80 surgeons and anaesthetists upskilled in Kyiv, Ukraine
Our new Chief Operating Officer, Tim Law, recently returned from his first mission. Tim supported our trainers to deliver two surgical training courses in Kyiv. With logistical support from our partner World Health Organisation (WHO), 80 surgeons and anaesthetists from frontline cities learned how to treat mass trauma injuries using world-leading surgical teaching models.
To continue upskilling Ukraine’s frontline doctors, our team embarked on the challenging journey to Kyiv, first flying into Poland and travelling by bus to our final training location two days later. Despite a temporary bus breakdown in scorching heat and consequent concerns about entering Lviv before curfew, our trainers arrived safely in Kyiv and began preparing teaching materials, tools and models for the arrival of more than 80 Ukrainian doctors.
Over six days, our faculty of trainers delivered two condensed hostile environment surgical training (HEST) courses, rich in trauma surgery teachings and practical sessions.
This year, we expanded our course to include anaesthetics – a vital component of trauma surgery care. During this mission, two new faculty trainers, Dr Ian Tyrrell-Marsh and Dr Tom Dolphin, led our anaesthetics module and upskilled 22 anaesthetists from across Ukraine.
Doctors united in learning
Although united by a shared desire to manage catastrophic injuries, attendees came to our training from different Ukrainian cities.
Tim Law, our COO at the Foundation, shared: “Participation in the course was designed such that about two thirds of doctors came from front-facing oblasts or provinces. They came from Zaporizhizhia, Dnipro, Kyiv and beyond. Most of them were based in civilian hospitals.
A lot of their cities are subjected to bombardment on a reasonably regular basis. As we’re still seeing in the news, attacks lead to casualties of war, some of which are military, but many are everyday people.
Often civilian hospitals treat both civilian and military casualties, as many frontline fighters are transferred from military hospitals to make space for the next round of injured.”
Unrivalled education
Witnessing my first surgical training course in action – there is no doubt it is world-leading education.
"It was fascinating to be able to see the real value that the David Nott Foundation can add to the skills of medical professionals forced by circumstance to react to the challenges presented by armed conflict. It’s world-class education delivered by seasoned practitioners, and based on years of accumulation of course materials and conflict-specific skills.
The combination of experience within the training faculty, course material quality and the practical sessions with Heston, our human body war wound simulator, enables demonstrations that otherwise aren’t possible in Ukraine,” continued Tim.
Cadavers cannot be used for teaching in Ukraine, and our war wound model has been described by surgeons as even more effective than cadaver training.
Some shared that they’ve never had access to such state-of-the-art materials and were excited to be able to take our hand-made silicone hearts back to their hospitals to continue their practice of cardiac suture repair.
Remnants of war
Although the likelihood of active conflict in Kyiv has lessened, remnants of war can be seen in and around the city. Air raids are a common backdrop, often ignored by locals as they try to continue with their everyday lives.
On the road from Lviv into Kyiv, you can see signs of Ukrainian defence. Minefield markings, skull and cross bone signs and string between trees signpost dangerous land.
On the anniversary of Ukraine’s independence, approximately 40 Russian military vehicles had been lined up along the main street. A sign that although life goes on in Kyiv, national pride and the community’s acknowledgement of their country’s continued battle remains.
“We aim to continue to develop this world-class training, such that we can continue to deliver training in the world’s most challenging environments, enabling medical professionals to enhance their skills whilst remaining close to where they are most needed", shared Tim.
"We will develop our offering to include new modules on hospital management and surgical nursing and are in the process of building a second synthetic full-body simulator and of increasing the scale of our teaching faculty. Taken together, this should enable us to increase the scale, scope and quality of our future interventions. Thank you to our supporters for helping to make these dreams a reality.”
This World Humanitarian Day
This World Humanitarian Day, we reflect on our commitment to the humanitarian values that inspire our work - training medical professionals to provide safe, skilled surgical care in countries impacted by conflict and catastrophe.
Our flagship Hostile Environment Surgical Training (HEST) course continues to provide the best in surgical training to those who need it most. Using innovative teaching materials such as our prosthetic hearts, kidneys, arteries and veins, our world-class trauma surgery modules are brought to life by the remarkable, talented training faculty who deliver it. We are so grateful to our team of trainers who give up their time to share knowledge with doctors around the world. We know they also learn as much from them in return.
In addition to training surgeons, we have developed an anaesthesia module, expanding our focus from the surgeon to the wider - any equally important - operating theatre team. As with surgery, conflict presents unique challenges for anaesthetic practice including severe blast injuries, blood loss and resource constraints.
I was inspired to start our Foundation by a single, grainy photograph of David.
In a room in a hospital in Aleppo, lit solely by the steady beam of a projector, he was discussing cases with a group of Syrian doctors at the end of a day of operating. I started thinking how that life-saving training delivered by David in Aleppo, built on decades of frontline experience, could be brought to hundreds, perhaps thousands, more doctors.
David’s unwavering connection with the doctors of northwest Syria goes back a decade and when the devastating earthquake hit southern Türkiye and northwest Syria in February, we immediately started discussing with local partners and colleagues what they were seeing and how we could help. It rapidly became clear that thousands of survivors were left with life-altering injuries in need of surgical treatment and rehabilitative care.
Thanks to expert navigation of local permissions by our partners, we were able to run a joint teaching and operating mission with Action for Humanity in Aqrabat Hospital, Idlib. The Action for Humanity team saw 300 patients in clinic before completing 60 surgeries the following week. Above the operating theatres, we equipped 35 Syrian doctors with the surgical techniques they need to treat complex injuries inflicted by the earthquake or ongoing conflict.
Ninety percent of our training faculty on the mission were Syrian and based in the northwest, therefore able to better understand local health system challenges and teach the course in Arabic.
Sustainability is vitally important to us; we want surgical knowledge to be embedded in communities to the extent that it is self-perpetuating and we are no longer needed. Until it is, we’ll keep returning as long as we are needed, No Matter What.
As a small charity, we are able to deliver so much more in terms of training and value for our donors’ money by partnering with other humanitarian organisations like Action for Humanity. Our training partners are diverse in scale and size. We delivered training in Moldova with the World Health Organisation and for Yemeni surgeons with Médecins Sans Frontières. We are excited to collaborate with MedGlobal in the coming months, and in Ukraine, were proud to partner with our friends at UOSSM, a charity initially formed to provide relief and assistance to Syrian civilians affected by the deadly conflict there.
Unfortunately, risks for humanitarians and attacks on healthcare have increased in recent years.
Last week, Physicians for Human Rights reported that 1014 attacks have been perpetrated against Ukraine’s hospitals, health workers, and other medical infrastructure since February 2022. Recent Elrha research also revealed that attacks on Syrian health facilities have deterred people from accessing health services and seeking help when needed.
Every hospital bombed, every healthcare worker killed, denies people vital care and destabilises communities both physically and psychologically. These atrocities are under-reported and we are honoured to support the campaigning efforts of Action for Sama, seeking to raise awareness of and ensure accountability for attacks on healthcare.
We believe in safe, skilled surgical care for all and stand with the communities we serve, No Matter What.
Elly Nott, Co-Founder and CEO
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
Hospice Ukraine raises over £50,000 to better serve the terminally ill
Photo credit: Hospice Ukraine and the Royal Society of Medicine, London
As part of a special Hospice Ukraine event raising funds for palliative care in Ukraine, our Co-Founder David Nott was invited to share his reflections of upskilling over 200 Ukrainian doctors during eight missions, and the importance of fighting for continued holistic healthcare - from the beginning of life to the end - during war.
Since Russia’s violent attacks against Ukraine began last February, the Ukrainian people’s access to healthcare has suffered immensely. We know conflict leads to reduced medical equipment, medicines, specialist care and hospital staff numbers. Despite our mission focussing on saving lives with skilled surgery, palliative care for the terminally ill remains of equal and vital importance.
Hospice Ukraine is a charity that believes everyone deserves access to high-quality palliative care, no matter where they live. But the upheaval of war has overwhelmed the ability of Ukrainian healthcare professionals to support those nearing the end of life.
To better provide comfort, dignity and care for the terminally ill, Emily Maitlis and Jon Sopel came together at the Royal Society of Medicine in London to host a special fundraiser organised by palliative care doctor, writer and Co-Founder of Hospice Ukraine, Dr Rachel Clarke.
When asked how David copes working in war zones like Ukraine, he shared: "Humans become incredibly resilient under pressure. It's what we train (during our courses too). We're not going to waver, we'll be here for our friends in Ukraine until this war is over."
David was joined by fellow speakers such as writer and comedian, Adam Kay, and world-renowned former neurosurgeon, Dr Henry Marsh, who holds deep connections with doctors and academics in Ukraine. Guests also heard a selection of beautiful songs from a Ukrainian refugee choir now based in the UK.
Speaking of the remarkable ability for the terminally ill to exude love and concern for others as they near death, Adam Kay shared, "The thing I realize (during a 2-hour conversation with a patient) is that none of her many concerns are about herself; it's all about the kids, her husband, her sister, her friends. Maybe that's the definition of a good person."
A live auction, which included a piece of work donated by Grayson Perry, led to a final fundraising figure of £50,000. We will continue to advocate for healthcare excellence and the people of Ukraine, for as long as this war wages on.
“The need in Syria is astonishing”
We’ve just returned from northwest Syria after training 23 local doctors to surgically treat complex wounds caused by the earthquake that shattered parts of Syria and Türkiye in February. Our CEO, Elly Nott, shares her reflections of our latest mission and how we will continue to stand with Syria.
As soon as we crossed the border into Syria, fields of olive trees stretched as far my eyes could see. Row after row, the trees continued until we reached Atmeh.
Our destination was Aqrabat Hospital, where I was leading a surgical mission to train local doctors to provide specialist orthopaedic and plastic surgical care to the survivors of February’s devastating earthquake.
The need for our training is astonishing.
After hearing that ours and Action for Humanity’s specialist doctors were visiting, a staggering 2,000 people sought care at the Hospital.
Action for Humanity’s team, who led the operating arm of our mission, saw 300 in clinic and were able to surgically treat over 60 patients over a week period. At the same time, in rooms above the operating theatres, we taught 23 Syrian doctors with the skills needed to treat complex trauma injuries inflicted by earthquakes or the ongoing conflict. Our team also taught nine Syrian surgeons to become David Nott Foundation trainers themselves, leaving a lasting legacy of shared knowledge and confident doctors in Syria.
Aqrabat sits in northwest Syria and is supported by a remarkable network of civil society organisations and NGOs. Despite this, the region is vulnerable. The hospital serves a population of around four million, the majority of whom are dependent on humanitarian aid. Some 2.6 million of residents have already been forcibly and repeatedly displaced from their homes by the conflict from places including Ghouta, Dara’a, Homs, Aleppo. Families faced food and fuel shortages and health challenges including a cholera outbreak. The recent earthquakes have added further pressure to weakened economies and healthcare systems across the country.
As conflict and the effects of the earthquake continue to fuel instability, we must not abandon Syria.
Speaking to doctors we’ve trained, it’s clear our mission has had a lasting impact. Many have commented on their restored confidence and others that they now feel better equipped to treat those most in need.
A personal highlight for me was meeting Syrian doctors who had learned from, met or heard about my husband and Co-Founder, David Nott. Many had operated alongside David in underground hospitals in Aleppo while the Assad Regime and its Russian allies bombed the east of the city relentlessly in 2013 and 2014. Their connection with David, despite the passing of years, reinforces just how powerful shared knowledge is.
Our Faculty Director for this mission, Dr Ammar Darwish (pictured below), who is originally from Syria, shared:
‘Going back to Syria was one of the happiest days of my life. Crossing the border and seeing Syria again, with all the sadness and monstrosities that have happened, there’s still a sense of happiness, a sense of pride. It was a very special feeling. Training the doctors there and seeing those we’ve worked with and taught before was something else. It put tears into our eyes.’
Northwest Syria faces vast challenges. We cannot remedy a decade of pain, but we can continue to arm surgeons with life-saving skills and show them that we stand beside them.
We’ll be back to train more doctors soon.
Elly Nott, Co-Founder and CEO at the David Nott Foundation
“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
Earthquake causes widespread devastation in Turkey and Syria
We are appalled by the devastating earthquake which struck northwest Syria and southern Turkey. It is apparent that there has been destruction on an enormous scale and a correspondingly huge loss of life.
The people of northwest Syria have endured enormous hardship during almost thirteen years of conflict. The health system in northwest Syria was already fragmented and under strain and this will stretch it even further.
Rescue efforts have been mounted by the White Helmets and the locally-led NGOs that have sustained the northwest for the past decade have commenced a humanitarian response. The scale of the disaster demands an international response, yet in northwest Syria there is no state capacity to resource and lead it. All efforts must be made to keep aid travelling swiftly through the Bab al-Hawa crossing, the last UN-mandated border crossing between Turkey and northwest Syria.
Our Foundation is deeply proud of the close links we have with Syrian healthcare workers. In Gaziantep, Idlib and Aleppo, we have trained Syrian doctors in both lecture and operating theatres. We stand in solidarity with all those in Turkey and Syria affected by this catastrophe and are ready to help in whatever way is constructive and helpful to our partners.
Training anaesthetists in war zones
Dr Elma Wong is a consultant anaesthetist in Worcestershire Acute Hospitals NHS Trust. For the past ten years, Elma has taken several months of unpaid leave to volunteer in conflict zones each year. Elma and a small team of faculty recently returned from training 71 doctors in the Ukrainian cities of Poltava and Zhytomyr. Here, she reflects on her experience after delivering our first-ever anaesthetics HEST course module alongside Dr Rachael Craven.
After a decade of volunteering in war zones, Elma knows all too well how important education is. When she heard we were looking to deepen our impact by upskilling anaesthetists in conflict zones, Elma jumped at the chance to get involved.
“I’m interested in building up local workforces, making communities in conflict more sustainable. It’s about the longevity of the impact you want to have in a place.
The biggest gift you can give to a healthcare worker in a conflict zone is self-sufficiency – the dignity to be able to do everything themselves. It’s important to empower people to look after their own patients. A job well done is ultimately making yourself redundant.”
Training anaesthetists in war zones
“I first heard of the Foundation after reading War Doctor. As a fellow humanitarian, I could relate to David’s experiences. When I heard the Foundation wanted to develop an anaesthetics training module, it felt like a great fit for me.”
In October, Elma, David and a small team of trainers travelled to Poltava and Zhytomyr to deliver two HEST courses – Elma’s first time in Ukraine since the war began.
The team flew to Warsaw and with the support of our partner, UOSSM International, crossed the border before driving for most of the day to eastern Ukraine.
“During our first course in Poltava, there was a lot of unknown. We designed the module ourselves but didn’t know exactly who we’d be training or how it would be received.
In the end, we trained around 10 anaesthetists in Poltava and 12 in Zhytomyr and it was wonderful - I think they found it refreshing to have dedicated trauma training with practical advice. They were really excited to handle different kit and learn new techniques.”
Adapting in conflict
When it comes to war anaesthetics, there are two main considerations. Firstly, the injuries anaesthetists face in war are starkly different to cases seen in the west.
“Blast injuries from explosives are devastating to the body. Patients can have multiple life-threatening injuries and lose so much blood. The priority is stabilising the situation and giving blood.
We taught specific techniques for giving drugs and blood via the bone (intra-osseous), for when you can’t find a blood vessel. Many had not used this life-saving equipment and really benefited from learning this skill.
Many of these cases would need care on the intensive care unit - supporting patients with complicated head and lung injuries on our breathing machines and giving dialysis therapy to people with kidney failure as a result of crushing injuries.”
The other consideration in a war setting is reduced resources. Hospitals may be faced with electricity cuts or low oxygen supplies.
“We trained the groups on alternative anaesthesia machines - very different to ones we use in our hospitals here. They are portable enough to fit into a bag or small case and they can be life-saving in critical conditions - when you don’t have electricity or oxygen yet need to perform emergency operations.”
Teaching the group how to use basic machinery, available in most hospitals, will help them continue to save lives despite slashed resources.
“The rest of the world hasn’t forgotten you”
“Often, I think when you are stuck and living within conflicts, you feel the rest of the world has forgotten you.
But seeing people travel far distances to come and help, standing in solidarity with them, I hope shows them some humanity."
Contemplation on safe ground
“It can be challenging dealing with the trauma of what you experience on missions. Often its worse when you get back home and have time to process things, devastating things you’ve seen.
The more missions I’ve done, the more I realise the importance of looking after yourself. Finding time to have breaks, even on busy missions. In Yemen, we were working and living in the hospital. Each day around 5pm I would try and go to the roof for 10 minutes to take in some fresh air, watch the sunset, whilst listening to the atmospheric call for prayer from the nearby mosques. It was time just for me.
The important thing is to be kind to yourself - and ask for help when you need it.
When reflecting on my time in Ukraine, it’s difficult to know quite how to describe how I feel. ‘Privileged’ comes to mind – for being able to work hand in hand with people on the ground and support them as best I can.”
More on our training in Ukraine
Photographer: Annabel Moeller
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