International Women’s Day – making safe surgery and anaesthesia happen

It’s late on a Monday and l’ve been scrolling through my Twitter feed for the past hour. I don’t normally spend this much time on one Twitter session but it’s almost as if I’m reading a book that I just can’t put down! The reason for this: it’s the night after International Women’s Day. March 8th, a date that has become increasingly important on my calendar over the last few years.

For me, this one day in the year is symbolic of a global effort to recognise and celebrate the achievements of women and girls all over the world, and to shine a light on the injustices they continue to face. And since joining Lifebox Foundation as a Communications Assistant in January, I’ve learned about a new one: unsafe surgery.

For the first time in history you’re more likely to be killed by a surgically treatable condition than a communicable disease, but in low resource settings surgery can be a challenge to access and desperately unsafe.  And all too often, women bear the brunt.

Social media has become a powerful tool for sharing these experiences.  And across great distances, it mobilises us all, encourages us to advocate for change. Sometimes it begins with just one story.

Carolina Haylock Loor - IWD2015

So when my colleague Sarah and I were planning our social media campaign for International Women’s Day this year, we really wanted to share the stories of some of the colleagues we work with around the world.  Women whose stories, from the forefront of the global crisis in unsafe surgery, show change in action.

I’m still new to the world of a surgery and anaesthesia, but I quickly saw why this year’s IWD theme, ‘Make it Happen,’ is so fitting.  Unsafe surgery is a global crisis, and our colleagues around the world aren’t waiting to be told to fix it.  They’re busy taking action.

Take Dr Ronke Desalu who works as a consultant anaesthetist at Lagos University Teaching Hospital. “I work in a 770 bed teaching hospital,” she explained, “and along with some colleagues was instrumental in establishing the use of the WHO Surgical safety checklist in my hospital.”

Ronke Desalu- IWD2015

This essential checklist has been proven to reduce surgical complications and mortality by 40 percent.

Or Dr Sandra de Iziquierdo from Guatemala, who told us that this year she aims to “introduce the use of pulse oximeters in five public hospitals with the highest maternal mortality rates.”

Sandra de Izquierdo - IWD2015

Distribution of pulse oximeters, training and education is a crucial part our work here at Lifebox – this robust tool means that anaesthesia providers in low-resource settings can confidently monitor their patients’ oxygen and blood saturation levels during surgical procedures.

Over the last two weeks our Twitter and Facebook pages have been bursting with action, with ambition, with compassion and with the voices of women at the forefront of safer surgical care in their communities.  There is so much work for them to do.

Kayser Enneking - IWD2015

What l have learnt over the last month at Lifebox is that it is not simply a matter of whether people in low-resource settings have access to surgery, but whether they will even survive it. Anaesthesia is up to 1,000 times more dangerous in low-resource countries than in high-recourse ones. Unsafe surgery is a global crisis that not only affects patients and their families but it also has implications for the doctors, health workers and medical teams who attend to them.

As I sat there scrolling, tweet after tweet, the resounding message about gender equality I took away is this – we must do more.  But then I thought about that day a few weeks back, when we emailed our colleagues to ask, ‘what are you doing right now to make surgery and anaesthesia safer?’  The answers came back so suddenly, so powerfully, so engaged.  These women are already working to make it happen.

Who are these brilliant individuals, advocating for global surgery at home and on the world stage?  Click here to find out!

Happy International Women’s Day.  Here’s to our safe surgery and anaesthesia champions!

Anna

Putting anaesthesia on the map

This is a map of where to find fish in Lake Malawi. The 3 million year old basin lapping against the ‘The Warm Heart of Africa”s eastern border has a unique biodiversity of cold-blooded residents.

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This is a map of the voter breakdown during Malawi’s fourth multi-party election, in 1993.

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And this is a map showing the start point of every patient arriving for surgery at the Fistula Care Centre in the capital city, Lilongwe: hundreds of women from dark corners of small rooms in rural villages across the country, living with the permanent incontinence of obstetric fistula. Usually in isolation, locked out of society mourning their baby, their dignity, their place in society.

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Maps can teach you a lot of different things, but of course it depends what you’re looking for.

In the last month Lifebox has joined two trips to Malawi, plotting a route directly towards the country’s anaesthesia providers.  Without them the fish will keep jumping and the politicians will keep campaigning – but victims of road traffic accidents will never be stitched up, fistula women will never be dry, and mothers in obstructed labour will continue to struggle and tear and lose their babies and join these neglected ranks.

Unfortunately it wouldn’t take long to put them on the map: there are just a few hundred clinical anaesthetic officers in Malawi, and fewer than five Malawian medical anaesthetists for a population of 16.4 million.  (Compared with more than 10,000 for a population of 64 million in the U.K.)

A small group of visiting medical anaesthetists effectively doubles the country statistics.

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In August, Lifebox trustee Dr Isabeau Walker travelled with long-time Lifebox friend and president of the College of Anaesthetists of Ireland Dr Ellen O’Sullivan to Queen Elizabeth Central Hospital in Blantyre, in the south of the country.

They were working with Cyril Goddia, who heads the hospital’s Anaesthesia Clinical Officer training programme.  A survey he undertook last year with Gradian Health Systems revealed a significant pulse oximetry gap.  So we set about a project to close it.

Some anaesthesia colleagues travelled 10 hours to get to Blantyre, from small rural hospitals across the region. They were working without pulse oximeters, or having to share one between two to four theatres.  Basic monitoring was a finger on the pulse and an eye on the colour of the patient’s lips…

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Thanks to the Cycling Surgeons, who took on hill and dale and puncture in the name of safer surgery, to the College of Anaesthetists of Ireland (COI) who led the faculty alongside our Malawian colleagues, we were able to donate 100 pulse oximeters and deliver training to 80 anaesthesia providers and 20 clinical officer surgeons.

“Thousands of lives will be safer as a result of all your efforts,” Dr Walker reported back.  Of the photo from the course – “The smiles say it all!”

Two weeks later we were back in the north, at Kamuzu Central Hospital with ACTS – the African Conference Team led by Dr Keith Thomson. This three-day conference (in the ‘Warm Heart of the Warm Heart’, according to Fanny Mtambo, who supports the UNC Project-Malawi) was an opportunity to improve practice in an area of anaesthetic care that makes up almost 80% of emergency cases: obstetrics.

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Think about surgery and (much like toast in a toaster) who comes to mind – the surgeon. But think again about an operation at its most basic level – scalpel rending skin – and imagine it without anaesthesia. It’s the difference between modern medicine and torture, but it’s often overlooked.

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This workshop, with support from the Gloag Foundation and UNC, was an opportunity to support the skills, the concerns and the community spirit of a group who know more than any other that something needs to be clear:

“There is no surgery without anaesthesia.”

Explained William Banda,  a medical anaesthetist working at Kamuzu: “You can train 100 surgeons – but there will be no operation.”

This shouldn’t be news – but since the message is still lacking, we’re delighted to see that it was! IMG_6322

MBC TV, the main television station in Malawi, sent two journalists and a camera to the conference, to meet the delegates and shine a lens on the vital role of anaesthesia in safe motherhood.  It’s possible that they zoomed in on more than expected – a visit to the maternity ward moved quickly from theory to practice – and a gown, mask and a brightly beeping corner of an operating room as a baby was born by emergency C-section.

“Bringing life into this world is an exciting experience,” narrates the journalist, “but at times it can be life-threatening…However there is no surgery without anaesthesia, as anaesthetists play a crucial role in an operation.”

The report was screened twice in 24 hours.  What was the response?

“We didn’t know, they say,” explained Marie. “We didn’t know you needed all this to deliver, to survive.”

map_malawi_pointsThis is a map of how far delegates at the Lifebox pulse oximetry workshop travelled to get to Blantyre – making the long journey by crowded bus, by bike, from all over the southern region.  They came to learn about safer surgery, and take an oximeter back to keep their patients safer.

There are so many more maps we need – where pulse oximeters and training are urgently needed next.  Where women wait for fistula repair surgery – or soon will, if they can’t get to a hospital.  Where safe surgery is taking place – and where we support the equipment and training to make it evem safer, so that providers and families aren’t forced to make terrible choices to do their jobs or save the people they love.

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Till then we’ll be leaving the fish to mind their own business.

 

 

 

 

 

 

 

 

Hej hej E.S.A!

Travel broadens the mind, and the European Society of Anaesthesiology (ESA) gives us a reason to travel!

Lifebox a ParisTheir conference sets up shop in a different European city each year. In 2012 we put our best bisou forward making introductions in Paris

…last year we said hola to old acquaintances in Barcelona, and this year…

Barcelona_ESA view

 

 

 

Hej!  Welcome to Stockholm.

Bjorn welcomes you

More than 5000 anaesthetists spent a busy week under bright northern hemisphere summer skies, hopping islands and a broad scientific programme covering what looked like every aspect of anaesthesia.

Of course there’s one we’re interested in above all others: global.  Do we really understand the challenges facing colleagues delivering anaesthesia in low-resource settings, and what can the community do to help?  Because as Dr Wayne Morris showed at the WFSA‘s  symposium on global quality and patient safety – the world is not a balanced place to practice or receive safe surgery.

In fact, when you plot it to scale on a map, it looks utterly absurd.

Physician scale world map

Of course a lot of ESA members are all too aware, from their own work in low-resource settings, or from their daily practice.  So the conference was a great opportunity to talk face to face about the wheres and whats and whos and hows.

ESA lineup1.jpg  From Australia to America to Lebanon…

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Tanzania to Tunisia to Egypt…

ESA lineup4.jpg…Switzerland to Turkey to our Swedish hosts, the charge to make surgery safer is going global!

And it’s taking effect.  We were thrilled when ESA told us that they would be donating 100 pulse oximeters for hospitals in member countries where access to safe monitoring is more of a challenge than you might think.

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Smile!  For the handover of the first oximeter from ESA to representatives from the Uzbekistan Society of Anaesthesiology and Intensive Care – and the beginning of a life-saving collaboration.

Because, as Dr Isabeau Walker pointed out in her panel presentation about Lifebox, the journey so far and the miles yet to go: making surgery safer is an enormous challenge, but one that’s already underway.

With your help we’re making a difference, and you don’t have to take our word for it.

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