Expanding our global network of surgical trainers
Last month, we were delighted to hold our annual Train the Trainers course, giving 29 doctors from around the world the skills they need to become David Nott Foundation Trainers within their home countries and better serve their communities.
Our goal is to create a model of sustainability in conflicted countries by helping doctors strengthen their own healthcare systems. It was this thinking that led us to develop our Train the Trainers course. What if we could upskill doctors in conflict zones around the world to become skilled surgical trainers themselves, helping them to train their own peers, strengthen their own healthcare systems and support their own communities?
This November, we brought previous HEST course participants together - from regions such as Somaliland, Ethiopia, South Sudan, Syria and Palestine - to solidify their trauma surgery knowledge, while assessing and strengthening their teaching skills.
Dr Mariam Aweidah, a long-standing friend of the Foundation and participant from Palestine, said: “Being part of the David Nott Foundation family, and helping it to grow, is a privilege.”
For the first time we invited anaesthetists to the course, as part of our mission to upskill additional surgical team members in conflict zones, not just surgeons. Each participant learned how best to approach a wide range of traumatic injuries seen in war and disaster, and how to efficiently triage mass casualties.
During the triage lecture, David shared: “Showing footage of mass casualties and the chaos that can result in hospitals without proper planning and roles makes this module particularly shocking.
But it’s deliberate – it stays with you. At this point, I ask each of you, what will you do now that you’ve seen this?”
The group replied together, “make a mass casualty plan.”
Elly Nott, CEO and Co-Founder of the David Nott Foundation, said:
“It was a privilege to host 29 surgeons from across the UK, Europe, Middle East and Africa at the Wellcome Collection for our 2022 Train the Trainers course.
Train the Trainers aims to expand our number of teaching faculty, enabling us to undertake more training courses and reach more areas in need.
Russia’s brutal invasion of Ukraine this year shocked us all, but the diverse backgrounds of our delegates remind us that dozens of conflicts demanding our attention continue to simmer worldwide. Our mission is to equip the doctors treating those affected by these conflicts with the best surgical training available, enabling them to better treat the complex injuries inflicted by war.
Initiatives like TTT demonstrate our commitment to making our training truly sustainable by empowering local surgeons with the knowledge to teach our courses. As ever, we are motivated by our belief that well-trained doctors save more lives.”
Help us train more war doctors
Training anaesthetists in war zones
Dr Elma Wong is a consultant anaesthetist in Worcestershire Acute Hospitals NHS Trust. For the past ten years, Elma has taken several months of unpaid leave to volunteer in conflict zones each year. Elma and a small team of faculty recently returned from training 71 doctors in the Ukrainian cities of Poltava and Zhytomyr. Here, she reflects on her experience after delivering our first-ever anaesthetics HEST course module alongside Dr Rachael Craven.
After a decade of volunteering in war zones, Elma knows all too well how important education is. When she heard we were looking to deepen our impact by upskilling anaesthetists in conflict zones, Elma jumped at the chance to get involved.
“I’m interested in building up local workforces, making communities in conflict more sustainable. It’s about the longevity of the impact you want to have in a place.
The biggest gift you can give to a healthcare worker in a conflict zone is self-sufficiency – the dignity to be able to do everything themselves. It’s important to empower people to look after their own patients. A job well done is ultimately making yourself redundant.”
Training anaesthetists in war zones
“I first heard of the Foundation after reading War Doctor. As a fellow humanitarian, I could relate to David’s experiences. When I heard the Foundation wanted to develop an anaesthetics training module, it felt like a great fit for me.”
In October, Elma, David and a small team of trainers travelled to Poltava and Zhytomyr to deliver two HEST courses – Elma’s first time in Ukraine since the war began.
The team flew to Warsaw and with the support of our partner, UOSSM International, crossed the border before driving for most of the day to eastern Ukraine.
“During our first course in Poltava, there was a lot of unknown. We designed the module ourselves but didn’t know exactly who we’d be training or how it would be received.
In the end, we trained around 10 anaesthetists in Poltava and 12 in Zhytomyr and it was wonderful - I think they found it refreshing to have dedicated trauma training with practical advice. They were really excited to handle different kit and learn new techniques.”
Adapting in conflict
When it comes to war anaesthetics, there are two main considerations. Firstly, the injuries anaesthetists face in war are starkly different to cases seen in the west.
“Blast injuries from explosives are devastating to the body. Patients can have multiple life-threatening injuries and lose so much blood. The priority is stabilising the situation and giving blood.
We taught specific techniques for giving drugs and blood via the bone (intra-osseous), for when you can’t find a blood vessel. Many had not used this life-saving equipment and really benefited from learning this skill.
Many of these cases would need care on the intensive care unit - supporting patients with complicated head and lung injuries on our breathing machines and giving dialysis therapy to people with kidney failure as a result of crushing injuries.”
The other consideration in a war setting is reduced resources. Hospitals may be faced with electricity cuts or low oxygen supplies.
“We trained the groups on alternative anaesthesia machines - very different to ones we use in our hospitals here. They are portable enough to fit into a bag or small case and they can be life-saving in critical conditions - when you don’t have electricity or oxygen yet need to perform emergency operations.”
Teaching the group how to use basic machinery, available in most hospitals, will help them continue to save lives despite slashed resources.
“The rest of the world hasn’t forgotten you”
“Often, I think when you are stuck and living within conflicts, you feel the rest of the world has forgotten you.
But seeing people travel far distances to come and help, standing in solidarity with them, I hope shows them some humanity."
Contemplation on safe ground
“It can be challenging dealing with the trauma of what you experience on missions. Often its worse when you get back home and have time to process things, devastating things you’ve seen.
The more missions I’ve done, the more I realise the importance of looking after yourself. Finding time to have breaks, even on busy missions. In Yemen, we were working and living in the hospital. Each day around 5pm I would try and go to the roof for 10 minutes to take in some fresh air, watch the sunset, whilst listening to the atmospheric call for prayer from the nearby mosques. It was time just for me.
The important thing is to be kind to yourself - and ask for help when you need it.
When reflecting on my time in Ukraine, it’s difficult to know quite how to describe how I feel. ‘Privileged’ comes to mind – for being able to work hand in hand with people on the ground and support them as best I can.”
More on our training in Ukraine
Photographer: Annabel Moeller
Trekking to Everest's viewpoint in Lucy’s memory
We were recently contacted by Dominic Cahillane, the beloved brother of Lucy who sadly passed away on the 12th of March. Dominic, additional family members and friends of Lucy’s came together to raise funds in her memory. We were honoured when Lucy’s loved ones told us they were trekking to Mount Everest's viewpoint and raising funds for us, a mission that was close to Lucy's heart.
Dominic, Lucy’s brother, shared:
“On March 12th of this year, my amazing sister Lucy Cahillane left this life for what we can only hope is a serene and fitting higher plane, where her energy can be used for the betterment of those in need, both past and present.
Lucy gave herself tirelessly to the needs of others, always there to listen, to shoulder a burden, offer advice, and make you feel safe in the toughest of periods. Her focus was that the people she came across in her life should always feel loved and have an optimism for the future, the painful juxtaposition being that she was eventually unable to do this for herself.
In her memory, and on behalf of the David Nott Foundation, a charity that was close to Lucy's heart, my partner Radka Nemcova and friend Katerina Tumova (pictured above) took on a 5-day return hike in the Himalayas from Lukla to Everest Viewpoint above Namche Bazaar.
I hope you can join them in this feat to donate to those who look to make even the slightest of difference in an increasingly marginalised and difficult world where those in need are rarely heard.
‘Three passions, simple but overwhelmingly strong, have governed my life: the longing for love, the search for knowledge, and unbearable pity for the suffering of mankind.’ - Bertrand Russell
Miss you sis, love Dom xxx”
We are incredibly honoured to receive donations in Lucy’s memory, with £2,300 raised so far. If you’d like to donate, please visit the family’s JustGiving page.
Over 160 Ukrainian doctors now trained to treat war wounds
David Nott and Faculty Trainers Dr Pete Mathew and Dr Ammar Darwish recently returned from delivering two back-to-back surgical HEST courses in Odessa, Ukraine. The team upskilled 74 doctors in a city battered by targeted missiles and heavy shelling.
Standing in solidarity
Continuing our mission of standing shoulder to shoulder with Ukrainian healthcare professionals, David, Dr Ammar Darwish and Dr Pete Mathew returned to Ukraine in August with UOSSM International, this time running two of our surgical training courses in the southern city of Odessa.
Over an exhausting six days, the team delivered a condensed version of our HEST course to 74 healthcare professionals, taking the number of Ukrainians who have received our training this year up to 160.
We deliver our training to those in need of our help, no matter their experience or seniority. During the two courses, the team trained junior doctors, senior consultants, anaesthetists and Ukrainian army officers.
From burr holes to skin grafts
To prepare the group for any trauma injury, our trainers used cutting-edge teaching tools to illustrate a range of techniques such as how to pin and stabilise the pelvis, drill burr holes to relieve cranial pressure, repair heart tears, prepare healthy skin grafts for burn injuries, or how to insert and stitch emergency chest tubes using our prosthetic skin pads (pictured below).
Speaking exclusively to The Telegraph, David said: “I was fairly sure it (the war) would go the same way as Aleppo in Syria. I knew we would see a lot of blast injuries, such as lung trauma, shrapnel wounds and burns."
David was right. Speaking to frontline doctors in Odessa, they are seeing multi-organ injuries for the very first time, such as penetrating damage to the heart and lungs, caused by flying shards of metal. The confidence and skills learned on our courses better prepare doctors for war injuries like these, not commonly presented in standard medical training.
We are incredibly proud of David and our Teaching Faculty as they continue to upskill and support healthcare professionals in Ukraine. "If I was a pessimist, I’d never be able to do what I do”, says David. “You can always make things better for people.”
David's story in The Telegraph
Inspiring the next generation of war doctors
On Friday 21st October, David and a key member of our Training Faculty, Dr Ammar Darwish, met over 100 sixth form students at Whalley Range School in Manchester. The pair shared their experiences as frontline doctors and some of our cutting-edge teaching equipment, such as our war wound model Heston, 3D printed hearts and model blood vessels.
Earlier this year, we received a letter from Waad Fellag, a sixth form student who dreams of becoming a doctor. After reading our Co-Founder’s book, War Doctor, Waad shared: “David Nott showed me the impact he and his team have had on families, especially children. I grew to understand that the simplest and slightest words or actions make a real difference in a person’s life.
Waad asked if we would visit her school to meet the “many bright minds who are passionate about become doctors”, some of which have lived in war-torn countries such as Syria, Libya and Afghanistan.
“A medical degree gives you a passport”
Speaking to over 100 female students, David shared stories from 31 surgical missions and his time treating the wounded following two natural disasters. His first humanitarian mission to Sarajevo in 1993 will always stay with him.
Students listened intently as he reflected on operating in a makeshift hospital, nicknamed ‘The Swiss Cheese’ due to gaping holes in the walls caused by bomb blasts and artillery. Steam escaped the edges his mask as he operated in the freezing cold with no electricity.
David shared: “A Lancet article revealed that 17 million people die every year due to conditions that require surgical treatment. It’s a wonderful thing to have the skills, hands and brain to make people in need better again. A medical degree gives you a passport to help people anywhere in the world.”
Future leaders
Elly Nott, our CEO and Co-Founder, said: “David receives dozens of invitations to speak each year, but Waad’s message, with her desire to inspire her fellow students to become humanitarian doctors, struck a chord with us. Encouraging the next generation of humanitarian doctors, in particular those attending state schools and young women, is an important and valued arm of our work.
I was also pleased to share with students that there are many different ways to lead a humanitarian life. Your contribution may not be medical but is just as valued no matters its form, be that legal, administrative, operational or diplomatic. It was an incredibly uplifting and inspiring afternoon for our team.”
After David’s stories, Faculty Trainer, Dr Ammar Darwish, talked the group through our one-of-a-kind war wound model, Heston. Students gasped as he used Heston to illustrate the damage caused by penetrating head injuries, the benefits of using skin flaps to encourage wound healing, and how to stop severe bleeding in the heart and lungs.
Scrubbed Up
Dr Darwish was followed by Scrubbed Up, an outstanding student-led organisation that supports prospective and current medical students, offering guidance on every career step from university applications to exam preparations.
Miss Toyin Bakare, Assistant Head Teacher at Whalley Range School, said: “We are grateful to David Nott, Scrubbed Up and the team for going above and beyond the request made by one of our incredible students, Waad, to visit our school.
It was a demonstration of the power of the written word, which can sow seeds, nurture ideas, and empower others to make a meaningful impact in their spheres of influence.”
What can you do?
We were in awe of each and every student’s enthusiasm, vibrancy and determination to make a difference in the world in their own way. In Waad’s words, “I ask you all – what can you do to help those who need us the most?”
Running London's streets for war doctors
We have been overwhelmed by the determination and generosity of our supporters this running season. Here, we reflect on the achievements and stories of some of our runners in this year’s London Marathon and Royal Parks Half Marathon.
Beth Needham (pictured above), a fourth-year medical student at the University of Liverpool, ran this year’s London Marathon in our name and has raised almost £1000. Beth dreams of becoming an army doctor and was so inspired by David’s story that she decided to get involved in the Friends of David Nott Foundation (FDNF) Society at her University, raising awareness of our mission and vital funds for our surgical training.
“David is such a massive inspiration to me. I’m over the moon to raise some money for the charity he set up.”
“Worth every painful second”
Reflecting on her marathon experience, Beth shared: “It was so, so difficult, but worth every painful second. I was absolutely overwhelmed by the support and encouragement we received on the day and, even though it was one of the hardest things I’ve ever done, I’ve already entered next year’s ballot!
The sheer amount of love, teamwork and pride made for a very emotional finish! I’ll now be wearing my medal for the foreseeable.”
Crossing the finish line together
This weekend, eight supporters ran the Royal Parks Half Marathon with our name on their shirts, raising a fantastic £3000 for our mission. Our Faculty Trainer Dr Ammar Darwish took on the race with his son Mohammad. It was not an easy task for the pair, but Mohammad’s determination pushed them to the finish line.
Dr Darwish shared: “Not sure how, but I just completed the Royal Parks Half Marathon! Having my son Mohammad run next to me constantly calling “come on!” is what no doubt got me through.”
A race to be proud of
Fi Nicholson ran the Royal Parks Half Marathon in an impressive 1 hour 50 minutes – the fastest finishing time of all of our runners this year. Fi has raised an outstanding £1000, which will help us train more doctors serving devastated communities in conflict zones.
“David Nott, to be honest, is an inspiration. I know each penny will go directly to training of surgeons in war-torn areas. If only his work wasn’t needed. I got a shout out from the David Nott Foundation at Westminster. Every shout was a boost," shared Fi.
"Thank you (to all) for the support and friendship, and to the David Nott Foundation for what you do.”
If you’re raising funds for us or would like to share your story, we’d love to hear from you.
Our surgical webinars for frontline doctors are back
On Thursday 30th August, we relaunched our webinar series for doctors. We invite surgeons around the world to share their treatment of complex injuries, some with limited resources in conflict zones. During our webinar, two Ukrainian surgeons shared how they removed shrapnel from a little boy’s heart and treated a woman’s devastating leg injury using skills learned on our Hostile Environment Surgical Training (HEST) course.
Dr Natalia Romanova from Kharkiv Regional Paediatric Hospital joined our HEST course in Ukraine this June. There, she learned how to treat fragment wounds – injuries caused by flying shrapnel – using our human war wound model (pictured below).
Dr Romanova shared: “Unfortunately, we face mine-blast trauma or penetrating wounds constantly (in Ukraine). Every single day.”
Shortly after completing our surgical training course in Kharkiv, Dr Romanova had to put her new skills to the test. A number of children were rushed to hospital after a shelling attack. Metal shards from a cluster munition had penetrated the lung and heart of a 12-year-old boy - fatal injuries without rapid action.
Together, the team performed a thoracotomy and pericardiotomy, opening the chest and heart's sac to find the source of bleeding.
From there, the team removed a blood clot covering a tear in the boy’s heart and blocked the hole with a finger. Carefully and swiftly, they repaired the injury using a piece of the heart's sac, before sewing the torn lung back together. Thanks to their speed and skill, Dr Romanova and her team saved the little boy’s life.
“I was ready"
Before her team presented this case to fellow surgeons, Dr Romanova felt compelled to contact us and share her delight at saving a life against the odds.
It may be unexpected for you to receive this letter. You might not remember me, but it is the (best) way to express my gratitude and it is my duty to do it.
I am a paediatric surgeon from Kharkiv, Ukraine. In June, we attended your magnificent HEST course. My colleagues and I are very grateful to you for all the information and skills we gained within those three days of training.
We were not used to work with such cases in peaceful times, so your professional guidance and knowledge are priceless for us now.
Despite never treating a penetrating wound before, Dr Romanova shared: “I was ready.” The surgery was successful, and the child was later discharged and evacuated from Ukraine.
After Dr Romanova’s team presentation, our Co-Founder, David Nott, said: “Many, many congratulations on such an amazing operation. I was so delighted that you were able to save this child’s life. You have done a brilliant job.”
Surgeons also heard from Dr Ivan Parkhomenko during the webinar, a junior doctor trained by David and other faculty members in Ukraine earlier this year. Dr Parkhomenko described how he’s “starting a little revolution” in his hospital, sharing the skin grafting technique he learned on our course with senior consultants and junior doctors alike.
A global community
We’re committed to continuing to grow our global network of doctors and creating a supportive space for the sharing of surgical knowledge.
If you are a surgeon who would like to receive information about our courses or contribute to one of our webinars, please get in touch.
"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.