Dear Friends –

Somehow, our first week in Ukraine has already passed us by. While it took most of that time just to get to our training locations, the team has already spent several days providing high quality advanced pre-hospital training, which is sadly still in dire need across the country. We have seen destruction both from the very start of the invasion as we passed by Izyum and new as of this week as the war continues to ravage this beautiful country. Our team started in a location we had also visited in our July trip, though all immediately noticed the difference just a few short months and waning Western support has made. A town that we had felt very comfortable in previously now felt on edge. It has seen additional missile and drone strikes as the front has moved. The team house that we had used previously had been uninhabited for about a month, and we arrived to find no running water, no usable indoor toilet, and no internet. These impediments did not seem to bother the mice at all, which had taken up residence. Fortunately this team is nothing if not resilient and dynamic, and immediately got to cleaning and making the place livable for the days we were there. Amazingly, we had a chance to see some of the medics that we had trained previously, and their skills and knowledge retention were incredible. We all felt like it validated the work we did previously and the way these amazing trainers pass information – it clearly resonates with those we are training.

After several days there, the team moved to our current location to link up with an old friend who we had worked with in July as well. Their medics have recently been pulled back from the front lines, with plans to return imminently to continue the defense of Ukraine, Many of these medics have functioned in the role for a year or more but with little to no formalized vocational education. Their skills and experience in many ways eclipse our own, yet their understanding of the why of interventions and medicine is where we are really helping. We are also able to finally engage in what we hope is the endstate – training an organic capability here that can in turn train others. Even two years into the war, no such capability exists. But today, after demonstrating blood transfusions since September 2022, our trainers were able to mentor an incredibly talented Ukrainian medic through the process, watching her complete the entire intervention unaided. The ability to transfuse blood is a critical skill in trauma medicine – it absolutely saves lives and in some cases is the only thing that will do it. These medics were so skilled that we also increased the training stress to low-light and red light conditions, and watched them excel every time.

Their skills are admirable, but the reality that they have attained this knowledge through months if not years of on the job training is sobering. We are privileged to be here to help them sharpen those skills even further and enhance their knowledge of the why. We are also aided by some of the best training tools I have ever seen – using wearable moulage to simulate realistic wounds has allowed us to show concepts, rather than try to explain them – and that through an interpreter. As good as our interpreters are – and they are the best I have ever worked with – there is something about being able to see the concept that is really driving it home. We all notice an obvious change in both the way we can teach concepts and how our trainees comprehend.

We will be here for several more days, working with these medics and showing them increasingly advanced skills. Tomorrow we will be focusing on surgical airways, as well as refining what was learned today. At the end of next week, we will do a team reset back in Dnipro, likely the next time I’ll be able to update you.

While I am so incredibly proud of the quality of the medics here, I would be remiss in not also talking about the team. These trainers and interpreters are truly special people – we have pushed into more challenging conditions than ever before. Today was the first day most of us had showered since leaving Dnipro five days ago. They have been tough, resilient, and most of all kind and professional throughout. They care about the mission, the people we train, Ukraine, and each other. I have been incredibly fortunate to work with some very elite teams across my career – there is none finer than the people I am with right now. We are currently all sleeping in a single room heated by a fire that we take turns tending at night – that is the kind of people they are.

I am so proud of them and so grateful to you for making this possible. Your generous support allows this team to do the work. And that work in turn empowers people with the knowledge and the skills to save lives. There is a direct line from you, through us, to them and their patients – the ones that will truly benefit from the ripple effect you started.

In gratitude – Mike