Global Surgery team work

An email pings in from Boston, USA – subject: Oximeter to India?

As l read Lifebox chair and co-founder Atul Gawande’s editorial published in the Lancet Commission on Global Surgery I am reminded of this moment: our part in a global chain reaction sparked in  desperate response to the challenges faced by Dr Shrikant Jaiswal, first and only anaesthetist at Umarkhed Hospital in India.

Lancet Commission on Global Surgery

Umarkhed is the closest hospital to the rural village where Atul’s father grew up.  It serves a community of over 60,000 people in the town and a quarter million others in surrounding areas, and, as he wrote in a recent Lancet article  “like so many hospitals in low-income settings, [it did] not have essential monitoring systems – even just a pulse oximeter.”

Pulse oximeters are the single most important monitors in modern anaesthesia, allowing healthcare workers to ensure their patients are adequately oxygenated and stable. The Lancet Commission on Global Surgery, a year-long, collaborative research effort into the issue chose pulse oximetry as a proxy measure for safety in surgery: it’s a machine with enormous practical and symbolic value, and a key component of Lifebox’s safer surgery work. 

Oximetry_Tanzania_2013_Haydom Lutheran Hospital (1)

“Listening to Dr Jaiswal on the phone, I realised that for all the communities Lifebox had helped, we had not helped the community where my own family had come from,” Atul wrote in the Lancet.

“How fast could we get three oximeters to reach the frontline in India?” he wrote to us.

This moment also represents team work – it shows how a small group of people working together in a shoebox office in London respond to the needs of medical professionals, like Jaiswal, all over the world.

Countries worldwide

Since 2011, Lifebox has distributed nearly 9000 pulse oximeters to hospitals in 90 countries – working with anaesthetists, surgeons and healthcare professionals across low and high resource settings to ensure that more communities have access to safer surgery.


When Atul’s email came in, the next step was to pass on to Lifebox Procurement Manager, Remy Turc. Remy handles the distribution of pulse oximeters, ensuring that this essential piece of monitoring equipment makes its way from our manufacturer in Taiwan, to hospitals in low resource settings.

2015_Remy oximeter team2_April_Acare Taiwan visit_Remy Turc

“I gave Lifebox Jaiswal’s address and made a donation for three oximeters to be delivered,” explained Atul.

Thanks to a collaborative effort, in just over a week Jaiswal received the three pulse oximeters he so desperately needed in order to provide life-saving treatment – one for the operating theatre, one for the labour ward and one for the recovery room.

His story powerfully demonstrates the changing global health landscape. 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.

The recent launch of the Lancet Commission on Global Surgery, culminating in a report that aims to put the problems of essential surgery at the heart of the global health agenda offers a rallying call – Universal access to safe and affordable surgical and anaesthesia care for all when needed.

5 billion Lancet

According to this report five billion people cannot access safe surgery when they need it, with 33 million others facing catastrophic expenditures paying for surgery and anaesthesia annually.

33 million - Lancet

There are huge challenges ahead but the dedication of people like Jaiswal is what keeps us going here at Lifebox. We are committed to the distribution of essential monitoring equipment, education and training – to saving lives though safer surgery.

To learn more about what we do click here.


The Things That Really Need To Be Done

“We’re here today to talk about surgery,” said Lord Bernard Ribeiro, vice chair of the All Party Parliamentary Group (APPG) on Global Health, as he welcomed the audience to the Houses of Parliament yesterday.  “Not as a luxury, but as something that changes lives.”

Houses of ParliamentPast the policemen, across Westminster Hall and over the commemorative plaques marking where Charles I was tried and Winston Churchill laid in state – such rarified air and elegant sandwiches might seem an unlikely setting to talk about the 2 billion people around the world who lack access to essential surgical care.

But for the first time in history more people are dying from surgically-treatable conditions than infectious diseases.  The arrow keeps going up, and global surgery is utterly failing to keep pace.

Arrow going up

“People are dying unnecessarily, and with great suffering,” said Michael Cotton, surgeon, co-founder and chair of the International Collaboration for Essential Surgery (ICES).  “It’s not necessarily complicated or expensive to deliver essential surgery, it’s a cost-effective, one-off intervention with life-long results.  These are the things that really need to be done.”

Global surgery is in crisis and it’s time for global action.  It’s a thrilling step that politicians and Lords are crossing party boundaries to open the hallowed doors and talk about it.

APPG panel

To talk and to listen.  The APPGs on Global Health and on Population, Development and Reproductive Health joined forces to host a screening of The Right To Heal, the documentary by surgeon and ICES co-founder Jaymie Henry that puts the spotlight on the people whose lives are wrecked by lack of access to safe and timely surgical – and those who are working to change this.

“I grew up in the Philippines, and have first-hand experience of lack of access to healthcare. But working in ‘global surgery’ felt increasingly like an idealistic, academic experience. We were looking at it through a second-hand lens,” Jaymie explained to Lifebox in an interview for the Make It Zero campaign on International Women’s Day.

“I started traveling, and meeting people, talking about their experience of not having access to something so vital. And I thought the gap was really just about letting people know.  We become complacent knowing everything for us is working well.  But how can you be a human being and stand by, not do something about it?”

Screenshot 2014-04-04 16.01.58

Watching Priscilla, a young student in Kenya, talk about her experience of rape, obstructed labour and the resulting obstetric fistula, it feels criminal not to.

But global surgery has been on the agenda – and largely ignored – for more than 30 years. It needs infrastructure, training, equipment and education – and it needs us to make more noise.

This was a room full of leaders in the field – the Royal Society of Medicine (RSM), the Association of Anaesthetists of Great Britain and Ireland (AAGBI), The George Institute, Tropical Health and Education Trust (THET), and The Lancet which has just hosted the first meeting of its commission on global surgery – asking each other what can we do, what do we do next.

The answer isn’t clear, but the imperative is – and as Right To Heal continues its journey across the medico-festival circuit, with screenings across continents – and of course Lifebox Day earlier this year – it’s exciting to hear the response, the urgency, the conversation getting louder.

Screenshot 2014-04-04 15.59.22

With the MDGs expiring in 2015 it’s a vital time to get surgery on the international agenda. We’ll leave the politics to our hosts, but it seems to us it’s good sense and good rhetoric: lack of access to safe surgery is a global health crisis, but unlike polio or HIV, surgery is its own solution too.

“Surgery is as important as infectious diseases in public health,” says Agnes Binagwaho, the Rwandan Minister of Health in the film.  “How can you save someone from HIV only to let them die in a road traffic accident?”