Philanthropy Podcast: From the Front Line with David Nott

Emma Turner (ET): Welcome to the Barclays Private Bank Philanthropy podcast, a series that tries to understand what drives leading philanthropists and what they’ve learnt along the way.

My name is Emma Turner and I run the Philanthropy Service and today I’m joined by David Nott, the renowned trauma surgeon, also known as the War Doctor, who’s dedicated his life to saving others both here and some of the world’s worst warzones. David qualified as a consultant surgeon in 1992 and is currently based at St Mary’s Hospital in London where he specialises in vascular and trauma surgery and also performs cancer surgery at the Royal Marsden Hospital.

But for the past 25 years David has taken unpaid leave each year to work for the aid agency Médecins Sans Frontières, the International Committee of the Red Cross and Syria Relief. He has provided surgical treatment to patients in conflict and catastrophe zones across numerous countries - too many to mention. As well as treating these patients David teaches advanced surgical skills to local medics and surgeons when he’s abroad.

And in Britain he teaches the Surgical Training for the Austere Environment course at the Royal College of Surgeons. In 2015 David established the David Nott Foundation with his wife Ellie and the Foundation supports surgeons in developing their operating skills for warzones and austere environments.

Hi, David. I can’t thank you enough for taking the time to join us today because I know you’re incredibly busy particularly at the moment. So let’s start. Looking back from today do you think your younger self had any idea where your life might lead you? And what might some of the early influences have been?

David Nott (DN): Well, thanks very much, Emma for inviting me on. I’m delighted to be able to talk to you. No is the answer. I think it’s very difficult to know when you’re starting off as a young person where actually you’re ever going to be at the end of the day. And I mean I’m still glad to be around to be honest with you from what I’ve been through over the past two or three decades now.

But do I recognise myself? I think I recognise the inside of myself. I don’t recognise the sort of qualities that one developed over time, the experience, the leadership qualities and things like that. I was always a bit of a reticent sort of child and a teenager and always the one that was sitting at the back of the class and never really, you know, was a high achiever at all.

And because of those reasons I think it spurred me on to realise that you can do something with your life and it is possible to get somewhere that you really feel comfortable in your skin with. And so I think I’ve got to that level really. But would I have known about that as a child and a teenager and a medical student? No, not at all.

ET: So was there something or a particular moment when you decided that you wanted to go into medicine?

DN: Yes. Basically, yes. I failed to be honest with you. I did very badly in my A-levels at school and I’d always had this thing about flying aeroplanes and I thought, well, it didn’t really, really matter because I’d got myself into the Royal Navy as a helicopter pilot and I needed two Es at A-level and I actually got two Es. And then my dad said to me, well, what happens if you have a medical problem and that’s it? Your life is over so to speak really. And he was right in one respect.

And then the worst thing was that other friends that went off to university and other ones that went off to medical school and so and so forth and I really felt that I was a failure. And I remember going, I didn’t quite know what to do really because I’d done so badly in the A-levels and everybody else had done so well and I thought, well, something must be seriously wrong with me. And I think I know a little answer to that question now.

I was born in July, late July, and I was a year behind everybody at school in my matureness and age and everything else and I think that had a significant effect on me as a child at school. But the reason I remember people ringing me up and one person rang me up and said, well, Dave, what’s it like to be a failure? And I thought, at that moment I thought, no, I’m not going to be a failure. I’m going to really try and turn my life the other way round.

So from that moment on I went for a walk in the garden after getting these A-level results and thought, no, I’m not a failure. So I went back to school and I did a third year Sixth and I studied myself with all the physics and chemistry and biology books that I could find and was determined that I was going to do better than I had done. And then the following year I changed the Es to As and got into St Andrew’s.

So it was that sort of pivotal moment that I realised that was the time when I wanted to go into medicine was because I felt just as good as everybody else and why shouldn’t I do it? And that’s the reason.

ET: Wow. That’s an amazing story and actually incredibly inspiring to people who might not be doing so well right now that in a year or two you managed to turn it around. I have to say I got Fs in most of my O-levels but we won’t go there today. And then at what point did you decide you wanted to be a surgeon?

DN: Well, my dad was an orthopaedic surgeon and when I was a schoolboy and when I was a teenager and so on he would take me into the operating theatre. It’s not possible to do that nowadays, but I would go in and I would help him operate on people. And as a 16, 17, 18 year old I mean, gosh, he would have been in front of the GMC by now if that had been known. But, no, I would go in, get scrubbed, I’d help him.

I remember there was a patient that had a kidney abscess and I can remember holding the scope as he put the plunger into this person’s back, sucking out all the pus. And he said, “you do it”. He said, “you hold the sucker”. Anyway, it was that sort of enjoyment really after that was just, and then as a medical student I’d go in and help him a lot as well and I just enjoyed being in the operating theatre.

I enjoyed the smell of the disinfectant. I know it sounds strange to say but it’s got this very odd, peculiar smell and feeling going into an operating theatre and I really enjoyed it and that’s how I wanted to be a surgeon. And when I qualified and got my first house job, in Manchester Royal Infirmary I did neurosurgery and I happened to fall on this operation which I did in the middle of the night and that was a time when I thought, no, this is a great job to do, I’m going to be a surgeon.

ET: And you clearly love it all the way up until today. Was there a trigger event that made you go to warzones and then to keep going back to warzones? I know I’ve heard you say you’re addicted to war, maybe less so now that you’re married with children, I don't know, but what was it that made you take that first trip?

DN: Again, it was my father. He had a huge influence on me throughout the whole of my career really. I mean he was a refugee in the Second World War. He was born and brought up in Burma and he rescued his family when the Japanese were coming in, he was born in Mandalay and in Rangoon when the Japanese were coming in they all had to evacuate very rapidly.

And he was with those thousands of people that were walking to try and get over the hills to try and get into India after the Japanese were taking over Burma.

And so he ended up in a refugee camp with his family and he, from those early beginnings he made it well and he became an orthopaedic surgeon in England. And he wanted to work for the United Nations and always said, you know, David, if I had my chance again I’d work for the UN, I’d want to go abroad and so on.

And he was pivotal really in saying to me one day, I want to, he went to see a film with his, with my mum and it was called The Killing Fields. And he said, Dave, what are you doing tonight? I said, well, I’m a surgical registrar at Manchester Royal Infirmary. He said, well, I’m going to pick you up and I’m going to take you to see this film.

And so him and I just sat and watched this film of The Killing Fields. And it was about Cambodia. It was about two journalists who were helping each other survive basically.

One was a South Vietnamese called Dith Pran and the other one as an American journalist. And the two, Dith Pran sort of saved this other, William [Sydney] Schanberg’s life and then had a dreadful time in war and you could see, then they went to this hospital where they saw a doctor operating. And this doctor had said, you know, “look at me, I’ve got no person to help me, I’ve got all these casualties to do and it’s a dreadful situation and I’m trying to cope”.

And in the end of the film, these two journalists met up and it was under this banner called the International Committee of the Red Cross Hospital. And I looked at this and I was absolutely stunned. It was one of those stunning moments in life really when I just thought, you know, what is it like to go to war? What would it be like to work in a hospital, the International Committee of the Red Cross Hospital? Gosh, I really want to go and do that.

And that was the initial moment that just suddenly a light went off in my head and thought, you know, I really want to go and do humanitarian work. I really want to go and help people that can’t help themselves and this is what I want to go and do. So that was the moment.

ET: Wow. Very quickly, but when you first landed in your first warzone was it everything you thought it was going to be? Was it bigger? Was it smaller? Was it terrifying?

DN: It was everything and more. I landed in Sarajevo in Christmas time ’93 and the war had been going on for about 18 months by that time and Sarajevo was heavily bombed and targeted by incoming shells and rocket propelled grenades and bombs and tank machinery and all sorts of stuff. And I landed there and jumped out and was working for MSF at the time and they put me in this, it was an armour plated Land Rover and took me to this hospital called the State Hospital.

And the State Hospital was also nicknamed the Swiss cheese hospital because it had so many holes in it because it was being bombarded all the time. And I then spent my time under the ground in our operating theatre and a couple of the surgeons actually left at that time. So I actually ended up being a young man having almost the surgical department to myself with an anaesthetic team and everybody else. And I was in my element.

I really, really felt that this was, I think it was to do with all the endorphins that were flying round in my head, the excitement, the feeling of immortality, the feeling that you’re really helping people that if you weren’t there they wouldn’t survive. And it was an amazing feeling that I was doing a really good job. And I felt this was what I had always wanted to do. So definitely more than just going to a warzone. And was it dangerous? Yes, it was extremely dangerous.

Was it exciting? Yes, it was really exciting. And once I’d done that I couldn’t stop.

ET: Wow. So over the last few years or since you’ve been doing this has there been a moment when you thought, hmm, I’m in a bit deep here?

DN: Yes. I would say Syria 2013/14. I worked in Aleppo twice, ’13 and ’14 for six weeks each mission and it was really, really, really dangerous. I mean there were rockets coming in all the time. People were being shelled all the time, there were multiple causalities on a daily basis. It was a very hard slog mission. And the hospitals were being targeted. Our hospital was targeted. I sometimes worked in underground hospitals because those type hospitals had also been targeted.

But one day when I felt I had really bitten too much off was I think twice on those missions.

Once was when I was in the operating theatre and we were operating on somebody that had been shot and was brought in. And he was upstairs and had a chest drain put in. And so that’s a tube going into the chest. And I was called to see him because there was a significant amount of blood coming out of the chest drain. So I said, well, to be honest with you we need to open this chest up because it’s obviously bleeding from somewhere significant.

So we brought him down to the operating theatre and on the operating theatre we, again at that time I was training lots of Syrian doctors who were very young, they hadn’t had a significant amount of training so it was a joy to actually train them to do various operations. And so I said to him, have you ever done a thoracotomy? He said, no. Well, I’ll teach you how to do it.

So we put the patient on the side in the operating theatre and anaesthetised him and we made the cut into the thorax to open up his chest to find the bleeding point.

And just at that moment arrived, the door of the operating theatres flew open and six members of ISIS came in with all their guns blaring, with their AK-47s and, pointing at us. And we realised that the person that we were operating on was actually an ISIS fighter. And it wasn’t just an ISIS fighter, this was the worst group going around Aleppo at the time. They were the Chechen Brigade and they were very notoriously unpleasant I think is probably a minor word to say.

But they were doing dreadful things to people on the streets and so on. And at that moment I thought, do you know, I think this is it and I think I’ve bitten too much off now. I think the time has come.

And I remember sort of thinking, and I don’t pray very often but I thought, well, here’s a time to pray really because, and I could feel my legs going to jelly and I could feel my whole body going into a total body shake and I thought, if they find out that I’m British, if they find out that then that’s me done for.

And that was the time when I felt, that was the first time I’d felt I’d probably taken on a bit too much and was I going to survive this. And the second time was when I went back to Aleppo in 2014 and the road was closed to get out of Aleppo.

It was called the Castello Road and that road was being fought over heavily by the regime fighters and the rebels and suddenly the road was closed and I thought, well, that’s it now, I’m stuck here and I’m going to be stuck here and I’m not going to be able to get out.

And I think that was the two times I think in my life that I really felt that I’d probably taken too much on and probably, you know, this was a bit too much to take.

ET: Ellie must be so pleased every time you come back in one piece. Honestly I just…but thank you for sharing that with us. I was absolutely on the edge of my seat as you told that story. Let’s just move now to more recent times and London. So you’ve been in the frontline of the pandemic at St Mary’s. What were the similarities to being in a warzone and did you have to have to call on some of those specialised skills to get through last year and this year up until now?

DN: Yes. It was more, it was a shock actually to the system, a real shock to the system. I mean I never quite realised, it was I think March 2020 that suddenly we were all operating and suddenly it all came to a complete halt. And I was, did my last operating session I think mid-March and was taken around the hospital at St Mary’s, and I looked into the recovery area and it was 24 ventilated beds and they were all empty.

And I got taken down to the Paterson Wing which had another 20 empty ventilated beds. And I thought, what’s going on here? And downstairs the respiratory wards were all cleared out of patients and ready to accept this tidal wave of patients. And I thought this is never going to happen. This isn’t going to happen at all. But, you know, 10 days later the whole hospital was full of COVID patients.

I’ve never seen anything like it and how they, you know, obviously they were going to know that this was going to happen but I never in a million years thought it would.

So I then spent that time doing emergency surgery and emergency surgery in those times because the anaesthetists were going down with COVID, the cardiologists were going down with COVID and we sort of spent our time operating on emergencies that were coming in not knowing whether they had COVID or not, in PPE but also with PPE with elephant tubing so that you were breathing into ventilators and things like that at the same time.

You couldn’t hear yourself talking to your assistant nor the scrub nurse. You could just hear the breathing in your helmet basically as we were operating on patients that were coming in anyway because the accident and emergency department was opened for all sorts of patients and there were still patients requiring emergency procedures. So I ended up doing lots of emergencies at that time and not really paying much attention to what was going on on the intensive care unit.

But then the emergency started to dry up as well so I ended up then working on the ITU and got some sort of idea of what it was like.

But it was only really in the second lockdown that I started, that I thought, well, I really want to work on the ITU this time because I want to feel what it’s like to be able to look after these patients that had problems and in fact when the COVID crisis happened it was very much like working in a warzone with lots of sophisticated equipment which of course you don’t have in warzones.

But we had all the ventilators, we had all the oxygen, we had all the drugs and we had everything to treat patients but it was like a warzone because you did have an enemy and you had an invisible enemy and you did not know in the first lockdown whether you were going to get affected by it or not.

And I said to Ellie before that sort of started and suddenly before the actual lockdown happened that, well, this is, you know, I think I’m working in the hospital and I don’t really want to give you or the girls COVID. And so they went down to Devon and spent their lockdown, the first six weeks, in Devon and I spent it in the hospital wondering that if I caught COVID at least I’d catch it myself and not give it to anybody.

And I’d come back every night and I’d wash myself from top to bottom and I’d try and do everything I possibly could not to catch it but remarkably and miraculously I didn’t catch it.

And in the second lockdown then I wanted to do something better really and I wanted to work on the ITU.

So I got trained up as a critical care nurse and went through training to work as a critical care nurse and was very happy that I did that because it’s amazing the amount of work that nurses actually do. And the stress and the strain of actually having to wear full PPE for 12 hours on a shift having three 45 minute breaks and then looking after one ventilated patient was the hardest thing I think I’d ever done.

Harder than being in a warzone, harder than doing anything else because you’re dehydrated, you’re there, you’re breathing, you know, and trying to survive yourself and you’re doing your very best for your ventilated patients. But it was also beautiful as well at the same time because you then hold up iPads which relatives would be speaking to their loved ones who were on a ventilator and perhaps could or couldn’t hear, you don’t know.

But I remember holding one ventilator up, one iPad up for a patient who was on a ventilator who came from the Ivory Coast, who was related to members in the Ivory Coast and I, and these people were living in a hut on a beach basically and they were talking to their loved one who was on a ventilator getting all the support that we could possibly manage and doing everything that we could possibly do to make that patient survive.

And it was a beautiful thing to watch this group of relatives singing and playing the guitar and singing to this patient. It was one of those most beautiful moments that you were privileged to see and understand.

ET: Thank you. Thank you for sharing that. Right. Let’s talk about the David Nott Foundation. So what are you hoping to achieve with it? What’s your goal?

DN: Well, over the years I’ve spent, what, 25, 30 years working abroad and you do change as a person. You do change also as a surgeon. And you start to learn things which it’s impossible to know about unless you’ve been to multiple warzones. It’s impossible to know how to treat patients with casualties that you would get in the United Kingdom and how it is that you don’t have the equipment, you don’t have the ventilator, you don’t have the blood, you don’t have the drugs but you’ve got the same sort of problem.

And there are various ways of looking at patients and treating them as the best you possibly can. And it may mean such that you can’t do enough for that patient because if you do, you use all your resources and you won’t have any for anybody else. So it’s making very difficult decisions.

Not only that it’s learning all about all, so for example in the UK I’m a vascular and trauma and cancer surgeon but when I’m working abroad I’m a neurosurgeon, faciomaxillary surgeon. I deal with ENT problems, I deal with chest and thorax, I deal with abdominal problems.

I deal with orthopaedics and paediatrics and obstetrics and all this sort of work which you would never learn if you were working only in the UK and you would never learn the nuances of having those specialties and knowing how to use those specialties to save people’s lives. So I thought, well, what I’ll do, what I’ve learnt with my life is I’ll try and train other people.

So I set up a course at the Royal College of Surgeons called Surgical Training for the Austere Environment and we have various people that come on that course who are sometimes with the ICRC or MSF or other NGOs but the real people that really wanted to know about how to look after their patients and have the understanding of all this experience.

We set up the Foundation to be able to pay for surgeons from all over the world to get scholarships so that they could come to the UK and get their hotel paid, to get the registration and all their food and their flights and everything all paid for so they could come and spend a week with us and then they could go back home having a whole host of knowledge that they would never get unless going on this course. So that’s how the Foundation was set up.

And Ellie, my wife, was the kingpin for setting up the Foundation and she was the one while she was pregnant wrote all the charitable status and we got charitable status the day that Molly was born and we were able then to run the Foundation. And so far we’ve trained about, before the COVID crisis happened 77 scholars had over from all over the world. But we also take the course which was called now the Hostile Environment Surgical Training Course which is paid through by the Foundation.

We take that course which we have the best mannequins and the best simulation we can possibly make and we take all those around the world. And we’ve done something like 17 missions around the world and trained over 1,000 doctors doing it that way. So it’s a wonderful thing to leave a legacy almost of training, war training and also austere environment training and training for disasters and conflict and catastrophes that people may find themselves in all round the world.

And if I could just go on a little bit longer, we went to Marib recently with, in the Yemen where there’s severe fighting going on in the, between the Al Houthi regime and the government and we went in April with the Foundation which kind of cojoined with Humanity International, which is another NGO, and we trained doctors and also operated with them about 12 hours a day.

Some of the doctors had never seen any of the surgeries before and again their patients were coming in and we were able to not only lecture to them and show them how to do things but actually operate on their patients with them as well and it was a fantastic thing to be able to have offered the Foundation, plus going abroad.

ET: Well, I wish you every success with that going forward and I’ve got two final questions. What’s been your proudest moment to date and what’s next?

DN: I think the proudest moment to date really, well, two. One was getting married to Ellie if I can say that. And I think the real proud moment was the work in Syria that I did. I was there alone as the only westerner really in the whole of Syria both 2013 and ’14 and being able to train all the doctors and being able to leave a legacy with them. And they would send me WhatsApp pictures of all the patients they’d been operating on which they’d never been able to have done before.

And I think that’s my proudest moment I think really of being able to help people which if I hadn’t gone they would not have had that help.

ET: And what’s next?

DN: Gosh, what’s next? So I can’t do this on my own, and so we’re running train-the-trainers courses now and in fact in July I’m running a train-the-trainers course. We’ve got 30 people on there and I’m trying to train up the next generation of war doctors if I could say that, or people that have an interest in humanitarian work, that want to go abroad and train doctors.

It’s a different matter running a course because if you’re running a course you can run that course anywhere and the last time we went abroad was before we went to Yemen was also in Yemen in the northern part in a place called Hajjah where we trained 40 surgeons in a hotel room and with all our equipment and so on. So I want to train up the doctors so that they can train people and be able to do it in an environment where they feel safe and secure.

And after they’ve got the knowledge of training people and giving the information over maybe they then can come with us to a hot warzone to see what it’s like operating on people and learning the skills again, which I’d like to be able to share with them.

ET: David Nott, also known as the War Doctor, I cannot thank you enough for joining us today and for having this conversation with me. It’s absolutely made my year.

DN: Well, thanks very much, Emma. It’s been a privilege. Thank you for talking to me.