Newsletter April 2019
Welcome to our latest news and round-up of how your support has been helping us to train more doctors with the specialist medical skills they need to work in war and disaster zones.
Meet Yemen’s only female surgeon
For International Women’s Day 2019, we featured the inspirational account of an exceptional woman. Samah is the only female surgeon in Aden and possibly in Yemen. We originally met her when she completed our HEST course in 2016 having just recently qualified. We met again recently her when she attended our second HEST in Yemen. Over the last three years, she has come to be regarded as one of the very best and has consistently impressed our training team with her dedication and diligence. Samah has already applied some of the skills she gained from our course. Recently she told us that she carried out an emergency procedure during a life-threatening situation, saying "I saved his life, it was great what I felt at that moment. It's all thanks to the Foundation".
Her legacy is a reminder of the many extraordinary women who’ve been in the “front line” for years. We celebrate and thank them on this special day.
Help us train more surgeons like Samah by donating www.davidnottfoundation.com/donate
Bestseller book
Have you read War Doctor yet? This is David’s gripping account of life as a trauma surgeon in some of the world's most dangerous war zones. We’re proud that it debuted at NUMBER ONE in the Sunday Times chart and has been TOP 10 for six weeks now!
Here’s the latest news from its publisher, Picador:
- 27,000 hardbacks have been sold via the publisher so far
- 16,000 hardbacks have been sold through the tills in the UK
- It’s been reprinted six times already!
Lebanon
We recently ran a surgical and training mission to Lebanon with Syria Relief to support Syrian and Palestinian refugees living in refugee camps. The work done by the team involved everything from repair of blast injuries from conflict, skin grafts for burns as well as more routine operations. David also taught surgical procedures to local surgeons in Lebanon giving them the specialist skills needed to work with victims of conflict.
We’ve been hearing from one of the doctors on the mission, who told us “This work not only invests in the local surgical team, but also provides life changing operations free of charge for Syrian and Palestinian refugees who would not be able to access this treatment otherwise”.
Tell us what you think
What do you like hearing about from us and what interests you? We’re keen to tailor our communications according to what you want. This survey is an opportunity for you to tell us your opinions and preferences, please help us by filling it out – it’s very quick!
War Doctor
Have you read War Doctor yet? This is David's gripping account of life as a trauma surgeon in some of the world's most dangerous war zones. The book was released on the 21st February 2019 and we are proud to report that it debuted at Number 1 on the Sunday Times Bestseller List. Here is the latest news from the publisher, Picador:
- 27,000 hardbacks have been sold via the publisher so far
- 16,000 hardbacks have been sold through the tills in the UK
- It's been reprinted six times already!
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.
November 2018 newsletter
Note from the Chief Executive
In September we took our Hostile Environment Surgical Training (HEST) course to sub-Saharan Africa for the first time. The David Nott Foundation will travel to wherever in the world our teaching is needed and the doctors in Cameroon are contending with very challenging circumstances as they seek to care for their patients.
Violence from the Nigerian Army’s conflict with Boko Haram has spilled over into the north of Cameroon and the doctors there are having to cope with the aftermath of major trauma incidents such as suicide bombings with minimal equipment. Their training has not always equipped them to manage the cases they face in the most effective way, which is where the DNF steps in.
We are motivated by the fact that well-trained doctors save more lives. If doctors have the knowledge and confidence to handle the complex cases in front of them, they will be more likely to save life and limb.
Thank you for your support.
Elly
Hostile Environment Surgical Training (HEST) course for Syrian doctors
17-20 July
Our training team returned to Gaziantep, for the third time since the Foundation was established, in July to train a group of Syrian surgeons. For David, it was a chance to see friends of many years with whom he lived and operated in Aleppo and Idlib.
Among those attending was the doctor with whom David had conducted an operation over Skype in 2016. When the siege of Aleppo was at its height, David helped the doctors in M10 Hospital reconstruct a man’s jaw, the majority of which had been blown off in an explosion.
The training was enhanced by the use of prosthetic organs upon which the Faculty demonstrated various surgical techniques.
Our third HEST for Syrian doctors
Practising surgical procedures on prosthetic organs enhanced the teaching for these experienced doctors
HEST course in Cameroon
10-14 September
The class of Maroua, 2018
The Foundation’s first mission in sub-Saharan Africa; a Faculty of three set off for Cameroon on 9 September. There has been a considerable overspill of violence from military operations against Boko Haram in neighbouring Nigeria into the far north of Cameroon. Our team arrived into Yaounde and then took a further internal flight to Maroua, travelling by car to the MSF field hospital where the training took place. 29 local doctors attended and the lectures were selected in order to match the experience of the trainees. Many attending were not surgeons but general doctors with surgical skills, so the faculty spent more time covering common procedures in detail and mentioned for general knowledge other procedures that will require a more advanced level of training.
Some sessions were combined with practical dry lab stations, using prosthetic organs commissioned by the Foundation and funded by your generous donations. The doctors practised cardio vascular repair on hearts, arteries and veins; bowel repair, anastomosis and stoma principles and post-partum haemorrhage management using an intrauterine balloon.
The training in action using specially-commissioned training materials
Systematic Management and Emergency Care in Obstetrics and Midwifery (SMEC-OM) for Syrian Obstetrician and Midwives. Gaziantep
24-28 September
The obstetricians and midwives attending travelled from Idlib, Syria
The training comprised practical and written assessment and tests
Organised and funded by the David Nott Foundation, Hand in Hand for Aid and Development and World Vision International; the course aimed to address the high rates of maternal and neonatal morbidity in Idlib.
An account of the training and the challenges facing Idlib’s obstetricians was published by the British Medical Journal on 9 November: https://blogs.bmj.com/bmj/2018/11/09/elly-nott-training-idlibs-obstetricians/
Fundraising
There have been several wonderful fundraising events organised by our supporters over the past few months. They include a group of friends doing a sponsored walk along Hadrian’s Wall, an open day at a beautiful fruit nursery in Kent, coffee mornings and garden parties. We are so incredibly grateful for all these efforts as they enable us to keep doing the work we do.
In June, we held a cello recital and reception at Fishmongers’ Hall in London. We were generously sponsored by the April Trust and heard from the ‘cellist of Baghdad,’ Karim Wasfi. David Nott presented Karim with the Arabian Business ‘Humanitarian of the Year’ Award in 2015 for his work promoting peace through music and the arts in his native Iraq.
Iraqi cellist Karim Wasfi performs
Our life-sized whole body training simulator on display; anatomy being described by David Nott
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: The 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:
The David Nott Foundation,
Second Home - Holland Park
48-49 Princes Place
London W11 4QA
The BMJ: Training Idlib’s obstetricians
Giving birth is one of the most vulnerable moments a woman can experience. It can be anxiety-inducing enough in a well-equipped hospital in the UK, but the women of Idlib, Syria are literally having their babies in a warzone. The threats they face are myriad, not only to themselves and their babies, but also to the physical fabric of the hospital and the medical workers who care for them. In early September the Has hospital was barrel-bombed and put out of action. Ambulance stations and a Syria Civil Defence (White Helmets) first response centre were also put out of service.
Beneath the headlines about “shapeshifting” rebel groups which have formed, fractured, and re-formed over the course of the civil war, and deals cut in regional capitals, is the suffering of the civilian population of Idlib, the last province in Syria not under regime control.
The numbers are stark; 336 maternal deaths per 100,000 births in provinces outside government control in Syria. [1] There are 9 per 100,000 in the UK. The figures for neonatal deaths are similarly distressing; 30.6 deaths per 1,000 births in Idlib compared to 3/1,000 in the UK. [2]
Violence against hospitals and medical staff affects clinical decision-making.
On 19 March 2018, the Union of Medical Care and Relief Organisations (UOSSM) reported that doctors in eastern Ghouta had, on the previous day, performed 15 caesarean sections out of a total of 30 births. The doctors said that they were being forced to do caesareans as the intense besiegement made it difficult for expecting mothers to predict when they could safely go to the hospital. The risk of complications for the mother and child are increased by the lack of incubators, medical equipment, and staff with the right training to perform follow up care.
However, the war alone cannot explain the high levels of maternal and neonatal morbidity. There is a serious shortage of obstetricians and midwives to care for a population of some 3 million. This can lead to non-specialists having to undertake the care of pregnant women and neonates and sometimes not making the correct decision for the patient. While not all of that population of 3 million will be having children, of course, the pressure on health services has increased as much of that population is made up of internally displaced people from areas including eastern Aleppo, eastern Ghouta and Homs. The province has become a receptacle for the vanquished as the regime has hammered those opposed to Assad’s rule. Following relentless campaigns of bombing and the use of chemical weapons, those civilians left alive boarded buses for Idlib province.
Among those on the green buses heading for Idlib in December 2016 was Farida; known as the last obstetrician in eastern Aleppo. Farida made impassioned pleas for the indiscriminate bombardment of her City to stop on several media channels in 2016. Her departure with her husband and daughter is an evident source of present pain, but there was something about those months leading up to the evacuation. “We made a difference. We were working so hard and helping so many people. Though we were under constant attack, we were part of something extraordinary and saving lives every day.”
Farida and 17 other obstetricians were in Gaziantep recently for Systematic Management and Emergency Care in Obstetrics and Midwifery (SMEC-OM), a course organised and funded by the David Nott Foundation, Hand in Hand for Aid and Development, and World Vision International. The Syrian civil war has stalled the medical education of doctors and midwives, a further major contributing factor to the poor outcomes in obstetrics and gynaecology. Postpartum haemorrhage and eclampsia/pre-eclampsia were responsible for the majority of maternal deaths in areas of Syria not under government control in 2017. [3] The SMEC-OM has been devised to save the lives of mothers and babies by training clinicians to use established algorithms and guidelines for managing conditions such as maternal collapse, post-partum haemorrhage, pre-eclampsia, sepsis, and neonate resuscitation. The Royal College of Obstetricians and Gynaecologists (RCOG) in London is supporting these efforts and the course is conducted under the auspices of its Syrian Liaison Group.
Organising this essential training is Saladin Sawan, a British-Syrian gynaecologist. Saladin is joined by a faculty of trainers from several Arab states, all of whom give up their time for free. They lecture with authority and passion for their subject, inviting debate and questions from the doctors, 90% of whom are women. The energy in the room is palpable as they question graphs and diagrams and participate in practical exercises on specialist obstetric simulator models.
What they learn is being measured by an exam comprising both a paper of multiple-choice questions and a practical assessment on a simulator. The candidates who perform most strongly in the assessment proceed to a “train the trainers” day, where they will be coached to provide help and supervision to their colleagues in Idlib. This is especially important as 35 candidates had registered to attend the training but only 18 were able to make it across the Turkish border.
Getting the best in surgical training to those who need it most is the mission of the David Nott Foundation and we were proud to be able to support this thorough, detailed training.
In the coffee area I meet Abdulaziz. Before the war, Abdulaziz was a surgeon at Aleppo University Hospital and lecturer at the University’s faculty of medicine. With a small group of others, he was instrumental in locating safe houses where emergency operations could be performed on wounded protesters in the early days of the revolution. At night he gave lectures to medical students over Skype; focusing on emergency first aid and treating gunshot wounds. [4]
It is the focused effort of Abdulaziz, Saladin, and countless other individuals and charities that has created a shadow health system in areas of Syria not under government control. As the Syrian regime and its Russian supporters bombed hospitals and medical facilities, they scrambled to set up new ones underground and in caves. As the number of doctors shrank, they strove to train and upskill those who remained.
Idlib is the final front in the Syrian civil war and it is uncertain whether the current ceasefire will hold. The diplomats and politicians negotiating Syria’s fate owe it to the obstetricians I met in Gaziantep, and the thousands of women and babies who depend on them, to come up with a solution which creates the peace, security and dignity they so greatly deserve.
Elly Nott, Co-Founder and Chief Executive, David Nott Foundation
References:
1] 2017 survey conducted by the Syrian Board of Medical Specialities (SBOMS), “article in preparation”
2] World Bank data
3] 2017 survey conducted by the Syrian Board of Medical Specialities (SBOMS), “article in preparation”
4] Ben Taub, ‘The Shadow Doctors,’ The New Yorker, June 27, 2016 Issue
Originally posted on: https://blogs.bmj.com/bmj/2018/11/09/elly-nott-training-idlibs-obstetricians/