The idea of providing oximeters to those in
need first came about at the World Congress in Paris in 2004 when members of the
Safety and Quality Committee were discussing ideas around improving patient
safety. With the assistance of the Association of Anaesthetists of Great
Britain and Ireland (AAGBI) and GE Healthcare, who provided the oximeters, they
developed projects in 4 countries – India, Philippines, Uganda and Vietnam. They
found that there was a huge need for oximeters, and that significant education was
required in how to use them and how to respond to the information provided by
them. (Anaesthesia 2009; 64:1051-1060).

At the same time, the WHO was developing
its Safe Surgery Saves Lives initiative, led by Dr Atul Gawande of the Harvard
School of Public Health and a surgeon at the Brigham and Women’s Hospital in
Boston. This resulted in the provision of a surgical checklist. Studies showed
that using the checklist, no matter what resources were available, resulted in
a reduction in surgical morbidity and mortality. (N Engl J Med, Volume 360(5):491-499, January
29, 2009).

The use of a pulse oximeter was included as
one of the points on the checklist because of the importance of this form of
monitoring to patient safety, but also because it was recognized that a
significant portion of the anesthesia world lacked pulse oximeters. In October
2008, WHO gathered together interested parties such as the WFSA, Harvard School
of Public Health, procurement experts, industry and others. This group embarked
on a project to provide low cost pulse oximeters to anesthesiologists in need
of this technology to support the care of their patients. Teams were formed to
determine the specifications of a suitable oximeter, to set up a procurement
process, to secure financing and to develop educational materials.

All have done their work admirably. The
chosen oximeter is ISO and CE certified, with all of the qualities and
safeguards required. It comes with extra features, such as long-lasting
batteries, which make it suitable for use in austere environments. The successful
manufacturer is able to provide this state-of-the art oximeter at the
incredibly low cost of $250 US. This should enable governments and hospitals in
low and middle-income countries to purchase oximeters for a fraction of their usual
cost. We also hope groups, organizations and even individuals, will donate them
to those in need.

The project has gathered new partners such
as AAGBI and Smile Train. As well, many people have donated their expertise in
areas required by such a huge undertaking, for example management, branding,
law and public relations. These are people outside of the anesthesia, and even
the medical, world. They are contributing because they believe in the value of
the project to improve patient safety during anesthesia and surgery.

Research done as the project developed
shows that about 77,000 operating rooms in the world lack pulse oximetry. This
equates with about 35 million patients per year having anesthetics without an
oximeter (Lancet 376 (9746), 1055-1061, Sept 2010).  In addition, there is a lack of oximeters in Recovery Rooms,
Obstetric Units, Neonatal Units or Intensive Care Units. The potential for improving
patient safety with these devices, supported by appropriate education, is
enormous.

The education team has created materials
for use in self-learning or for teaching. Each pulse oximeter that is
distributed will have a CDROM with it which will include materials on the Surgical
Safety Checklist and the oximeter. These include a manual describing oxygen
transport, use of an oximeter, an algorithm on what to do when the oxygen
saturation is falling, two power-point presentations, scenarios for use in
teaching, quizzes and a prize-winning video made especially for this project by
Dr Rafael Ortega, an anesthesiologist at Boston University. All of the material
has been produced by us in six languages – English, French, Spanish, Chinese,
Russian and Arabic. It will also be available free of charge from the WHO
website. The content and quality of this material makes it relevant to any
anesthesia provider – not just those in economically constrained settings.

We are calling on all of our member
societies to assist us with the teaching programmes.

We are pleased to announce that this
project will shortly be set up as a not-for-profit

organization called Lifebox, with a board led by Dr. Atul Gawande and including
representation from WFSA.  This
will allow us to develop a sustainable structure, generate funds for the
donated distribution of oximeters and target on-site education programmes.  Importantly, it will allow the WFSA to
continue to promote our anaesthesia mission.

We will soon have a website dedicated to
this project where, for just $250 including delivery costs, eligible facilities
can purchase oximeters for themselves, and donors can buy on their behalf,
specifying the recipient if they wish. 
In time we will maintain a database of global need, so you can see
exactly how we are working to target the oximetry gap, and where donations are
needed next.

Lifebox aims to distribute 5000 oximeters during 2011, and 12,000 in
the first two years, through a combination of sales and donations.  If we are to target the 70 000 plus
operating rooms worldwide without oximeters, we need your help.

If you would like to donate funds for the
supply of oximeters where they are most needed; if you know of sites and
anaesthesia providers who are working without pulse oximeters; if you are able
to help us with coordinating distribution; if you would like more information
about the project please contact [email protected]. 

Please also watch the WFSA website, www.anaesthesiologists.org, for
updates of the work and our  website, www.lifebox.org,
which will be accessible early in 2011.

Angela Enright

Alan Merry