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
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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/
Scholarship to help Nepalese student reach more people following earthquake disaster
A postgraduate student who has treated more than 25,000 people cut off from healthcare following an earthquake has received a prestigious scholarship to further his work.
Dr Aban Gautam, who is originally from Nepal and currently studying for a masters in clinical research (MClinRes) at the University of Plymouth, was selected to receive the David Nott Foundation scholarship.
Literally a Life Saver
Nott is a remarkable consultant surgeon who regularly leaves his day job at three London NHS hospitals to provide emergency surgical treatment in war zones. It bgan when he was moved by the siege of Sarajevo in the 1990s, and he has since treated victims of conflict in places such as Sierra Leone, Afghanistan, Iraq and Syria.
Skype Blog: The first ever known surgery over Skype with Dr. David Nott
Skype was developed in 2003 to help people stay together, no matter where in the world they happen to be. Since launch, we’ve discovered many weird, wonderful and original ways that people use video calling. From pet sitting to interior design. From working out to personal stylist advice—people really do use Skype in the most creative ways.
Recently, we came across the The David Nott Foundation, a UK-based charity which gives surgeons and medical professionals the skills they need to provide relief and assistance in conflict and natural disaster zones around the world.
Founded by Dr. David Nott and his wife Elly, The David Nott Foundation’s main focus is to improve the standards and practice of humanitarian surgery in conflict and catastrophe areas around the world. Both are passionate about helping those less fortunate than themselves and their efforts in treating victims in areas of catastrophe goes from strength to strength. We caught up with Dr. Nott, “the Indiana Jones of Surgery”, and found out how Skype features in their mission to help surgeons develop their skills for warzones—and how he and his wife started volunteering their time:
“I started in Sarajevo in 1993. I watched a film called The Killing Fields with my Dad and I had a fascination about different places and helping people. The film was about a friendship between a journalist and a local interpreter in Cambodia during the civil war but essentially about people helping each other. And then something sparked in my head, that I’d like to do something like that myself. When I became a consultant, the first thing I did was to volunteer my services to Médecins Sans Frontières in Sarajevo. I should have only stayed for a couple of weeks but I ended up staying for three months.”
Dr. Nott tells us how technology and Skype came into the picture. “In 2007, I believe I was the first person ever to receive details of how to perform surgery via text messages in the Congo. This was when a friend of mine texted me the procedure of how to take off somebody’s shoulder and arm. This was in the Congo, in the middle of a jungle, without any help or anything!”
And then after surgery by text message, came the first ever known surgery performed over a Skype video call.
Surgeons in Aleppo sent me a picture of a man whose jaw had been blown off by a fragment in a bomb blast. They asked me what they thought they could do. I took the pictures around to several of my colleagues to get their opinions on what they thought was the right thing to do to fix it. The doctors in Aleppo had never done this sort of operation; they’d never mobilized a myocutaneous flap (which is a muscle and tissue flap that rotates into the neck). They’d never mobilized a muscle before either, so that’s where Skype came in. They had a phone attached to a selfie stick so I could view everything. The operation started at about 8 in the morning and went on until 4 in the afternoon. It was very complicated but it worked 100%. Using Skype was fantastic because it allowed me to see what they were doing in real time. I was telling them which bit to cut, which bit not to cut—I directed them all the way through, from the moment they picked up the knife to the moment they put in the stitches.”
Read the full article here.
Philanthropy Age: ‘You carry on because you’re saving somebody else’s life’
British surgeon David Nott has spent two decades operating on thousands of people in war zones, making life and death decisions under fire. Now he hopes to pass his hard-earned skills on to a small army of frontline volunteers
There’s a simple reason why I keep going back: I feel sorry for those who are caught up in conflict. Everyone needs access to healthcare, and I try to be the person to provide it. I first volunteered in the besieged city of Sarajevo, Bosnia, in 1993 after seeing TV coverage of the conflict. What happened to me there changed my life. I’ve worked in conflict and catastrophe zones ever since: from Liberia and Darfur, to Haiti, Syria and Yemen.
In places wracked by war or natural disaster, there are few surgical provisions. There are limited blood supplies, few drugs and no diagnostic aids to speak of, so you rely on your medical skill. Yet, in war, most of the senior surgeons will have fled and it is the junior medics who are left behind. They may know basic surgical techniques, but they are faced with the most difficult wounds imaginable, from gunshots, snipers, IEDs and mines.
I take part in up to three missions a year with organisations such as Syria Relief, Médecins Sans Frontières (MSF) and the International Committee of the Red Cross (ICRC). I go for three weeks at most if it is a really hot war zone; six weeks if the frontline is further away. If there are no casualties from the night before, my day starts around 7am, with a security briefing at 7.30am. I take an hour to visit patients and from 9am there are either new patients to see in the clinic or, if there are casualties in the emergency room, I begin operating. I can be doing that all day and sometimes all night. At my longest stretch, I operated for 22 hours. You forget the time, although you’re absolutely worn out. You carry on because you’re saving somebody else’s life – and then somebody else and somebody else. You sleep where and when you can.
In quieter periods, I teach. In Syria, for example, there are lots of junior surgeons who are not particularly well trained. They accompany me in the operating room and we do the surgery together. I show them first, and then they pick up the knife, scissors and forceps. Speed and accuracy are very important. I teach techniques to limit blood loss, and quick procedures. You get very engrossed in surgery – even though you are in a war zone, your mind is utterly focused on the job at hand.
Read the full article here.
Press Release: The Rt. Hon. the Baroness D’Souza CMG to be Chairman of the Trustees of The David Nott Foundation
London, 10 October 2016: The David Nott Foundation is honoured to announce that The Rt. Hon. the Baroness D’Souza CMG has agreed to become Chairman of the Foundation’s Board of Trustees.
Baroness D’Souza said: ‘The anguish we all feel about the plight of those caught in war zones is in part eased by knowing that the David Nott Foundation is there to carry out its pioneering work. Long may it continue.’
Baroness D’Souza was elected by Lords members as the second Lord Speaker on 18 July 2011 and took office on 1 September 2011, serving until the conclusion of her term in August 2016. As Lord Speaker she attended and spoke at ceremonial occasions on behalf of the House of Lords and met visiting dignitaries and heads of state.
David Nott commented: ‘From the start, Baroness D’Souza has been an invaluable source of encouragement and guidance to our Foundation. She has provided the most wonderful support to Elly and I for which we are so grateful and we are just so thrilled that she has agreed to be Chairman of the Trustees. We are growing so rapidly in our activities and she will bring vitally important experience, energy and drive to the Board as we expand and further professionalise our operations.’
Baroness D’Souza becomes Chairman of the Trustees at an exciting time for the Foundation as it expands its activities and programmes. The past six months have seen a huge increase in demand for the training the Foundation provides under David’s leadership. Activities have included:
- The inaugural David Nott Foundation Hostile Environment Surgical Training (HEST) course, held in Gaziantep, Turkey, in April.32 Syrian surgeons travelled from Homs, Hama, Idlib and Aleppo to attend.
- The second HEST course was held in Aden, Yemen, at the invitation of MédecinsSans Frontières in July and trained 43 local surgeons.
- 2016 will see two further HEST courses; in Gaziantep again for Syrian surgeons and in Gaza in December at the invitation of the International Committee of the Red Cross.
- Our first three David Nott Foundation scholars were trained by David on the course he directs at the Royal College of Surgeons of England, Surgical Training for the Austere Environment (STAE), in July.We trained two Libyan surgeons and one Syrian.
- The Foundation is in discussions to develop a state of the art simulation model which will be a teaching aid on the HEST course.
- The Foundation is in talks with technology developers to design an app that will serve as a resource for doctors and also a way for the community of humanitarian surgeons trained by David Nott to share experiences and advice.
- In September, David Nott directed a life-saving operation to a team of 6 surgeons in Aleppo using Skype and What’s App; the first known incidence of the technology being used in this way.
- The Foundation, led by David Nott, has spoken out passionately and frequently against the targeting of medical facilities and civilians in Syria’s civil war and advocated for humanitarian access to besieged and heavily-bombed areas.
ENDS.
Notes to editors
For further information contact Suvi Dogra: [email protected] or +44(0)7920 135796.
About The Rt Hon The Baroness D’Souza CMG
Baroness D’Souza was elected by Lords members as the second Lord Speaker on 18 July 2011 and took office on 1 September 2011, serving until the conclusion of her term in August 2016. She was appointed Chairman of the Trustees of the David Nott Foundation in September 2016. She succeeded Baroness Hayman, the first elected Lord Speaker. She took her place on the Woolsack to oversee work in the Lords chamber on 5 September 2011. She entered the House of Lords in 2004.
Political career
Before taking up the post of Lord Speaker, Baroness D’Souza was Convenor of the Crossbench Peers (2007-11). As Convenor, Baroness D’Souza was a member of the following committees: Administration and Works Committee, Liaison Committee, Privileges and Conduct Committee, Selection Committee, Procedure Committee and House Committee. She was also previously a member of European Union Sub-Committee F.
Human rights and development work
Baroness D’Souza has a special interest in human rights and development issues. She was a director and consultant for the REDRESS Trust (director 2003-04, consultant 2004-06), executive director of Article 19 (1989-98) and trustee at a range of human rights and development organisations. In her previous career, Baroness D’Souza lived and worked in southern Europe, Africa, Asia and Oceania.
Research work
Baroness D’Souza was director of an independent research group focusing on development and emergency aid and has researched the economic origins and alleviation of famine.
She was an independent research consultant for the UN from 1985 to 1988. She also worked for the Nuffield Institute of Comparative Medicine (1973-77) and Oxford Brookes University (1977-80).
Academic background
Baroness D’Souza studied Anthropology at University College London. After graduating in 1970, she studied for her Doctor of Philosophy at Lady Margaret Hall, University of Oxford. She taught anthropology at both the London School of Economics (1973-80) and Oxford Brookes University (1977-80)
About David Nott OBE FRCS
David has been a Consultant Surgeon at Chelsea and Westminster Hospital for 23 years where he specialises in general surgery. David also performs vascular and trauma surgery at St Mary’s Hospital and cancer surgery at the Royal Marsden Hospital.
For the past twenty three years David has taken unpaid leave each year to work for the aid agencies Médecins Sans Frontières, the International Committee of the Red Cross and Syria Relief. He has provided surgical treatment to the victims of conflict and catastrophe in Bosnia, Afghanistan, Sierra Leone, Liberia, Ivory Coast, Chad, Darfur, Yemen, the Democratic Republic of Congo, Haiti, Iraq, Pakistan, Libya, Syria, Central African Republic, Gaza and Nepal.
As well as treating victims of conflict and catastrophe and raising hundreds of thousands of pounds for charitable causes, David teaches advanced surgical skills to local medics and surgeons when he is abroad. In London, he teaches the Surgical Training for the Austere Environment (STAE) course at the Royal College of Surgeons of England.
In 2015 David established the David Nott Foundation with his wife Elly. The Foundation supports surgeons in developing their operating skills for warzones and austere environments.
About The David Nott Foundation
The David Nott Foundation is a UK registered charity which provides surgeons and medical professionals with the skills they need to provide relief and assistance in conflict and natural disaster zones around the world. As well as providing the best medical care, David Nott Foundation surgeons train local healthcare professionals; leaving a legacy of education and improved health outcomes.
Founded and led by renowned British surgeon David Nott, the Foundation benefits from his passion for advancing the best in surgical research, practice and teaching as well as his commitment to helping vulnerable people in some of the most dangerous and disadvantaged places in the world.
The Times: Surgeons save Syrian lives by Skype
The messages arrive at all hours of the day and night, the vibration of a mobile phone signalling that another life hangs by a thread in Aleppo.
For the renowned British trauma surgeon David Nott and other doctors in London, Seattle, Washington and West Virginia, the Russian-backed onslaught on the city has been a daily reality.
They are a loose network of doctors who provide real-time medical support, often via WhatsApp and Skype internet services, to the desperately overstretched and sometimes dangerously inexperienced medical staff in the besieged areas of Syria.
Read the full story here.
BBC Newsnight: The doctors ‘breaking the siege’ in Aleppo via Skype
The battle over Aleppo has been raging for more than five years – with the Syria city under siege for much of this time.
The medical and humanitarian situation is desperate.
Two years ago, British doctor David Nott got into Aleppo to help train doctors there. Now he’s helping to get round the siege by directing life-saving operations via Skype. He spoke to BBC Newsnight.
Watch the full report here.