Training surgeons in hostile environments

In this episode we hear from Dr Moez Zeiton – a trauma surgeon who’s worked with WHO in Iraq and now is a trainer with the David Nott Foundation, teaching surgeons how to treat trauma patients in some of the most difficult circumstances imaginable.

To find out further about any of the subjects covered in the Health In Europe podcast, visit our website: https://www.who.int/europe/

Transcript

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00:00:00:16 - 00:00:06:12
Greg Bianchi
Hello and welcome to the Health in Europe podcast. I'm Greg Bianchi.

00:00:11:07 - 00:00:42:03
Greg Bianchi
We've launched this podcast to bring you the latest on W.H.O. work in the European region. Our region is broad and diverse from the mid-Atlantic and stretching as far as the Chinese border. We work with fascinating and driven individuals and groups. This podcast is about hearing their stories and how they might impact your day to day life.

00:00:45:02 - 00:01:10:23
Greg Bianchi
Trauma surgeons learn how to work under a great deal of pressure. As we mark one year of war in Ukraine, some surgeons are required to carry out surgery in incredibly difficult circumstances, to which a Europe recently attended a training on care in hostile environments with the David Knot Foundation, an organization that specializes in training surgeons to save lives in areas affected by conflict and other disasters.

00:01:11:18 - 00:01:31:23
Greg Bianchi
Dr Moez Zeiton was one of the trainers. A surgeon with the British NHS, he also spent time working with WHO in Mosul, Iraq. Sophie Scott, a communications consultant at WHO Europe, spoke with Moez to find out a little bit more about his experiences and why his skills of performing surgery in a war zone were tragically required much closer to home.

00:01:32:11 - 00:01:38:03
Sophie Scott
Can you tell us a little bit about why you volunteered to work in a hostile environment Surgical Team?

00:01:38:06 - 00:02:02:18
Dr Moez Zeiton
The reason I volunteered to work in hostile environments, the start of it is actually probably quite personal. So I'm originally from Libya, my parents are from Libya, and I have a lot of family out there. And during the conflict in 2011, I became very involved in charitable work and sending medical aid to Libya from my junior doctor job here in the UK.

00:02:03:06 - 00:02:41:10
Dr Moez Zeiton
And I also became involved in advocacy. And I think I just wanted to take the next step and as a result, I ended up traveling to Libya with a group of expat British Libyan doctors and worked in that environment and that exposed me to this world of humanitarian surgery. And subsequently I've had various opportunities to work on research in this field and then further deployments, working with people like the World Health Organization in Mosul, in Iraq, and then also with the David Knot Foundation doing their teaching.

00:02:41:10 - 00:02:49:21
Dr Moez Zeiton
So it's quite a long story, but I think the initial interest term was by chance or circumstance.

00:02:50:04 - 00:03:03:00
Sophie Scott
Broadly speaking, what role do international organizations and NGOs such as W.H.O. and others play in providing emergency care in hostile environments?

00:03:04:06 - 00:03:41:07
Dr Moez Zeiton
So international organizations and NGOs provide a very crucial role in providing surgical care and emergency care in hostile environments. I think the remit and the type of work or help that they provide depends on the organization, because every organization has its own goals or strategies and they work in specific fields. Certainly when I worked for the World Health Organization in Mosul in Iraq in 2017, I believe that was the first time they were providing this type of care, providing trauma and surgical care.

00:03:41:23 - 00:04:12:24
Dr Moez Zeiton
And so this was a new area for the World Health Organization, and it was a very successful mission to provide care for those that were affected by the war in Mosul during that time. And so, yeah, in summary, I think that it really depends on the the organization and what their missions are. But anecdotally, I would say that I think it's being recognized more and more as quite an important aspect of providing global health and global surgery.

00:04:13:08 - 00:04:37:00
Dr Moez Zeiton
And I know that the World Health Organization are doing a lot of work to validate Tokenisation in terms of trauma field hospitals and their capacity and and what they're able to do and trying to centralize this type of work and coordinated amongst the NGOs and national medical response agencies.

00:04:38:06 - 00:04:46:11
Sophie Scott
And so I understand that you worked with W.H.O. in Mosul. Can you tell us a little bit about your experiences there?

00:04:46:17 - 00:05:13:01
Dr Moez Zeiton
Yeah, of course. So my experience is in Mosul, in Iraq. So the time I went there was in 2017, and actually the opportunity came up directly as a result of being a candidate on one of the David Knoll courses, which is called Surgical Training. And elsewhere Environment course. And this was a course that took place in London at the Royal College of Surgeons in London.

00:05:13:01 - 00:05:39:18
Dr Moez Zeiton
And it's a five day kind of very course teaching us all aspects of war surgery or humanitarian surgery. And on the final day of the course, we were approached by members of W.H.O. who told us about this opportunity that was being set up in Mosul as there was an acute need. And I was very interested. And in short, I think about two months down the line, I ended up finding myself in Mosul.

00:05:40:19 - 00:06:12:22
Dr Moez Zeiton
And so the the actual work in Mosul was split across three hospitals. So there were three trauma field hospitals which were established and they had three theaters each. And to 25 Fed wards. And at the time there was the Iraqi army was liberating Mosul from ISIS and a lot of civilians. There were 2 million civilians in Mosul who were caught in the crossfire.

00:06:12:22 - 00:06:38:22
Dr Moez Zeiton
So a lot of civilian injuries. And the aim of the project was to try to save life and limb by providing lifesaving surgery as close as possible to the frontline. And so I was part of a team of international expert surgeons, as well as local Iraqi Ministry of Health Surgeons. And we worked in partnership in rotating teams, and we were based on site providing this type of care.

00:06:39:00 - 00:07:08:22
Dr Moez Zeiton
And the type of work we did was quite eye opening, as I hadn't really had a lot of direct experience with this type of surgery. And I thought from my brief experiences in Libya before that and I would say that we saw a lot of mass casualty events, and these are events in which you get a lot of casualties arriving at the same time from, for example, a blast or something like that.

00:07:09:16 - 00:07:34:17
Dr Moez Zeiton
And this creates its own challenges as often the number of casualties that arrive exceeds the resources that you have available in terms of personnel and equipment at the time theater space. And so we were very well drilled. We had a lot of experience surgeons who ran teaching exercises. And I think that overall it was a very successful mission.

00:07:34:17 - 00:07:39:11
Dr Moez Zeiton
And I learned a lot and made a lot of connections which last till today.

00:07:40:05 - 00:07:55:20
Sophie Scott
You continue to do humanitarian work alongside your work in the UK's National Health Service. How do you think your experience in hostile environments has benefited your work and what would be your advice to other health workers who might be thinking of following your example?

00:07:57:12 - 00:08:45:03
Dr Moez Zeiton
So I think the experiences that I've gained from the international and humanitarian surgery work I've done have have helped directly with my work in the UK, working in the in the NHS. Certainly 2017 was a very you could call it's an interesting year for me because I had this opportunity to go to Iraq with the W.H.O. and around two or three weeks after returning to the UK, the Manchester bombings actually occurred in the arena with the terrorist attack and I was working in a hospital in Manchester at the time and again we had a mass casualty incident in the UK, in Manchester, in my in my hometown, which I never thought would happen.

00:08:45:03 - 00:09:18:24
Dr Moez Zeiton
And it's not something that I think that we were necessarily prepared for. And so I was able to translate some of the experiences that I had in Iraq and in Libya before that and apply that to my work in the NHS. And I think that that experience served me very well. My advice to other health workers who might be thinking of following this line of work would be to try to, first of all, establish your basic skills, your basic training.

00:09:19:07 - 00:09:47:16
Dr Moez Zeiton
And I mean, this is sort of aimed at more sort of junior and surgical trainees or even medical students being the best possible health care worker, whether as a doctor, nurse, paramedic within, you know, your your country is is the best thing that you can do. And then when you do get the opportunity to go abroad, you can take the skills that you've gained within your own health care, environment or system and apply that.

00:09:47:16 - 00:10:23:10
Dr Moez Zeiton
And secondly, there are opportunities. I think there are a lot of organization ins now that have careers, events, careers, evenings, just to expose you to that type of work and find out what what's working in these environments and pursuing this line of work might involve. Because I think what I've realized over the years is that there are also personal sacrifices that you have to make, and there are lots of good parts of doing this type of work, but they're also quite important personal considerations.

00:10:23:19 - 00:10:26:08
Sophie Scott
So can you tell us about the health cluster work?

00:10:26:19 - 00:11:00:21
Dr Moez Zeiton
Yes. So in Libya in 2011, I went out there as a humanitarian doctor and as providing lifesaving first aid, emergency care with the group of doctors that I was out there with. And then I think, again, none of this was planned. It was a quite an opportunistic opportunity that came up. And the fact that I could speak Arabic and English fluently, I was dealing with a lot of the NGOs and foreign missions who started to establish themselves in Libya and were performing NGO type work.

00:11:01:09 - 00:11:28:08
Dr Moez Zeiton
And quite quickly I ended up working alongside the Libyan Ministry of Health and there was something called the health cluster, which is run by the World Health Organization. And when the UN are working in conflict zones, they at that time they split into different clusters. So there would be a health cluster, a food cluster, a security cluster. And the clusters are all of the people that are working within that particular field.

00:11:28:19 - 00:11:50:01
Dr Moez Zeiton
So the health cluster would maintain a weekly basis and it would be all of the international NGOs that would meet and it would be chaired by the W.H.O. as well as local actors. And in this case, the local Ministry of Health. And I ended up chairing that meeting for a period of time. And this was a quite interesting opportunity.

00:11:50:01 - 00:12:21:24
Dr Moez Zeiton
I would say something that I wasn't necessarily prepared for, but something that I threw myself into. And it opened me up to a fascinating world of public health and crisis management and NGO work. And this isn't something that I had much experience in before and thankfully received quite positive feedback for that. But yeah, my previous work was all clinical work and so this was quite an interesting aspect which I've tried to maintain over the years since that time.

00:12:37:23 - 00:13:09:11
Greg Bianchi
And that's all we have time for. Special thanks to Dr Moez Zeiton for speaking with us for this podcast. This episode of Health in Europe presented by me, Greek Bianchi. Sound and Production by David Barrett. And our interviewer and researcher for this episode was Sophie Scott. If you'd like to find out more about the topics covered in the show, check out the links in the show notes.

00:13:10:23 - 00:13:18:11
Greg Bianchi
Check out previous episodes of Health in Europe wherever you get your podcasts. Thanks for listening. Until next time, stay safe and stay healthy.