OPT’s managing director Lara Gillespie (Wieland), interviewed Assoc. Professor Dr Ryan Winters, a Facial Plastic & Reconstructive Surgeon currently based in Newcastle, NSW, Australia. He has not long returned from his second surgical mission to Ukraine with plans to return again later in the year. He had been operating and teaching at several hospitals in Kyiv and Lviv, including the Okhmatdyt Children’s hospital in Ukraine, that was destroyed just two days ago by Russian Khinzal missiles [1] in a massive missile attack across Ukraine that killed over 40 and injured over 170 and rising[2], and from where he still awaits news of some of the colleagues he had been operating with[3].
Read his story here…
Lara: What inspired you to volunteer for this medical mission in Ukraine?
Dr Ryan: I have been very fortunate to be able to incorporate medical relief work, both domestic and international, as a significant part of my career and have worked in a number of different countries in Africa, Asia, and Latin America in this regard over the years, and with a variety of NGOs. I am a very active member of the American Academy of Facial Plastic & Reconstructive Surgery’s Face to Face Program and sit on the organising committee. I am particularly passionate about relief work that builds local capacity, training and working with in-country surgeons to improve care available full-time in the countries I travel to. That is the underlying goal with these Ukraine trips: to build local capacity for complex craniofacial reconstruction for victims of war violence, and thus I was very excited to be able to contribute. I was approached by some friends and mentors who are also Facial Plastic & Reconstructive Surgeons in the US and Canada to join them on their second trip to Lviv, Ukraine, last year with the principal goal of training two Ukrainian surgeons in free tissue transfer and other complex facial reconstructive techniques. Even in countries with quite well-developed health systems, such as Ukraine, war or other disasters create significant technical and logistical, as well as personnel, challenges. My most recent trip to Lviv and Kyiv was really an extension of this underlying goal of up-skilling some of the already very talented Ukrainian surgeons, this time under the auspices of CMA [OPT’s lead charity partner in Ukraine www.cma-ukraine.com] and Razom for Ukraine (two wonderful NGOs very active in the Ukrainian crisis).
Lara: How did you prepare for the trip, both personally and professionally?
Dr Ryan: Professional preparation is important, and the realities of operating and caring for patients in situations and medical systems with more limited resources than we enjoy here in Australia cannot be understated. The first line of my “introduction” packet from my first field mission with Medecins Sans Frontieres/Doctors Without Borders many years ago is very close to my heart and guides me:
“Be patient. Be very patient. Be very, very patient.”
I am in awe every time I go and work in such settings, and especially once I return, of just how much can be done safely and effectively with comparatively little in terms of personnel and equipment, when a dedicated team of people (Ukrainians first and foremost, but also all the international volunteers) seek to achieve the same goal. It is truly inspiring, and honestly rekindles my passion for my career in medicine in general. Service and volunteerism is very good for the soul.
Preparing personally has become easier, and more so when returning to a place I’ve been and worked before and with a group of people with whom I’ve worked (though there are always new teammates, Ukrainian and international).Preparing my family for each of these trips has also become a bit easier, in that they’re no longer surprised by my desire to work in conflict zones after all of these years, but it is the most stressful part. I’ve yet to meet a parent who is excited their child is off to a war zone, and that includes mine! Assessing the risk pre-trip as best we can helps assuage some of these concerns, but it is still the most difficult part: explaining this passion for service to my family and friends who are all very (understandably) worried. Having NGOs such as Razom and CMA is really crucial, as they can best assess the in-country risk and facilitate our work and our safety as much as is possible.
Dr Winters meeting Ukrainian colleagues
Lara: Can you describe the role of the Christian Medical Association of Ukraine and Dr Rudi Myhovych in organising your trip?
Dr Ryan: Dr Rudi and CMA were absolutely instrumental. As described above, they greatly facilitated security assessment and procurement of some supplies. More importantly, they facilitated contact between the Ukrainian teams and ours, as well as handling licensing and credentialing with the various hospital and medical authorities. They facilitated patient recruitment (together with Razom). We truly would not have been able to make a meaningful impact without them. One common folly in international work, specific to disaster and war zones, is an overabundance of ‘good will.’ People mean well and want to volunteer and help and can even turn up to such areas without any plans in place or contacts, and this can actually worsen an already tense and complex logistical situation. Dr Rudi and CMA made sure this did not happen; plans were in place, licenses and permissions were granted, and that we could actually contribute in a way that benefits Ukraine. I’d like to add that despite CMA’s name it was not necessary to have any kind of religious affiliation to join this team, just a willingness to help and share the needed skills and teaching.
Lara: Can you describe some of the complex cases you worked on during your time there?
Preparing my family for each of these trips has also become a bit easier, in that they’re no longer surprised by my desire to work in conflict zones after all of these years, but it is the most stressful part. I’ve yet to meet a parent who is excited their child is off to a war zone, and that includes mine! Assessing the risk pre-trip as best we can helps assuage some of these concerns, but it is still the most difficult part: explaining this passion for service to my family and friends who are all very (understandably) worried. Having NGOs such as Razom and CMA is really crucial, as they can best assess the in-country risk and facilitate our work and our safety as much as is possible.
Reconstructing both blast and major facial injuries nearly always requires multiple operations. The nose, mouth, jaws, and eye sockets are complex anatomical structures with a variety of functions that must be restored. For major injuries where large amounts of tissue are missing, such as after blast injuries or other major penetrating trauma, Tissues from the patient’s own body must be brought in and used to re-sculpt and rebuild the missing elements. This is “free tissue transfer,” or more colloquially in the medical world “free flap” surgery. It is analogous to a kidney transplant; where an organ is taken, together with it’s blood supply, and sewn into a recipient. Rather than a donor kidney, it is a piece of the patient’s own tissues, which can be skin, muscle, bone, fat, fascia, or really any combination thereof, that has a defined artery and venous supply. This is taken from a non-injured part of the body such as the torso (which may have been armour-protected, or an un-injured arm or leg), and sewn into blood vessels to re-vitalise it in the injured area of the head and neck. These tissues are then re-sculpted into a jaw, eye socket, midface, etc, depending upon the injury. This is an operation that takes many hours, often with two teams of surgeons, and is always challenging.
Surgeons operating
Lara: What were the most challenging aspects of performing surgeries in a war zone?
Dr Ryan: I think I’ve covered a good bit of this prior, but the main challenges now are in getting material/supplies. You cannot order or ship things to Ukraine easily. There are no regular commercial cargo flights and no commercial passenger flights. So getting ANY equipment and/or people to the sites of utmost need is extremely difficult and costly. Even supplies destined for Ukraine that are ordered and delivered to neighbouring Poland or Romania require Herculean efforts to retrieve them and bring them across the border. And they’re subject to delays of hours to days or weeks if we’re talking commercial quantities. Even something as mundane as sending money to an internationally-recognised charity or NGO working in Ukraine is subject to extreme scrutiny, due to sanctions on organisations with any ties to Russia or the conflict. The costs for everything are therefore astronomical. In this latter way, OPT (www.passingthrough.net/donating) can make huge inroads. It is a safe, secure, legal, and risk-free way to donate money for desperately-needed supplies, and essentially 100% of any donation to OPT goes directly to medical and social relief efforts, not weapons, in Ukraine.[4]
Lara: How did the local medical teams and facilities support your efforts?
Dr Ryan: Simply put: they are AMAZING. While Ukraine was already blessed with a highly-educated and trained medical and surgical workforce, those nurses, physicians, surgeons, physiotherapists…every medical profession…that remain and are still working can scarcely be commended highly enough. It is an understandable yet unfortunate reality, that in times of great conflict in any location, many highly-educated people with desperately-needed skills will seek to leave for the sake of themselves and their families. This is understandable. We all want our families to be safe. This ‘brain-drain,’ of some very skilled individuals, especially in the healthcare field, yields acute shortages in medical knowledge that are at great risk of becoming chronic. We all want our families to be safe and prosperous. It is therefore SO important for us, as a global society, to support those professionals, whether they be doctors, nurses, engineers, teachers…those professionals who could go elsewhere but choose to stay and to maintain and build Ukraine in such a crisis time. They’ve already made the hardest decision: to stay and make things better. Our group’s mission to help improve complex craniofacial reconstruction is a drop in the ocean of the medical needs of Ukraine. Our Ukrainian colleagues have emerged as EXTREMELY talented trauma and reconstructive surgeons, intensive care teams, and all the other milieu that is required to care for the consequences of a conflict such as this, even whilst it’s ongoing. I would encourage EVERYONE to look into the Unbroken project;( https://unbroken.org.ua/) a masterpiece plan of re-integration of veterans, accessibility and care, and medical and urban planning championed by the mayor of Lviv.
Lara: Can you share a particularly memorable or impactful moment from your trip?
Dr Ryan: The continuity of care has been quite inspiring. We all meet via Zoom or WhatsApp to discuss the next stages of surgery for patients, and to address any challenges or complications. Easily the most memorable and inspiring aspect has been seeing the first two Ukrainian surgeons we went there to help train now start to build a complex facial reconstructive service of their own at the hospitals in Lviv. This strange ad hoc model of a ‘fellowship,’ combining international team visits like ours with short-term observerships in other countries (as of now the US and Canada) in-between, has borne fruit in the form of a nascent surgical service run by these Ukrainian surgeons, for Ukrainians. My home hospital, John Hunter Hospital was EXTREMELY supportive of me bringing one of these surgeons here to observe with me but they could not get a visa in time last year before they had to deploy back to the front lines. It is a testament to the drive and dedication of these Ukrainian surgeons, as well as to the generosity of Americans, Canadians, and Australians in this time of true crisis.
Lara: What do you believe was the most significant impact of your team’s work in Ukraine?
Dr Ryan: Easily the most significant impact has been the nascent craniofacial reconstruction team in Lviv. Run by Ukrainian surgeons, for Ukrainians. This is the goal, and it’s been amazing to see the first steps of this!
Lara: Are there any ongoing or future plans to continue supporting the medical efforts in Ukraine?
Dr Ryan: Yes. I will be going back to Lviv to further support and to potentially teach some additional free flap types to further expand the capabilities they have. I had initially planned on going back to Kyiv to do some major paediatric facial reconstruction, but this was to be done at the hospital that was just catastrophically damaged by the recent Russian missile strike. I am in contact with some of my colleagues there (the ones who I know are OK and alive and uninjured) but the fate of the hospital remains in limbo for now.
Lara: What would you like readers to know about the situation in Ukraine and the need for medical volunteers?
Dr Ryan: I think we are all better citizens of the world when we look outward as to how we can help others. Locally, regionally, nationally, and internationally. If this is something you are interested in, in this instance Ukraine, please contact OPT (if in Australia) or CMA, and we can help anyone find the best way to contribute given their specific skill set and situation. Above all, thank you all for reading this far and taking an interest. This is truly the first step.
Lara: Anything else you would like to add?
Razom for Ukraine (https://www.razomforukraine.org/) is another EXTREMELY worthwhile Ukrainian NGO where nearly all donated monies go to help. They work hand-in-hand with CMA and Face to Face, among other organisations. They are also (like CMA) really, REALLY, good at providing the “nuts-and-bolts” of disaster relief. The non-sexy stuff like laundry detergent, dishsoap, infant formula, and all the other things that we all take for granted in stable environments but that are necessary for our lives. Dr Rudi was kind enough to show me around the CMA warehouse, which is a super-impressive operation, and a huge portion of it was dedicated to providing these basic necessities. They are true heroes in this regard.
Lara: What final thoughts or reflections would you like to share about your experience?
Dr Ryan: Well, dear readers, if you’ve made it this far I hope you’re at least peripherally interested. Here is the point where I’m sure you’re expecting some sort of a “call to action,” and I don’t want to dissuade you of this.
Please. Get involved. Donate to worthy causes such as OPT, CMA, Razom.
Contact your representative in parliament or congress or equivalent, depending on where you’re reading this from.
But the message I’d like most to leave you with is not from me, but rather from my esteemed Ukrainian colleague who is on the ground after the most recent hospital attack.
This is from our esteemed colleague Christina Pohranychna, from Razom Ukraine, who was one of our “on the ground” fixers and admin people on this last trip with CMA and Razom. The following are her powerful words, edited for clarity due to translation:
“All world media, of course, will write and show how Russian terrorists attacked a children’s hospital. All the horrifying photos and videos of children and destruction will be everywhere. [The Russian forces seem] pleased with the killing of children, everything is hopeless here. Therefore, the Russian government arranges these attacks – to please their own orcs on the one hand, and on the other hand, try to influence ordinary residents of Western countries to make them scared and think about how to appease Russia with a piece of Ukraine. We are now living in anticipation of [a 1938-style] Munich conspiracy.
The photos and videos of wounded children are more like documenting Russian crimes. And simply broadcasting all Ukrainian suffering is justifying the expectations of Russian terrorists and spreading fear of their terror. For journalists, this dilemma has long been known – on the one hand, you cannot not show the consequences of a terrorist act. And on the other hand, you are helping terrorists spread their propaganda. And the difficult question is, what should be done then?
In my opinion, in addition to showing the consequences of these attacks, we must definitely show how hundreds of Kyiv residents mobilized to manually clear the rubble of the hospital within a few hours. How people brought water and food. How they moved children to bomb shelters during the threat of another attack.
Let’s show the world that we not only suffer, but we save our own, we mobilize to overcome the consequences of Russian terror. I think this is the main thing right now.”
Her last few sentences really hit me hard. The focus on the obvious atrocities claims headlines, for better or worse. The world is admittedly complex, and even nuts at the moment. One atrocity shouldn’t have to ‘compete’ with any other; but predators prey on the distracted as much as on the weak. We, globally, cannot ignore what is going on here. The stories of the truly heroic and almost instinctive response of everyday Ukrainians to such events is not as widely reported. Videos of blood-soaked civilians and passers-by clearing rubble in a bucket-brigade from the ruins of the hospital exist, but don’t get the airtime they should. These are people doing everything and anything they can in a horrific situation.
Let’s be like them.
1. Note the UN and other investigators have now declared that this was a deliberate strike by more than one precision guided Russian Kh-101 missile and was the intended target.
2. Civilians killed or injured in multiple strikes across Ukraine on July 8th as of 10th July – these numbers may rise.
3.Dr Winters has since received confirmation that the colleagues he operated with are alive.
4. 100% of all donations made to OPT for Ukraine are sent to Ukraine with OPT volunteers absorbing the cost of fees and arranging transfers and all paperwork involved. Donations over $2 are tax deductible in Australia.
