Surgeon describes medical mission trip to Ukraine

Host Amber Smith: Upstate Medical University in Syracuse New York invites you to be "The Informed Patient" with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. Dr. Sherard Tatum has devoted his career to the reconstruction of children and adults with deformities of the face, head, and neck. He recently returned to Syracuse from a medical mission to Ukraine, which has been under attack by Russian forces since February, 2022, and he agreed to tell about his trip. Dr. Tatum is a professor of otolaryngology and pediatrics and medical director of facial plastic and reconstructive surgery. Welcome back to The Informed Patient, Dr. Tatum.

Sherard Tatum, MD: Thank you very much.

Host Amber Smith: Now this trip was organized through the American Academy of Facial Plastic and Reconstructive Surgery, is that right?

Sherard Tatum, MD: That's correct. We have a not-for-profit arm of the academy, called Face to Face, and it's been around for about 30 years. We travel all over the world doing reconstructive surgery, mostly for congenital work, some trauma and occasionally, war injuries.

Host Amber Smith: So, like birth defects or like you say, war injuries or trauma. What other countries has the team traveled to?

Sherard Tatum, MD: Well, it's not just one team. There are numerous teams, and we've been all over Southeast Asia, Eastern Europe, South America. There's a fair number of trips to go to Africa. Wherever there's a need, we try to get into. India.

Host Amber Smith: Have previous trips been to countries in an active war?

Sherard Tatum, MD: Yeah. It's been a while, but we were in Yugoslavia for that conflict in the mid-1990s. We were in El Salvador for a conflict in the early 1990s.

Host Amber Smith: Now, before we get into the trip too much, I wanted to ask if you can give a short description of what the academy is.

Sherard Tatum, MD: Well, the academy is basically a trade organization. It's the largest organization of official plastic surgeons in the world. And like other trade organizations, it advocates for the membership and for public health and wellbeing of the patient population.

Host Amber Smith: When did the idea of a mission trip to Ukraine take root?

Sherard Tatum, MD: Well, once we realized that the war wasn't going to be quick, and the casualties started mounting up, from our previous experience in war zones, we knew what kind of civilian and military injuries there would be and that they would be needing help. So we thought we would try to offer that.

Host Amber Smith: Was there an academy member from Ukraine, or in Ukraine, who helped organize the trip?

Sherard Tatum, MD: There are several Ukrainian American people involved in the trip, inside and outside of the academy.

Host Amber Smith: Logistically, how did the group decide on a nine-day mission split between two different hospitals?

Sherard Tatum, MD: We typically try to have about five days of surgery, and there's usually a triage day in the beginning and unpacking and getting all the equipment ready, and particularly going into a war zone, you don't know exactly what the ground transportation is going to be like. So we allowed a couple of days travel on either side of the surgery days.

Host Amber Smith: Now, besides yourself and five other surgeons, there were 10 additional staff. What were their roles?

Sherard Tatum, MD: There were several administrative people who were part of some of these other organizations like Razom and Heal the Children Northeast that helped us. And they were responsible for getting the paperwork done to get us approval with the Ukrainian Health Ministry and getting us across the borders and just things like arranging hotels and meals. And then in the day to day work we had nurses and OR (operating room) techs who would help us just like they would at home with passing instruments and organizing all the supplies we need in the middle of cases and between cases.

Host Amber Smith: So the medical staff, were you all volunteering your time?

Sherard Tatum, MD: Yes.

Host Amber Smith: But the academy arranged like the travel and the housing and stuff? So you weren't involved in that part of it?

Sherard Tatum, MD: Well, the academy didn't do that because they don't have the connections in Ukraine. We were actually working with agencies that have presence in Ukraine to sort of organize the on-the-ground activities.

Host Amber Smith: Who arranged for medical supplies and gear? Did you bring all of that that you needed from the U.S.?

Sherard Tatum, MD: Yeah. I mean, they had some things, but we were doing some pretty sophisticated reconstruction. We had patient-specific custom titanium implants made by a company called Materialise to help us reconstruct the bone defects from the injuries. We had a lot of sutures from Johnson and Johnson. We had headlights that were donated and a lot of plating sets. Those are little titanium brackets and screws that are used to put bone back together. Those those came from Synthes and from Stryker.

Materialise is a Belgian rapid prototyping company, and they have a small medical arm. And they're masters at 3D printing. So they made all these implants for us. They donated them, and they were there waiting for us when we got there. We spent a couple of months reviewing CT scans for all the patients and we went over them with the Materialise people, and then they made these titanium replacements for the bone that was blown away by the projectiles.

Host Amber Smith: So that's how you knew what size implants... They were custom made for each patient.

Sherard Tatum, MD: Yeah, they were 3D printed based on the CAT scans.

Host Amber Smith: Wow. Very interesting.

Sherard Tatum, MD: Yeah, it's pretty cool technology.

Host Amber Smith: This is Upstate's "The Informed Patient" podcast. I'm your host, Amber Smith. I'm talking with Dr. Sherard Tatum. Dr. Tatum is a professor of otolaryngology and pediatrics, and he's the medical director of facial plastic and reconstructive surgery at Upstate, and he has recently returned from a medical mission to Ukraine.

So, Dr. Tatum, I wanted to ask why you were willing, individually, yourself, to consider going into this war zone.

Sherard Tatum, MD: Well, as you might imagine, I had to get permission from my wife. But she was very supportive. It's just been a regular, not necessarily war zones, but these mission trips have just been a regular part of my career since it began. It just feels right. And there are people that need help, and we have the ability to help. We have a lot here in this country, and I think we can share a little bit.

Host Amber Smith: So you sort of have to put aside your fears or worries about personal safety?

Sherard Tatum, MD: A little bit. But we researched this pretty carefully. The city we went to hadn't been hit by a missile strike since February, and we really didn't see any overt signs of war other than sandbags and those hedgehog anti-tank things.

Host Amber Smith: Did you know the other five surgeons before this trip?

Sherard Tatum, MD: I knew about three of them. There were a couple of people that were new to me. Most of the rest of the team was from New York City. They all knew each other.

Host Amber Smith: So how do you go about packing for a trip? What did you bring?

We had to pack pretty light because we were carrying bags of supplies with us too. So you don't take a lot of great clothes, just some simple stuff to get back and forth from the hotel to the hospital every day. And everything else was medical supplies.

Host Amber Smith: I understand there were 34 patient consults, and 31 of those patients required surgery. What can you tell us about the patients? Were they adults or children?

Sherard Tatum, MD: They were almost all adults. I think we had one child who had some facial burns, scars that we did some work with. But everybody else had penetrating maxilla facial trauma. That means they were hit in the face with projectiles, either bullets or shrapnel from explosions. I think about maybe two-thirds were soldiers, and one third were civilians. Or maybe half and half, something like that.

Host Amber Smith: Are the injuries there, is there any need to take care of them immediately after they occur, or can they wait for months to have reconstruction done?

Sherard Tatum, MD: Well, they have aid stations and military hospitals and whatnot near the front lines. So these people get patched up as best they can. But they don't have people with our expertise at the front line. These cases are not as important as when people come in with life-threatening injuries. So they just put band-aids on for these problems. Like one of the guys we took care of had his foot blown off, and somebody had to stop that bleeding and get him hooked up with a prosthesis and whatnot. So the stuff we're doing is not life saving. It might be life altering, but it's not life saving.

Host Amber Smith: How did the hospitals in Ukraine compare with those in the U.S.?

Sherard Tatum, MD: The hospitals are great. They have a lot of supplies. Sometimes they don't have some of the fancier stuff that we bring. But the anesthesia was excellent. The support staff were very good. They had good intensive care units for some of the more complicated cases we did. So we were very happy with establishing a relationship with these people.

Host Amber Smith: Now these patients, what is recovery going to be like for them? you did the surgery, but then you're leaving the country. Do you hand them off to another physician that stays in Ukraine?

Sherard Tatum, MD: Well, technology now really allows you to do so much. We did all of this work through the otolaryngology department at the hospital. And, they would go around every day and take pictures of the patients if they had questions about how things looked or how things were healing, and we had numerous video conferences with them to go over how the patients were doing, and we helped troubleshoot a few complications. We were almost right there with them, even though we were gone, for several weeks, until all the patients were able to be discharged.

Host Amber Smith: That's amazing. Well, what impression did you have of the country of Ukraine?

Sherard Tatum, MD: It's a beautiful country. It is very similar to Upstate New York. It's got rolling hills, very plush, cool, lot of water, a lot of fields of various crops. And then the cities are, a lot of them are sort of old European style cities that are beautiful, and there are some walled cities and lots of old churches and that sort of thing. The people were very impressive. They are incredibly warm and welcoming, and their bravery was standout for me. The military people who were injured, the first question after we operated on them was, when can they get back to their comrades and fighting? They were very brave, and the civilian folks are just as brave.

Host Amber Smith: Does the news coverage that we see on TV and the U.S. resemble what you saw on the ground?

Sherard Tatum, MD: I think so. The news coverage tends to show sort of the acutely damaged areas. And I guess what you see when you go there is that those areas are just piling up. You know, there's just more and more damage upon damage and more and more injuries piling up, and death. That part's pretty sad.

Host Amber Smith: So during your stay, where did you sleep, and what did you eat? I mean, are, are restaurants open? Are hotels open?

Sherard Tatum, MD: Yeah, the city we were in was pretty much business as usual. There was a curfew. They turn all the lights off at 10 o'clock. But yeah, the restaurants and the hotel were very nice, and they were open for business.

Host Amber Smith: And while you were there, did you hear air raid sirens or shelling, or...?

Sherard Tatum, MD: We did have sirens go off a few times. They, you know, in a hospital, people tend to ignore that because if you're operating, you don't just run out of the room and go into the basement. They had this system that would send an alarm over your cell phone too, when they thought there was a threat. We saw one plane fly over. And we're not sure what that was. But there were no explosions.

Host Amber Smith: So just getting to Ukraine, you had to drive into Ukraine, right?

Sherard Tatum, MD: Yeah, it's not safe to fly. We flew into Krakow, Poland, which is on the eastern border of Poland, Western border of Ukraine. And then we spent the night there and got a bus the next day and drove to Ivano-Frankivsk, which is the city we were in. And that took about 12 or 14 hours.

Host Amber Smith: Now the people, are the people there constantly on edge?

Sherard Tatum, MD: No, I did not feel that. I was taking a picture one evening of I think it was the Main administrative building for the city, and a guard came over and asked me not to do that, and that was about the only interaction I had with anybody military at all.

Host Amber Smith: Now we've heard President (Volodymyr) Zelensky asking for more military aid. Do you think the country is in need of more medical aid, as well?

Sherard Tatum, MD: Yeah, they could certainly use more aid. We're in the process of organizing several trips over the next few months to different cities to try to increase the aid effort that we're offering.

Host Amber Smith: Well, Dr. Tatum, thank you for making time to tell us about this. It's really interesting and amazing.

Sherard Tatum, MD: Well sure, Amber. Thank you.

Host Amber Smith: My guest has been Dr. Sherard Tatum. He's professor of pediatrics and otolaryngology and medical director of facial plastic and reconstructive surgery at Upstate. "The Informed Patient" is a podcast covering health, science and medicine, brought to you by Upstate Medical University in Syracuse, New York, and produced by Jim Howe. Find our archive of previous episodes at Upstate.edu/Informed. This is your host, Amber Smith, thanking you for listening.