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.

Help us train more doctors


"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


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