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.
CONTAINS GRAPHIC IMAGES OF SURGERY
"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.
"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."
"Again, another abdominal injury to a patient. We are doing an emergency trauma laparotomy and treating the patient. David, Myself and one of the local surgeons".
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.
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."
The Mail on Sunday: My secret mission to save Aleppo’s babies of the blitz
David Nott writes for The Mail on Sunday
Of all the wounded children of Aleppo who passed before me, the memory of one has lodged in my mind like no other. Maram. I spent the week before Christmas in a field hospital in Syria operating on many tiny souls see-sawing between life and death, their bodies held together with metal pins and scaffold-like fixators.
But in Maram, a five-month-old orphan and beautiful despite her injuries, I saw my own child and, perhaps because I missed her so desperately, I felt intensely overwhelmed.
I have made numerous trips to Syria to treat the casualties of this war, but none was as sorrowful as the week I spent with Aleppo’s children. Bone-weary and drained emotionally, I returned to London on Christmas Eve and couldn’t wait to hold my 17-month-old daughter and see my wife and family. Christmas was a joy.
Yet Maram was never far from my mind’s eye: a haunting, residual memory that I could not have shaken even if I had wished; I find myself waking in the early hours worrying about her. I first saw Maram on December 20, a few days after she was evacuated from Aleppo in an ambulance. Her legs and left arm had been shattered in a bomb attack that killed her parents and injured her brother and sister.
Pieces of ordnance shell were embedded in her infected wounds but, because the Aleppo doctors had run out of dressings, disinfectant and saline, they had no choice but to operate on her dirty body tissue. As I looked down at Maram on the treatment table she was crying, not because she was tired and hungry, even though she was both, but because she was in great pain.
There are no paediatricians in Aleppo, or at the hospital where I was working; nobody qualified to make the very difficult decisions about how much analgesics and fluids to dispense. So in spite of all her suffering, Maram was simply on a small dose of paracetamol. It was heartbreaking. I checked her charts. In the UK, these would have been filled in with scrupulous attention to detail, but in Syria, with doctors battling to save the lives of so many, charts were overlooked. I couldn’t even tell what medication she had already received.
Maram wriggled uncomfortably. I tried to think logically about how to help her and what I’d need to do when I operated on her the following day. But precise thought was difficult as I felt myself experiencing the same sort of emotions that any father would have towards a wounded child.
I operated on December 21, carefully debriding Maram’s wounds and removing the decaying tissue inside her. The whole hospital stank of the bacteria that had caused her infections, and those in other patients. I worked delicately around the open compound fracture Maram had suffered in her left leg.
Correctly in my opinion, the surgeon who had operated on her in Aleppo had applied an external fixator, but this was so big and heavy that Maram couldn’t move her leg when she was awake. It was so sad to see. She also had a pin in her femur and another in her tibia, and she had a really big gap of leg bone missing from the explosion.
Read more here.
Skype Blog: The first ever known surgery over Skype with Dr. David Nott
Skype was developed in 2003 to help people stay together, no matter where in the world they happen to be. Since launch, we’ve discovered many weird, wonderful and original ways that people use video calling. From pet sitting to interior design. From working out to personal stylist advice—people really do use Skype in the most creative ways.
Recently, we came across the The David Nott Foundation, a UK-based charity which gives surgeons and medical professionals the skills they need to provide relief and assistance in conflict and natural disaster zones around the world.
Founded by Dr. David Nott and his wife Elly, The David Nott Foundation’s main focus is to improve the standards and practice of humanitarian surgery in conflict and catastrophe areas around the world. Both are passionate about helping those less fortunate than themselves and their efforts in treating victims in areas of catastrophe goes from strength to strength. We caught up with Dr. Nott, “the Indiana Jones of Surgery”, and found out how Skype features in their mission to help surgeons develop their skills for warzones—and how he and his wife started volunteering their time:
“I started in Sarajevo in 1993. I watched a film called The Killing Fields with my Dad and I had a fascination about different places and helping people. The film was about a friendship between a journalist and a local interpreter in Cambodia during the civil war but essentially about people helping each other. And then something sparked in my head, that I’d like to do something like that myself. When I became a consultant, the first thing I did was to volunteer my services to Médecins Sans Frontières in Sarajevo. I should have only stayed for a couple of weeks but I ended up staying for three months.”
Dr. Nott tells us how technology and Skype came into the picture. “In 2007, I believe I was the first person ever to receive details of how to perform surgery via text messages in the Congo. This was when a friend of mine texted me the procedure of how to take off somebody’s shoulder and arm. This was in the Congo, in the middle of a jungle, without any help or anything!”
And then after surgery by text message, came the first ever known surgery performed over a Skype video call.
Surgeons in Aleppo sent me a picture of a man whose jaw had been blown off by a fragment in a bomb blast. They asked me what they thought they could do. I took the pictures around to several of my colleagues to get their opinions on what they thought was the right thing to do to fix it. The doctors in Aleppo had never done this sort of operation; they’d never mobilized a myocutaneous flap (which is a muscle and tissue flap that rotates into the neck). They’d never mobilized a muscle before either, so that’s where Skype came in. They had a phone attached to a selfie stick so I could view everything. The operation started at about 8 in the morning and went on until 4 in the afternoon. It was very complicated but it worked 100%. Using Skype was fantastic because it allowed me to see what they were doing in real time. I was telling them which bit to cut, which bit not to cut—I directed them all the way through, from the moment they picked up the knife to the moment they put in the stitches.”
Read the full article here.
The Times: Surgeons save Syrian lives by Skype
The messages arrive at all hours of the day and night, the vibration of a mobile phone signalling that another life hangs by a thread in Aleppo.
For the renowned British trauma surgeon David Nott and other doctors in London, Seattle, Washington and West Virginia, the Russian-backed onslaught on the city has been a daily reality.
They are a loose network of doctors who provide real-time medical support, often via WhatsApp and Skype internet services, to the desperately overstretched and sometimes dangerously inexperienced medical staff in the besieged areas of Syria.
Read the full story here.
BBC Newsnight: The doctors ‘breaking the siege’ in Aleppo via Skype
The battle over Aleppo has been raging for more than five years – with the Syria city under siege for much of this time.
The medical and humanitarian situation is desperate.
Two years ago, British doctor David Nott got into Aleppo to help train doctors there. Now he’s helping to get round the siege by directing life-saving operations via Skype. He spoke to BBC Newsnight.
Watch the full report here.
BBC Radio 4: ‘Aleppo doctors facing armageddon’
A British volunteer is worried for his colleagues as two hospitals in Aleppo, Syria, were hit during an aerial bombardment and are vulnerable to further attacks.
David Nott is a British surgeon and has worked in the hospitals and trained some of the doctors who treat people with the terrible injuries inflicted by these bombs.
He told World At One reporter Becky Milligan of his concerns for the doctors still working there and how he feels like a father to many.
More here.
The Telegraph: ‘They looked like they were coming out of a concentration camp’
By Raf Sanchez, Middle East Correspondent
For fifteen hours a day, the flow of wounded men, women and children from the remains of Syria’s largest city did not stop. Aleppo residents – evacuated to the safety of the countryside after a six-month siege – came with bones jutting through their skin, limbs succumbing to gangrene and shrapnel still buried in their wounds.
“They looked almost like they were coming out of a concentration camp,” said David Nott, a British surgeon who returned to Britain last week after spending eight days in Syria’s Idlib province treating the injured.
Dr Nott works in operating theatres across three London hospitals but has made repeated medical trips into Syria since fighting started in 2011. He trained many of the doctors who worked in east Aleppo’s makeshift hospitals throughout the regime siege and Russian bombardment and wanted to be there to help when 30,000 civilians and fighters finally left the city in early December under the terms of a ceasefire deal.
Over the course of a frenetic week of surgery, he operated on 90 people, including 30 children. “The patients were really in desperate state” after months with little food and harrowing journey out of the city through snow and freezing temperatures, Dr Nott said.
“They were coming in not just injured but dehydrated, malnourished, and psychologically traumatised.” Doctors in Aleppo focused on saving “lives not limbs” and performed hundreds of rapid amputations with only valium and ketamine to offer their patients for the pain. With no way of sterilising the wounds, the injuries became infected and Dr Nott and his colleagues were sometimes forced to amputate a second time in order to keep people alive.
Read more here.
David Nott: Working in Aleppo
When Abdel Malek was brought into the emergency room in Aleppo in September 2014, his lower left leg was so badly damaged by fragments from a barrel bomb attack that the Syrian doctors thought they would have to amputate the little boy’s foot.
The doctors that remain in Aleppo are passionate and committed but did not have specialist training in vascular, orthopaedic, plastic or reconstructive surgery, understandably given how the war has halted their education and training. I took over the management of the case and was able to show them another way of treating the little boy which would also save his foot.
We took the tiny long saphenous vein from Abdel Malek’s right leg and did a bypass graft to the injured lower leg and foot. The next stage was a cross leg flap to cover the bypass graft. Abdel Malek was kept in this position for three weeks, with his foot elevated and held in place with external fixators, to allow the flap to get its blood supply from the injured leg.
The flap was cut a month later and the legs separated. With the continuing care of the surgeons I trained, Abdel Malek’s foot healed and slowly and steadily, he started to walk again. I was overjoyed when my friends in Aleppo sent me a video on WhatsApp of Abdel Malek playing football with his friends. It demonstrated to me the power of surgery and the options it presents for reconstruction and recovery.
Moments like this were sadly very rare when I was in Syria in September – October 2014. Indiscriminate bombing of civilian areas with grossly destructive barrel bombs – crude devices filled with TNT and shrapnel – caused the most injuries. Day after day, the emergency room and operating theatre were filled with innocent people blown to pieces by these crude devices. Often all we could do was try to ease their pain.
Read the complete blog at: The Hippocratic Post