We rapidly delivered war surgery training to 573 doctors in Ukraine
In response to the Ukrainian crisis, our Co-Founder David Nott and Former Consultant Surgeon at St George’s Hospital Henry Marsh joined forces to deliver a 12-hour surgical training course to over 570 healthcare professionals on Saturday 5th March.
After the Russian invasion of Ukraine, David Nott rapidly developed a surgical training course for doctors who are working, or will work, to save lives in Ukraine as the devastation continues to unfold.
David condensed our 5-day surgical training course into a comprehensive 12-hour course online. To ensure healthcare professionals in Ukraine are best prepared for complex war injuries, the course included triage, damage control, burns, cardiothoracic, orthopaedic, paediatric, and plastic surgery sessions. Former Consultant Surgeon and pioneer of surgical advances in Ukraine, Henry Marsh, led the neurosurgery session of the course.
The attendees learned a range of skills that can be used when faced with limited resources, from learning how to create make-shift pelvic binders to knowing when to operate without a CT scanner.
Vadim Corjos, a General Surgeon from Ukraine based in the UK, said:
"(The David Nott Foundation surgical training course) in essence is the fullest and deepest course for surgeons who are in war zones. Providing this course for (Ukrainian) surgeons gives a very good base to save more lives in war and conflict areas. I have no words to appreciate this great effort. Thank you and God bless."
David Nott OBE FRCS, Consultant Surgeon at St Mary's Hospital and our Co-Founder, said:
“At the frontline of conflict zones are medical teams working tirelessly in often under-resourced and ill-equipped hospitals. Many have never experienced traumatic war injuries.
When the crisis unfolded in Ukraine, we knew we had to spring into action and condense my 25 years of war surgery experience on the frontline into a 12-hour course for those in need.”
Henry Marsh CBE FRCS, Former Consultant Neurosurgeon at St George’s Hospital, said:
“I hope and pray that my Ukrainian friends and colleagues will not need to apply all that they learn from the David Nott Foundation webinar.
But we must do what we can to prepare them for the possible horrors ahead as Russia continues with its evil and murderous invasion.”
Thanks to Nick Southwell and Terry Hancock for providing technical support and advice on this course.
Dr Rebekka Troller, from student to war doctor trainer
Dr Rebekka Troller, Colorectal Robotic Fellow and Emergency and General Surgery Consultant at Medway Hospital NHS, is one of our talented trainers. Here Dr Troller shares her journey into humanitarian work and her transition from student to teacher.
From student to teacher
I first met David at St Mary’s Hospital in 2019. I was the Trauma Fellow there and, in all honesty, – I didn’t know who David was! When people found out he was the Trauma Consultant I’d be working with they thought I was very lucky. I was quite embarrassed that I didn’t know him, but maybe it’s helped us have such a comfortable working relationship today.
When discussing my career, I told him that working with Médecins Sans Frontières (MSF) has been my life-long ambition and is the reason I started studying medicine. It was also the main reason for me leaving Switzerland and coming to the UK, where I could work and train internationally. David was really encouraging, giving me guidance on how to enter the humanitarian field. To gain an insight into the work, he asked me to attend the Foundation’s upcoming STAE course.
It was one of the best surgical training courses I had ever experienced.
After taking part in the STAE course, I registered to work with MSF in 2019 and David asked if I’d consider being a trainer for the Foundation, teaching trauma surgical skills to war doctors in need.
Transitioning from someone who had experienced the course first-hand, to teaching, was really exciting. Being faculty at the Foundation and teaching multiple courses was also a great preparation for my work at MSF. In particular it helped me gain valuable skills for a mission in Cameroon, where I worked for two months as the only surgeon in a remote conflict area. In this situation I was really glad to know the techniques we teach at the courses, and it was reassuring to know that I can reach out to all my friends and mentors at the Foundation for advice, at all times.
Ever since I was little, I always knew humanitarian work was what I wanted to do. Seeing someone like David do what he does is a real inspiration and motivation for me.
He has always told me – if you want something, just go for it – this has always stuck with me.
Teaching war doctors for the first time
My first mission with the Foundation was in Yemen in 2020. I was teaching the cardiothoracic part of the course, helping the doctors perform thoracotomies or cardiac repairs at speed. I also supported the doctors throughout the course, as they learned other fields such as vascular or abdominal surgery.
I was very excited to be a part of the course. It was a small team, but a big adventure. It can be tense during travel through checkpoints, as we were never sure if we’d get through, but the team and our MSF partners were fantastic.
Yemen is also such a beautiful country. The mountains, scenery and people are beautiful - some even became friends. On the course, the 30 participants were very eager to learn. Many came with a lot of experience, but everyone learned something new - a technique they could improve or a surgery they’d never performed before.
Leaving a lasting legacy
The course is so important because we bring the training to them. For many doctors in conflict zones, even getting access to emails can be difficult, so bringing a course to their doorstep is so valuable. We want to reach every doctor who might be in need of new skills. Our aim is to leave them with knowledge they can share with their own colleagues or other people in their hospitals.
In some cases, we travel to dangerous regions because we want to empower local surgeons with life-saving knowledge. From speaking to participants, I know that the work of the Foundation is very much appreciated.
One participant told me they can feel forgotten, but by showing up we are saying: “We see you. We are thinking of you. You are not alone.”
Stories that stay with us
Being a faculty trainer means I get to meet very special individuals. Many war doctors live busy lives, working in under-resourced hospitals 24/7. I met surgeons from Syria who were working 10 hours away from their families, risking their lives on a daily basis. Despite these sorts of circumstances, the doctors are often very cheerful. They are grateful for life, which is incredibly humbling.
Now that we’ve entered 2022, the Foundation has big plans for surgical training courses this year. I can’t wait to get back on the road with the team – doing what I love.
Another successful STAE course
This month, we were honoured to train 14 doctors from Afghanistan, Syria, Palestine and Ethiopia on our latest Surgical Training for Austere Environments (STAE) course. Over five days, the group participated in bespoke surgical workshops, specifically designed for treating traumatic – and often unique – injuries caused by war and catastrophe.
Starting the week off in Brighton and Sussex Medical School, the participants practiced an extensive range of cardiothoracic procedures, such as fast and efficient thoracotomies (gaining access to the chest), heart repairs and how best to manage injuries to the lungs.
Aided by videos taken by our Co-Founder, David Nott, during overseas missions, the group also learned how to repair blood vessels – a vital skill for managing severe blood loss.
Equipped for every emergency
As the week progressed, every doctor was exposed to a different but equally vital field of medicine, from plastic surgery to orthopaedic trauma. This is key, as we know war and catastrophe can present patients with often varied and complex injuries.
In conflict for example, it is not uncommon for junior doctors to be the only healthcare workers left in hospitals. This means they need to step into a number of roles, from cardiothoracic surgeon one day to paediatric specialist the next.
New obstetric simulators
On the last day of training, the participants completed a range of obstetrics workshops in the beautiful new facilities of the Royal College of Obstetricians and Gynaecologists in London. Using our new simulators (pictured below), the group refined their C-section techniques and learned how to address emergency scenarios, such as breech births or neonatal resuscitation.
Listening and learning
We were honoured to be joined by doctors from Palestine, Syria, Afghanistan and Ethiopia, and each country is recovering from - or still facing – conflict. To ensure we continue to deliver the highest quality training and meet the needs of our doctors, we listen to participants’ experiences of their home countries.
Dr Naseebah Nayef left Syria in 2013. She shared with us: “(During the war) I treated Syrian protestors in my private practice. Post-that, my house was bombed, and I had to flee with my three children from Syria. I am so very, very grateful for being a part of this course.”
Merry Christmas from our Chief Executive
The end of the year provides us with a moment to reflect on what has passed and think about the future. It has been a year of many challenges and difficulties, but I am so grateful for the incredible ongoing support we have been so honoured to receive from you all.
I have found joy this year in the time I have spent with the doctors we have had the privilege to train on our courses. Speaking with doctors from Mosul, Iraq, on our HEST in November and from Ethiopia, Palestine, Afghanistan and Syria on our latest STAE course; they provide such inspiration to us as a team.
Thanks to your generosity, we have a full programme of training planned for 2022 and cannot wait to get started. It is our ambition to run six Hostile Environment Surgical Training (HEST) courses and re-start our Obstetric and Neonatal Care specialist courses. We will have two more cohorts of scholars on our scholarship programme and continue to deepen and strengthen the relationships we have built with healthcare workers and partner organisations over the previous six years.
To our DNF community, we wish you a very Happy Christmas and New Year. We truly couldn’t do what we do without you.
Meet war doctor trainer, Dr Una Walsh
Dr Una Walsh, General Surgeon and Major Trauma Fellow at St Mary’s Hospital London, is the newest member of our faculty. Here, Dr Walsh shares her experience of our latest course in Iraq, where she was responsible for teaching abdominal and paediatric trauma.
Joining the Foundation
I first met Professor Nott in 2016, when I worked as his Registrar at Chelsea and Westminster Hospital. Since then, I am privileged to call him my mentor. It quickly became very clear to me that our thoughts were aligned on global health and inequalities, and I was keen to get involved and help in whatever way I could.
I was quite junior at the time - a 3rd year Registrar - but I knew if I continued my training, stuck with it and pushed hard, I could use the skills and operative knowledge I gained to join the Foundation and further their aims abroad.
This required a considered rethink on my career path and after discussion with Professor Nott and deanery tutors, I made the decision to switch training from breast to colorectal surgery and create a path towards emergency and trauma surgery. This also laid the groundwork for a humanitarian-focused career. I have since completed general surgery training, joined the Foundation’s faculty and currently work as a Major Trauma Fellow alongside Professor Nott at St Mary’s Hospital London.
A pull to help those in need
My first experience of humanitarian work was with Sir Magdi Yacoub’s charity, Chain of Hope, based at the Brompton in London. Through a chain of volunteer surgeons and medical doctors, Chain of Hope identifies children with congenital heart disease in urgent need of surgery not available in their own country and arranges transfer to centres in high-income countries that sponsor their surgery. They also have an active training programme, whereby teams fly out to operate or train local teams across the developing world. My role is to travel to low- and middle-income countries and provide aeromedical escort for children to sponsor centres for life saving heart surgery.
On behalf of the charity, I have retrieved children from Zambia, Haiti, Sierra Leone, and the Ivory Coast. This work is extremely rewarding working with a fantastic charity, plus I have a very lovely collage of pictures of the children I have helped, recovered after surgery. This work has also given me a wealth of experience in mission planning and the nuances of humanitarian work including navigating many and varied world airports with understandably terrified mothers and often babies in tow.
Whilst, heart-warming work it feels like a very small drop in the ocean - that's what drew me towards global health as an entity. The ability to help more than just single individuals.
At the David Nott Foundation, if you train one surgeon, the knowledge is shared with many more in local communities helping hundreds - that ethos resonates really strongly with me.
Cutting-edge teaching technologies
The latest HEST course in Erbil, Iraq, was my first course as a Faculty Trainer. It was a really lovely introduction to working with the Foundation. I led the abdominal and paediatric sections of the course. This involved both lectures and skills training.
All the training equipment, funded by our supporters, is superb. We were able to provide near-to-life simulated training through the use of purpose-made and anatomically correct tissue, including bowel arteries and veins, hearts, kidneys, windpipes and even skulls. The hearts and kidneys were my particular favourites, truly amazing and life-like.
Then Heston – the anatomical model! It’s just the cherry on top. You can demonstrate the exact movements you’d make in surgery. For example, how to mobilise the colon to get to the kidney, or more importantly the major vessels which can often represent the most challenging of traumatic injuries.
Heston also has little magnetic buttons that keep the organs in the correct anatomical positions, which allows you to simulate exactly how you would move and access body parts. It’s a tremendously clever part of his design.
Humbling stories
Most of the surgeons I trained came from Mosul, so many had experiences of the war to liberate their city from Islamic state (IS) invasion.
I admired so much the strength and courage they showed - and listening to their stories was humbling.
When Dr Troller (another faculty member) was teaching a procedure called a resuscitative thoracotomy, one of the surgeons commented during the war that they'd done ten - and only one survived. This could be down to the catastrophic injuries caused by war, making procedures like this even more challenging.
After completing the course, they were equipped with helpful strategies, giving them confidence that future outcomes will be different for patients. This is the real-world value of this innovative course.
They were a very talented, welcoming and hard-working group of individuals and I’m really looking forward to training many more like them.
We’re back where we belong
We are delighted to be back training doctors on the frontline. Our latest Hostile Environment Surgical Training (HEST) course in Erbil, Iraq, equipped 31 local healthcare professionals with skills that will serve their communities. Our Chief Executive, Elly Nott, shares her experience of the course.
Our latest course in Erbil was an incredibly humbling experience. Facilitated by our partners at Médecins Sans Frontiers-Belgium (MSF), we were able to train 31 Iraqi healthcare professionals in the surgical skills they need to manage any case they might encounter in an emergency or conflict situation.
During the course, our faculty used our cutting-edge anatomical model, Heston (pictured below), to teach a range of surgical techniques for treating traumatic injuries. Model hearts and synthetic skin helped them practice how to manage cardiac injuries and chest tube insertion. Virtual reality headsets also immersed our participants in emergency scenarios, putting their mass casualty triage and decision-making skills to the test.
A number of the participants were from Mosul, a beautiful and historic city that freed itself from the oppressive rule of Daesh in 2017. The resilience, courage and grace of the doctors was an inspiration to us all.
We are so grateful for your support of our mission. Every donation helps us deliver world-class surgical training that saves and improves the lives of those most in need.
Training of Trainers: Future-proofing the Foundation
Last weekend, the David Nott Foundation invited 24 leading surgeons to London to attend a Training of Trainers course. The aim of the course was to introduce each surgeon to the HEST Course, with the hope that many will want to travel to conflict zones with the Foundation to teach it.
The Foundation receives many requests to run HEST courses, in so many locations affected by war. By expanding our faculty, we can reach more of these places in a timely manner.
The 3-day course was held at the iconic Wellcome Collection, a monument to the health sciences in Central London. Our extant faculty, led by David Nott, took participants through the different modules that comprise the HEST course. By the end of the weekend, participants felt ready to teach the course overseas. One participant said:
"David and colleagues have lots of experience and I am in awe of what they have been able to achieve. The practical tips in management of patients in humanitarian settings are equally valuable for trainees and established consultants in this country. "
Interspersed with surgical modules was discussion of the practicalities of attending humanitarian missions:
" I found the session delivered by Mr Hakimi on the practicalities of what to expect when travelling and working in countries where HEST is being delivered to be excellent and insightful."
We were additionally delighted to welcome students from the Friends of the David Nott Foundation Societies to the course. Delegates from Manchester, Leicester and Queen's University Belfast came to get a taste of their future humanitarian careers.
Training the Trainers has allowed us to invigorate the Foundation with new and enthusiastic teaching faculty. The DNF is poised to return to in-country HEST courses future-proofed and with more courses than ever.
British Contemporary Artist's Exclusive Offer to Our Supporters
Nadia Day is a contemporary British artist based in Richmond, UK. She paints Impressionist views of nature, both local and further afield through seascapes and commissions.
“I use a brisk technique of flat brushstrokes and pallet knife work, ensuring my paintings reflect the energy and beauty of nature at their core. I love painting a big fresh sky - this is always my starting point”
After reading War Doctor she felt so moved by David’s story that she contacted us to pledge her support and donate four original paintings. Nadia’s work has been selected for national exhibitions including the Battersea Affordable Art Fair. She studied art at Kingston University and gained a BA in Drama & Theatre Arts from Birmingham University. Here is what she had to say about the collaborating with the David Nott Foundation:
“I was profoundly moved reading War Doctor. David Nott was continually taking himself away from his safe set up in the UK, to risk his life to help others. I felt compelled to do something, but helpless - my artistic skills are a world away from the medical practise, so how could they be applied?
I remember seeing Quentin Blake’s illustrations brightening up the walls of Great Ormond Street Hospital, where we often visit with my son Jasper, and the art offers a cheery brightness at a time of need.
My aim was to create pieces which inspire positive feelings of calm and contemplation. The landscape needed to be non-descript but to suggest change and travel – themes residents fleeing war torn countries must often face. I wanted to touch on the base human feelings of courage and hope, feelings required in difficult situations.
I carefully chose names to conjure up the emotions they represented to me; there is Solace, Reflection, Legacy and New Beginnings.
If you bought one of these pieces, the message is clear, you are paying for a doctor to be trained and I personally thank you so much.
Solace
Reflection
New Beginnings
Legacy
Operating and Teaching in Yemen: an Interview with David Nott
In April, David travelled to Yemen with Ammar Darwish, Mounir Hakimi and Asan Raffee to deliver both teaching and hands-on surgery in the World's worst humanitarian crisis. Below is a short interview that we conducted with him on his return.
How did this trip come together?
It came about with a telephone call from Syria Relief. Mounir Hakimi (of Syria Relief) had been in contact with several of the doctors who had been working in Marib. They were operating on a large amount of cases and they wanted help. Some of the surgeons who were there had difficult wounds or injuries presenting, and they wanted advice and teaching on how to cope with those injuries. That was how we heard about it.
The Syria Relief - DNF Team break their fast in Marib.
What did you see of the city of Marib?
It was pitch black at night when we arrived. We landed in Seiyun and it was a 6 or 7 hour drive to Marib. We arrived very early in the morning and went to a hotel local to the hospital. A few hours later, in the morning, we went to the hospital and were very much welcomed by the medical team working there.
What was the hospital like?
We had a very nice tour around. The Medical Director was extremely enthusiastic in showing us exactly what they had been able to continue to do. They had a very good blood transfusion bank, they had very good blood chemical laboratories. They had an intensive care unit, they had well-stocked theatres and they had a good array of back-up support. There were a lot of nurses on the wards.
At the time, Marib was becoming the epicentre of the civil war. Could you see that that hospital and its staff had been affected by escalating conflict within and around the City?
Yes. It was the epicentre. And it still is. The fighting is intense. Probably about 15km north of Marib. At the moment, Marib has about two million refugees and it is very densely populated. The fighting is continuing and obviously the hospital that we were in was the frontline hospital to accept all those casualties that were wounded. Both civilian and non-civilian.
We heard jets going over the top and we also heard rockets coming into Marib. You were aware that you were in a very hot war zone.
Who did you meet at the hospital?
Some were senior doctors. Some had just come in the last couple of months from Egypt to help out. There were quite junior doctors. There were those that required quite a lot of teaching and understanding of how to manage injuries. The hospital had stopped almost all of its elective surgeries. They were focusing purely on the war-wounded patients. Unfortunately those patients that had cancer problems weren’t really dealt with at this time.
Which case stands out the most in your memory?
I think the case that stood out most was after the teaching we gave the night before on gunshot wounds to the chest and abdomen. The surgeons had never done a thoracotomy before for a gunshot wound to the chest. The following night we were called back to the hospital with a surgeon who had watched our lecture and we found there was a patient who needed a thoracotomy. Because we were there, we were able to show him exactly how to do it and exactly how to extend this incision onto the abdomen and do a thoracoabdominal procedure. The patient did extremely well and thanked us a couple of days later.
We discussed a lot of reconstructive work. Most of the flaps that we discuss on our HEST course, we did in Marib. There was a lot of surgery done with a view to the surgeons being able to do that kind of surgery when we left.
Going forward, what do you think the Foundation's work in Yemen is going to look like?
I think that we will be going back to Marib, and I think we will continue to go back and support them both with teaching the DNF HEST course and perhaps this time taking our models with us as well so that we can run a course during the day or the evening and then operate as well. I think the future of the DNF is operating as well as hands-on teaching as well as the classroom for some courses. The future lies both within the operating theatre and the classroom.
I think we had developed a significant rapport with the doctors such that I heard recently that they desperately want us to go back again to show them more and more. I think that is the perfect opportunity for the DNF to show what it is worth really.
This mission epitomised what the DNF is all about. The DNF goes out to the field, it saves lots of lives as well as teaching the doctors so that they can continue to save lives. The DNF leaves a legacy.
You can read Ammar Darwish's story of the mission here.