Mosul to Manchester: Our war surgery training in practice
Dr Moez Zeiton is one of our surgical trainers. As a humanitarian surgeon, Moez has witnessed the realities of war, but never expected to see similar horrors on British ground. Here, Moez shares his journey to joining our teaching faculty and how he’s used his surgical skills around the world.
Moez’s first exposure to medicine was through his father training as a general surgeon and specialising in oncoplastic breast surgery.
“I sort of drifted into medicine myself. I loved biology at school, but my love for the sciences and in particular, my inspirational high school Biology teacher shaped my decision to study it. When I started the course at the University of Leeds, I remember loving the anatomy and dissection work and knew surgery and acute trauma were fields I was interested in,” Moez shares.
A fork in the road
“My entry into humanitarian work started by accident. I always felt a connection to the Middle East through my family and having regularly travelled there as a child to visit extended family and friends.
So, when the Arab Spring uprisings in 2011 arose, I got involved with charitable initiatives sending medical aid and worked on advocacy, opinion pieces and articles. I knew I wanted to be there on the ground, so I negotiated a one-year sabbatical from my surgical training. At the age of 25, I left for Libya to do my part.”
Moez worked with non-government organisations and local Libyan doctors, opening him up to the world of humanitarian health. This led to him taking on a voluntary role as National NGO Coordinator for six months. He also attended courses on analysing disrupted health systems with the World Health Organisation (WHO).
Taking part in our training
After his sabbatical, Moez continued his surgical training in the UK and fed his interest in humanitarian surgery with research. He was part of The Lancet’s series on health in the Arab world and commission on global cancer surgery. He also attended the Scholars in Health and Research Programme at the American University of Beirut.
Working at a major trauma centre in the UK, Moez worked alongside some of our senior faculty and was introduced to our Surgical Training in Austere Environment (STAE) course. He was one of the first doctors to benefit from our scholarship programme, attending our STAE course in 2017.
“On the final day of the course at the Royal College of Surgeons, I met people from WHO and Aspen Medical International who were looking for doctors to help with trauma victims in Mosul, Iraq, following ISIS invasion. Two months later, I found myself there, with a group of expat and Iraqi doctors.
Immediately, I was able to put my new war surgery knowledge to practice - damage control and how to save lives and limbs.”
War wounds in Manchester
Two weeks after returning from Mosul, Moez was unexpectedly faced with war injuries in Manchester – blast wounds following the Manchester Arena bombings.
“The injuries I saw were very similar to what I’d seen in Iraq and had been teaching on the Foundation’s courses - blast injuries from shrapnel and metalwork. I was able to use what I’d learnt but now in my home country.
Although it was shocking and very stressful, things worked seamlessly in our hospital and the camaraderie, hard work and collaboration I saw across 7 or 8 local hospitals that received injured patients was unlike anything I had seen before. I truly saw the NHS at its best.”
Becoming a trainer
“After my return from Mosul, I was invited to join the Foundation’s orthopaedic faculty. Being part of the Foundation’s faculty for the past 5 years, teaching the skills I learned on that STAE course in 2017, is incredibly special.”
For the first time, Moez led the orthopaedic section of our recent course in Gaziantep.
“Although I had been teaching on the STAE course in London for some time, the oversea HEST course required a slightly different approach. I needed to prepare and familiarise myself with the course material. Attending the Train the Trainers course which was put on by the Foundation really helped with this.
The 26 Syrian surgeons we trained shared incredible stories and the cases they faced during conflict with limited resources. Rather than teaching, I facilitated discussions around patient cases, learning from shared experiences and taking things back to fundamental principles. I learned just as much from the inspiring candidates as they learned from me!
This was also the first time that I had delivered an all-day comprehensive professional course in Arabic. It was extremely challenging considering I’ve only practiced medicine in English. However, the feedback and appreciation that I received from attendees is certainly one of the best achievements in my career.”
Leaving a legacy
Looking to the future, Moez wants to continue serving those in need in the UK and around the globe.
“I feel passionately about my humanitarian work and want to continue this in tandem with my NHS role, ideally doing one or two missions a year.
The NHS is such a huge organisation and has a vast resource of skills, knowledge and cultural experiences that can be tapped into. The world is incredibly connected. No matter how far away they may seem, conflict and disasters that happen in other countries continue to affect us directly or indirectly through human migration, security and the economy. We should be using our training and unique cultural experiences to help others around the world.”
Help us train more war doctors
Two war doctors, one family
On day one of our HEST course in Erbil, Iraq, our Chief Executive Elly Nott had the pleasure of meeting two participants from Mosul. Together, Dr Basma Haqi Ismael and her daughter Shahad, a medical student from Mosul University, are delighted to learn surgical skills that will serve their community in times of need.
EN: I’m delighted to meet you both. Can you start by telling us who you are and where you’re based?
Dr Basma: I’m Dr Basma and I work with MSF. I am very grateful (to be here) because I help many people, especially people after war and disaster. Especially the people of Mosul post-war.
EN: And you must be very proud that your daughter is close to qualifying as a medical student.
Dr Basma: I am very proud of that… I always transfer what I see in MSF hospitals and give lots of information to her so she can get revision from that also.
EN: And is your mum an inspiration?
Shahad: She has always been an inspiration! I always wanted to be like her, in medicine, in life, in everything!
EN: That’s wonderful. And where are you training?
Shahad: I’m at Mosul University and training at Mosul Hospitals.
EN: There’s quite a lot of practical work on our HEST courses, are you looking forward to getting involved on our practical work here?
Shahad: Yes! I have found it was very nice to attend and gain some experience.
Dr Basma: This training will be very beneficial. The (course) information comes from many countries and can be beneficial and transferred to people inside Iraq - and other countries too.
EN: Absolutely, that’s the great thing about this course. It’s the accumulation of about 30 years of experience in various parts of Africa, the Middle East, Asia.
Dr Basma: Yes, emergency skills. I have experience of more than 20 years – but yesterday I was learning about lung twisting. It is for vascular thoracic surgery.
EN: The lung twist was a new skill?
Dr Basma: A new thing for us. We can transfer this information to our surgical department, for any blood loss or vascular injury. It’s very beneficial for the patient.
EN: So, you’ve already learned something new on day one of the HEST course?
Dr Basma: Yes, we’ve learned new information.
EN: And did you try the lung twist on our model Heston?
Dr Basma: Yes, very good. We also tried the open-heart cardiac massage. (We are) very grateful to do this training. For my daughter, transferring this information to hospitals, friends, medics, doctors – it’s beneficial for all.
Dr Basma: At this time, I worked at Al-Jamhoori Teaching Hospital in Mosul. I help many people with MSF Belgium. Most of the people who come by have many deformities.
EN: With the injuries that you see. Are many of them the result of conflict?
Dr Basma: Yes, we’ve received many injured people from Mosul, but also many, many with psychological problems.
EN: Is there a particular patient that’s stayed with you?
Dr Basma: Most of the cases we receive are post-burn deformities, especially during ISIS. Explosions causing burns. Most of these patients are crying, saying I want to be saved. Always, I remember my daughter, and most of the time I am crying with the patient.
EN: I have two daughters, I can understand that. What are your hopes for the future?
Shahad: For me, I want to learn. In the future, all I want to be is a good doctor. I want to be like my mum! That’s all. She is doing very well in her career, and that’s all I want.
EN: That’s wonderful.
Dr Basma: We are so grateful (to be on this course). We want you to come to Mosul! We have heard very nice things about David – a great man. Many people pray for him.
Meet war doctor trainer, Dr Una Walsh
Dr Una Walsh, General Surgeon and Major Trauma Fellow at St Mary’s Hospital London, is the newest member of our faculty. Here, Dr Walsh shares her experience of our latest course in Iraq, where she was responsible for teaching abdominal and paediatric trauma.
Joining the Foundation
I first met Professor Nott in 2016, when I worked as his Registrar at Chelsea and Westminster Hospital. Since then, I am privileged to call him my mentor. It quickly became very clear to me that our thoughts were aligned on global health and inequalities, and I was keen to get involved and help in whatever way I could.
I was quite junior at the time - a 3rd year Registrar - but I knew if I continued my training, stuck with it and pushed hard, I could use the skills and operative knowledge I gained to join the Foundation and further their aims abroad.
This required a considered rethink on my career path and after discussion with Professor Nott and deanery tutors, I made the decision to switch training from breast to colorectal surgery and create a path towards emergency and trauma surgery. This also laid the groundwork for a humanitarian-focused career. I have since completed general surgery training, joined the Foundation’s faculty and currently work as a Major Trauma Fellow alongside Professor Nott at St Mary’s Hospital London.
A pull to help those in need
My first experience of humanitarian work was with Sir Magdi Yacoub’s charity, Chain of Hope, based at the Brompton in London. Through a chain of volunteer surgeons and medical doctors, Chain of Hope identifies children with congenital heart disease in urgent need of surgery not available in their own country and arranges transfer to centres in high-income countries that sponsor their surgery. They also have an active training programme, whereby teams fly out to operate or train local teams across the developing world. My role is to travel to low- and middle-income countries and provide aeromedical escort for children to sponsor centres for life saving heart surgery.
On behalf of the charity, I have retrieved children from Zambia, Haiti, Sierra Leone, and the Ivory Coast. This work is extremely rewarding working with a fantastic charity, plus I have a very lovely collage of pictures of the children I have helped, recovered after surgery. This work has also given me a wealth of experience in mission planning and the nuances of humanitarian work including navigating many and varied world airports with understandably terrified mothers and often babies in tow.
Whilst, heart-warming work it feels like a very small drop in the ocean - that's what drew me towards global health as an entity. The ability to help more than just single individuals.
At the David Nott Foundation, if you train one surgeon, the knowledge is shared with many more in local communities helping hundreds - that ethos resonates really strongly with me.
Cutting-edge teaching technologies
The latest HEST course in Erbil, Iraq, was my first course as a Faculty Trainer. It was a really lovely introduction to working with the Foundation. I led the abdominal and paediatric sections of the course. This involved both lectures and skills training.
All the training equipment, funded by our supporters, is superb. We were able to provide near-to-life simulated training through the use of purpose-made and anatomically correct tissue, including bowel arteries and veins, hearts, kidneys, windpipes and even skulls. The hearts and kidneys were my particular favourites, truly amazing and life-like.
Then Heston – the anatomical model! It’s just the cherry on top. You can demonstrate the exact movements you’d make in surgery. For example, how to mobilise the colon to get to the kidney, or more importantly the major vessels which can often represent the most challenging of traumatic injuries.
Heston also has little magnetic buttons that keep the organs in the correct anatomical positions, which allows you to simulate exactly how you would move and access body parts. It’s a tremendously clever part of his design.
Humbling stories
Most of the surgeons I trained came from Mosul, so many had experiences of the war to liberate their city from Islamic state (IS) invasion.
I admired so much the strength and courage they showed - and listening to their stories was humbling.
When Dr Troller (another faculty member) was teaching a procedure called a resuscitative thoracotomy, one of the surgeons commented during the war that they'd done ten - and only one survived. This could be down to the catastrophic injuries caused by war, making procedures like this even more challenging.
After completing the course, they were equipped with helpful strategies, giving them confidence that future outcomes will be different for patients. This is the real-world value of this innovative course.
They were a very talented, welcoming and hard-working group of individuals and I’m really looking forward to training many more like them.
We’re back where we belong
We are delighted to be back training doctors on the frontline. Our latest Hostile Environment Surgical Training (HEST) course in Erbil, Iraq, equipped 31 local healthcare professionals with skills that will serve their communities. Our Chief Executive, Elly Nott, shares her experience of the course.
Our latest course in Erbil was an incredibly humbling experience. Facilitated by our partners at Médecins Sans Frontiers-Belgium (MSF), we were able to train 31 Iraqi healthcare professionals in the surgical skills they need to manage any case they might encounter in an emergency or conflict situation.
During the course, our faculty used our cutting-edge anatomical model, Heston (pictured below), to teach a range of surgical techniques for treating traumatic injuries. Model hearts and synthetic skin helped them practice how to manage cardiac injuries and chest tube insertion. Virtual reality headsets also immersed our participants in emergency scenarios, putting their mass casualty triage and decision-making skills to the test.
A number of the participants were from Mosul, a beautiful and historic city that freed itself from the oppressive rule of Daesh in 2017. The resilience, courage and grace of the doctors was an inspiration to us all.
We are so grateful for your support of our mission. Every donation helps us deliver world-class surgical training that saves and improves the lives of those most in need.
War Doctor Heroes: Meet Dr Awss
We are delighted to feature Dr Awss from Iraq as our latest War Doctor Hero.
Dr Awss was responsible for eight field hospitals in Iraq during the worst of the fight with ISIS and he continues to treat victims of war there. He has trained with us overseas and recently attended one of our surgical training courses here in the UK (STAE).
Through the sharing of knowledge, his training has not only benefited him but also his colleagues, who work in challenging conditions and face difficult decisions every day. As a result of this skills sharing, Dr Awss and his colleagues noticed a significant decrease in the referral rate to their hospitals.
Aware of the impact these courses have on the provision of treatment in the hospitals under his care, Awss wrote to both the Prime Minister and Minister of Health in Iraq recommending that "every single person who enters into surgery, should have this course."
The work of Dr Awss and all the war surgeons with whom we work inspires us to keep moving forward so that we can continue to save more lives and limbs.
You can help us to train more doctors by donating here.
War Doctor Heroes: Meet Dr Omar
This is Omar. He is an orthopaedic surgeon in Iraq. He came on one of our surgical training courses in 2018.
We heard that, following a massive road traffic accident, a young patient was brought into his hospital with a compound hip fracture. He was losing so much blood that doctors were gravely concerned that he might not survive. Omar decided to perform a procedure he'd learnt to do properly on our training course.
He recently visited his patient and was delighted to see that he's doing really well. "You saved another life without even knowing it. We are so proud of you. I want people to know the real benefits of these training courses".
"The training helped me to do the procedure properly and without it the boy may not have lived" said Omar.
Help us train more surgeons like Omar https://lght.ly/1jbkc1g