In 2009, Obama convened senior politicians in the Oval Office to discuss one magazine article: why were there Medicare costs of $15,000 per person per year in the Texan town of McAllen, when a neighbouring town had costs of $7,500 per person per year? Especially when the hospitals in McAllen were performing worse than its neighbour.

“He came into the meeting with that article having affected his thinking dramatically. He, in effect, took that article and put it in front of a big group of senators and said, ‘This is what we’ve got to fix,’” recalls one of the senators. more…

I see a lot of medical equipment that isn’t working. In fact, that’s my job. I’m a biomedical engineer and I spend a lot of time in Africa working with hospital staff, educators, and policy makers trying to understand why equipment doesn’t work and trying to do something about it. The figures themselves speak loudly. There isn’t a large evidence base, but the World Health Organization estimates that 50-80% of medical equipment in developing countries isn’t working. The rough figure from many hospitals I’ve visited in West and Southern Africa is around 40%. more…

The first person I saw die accidentally from an anaesthetic accident was a kind, distinguished man in his sixties, scheduled for surgery to a large leg tumour. During anaesthesia his endotracheal tube became kinked, which was not noticed by the anaesthetist. Undetected hypoxia was quickly followed by cardiac arrest and then resuscitation attempts, resulting in a brain-injured patient. In intensive care his grieving extended family were dignified and accepting. He died within 48 hours. Another preventable perioperative death in a hospital in central Africa in 1986.    more…

Thousands of well intentioned donations are made to developing countries every year but many of these do not achieve what was hoped; they don’t make it to the intended recipient, or they’re unfit for purpose when they do. I hope I can persuade you that this is not the case for Lifebox oximeters.

I was involved in one of the first donations of Lifebox oximeters: 80 pulse oximeters to anaesthetic officers and nurses across Uganda, delivered at a three day training workshop in June 2011. more…

A pulse oximeter in the operating theatre doesn’t make surgery safer; it’s the anaesthesia provider using the oximeter effectively who will save lives.

For Lifebox, the BMJ’s Christmas charity, provision of education is inseparable from donating equipment.

That’s why we’re excited to share a recent conversation with Sandra Leal the president of the association of medical anaesthetists in El Salvador (AMAES—Asociación de Médicos Anestesiólogos de el Salvador).   more…

My wife and I arrived in Zambia in August 2012 for a six month placement as surgical registrars in a busy rural hospital in the Eastern Province. This was my first experience of hospital care in the developing world and I was soon working all hours of the day and night, operating on everything from minor wounds, to major trauma, and abdominal catastrophes.

St Francis’ Hospital is unique in the local area because it provides an entirely free service and always has at least one experienced consultant surgeon from Europe. Patients travel for hundreds of kilometres to the hospital expecting, and receiving, a high quality of care. more…

When people talk about the crisis of unsafe anaesthesia worldwide, there’s one particular publication that is frequently referenced—it’s too shocking to ignore.

“Deaths associated with anaesthesia in Togo, West Africa,” published in Tropical Doctor in 2005, demonstrated that anaesthesia mortality in Togo could be as high as 1:133 patients.

Lifebox recently spoke to lead author Fataou Ouro-Bang’Na about the origins of this paper, the culture of surgical safety, and his role in a recent Lifebox training workshop in the capital city of Lomé. more…

“Can I ask your advice doctor?” The recovery nurse who I had been teaching looked puzzled. “I have been asked by some of my colleagues on the wards how to wake up patients who have not recovered from their anaesthetic after one or two days. What do you suggest?”

My heart sank; all of the drugs we were using for anaesthesia should have cleared within hours, and a patient who was still asleep after two days was more likely to have suffered some other untoward event. After a few months of working in Ethiopia, I had a near certain guess as to the cause. more…

Just 3.5% of the 234 million major operations taking place each year are in low-resource settings, often carried out in very dangerous conditions due to lack of resources and training.

Lifebox Foundation, the BMJ’s christmas charity, works in more than 70 countries to improve the quality and safety of surgical care.

They spoke recently with Patrick Kyamanywa, dean of medicine at the National University in Kigali, about the challenges of delivering safe surgery in Rwanda. more…

Whenever I tell people I work for Lifebox, they often say, “Oh, is that the pulse oximeter charity?” I’ve heard this so many times now that it is easy to fall into the trap of believing that’s all we do—send out pulse oximeters.

Don’t get me wrong, we do send out pulse oximeters, and they play a vital role in surgical safety. Patients are over a thousand times more likely to die from a general anaesthetic in sub-Saharan Africa compared to the UK, and in many cases we know why. Hypoxia goes undetected, aspiration is missed, or the oesophagus is intubated by mistake. Each time these mistakes could have been detected with a pulse oximeter, yet there are still thousands of operating rooms that don’t have one. It is one tragedy after another, and support from BMJ readers will make a life saving difference. more…