Intended for healthcare professionals


A chance of life

BMJ 2008; 337 doi: (Published 10 December 2008) Cite this as: BMJ 2008;337:a2958
  1. David Nott
  1. 1London

    The surgeon David Nott, a Christian who does regular voluntary work abroad, made headlines last week when he recounted how he used instructions sent by text message to do a forequarter amputation on a boy in the Democratic Republic of Congo. Here he tells the story in his own words

    Every year I volunteer to work for a month as a surgeon for Médecins Sans Frontières. I have worked for the charity since 1994, in Bosnia, Afghanistan, Liberia, Sierra Leone, Ivory Coast, Chad, and Darfur, Sudan, and this year I was posted to work in the town of Rutshuru in the war torn eastern territories of the Democratic Republic of Congo.

    On my first round I noticed a 16 year old boy lying almost motionless in one of the surgical wards. The surgeon that I had replaced had had to do an emergency left upper limb amputation for a severe injury several weeks previously. The cause of the injury wasn’t clear. I was told that it may have been a hippopotamus bite, but when he recently became better it was revealed that he had been caught in crossfire.

    He was very septic and unwell. Taking down the dressings showed a very infected stump. The muscles were becoming gangrenous, what was left of the humerus was infected, and the skin had that tinge of ischaemia.

    I believed that this boy, if left, would have a certain miserable death. The only way to treat him was to perform an emergency forequarter amputation. Though a consultant vascular surgeon for the best part of 16 years, I had never seen one nor been involved in one. It is performed only very rarely in the United Kingdom, in specialist centres that deal with upper limb malignancies.

    I am fortunate …

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