Libya - « Teaching the correct way of managing trauma surgery »
June 20, 2011
MSF is running a surgery programme in two hospitals in Misrata, a city controlled by the rebels which was besieged by pro-Gaddafi forces during two months. David Nott, MSF surgeon, who worked in Misrata last May tells about his experience.
What was specific about your mission in Misrata?
It was very much a teaching mission. For the first time, I did this sort of teaching. In any other mission, you do the job on your own but in Misrata, I was able to disseminate my knowledge. Libyan surgeons and doctors in Misrata were all very skilled in their own specialty, however they had no proper trauma training.
When watching in the operating theatre or the triage areas of Abbad hospital, I felt that although the staff was doing quite good work, significant improvements could be made regarding for example, the initial management of the airway breathing and circulation or to stop a catastrophic haemorrhage. They had not enough experience or knowledge to deal with that kind of problems. And I decided to teach the correct operative way of managing trauma surgery because normal day-to-day surgery is different from trauma surgery.
How did you organize the training?
In London, I teach trauma surgery at the Royal College of Surgeons and I did the same course in Misrata, in English as they were all speaking English. I had a lot of information and videos on a USB stick on how to do proper procedures. So I gave lectures on management of trauma: initial management and operative management. I showed for instance videos on how to do fasciotomise. After lectures, we would use the knowledge and information acquired, go to the operating theatre and do the same.
Mike, another MSF surgeon, used the information and the videos to give the same lectures in Kasr Ahmed hospital where MSF is working as well. Every day from 2.30 to 4 pm, I would give a lecture to around 40 people: surgeons, anaesthetists, medical students, emergency doctors, triage doctors…
You were doing surgery as well?
I did the training all the time I stayed in Misrata, during three weeks. And I did surgery as well in Abbad hospital, on the morning, late afternoon and in the evening. It was trauma surgery - but not that much because most wounded were referred to Al Hikma hospital, the Misrata trauma centre - and mainly post-conflict surgery. We were doing a lot of flap plastic surgery (incorporating skin flap) and skin grafts. We treated fighters as well as civilians with fragmentation wounds or gunshot wounds. There is one thing I noticed. All patients were treated the same way, regardless of the side there were fighting for.