Science without borders, numbers with intent

Preeminent sword-swallowing toxico-nutritional neuro-epidemiologist Hans Rosling just leapt on the table.

Gymnastics in service of illustrating a point (and charming the crowd) during his keynote speech at the Médecins Sans Frontieres (MSF) Scientific Day in London last Friday, and he’s waving his arms enthusiastically.

Intelligent data can do that  – draw insight and outrage from dense statistics, and make you want to stand 10 feet tall so people can see what you see.

For instance a better view of the impossible equation facing the ministry of health in Vietnam today, which Hans challenged the audience to balance: a disease panel equivalent to America in the 1980s divided by the resources of the U.S. economy in the 1960s, multiplied by popular demand for 21^st century technology.*

Answers on a very large postcard.  Please.

Or the view from Lagos State, Nigeria, where the maternal mortality ratio is 545/100,000 live births (one of the highest in the world, compared with 8.2 in the U.K., 16.7 in the U.S.). That’s bad, but sub-regional data focuses the binoculars, and  it gets much worse: MSF research has shown that in two of Lagos’ urban slums, the ratio is nearly double – a sinkhole of a crisis unseen except by those who are falling in.

Responsive and responsible statistics can give vulnerable populations a table to stand on, and global health workers a more effective place to begin.  They can help allocate resources and advocate for change.

In other words – heck, in Bill Gates’ words! – measurement matters.

So say the professionals – so says Lifebox – and so says MSF, whose Manson Unit aims to use medicine, lab work and epidemiology to identify developments in the management of medical issues and help MSF field projects to put these changes into practice.

“What is the most important next step in improving research IMPACT in MSF?”

And our audience survey says:

Make sure all MSF research is freely accessible to everyone, by publising in open access journals (39%)

MSF has been presenting research findings at its yearly scientific conference since 2004 (holy archives!) and seems to aspire to a central message: to make a useful impact in global health, we have to listen.

Listen to patterns, listen to colleagues, and most obviously listen to the needs of those groups we are trying to support against a vastly unequal setup.

“Do we actually know the people in the refugee camps?  Do we know their needs?” asked Philipp du Cros, head of the Manson Unit.

For MSF, this has most recently meant investigating reports of excessive deaths in young children in Zamfara State, Nigeria, and joining a multi-agency response to treat the lead poisoning caused by small-scale gold mining; implementing a voluntary reporting system for medical errors in its projects to improve systems (such as increased use of the WHO Surgical Safety Checklist) without allocating blame; following up on reports of death due to ‘yellow eye’ in South Sudan and acting to address the Hepatitis E outbreak (often first identified by acute jaundice), in real time.

Open access was a happy feature of the day, with support from PLOS (the Public Library of Science), dynamic Twitterlogue, and all presentations available online here.

Even more boundless was the audience that followed online, joining in the conversation via live streaming from 92 countries wordwide.

The boundaries between research, advocacy and resources are blurry, and objectivity requires a stance that doesn’t leave much room for compromise.  So there was criticism on Friday, too, but that wasn’t our takeaway message.

The primary concern of any global health initiative needs to be a constantly renewed understanding of the reality of the situation, so that we have a chance of successfully addressing it.  If we don’t ask, regard, review, how do we know?

There are a lot of people listening.  Let’s ask them.

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*See Hans Rosling’s 2006 TED Talk, ‘Stats that reshape your worldview’.  And his curated 5 TED Talks on global issues here.  And his conversation with Partners in Health.  In fact, why don’t you go for a Rosling ramble – good for your circulation, and we’ll be right here when you get back.

Bright as yellow

If Rotarians lit up yellow on a map wherever they traveled, Yorkshire would have been a lot sunnier mid-April.

Despite the rain and the general drear, hundreds of members of their vast network gathered for three days at the Harrogate International Centre for the 88^th Rotary International in Great Britain and Ireland Annual Conference.

Our oximeter sits quite close to Rotary, at least on the Pantone spectrum, and so we set out to join them!

In between the business meetings and the voting and the Young Citizen Awards, Rotarians made purposeful turns around the exhibition hall, packed with so many good organizations (and good whiskies) that it was hard not to feel dispirited and elated at the same time – so much imbalance, and so many people working to redress it.

A snapshot of Rotary initiatives worldwide

Rotarians support practical projects – barrels, straws, boxes – and  they like to roll up their sleeves for results.

From 1009 healthy babies born to mothers diagnosed with HIV in Uganda, to  250 reported cases of polio in 2012 down from 350,000 in 1985, they count in real numbers, and set out to see a job through.

So we’re delighted that Rotary clubs around the world are starting to get involved with Lifebox, helping ups to count down and close the 77,000-strong global pulse oximetry gap.

Over the last year they have nominated to direct oximeters to particular countries – like members of the Portishead Rotary Club who donated oximeters and spare probes to Kivunge Hospital hospital in Zanzibar, to complement the support a neighbouring club gives to Makunduchi Hospital, nearby on the island.

Dr Carl Heidelmyer of the Portishead Rotary Club models a pulse oximeter at the ESA conference in Paris last year.

Others have elected to meet the need on our growing waiting list – like the Ilkley Wharfdale Rotary Club, whose members hosted an Indian Evening to raise funds for pulse oximeters.

Clubs in target countries have supported their own colleagues – like the Dili Rotary Club in East Timor, which funded 16 oximeters and double the number of spare probes for the St John of God Hospital neonatal unit.

Clubs have even clubbed together, cross-continent, to support entire countries – as with the ‘Benin Saturation 100%’ projects developing between Rotarians in Benin and Belgium.

In short – or long, and hopefully longer – Rotary Clubs around the world are making surgery safer!

Rotarians from the Edinburgh area demonstrate healthy oxygen saturation levels!

Every oximeter that we send safeguards thousands of patients a year.  Because the equipment is specially designed for low-resource settings, they’ll last a long time – and because training and follow-up is such an essential part of what we do, we’ll be around to make sure of it.

We had such a good time at the conference, meeting Rotarians from all over the country, taking their oxygen saturation levels and hearing more about the various projects they’re involved with – and we hope they had fun meeting us too.

The sun didn’t come out, but the days did seem a little brighter.