Fuld transskription af A Trauma Surgeon Explains Why Ukraine Will Need Decades Of Orthopaedic Care with Roman Hayda, MD

volume and complexity that you see in war is completely different. 00:05:43.439 --> 00:05:50.720 And so that experience is indelible, and certainly you can't help but learn. 00:05:50.800 --> 00:05:55.680 You see things from various different perspectives, and you see the complexity. 00:05:55.759 --> 00:06:00.800 You see these young folks with bad injuries, and you see them recover. 00:06:01.040 --> 00:06:07.519 And so that has a very important place in my heart and in my mind. 00:06:08.000 --> 00:06:21.279 And as war occurred in Ukraine, and I was already out of the army at that point, it was just logical that I should be involved in that. 00:06:21.439 --> 00:06:26.480 And I started that involvement in 2014, going there a few times. 00:06:26.720 --> 00:06:36.800 That war when that started was relatively low level and static, but I did a couple missions in 14 and 15. 00:06:37.040 --> 00:06:40.399 And then that was in the Crimean peninsula, right? 00:06:40.879 --> 00:06:45.600 That's when the Crimean Peninsula was annexed in the Sake Vote. 00:06:45.920 --> 00:06:56.079 And in the Donbass, in the eastern part of Ukraine, there were quasi-military people, but they're clearly supported by the Russian military. 00:06:56.399 --> 00:07:05.600 But there was basically a static line established by 2015-2016, and that persisted till 2022. 00:07:05.839 --> 00:07:10.560 When the full-scale invasion, then that's a totally different scale of war. 00:07:11.120 --> 00:07:29.279 And I looked at ways, and there was a lot of people doing lots of great things then, but looking at ways to engage my skills as an army surgeon, engage my knowledge of Ukraine, and provide help for these casualties. 00:07:29.519 --> 00:07:35.040 And so since that time, I've been now eight times since 22. 00:07:36.000 --> 00:07:40.079 So if you count all the times, it's now 10 or 11 times. 00:07:40.399 --> 00:07:40.959 Wow, yeah. 00:07:41.199 --> 00:07:42.319 On medical mission. 00:07:42.720 --> 00:07:44.240 Let me uh back up a Scotia. 00:07:44.720 --> 00:07:55.279 So, in many ways, you are the definition of a true red-blooded American in that you grew up in a Ukrainian household. 00:07:55.360 --> 00:07:56.959 You said your first language is Ukraine. 00:07:57.199 --> 00:08:14.079 What the folks don't may not know is, as you were telling me, and we spent a lot of time together in that time that we were over there, that you went to Ukrainian school that I where you learned Ukrainian customs, you married a woman who also is Ukrainian, speaks Ukrainian. 00:08:14.319 --> 00:08:26.720 Yet, even embracing all this Ukrainian heritage, to your point, you felt the obligation and the demand, personal demand, to serve the country that you are a citizen of. 00:08:26.800 --> 00:08:31.279 You're a proud American, and you went to Bethesda and served as a U.S. 00:08:31.360 --> 00:08:36.879 Army officer up all the way up through the rank of colonel to serve in our army for that. 00:08:37.039 --> 00:08:48.559

So can you tell a little bit more about the Ukrainian school and how you met your wife and her your relationship with her in terms of her basically endorsing or encouraging your trips overseas like this? 00:08:49.120 --> 00:08:49.759 Yeah. 00:08:50.399 --> 00:08:54.960 It certainly gave her a lot of insight into what I was thinking. 00:08:55.200 --> 00:09:03.360 My parents knew what living under the Soviets was like, particularly my dad, is a terrible thing. 00:09:03.600 --> 00:09:22.240 And growing up in the United States, hearing these stories, there is no question, there's no question at all about which system makes sense, which system values humanity and human values. 00:09:22.480 --> 00:09:33.519 And it was not a big deal in those times to, I thought we owe a lot to the way the US system is set up. 00:09:34.159 --> 00:09:57.840 And so it was very easy for me to forego some of the advantages of civilian practice to serve in the system that allowed my family to continue to survive, because that would not have been the case should they have they stayed in Ukraine and which was part of the Soviet Union. 00:09:58.080 --> 00:10:01.039 And for that, are forever grateful. 00:10:01.120 --> 00:10:14.000 And so it's a really important thing to engage and for people with values to serve in our government, because that's it should reflect our society. 00:10:14.240 --> 00:10:40.559 And so when the Ukrainian people said we're not going to stand for Russia impinging on our nine, that whole scenario started because the elected president, who was supported covertly by Russia, reneged on his agreement to turn towards Europe, and he turned back towards Russia. 00:10:40.720 --> 00:10:48.320 And so that is what started the whole Maidan movement, the protests in their Central Square. 00:10:48.559 --> 00:10:54.320 And so we were watching that intently because it was something very important to us. 00:10:54.960 --> 00:10:57.039 And they fought for their freedom. 00:10:57.279 --> 00:11:03.039 So as an American, yeah, I felt that that reflects our values. 00:11:03.600 --> 00:11:07.600 And with my skills, I have certainly something to offer. 00:11:08.000 --> 00:11:14.000 And I felt it very important to do what I can and continue to do so. 00:11:14.799 --> 00:11:16.240 Yes, thank you. 00:11:16.639 --> 00:11:21.200 So we went uh Dnipro, I'm pronouncing that correctly. 00:11:23.039 --> 00:11:26.559 If you want the official but that that works, everybody understands. 00:11:27.360 --> 00:11:28.320 Still your way. 00:11:28.559 --> 00:11:34.159 So we get there, and to your point, the Ukrainians have been at war for four years. 00:11:34.320 --> 00:11:38.080 So in many ways, they were living life. 00:11:38.240 --> 00:11:39.120 They have to live life. 00:11:39.200 --> 00:11:46.240 They can't just go on hold and put everything in and just go into bomb shelters and just hope for the best for four years. 00:11:46.320 --> 00:11:54.000 They have to get out and go grocery shopping and

go to church and be married and have children and send their kids to school. 00:11:54.320 --> 00:12:11.279 On the other hand, they're under constant threat of drug attack and missile launches and air raids all this time, plus the incredible insurgence of wounded soldiers that are coming in Medevac all the time into the hospitals that we worked at. 00:12:11.840 --> 00:12:17.919 So you said this was your eighth time since in this war, in the four years of this war that you came in there. 00:12:18.000 --> 00:12:36.159 What particularly takes you where we were in terms of the culture, the ability to the ironies that we ran into in terms of the Ukrainian people and the fact that there was a full-blown war going on, but in some ways it almost seemed like normal society in a very strange context. 00:12:37.519 --> 00:12:46.080 Yeah, the first time I was in Dnieproa, I was sponsored by a Jewish group, the Kalila Project out of Boston. 00:12:46.159 --> 00:12:48.000 And that was in 2015. 00:12:48.879 --> 00:12:56.080 And but to help take care of war wounded, to help exchange ideas and knowledge. 00:12:56.639 --> 00:13:01.279 And I met some people there that were just wonderful people. 00:13:01.440 --> 00:13:06.000 And I'm my family in Ukraine is in the western parts. 00:13:06.480 --> 00:13:09.279 This is central, south central. 00:13:09.519 --> 00:13:15.039 I had never been to that part, but it was actually under the Soviets, it was a closed city. 00:13:15.120 --> 00:13:17.360 You couldn't travel there even if you wanted to. 00:13:17.600 --> 00:13:20.720 In any case, those friendships continued. 00:13:20.799 --> 00:13:32.480 And you know, when the full-scale invasion happened eight years later in 22, then we started thinking about what else I can do. 00:13:32.559 --> 00:13:44.480 And there's been a number of times, and that was I think the second time I went, and there I felt that same thing that here we are closer to front. 00:13:44.559 --> 00:13:45.919 There's a huge need. 00:13:46.399 --> 00:13:52.720 There's people who are willing to learn and will and are working extraordinarily hard. 00:13:53.039 --> 00:13:55.679 And how could you not support that? 00:13:56.559 --> 00:14:02.399 And so this was the third time I've been to meet them. 00:14:03.600 --> 00:14:06.960 And because I knew those people, worked at different hospitals. 00:14:07.200 --> 00:14:11.759 The Mechnikov is the biggest trauma center in Ukraine. 00:14:12.000 --> 00:14:16.559 And because it is very close to the front, they had to expand. 00:14:16.639 --> 00:14:17.759 They remember what they said. 00:14:17.840 --> 00:14:26.080 They said their ICU went from 40 beds to 140 with people still in the hallways because there's a compelling need. 00:14:26.240 --> 00:14:29.840 And that's just kind of people flowing through. 00:14:44.720 --> 00:14:46.399 That's echelon care. 00:14:47.200 --> 00:14:52.000 And the military, wherever you are, and that's what they practice. 00:14:52.639 --> 00:15:06.799 But when you talk about the scale of the war, okay, this is completely different than Desert Storm, completely different than OIF or OEF. 00:15:07.600 --> 00:15:09.600 This is on the scale of World War II. 00:15:09.840 --> 00:15:16.559 You hear the news reports, they talk about this is the largest land war in Europe since World War II. 00:15:18.159 --> 00:15:21.039 And in some ways, the casualties are greater. 00:15:21.519 --> 00:15:36.720 If you look less that so we looked at that, and the US has reported 6,700 deaths since the war on terror began in 2001 in the US, 6,700 deaths in U.S. 00:15:36.799 --> 00:15:37.840 service members. 00:15:38.000 --> 00:15:40.799 In comparison, how many Ukrainians have been killed? 00:15:41.919 --> 00:15:48.159 Last I looked about six or nine months ago, these are not numbers that are readily available. 00:15:48.240 --> 00:15:49.519 They don't publish them. 00:15:49.759 --> 00:15:55.600 But when Zelensky, the president, came out and said that there were year 30 or 50,000. 00:15:56.639 --> 00:16:04.960 And if you look at all these cities, they have cemeteries where they have fresh graves and flags and all that. 00:16:05.200 --> 00:16:20.399 They also, we did not see it in in Ypro, but there are certain places in every city where each city memorializes the people that were killed in the war. 00:16:20.639 --> 00:16:26.799 And I have pictures from Thernopy and Cave, Reviv that that show just that. 00:16:26.879 --> 00:16:30.799 And it's just picture after picture from all parts of Ukraine. 00:16:30.879 --> 00:16:33.919 But these are for those and particularly it's that city. 00:16:38.720 --> 00:16:46.879 I was in the army as well, not to the level you were, of course, that the combat in Ukraine is extremely unique. 00:16:47.039 --> 00:16:58.960 Whereas in the US wars in Afghanistan and Iraq, we had air parity, air superiority, and we could fly into combat areas and evacuate our wounded soldiers. 00:16:59.360 --> 00:17:01.840 Not the case in Ukraine. 00:17:02.000 --> 00:17:11.680 Can you explain to folks the additional challenges that face the wounded soldier on the front in Ukraine as compared to perhaps the war in Afghanistan or Iraq? 00:17:12.319 --> 00:17:22.240 Yeah, the military, the terms that they use for theirs is a near-peer or Lisco war, where there is not air superiority. 00:17:22.400 --> 00:17:37.039 And what's also a difference here is not only can you not evacuate by helicopter because that helicopter would get shot down, but in addition to that, we've gone into the next phase, the 21st century. 00:17:37.200 --> 00:17:38.720 You have drones. 00:17:40.480 --> 00:17:45.359 What was true two years ago is no longer true now. 00:17:45.519 --> 00:17:47.039 It has evolved. 00:17:47.359 --> 00:17:52.319 That evolution is much quicker than what I experienced in taking care of U.S. 00:17:52.400 --> 00:17:53.440 war casualties. 00:17:54.160 --> 00:17:58.640 It's probably different than what occurred during World

War II. 00:17:59.119 --> 00:18:10.880 But at this in 22, 23, you still have the ability to evacuate people by ground and a few by helicopter. 00:18:11.039 --> 00:18:12.960 That is no longer true. 00:18:13.440 --> 00:18:17.440 Because there's no air superiority, you can't evacuate by helicopter. 00:18:17.759 --> 00:18:28.960 But what's different now with the drones is you can't even evacuate by land because what occurs is those drones are surveilling. 00:18:29.519 --> 00:18:36.319 And I was talking to some medics, and they were saying that you can't square this math. 00:18:36.400 --> 00:18:46.319 If you send three or four medics in to rescue somebody, and they do rescue that person, but they lose two, that math doesn't work. 00:18:46.640 --> 00:19:07.119 And so they've advanced to drone evacuation on ground platforms that they figure out how to load them onto that platform, and then this four-wheeled or whatever track vehicle with the patient on it, but no other personnel can get out of the zone of those drones. 00:19:07.359 --> 00:19:13.759 So the kill zone, from what I read now, is on the zone area like 20, 30 miles. 00:19:14.240 --> 00:19:19.680 That you know, you just can't walk around because drones are surveilling everything. 00:19:20.160 --> 00:19:27.599 And that's very different than what we experience in Afghanistan and Iraq, very different than World War II. 00:19:28.480 --> 00:19:34.400 Can you tell folks about the types of injuries that we treated both at Meshikov and at the Institute? 00:19:35.839 --> 00:19:43.359 Yeah, so the injuries themselves are very similar to war injuries. 00:19:43.680 --> 00:19:49.119 In this case, there are many of them are caused by drones, but they're what do drones do? 00:19:49.279 --> 00:19:51.279 They drop explosives. 00:19:51.839 --> 00:20:21.200 And there are gunshot wounds too, but explosives, whether they're mines or artillery shells, what have you, the explosive munition causes a high-energy, very close, highly contaminated wound with complex fractures and multi, multiple tissues that are injured, not just bone, but ligaments and muscle and skin and nerves and vessels. 00:20:21.759 --> 00:20:31.519 And a lot of them, in order to survive, you have a severe mangled limb, and you don't know when you're going to be evacuated, that golden hour is gone. 00:20:31.680 --> 00:20:34.000 You're instructed to put on a tourniquet. 00:20:34.319 --> 00:20:43.599 And they may need to keep that tourniquet on, not just for an hour or two, it could be a day. 00:20:53.039 --> 00:20:55.839 And obviously, those go on to amputation. 00:20:56.559 --> 00:21:03.519 That's a whole nother discussion about which persons should have tourniquets and which should not, and so forth. 00:21:03.839 --> 00:21:14.079 But if it gives you a potential for survival and a severe injury in a very isolated environment, well, that may be something that that you do. 00:21:14.799 --> 00:21:15.599 It's hard. 00:21:15.839 --> 00:21:19.680 And with

the winter, we saw a lot of frostbite injuries too. 00:21:20.640 --> 00:21:21.200 Right. 00:21:23.839 --> 00:21:26.240 So let's talk a little bit about leadership in this. 00:21:26.319 --> 00:21:28.240 And let me paint the picture. 00:21:28.400 --> 00:21:40.400 So when we get there, these are highly competent, motivated, exhausted, but highly competent and motivated orthopedic surgeons who have been taking care of war injuries for four years now. 00:21:40.559 --> 00:21:42.319 These are not people that don't know what they're doing. 00:21:42.400 --> 00:21:43.839 They're quite skilled. 00:21:44.079 --> 00:21:45.839 And then we show up. 00:21:46.720 --> 00:21:59.759 Discuss some of the leadership techniques and mentality that you use when you're walking into an environment like this where you're trying to help, you've got additional skill that you can teach things. 00:22:00.319 --> 00:22:08.799 Yet these are very proud and independent people who are competent and doing their own thing in the midst of an extremely stressful and trying time. 00:22:09.680 --> 00:22:14.720 It really takes a strong character and leadership in order to excel in that domain. 00:22:14.880 --> 00:22:16.400 And you've been doing it a number of times. 00:22:16.559 --> 00:22:17.920 Walk us through that. 00:22:19.839 --> 00:22:21.920 Yeah, that's a really good question. 00:22:22.079 --> 00:22:28.960 I actually I'd be interested to hear your perspective because of you needing to work through a translator. 00:22:29.279 --> 00:22:33.119 But for me, speaking Ukraine, I get that trust right away. 00:22:33.599 --> 00:22:39.200 And to an extent, I'm a known entity among orthopedic circles in Ukraine. 00:22:39.279 --> 00:22:40.400 So that helps. 00:22:40.720 --> 00:22:44.880 But I think fundamentally, you know, I didn't get there overnight. 00:22:45.119 --> 00:22:55.119 I think it's always about showing respect, listening well, giving suggestions. 00:22:55.839 --> 00:23:01.279 And the other part of it is really fundamentally true. 00:23:01.519 --> 00:23:11.359 And this is one of the things I always learn when I go in these environments, is you have to learn to be flexible and adapt. 00:23:11.920 --> 00:23:19.200 If you expect those same conditions and the same equipment that you have back home, that's not going to happen. 00:23:19.359 --> 00:23:21.920 And you'll be just blowing your top. 00:23:22.000 --> 00:23:23.599 And that's not going to help anyone. 00:23:23.759 --> 00:23:25.279 You might as well go home. 00:23:25.599 --> 00:23:33.359 But you know, if you watch these guys do what they do with what they have, it's amazing. 00:23:33.839 --> 00:23:45.279 Now, I think the other part, and we talk about this a little bit, is if you think about where they were four years ago, where they were 10 years ago. 00:23:45.519 --> 00:23:48.559 Orthopedic residency in Ukraine is two years. 00:23:49.119 --> 00:23:50.240 Two years. 00:23:51.519 --> 00:23:59.839 Imagine yourself if you after two years

say, okay, you're an orthopedic surgeon, take care of this really bad injury. 00:24:00.160 --> 00:24:11.440 Not only that, but when you train, you don't have free access to all kinds of corsairs and all kinds of equipment and all those things. 00:24:15.519 --> 00:24:24.720 That some of those surgeons are as incredible as they are with those handicapped, but that's because they're dedicated surgeons. 00:24:25.519 --> 00:24:40.400 And so, yes, I always feel that we have things to learn, but we also have things that we can teach, and making that a two-way street is really what helps everybody. 00:24:50.400 --> 00:24:51.839 Right, exactly. 00:24:52.240 --> 00:25:09.519 So if if folks were gonna were going to embark on something like this and try to get involved, and you've given some very good pearls of attitudes and mindset to go in with, what other principles or leadership thoughts would you give people if they were saying, I need to get involved? 00:25:09.680 --> 00:25:19.680 And it's not necessarily just in Ukraine, but in any developing world setting, I want to really make sure I point out that Ukraine is not necessarily the developing world. 00:25:19.759 --> 00:25:24.079 It's a very modern and industrial country that has a tremendous amount of assets. 00:25:24.240 --> 00:25:30.480 Unfortunately, those assets have been stretched to the edges with the tremendous number of injuries that they've had to take care of. 00:25:30.720 --> 00:25:40.960 And it's not to some degree, certainly not a developing world area, but for folks that were encouraged in doing things like that, what would you tell them that they should think about or prepare for? 00:25:42.160 --> 00:25:45.920 Yeah, every one of these situations is a little different. 00:25:46.000 --> 00:25:48.480 And every time I go to Ukraine, it's a little different. 00:25:48.559 --> 00:25:50.720 You see slightly different injuries. 00:25:50.880 --> 00:25:54.799 If you go to different hospitals, their setup is slightly different. 00:25:55.440 --> 00:26:12.880 And what helps a lot is doing some research ahead of time, getting some intel, if you will, understanding kind of the culture, the history, the traditions, and maybe if you can learn a few phrases, that goes a long way to opening doors. 00:26:13.200 --> 00:26:14.880 The nice words, Doug. 00:26:14.960 --> 00:26:15.279 Yeah. 00:26:15.680 --> 00:26:17.200 I tried, it was tough. 00:26:17.519 --> 00:26:25.680 Okay, those will open hearts and open minds, and that's really valuable. 00:26:26.000 --> 00:26:41.200 And I think by far the most critical thing is to go in with not a sense of you're gonna show everything and do everything, but that it's gonna be a two-way exchange. 00:26:41.440 --> 00:26:53.279 And if you have that intel, you can figure out what are the things maybe you can help them with, and what are the things you may be able to learn from them because they'll be more than happy to teach. 00:26:54.079 --> 00:26:57.440 And you had that great

experience, Andre with Elizabeth. 00:26:58.880 --> 00:27:01.039 Yeah, to catch people up with what you're saying. 00:27:01.119 --> 00:27:09.680 We had a rather stern, let's describe them that way, older orthopedic surgeon that I think to some degree he may have been humoring us. 00:27:09.839 --> 00:27:20.559 And you and I both have done a lot of Illisarov work over the years, and this guy was putting wires in like I've never seen anybody do before. 00:27:20.640 --> 00:27:23.759 I mean, he was obviously an incredible master. 00:27:23.839 --> 00:27:32.720 And when he realized that we appreciated that I appreciated his expertise and his incredible skill, all of a sudden hearts melted. 00:27:32.799 --> 00:27:39.119 And if you recall, me and him were BFFs, even though we couldn't understand a word either one was saying. 00:27:39.359 --> 00:27:41.359 But yeah, I was on the learning side on that one. 00:27:41.440 --> 00:27:42.799 That was something else. 00:27:43.039 --> 00:27:50.559 So the future for Ukraine, let's suppose this unfortunately this would not happen, but let's suppose that the war ended today. 00:27:51.680 --> 00:27:55.119 The work there will survive, you and me. 00:27:55.279 --> 00:28:04.480 We'll probably survive any orthopedic surgeon listening to this podcast because the wounded soldiers there will require care for decades. 00:28:04.880 --> 00:28:09.759 You want to talk about a little bit about the let's suppose war was over when I own a peacetime. 00:28:10.720 --> 00:28:15.359 The demand and the need there just surpasses anything we can fathom. 00:28:16.559 --> 00:28:19.440 Yeah, first off, just more injury care. 00:28:19.519 --> 00:28:23.039 It doesn't occur in two months, three months, or six months. 00:28:23.279 --> 00:28:26.000 Just think of your severe trauma patients. 00:28:26.480 --> 00:28:30.400 Those are easily six months a year that you're following up. 00:28:30.559 --> 00:28:36.880 And those are by number and by complexity on the simpler side. 00:28:37.200 --> 00:28:52.799 If they have an infection, if they have a contracture, if uh they have a nerve injury, if they're an amputee and they're having problems, as you know, those are things that will need continuing care. 00:28:53.759 --> 00:29:12.240 And a lot of care in Ukraine with these complex injuries, given their limited resources, a lot of it is treated with external fixator as a definitive treatment, or they show up late to the centers that are capable of doing complex internal fixation and so forth. 00:29:12.559 --> 00:29:15.119 But they come with contractions. 00:29:15.200 --> 00:29:16.240 And how do you solve that? 00:29:16.400 --> 00:29:24.720 I routinely get calls and consultations on folks, you know, this guy is two years out from his injury and he has this problem. 00:29:24.880 --> 00:29:25.759 What do you do? 00:29:26.000 --> 00:29:27.599 And so that's going to continue. 00:29:27.759 --> 00:29:36.640 And I can also say, just from my US military experience, there's a guy that I took care of as a resident, first-year resident, great guy. 00:29:36.799 --> 00:29:42.319 And that's actually, in my mind, he compelled me to go into horse-dave trauma. 00:29:42.640 --> 00:29:50.000 But years later, he had developed this chronic draining fistula that went on to a marginalized ulcer. 00:29:50.400 --> 00:29:54.160 Recognizing that and taking care of it was extremely important. 00:29:54.400 --> 00:29:58.160 He got it taken care of, and he's doing incredible things still. 00:29:58.799 --> 00:30:05.039 And so that will be the specter that will continue to exist in Ukraine for a long time. 00:30:05.920 --> 00:30:10.000 So I can hear folks thinking, all right, so you're the ultimate triple threat. 00:30:10.079 --> 00:30:17.519 You speak Ukrainian, you're an ex-army officer, and you're a fellowship trained orthopedic trauma surgeon. 00:30:17.680 --> 00:30:22.640 So you have an ability to contribute that very, very few people would. 00:30:22.880 --> 00:30:37.599 So for the average orthopedic surgeon out there who wants the help that doesn't have those, that necessarily that skill set, what would you advise them in terms of both helping within the Ukrainian space or any space in the part of the world that has need? 00:30:38.640 --> 00:30:39.200 Yeah. 00:30:40.319 --> 00:31:06.000 Some of the stuff that I feel that my presence there and your presence there is not the technical expertise that we shared, but the fact that we're just merely present to share the burden, to show that we care and understand, that is a tremendous uplift. 00:31:06.160 --> 00:31:12.799 If you think about it, as you said, the there's been a very big active war for four years. 00:31:13.039 --> 00:31:13.359 Okay. 00:31:14.000 --> 00:31:25.440 Many of those families there are divided, where their spouses and their kids may be in another city, they may be in another country. 00:31:26.160 --> 00:31:32.160 You even if they're at home, when you were in Dniprov, what do they say? 00:31:32.480 --> 00:31:35.680 We have power for four hours and are at home. 00:31:35.920 --> 00:31:42.000 The hospitals are they have all the electricity they need, but they're working under those conditions day in, day out. 00:31:42.160 --> 00:31:45.599 They don't know how many patients are going to come in on any given day. 00:31:45.759 --> 00:31:48.400 They know that they're dedicated and we'll take care of them. 00:31:48.559 --> 00:31:54.319 And so if we can offer a slight respite to that, that's a win. 00:31:54.640 --> 00:31:57.839 And I think we for sure got that. 00:31:58.559 --> 00:32:02.799 We got some other benefits as well, but we for sure got that. 00:32:02.880 --> 00:32:06.720 But getting back to your other question, you know, what else can you do? 00:32:06.960 --> 00:32:10.319 Well, it's any range of things. 00:32:10.640 --> 00:32:22.480 And talking to your congressman, collecting used equipment, external fixators, tailored spatial frames, those kind of things that

is being reused in Ukraine. 00:32:22.799 --> 00:32:32.079 You can donate money to any number of NGOs that are very active in that space. 00:32:32.319 --> 00:32:45.440 And you can pick what is it that you want to do, whether it's strictly medical or humanitarian or military, all those things exist, and all those things are meaningful. 00:32:45.599 --> 00:32:53.200 I think it'd be wrong to think that the only way you can contribute is by going there and putting your hands in. 00:32:53.440 --> 00:32:55.839 Well, it's not for everybody, for one. 00:32:56.799 --> 00:33:00.799 And if you do decide to go, yes, I think it's possible. 00:33:01.519 --> 00:33:06.400 But I would encourage you to go with a group. 00:33:06.559 --> 00:33:09.440 There are a number of different groups that are that go. 00:33:10.000 --> 00:33:25.279 They do need help, and it is possible to do that, but it's not something you can just hop on a plane because first off, you can't fly into Ukraine right now, but you can get to the border and go in that way, and there's various ways to help. 00:33:25.440 --> 00:33:39.839 My wife has volunteered in uh basically a kitchen that frees, dries food for soldiers in cleaning, and so she it's a great group of folks, and there's those kind of things. 00:33:39.920 --> 00:33:42.160 So there's any number of ways you could do it. 00:33:42.240 --> 00:33:50.240 I think expressing that support in whatever way works for you is meaningful and really appreciated. 00:33:51.119 --> 00:33:52.319 They're working hard. 00:33:53.519 --> 00:33:56.799 Right, under very severe circumstances. 00:33:57.759 --> 00:34:10.559 Now, I'm pretty sure you remember that very first morning after we were there, the evening before, you and I met for breakfast, and we discussed about some of the events of the night before as we were in an act of war zone. 00:34:10.639 --> 00:34:12.719 Do you want to tell folks what we experienced? 00:34:13.920 --> 00:34:19.199 Well, Doug, you are the very astute and prepared infantry officer. 00:34:19.519 --> 00:34:26.239 I was the jet-lagged medical person, and so he you heard the air raid siren. 00:34:26.480 --> 00:34:31.679 I didn't hear it, but there was an air raid siren that went off that very first night. 00:34:31.920 --> 00:34:36.000 And later, and you saw and heard the booms. 00:34:36.239 --> 00:34:38.320 They're a few miles away. 00:34:38.639 --> 00:34:46.559 So I that certainly for you was a reminder that yeah, this is the war zone. 00:34:46.800 --> 00:34:49.440 This is not something to be trifled with. 00:34:49.599 --> 00:34:51.760 It is not for anyone. 00:34:52.159 --> 00:34:57.360 You have to understand that that there is risk with that. 00:34:57.599 --> 00:35:04.639 As you and I talked about, this is not a place where I would ever consider taking a resident or a fellow. 00:35:05.119 --> 00:35:09.840 Uh, if they end up there on their own, that's their problem, their issue. 00:35:10.159 --> 00:35:19.599 But it requires a certain commitment, if you will, but you have to assess the risk, and it's not for everybody. 00:35:19.760 --> 00:35:21.360 And I would not recommend it. 00:35:21.440 --> 00:35:36.079 I've I have a I feel a compelling need, and I really appreciate the fact that you felt similarly, but unless you go into that with eyes wide open, you're gonna turn around and walk away. 00:35:36.239 --> 00:35:52.000 And we did hear, remember, from the director, the orthopedic chief at Metznikov, that they've had a few volunteer groups that came in and turned around and walked out when they heard how close the war was. 00:35:52.239 --> 00:35:54.159 And those are decisions you make. 00:35:55.679 --> 00:35:57.360 That was obviously very true. 00:35:57.440 --> 00:36:04.559 And we did have those intermediate range ballistic missiles that came over the hotel, and I was jet lagging, so I was wide awake at 2 a.m. 00:36:04.800 --> 00:36:08.159 It wasn't that I was exceptionally aware, I was just awake anyway. 00:36:08.480 --> 00:36:16.559 And the drones, we did also hear the drones flying around as well, which obviously you stay inside, you stay covered when you hear those things. 00:36:16.880 --> 00:36:24.559 However, at the same time, the one of the things that just astonished me is folks are living their lives. 00:36:24.719 --> 00:36:27.199 So, yeah, we went in there with eyes wide open. 00:36:27.280 --> 00:36:29.280 Yes, we were in an active combat zone. 00:36:29.440 --> 00:36:33.280 Yes, our safety was in peril. 00:36:33.920 --> 00:36:43.039 But at the same time, there are folks that were that lived there, they lived there for the last four years under this incredible threat, and just suck it up and keep going. 00:36:44.079 --> 00:36:45.519 Yeah, that's true. 00:36:45.760 --> 00:36:50.719 And I think that can be said of a lot of humanitarians, depending on where you go. 00:36:51.679 --> 00:36:59.599 That is one of those intel things you look for before you go in to know what are the threats. 00:36:59.760 --> 00:37:05.280 It could be bombs, it could be gunshots, it could be various diseases. 00:37:05.440 --> 00:37:06.880 Is the water safe to drink? 00:37:07.199 --> 00:37:12.400 And so knowing that will keep you safer and more effective. 00:37:13.920 --> 00:37:19.840 And when somebody goes, That's the craziest thing I've ever heard, bless you for going, but why would you put yourself in harm's way? 00:37:20.400 --> 00:37:21.920 What would you say for that? 00:37:22.239 --> 00:37:26.159 Why would you risk your life for do or your safety for something like that? 00:37:26.559 --> 00:37:31.039 Yeah, well, these folks are doing it every day. 00:37:31.760 --> 00:37:53.920 And for me, yeah, I it's my background that compels me for not only as being of Ukrainian heritage, but my military background, knowing that, yeah, I can't stand if a soldier who's doing their job for whatever country that is, they're injured and they can't get the best possible care. 00:37:54.079 --> 00:37:56.079 That hurts me as a soldier. 00:37:57.199 --> 00:38:00.159 And I think they deserve the best that they can get. 00:38:00.239 --> 00:38:07.280 And these guys are working extremely hard at their job, putting their lives at much, much, much more risk than I am. 00:38:08.719 --> 00:38:10.480 Very well said, thank you. 00:38:11.280 --> 00:38:28.159 All right, it has been an absolute honor and pleasure to discuss this incredible experience and the ability to really serve at the top of our profession at the important, the most important things that we have as orthopedic surgeons with my friend and colleague, uh Dr. 00:38:28.239 --> 00:38:29.039 Roman Haida. 00:38:29.119 --> 00:38:41.360 And Roman, I want to publicly thank you once again for your incredible guidance during this very, probably without question, one of the most salient important moments of my entire life as an orthopedic surgeon. 00:38:41.440 --> 00:38:43.360 And I thought it was important to share this with everybody. 00:38:43.440 --> 00:38:45.519 So thank you for being on the podcast, sir. 00:38:47.920 --> 00:38:48.800 Thank you. 00:38:49.039 --> 00:38:50.159 Appreciate it. 00:38:50.400 --> 00:38:50.880 All right. 00:38:50.960 --> 00:38:55.440 And y'all join us again for other episodes in this podcast series.