and efficiently to civilians impacted by Russia’s full-scale invasion of Ukraine, including relief for displaced persons in Europe and Canada.

To date, we have delivered over $46 million in food, medicine, emergency shelter, mental health support, surgical aid, firefighter gear, individual first aid kits, ambulances, generators, and many more types of aid.

Please click here to read further about our humanitarian relief efforts since the full-scale invasion on February 24th, 2022.

Canada-Ukraine Foundation (CUF) was established in 1995 to coordinate, develop, organize and implement aid projects created by Canadians and directed to Ukraine. Read more about CUF’s history on Wikipedia and donate.

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News Humanitarian/Medical

Canada Ukraine Surgical Aid Program (CUSAP): First mission since russia’s full-scale invasion of Ukraine

September 5th to 20th, a team of 30 Canadian medical professionals travelled to Czeladz, Poland to treat Ukraine’s victims of war.

Team (35 individuals) consisted of:

  • Medicine
  • Anesthesia
  • Pharmacy
  • Nursing
  • Procurement/Equipment manager
  • Administration
Image is courtesy of Anka Wrzesnewskyj

The primary goal of the mission was to provide complex reconstructive surgical care to victims of Russia’s invasion of Ukraine.

This was an exploratory (pilot) mission to:

  • Organize and fully equip an expert multidisciplinary Canadian volunteer surgical team
  • Identify a suitable host hospital, and establish the requisite professional collaborations, processes and protocols
  • Develop and implement a method for patient referral, virtual triage, safe transport and repatriation
The host hospital: Powiatowy Zespół Zakładów Opieki Zdrowotnej in Czeladz, Poland // Image is courtesy of Anka Wrzesnewskyj

CUSAP is well supported by volunteers, supporters and donors. Over $1.5 million dollars of equipment and supplies were donated from major companies. Volunteers provided warehouses, physical and monetary support allowing the team to transport over 14,000 tons of medical supplies and equipment.

Logistical planning and arrangements involved multiple levels which included both Ministry of Health in Poland and Ukraine. Licensing, patient documentations and arrangements of transportation were a major focus to ensure the process ran effectively and efficiently.

Image is courtesy of Anka Wrzesnewskyj

The Canadian team together completed numerous virtual patient assessments and an initial outpatient preoperative clinic (September 11, 2022) assessing 45 patients. Patients arrived to Poland in ambulances and were admitted and assessed by both the Canadian and Polish teams. Patients underwent multidisciplinary assessments and preoperative anesthesia evaluations. Where required, surgical plans were developed and operating room bookings were completed.

After 5 days of surgery over 40 extremely complex procedures were performed. The surgeries focused on the reconstruction of post traumatic or post ablative defects and deformities of the face, craniofacial skeleton, and upper and lower extremities. Etiology of the deformities varied, including military and civilians but all were war casualties.

The patients were monitored postoperatively, and provided care by the Canadian ward team consisting of highly qualified physicians and nurses. Team continued to receive daily updates on progress and recovery post-mission, and also provided necessary advice and guidance to leading (Ukrainian) physicians on care for these patients. 

The stories shared by the patients left a mark on the whole team. From a young soldier who was the only survivor after an attack on his brigade, to the woman who lost her home and nearly her life when a missile hit her village on a bright summer day.

The war continues and innocent lives are affected and lost every day. There are many more stories like these and so many more people in need of our help. 

The next CUSAP mission is being planned for the end of the year. Please continue supporting the casualties of this war by donating to CUSAP via Canada-Ukraine Foundation.

Background

Canada-Ukraine Foundation (CUF) was established in 1995 to coordinate, develop, organize and deliver assistance projects generated by Canadians and directed to Ukraine and to the Ukrainian diaspora in Canada.

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CUF’s Medical Mission to Odesa

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.

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Medical Missions in Kyiv: Part 4

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.

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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.