Kenya HEST April 2019
The Faculty of the David Nott Foundation recently returned from its latest mission to Nakura, Kenya (just a short ride from the capital Nairobi) where it delivered its latest Hostile Environment Surgical Training course.
Graciously hosted by Egerton University and COESCSA, the Faculty delivered training to 24 surgeons and general practitioners over a 4-day period. During this time, a great range of skills were covered including everything from ballistics examining the effects of low and high-velocity bullets and the stages of a blast injury on the body; vascular surgery and head and neck surgery.
Despite the course being full-on and packed with content, all the delegates were conscientious and showed impressive dedication to learning all they could from the course.
On our HEST courses it is important to select a curriculum of training we feel will best match the level of ability of delegates in attendance. With the general practitioners being relatively experienced and accomplished surgeons, the level of training was advanced and the quality of interaction all round was excellent.
A recent addition to our team (one that comes in the form of a full-body simulator called Heston) has proven to be one of our most valuable assets. It makes a great addition to the training process, allowing delegates to easily visualise and study further the surgical procedures being taught, with reference to a perfectly accurate human body.
As ever, we are grateful to our donors for supporting us in our increasingly important work to deliver the best surgical training directly to those who need it most. A recent study in The Lancet showed that nearly 17 million people die prematurely every year from surgically treatable conditions, and that of the 313 million surgical procedures that are carried out each year, only 6% of these take place in the poorest countries worldwide. Furthermore, the study notes that, 5 billion people worldwide do not have access to safe and affordable healthcare and that 143 million additional surgical procedures are needed in lower and middle-income countries in order to save lives and prevent disability.
What this shows then is a lack of, currently, adequate surgical healthcare worldwide, though impacting the poorest nations most. We believe our mission ties in directly with one of the primary needs for the provision of safe surgical care as suggested by the authors of this study: increased numbers of trained surgical providers.
With this in mind, any support you kindly give us goes a long way to tackling this issue that effects so many. Our training serves those on the front-lines. Our training saves lives.
Training Update
We're proud to have trained over 600 doctors since we started in 2015. Our training equips them with the specialist medical skills they need to work in war and disaster zones. Critically, these skills enable more lives to be saved. Help us save even more by donating via the website.
Yemen HEST January 2019
The David Nott Foundation ran two HEST courses in Aden, Yemen in January 2019 with the support of Médecins Sans Frontières.
These two HEST courses were the first occasion that the Foundation’s whole body simulator was employed for training and supporting it was a suite of individual models of organs, blood vessels and key anatomies with which the students could train. For the obstetrics modules, the Faculty used its commercially-sourced obstetrics simulator enabling each surgeon to practise multiple Caesarean section deliveries as well as neonatal resuscitation.
Training
Covering 2-5 hours each, the courses were taken through:
- Ballistics – the effects of low velocity bullets and high velocity bullets and the four stages of a blast injury on the human body
- Primary and secondary survey
- Damage control
- Cardio-thoracic trauma – thoracotomies; lung twist and tractotomy; effects of a cardiac tamponade; pericardial sac opening; heart suturing
- Vascular surgery – ligating, shunting, patching and grafting vessels; fasciotomies; proximal and distal control
- Head and neck trauma – removal of extracranial haematoma; burr holes and craniotomies for extradural haematoma; fragment removal with depressed skull fractures; treatment of mandibular and Le Fort fractures; jaw and maxilla wiring
- Principles of paediatric surgery – differences in physiology; burns; common injuries and diseases; cultural considerations
- Abdominal trauma – laparotomies; control of bleeding; pelvic injuries and bracing; splenectomy; Cattel-Braasch manoeuvre; Whipple procedure; bowel anastomoses; ileostomy and colostomy; closure of abdomen
- Orthopaedic surgery – stabilisation by plaster of Paris; traction; external fixation; management of difficult fracture, non-union and infection; osteomyelitis; amputations
- Plastic surgery – burns; debridement and reconstruction; skin grafts; tissue flaps
- Trauma in obstetrics and gynaecology – vaginal deliveries; Caesarean sections; hysterectomies; post-partum haemorrhage with compression techniques and tamponade; perineal trauma; retained products; ectopic pregnancy; neonatal resuscitation
Students
The Faculty trained 52 students over the two courses. 20 surgeons and doctors from across the country came for the first week and demonstrated a high level of experience and skill, and engaged well with all the training, even putting some of it into use the same day once they returned to theatre. By the time the second course started the work had spread and many more than expected turned up to start, with some having to be turned away to keep the numbers manageable.
Particularly interesting was the attendance of five surgeons who had previously attended a HEST course delivered by David and team in Aden in 2016. Among those was a highly respected female surgeon; the only in Aden and possibly the only in Yemen, who had only recently qualified. In the three years since she had come to be regarded as a one of the best there and consistently impressed the Faculty. Such was her appetite to learn that she even sat in on some of the sessions in the second week to make sure it was all sinking in.
Conclusion
There is no doubt in our minds as to the value of the courses in Yemen and the evidence of and potential for making a very real difference to the surgical outcomes for patients not only treated by the surgeons we taught, but also those to whom the training, techniques and procedures can be cascaded.
The impact that the models have made is exceptional; they have transformed the course and are now invaluable training aids for almost all components of the syllabus. Both the surgeons that have trained with the models, and the David Nott Foundation faculty that have used it in their teaching, have been emphatically enthusiastic in their feedback about the value it brings to the training. Both the surgeons that have trained with the models, and the David Nott Foundation faculty that have used it in their teaching, have been emphatically enthusiastic in their feedback about the value it brings to the training.
HEST in Libya
It was the early hours of 4 March when our DNF team touched down at Misrata airport. David and Ammar were this time joined by Harald Veen, formerly Chief Surgeon of the Red Cross and now a valued addition to our teaching faculty.
Over the next three days they taught 55 Libyan doctors in the skills they need to provide the best surgical care for patients with complex injuries.
The doctors had travelled from across the country from towns including Tripoli, Misrata, Houn and Sabha. The majority specialised in general surgery but there were also orthopaedic surgeons, an obstetrician and a neurosurgeon present; demonstrating the relevance of our training programme to all medical specialities.
HEST faculty in Misrata
The course concluded with a practical workshop at Misrata Central Hospital where they put their newly-learnt skills into practice with tuition from David, Ammar and Harald on vascular, general surgical, neurosurgical and facio-maxillary techniques.
We have already had three applications for scholarships from surgeons attending the Misrata course and look forward to continuing to build our friendships with the doctors of Libya.
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.”
