Niger diary

We’re working with the Nigerian National Society of Anaesthesiology (NNSA), the Nigerien Ministry of Public Health and the Flatley Foundation to bring safer surgery and anaesthesia to every government hospital in the country. Follow along, with our reports from the front line…


Just me! Faye, Cheik and Svetlana left either last night or early this am. This was due to a change of scheduling of the programme which we had intended to start on Monday but, for a whole variety of reasons, had to be delayed by a day. However I need not have worried. Our local hosts had everything completely under control and, for the last day, we started on time (just ahead). We also had to adjust for Friday prayers, as most people wanted to get to the Mosque shortly after midday.This was the largest day yet with 49 people attending. Again we had many surgeons and great interaction. I just sat back and listened.

One of the challenges for this course was to introduce the logbook in a new way. We want to retrieve them so we can assess the progress of the education and the oximetry so, for 6 months, the participants are asked to complete the information on their first 20 patients each month. After that we will collect the logbooks and review them. Dr Chaibou, our local champion, has a student who will collect them. We also had everyone do the WFSA questionnaire on what their resources are. When tabulated, we should have a good idea of what they have and have not. The results should be very interesting as our participants covered the whole country.

So the Lifebox course is finished. This was the most enthusiastic, receptive group I have ever had. The Ministry of Health was fully committed and supportive as was the Nigerienne Society of Anesthesia and all of the hospital leaders. Where else have we had the Ministry order the hospital Operating Rooms to close down except for emergencies so that everyone could attend the Opening and to slow down so as many as possible could attend the course?

Well done Niger!


Once again an on-time start with the Nigeriens doing the registration work under Faye’s supervision. Everyone was there on time and seated in the room ready to go at 0900. Traffic in Niamey is a challenge and so this is quite an accomplishment. The audience looked like a collection of wonderfully coloured birds with the ladies in their amazing hats. They leave the British ‘fascinators’ way behind. The men are not to be ignored either, as many of them have very colourful gowns, suits and hats as well. Certainly our very ordinary clothes did not measure up.

Today our local teachers stole the show with Ada and Adamou being absolute stars. They presented well. They interacted well. They got everyone involved but stayed in control. Faye and I began to be able to look at how well the new materials worked – mostly very well, I am pleased to say! Changing the programme completely and doing it first in another language was quite a challenge. Doing it in English will be much easier. Overall we are fairly satisfied with it.


We started ahead of time. Unbelievable!  And what’s more, we finished on time. I am so impressed with the local organizers. They made it happen, notwithstanding frequent ‘coupures’ of electricity. In other words, power cuts. if we had no slides, we just used magic whiteboards and continued.

We have someone new to introduce to Lifebox the ‘Bonhomme d’Oxygène’. For those not familiar with the Quebec City ‘Bonhomme de Neige’, he is a rather chubby little snowman with a red hat who welcomes everyone to the Winter Carnival. We are far from snow and winter here but, in trying to convey the important concepts of oxygen transport, Faye devised a little man sliding down the curve when the saturation falls. Svetlana, one of our Burkinabé teachers, did the presentation and coined the phrase the ‘Bonhomme d’Oxygène’. I think it will really help people remember what happens when the saturation falls.

Our local ‘formateurs’ (teachers), got their toes metaphorically wet today teaching in the workshops. They and the participants really enjoyed the interactive form of teaching, and definitely got into it. Cheik did a fabulous presentation on the Checklist, now called the ‘Cheiklist’, and once again we had a grand debate. We were expecting 30 participants but we had about 45, including a whole host of surgeons. They came, not just for the Checklist, but also for the oximetry teaching. Some of them actually took the before and after tests.

Today was the first day for distribution of the oximeters. Faye did a masterful job of organizing them. We have serial numbers, hospitals, contact names, phone numbers and emails for each one. This was a huge amount of work and hopefully it will facilitate useful follow up.


Well I have heard of people, especially kids, having a meltdown – but not computers. Only that is what mine seems to have done. Il est fou, and for the non-French speakers amongst you, that means it has gone mad. And who would wonder with a temperature of 44 degrees C at midnight last night?

I am still out looking for eggs to cook on the car. I think the sun burns through the buildings – as I even feel burned and I was indoors all day.

We launched today! TV and press and everyone else assembled for the presentation of the Lifebox oximeters by the Secretary of the Department of Health (replacing the Minister, who is in Geneva at World Health Assembly – as is Lifebox!)

All the cartons were unloaded onto the ground in front of the building, creating a veritable wall of Lifeboxes. We opened enough to show that that’s what they really were, and presented one to the Secretary and one to the Director. Of course we had to measure their saturations – not that anybody could see the numbers in the blinding sunlight, but I am sure it looked great on TV!

Truly it was an excellent day. We spent the morning with 12 anaesthesiologists who were taking the Teach the Teachers Course. They were an excellent group and very quick to pick up everything. Our two teachers from Burkina Faso, Dr Svetlana Barro and Dr Cheik Bougouma, did really well.

After lunch is when the real fun began. We had at least 12 anaesthesiologists, and I counted 13 surgeons and 1 lone internist for the presentation of the WHO Surgical Safety Checklist. I led off with a formal presentation, which of course included a reference to Lionel Messi.

After that, I handed over to Dr Cheik, who did an outstanding job of running a 2 hour, very lively discussion of the Checklist. I am actually suggesting now that we rename it the Cheiklist! It was a great discussion of the pros and cons and the difficulties of introducing it into their hospitals. Nobody wanted to stop. I suspect there will be a lot of debate about its introduction in the days to come.

The Faculty meeting at which we finished almost finished us. Nevertheless we made plans for the rest of the week with the local teachers and then headed for home. It is still hot but we can see stars tonight.

Jusqu’à demain,



Began with a meeting of the key local organizers and, when I asked to them speak “doucement, lentement et fort”, my French stood up surprisingly well! Faye is assimilating French words at a great rate.

We had an excellent meeting. The Minister of Health has ordered the ORs closed on Tuesday afternoon so surgeons, nurses, directors etc can all attend the training. Dr Cheik is going to run the discussion afterwards and they have asked us to do a scenario so we had better polish up our acting skills and our French dialogue…

This afternoon we explored some of Niamey – important places like the bank, the supermarket and the Grand Marché, which was extremely colourful. I really think one could buy anything there. Impressive were the mangoes and the avocados which are produced locally. We had lunch at a restaurant where the patisseries would rival Paris and the ice cream Rome. We will definitely have to figure out how to get exercise.

On return to the car, I leaped in and quickly out again, much to the great glee of the onlookers who understood perfectly what I did not: that one could literally fry and egg on the leather seats. The outside temperature was 45 degrees or so, but inside must have been much higher. I am temped to buy an egg just to test the hypothesis.

That’s it for now as I am supposed to be working finalizing the presentations.

A toute à l’heure,



Flying over the Sahara in daylight illustrated just how immense it is. What we could not appreciate was how hot – but the moment we stepped off the plane, we knew. We walked straight into a dense wall of heat and dust.

42 degrees centigrade. Unbelievable.

Our old friend and delightful host, Dr Chaibou, was there to meet us with his whole family, including their new baby daughter of four months. Our colleagues from Burkina Faso, Drs Cheik and Svetlana, were to have arrived before us but their flight was very late so they did not get here until evening.