Dr. Andrew Bauder first went to Ukraine to support a pediatric surgical case requiring specialized microsurgical skills. After a week with colleagues at a local children’s hospital and a regional hospital, it became clear that the country’s medical system would need far more support to address the volume of patients suffering severe traumatic injuries

Bauder, who currently works at a U.S. military treatment facility in San Diego, is part of a Penn Center for Global Health team that has spent almost three years working inside Ukrainian hospitals overwhelmed by patients with blast injuries from artillery, missiles, and land mines. With support from Direct Relief, the team has focused on saving limbs after these traumas, which requires highly specialized surgery techniques that were not widely available in-country at scale before the war.

“It’s hard to overstate the need,” Bauder said. “It’s far worse than what most people understand. I’ve been back multiple times, and it hasn’t gotten better. If anything, it might be getting worse.”

The crisis he describes began almost as soon as the war did. Shortly after the invasion, Ukraine’s health care system was overwhelmed by casualty numbers it was never designed to handle.

Less than two months after the war began, Penn launched near daily telemedicine consultations with Ukrainian doctors.

“There were surgeons doing heroic work,” said Kierstyn Claycomb, program manager of Ukraine initiatives at the Penn Center for Global Health, who has traveled on the medical missions. “But they were struggling with orthopedics. They didn’t have the training to be able to close soft tissues, so they were amputating.”

The calls soon revealed a deeper problem present throughout the country. Ukrainian surgeons lacked widespread training in orthoplastic surgery, an integrated approach combining orthopedic and plastic reconstruction. Virtual guidance helped, but it soon became clear that remote support alone was not enough.

“There’s no substitute for being in the operating room together,” Claycomb said.

After learning about a particularly difficult case from surgeons in Ukraine’s Zakarpattia Oblast, who had been introduced to them by a physician at the Children’s Hospital of Philadelphia, Bauder, Kovach, and Dr. Benjamin “Kyle” Potter traveled to Ukraine on their first medical mission in March 2023. They worked on the pediatric case and performed additional surgeries alongside local teams in the children’s hospital and across western Ukraine.

The missions have since focused on hospitals in Vinnytsia, Uzhhorod, and Mukachevo. On the adult reconstruction side alone, the team has now completed seven in-country missions, performing roughly 100 complex cases, many requiring surgeries lasting six to 14 hours.

A central, advanced technique is the use of “flaps,” which transfer living tissue, including muscle, skin, and blood vessels, from one part of the body to another to restore blood flow and protect bone. Flaps can often mean the difference between amputation and saving a limb, as they reduce infection and give damaged limbs a chance to heal.

Beyond performing the surgeries directly, a central focus of the program has been training local surgeons in-country as well as in Germany and Philadelphia.

Program data show that this training model has produced a clear multiplier effect. Penn has trained at least 46 local surgeons across Ukraine, including one who has performed over 1,150 flap procedures himself.

Penn’s missions also extend to material support. From late 2024 through 2025, Penn procured and delivered microsurgical instrument sets, micro sutures, vessel couplers, handheld Dopplers, micro sagittal saws, portable imaging devices, and custom-fitted surgical loupes to hospitals in Vinnytsia, Odesa, and Uzhhorod. These tools allow advanced reconstruction in settings where operating microscopes and specialized equipment are otherwise unavailable.

Bauder said his decision to go was shaped by timing, conviction, and clarity.

“I’m at a stage of life where no one is dependent on me,” he said. “The work is interesting to me… It is very easy from an ethical standpoint, and you feel like you’re doing as much good as you can with the skills that you have,” he said.

What keeps bringing him back, he said, is the transformation he sees in patients who have spent months immobilized in hospital beds.

“There’s a look, the hopelessness, when someone has been lying there for months with no plan,” Bauder said. “You see the thousand-yard stare. Then you do the surgery, and you see the light come back.”

One patient, a carpenter injured in a phosphorus bomb attack, underwent three reconstructive surgeries after doctors initially feared amputation was inevitable. Months later, the team received a video showing him back on his farm, loading equipment onto a tractor using arms that had once been at risk of being lost.

“When you see that,” Claycomb said, “you understand the scale of the impact, not just for that person, but for everyone who depends on them.”

That long-term vision includes plans for dedicated orthoplastic centers where orthopedic and plastic surgeons work together under one roof. The estimated cost to build such a facility is $15 million to $20 million, with an annual operating budget of about $600,000. Visiting international surgeons volunteer their time, while Ukrainian physicians are compensated locally.

Even if the fighting were to stop tomorrow, Bauder said, the medical need would persist for decades.

“There will be reconstruction for years, war injuries, cancer, trauma,” he said. “This is about building something that lasts.”

For Bauder, the choice to keep returning feels uncomplicated.

“There are a lot of shortcomings in U.S. medicine, and many of those shortcomings don’t exist in Ukraine. It feels like medicine in its purest form,” he said.

Direct Relief provided $1 million to support the Penn Center for Global Health and efforts to increase surgical capacity in Ukraine.