Feature BMJ Winter Appeal

Winter appeal latest: BMJ readers raise almost £34 000 for Lifebox

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e807 (Published 27 April 2012) Cite this as: BMJ 2012;344:e807
  1. Jane Feinmann, freelance journalist

Jane Feinmann finds out how the donations of BMJ readers will contribute to maternal and child mortality

BMJ readers raised almost £34 000 for the charity Lifebox this year, making this the journal’s most successful winter charity campaign to date. Tony Falconer, president of the Royal College of Obstetricians and Gynaecologists, explains how the pulse oximeters purchased as a result will improve obstetric care and reduce maternal mortality in Africa.

“Caesarean section is probably the most common emergency surgery in Africa, with most operations carried out by medical officers either working solo or relying on an assistant with limited medical training. In that situation, it’s extremely difficult to monitor the mother’s health during anaesthesia without a pulse oximeter that can reliably alert the practitioner with an alarm when something is amiss,” he says.

Falconer predicts that with better access to pulse oximetry, the risks of caesarean section in some under-resourced communities should start to fall. “Caesarean section is not a luxury. It’s the only safe way to give birth in many cases. In addition, pulse oximetry can help doctors in low income countries manage critically ill mothers with obstetric problems such as haemorrhage, high blood pressure, and sepsis,” he says.

These clinical benefits are reinforced by Lifebox’s robust, sustainable, and high quality teaching programme that is focused and sensitive to local requirements. “Perhaps most importantly, Lifebox aims to facilitate linkages between hospitals in the UK and Africa, putting in place a basic training infrastructure and ensuring that the momentum of raising standards of obstetric care is sustained,” he said.

Lifebox will also save lives in paediatrics, according to Isabeau Walker, consultant paediatric anaesthetist at Great Ormond Street Hospital—notably from pneumonia, the leading cause of death among children under 5 years old in Africa. “A pulse oximeter may not be able to cure pneumonia. But it’s the best possible triage tool when you have a long queue of children brought to hospital,” says Walker. “A Lifebox pulse oximeter enables a healthcare practitioner to identify the sickest children who need oxygen and antibiotics most urgently in order to stay alive for the next few hours.”

Oximeters will also prove “hugely valuable” in treating neonates, especially babies born prematurely who are in need of oxygen, according to Walker. “There is a major problem in countries affluent enough to have oxygen but which do not have routine access to oximetry,” she said. “Babies can be given too much oxygen, putting them at risk of retinopathy and blindness. That’s where Lifebox will be able to make the difference.”

But can such huge improvements in care really be achieved with this piece of kit that rarely features in medical history books? Absolutely, says Paul Clyburn, consultant obstetric anaesthetist at the University Hospital of Wales in Cardiff.

“The use of pulse oximetry has been common practice in Western countries for just over 20 years. It is something doctors take for granted and frequently underestimate,” says Clyburn, one of the lead Lifebox trainers. “As an anaesthetist, I can vouch for the fact that their introduction was the most significant milestone in safer anaesthetics during my working lifetime. Low income hospitals deserve to have access to this device,” he says.

While most pulse oximeters that are designed for operating theatres are available only at hugely inflated prices in many developing countries, there are also much cheaper devices available online. Won’t they do?

“Not at all,” says Falconer. “Anyone who has worked in an under-resourced hospital knows the horror of equipment failure—with bits of expensive kit left on the shelf because they have run out of batteries or spare parts. The beauty of Lifebox is that it is designed to be robust and reliable in such an environment—so that it virtually cannot run out of batteries. That’s what BMJ readers are now able to support,” he says.


Cite this as: BMJ 2012;344:e807


  • Competing interests: The author has completed the ICJME unified disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares no support from any organisation for the submitted work; no financial relationships with any organisation that might have an interest in the submitted work in the previous three years; and no other relationships or activities that could appear to have influenced the submitted work.

  • Provenance and peer review: Commissioned; not externally peer reviewed.