Journey of an oximeterBMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f241 (Published 15 January 2013) Cite this as: BMJ 2013;346:f241
Surgery at Niamey National Hospital in the Republic of Niger is a challenging experience, dangerous even by third world standards where lack of access to properly equipped surgical care is a near universal public health crisis. Niger is among the poorest, and most youthful, countries in the world. Most of the 4000 operations in the hospital’s seven operating suites are on children or teenagers who have been injured in road crashes or as a result of unsafe working conditions.
But operating conditions at the hospital are improving dramatically because of a donation to Lifebox, the BMJ’s Christmas Appeal charity.
Maman Sani Chaibou, the hospital’s lead consultant in anaesthesiology and intensive care, was “very happy” to receive a delivery in March 2012 of a robust, portable, audible, rechargeable Lifebox pulse oximeter costing just £160 (€194; $250). “It has changed my practice by keeping my patients safe throughout their treatment,” he says. “For me, the greatest benefit is that it can follow the patient from the operating room to the postoperative room, keeping them secure beyond surgery.”
The donation was made by Janet Dewan, an American nurse anaesthetist based at Northeastern University, Boston, who had worked as a volunteer in Niger in the 1970s and returned two or three times a year between 2006 and 2009, when she worked alongside Chaibou. He had impressed her as one of the first African doctors to engage with the World Health Organization’s Surgical Safety Checklist as well as being an influential academic and trainer. “It was gratifying to be able to earmark my donation for someone I knew needed it and would use it,” says Dewan.
She made the donation in February 2012 just as the BMJ’s 2011 Christmas appeal for Lifebox had raised a record £34 000, funding 210 pulse oximeters for low income countries.
The blueprint for Niamey National Hospital’s new oximeter was developed after anaesthesia experts helping to put together WHO’s Surgical Safety Checklist in 2008 insisted that a pulse oximeter was an essential prerequisite of safe surgery.1 Further research found that more than 70 000 of the world’s operating theatres lacked this essential piece of kit.2
Chaibou is only too aware of the importance of oximetry. “Before we received the Lifebox oximeter, we could improve safety by getting the nurses to count the sponges and asking all the checklist questions. But going ahead with surgery without adequate monitoring was risky for patients,” he says.
Lifebox oximeters are manufactured in Taiwan, according to a specification written by the WHO and the World Federation of Societies of Anesthesiologists.
The direct contact between the charity and the anaesthesia provider provides transparency, avoiding the bureaucratic hurdles that can plague equipment donation. A further priority for the charity’s small but energetic staff is the speedy delivery of the devices. “We follow up every oximeter as it leaves the factory until it reaches its recipient, no matter how remote the destination,” says Iain Wilson, a Lifebox trustee and past president of the Association of Anaesthetists of Great Britain and Ireland. Niamey National Hospital’s Lifebox arrived just one month after Dewan’s donation was received—and she was delighted when Chaibou emailed a photograph of it in use in a theatre just a day or so later.
A further priority, as Lifebox chair Atul Gawande points out, is the provision of training for practitioners who lack experience in using oximetry. “If all we were doing was parachuting in a bunch of pulse oximeters, we wouldn’t have such a tremendous impact,” he explains. “Instead we work with local anaesthesia societies and ministries of health to identify the need for pulse oximeters and then organise training.”
It’s this aspect of Lifebox’s work that may make the crucial difference to healthcare in low income countries. So the delivery of 36 Lifebox oximeters to Connaught Hospital in Sierra Leone’s capital, Freetown, in March 2012, all funded by last year’s BMJ appeal, was accompanied by two half day courses using manuals provided by Lifebox. The courses were attended by the country’s 60 nurse anaesthetists during their annual symposium. For lead trainer Eva Hanciles-Roberts, one of five medically qualified anaesthetists in Sierra Leone, it was a rare opportunity for specialist training in a country where “the majority of anaesthesia providers will have between six months and two years’ training before heading out to rural facilities where they will be the only person qualified to deliver anaesthesia.”
“It helps that the Lifebox oximeter is intuitive, with a basic interface and a large screen with education materials in six different languages,” she says. “Complex surgery is still referred to Freetown, but nurse anaesthetists who work outside the capital report they now carry out their work with more confidence.”
A further benefit is the support to working relationships between clinicians in low and high income countries, particularly when a hospital is earmarked for a donation. Dewan says that she and Chaibou have “re-established our collegial relationship, and I was able to consult on and translate into English a postoperative pain research paper that Sani [Chaibou] had just had accepted for publication in the Journal of Pain Research—a project that otherwise probably wouldn’t have happened.”
Meanwhile Naimey National Hospital is on the Lifebox waiting list to receive more oximeters. “It would make a huge difference if each of our operating rooms had its own pulse oximeter. It would be a wonderful gift from BMJ readers,” says Chaibou.
Cite this as: BMJ 2013;346:f241.
To donate to Lifebox go to www.lifebox.org/donations or use the coupon in the print journal.