Center for
Global Health

Ukraine Initiatives

DISPARITIES IN CARE

The primary goal of Penn Medicine’s global health mission is to address and remediate disparities in health care. We work routinely in over 75 countries world-wide on projects ranging from clinical training to health systems implementation, to biomedical research. Our approach is to work in partnership with on-site hospitals and ministries of health as they ultimately hold responsibility for the long-term care of their residents/citizens. There is no more urgent need of this engagement than in Ukraine.

Surgical Capacity Building in Ukraine

Significant wounds from blast injuries to extremities and torso have emerged as a major clinical treatment challenge in Ukraine. While Ukrainian surgeons are well trained and talented, the scope of managing these wounds does not often lie in their skill set.  The impact of effective care in these settings often means the difference between limb salvage vs loss, and at times life vs death.

As a result, the University of Pennsylvania Perelman School of Medicine (Penn) together with the Children’s Hospital of Philadelphia (CHOP) have developed a comprehensive effort to assist Ukrainian medical colleagues in treating patients effectively in Ukraine so that they can remain in close proximity to their family and support network. Our collective goal is to develop regional experts in advanced surgical techniques and build surgical capacity generally within Ukraine. Again, this approach mirrors the overall global mission of Penn – to build local capacity so that the home country can be supported in providing the highest quality care for its citizens on-site.

To address this challenge, Penn Medicine, in collaboration with the National Ministry of Health developed programming with the following objectives:

• Making tiered decisions on sequential treatment in wound salvage and repair
• Building expertise in soft tissue flap repair for preserving limb function and minimizing infection
• Performing basic microvascular techniques to restore tissue and limb integrity as best as possible 

 

To effectively accomplish these objectives, a 3-Stage approach was adopted and remains active:

1.  Virtual clinical consult sessions on optimal staging of repairs and medical care protocols

2.  Hands-on surgical training off-site using animal and other tissues

3.  Paired treatment of Ukraine war victims with training jointly conducted by Penn and Ukrainian surgeons on-site in Ukraine hospital facilities.

The effort is coordinated by the Penn Center for Global Health, led by Dr. Glen Gaulton, guided medically by the Penn Chief Medical Officer, Dr. PJ Brennan, and supported logistically by Ms. Kierstyn Claycomb. As listed here, numerous surgeons at Penn/CHOP provide the essential effort:

PENN AND CHOP FACULTY INVOLVEMENT

UKRAINIAN PARTNER INSTITUTIONS:

Our Ukrainian partners represent the institutions below, their names have been withheld to ensure their continued safety.

• Vinnytsia Regional Pirogov Clinical Hospital, Vinnytsia
• Transcarpathian Regional Clinical Hospital of A. Novak, Uzhhorod
• Lviv Regional Hospital for War Veterans, Lviv
• Zakarpattia Oblast Children's Hospital, Mukachevo
• First Medical Union, Lviv
• Institute of Traumatology and Orthopedics, Kyiv
• Cherkasy Regional Hospital, Cherkasy
• First Cherkasy City Hospital, Cherkasy
• KNP MKL No. 11 OMR, Odesa
• Mukachevo Military Hospital, Mukachevo
• National Military Medical Clinical Centre, Kyiv
• Military Medical Clinical Center of Northern Region, Kharkiv
• Military Medical Clinical Center of the Central Region, Vinnytsia
• Military Medical Clinical Center of the Western Region, Lviv
• Military Medical Clinical Center Southern Region, Odesa
   

Detailed descriptions of Penn’s ongoing work are listed below:

Virtual clinical consult sessions on optimal staging of repairs and medical care protocols

Penn Medicine established a collaborative project in April 2022 between Penn specialists in orthopedic surgery, trauma, infectious disease and plastic surgery with the administration and surgeons at several hospitals in Ukraine including Vinnytsia Regional Pirogov Clinical Hospital (Vinnytsia), Mukachevo Military Hospital (Mukachevo), Transcarpathian Regional Clinical Hospital of A. Novak (Uzhhorod) and Zakarpattia Oblast Children's Hospital (Mukachevo). This project took the form of individual case reviews with practical guidance in treatment plans and staging of repairs and reconstruction by Penn physicians.

Feedback from the virtual support process with initial partners was overwhelmingly positive and has expanded to additional hospitals including Cherkasy Regional Hospital (Cherkasy) and KNP MKL No. 11 OMR (Odesa). The joint teams have met regularly since the beginning of the war.  In total over 300 sessions have been held covering more than 475 individual case consultations.

Over time these sessions were expanded further from orthoplastics to include GI, neurosurgery, acute trauma, neonatology, and infectious disease among others. On certain occasions live surgical cases and protocols are assisted, for example in endoscopy, where advice is provided during the actual course of diagnosis or treatment. Sessions are uniformly conducted with the blessing and full cooperation of the Ukrainian Ministry of Health.

Hands-on surgical training off-site using animal and other tissues.

Through the virtual sessions, soft tissue repair skills related to blast injuries were identified as a critical surgical training need. In response to this request Penn developed a hands-on program for skill development in soft tissue flaps and microsurgery to build capacity in country. The program was launched in summer-fall 2022 with participation from 16 surgeons practicing in 5 regions across Ukraine representing hospitals including Vinnytsia Regional Pirogov Clinical Hospital (Vinnytsia) and Zakarpattia Oblast Children's Hospital (Mukachevo). Transcarpathian Regional Clinical Hospital of A. Novak (Uzhhorod), Clinical Municipal Communal Emergency Hospital (Lviv), and Institute of Traumatology and Orthopedics (Kyiv).

The first component of this training was a mandatory 6-hour live but virtual training session in September 2022.  This was followed in December 2022 by an in-person training program held in Heidelberg, Germany led by Drs. Scott Levin and Dr. Steven Kovach. All 16 Ukrainian surgeons attended along with several more junior trainees. Feedback from this training was extremely positive.

A second virtual training was conducted in February 2024 and was attended by more than 125 Ukrainian surgeons representing 19 oblasts.

Paired treatment of Ukraine war victims with training jointly conducted by Penn and Ukrainian surgeons on-site in Ukraine hospital facilities.

The current limiting challenge lies in improving the clinical/technical competency of the Ukrainian surgeons – this especially in the domain of bone and aligned tissue repair via microvascular surgery to support the long term needs of late-stage reconstructive surgical expertise. The acquisition of refined surgical skills in domains such as microvascular surgery requires substantial expertise built both by practice and over-the-shoulder coaching prior to the treatment of live patients. As a result, in February 2023 Dr. Oksana Jackson, Dr. Steven Kovach and Dr. Andrew Bauder traveled to Uzhhorod, Ukraine and assisted their Ukrainian colleagues during surgeries on numerous victims of the war. 

In April 2024 the training cohort was expanded to include a total of 24 Ukrainian surgeons, both civilian and military, representing 8 major medical hubs across Ukraine.

Penn/CHOP teams have visited Ukraine for 5 separate training sessions since our collaboration began with planning underway for future training sessions in country.

These live, in person sessions provided the ideal complement to top-off prior skill training. Penn/CHOP surgeons worked side-by-side with colleagues to further refine their skills both in mapping the ideal course of surgical correction and in the technical aspects of performing the surgery. 

Future Program Development

The positive impact of this effort, in terms of improving patient outcomes, of enhancing the capacity of Ukrainian surgeons and hospitals to achieve their missions, and of the growing interpersonal relationships has created opportunities for continued learning and collaboration among the participants who are now developing their skills in real-life situations and consulting with one another on cases.  Clearly, one of the most exciting outcomes of this work is to witness the improved outcomes for patients indeed, along these lines our longest standing partner, Vinnytsia Regional Pirogov Clinical Hospital (Vinnytsia) has recently been designated as a Center of Excellence for Orthoplastics.

The success of this pilot program has also garnered national attention within Ukraine and, not surprisingly, this work has resulted in an expanding number of requests to Penn/CHOP. Along these lines we are discussing new partnerships to extend training to more surgeons, and to expand programming on best practices for amputation with a goal of limb salvage and post-operative care and rehabilitation, among other topics. Similarly, on the academic front, in partnership with Ukraine’s oldest medical university – Vinnytsia National Pirogov Memorial Medical University – the Center for Global Health is excited to announce that we have begun the initial phases of collaboration between our respective medical universities. Areas of focus here include but are not limited to:

• Development of curriculum to pioneer Ukrainian medical education to match global standards of excellence
• Creation and implementation of a first-of-its-kind clinical practice center for surgical students based on advances in simulation and virtual reality
• Exchange opportunities for both students and faculty to enhance clinical skills and develop clinical research
• Create model partnerships between Ukrainian universities and hospitals that promote the sustainable development of academic medicine in Ukraine 

The positive effects of Penn’s effort are currently limited only by the resources available to us - we hope that you will donate to the Penn-Ukraine Program, even if a small contribution, by accessing the site below:

Donate Today!