David Nott Foundation: Becoming the calm in any storm

Dr Esayas Mustefa is the only general surgeon within a 130km radius in Ethiopia. When we trained him during one of our UK HEST courses, we knew we’d come across a very talented surgeon who would make an outstanding trainer. We’ve since upskilled Esayas to become a David Nott Foundation trainer, upskilling his peers. Here, he shares the impact of his new skills in the Afar region of Ethiopia.

Since my first training with the Foundation in December 2021, the war has been a bit calmer in Afar. There have been a few leftover soldiers, but it is calmer. Nonetheless, with the energy and resource invested in us, many patients have been helped because of my training.

Controlling bullet damage
I remember a patient with a bullet to the right of his groin. That day, I remember I was home. The emergency surgeon didn’t call me and did a laparotomy, but then decided he needed me to come in when he saw the damage.

There was an extensive haematoma (build up of blood) in the pelvis. I thought it was a vascular injury but didn’t have the proper instruments or stitches to fix it.

That’s when I did damage control.

I got proximal and distal control of the bleeding, which I learned on the course. I managed to dissect the haematoma and with the help of the other surgeon, I did a bypass. This means putting in a tube conduit that bypasses the dissection, allowing blood to carry on flowing through the vessels as normal.

We transfused him with blood and transferred him to specialist care, to have his vascular surgery. It was great.

Passing on life-saving skills
I’m also really, really happy to share what I’ve learned on the course. We have two emergency surgeons and I do my best to teach them.

They didn’t know how to do colectomies, resections, anastomoses, or some basic decision making in difficult times. I’ve taught them these things, and also when to operate and when not to operate.

Now they know to ask me – they call to ask me questions. We have a good working relationship.

The difference between life and death
I’m now also confident with abdominal injuries. I’m a better surgeon, and those I teach are better, because of the training I had with David.

Explosive injuries, I was never used to. I usually see bullets. Even seeing photos of explosive injuries used to get to me. But seeing David’s live videos in training stimulated me to be ready for anything.

Calm in a storm
In all honesty, no matter how many patients I saw or the injuries I faced – bullets, road traffic accidents – every time I opened an abdomen, I used to get nervous. No matter how much I’m used to these patients, I don’t know how to describe it. The anxiety would come.

After I met David, I thought how many years will it take me to get to that level of calmness?

But with the course, I learned to be really calm and collected in demanding situations.

For me, my patients, my future patients, and those willing to learn from me – have all benefitted from my training.