The Secret to Surviving Surgery in a Little Yellow Box

Digital-DiversityWhen philosophers muse upon the secret to life, they probably aren’t imagining a little yellow box. And yet, when it comes to surgery, that box can hold the secret to life, and it turns out that the answer is simple: oxygen.

Digital Diversity is a series of blog posts from featuring the many ways mobile phones and other appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives. This article was written by Layla McCay, a member of our Media and Research Team.

By Layla McCay

It’s no mystery that oxygen keeps people alive. If we don’t receive enough oxygen, it’s not long before we sustain brain damage, and death. But during surgery, making sure we receive enough oxygen to keep us alive can be tricky. General anesthetics suppress the muscles in our body that make us breathe naturally, plus the gases used for anesthesia can dilute the oxygen in the air going into our lungs. It’s the job of the anesthesiologist to make sure that we get enough oxygen to keep us healthy while the surgeons operate. Luckily in hospitals in high-income countries, there is all sorts of technology that keeps us safe.

If you have ever been in hospital or a doctor’s office, and someone has stuck a plastic clip onto one of your fingers or your ear lobe, you have already experienced one of the most important technological advances in safe surgery. It’s called a pulse oximeter and it measures the oxygen levels in your blood. It works by taking advantage of the fact that the precise colour of our blood is affected by how much oxygen it contains. Using a light, a light detector, and a microprocessor, the pulse oximeter can calculate just how much oxygen is in the blood – and if it starts falling below a safe level, the pulse oximeter sounds an alarm. By alerting doctors to the problem in good time, it helps reduce the risk of complications from surgery by an impressive 40%.

An operating room using a Lifebox pulse oximeter, Ghana. (Photo copyright Lifebox Foundation)
An operating room using a Lifebox pulse oximeter, Ghana. (Photo copyright Lifebox Foundation)

In West Africa, for every 133 people who have surgery one of them will die from largely avoidable complications of anesthesia. Nneka, a young anesthetist from Abiya State in rural Nigeria, knows this all too well. Her own cousin died on the operating table because the surgeons didn’t have access to a way of monitoring the oxygen levels in his blood. “He couldn’t breathe,” she explained, “but the hospital didn’t have a pulse oximeter – just a stethoscope to monitor his vital signs – and the surgical team didn’t notice. If there was a pulse oximeter in his hand they would have noticed when he lost oxygen.”

It is hardly surprising that there is an equipment gap between richer countries and those with fewer resources. Operating room pulse oximeters can be expensive, around $2,000. But it’s not just a matter of affording them. As with lots of surgical equipment, they tend to be designed with a high resource setting in mind, which means they often need regular servicing, calibration, and reliable electricity to work, and their operation can require high levels of training – demands that may not be feasible for hospitals in low and middle income countries. This means that in around 77,000 operating rooms in these countries, the doctors and nurses have no reliable way of knowing whether their patient is receiving enough oxygen during surgery. This makes it up to a thousand times more dangerous to have surgery in many countries compared to, for example, the USA.

Nneka now works with Lifebox, an international NGO that has seized on the issue of unsafe surgery and driven the development of a pulse oximeter that is nearly ten times cheaper than the alternative options, costing just $250. Their pulse oximeter is not only more affordable, it is also high quality, durable, and can operate on rechargeable battery power when the electricity cuts out. Lifebox not only provide the pulse oximeters, they train health workers to use it as part of the World Health Organization’s safe surgery checklist.

Young boy in hospital with Lifebox pulse oximeter monitoring his oxygen levels, Ethiopia (Photo copyright Lifebox Foundation)
A young boy in hospital with Lifebox pulse oximeter monitoring his oxygen levels, Ethiopia (Copyright: Lifebox Foundation)

Nneka has conducted a needs assessment in Nigeria, and is coordinating a training program. The operating rooms across Abiya State will not just receive this vital equipment, but receive high quality training in how to use it, and how to respond when the alarm goes off. This is one of the latest in Lifebox’s projects, which have delivered pulse oximeters to hospitals in 90 countries around the world.

Lifebox’s approach is bringing equity to surgery. If you should ever have the misfortune to be in hospital for surgery, as soon as the pulse oximeter is clipped to your finger know that across the world, others in countries like Nigeria are having very similar pulse oximeters clipped to their fingers, to keep them safe, just like you. Though not everyone is so lucky. Lifebox has so far managed to distribute 7,000 pulse oximeters, and no other NGOs are focused on increasing the availability of this equipment. If the secret of life is in this little yellow box, it is sad that there are another 70,000 operating rooms, full of patients every day, who are still waiting in vain for that clip on their finger.

Layla McCayLayla McCay is a medical doctor and global health specialist, with a special interest in global health technology and innovation. She has worked across health policy sectors, from the World Health Organization and the World Bank to International NGOs and the British Government. She teaches international health at Georgetown University. You can find her on Twitter @LaylaMcCay

Digital Diversity is produced by Ken Banks, innovator, mentor, anthropologist, National Geographic Emerging Explorer and Founder of, FrontlineSMS and Means of Exchange. He shares exciting stories in Digital Diversity about how mobile phones and appropriate technologies are being used throughout the world to improve, enrich, and empower billions of lives. You can follow him on Twitter @kiwanja

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Meet the Author
Ken Banks is an innovator, mentor, anthropologist and National Geographic Emerging Explorer. Founder of and now Head of Social Impact at Yoti, he spends his time applying Yoti's digital identity solutions to humanitarian problems around the world. His earlier research resulted in the development of FrontlineSMS, an award-winning text messaging-based field communication system designed to empower grassroots non-profit organisations. He shares exciting stories in "Digital Diversity" about how mobile phones and other appropriate technologies are being used around the world to improve, enrich, and empower billions of lives.