The young man lies back on the hospital trolley and waits patiently as his head is secured in place with a vice.

Marian Dolishny’s nervous smile and worried, flicking eyes, betray the certain knowledge that what he is about to undergo will be anything but pleasant. But he also knows that time is short: if the enormous tumour inside his head is not removed, it will soon kill him.

Minutes later the team of doctors, including one of Britain’s most eminent brain surgeons, begins to break into the skull of their fully conscious patient – with a £30 Bosch PSR960 handy-man’s cordless drill.

Amazingly, and despite the low-voltage tool running out of power halfway through the process, Dolishny’s operation is a success, with his tumour skilfully excavated at the hands of Henry Marsh.

The procedure, captured as part of a documentary to be screened on BBC2 later this month, was a routine triumph for Marsh, who regularly takes time off as a consultant at St George’s hospital in south London to travel to Ukraine and save lives despite having access only to primitive tools.

In Britain, the same operation would only be undertaken with the benefit of a £30,000 compressed air medical drill.

Speaking about the trials of his visits to Ukraine, Marsh said: “I’m not recommending that we should all use Bosch do-it-yourself drills in England, but it shows how with improvisation you can achieve a lot.”

Marsh’s life-saving exploits in Ukraine began 15 years ago when he visited a state hospital in the former Soviet republic to give a series of lectures. Little could have prepared him for the conditions endured by both doctors and patients. “It was like being in a horror film,” he said. “It was so awful it didn’t seem real.”

Patients with benign tumours, which would have been diagnosed early and quickly dealt with in Britain, were only treated once they had caused blindness or were bulging grotesquely off the sides of patients’ heads.

In Ukraine so little money is invested in the state health system that Marsh has to drill through the skulls of patients under local anaesthetic because no one is sufficiently trained to fully sedate them.

Marsh said he had watched aghast as patients died while doctors were locked in bureaucratic meetings. “I couldn’t bear to stand by and do nothing,” said Marsh, 58. “A Ukrainian doctor told me I couldn’t do anything to help but I wasn’t prepared to accept that.”

Then he met Igor Petrovich, a Ukrainian neurosurgeon who wanted to fight against his country’s bankrupt medical system. Impressed by his willingness to speak honestly about the atrocious conditions in a climate where no one criticised the state, Marsh championed Petrovich and organised for him to come to Britain to learn more.

Since meeting Petrovich, Marsh has been making at least two private trips a year to work voluntarily with him at his neurology clinic in Kiev. On each visit, he takes a raft of disused equipment that has been thrown out by the NHS, and helps Petrovich make diagnoses and perform operations.

“I’ve taught him everything I know,” said Marsh, who has given Petrovich an advanced compressed air drill to replace his Bosch. “He’s now able to do things that I can’t.”

For all its failings, some aspects of the Ukrainian health service compare favourably with the NHS, Marsh said.

At the time of their first meeting, Marsh was a senior surgeon at the specialist Atkinson Morley hospital in Wimbledon, operating on 10-15 patients a week. “I was completely free; I made clinical judgments and was trusted to treat patients to the best of my ability.”

Today, though, their roles have more or less reversed, he said. “Igor is now doing a huge amount of operating, far more than me, while I, as with all senior doctors on the NHS, am struggling under a tsunami of regulation and bureaucracy.”

Working in Ukraine has also brought the wastefulness of the NHS into focus for Marsh. Drill bits used in brain surgery that cost the NHS £80 a piece are thrown away after a single use to help prevent the spread of prion-related diseases such as CJD.

In Petrovich’s practice, a drill bit will be used for up to 10 years, perfectly safely. “We never used to throw them away in the UK,” says Marsh. “They would be sterilised and reused. Now they just end up as landfill, and Igor’s rates of infection are no worse then ours. It’s insane.

“I am one of the government advisers on prion disease. In the case of the skull perforators, skull and scalp is not an at-risk tissue for surgical treatments. So that argument does not apply.”

The English Surgeon will be shown on BBC2 on March 30

Makeshift jobs that saved lives

— In an emergency far from hospital, improvisation can be the only way to save life.

— In 1995 two doctors on a flight from Hong Kong to Britain operated on a woman with a collapsed lung using a scalpel, a knife and fork and a coathanger to push in a catheter.

— In Iraq in 2004, an American medical journalist removed a bullet from a marine’s head with a drill used to put up a tent.

— In 2003 Aron Ralston, an American climber, cut off his arm with a penknife after it became trapped under a boulder in Utah.

— The following year Ines Ramirez Perez, a Mexican, delivered her son by caesarean section with the help of three stiff drinks and a kitchen knife.

Explore Health

• Expert Advice

• Health Features

• Mental Health

• Alternative Medicine

• Child Health

• Health Club