A two-way street

You can cite the right statistics. You can read the New York Times over morning coffee. But stepping up to the operating room table while the sweat drips off your forehead?

As colleagues in low-resource settings know, that’s when unsafe surgery gets personal.

UTH_Lowri Bowen_Zambia2014

Just ask Steve Brosnan and Corinna Matt, consultants from the Luton & Dunstable University Hospital in the U.K. who spent three months at the University Teaching Hospital (UTH) in Lusaka, Zambia.

“The complete lack of 20ml syringes isn’t much of an issue,” Steve wrote to his department. “What is more of an issue is the search needed to find basic airway equipment and a properly working suction. The theatre oxygen supply is an exercise in patience, and constant vigilance is required.”

But as last year’s under-appreciated report from the All-Party Parliamentary Group on Global Health points out, there’s a mutual benefit to overseas volunteering.

Improving Health at Home and Abroad builds its case around a globalised reality: “We are now all connected and interconnected at every level: facing the same risks from pandemics and non-communicable diseases, relying on the same health networks, and sharing the same commitments to international development.”

When challenges faced by operating room teams across continents vary so wildly, everyone has something to give and something to learn.

In the classroom__UHT 2014_Zambia

The APPG report focuses on three recommendations: spreading good practice, creating a movement and providing the right environment to sustain success.

Steve and Corinna were involved with a number of projects that are doing just that!

Workshop_flyer_UHT 2014_ZambiaThey taught trainees on the MMed physician anaesthesia programme, supported by the Zambia UK Health Workforce Alliance, THET and DFID. The aim is to build high-level anaesthetic capacity across the country – as vital a priority as increasing the number of surgeons, but not always given the same attention.

They helped to run a SAFE Obstetric Anaesthesia Course (like the ones in Uganda and Rwanda), developed by our co-founder the AAGBI and supported by THET, training non-physician anaesthetists in managing the leading causes of maternal death in low-resource settings.

And they worked with Zambian colleagues and Lifebox friend/long-term UTH faculty Dr Dave Snell to deliver the first phase of a country-wide oximeter and safer surgery rollout!

Receiving oximeters__UHT 2014_Zambia

Even at UTH, the largest hospital and a referral centre for the entire country, this takes planning.  We started in November.

For expected items – a to-do list, a budget, a venue; and for unpredictable items, say, customs clearance negotiations for a 50kg shipment of pulse oximeters…

Ready for teaching_UHT 2014_Zambia

…so that, come February when the delegates arrived, things were ready to go.  More than 40 from all over the region were welcomed by the faculty, by the Dean of the Medical School and by the Permanent Secretary to the Minister of Health.

The workshop was a great success. Corinna reports that everyone, from the nurses through to the trainee surgeons, now knows how important the oximeter is.  They listen for the beep and the falling pitch, taking evasive action as soon as a patient’s saturation dips.   The MMed anaesthesia trainees are bringing safety out into the recovery areas, sitting with post-surgical patients as they write up case notes.

St Francis Katete_Zambia_Lifebox in OR_2012

There’s another course planned for October in Livingstone, and two more next year. By the time the courses are finished, every anaesthetic clinical officer in Zambia will have training and access to essential oxygen monitoring.

These are big numbers, just ripe for a big political speech.

But that’s not what the Permanent Secretary did.

“Instead of making a long speech, he got all of the delegates to stand up introduce themselves, saying where they were from,” explained Steve. “It was only then that I realised that a lot of delegates had come a long way to be taught by us.”

Zambia delegate map

As we said at the top – and as Steve and Corinna, who started off with three months sabbatical and now can’t imagine not being part of the next three courses, will tell you – unsafe surgery gets real personal, real fast.

And that’s why we know that it’s going to change.

The crew__UHT 2014_Zambia

 

 

 

 

Thank you

They say that the recession is affecting charitable giving.

We say, have you met the readers of the British Medical Journal.

Over the last two months, a stationer’s rainbow of envelopes has greeted our mornings and a rush of online donations have cheered our afternoons (sometimes we actually cheered!)

Generous readers have raised more than £26,000 for Lifebox.

Rwanda_oximeter training

That’s more than 160 pulse oximeters for hospitals in low-resource settings currently delivering surgery without this essential monitoring.  That’s spare probes to extend the life-saving lifespan of the oximeters, and training for anaesthesia providers to ensure that the equipment is used to its fullest, essential function.

We are enormously grateful to everyone who gave – familiar friends from the previous year’s campaign, new names we are delighted to get to know, and every modest Anonymous in between, to whom we are immodestly thankful.

We’re equally grateful to the BMJ for this opportunity.  We’ve worked hard with staff at the journal to show you why your contribution is needed, and what your generosity allows us to do.

BMJ_landing page_screenshot_thanks BMJ

You’ve helped us effectively turn the lights on for anaesthesia providers in Togo, with a donation of 113 oximeters – enough for every operating theatre in the country:

“Before he had a pulse oximeter he felt like an airplane pilot without a radar,” our colleague explained of one of the nurse anaesthetists.  “Now he has an oximeter he has a radar; now he can see where he is going.”

You’ve helped strengthen communities, given medical anaesthetists in El Salvador the opportunity to practically support their technician colleagues across the country, making anaesthesia safer for everyone.

Oximetry_training_Rwanda

In the last two months we’ve explored a rationale for pulse oximetry that spans decades, from “another preventable perioperative death in a hospital in central Africa in 1986” without monitoring, to an operation in the same country more than 20 years later where a pulse oximeter from Lifebox directly saved a life.

Experts have taken us behind the scenes to the frustratingly full-and-wrongly-stocked store cupboards at low-resource setting hospitals, and donors and recipients have taken us cross-continents, showing how directly and immediately your donation can make a difference.

Unused hospital equipment West Africa

Every single feature, podcast and blog from the campaign is available here on our website.  We hope you’ll take a moment to browse, and join us in marveling at how widespread and complex the surgical safety crisis can be, and at how many incredible individuals are fighting to make a difference.

We hope you’ll stay tuned this year to see what happens next!

With sincere thanks from everyone at Lifebox.