A bad day and a good day

You might know (because we told you.  A couple of times.  We told quite a few people) that back in February, Lifebox was in the Solomon Star, the leading newspaper of the Solomon Islands.

Thanks to generous donors from the Department of Anaesthesia at Christchurch Hospital  in New Zealand, a physician-owned anesthetic machine company, and the Australian Society of Anaesthetists (ASA), Lifebox was able to send 13 pulse oximeters to the National Referral Hospital in Honiara, Guadalcanal.

By the by (it’ll all come together!), did we mention that the best thing about the WCA was putting faces, voices, characters and handshakes to the names that once seemed so far away?

For instance, Dr Bata Anigafutu from the Solomon Islands, who was instrumental in coordinating the oximeters:

Bata originally trained as a surgeon, but the civil war of the late 1990s changed a lot of things.  The anaesthetist at his hospital left because of the troubles, and, smiling wryly, Bata explained that he “was pushed to the head of the table.”

He’s an anaesthetist now, not a surgeon (cheers from the WCA crowd – totally biased) – one of just three qualified physician anaesthetists amongst the thousand islands, with three more in training.

The first time he really thought about the importance of pulse oximetry was during his residency in neighbouring Bougainville, Papua New Guinea.

“We had a case, a 20 year-old girl, where the nurse anaesthetist, with no pulse oximeter, did the intubation. Supposedly. Twenty minutes in to the operation, the surgeon noticed that the blood was dark.  We checked the patient – it had been an oesophageal intubation [when the tube goes into the oesophagus, instead of the trachea].  It took a while to see that the patient had arrested.”

The girl died.  Bata remembers the horror of the case clearly – and the traumatized nurse anaesthetist, whose error had not been caught.

Pulse oximeters keep patients safely monitored, but they also protect the anaesthesia provider.  In well-resourced hospitals, equipment and tools like the WHO Surgical Safety Checklist, cushion the risk that a simple mistake will go unnoticed and kill someone.  In low-resource settings, the absence of safety precautions can be harrowing.

That was one day he remembered.

Another was the day the oximeters arrived.   Bata first heard about the global oximetry project in 2005, and had been working towards this for some time.

The head of his department went to pick up the oximeters, he explained.”  We opened them.  We got to appreciate [them].  There was local TV, media – people really appreciated it…”

Filling the vacuum

Pneumonia is one of the leading causes of childhood death worldwide.

What does that have to do with safe surgery?  Nothing explicitly.  But pulse oximetry monitoring is essential for oxygen therapy, a basic pneumonia treatment – and if there aren’t any oximeters in the operating theatre, what are the chances that you’ll find one on an overcrowded paediatric ward in a low-resource healthcare centre?  The absence of appropriate equipment creates a vacuum that drags down everyone’s chances – simple procedures become more complicated, and essential interventions are postponed to heart-breaking, life-threatening ends.

Lifebox donates pulse oximeters to close the 77,000 operating room global gap.  But we know that these devices have a life-saving utility beyond the surgical sphere, and we have a vision that oximetry and monitoring in low-resource settings will eventually saturate every corner of every hospital – just like when it was introduced into high-resource settings in the 1980s.  Our environment-appropriate oximeters are available for purchase for use outside the OR, and we were delighted when a UK-based doctor raised the funds to purchase six of them, along with spare neonatal probes, for Nsambya Hospital in Uganda as part of a paediatric anaesthesia workshop in February!

The workshop was a great success – 52 health workers trained in pulse oximetry and oxygen therapy protocol, with the oximeters distributed across the outpatient dpartment, newborn unit and paediatric wards.  One of the paediatricians wrote to tell us how busy she, her colleagues, and the oximeters, have been since then.

“Many children with respiratory conditions will present with respiratory distress,” she explained.  “It is the commonest disorder encountered in the first 48-72 hours of life, and it is important to identify the babies that need oxygen early and promptly administer to reduce morbidity and mortality.”

She meant business: in the first three months, 1784 children had their oxygen saturations taken at point of triage.  This lead to the swift identification and treatment of 123 children with oxygen therapy.  500 babies had their saturations read, and 20 were monitored continuously due to respiratory failure.

Pulse oximetry, effectively used, is a fundamental tool for safe healthcare.  A culture of safe surgery can’t grow in a vacuum and we’re thrilled to be able to support such a dedicated team, working round the clock to fill that gap and make safe patient care a priority.

A favourite Lifebox story…

…begins once upon a time late summer of last year, at a hospital in Nigeria, when a very dynamic doctor placed an order to purchase 75 pulse oximeters and 75 spare probes.

And this is what happened next.

We sent the doctor an invoice, the hospital made a bank transfer, and less than 48 hours later the oximeters shipped from our manufacturer in Taiwan.

It took less than a week for them to arrive at the port in Nigeria, and a further few days for them to clear customs and reach the hospital’s central stores.

The Lifebox oximeter costs $250, including the price of delivery, making it about  a third of the price of a similar quality device on the open market.  Money might not make polite table talk, but this is big news.  Our donors need to know how much a life-saving contribution to surgical safety costs.  And most importantly, anaesthesia providers in target countries need to know that they may be able to afford it themselves.

Geography can make procurement a topsy turvy, punitive game.  Basic commodities, like hand sanitizer, can actually be more expensive across parts of Africa than in the U.K., because infrastructure is worn and supply chains aren’t cost-effective.  The fixed delivery price of the Lifebox oximeter means that this high-quality piece of equipment is, for the first time, within financial reach of larger institutions in low-resource settings.  Hospitals don’t have to wait for donations – they can take their own steps to improve the safety and quality of patient care.

Once the oximeters arrived, things moved quickly.

The doctor convened a training session in one of the hospital classrooms, and 36 nurses attended.

He ran the Lifebox pulse oximetry workshop – tutorials, videos, clinical scenarios and discussion, with a demonstration from senior technicians about the specifics of the Lifebox pulse oximeter.  They don’t require any complicated set up or calibration, and the education workshop can be delivered in half a day.

Staff had a chance to test out the oximeter on each other in the classroom.

Before they were distributed across the hospital departments.

  And began safeguarding lives immediately.

A Nice Complement

An anaesthesia machine and a pulse oximeter are the Fred and Ginger of the operating room.  Working in synch, the first enables surgery to take place, while the second gives the provider time to act should an adverse incident put them on the back foot.

(c) MusMs

So it was a nice collaboration when Gradian Health Systems, a not-for-profit provider of anaesthesia machines for low-resource settings, recently bought 20 Lifebox pulse oximeters for each of its UAM machines, currently in facilities across Nepal, Malawi, Nigeria and Ghana.

In a surgical setting where electricity may be unreliable and even essential equipment scarce, it is imperative that devices can withstand their environment.  The best equipment is useless if it’s inappropriate for the setting, and unfortunately too many pieces of equipment sit on warehouse shelves in low-resource facilities, far from the patient and provider.

But both the Lifebox oximeter and the UAM are specially designed for the low-resource setting.  They can be put to work immediately, and they function long-term.  And the feedback from recipients has been fantastic.

“Be assured that this oximeter will save lives amongst the 130,000 people who we are serving within and beyond our catchment area,” said an anaesthesia provider at Mua Mission Hospital in central Malawi.

The road up to St Anne’s, trod down by an enormous catchment area

“The Lifebox pulse oximeter is nice and working well. The other good thing is that it has got a rechargeable battery,” explained a doctor at St. Anne’s Hospital, also in Malawi.  “We had one pulse oximeter, we were using one more in the children’s ward, but it stopped working 2 months ago.”

The recovery room at Kamazu Central Hospital, Malawi

The education programme that is a fundamental part of the Lifebox Foundation mission to improve the safety and quality of surgical care, is equally important.

“The oximeters arrived in perfect time,” said the assistant dean of Bir Hospital in Nepal.  “We are running a course for 14 people today. I’ll be delivering the tutorial, and using the equipment for training and patient care.”

Pulse oximetry training in Nepal

This collaboration is an exciting realization of “a common belief in technology, training and local expertise as the way to increase access to safe surgery,” as Stephen Rudy, Gradian CEO, said.  We can’t wait to see more!