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.
David Nott in conversation with Sarah Montague
On the evening of the 30th April, David was joined in conversation with the BBC’s Sarah Montague at the Saatchi Gallery to discuss his new book, War Doctor. He was sharing stories of his work around the world in war zones and why he and Elly set up the Foundation to share his knowledge and expertise with local doctors working on the ground. Sarah asked him how many lives he thinks he's saved through his own work overseas in war zones and also through our training programme "Possibly in the hundreds of thousands," David replied.
Among the guests was actor and former doctor (of another variety) Peter Capaldi. He noted that the evening was "a humbling and inspiring experience, meeting both David and Elly."
We are delighted to report that, through the generosity of all those who attended the event, enough money was raised to provide equipment to train more than forty surgeons as well as award ten fully-funded scholarships to surgeons currently operating in war zones and disaster areas.
Melanie Feldman runs the London Marathon
Huge congratulations to Melanie Feldman who ran the London Marathon in April. She completed the 26.2 mile race in an impressive 5 hours and 41 minutes. We are very grateful for her hard work raising funds along the way.
Melanie shares her story below:
"The London Marathon is an iconic event and it was a great privilege to be able to take part with international champions and 42,000 other heroes. I’ve learned a great deal through 6 months of training and had fantastic support from my family and friends & colleagues at work. I was part of a Facebook support group for novice marathon runners and that made a huge difference to my preparation with tips and confidence building from a 7000-strong online family. Thanks go to Helen Phillips (The Cheesecake Runner)!
I feel the cold and having spent three hours at Blackheath in the blue start zone I was shivering by the time I got going 45 minutes later. The first half went well; I had been aiming to finish in around 5 hours. Seeing my family at mile 11 was a huge boost. In the second half though I started to get sore and feel sick. The mind remained excited and willing but the legs got stiffer and stiffer. I was desperate for the boost of seeing the family at mile 18 in Canary Wharf... that was the toughest section. From mile 20 I found it was more painful to walk than to carry on my slow jog. By then it looked more like a cyberman shuffle than any sort of running but I was still loving every moment of the day. I crossed over the line in 5:41.
It has been a great experience. Something completely
different to my usual life as a colorectal surgeon and mother of three. Raising
money for The David Nott Foundation and Bowel Cancer UK has been very important
to me. The fundraising has revolved around food - cakes piled up at work with a
donation box, fundraising dinners, lastly cake sales at my daughter’s school
every day in the week before the marathon.
At the end of the day I felt that 26.2 miles is hard - hard training, time away from the family, the weariness if running whilst working and still being part of a family. Half marathons should be enough from now on. But then I entered the ballot once more, so who knows? Maybe there will be another opportunity to experience it once more."
The Devizes to Westminster Canoe Marathon
A little over 35 hours is how long it took David Burton and Mattie Morgan to paddle 125 miles from Devizes in Wiltshire to Westminster in central London - a hugely demanding and impressive feat. We are incredibly grateful for their dedication to the Foundation. David shares their story below:
The Race
Amazingly, almost unbelievably…I am absolutely delighted to report that Mattie and I made it to Westminster!
We are incredibly pleased, proud
and relieved all rolled in one. It’s
still sinking in.
114th out of 145 starters, with
31 retirees.
The world’s longest non-stop
canoe race – 125 miles, 77 locks, paddled non stop. It is billed as one of the toughest endurance
events of its kind. I had quite
forgotten that bit… It requires close
teamwork between both the crew and the support group, and huge amounts of
empathy, understanding and determination.
Without it you won’t succeed.
We hit all the cut off times down
the course this time, but were slowed down by the conditions and just missed
the second tide window at Teddington on Easter Day. Which meant we had to wait until 0610 on the
Monday to set off again on the next tide, arriving at Westminster Bridge at
0900.
Conditions were pretty tough –
really hot during the day and really cold at night, thick mist and fog, no flow
on the Thames and really rough water just before Westminster. Many paddlers pulled out or were pulled out
of the race for a host of reasons. And
incredibly sadly, as you may have read in the press, one paddler died shortly
after reaching the finish.
Our time was officially circa 44:24:57…. But it was actually circa 35 hours paddling for us without the short Teddington stop-over (which put us ahead of some of the other non-stop finishers!).
The Finish and the Team
This was an amazing experience
overall on so many levels - pretty emotional at the finish; a mere 34 years
after my first finish with my very good friend Robert Martine who was there at
the finish this time too.
We could not have done it without
our amazing and ever patient support group.
Or without Simon Jones (who
amongst other things is in charge of kayaking at Bryanston School and has been
incredibly supportive of us throughout) whose amazing no-nonsense and positive
attitude towards the end helped push us to hit the final cut off time.
Or without the friends and family
who kept sending messages throughout and who also popped up from time to time
along the course – even if sometimes we didn’t actually see or hear them
because we were so tired!
And I certainly could not have done it without my very long suffering, but still very good friend, Mattie Morgan, who’s own determination and positive "can do" attitude helped pull me through on many occasions.
STAE Course April 2019
One of the key missions of this foundation is to provide specialist training to doctors and surgeons who would otherwise be unable to afford it. Our STAE courses help to meet this aim. These courses equip surgeons with specialist skills in how to work in conflict and disaster zones. Your support enables us to offer scholarships to surgeons who work in these challenging conditions. It costs £5,000 per student and we cover this entire cost through your generosity. On this course, delivered at the start of April 2019, training covered how to care for eye injuries from blast wounds, as well as a number of other elements of specialist surgery.
This course was attended by 13 surgeons from around the world including Nepal, Syria, Uganda and Chile. These are some of their stories
Introducing Lucien
Lucien Wasingya Lusenge is a general surgeon in Uganda and works in a rural area 100km from Kampala. He told us that healthcare in Kampala is expensive and not available to most people in rural areas of Uganda.
Lucien regularly sees patients with severe injuries from
road traffic accidents. He's been telling us that many of these patients die
unnecessarily because they're not properly managed due to lack of resources and
specialist skills.
Because of the STAE course, Lucien feels more confident that these patients will now have better outcomes and many more lives will be saved "Thank you for the training. I am so proud to be among the trainees".
Introducing Tula and Pawan
Tula Gupta and Pawan Bajaj Agrawal joined us from Nepal. They are both GPs and work in a rural area of the country where there are no surgeons. Being some distance from Kathmandu and the only medics in the area, they have to do everything including surgery such as orthopaedics, caesarians and trauma.
They work in a natural disaster area where there are lots of small earthquakes. Tula told us "Since the 2015 earthquake, we have been re-building the health system in Nepal. The course has been a great opportunity to learn so many things and supplement my knowledge to do even more difficult cases."
Introducing Awss
Awss Alhamadani is a surgeon working in Iraq. He had previously been on our overseas training course and came to the UK as one of our scholars to gain additional practical training. Responsible for eight field hospitals in Iraq, Awss is able to share his additional skills and expertise with his colleagues who often work with limited resources and in very challenging conditions. Aware of the impact these courses have on the provision of treatment in the hospitals under his care, Awss wrote to the both the Prime Minister and Minister of Health in Iraq recommending "that, every single person who enters into surgery, should have this course."
The scholars tell us that the way the course is organised is invaluable. "We're taught the procedure first as a whole group and then get to practice it afterwards in a small team under the supervision team of a surgeon from the Faculty Team," all of whom are expert surgeons with first hand experience of working in a conflict zone.
We heard from Vadvm who joined us from Ukraine; "This course is way beyond my expectations. It is the best thing that has happened to me in the field of austere environment surgery."
We're delighted to share these stories, and hear how our course will bring about better health outcomes for patients and save lives. Every one of our scholars works in very challenging conditions, whether it's with limited resources, personnel or in an austere environment like a conflict zone or area affected by natural disaster.
We're proud to be fully funding our scholars on the course. Through your generosity their travel, accommodation and course fees are all covered. Without your support, none of this would be possible.
Mission to Lebanon
In early March 2019, we ran a surgical mission to Lebanon with Syria Relief to support Syrian and Palestinian refugees living in refugee camps. The work done by the teams involved everything from repair of blast injuries from conflict to skin grafts for burns, as well as more routine operations.
With your support we were also able to run primary care
clinics for day-to-day healthcare issues. David also taught surgical procedures
to local surgeons in Lebanon giving them the specialist skills needed to work
with victims of conflict.
We've been hearing from one of the doctors on the mission, who told us: "This work not only invests in the local surgical team, but also provides life changing operations free of charge for Syrian and Palestinian refugees who would not be able to access this treatment otherwise."
Yemen HEST January 2019
The David Nott Foundation ran two HEST courses in Aden, Yemen in January 2019 with the support of Médecins Sans Frontières.
These two HEST courses were the first occasion that the Foundation’s whole body simulator was employed for training and supporting it was a suite of individual models of organs, blood vessels and key anatomies with which the students could train. For the obstetrics modules, the Faculty used its commercially-sourced obstetrics simulator enabling each surgeon to practise multiple Caesarean section deliveries as well as neonatal resuscitation.
Training
Covering 2-5 hours each, the courses were taken through:
- Ballistics – the effects of low velocity bullets and high velocity bullets and the four stages of a blast injury on the human body
- Primary and secondary survey
- Damage control
- Cardio-thoracic trauma – thoracotomies; lung twist and tractotomy; effects of a cardiac tamponade; pericardial sac opening; heart suturing
- Vascular surgery – ligating, shunting, patching and grafting vessels; fasciotomies; proximal and distal control
- Head and neck trauma – removal of extracranial haematoma; burr holes and craniotomies for extradural haematoma; fragment removal with depressed skull fractures; treatment of mandibular and Le Fort fractures; jaw and maxilla wiring
- Principles of paediatric surgery – differences in physiology; burns; common injuries and diseases; cultural considerations
- Abdominal trauma – laparotomies; control of bleeding; pelvic injuries and bracing; splenectomy; Cattel-Braasch manoeuvre; Whipple procedure; bowel anastomoses; ileostomy and colostomy; closure of abdomen
- Orthopaedic surgery – stabilisation by plaster of Paris; traction; external fixation; management of difficult fracture, non-union and infection; osteomyelitis; amputations
- Plastic surgery – burns; debridement and reconstruction; skin grafts; tissue flaps
- Trauma in obstetrics and gynaecology – vaginal deliveries; Caesarean sections; hysterectomies; post-partum haemorrhage with compression techniques and tamponade; perineal trauma; retained products; ectopic pregnancy; neonatal resuscitation
Students
The Faculty trained 52 students over the two courses. 20 surgeons and doctors from across the country came for the first week and demonstrated a high level of experience and skill, and engaged well with all the training, even putting some of it into use the same day once they returned to theatre. By the time the second course started the work had spread and many more than expected turned up to start, with some having to be turned away to keep the numbers manageable.
Particularly interesting was the attendance of five surgeons who had previously attended a HEST course delivered by David and team in Aden in 2016. Among those was a highly respected female surgeon; the only in Aden and possibly the only in Yemen, who had only recently qualified. In the three years since she had come to be regarded as a one of the best there and consistently impressed the Faculty. Such was her appetite to learn that she even sat in on some of the sessions in the second week to make sure it was all sinking in.
Conclusion
There is no doubt in our minds as to the value of the courses in Yemen and the evidence of and potential for making a very real difference to the surgical outcomes for patients not only treated by the surgeons we taught, but also those to whom the training, techniques and procedures can be cascaded.
The impact that the models have made is exceptional; they have transformed the course and are now invaluable training aids for almost all components of the syllabus. Both the surgeons that have trained with the models, and the David Nott Foundation faculty that have used it in their teaching, have been emphatically enthusiastic in their feedback about the value it brings to the training. Both the surgeons that have trained with the models, and the David Nott Foundation faculty that have used it in their teaching, have been emphatically enthusiastic in their feedback about the value it brings to the training.
HEST in Libya
It was the early hours of 4 March when our DNF team touched down at Misrata airport. David and Ammar were this time joined by Harald Veen, formerly Chief Surgeon of the Red Cross and now a valued addition to our teaching faculty.
Over the next three days they taught 55 Libyan doctors in the skills they need to provide the best surgical care for patients with complex injuries.
The doctors had travelled from across the country from towns including Tripoli, Misrata, Houn and Sabha. The majority specialised in general surgery but there were also orthopaedic surgeons, an obstetrician and a neurosurgeon present; demonstrating the relevance of our training programme to all medical specialities.
HEST faculty in Misrata
The course concluded with a practical workshop at Misrata Central Hospital where they put their newly-learnt skills into practice with tuition from David, Ammar and Harald on vascular, general surgical, neurosurgical and facio-maxillary techniques.
We have already had three applications for scholarships from surgeons attending the Misrata course and look forward to continuing to build our friendships with the doctors of Libya.
Yemen HEST July 2016
David Nott Foundation ran a HEST course in Aden, Yemen from 10-12 July, 2016. 43 surgeons from hospitals in Aden, Lahj, Abyan, Lawder and Shabwa attended the three-day war surgery training.
David showed the doctors how to treat a variety of complicated war injuries, principally fragmentation and gunshot wounds. There had been an increase in suicide bomb attacks and bombs placed under cars in recent weeks, causing horrendous blast injuries which David also showed the doctors how to treat.
The Foundation taught the course at the invitation of Médecins Sans Frontières (MSF) as part of their regular training for local doctors and nurses.
David said: “I was thrilled to receive the invitation from MSF to run the HEST course in Yemen and am delighted to say we have had more invitations to run courses from other aid agencies in various countries. It shows the huge importance of the work we are doing and the very real need for surgical training in war zones.”
