Baylor College of Medicine’s first clinical operation for global health started in 2001 in Romania at the Baylor Black Sea Foundation, part of what was then called Baylor College of Medicine International Pediatric AIDS initiative (BIPAI).

The clinic originally treated pediatric HIV cases, but as a war in Ukraine unfolded in 2022, Baylor officials immediately saw a need to help refugees fleeing the country to borders in Romania and Poland.

“I was at our clinic in Malawi when I saw the news that the war unfolded and knew that we would probably have refugees coming from southern Ukraine into Romania,” said Michael Mizwa, director of Texas Children’s Global Health and CEO of Baylor College of Medicine Global Health.

Baylor College of Medicine Global Health provides amputee care in Ukraine.

Mizwa and the team visited Romania and Poland weeks after the war began to understand the impact and found that hundreds of people were crossing the border and visiting the clinic. Texas Children’s Hospital supported a pediatrician and women’s health services and started assessing displaced Ukrainian families. Eventually, conversations developed surrounding the need for amputee care. Estimates as high as 70,000 amputees who need care, most without access to prosthetist services, with few having access to wheelchairs and many bound to a bed.

Uzhhorod, a city in western Ukraine on the border with Slovakia, and away from missile and drone attacks, is a safe area where Baylor officials can travel to and from the border within 20 minutes to care for patients. The global health team conducted site assessments to potential hospital systems to partner with in Lviv and Uzhhorod to help the under-resourced healthcare systems.

“Day-to-day preventive health processes have been hampered,” Mizwa said. “The health systems there are very robust, and they need education, training and supplies.”

Dr. Michael Y. Lee, professor and Martin S. Adams Endowed Chair of the H. Ben Taub Department of Physical Medicine and Rehabilitation at Baylor, started with the global health program after visiting South Korea where he learned about the dire situation in Ukraine. South Korea has close ties with Ukraine and supports their redevelopment, and Lee wanted to help make a difference.

“They have essentially no prosthetics and orthotics programs. They have some physical medicine and rehabilitation physicians, but they’re more in the infancy of development of their specialty,” Lee said. “Patients cannot receive the care they deserve.”

Lee, along with additional Baylor faculty, met with several Ukrainian physical medicine and rehabilitation physicians in Poland to teach them about setting up a future training program and how to fill the gaps of their knowledge and experience in the field.

Baylor also holds a web-based annual review course for the field of physical medicine and rehabilitation, and Ukrainian specialists and residents were invited to participate in the online, interactive 10-day course to learn from faculty. Lee and other experts provided an overview of the global state of physical medicine and rehabilitation to expose attendees to medical knowledge that they can eventually adapt for their practice in Ukraine.

Baylor College of Medicine Global Health provides amputee care in Ukraine.

“We don’t know their background or experience because their residency program started in 2019, but because of COVID and the war, their training program is not in an ideal situation,” Lee said. “We’re hitting them at an educational level and exposing them to new practice. We’re also working with them to set up residency programs and give them more manuals, policies and training programs. If we can train them to increase and improve their knowledge, they can train future generations of physicians and translate that to their trainees and junior-level staff.”

Funding from donors has allowed the global health team to ship a 3D printer that prints sockets of the prosthesis. The 3D printer will be set up in the Czech Republic and taken to Uzhhorod’s hospital system to train Ukrainians how to measure, print, fit and address prosthetic and orthotic needs for men, women and children. The goal is to provide 150 prostheses by the end of the year once the clinic starts treating amputee patients. They hope to start serving patients by the end of 2024.

“There are tens of thousands of amputees, so it’s a drop in the bucket. If we can work out the algorithms and the technology transfer, we hope to put multiple printers in-country. Through onsite and remote education and training, our hope is to then support 3D printing capacity in other parts of Ukraine, especially where we can’t work because of active warzones,” Mizwa said. “We’re trying to address what the community needs are regardless of age, gender or military or civilian status.”

While an influx of donations is necessary to make this possible, the team is hopeful to make an impact among amputees in Ukraine.

“Our ability for Baylor to support and advocate for us and be able to get approval to travel to Ukraine having sanctioned College efforts on the ground speaks to Dr. (Paul) Klotman and the leadership’s desire to help make a difference globally around health equity,” Mizwa said.

By Homa Warren

Baylor College of Medicine Global Health provides amputee care in Ukraine.