We’re back from training frontline doctors in two Ukrainian cities

An experienced team of trainers have just returned from delivering two HEST courses in Dnipro and Kharkiv. Here, consultant neurosurgeon and faculty member Pete Mathew shares his experience of teaching frontline doctors in Ukraine and what makes a course successful.

After David volunteered in Ukraine in April, it became clear there was an urgent need to return and deliver our war surgery training course to doctors in the country.

We decided it was best to send a small but experienced team, consisting of David, myself and Ammar Darwish. The three of us have worked in a number of war zones over the past decade – and Ammar and I have been part of the Foundation’s teaching faculty for years.

Reaching as many doctors as possible

To have a bigger impact, we decided to deliver two courses in Ukraine. We held one three-day course in Dnipro and another in Kharkiv – two cities that have faced significant attacks over the past few weeks.

To enter the country and support us on our mission, we worked with UOSSM International. Together, we travelled from Poland and made our way to our first training destination – what appeared to be a teaching facility in Dnipro.

On the walls, there were pictures of students happy and smiling, a stark difference to Ukraine’s present reality.

Training overseas is always a leap into the unknown. We never quite know where the teaching location will be. We don’t always know what sort of doctors will arrive. But it always comes together.

Once we got our bearings, we set our equipment up before the doctors arrived – from Heston our war wound model to David’s comprehensive training videos on a projector. Heston is an excellent teaching aid for describing injuries or techniques.

Making an impact in Dnipro

In Dnipro we had over 30 attendees of varying seniority and specialties - junior doctors, consultants, emergency doctors and an anaesthetist. We had a fantastic Ukrainian translator with us, which was amazing. Different doctors arrived on different days, which is quite normal in an emergency, resource-poor setting. They need to return to treating patients on the frontline.

Sometimes it can take a little time to gain the trust of attendees. We need to prove our worth – which is absolutely understandable.

Creating a community

Some of the surgeries are quite simple, but the hurdle is finding the confidence to do them under challenging, high-stress circumstances. We want doctors to feel empowered - sometimes all that’s needed is confidence. We want doctors to feel inspired to learn and try the techniques they’ve seen on our course.

We hear from those we train that we offer a morale boost, but perhaps more importantly we provide a forum for surgeons with different levels of experience to have discussions and raise questions – a safe space for doctors to debate views.

Speaking with the doctors we met in Dnipro, it was clear they were resigned to the inevitability of returning to the frontline after our course ended. They are solemnly grinding away.  Some of the very junior doctors were more anxious about returning to work.

The road to Kharkiv

After three days, we packed up and travelled up to Kharkiv to deliver our second course. The group – 28 doctors - were very happy to see us.

Back-to-back courses can be very tiring, but we are always happy to do it. It’s always very tempting to do two in a row, to reach more people.

There was a marked change in behaviour from the beginning to the end of our courses. Being an effective teacher requires getting your message across with enthusiasm. If you don’t feel drained after a course, or you don’t see excitement in your audience, you haven’t given it everything.

You also need to be able to adapt to the needs of your attendees. It’s important to be flexible and go off-script – to deliver the course in a way that best suits those in front of you.

Standing in solidarity

When training in active war zones like Ukraine, an experienced team, support from the Foundation and partners like UOSSM International are important.

I hope our training has boosted Ukrainian doctors. As long as this war wages on, we will continue to offer whatever support we can.

Read our story in the BBC


Surgery on the frontline in Ukraine: David Nott in conversation with Bridget Kendall

We are delighted to announce that The BEARR Trust is hosting an event with our Co-Founder David, to discuss his work providing emergency surgical care and training local doctors in Ukraine.

David will be in conversation with award-winning journalist and BEARR patron, Bridget Kendall, to share his stories of working in crisis and catastrophe zones for over 25 years - including the delivery of two HEST courses in Ukraine. The online event will take place at 18:30 BST on Monday 27 June via Zoom.

About Bridget Kendall

Bridget Kendall worked for the BBC for over 30 years, specialising in Soviet and Russian affairs after graduating from Oxford and Harvard universities. From 1989 to 1995, Bridget was the BBC’s Moscow correspondent, covering the final years of the USSR and the first years of post-Soviet Russia.

As the BBC’s Diplomatic correspondent from 1998 to 2016, she covered conflicts in Chechnya, Georgia, Tajikistan and Ukraine, among others, and in 2001 and 2006 she conducted two interviews with Vladimir Putin, both broadcast live to the world from inside the Kremlin.

In 2016, Bridget was elected Master of Peterhouse Cambridge. She is also a patron of The BEARR Trust.

Register to attend this special event today


Messums Gallery raises £17,000 to help us train doctors in Ukraine

When the war in Ukraine unfolded, Johnny Messum and fellow colleagues at Messums Gallery decided to offer their help by raising funds for charities working in the field. They auctioned a selection of beautiful works and raised an outstanding £17,000 for our cause, helping us upskill local doctors and prepare them for war injuries.

After Russian invasion, artists at Messums Gallery and the art-collecting community were keen to find a way of offering support to the people of Ukraine. This led to Messums Gallery holding their first ever auction, raising funds for our Foundation and Hope and Homes, a charity dedicated to protecting families torn apart by war.

Artists donated exceptional works of art (a selection below) to an online auction that closed on the 2nd May. The auction led to a generous donation of £17,000 to the David Nott Foundation, and the same figure to Hope and Homes.

Left to right: Hill 23 by John Beard, 29th March 2017 by Charles Poulsen and Hedda by Sean Henry.
Left to right: Talk by Tom Robinson, Moss Girl with Hat by Kim Simonsson and The Stars go Waltzing out in Blue and Red (For Sylvia) by Agalis Manessi.

Johnny Messum, Founder of Messums Gallery, said:

“It is so difficult to know, beyond the immediate instinct to want to help, how best to assist Ukraine. Our way was to find personal connections to charities doing brilliant work in the field.

The David Nott Foundation was immediately identifiable as a charity representing a clear and direct course of action in the face of great human tragedy. We particularly admired the Foundation’s work because it is so enabling of others.”

Rebecca McLoughlin, Head of Donor Relations at the David Nott Foundation, said:

“We are overwhelmed by the incredible generosity of Messums Gallery and their artists.

These funds have helped us physically reach and surgically train doctors within war-torn regions of Ukraine, giving them the vital skills needed to treat traumatic wounds and save lives.”

Find out about our latest mission to Ukraine


HEST course in Gaziantep, Turkey

From underground hospitals in Syria to training in Gaziantep

For the first time, we delivered two surgical training courses over a four-week period in different countries. Our latest course was for Syrian doctors in the Turkish city of Gaziantep, some of whom had worked together in hospitals in Aleppo between 2011 and 2016.

Gaziantep City

After a memorable course at Edna Adan Hospital in Somaliland, we partnered with Syria Relief to train 26 healthcare professionals in Gaziantep.

A Turkish city near the border with Syria, Gaziantep is home to a number of doctors who know the destruction of war all too well. Many were forcibly displaced from Syria by conflict and some had operated with David in underground hospitals when eastern Aleppo faced military bombardment and siege.

Unbreakable bonds

When the Syrian government, with Russian air support, began targeting medical workers and healthcare facilities, doctors started treating patients in secret hospitals with extremely limited resources. David travelled to Aleppo to help the doctors manage complex injuries and save lives. His sharing of surgical knowledge often led to life-long bonds with those he taught.

Dr Mahmoud Hariri from Aleppo shares: “I first met David in 2013. He came to us in Aleppo, and we learned many things. We learned to be multi-tasking surgeons. I can now do surgery on the kidney, heart, vessels. This is the notion of the multi-tasking doctor. A lot of lives have been saved.”

Dr Hariri and 25 others joined our Gaziantep course with the help of our Course Director Dr Ammar Darwish and the Syrian Board of Medical Specialties (SBOMS), an organisation dedicated to helping Syrian medics work as specialised doctors in northern regions of Syria.

Trainees becoming trainers

The course was taught by accomplished Faculty - some who had learned from David in Syria or during a previous HEST course - and were now excellent surgical teachers.

Helping trainees become trainers is what we are here for. We want to empower doctors within countries affected by conflict and catastrophe to be surgical and health system leaders, serving their own communities.

The group learned how to manage and treat complex war wounds, such as blast injuries, gaping holes in the body, or deep burns. They also learned what to prioritise when faced with multiple wounds, the majority of which they will never have seen during standard medical training.

Faculty Trainer Rebekka teaching in Gaziantep

New skills in practice

Others on the course had also worked with David in conflict. Dr Ehab Baydak, a maxillofacial surgeon from Idlib, Syria, saved a man’s life with David’s help over skype. Since then, Dr Baydak has put his skills to practice in his community.

Dr Ehab Baydak

“During the siege of Aleppo, I was working in an underground hospital and received a patient whose face was severely injured from a bombing.  We hadn’t seen this type of injury before and didn’t know how to deal with this,” Dr Baydak shares.

“Due to the siege, we couldn’t transfer patients outside of the city. Dr Murhaf Assaf and I contacted David who talked us through how to do the operation over Skype.

After the Syrian regime took control of Aleppo, I moved back to Idlib to be with my family. There, I came across the same injury, and I was able to do the surgical procedure alone – all because of my experience with David.”

Our courses teach healthcare professionals how to perform procedures just like this – operations that David has undertaken in war zones over 30 years of voluntary humanitarian work. We were honoured to contribute to the surgical education of 26 doctors in Gaziantep, giving them the skills needed to save lives and limbs against the odds.

More on our courses


Uprising

Mosul to Manchester: Our war surgery training in practice

Dr Moez Zeiton is one of our surgical trainers. As a humanitarian surgeon, Moez has witnessed the realities of war, but never expected to see similar horrors on British ground. Here, Moez shares his journey to joining our teaching faculty and how he’s used his surgical skills around the world.

Moez’s first exposure to medicine was through his father training as a general surgeon and specialising in oncoplastic breast surgery.

“I sort of drifted into medicine myself. I loved biology at school, but my love for the sciences and in particular, my inspirational high school Biology teacher shaped my decision to study it. When I started the course at the University of Leeds, I remember loving the anatomy and dissection work and knew surgery and acute trauma were fields I was interested in,” Moez shares.

A fork in the road

Dr Moez Zeiton

“My entry into humanitarian work started by accident. I always felt a connection to the Middle East through my family and having regularly travelled there as a child to visit extended family and friends.

So, when the Arab Spring uprisings in 2011 arose, I got involved with charitable initiatives sending medical aid and worked on advocacy, opinion pieces and articles. I knew I wanted to be there on the ground, so I negotiated a one-year sabbatical from my surgical training. At the age of 25, I left for Libya to do my part.”

Moez worked with non-government organisations and local Libyan doctors, opening him up to the world of humanitarian health. This led to him taking on a voluntary role as National NGO Coordinator for six months. He also attended courses on analysing disrupted health systems with the World Health Organisation (WHO).

Taking part in our training

After his sabbatical, Moez continued his surgical training in the UK and fed his interest in humanitarian surgery with research. He was part of The Lancet’s series on health in the Arab world and commission on global cancer surgery. He also attended the Scholars in Health and Research Programme at the American University of Beirut.

Working at a major trauma centre in the UK, Moez worked alongside some of our senior faculty and was introduced to our Surgical Training in Austere Environment (STAE) course. He was one of the first doctors to benefit from our scholarship programme, attending our STAE course in 2017.

“On the final day of the course at the Royal College of Surgeons, I met people from WHO and Aspen Medical International who were looking for doctors to help with trauma victims in Mosul, Iraq, following ISIS invasion. Two months later, I found myself there, with a group of expat and Iraqi doctors.

Immediately, I was able to put my new war surgery knowledge to practice - damage control and how to save lives and limbs.”

War wounds in Manchester

Two weeks after returning from Mosul, Moez was unexpectedly faced with war injuries in Manchester – blast wounds following the Manchester Arena bombings.

“The injuries I saw were very similar to what I’d seen in Iraq and had been teaching on the Foundation’s courses - blast injuries from shrapnel and metalwork. I was able to use what I’d learnt but now in my home country.

Although it was shocking and very stressful, things worked seamlessly in our hospital and the camaraderie, hard work and collaboration I saw across 7 or 8 local hospitals that received injured patients was unlike anything I had seen before. I truly saw the NHS at its best.”

Becoming a trainer

“After my return from Mosul, I was invited to join the Foundation’s orthopaedic faculty. Being part of the Foundation’s faculty for the past 5 years, teaching the skills I learned on that STAE course in 2017, is incredibly special.”

For the first time, Moez led the orthopaedic section of our recent course in Gaziantep.

Teaching on Gaziantep HEST

“Although I had been teaching on the STAE course in London for some time, the oversea HEST course required a slightly different approach. I needed to prepare and familiarise myself with the course material. Attending the Train the Trainers course which was put on by the Foundation really helped with this.

The 26 Syrian surgeons we trained shared incredible stories and the cases they faced during conflict with limited resources. Rather than teaching, I facilitated discussions around patient cases, learning from shared experiences and taking things back to fundamental principles. I learned just as much from the inspiring candidates as they learned from me!

This was also the first time that I had delivered an all-day comprehensive professional course in Arabic. It was extremely challenging considering I’ve only practiced medicine in English. However, the feedback and appreciation that I received from attendees is certainly one of the best achievements in my career.”

Leaving a legacy

Looking to the future, Moez wants to continue serving those in need in the UK and around the globe.

“I feel passionately about my humanitarian work and want to continue this in tandem with my NHS role, ideally doing one or two missions a year.

The NHS is such a huge organisation and has a vast resource of skills, knowledge and cultural experiences that can be tapped into. The world is incredibly connected. No matter how far away they may seem, conflict and disasters that happen in other countries continue to affect us directly or indirectly through human migration, security and the economy. We should be using our training and unique cultural experiences to help others around the world.”

Help us train more war doctors


How we rose to the challenge of COVID-19

The coronavirus impacted our ability to deliver the in-person training we are internationally known for. Despite this challenge, we found new and effective ways of supporting war doctors around the world. Here are a few of the things we got up to.

DigiHEST

In December 2020, we piloted our first ever Digital Hostile Environment Surgical Training (DigiHEST) course. We transformed an office space, generously provided by Whitby Wood, into an operating theatre and our friends at Redux Content decked the place out as a recording set.

Over the course of a weekend, David was joined by DNF faculty members Ammar Darwish, Rebekka Troller and Pete Mathew to present an ambitious programme of surgical training that was live streamed around the world. Modules covered included abdominal trauma, neurosurgery, maxillofacial surgery, ballistics and more. David was also joined by special guest lecturers Mounir Hakimi (orthopaedics) and Shehan Hettiaratchy (plastics) to form a world-class team of surgical specialists ready to reach out to surgeons in conflict zones and austere environments.

We were joined by up to 100 doctors from around 29 countries over the course the weekend, who were additionally able to pose their questions in real-time to the presenters and ask for advice on cases presenting to them in their localities.

Webinars

Throughout 2020 (and re-starting in 2021), we ran webinars for doctors in conflict zones. These webinars, led by David, saw doctors submit difficult or interesting cases and discuss together the best course of action for treating individual patients. David and our Faculty also delivered lectures during these sessions.

Creating a global network

Our webinars led to the creation of a thriving online community of surgeons, each able to send photos and submit descriptions of cases for the purpose of collaboration with other David Nott Foundation alumni around the world. This forum has been an incredible thing to witness - rapid surgical feedback and collaboration between doctors in conflict zones.

Despite rising to the challenge of coronavirus, we are delighted that our in-person surgical training has resumed.

Find out more about our courses


David operating in Ukraine

David reflects on his latest mission in Ukraine

Our Co-Founder David Nott recently travelled to Ukraine with UOSSM International, performing life-changing surgeries and offering guidance to doctors across the country. Here, David shares his reflections on what will remain a memorable and emotional mission.

My latest mission to Ukraine was an incredibly important one for me. I travelled everywhere, north, south, east and west.

I initially started in one hospital. When they knew what I could do, I was asked to go to more hospitals, and it started to snowball from there. I began by treating a number of old war injuries, people that had holes in their legs and arms, loss of shoulders and big fragmentation wounds.

It was clear that Ukrainian surgeons wanted support with plastic surgery. Many didn’t know how to rotate flaps, some had never seen one before. Many had never done war surgery at all. So, I spent my first week just operating and operating - doing all I could.

At one point, I had 14 or 15 people in an operating theatre all bent over watching what I was doing. It's a great way to teach - I stood back and told them where to make the incisions. They were delighted to learn.

I reconstructed a patient’s shoulder that had been blown off and other serious blast wounds. When I went back the next day to see one of the blast patients, they gave me a thank you plaque which was incredibly kind. They were desperate to have somebody show them what to do – someone there to help them.

I travelled all over the country to regions that have now been heavily bombed. I saw how refugees in Lviv are gathering in a railway station, and the fantastic work that NGOs are doing there. There are thousands of people, all being fed and sheltered with the help of outstanding charities.

Now having seen the devastation, it feels like the exact same tactics as in Syria. When I was in Aleppo in 2016, the whole region was completely and utterly destroyed. What we’re seeing in cities like Mariupol – the destruction - feels very similar to what I witnessed in Aleppo.

Teaching has carried on here in the UK. I taught a doctor called Oleksandr who contacted me when I was back home. He watched me repair a serious leg wound in Ukraine and had seen the condensed training videos we made for surgeons there, but Oleksandr was now the lead surgeon faced with a similar blast injury.

I guided him through his surgery remotely, as he took a flap of skin from behind the knee to repair and close the wound.

"I was quite nervous, but it went well thanks to David Nott. He showed us ordinary doctors how to fight on the medical frontline." - Oleksandr

Oleksandr and his colleagues are treating awful injuries that no-one should ever experience. But the injuries will keep coming, so it’s my hope that they will pass on what they’ve learned. By sharing my knowledge and 30 years of war surgery experience, a lasting legacy is created.

There’s a huge amount of work to do. I think surgeons and healthcare professionals in Ukraine will be faced with war wound reconstructions for many years. Plastic surgery will be incredibly important as the conflict continues – and far into the future too. The Foundation will do all we can to help doctors navigate this war and its aftermath.

Read David's story in the BBC


David Nott training

We translated our war surgery training into Ukrainian

In response to the Russian invasion of Ukraine, we turned our life-saving course into a condensed recording and translated it into Ukrainian. We now invite every Ukrainian surgeon to contact us to receive this life-saving war surgery resource.

When the crisis began, our Co-Founder David Nott worked around the clock to condense our surgical training course into a 6-hour recording, divided into 15 chapters and packed full of surgical experience from the frontline. Chapters include triage, neurosurgery, damage control, burns, cardiothoracic, orthopaedics, paediatrics, plastic surgery and anaesthesiology.

David Nott delivering surgical training online.

Taking the training one step further, we’ve translated every chapter into Ukrainian to ensure our life-saving resource reaches every single doctor in need, no matter their ability to understand English.

Contact us if you're in Ukraine

Our Co-Founder, David Nott, said: “After Russia invaded Ukraine, I knew I had to get there. I had to help. Thankfully, I was able to get into Ukraine, volunteering my surgical skills in multiple hospitals right across the country and sharing our training recordings with the doctors I met.

Although a powerful resource, it quickly became clear that many didn’t speak English well and I knew we needed to work hard to ensure our training was even more accessible.

We’ve worked around the clock with Absolute Translations to translate every single chapter into Ukrainian and are now on a mission to ensure every doctor in the country has access.”

If you are a Ukrainian healthcare professional or know of doctors in need of help, we are here for you. Email us at enquiries@davidnottfoundation.com for access to our translated resource.

Email us today

Many thanks to the team at Absolute Translations for their hard work and dedication. 


Elly Nott presenting certificates

Training in Somaliland with 'A Woman of Firsts'

In March 2022, we were honoured to train 34 healthcare workers in Hargeisa, Somaliland. Here, our CEO Elly Nott shares how this HEST course came to fruition and how it marks the beginning of a special relationship with a very special hospital. 

Over Christmas, I came across a book. ‘A Woman of Firsts’ is Edna Adan Ismail’s inspiring story of how she became a pioneering political and global health leader and campaigner for women’s rights. The respect and affection in which she is held in her home country, Somaliland, is truly remarkable and witnessed wherever one goes with her.

Building an empire

In 1998, she began building a hospital on an empty patch of land in the capital of Somaliland, Hargeisa. Through her will and determination, the foundations Edna established became a maternity hospital, which has since diversified into a major referral institution.

The Edna Adan Hospital treats obstetric, paediatric, surgical and medical cases from across the Horn of Africa. The Edna Adan University provides skilled healthcare workers to work in the hospital and other institutions in Somaliland, consistently occupying the top of the teaching league tables.

When I contacted Edna and asked if she would be interested in us running a HEST course at her hospital, she welcomed the idea straight away.

From the moment we arrived in Somaliland, we felt the warmth of Edna’s hospitality and all the inspirational healthcare workers who had travelled from across the country to participate in our training. Our outstanding faculty enjoyed sharing knowledge and techniques that would make a real difference to the participants’ management of traumatic injuries.

A need for well-trained surgeons

There is a real need for our partnership. A 2020 paper for the Lancet written by Dr Shukri Dahir et al, concluded that ‘the surgical system in Somaliland did not reach any of the target indicator goals as defined by LCoGS’ [Lancet Commission on Global Surgery]. The greatest need was for protection against catastrophic expenditure for low-income families on medical care and access to well-trained surgeons, anaesthetists and obstetricians.

The HEST course was just the start of our collaboration. In the coming months, we will welcome the doctors we met to the UK for our next Train the Trainers course. This time, they will teach alongside our UK-based faculty. We will also continue to work with the dedicated healthcare workers of Somaliland to support their training and ensure local people have access to safe, skilled surgical care.

By chance, our course coincided with International Women’s Day (IWD). A solid third of the participants in this HEST course were women and we were delighted to have the opportunity to contribute to their surgical careers. To spend IWD 2022 in the company of Edna, and the healthcare workers she has inspired and mentored, was truly an honour.

More on our HEST course in Somaliland