Pulse oximeters for all

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What difference will a £160 (€186, $250) Lifebox pulse oximeter make to low resource countries where surgery is still routinely carried out without this piece of kit, regarded as essential in Western operating theatres?

“It will reduce mortality during anaesthesia,” says Merhab Apiny, anaesthetic officer at Health Centre IV in Mukono Town, one of Uganda’s fastest growing urban areas, 20 kilometres south of Kampala.

“Patients die,” she says, “because anaesthetic officers assume that spinal anaesthesia especially is safe and so may not always monitor the patient closely or notice if he or she stops breathing. But the early warning alarm on the Lifebox pulse oximeter alerts us so that we can take the necessary action.”

The BMJ’s Christmas Appeal this year is raising money for Lifebox—which aims to distribute uniquely robust and high quality pulse oximeters, built to the charity’s own specifications, to the 77 000 operating theatres in low and lower-middle income countries that currently provide anaesthesia without this essential piece of kit. A pulse oximeter, recommended as part of WHO’s Safe Surgery Save Lives campaign, is used for an average of 3000 operations every year.

For Mrs Apiny, the device is already having a dramatic effect on the safety of surgery at her hospital. In June 2011, she was one of 126 Ugandan anaesthetic officers who attended a session on pulse oximetry, during a course on obstetric anaesthesia run by British anaesthetists. She was able to take home a Lifebox oximeter donated by the Association of Anaesthetists of Great Britain and Ireland—one of Lifebox’s founding partners.

The difference that a pulse oximeter can make is only too well understood by Isabeau Walker, Lifebox trustee, consultant paediatric anaesthetist at Great Ormond Street Hospital, and the AAGBI’s representative at Lifebox, who led the training in June. She said the experience of surgery without pulse oximetry was “terrifyingly difficult.”

“The only way of knowing that someone is hypoxic is if the blood darkens and that can be too late. The anaesthetic officers are dedicated, skilled people who had travelled hundreds of miles in difficult conditions to attend the course to improve the safety of their surgery.”

Trainee anaesthetist, Louise Finch was similarly impressed when she visited 74 of the anaesthetic officers who had received a Lifebox pulse oximeter at hospitals and clinics in Uganda in October 2011 to provide a follow-up service to the course. “It was a humbling experience,” she says. “Anaesthetic providers have to work hard in harsh, stressful conditions for little money and with barely any equipment. Emergency caesareans are the most frequent operations and are often on much sicker women than we tend to see in the UK, making a pulse oximeter even more vital.”

Visiting these clinics, she said, showed clearly the value of the Lifebox initiative. “In many of these units, I’d see expensive pieces of equipment that had been donated by charities but were lying idle because they required an electricity supply that wasn’t available or a vital piece of the kit had broken and couldn’t be replaced.”

The Lifebox pulse oximeter is designed for use in low resource settings: robust, durable, resistant to damage, and with long lasting rechargeable batteries. “The training we provide enables anaesthetic officers with little or no previous experience to use pulse oximetry safely and with confidence,” says Dr Finch.

Lifebox has got off to a flying start. Already Smile Train has bought 2000 pulse oximeters for use in hospitals throughout the Third World. Staff across the entire anaesthetic department at University of Florida recently raised $33 700 for the charity. Now BMJ readers can help the charity maintain that momentum, as Lifebox embarks on a programme for 2012 that will support safe surgery and safe anaesthesia training for anaesthesia providers across Africa, Asia, Latin America, and the Pacific.