February 2019 newsletter
Note from the Chief Executive
At the forefront of all we do is the knowledge that well-trained doctors save more lives and I am hugely proud to have led the Foundation since we were granted charitable status. I will always be closely involved with what this special charity does but have decided it is the right moment to hand over the leadership of this next phase of its growth.
Succeeding me as Chief Executive is Ivar Milligan, who since joining us last year has demonstrated remarkable impact, capability and commitment to the values and mission of the Foundation. Between our staff, Trustees, Patron and faculty, the Foundation will continue to thrive and bring the best in surgical training to those who need it most.
When I set up the Foundation with David we had in mind two principal activities; raising money for doctors to be taught in the UK on the STAE course, and running war surgery courses abroad.
Since 2015 we have trained 608 doctors including 49 on our scholarship programme and 519 over 11 Hostile Environment Surgical Training (HEST) courses abroad.
What the Foundation has at its core is an open-heartedness and willingness to set our eyes beyond the horizon; beyond our shores and out to the world. It’s an unwillingness to look away from suffering and instead ask what we can do to make things better.
Whether you donate, give up your time or support us in another way; you are all a vital part of our community and I thank you from the bottom of my heart.
Thank you for your support.
Elly
About Ivar Milligan
Ivar joined the Foundation in October 2018 and took over as Chief Executive in February 2019. He joined from Consilium Strategic Communications, a financial public relations firm within which he was an Associate Partner specialising in investor and corporate communications for the healthcare sector.
Prior to this, Ivar served in the British Army as an officer in the Scots Guards. He deployed on operations to Afghanistan in 2010 and managed a Joint Services exploratory ski-mountaineering expedition to Antarctica.
Ivar commented: “The Foundation is preparing for a surge in growth, taking training to more surgeons worldwide and I’m hugely excited to be able to continue the fantastic work that Elly has already done. Having been a part of the Foundation’s training both in the UK and Yemen I have been delighted at the feedback from the surgeons and the impact that the training is making; I’m thrilled to be a part of delivering this and seeing the difference that we can make.”
Surgical Training for Austere Environments (STAE) course scholarships
19-23 November
The Royal College of Surgeons of England’s STAE course is arguably the most advanced conflict trauma course worldwide. Set up by David Nott with the Royal College of Surgeons of England, it covers the full spectrum of injuries, procedures and considerations expected in austere or hostile environments. The first four days of the course were held in Manchester in the university’s cadaver lab, giving the surgeons a chance to learn and practice on real bodies supported by videos, slides, anatomical models and a world-leading faculty. The final day was held at the Royal College of Obstetricians and Gynaecologists, learning to deal with the decision making and management of obstetric emergencies including post-partum haemorrhage and caesarean section.
The Foundation hosted 13 scholars from South Sudan, Uganda, Mexico, Iraq and Nepal, among others, encouraging a fully international sharing of experience and ideas and the beginning of an enduring relationship with each of these scholars.
On the final day we invited the scholars to meet a number of our donors, including those that made their scholarships possible. During this meeting we had the opportunity to hear from the surgeons about where they had come from, the conditions they work in and what the training will enable to do, and it was exceptional. To hear about the escape from ISIS and the fear of persecution providing even more motivation to do what they can for their patients and to understand what they had learned, the boost this has given them and the opportunity they now have to pass this on to their colleagues is immensely gratifying and wholly validates the Foundation’s mission.
HEST course in Yemen
7-25 January
With a faculty of four and the support of MSF, we ran two four-day courses for over 50 doctors; teaching, discussing cases and learning about the latest injuries from the front line and what these surgeons were able to do. They came from Mocha, Hudaydah, Aden and surrounding smaller towns. We arrived in the wake of a drone attack at a military parade, with some of the casualties being brought to the hospital where we were going to teach.
The training we deliver is for often complex situations and targeted at surgeons and doctors who, on the whole, have to deal with complex trauma in often under-equipped theatres. To cope with this, they have to be creative, combining the art of surgery with an exemplary understanding of the science of physiology.
Critical to the successful learning of surgical procedures is the ability to touch, feel and observe the anatomy of the patient and for this mission we were accompanied by our bespoke simulator mannequin on its first training mission.
Our faculty talked through and demonstrated various procedures on the mannequin as the doctors crowded around to observe this unusual visitor to their hospital. Thanks to donations from the UK we were also able to purchase two obstetric simulators last year, one of which also travelled to Yemen and enhanced our teaching of possible surgical interventions during childbirth.
We taught the basics of plastic surgery that would allow muscle and skin flaps to be raised and used to cover terrible wounds. It was a joy to see that after one training day, in the evening we assisted the Yemeni surgeons with an eight-year-old boy having a patch of skin and muscle from his forearm pivoted down to cover a bone-deep wound to his hand, keeping the blood supply intact and likely saving him the use of that hand. Without the training this would not have been possible to do in the same way.
During the evening we would spend time with the surgeons in the operating theatre putting into practice the techniques they had learned in the classroom, notably severe pelvic injuries, gunshot wounds to the kidney and major vessels and thoracic injuries. Many of the casualties were dreadful blast injuries from the effects of landmines, which we had also covered in our plastics sessions showing how to properly debride wounds to remove all sources of sepsis.
In a wonderful continuation of our relationship with the surgeons of Yemen, several of those trained by David back in 2016 were able to come along to this course as well, contributing a huge amount and helping the faculty with case studies and feedback which was overwhelmingly positive.
War Doctor
David Nott’s new book, War Doctor, will be launched on 19 February and on sale from 21 February. Describing some of the most harrowing, the most beautiful and the bravest of happenings, it takes a reader through David’s riskiest times whilst also giving an understanding of the human behind it. It goes without saying that we wholly commend this to you all and hope that you will want to find a copy for yourselves and to give to others.
Amazon Smile
The Foundation is now registered with Amazon Smile, Amazon’s charitable portal which donates 0.5% of each sale to your nominated charity. To be a part of this, please login to Amazon via www.smile.amazon.co.uk, select the David Nott Foundation from the drop down and then make sure you return to this portal each time you buy; the Amazon system is identical once you are ‘in’. The perfect place to buy a copy of War Doctor.
Fundraising
We are constantly in awe of the support we get from volunteers and friends of the Foundation. The remarkable Joyce Nettles set herself a target to pay for all the costs of the Yemen mission and has, since November and with the support of an amazing army of donors, raised over £40,000. We cannot thank her and her donors enough for this.
We’ve also been preparing a fundraising event in April with the wonderful Sally Ann Whetherly and her committee who have done a huge amount of work to plan and organise what promises to be a fantastic evening. We’re looking forward to the night and would like to thank them all for their help.
If you would like to get involved in any events as a fundraiser or volunteer, please do send us an email and we’d love to talk to you.
Can you help us?
If we are to continue to train surgeons and take these desperately-needed courses abroad, we need your help.
There are several ways you can donate:
Bank transfer
Bank: The Co-operative Bank
Account name: David Nott Foundation
Account number: 65774847
Sort code: 08-92-99
Credit/debit card
Please visit http://davidnottfoundation.com/donate and donate through our secure connection
Cheque
Please make cheques payable to ‘The David Nott Foundation’ and post to:
David Nott Foundation
48-49 Princes Place
London W11 4QA
Yemen HEST January 2019
The David Nott Foundation ran two HEST courses in Aden, Yemen in January 2019 with the support of Médecins Sans Frontières.
These two HEST courses were the first occasion that the Foundation’s whole body simulator was employed for training and supporting it was a suite of individual models of organs, blood vessels and key anatomies with which the students could train. For the obstetrics modules, the Faculty used its commercially-sourced obstetrics simulator enabling each surgeon to practise multiple Caesarean section deliveries as well as neonatal resuscitation.
Training
Covering 2-5 hours each, the courses were taken through:
- Ballistics – the effects of low velocity bullets and high velocity bullets and the four stages of a blast injury on the human body
- Primary and secondary survey
- Damage control
- Cardio-thoracic trauma – thoracotomies; lung twist and tractotomy; effects of a cardiac tamponade; pericardial sac opening; heart suturing
- Vascular surgery – ligating, shunting, patching and grafting vessels; fasciotomies; proximal and distal control
- Head and neck trauma – removal of extracranial haematoma; burr holes and craniotomies for extradural haematoma; fragment removal with depressed skull fractures; treatment of mandibular and Le Fort fractures; jaw and maxilla wiring
- Principles of paediatric surgery – differences in physiology; burns; common injuries and diseases; cultural considerations
- Abdominal trauma – laparotomies; control of bleeding; pelvic injuries and bracing; splenectomy; Cattel-Braasch manoeuvre; Whipple procedure; bowel anastomoses; ileostomy and colostomy; closure of abdomen
- Orthopaedic surgery – stabilisation by plaster of Paris; traction; external fixation; management of difficult fracture, non-union and infection; osteomyelitis; amputations
- Plastic surgery – burns; debridement and reconstruction; skin grafts; tissue flaps
- Trauma in obstetrics and gynaecology – vaginal deliveries; Caesarean sections; hysterectomies; post-partum haemorrhage with compression techniques and tamponade; perineal trauma; retained products; ectopic pregnancy; neonatal resuscitation
Students
The Faculty trained 52 students over the two courses. 20 surgeons and doctors from across the country came for the first week and demonstrated a high level of experience and skill, and engaged well with all the training, even putting some of it into use the same day once they returned to theatre. By the time the second course started the work had spread and many more than expected turned up to start, with some having to be turned away to keep the numbers manageable.
Particularly interesting was the attendance of five surgeons who had previously attended a HEST course delivered by David and team in Aden in 2016. Among those was a highly respected female surgeon; the only in Aden and possibly the only in Yemen, who had only recently qualified. In the three years since she had come to be regarded as a one of the best there and consistently impressed the Faculty. Such was her appetite to learn that she even sat in on some of the sessions in the second week to make sure it was all sinking in.
Conclusion
There is no doubt in our minds as to the value of the courses in Yemen and the evidence of and potential for making a very real difference to the surgical outcomes for patients not only treated by the surgeons we taught, but also those to whom the training, techniques and procedures can be cascaded.
The impact that the models have made is exceptional; they have transformed the course and are now invaluable training aids for almost all components of the syllabus. Both the surgeons that have trained with the models, and the David Nott Foundation faculty that have used it in their teaching, have been emphatically enthusiastic in their feedback about the value it brings to the training. Both the surgeons that have trained with the models, and the David Nott Foundation faculty that have used it in their teaching, have been emphatically enthusiastic in their feedback about the value it brings to the training.
HEST in Libya
It was the early hours of 4 March when our DNF team touched down at Misrata airport. David and Ammar were this time joined by Harald Veen, formerly Chief Surgeon of the Red Cross and now a valued addition to our teaching faculty.
Over the next three days they taught 55 Libyan doctors in the skills they need to provide the best surgical care for patients with complex injuries.
The doctors had travelled from across the country from towns including Tripoli, Misrata, Houn and Sabha. The majority specialised in general surgery but there were also orthopaedic surgeons, an obstetrician and a neurosurgeon present; demonstrating the relevance of our training programme to all medical specialities.
HEST faculty in Misrata
The course concluded with a practical workshop at Misrata Central Hospital where they put their newly-learnt skills into practice with tuition from David, Ammar and Harald on vascular, general surgical, neurosurgical and facio-maxillary techniques.
We have already had three applications for scholarships from surgeons attending the Misrata course and look forward to continuing to build our friendships with the doctors of Libya.
Yemen HEST July 2016
David Nott Foundation ran a HEST course in Aden, Yemen from 10-12 July, 2016. 43 surgeons from hospitals in Aden, Lahj, Abyan, Lawder and Shabwa attended the three-day war surgery training.
David showed the doctors how to treat a variety of complicated war injuries, principally fragmentation and gunshot wounds. There had been an increase in suicide bomb attacks and bombs placed under cars in recent weeks, causing horrendous blast injuries which David also showed the doctors how to treat.
The Foundation taught the course at the invitation of Médecins Sans Frontières (MSF) as part of their regular training for local doctors and nurses.
David said: “I was thrilled to receive the invitation from MSF to run the HEST course in Yemen and am delighted to say we have had more invitations to run courses from other aid agencies in various countries. It shows the huge importance of the work we are doing and the very real need for surgical training in war zones.”
