Dr. Angela Enright, champion of surgical safety, is our 2019 Teasdale-Corti recipient
B.C. anesthesiologist Angela Enright, OC, MBBCh, FRCPC, has earned accolades from far and wide for her efforts to make anesthesia accessible and safe in low-income nations. She is “arguably the most outstanding living figure in the pantheon of Canadian anesthesiologists who have made an impact on global health,” says Douglas DuVal, MD, FRCPC, past president of the Canadian Anesthesiologists’ Society (CAS).
For her commitment and success in improving surgical safety around the world, Dr. Enright is this year’s recipient of the Royal College Teasdale-Corti Humanitarian Award.
Halting Rwanda’s brain drain with novel training program
For years, Dr. Enright has provided training and education programs for anesthesiologists and non-physician providers around the world through the CAS’s International Education Foundation. This work eventually led her to Rwanda, where the government had heard about the foundation’s earlier success in Nepal.
Rwanda had been sending physicians to France and Belgium for training in Anesthesiology but many of them didn’t come back — or returned only briefly. The country needed a solution at home where, at the time, there was only one anesthesiologist for nine million people.
“So I went in 2004 to see what we could do,” says Dr. Enright. “We set up a program with university and government, similar to what we did in Nepal.”
The program, which continues today, sees volunteer anesthesiologists go to Rwanda to teach for a minimum of a month at a time. It’s a success story that brought the number of anesthesiologists working in Rwanda today to 18, with many residents in training.
Meanwhile, Dr. Enright has helped CAS expand its outreach to other low-income nations, including Burkina-Faso.
Dr. Enright (centre) with Dr. Cheik Bougouma and Dr. Bertille Ki, young stars of Anesthesia in Burkina-Faso.
WHO Surgical Safety Checklist
In 2008, Dr. Enright was part of a group of surgeons and anesthesiologists that collaborated with the World Health Organization (WHO) to implement the Surgical Safety Checklist.
“The real focus of the checklist is in communication,” she says. “Communication between surgeons, anesthesiologists, nurses — the whole team — because good communication leads to not making errors.”
And she was right. Evaluation of the checklist showed a marked reduction in mortality and morbidity in both high-income and low-income countries. But something was still missing.
Enter the low-cost pulse oximeter.
A pulse oximeter developed by Lifebox Foundation.
Making oximeters accessible with the LifeBox Foundation
An oximeter is a small clip that measures the amount of oxygen in a patient’s blood. It sounds a beep, starting at a soprano tone and lowering to deep bass as a patient’s oxygen level drops. The device came to Canada and other countries around 1980, but the CA $1,500/unit cost meant that almost 80,000 operating rooms in the world did not have access to this technology in 2008, when the WHO Surgical Safety Checklist was debuted.
Dr. Enright was president of the World Federation of Societies of Anaesthesiologists at the time. The organization partnered with the Association of Anaesthetists of Great Britain and Ireland, as well as Brigham & Women’s Hospital and Harvard University, to “develop a low-cost, highly functional, resilient pulse oximeter that could be used in low-income countries.”
This initial effort was successful but the group soon realized that a foundation was needed to keep the work going. “That’s why we formed the LifeBox Foundation,” says Dr. Enright, who thanks the CAS for their generous support amid ongoing challenges of funding this work. “We’ve now delivered more than 20,000 oximeters to over 100 countries and trained people on how to use them.”
Dr. Enright with participants from the Pulse Oximetry course in Burkina-Faso.
Getting global attention and measuring action
Even though more people die from surgical problems than from HIV, AIDS and tuberculosis combined, it is often very hard to get funding to support solutions.
When The Lancet launched its Commission on Global Surgery in 2014 to draw global attention to the need to improve surgical outcomes, it presented an opportunity to reignite the WHO’s focus on surgery and Anesthesiology.
“After years of trying, finally surgery, anesthesiology and obstetrics got together and really forced the WHO to accept that these fields were essential parts of universal health care and had to be included. That was a landmark decision,” says Dr. Enright.
Getting funding also means getting data.
Unlike maternal and neonatal mortality rates which are tracked by country, “no one collects mortality rates from surgery,” says Dr. Enright. “We need to do that because you can’t fix something you can’t measure.”
She expects that putting systems in place to bring mortality rates down will cost in the billions of dollars. “But the cost of not doing it is in the trillions,” she says.
“I’ve always had the philosophy that there’s always money; it’s just a case of where you want to spend it.”
Originally from Dublin, Ireland, Dr. Enright trained in Anesthesiology in Calgary, Alta., and practised in Saskatoon, Sask., and Victoria, B.C., until her retirement from clinical practice in 2015.
