By Olena Goncharova.

October 17, 2020

Kyiv Post


Editor’s Note: United by Ukraine is a collaboration between the Kyiv Post and the Ukrainian World Congress. It offers special coverage that showcases the contribution of diaspora Ukrainians to their homeland.

When Dr. Oleh Antonyshyn heard a story about a 15-year-old EuroMaidan volunteer whose face was badly injured as a result of a bomb blast, he knew he had to go to Ukraine to help. “He was a young patriotic boy with a devastating, life-changing injury. He was one of the main reasons that I decided I need to go to Ukraine to operate,” Antonyshyn said.

The renowned Toronto surgeon was ready to put his life in Canada on hold to help his counterparts in Ukraine as they were dealing with the avalanche of patients with complex post-traumatic defects and deformities in the early days of 2014, as the EuroMaidan Revolution that ended Viktor Yanukovych’s presidency gave way to Russia’s war against Ukraine.

The doctor didn’t hesitate to form a group of colleagues who supported his idea to embark on an overseas trip to operate in the country most of them had never visited before. Since his first trip in 2014, Antonyshyn headed six medical missions to Ukraine where he and his team saw 509 patients in consultations and operated on 219.

Growing up in Canada, Antonyshyn didn’t have a chance to travel to his ancestral homeland until Ukraine has gained independence. His parents emigrated from Ukraine and settled in Toronto, Ontario. He was always active in the community of Ukrainian expatriates. He attended a Ukrainian school on Saturdays and from his young years was most notably involved with Plast.

It took 14 years of studies to bring Antonyshyn to where he is today: teaching at the Division of Plastic, Reconstructive, and Aesthetic Surgery at the University of Toronto and heading the Adult Craniofacial Program at Sunnybrook Health Sciences Centre.

“I was inspired to pursue subspecialty training in craniofacial reconstructive surgery after meeting Dr. Ian Munro at the Hospital for Sick Children and Dr. Joe Gruss at Sunnybrook Health Sciences Centre…both of whom had an international reputation as pioneers in craniofacial surgery,” he recalled.

It motivated the future surgeon to pursue four additional years of post-graduate fellowship training specifically in craniofacial surgery: one year in London, two years in Toronto and finally a one-year clinical traveling fellowship, during which he worked all over Europe – from Gothenburg and Madrid to finally join a pediatric craniofacial traineeship in Mexico City.

The Ukrainian World Congress is the international coordinating body for Ukrainian communities in the diaspora representing the interests of over 20 million Ukrainians.

First assessment

The opportunity to contribute in a meaningful way to Ukraine in a time of urgent need presented itself immediately after Yanukovych fled the EuroMaidan Revolution on Feb. 22, 2014, Antonyshyn explained. A total of 1,791 civilians were treated for injuries during Maidan and, of these, 1,198 were hospitalized with significant injuries.

“The sheer number of casualties was overwhelming and the Canada-Ukraine Foundation reached out and invited me to join a group of Canadian Ukrainian health professionals who were tasked with identifying the specific needs, the scope and range of injuries, and the most effective ways in which the Canada Ukraine Foundation could provide humanitarian assistance,” he said.

In April 2014, Antonyshyn traveled to Ukraine as part of a medical needs assessment team sponsored by the Canada-Ukraine Foundation, to assess the capacity of various medical facilities in Ukraine to manage trauma following EuroMaidan.

Having visited at least 20 hospitals across Ukraine, familiarizing themselves with local anesthesia equipment, microscopes, operating tables, instruments, and having met with local surgeons to discuss their most urgent needs, Antonyshyn thought of projects that could potentially be undertaken by the foundation most effectively help the wounded.

“I was confident that a complete surgical team comprising Canadian surgeons, anesthesiologists, nurses, and physiotherapists, could very effectively treat a large number of patients with complex post-traumatic defects and deformities,” he said. “More importantly, the surgery could be performed in collaboration with Ukrainian medical professionals, providing consultation, guidance, surgical training, as well as equipping them to perform similar procedures independently.”

Their target patient population at the time were mainly civilian patients injured during Maidan, with post-traumatic defects or deformities of the face, skull, or upper extremity and military patients as the war with Russia immediately followed the revolution.

Organizing a surgery mission is a “complex and daunting undertaking,” Antonyshyn recalls.

First, he decided to consult with Dr. Kimit Rai, a Vancouver plastic surgeon who directed Operation Rainbow Canada. Rai had extensive experience in organizing surgery missions to various parts of the world. He, in turn, provided the templates for all aspects of organizing such a surgical mission: “He told us exactly how to organize everything, he was outstanding.”

The next critical step was funding. But then the Ukrainian diaspora stepped in to help. On Sept 11, 2014, the United for Ukraine Gala Event was held in Toronto. It was sponsored by a Canadian businessman Eugene Melnyk, the billionaire owner of the Ottawa Senators hockey team, and attended by then Prime Minister Stephen Harper, hockey star Wayne Gretzky, and other guests.

Then the team had to find volunteers and were “overwhelmed with applications from across Canada from health professionals who were eager to volunteer for our missions,” Antonyshyn said.

Finally, they put together a team of 25 volunteers, including surgeons, surgical fellows or residents, anesthesiologists, operating room nurses, Outpatient clinic nurses, physio/occupational therapists, established contacts with surgical partners in Ukraine. The Canadian Ukrainian Foundation and its president Victor Hetmanczuk were the main drivers of the initiative.

Ready to work

The team arrived in Ukraine to start the mission in November 2014. All of the missions were run through the Ministry of Defense.  “Surgeons I brought with me were plastics and reconstructive surgeons, subspecialized in craniofacial surgery or hand microsurgery; one neurosurgeon, general surgeons specializing in trauma; and anesthesiologists. Although some of the physicians were Ukrainian, the vast majority were not,” Antonyshyn said. “We started working and it was very

productive; we established such good relations with local surgeons, who were a little nervous, anxious with us coming – they didn’t know what to expect.”

During their first mission to Kyiv, just as the group of doctors finished operating on the first patient, there were already 20 additional patients in the waiting room, the next day –  an extra 30. “All of a sudden it blossomed. We worked very closely with Ukrainian colleagues and it made every subsequent trip easier.”

Antonyshyn and the team returned to the country five more times from 2014 to 2018 to operate on hundreds of wounded Ukrainians. They treated around 40 cases each mission and by the fifth mission, they would routinely see 100 patients in consultation.  “At the military hospital they separated the wing of the hospital for us; we had our own area, we could see all the patients, they could sleep and recover there. We had three operating rooms (working at the same time), could change bandages and we could set all our equipment there,” Antonyshyn recalls.

They typically had major and complex cases – reconstructing defects of the skulls (as the result of shrapnel or sniper wounds) where segments of the skulls were missing; fractures of the orbit (eye socket). “The very latest and best technology was utilized and Ukrainian surgeons were instructed in the application of both the techniques and technology,” he said. “Collaborative multispecialty surgery was actively demonstrated, where plastic surgeons and neurosurgeons operated together to perform the most complex craniofacial reconstructions.”

In Ukraine, the vast majority of trauma was ballistic trauma: shrapnel wounds, bomb blasts, sniper injuries. “The level of trauma was huge,” said Antonyshyn. “Those young people volunteered to serve, and probably had no idea of how horrific war casualties could be, and these wounds could change their life forever.”

The doctors wanted to make sure they can make the life of the soldiers at least a little easier. “I think all (of the doctors and nurses) were taken aback by the horrors of the war and taken aback by the resiliency of soldiers and seeing how grateful those people were – experiencing that was wonderful for all the team members.”  On their team of surgeons and nurses, many were not Ukrainians. “These were genuine humanitarian volunteers, eager to offer their expertise to help injured or more unfortunate people anywhere, anytime. Some probably had only cursory knowledge of the Maidan, or the significance of the ensuing war with Russia,” said Antonyshyn. “It was so impressive to see them participating wholeheartedly in this mission, devoting hours of their time and all of their energy in operating and trying to help the soldiers.”

The 15-year-old EuroMaidan volunteer who solidified Antonyshyn’s desire to help Ukrainians was a frequent patient in their operating room. “He needed many surgeries, probably four over the course of six missions.”

From the operating room to the classroom

Through their experiences, Antonyshyn identified an opportunity to leverage the Sunnybrook Health Sciences Centre’s expertise in complex reconstructive surgery to help Ukrainian surgeons address their lack of experience in reconstructive surgery. “While in Ukraine, we were struck by the urgent desire of local surgeons to learn novel techniques in reconstructive surgery and embrace the collaborative model of care used by Canadian surgeons,” he said.

That’s how the Sunnybrook Ukraine Surgical Educational Initiative was formalized in September 2019. The initiative partners Sunnybrook Health Science Centre (through the support of the Sunnybrook Foundation and its donors, in particular, the Temerty Foundation and Ihnatowycz Foundation), Canada- Ukraine Foundation, and three hospitals in Lviv, Ukraine.

The initiative aims to provide education and training to medical specialists in Ukraine, specifically in microsurgery, craniofacial reconstruction and upper extremity reconstruction through advisory missions, live surgery demonstrations, and focused symposia, workshops and educational observerships.  “The goal of the partnership is to enhance the lives of trauma victims within a country in need by equipping local surgeons with advanced surgical techniques and clinical knowledge, and building capacity,” Antonyshyn explains. “We have a program manager in Toronto and hired a Ukrainian physician to help us with the patient assessment on site.”

They hope to run the program for a minimum of three years. On Oct. 25, 2019, a team of six surgeons, two anesthesiologists, and three operating room nurses from Sunnybrook Health Sciences Centre set off on the first medical mission under the Sunnybrook Ukraine Surgical Educational Initiative.

The Canadian team, together with their Ukrainian colleagues, completed an initial outpatient preoperative clinic where they assessed 39 patients. Patients underwent multidisciplinary assessments and preoperative anesthesia evaluations.

“Our team was divided into three groups, and surgery was conducted daily in three different operating rooms simultaneously,” he recalls. A total of 25 surgical procedures were completed on patients ranging from 9 to 65 years of age. As part of the program, a nationwide symposium covering topics in craniofacial surgery and microsurgery was held on Oct. 31, 2019. A total of 138 participants from various disciplines and from all parts of Ukraine participated.

The novel coronavirus pandemic disrupted the plans to launch the second mission, but the group still plans to develop the initiative and implement new programs.  “This project is very dear to my heart, and thanks to the efforts of many donors, supporters, volunteers, and remarkable specialists, we have come a long way. I can’t wait to see what challenges and adventures await us.”