A life-affirming measurement

Maybe we’re biased, but we feel a real affinity with the colour yellow.

Yellow_RIBI_Birmingham.jpg

Spot the Lifebox

So we were predisposed to like Rotary, and that’s before you factor in the amazing work they’ve been helping us with over the last year!

As we wrote in the April issue of Rotary Today (you can read a copy here), Rotarians around the world from Yorkshire to Benin have been rolling up their sleeves to help us make surgery safer in low-resource countries.

In the last year, with their help, we’ve been able to supply many more pulse oximeters and training programmes to healthcare workers in low-resource settings.

Of course we know we’re not the only ones who have been busy.  Last year in Harrogate we learned about the amazing global range of projects that Rotary clubs lead. So this year we followed the wheel to Birmingham, and the 89th Annual Rotary International Great Britain and Ireland (RIBI) Conference – to share our news, and catch up with members, projects and old friends!

RIBI 89th Conference

Like Dr Carl Heidelmeyer, our regular friendly face of the Rotary Club of Portishead –

RIBI 2014 Heidelmeyer

and Jane Palmer from Mercy Ships (a double meeting, with a Lifebox/Mercy Ships reunion also underway that weekend in the Congo!)

RIBI 2014_Mercy Ships

Our booth looked a little lonely at first – but they don’t call it the House of Friendship for nothing…

Sure enough, we were soon joined by new friends Barbara and Lindsay Bashford, whose son Tom Bashford was a medical VSO volunteer in Ethiopia two years ago.

Is surgery in low-resource settings really so unsafe? Tom recalls a nurse asking him for advice on “how to wake up patients who have not recovered from their anaesthetic after one or two days” – patients who, he knew, would never properly ‘wake up’ and recover from the permanent damage they’d sustained during the operation, caused by loss of oxygen.

He worked with the surgical team at a hospital to introduce the WHO Surgical Safety Checklist, the life-saving communications tool that is a vital component of Lifebox programmes.

And later that year Barbara and Lindsay’s club, the Rotary Club of Market Drayton, raised funds to send pulse oximeters to him at the hospital – ensuring that future patients would be more safely monitored.

Before they knew it, passing Rotarians were finding themselves monitored too.

Suspicious at first…

RIBI_suspicious at first…they soon realised, as the oximeter probe clipped onto their finger and – breathless pause – began to beep reassuringly…

RIBI 2014_suspicious no more

…that this was “a very life-affirming measurement!” (as Lindsay Bashford poetically put it.)

Soon everyone wanted to know their blood oxygen saturation.

RIBI_sats testing.jpg

Pulse oximetry isn’t just life-affirming – it’s life-saving.  A pulse oximeter is the most important piece of monitoring equipment in modern anaesthesia, essential for making it safe (risk of death from anaesthesia in the U.K.: 1 in 200,000) rather than desperately unsafe (risk of death from anaesthesia in West Africa: as high as 1 in 133).

But it’s missing from more that 70,000 operating rooms worldwide and so every day, essential operations – emergency Caesarean sections, trauma repair – take place with the surgical team effectively flying blind.

Lifebox distributes this vital equipment to hospitals in need, and in the last three years we’ve sent out more than 7000 across 90 countries.  But for the first time in history, more people are dying from surgically-treatable conditions than from infectious diseases. Global surgery is in crisis.

We love the Rotary attitude to getting things done – practical and effective.  “We asked what they wanted, needed,” explained David Pope, of the Rotary Club of Abindon Vesper’s work in Uganda, Kenya and Tanzania – real evidence of Rotary’s motto, ‘Service above Self’.

In the week after the RIBI conference, two academic papers were published – one showing the dangers of anaesthesia in low-resource countries, and one showing the long-term impact of Lifebox distribution and training.  There has never been a more important time to be practical and effective when it comes to global surgery.

Please get involved – it’s life-affirming for everyone!

Lindsay Bashford

 

 

 

 

Got any bright ideas?

At 8:30 a.m. on a Saturday morning?  After a long journey to London from Leeds/Cardiff/Newcastle/St. Andrews?  About my – sorry, have I got this right – my innovative solutions for implementing universal health coverage?

Got any coffee?

Maybe that’s what you’d say, you older people with your groggy eyes and your cynical morning breath.  Medsin members are different.  They don’t just show up like warm bodies – they show up to participate.  What’s more, they bring their own coffee mugs.

Medsin is a student network and registered charity with a vision for “a fair and just world in which equality in health is a reality for all.”  It’s driving towards this ideal future with global health’s stealth weapon: medical students.

With a network of more than 30 branches across universities in the U.K., the organization is focused on education, advocacy and community action.  And this weekend several hundred of them gathered at Barts and the London for their annual global health conference.

We were delighted to spring out of bed and join them!

Lifebox trustee Dr. Isabeau Walker hosted one of 40 workshops as part of a dynamic programme that spanned neglected tropical diseases, the condom revolution, mathematical innovation in medicine, women’s rights, HIV, maternal health, access to drugs, post-2015 agenda, mental health, universal coverage, partnerships…

Workshop crowd

We were told there would be innovation

It was a relief to see that while surgery may be the long-neglected stepchild of global health, it’s not out in the cold with Medsin – the workshop room was packed.

But it’s also clear that when it comes to global surgery, there’s a huge amount of education to do – even amongst those most attuned to the issues at stake.

Isabeau Medsin workshop“If you were in an accident in the U.K., what’s the likelihood that you’d get surgical treatment?” asked Dr Walker, using her own broken arm as a prime example.

100%, the room agreed.

“And if you were in Uganda?  What are the chances that you’d get an operation?”

“40-60%?”

“Would it shock you if I said it was less than 4%?”

Yes.  Of course it would, and it did, because the actual number of lives lost every day to death, disability, pain and social isolation for lack of safe, simple surgical care is almost incomprehensible.  Especially when we know how to save them.

So it was a great privilege to spending our morning with a diverse group of people – nurses, new medical students, on-their-third-degree students  – resolving to challenge this. We talked appropriate technology, safe surgery and the different ways to make a difference to the global health crisis of this decade, and certainly the one to come.

It was also the grand debut of our Lifebox Toolkit, specially designed for medical students to get up to speed on the facts about unsafe surgery, the science behind the WHO Checklist and pulse oximetry, and the opportunities for getting involved.  Lifebox Rep?  Lecture?  Elective?  We have something for everyone!

Screenshot 2014-04-04 14.11.15

Our Whitechapel hosts were recently renovated, and the new Barts and the London is shiny and blue and whirring with emergency helicopters headed for the roof.

Newhospital

The old building dates to 1740, and the original Barts  – apparently the oldest hospital in Europe – all the way back to 1123.  Looking out the window you see a medical world in flux; a dead building crumbling in front of the new.

Oldhospital

Basically the perfect scene for a conference on innovation!  And for looking in a wider, more futurely direction.  Appropriately enough while we were talking global surgery in one hemisphere, Lifebox’s Dr Ed Fitzgerald was in another, actively laying foundations for it with Mercy Ships and a team at Hôpital General de Dolisie, in the Republic of Congo.

We were so pleased to join the friendly faces and portholes on board the MV Africa Mercy again, after our last visit in Guinea, and to work together to deliver pulse oximeters and training in oximetry and the WHO Surgical Safety Checklist.

Congo_Mercy Ships_training

More to the Medsin point: it goes to show this conversation about unsafe surgery in low-resource settings isn’t abstract.  It isn’t forward planning and it isn’t just an interesting concept worth kicking around.

In the U.K., risk of dying from anaesthesia is 1 in 200,000. In West Africa, it’s as high as 1 in 133.

Congo_Mercy Ships_oximetersUnsafe surgery is a crisis that is happening now.  Obstructed labour and road traffic accidents can’t be put on pause till we have a solution, and so day after day, healthcare workers are forced to deliver emergency C-sections and trauma repair without the resources they need to do them safely.

Patients are forced to chose between unsafe surgery or no surgery, which is no choice at all.

Lifebox provides the essential equipment and training that starts to make surgery safer as soon as it reaches the operating theatre.  Medsin members traveled down to London because they want to make a difference.  You don’t have to wait until graduation – you can start right now.

Download the Lifebox toolkit here and get started. This crisis belongs to you.

 

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.