Buenos Dias Buenos Aires!

Taking the subte from Catedral to Plaza Italia in Buenos Aires this week is an insiders game of ‘I spy.’

With the band

I see a blue laynard! we hiss, subtle as neon, hopping out into the sunshine across the cobbles and following our subjects in to the courtyard at La Rural convention centre, for the 2012 World Congress of Anaesthesiologists.

Usually Lifebox oximeters go out to the world – more than 1600 distributed in 48 countries so far – but this week the world is mustering in one place and we’ve come to join, as the official charity of our host and co-founder, the World Federation of Societies of Anaesthesiologists (WFSA).  We’re here to meet the anaesthesia providers and societies helping us in the Lifebox mission to Make It Zero, and learn more about the countries we hope to be doing more work with.

On Sunday the exhibition hall was still a construction zone, and we unfurled our banner in the ghost town of the WFSA networking zone.

Nadie está en casa

But by 9:30 a.m. on Monday morning ghosts were giving themselves up, as more than 9000 delegates shouldered WCA backpacks and set out across the exhibition centre.

Todo el mundo está en casa!

Last week we joked about the Oscars, but forgive the flippancy, because this week we really do feel a little star struck!  So many celestials of the Lifebox constellation – our colleagues across seven continents, who teach, fundraise and research on our behalf – have blazed across to BA, and it’s a strange feeling to find them all under one roof.

Stay tuned to hear about our conversations!

And in the meantime, check out our Make It Zero video – now with Spanish captions…

Roll out the Red Carpet

They kick up enough fuss about the Oscars and those things roll around every 12 months.

Not invited to the World Congress of Anaesthesiologists (c) Creative Commons

At Lifebox we’re much more excited about the World Congress of Anaesthesiologists (WCA), which takes place on an exclusive four-year basis.

And suddenly WCA 2012, hosted this time in Buenos Aires, Argentina, is less than a week away!

The congress, organized under the auspices of our co-founding partner the World Federation of Societies of Anaesthesiologists, held its last meeting in Cape Town, South Africa in 2008.

It was a big one for Lifebox – we just didn’t know it, as we didn’t yet exist.

An updated draft of the 1992 International Standards for the Safe Practice of Anaesthesia, revised as part of the World Health Organization’s “Safe Surgery Saves Lives” Global Patient Safety Challenge, was submitted, refined and adopted.

These standards elevated pulse oximetry to the highest level of recommendation, making its use, in effect, a mandatory standard of care.

This decision – that pulse oximetry was essential to safe anaesthesia and safe surgery – was quickly followed by the question of how to make it available worldwide, how to ensure that geography was not a barrier to essential equipment.

The Global Pulse Oximetry Project was born, and out of that, Lifebox.

But that’s really a story for another day.

We just wanted to let you know that Lifebox will be making a splash where it all began, launching our global Make It Zero campaign to put 5000 oximeters in the hands of anaesthesia providers who need them in the next two years.

We’re also excited because, to be honest, it’s a pretty special event – representatives from every national anaesthesia society around the world come together to set global standards, pore over recent clinical and practical developments, talk, and learn.

As Dr Angela Enright, Lifebox trustee and WFSA president said “it is one of the few meetings where you can hear cutting-edge science on the one hand and how to give anesthetics with almost nothing and in the most challenging of circumstances on the other.  It is humbling.”

We’re looking forward to meeting our global colleauges in safe anaesthesia, learning and listening as much as we can, and planning what an equipment and education dent we can put in the 77,000 plus global pulse oximetry gap by the time 2016 rolls around…

You can follow us at the conference on Twitter @safersurgery with the hashtag #WCA2012.

Our Health our Common Wealth

Did you know that a nursing unit manager in South Africa performs on average 36 different activities an hour?

Multi-tasking may be a modern affliction, but for nurses – particularly those in low-resource settings – it is a life-saving skill.  With medical degrees overwhelmed and under-represented, it is the nurses, generally the largest group of skilled workers in any healthcare system, who deliver a majority of frontline care.

That scheduling insight, from a study delivered by Professor Laetitia Rispel (‘Today was a hectic day: exploring the average working day of nursing unit managers in South Africa’) – is just one of the things we learned at the Inaugural Commonwealth Nurses Conference, supported by the Royal College of Nursing in London this past weekend, where Lifebox was lucky enough to be invited to exhibit.

We’re used to hearing stories about the miles that medical professionals will travel for equipment, education and community support.  But we don’t often get to meet them.

So it was a real pleasure to walk around the room at the Commonwealth Club and talk to some of the 180 people who had traveled from 27 of the Commonwealth countries to London for the occasion.

Over the two days we joined sessions on meeting the health-related MDGs (both “Challenges and the way forward” and “Caribbean style”); reducing maternal and neonatal mortality by scaling up midwifery education; the use of information technology in hospitals in Cameroon and many more.

Talks were delivered in a range of accents and fabrics that spoke something to the breadth of cultures and nations that make up global healthcare, and strive alongside each other to improve it.

As though to underline this point, THET trustee and past president of the RCN Maura Buchanan spoke about the difference we can make to global health through established partnerships – the reciprocal transfer of skills and knowledge stretching beyond individual scope to encompass whole institutions, that THET has encouraged for 20 years.

Some delegates we spoke to were from countries with widespread pulse oximetry use; others from countries where a finger on the pulse is all the monitoring that is available.  But all of them were confident about the value of an oximeter.

“We, the clinical staff know how important this is,” said Cecilia Anim, RCN Deputy President of Ghanaian origin, examining the Lifebox pulse oximeter.  “It is the governments that have to listen.”

In memory

The late Dr Vincent James Hughes was a Canadian anesthesiologist who dedicated his professional life to improving anaesthesia care worldwide.

"A truly remarkable man"

He spent ten years working in the West Indies; ten as a physician-anesthesiologist in Zimbabwe, and ten back home at St. Michael’s Hospital in Toronto, where he continued to support outreach programmes in low-resource settings.

By force of dedication, compassion and example, the beloved member of the St Michael’s anesthesiology team has continued to make a difference to surgical safety in low-resource settings since his sudden death last year: recently his colleagues raised funds for the purchase of 39 oximeters in his memory.

“I thought it would be three or four – but the department said absolutely, we must do this, but in a way that shows how important Vince was to all of us,” explained Dr Patricia Houston, Vice President for Education at St. Michael’s, who proposed the tribute.

“It very much resonated with me and my department.  It’s probably the most useful piece of technology that can be sent.”

Every single member of the physician faculty donated, and their generosity has contributed to the enormous success of the Canadian Anaesthesiologists’ Society drive to send enough oximeters for every operating room in Rwanda.

Rwanda-bound and raring to go

268 oximeters have been paid for so far, and today the first 50 are being sent out to the University Central Hospital of Kigali.

You can read more about their success on the website of the Canadian Medical Association.

Lifebox is grateful to everyone who contributed, and to the memory of the man who inspired them.  “Vince was an incredibly important part of the department,” said Dr Houston.  “He lived a set of values that we all believed in.”

OK!

According to OK Links, the amount spent on healthcare per person per year in Tanzania would buy one cappuccino in the UK.

Maybe you’re reading this blog while you have a cup of coffee.  Certainly the author must admit that she’s got one to hand right now.  It’s impossible not to be shocked again and again by such comparisons – and to delight in partnerships and organizations that grow out of the divide to support each other.

"Producing healthy citizens!" - image courtesy of OK links

Recently Lifebox donated three pulse oximeters to OK links, a network that joins staff at the Oxford Radcliffe Hospitals NHS Trust (ORH) in the UK with colleagues at the Kilimanjaro Christian Medical Centre (KCMC) in Tanzania.

Miss Lakhoo, the anaesthetic clinical officer and the senior scrub nurse

“The equipment was received with overwhelming joy,” explained Consultant Paediatric Surgeon and Clinical Lead for Paediatric Surgery Kokila Lakhoo, the Oxford-based OK links coordinator.  “We used it in theatre and it was also very helpful in the neonatal unit as they have no monitoring there.”

The anaesthetic clinical officer in the photo is a trained clinical officer, rather than a qualified medical anaesthetist.  Like the majority of anaesthesia providers in low-resource settings, he graduated from what training was available and built up his skills on the job, carrying enormous responsibility.  KCMC is a 450 bed hospital, providing care for 11 million people in northern Tanzania, and he does anaesthesia for all the children at the hospital.  He also works with a flying doctor, and the pulse oximeter will help him safely anaesthetize and monitor patients in the most remote areas.  We are honoured to be able to provide him with this essential piece of kit!

The flying anaesthetic clinical officer

“More African healthcare workers could benefit from short visits to Oxford to learn specific skills, [while] KCMC can provide valuable experience for UK health professionals at all stages of their careers,” says the OK links flyer.  ”There is virtually no limit to what can be done.”

135/1000

Although the Lifebox mission is to ensure that all operating rooms have access to a pulse oximeter, we know that they can play a lifesaving role outside of surgery.  

The boy, 16 months old and unconscious, was lying limp on the floor of the children’s ward at the Martha Primary Health Care Centre, spooned against his mother.

A 16-month-old boy 24 hours after receiving oxygen therapy and treatment for malaria at Martha in South Sudan

She was exhausted too: 5 hours holding the child tight on the back of a motorcycle, bumping and choking over 100 miles of bad road, south west from Juba in the foot of South Sudan, across the White Nile river to Yei.

Earlier that day he’d been diagnosed with pneumonia, but started fitting and eventually lost consciousness.  When he arrived at Martha he was dangerously starved of oxygen, and quickly diagnosed with malaria too.

The under 5 mortality rate in South Sudan is 135 per 1000 children.  In the UK it is 5. 

A girl there has a higher chance of dying in childbirth than she does of finishing high school.

For so many in this part of the country, Martha is the only primary care that they will ever see.

Mothers wait to vaccinate their children and get a mosquito net (more than 6500 distributed so far)

After a lifetime in Winchester, U.K., Poppy Spens, a nurse practitioner, and her husband John agreed that once their youngest child finished university they would “go do something different.”

She got a diploma in tropical diseases, and they set off for South Sudan.

“Initially we went out for a year, but in a year you can’t achieve anything,” she explained to the Lifebox team, five years later and freshly returned from another trip.  “If you’d told me before that I would be setting this up, I would have said that…”

‘This’ is Martha, a brand new primary healthcare centre with a sizeable training budget, aiming to improve morbidity and mortality, particularly child and maternal, and to increase the numbers of well-trained local staff.

Today they treat nearly 2500 patients a month, and have expanded to another centre, a mobile clinic that does weekly rounds of the surrounding villages, a paediatric ward and an eye clinic, with 51 health care staff trained or in training.

Combination clerical road trip and first ever eye exam!

Poppy and John purchased two oximeters for Martha through The Brickworks, a charity they set up to support projects in South Sudan.  One will be used in surgery; the other is used on the children’s ward, and on the boy in the top photo three weeks ago.

“Because we had an oximeter, we could give oxygen therapy,” she said, happily.

24 hours later he regained consciousness.

Mothers and children at Martha. They shouldn't be facing such stark odds.

 

 

But it could be so much more

“We have a couple of monitors from the US.  Lovely, lovely multi-parameter monitors – but they only work with a battery.  And they didn’t send the battery.”

“People send things with the best of intentions, but they’re not thinking about where these things are going to be used,” explained Dr Eva Manciles-Robert, when she visited the Lifebox office yesterday to confirm plans for the workshop she’ll be running in April at the Connaught Hospital in Freetown, Sierra Leone.

Dr Eva Manciles-Robert visits London and demonstrates the pulse oximeter (in colour-coordinated style)

In Sierra Leone, where Dr Manciles-Robert returned to practice in 2007, you need equipment that is fit for purpose.  Like the Lifebox oximeter.

It’s high quality but it does a very specific job, for a very specific environment.

For instance – in a low-resource setting, the operating room will likely have a concrete floor, and no engineer to fix broken equipment.  So the Lifebox oximeter is robust enough that you can drop it from a metre’s height off the table without immediate consignment to the equipment graveyard.

The electricity supply will almost certainly be fickle, so it runs off a rechargeable battery that can be powered up when mains power is available, and will keep a patient safely monitored throughout an operation even when the power inevitably fails.

The majority of anaesthesia providers will have between six months and two years of training before heading out to rural facilities where they will be the only person qualified to deliver anaesthesia for miles around.  So the Lifebox oximeter is intuitive, with a basic interface and large screen.  And the education materials come in six different languages.

There are only two medical anaesthetists in the entire country of Sierra Leone, as well as 60 nurse anaesthetists.  (“Sixty more than there were just after the war,” Dr Manciels-Robert reminded us.)  They are responsible for the anaesthesia care of 6 million people.  And they handle everything.

So the Lifebox workshop that Dr Manciles-Robert is leading will make an enormous difference.  Over two days, nurse anaesthetists will learn about pulse oximetry and the WHO Surgical Safety Checklist.

Thanks to our donors Dr Manciles-Robert will be able to distribute 36 oximeters, ensuring that every operating room in the country is equipped.  Surgeons and anaesthesia providers in the provinces will be able to do more complex cases, safely, rather than sending patients hundreds of miles to over-crowded, under-resourced main hospitals.

“When I went back I was in awe of my colleagues,” said Dr Manciles-Robert, who trained in Ireland.  “In Sierra Leone, you go back to medicine as medicine once was.  You depend on your finger, eyes, nose.  But it could be so much more.”

We’ll keep you updated on how it goes.