Westminster City Council have advised that the pump may be reinstated in around six months’ time, and we are hopeful that it will be replaced near the pub. As shown in the photograph, an image of the pump is currently displayed on the pub hoarding whilst the real pump is stowed safely in a crate.
Watch this space near the John Snow pub; an image of the pump is due to appear on nearby hoarding while we await the return of the statue of Snow’s pump which was removed in January during construction work
The 23rd annual Pumphandle Lecture was given on the 8th of October 2015 by Dr Atul Gawande, Professor of Surgery and of Public Health at Harvard, well known author (eg The Checklist Manifesto and Being Mortal), and Executive Director of Ariadne Labs, a joint centre for health systems innovation, as well as Chairman of Lifebox, a UK-based nonprofit devoted to making surgery safer globally.
Dr Gawande began by referring to Snow’s work on cholera, and the subsequent evolution of the complex health care systems of today.
He highlighted the effectiveness of a simple checklist approach in three key areas – surgery, maternal and childcare, and primary healthcare – emphasising that a checklist is not a protocol, but a list of the most common things that experts miss, and which should be tailored for particular activities and institutions.
Drawing from experience in the airline industry, the checklist approach was adapted by Dr Gawande’s team and recently introduced, first in surgical practice. The explicit checking of a list of just 19 items, in theatre, has led to important reductions in surgical mortality in many countries. He emphasised the necessity of monitoring the system through setting targets, continued contact and data feedback.
In the case of maternal and child health, he emphasised the importance of identifying a set of ”minimum required guidelines” and the collection of data to identify what is missing in the real world. He described studies in areas of India where one in 20 newborns die in utero or soon after birth. Critical analysis led to agreement on a series of actions before admission, during birth, after birth and when the mother was being discharged. Improved results were not from additional skills training or supplies but the use of a 30-item checklist at different stages.
In assessing primary healthcare, it is common to consider four S categories: staff; stuff; structure and systems. However, users typically ask about four C’s: contact (is there a place to go that is open); continuity (do staff recall medical histories); coordination (is information transmitted to add to wider public health discussion) and comprehensiveness (can a primary healthcare institution take care of the majority of medical needs). To address these concerns, Dr Gawande and colleagues have recently launched the primary healthcare performance initiative, which has been approved by the UN General Assembly, in order to identify which is the simplest system to follow to close the gap between aspiration and achievement.
All these are examples of innovative ways by which to remove crucial pumphandles confronting public health.
The vote of thanks was proposed by Professor Dilys Morgan, using a checklist, and Dr Gawande was invited to remove the handle of the pump to close the lecture. Society members then adjourned to the John Snow pub in Soho for the Annual General Meeting of the society.
Money raised for repairs to the John Snow memorial. The need for repairs to the memorial by Dr. Snow’s grave was noted in Broadsheet 2014.
The original memorial was damaged during WWII and was replaced by the Association of Anaesthetists for Great Britain and Ireland (AAGBI) and the History of Anaesthesia Society, but over the years since then the lettering has become eroded, particularly at the base.
The photo shows the John Snow memorial in Brompton Cemetery, taken in 2013
Thanks to the generosity of members who contributed at the last AGM, the Society has been able to make a donation of £200 to the AAGBI towards the cost of repairs and further maintenance – and we hope soon to be able to report that repairs are underway.
The Brompton Cemetery in West London forms part of the Royal Parks and may be visited, with tours available on Sundays.
Several events have marked the bicentenary of John Snow’s birth (March 15 1813), including a day-long meeting in York, Snow’s birthplace, and a special session of the American Epidemiological Society. The biggest celebrations were held in London: two international meetings on the Legacy of John Snow and an art exhibition on disease mapping, all at the London School of Hygiene and Tropical Medicine, sponsored by the John Snow Society (as well as the Wellcome Trust, The Bill and Melinda Gates Foundation, the International Epidemiological Association, the UK Arts Council, the History Centre of the LSHTM, and LSHTM), and supported by RSPH. The programme helps navigate the many exciting events and eminent speakers.