Miami trauma surgeon goes to Ukraine, works on war victims

MIAMI — A woman whose arm and leg were shattered from mine-like projectiles shot into her apartment. A young man whose face was nearly blown away by a rocket-propelled grenade. A man whose chest and liver were obliterated from a missile strike.

These were among the cases that Dr. Enrique Ginzburg, trauma medical director at Jackson South Ryder Trauma Center, encountered on his recent trip to Ukraine, where he worked side by side with local physicians performing complex surgeries on victims of Russia’s invasion of the Eastern European country.

“It’s a very rewarding experience at this point in my life (…) to be able to contribute to such a humanitarian mission,” says Ginzburg, also a professor of surgery at the University of Miami Miller School of Medicine.

In early April, Ginzburg traveled with a small team of trauma surgeons to the Lviv Clinical Emergency Hospital in western Ukraine to provide medical support and training for Ukrainian physicians.

Global Surgical and Medical Support Group (GSMSG) organized the mission; its purpose is to provide “humanitarian services to conflict zones and austere settings,” says Dr. Aaron Epstein, president and founder of GSMSG, a Washington-based nonprofit.

Epstein, who had a background in defense, national security and intelligence before becoming a physician, says he was inspired to start GSMSG when he was working in the Middle East and saw groups simply “come in and do their piece for a CNN photo shoot and leave or come in and provide really subpar medicine.”

But the GSMSG team wanted to do more: “I heard a lot of people talking (about Ukraine). And I wanted to do more,” said Ginzburg, 65, who met Epstein in 2016 when he was doing a rotation at Ryder Trauma during medical school at Georgetown University. Before working with Epstein and the GSMSG group in the Ukraine, Ginzburg worked with them in Iraq.

For Ginzburg, the connection to Ukraine is personal: His grandfather is from Kyiv and his grandmother is from eastern Poland.

Although Ginzburg has parachuted into difficult places such as Haiti and Iraq, he had never before operated in a war zone. The situation in Ukraine was particularly precarious since they were “operating in the context of theoretically a first-world military that could be trying to destroy them,” rather than isolated attacks such as car bombs, suicide bombers or random attacks.

After arriving in Ukraine, Ginzburg spent the next two days working alongside Ukrainian doctors, consulting with the physicians on the most complex patients.

One was the young woman whose arm and leg were shattered. The doctors considered covering the wound with a skin graft or flap, or even possible amputation. Ginzburg doesn’t know the outcome.

Another involved the young man whose face was destroyed by a rocket-propelled grenade, a case for which surgeons decided to follow a “staged approach,” entailing up to 20 operations to reconstruct the jaw and cover the face with muscle and skin.

Perhaps the most complex case was that of a patient whose chest and abdomen were ripped open from shrapnel from a missile strike. Physicians debated between operating immediately, or draining fluid buildup with a catheter. The team decided to operate but were too late. The patient died just before they took him to the operating room.

Most of the patients were shipped in from hundreds of miles away, from eastern Ukraine, where the fighting has been the heaviest and where medical care is scarce as Russian forces have bombed hospitals and clinics.

However, as Epstein notes, simply donating supplies or performing a few medical procedures doesn’t affect the community in a lasting way. Instead, GSMSG focuses on “training host partners and communities so they can gain the expertise and skills to use in their communities going forward.”

RYDER TRAUMA EXPERIENCE PLAYED BIG PART

Due to Ginzburg’s three decades of treating trauma patients at Ryder, he was well-suited to work with the Ukrainian physicians, training them on treating patients with penetrative and blunt trauma wounds.

At Ryder, Ginzburg has seen a lot, from patients with multiple gunshot wounds to devastating injuries caused by car accidents.

“He’s one of the most senior surgeons,” says Dr. Antonio Marttos Jr., a trauma surgeon at Ryder, who has known Ginzburg since he came to the Center in 2004 for a trauma and critical care fellowship. “He’s a world leader,” always making himself available for education and support and even putting his life on the line, as he did in Ukraine, Marttos added.

Ginzburg notes that although the extent of the injuries in Ukraine were greater and had some peculiarities — he had never dealt with injuries caused by radioactive projectiles — cases at Ryder were similar to those on the Ukrainian battlefield.

“With all the AR-15s that are being used in this country, they’re creating those type of wounds.” Ginzburg said.

PLANS TO RETURN TO UKRAINE

Ginzburg’s work prompted members of the Ukrainian government, from the mayor of Lviv to the World Health Organization’s regional director for Europe and Ukraine’s minister of health, to request additional surgeons and telemedicine initiatives.

Since then, GSMSG has set up surgical teams, with groups of four surgeons visiting Ukraine every two weeks; the first of the teams is about to return home. GSMSG is also obtaining certifications to establish multi-institutional telemedicine efforts.

In the meantime, with the help of the Panamerican Trauma Society, a Virginia-based nonprofit, and the University of Miami Miller School of Medicine telemedicine efforts, Ginzburg and a team of surgeons have already completed two formal consultation calls and “are available for them (Ukrainian physicians) to present to us at anytime.”

Marttos, president of the Panamerican Trauma Society, says the mission of the organization was initially to “improve trauma and critical care throughout the Americas.”

But since the start of the coronavirus pandemic in March 2020, the group has expanded its reach globally, including to the recent Ukraine mission.

“You have a problem in Ukraine, somebody requests (help) and right away, within a matter of hours, you can connect everybody (…) and be able to discuss a case,” he said.

Ginzburg plans to return to Ukraine within the next several months.

Ginzburg was relatively unfazed while working in Ukraine, despite seeking refuge in safe houses when intelligence reports warned them of several impending missile attacks. However, he recognizes the precariousness of the situation.

“Today, I was calling my life insurance because I have young sons and my wife, so I’m trying to make sure I have good coverage.”

His family is supportive of his missions but his wife, an occupational therapist who accompanied Ginzburg on his trips to Haiti, Iraq and Ukraine, insists he call her every day.

Yet while his family may worry, they know that his work is important.

Ginzburg is “one of the most intelligent and talented trauma surgeons that I’ve had the pleasure to work with,” Epstein said.

Added Marttos: “He’s someone that does not just stay on the ocean and follow the currents, going where the wind takes him. He’s a sailor. He knows where to go. He’s a leader.“

Ginzburg credits his love of adventure and helping others as the reason why he became a trauma surgeon.

“There’s nothing like getting someone who’s about to die and (…) being able to pull them from the jaws of death. There’s nothing more rewarding.”