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.

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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.

Lifebox Day

When two global surgery events come along at once you don’t grumble.  Unlike a bad bus day, you get on board!

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As Lifebox chairman, surgeon, author and casual time traveler Atul Gawande (bodily in Boston and telegenically in London) explained by video,  “the global health landscape is changing.  For the first time in history, you’re more likely to be killed by a surgically-treatable condition than a communicable disease.”  

The struggle to activate a response to this shift has precedence: the WHO Global Initiative for Emergency and Essential Surgical Care (GIEESC) launched in 2005, the Bellagio Essential Surgery Group convened in 2007.

Still, our ‘neglected stepchild’ is dangerously out of synch with global need.  As the MDGs count down to expiration in 2015, the need to act is clear and urgent.

Shift in burden of disease

So this past weekend we kept one eye on the live stream as the world’s best minds gathered in Boston for the first meeting of the Lancet Commission on Global Surgery, and another on the world’s other best minds, gathered in London for Lifebox Day!

AudienceMore than 60 colleagues with an interest in global surgery swapped a rare sunny Saturday for a darkened room in the Camden People’s Theatre.  Never mind the artificial light: the right speakers and the right conversation let in the great wide world, and we were thrilled to join such a passionate, thoughtful, global group, looking to make noise about a silent crisis.

We were in good company!  Atul introduced our patron Lord Bernard Ribeiro, past president of the Royal College of Surgeons, who reminisced about being (gently) strong-armed into joining the Lifebox mission.  

Patron and Board members

“It just goes to show that surgeons and anaesthetists can learn from each other,” he said, introducing  with a lordly smile the broadest theme of the day: trust.

Trusting you with my story.

Trusting you with my patients.

Trusting you with my life.

A permanent improvement in the safety and quality of surgical care in low-resource settings doesn’t happen overnight – and why should we expect it to?  Like anything in life, long-term solutions take long-term commitment.

“You must invest your time in this,” explained Dr Stephen Ttendo, past president of the Ugandan Society of Anaesthesia  “If you don’t gain trust, you will fail.”

Dr Ttendo joined Lifebox friends and colleagues Dr Faye Evans (Georgia fundraiser and a Rwanda oximetry lead) Dr Tom Bashford (Ethiopia implementation) and Dr Ed Fitzgerald (Lifebox clinical advisor and WHO Surgical Safety Checklist implementation lead), to talk about experiences of global surgery in low-resource settings.

Panel sessionThis means confronting the brutal reality that universal solutions to universal problems don’t have universal application.  As Dr Sophia Webster of Flight for Every Mother reminded us, all women are  at risk from the same complications during pregnancy – but only in some countries do they die from them.

The obstetrician, recently returned from her solo flight across 26 countries in Africa to raise awareness of unsafe pregnancy, took the room on the journey with her.

The next speaker stayed in trajectory, swinging the NHS via NASA and heading for space. Anaesthetist, Extreme A&E and Horizon presenter Dr Kevin Fong‘s investigation of risk and how we learn from our errors made the audience laugh, sober up sharply, and then laugh again, but nervously this time – mistakes can seem so silly till they happen.

kevin fong2

burritosFuel for ire and action – and probably time for lunch.  Enter Chipotle, the only local restaurant to not only answer their phones in friendly style, but enthusiastically agree to sponsor lunch at Lifebox Day!  A grateful dash to the Mexican grill’s Wardour Street branch and we were back with 70 burritos – a very practical conference snack as it happens.

Another generous donation from our friends in the north at Thomas Tunnock Ltd kept the room sweet through tea time.

Tunnocks

Doctors and nurses spend their days on close terms with life and death – no wonder they make powerful poets and writers, and we were so pleased to see the Lifebox crowd in strong metre!  Poems took the top three spots in the Lifebox Competition, and second prize winner Emily Lear was on hand to read her submission.

Maybe it was the theatrical setting but somehow the words “champagne coloured wee” never sounded so dramatic, while the last couplets –

But if the worst happens, if things aren’t as planned / If you find yourself holding a relative’s hand: / It is those humble numbers which helped us to say / We did all that we could and in just the right way.

Emily Lear_poem

– reminded the room, in ways that statistics make it easier to forget, that unsafe surgery is a tragedy – and a burden of grief that isn’t fairly shared.

The human cost of lack of access to safe surgery worldwide was given an unflinching, high definition focus in a new documentary: The Right To Heal, directed by surgeon Jaymie Henry, and screened at Lifebox Day for only the second time in the U.K.

Dr Henry, born in the Philippines, spoke with passion and experience about what she and her team have seen on the road, camera in hand.  Her subjects appeal for attention – and trust enough to tell you their stories.  The 15 x 15 Campaign is one of the ways that Jaymie and her colleagues at the International Collaboration for Essential Surgery (ICES) are working to make good on that  decision.

Lifebox was founded in 2011 to make surgery safer in countries where lack of equipment and training means that undergoing a life-saving operation is, perversely, one of the most dangerous thing to do.

We left Lifebox Day as airborne as Sophia and Kevin’s flightmobiles, after a day in company that is striving to support a world where access to safe surgery is a right, not a privilege.  Thanks to team efforts, this largely silent global health crisis is starting to make noise.

As Omiepirisa Yvonne Buowari, a Nigerian anasthetist and one of the competition winners wrote,

Team work is good. / We can beat our chest and say / Together, each achieves much.

because