Above: Ebola treatment centre in Conakryset up by Dr. Fowler and colleagues.
Dr. Oleh Antonyshyn is helping to rebuild the bodies – and lives – of Ukrainians injured during the country's revolution and its simmering war along the Russian border. Dr. Eugenia Piliotis is playing a key role in the much-needed expansion of specialty medicine education in Ethiopia. And Dr. Robert Fowler has spent months on the frontlines of the worst Ebola virus outbreak in history. Their efforts demonstrate the difference Sunnybrook staff is making around the globe, often in countries consumed by crisis
"The surgical procedures were complex, technically demanding and time-consuming, some lasting for as many as seven hours," says Dr. Oleh Antonyshyn, describing the work of a volunteer, 25-member Canadian medical team that travelled to Ukraine's capital, Kiev, last November.
Dr. Antonyshyn, a plastic surgeon who leads Sunnybrook's Adult Craniofacial Program, served as head of the 10-day mission, which was organized by the Canada Ukraine Foundation and Operation Rainbow Canada.
Comprised of surgeons, anesthetists and nurses, the Canadian team worked alongside their Ukrainian counterparts to complete a total of 37 procedures on 30 patients. They reconstructed skulls, facial bones, eyelids, noses and more.
"We focused on post-traumatic defects and deformities, many of which were horrific. Most resulted from explosive blast wounds and high-velocity missile wounds. The patients presented major reconstructive challenges," says Dr. Antonyshyn.
Earlier on in the planning of the mission, it was expected that the team would focus largely on demonstrators injured during the protests that had taken over Kiev's central square, known as the Maidan. But as the mission neared and the armed conflict in eastern Ukraine continued to intensify, it became clear that war casualties would form a significant portion of the patients seen by the team.
The patients were extremely grateful to have access to surgical procedures that otherwise would have been unavailable to them, Dr. Antonyshyn says.
On the weekend of arrival, the team met with the local health-care providers and received a tour of Kiev's main military hospital, where one wing of the hospital's operating room suites was reserved for them. The team began consulting with patients and setting up the operating room with the multiple bags and boxes of surgical equipment and supplies they had brought with them.
Dr. Antonyshyn in the operating room.
Photo: Doug Nicholson
Dr. Antonyshyn and his fellow surgeons began their procedures on the Monday morning, and from there it "was full-on, morning-to-night operating," he says.
Deciding to head up the mission wasn't difficult for Toronto-born Dr. Antonyshyn, whose parents immigrated to Canada in their twenties. Though he had been to Ukraine just once prior to his mission-related visits, he had felt a connection to the country, one that grew stronger as the turmoil intensified. "I follow it very closely," Dr. Antonyshyn says of the historic developments that continue in Ukraine.
He appreciates the contributions that others at Sunnybrook made to the mission. Dr. Todd Mainprize, head of neurosurgery at Sunnybrook, Kathryn
Monardo, a retired Sunnybrook operating room nurse, as well as two recent medical residents and a former fellow – all were part of the team.
Ukraine's need for medical assistance will continue. Even if the conflict in the country's eastern regions was to end today, Dr. Antonyshyn said in mid-January, "There would be post-traumatic defects and deformities [to be tended to] for years to come."
That's why Dr. Antonyshyn and his partners set out for Kiev in late-January for another needs-assessment trip, which was expected to lay the groundwork for a second medical mission as early as June.
For Sunnybrook's Dr. Eugenia Piliotis, Ethiopia has become something like a second home. She has travelled there nine times since 2008 to help build subspecialty medicine training programs in the country of 94 million people.
Well-known for its poverty and tensions with neighbouring Eritrea, Ethiopia now has one of Africa's fastest-growing economies. The country is also in the midst of an education explosion that has seen the number of medical school entrants triple in the last few years, says Dr. Piliotis, a Sunnybrook hematologist and an associate professor at the University of Toronto (U of T).
The Toronto Addis Ababa Academic Collaboration – a partnership between U of T and Addis Ababa University (AAU), Ethiopia's largest – plays an important role in building AAU's capacity for specialty medicine, both in delivery and educating future Ethiopian leaders. Through the collaboration, small teams from departments at U of T work closely with their sister departments at AAU to understand their educational needs and objectives. These well-organized volunteer teams travel to AAU to teach, co-teach, mentor and collaborate.
Dr. Piliotis has led a collaboration between the U of T Department of Medicine and AAU to create training programs in gastroenterology, endocrinology and hematology, serving as the direct lead for the latter. Sunnybrook's Dr. Julia Lowe, an associate professor at U of T, is the direct lead for endocrinology.
"It's been a long and intense undertaking," says Dr. Piliotis, describing the work that has gone into helping AAU to establish training programs in the three medical subspecialties.
She worked with her AAU counterparts to develop a two-year hematology curriculum tailored for the Ethiopian medical environment, while maintaining international standards. All three subspecialties began training student doctors at AAU in the spring of 2012, with the first classes graduating in the spring of 2014. They included two newly minted hematologists, two endocrinologists and four gastroenterologists.
"When I started, there was one hematologist in the entire country of more than 90 million people. Now there are four," Dr. Piliotis says with enthusiasm and a short laugh, recognizing the long road ahead.
But it's a road that must be travelled in order to improve health care for Ethiopians struck by blood cancers and other blood diseases. Training hematologists and other medical specialists in Ethiopia is critical to stemming a brain drain that, for years, has seen Ethiopians receive training outside of their country and never returning, she says.
So why does Dr. Piliotis volunteer her time – often being away from her practice weeks at a time – to help advance health care in a far-off country?
There are several reasons, she says. Naturally, there's a satisfaction that comes with humanitarian work. Also, "it's rare to get the opportunity to build something this big here," she says, alluding to Canada's already well-developed medical education infrastructure.
Finally, Dr. Piliotis notes the inspiration she draws from her Ethiopian colleagues and residents. "We're working with a unique group of individuals who are both the cream of the crop of their profession and highly dedicated to their country."
Sunnybrook critical care physician Dr. Robert Fowler was volunteering with the World Health Organization (WHO) in Switzerland when news broke of the Ebola virus outbreak in the West African country of Guinea.
It was March 2014. The outbreak that began quietly in a remote Guinean village three months earlier was beginning its spread to neighbouring Liberia and Sierra Leone. By mid-January 2015, it would claim more than 8,400 lives.
In March, Dr. Fowler was dispatched to Guinea's capital, Conakry, to "be part of the first team that was there and to describe the clinical situation – the challenges, the needs – and then we ended up, very quickly, providing primary care to patients because there weren't enough clinicians around to do that," says
Dr. Fowler.
Dr. Fowler and Dr. Adrienne Chan (white shirt, middle) in Sierra Leone.
Photo: Supplied
Ebola causes severe fever, vomiting and diarrhea, and can ultimately lead to the failure of multiple organs. West Africa had never experienced an Ebola outbreak, and, as the WHO notes, the health-care systems of Guinea, Liberia and Sierra Leone were ill-prepared to handle it. Dr. Fowler, his WHO colleagues and staff from Doctors Without Borders set up the first Ebola treatment centre in Conakry.
Between March and December 2014, Dr. Fowler made five trips to the West African countries, often delivering intensive supportive care – rehydrating patients, replacing electrolytes administering anti-nausea and anti-diarrheal medications – that has proven most effective in helping patients to defeat the virus. More recently, Dr. Fowler has helped to train the growing ranks of international health-care professionals responding to the outbreak.
"A typical day [at a treatment centre] is usually a long day and, depending on the time of year, pretty hot," he says, noting the array of equipment he would wear, including a full-body suit, a face shield, a mask to cover his nose and mouth, boots and an apron.
The intense heat limited health-care workers to three daily shifts of between one and five hours. "You could spend 24 hours inside the treatment centre and still not do everything you would want to for patients," Dr. Fowler says.
Fortunately, the outbreak has been brought under better control, thanks to a range of factors. Crucially, people with symptoms are seeking medical attention, rather than trying to hide their illness due to the stigma associated with it. They're also seeking that help much earlier in the course of their illness.
Disease prevention and control practices, including the safe burial of bodies, have been greatly improved. And treatment capacity has continued to increase with the arrival of more international health-care teams, including three Sunnybrook staff members: Dr. Andrew Simor and Dr. Adrienne Chan, both infectious disease specialists, and Dr. Neill Adhikari, a critical care physician, left for Sierra Leone between December and January.
Though Dr. Fowler has witnessed immense pain and loss, he has also seen the gratitude of survivors, such as Mohamed and Zena, two Guineans he cared for in Conakry early on during the outbreak. The three had an emotional reunion months later in Ghana at a WHO meeting.
"It's great when you see people get better," he says. •
EBOLA: a family's story
Mohamed says he will never forget Dr. Robert Fowler and others who helped to save his life, as well as the life of his cousin, Zena.
Mohamed, a 34-year-old civil servant, and Zena, a 24-year-old teacher, were infected with Ebola in March 2014. It all started when Mohamed's older brother came to Conakry to seek medical attention, having been diagnosed with malaria and typhoid fever. He stayed with Mohamed, and Zena was also there to help care for the brother, who was vomiting, fatigued and had a high fever.
The brother's condition worsened and he died in hospital days later. Those who cared for him while he was sick and after he died soon became ill, including Mohamed and Zena. In total, nine members of the family were infected with Ebola and just three survived.
Zena tells the World Health Organization how she vomited so much that she thought she would never overcome Ebola. Fortunately, the arrival of international medical staff, including Dr. Fowler, increased treatment capacity and enabled more people to survive.
Though Mohamed and Zena recovered, Ebola has had a lasting effect on them. Many of their loved ones have died, and the two must contend with a stigma that surrounds survivors. Both lost their jobs due to fears that they would somehow infect others. (The stigma is so great that they will not use their real names or show their faces in print.)
Nonetheless, Mohamed and Zena have made the most of their situation by working in their communities to raise awareness about Ebola prevention and treatment, and to serve as living proof that the virus can be beaten. •
This content was produced by The Globe and Mail's advertising department, in consultation with Sunnybrook. The Globe's editorial department was not involved in its creation.