Got any bright ideas?

At 8:30 a.m. on a Saturday morning?  After a long journey to London from Leeds/Cardiff/Newcastle/St. Andrews?  About my – sorry, have I got this right – my innovative solutions for implementing universal health coverage?

Got any coffee?

Maybe that’s what you’d say, you older people with your groggy eyes and your cynical morning breath.  Medsin members are different.  They don’t just show up like warm bodies – they show up to participate.  What’s more, they bring their own coffee mugs.

Medsin is a student network and registered charity with a vision for “a fair and just world in which equality in health is a reality for all.”  It’s driving towards this ideal future with global health’s stealth weapon: medical students.

With a network of more than 30 branches across universities in the U.K., the organization is focused on education, advocacy and community action.  And this weekend several hundred of them gathered at Barts and the London for their annual global health conference.

We were delighted to spring out of bed and join them!

Lifebox trustee Dr. Isabeau Walker hosted one of 40 workshops as part of a dynamic programme that spanned neglected tropical diseases, the condom revolution, mathematical innovation in medicine, women’s rights, HIV, maternal health, access to drugs, post-2015 agenda, mental health, universal coverage, partnerships…

Workshop crowd

We were told there would be innovation

It was a relief to see that while surgery may be the long-neglected stepchild of global health, it’s not out in the cold with Medsin – the workshop room was packed.

But it’s also clear that when it comes to global surgery, there’s a huge amount of education to do – even amongst those most attuned to the issues at stake.

Isabeau Medsin workshop“If you were in an accident in the U.K., what’s the likelihood that you’d get surgical treatment?” asked Dr Walker, using her own broken arm as a prime example.

100%, the room agreed.

“And if you were in Uganda?  What are the chances that you’d get an operation?”

“40-60%?”

“Would it shock you if I said it was less than 4%?”

Yes.  Of course it would, and it did, because the actual number of lives lost every day to death, disability, pain and social isolation for lack of safe, simple surgical care is almost incomprehensible.  Especially when we know how to save them.

So it was a great privilege to spending our morning with a diverse group of people – nurses, new medical students, on-their-third-degree students  - resolving to challenge this. We talked appropriate technology, safe surgery and the different ways to make a difference to the global health crisis of this decade, and certainly the one to come.

It was also the grand debut of our Lifebox Toolkit, specially designed for medical students to get up to speed on the facts about unsafe surgery, the science behind the WHO Checklist and pulse oximetry, and the opportunities for getting involved.  Lifebox Rep?  Lecture?  Elective?  We have something for everyone!

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Our Whitechapel hosts were recently renovated, and the new Barts and the London is shiny and blue and whirring with emergency helicopters headed for the roof.

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The old building dates to 1740, and the original Barts  – apparently the oldest hospital in Europe – all the way back to 1123.  Looking out the window you see a medical world in flux; a dead building crumbling in front of the new.

Oldhospital

Basically the perfect scene for a conference on innovation!  And for looking in a wider, more futurely direction.  Appropriately enough while we were talking global surgery in one hemisphere, Lifebox’s Dr Ed Fitzgerald was in another, actively laying foundations for it with Mercy Ships and a team at Hôpital General de Dolisie, in the Republic of Congo.

We were so pleased to join the friendly faces and portholes on board the MV Africa Mercy again, after our last visit in Guinea, and to work together to deliver pulse oximeters and training in oximetry and the WHO Surgical Safety Checklist.

Congo_Mercy Ships_training

More to the Medsin point: it goes to show this conversation about unsafe surgery in low-resource settings isn’t abstract.  It isn’t forward planning and it isn’t just an interesting concept worth kicking around.

In the U.K., risk of dying from anaesthesia is 1 in 200,000. In West Africa, it’s as high as 1 in 133.

Congo_Mercy Ships_oximetersUnsafe surgery is a crisis that is happening now.  Obstructed labour and road traffic accidents can’t be put on pause till we have a solution, and so day after day, healthcare workers are forced to deliver emergency C-sections and trauma repair without the resources they need to do them safely.

Patients are forced to chose between unsafe surgery or no surgery, which is no choice at all.

Lifebox provides the essential equipment and training that starts to make surgery safer as soon as it reaches the operating theatre.  Medsin members traveled down to London because they want to make a difference.  You don’t have to wait until graduation – you can start right now.

Download the Lifebox toolkit here and get started. This crisis belongs to you.

 

The Things That Really Need To Be Done

“We’re here today to talk about surgery,” said Lord Bernard Ribeiro, vice chair of the All Party Parliamentary Group (APPG) on Global Health, as he welcomed the audience to the Houses of Parliament yesterday.  “Not as a luxury, but as something that changes lives.”

Houses of ParliamentPast the policemen, across Westminster Hall and over the commemorative plaques marking where Charles I was tried and Winston Churchill laid in state – such rarified air and elegant sandwiches might seem an unlikely setting to talk about the 2 billion people around the world who lack access to essential surgical care.

But for the first time in history more people are dying from surgically-treatable conditions than infectious diseases.  The arrow keeps going up, and global surgery is utterly failing to keep pace.

Arrow going up

“People are dying unnecessarily, and with great suffering,” said Michael Cotton, surgeon, co-founder and chair of the International Collaboration for Essential Surgery (ICES).  “It’s not necessarily complicated or expensive to deliver essential surgery, it’s a cost-effective, one-off intervention with life-long results.  These are the things that really need to be done.”

Global surgery is in crisis and it’s time for global action.  It’s a thrilling step that politicians and Lords are crossing party boundaries to open the hallowed doors and talk about it.

APPG panel

To talk and to listen.  The APPGs on Global Health and on Population, Development and Reproductive Health joined forces to host a screening of The Right To Heal, the documentary by surgeon and ICES co-founder Jaymie Henry that puts the spotlight on the people whose lives are wrecked by lack of access to safe and timely surgical – and those who are working to change this.

“I grew up in the Philippines, and have first-hand experience of lack of access to healthcare. But working in ‘global surgery’ felt increasingly like an idealistic, academic experience. We were looking at it through a second-hand lens,” Jaymie explained to Lifebox in an interview for the Make It Zero campaign on International Women’s Day.

“I started traveling, and meeting people, talking about their experience of not having access to something so vital. And I thought the gap was really just about letting people know.  We become complacent knowing everything for us is working well.  But how can you be a human being and stand by, not do something about it?”

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Watching Priscilla, a young student in Kenya, talk about her experience of rape, obstructed labour and the resulting obstetric fistula, it feels criminal not to.

But global surgery has been on the agenda – and largely ignored – for more than 30 years. It needs infrastructure, training, equipment and education – and it needs us to make more noise.

This was a room full of leaders in the field – the Royal Society of Medicine (RSM), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), The George Institute, Tropical Health and Education Trust (THET), and The Lancet which has just hosted the first meeting of its commission on global surgery – asking each other what can we do, what do we do next.

The answer isn’t clear, but the imperative is – and as Right To Heal continues its journey across the medico-festival circuit, with screenings across continents – and of course Lifebox Day earlier this year – it’s exciting to hear the response, the urgency, the conversation getting louder.

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With the MDGs expiring in 2015 it’s a vital time to get surgery on the international agenda. We’ll leave the politics to our hosts, but it seems to us it’s good sense and good rhetoric: lack of access to safe surgery is a global health crisis, but unlike polio or HIV, surgery is its own solution too.

“Surgery is as important as infectious diseases in public health,” says Agnes Binagwaho, the Rwandan Minister of Health in the film.  “How can you save someone from HIV only to let them die in a road traffic accident?”

 

Unsafe surgery is our issue

Sometimes a picture -

Screenshot 2014-03-07 23.53.02Sometimes a picture says it all.

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And you don’t need 1000 words to make a point.

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But sometimes there’s too much to be said.

The problem is complicated, urgent, human, unfair, and the statistics are so vast that you can’t see past them.

Sometimes the story is so much more than the front cover.  

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And a picture is only a signpost:

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to let you know the conversation is just getting started.

Unsafe surgery is a global health crisis silencing millions of women worldwide.

It’s time to start talking about it.  Join Lifebox at www.makeitzero.org

Lifebox Day

When two global surgery events come along at once you don’t grumble.  Unlike a bad bus day, you get on board!

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As Lifebox chairman, surgeon, author and casual time traveler Atul Gawande (bodily in Boston and telegenically in London) explained by video,  “the global health landscape is changing.  For the first time in history, you’re more likely to be killed by a surgically-treatable condition than a communicable disease.”  

The struggle to activate a response to this shift has precedence: the WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC) launched in 2005, the Bellagio Essential Surgery Group convened in 2007.

Still, our ‘neglected stepchild’ is dangerously out of synch with global need.  As the MDGs count down to expiration in 2015, the need to act is clear and urgent.

Shift in burden of disease

So this past weekend we kept one eye on the live stream as the world’s best minds gathered in Boston for the first meeting of the Lancet Commission on Global Surgery, and another on the world’s other best minds, gathered in London for Lifebox Day!

AudienceMore than 60 colleagues with an interest in global surgery swapped a rare sunny Saturday for a darkened room in the Camden People’s Theatre.  Never mind the artificial light: the right speakers and the right conversation let in the great wide world, and we were thrilled to join such a passionate, thoughtful, global group, looking to make noise about a silent crisis.

We were in good company!  Atul introduced our patron Lord Bernard Ribeiro, past president of the Royal College of Surgeons, who reminisced about being (gently) strong-armed into joining the Lifebox mission.  

Patron and Board members

“It just goes to show that surgeons and anaesthetists can learn from each other,” he said, introducing  with a lordly smile the broadest theme of the day: trust.

Trusting you with my story.

Trusting you with my patients.

Trusting you with my life.

A permanent improvement in the safety and quality of surgical care in low-resource settings doesn’t happen overnight – and why should we expect it to?  Like anything in life, long-term solutions take long-term commitment.

“You must invest your time in this,” explained Dr Stephen Ttendo, past president of the Ugandan Society of Anaesthesia  “If you don’t gain trust, you will fail.”

Dr Ttendo joined Lifebox friends and colleagues Dr Faye Evans (Georgia fundraiser and a Rwanda oximetry lead) Dr Tom Bashford (Ethiopia implementation) and Dr Ed Fitzgerald (Lifebox clinical advisor and WHO Surgical Safety Checklist implementation lead), to talk about experiences of global surgery in low-resource settings.

Panel sessionThis means confronting the brutal reality that universal solutions to universal problems don’t have universal application.  As Dr Sophia Webster of Flight for Every Mother reminded us, all women are  at risk from the same complications during pregnancy – but only in some countries do they die from them.

The obstetrician, recently returned from her solo flight across 26 countries in Africa to raise awareness of unsafe pregnancy, took the room on the journey with her.

The next speaker stayed in trajectory, swinging the NHS via NASA and heading for space. Anaesthetist, Extreme A&E and Horizon presenter Dr Kevin Fong‘s investigation of risk and how we learn from our errors made the audience laugh, sober up sharply, and then laugh again, but nervously this time – mistakes can seem so silly till they happen.

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burritosFuel for ire and action – and probably time for lunch.  Enter Chipotle, the only local restaurant to not only answer their phones in friendly style, but enthusiastically agree to sponsor lunch at Lifebox Day!  A grateful dash to the Mexican grill’s Wardour Street branch and we were back with 70 burritos – a very practical conference snack as it happens.

Another generous donation from our friends in the north at Thomas Tunnock Ltd kept the room sweet through tea time.

Tunnocks

Doctors and nurses spend their days on close terms with life and death – no wonder they make powerful poets and writers, and we were so pleased to see the Lifebox crowd in strong metre!  Poems took the top three spots in the Lifebox Competition, and second prize winner Emily Lear was on hand to read her submission.

Maybe it was the theatrical setting but somehow the words “champagne coloured wee” never sounded so dramatic, while the last couplets -

But if the worst happens, if things aren’t as planned / If you find yourself holding a relative’s hand: / It is those humble numbers which helped us to say / We did all that we could and in just the right way.

Emily Lear_poem

- reminded the room, in ways that statistics make it easier to forget, that unsafe surgery is a tragedy – and a burden of grief that isn’t fairly shared.

The human cost of lack of access to safe surgery worldwide was given an unflinching, high definition focus in a new documentary: The Right To Heal, directed by surgeon Jaymie Henry, and screened at Lifebox Day for only the second time in the U.K.

Dr Henry, born in the Philippines, spoke with passion and experience about what she and her team have seen on the road, camera in hand.  Her subjects appeal for attention – and trust enough to tell you their stories.  The 15 x 15 Campaign is one of the ways that Jaymie and her colleagues at the International Collaboration for Essential Surgery (ICES) are working to make good on that  decision.

Lifebox was founded in 2011 to make surgery safer in countries where lack of equipment and training means that undergoing a life-saving operation is, perversely, one of the most dangerous thing to do.

We left Lifebox Day as airborne as Sophia and Kevin’s flightmobiles, after a day in company that is striving to support a world where access to safe surgery is a right, not a privilege.  Thanks to team efforts, this largely silent global health crisis is starting to make noise.

As Omiepirisa Yvonne Buowari, a Nigerian anasthetist and one of the competition winners wrote,

Team work is good. / We can beat our chest and say / Together, each achieves much.

because

Once Upon a Landline: putting the global in global health

Back in the late 1990s, an Ethiopian doctor was working with a Norwegian institution to fund a plastic surgery unit at his hospital.

Yekatit 12 Hospital_Ethiopia

When he wanted to speak to them by phone, he’d stay at his mother’s house to use the landline.

When they needed to email him he’d go to the university library, ask the authorised person to connect and print off the message, draw up a handwritten response, hand it over for type, connection, send – and sleep in the library, waiting for someone to come and wake him with the return message.

Fast forward several years and then reverse to a few weeks ago, and Lifebox was hosting a faculty meeting for trainers from Cameroon, Congo Togo, USA and UK.  October and November were  packed months for our safer surgery work, with training sessions at a national conference in Yaoundé, Kinshasa, Lagos, and there was a lot of prep work to do.

The call was confirmed by email.

Teleconference map

Everyone joined over Skype.

After two quick rounds of “hello, hello, can you hear me…?” the agenda got underway.

Someone took notes.

People asked questions.

An hour and a chorus of goodbyes later we had insight, we had enthusiasm, we had a plan.

And everyone slept in their own bed.

Communication is changing.  Radically.  And yes, the cynic says, sure.   Everything changes and everything stays the same; it’s no easier than it ever was to make a difference in global health.  Show me the other plastic surgery units in Ethiopia.

But the cynic always has something to say.  The reality is – of course it’s easier than it was to make a difference!  To work in collaboration, not isolation.  To collect and share data, use it effectively, and send a photo round the world in 30 seconds that brings two faraway faces into each others’ line of vision.

Kibagabaga waiting room

The growing number of institutional links, academic platforms, education forums – the articles, the public awareness that increasingly makes action the imperative, not the anomaly.

Of course there are pitfalls – and there is ego, and there is scope for abuse; and this giddy tone isn’t to deny the full-blown and circling, global surgery crisis.

Quite the contrary – it’s inviting the crisis into our homes, it’s saying that a comfortable distance from chaos and suffering ‘over there’ doesn’t exist any more.

The very fact that you’re reading this blog post.  That you’re connected by proxy to Benson in Cameroon, Fataou in Togo, the Mercy Ships crew and patients in the Republic of Congo.  That you know avenues to get involved, to spread the word.

There is a long way to go.  But we’re excited to be working at a time when there is scope for everything that needs to be changed changing.  For nothing that has been flawed, for too long, to stay the same.

Great and glad tidings!

Lifebox isn’t a faith-based organization, but you don’t need to tell us twice about the true meaning of Christmas.

Hope and renewal, sacrifice and generosity – looking back at the most popular stories we’ve shared on our blog this year, there’s meaning behind every message, and inspiration to build a better 2014.

Here’s to a year of great and glad tidings!  And our top ten most-read stories:

BBC_screenshot1. Counting to Save Lives: a heartbreaking horror story from a colleague in Uganda about how one of the simplest steps on the WHO Surgical Checklist  – counting swabs – would have saved a life.  This post got a huge boost from our work with the BBC’s Health Check team this summer, thanks to a short video we made with them at our pilot programme at Kibagabaga Hospital in Rwanda.  The accompanying article highlights why surgical safety isn’t just a low-resource challenge – it’s a global concern.

Kristen and Austen2. Honestly, people in love: an oldie, but a grow-old-with-me goodie!  This ‘favourite ever’ story (and the treatment for our global surgery romcom if it ever gets off the ground), shared interviews and photos of couples who used their wedding spotlights to shine a light on the crisis of unsafe surgery worldwide.   They raised thousands of pounds by putting Lifebox on their gift registries, and have inspired other couples to use the power of love to make surgery safer worldwide.

Cake Collage3. Raising the dough: chefs hats off to a phenomenon we never saw coming: the runaway popularity of the AAGBI’s Great Anaesthesia Bake.  The Association encouraged anaesthesia departments around the country to swap scrubs for aprons and host bakes sales to raise funds for Lifebox.  Word spread, more and more teams took part, and the cakes became increasingly anatomically-correct.   To date, the challenge has raised more than £17,000 for safer surgery.  FROM CAKE.  Just think about that.

Mercy Ships4. A medico-maritime life for me: Capacity-building is essential for securing long-term access to safe surgery in low-resource settings.  But in the meantime there are millions of people who need an operation last year, last month, last week, now.  We’re proud to be working with Mercy Ships, the world’s largest floating hospital, which docks each year in a different African port and embarks on an intensive surgical rota that gives life and livelihood back to thousands of people.  Click here to read about our stay with them in Guinea.

Haydom_oximter on finger5. Man v Machine: the ‘equipment graveyard’ – warehouses full of unusable and unrepairable equipment that so often haunt hospitals in low-resource countries – is a stark failure of international corporations, communities and common sense.  Karoline Linde, at Haydom Lutheran Hospital in Tanzania, wrote to tell us about a day in the life of a Lifebox pulse oximeter – and the challenges, decisions and constant pressure that equipment and healthcare workers are under as they strive to save lives on the front line.

OR staff Kibagabaga

6. Change we can believe in: In 2006 there was just one medical anaesthetist in the entire country of Rwanda.  Today there are 20.  We’ve spent the last year working with Canadian and Rwandan anaesthesia colleagues to deliver oximeters, training and support to this growing community, and the nurse anaesthetists who share the burden.  We’re so proud to stand alongside colleagues so deeply invested in the country’s painful and dramatic capacity to heal itself.

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7. Riddle me this: What do you call an operation that saves two lives at once?  A caesarean section.  Safely deliver a struggling baby from a mother locked in obstructed labour for days and deadly weary, and you’ve pulled two lives back from certain brink.  But lack of access to surgery is a crisis compounded by the crisis of unsafe surgery.  We took a look at the perils of obstetric surgery in low-resource settings, and some of the new organizations and programmes that have been developed to address them.

Teleflex ad

8. I left my heart in San Francisco: As some loud-mouthed puppets wisely said, ‘You need a montage” – so we had a lot of fun making one of our recent trip to San Francisco, for the American Society of Anesthesiologists’ annual conference.  We met colleagues from around the world, worked with the ASA’s Global Humanitarian Outreach committee to deliver a session on Lifebox training in the field, and were the lucky beneficiaries of Teleflex’s ‘play it forward’ game.  And oh, you should have seen those skies…

9.  Before and After: a hymn to the numerical imperative!  “To make people count, we first need to be able to count people,” said a previous WHO Director General – and Bill Gates (who made a whole video about it).  We took a look at the value of measurement in our programmes, following up with Dr Eva Manciles at Connaught Hospital in Sierra Leone, to see what difference the oximetry distribution and training had made in the last year.  We hope you’ll be just as excited as we were by the results.

 

C-section10. The World We Want 2015: It’s a magnificent proposition.  Go on: design the world you want your children to grow up in.  Just remember that you can’t choose their sex, their race, their long- or latitude.  And you don’t know their characters, their ideas, their – well, you don’t know anything about what they really want, do you?  You just need to know that, wherever or whoever they are, they’ve got the best shot at a life and let living.  Join Lifebox as we enter the essential fray of post-Millennium Development Goals debate, and make our case for safe surgery as an essential component of healthcare in the framework that follows in 2015.

And that’s barely a wrap!  There are so many more stories to hear and people to meet that we humbly suggest, if you find yourself a little wearied by this festive time of year, nab a quiet corner and a wifi connection, and go fishing at www.safersurgery.wordpress.com

We’d love to hear from you about your favourite pieces!

Returning to the spirit of the season, we can’t avoid a closing plea.  With only a few days to go, your presents are probably wrapped and ready for fetching from under the tree – but there are some gifts that last long after the box is gone and spring feels closer than Christmas.

Holiday Giving Guide

Donate to Lifebox in someone’s name.  It’s easy to give the gift of safer surgery – just follow the instructions below, and we’ll let them know that they have received – and given – a life-saving present this year.

With sincere thanks, and our best wishes for a very happy holiday season and a joyful new year to you and yours.

The Lifebox Team.

Together to Liberia

Read all about it!  Read all about it!  Two teams of anaesthetists working in Liberia join forces to provide training for over 50 nurse anaesthetists!

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When news from Liberia goes international, the stories aren’t often positive.  We think that’s because they’re reporting the wrong ones.  There are plenty of positive readallaboutits if you allow for stories that matter more than they shock.

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Like the recent anaesthetic conferences held in Phebe Hospital, Bong County and JFK Hospital, Monrovia.

Two U.K. groups  we’ve worked with before – Mothers of Africa, who took Lifebox to Liberia last year and the ACTS team, who’ve delivered oximeters and training in Togo,  Gambia and Guinea - flew out to West Africa where they worked together to deliver pulse oximeters, paedaitric probes and training to nurse anaesthetists working in some of the most challenging hospital conditions in the world.

Everyone did a fantastic job!

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Safe anaesthesia in Liberia is a challenge.  An overworked and ageing cadre of two dozen nurse anaesthetists is responsible for the sedation and pain management of – readallaboutit - 3.5 million people.

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But they’re doing incredible work.  The visiting teams were delighted to see, on a visit to Redemption Hospital in Monrovia, the head anaesthetist produce a completed Lifebox logbook.

Turning the well-thumbed pages it’s clear that the oximeter, which was donated last year, is not only regularly used, it’s intelligently used and integrated into the safer practice of anaesthesia.

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Page after page of patients who were safely monitored during their surgery, who were given a chance to get off the table with their life back under control.

An additional 26 pulse oximeters were distributed alongside training as part of this trip.  Each one will make a difference to thousands of patient lives in the coming years.

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But the team identified the need for further donations still.  There’s the news.  Now we’ve read it.  What are we going to do about it?