"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.
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
David reflects on his latest mission in Ukraine
Our Co-Founder David Nott recently travelled to Ukraine with UOSSM International, performing life-changing surgeries and offering guidance to doctors across the country. Here, David shares his reflections on what will remain a memorable and emotional mission.
My latest mission to Ukraine was an incredibly important one for me. I travelled everywhere, north, south, east and west.
I initially started in one hospital. When they knew what I could do, I was asked to go to more hospitals, and it started to snowball from there. I began by treating a number of old war injuries, people that had holes in their legs and arms, loss of shoulders and big fragmentation wounds.
It was clear that Ukrainian surgeons wanted support with plastic surgery. Many didn’t know how to rotate flaps, some had never seen one before. Many had never done war surgery at all. So, I spent my first week just operating and operating - doing all I could.
At one point, I had 14 or 15 people in an operating theatre all bent over watching what I was doing. It's a great way to teach - I stood back and told them where to make the incisions. They were delighted to learn.
I reconstructed a patient’s shoulder that had been blown off and other serious blast wounds. When I went back the next day to see one of the blast patients, they gave me a thank you plaque which was incredibly kind. They were desperate to have somebody show them what to do – someone there to help them.
I travelled all over the country to regions that have now been heavily bombed. I saw how refugees in Lviv are gathering in a railway station, and the fantastic work that NGOs are doing there. There are thousands of people, all being fed and sheltered with the help of outstanding charities.
Now having seen the devastation, it feels like the exact same tactics as in Syria. When I was in Aleppo in 2016, the whole region was completely and utterly destroyed. What we’re seeing in cities like Mariupol – the destruction - feels very similar to what I witnessed in Aleppo.
Teaching has carried on here in the UK. I taught a doctor called Oleksandr who contacted me when I was back home. He watched me repair a serious leg wound in Ukraine and had seen the condensed training videos we made for surgeons there, but Oleksandr was now the lead surgeon faced with a similar blast injury.
I guided him through his surgery remotely, as he took a flap of skin from behind the knee to repair and close the wound.
"I was quite nervous, but it went well thanks to David Nott. He showed us ordinary doctors how to fight on the medical frontline." - Oleksandr
Oleksandr and his colleagues are treating awful injuries that no-one should ever experience. But the injuries will keep coming, so it’s my hope that they will pass on what they’ve learned. By sharing my knowledge and 30 years of war surgery experience, a lasting legacy is created.
There’s a huge amount of work to do. I think surgeons and healthcare professionals in Ukraine will be faced with war wound reconstructions for many years. Plastic surgery will be incredibly important as the conflict continues – and far into the future too. The Foundation will do all we can to help doctors navigate this war and its aftermath.
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.
A mission to reach every healthcare professional in Ukraine
In response to the Ukrainian crisis, our Co-Founder David Nott and Former Consultant Surgeon at St George’s Hospital Henry Marsh delivered a 12-hour online war surgery course to hundreds of doctors in Ukraine on Saturday 5th March.
Taking our action one step further, we’ve turned our life-saving course into a condensed recording and are translating it into Ukrainian. Now, we are on a mission to share it with every healthcare professional in Ukraine.
To reach as many doctors as possible, David has further condensed the Foundation’s surgical training 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.
The resource has already been shared with many doctors within Ukraine. One shared with us: “Perhaps hundreds of lives and destinies will be saved, thanks to your work. Thank you!”
Another healthcare professional within Ukraine, said: “David has gone through almost all the wars of the past 20 years and arguably has the most conflict medical experience in the world. He did this course for us.”
David Nott, our Co-Founder, said: “The emotions that healthcare professionals in Ukraine are feeling and the circumstances within which they are working – I’ve been there. I’ve worked in hospitals that have been hit by bombs. I’ve performed surgeries in the dark. I’ve been terrified for the lives of my patients. I can’t stop this war, but I can arm them with knowledge.
Condensing my war surgery experience into a recording that can be streamed from any device means any doctor within Ukraine can gain life-saving skills. All of us at the Foundation will continue to do all we can to help.”
We rapidly delivered war surgery training to 573 doctors in Ukraine
In response to the Ukrainian crisis, our Co-Founder David Nott and Former Consultant Surgeon at St George’s Hospital Henry Marsh joined forces to deliver a 12-hour surgical training course to over 570 healthcare professionals on Saturday 5th March.
After the Russian invasion of Ukraine, David Nott rapidly developed a surgical training course for doctors who are working, or will work, to save lives in Ukraine as the devastation continues to unfold.
David condensed our 5-day surgical training course into a comprehensive 12-hour course online. To ensure healthcare professionals in Ukraine are best prepared for complex war injuries, the course included triage, damage control, burns, cardiothoracic, orthopaedic, paediatric, and plastic surgery sessions. Former Consultant Surgeon and pioneer of surgical advances in Ukraine, Henry Marsh, led the neurosurgery session of the course.
The attendees learned a range of skills that can be used when faced with limited resources, from learning how to create make-shift pelvic binders to knowing when to operate without a CT scanner.
Vadim Corjos, a General Surgeon from Ukraine based in the UK, said:
"(The David Nott Foundation surgical training course) in essence is the fullest and deepest course for surgeons who are in war zones. Providing this course for (Ukrainian) surgeons gives a very good base to save more lives in war and conflict areas. I have no words to appreciate this great effort. Thank you and God bless."
David Nott OBE FRCS, Consultant Surgeon at St Mary's Hospital and our Co-Founder, said:
“At the frontline of conflict zones are medical teams working tirelessly in often under-resourced and ill-equipped hospitals. Many have never experienced traumatic war injuries.
When the crisis unfolded in Ukraine, we knew we had to spring into action and condense my 25 years of war surgery experience on the frontline into a 12-hour course for those in need.”
Henry Marsh CBE FRCS, Former Consultant Neurosurgeon at St George’s Hospital, said:
“I hope and pray that my Ukrainian friends and colleagues will not need to apply all that they learn from the David Nott Foundation webinar.
But we must do what we can to prepare them for the possible horrors ahead as Russia continues with its evil and murderous invasion.”
Thanks to Nick Southwell and Terry Hancock for providing technical support and advice on this course.