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8th December 2016

Safe surgery is a right, not a privilege

That’s what many of us have grown up to believe. But for billions of patients in low-resource countries, safe surgery is an unaffordable luxury. International charity Lifebox is working to change this.

It helps hospitals in poorer countries with the equipment, education and ongoing support they need to use the World Health Organization’s Surgical Safety Checklist. This is a seemingly simple communications tool designed for surgical teams to ensure that specific steps are always taken before, during and after an operation. Among other things, these include confirming the patient’s name, using a pulse oximeter to monitor oxygen levels in the patient’s blood and making sure all instruments are accounted for at the end of the procedure.

“The Checklist can reduce the risk of surgical complications and mortality by more than 40% when used correctly,” Lifebox Communications Director Sarah Kessler explains to This Is Medtech.

She’s keen to point out that a pulse oximeter is the only piece of medical equipment mentioned on the list. It’s a small device that clips onto the patient’s finger and sounds an alarm if there’s any change in the amount of oxygen in their blood stream. In high-resource countries anaesthetists wouldn’t dream of sedating a patient without one, because when oxygen levels drop to dangerously low levels without warning, organ failure, brain injury and death can follow within minutes.

However, despite being such a critical piece of equipment, more than 70,000 operating rooms around the world are missing one. Lifebox’s vision is to close this gap. “In these settings, they’re dealing with very urgent cases in an environment that has few resources. We’re talking about operations like emergency C-sections, trauma repair, hernia repair ‒ life and livelihood saving. With anaesthesia an essential but primary risk factor in surgery, oxygen monitoring is fundamental,” Sarah says.

Getting pulse oximeters to the hospitals that need them is only half the battle. The ones used in Europe and other developed countries can be too expensive ‒ and simply not thoughtfully designed to last in low-resource environments. Lifebox has therefore designed a low-cost, high-quality pulse oximeter that is specially built to work in settings where power cuts are frequent and biomedical engineering is virtually non-existent.

Education: the gift of life

This Is Medtech caught up with Dr. Angela Enright, one of the anaesthetists who founded Lifebox and now leads its educational programme. “To date, we’ve delivered about 14,000 pulse oximeters to hospitals in more than 100 countries,” she says. “But you can’t just give away the equipment. You’ve got to explain how it works and also its significance. It may be the only monitor in the room.”

That’s why Lifebox works directly with local organisations to host in-country education workshops alongside distribution. The pulse oximeters also all come with a multi-language training DVD. “In low and middle income countries, most anaesthesia is given by non-physicians. Some have nursing training but most only have about six months to three years’ training. The quality of their training can therefore be quite variable,” she notes.

In order to make the Lifebox mission sustainable, the charity also trains local doctors to become trainers themselves. “It’s a whole new window on patient safety, a whole new approach on picking up a warning early and dealing with it before it becomes a crisis situation,” says Angela.

The charity has also started a new programme called Clean Cut, which aims to reduce surgical site infections in low-resource settings.

To see the trailer for Lifebox’s recently released documentary called The Checklist Effect, about safety in surgery from Moldova to Mongolia and beyond, click here.