Yemen HEST July 2016
David Nott Foundation ran a HEST course in Aden, Yemen from 10-12 July, 2016. 43 surgeons from hospitals in Aden, Lahj, Abyan, Lawder and Shabwa attended the three-day war surgery training.
David showed the doctors how to treat a variety of complicated war injuries, principally fragmentation and gunshot wounds. There had been an increase in suicide bomb attacks and bombs placed under cars in recent weeks, causing horrendous blast injuries which David also showed the doctors how to treat.
The Foundation taught the course at the invitation of Médecins Sans Frontières (MSF) as part of their regular training for local doctors and nurses.
David said: “I was thrilled to receive the invitation from MSF to run the HEST course in Yemen and am delighted to say we have had more invitations to run courses from other aid agencies in various countries. It shows the huge importance of the work we are doing and the very real need for surgical training in war zones.”
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
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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.
The Mail on Sunday: My secret mission to save Aleppo’s babies of the blitz
David Nott writes for The Mail on Sunday
Of all the wounded children of Aleppo who passed before me, the memory of one has lodged in my mind like no other. Maram. I spent the week before Christmas in a field hospital in Syria operating on many tiny souls see-sawing between life and death, their bodies held together with metal pins and scaffold-like fixators.
But in Maram, a five-month-old orphan and beautiful despite her injuries, I saw my own child and, perhaps because I missed her so desperately, I felt intensely overwhelmed.
I have made numerous trips to Syria to treat the casualties of this war, but none was as sorrowful as the week I spent with Aleppo’s children. Bone-weary and drained emotionally, I returned to London on Christmas Eve and couldn’t wait to hold my 17-month-old daughter and see my wife and family. Christmas was a joy.
Yet Maram was never far from my mind’s eye: a haunting, residual memory that I could not have shaken even if I had wished; I find myself waking in the early hours worrying about her. I first saw Maram on December 20, a few days after she was evacuated from Aleppo in an ambulance. Her legs and left arm had been shattered in a bomb attack that killed her parents and injured her brother and sister.
Pieces of ordnance shell were embedded in her infected wounds but, because the Aleppo doctors had run out of dressings, disinfectant and saline, they had no choice but to operate on her dirty body tissue. As I looked down at Maram on the treatment table she was crying, not because she was tired and hungry, even though she was both, but because she was in great pain.
There are no paediatricians in Aleppo, or at the hospital where I was working; nobody qualified to make the very difficult decisions about how much analgesics and fluids to dispense. So in spite of all her suffering, Maram was simply on a small dose of paracetamol. It was heartbreaking. I checked her charts. In the UK, these would have been filled in with scrupulous attention to detail, but in Syria, with doctors battling to save the lives of so many, charts were overlooked. I couldn’t even tell what medication she had already received.
Maram wriggled uncomfortably. I tried to think logically about how to help her and what I’d need to do when I operated on her the following day. But precise thought was difficult as I felt myself experiencing the same sort of emotions that any father would have towards a wounded child.
I operated on December 21, carefully debriding Maram’s wounds and removing the decaying tissue inside her. The whole hospital stank of the bacteria that had caused her infections, and those in other patients. I worked delicately around the open compound fracture Maram had suffered in her left leg.
Correctly in my opinion, the surgeon who had operated on her in Aleppo had applied an external fixator, but this was so big and heavy that Maram couldn’t move her leg when she was awake. It was so sad to see. She also had a pin in her femur and another in her tibia, and she had a really big gap of leg bone missing from the explosion.
Read more here.
Elly & David Nott featured in Foreign Policy’s Global Thinkers 2016 list
Since the Syrian civil war erupted, the Assad regime has killed almost 700 medical personnel—and thousands more have fled. In Syria, “health care is seen as a weapon,” Welsh surgeon David Nott told the Independent. “You take out one doctor, you take out 10,000 people he or she can no longer care for.” Over the past four years, Nott has provided emergency care in Syrian clinics and has trained the remaining health workers in triage techniques and basic surgical skills. When he’s back home in London, he provides trainees with real-time advice about cases through text messaging. In February, Nott and his wife, Elly, launched a foundation dedicated to preparing doctors for war zones. About 30 Syrians attended its first training session in southern Turkey.
Read the full article here.
The Observer: In Aleppo’s destroyed hospitals the dead lie with the living
David writes for The Observer
I don’t think that in all my years of doing this I’ve ever seen such dreadful pictures of injuries, of people lying on the floor of an emergency room, the dead mixed with the living.
One colleague, who I speak to all the time, was in despair, sending me all these photographs, and saying: “David, you have to do something to help us.” But what can I do?
The message out of eastern Aleppo is that there are no hospitals functioning at all. They have all been repeatedly attacked in the past few days. Some were able to evacuate, but one was totally and utterly destroyed by rockets and bombs. I heard that two doctors were killed and 16 other staff injured and I am afraid that one of the dead may be a brilliant surgeon, who would be a particularly serious loss.
There is another hospital that we haven’t even had a message from. So, I suspect they are out of action, but we know nothing about the staff or the conditions there.
The Aleppo hospitals have been re-opened so many times, underground or at new locations, but between the bombing and the siege I don’t know if it will be possible to resurrect them this time. There is so much equipment that you need in order to operate and there is no sterilisation and no monitoring machines for anaesthetics. Even if the hospitals saved some machines they can’t run them because the generators have been destroyed or are out of fuel.
The taking out of every hospital and medical facility that gives hope and help to civilians is not a coincidence. The medics have such fantastic morale that you would not imagine them giving up, but I have an awful suspicion that this is the endgame.
Read the full article here.
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.