Serving low-resource hospitals in the DRC
This year, we were contacted by a doctor from the Democratic Republic of Congo (DRC) to set up a Friends of David Nott Foundation (FDNF) society – our very first FDNF in Africa. In a bid to support the development of African doctors in hospitals with poor resources, we provided funding for teaching tools used to upskill medical professionals in deep DRC territory.
In June 2023, a WHO report found that the number of internally displaced persons (IDPs) in the DRC has more than doubled to 6.3 million, since the end of 2022. The crisis has emerged as decades of conflict and food insecurity soars in the DRC, made worse by extreme flooding and disease outbreaks throughout the Ituri and North Kivu Provinces.
Chris Kitumaini, a medical doctor and President of our FDNF in the DRC, arranged a training course for doctors at the Murhesa Medical Center, a modest hospital with very limited resources, medical equipment and staff. He shared:
“We travelled to Bukavu, in the South-Kivu Province in the DRC, and then went onto Kabare’s deep territory to get to the Murhesa Medical Center. We picked this location to train in because it is a hospital with very low income. Resources are so limited there."
"In the operating rooms, there is nothing. Women are giving birth on wooden tables. The doctors there are working with the smallest amount of materials, no beds, no anaesthesia machines. Nothing but the doctors and medical assistants."
Basic medical skills
The surgical teaching team, some of whom had travelled from Bordeaux, taught a range of basic medical and surgical skills to a group of 20 doctors from different territories. Some had travelled from small villages to get to the training in Murhesa Medical Center.
Four courses were delivered during two intensive days of training, using surgical toolkits, mannikins and anaesthesia tools funded by us. Dr Raïssa Kizungu, a cardiologist from Bordeaux, led the management of cardiovascular pathologies in the context of war and environments with limited resources. The team used mannikins to teach the group cardiopulmonary resuscitation (CPR) and essential tools for resuscitation to preserve life in resource-limited settings. Dr Elie Bugashane, a general surgeon, led the management of battlefield wounds and suture techniques in resource-limited environments. Finally, Dr Charles Kachungunu led the management of head trauma and how to deliver excellent nursing care.
During other practical sessions, the surgeons learned how to do a craniotomy to stop serious bleeding, as well as suture techniques to manage wounds in war and low-resource contexts.
A thirst to learn
“Our first workshop, funded by the David Nott Foundation, was a success. We chose doctors and medical professionals who really needed training. It was a big moment for us.
We now want to focus on training in other places that need us the most – villages deep in the Congo forest. Learning simple procedures, like how to secure broken limbs, could really help people that cannot move to other hospital easily.”
We remain committed to supporting medical professionals living and working in countries impacted by war and disaster.
103 surgical life savers in Tripoli, Libya
We’re back from a week in the Libyan city of Tripoli after completing a first-in-our-history mission. We upskilled 103 doctors – the largest number trained on one mission – and trialled our brand-new obstetrics and gynaecology course.
Libya’s history is marked by political turmoil and civil unrest. The uprising against the rule of Gaddafi led to brutal violence against Libyan civilians and instability across the country. Today, 13 years after the ruler’s death, conflict between armed groups continues and Libya’s security remains fragile.
Outside of politics, Libya has been devastated by natural disaster. In September of 2023, heavy rain caused the collapse of two dams, leading to horrific damage and the loss of thousands of lives. Wounds inflicted by violence or natural disasters often require rapid surgical care, with a need to focus on controlling the worst of the damage first.
Surgical toolkit for any crisis
In a bid to empower Libyan doctors with skills to treat wounds caused by war or natural disaster, we partnered with the Libyan Board of Medical Specialties to deliver four surgical training courses in parallel. Over five intense days, our team of expert trainers delivered two trauma surgery courses, two anaesthesia courses and a brand-new obstetrics and gynaecology course.
According to a 2023 UN agency report, a woman dies from pregnancy or childbirth every two minutes. During conflict, women are less likely to seek maternal care and hospitals are under-staffed or under-resourced. That's why our trainers created a bespoke obstetrics and gynaecology course to help doctors better protect mothers and their babies in war and catastrophe.
During the week, we trained 103 doctors. Doctors we’d previously upskilled in Libya also joined our training faculty and led the teaching of a number of our modules for the first time. Dr Aisha Alghamji was one of them.
It really was paralysing
Dr Alghamji shared: “I remember I have a case of a 70-year-old lady. We found there was a huge bleed in her tummy. Most of her blood is – in minutes – almost drained out. It really was paralysing – what to do? She doesn’t have that much time.
"That lack of knowledge paralysed me. She is a living, human being – with dreams, hopes, a whole community. She is part of it. It keeps haunting you, that feeling. What I could do differently?"
She lost her life.
After 2018 when I attended the course with the Foundation, there is something shifted in my way of thinking. It did that thing for me, that confidence the surgeon needs to do more than their best – to run the extra mile for the patient.
I faced another case similar to it (this lady). I told immediately to me brain – ‘damage control! Damage control!’. I was able to send her home. She is alive, she is a grandmother, she is everything.”
A resilient healthcare system
Dr Moez Zeiton, Consultant Orthopaedic Surgeon and our Faculty Lead for Libya, said: “It is a privilege to have had the opportunity to lead the single most ambitious series of courses for the foundation, training over 100 doctors in a week. It was a huge effort from the foundation’s team and superb faculty to get over the line.
Candidates in Libya travelled from every part of the country with many travelling over 1000km to participate in our surgical training. Their eagerness to learn and share their own experiences was evident and they will now be equipped with the skills needed to deliver high quality care to their patients. "
This marks the beginning of continued training in Libya and a commitment to gifting doctors with extensive trauma skills to handle any challenge.
HELP US FUND MISSIONS IN LIBYA
Dr Esayas Mustefa - Becoming the calm in any storm
Dr Esayas Mustefa is the only general surgeon within a 130km radius in Ethiopia. When we trained him during one of our UK HEST courses, we knew we’d come across a very talented surgeon who would make an outstanding trainer. We’ve since upskilled Esayas to become a David Nott Foundation trainer, upskilling his peers. Here, he shares the impact of his new skills in the Afar region of Ethiopia.
Since my first training with the Foundation in December 2021, the war has been a bit calmer in Afar. There have been a few leftover soldiers, but it is calmer. Nonetheless, with the energy and resource invested in us, many patients have been helped because of my training.
Controlling bullet damage
I remember a patient with a bullet to the right of his groin. That day, I remember I was home. The emergency surgeon didn’t call me and did a laparotomy, but then decided he needed me to come in when he saw the damage.
There was an extensive haematoma (build up of blood) in the pelvis. I thought it was a vascular injury but didn’t have the proper instruments or stitches to fix it.
That’s when I did damage control.
I got proximal and distal control of the bleeding, which I learned on the course. I managed to dissect the haematoma and with the help of the other surgeon, I did a bypass. This means putting in a tube conduit that bypasses the dissection, allowing blood to carry on flowing through the vessels as normal.
We transfused him with blood and transferred him to specialist care, to have his vascular surgery. It was great.
Passing on life-saving skills
I’m also really, really happy to share what I’ve learned on the course. We have two emergency surgeons and I do my best to teach them.
They didn’t know how to do colectomies, resections, anastomoses, or some basic decision making in difficult times. I’ve taught them these things, and also when to operate and when not to operate.
Now they know to ask me – they call to ask me questions. We have a good working relationship.
The difference between life and death
I’m now also confident with abdominal injuries. I’m a better surgeon, and those I teach are better, because of the training I had with David.
Explosive injuries, I was never used to. I usually see bullets. Even seeing photos of explosive injuries used to get to me. But seeing David’s live videos in training stimulated me to be ready for anything.
Calm in a storm
In all honesty, no matter how many patients I saw or the injuries I faced – bullets, road traffic accidents – every time I opened an abdomen, I used to get nervous. No matter how much I’m used to these patients, I don’t know how to describe it. The anxiety would come.
After I met David, I thought how many years will it take me to get to that level of calmness?
But with the course, I learned to be really calm and collected in demanding situations.
For me, my patients, my future patients, and those willing to learn from me - have all benefitted from my training.
More on our latest Train The Trainers course
Training in Somaliland with 'A Woman of Firsts'
In March 2022, we were honoured to train 34 healthcare workers in Hargeisa, Somaliland. Here, our CEO Elly Nott shares how this HEST course came to fruition and how it marks the beginning of a special relationship with a very special hospital.
Over Christmas, I came across a book. ‘A Woman of Firsts’ is Edna Adan Ismail’s inspiring story of how she became a pioneering political and global health leader and campaigner for women’s rights. The respect and affection in which she is held in her home country, Somaliland, is truly remarkable and witnessed wherever one goes with her.
Building an empire
In 1998, she began building a hospital on an empty patch of land in the capital of Somaliland, Hargeisa. Through her will and determination, the foundations Edna established became a maternity hospital, which has since diversified into a major referral institution.
The Edna Adan Hospital treats obstetric, paediatric, surgical and medical cases from across the Horn of Africa. The Edna Adan University provides skilled healthcare workers to work in the hospital and other institutions in Somaliland, consistently occupying the top of the teaching league tables.
When I contacted Edna and asked if she would be interested in us running a HEST course at her hospital, she welcomed the idea straight away.
From the moment we arrived in Somaliland, we felt the warmth of Edna’s hospitality and all the inspirational healthcare workers who had travelled from across the country to participate in our training. Our outstanding faculty enjoyed sharing knowledge and techniques that would make a real difference to the participants’ management of traumatic injuries.
A need for well-trained surgeons
There is a real need for our partnership. A 2020 paper for the Lancet written by Dr Shukri Dahir et al, concluded that ‘the surgical system in Somaliland did not reach any of the target indicator goals as defined by LCoGS’ [Lancet Commission on Global Surgery]. The greatest need was for protection against catastrophic expenditure for low-income families on medical care and access to well-trained surgeons, anaesthetists and obstetricians.
The HEST course was just the start of our collaboration. In the coming months, we will welcome the doctors we met to the UK for our next Train the Trainers course. This time, they will teach alongside our UK-based faculty. We will also continue to work with the dedicated healthcare workers of Somaliland to support their training and ensure local people have access to safe, skilled surgical care.
By chance, our course coincided with International Women’s Day (IWD). A solid third of the participants in this HEST course were women and we were delighted to have the opportunity to contribute to their surgical careers. To spend IWD 2022 in the company of Edna, and the healthcare workers she has inspired and mentored, was truly an honour.
More on our HEST course in Somaliland
A lasting legacy in hospitals across Somaliland
Michael Odesoji, Surgical Nurse at St Mary’s Hospital, attended his first HEST course as Nurse Lead in Hargeisa, Somaliland. Here, Michael shares the importance of surgical nursing for improving patient safety, and how his training will make an impact right across the country.
Hargeisa was my first mission with the Foundation as Nurse Lead – and it was amazing. We trained 34 healthcare workers at the Edna Adan Hospital in Hargeisa, Somaliland.
Following David Nott’s ethos, it’s important to ask healthcare workers what they need, rather than deciding for them. Imposing knowledge without insight isn’t useful. Some of the topics the participants wanted to cover included how to form a safety checklist for surgery, emotional preparation of patients for operations, and maintaining good antiseptic techniques in the operating theatre.
With Mubarak, the Nurse Anaesthetist at Edna Adan Hospital, I led an interactive session on the importance of the surgical safety checklist for both the multidisciplinary surgical team and the patients. It resonated really well with the participants and the hospital’s surgical theatre staff.
Making a big impact
I then helped to design a bespoke surgical safety checklist for the hospital, which suited the cultural environment of Somaliland, using the WHO surgical safety checklist template. The checklist was implemented and put into use in the operating theatre before the end of the course, which was incredible to see.
Mubarak took it upon himself to champion its continued use, as well as ensuring it is implemented in every hospital in Somaliland. This was fantastic to hear, as it will further enhance patients' safety and reduce avoidable mistakes in operating theatres across the region.
I also organised a neonatal resuscitation session with the midwives and ward nurses, alongside Faculty Member, Dr Jeanne Frossard. The whole team were awesome and worked tirelessly to deliver the best possible experience for every trainee.
It was so exciting to see that the course was making a big impact in such a short period.
Moments to remember
Edna Adan Ismail, a passionate advocate for women’s health and Founder of the Edna Adan Hospital 20 years ago, was a force of nature and very welcoming. One of my best memories of the trip was when Edna and the hospital team organised a surprise birthday party for me, which was very thoughtful.
My first David Nott Foundation mission as Nurse Lead was an incredible one – and gave me a real favour for the real impact of the charity's mission. This trip was hopefully one of many.
War Doctor Heroes: Meet Dr Koma
We are delighted to feature Dr Koma Akim, a general surgeon from South Sudan, as our latest War Doctor Hero.
South Sudan is the world's youngest sovereign state, having gained its independence from Sudan in 2011.
Since December 2013, the country has been embroiled in a civil war that has resulted in the displacement of more than 4 million people, and contributed to the endemic poverty that affects 80% of the population. Conflict between nomadic people, particularly over the issues of cattle and grazing rights, has compounded the violence, yet health resources and medical professionals remain scarce.
Dr Akim is one of only a handful of general surgeons in the country, and regularly deals with gunshot and arrow wounds as a result of cattle rustling. Those who make it to his hospital are often in a very bad way, suffering from internal bleeding and broken bones. Without any advanced orthopaedic instruments, Koma must often treat these fractures non-operatively, even though his patients would benefit from external fixators or skeletal traction.
Alongside his work in the district hospital, Dr Akim has also undertaken humanitarian missions in Ganyiel, in the Unity State of South Sudan. Koma recalled performing an emergency C-section for a retained second twin in the midst of the fighting here. In spite of the high maternal mortality associated with this complication, Dr Akim was miraculously able to save the lives of both the mother and her two babies.
These experiences motivated Koma to learn more and enhance his skill set, so that he could continue to alleviate the suffering of ordinary people in his country.
In 2019, Dr Akim attended our London based Surgical Training for the Austere Environment course (STAE). On this training programme, he learnt how to properly expose blood vessels and said “being able to practise it means I have the confidence to do it in a real situation. If I can do it, I can teach it.” This skills-sharing is a vital part of what we as a Foundation hope to achieve. By training one doctor on our course, we give them the knowledge and skills needed to teach countless more.
It is Koma's ambition to become a role model for the next generation of South Sudanese doctors. He hopes to inspire more to become surgeons in order to better serve the people of war torn South Sudan and told us that "my skills and theirs will be more needed here, in South Sudan, than anywhere else in the world."
To help us train more surgeons like Koma, you can make a donation here.
War Doctor Heroes: Meet Dr Lucien
Our global network of #wardoctorheroes is at the heart of everything the foundation strives to achieve, and we are proud to introduce Dr Lucien Wasingya Lusenge from Uganda in this latest instalment.
When Lucien was just 3 weeks old, he contracted a febrile disease and his health deteriorated rapidly. His family were beginning to lose hope, and he was referred to another hospital 20km away.
It was here that a volunteer from MSF correctly diagnosed Lucien and successfully treated him in under a week. Lucien's father told him this story dozens of times as he was growing up, inspiring Lucien to become a surgeon and dedicate his own life to saving others.
In April of 2018, the Foundation awarded Lucien a scholarship to come to London and attend our specialised course, Surgical Training for the Austere Environment (STAE). The course greatly boosted Lucien's confidence in dealing with trauma patients and improved his decision-making skills for surgical emergencies. Lucien said, "After only five days, I was able to gain the confidence to handle surgical, obstetric and gynaecological emergencies with limited equipment and resources."
The skills learned on this training course have enabled Lucien to save the lives of countless people, including many victims of traffic collisions on Masaka Road, a dangerous stretch of highway that claims 200-300 lives annually.
In September, Lucien was able to journey to London once again to present his research, and paid David Nott a visit, to thank him in person.
The courage, dedication, and selflessness of doctors like Lucien inspires everything that the Foundation works for, but we cannot do it alone. You can help us to train even more surgeons and save more lives by donating today, and spreading awareness.
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.
