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.”



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.

What a difference a day makes

Dr Traudl Elsholz would be forgiven for feeling overwhelmed and overworked.  She’s one of only three medical anaesthetists in the entire country of Eritrea.

That’s in addition to the 37 diploma nurses who have spent between 6 months and 2 years training in anaesthesia to meet the needs of 5 million people.

“As you can see,” the Ludwigsburg, Germany native wrote last year, “anaesthesia is in agony in Eritrea and changes have to come rather quickly.”

Dr Tradl Elsholz (right) watches Dr Berhane Debru, director of medical services at the Eritrea Ministry of Health, formally open the workshop

The one positive thing to be said about these terrifying numbers is that, boy, you can really see what difference a small group of people can make.

 “First of all I would like to thank you, because mostly there is not any workshop done for anaesthetists for the last three or four years.”

“I really appreciate the Checklist, that [taught] me to create a good working atmosphere for the future.”

“About 80% of my knowledge is improved from the sessions of pulse oximetry.”

Just a peek at the incredible feedback we received last week from participants in a Lifebox workshop that Dr Elsholz ran in Asmara on February 3rd.  Alongside her full time responsibilities as head of the department of anaesthesia at the College of Health Sciences in Asmara, she has taken up the Lifebox mission, and you can see that the impact is immediate – and that the yearning for education and training is immense.

Ready, set, pre-test

35 nurse anaesthetists attended from across the country.  One stayed overnight in Asmara; eight stayed two nights, as they had traveled more than six hours to reach the workshop; two traveled more than 10 hours, to learn about pulse oximetry and the WHO Surgical Safety Checklist.

They left full-headed and full-handed – Lifebox donated 78 pulse oximeters to the Eritrea Ministry of Health, and Dr Elsholz distributed them to ensure that all operating theatres would have access to a device.

"What can happen during anaesthesia that might cause problems with oxygen delivery to the tissues?" (Note oximeter on the table!)

A multiple-choice quiz given before and after the workshop showed that training had an instant effect: comparing pre-and post-workshop results was like comparing the football scores of matches played in the dark, and then played again in the light.  Goal!

Of course sustainable change needs reinforcement, and we’ll be following up with Dr Elsholz and the participants in the next few months to make sure that their oximeters are working, and that the training has stuck.

And Dr Elsholz will continue her indomitable work, developing basic nationwide standards of anaesthesia, and securing education opportunities for her colleagues.

“If you are interested, you might some day visit Eritrea to see [for] yourself,” she wrote warmly.  But “if ever you come, be prepared for some CME [continuing medical education] courses for the anaesthetists and some nice lectures for our students.”