Lifebox in Central America

Our work in Central America began in 2011, with large-scale oximetry distributions and training workshops across the region. In 2018, with the support of the IZUMI Foundation, and in coordination with the anesthesia societies of El Salvador, Guatemala, Honduras and Nicaragua, Lifebox launched two new programs, delivered twenty workshops, and trained over 1,000 healthcare providers across Central America

Launched in 2018 with support from the IZUMI Foundation, Lifebox and partners implemented an ambitious two-year project across El Salvador, Guatemala, Honduras, and Nicaragua to improve the safety of surgery and anesthesia for the 39.7 million population.

The beautiful landscape, stretching across the arc of land that separates the Pacific Ocean from the Caribbean Sea, can mask the widespread poverty and challenges of providing adequate healthcare in this region. Half of the populations of Guatemala and Honduras live below the poverty line and all four countries are towards the bottom third of the Human Development Index (between 124 and 132 out of 189).

In terms of healthcare, Guatemala has only 1.9 anesthesia providers per 100,000, El Salvador 2.71, Honduras 2.23, and Nicaragua 4.11. This compares to over 20 anesthesia providers per 100,000 in Europe and the United States. What these numbers mean on the ground are hundreds of thousands of Central Americans lacking access to safe surgical treatment, with patients facing significantly higher risks compared to those in North America or Europe. Surgical teams in these countries must work at maximum capacity under the most challenging conditions, often lacking the resources they need to deliver the care they want.

The project worked across Lifebox’s three pillars of safer surgery – Promoting Teamwork, Improving Anesthesia Safety and Reducing Surgical Infection. To deliver the project, we worked alongside the national anesthesia society of each country – long-term partners since large-scale oximetry distributions in 2011. Using a “Training-of-Trainers” approach, we developed a regional faculty to lead on two new workstreams – Checklist Implementation Strategies and Safer Surgical Instruments and distribute Lifebox pulse oximeters.

Lifebox developed the Safer Surgical Instruments workshop in partnership with the Canadian non-governmental organization Sterile Processing Education Charitable Trust (SPECT). Working with partners in Honduras, Lifebox and SPECT created a locally adapted workshop that teaches the fundamentals of reprocessing surgical instruments. Lifebox is incredibly proud to work alongside the nurses and technicians that work to reprocess instruments. This cadre of the workforce has few, if any, training opportunities and yet surgery cannot be safe without clean and sterile instruments.

More than 175 providers across the four countries were trained through ten Lifebox Safer Surgical Instruments workshops. Evaluations across all Instrument workshops saw a knowledge increase of 34.7%, with 80.7% of participants feeling confident to teach a Safer Surgical Instruments workshop.

Drawing upon global expertise on implementation of the WHO Surgical Safety Checklist, Lifebox developed a Checklist Implementation Strategies workshop to bring together all members of the surgical team – nurses, anesthetists, surgeons – for training for the first time. We know that the Checklist is proven to reduce complications and mortality by nearly 40%. Although the Checklist is a simple tool – a 19-step list of basic safety checks – hospitals and surgical teams all over the world struggle to use it correctly. Through a facilitated and iterative process, participants develop strategies to troubleshoot the main barriers to effective Checklist use. More than 231 participants were trained through ten workshops across the region. Evaluations of participants across all Checklist workshops saw an increase in knowledge of 33.9% with 81.4% of all participants feeling confident to teach the workshop.

We would like to thank our local partners of AGARTD, AMAES, ANARE and SHARD, for their incredible work over the last two years and for IZUMI’s continued support to improve the safety of surgery and anesthesia across Central America.

Lifebox will continue its work in the region with SAFE OR and Clean Cut Programs to improve surgical teamwork and lower surgical site infection rates. SAFE OR is a highly interactive multidisciplinary course, co-developed by Lifebox and five partners, to improve surgical teamwork. Clean Cut is a three to six month facility based intervention designed to help hospitals strengthen perioperative infection prevention practices.