Supported by a school fellowship and trained at the Cumming School of Medicine, a Ukrainian doctor is nearing a return to help her home country after a packed learning experience in Calgary.

Some-three years ago, the University of Calgary launched a three-step humanitarian fellowship specifically designed for surgeons in areas of geopolitical crisis, led by oculofacial plastic surgeon and clinical associate professor at the Cumming School of Medicine Dr. Karim G. Punja, MD. Now, four years after Russia launched a full-scale invasion of Ukraine, the fellowship’s first student is nearly ready to enter step two.

Dr. Pavla Ivaniuta, MD, an ophthalmologist and surgeon from Kyiv, first met Punja a year ago at a conference in San Diego. There, Punja noticed her strong technical skills and knowledge and thought she’d be a strong fit for the fellowship.

“I thought she was a very teachable surgeon through that first interaction; we had some good chemistry, and I agreed wholeheartedly to bring her to Calgary if she was willing to come. I said, ‘please just come, and I’ll take care of the rest. Just come, we need to train you,’” Punja said.

Instantly, Ivaniuta knew the weight of the opportunity both for her career but also for her community.

“In general, we have a bit of a different system of education. In Canada, they have five years of residency, but in Ukraine, we have just two; it’s nothing, and I realized that it’s not enough, and I need to improve my skills,” she said.

“I’m here because of a business trip from my Bogomolets National Medical University, and they really support me and understand how it’s important for our country to improve the knowledge of our doctors.”

Benefitting from ongoing learning

Since coming to Calgary four months ago, Ivaniuta has re-learned how to treat patients, from day-to-day civilian injuries to intense soldier trauma.

“I feel myself more confident. Due to Dr. Punja, I can do cases, even some complex cases, together with him, or even by my own,” she said.

Punja said that Ivaniuta has flexed her doctor muscles, watching and then performing post-cancer reconstructions.

“She’s doing full (reconstruction) cases, and in a very accelerated, compressed timeline, she’s managed to really rapidly acquire these skills and now she’ll be able to utilize them with cancer reconstructions, trauma reconstructions, and everything in between,” he said.

Thinking about the knowledge she’ll share with her peers in Ukraine, Ivaniuta hopes to open her own practice once she’s through with the fellowship.

“I would like to share this knowledge, because when you teach, you learn. This is my main goal, I would love to teach my colleagues, not just in Kyiv, but in the whole Ukraine, because we have so many soldiers, we have so many children, and so many civilian people that needs our help,” she said.

Because of the normalization of violence and destruction in the last four years, Ivaniuta had difficulty explaining the difference between her work pre-war and now. 

“I’m really used to it. Of course, I feel like some weakness, I feel some exhausted, because almost every night in Kyiv we have drone attacks or rocket attacks and then you just have to wake up and go to your work and just smile and try to treat your patients and try to do this like everything is good, ‘let’s go for work,’” she said.

Because of the fellowship’s sandwich model, Ivaniuta will return to Ukraine for the second phase of the program, before returning to Canada to wrap up phase three.

Improvements are possible in wartime and general practice

Though the skills are translatable, Dr. Punja said the day-to-day job of Canadian and Ukrainian doctors is very different. As a surgeon, remaining on your toes and having multiple courses of action can be key to success.

“(In wartime) there’s often deeper wounds, unpredictable wounds, and they’re not clean wounds, like we see normally. So the chaos, the disarray, the unpredictability, you don’t know what you’re going to get, until you start to open up and go layer by layer and discover more injury or more distortion than anticipated,” he said.

“Remaining nimble as a surgeon, remaining prepared with several plans, not just one plan, in terms of how to repair it, anticipating staged repair, anticipating the need for preservation of the nourishing blood supply, those are all challenges when you’re dealing with trauma, whether it’s missile, blast, gunshot, chemical, thermal, mind injuries, those are all challenges.”

In Canada, surgeons do see injuries similar to what Ivaniuta has dealt with back home, just nowhere near the frequency, Punja said. Especially in times of geopolitical crises, Canada needs to continue nurturing surgical teachers and patients.

“It’s hard for people to hand over the scalpel blade to somebody else and trust that it’s going to all work out, but we’ve got a whole host of talent here in Canada and here in Calgary, I think we can do even more to support our surgical teachers.”

Things like prioritizing one-on-one learning where possible, but accepting three-student, one-teacher learning scenarios could do wonders, Punja said.

“Some teaching is better than no teaching, and that’s the kind of situation we’re in now.”