Lifebox Day

When two global surgery events come along at once you don’t grumble.  Unlike a bad bus day, you get on board!

Atul_2

As Lifebox chairman, surgeon, author and casual time traveler Atul Gawande (bodily in Boston and telegenically in London) explained by video,  “the global health landscape is changing.  For the first time in history, you’re more likely to be killed by a surgically-treatable condition than a communicable disease.”  

The struggle to activate a response to this shift has precedence: the WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC) launched in 2005, the Bellagio Essential Surgery Group convened in 2007.

Still, our ‘neglected stepchild’ is dangerously out of synch with global need.  As the MDGs count down to expiration in 2015, the need to act is clear and urgent.

Shift in burden of disease

So this past weekend we kept one eye on the live stream as the world’s best minds gathered in Boston for the first meeting of the Lancet Commission on Global Surgery, and another on the world’s other best minds, gathered in London for Lifebox Day!

AudienceMore than 60 colleagues with an interest in global surgery swapped a rare sunny Saturday for a darkened room in the Camden People’s Theatre.  Never mind the artificial light: the right speakers and the right conversation let in the great wide world, and we were thrilled to join such a passionate, thoughtful, global group, looking to make noise about a silent crisis.

We were in good company!  Atul introduced our patron Lord Bernard Ribeiro, past president of the Royal College of Surgeons, who reminisced about being (gently) strong-armed into joining the Lifebox mission.  

Patron and Board members

“It just goes to show that surgeons and anaesthetists can learn from each other,” he said, introducing  with a lordly smile the broadest theme of the day: trust.

Trusting you with my story.

Trusting you with my patients.

Trusting you with my life.

A permanent improvement in the safety and quality of surgical care in low-resource settings doesn’t happen overnight – and why should we expect it to?  Like anything in life, long-term solutions take long-term commitment.

“You must invest your time in this,” explained Dr Stephen Ttendo, past president of the Ugandan Society of Anaesthesia  “If you don’t gain trust, you will fail.”

Dr Ttendo joined Lifebox friends and colleagues Dr Faye Evans (Georgia fundraiser and a Rwanda oximetry lead) Dr Tom Bashford (Ethiopia implementation) and Dr Ed Fitzgerald (Lifebox clinical advisor and WHO Surgical Safety Checklist implementation lead), to talk about experiences of global surgery in low-resource settings.

Panel sessionThis means confronting the brutal reality that universal solutions to universal problems don’t have universal application.  As Dr Sophia Webster of Flight for Every Mother reminded us, all women are  at risk from the same complications during pregnancy – but only in some countries do they die from them.

The obstetrician, recently returned from her solo flight across 26 countries in Africa to raise awareness of unsafe pregnancy, took the room on the journey with her.

The next speaker stayed in trajectory, swinging the NHS via NASA and heading for space. Anaesthetist, Extreme A&E and Horizon presenter Dr Kevin Fong‘s investigation of risk and how we learn from our errors made the audience laugh, sober up sharply, and then laugh again, but nervously this time – mistakes can seem so silly till they happen.

kevin fong2

burritosFuel for ire and action – and probably time for lunch.  Enter Chipotle, the only local restaurant to not only answer their phones in friendly style, but enthusiastically agree to sponsor lunch at Lifebox Day!  A grateful dash to the Mexican grill’s Wardour Street branch and we were back with 70 burritos – a very practical conference snack as it happens.

Another generous donation from our friends in the north at Thomas Tunnock Ltd kept the room sweet through tea time.

Tunnocks

Doctors and nurses spend their days on close terms with life and death – no wonder they make powerful poets and writers, and we were so pleased to see the Lifebox crowd in strong metre!  Poems took the top three spots in the Lifebox Competition, and second prize winner Emily Lear was on hand to read her submission.

Maybe it was the theatrical setting but somehow the words “champagne coloured wee” never sounded so dramatic, while the last couplets –

But if the worst happens, if things aren’t as planned / If you find yourself holding a relative’s hand: / It is those humble numbers which helped us to say / We did all that we could and in just the right way.

Emily Lear_poem

– reminded the room, in ways that statistics make it easier to forget, that unsafe surgery is a tragedy – and a burden of grief that isn’t fairly shared.

The human cost of lack of access to safe surgery worldwide was given an unflinching, high definition focus in a new documentary: The Right To Heal, directed by surgeon Jaymie Henry, and screened at Lifebox Day for only the second time in the U.K.

Dr Henry, born in the Philippines, spoke with passion and experience about what she and her team have seen on the road, camera in hand.  Her subjects appeal for attention – and trust enough to tell you their stories.  The 15 x 15 Campaign is one of the ways that Jaymie and her colleagues at the International Collaboration for Essential Surgery (ICES) are working to make good on that  decision.

Lifebox was founded in 2011 to make surgery safer in countries where lack of equipment and training means that undergoing a life-saving operation is, perversely, one of the most dangerous thing to do.

We left Lifebox Day as airborne as Sophia and Kevin’s flightmobiles, after a day in company that is striving to support a world where access to safe surgery is a right, not a privilege.  Thanks to team efforts, this largely silent global health crisis is starting to make noise.

As Omiepirisa Yvonne Buowari, a Nigerian anasthetist and one of the competition winners wrote,

Team work is good. / We can beat our chest and say / Together, each achieves much.

because

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Once Upon a Landline: putting the global in global health

Back in the late 1990s, an Ethiopian doctor was working with a Norwegian institution to fund a plastic surgery unit at his hospital.

Yekatit 12 Hospital_Ethiopia

When he wanted to speak to them by phone, he’d stay at his mother’s house to use the landline.

When they needed to email him he’d go to the university library, ask the authorised person to connect and print off the message, draw up a handwritten response, hand it over for type, connection, send – and sleep in the library, waiting for someone to come and wake him with the return message.

Fast forward several years and then reverse to a few weeks ago, and Lifebox was hosting a faculty meeting for trainers from Cameroon, Congo Togo, USA and UK.  October and November were  packed months for our safer surgery work, with training sessions at a national conference in Yaoundé, Kinshasa, Lagos, and there was a lot of prep work to do.

The call was confirmed by email.

Teleconference map

Everyone joined over Skype.

After two quick rounds of “hello, hello, can you hear me…?” the agenda got underway.

Someone took notes.

People asked questions.

An hour and a chorus of goodbyes later we had insight, we had enthusiasm, we had a plan.

And everyone slept in their own bed.

Communication is changing.  Radically.  And yes, the cynic says, sure.   Everything changes and everything stays the same; it’s no easier than it ever was to make a difference in global health.  Show me the other plastic surgery units in Ethiopia.

But the cynic always has something to say.  The reality is – of course it’s easier than it was to make a difference!  To work in collaboration, not isolation.  To collect and share data, use it effectively, and send a photo round the world in 30 seconds that brings two faraway faces into each others’ line of vision.

Kibagabaga waiting room

The growing number of institutional links, academic platforms, education forums – the articles, the public awareness that increasingly makes action the imperative, not the anomaly.

Of course there are pitfalls – and there is ego, and there is scope for abuse; and this giddy tone isn’t to deny the full-blown and circling, global surgery crisis.

Quite the contrary – it’s inviting the crisis into our homes, it’s saying that a comfortable distance from chaos and suffering ‘over there’ doesn’t exist any more.

The very fact that you’re reading this blog post.  That you’re connected by proxy to Benson in Cameroon, Fataou in Togo, the Mercy Ships crew and patients in the Republic of Congo.  That you know avenues to get involved, to spread the word.

There is a long way to go.  But we’re excited to be working at a time when there is scope for everything that needs to be changed changing.  For nothing that has been flawed, for too long, to stay the same.