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

What’s it like to volunteer at Lifebox?

“In every aspect of life, the phrase ‘the more you learn, the more you realise how little you know’ seems to ring true – yet in the context of volunteering with Lifebox on my gap year, it has never felt more apt. I came to the office vaguely conscious of my naivety: fresh from sixth form, the notion of working in global health was appealing and, eagerly armed with my copies of “Half the Sky” and “Mountains Beyond Mountains”, I was keen to learn.

because

Nearly six months down the line, while my knowledge has increased, I’m also increasingly aware of my limited understanding of global health’s huge economic, social and political facets. My eyes have been opened to the challenges of trying to make a difference, although I’m sure I’ve yet to fully appreciate the scale of these challenges.

Each week I’ve been lucky enough to see behind the scenes of an international charity – the nuts and bolts of an organisation successfully delivering equipment and education to remote hospitals around the world, all conducted from a small office in central London.

Communicable diseases – HIV/AIDS, TB, malaria – tend to get a lot of media coverage, while non-communicable diseases and the global surgery crisis are rarely given attention. I was unaware of unsafe surgery’s significance for billions of individuals around the world until I started to volunteer with Lifebox; a position many of the general public are still in. Considering the magnitude of the problem, it is a travesty global surgery doesn’t receive more coverage.

Shift in burden of disease

Lifebox has exposed me to the virtual global health community, and seeing what people are thinking, saying, and then actively going and doing, is really inspiring. Social media is undoubtedly a useful tool for raising awareness and making connections, and it has been great seeing the likes of Facebook and Twitter being used for something other than posting selfies and pictures of cats (lovely though they are).

Papua New Guinea_surgical team with oximeter

I’ve volunteered with Lifebox through a busy few months – 8th March was International Women’s Day, which saw the wider launch of Lifebox’s “MAKE IT 0®” campaign, and I felt privileged to overhear some of the interviews taking place, interviews which went on to build the striking online compilation of real women’s experiences with surgery. An equal privilege was being able to help out at Lifebox Day, an exciting event in January which saw the gathering of many motivational safe surgery advocates, sharing their experiences of practice in low resource areas and ideas for how to move forward.

Mozambique_questions from the audience

Volunteering with Lifebox has been such a valuable, inspiring experience for me. I start medical school in September and really hope to pursue this area of healthcare further – the option to intercalate with a BSc in Global Health is definitely looking appealing at the moment. While there is still an appalling disparity in access to safe surgery globally, the determination of passionate individuals fighting for change is promising; one thing I’ve definitely learned is that there really is infinite possibility for progress.”

Oximeters make a difference on Make A Gif

Robyn Evans spent six months as a volunteer with Lifebox Foundation. She is currently volunteering with Orion and will be starting medical school later this year.

Unsafe surgery is our issue

Sometimes a picture –

Screenshot 2014-03-07 23.53.02Sometimes a picture says it all.

IWDcollage.jpg

And you don’t need 1000 words to make a point.

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But sometimes there’s too much to be said.

The problem is complicated, urgent, human, unfair, and the statistics are so vast that you can’t see past them.

Sometimes the story is so much more than the front cover.  

Screenshot 2014-03-07 23.34.36

And a picture is only a signpost:

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to let you know the conversation is just getting started.

Unsafe surgery is a global health crisis silencing millions of women worldwide.

It’s time to start talking about it.  Join Lifebox at www.makeitzero.org

Women in the workplace

Over breakfast at the SAFE course/Lifebox training in Rwanda a few weeks ago – bread, boiled eggs, thick black coffee and milky African tea –

Breakfast

It’s always nice to see what people have for breakfast

– a male guest at the Dereva Hotel was heard to inquire:

“Tell me, why it is that women dominate anaesthesia?”

Was that a glint in his eye or not?  Either way, he had a point – to a point.

There’s limited evidence of female domination in the higher echelons of the healthcare profession, i.e. medical anaesthesia.  The road through medical school to specialization is male-dominated, and although there are two female residents in the current first year cohort of the anaesthesia programme at CHUK no women have graduated since it launched in 2006.

Female residents_CHUK

Professor Angela Enright with the two female trainees at the CHUK anaesthesia programme

But the anaesthesia technician profession is different.

All techs graduate from the same three-year programme at the Kigali Health Institute (KHI), which was set up in direct response to the crisis-point shortage of healthcare workers in Rwanda.

They are trained in the practicalities of anaesthesia, and only the essentials of physiology necessary for the job at hand. KHI has trained about 30 anaesthesia technicians a year since the programme began in 1996, and there are now about 160 working in Rwanda.  Although the medical anaesthesia programme is no longer nascent, techs far outstrip the number of medical graduates at present.

Resus_SAFE

Practicing patient resuscitation at the SAFE course

So their responsibilities are vast. Techs look after the operating rooms; they do emergency resuscitation (trauma, shock, cardiac arrest).  In rural areas, they can end up with cases even more complicated than a medical anaesthetist at a teaching hospital would be faced with, alone.

And because applicants must have completed a science qualification to be eligible for the programme, with the majority coming from nursing, demographics mean that a high proportion of techs are women.

Resus 2_SAFE

“I had to work all hours!” explained Jeanette Kayitesi, an anaesthesia tech in Kigali, reminiscing about her first job in a small city hospital where she was the only anaesthesia technician.  “They always came to get me.  They came to get me in the middle of the night.  They came to get me on maternity leave…”

Domination?  Maybe not.  But it’s certainly a dramatic change from the position of women in Rwanda a generation ago.

Women at SAFE

La DOMINATION at the SAFE course

“In the past, they didn’t like it when a married woman kept working,” explained Mediatrice Usabye, an education director from southern Rwanda, who was in Rwamagana for a conference.

“People saw a woman as someone to marry, to raise children; if a family had a boy and a girl, the boy was the one who went to school.

In the classroom_SAFE

“But after the genocide the government realized there was a disparity between male/female education, and a gender imbalance in all domains.  Now things are changing.  They’re working to close the gap.  Women have paid maternity leave (one month in the private sector; three months in the public sector).”

Today, the rector of KHI is a woman.

KHI_rector

Dr Chantal Kabagabo, Rector of the Kigali Health Institute

So is the anaesthesia department head at the National University of Rwanda.

Christine

So is the Minister of Health.

MOH

Dr Agnes Binagwaho, Minister of Health

That doesn’t change the fact that the reason women appear to ‘dominate’ in anaesthesia, sir, is partly because they are encouraged to train as nurses, not doctors.

“You may ask me why that is,” said Mediatrice, imposingly.  “It’s because so many books are written in Rwanda, especially in primary studies…they show pictures.  Pictures of women as nurses and teachers.”

CHUK_OR

Anaesthesia providers pose outside the operating theatres at CHUK

But Rwandan women are writing their own stories long after they finish primary school.  Take Jeanette.  She recently finished her Masters in Public Health (MPH), and wouldn’t be satisfied, she explained, if she didn’t keep learning and working.  She likes her job as an anaesthesia tech because her day is never the same twice.

She also has five children, aged between 12 and three.

At first her husband nagged when she carried on working after they were married, after their children were born.  Why did she have to take further studies?  Why couldn’t she stay home with the kids?

And now?

The magnificent Jeanette

“He’s so proud. Now when we’re out, I hear him on the other side of the room, telling strangers about my job.  Well, he says, my wife…

Happy International Women’s Day!