Stories From the Field:

UKRAINE

Improving Burn Care in Ukraine

Justin Knittel, a Resident in Mass General’s Department of Anesthesia, Critical Care, and Pain Medicine, was granted a Center for Global Health Travel Award to spend two weeks in Ukraine consulting and providing perioperative care and postoperative management for burn patients.  His colleague Dr. Arthur Turko, a Resident in the Plastic and Reconstructive Surgery Department at Mass General, also received a Travel Award and joined him in Ukraine.

We recently embarked on a 2-week medical mission to Lviv, Ukraine in as part of a multilevel approach to improve burn care in the country. The trip began with an outreach clinic where patients who had been operated on both in the United States and Ukraine were seen for follow-up, as well as potential surgical patients were evaluated for possible procedures.

Shriner’s Hospital in Boston has provided funding in the past for medical missions to different parts of Ukraine, and even arranged transport back to the United States for patients who were critically ill or needed more extensive surgeries. We selected 16 patients for procedures in Ukraine and began the process to transport four more back to Shriner’s Hospital for their surgery. We filled 4 OR days with a variety of cases, from patients 3 years of age up to patients in their 40s. Surgeries were done in conjunction with Ukrainian surgeons and anesthesiologists and a second OR table was brought into one of the larger operating suites so that cases could be run in tandem. This allowed for better supervision of both cases and extra hands were immediately available if needed.

Working in a foreign country for the first time really made me appreciate the luxuries we have at Mass General. Any drug we need is essentially readily available, and we can depend on all of our machines and monitors to be working as expected. This is not a luxury available in Ukraine.  Much more planning had to take place so that we could safely practice in a manner similar to here, resources were limited and we had to take a daily inventory of what we had as well as frequently test and re-test monitors to make sure they worked properly.

We completed 12 successful operations, including specialized postoperative care, during our first week. The end of the week concluded with a one-day conference designed to provide assessment of the state of burn care in Ukraine, as well as to present our methods for perioperative burn care. Over 150 burn physicians and personnel, including groups from some of the large burn programs in the country, were in attendance. Overall the conference was very well received with great discussion and interaction from all groups. It ended with a large celebratory dinner with the meeting attendants where we were able to interact with our hosts and colleagues on a much more casual level.
My second week was spent with more personal interaction with residents and hospital staff from Lviv, as well as exploring the city itself. Lviv is a beautiful city, considered the “Paris of Ukraine” and carries with it a rich history that traces back over eight centuries. I spoke with anesthesia residents and about life in Ukraine as well as discussed our medical education. I spent time with attending physicians in multiple medical fields to discuss the medical system in Ukraine and how care is provided. I learned a great deal about their system and also was able to learn more about our system here in the US from their perspective.

Overall, this was a fantastic experience that has thoroughly enhanced my medical education here at Mass General.  We have already begun to plan a return trip for next year to expand on some of the projects and learning objectives from this past experience. I am very thankful to the Center of Global Health at Mass General for this great opportunity and look forward to continuing this work in the future.