Sophie Reshamwalla: Lifebox—is that the pulse oximeter charity?

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.

But the Lifebox mission extends beyond pulse oximeters. Having a monitor for your patients will help to avoid the pitfalls of anaesthesia, but it is just one of the requirements for safe surgery. What about all the other mistakes? Surgical safety requires much more, and we have much more to give.

So, what else does Lifebox do? If I met you in an elevator I would tell you the short version: millions of people around the world are dying needlessly from surgical conditions and we are doing something to change that. I hope this would be enough to pique your interest and you would invite me for a coffee so I could tell you a bit more—that these patients: mothers, babies, old people, young people—are often dying because of a system failure. The “Swiss cheese model,” as it’s called, whereby a series of small errors goes unchecked and results in full blown crisis.

Problems with global health inequality are multi-faceted and solutions are complex. But by the time I gave you the full picture, I hope that you would be ready to take a stand against these avoidable tragedies, and join the campaign for surgical safety worldwide. At Lifebox we know that we cannot remedy all that is wrong with global surgery. But we can do something—and, thanks to support from the BMJ and others, we have started.

We know that people make mistakes in the UK—the so-called “NHS blunders” that we read about in the papers, where the wrong kidney was removed, or a blood clot was missed. These errors are made by highly qualified professionals, working within a robust system. But what about the situation in a poor country, where there is no NHS, a lack of skilled staff, unreliable diagnostics, and patients are moribund? How many mistakes are made there? The answer is nobody knows.

And let’s not forget the impact these incidents have on the health workers themselves. Imagine going to work everyday knowing that half the patients you see won’t make it through the night. Or knowing that every time you performed an operation to save someone’s life, something else would go wrong and undo all your hard work.

These are the stark situations some of our colleagues in these countries face, and it’s about time we did something to help them. Do you remember the last time you made a mistake when caring for a patient? Do you remember the guilt, shame, fear, and sorrow you felt? I do.

The WHO surgical safety checklist has been developed to prevent avoidable deaths and has been shown to reduce surgical morbidity and mortality by over 30%. It has specifically been developed as a global tool, i.e. it should be as applicable in a low income setting as a high income one. Lifebox is working to introduce the checklist worldwide, to the places that need it the most.

At a Lifebox training workshop in Tanzania last month, I was able to meet the staff to find out a bit more about what things were like for them. In some ways I was surprised to learn a lot of their experiences mirrored my own experiences as a clinician. The anxiety of being a house officer and not really knowing what to do, or the frustrations of knowing what to do but not being able to do it and the feelings of shame and inadequacy after making a mistake.

When I had the opportunity to teach them about the surgical safety checklist, I could see something inside them shift. This wasn’t a fancy piece of equipment that would break down in a few months time, or a book that would end up on the library shelf. This was an awesome tool that they could start using immediately, and not only would it revolutionise the care they gave to their patients immediately, they themselves would work better as a team and work better. And as a healthcare professional with the burden of responsibility on ones shoulders, this impact cannot be underestimated.

Donating fifty pulse oximeters in Tanzania was the icing on the cake. There was more than gratitude in the eyes of the recipients—there was hope. Someone out there had heard them and responded. It reminded me of when I spent the money on a 3M Littman Cardiology II Stethoscope and how I felt when I first opened the box to use it. Some may question why a surgical registrar would need such a fancy stethoscope, (maybe it’s because I really, really wanted to hear the bowel sounds), but I felt empowered by it. And I knew I could provide better care for my patients with it.

The nurse anaesthetists in the countries we work in don’t have the luxury of choice—they get what they are given. And pulse oximeters aren’t often on that list. We know that more than 70,000 operating rooms globally don’t have pulse oximeters and people are dying needlessly around the globe. Lifebox is working tirelessly to set this straight and we need all the support we can get. Pulse oximeters are just the start.

Lifebox is this year’s BMJ Christmas charity. To donate to Lifebox go to or use the coupon in your print journal.

Sophie Reshamwalla, implementation manager, Lifebox Foundation.