A two-way street

You can cite the right statistics. You can read the New York Times over morning coffee. But stepping up to the operating room table while the sweat drips off your forehead?

As colleagues in low-resource settings know, that’s when unsafe surgery gets personal.

UTH_Lowri Bowen_Zambia2014

Just ask Steve Brosnan and Corinna Matt, consultants from the Luton & Dunstable University Hospital in the U.K. who spent three months at the University Teaching Hospital (UTH) in Lusaka, Zambia.

“The complete lack of 20ml syringes isn’t much of an issue,” Steve wrote to his department. “What is more of an issue is the search needed to find basic airway equipment and a properly working suction. The theatre oxygen supply is an exercise in patience, and constant vigilance is required.”

But as last year’s under-appreciated report from the All-Party Parliamentary Group on Global Health points out, there’s a mutual benefit to overseas volunteering.

Improving Health at Home and Abroad builds its case around a globalised reality: “We are now all connected and interconnected at every level: facing the same risks from pandemics and non-communicable diseases, relying on the same health networks, and sharing the same commitments to international development.”

When challenges faced by operating room teams across continents vary so wildly, everyone has something to give and something to learn.

In the classroom__UHT 2014_Zambia

The APPG report focuses on three recommendations: spreading good practice, creating a movement and providing the right environment to sustain success.

Steve and Corinna were involved with a number of projects that are doing just that!

Workshop_flyer_UHT 2014_ZambiaThey taught trainees on the MMed physician anaesthesia programme, supported by the Zambia UK Health Workforce Alliance, THET and DFID. The aim is to build high-level anaesthetic capacity across the country – as vital a priority as increasing the number of surgeons, but not always given the same attention.

They helped to run a SAFE Obstetric Anaesthesia Course (like the ones in Uganda and Rwanda), developed by our co-founder the AAGBI and supported by THET, training non-physician anaesthetists in managing the leading causes of maternal death in low-resource settings.

And they worked with Zambian colleagues and Lifebox friend/long-term UTH faculty Dr Dave Snell to deliver the first phase of a country-wide oximeter and safer surgery rollout!

Receiving oximeters__UHT 2014_Zambia

Even at UTH, the largest hospital and a referral centre for the entire country, this takes planning.  We started in November.

For expected items – a to-do list, a budget, a venue; and for unpredictable items, say, customs clearance negotiations for a 50kg shipment of pulse oximeters…

Ready for teaching_UHT 2014_Zambia

…so that, come February when the delegates arrived, things were ready to go.  More than 40 from all over the region were welcomed by the faculty, by the Dean of the Medical School and by the Permanent Secretary to the Minister of Health.

The workshop was a great success. Corinna reports that everyone, from the nurses through to the trainee surgeons, now knows how important the oximeter is.  They listen for the beep and the falling pitch, taking evasive action as soon as a patient’s saturation dips.   The MMed anaesthesia trainees are bringing safety out into the recovery areas, sitting with post-surgical patients as they write up case notes.

St Francis Katete_Zambia_Lifebox in OR_2012

There’s another course planned for October in Livingstone, and two more next year. By the time the courses are finished, every anaesthetic clinical officer in Zambia will have training and access to essential oxygen monitoring.

These are big numbers, just ripe for a big political speech.

But that’s not what the Permanent Secretary did.

“Instead of making a long speech, he got all of the delegates to stand up introduce themselves, saying where they were from,” explained Steve. “It was only then that I realised that a lot of delegates had come a long way to be taught by us.”

Zambia delegate map

As we said at the top – and as Steve and Corinna, who started off with three months sabbatical and now can’t imagine not being part of the next three courses, will tell you – unsafe surgery gets real personal, real fast.

And that’s why we know that it’s going to change.

The crew__UHT 2014_Zambia






Raising the dough

Thank you for visiting the Lifebox Foundation blog.

Please check as appropriate:

          1. I like eating cake

          2. I like making cake*

          3. I believe that no patient should die from unsafe surgery

If any of these statements apply then – hi there! – we’ve got an idea for you.**

On behalf of our co-founder the AAGBI, Lifebox is proud to introduce…

The Great Anaesthesia Bake!

Eat cake save lives

The AAGBI is challenging anaesthesia departments around the UK to get in the kitchen, get baking, get – er, out of the kitchen again, and host a hospital bake sale to raise funds for Lifebox.

Today in more than 70,000 operating rooms worldwide, surgery is taking place without any monitoring beyond a blood pressure cuff or a finger on the pulse.

Life-saving operations – emergency c-sections for mothers locked in obstructed labour, trauma care for children struck down in road traffic accidents – become life-threatening ones, because vital safety checks aren’t carried out, and essential equipment isn’t available.

Download this handy pack and make a difference.

Lifebox and cakes

Just £160 will enable Lifebox to send a pulse oximeter directly to the door of any hospital in a low-resource country where surgery is taking place without pulse oximetry monitoring.

Your cake making/buying/eating will help us to host training workshops for anaesthesia providers in pulse oximetry and the WHO Surgical Safety Checklist.

If you attended the GAT conference in Oxford a couple of weeks ago you’ll know that the Great Anaesthesia Bake is already underway!

Dr Daniele Bryden and Dr William Harrop-Griffiths

Great Anaesthesia Bake judge Dr Daniele Bryden and AAGBI president Dr William Harrop-Griffiths smile for the cakes and the cameras

Committee members prepared (and even more impressively, traveled long distances with) a first class array of treats to be judged by anaesthesia and the BBC’s own consultant Dr Daniele Bryden.

(Although not before our pulse oximeter found time to style and shoot in its own Pirelli calendar…)

Oximeter and brownies

The camera

Easter cupcakes

doesn’t add ten pounds

Orange cake and oximeter

it’s only the cake

We even spotted a very presidential-looking entry, a sturdy, signed Victoria sponge celebrating the AAGBI’s last great fundraising venture for Lifebox.

Cycle race cake

AAGBI council members cycled from London to the 2012 Annual Congress in Bournemouth to raise funds for Lifebox

At 3 in the afternoon Dr Bryden paced the table, cutting scientific (but elegant) slices from each entry.  After a short confab, she announced the winner:

Lifebox and winning cake

Majestic! (And demolished five minutes later)

Elaine Yip’s cardamom cake with pistachio and orange icing was pronounced “unusual and distinctive”.  The CT2 found her cake in a Hugh Fearnley-Whittingstall receipt, but the stickily delicious icing was her own paired invention.

Judges agreed that the propofol molecule dusted on top was a particularly special touch.  (Stay tuned for an interview with the baker herself!)

Judging from the scene 15 minutes later, it looked like GAT attendees agreed with the choice – and all the other cakes too.   They razed the table to crumbs, and raised £48 for Lifebox in the process!

Winning cake celebration_Elaine Yip

Congratulations Elaine!

The Great Anaesthesia Bake is running until the end of August (at the AAGBI annual congress), so you have plenty of time to get your own inspiration and  your department on board.

Over the next few weeks we’ll be tweeting updates at #greatanaesthesiabake, sharing photos cakes, receipts and all the baking secrets we can get our hands on – as well as updating you on the difference you’re making to anaesthesia providers and patients worldwide.

This is a delicious, flagrantly non-nutritious way to help your colleagues on the frontline of the surgical safety crisis.  Please join us – and remember (click the photo):

William Harrop-Griffiths

– – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – – –

* option 2b) I like making cake and often bring baked goods in to the department, but never make people pay for them, and it’s about time that I do

** Or all three?  There must be a reason this was @safersurgery’s most popular Tweet ever:

Baking tweet

Change we can believe in

Did you know that in 2006 the Rwandan government banned plastic bags in the capital city of Kigali?

Airport contraband

(Spot the rookie at the airport, sheepishly jettisoning contraband.)

Today the grass, unpocked with litter, is buena vista green. Thanks to the civic and environmental efforts of the last few years, Kigali is one of the cleanest cities you could hope to visit.


Another fact about Rwanda in 2006: did you know that at the time there was just one single medical anaesthetist, Dr. Jeanne D’Arc Uwambazimana, in the entire country?

Today, there are 20.

Thanks to a collaborative, empathetic and energetic partnership between the National University of Rwanda (NUR), the Kigali Health Institute (KHI) and the Canadian Anesthesiologists’ Society International Education Foundation (CAS IEF), an anaesthesia residency programme was set up. The Rwanda Society of Anaesthesiologists (RSA) has  now been formally acknowledged by the government as an official organization, with an important role to play in the ongoing improvement of Rwandan healthcare.

Anaesthesia residents

Anaesthesia residents are training in Rwanda for the first time

Such dramatic changes, in such a short amount of time – it’s easy to invest them with symbolism.  A city in healing from the appalling atrocities that took over its streets; a profession long-marginalized that has raised its profile twenty-fold.

But forget symbolism and consider practical impact: this beautiful city that people are pleased and proud to live in; those countless lives that have been saved through increased access to safe anaesthesia.

Certainly surgery is still a critical healthcare concern in Rwanda, but it’s a damn sight better than it was ten years ago.  And it’s against this optimistic background that #SAFERwanda came to town!

knowledge test

There are so many exceptional organizations and individuals involved in delivering this rigorous programme, that they really need their own background stories told.

Luckily, Lifebox can fill you in here.

Patty Livingstone
Faye Evans

And here!

Drs Patty Livingstone, left, and Faye Evans, right (who you might remember from her role in the Georgia Society of Anesthesiologists’ runaway-success Make It 0 campaign for Lifebox) have been blogging about their work in getting  the SAFE Course up and running in Rwanda since they arrived in the country several weeks ago.

It’s a great behind-the-scenes insight into hosting a course like this.  (Step one: begin more than a year ago.)

Week 1 participants

Week one participants at the SAFE Course in Rwamagana

But the whirlwind really picked up speed (cc: “The Calm Before the Storm“) last Monday, with the arrival of 55 anaesthesia techs, residents and consultants from 13 district hospitals across the country.

Also on the guest list: two Universal Anaesthesia Machines (UAM) donated by Gradian Health Systems


Sun sets, electricity fails – the UAM keeps working

…and 90 Lifebox pulse oximeters, part of an incredible 250 units donated by members of CAS to Rwanda.  That’s enough oximeter for distribution to every single operating room and recovery setting at the district hospitals currently delivering surgery without this essential monitoring.

Lifebox oximeters for donation

The road to safe anaesthesia is paved with pulse oximeters

So the first SAFE Course thundered by, four days of well-ordered breakfast, equipment training, communication, reflection, pre-test, lunch, airway assessment, cricothyroidotomoy, reflection, lunch, simulation, post-test, neonatal resuscitation, ruptured uterus, questions, cord prolapse, malaria, etc, English, French, Kinyarwandan, dinner, birdsong, and breakfast again.

And here we are, Tuesday morning, and ready for round two…

The second group of anaesthesia providers began arriving last night, fired up by reports from their friends who attended last week. (“Not boring!” – what higher praise?)


It’s exciting to think about the first group, back at work and scattered around the country.

This morning they’re checking their anaesthetic machines and charging their pulse oximeters.  Hopefully they feel a little more prepared for whatever obstetric emergency rolls through the door next, and energized to know that their colleagues in anaesthesia worldwide are proud to stand with them – in symbol, and in practice.