Center for
Global Health

AN INTERVIEW WITH YULIIA KOVACH

Tell us a little bit about your background and what inspired you to enter the field of Reconstructive Surgery.

There are two pediatric surgeons who inspired me to focus my future in Plastic and Reconstructive surgery, both are women. Both women started a new chapter in medicine for me and demonstrated how versatile the field of Plastic Surgery can be. Working with Dr. Oksana Jackson both in Ukraine and now here at CHOP has been instrumental in leading me toward the path I am currently on. These female role models were crucial, not only providing a model of talented and qualified female professionals in the field, but also providing a model that you can be an excellent mother and wife too.

How does your research and work here in the United States affect health in Ukraine – or elsewhere globally?

The greatest injustice in the world is that children, depending where they live, do not have equal access to advanced and evidence-based treatment methods. Cleft lip and palate are not rare pathologies worldwide, but in some resource-limited countries, treatment remains ineffective and insufficient. Children's Hospital of Philadelphia (CHOP) is unquestionably a global leader, and I believe that the strength of a leader lies in the sharing of its strength. CHOP possesses the world's best expertise and capabilities to not only demonstrate ideal results in its patients but also to disseminate knowledge to colleagues worldwide, from Guatemala to Ukraine.

With this purpose in mind, people write publications, hold conferences, and conduct international missions, which connects doctors and researchers with their international colleagues. I feel fortunate to be part of this, and I consider my work an investment in patient equality, even in parts of the world where I have never been.

What opportunities or initiatives do you think could improve access to medical care for children with cleft lip and palate in Ukraine or elsewhere globally?

In the United States, I often observe the work of local doctors, clinical psychologists, orthodontists, speech therapists, nurses, medical assistants, and social workers. It is precisely the collaboration of a comprehensive, diverse team of different specialists complementing each other that yields such high results. Discussion, mutual respect, and the absence of fear in asking questions reduces the likelihood of errors, which we cannot afford when working with children.

I believe an excellent option would be to have international internships for entire teams like these.

Perhaps if these care teams learn together, in an intensive regimen, with a wealth of both theoretical and practical tasks it could significantly improve access to quality care.
 

Does your research and work here have an impact on the state of medical care in Ukraine?

The quality of the healthcare system in Ukraine has never been at a sufficiently high level. Now, with the onset of a full-scale war, the situation has deteriorated. For the citizens of Ukraine, survival, and the defense of personal values, right, and freedom have become the priority. As a result, a substantial number of civilian doctors, including pediatricians, are on the front lines. While these physicians and some in our hospitals spend time treating the wounded and returning them to the war, we cannot forget about the treatment and care of children and people with issues unrelated to the war.

Ukraine recognizes the knowledge and experience gap between us and highly developed countries, so we are ready to learn and work hard for the future of our nation. My goal in the United States through this fellowship is to absorb all of the knowledge provided to me here to use back in Ukraine. I am immensely grateful for this opportunity.
 

In what ways do you believe international collaboration can play a role in addressing medical challenges in Ukraine, particularly in the field of plastic and reconstructive surgery?

Plastic and reconstructive surgery is just beginning to develop as a field in Ukraine. The priority has shifted from the aesthetic aspect towards comprehensive functional restoration. Considering the volumes and numbers of injuries in both the pediatric and adult populations, the significance of education is invaluable, and it should be organized quickly and efficiently. We fully trust the years of experience of Penn, CHOP, and other global medical centers. The knowledge shared with us not only helps improve the system but also significantly accelerates the scientific development of Ukraine.
 

How does the conflict between Ukraine and Russia affect access to medical care, particularly for individuals with conditions like cleft lip and palate?

From the news, we can all learn that hospitals in Ukraine are constantly subjected to rocket attacks. These attacks can make it nearly impossible to provide qualified medical assistance there. Within the country, many specialists have mobilized into the Armed Forces, where they are now treating the wounded on the battlefield or near the front lines. In the occupied territories, people are essentially without rights, including to medical care. In cities close to the East, patients often find themselves without access to the most basic care, and complex care required for conditions like cleft lip and palate. This is further compounded by internal migration and emigration abroad, making it challenging to form teams of highly specialized practitioners.
 

 

What kind of support, whether it be resources, funding, or collaboration, do you believe is most crucial from the international community to improve medical interventions in Ukraine?

Despite the grim loss of life, the Revolution of Dignity 10 years ago became a catalyst for progress, and now the current war has proved that time is sparing. I have always firmly believed that we will never overcome this violence with weapons alone and it will only lead to even more violence. The key to peace and security is knowledge.

Over the past 2 years, I have been lucky to meet hundreds of people, some of the brightest minds in the world, who are willing to share their experiences with me. The United States possesses the largest amount of both theoretical knowledge and experience (both civilian and military) that they are ready to share and teach us, Ukrainians, thereby providing us an opportunity to succeed and survive. I hope that the quantity of training, international internships, courses, and educational missions will only increase. This is invaluable for us.
 

What is the impact you hope to achieve through your work?

When the revolution started in Ukraine, I was 11 years old. I do not remember much from that time, except questioning why it was all happening. Now, 10 years later, I finally comprehend why people didn't flee from the protests.

A close friend once said, "Since there's no queue behind us to make changes, it's obvious that we'll have to make the changes ourselves." It's true. The future of my country lies with those who don't wait for someone to come and save us, who understand that we are the ones shaping the future. Myself and many other conscious citizens feel that we are the people influencing the future through our actions. It instills a sense of responsibility.
 

Do you see a role for advocacy in raising awareness about these issues on an international scale?

I've been fortunate to be given the opportunity to speak, represent Ukraine, and be heard. It's an honor for me, but at the same time, it's a responsibility. I consider it my duty to do this now and in the future. Perhaps someday, I'll be able to advocate for other countries facing challenging situations.

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an interview with Stephen Avery

You have a leadership role in the Global Health Catalyst Summit which took place last year at Penn. Please tell us about this initiative.

I’m co-Director of the Global Health Catalyst (GHC) Summit. The goal of the yearly GHC Summit has been to catalyze and strengthen high-impact win-win international collaborations with stakeholders in curbing the growing global burden of cancer and other diseases, with a major focus on collaborations to address disparities. Outcomes include establishing cancer centers in Africa, telehealth initiatives, bi-directional learning with the training of thousands of health professionals to strengthen healthcare systems, and fecund research collaborations like multi-center/country clinical trials to increase access to care. One policy outcome of the summit has been a Lancet Oncology Commission for sub-Saharan Africa, which was launched last year highlighting a growing cancer emergency in Africa. This served as a reference for new actions that were announced by the Whitehouse during the U.S.-Africa Leaders’ Summit in December 2022 aimed at Reducing the Cancer Burden in Africa. Building on the foundation of those efforts the theme of the summit at UPenn in May 2023 was “Cancer Moonshot 2.0: win-win collaborations to advance global health and development”, with a focus on mobilizing further actions to extend the Cancer Moonshot globally via win-win collaborations that benefit the USA and Africa.

Participants at the summit come from all across North America, Europe, Africa, and other world regions interested in advancing disease prevention and control, and establishing collaborations for global health and development. Participants also include leaders from the World Health Organization or international health agencies, industry, World Bank, LMIC country ministers, ambassadors, policymakers, USA congressional leaders, Nobel Prize Laureates, health institution leaders, hundreds of Diaspora organization leaders, religious institution leaders, students, residents, oncology health professionals, and sports celebrity advocates, amongst others. 

 

When did you become interested in applying your expertise in other countries?

Dr. Jim Metz (Chair, RadOnc) started a program in 2011 to train Radiation Oncology Nurses in Dar es Salaam, Tanzania. They created in-person trainings, online modules, and a certification program for nurses. From this work, two classes of nurses have been trained and certified. He mentioned there was a huge need for medical physics support.  In September of 2013, I began working with Jumaa Bin Dachi, a Therapy Physicist at the Ocean Road Cancer Institute in Dar es Salaam, Tanzania. We hoped to develop a working Quality Assurance (QA) program that could be easily implemented from abroad. QA in radiation therapy helps to ensure correct radiation doses are being delivered to patients, mainly through the checking of radiation output and field shape, patient positioning systems and alignment systems, along with image verification systems. I am still working with Jumaa and plan to serve as one of his PhD advisors.

 

What is your favorite part about working globally/ most difficult part of working globally?

My favorite part about global work is learning about different cultures and their approach to healthcare. I enjoy sharing knowledge and discussing innovative ideas such as using phytomedicines to enhance the therapeutic effects of radiotherapy while mitigating the damaging effects – over 60% of people around the world rely on plant plant-based medicines. I get to network with policymakers, LMIC country ministers, and government leaders – recently I had the opportunity to meet with the Asantehene (Ghana King). The most difficult part of working globally is navigating through the multiple pieces that entail global health. Sometimes there are moving parts that require adapting plans, since capacity building is needed identifying local champions can take time and you need to understand how the decision-making process works for each project. It’s important to do a thorough assessment so your project has focus for optimum impact and you are aware of the available resources for the project.

 

 

 

 

 

 

 

 

Congratulations on your recent promotion to full professor! As an underrepresented minority in the field, could you share some insights into your journey and any challenges you may have faced along the way? How do you think your unique perspective contributes to your role as faculty at an Ivy League institution?

I like to reference an article written by UPenn Provost John L. Jackson Jr. (former Dean of the School of Social Policy & Practice) 8 years ago titled “What it feels like to be a Black Professor”. His story is all too familiar to me and many of my colleagues – these summative effects can be difficult to overcome for underrepresented faculty resulting in a lack of recruitment and retention. To be successful you have to stay persistent; to be persistent you need a sense of belonging and a network of people who care about your success. I was a sophomore in college when I first met a black physicist – he was trained at Stanford and MIT - it had a profound effect on me to see someone in this role. Now as a professor, I think of the role I play by just being present, sharing my experience, and letting students know it is possible to grow up in West Philadelphia, attend an HBCU, and be the first (but not the last) black full professor in the department of Radiation Oncology at the University of Pennsylvania. Coming full circle – I recently had the opportunity to speak with the Social Justice Scholars in the School of Social Policy & Practice to share my experience in hopes it helps them to persevere.

 

Given your expertise in quality assurance and safety in proton therapy, could you elaborate on the significance of these aspects in advancing cancer treatment? How does your research in this area contribute to global efforts to ensure access to safe and effective radiation therapy, especially in middle to low-income countries?

Radiation therapy (RT) is an essential part of a successful cancer treatment, with more than 50% of all patients receiving RT for the management of their cancers. There has been a steady gain in the five-year survival rate for cancer patients, with an improvement of 66% across all cancer types. This increase has been attributed in part to technological advancements in RT, which now allow better targeting of radiation dose to the 3D shape of the tumor and minimization of dose to surrounding healthy tissue. With each RT treatment being delivered over the course of 20-30 fractions, it is estimated that cancer patients will make over 23.4 million RT visits to hospitals and freestanding therapy centers this year.

During each RT visit, a series of complicated patient-machine processes will take place to ensure that radiation is delivered safely to the tumor and not to nearby healthy tissues. These processes involve many degrees of complexity, sophisticated human-machine interactions, and decision-making steps that in some cases are repeated hundreds of times per day at busy clinics. Due to this high level of complexity and high degree of repetition, serious accidents can occur resulting in either patient injury or death. As a result, RT has been consistently listed as a top 10 health technology hazard by the ECRI (Emergency Care Research Institute). Safety concerns have been recognized by many national and international organizations including IAEA (International Atomic Energy Agency), NRC (Nuclear Regulatory Commission), and AAPM (American Association of Physicists in Medicine). Many clinical treatment errors have been attributed to technological error-based miscalibration or technical component failure. With cancer incidence increasing across Africa, the scarcity of radiation oncology resources becomes more evident. As more African facilities begin to invest in radiotherapy services, it will be crucial to develop a regional clinical auditing system that improves radiation oncology practice and assures an accurate dose delivery from radiotherapy equipment to ensure all African cancer patients receive safe and high-quality treatment delivery.

For students aspiring to enter the field of medical physics or global health, what advice would you offer based on your own experiences and the evolving landscape of these disciplines?

I would tell aspiring students to talk to someone actively working in the field to find out what their job entails. Try to spend some time shadowing them or applying for a summer program to get more experience. This is a multi-disciplinary field that is consistently changing so it’s important to have an open mind when trying to find your niche. You can focus on research, teaching, and/or clinic; you can start your own company, become university faculty, or work in industry or government. As a student explore your options, build your network, and seek mentors that can help you move your career forward. Ultimately, this is your career – you make the decisions don’t give up this power. Everyone has a unique path that reflects his or her interests, skills, talents, and environment – don’t compare your path with others. Remember effective habits can help you achieve your goals and be more successful in whatever career path you choose. The personal sacrifices you will make to achieve success will be burdensome, there will be long work hours, job insecurity, lower salary, and delayed gratification. If you find yourself saying, “I don’t want to do this or work like this,” then ask yourself whether this is the best career choice. But if you find something you enjoy that gets you up early and makes you stay up late then you may have identified your passion – go with it.

 

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