News & Features — 15 October 2016 at 2:49 pm

Safer Surgery: behind the scenes at Lifebox

Sibonile Mathe / Communications & Engagement Manager / Lifebox Foundation

Sarah Kessler / Director of Communications & Strategic Partnership / Lifebox Foundation

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Sarah and Sibonile work at Lifebox Foundation, the only NGO devoted to promoting and maintaining safer surgery in low-resource countries around the world. The charity aims to provide sustainable equipment, safety check-lists and education to vastly improve surgical outcomes. As those who work at the healthcare end of the spectrum, we rarely hear the perspective from non-medical charity staff. Here, Sarah and Sibonile give us some insight into working for a medical charity, and put Lifebox into context by highlighting the work they have recently seen the charity undertake in Guatemala and Zambia.

Guatemala: where the trees frame the sky better than an MGM epicFresh produce from the small farm holds. Agriculture accounts for 40% of Guatemala's labour forceWith 113 deaths per 100,000 live births, Guatemala has the 4th highest maternal mortality rate in the continentWith limited access to functional monitoring, belated detection of haemorrhage and hypovolaemia is commonPulse oximetry is the only piece of equipment needed to complete the WHO Surgical Safety Checklist. AGARTD is leading a project to support maternal hospitals with additional pulse oximetersDr Manolo Ramirez at Pedro de Betancourt National Hospital, with his Lifebox pulse oximeterIn 2013, Lifebox docated 140 pulse oximeters for use in operating and recovery rooms in 22 public hospitals in Guatemala

Sarah / Safer surgery in Guatemala

Surgery in low-resource settings isn’t cosmetic or elective; emergency demand is often barely covered and palliation is rare.  The surgery is life and livelihood saving – but because of a chronic lack of essential resources and training, can be extremely dangerous. Lifebox is an international NGO making surgery and anaesthesia safer in resource-poor settings. We work in partnership with local communities to deliver essential monitoring equipment and training in 100 countries around the world.

When we talk about the value of surgery as compared to other healthcare interventions, consider Guatemala. Almost half of the population is under 19 years old, making it the youngest in Latin America. And the most common health risks they’ll face – road traffic accidents, complications of childbirth – have a mortality point of no return that only surgery can cross.

“The patients we’re saving are actually very young and have the potential for many, many years ahead – their whole lives, really,” explains Professor Alan Merry, Lifebox Foundation trustee.  “They’re people having highly correctable, life-saving surgery – a C-section for example – and if they get through it they’ll live another 30, 40 years.”

In 2013 we joined Dr Sandra de Izquierdo, an anaesthesiologist at the Herrara Llerandi Hospital in Guatemala, and the Guatemalan Association of Anesthesiology and Pain Treatment (AGARTD) to learn more about the challenges hospitals face in providing safe surgical care. Some of the stories will feature in an upcoming documentary about the state of safety in surgery, globally, and some of the photos you see above are debuting here.

Global surgery sits at an incredibly busy intersection: science, politics, philanthropy, research, technology – but most importantly, community. So working for Lifebox isn’t just a chance to understand these worlds better, it’s an extraordinary opportunity to be part of a global movement with an undeniable goal: make surgery safer for the millions who need it now. It’s been fascinating to grow with the organization, humbling to see my personal experiences of life-saving surgery in a bigger context, and a privilege to work with so many people around the world, from ministries of health to the frontline of the global surgical safety crisis, who are committed to making a difference.

Sibonile / My safer surgery journey

What is ‘safer surgery’? If someone had asked me this question two years ago they would have been met with silence. At that time I was studying for my masters degree in international development at the University of Birmingham. I was completely immersed in my studies, exploring the field I love. My course focused on poverty and equality. We learned about the multidimensional nature of poverty – how the world’s poorest people don’t face just one but a myriad obstacles that make and keep them poor – and what initiatives are and have been implemented to help people lift themselves out of poverty.

One such barrier is lack of access to adequate healthcare. For many people around the world even the most basic healthcare services are simply out of reach. Global health is a field which seeks to address such disparities through education, research, funding and implementation of projects to enable communities to live healthier lives. We have rightfully rejected the idea that where you’re born should dictate your well-being and your future. We recognise the importance of vaccinating children against deadly diseases and we support HIV prevention initiatives – yet startlingly in this day and age you’re more likely to be killed by a surgically treatable condition than a communicable disease. So why is surgery not visible in many healthcare systems worldwide?

Joining Lifebox

In January 2015 I was formally introduced to the field of global surgery, often referred to as ‘the neglected step child of global health.’ Prior to joining Lifebox I had never really thought of surgery in the context of global health. I was lucky to start my work at a time when there was a real international shift in the understanding of the important role that surgery and anaesthesia play in a functioning healthcare system.

In this landmark year the World Health Assembly passed an historic resolutionstrengthening emergency and essential surgical and anaesthesia care as a component of universal health coverage – putting the often overlooked and under-resourced area of global surgery on the international health agenda for the first time. In the same year, the Lancet Commission on Global Surgery published a report that showed that 5 billion people around the world do not have access to safe surgery when they need it. This data was invaluable in grounding my understanding of the often dire realities of accessing safe surgical care around the world, and Lifebox’s work in supporting front-line healthcare workers in low-income countries to provide the best care.

Pulse oximetry is a proxy for safety, and deemed to be one of the essential components of surgical access. Through its Safe Anaesthesia work, Lifebox distributes this vital piece of monitoring equipment – the pulse oximeter – used to monitor a patient’s oxygen levels when they’re under anaesthesia. Sadly this lifesaving device is missing from over 70,000 operating theatres in the developing world, which often means that routine surgical procedures can become life-threatening. Distribution of pulse oximeters goes hand-in-hand with our education programme to help build the capacity of anaesthesia providers in low-resource settings. This sustainable approach to training means that medical teams gain essential anaesthesia knowledge and the skills to pass this on to their colleagues.

Safe surgery in action!

Since Lifebox was founded in 2011 we’ve distributed over 13,000 pulse oximeters to 100 countries across Africa, Asia, Eastern Europe and Latin America, and trained over 5,000 anaesthesia providers in basic safety checks making surgery safer for 10 million people around the world.

As part of my communications role at Lifebox I spend a lot of my time promoting and sharing these powerful stats with our donors, friends, partners and supporters around the world: they not only demonstrate the impact of our work, but the collaborative effort required to help make surgery safer. I was delighted to have the opportunity to travel to Zambia last November to see our work on the ground, and was keen to meet the team working to support anaesthesia practice across the country.

In preparation for my trip l learned about Lifebox’s long history in Zambia: from supporting the MMed programme (training of the first medically qualified anaesthesiologists in the country) with equipment and education materials, to conducting follow-up research on the impact of our pulse oximeter donations. I was off to take part in Lifebox’s fourth training workshop in collaboration with our co-founder the Association of Anaesthetists of Great Britain and Ireland (the AAGBI). This four day refresher course focused on safe anaesthesia and introduction of the WHO Surgical Safety Checklist, as well as the delivery of the AAGBI’s SAFE obstetric anaesthesia training.

Meeting the dream team

Zambia is a large country with a population of over 16 million and, as with many low-resource countries, medically trained and qualified anaesthetists are scarce. Most anaesthetics are provided by clinical officer anaesthetists (COAs) who by and large have some medical training, but not the up-to-date knowledge required to provide a safe anaesthetic. This disparity, coupled with a lack of adequate monitoring equipment, means that anaesthesia mortality is 100 to 1000 times more dangerous in these settings compared to high-income countries.

Many people live in the country’s historically and commercially significant Copperbelt region. This mining area includes Ndola: Zambia’s third largest city, a gateway to the mineral-producing region of the country, and my base for the week.

I arrived in Ndola on a hot Monday afternoon, and as the plane touched down I went back to this idea of impact. I thought about our small team of fewer than 10 colleagues based in London and Boston, and the amazing global reach we’ve had over the last five years. It really struck me that I was about to witness first-hand the collaborative effort stretching across the world, from idea to action, to make safer surgery happen. So I was thrilled to meet two of our workshop coordinators when they picked me up from the airport: Wisdom Chelu (Zambia’s national anaesthesia lead) and Dr Phil Bonnett (a consultant anaesthetist in the UK) . After a quick stop to drop off my luggage we made our way to Ndola Central Hospital where set-up for the course began.

We were based at the hospital’s School of Nursing, a block of four classrooms (perfect for group sessions) with a larger room used as the main lecture area. I was introduced to the course faculty, a group of 11 UK and Zambian anaesthetists including two MMeds, Masuzyo Zyambo and Ushmaben Patel, based at the University Teaching Hospital in Lusaka. Over the week I came to know this dynamic group better – learning more about their backgrounds, what drew them to this specialty and their motivations for supporting Lifebox’s work. Consultant anaesthetist Papari Deka, who had been working in Zambia for a year, summarised: she was, simply, “keen to impart my knowledge to train anaesthetic providers to go out into Zambia and practice safe anaesthesia.”

Over 20 COAs attended our Ndola workshop, travelling from across the Copperbelt region and beyond. For many of them this was a rare opportunity to receive refresher training and a pulse oximeter.

“This would actually make a difference, and would help save many lives.”

Chilala Hakayobe, Namwala Hospital. Delegate at the Ndola workshop.

Throughout the week I attended various sessions led by the faculty and witnessed practical demonstrations of pulse oximeter use, checklist discussions and role-play focused on supporting expectant mothers. This was particularly significant as the majority of the surgeries that these anaesthesia providers attend are obstetric. Keguin Chifunda, a delegate from Arthur Davidson Children’s Hospital stressed the importance of receiving refresher training as it provides, “the latest information on the management of obstetric cases and neonatal resuscitation.”

Although my time in Zambia was brief it really informed my understanding of what it means to support colleagues on the front line of surgical care in their communities. This workshop was a collaborative effort supported by different groups and individuals all with the goal to help improve surgical safety in Zambia. Thanks to funding from the Ministry of Health and support from the AAGBI, Lifebox distributed 33 pulse oximeters and equipped 21 anaesthesia providers with the skills and knowledge to provide better anaesthesia care to their patients.

So what have I learnt over the last 18 months in my role at Lifebox? It was and is clear to me that partnerships are crucial to making safe surgery and anaesthesia a global reality. From our Ndola dream team who use the very oximeters we distribute, to our group here at Lifebox, chaired by renowned surgeon Atul Gawande. Surgery and anaesthesia are vital to global health, and ensuring access to safe, affordable care for those in need takes team work.


Want to help? / Click here to donate to Lifebox, or help the AAGBI to reach their target of £96,000 in their Lifeboxes for Rio fundraising campaign.

Photos: Kristopher Anderson, Lauren Anders Brown, Luca Koritsanszky, Sandra Leal & Sandra de Izquierdo. Patient images taken with consent.