Medicine in Ukraine – promoting young leaders

Dr Olya Tychkivska And Mr. James Temerty in Lviv honouring his donation of medical equipment to Lviv City Children’s Clinical Hospital as part of UPFP

Myroslava Romach for New Pathway – Ukrainian News, Toronto.

This past year of the Covid-19 pandemic has become a time to reflect on our past experiences and accomplishments and to consider how we will adapt and create opportunities for progress in the future in what will be a very different environment from pre-Covid-19 years. This challenge has been particularly on my mind as I consider how the Ukraine Paediatric Fellowship Program (UPFP), based at SickKids Hospital in Toronto, can continue to evolve over the next few years. This capacity building program was established as a collaboration between the Children of Chornobyl Canadian Fund, the Ukrainian Canadian Congress and SickKids Hospital following a seeding donation by the estate of Saskatchewan resident Fred Tkachuk in 2011 and generous support from the Temerty Foundation. It has grown steadily in its influence and is now well known in the medical community in Ukraine.

With international travel suspended indefinitely in March 2020, UPFP was forced to modify its approach to training. Our team quickly pivoted, like many educational and training programs, to virtual teaching and clinical case consultations with our Ukrainian colleagues. This modality has been very effective in supporting the goals of the program and has the capability to involve a greater number of participants. Nevertheless, the loss of in-person interactions has reminded us that camaraderie and teamwork play a vital role in the mentoring component of our exchange program. We are looking forward to the resumption of our exchanges in 2021.

We have had more than 50 very talented physicians participate in our Observership program at SickKids Hospital, who then return to Ukraine with new medical and leadership skills and new ideas to implement at their home base children’s hospitals. This year marks the 10th anniversary of the conception of this project and I would like to use this milestone to share the stories of some of our trainees and their accomplishments. Two in particular have had a significant impact on children’s health in Ukraine.

Expanding Cancer Care

Roman Kizyma is a paediatric oncologist working at the Western Ukraine Specialized Children’s Hospital in Lviv. Roman has trained at SickKids on two separate month-long visits. Over the past 6 years, he has collaborated closely with UPFP team member, Dr. Eric Bouffet, an internationally recognized oncologist who has much experience in supporting global health initiatives in paediatric cancers. Dr. Bouffet encouraged Roman to attend and present papers at international conferences on the state of paediatric cancers in Ukraine and introduced him to colleagues from other countries. Dr. Bouffet, as President of the International Society of Pediatric Oncology, also worked with Roman to have Ukraine included as a focus country in the World Health Organization’s Pediatric Cancer Initiative, established in 2018 to improve the survival rates of children with cancer. In Ukraine, survival rates are much lower than in North America and Europe. This is a result of many factors including poor training of physicians in up-to-date treatments and delays in diagnosis. With these activities, Roman captured the attention of international colleagues and was invited to collaborate with St. Jude’s Children’s Hospital in Memphis, USA, to include Ukraine in the International Pediatric Cancer Treatment Registry. St Jude’s Hospital focuses exclusively on treating children with cancer and remission rates in children treated there are over 90%. Being a member of this registry will allow Ukrainian oncologists to have access to the latest standardized protocols of treatment and see their outcomes, to share expertise in clinical care and to engage in training programs. They will be able to compare how specific tumours are treated in different participating countries – Japan, Sweden, Australia, Canada, USA and in Ukraine. This project began in January 2021 in Lviv and will eventually involve oncologists across the country.

Recently Roman has partnered with a very talented haematologist at the National Specialized Children’s Hospital (Okhmatdyt) in Kyiv, Dr. Oleksander Lysytsia, to form the first Ukrainian Association of Paediatric Haemato-Oncologists. In 2019, UPFP sponsored a visit to Okhmatdyt by a haemato-oncologist from Vienna’s St. Anna’s Children’s Hospital to provide training on bone marrow transplantation for children with blood disorders and specific cancers. In 2020, Dr. Lysytsia performed Ukraine’s first pediatric non-related donor bone marrow transplants. He is planning to come to SickKids for further training, hopefully later this year. Thus, a network of young outstanding oncologists has been formed whose goal is to advance the treatment of pediatric cancers.

In addition and in recognition of his leadership, Roman Kizyma has been named an Ambassador of the city of Lviv and has been appointed to the Ministry of Health’s Advisory Council on cancer medications.

Dr. Roman Kizyma during his Observership at SickKids Hospital

Leadership in Pediatric Neurology

Olha Tychkivska is a pediatric neurologist, also from Lviv, working at the Lviv City Children’s Clinical Hospital, another partner hospital with UPFP. Olha completed an observership through UPFP several years ago and is now in Toronto with her family in her second full year of training as a Clinical Fellow in Pediatric Neurology. Her work is focused on child epilepsy. She is under the supervision of another UPFP team member, Dr. Cristina Go. Olha has received laudatory reviews of her performance from her SickKids colleagues. After her first year of a Clinical Fellowship, she was invited by the Department of Neurology to remain for an additional year of training because her supervisors recognized her outstanding clinical skills. She was recently certified as a Diplomate of the Canadian Society of Clinical Neurophysiologists. There is no clinician currently in Ukraine with this specialized expertise. When she returns to Ukraine, she will be able diagnose and advise on the treatment of the most complex forms of childhood epilepsy.

Olha has been a vocal advocate for many years for the improvement of children’s health in Ukraine. She has been involved in numerous campaigns helping families find appropriate care for their children’s medical needs. A particularly important initiative she has been involved with, along with American geneticist Dr. Volodymyr Wertelecki, is advocating the Ukrainian government to mandate fortification of flour with folic acid. Such fortification dramatically reduces the incidence of neural tube defects in newborns. Neural tube defects are a group of congenital birth defects in which an opening in the spine or cranium remains from early in fetal development. Specific types include Spina Bifida. Most infants with such defects either die at birth or have major neurological disabilities. During UPFP visits to neonatal units in Ukraine, we have seen many infants with such birth defects, often requiring some degree of surgical intervention. More than 80 countries around the world have now implemented folic acid fortification of flour, including Canada, with dramatic reductions in the number of children born with NTDs. Ukraine is a major exporter of grain, which it fortifies in order to be able to sell the grain abroad. However, it does not fortify grain sold domestically. Ukraine has Europe’s highest incidence of neural tube defects (NTDs), 21.5 cases per 10,000 live births compared to 4.5 cases per 10,000 live births in Canada and the United States. Drs. Tychkivska and Wertelecki and their colleagues have campaigned for years for mandatory fortification and after a major push in 2017-2018, with UPFP’s support, their efforts led to the tabling and first reading of a new law in Parliament in August 2018. Mandatory fortification was to start in 2020, but unfortunately with a change in government the law has stalled in Parliament awaiting a second reading and confirmatory vote in order for implementation to proceed. With the support of UPFP, Drs. Tychkivska and Wertelecki continue to fight to bring this initiative to a successful outcome.

Fetal and Infant Neurodevelopment

As part of this focus on the prevention of neurodevelopmental complications in infants, UPFP has been developing a project on maternal perinatal mental health in Lviv. Mental health issues in women during pregnancy and the postpartum period, if undetected and untreated, can have significant adverse effects on the cognitive, behavioural and social development of children. For a number of years, I have been working with psychiatrists Drs. Sofiya Vlokh and Oleh Romanchuk, from the Lviv National Medical University, to raise awareness in the medical and general communities about maternal perinatal mental health, to encourage early detection and treatment by physicians to prevent and mitigate the development of neurobehavioral problems in children later in life. As this project grows, it has also brought attention to subjects previously unaddressed by physicians and society, for example fetal loss and still births, and how to support families through these traumas.
There are many additional stories we could recount as part of the growth of our program and its emphasis on early interventions. We are extremely proud and gratified by the clinical and leadership accomplishments of the Ukrainian colleagues we have collaborated with and who have participated in UPFP. We look forward to many more years of partnering together to advance the health of all children in Ukraine.

To those readers who have been donors to UPFP, we thank you for supporting such amazing young leaders in Ukraine!

Myroslava Romach MSc, MD, FRCPC
Professor,
Temerty Faculty of Medicine, University of Toronto
Co-Director, Ukraine Paediatric Fellowship Program, SickKids Hospital, Toronto