“As soon as Russia invaded, we started seeing the wounded”
After troops crossed Ukraine’s borders in March 2022, Igor Belkin, a surgeon from Zaporizhzhia, watched our translated war surgery videos in a bid to better treat devastating wounds inflicted by the war. Last month, Igor furthered his skills and training during our latest HEST course in Ukraine.
Faculty Trainers in Zaporizhzhia and Lviv: Professor David Nott, Dr Pete Mathew, Dr Ammar Darwish, Dr Rachael Craven, Dr Ian Nesbitt.
“On the night of the 7th of May, the first attack on our hospital took place. Hospital walls and communications were damaged,” shared Igor. “After that, the shelling of Orikhov became even more intense. The hospital was shelled again later in May, which led to it being evacuated.”
Igor was forced to transfer to a military hospital in the field to continue treating the injured. Right from the beginning of the war, he and his team were faced with severe trauma injuries - many of which they had never seen before. Patients with internal and external damage caused by blasts, penetrating wounds and severe burns were entering their doors for the first time.
“I decided I needed to study combat trauma. A medical colleague told me about videos made by Professor David Nott.”
Armed with life-saving tools
Just days after Russia’s invasion, we ran a 12-hour surgical training course on zoom with former consultant neurosurgeon and author, Dr Henry Marsh. Together, David and Henry trained 573 Ukrainian surgeons, giving them surgical techniques, tools and tips for treating a range of traumatic war wounds. It was only when David lost his voice 12 hours in that the training stopped.
As attention started to mount around our online training, we created a series of surgical training videos in a bid to reach even more doctors in need of life-saving skills.
“It (the video series) was very informative, clear and concise. In just a few hours of viewing I grasped the main fields of trauma medicine - damage control and important techniques for cardiovascular surgery.”
Upskilling 114 Ukrainian doctors
Last month, David and a team of our trainers travelled to Zaporizhzhia and Lviv to deliver our HEST course. 114 doctors and anaesthetists were empowered with the knowledge needed to treat neurological, plastics, vascular, cardiothoracic, paediatric, orthopaedic and abdominal trauma cases – creating a powerful network of multi-skilled surgeons.
“I was very pleased to attend this course and meet David personally. I got very concise, practical information and was able to practice my skills and learn how to provide assistance in areas of medicine I don’t specialise in.
I’m grateful to David, his entire team, and the foundation for sharing their great experience and imparting their knowledge of medicine in war zones”
Before the course, I used to use a technique called a lateral thoracotomy which involves turning the wounded onto their side (entering the chest from the side). Given the fact that chest injuries can make patients very unstable, this sort of movement could worsen conditions.
Now, I only do thoracotomies while patients are on their backs. This is a far better method for both surgeons and anaesthetists to approach trauma injuries.
I also learned how to use external fixations to secure bones and now perform fasciotomies on patients needing urgent pressure release in the limbs.
This sort of knowledge, acquired from experienced frontline doctors like David and the team, will help me and my fellow Ukrainian doctors save more lives.”
We’re committed to training and instilling confidence in Ukraine’s doctors until the war is over.
Help us train others like Igor
Upskilling doctors in Malaysia during Tripartite Conference
In December, we were delighted to be invited by the Royal College of Surgeons of Edinburgh (RCSEd) to attend the AFSM Tripartite Conference 2022 in Borneo, Sarawak. We upskilled 42 doctors and medical students during a condensed, one-day Hostile Environment Surgical Training (HEST) course.
Faculty Lead: Dr Pete Mathew. Faculty Trainers: Dr Una Walsh, Dr Ankur Thapar and Dr Pippa Letchworth. Programme Support: Christie Norris.
The Academy for Silent Mentor (AFSM), RCSEd, College of Surgeons Academy of Medicine of Malaysia (CSAMM), and the Ministry of Health of Malaysia (MOH) joined forces to develop a comprehensive 3-day conference program on healthcare challenges in the 21st century.
Our Faculty Lead Dr Pete Mathew (right) delivered a lecture to conference attendees. He shared details of his experience as a neurosurgeon, working to save lives in conflicted countries such as Afghanistan and Iraq with the Royal Air Force, and volunteering with humanitarian organisations such as the International Committee of the Red Cross before joining our team as a surgical trainer.
Wounds seen in war
The following day, we delivered a condensed version of our Hostile Environment Surgical Training course to 42 participants covering damage control, cardiothoracic and vascular surgery, maxilla-facial trauma, plastics, and obstetrics and gynaecology.
Using our human simulator model, Heston (below), the group got to grips with a range of injuries commonly seen in conflict and mass emergencies, such as penetrating head wounds and shrapnel injuries.
They manoeuvred skin flaps on Heston’s body, practicing how to cover blast injuries and encourage healing, and performed lung twists in Heston’s open chest to stop severe haemorrhage.
We also used our new, state-of-the-art birthing simulators to allow attendees the opportunity to experience how to manage challenging deliveries, such as obstructed labours, breach positioning, or C-sections.
Care without boundaries
Rural communities in Sarawak often have limited access to healthcare due to their remote locations. For some, it can take many days to reach hospital facilities. Outstanding local charities such as Mercy Malaysia and Andante coordinate regular medical and dental visits to communities in urgent need, thanks to the generosity of trained volunteers.
Basic clinics have also been built in hard-to-reach regions, with the goal of ensuring expectant mothers receive better care. Outreach doctors who take part in our comprehensive obstetrics training could have a significant – and potentially life-saving - impact in rural communities.
Professor Angus Watson, Consultant General and Colorectal Surgeon and Chair of the Research RCSEd Committee, said:
“Having an internationally renowned charity, like the David Nott Foundation, delivering their highly acclaimed course to healthcare providers in Malaysia, was one of the highlights of the conference.
The feedback received from course participants was very good and we hope this is the start of a highly productive global partnership between the Royal College of Surgeons of Edinburgh and the Foundation.”
Speaking of our training, a medical student from University Putra Malaysia who attended the course, said:
“Me and my medical peers participated in the Hostile Environment Surgical Training (HEST) during the conference. We were deeply amazed by this course. It gave us very different exposure from other courses we’ve been to.”
We look forward to exploring future courses in Malaysia and thank the RCSEd for their invitation.
Watch our video and reflect on 2022's successes
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
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.
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.
Surgery on the frontline in Ukraine: David Nott in conversation with Bridget Kendall
We are delighted to announce that The BEARR Trust is hosting an event with our Co-Founder David, to discuss his work providing emergency surgical care and training local doctors in Ukraine.
David will be in conversation with award-winning journalist and BEARR patron, Bridget Kendall, to share his stories of working in crisis and catastrophe zones for over 25 years - including the delivery of two HEST courses in Ukraine. The online event will take place at 18:30 BST on Monday 27 June via Zoom.
About Bridget Kendall
Bridget Kendall worked for the BBC for over 30 years, specialising in Soviet and Russian affairs after graduating from Oxford and Harvard universities. From 1989 to 1995, Bridget was the BBC’s Moscow correspondent, covering the final years of the USSR and the first years of post-Soviet Russia.
As the BBC’s Diplomatic correspondent from 1998 to 2016, she covered conflicts in Chechnya, Georgia, Tajikistan and Ukraine, among others, and in 2001 and 2006 she conducted two interviews with Vladimir Putin, both broadcast live to the world from inside the Kremlin.
In 2016, Bridget was elected Master of Peterhouse Cambridge. She is also a patron of The BEARR Trust.
Register to attend this special event today
From underground hospitals in Syria to training in Gaziantep
For the first time, we delivered two surgical training courses over a four-week period in different countries. Our latest course was for Syrian doctors in the Turkish city of Gaziantep, some of whom had worked together in hospitals in Aleppo between 2011 and 2016.
After a memorable course at Edna Adan Hospital in Somaliland, we partnered with Syria Relief to train 26 healthcare professionals in Gaziantep.
A Turkish city near the border with Syria, Gaziantep is home to a number of doctors who know the destruction of war all too well. Many were forcibly displaced from Syria by conflict and some had operated with David in underground hospitals when eastern Aleppo faced military bombardment and siege.
Unbreakable bonds
When the Syrian government, with Russian air support, began targeting medical workers and healthcare facilities, doctors started treating patients in secret hospitals with extremely limited resources. David travelled to Aleppo to help the doctors manage complex injuries and save lives. His sharing of surgical knowledge often led to life-long bonds with those he taught.
Dr Mahmoud Hariri from Aleppo shares: “I first met David in 2013. He came to us in Aleppo, and we learned many things. We learned to be multi-tasking surgeons. I can now do surgery on the kidney, heart, vessels. This is the notion of the multi-tasking doctor. A lot of lives have been saved.”
Dr Hariri and 25 others joined our Gaziantep course with the help of our Course Director Dr Ammar Darwish and the Syrian Board of Medical Specialties (SBOMS), an organisation dedicated to helping Syrian medics work as specialised doctors in northern regions of Syria.
Trainees becoming trainers
The course was taught by accomplished Faculty - some who had learned from David in Syria or during a previous HEST course - and were now excellent surgical teachers.
Helping trainees become trainers is what we are here for. We want to empower doctors within countries affected by conflict and catastrophe to be surgical and health system leaders, serving their own communities.
The group learned how to manage and treat complex war wounds, such as blast injuries, gaping holes in the body, or deep burns. They also learned what to prioritise when faced with multiple wounds, the majority of which they will never have seen during standard medical training.
New skills in practice
Others on the course had also worked with David in conflict. Dr Ehab Baydak, a maxillofacial surgeon from Idlib, Syria, saved a man’s life with David’s help over skype. Since then, Dr Baydak has put his skills to practice in his community.
“During the siege of Aleppo, I was working in an underground hospital and received a patient whose face was severely injured from a bombing. We hadn’t seen this type of injury before and didn’t know how to deal with this,” Dr Baydak shares.
“Due to the siege, we couldn’t transfer patients outside of the city. Dr Murhaf Assaf and I contacted David who talked us through how to do the operation over Skype.
After the Syrian regime took control of Aleppo, I moved back to Idlib to be with my family. There, I came across the same injury, and I was able to do the surgical procedure alone – all because of my experience with David.”
Our courses teach healthcare professionals how to perform procedures just like this – operations that David has undertaken in war zones over 30 years of voluntary humanitarian work. We were honoured to contribute to the surgical education of 26 doctors in Gaziantep, giving them the skills needed to save lives and limbs against the odds.
How we rose to the challenge of COVID-19
The coronavirus impacted our ability to deliver the in-person training we are internationally known for. Despite this challenge, we found new and effective ways of supporting war doctors around the world. Here are a few of the things we got up to.
DigiHEST
In December 2020, we piloted our first ever Digital Hostile Environment Surgical Training (DigiHEST) course. We transformed an office space, generously provided by Whitby Wood, into an operating theatre and our friends at Redux Content decked the place out as a recording set.
Over the course of a weekend, David was joined by DNF faculty members Ammar Darwish, Rebekka Troller and Pete Mathew to present an ambitious programme of surgical training that was live streamed around the world. Modules covered included abdominal trauma, neurosurgery, maxillofacial surgery, ballistics and more. David was also joined by special guest lecturers Mounir Hakimi (orthopaedics) and Shehan Hettiaratchy (plastics) to form a world-class team of surgical specialists ready to reach out to surgeons in conflict zones and austere environments.
We were joined by up to 100 doctors from around 29 countries over the course the weekend, who were additionally able to pose their questions in real-time to the presenters and ask for advice on cases presenting to them in their localities.
Webinars
Throughout 2020 (and re-starting in 2021), we ran webinars for doctors in conflict zones. These webinars, led by David, saw doctors submit difficult or interesting cases and discuss together the best course of action for treating individual patients. David and our Faculty also delivered lectures during these sessions.
Creating a global network
Our webinars led to the creation of a thriving online community of surgeons, each able to send photos and submit descriptions of cases for the purpose of collaboration with other David Nott Foundation alumni around the world. This forum has been an incredible thing to witness - rapid surgical feedback and collaboration between doctors in conflict zones.
Despite rising to the challenge of coronavirus, we are delighted that our in-person surgical training has resumed.
Find out more about our courses
We translated our war surgery training into Ukrainian
In response to the Russian invasion of Ukraine, we turned our life-saving course into a condensed recording and translated it into Ukrainian. We now invite every Ukrainian surgeon to contact us to receive this life-saving war surgery resource.
When the crisis began, our Co-Founder David Nott worked around the clock to condense our surgical training course into a 6-hour recording, divided into 15 chapters and packed full of surgical experience from the frontline. Chapters include triage, neurosurgery, damage control, burns, cardiothoracic, orthopaedics, paediatrics, plastic surgery and anaesthesiology.
Taking the training one step further, we’ve translated every chapter into Ukrainian to ensure our life-saving resource reaches every single doctor in need, no matter their ability to understand English.
Contact us if you're in Ukraine
Our Co-Founder, David Nott, said: “After Russia invaded Ukraine, I knew I had to get there. I had to help. Thankfully, I was able to get into Ukraine, volunteering my surgical skills in multiple hospitals right across the country and sharing our training recordings with the doctors I met.
Although a powerful resource, it quickly became clear that many didn’t speak English well and I knew we needed to work hard to ensure our training was even more accessible.
We’ve worked around the clock with Absolute Translations to translate every single chapter into Ukrainian and are now on a mission to ensure every doctor in the country has access.”
If you are a Ukrainian healthcare professional or know of doctors in need of help, we are here for you. Email us at [email protected] for access to our translated resource.
Many thanks to the team at Absolute Translations for their hard work and dedication.