Auckland plastic surgeon Dr Mark Gittos is flying to London this week to train four Ukrainian doctors in facial reconstruction surgery. The war in Ukraine has entered its fourth year following Russia’s 2022 invasion.
In a Lviv hospital, a blaring air-raid siren does little to disrupt the sense of calm for a surgical team preparing to operate.
Their patient, a soldier named Sergei, has a gaping hole in his face where his nose should be. It was blown off by a piece of shrapnel.
The eerie calm is remarkable to witness for New Zealand plastic surgeon Mark Gittos – none of this is normal to him.
“When you look around, you see all your colleagues just getting on with their daily lives,” Gittos said.
“There are air raid sirens and a missile strike happening on a fuel depot quite close to the hospital, but people are pretty unfazed by it.”
Gittos travelled to Ukraine in April to assist with a complex facial reconstruction procedure at the Unbroken National Rehabilitation Centre.
Wounded soldiers have to make a 1000km journey by train from the front line to be treated at the hospital.
Gittos was asked by his friend, fellow surgeon Dr Peter Vickers, to help with the surgery.
When Gittos met Sergei, his eyes were riddled with fear, a bloody, open wound in the centre of his face.
“Don’t worry brother, we’ve got this,” he told Sergei.
Working alongside the Ukrainian team, Gittos used the muscle, skin and bone of Sergei’s forehead flap to reconstruct his nose during a 10-hour operation.
The use of the forehead flap for nasal reconstruction is a surgery technique that dates back to ancient India.
Sergei’s nose was successfully restored and after the operation he had begun to look like himself again.
“You can see it on his face ... the relief afterwards,” Gittos said.
The patients Gittos saw at the Ukrainian hospital were resilient and very accepting of any treatment that needed to be carried out.
“You walk through the hospital and you see a lot of amputated arms and legs, people in wheelchairs and on crutches,” he said.
The NZ Government recently announced a further $16 million aid boost to Ukraine, with $8m being put towards the Nato Security Assistance and Training for Ukraine (NSATU) fund, and the United Kingdom and Latvia-led Drone Coalition for Ukraine.
The remaining $7m would be given to humanitarian assistance for conflict-affected communities in Ukraine, and $1m for Ukrainians displaced in neighbouring countries.
Yesterday, Gittos was to fly to his London practice to meet up with four Ukrainian doctors, who are visiting him for one week to receive further training in non-emergency plastic and reconstructive surgery.
“At the moment they’re brilliant at doing war trauma but they don’t really get exposed to any of the day-to-day, ‘bread and butter’ plastic surgery,” he said.
It would also be a chance for the doctors to have a break from the conditions and pressure of life in a warzone.
“We want to show them that they’re not forgotten ... I think over there they do at times feel like the rest of the world has forgotten what’s going on.”
During his time in Ukraine, Gittos witnessed a flaming missile strike on a fuel depot close to the hospital.
He described Lviv as “a beautiful old town” with a picturesque opera theatre in its main square. Despite it being April, spring in the eastern European country, the ground was covered in snow.
In spite of the cold weather, he was able to eat dinner outside surrounded by the richly illuminated buildings. One restaurant even served New Zealand lamb.
The signs the country was at war, however, were never far away.
The hotel Gittos was staying in had a bunker for sheltering from air-raids and every shop had a generator outside in case missile strikes ruptured the power infrastructure.
Soldiers would drive through the streets in their camouflaged army vehicles covered in electrical equipment that blocked the signals used by enemy drone attacks.
The Ukrainian civilians Gittos met used an app on their phone to check if a missile strike was incoming.
“When you cross the border into Ukraine you think, ‘oh my gosh this is the first time I’ve been in a war zone’, but very quickly after a few hours you forget about it,” he said.
“I think that’s part of their resilience is that they’re not going to let the invading forces upset their will to have a normal life.”
Gittos said the medical staff at the hospital were not suffering from burnout, despite operating daily in a warzone, with some of the “more superficial protocol details” able to be overlooked for patients.
“Everyone was very calm, there was no sort of hurrying ... everything takes as long as it takes,” he said.
He said in some ways it was a more relaxed environment than the demands of list surgery in New Zealand due to the time pressure.
The Kiwi surgeon’s motivation for going to Ukraine is to help in any way he could.
“It just seemed to be a good thing to do,” he said.
“I’m embarrassed if anyone says it’s dangerous because you don’t really feel that danger, and it’s actually a really good experience.”
The skills of aesthetic or plastic surgery overlapped with reconstructive surgery and if a body part functioned well, it often looked good in appearance, he said.
“One of the sayings in surgery and especially in plastic surgery is, war is the best school for surgeons.
“In New Zealand – and I don’t put myself in this category – but we’ve got an amazing tradition of surgeons like Archibald McIndoe and Harold Gillies working in Europe and pioneering reconstructive [techniques] of injured military personnel from World War I and World War II."
Gittos hopes to return to Ukraine to do further work in Lviv in October/November.
Eva de Jong is a New Zealand Herald reporter covering general news for the daily newspaper, Weekend Herald and Herald on Sunday. She was previously a multimedia journalist for the Whanganui Chronicle, covering health stories and general news.
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