A Great Initiative

Looking back on last year, it really seems like Lifebox was set up and three minutes later Laura Peltola called the office and said that she and her boyfriend, Andrew Moulds, wanted to do a fundraising campaign to buy oximeters for the Queen Elizabeth Central Hospital in Blantyre, Malawi.

It was very exciting.  The Peltola/Moulds initiative, (“another one just came in!”) was one of the first individual fundraising efforts for Lifebox, and it was so successful that we ended up sending not one, but two large shipments to Blantyre.

After the second shipment, Laura wrote to tell us about how the initiative got started, and about her time working at the Queen Elizabeth Central Hospital.

When speaking to one of my consultants in England last June about my preparations for a year volunteering as an anaesthetist in Malawi, he mentioned Lifebox. When researching this charity, I found it to be a highly worthy cause and relevant to the work I would be doing in Malawi. My boyfriend and I were keen to try to contribute something sustainable to the community, and so we undertook fundraising prior to our departure. Through generous donations from friends and family, we managed to raise enough funds for 14 pulse oximeters, all with adult and paediatric probes and spare rechargeable batteries, as well as 9 additional probes.

Queen Elizabeth Central Hospital, Blantyre, is the largest and busiest hospital in Malawi with 1,100 beds and approximately 1,300 inpatients. The hospital provides care for roughly 500,000 in- and out-patients every year. It has ten operating theatres with a mixed standard of monitoring and a 4-bedded ITU. The pulse oximeters were gratefully received. One of the local Anaesthetic Clinical Officers even commented that, “you are giving the gift of life!”

With these pulse oximeters we have been able to ensure that every theatre has a working pulse oximeter and that a spare is always available. Additionally, the pulse oximeters have helped improved the safety of patients in obstetric recovery, where patients were previously completely unmonitored. Furthermore, as a portable monitor they have provided the means to monitor critically ill patients during transfer and also assess the oxygen saturations of patients prior to surgery. It has been fantastic to see the impact on patient safety the pulse oximeters have had!”

Land of the Free

Liberia, founded in eastern Africa in 1820 by freed slaves from the United States, was traditionally known for its hospitality and academic institutions.

A Liberian flag is hung at the entrance of the Sanniquellie Magisterial Court in Nimba County, Liberia.
Photo ID 468148. 19/02/2011. Sanniquellie, Liberia. UN Photo/Staton Winter.

But the civil wars of the 1980s and 90s wrecked lives and infrastructure.  The school of anaesthesia in the capital Monrovia closed down, and the one in Phebe was always on the retreat to ‘safer areas.’  Training halted and many anaesthetists were amongst those killed.

Today there are just 22 nurse anaesthetists for a population of 3.5 million.  10 of them are middle-aged; 12 are more than 60 years old.  Access to caesarean section is so limited, and the country has one of the highest maternal mortality rates in the world.

Developing life-saving skills for a new generation of Liberian nurse anaesthetists

Mothers of Africa is a Welsh charity set up between Cardiff University and NHS Departments of Anaesthesia in South Wales that aims to support maternal health in sub-Saharan Africa.  They’ve had a link with the Phebe school of anaesthesia for four years now, working together to develop the training curriculum for these desperately-needed nurse anaesthetists.

They’re one of our favourite organizations on Twitter (we’re still new to that game!) and we were thrilled to send them on their most recent trip in February with 18 Lifebox pulse oximeters.

“Pulse oximeters are a much needed resource in Liberia, reflected by the lively debate they provoked when deciding which hospitals needed them most,” explained Dr Diane Watson, who lead the training for 44 attendants.  “Anaesthetists who had none in their hospitals took priority,” she explained of the difficult decisions made by the Liberian Association of Nurse Anaesthetists.

An essay competition for the participants revealed again and again the importance of pulse oximetry – particularly in low-resource settings where staff and training are strained.

“A 20 year old man who had a goitre for the past eight years came to the hospital for a thyroidectomy,” wrote one of the NAs.  “The surgery lasted 5 hours.  At the end of the surgery the patient was taken to the recovery room, where there is no oxygen.  Whilst doing the monitoring I noticed that the saturations were dropping, so I did the head tilt, chin lift, jaw thrust and encouraged him to breathe.  I did this for 2 hours and 45 minutes on and off until his Sp02 could be maintained without me.”

Without the pulse oximeter the patient would have been sent back to the ward earlier and his airway obstruction would likely have gone unrecognized.  Eight years of living with a debilitating, easily operable condition would have ended, entirely unnecessarily, in death.
Congratulations to all the attendees!  And to Mothers of Africa for such a successful programme – we’re proud to stand together in support of safer surgery worldwide.

East in the desert

Last week a man called Robert Neighbour used a miniature bottle of cognac from an Air France flight to fix the jammed up vaporizer of a drawover anaesthesia machine.  (That’s not really central to the story, but we just thought you might like to know.)

Robert (above right) is the director of Diamedica, a manufacturer of anaesthesia equipment fit for purpose in low-resource settings.  He recently returned from Chad, in central Africa, where he took a Lifebox pulse oximeter to leave alongside the Glostavent anaesthesia machine he went to install.

He sent us an update after his return:

A few hours by car from Sudan in the east, south from the Libyan border in the north, sits Abéché, in eastern Chad, 900 kilometres from the capital N’Djamena.

It is hot and dry, with temperatures reading into the 50°s(C) and humidity in single figures. The terrain is largely desert, the rains never came last year and are not due until later this year.

The Sudanese region close by is still an area of some conflict and following the earlier situation in Libya the border is still closed to many vital commodities. Additionally, in common with neighbouring Mali, Chad has see thousands of returning soldiers who were members of Gaddafi’s foreign army. They have returned without funds or jobs to go to, and many have returned with their weapons often leading to violent local conflicts.

Abéché Regional Hospital, with approximately 150 beds has to deal with many cases of knife and gunshot wounds, the inevitable results of those conflicts, as well as the usual surgical needs of such a location.

The theatre block has three ORs, a recovery area, and a corridor for waiting pre-op.  The hospital has no piped gases and no oxygen cylinders.  Nor does it have a reliable water supply at present with sterilization being carried out using a simple pressure cooker.

I saw three pulse oximeters while I was there.  One was non-functional, the other two were unreliable.  I believe that they were badly affected by the heat and that the probes were of poor design.  They had one patient monitor, that I examined, with ECG and capnography (no pulse oximetry function).  The WHO Checklist is not used.

There are no Chadian physician anaesthetist in the country at present.