Great and glad tidings!

Lifebox isn’t a faith-based organization, but you don’t need to tell us twice about the true meaning of Christmas.

Hope and renewal, sacrifice and generosity – looking back at the most popular stories we’ve shared on our blog this year, there’s meaning behind every message, and inspiration to build a better 2014.

Here’s to a year of great and glad tidings!  And our top ten most-read stories:

BBC_screenshot1. Counting to Save Lives: a heartbreaking horror story from a colleague in Uganda about how one of the simplest steps on the WHO Surgical Checklist  – counting swabs – would have saved a life.  This post got a huge boost from our work with the BBC’s Health Check team this summer, thanks to a short video we made with them at our pilot programme at Kibagabaga Hospital in Rwanda.  The accompanying article highlights why surgical safety isn’t just a low-resource challenge – it’s a global concern.

Kristen and Austen2. Honestly, people in love: an oldie, but a grow-old-with-me goodie!  This ‘favourite ever’ story (and the treatment for our global surgery romcom if it ever gets off the ground), shared interviews and photos of couples who used their wedding spotlights to shine a light on the crisis of unsafe surgery worldwide.   They raised thousands of pounds by putting Lifebox on their gift registries, and have inspired other couples to use the power of love to make surgery safer worldwide.

Cake Collage3. Raising the dough: chefs hats off to a phenomenon we never saw coming: the runaway popularity of the AAGBI’s Great Anaesthesia Bake.  The Association encouraged anaesthesia departments around the country to swap scrubs for aprons and host bakes sales to raise funds for Lifebox.  Word spread, more and more teams took part, and the cakes became increasingly anatomically-correct.   To date, the challenge has raised more than £17,000 for safer surgery.  FROM CAKE.  Just think about that.

Mercy Ships4. A medico-maritime life for me: Capacity-building is essential for securing long-term access to safe surgery in low-resource settings.  But in the meantime there are millions of people who need an operation last year, last month, last week, now.  We’re proud to be working with Mercy Ships, the world’s largest floating hospital, which docks each year in a different African port and embarks on an intensive surgical rota that gives life and livelihood back to thousands of people.  Click here to read about our stay with them in Guinea.

Haydom_oximter on finger5. Man v Machine: the ‘equipment graveyard’ – warehouses full of unusable and unrepairable equipment that so often haunt hospitals in low-resource countries – is a stark failure of international corporations, communities and common sense.  Karoline Linde, at Haydom Lutheran Hospital in Tanzania, wrote to tell us about a day in the life of a Lifebox pulse oximeter – and the challenges, decisions and constant pressure that equipment and healthcare workers are under as they strive to save lives on the front line.

OR staff Kibagabaga

6. Change we can believe in: In 2006 there was just one medical anaesthetist in the entire country of Rwanda.  Today there are 20.  We’ve spent the last year working with Canadian and Rwandan anaesthesia colleagues to deliver oximeters, training and support to this growing community, and the nurse anaesthetists who share the burden.  We’re so proud to stand alongside colleagues so deeply invested in the country’s painful and dramatic capacity to heal itself.

Guheka_low res

7. Riddle me this: What do you call an operation that saves two lives at once?  A caesarean section.  Safely deliver a struggling baby from a mother locked in obstructed labour for days and deadly weary, and you’ve pulled two lives back from certain brink.  But lack of access to surgery is a crisis compounded by the crisis of unsafe surgery.  We took a look at the perils of obstetric surgery in low-resource settings, and some of the new organizations and programmes that have been developed to address them.

Teleflex ad

8. I left my heart in San Francisco: As some loud-mouthed puppets wisely said, ‘You need a montage” – so we had a lot of fun making one of our recent trip to San Francisco, for the American Society of Anesthesiologists’ annual conference.  We met colleagues from around the world, worked with the ASA’s Global Humanitarian Outreach committee to deliver a session on Lifebox training in the field, and were the lucky beneficiaries of Teleflex’s ‘play it forward’ game.  And oh, you should have seen those skies…

9.  Before and After: a hymn to the numerical imperative!  “To make people count, we first need to be able to count people,” said a previous WHO Director General – and Bill Gates (who made a whole video about it).  We took a look at the value of measurement in our programmes, following up with Dr Eva Manciles at Connaught Hospital in Sierra Leone, to see what difference the oximetry distribution and training had made in the last year.  We hope you’ll be just as excited as we were by the results.


C-section10. The World We Want 2015: It’s a magnificent proposition.  Go on: design the world you want your children to grow up in.  Just remember that you can’t choose their sex, their race, their long- or latitude.  And you don’t know their characters, their ideas, their – well, you don’t know anything about what they really want, do you?  You just need to know that, wherever or whoever they are, they’ve got the best shot at a life and let living.  Join Lifebox as we enter the essential fray of post-Millennium Development Goals debate, and make our case for safe surgery as an essential component of healthcare in the framework that follows in 2015.

And that’s barely a wrap!  There are so many more stories to hear and people to meet that we humbly suggest, if you find yourself a little wearied by this festive time of year, nab a quiet corner and a wifi connection, and go fishing at

We’d love to hear from you about your favourite pieces!

Returning to the spirit of the season, we can’t avoid a closing plea.  With only a few days to go, your presents are probably wrapped and ready for fetching from under the tree – but there are some gifts that last long after the box is gone and spring feels closer than Christmas.

Holiday Giving Guide

Donate to Lifebox in someone’s name.  It’s easy to give the gift of safer surgery – just follow the instructions below, and we’ll let them know that they have received – and given – a life-saving present this year.

With sincere thanks, and our best wishes for a very happy holiday season and a joyful new year to you and yours.

The Lifebox Team.


I left my heart…

…in San Francisco,Arrow heart

where the American Society of Anesthesiologists (ASA) held their annual conference this year.

Trolley car

“How beautiful!” everyone back home told you.


But you probably spent most of your time here:

Moscone Center

Never mind the early starts…

Coffee cup

…we  had a great time!

Dr Alex Hannenberg and cheque

But then, we had the best seat in the house – a beautiful booth alongside our friends at the ASA’s Global Humanitarian Outreach (GHO) committee:


With special shout out to the AAGBI’s Great Anaesthesia Bake:

Great Anaesthesia Bake

A Lifebox trustee on the front page of the ANESTHESIOLOGY 2013 Daily News:

Daily News_arrow

And a training workshop on how to implement safe surgical practice in a low-resource setting that inspired real conversation…

Lifebox workshop ASA

…so much conversation that we couldn’t get people to sit down again between sessions.

Lifebox workshop ASA 2We found a good home at a hospital in Nigeria for some oximeters:

Oximeter handover_ASA

and a friend to help carry them there!

Carrying oximeters

We felt like the sun was rising every time we saw this ad across the big screen…

Teleflex adand are enormously grateful to Teleflex, who gave a whole new purpose to trivia and presented us with this giant gameshow cheque.  It means real life change for surgical patients and providers in low-resource settings.

Teleflex presentation

(And comes it its own giant gameshow cheque box.)

Teleflex box

It felt good to work with the ASA as friends and allies for safer surgery, with our upcoming projects in Nicaragua and Guatemala, and the announcement of the First Annual National Lifebox Challenge led by the Residents Component.

Central American project

So even though we had to go home, we took the ASA’s advice –

Be Social

– and told you all about it!

It really was pretty.

SF from the air

A medico-maritime life for me

If it looks like a ship and it sails like a ship and makes sounds like a ship…it’s probably a floating hospital.  At least if it’s the one that belongs to the charity Mercy Ships, currently docked in the Port of Conakry in Guinea, West Africa.

Photo 1_ship

Bon jour! (The port approach is a lot wetter than starboard entrance)

The MV Africa Mercy is the largest charitable hospital ship in the world, providing free surgical services (primarily facial reconstruction, benign tumor excision, cataract removal and child orthopaedics) to the African countries Mercy Ships visits on a rotating basis.

Photo 2_map

Pre-Very Useful Bridge

A repurposed Danish passenger ferry, she took to the seas in 2007 after a very useful bridge built between coasts en route, put the 16,500-ton vessel on the job line.

About 400 long-term staff, 200 local day workers and a rotating crew of volunteers – surgeons, anaesthesiologists, nurses, radiographers, technicians, engineers, administrators, cleaners, cooks, carers, families, officers and of course a captain – are paid up members of this unique medico-maritime community.

(Actually staff pay their own way on board – although the volunteer-staffed Starbucks is generously subsidized by the mermaid herself.*)

This week, by gracious invitation, Lifebox is finding our sea legs too!

Photo 3_oximeters

We’ve joined the faculty of the Anaesthesia Care Team (ACT), led by Mercy Ships international board member Dr Keith Thomson (who, alongside his team, delivered our pulse oximeters to Togo last summer), for a three-day training course at Donka Hospital – one of two national facilities, both in Conakry, and the largest hospital in Guinea.

We’re ready to join about 60 anaesthesia providers and midwives for two days of lectures, workshops, quizzes and dancing (possibly we’re not 100% ready for the dancing? But you should be!) in essential anaesthesia and midwifery techniques, followed by a day of the WHO Surgical Safety Checklist and pulse oximetry.

Photo 4_ACTs

And we’re very excited for the donation of French-language pulse oximeters to outfit the six hospitals represented at the course, donated with the proceeds from Dr Keith’s recent half marathon adventures!

The Africa Mercy usually spends ten months in each country it visits, wending along the West African coast and ducking back to the Canary Islands in between for repairs.  This is her first trip to Guinea but the charity’s third, following two prior visits from the MV Anastasis (nee Victoria).  She arrived in August, with six operating rooms and nearly 80 patient beds to house the patients eligible for surgery.  Many thousands have shown up for screening, and the lists will stay full until the ship pulls out of port this spring.

Guinea is a low-resource country, but isn’t resource-poor: as the world’s top exporter of bauxite, a key component of aluminium, it sends mini-mountain ranges out of the port regularly.

Photo 6_bauxite

The islands are lush and the sea is fish-blue.

Photo 7_lush Guinea

But the post-colonial legacy and ongoing conflict has been disastrous for most of the 10 million people who live here now, heightened by refugees and tensions from neighbours including  Sierra Leone and Mali.  Guinea most recently ranked 178 out of 187 on the UN’s Human Development Index, with just 1.6 mean years of school for adults and a life expectancy of 54.5 years.

There are only four medical anaesthetists in the entire country, and no standardized programme for anaesthesia training whatsoever.  The doctors here have studied in France, in Moscow; the technicians have learned on the job. There isn’t a single working pulse oximeter in the main operating block in Donka.

The unmet surgical need is vast.


An operating room at Donka Hospital

Over the next few weeks we’ll be sharing stories from the ship, from the dedicated crew, from the fabulous ACT team – and from the patients.  They are still queuing up in the hot sun on the dock for screening, often alone and from far up country, in the hope of a life-changing operation they’ll not find anywhere else, from a ship that – with the best will in the world – was built to sail away to another port in need.

Sail away


Thank you

They say that the recession is affecting charitable giving.

We say, have you met the readers of the British Medical Journal.

Over the last two months, a stationer’s rainbow of envelopes has greeted our mornings and a rush of online donations have cheered our afternoons (sometimes we actually cheered!)

Generous readers have raised more than £26,000 for Lifebox.

Rwanda_oximeter training

That’s more than 160 pulse oximeters for hospitals in low-resource settings currently delivering surgery without this essential monitoring.  That’s spare probes to extend the life-saving lifespan of the oximeters, and training for anaesthesia providers to ensure that the equipment is used to its fullest, essential function.

We are enormously grateful to everyone who gave – familiar friends from the previous year’s campaign, new names we are delighted to get to know, and every modest Anonymous in between, to whom we are immodestly thankful.

We’re equally grateful to the BMJ for this opportunity.  We’ve worked hard with staff at the journal to show you why your contribution is needed, and what your generosity allows us to do.

BMJ_landing page_screenshot_thanks BMJ

You’ve helped us effectively turn the lights on for anaesthesia providers in Togo, with a donation of 113 oximeters – enough for every operating theatre in the country:

“Before he had a pulse oximeter he felt like an airplane pilot without a radar,” our colleague explained of one of the nurse anaesthetists.  “Now he has an oximeter he has a radar; now he can see where he is going.”

You’ve helped strengthen communities, given medical anaesthetists in El Salvador the opportunity to practically support their technician colleagues across the country, making anaesthesia safer for everyone.


In the last two months we’ve explored a rationale for pulse oximetry that spans decades, from “another preventable perioperative death in a hospital in central Africa in 1986” without monitoring, to an operation in the same country more than 20 years later where a pulse oximeter from Lifebox directly saved a life.

Experts have taken us behind the scenes to the frustratingly full-and-wrongly-stocked store cupboards at low-resource setting hospitals, and donors and recipients have taken us cross-continents, showing how directly and immediately your donation can make a difference.

Unused hospital equipment West Africa

Every single feature, podcast and blog from the campaign is available here on our website.  We hope you’ll take a moment to browse, and join us in marveling at how widespread and complex the surgical safety crisis can be, and at how many incredible individuals are fighting to make a difference.

We hope you’ll stay tuned this year to see what happens next!

With sincere thanks from everyone at Lifebox.

Hot off the press

If you’ve seen our excitement on Facebook or watched us struggle to contain our characters on Twitter, you’ll know that we’ve got some big news to share.

Papua New Guinea_surgical team with oximeter

Our colleagues in Papua New Guinea have heard the news.

The British Medical Journal, one of the most prestigious peer-reviewed medical journals in the U.K., has – well – we’ll let them tell you:

“Christmas is coming and this week we launch the BMJ’s Christmas appeal,” explained editor Fiona Godlee in her recent editorial.

“After last year’s success, when BMJ readers gave over £33, 632 to buy 210 pulse oximeters for use in 10 low resource countries, we are supporting the Lifebox Foundation again.”

BMJ_landing page_screenshot_thanks BMJWell!

We’re excited to have a second introduction to the BMJ readership, and thrilled at the opportunity to update those readers whose generosity allowed us to do so much more over the last 12 months.

And so we interrupt your regularly scheduled Lifebox broadcast for a foreign holiday of sorts: feature articles, blog posts and Q&As hosted on the BMJ website.  We’ll introduce you to colleagues worldwide whose work on the frontline of the surgical safety crisis has been supported by BMJ readers, and to the educators, donors and hands down champions we are working with to make surgery safer.

Click on over with us to read more about how Lifebox is working to support the rebuilding of surgical capacity in Rwanda following the genocide, what it feels like to be a house officer at a hospital in Tanzania, and how your support is helping to take away the terrible, answerless questions faced by anaesthesia providers in Ethiopia.

BMJ oximeters were part of a large shipment we sent to Togo last month, and the pictures from the workshop came back just this week.  113 monitors were distributed and 179 anaesthesia providers were trained by the Association National des Techniciens en Anesthesie du Togo (ANTART).  Look at what you helped to make happen!  And imagine how much more we can do.

Picture 5 donation of oximeters


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!

Target 80

How long does it take to count down from 77,000?

Well, in the 18 months since we got this global pulse oximetry gap in our sights and set out to Make It 0, we’ve knocked more than 3000 off the target!  Thanks to the generosity of Lifebox donors and the dedication of our colleagues worldwide, the number of operating rooms without access to a single pulse oximeter is getting smaller day by day.

Lifebox pulse oximeter #2992

But each oximeter we send out is more than just a number crossed off a target.  Every box has a story behind it – someone’s sweat, heart and dedication sent that essential equipment on its way, often thousands of miles by air and bumpy road, to the door of a hospital, into the hands of an anaesthesia provider who will use it to safeguard hundreds of lives – and help ensure that many more surgical patients live to tell their own stories.

Let’s take a look at the sweat, heart and dedication that went in to one of the largest individual donations Lifebox has received yet – 88 pulse oximeters from the Department of Anaesthesia and Perioperative Medicine at The Alfred hospital in Melbourne, Australia!

(image courtesy of ANZCA)

Do you follow us on Twitter (@safersurgery)?  If you do you’ll have noticed, like us, a persistent hashtag that appeared a few months ago.  #target80.  Thousands of miles away a countdown – or a count up? – had begun…

“As anaesthetists we possess a unique skill set which, given the right circumstances, we can use to aid those less fortunate,” explained consultant anaesthetist Dr Jamie Smart, one of the driving forces behind the department’s fundraising success.  “For the majority of us such opportunities seldom arise due to the conflicting time demands of work, family, and other life events.  Through the Lifebox Foundation, members of our department have been able to contribute in a small, but significant way, to providing safer surgery in areas of need.”

(image courtesy of ANZCA)

“Lifebox first came to our attention at Anesthesiology 2011 in Chicago last October, during Atul Gawande’s inspiring plenary lecture.  However it was over a steak and a few glasses of excellent Argentinean Malbec at this year’s World Congress of Anaesthesiologists (WCA), that the seeds of our campaign were first sown.

Our strategy was simple.  We would simply ask each member of our department to donate $250 for one pulse oximeter, or any amount they could afford.

From the moment the first email was sent alerting department members to our campaign, the response was overwhelming.  Donations poured in from specialists, trainees, nursing staff and even some of our surgical colleagues.

(image courtesy of ANZCA)

By the end of May, with little work but a lot of generosity, we exceeded our target.  A total of $22,130 was raised – enough to fund 88 Lifebox pulse oximeters, enabling the provision of safer surgery on a daily basis.

I encourage all anaesthetic departments to follow our lead and to try to match our efforts.  For just $250 a Lifebox oximeter can be delivered to an area of need and put to immediate use.  There are many ways to spend $250, but very few that are more worthwhile.”

Celebrating an enormous contribution to safer surgery worldwide at the Australian Society of Anaesthetists meeting this month

We are enormously grateful to Jamie, his colleagues at The Alfred, and the Australian Society of Anaesthetists (ASA), who supported the #target80 campaign – and we hope you’ll take his advice and get counting!