A Long Term Relationship

It started with this photo:

October 2011: Dr Jerry Cohen, ASA president elect and University of Florida associate professor, presents Lifebox chairman Atul Gawande with a GIANT CHEQUE.

Actually that’s not true.  It started with this article, backed up by this article, which prompted Dr Sephalie Patel, a resident anesthesiologist at the University of Florida, to propose a challenge: 100 percent departmental support for Lifebox.

Clearly the U of F anesthesiology department, like its football team,  plays for the field!  The challenge quickly gathered speed.  From residents to faculty, support staff to ASA president elect Dr Jerry Cohen, the 135 oximeter target – one for every member of the department – grew closer.

Now you don’t just throw around a giant cheque – people will get hurt – and head of department Dr Kayser Enneking had a notion to develop this fundraising success into a long-term relationship with the healthcare community of another country.

Gainsville, Florida to San Pedro Sula, Honduras (the long way round)

At the same time, about a thousand miles due south in Honduras, Dr Carolina Haylock Loor – president of the Sociedad Hondurea de Anestesiologia, Reanimacion y Dolor (SHARD) – was looking for ways to help her colleagues deliver safer anaesthetic and surgical care.  In many of the hospitals, equipment was a major barrier.

Sometimes there wasn’t enough:

And sometimes there was too much – a tangle of machines and cables, different models and manuals in every hospital, making it very difficult to maintain equipment or train providers:

At Lifebox we quickly realized: these colleagues on a mission have got to meet!

And so in March we sat down together at the World Congress of Anaesthesia.  Half in English, half in Spanish, we made warm introductions and grand plans: to enhance country-wide patient safety across Honduras with Lifebox pulse oximeters and the WHO Surgical Safety Checklist – and take the first steps in establishing a long term, mutually-beneficial, capacity-building relationship between Lifebox, the U of F and SHARD.

Hola! Hello!

Things haven’t really slowed down since.

Dr Haylock Loor worked directly with the University of Honduras and the Honduran Ministry of Health  to plan for the smooth import of 135 Spanish language pulse oximeters (Lifebox oximeters are available with an interface in English, French or Spanish); the WISE-Foundation, run by Bella and Yogesh Patel (Sephalie’s parents), stepped in to help with fundraising; Rafael Nin, father of anesthesiology resident Dr Olga Nin, leant his business nous to nurture the group from a ragtag bunch of highly efficient medical professionals to the UF Lifebox Honduras powerhouse you see today!

A scoping visit in gave the team some insight into appropriate engagement – where they could be most helpful and how the oximeter distribution and education programme could have the most impact.

Along the way they even had time to meet with the First Lady of Honduras…

Finally the big day arrived!  Reflecting the multidisciplinary nature of the WHO Surgical Safety Checklist, a multidisciplinary team with expertise ranging from anesthesia to radiology to surgery to engineering delivered a packed workshop to anaesthesia providers from all across Honduras.

And of course they distributed oximeters:

Lots of oximeters!

What’s so exciting about this collaboration, is that after all the work – the work is only just beginning.  There is no limit to what a relationship like this can achieve, and what mutual benefit it brings to both sides.

We were delighted to invite the U of F team to join the Lifebox panel session at the ASA’s Anesthesiology 2012 last month, on How to Deliver Lifebox Training in the Field (interested?) and we can’t wait to see what happens next, with eight further educational trips planned in the next two years.

This is an incredible example of what can be achieved with intelligent engagement, communication, teamwork and a spirit to challenge the unsafe status quo.

We’re inspired, and hope other groups will be likewise inspired to set their own challenges and work with us to Make It…

 (Zero).

I’ll take you there

This is the road leading up to the Outpatient Department at Bungoma District Hospital, in Western Kenya, not far from the border with Uganda:

And this is the queue of patients trying to get in:

“The hospital suffers from a severe lack of staff,” explained Alice Greenlees, the International Coordinator for CHASE Africa.  “If you want to see a doctor it is normal to wait for six hours, just for someone to take your name.  It is such a small site for such large numbers…”

CHASE (which stands for ‘Cradle Land, Healing, Adventure, Safari’) is a service organization that sends volunteers on short term placements to grassroots projects across Kenya.

Alice spends a lot of time on the ground working with local partners, and she kindly offered to help Lifebox with our needs assessment, taking us with her to the district hospitals she visited.

She found the same problems that healthcare providers across low-resource settings continue to face: poor electricity, overburdened administration, epic battles with dust and bacteria, and a catchment area of more than a million people.

But she also found an overwhelming commitment from the hospital staff to deliver healthcare against the odds.

And she found a Lifebox pulse oximeter!

Earlier this year we sent a monitor to Bungoma Hospital, as part of our work with the cleft lip charity Smile Train.

“I really wanted to see the impact of the pulse oximeter donated,” said Alice.  “And also to make sure they had received the instrument (as the postal service is notorious in Kenya!)”

Actually, we’re happy to admit it’s not technically true that she found it – because it was being used in the operating theatre for surgery.

“I met two theatre nurses, who showed me the box that the oximeter came in.  They were beaming and obviously so proud of having such an instrument – outside was so dusty – but the oximeter box was perfectly clean and cared for!”

The surgical team at Bungoma does three operations a day, on average, and they try to use the oximeter for every patient.

“They said it had helped them so much – and wanted to express their gratitude to both Lifebox and Smile Train donors.  It was just great seeing first hand what a difference a basic instrument can make!”

But Bungoma handles a lot of emergency cases, and often has to cope with multiple surgeries at once.

“They can’t monitor both patients when they have two operations at the same time,” Alice told us.

It’s terrible to think that staff must decide which patient gets the pulse oximeter, when all patients deserve this essential care.  Thanks to the generosity of our donors, we were able to send a second monitor to Bungoma when we heard about the situation from Alice.

It’s on it’s way!

Honestly, people in love.  

They glow.  And they’re so happy all the time.

(c) This Sweet Love Photography

We might just find it annoying, if people in love weren’t so beautifully generous in their joy!

Three happy couples, six friends of Lifebox, have taken a day that is supposed to be all about them and made it about the difference they can make to other people, by putting the Lifebox surgical safety mission on their wedding registry.

“Your presence, love, and support are the most meaningful gifts we could ever hope to receive,” wrote University of California, San Francisco anesthesiology resident Kirsten Rhee, and her fiancé-now-husband Rob Steffner.  And of course they meant it, but…

“…if you do choose to give, one option is to donate on our behalf to Lifebox. The global surgical and perioperative burden of disease is too often neglected by the international public health community. However, Lifebox is one organization that we believe is making significant in-roads by supporting creative and sustainable solutions to a problem that does not get the exposure or support that it deserves.”

Kristen Dowling and Austin Enright, an American business major and a Canadian medic felt the same way.

“We look at it like this,” explained Kristen (avert your eyes from the glow).  “We’ve all had times in our lives when things are good, and we’ve all had times in our lives when things aren’t.  We’re so fortunate to have an amazing support system to celebrate with us in the good and help out in the bad.  At this time of celebration, we thought it would be great to share our support system with those that are in need.”

Louise Finch, a British anaesthetist, has seen that need first hand.  She was part of the very first Lifebox training and distribution workshop in Uganda, July 2011, and spent three months criss-crossing the country at rickety speed to ensure that all 80 recipients of Lifebox pulse oximeters were successfully using the machines six months later.

“Louise has first hand experience of how much the anaesthetic providers value these oximeters and the huge impact they have on patient safety,” wrote her fiance, Andy Bates.  “When we started planning our wedding we realised that we had everything we needed but that some of our friends and family might still want to give something to mark the occasion. We thought that making our guests aware of Lifebox offered a positive solution.”

All of us at Lifebox are touched, grateful and frankly giddy that at such a personal time in their lives, these couples are entrusting us to mark the occasion by making a direct difference to the quality and safety of patient lives worldwide.  Without getting mushy, we think that’s a fine testament to love.

A mother watches her child, prepped for surgery and safely monitored, at a hospital in Ethiopia.

“I can’t imagine knowing that your child (family member/friend) is sick and instead of hoping that the surgery works, you also have to hope that the surgery is safe,” said Kristen.  “Lifebox, through their extensive research and amazing reach within the medical community, helps to make surgeries safer.  It’s as simple as that.”

Participants at a Lifebox workshop in Mbarara, Uganda last year

Thank you from all of us at Lifebox.  And congratulations!