Altitude sickness

This is a photo of Dr Nikhil Rastogi, director of undergraduate anesthesia at the Ottawa Hospital in Canada.  It was taken last year at Cotacachi Hospital in Ecuador, where Lifebox donated a pulse oximeter through Medical Ministry International.

He seems quite healthy, but look at the Lifebox pulse oximeter (and the knowing smile) he’s wearing: 92% oxygen saturation.

Anything higher than 80 out of 100 on a test is a pretty high pass, but when it comes to oxygen saturation, anything lower than than 95% is a concern and 80% is a crisis situation. If Dr Rastogi wasn’t wearing a pulse oximeter you’d have no way of knowing that his oxygen saturation is not at the level it should be.

This is the blindfolded reality that anaesthesia providers in more than 77,000 operating theatres worldwide face every day.  The only way they can tell if a patient is becoming dangerously hypoxic (starved of oxygen) is by close observation for signs of cyanosis – when the patient’s skin starts turning blue.

Action stations!

When we’re training anaesthesia providers in pulse oximetry and the WHO Surgical Safety Checklist, we focus on the fact that the Sp02 (oxygen saturation) for patients of all ages should be 95% and above.  When the Sp02 falls below 90%, the patient is becoming dangerously deprived of oxygen.

In low-income countries, oxygen cylinders can sit empty for months; many of the critical therapies that we take for granted just aren’t an option.  Early identification of a problem makes successful intervention, with the limited resources available, much more likely – pulse oximetry monitoring, quite obviously, saves lives.

Breathing easy

And please don’t worry about Dr Rastogi – Cotacachi Hospital is at 8000 feet above sea level, and he’s just acclimatizing to the altitude!

Surgery is aimed at the majority, not the rich

Did you know that a full 11% of the global burden of violence and injury – which occurs overwhelmingly in low and lower-middle income – countries could be treated with surgery?

That’s an incredible opportunity to save lives! And it’s one of the reasons why we need to do something about the fact that the poorest third of the world’s population receives only 3.5% of the world’s major surgical procedures (the richest third receives 73.6%). {1}

At Lifebox we’re regularly shocked by these statistics – but we also see how many people and organizations there are committed to making a difference.  Last Friday we were lucky enough to meet some of them, at the Global Surgical Frontiers Day , hosted by the Royal College of Surgeons.

It was like walking into a party where you want to talk to every single person in the room!

Professor Chris Lavy, who worked as an orthopaedic surgeon for a decade in Malawi, brought together more than twenty organizations of all different sizes to present their initiatives and talk about opportunities for working together.

Some groups, like Aid to Hospitals Worldwide, redress the balance shipping container by shipping container – they send recycled NHS equipment  to ill-equipped facilities in low-resource countries.  Others, like Out To Africa, nurture direct links, pairing colleagues between the Mid Essex Hospital in Chelmsford and the University Teaching Hospital in Zambia to support professional development.

Some, like the College of Surgeons of East, Central and Southern Africa (COSECSA) cross a continent, helping to develop national surgical policy, running training and exams. Others, like Mercy Ships cross waves and oceans, in liners refitted with operating rooms, surgeons and family on board, to perform crucial procedures docked along the coast of Africa.

Like we said, the statistics made our eyes water, and the personal stories – two-year old twins who received cataract operations through Mercy Ships and woke up to see their mother – and each other – for the first time; a gentleman from the Congo eating by himself for the first time in eleven years after receiving prosthetics from Willing and Abel – made our throats catch.

Lord Ribeiro wants YOU to Make it Zero

But we straightened our ties and talked to Lord Ribeiro, a leading figure in international surgery, who spoke about his hometown of Achimota in Ghana, and asked attendees to create an organizational structure that could benefit those who really needed it.

During his speech on the surgical and education work done by Mercy Ships Lord McColl told that old story of the child on the shore throwing marooned starfish, one by one, back into the water – what difference will it possibly make? asks the cynic, with so many of them hopelessly beached ?

Well of course it makes all the difference in the world to the ones that get thrown back, reminded His Lordship.  But he also acknowledged what was special about this conference – figuring out how we can work together in training and education, making a sustainable change, so that people in low-resource countries get the surgical opportunities they deserve – and lives aren’t beached prematurely.

{1} Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144