Intended for healthcare professionals

Feature BMJ Christmas Appeal 2012

Lifebox: Make it zero

BMJ 2012; 345 doi: (Published 04 December 2012) Cite this as: BMJ 2012;345:e8241

This article has a correction. Please see:

  1. Sarah Kessler, project manager
  1. 1Lifebox Foundation, London, UK
  1. sarah{at}

Some Christmas presents don’t make it past Christmas dinner. Others are lost under the sofa by the time January rolls around. There are very few gifts that you can guarantee will be in constant use one year later—and what’s more, that they will be used to save lives.

BMJ readers can claim just that. Last Christmas you put 187 pulse oximeters directly into operating theatres in 10 low resource countries through your generous response to the BMJ’s Christmas appeal for the Lifebox Foundation.1 2 3

Every penny you donated—more than £30 000 in a few weeks—was used to send oximeters and education materials to hospitals in need. From Cambodia to Cameroon, Nepal to Nicaragua, Papua New Guinea to the Philippines, your support is making a difference.4

In these countries, surgery regularly takes place without any monitoring equipment beyond a manual blood pressure cuff or a finger on the pulse. Essential healthcare interventions that give back life and livelihood are delivered in such dangerous conditions that the operation itself is a regular cause of mortality.

In this kind of austere setting, a pulse oximeter isn’t just another piece of monitoring equipment: it’s a vital component of safe surgery.

The Lifebox oximeter has an audible tone that drops as a patient’s oxygen saturation decreases. In the past year, the changing of the beep has identified internal haemorrhage during emergency caesarean sections while there was still time to act, been the eyes and ears of the surgical team in a suddenly dark operating theatre when the generator failed again, and alerted an anaesthesia provider to an oesophageal intubation; in short, oximeters have had a direct effect on the safety of surgical care.

The oximeters have transformed the lives of your colleagues too.

Take Abayehu Haile, an anaesthesia provider at Limmu Geenet Hospital, Ethiopia. Before she got a pulse oximeter from a BMJ reader, she had an impossible dilemma: go into the theatre without the right equipment and risk the patient’s life, or refuse to proceed and leave the patient no chance.

“When you come to my profession, pulse oximetry is the heartbeat for my work, for safe surgery,” Haile told us. “But I couldn’t ever say—‘we have no monitor’ and refuse to work—I had no choice but to try to save life as best I could.

“Now thanks to you, we are using the oximeter and the World Health Organization Surgical Safety Checklist in our hospital. I would like to thank you again and again for your impressive life saving activity. You are not only supporting patients, you are also helping professionals.”

Thank you from all of us at Lifebox too. We were overwhelmed by your generosity and grateful for your ideas and feedback—both in person, when you picked up oximeters to hand deliver on your service trips, and in rapid responses on

In the weeks to come we will share stories from the colleagues worldwide you’ve supported this year; the training workshops that have been held in Ethiopia, Cameroon, Honduras and many other countries; and our plans for the future.

There’s still a long way to go.

Lack of access to safe surgery in low resource countries is a full blown global health crisis. More than 70 000 operating theatres still don’t have a single pulse oximeter.5 The WHO Surgical Safety Checklist, consistently proved to significantly reduce surgical complications and mortality, is still used in only a few low resource hospitals.6 Patients are dying needlessly, and providers lack the resources to do more than fight a losing battle.

We hope you will consider donating again to Lifebox, or making your first contribution. Unsafe surgery is a devastating cycle, and we can help to break it. Thank you.


Cite this as: BMJ 2012;345:e8241