10 minute read
CALL OF DUTY
by RCSI
Consultant Trauma and Orthopaedic Surgeon at the Mater, Mr Keith Synnott FRCSI is National Clinical Lead for Trauma Services for Ireland. A committed humanitarian, he has worked in Haiti and across Africa, and teaches trauma team management and leadership skills in war-stricken Ukraine
After completing the BST in 1997 and HST in 2003, Keith Synnott went on fellowship to the Hospital for Special Surgery in New York. In 2004 he was appointed Consultant Trauma and Orthopaedic Surgeon with a special interest in spine, and particularly spine trauma, in the Mater Misericordiae University Hospital in Dublin. Currently he spends half his time on clinical work in the National Spinal Injuries Unit and Major Trauma Centre at the Mater, and half as the National Clinical Lead for Trauma Services for Ireland with the responsibility for leading out on the implementation of the Trauma Strategy.
I always had an interest in doing humanitarian work abroad, as do many people, but it’s more difficult to get into than you might imagine. For example, if you want to work with Médecins Sans Frontières you have to commit to one or even two years and the paperwork is quite onerous. In 2006, I was doing an ABC travelling fellowship in America, and in an airport bookshop a book caught my eye because it had an aeroplane on the cover and mentioned Africa, two things I was interested in. The book was by Scott Griffin, a Canadian businessman who flew his Cessna 172, the same aeroplane I fly, from Toronto to Nairobi so he could work as a business consultant with AMREF, the charity which runs the Flying Doctors of East Africa.
I did some research and learned that AMREF ran a visiting physicians programme, so you could volunteer to spend a month working with them. They have a doctor and a nurse on every mission, and if they have an overseas volunteer, it saves them paying a local. So, in 2008, I took a month’s leave of absence. The work in Nairobi involved pre-hospital care, critical care and transfers.
What they really needed was an anaesthetist or critical care doctor, but there wasn’t one available so they got me instead. A lot of what I did was straightforward, but sometimes I was out of my depth, so it was a bit uncomfortable. But it was interesting. On the one hand, the Flying Doctors did work for overseas insurance companies and tourists, so you might be sent to collect a tourist in Madagascar with chest pain, and bring them back to the private hospital in Nairobi. Or to collect an injured tourist in Ethiopia, and bring them back to Germany. On the other hand, was the work that funded the local missions, which might involve going to a rural bush hospital to collect someone injured in an industrial accident and bring them back to the public hospital in Nairobi.
My grandfather was a pilot in the RAF, and he flew in the Second World War. From him I have a sense of duty – if you’re able to do stuff, you have to do stuff.
While I was there, I met an orthopaedic surgeon based in Eldoret, in the east of Kenya, which is where all the runners do all their training. He told me they needed training in joint replacements, so we partnered with a company here in Ireland called PEI, and they agreed to pay for a mission, and to cover the cost of the surgeons, the instruments, and the implants. In 2010, I went with fellow surgeons Gerry McCoy and Fintan Doyle and we spent a couple of weeks doing clinics, identifying patients, performing hip replacements and training the local surgeons.
Later in 2010, I went to Haiti about a week after the earthquake. On the news it all looked very bad with buildings collapsing and amputations being done in terrible conditions. I spoke to Kieran Ryan at RCSI and mentioned that it looked like they needed orthopaedic and trauma people. I was wondering if there was anything we could do to help. A couple of days later I got a call from someone saying that Denis O’Brien was flying to Haiti to visit his business there and did I want to get on the plane and go with him?
The prospect was scary but I went with surgeons John O’Byrne and Michael O’Sullivan. Things were chaotic. We ended up going to a hospital about 30 or 40 miles outside Port au Prince to replace an American team who had been working there. We spent a week operating there, and when we came back we set up a charity to raise funds. Over the course of about six months, we sent a series of teams – surgeons, nurses and physios – to work in the hospital. Conditions were very challenging. The steriliser was used half the time for sterilising instruments, and half the time for cooking people’s food. The scrub area was like the parlour of your granny’s kitchen.
Subsequently we worked with Boston Group Partners in Health, who ran a number of hospitals in Haiti, and I went to Haiti five or six times over the following couple of years. As the acute need abated, we went on different missions. Seamus Morris and I went to do some spine fixations, as there were no spinal surgeons in the country.
Generally, we stayed in the hospital compounds which had armed guards but the security situation got so bad in 2019 we had to stop going. It was chaotic and I often felt in personal danger driving to the airport in a van, as you could get hijacked.
I got involved in Ukraine through my work as an instructor on the European Trauma Course (ETC), which is designed to teach trauma team leadership skills and trauma team management. The way in which the health services are organised in Ukraine is quite different to Ireland. Traditionally, they did not have emergency rooms, resuscitation bays and major trauma centres. Following the outbreak of the war, the Ministry for Health decided they wanted to reorganise the way in which healthcare was delivered with a particular focus on trauma, and emergency department trauma team response. They approached the UN and WHO for help in identifying the best training, and they recommended the ETC. Then the ETC organisation was seeking instructors to go to Ukraine. The way the course works is that you deliver the course and the instructors identify people who would make good instructors, and they then do three courses as a trainee instructor before they are qualified to instruct themselves. The plan was to go out to Ukraine to run a course, identify potential Ukrainian instructors, and then run three more courses.
It was a five-week mission to do all of that. But the UN has a rule that if you are ‘in country’ for more than a week, you need to do specific threat training in terms of what to do if you are hijacked or in a mine field etc. So we ran the course, then we did the UN threat training for a week, and then we ran three courses. By the time we left, we had trained twelve full instructors in Ukraine. It was very worthwhile. In Haiti, I had done missions where I went and operated on the ground whereas this was more about training people to train. The ETC is not just about how to stop somebody bleeding to death, it incorporates teamwork, interactions and human factors. In a post-Soviet society, things can be very hierarchical and the ETC is not like that at all. The feedback we got from the locals was excellent, with senior surgeons noting they now felt they could listen to their juniors, and juniors saying they felt they could challenge their seniors and work better as a team. In Ukraine, we weren’t on the frontline and we weren’t operating, it was all teaching local Ukrainian doctors how to run trauma teams. At time of going to press, Дмитро Мясніков and Анна Анісімова were due to instruct on the ETC course in Dublin in late November.
In Ukraine we were in Ternopil in West Central Ukraine, which is very safe. The hospital has a big SIM centre, which is why it was chosen. We delivered another three courses in November in Kyiv. You don’t really know what it’s going to be like until you get there, and obviously you see on the news that there are a lot of bad things going on. I was apprehensive initially. The UN makes you do a lot of online training in advance so you are prepared for the worst. But Ternopil was only ever hit by a missile once, and that was when Ukraine won the Eurovision, and the person who won it was from Ternopil. In Lviv and Kyiv we spent a few nights in shelters because there were missile strikes.
My work at the moment is half-clinical, and half-administrative. A lot of my HSE Clinical Lead work is done remotely, so I am able to continue that while I am in Ukraine. The Mater gave me and Seamus Morris humanitarian leave, and our colleagues picked up the slack. ey were all very good. Without them, we couldn’t have gone. The hospital was very accommodating and so was the HSE. I have a history of doing these mad things and disappearing off to funny places, so in terms of my family, it wasn’t unexpected. My wife and family were very supportive. My kids are all in college now, so it’s a bit different to when they were small. I’m fundamentally a chicken so when it came to going to Haiti I was looking for excuses not to go, but I felt that I had to go. My grandfather was a pilot in the RAF, and he flew in the Second World War. From him I have a sense of duty – if you’re able to do stuff, you have to do stuff I suppose it sounds daft, but that’s the way I’ve always thought of these things. People often say to you, “Oh, I’d love to be able to do something to help.” And I was in a lucky situation, where I was able to do something, so I couldn’t really say no.” ■
