SEATTLE — People are familiar with shortages of gasoline, food and water, but few people correlate the word shortage with oxygen, especially in hospitals. In the U.S. and Europe, hospitals manufacture oxygen on-site, but less than half of the hospitals in Africa have access to a reliable source of medical-grade oxygen. A shortage of oxygen in Africa threatens the lives of millions suffering from life-threatening diseases and injuries.
Oxygen is essential to treat critically ill patients, trauma, obstetric complications, heart failure and pneumonia. Mwemezi Kaino, head of anesthesia and intensive care at Kilimanjaro Christian Medical Center says, “when lungs become diseased – like in patients with pneumonia – they lack the capacity to function optimally in normal air, which is roughly 21 percent oxygen. So we must be able to provide air with higher concentration and monitor its saturation in the blood.”
The shortage of oxygen in Africa is due in part to the fact that it is not listed as a standalone treatment on the WHO’s Essential Medicines List – it is listed for use during anesthesia. The WHO Essential Medicines List guides donors, hospitals and government in decisions regarding safe, effective and affordable medicines. The list also guides production and distribution.
Poor countries depend on oxygen-generating plants to supply them with oxygen cylinders. Sadly, there are very few of these plants, and they are far from the rural hospitals that need their service. The small number and the distance from rural hospitals create additional challenges, including costs for the cylinders, oxygen, transportation, accessories, training, maintenance and inspection. Many hospitals must ration the oxygen they have using it only surgery and acute medical cases.
Zithulele Hospital, in Oliver Tambo District in South Africa’s Eastern Cape province, an isolated and poor part of South Africa, was recently renovated. It also has a full staff of health care workers that are leaders in rural medicine. None of this prevents them from being affected by the shortages that affect poorer hospitals. According to doctor Liz Gatley, hospitals and clinics deal with shortages of basic medical supplies, “We’ve run out of surgical gloves. We’ve run out of oxygen many times… Sometimes it means people die.”
Shortages led Kenyan medical practitioners to strike on December 5, 2016, closing the countries public medical facilities. When asked what prompted the strike they described shortages of oxygen, recycling single-use gloves and working extended hours to ensure patients received treatment.
One solution to the shortage of oxygen in Africa can be found in an enterprise called Hewa Tele (Kiswahili for “abundant air”). Bernard Olayo, the entrepreneur responsible for creating Hewa Tele, had this to say: “We found a way of reducing costs by creating a local plant in Western Kenya, timing distribution to nearby hospitals based on projected oxygen consumption and sticking to efficient, routine delivery routes. We also offer customers training, maintenance packages and accessories, such as face masks, pulse oximeters and manifolds (piping devices that allow oxygen to be distributed throughout a hospital.” Hewa Tele serves health facilities with a catchment area of six million people and is expected to double in size this year.
Lifebox, founded by Atul Gawande, offers healthcare facilities another solution to the shortage of oxygen in Africa. Lifebox developed a low-cost pulse oximeter. Pulse oximeters are tools that clip onto patients finger and help monitor oxygen levels during surgery and other procedures. An alarm sounds if oxygen levels fall below normal levels. They have distributed more than 14,000 in 100 countries. They also provided training to ensure health care workers use the tool more effectively. Hypoxemia or low blood-oxygen level can occur at any time and can be fatal. For that reason, healthcare providers need access to oxygen throughout the hospital as well as the ability to monitor oxygen levels.
Gradian Health Systems also offers health care workers another solution to the shortage of oxygen in Africa. The Universal Anesthesia Machine (UAM) functions indefinitely without power or oxygen. The integrated oxygen concentrator allows the UAM to generate its own oxygen and provides connectors for a cylinder, pipeline and portable oxygen. When no external source of oxygen is available, the UAM draws in oxygen from the room.
PATH is working with the WHO to find a resolution to the shortage of oxygen in Africa by changing the way oxygen is listed on the EML. They are also working with donors, governments and policymakers in low-middle income countries to increase awareness. Oxygen must be recognized as an independent treatment for hypoxemia and accessible throughout hospitals and health care facilities.
– Mary Barringer