When I worked at Kilimanjaro Christian Medical Center (KCMC) in Moshi, Tanzania, for the first time in 2005, there was only one pulse oximeter for a 700-bed hospital serving over 10 million people with 14 ORs and multiple intensive care units (ICUs). Anesthesia mishaps were a near daily occurrence, and the ICUs struggled to take care of patients. When I returned to KCMC in 2017, every OR had a Lifebox pulse oximeter, the Surgical Safety Checklist was being implemented, and patient safety had massively improved.

As anesthesiologists working in the United States, most of us cannot imagine working without the monitors we use so routinely to ensure the safety of our patients. But we are the fortunate few. Due in part to a lack of proper monitoring, anesthesia-related mortality in low-resource settings can be orders of magnitude greater than in high-resource settings (Anesth Analg 2018;126:1312-20). This is not an insignificant concern, as more than 2 billion people live in low- or middle-income countries, where exposure to anesthesia frequently is accompanied by significant risk (Anesthesiology 2016;124:561-9).

For our colleagues working in lower-resource settings, the lack of modern anesthesia monitoring is a stark reality, with pulse oximeters still scarce and research pointing to a near 100% gap between the need for capnography and its availability. To date, Lifebox has distributed 35,000 pulse oximeters, with 248 million surgical patients now being monitored while under anesthesia as a result (lifebox.org). This is a tremendous improvement for patient safety. However, given that capnography has been used universally in the U.S. for more than 30 years, we need to take the next step. Addressing the global capnography gap is essential if we are to make surgery safer for all.

Patient monitoring with a donated Smile Train-Lifebox capnograph at CoRSU Hospital, Uganda. ©Lifebox/Muhwezi Davis.

I am proud to have been working with Lifebox and Smile Train for many years to help improve patient safety, including at KCMC, with the ASA Charitable Foundation, and with the ASA-Lifebox Resident Challenge to support raising funds to provide pulse oximeters and now capnographs to my colleagues in Tanzania and dozens of other countries (smiletrain.org).

The annual ASA-Lifebox Resident Challenge sees anesthesia residency programs across the U.S. compete to raise funds for safer anesthesia worldwide. In previous years, the Challenge has equipped thousands of ORs with Lifebox pulse oximeters. In 2023, the ASA-Lifebox Resident Challenge first began to raise funds for the new Smile Train-Lifebox capnograph. This is a high-quality, user-friendly, affordable capnograph with sturdy construction and long battery life that is well suited for use in low-resource settings. Developed by Smile Train, the world’s largest cleft repair organization, and Lifebox, this capnograph aims to address the critical shortage of capnography access in low-resource settings. Your support can help us bring this lifesaving technology to those who need it the most.

I had a great experience helping lead the Resident Challenge for the University of Cincinnati in 2022, with over $22,000 raised from our department alone. Having such a large impact on thousands of patients worldwide as well as bringing my department together for a common cause was incredibly rewarding. I am so proud of the compassion and solidarity shown by our department’s residents, CRNAs, AAs, attendings, and staff for their global anesthesia colleagues through this initiative.

OR equipped with a Smile Train-Lifebox capnograph at CoRSU Hospital, Uganda. ©Lifebox/Muhwezi Davis.

The 2023 Challenge raised an incredible $50,000 for Lifebox. This significant contribution funded capnographs to equip ORs across nine countries, including Guinea, Burkina Faso, Kenya, and Uganda. The impact was immediate, and the lives saved are proof of the power of collective action.

“If I did not have this device, I would not be able to tell that the tube is in the right place. And how does that affect me? Keeps me from panicking. The other alternative is using the stethoscope, the ones that doctors usually wear around to listen and make sure that the tube is in. But that takes a while, and it needs two people. But with the capnography, even when I’m alone and I see the reading of the carbon dioxide, I can be able to tell that the tube is in the right place. So that is why I am very happy that we have these capnographs that have been donated by Lifebox and Smile Train, to help us make sure we are giving safe anesthesia,” said Juliana Nanimambi, anesthesiologist, CoRSU Hospital, Uganda.

Not only does capnography reduce the risks to surgical patients, it also relieves an enormous burden for anesthesia providers who, until now, have effectively worked in the dark. Every patient deserves safe surgery, regardless of where they live. I urge residents to sign their department up for the 2024 ASA-Lifebox Resident Challenge and continue this lifesaving work to make anesthesia safer globally.

For details on how to participate in the 2024 ASA-Lifebox Resident Challenge, go to lifebox.org/about-us/get-involved/asa-lifebox-resident-challenge