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A doctor volunteering in war-torn Congo performed a complex amputation to save a boy’s life by following instructions sent by text message from a colleague in London.

David Nott, 52, a vascular surgeon, was working for a Medicins Sans Frontieres hospital in the eastern town of Rutshuru, an area ravaged by bloody battles between Congolese and rebel troops.

Among the hundreds of wounded soldiers and civilians brought into the hospital in October was a 16-year-old boy who had been caught in the midst of a gun fight between advancing combatants in a forest in the Nyanzale region.

The boy said that he had felt a heavy blast beside him, and woken up later with his brother screaming beside him and his arm “totally destroyed”.

He had walked out of the forest towards soldiers, who could not help him. Local people found him and escorted him to a nearby MSF clinic, from where had been taken by ambulance to Rutshuru.

A doctor had performed an amputation, but the stump had become gangrenous.

When Dr Nott saw him, what remained of his upper arm was severely infected. “He had about two or three days to live when I saw him,” he said.

He knew the boy’s only hope of survival lay in a forequarter amputation, a huge operation which involves removing the collar bone and shoulder blade. It usually requires much careful planning and a well-equipped operating theatre.

“In the best hands (it) carries huge risks,” he said. “I had never done this operation before but I knew a colleague in London who had so I texted him. He sent me two very long text messages back explaining how to do the operation step by step.”

Dr Nott was unsure that he should operate. “I had to think long and hard about whether it was right ot leave a young boy with only one arm in the middle of this fighting,” he said.

“In the end he would have died without it so I took a deep breath and followed the instructions to the letter.”

He felt able to understand precisely what his colleague meant in each text message, having operated with him many times before on a more immediate basis.

He was equipped with a pint of blood and an elementary operating theatre. The boy has now made a full recovery.

“It was just luck that I was there and could do it,” said Dr Nott, who works at Charing Cross Hospital and volunteers for MSF for a month every year.

“I don’t think that someone that wasn’t a vascular surgeon would have been able to deal with the large blood vessels involved. That is why I volunteer myself so often, I love being able to save someone’s life.”

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