Many ask, how can I help in Ukraine?
Turning the spotlight to the resilience of a war-torn nation, Antonina Kumka from Protez joins us to discuss the challenging yet uplifting strides in building sustainable prosthetic solutions amidst Ukraine's ongoing crisis. From meeting a double amputee soldier, which ignited a transformation in prosthetic care, to collaborating with international partners for local capacity building, Antonina's journey is nothing short of remarkable. The episode touches on Ukraine's storied history in tech innovation, the hurdles in device certification, and the paramount importance of psychological support for amputees. It's a stirring reminder of the indomitable human spirit and the profound difference one person's resolve can make in the lives of many.
Special thanks to our sponsor, Coyote, for bringing us this episode.
Many ask, how can I help in Ukraine?
Turning the spotlight to the resilience of a war-torn nation, Antonina Kumka from Protez joins us to discuss the challenging yet uplifting strides in building sustainable prosthetic solutions amidst Ukraine's ongoing crisis. From meeting a double amputee soldier, which ignited a transformation in prosthetic care, to collaborating with international partners for local capacity building, Antonina's journey is nothing short of remarkable. The episode touches on Ukraine's storied history in tech innovation, the hurdles in device certification, and the paramount importance of psychological support for amputees. It's a stirring reminder of the indomitable human spirit and the profound difference one person's resolve can make in the lives of many.
Special thanks to our sponsor, Coyote, for bringing us this episode.
Welcome to season seven of the prosthetics and orthotics podcast. This is where we chat with experts in the field, patients who use these devices, physical therapists and the vendors who make it all happen. Our goal to share stories, tips and insights that ultimately help our patients get the best possible outcomes. Tune in and join the conversation. We are thrilled you are here and hope it is the highlight of your day.
Speaker 2:Hi everyone, my name is Joris Piels and welcome to another episode of the prosthetics and orthotics podcast with Brent Wright. How you doing, Brent?
Speaker 1:I'm doing well, man. I'm in the jungle of Guatemala, but I'm doing a clinic up here.
Speaker 2:So how's Guatemala Brent?
Speaker 1:Oh man, this is great, and you know it's crazy, as it seems like I brought the winter weather here. I mean, it's like 80 degrees out and people are wearing Eskimo jackets. It's the funniest thing. They are freezing, so I don't know what that translates to in Celsius, though, but you know it's not jungly weather, which is great, but we're seeing a bunch of kids.
Speaker 1:I actually brought my bamboo lab printer down here, and we've already got it rocking and rolling, and so that's been really neat. We're actually going to be doing a couple of pediatric arms For on the bamboo lab printer, and then we've done a couple of little tools that helps us capture the model, so I'm really thankful I'll be using ComScan and then, obviously, the bamboo lab printer, and so I'm still digging it and, believe it or not, you'll get a kick out of this. I invited the executive from the hospital that we work with to come over and check out the printer, and he goes I want that, how much is it? So, he's, I'm actually going to leave it there. They're going to buy the printer from me and I'm going to replace it when I get to the US, so I'm super excited about that. No, I think it's a great thing.
Speaker 2:I think it's going to change everything really seriously. I think, you know, is it going to be them in five years? Is there still going to be the biggest three printer manufacturers? I don't know, but they really taught everybody that they need to really get much more ambitious. And everybody was going, you know, trundling about in second gear and now everybody knows I have to pump it up to fifth gear to even survive. So you know, things have really gotten a lot more exciting Thanks to them, I think, a lot more ambitious and we're going to get a lot more, a lot better printers as a result. So I think it's absolutely fantastic, absolutely fantastic. I'm glad you use it. It's a useful way and you know, when you do this kind of stuff, is it like there's a lot of planning, right? You have to kind of know what to bring in and who to bring, and all the stuff. Like the planning must be immense for this, right, it is immense.
Speaker 1:And I think that's one of the things that you know life enabled does very well.
Speaker 1:We work well with the local hospital here, hospital Shalom, and what they do is they have, you know, not only a hospital, the people doing the amputations, but then they have some of the social work people that are keeping track of the people that have lost limbs or what have you, and so then we're able to take a look at that and say, okay, so we've got the equipment and components to do this, or do we need to bring the equipment? And we need to bring this, and so, like that's one of the reasons why I brought the bamboo printer was I knew that we were going to be seeing a bunch of kids and so and obviously kid stuff fits well on that smaller build volume of the printer. And so, while I might not have known exactly what I was going to do, I already had some pictures and photos and some diagnoses that allowed me to know and have a little bit of a mind plan. But you know, everything changes when you land, but at least you're somewhat prepared going into the week. Okay.
Speaker 2:And then how many people you brought with you today, at this time.
Speaker 1:So I brought two more, two clinicians that I work with, and then I brought a technician, diego Suarez, that works with Bionic, so with Tony and Sagar, who we've had on before, and so that's been, that's been really neat, and then we've got some you know, some support staff down here as well. So it's a small team, but a small but mighty is what I say and we'll be doing stuff for about six days. So we take two days of evaluation of patients, two days of fabrication and then two days of fitting.
Speaker 2:And are you really like, are you going to do a lot of stuff? Is it just a lot of hard work? But you, you know, you know in advance, you can realize it. Or are there some certain things in there where you're like, well, I don't know if we're going to be able to do that, because that's kind of out there, that's really difficult, or you don't know that yet.
Speaker 1:Yeah, so I mean from yesterday. Yesterday was our first patient day. We had a pretty complex orthosis that needs to be made and we just we just don't have the components nor the time. It's a very in-depth one to do, but here's where the digital scanning comes into play is and it was for knee braces for this little girl that her knees almost go fully backwards. They it's not. It doesn't look good, but what we're able to do. I was able to get a cast and then I'm just going to scan the cast with the ComScan and and then I don't even have to bring a cast back. I've got the digital model and I'm going to 3D print her braces and I'll bring them down the next time.
Speaker 2:Okay, that's super cool, that's super nice, all right. So hey, I heard we have a sponsor and it's Coyote, right?
Speaker 1:Yes, and I love working with Coyote.
Speaker 1:You know we're both of us we're big fans of Coyote and kind of the I would say independent.
Speaker 1:But there are a large independent organization that does a bunch of things, but, you know, very practical, for not only orthosis and prostheses, and you're going to love this, joris. So they actually just got a Filament Innovations Icarus machine and they love vase mode and they're a component manufacturer and so they were like you know what? We are going to make components specifically for printing prostheses in vase mode. And that's what they've done, and I believe they're the first company to do so, and so I'm really excited. They're gonna be the next show, they're gonna be releasing some of those products at the next show and you know, if it's anything like the other products that they've released, it's going to be great. And so I thought you would appreciate that, being a vase mode fan. But then also like this idea of how do you combine the strength and speed of vase mode to some of the practicality that we didn't have before because we didn't have the right components, and now they've done that.
Speaker 2:Well, that's all super good, man. I really liked them and you know I liked the whole. Yeah, vase mode is the future man, vase mode is the future.
Speaker 1:Oh, my goodness, I'm gonna have to take that out of this podcast. Edit it out, just snip it right out.
Speaker 2:So anyway, oh okay, and what other stuff do they do? They also do like that they have a CFAB as well, right, so you can actually they'll make stuff for you, right.
Speaker 1:Yeah, so they'll make they have a whole line of not only bracing but prosthetic stuff. So you know, as technicians are either moving on, or you don't have technical facilities or you're an independent facility and you want a place to fabricate. Their lab is open with their skilled technicians, and you know it's pretty neat to have stuff fabricated by the actual fabricator of the components and so you know it's gonna look good and it's gonna function well and yeah, so really neat program that they've got and it's also gonna start incorporating a lot of this 3D printing and even the vase mode stuff. So it's gonna be interesting.
Speaker 2:All right, all right. So thank you so much for Kodi for sponsoring this episode. So now on to our guest. Who do we have on the show today?
Speaker 1:Joris, I'm really excited about having Tanya Koumka on the show today. We interacted on LinkedIn a little bit. She had put some stuff out on LinkedIn that kind of made me pause just a little bit, and I love the perspective that she had as far as how education impacts the country. So you know, a lot of the things that she does through her organization of Protez, which works with the government and other social organizations within the Ukraine, is how do we make sure that we create a way to be sustainable and we don't rely on outside help coming in, and I really like that. So I just reached out to her and said, hey, I would love to have you come on the podcast. She obliged and said, hey, I've got this little spot here. And so here we are today and we've got a little bit of time with her to hear her story.
Speaker 2:All right, thank you. Welcome to show Antonina how you doing.
Speaker 3:Thank you, I'm doing. Great Thanks for inviting me.
Speaker 2:So, first of all, how did you get involved with the prosthetics?
Speaker 3:It all started back in 2014, when Ukraine first was invaded and Crimea the peninsula was occupied, and then the war started in the eastern part of Ukraine, so the first injuries started coming in and some of the guys were losing limbs and had really complex amputations, for example, bilateral lower limb amputation and so at that time, I was running a charity that was not related to prosthetics, but just general humanitarian support, and we were working on a project. That was where we delivered the e-readers to the wounded soldiers in hospitals, and one of the soldiers that we delivered the e-reader to was a guy who was missing both of his legs, and one thing he brought up, kind of, was the thing that made me think differently about the problems. So he said that there wasn't much available in Ukraine to help him come back to the functionality that he wanted, and whatever was available would not give him exactly what he wanted, and not because it was not possible, but because it was simply not available there at the time and he would have to go abroad and get his prosthetics there. Plus, he would have to fundraise a tremendous amount of money for that. I realized that that was completely not sustainable, that we could not send wounded soldiers abroad every single time that there would be more of them like him, and it would be super expensive too. So I was searching for someone who could help me streamline the process in Ukraine and build the system that would change the whole scope and the whole field in the country.
Speaker 3:And I literally googled John Badstorf, who was the president of Prosterica. And that was what he was doing with his group of his volunteers. They were traveling to other countries helping establish, helping teach and train local prosthetists and build the capacity on the ground, and he immediately said yes, let's work together. And that's how that work started, and since then we have been doing all this wonderful work to support the sustainable development of the country.
Speaker 3:Since then, we were able to work with the government to change the system of reimbursement in Ukraine. We were able to introduce a variety of technology, because at that time only one or two manufacturers were available in Ukraine only, and then we were able to work with manufacturers to certify prosthetists in like my electric hands fitting and so on and so forth. That was. There was a lot of work done prior to this full-scale invasion, and that work has now paid off in terms of what was available to the new wounded soldiers. There are so many now in terms of what's available in country rather than outside of the country, and if you're talking about the scope of how many new MPTs are there from this war?
Speaker 2:do you have any idea of the numbers?
Speaker 3:Yeah, so there are different numbers floating around and some journalists or some groups are in their attempt to sensationalize it completely. They use numbers that are too much. Right now it's just about 20,000 from the war injuries, which is a lot, but you will see numbers as high as 50,000, 60,000 and on.
Speaker 2:Okay, and because this is a war, you're actively looking at the soldiers and the war injuries. Is there like a difference in there? Is there more injuries to arms, for example, than legs, or are there different types of injuries, do you see, compared to just a normal patient population? Absolutely yes.
Speaker 3:So you know that this is the drone slash artillery war in many occasions.
Speaker 3:So there are a lot of mind blast injuries, also from land mines and so on.
Speaker 3:But also one of the biggest problems that causes really severe, complex types of amputations, where a person may not even be a candidate for prosthetics, is a tourniquet syndrome, when the person gets injured and the tourniquet gets placed onto a person's arm or leg, and they usually try to do it at the highest level possible.
Speaker 3:Unfortunately, this war has shown that because of difficulty of evacuation procedures, this could be for several reasons Lack of evacuation vehicles, the fact that they're being constantly shelled and they just cannot leave the combat field for hours until it's safer to do so, and so on. And because they are not using certain protocols like there is no conversion allowed for certain types of personnel. The guys stay with that tourniquet for like six hours, 10 hours, up to 30 hours, I've seen and of course the limb just dies off and it dies off at the very high level and we see a lot of high level upper limb amputations as a result. In general there are more upper limb amputations than normal. Usually you have a ratio of 10 to 90% upper to lower. In Ukraine it's closer to 40 to 60 right now.
Speaker 2:Okay, and then, and so you know, we were seeing a lot of stuff happening also in Ukraine, where people are either, like you know, they're giving their product right or they're flying in people all over the place, but you guys are really focused on that. Well, what I think is really interesting about your approach is you're focused on that capacity building in country, which I think would be always be cheaper and more effective, right?
Speaker 3:Exactly this has always been our goal. It's never a good idea to rely on the external support all the time. Everybody, especially the donors and the partners from other countries they would rather see Ukraine be independent and be able to deal with its own problems efficiently rather than constantly rely on assistance. So that's what we're trying to do, and we found that this can be done through education first of all and we are sending groups of international professionals into Ukraine, but it's too due exchanges with local practitioners so they're able to use the skills and apply the knowledge when the group leaves. Also, it's important to understand the capacity and the need and what's available in the country.
Speaker 3:I mean, it's great to think of something that can potentially be available in five years, fine. But right now these people are working with these types of things and you can introduce certain things, but you have to make sure that they are viable, that they will stay and not just be used by you when you go there for two weeks and then, once you leave, none of that will stick. It will just not be accepted by the people on the ground. Then it's not a successful solution and it's not sustainable in any way. So we're trying to avoid that and we encourage others to avoid that, but unfortunately there are still quite a bit of effort that's wasted on projects that bring things that are not necessarily going to stay there or be used there or are useful there at all.
Speaker 2:Yeah, that's a good point. We saw it before in the people in Myanmar. People were working with wood and lathes and there's tropical climate, so there's local consideration. I think that's a really great point to make.
Speaker 1:So I also had a question around that and the considerations. I think one of the things that's interesting to me and I know we talked about this, tanya, before you came on was I think people forget that Ukraine is a developed nation, right? So it's a first world country that needs first world solutions. So this is not developing world type of solutions that come. Can you just speak a little bit to that? As far as, hey, we're doing laminations and microprocessors and myoelectrics and all this stuff, that is high tech and not that the low tech stuff doesn't have a place, but it's not relevant in Ukraine at this time.
Speaker 3:That's correct. If you go back to the Soviet times, ukraine was the country in the Soviet Union that was the major inventor and producer of anything to do with technology in the Soviet Union. So Ukraine had very strong engineers. There were manufacturing facilities producing rocket ships, airplanes, all kinds of things. So that legacy stayed and it has transitioned into the field of prosthetics, because the field of prosthetics does have that component the engineering component to it. In addition to that, there are also facilities. There are state facilities that have deteriorated, but the stuff that has been working there and so on, they're still there. They know what they're doing.
Speaker 3:So it's the technology and the mindset and the abilities were always there in terms of the most not even the basic, but the core technology or engineering capacity, and then you build up upon it.
Speaker 3:So when you speak about Ukrainian wounded soldiers, these guys want what Americans want.
Speaker 3:They see what's available, they know what's out there, they realize that the Ukrainian prosthetists are capable of delivering results and, plus, the Ukrainian government has now actually for the past few years has had a very good program for funding prosthetics. There is no need in most cases to fundraise for prosthetics. However, not every technology and not every prosthetic device can be funded, they have to go through certification and licensing as based on ISO considerations and other requirements, and then, once they produce the documents and the results, then the government will pay for it if it's included in the list of acceptable components. So if we talk about technology that's developing or any of the startups or whatever it's, I mean people come and try things, but Ukraine cannot be the testing ground for anything that people want to try. It's people who are fighting for their freedom and, honestly, for the freedom of a lot of other people and countries, so it's important to understand that they deserve better, they deserve quality and they deserve technology and techniques that would help them live a functional and decent life for the rest of their lives.
Speaker 2:Okay, so if we're talking about that kind of stuff like what is what is needed right now, if you're taking the help that our listeners stuff can provide, what would be necessary and what would be helpful?
Speaker 3:If we talk about revision of prosthetic components, there are cases when civilians get injured. It's not as common as with military, of course, but in the case of civilians there's sometimes need for prosthetic component co-financing. So if someone wants to help get better components for the civilians, that's fine. But in most in general, the biggest help right now would be around building again, building projects that allow the building, the capacity on the ground, anything that creates that helps train the professionals. It doesn't have to be just prosthetist or tithist, it's multidisciplinary teams, it's teams that work within the hospitals with the amputees PT's, ot's, rehab doctors and so on. There are some cities that are absolutely oversaturated with support and there are other cities and towns that see just a little tiny fraction of that and they are hungry for knowledge. They're hungry for how do we provide better care to those people that we end up with? Because they have never many of them have never had to deal with such numbers of amputees or such types of amputations. So now they are a little bit overwhelmed and this is why, when we work with different facilities, we try to choose for each subsequent training that we do. We try to choose the ones that we haven't worked with yet, or the regions that we haven't covered yet, and so on, anything to do with education, anything to do with amputee support in general, psychological supports very important too, because you can only imagine and also certain types of amputees.
Speaker 3:For example, there are people who have lost both legs and they will not be able to go back to, they won't be able to walk on the prosthesis, they will have to be wheelchair users. It's hard for them to accept it and it's important to have programs that will help them work through that, realize that it's not the end of the world, and also train them and work with them to be effective wheelchair users. Or, for example, at the end of March, together with Enhancing Skills for Life organization from the US, we're going to be organizing a workshop for upper limb bilateral amputees in Ukraine Again a very unique group, but a group of Americans who have successfully lived their lives for a number of years with bilateral you know, bilateral amputations. They will share their experiences, they will show the guys in Ukraine what they can do, what they can achieve and how to move on from this injury. So things like that are very important and this is what we are trying to focus on and we encourage others to do the same.
Speaker 2:And if I'd like to get involved, what should I do?
Speaker 3:That's fine. Yeah, that's a possibility. We get quite a few emails from different people, from organizations, from companies, asking how they can support, and then we just ask them okay, what is the thing that you would like to support? And they explain to us what they're looking for, and then we share some ideas with them and move forward from there.
Speaker 2:And for you you have experienced running the prosthetics or charities generally before this has this been a very gratifying journey for you to help out in this way over the last couple of years?
Speaker 3:Yes, totally. Being a Ukrainian, you do whatever you can for the country to get out of this horrible situation. The country's been invaded and people die and get injured every single day. My father is in the front lines as we speak. He is a doctor and he saves the wounded from the battlefield, so it's very close to home, of course, and every Ukrainian that feels strong about their country, about their fellow citizens and about freedom in general, they do what they can every single day, and everyone chooses what they're able to do, how much they're able to do or in what direction, but we do what we can.
Speaker 1:When I love that. I think that is fantastic. I mean to kind of dovetail into what you're supporting your father to. I think that's really neat. I think one of the takeaways for me from what I'm hearing you say is listen, we have the talent within the Ukraine, we have the capacity within the Ukraine where the help really stems, as maybe some support for the civilian side of things. And then this idea of how can we educate and elevate the education within our ecosystem to be sustainable.
Speaker 3:That's absolutely right, brent.
Speaker 3:I'm very grateful to all of the people from different, so many different countries who come on board and they're so eager to work and support in many different ways we have. We're also working with the Guard, we work with the Ministry of Social Policy, with the Ministry of Health of Ukraine Ministry of Education, and they're very supportive of the initiative that we start and that and the initiatives we have already fulfilled. For example, establishing the professional standard for a prosthetist orthotist this is the first time happening in Ukraine, hasn't existed there before and now it's there. And now, with Anne Yemen from the University of Washington and others, we're working on a Maryland Rammstad from the University of Janczepin in Sweden. We're working on developing an educational standard which will be a national standard for the master's degree program in prosthetics and orthotics and once it's developed, the universities will be able to launch the programs based on the established standard. And, of course, when we do that, we keep all the best practices and whatever is the best out there in mind and we try to incorporate it in what we work on.
Speaker 2:Well, thank you so much for your work and thank you so much for being on our podcast today.
Speaker 3:Thank you for inviting me.
Speaker 2:And Brent, thank you for being here as well.
Speaker 1:Oh, this was great and, yes, thank you for the work that you do and I know it's kind of not it's thankless work right now, but man talk about, you know the potential of leaving, leaving a legacy, and I'm sure even other countries will look at what your model has done for the Ukraine. So thank you for doing that.
Speaker 3:Thank you. And as one of our friends, another great prosthetist, anton Johansson, says unless you've tried it in your own country, don't try to do it in Ukraine, and that's the message that I want to leave everyone with today. Thank you.
Speaker 2:All right, thank you very much and have a great day. Thank you for listening to another episode of the prosthetics orthodox podcast.