Lifebox Report: 2012

The Lifebox team would like to offer its sincere thanks to the WFSA and its member societies for their ongoing support.  Your involvement as a founding organization and your generosity through earmarking funds for our operations has been integral to the growth in scope and structure of Lifebox since our set-up in April 2011. We are proud to share exhibition space at this World Congress of Anaesthesiologists and look forward to developing our relationship in years to come: building on our shared mission of improving the quality and safety of anaesthesia and surgical care worldwide.

This report provides an outline of the progress and achievements made by the Lifebox in the period April 2011 to March 2012.

1.     Governance

On 21 April 2011 Lifebox incorporated in England & Wales as a private company limited by guarantee under the name ‘Lifebox Foundation’.  We received charitable registration from the Charity Commission in England & Wales on 21 July 2011.

1.1  Board

At our first Board meeting in April, the founding members – Dr Angela Enright, Dr Atul Gawande, Pauline Philip and Dr Iain H Wilson – ratified that the WFSA and the Association of Anaesthetists of Great Britain and Ireland (AAGBI) would be invited to nominate a representative to serve a three-year renewable term on the Board. Professor Alan Merry and Dr Isabeau Walker have taken up seats on the Board on behalf of the WFSA and the AAGBI respectively. Dr Atul Gawande has been elected to serve as Chair of the Lifebox Board. Kristine Stave serves as the Company Secretary.

Since incorporation in April, the Board has met by telephone at eight-weekly intervals and held two face-to-face meetings. The next face-to-face meeting will take place in Boston in early May 2012.

1.2  Staffing

Pauline Philip continues to act as the Chief Executive of Lifebox, not drawing a salary for this position. She is supported by a Head of Operations (Kristine Stave), an Implementation Manager (Dr Sophie Reshamwalla) and a Project Manager (Sarah Kessler).

1.3  US charitable status

We are currently proceeding with an application to set up “Lifebox USA” based in Massachusetts. This will allow us to receive donations directly from US funders and remove the need for these to be collected by the WFSA on our behalf.

We expect that US charitable status will be granted by the end of 2012.

2.     Finances

2.1  Funding

The WFSA generously provided core funding for Lifebox through its allocation of a $200,000 budget for the Global Pulse Oximetry Project for the period 2010-2012. As the project has grown into an independent entity, the balance of this budget has been transferred to Lifebox with the agreement of the WFSA Treasurer.

In 2011 Lifebox also received two significant donations totaling US$325,000 – secured through the Brigham & Women’s hospital and from a not-for-profit healthcare organization in the USA – and over $150,000 in donations from individuals and professional organizations.

$15,477 has now accrued with Acare in respect of the 5% administrative fee levied on each pulse oximeter or probe distributed. As per the contract with Acare this belongs to WFSA and is currently held in a restricted account for this purpose. We would like to propose that this sum is diverted back to Lifebox for the purpose of distribution of additional pulse oximeters.

2.2  Pro bono support received to date

In addition to the time committed by members of the WFSA and other supporters, Lifebox has received services and assistance from a range of organizations and companies representing an estimated value of $800,000:

·       Field Fisher Waterhouse – legal advice on Acare contract (est $100,000)

·       22 design – website and technical development (est $35,000)

·       LehmanMillet – creative communications and branding ($300,000)

·       HealthStar PR – media and campaigns (est $150,000)

·       McDermott Will Emery – legal advice on incorporation and charitable registration in the UK and the US (est $150,000)

·       Smile Train – initial branding and marketing advice (est $50,000)

·       Bill Hogan – accountancy support (est $15,000)

3.     Operations

3.1  Banking

The Lifebox Foundation operates two bank accounts with HSBC; a sterling account for UK operational expenses and donations, and a currency (US dollar) account for international payments and remittance.

3.2  Accommodation

As of 1 March 2012, Lifebox is based in office space donated by the AAGBI. The accommodation is located at 21 Portland Place in London. This is a particularly suitable arrangement as it allows Lifebox the space to function as an independent charity, while allowing for continued ease of communication with our two founding partners.

3.3  Tax-efficient giving

Lifebox has received HMRC recognition as a charity, and UK tax-payers are able to give tax-efficiently to Lifebox. We operate an online giving page in the UK which automatically collects Gift Aid on our behalf: https://mydonate.bt.com/charities/lifebox

As mentioned in 1.3, we are setting up a US organization and will apply for 501(c)(3) listing for this. Until such listing has come through – expected during Q4 2012 – we anticipate continuing our cooperation with the WFSA as recipient of our US donations.  These will be transferred to Lifebox on a quarterly basis.  Lifebox undertakes all written communication with donors in order to limit the administrative burden on the WFSA.

4.     Implementation

4.1  Country-wide roll-out (oximeterization)

In July 2011, Uganda was selected as the site for the first Lifebox oximeterization project, our country-by-country strategy for closing the global pulse oximetry gap.  In conjunction with the Uganda Society of Anaesthesia (which had conducted a needs assessment) Lifebox led an international faculty that worked alongside Uganda faculty to deliver 80 pulse oximeters to recipients from facilities without access to a single device.  We also delivered a one-day training session as outlined in the education package (pulse oximetry and WHO Surgical Safety Checklist) to approximately 130 anaesthetic officers. In addition we conducted a thorough survey of each represented facility’s anaesthetic and surgical capability.  We anticipate that this, and future surveys, will be invaluable to the furtherance of safe anaesthesia and safe surgical aims. 

Dr Louise Finch, a member of the anaesthetic faculty delivering the Lifebox education course in Mbarara, undertook a three-month follow-up trip to Uganda, visiting facilities that received pulse oximeters, collecting logbooks and following up on device functionality. In her words: “The feedback from recipients has been overwhelmingly positive. […] When asked for suggested improvements, there have been none given related to the Lifebox design per se.  The most common request has been for more to be donated and many have also asked for a paediatric probe to be provided. I would not hesitate to recommend the Lifebox oximeter over any of the others I have come across in resource-poor healthcare environments”.

The most recent country roll-out of oximetry and the WHO Surgical Safety Checklist took place in Eritrea in early February this year: The distribution of 78 Lifebox pulse oximeters was linked to a national training workshop organized and funded by the Ministry of Health and with representation from over 85% of the country’s hospitals.  Dr Berhane Debru, Director of Medical Services at the Ministry of Health, opened the workshop.

This model of targeted oximetry and education training is fundamental to the Lifebox strategy, and we are now implementing similar programmes in countries such as Sierra Leone, Ethiopia, South Sudan, Rwanda and Nepal. Our Implementation Manager is developing a holistic model for Lifebox work in countries, including an evaluation/measurement framework.

4.2  Distribution

We have now distributed over 1,600 pulse oximeters and probes to operating rooms in 48 countries. Please see our 2011 Annual Review (http://www.lifebox.org/wp-content/uploads/Lifebox-annual-review-2011.pdf) for full details of these.

5.     Fundraising & advocacy

5.1  Fundraising

We have been thrilled to see the mission of global oximetry and safe surgery taken up by our colleagues in professional organizations around the world.  During 2011 Lifebox launched campaigns with the American Society of Anesthesiologists, the Canadian Anesthesiologists’ Society, the Australian Society of Anaesthetists and the New Zealand Society of Anaesthesia to raise funds to provide pulse oximeters and training. 

Working with a professional fundraising consultancy, we are now expanding these efforts into a global Make It Zero campaign: A two-year initiative aiming to raise $1.25 million to put 5,000 pulse oximeters into the hands of anaesthesia providers who need them across Africa, Asia, Eastern Europe and Latin America. This campaign is being launched at the 2012 World Congress of Anaesthesiologists.

The BMJ Christmas Appeal 2011 raised over £30,000 for Lifebox.

5.2  Outreach

Our main platform for outreach in 2011 was the American Society of Anesthesiologists’ annual meeting in October. Lifebox had a significant presence at this event, both in the opening session (where our Chair Dr Atul Gawande delivered the keynote), at workshops and in pre-meeting publicity materials. On the exhibition floor we were given donated space alongside the ASA Global Humanitarian Outreach programme. A press release announcing the joint Lifebox/ASA campaign was picked up by more than 100 news outlets worldwide.

During and following the meeting we have received more than $100,000 in donations from ASA members and other attendees. The ASA campaign for Lifebox has inspired local fundraising drives at the University of Florida, Emory School of Medicine, among Boston anaesthesia residents, at Kaiser Permanente Northern California and at a host of state societies such as Alabama, Arizona and Kentucky.

2012 outreach continues with a strong presence at the World Congress of Anaesthesiologists, sharing a booth with the WFSA and telling the Lifebox story at the Harrop Griffith Symposium, presented by three of our trustees.  This is an exciting opportunity for Lifebox to further engage the global anaesthesia community, both in terms of fundraising and identifying collaborators from target countries in need of oximeters and training.

During 2012 we will continue to focus on the professional audiences who most instinctively understand and respond to the aims of our mission. However, we are also in early talks with our pro bono marketing and PR companies to explore what a public campaign for Lifebox would look like.

5.3  Online presence

The Lifebox website (www.lifebox.org) has had 16,238 visitors from over 120 countries in the period covered by this report. Together with our blog site (safersurgery.wordpress.com) launched in July 2011, our Twitter feed (@safersurgery) and our Facebook page (www.facebook.com/lifeboxfoundation), the website has complemented our use of traditional media and raised awareness of our mission with a much wider audience.