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…

ESA lineup2.jpg

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.

ESA-Uzbekistan-first handover

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.

Oximeters make a difference on Make A Gif

make animated gifs like this at MakeAGif

Are you sitting comfortably?

“Suddenly, to no one’s surprise, a large black object, namely Remy’s suitcase, flew off the roof, down the windshield and landed in front of us.”

Burkina Faso_flying suitcase

Well see, I was on the roof. And then I wasn’t.

Between the needs assessment and the measurement; alongside the logistics of funding and coordinating equipment distribution and training for a hundred people traveling in from a hundred different directions – behind every formal, filed report, it’s easy to forget that there are stories.

Really good stories, that sound like the beginning of a rollicking children’s book.  Scenes with uninventable characters who make outrageous jokes, and moments that take such unexpected turns they change your understanding of everything you thought you had cemented before take off.

And reflections.  And emotions.

And even, on occasion, flying suitcases.

Burkina Faso_mask

Lifebox is in the business of making surgery safer, not entertaining, but that doesn’t mean there isn’t a lot to laugh and gasp about along the way.  We don’t need to embellish the painful and difficult stories that come to us from colleagues in hospitals around the world, but we don’t want you to think for a moment that’s all there is either.

So we’ve found a new home for our friends and adventurers!

Introducing Lifebox Journeys – diarised days from our colleagues delivering Lifebox training around the world – a direct link from our (mostly) organized (always) paper-heavy desk to their eyes and ears and hearts and heads a thousand miles away.  Usually further.

Woman on scooter_Burkina Faso

Our first pages began a couple of weeks ago in Burkina Faso, West Africa, where Lifebox trustee Dr Angela Enright (past president of the WFSA and CAS) was assisted by project officer and logistics expert Remy Turc (of the flying suitcase) on a week-long training project, including distribution of 117 oximeters.

“[Burkina Faso] was a French colony formerly known as Upper Volta,” she writes.  “For some strange reason, this makes me want to burst into the Song of the Volga Boatmen but it is Volta not Vogal – although Volta is a river and maybe the boatmen do have a song of their own.”

The programme was led by Professor Nazinigouba Ouédraogo, president of the national anaesthesia society SARMU-B (Société d’anesthésie-réanimation et de médecine d’urgence).

Faculty_Burkina Faso

The A (BF) Team

They organized the workshops wonderfully well and were so gracious…The teachers were amazing.  They included staff and residents who had not previously been exposed to this type of workshop or the contents…It quickly became obvious that, once they had the idea of interactive learning and discussion, they did not need our help…natural teachers with flair and the ability to think on their feet.”

There were hospital visits, pre- and post- training tests, lectures and group sessions; there was a long piece in the local hospital website all about it – and no time to write down more than the most immediate, personal, insightful reflections.

So, back to the original question.  Are you sitting comfortably?  Then Angela will begin.


DAY 1: October 23rd 2013 Transportation Trails and Trials.

What do fog, ferries and Burkina Faso have in common?  Read on to find out.

Change we can believe in

Did you know that in 2006 the Rwandan government banned plastic bags in the capital city of Kigali?

Airport contraband

(Spot the rookie at the airport, sheepishly jettisoning contraband.)

Today the grass, unpocked with litter, is buena vista green. Thanks to the civic and environmental efforts of the last few years, Kigali is one of the cleanest cities you could hope to visit.


Another fact about Rwanda in 2006: did you know that at the time there was just one single medical anaesthetist, Dr. Jeanne D’Arc Uwambazimana, in the entire country?

Today, there are 20.

Thanks to a collaborative, empathetic and energetic partnership between the National University of Rwanda (NUR), the Kigali Health Institute (KHI) and the Canadian Anesthesiologists’ Society International Education Foundation (CAS IEF), an anaesthesia residency programme was set up. The Rwanda Society of Anaesthesiologists (RSA) has  now been formally acknowledged by the government as an official organization, with an important role to play in the ongoing improvement of Rwandan healthcare.

Anaesthesia residents

Anaesthesia residents are training in Rwanda for the first time

Such dramatic changes, in such a short amount of time – it’s easy to invest them with symbolism.  A city in healing from the appalling atrocities that took over its streets; a profession long-marginalized that has raised its profile twenty-fold.

But forget symbolism and consider practical impact: this beautiful city that people are pleased and proud to live in; those countless lives that have been saved through increased access to safe anaesthesia.

Certainly surgery is still a critical healthcare concern in Rwanda, but it’s a damn sight better than it was ten years ago.  And it’s against this optimistic background that #SAFERwanda came to town!

knowledge test

There are so many exceptional organizations and individuals involved in delivering this rigorous programme, that they really need their own background stories told.

Luckily, Lifebox can fill you in here.

Patty Livingstone
Faye Evans

And here!

Drs Patty Livingstone, left, and Faye Evans, right (who you might remember from her role in the Georgia Society of Anesthesiologists’ runaway-success Make It 0 campaign for Lifebox) have been blogging about their work in getting  the SAFE Course up and running in Rwanda since they arrived in the country several weeks ago.

It’s a great behind-the-scenes insight into hosting a course like this.  (Step one: begin more than a year ago.)

Week 1 participants

Week one participants at the SAFE Course in Rwamagana

But the whirlwind really picked up speed (cc: “The Calm Before the Storm“) last Monday, with the arrival of 55 anaesthesia techs, residents and consultants from 13 district hospitals across the country.

Also on the guest list: two Universal Anaesthesia Machines (UAM) donated by Gradian Health Systems


Sun sets, electricity fails – the UAM keeps working

…and 90 Lifebox pulse oximeters, part of an incredible 250 units donated by members of CAS to Rwanda.  That’s enough oximeter for distribution to every single operating room and recovery setting at the district hospitals currently delivering surgery without this essential monitoring.

Lifebox oximeters for donation

The road to safe anaesthesia is paved with pulse oximeters

So the first SAFE Course thundered by, four days of well-ordered breakfast, equipment training, communication, reflection, pre-test, lunch, airway assessment, cricothyroidotomoy, reflection, lunch, simulation, post-test, neonatal resuscitation, ruptured uterus, questions, cord prolapse, malaria, etc, English, French, Kinyarwandan, dinner, birdsong, and breakfast again.

And here we are, Tuesday morning, and ready for round two…

The second group of anaesthesia providers began arriving last night, fired up by reports from their friends who attended last week. (“Not boring!” – what higher praise?)


It’s exciting to think about the first group, back at work and scattered around the country.

This morning they’re checking their anaesthetic machines and charging their pulse oximeters.  Hopefully they feel a little more prepared for whatever obstetric emergency rolls through the door next, and energized to know that their colleagues in anaesthesia worldwide are proud to stand with them – in symbol, and in practice.