Overcoming hurdles to train doctors in Palestine
In collaboration with Juzoor for Health and Social Development and the Palestine Medical Council, we trained 34 surgeons in Ramallah, Palestine, in July. Despite logistical challenges, our faculty delivered a course that met the urgent needs of Palestinian doctors.
At the David Nott Foundation, we have a strong connection with Palestine and the dedicated healthcare workers serving their communities in acutely challenging circumstances. We first delivered our HEST course in Ramallah in March 2017 and, as part of our commitment to sustainability, also trained a dozen Palestinian surgeons on our UK course. It was a joy to return to Ramallah, seeing several familiar faces among very welcome new ones.
Daily challenges
Providing healthcare in Palestine is complicated by the realities of displacement and occupation. Since 2002, the construction of a separation wall cutting into Palestinian territory has severely inhibited freedom of movement across the West Bank.
The wall is a barrier to Palestinians seeking to exercise their fundamental human rights, including their right to healthcare. The movement of ambulances, healthcare workers and resources is impeded by military checkpoints and arbitrary closures.
During our latest mission in Ramallah, our Co-Founder and Chief Executive Elly Nott visited the Augusta Victoria and Al-Makassed Hospitals in East Jerusalem and heard about the challenges they face in providing care. Travel from the West Bank and Gaza to these hospitals requires a permit. Applications – and therefore treatment - is often delayed or denied.
Describing the city of Ramallah, Dr Salwa Najjab, Co-Founder and Chairwoman at Juzoor, said:
“I love Ramallah. But we don’t have control of our borders, we are living in a big prison. Our people should be exposed to the world. We are very happy and thankful to the David Nott Foundation, to come and see what we are doing, to understand our situation and see it in their eyes.”
Adapt and overcome
We were honoured to train 34 surgeons working in a number of Palestinian cities and towns, such as Ramallah, Jenin, Hebron and Jericho. Due to delays caused by the shipping company and customs, much of the course had to be taught with a fraction of our usual cutting-edge teaching equipment. However, the energy and enthusiasm of our faculty, led by Course Director Dr Rebekka Troller, ensured it was an engaging and successful course.
Our team, Juzoor, and the Palestine Medical Council worked together to recreate practical parts of the training. Until our simulation model arrived, we used soft silicone hearts, prosthetic blood vessels, and sponges to mimic lung repairs. Animal organs were also donated to allow attendees to practice kidney repairs.
Dr Morgan McMonagle, consultant trauma and vascular surgeon, and member of our teaching faculty, said:
“It’s always challenging holding a training course, even in the UK. When you train overseas, the hurdles are both different and magnified, but we rose to the challenge in Palestine.
Hospitals in conflict zones are often faced with reduced resources. Like any good doctor in an austere environment, we adapted to what was in front of us and were still able to deliver an excellent course for our attendees.”
An ongoing partnership
Addressing the doctors, Elly Nott, our Co-Founder and Chief Executive, said: “The goal of our training is the same wherever we go. To empower local surgeons and share our knowledge with them, in the hope that it will save more lives.
We see this course as the start of an ongoing journey with Juzoor and Palestine - training which we hope will strengthen doctors’ surgical education.”
The Palestinian surgeons we trained, and our partner Juzoor, will be remembered for their warmth, generosity and optimism.
"The skin is alive - it's all because of you."
“Here – you do it.” These were the words of our Co-Founder David, as he handed a skin grafting instrument to Ivan, a junior doctor in eastern Ukraine attending our surgical training course.
During a Russian shelling, a woman suffered catastrophic leg injuries. Working to repair her wound during a mission in Ukraine, David used the surgery as an opportunity to train local doctors.
He showed them how to perform a skin graft to treat the injury – and that wrapping the graft in fluffy gauze can help with healing. This technique differs to standard wound treatment, which often involves the application of antiseptic spirits and bandages.
David and Ivan have kept in touch since his returned to the UK – a common story for David and our trainers. We are proud to have created a supportive community of war doctors that can ask questions or share cases with us at any time, from anywhere.
When Ivan looked at his patient’s wound in recovery, he was overwhelmed with joy to see that it was healing. During a phone call, he shared with David:
“The skin is alive! It’s all because of you.
I’ve started a little revolution in my hospital. I’ve started to do what you do - using the fluffy gauze for skin grafts. The patient’s granulation (tissue that is an important component of wound healing) is awesome. We haven’t needed to use any antibiotics.
It was one of the best moments of my life doing this operation. I can only say thank you for your knowledge.”
Ivan, a junior doctor facing the horrors of his country’s war, is now armed with a skill that can be used to treat devastating injuries. He plans to teach this technique to his peers – and potentially even senior doctors who typically use other methods.
Although unusual for a junior doctor to teach senior consultants, in war, titles are stripped away. All that matters is the sharing of knowledge and saving of lives.
To carry out the next phase of the patient’s skin graft surgery, David offered his help over Skype. Ivan and his father, a Chief of Surgery based in Kharkiv, will work together with David to rebuild the woman’s leg and remove as many traces of the evidence of war as possible.
Surgery over Skype isn’t new to our Co-Founder. During the historic siege in Aleppo, David guided surgeons online as they reconstructed a man’s shattered jaw. The Syrian surgeons, Dr Assaf and Dr Baydak, successfully carried out the operation and put the man’s face back together again.
The stark similarities between Syrian and Ukrainian conflict do not go unnoticed. As witnessed in Aleppo, healthcare workers in Ukraine are in urgent need of our support. As the war continues to wage on, we are more driven than ever to train doctors and help them prevent needless deaths.
“You have given me new breath in surgery,” shared Ivan. “You were not scared to come here and share knowledge. Thank you.”
More on our training in Ukraine