A group of medical professions stand around a room as a specialist fits a man with an artificial limb

Training medical professionals to provide artificial limbs and braces to injured civilians

Since February 2022 in Ukraine, there have been more than 17,000 civilian casualties, including over 10,000 people injured. Humanity & Inclusion’s experts are working to strengthen prosthetic and orthotic services across the country.

With war ongoing in Ukraine, people are at risk of conflict-related injuries from explosive weapons during an armed attack, collapsing buildings, or accidental contact with a landmine or explosive ordnance that may be left over from combat or set as a booby trap.

These incidents can result in amputation and the eventual need for artificial limbs. Traffic accidents or medical conditions can also result in amputation and add to the overall demand for these services. In Ukraine, prosthetics and orthotics specialty care is relatively new and certain techniques are unavailable. Resources are even further limited by the war.

HI is providing training to medical staff in hospitals throughout Ukraine to increase their skillset ability to meet the needs of increasing war-wounded patients. So far, HI has begun training professionals in Kiev and Lviv. While the exact number of people who may require these services is unknown, HI staff are seeing a significant need for artificial limbs and braces across hospitals.


Providing temporary artificial limbs

HI is introducing technology never before available in Ukraine to provide temporary artificial limbs, or “training prosthetics.” Unlike permanent mobility aids, temporary ones can be quickly used by people shortly after amputation. The method also allows for maintenance directly at the hospital without requiring big machinery and rare, specific tools. This way, when people come to the hospital after surgery, they can receive a temporary prosthetic on-site to improve mobility early in their recovery. Temporary devices can be starting six weeks after an amputation, instead of the average 3-month period required for permanent artificial limbs.

“The idea is to enable people to regain their independence much more quickly,” explains Pauline Falipou, HI’s emergency rehabilitation manager. “They are eager to get back up and get walking again, so this allows them to do that. Then, when they’re ready, we switch them over to a permanent device. For this, we are able to reuse the same metal stem and foot piece from the temporary device and replace the socket with a permanent one.”

HI’s trainings combine instruction on artificial limbs and braces, psychosocial support and rehabilitation approaches to ensure holistic care. There is both theoretical training and practical hands-on training. Volunteers who previously underwent amputations are acting as “practice patients” so medical professionals can learn how to properly apply artificial limbs. So far, HI has provided training to 10 prosthetics and orthotics specialists and 20 physical therapists.

“It’s really important to have this care,” says Jerome Canicave, HI’s rehabilitation technical officer. “There are very many people with amputations here as a result of the war. In Ukraine, there are facilities and skilled medical staff, but it’s not enough to meet the current need. So, we are trying to support them by introducing the prosthetic technology that HI has relied on for many years in other war zones.”

As initial training concludes, HI plans to begin providing artificial limbs for patients in February. By the end of 2023, HI plans to distribute 1,000 prosthetic kits in Ukraine. HI staff remains active in the medical facilities to support and coach specialists on using the new technology and caring for patients with amputations.

“There is a lot of need in Lviv, since many patients from the front lines are transferred there after surgery for recovery,” Falipou says. “We will stay to support the staff as they put their training into practice with patients. We’re not going to come in, train them and then just abandon them. They receive continued coaching and on-the-job support, to strengthen their understanding and ensure quality care throughout this response.”


A physical therapist's perspective

Nazar Berezniuk, a physical therapist in the Acute Rehabilitation Unit at Ohmatdyt Children’s Hospital in Kyiv., shares his experience:

“My colleagues who were working on Feb. 24 stayed here, and even lived here in the hospital with their families. When I came, I also stayed for the night and lived here. At the time, the city was still heavily shelled. I had to find a way to help. My wife and children were in a safe place, but I had my second family here — my team. So, in these difficult times, I wanted to be with those who are dear to me.

"I've heard explosions nearby. Missiles were flying overhead. I was with my colleagues during the air alarm, and everyone was scared. For me, everything stopped and I just observed what was happening. I knew that soon heavily wounded people would be brought to our hospital. There would be children or adults, and I had to help.

"Since the start of the war, our hospital started to admit both children and adults. There were a lot of people wounded, and I've treated a lot of patients with war-related injuries. At first, it was very hard—hard to even understand how to speak to the children whose house was hit by a missile. It was psychologically difficult. Before the war, when we talked to children, we dealt with issues like convincing them to do their exercises when they’d rather watch cartoons. Now, there are different problems.

"The whole approach to rehabilitation is changing. It's like we've had an internal reform since the war started and our work process changed completely.

"We've worked with amputations before, but they were technical injuries from road and train accidents. But the prosthetics work took place separately and we weren’t involved. Now we want to arrange for joint cooperation with prosthetics specialists so that everything takes place in the same hospital. We want to use our hospital as a basis to create a large-scale prosthetics and rehabilitation hub. We want to create a diverse team to support the patients on different issues and be as efficient as possible.

"HI has helped us to make the first big step. It was very important for us to obtain credible information from people with experience in prosthetics and physical rehabilitation. I personally experienced this problem, when I had to treat a girl with a prosthesis and didn't know what to do with her altogether. Her parents wanted the prosthesis to be manufactured in Ukraine and for rehabilitation to take place here as well. I said that I could, but I had to get a lot of help. I looked everywhere, including the Internet; I called my friends. So, personally, I was really looking forward to this training. And I know my colleagues were, too."