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.
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.
Another successful STAE course
This month, we were honoured to train 14 doctors from Afghanistan, Syria, Palestine and Ethiopia on our latest Surgical Training for Austere Environments (STAE) course. Over five days, the group participated in bespoke surgical workshops, specifically designed for treating traumatic – and often unique – injuries caused by war and catastrophe.
Starting the week off in Brighton and Sussex Medical School, the participants practiced an extensive range of cardiothoracic procedures, such as fast and efficient thoracotomies (gaining access to the chest), heart repairs and how best to manage injuries to the lungs.
Aided by videos taken by our Co-Founder, David Nott, during overseas missions, the group also learned how to repair blood vessels – a vital skill for managing severe blood loss.
Equipped for every emergency
As the week progressed, every doctor was exposed to a different but equally vital field of medicine, from plastic surgery to orthopaedic trauma. This is key, as we know war and catastrophe can present patients with often varied and complex injuries.
In conflict for example, it is not uncommon for junior doctors to be the only healthcare workers left in hospitals. This means they need to step into a number of roles, from cardiothoracic surgeon one day to paediatric specialist the next.
New obstetric simulators
On the last day of training, the participants completed a range of obstetrics workshops in the beautiful new facilities of the Royal College of Obstetricians and Gynaecologists in London. Using our new simulators (pictured below), the group refined their C-section techniques and learned how to address emergency scenarios, such as breech births or neonatal resuscitation.
Listening and learning
We were honoured to be joined by doctors from Palestine, Syria, Afghanistan and Ethiopia, and each country is recovering from - or still facing – conflict. To ensure we continue to deliver the highest quality training and meet the needs of our doctors, we listen to participants’ experiences of their home countries.
Dr Naseebah Nayef left Syria in 2013. She shared with us: “(During the war) I treated Syrian protestors in my private practice. Post-that, my house was bombed, and I had to flee with my three children from Syria. I am so very, very grateful for being a part of this course.”
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.
Training of Trainers: Future-proofing the Foundation
Last weekend, the David Nott Foundation invited 24 leading surgeons to London to attend a Training of Trainers course. The aim of the course was to introduce each surgeon to the HEST Course, with the hope that many will want to travel to conflict zones with the Foundation to teach it.
The Foundation receives many requests to run HEST courses, in so many locations affected by war. By expanding our faculty, we can reach more of these places in a timely manner.
The 3-day course was held at the iconic Wellcome Collection, a monument to the health sciences in Central London. Our extant faculty, led by David Nott, took participants through the different modules that comprise the HEST course. By the end of the weekend, participants felt ready to teach the course overseas. One participant said:
"David and colleagues have lots of experience and I am in awe of what they have been able to achieve. The practical tips in management of patients in humanitarian settings are equally valuable for trainees and established consultants in this country. "
Interspersed with surgical modules was discussion of the practicalities of attending humanitarian missions:
" I found the session delivered by Mr Hakimi on the practicalities of what to expect when travelling and working in countries where HEST is being delivered to be excellent and insightful."
We were additionally delighted to welcome students from the Friends of the David Nott Foundation Societies to the course. Delegates from Manchester, Leicester and Queen's University Belfast came to get a taste of their future humanitarian careers.
Training the Trainers has allowed us to invigorate the Foundation with new and enthusiastic teaching faculty. The DNF is poised to return to in-country HEST courses future-proofed and with more courses than ever.
Operating and Teaching in Yemen: an Interview with David Nott
In April, David travelled to Yemen with Ammar Darwish, Mounir Hakimi and Asan Raffee to deliver both teaching and hands-on surgery in the World's worst humanitarian crisis. Below is a short interview that we conducted with him on his return.
How did this trip come together?
It came about with a telephone call from Syria Relief. Mounir Hakimi (of Syria Relief) had been in contact with several of the doctors who had been working in Marib. They were operating on a large amount of cases and they wanted help. Some of the surgeons who were there had difficult wounds or injuries presenting, and they wanted advice and teaching on how to cope with those injuries. That was how we heard about it.
The Syria Relief - DNF Team break their fast in Marib.
What did you see of the city of Marib?
It was pitch black at night when we arrived. We landed in Seiyun and it was a 6 or 7 hour drive to Marib. We arrived very early in the morning and went to a hotel local to the hospital. A few hours later, in the morning, we went to the hospital and were very much welcomed by the medical team working there.
What was the hospital like?
We had a very nice tour around. The Medical Director was extremely enthusiastic in showing us exactly what they had been able to continue to do. They had a very good blood transfusion bank, they had very good blood chemical laboratories. They had an intensive care unit, they had well-stocked theatres and they had a good array of back-up support. There were a lot of nurses on the wards.
At the time, Marib was becoming the epicentre of the civil war. Could you see that that hospital and its staff had been affected by escalating conflict within and around the City?
Yes. It was the epicentre. And it still is. The fighting is intense. Probably about 15km north of Marib. At the moment, Marib has about two million refugees and it is very densely populated. The fighting is continuing and obviously the hospital that we were in was the frontline hospital to accept all those casualties that were wounded. Both civilian and non-civilian.
We heard jets going over the top and we also heard rockets coming into Marib. You were aware that you were in a very hot war zone.
Who did you meet at the hospital?
Some were senior doctors. Some had just come in the last couple of months from Egypt to help out. There were quite junior doctors. There were those that required quite a lot of teaching and understanding of how to manage injuries. The hospital had stopped almost all of its elective surgeries. They were focusing purely on the war-wounded patients. Unfortunately those patients that had cancer problems weren’t really dealt with at this time.
Which case stands out the most in your memory?
I think the case that stood out most was after the teaching we gave the night before on gunshot wounds to the chest and abdomen. The surgeons had never done a thoracotomy before for a gunshot wound to the chest. The following night we were called back to the hospital with a surgeon who had watched our lecture and we found there was a patient who needed a thoracotomy. Because we were there, we were able to show him exactly how to do it and exactly how to extend this incision onto the abdomen and do a thoracoabdominal procedure. The patient did extremely well and thanked us a couple of days later.
We discussed a lot of reconstructive work. Most of the flaps that we discuss on our HEST course, we did in Marib. There was a lot of surgery done with a view to the surgeons being able to do that kind of surgery when we left.
Going forward, what do you think the Foundation's work in Yemen is going to look like?
I think that we will be going back to Marib, and I think we will continue to go back and support them both with teaching the DNF HEST course and perhaps this time taking our models with us as well so that we can run a course during the day or the evening and then operate as well. I think the future of the DNF is operating as well as hands-on teaching as well as the classroom for some courses. The future lies both within the operating theatre and the classroom.
I think we had developed a significant rapport with the doctors such that I heard recently that they desperately want us to go back again to show them more and more. I think that is the perfect opportunity for the DNF to show what it is worth really.
This mission epitomised what the DNF is all about. The DNF goes out to the field, it saves lots of lives as well as teaching the doctors so that they can continue to save lives. The DNF leaves a legacy.
You can read Ammar Darwish's story of the mission here.
David Nott and Ammar Darwish Return from Yemen Mission
Surgery on the Frontlines of the Yemen Civil War
Ammar Darwish's experience of operating and teaching in the world's worst humanitarian crisis.
"The Yemeni medical staff in Marib sent a call for assistance as they have been extremely overwhelmed with injured patients from the war"
David and Ammar were called up by Syria Relief to assist the medical staff in the city of Marib, who were facing an unprecedented number of patients injured in the intensifying conflict of which the city had become an epicentre. The team left London excited to get back to their roots, operating in areas of conflict and austere environments.The team left London ready to begin the long journey to Yemen, where they would meet with Syria Relief - a charity that provides support to Syrians needing medical intervention, food, education and other necessities. The team arrived at Seiyun airport in Yemen, and travelled through the night to reach the hospital in Marib that was to be their home for the next two weeks.
Marib is just 10 or 15 kilometres from the front-line of fighting, a grim reality that was ever-present as the team arrived and changed immediately into their theatre clothes.
After meeting the local medical team David, Ammar, Mounir and Dr Asan Rafee had a quick tour and then immediately started working. For the patients at this trauma centre, there was no time to lose.
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"This is one of the first operations that we dealt with. A gunshot wound to the abdomen in a young man who was left in a state of shock. He bled a lot and we had to do a trauma laparotomy and damage control surgery. We operated on him immediately.
David is just behind me in the background. He is getting ready to go to another theatre to deal with another case."
Although the local surgeons are very experienced, they have not dealt with many of these cases before. David and Ammar spent many hours training the local surgeons, imparting their years of knowledge gained through war surgery and taking them through complex operations.
They opened the chest to stop the bleeding, performed damage control surgery and took the patient into intensive care. All the while, David and Ammar were teaching their local counterpart how to perform this procedure, and to deal with these injuries.
After 7 days, the patient was discharged. His life had been saved.
"This is the team after a long day of operating, dealing with different kinds of injuries. We sat down, I think it was almost 8 O'clock in the evening to break our fast after a long day of operating - I think 12 or 13 hours of operating".
"When everything had calmed down, especially at night, we used to give teachings. David gave lectures on different kinds of injuries and how to manage those injuries. David did the main teaching, and Mounir and I helped to translate".
The team did around 45 operations in Yemen. This ranged from life-saving trauma surgeries to complex reconstructive surgeries.
They returned home to the UK ready to deploy again as soon as possible, to wherever they are needed.
The mission itself was organised and conducted by Syria Relief. Head to their website (https://syriarelief.org.uk/about-us/) to learn more about them.
April 2021 Newsletter: 10 Years of Conflict in Syria
10 Years of Conflict in Syria
Welcome to the David Nott Foundation’s April update. To those observing, we hope that you had a restful Easter and were able to come together with loved ones to celebrate. Today, we at the Foundation have been profoundly saddened by the new that His Royal Highness The Prince Philip has passed away. We wish to express our deepest condolences to Her Majesty The Queen, and the Royal Family. It has now been ten years since the civil war erupted in Syria. The price paid over the last terrible decade by Syrian civilians is incalculable, and millions still reside in vulnerable, crowded camps. Children have lost schools, friends and family members. So many thousands have lost their homes, businesses and loved ones. Hospitals, deliberately targeted by the Syrian regime now struggle to cope with the COVID-19 pandemic. As a show of solidarity with the Syrian people, the David Nott Foundation dedicated our social media accounts to small NGOs, individuals, civilians, humanitarians and journalists who have lived experience of the civil war. We hoped to provide a platform through which to amplify these voices. We encourage you to look back through our Tweets and Re-Tweets (@NottFoundation) to read first-hand accounts of the atrocities and reflect on the profound loss that we all feel after ten years of conflict. The David Nott Foundation has taken our HEST course to Syrian surgeons before, and plans to again soon. You can view an interactive map of where we have taken our training course by visiting the ‘Overseas Course’ section of our website. Good luck to our RPHM RunnersWhile we’re on the subject of challenge running events, the Foundation would like to wish good luck to our Royal Parks Virtual Half Marathon runners for the 11th of April. We asked some of those competing to raise money for the DNF what inspired them to do so:
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