The 21 April, surgeon David Nott was in London, a long way from the Ukraine. But that didn’t stop him from helping save the leg of a man who had been hit by an explosion in the war-torn country.
Oleksandr, the doctor who actually did the operation, had never before performed this complicated procedure. But just over a week ago, he had seen Professor Nott demonstrate how it was done in a Ukrainian hospital.
So Oleksandr took a photo of the wound with his cell phone and sent it to Nott , who had recently returned to the UK.
The experienced British war surgeon confirmed that the operation was necessary. Earlier he had also sent Oleksandr a video explaining how it was done.
“I was quite nervous and it was a slow surgery, step by step, but it went well thanks to David Nott”, says Oleksandr.
“Terrible injuries”
Nott, who was born in Carmarthen, West Wales, has previously worked in conflict zones including Afghanistan, Iraq and Syria.
Fortunately for Oleksandr and his patient, the surgeon at St Mary’s Hospital in London had made Ukraine the latest destination on his mission to train doctors on how to treat war wounds.
Russia’s tactic of bombing cities means Ukraine’s hospitals are currently seeing a lot of blast injuries.
“It is the worst possible way to attack the opposition, simply bombing”, says Nott, in his first interview since returning of Ukraine.
“It causes enormous damage. It causes terrible injuries
, terrible”. These include soft tissue, bone and extremity shrapnel injuries.
Even the shock wave from such an explosion can cause enormous damage, he says.
In its wake, the “explosive wind” is capable of amputating limbs. Being thrown against buildings can also cause traumatic injuries.
The barotrauma -physical injury caused by changes in pressure during an explosion- is of particular concern due to Russia’s use of thermobaric weapons, also known as vacuum pumps.
These can cause haemorrhages in the brain and lungs, causing victims to cough with blood. They are also capable of bursting the eardrums and perforating the intestines.
“War weapon”
Although it says Having been all over Ukraine: “north, east, southeast, west,” Nott does not want to talk about the specific hospitals or areas he has visited for fear that Russian forces will attack them. For the same reason, the BBC does not disclose Oleksandr’s full name or location.
During the war in Syria, Nott used a Skype connection from his London office to assist with surgery in Aleppo, only for the hospital to be bombed a few days later. He says that he will never know if the two facts are connected.
Now, he says, Russia has already bombed 115 hospitals in Ukraine.
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“Bombing hospitals and killing doctors is also a real weapon of war. It is simply despicable”, he affirms.
Distance indications
While in the Ukraine, Nott took as many doctors as possible into the operating rooms to watch him perform surgeries on war wounds, which included filling holes in limbs, grafting skin, and covering exposed bone.
But the mission, a joint venture between his own David Nott Foundation and the humanitarian group UOSSM International, did not end when he left the country, as he would soon end up advising Oleksandr from a distance before the complicated operation on his leg.
This involved removing a flap of skin from behind the patient’s knee to close a wound and prevent infection from entering the exposed bone.
“These are very difficult operations, they are not easy and they go wrong and cause problems”, explains Nott.
But despite these challenges, the result was “miraculous”, he says. “It worked very well”.
For his part, Oleksandr says that it was important to have the advice of someone with practical experience in surgery: “It is a relief for us when he tells us that (the patient ) will be fine”.
Share knowledge
Oleksandr has nothing but praise for Nott, whom he says “showed us ordinary doctors how to fight on the medical front line.”
Knowing how to perform these procedures, explains Oleksadr, is ” very necessary in our situation”, due to the number of blast injuries and open fractures that need to be treated.
Nott, through his organization charity, the David Nott Foundation, has translated into Ukrainian a series of slides and videos on how to treat war wounds, which were sent “to as many doctors’ phones as possible”.
He also hopes that those like Oleksandr whom he has taught will pass on what they have learned.
“He will train other people how to do it, they will train other people to do it and then, hopefully, everyone will know how to do it in the not too distant future”, says the British surgeon.
As in Syria
Unfortunately, the demand for these skills in Ukraine, it seems, will not disappear soon.
Earlier this month, Ukraine’s Foreign Minister said that the battles in the eastern Donbas region would resemble World War II World, with the use of “thousands of tanks, armored vehicles, planes, artillery”.
For Nott, the scenes they see from cities like Mariupol remind him of what he previously witnessed in Aleppo.
“It is exactly the same as Syria, exactly the same as tactics”, he says.
“Aleppo, when I was there in 1200, was completely razed to the ground, the entire place was totally and completely destroyed.”
Oleksandr says that he is now treating “terrible injuries” that he hoped he would never see again.
“We would like to treat normal problems, like that of grandmothers and grandfathers who need joint replacements, common fractures”, he says.
And he adds: “We are doing our job day after day and, whatever happens, we will stay home and do what we have to do.”
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