Teaching sustainable craniofacial surgical skills in Ukraine
This project is a 2020 recipient of grant funding from the Royal College’s new International Development, Aid and Collaboration (IDAC) program. This grant supports projects that improve health profession education and local capacity in low- and middle-income countries.
Craniofacial trauma has become far more widespread in Ukraine since the Euromaidan protests of 2013 and the subsequent Russian invasion of Crimea and Eastern Ukraine. Casualties of war have overwhelmed the Ukrainian medical system, with 25,000 people wounded — more than 25 per cent of whom have craniofacial injuries.
In the years since, a partnership between the Canada-Ukraine Foundation and the Ministry of Defense in Ukraine has arranged six surgical missions to the region to treat craniofacial injuries and traumatic deformities. Volunteers — mostly staff from Sunnybrook Health Sciences Centre in Toronto, including Oleh Antonyshyn, MD, FRCSC and Tara-Lynn Teshima, MD, FRCSC — have treated hundreds of patients.
A health care system hungry for knowledge
As they worked, the Sunnybrook volunteers recognized that their Ukrainian host surgeons were able to swiftly adopt and apply new surgical techniques once they had the appropriate instruction and technology.
“We saw that these surgeons, who had been so overwhelmed and unprepared to treat these patients, were thirsty for knowledge and able to apply it,” said Dr. Teshima, a plastic, reconstructive and craniofacial surgeon who has volunteered with the Sunnybrook missions since they began. “We decided we could make the most enduring impact by building the capacity of local surgeons to use advanced surgical techniques.”
In January 2019, Sunnybrook Health Sciences Centre, the Sunnybrook Foundation and the Canada-Ukraine Foundation launched a three-year education initiative that will empower Ukrainian surgeons to help their own citizens. The initiative includes advisory missions, live surgery demonstrations, symposia and sponsored surgery observerships that will help build capacity in the Ukrainian health care system.
Craniofacial skills lab
A key element of the program is a craniofacial skills lab — funded in part by the Royal College’s IDAC program — that simulates clinical scenarios involving facial fractures. Participants get a clinical history, photos and CTs of a patient with panfacial fractures, and are asked to provide a diagnosis and formulate a treatment plan. Then, participants are given a physical model of the same fractures and are asked to stabilize them using implants and fixation devices.
“By training surgeons in Ukraine with the latest techniques and giving them the right tools, we’re confident that we can rapidly expand the country’s capacity to care for trauma patients,” said Dr. Teshima. She said this educational initiative will provide long-term benefits that extend far beyond the war. Ukrainian surgeons can use their new skills to treat cancer patients who need reconstruction, car accident victims and children with congenital malformations.
Due to COVID-19 and travel restrictions, a number of project activities originally planned for earlier this year have been delayed. Some activities have since restarted, while others are waiting for an appropriate and safe time to resume.