Introduction:

On November 1, 2013 the Ukraine Paediatric Fellowship Program was formally launched at a wonderful evening reception at the Hospital for Sick Children. Hosted by Chrystia Freeland, and attended by over 140 members of the Ukrainian-Canadian community, all came to celebrate the successful creation of the Ukraine Paediatric Fellowship Program. A key component of the evening was to recognize the leadership of the CCCF in establishing this Program.

Over a year ago, the CCCF took the first step forward in creating the Ukraine Paediatric Fellowship Project by directing a $1.05 million gift from the CCCF to SickKids. This gift to SickKids was made possible by a bequest from the estate of Mr. Frederick Tkachuk of Melfort, Saskatchewan. Mr. Tkachuk was a successful farmer of Ukrainian descent born in Saskatchewan who left this significant bequest to the CCCF.

Thanks to the vision of the CCCF and the generosity of Mr. Tkachuk, the Ukraine Paediatric Fellowship Program (UPFP) now has a simple goal: To ensure that children in Ukraine can live healthy and happy lives. And the Program achieves this goal by providing specialized medical training to talented physicians in Ukraine.

Dr. James Rutka, an internationally recognized neurosurgeon at SickKids and of Ukrainian descent, volunteered to take on the role of Project Leader in implementing the program. SickKids quickly appointed Dr. Myroslava Romach to serve as the International Medical Director of the UPFP. Together, Dr. Rutka and Dr. Romach have moved this program from idea to reality, and that is what was celebrated at the launch event in November at SickKids.

May 2013 Mission:

During the Program launch, Dr. Rutka provided a fascinating summary of his mission to Ukraine that took place in May 2013. Through an engaging series of photographs, Dr. Rutka provided some insights into the unique challenges that paediatric surgeons face when treating vulnerable children in Ukraine.

Landing in Lviv, Dr. Rutka was accompanied by his colleague, Dr. Mark Bernstein—also a Neurosurgeon—and Dr. Romach. For the next week, Drs. Rutka, Bernstein and Romach conducted an impressive series of visits to various  hospitals in Ukraine.

Specifically, the team visited the Lviv City Children’s Clinical Hospital. This hospital was selected because it has just opened a paediatric neurosurgical unit of 10 beds and the physicians, including the Physician in Chief, expressed intense interest in collaborating with SickKids. In Kyiv, the Ramodanov Neurosurgical Institute was visited because it is the site of training of all neurosurgeons in Ukraine. It has  350 inpatient beds which include a  paediatric wing and Intensive Care Unit. Here again, a connection with committed surgeons had been made the previous year. The main Specialized Children’s Hospital in Ukraine, the Okhmatdyt in Kyiv, was also visited.

The purpose of this mission was three-fold:

  • First, to conduct workshops and lectures on the latest techniques in paediatric neurosurgery;
  • Second, to provide hands-on training in surgical technique by assisting in specialized  operations on children and to share medical knowledge through consultations on management of patients;
  • Third, to select the first Surgical Fellows to come to SickKids.

The trip was a great success, with Drs. Rutka and Bernstein able to achieve all of their objectives.

Teaching and Lectures:

At each medical centre, Drs. Rutka and Bernstein delivered  eight lectures to Ukrainian medical colleagues. The topics were very specialized, and covered the range from “Paediatric neurosurgical oncology” to “Epilepsy surgery in children”.

The Ukrainian surgeons were honoured to hear from Dr. Rutka and Dr. Bernstein, who are truly recognized as international experts in their field. The slides for their lectures had been sent in advance and in Lviv were subsequently all translated into Ukrainian by one of the paediatric surgeons, Dr. Yurij Kolivoshka, who also provided simultaneous translation into Ukrainian during delivery of the lectures.

This extensive effort in preparation demonstrated the extent of commitment the young physicians in Lviv made to ensure a successful event. Approximately 50 health professionals attended the lectures at each center: local and regional paediatric and adult neurosurgeons, neurologists, oncologists, paediatricians, neonatologists and others. An active question and answer period ensued after each presentation.

Performing Surgery: Lviv

While lectures are important, there is nothing like hands-on training in a surgical setting. Prior to the arrival of the mission team, the participating centres had been asked to select patient cases for teaching both for expert opinions and for an assisted surgical intervention.

In Lviv, Dr. Bernstein instructed the three Ukrainian neurosurgeons in the technique of awake craniotomy on a 14-year-old girl for removal of a brain tumour. Tumour removal had not been attempted before in a paediatric setting in Lviv and patients had either been referred to Kyiv or to the adult hospital in Lviv. The Children’s Hospital does not have an operating microscope, advanced neurosurgical instruments, a MRI or CT scanner and relies on equipment from the adult hospitals.

The surgery was carried out successfully despite lack of such basic and essential equipment. The lead young neurosurgeon, Dr. Taras Mykytyn, was coached throughout the procedure by Dr. Bernstein.  In the end, a large brain tumour was removed completely without complications.  We have been told the child has done well postoperatively; her seizures have stopped and she is now home with her family.

Performing Surgery: Kyiv

In Kyiv, Dr. Kostiantyn Kostiuk, Head of Functional Neurosurgery at the Neurosurgical Institute, selected a 15-year-old patient with severe epilepsy.  The operating room at the Institute was much better equipped than the neurosurgical operating room in Lviv with instruments and with an operating microscope. The surgery was conducted by Dr. Kostiuk and his colleague, Dr. Valerij Chyburahin. Drs. Kostiuk and Chyburahin were instructed by Dr. Rutka on the appropriate manner in which to perform a procedure in which the two hemispheres of the brain are disconnected using microneurosurgical techniques. This was the first time that such a procedure was performed in Kyiv.

As in Lviv, the surgery was telecast to other hospitals and then posted on the website of the Ukrainian Association of Neurosurgeons. Both local neurosurgeons were very excited to receive supervision on this technique. We were told later that the surgery was also viewed and discussed the following week at the annual Congress of the Ukrainian Association of Neurosurgeons.

Selecting the First Fellows:

Based on the success of the surgical supervision provided in both Kyiv and Lviv, the team was able to select the first Ukrainian Fellows to come to SickKids October 2013, thanks to the creation of the UPFP. Dr. Taras Mykytyn, a paediatric neurosurgeon from the Lviv City Children’s Clinical Hospital, Dr. Andrij Kuzyk, a paediatric surgeon from the Lviv Regional Children’s Hospital, and Dr. Kostiantyn Kostiuk, Head of Functional Neurosurgery at the Neurosurgical Institute in Kyiv were invited and all attended observerships at SickKids and at Toronto Western Hospital.

While in Toronto they had the opportunity to observe multiple specialized operations, take part in clinical rounds and discussions on numerous patients and practice their surgical skills at the Temerty Chang Simulation Center at the Toronto Western Hospital.  The Canadian surgeons were very attentive in mentoring their Ukrainian colleagues and demonstrating patient care approaches utilized in Canada. Drs. Mykytyn and Kostiuk  were on hand for the November 1, 2013 launch event at SickKids and answered many questions asked by the attendees.

The Next Steps:

With a successful year behind us, the UPFP now has a long road ahead. And this was part of the message that was shared by Paul Grod, national President of the UCC, when he spoke at SickKids. Mr. Grod announced that SickKids, CCCF and the UCC are launching a national campaign to raise an additional $1 Million to ensure that the Ukraine Paediatric Fellowship Program can continue to serve more children and physicians in Ukraine.

This additional funding is required to place the program on a stable and sustainable basis—and each dollar raised will help to ensure that a child in Ukraine—who needs the special skills of a surgeon like Dr. Mykytyn, Dr. Kuzyk and Dr. Kostiuk—are able to access it.

As was said before, the goal of the Program is simple: to ensure that every child in Ukraine can live a healthy and happy life. To learn more about the Program, or to make a donation, please visit www.sickkidsfoundation.com/page/Ukraine.