Inside the operating theatre of the Tobruk Medical Center in eastern Libya, the OR surgery was both sublime and surreal. White overhead lights reflected off Dr. William Novick’s ice blue surgical scrubs while his headlamp sent a beam of light deep into a child’s open heart.
Novick had three-week-old Naji on his operating table. Naji was one of the toughest anticipated cases, reserved by the local Libyan doctors specifically for Novick’s top-tier surgical skills so the child has the best odds for survival. Novick worked surrounded by multicoloured graphs and blinking monitors matching the high-pitched frequencies and viper-like hisses emitting from the various machines. Hours into the operation, the tension was redlining to get Naji’s complicated surgery right. Novick roared out pent-up frustration over small infractions, like staff using instruments incorrectly.
“No, hold it this way!” he barked. Such outbursts were quickly forgiven by his assistants and technicians. Novick’s world-class surgical skills, which he’d amassed through the decades, and his steady, dedicated hands, held the balance of Naji’s fate in Libya’s uncertain future.
When it comes to performing heart surgery on children in the developing world, Novick, 65, is perhaps the best in the business. So too, arguably, are the doctors and nurses working around him—all pledged disciples of the Novick Cardiac Alliance, a non-denominational NGO serving children who suffer from congenital and other life-threatening heart defects. They’re a rough-and-tumble crew of physicians from the U.S., Europe and Australia, all committed to delivering first-world pediatric heart surgery—free of charge—in some of the most dangerous places imaginable: Iraq, Afghanistan, Ukraine, and Nigeria, to name a few.
In The Pediatric ICU
“Every heart is like a snowflake—no two are alike,” explained Elizabeth Sauter, just next door in the pediatric ICU. Sauter, a pediatric nurse and also a renowned big-wall speed climber from the U.S., couldn’t remember if this was her sixth or seventh NCA trip to Libya as she prepared for Naji’s arrival and the flow of young children that would cycle through the ICU in the next 30 days. Like Novick and the NCA crew, she knew that if children like Naji don’t receive heart surgery, they would likely die.
Later that night, in the ICU’s quiet graveyard hours, Stacey Marr, NCA’s lead nurse practitioner, looked after Naji, who was tenuous and intubated on a breathing machine. He was the first child to visit the seven beds in the ICU ward in what would become rotating care in the coming weeks. Novick was back in the OR, already several hours into another tough case with three-year-old Eslam, who has Down syndrome, a disorder that can lead to congenital heart disease and other defects at birth.
Marr first met Novick in 2005 in a hospital in Rawalpindi, Pakistan, while she was working for Medicines Sans Frontiers (MSF). She and Novick connected right away, and she’s since become Novick’s right hand in the ICU. Marr accepts that Novick can be difficult to work with and intimidating at times, but through the years she’s found a profound respect for the man who has dedicated his life to saving children’s lives.
“I see what he’s given up for it and the energy he puts into every single patient. It’s never become just what he does,” she explained. “Any patient that doesn’t go well—it hits him the same every time.” Marr looked down at her watch and got up to check on Naji again.
“What makes a surgeon a good surgeon is a level of arrogance—in a good way,” added Marr. Her stethoscope, which draped around her neck like a medallion, had allowed her to listen to the heartbeats from countless children in underserved regions around the world.
“If you cut into somebody’s body and it all goes terribly wrong, how would you do it again if you didn’t have a level of self-confidence that you could do it right the next time?” she said. “There are not that many people in the world that possess that.”
The Mission Begins
The team had already endured a long journey to get here. Before arriving in Libya, Novick and several NCA members convened in Tunis, Tunisia, a one late dinner before their flight to the medical facility. They’ve all worked shoulder-to-shoulder for years, but Novick is the undisputed godfather. He’s a large man with a full beard and rimless glasses who regularly tokes on his favorite Cuban cigars. His signature Alabama hat (an homage to his alma mater) sat crumpled on the table before him. A walking cane, which he now uses after surviving a life-threatening infection in Iraq, leaned against a chair.
Pediatric nurse Elizabeth “Libby” Sauter looks over her young patient in the children’s ICU.
PHOTOGRAPH BY JORDAN CAMPBELL
Novick was scheduled to meet with Dr. Reida El Oakley, Libya’s Minister of Health from the HOR Government in the east, the only legitimately elected government in Libya, for a chance to discuss opening up a pediatric heart surgery program in west. El Oakley, a central figure in advancing his country’s healthcare system, has been Novick’s key contact in Libya’s chaotic “anything can happen” geopolitical environment for years. El Oakley, accompanied by a tall, impeccably dressed man flashing a gold watch, greeted everyone around the table with a robust handshake and joined the dinner.
In August 2012, nearly a year after Libya’s former prime minister Mohmar Gadhafi was killed by rebel forces, El Oakley contacted Novick and outlined a serious concern for the country’s future youth. A dangerous power vacuum was growing throughout the country and the cost of flying Libya’s sick kids—children suffering from a multitude of heart conditions—to Italy, Jordan, and Egypt was becoming far too expensive. Novick agreed to visit El Oakley in Libya to mine out a pediatric heart program in the east and in short order they settled on the Benghazi Medical Center.
Just six months later, civil war broke out in Benghazi. Novick knew he had to find a new basecamp for NCA fast. El Oakley agreed to take Novick to site-check the hospital in Tobruk, just east of Benghazi, but the duo couldn’t risk the two-hour night drive through the open desert just south of Derna, an ISIS stronghold. With just 36 hours before he was scheduled to leave Libya, Novick and El Oakley took a private helicopter and, under the cover of darkness, arrived at the Tobruk Medical Center at 12:45 a.m.
“The staff took me on a tour of the OR, the cath lab, and the ICU,” said Novick, who could tell immediately that the facility was clean and sanitary. Locked in a forgotten storage room, Novick also discovered a new cardio-pulmonary bypass machine—expensive and critical for heart surgery. With the helicopter waiting, Novick realised he had everything to kickstart a heart program in eastern Libya.
At the conclusion of the dinner in Tunis, Novick lit up a cigarette, exhaled slowly, and nodded toward the two Libyan officials across at the table. “El Oakley is big picture,” he said. “That other guy who looks like a gun-runner—he just gets s--t done.”
Libya's Failed State
By 11 p.m. the following day, the team’s delayed flight finally took off. The half-empty aircraft felt as precarious as Libya’s troubled state of affairs. Seats were tattered and shopworn, dirty tray-tables rattled in place, and dried vomit was visible on the Libyan Airlines safety card.
After Mohmar Gaddafi was captured and then killed near in Sirte on October 20, 2011, the National Transitional Council, the legitimate government of Libya at that time, declared the country “liberated” and announced plans to hold elections. For a brief moment, Libyans experienced an unhinged sense of independence. After 50 years of dictatorship, democracy was suddenly on their doorstep. What emerged, instead, has been a complex series of attempts at governance by rival political factions in the east and the west—all vying for legitimacy from the international community—and a sharp rise of radical militant and terror groups like ISIS, Al Qaeda and Ansar al-Sharia, which have metastasized throughout the country.
Only weeks after Novick had completed a second month-long medical mission in Benghazi, U.S. Ambassador Christopher Stevens and three other Americans were killed when militants stormed the U.S. consulate. The event made headlines around the world and signalled a dangerous downturn in Libya. Militias from all over began seizing parts of the country in a power grab with no clear authority. By July 2014, United Nations staff pulled out and embassies were closed. ISIS quickly seized control of Derna, roughly 70 miles from Tobruk, NCA’s base of operations.
While the ongoing political unrest and constant threat of violent extremism have created security issues, Libya’s ‘failed state’ has been realised mostly in Libyans’ day-to-day lives. Since Gadhafi’s reign ended, the daily cost of living has skyrocketed nearly five-fold. Infrastructure, like transportation, power, and internet, can be spotty; access to basic goods and services has been dramatically reduced. Of most concern, the country’s healthcare system has almost completely fallen apart, which has since become NCA’s moral imperative to help rebuild.
Eslam and his father Fadil, both from Benghazi, smile in the ICU at Tobruk Medical Center.
PHOTOGRAPH BY JORDAN CAMPBELL
From Tunis, the flight path travelled southeast, reflecting a half-moon over the vast Mediterranean Sea. Tripoli, Misrata, and Sirte appeared to the south along the coast. As the plane breached Libya’s eastern airspace, the dark blue water was eclipsed by almost total darkness, with the lights of Benghazi, Al Bayda, and Derna blinking below.
The plane touched down at the Tobruk airport at 1 a.m. on a poorly lit airstrip. Just west of the Egyptian border, Tobruk is a relatively safe industrial port city, but it’s not immune from violence and conflict. Novick and the team stepped off the plane and were greeted by several Libyan officials and security handlers. In the early morning hours, the entire team boarded a small bus and was whisked away along dark desert roads toward the Tobruk Medical Center.
Risk, Reward, and Passion
Five days after the team arrived, several large explosions boomed loudly just outside the hospital compound, followed by blasts of red tracer fire that hurled into the darkness just above the Tobruk Medical Center. It wasn’t the “celebratory” machine gun fire the team had grown accustomed to hearing, and even though the explosions ceased, they were a sober reminder of everyone’s close proximity to Libya’s ongoing fighting and civil unrest.
Only a year ago, the Libyan army captured several ISIS fighters in nearby Derna and brought them through the front entrance of the hospital. Marr vividly recalled the event. “Two of them were already dead and one of them was dying,” she said. “They all eventually died. The local militia announced [the bodies] were at the ICU. They wanted to see who the relatives were, who would come for them, so they could then get the [ISIS] cell.”
Despite having worked in the world’s most hazardous countries, Marr doesn’t live her life steeped in fear. “It’s like giving into the bullies,” she said. “If you don’t do what you think is right because some crazy terrorist could go off, then they win every time.”
Sauter, who has worked with Marr in both Iraq and Ukraine, views risk through a different prism. In addition to global nursing, she’s spent her life rock climbing and scaling big walls. In 2014, as a recognised professional climber, she broke the women’s speed ascent record for scaling the ‘Nose’ on Yosemite’s El Capitan in just 4 hours and 43 minutes with her climbing partner.
“My climbing style and nursing style are complementary. They can be high risk-to-reward and high-stress situations. They are both very intense,” she said.
The next day Sauter ran laps around the hospital perimeter in the sweltering heat while afternoon prayers crackled across Tobruk’s cloudless blue sky. She was training for another climbing adventure back in the U.S. Sauter wore long pants and a hijab (headscarf)—compulsory for all women in Libya. Her face was flushed red as she passed uniformed security guards who stared at her.
Sauter admitted that climbing was a selfish endeavor, and that nursing had become her “moral engagement” with the world. “I don’t get that from climbing,” she said. “Climbing is personal, and this is a way for me to be a good human.”
"They're Just Trying To Survive"
For six days, the entire NCA team had been working around the clock with numerous, complex open-heart surgeries. Fragile Naji—everyone’s biggest concern—had just finished a second surgery with Novick. He was no longer incubated, but at just a few weeks old, he was still at high risk for infection.
Eslam was recovering well. His mother had visited several times, always cloaked in a full black niqab, pulling back her veil only as she entered the ICU. This time she was accompanied by her husband, Fadil, who played with Eslam by his bedside. Soon the whole family would return to their home in Benghazi, where the security situation continued to be far from ideal.
“These mothers, these fathers, these children—they’re just ‘average Joe,’” explained Marr, who bounced smiling Eslam on her lap. “They’re just trying to survive it.” Sauter weighed in: “They’re just like us—those mothers cry every time their babies come out of surgery and we say, ‘Your baby is ok.’ It’s the same look that a mother gives you in Ukraine, Iraq, and America.”
Novick entered the ICU donned in a clean white lab coat ready to start another 12-hour day. He was visibly relaxed now, seeing all seven beds filled with children who were all recovering nicely from surgery. He huddled with Marr and proceeded to visit each child’s bedside, carefully examining their charts and vitals. Naji was tracking well and would be discharged in a few days.
Novick and his NCA team have built a bold humanitarian bridge to reach Libya’s underserved children. They’ve been responsible for 276 pediatric heart surgeries in Libya and eight month-long trips to the country. Despite the country’s precarious situation, Novick doubled down, straight from his heart, on his unwavering commitment to Libya’s future generations in an interview with the BBC: “You can never give up on these kids, because if we give up, then these children have no hope and they have no future.”
The Novick Cardiac Alliance has performed surgery on 978 children worldwide since it was established in 2014. NCA collaborates with governments, health ministries, healthcare professionals and humanitarian organisations, providing total cardiac care to children in developing countries.
Header Image: Dr. William Novick operates on three-week-old Naji at the Tobruk Medical Center in Libya. PHOTOGRAPH BY JORDAN CAMPBELL
See our own Australian surgeons perform life-saving surgeries in the new documentary series Miracle Hospital.