Of Uganda’s knotty oxygen therapy infrastructure: Let’s fix our mess
Sometime in June this year, I found myself visiting -on the same day- four major hospitals in East Central Uganda or call it Busoga Sub-region. As I went about my work, I noticed two similar developments at two of the four hospitals. They were referring an unusual number of patients – a good number of them children – in critical condition to the regional referral hospital in Jinja. Reason? No Oxygen!
At one of the hospitals, I learned that a scheduled 12 hour power outage in the district by power distributors Umeme was to blame for the crisis. The Oxygen Concentrators which use electricity could not be powered. Yet the only two gas cylinders which had oxygen were in the labour suite and theatre. The hospital could not afford running a generator all day. The money for fuel had depleted.
About 60 to 90 kilometres (depending on which route one uses) away at the other hospital, all but one of their ten Oxygen Concentrators were down. Yet all their six Oxygen cylinders had been taken by the National Medical Stores for refilling and they would not be back until after 7 to 10 days.
For starters, an oxygen concentrator (also sometimes called “oxygen generator”) is a medical device used to deliver oxygen to those who require it. People may require it if they have a condition that causes or results in low levels of oxygen in their blood. The other source at many Ugandan hospitals are cylinders filled with this life saving gas.
Given that most of the referrals I witnessed at the two hospitals involved children under five, I will restrict myself within that context. According to the World Health Organisation, Hypoxaemia (insufficient oxygen in the blood) is the major fatal complication of conditions such as pneumonia and for babies with a difficult delivery at birth, increasing the risk for death many times. Globally, it is estimated that at least 13.3% of children with pneumonia have hypoxaemia, corresponding to 1.9 million cases of hypoxaemic pneumonia each year. Pneumonia is a leading killer of children in Uganda and Africa.
We also know that in the first hour after delivery, normal newborn infants have lower normal oxygen saturation. Similarly, we know that it may take an hour or more for oxygen saturation to reach levels above 90%. The normal level for a newborn in the first hours of life is typically 88% or more, and most newborn babies are able to adjust to normal by themselves, but a few need oxygen therapy.
With oxygen therapy remaining an inaccessible luxury for a large number of severely ill children admitted to hospitals in developing countries, the Uganda Government should be commended for buying Oxygen Concentrators for a number hospitals in the recent past. When working, these machines have seen many children’s lives saved.
However, in buying these electricity dependent concentrators, a solution to the intermittent power supply to hospitals should have been sought at the same time. Without solving this easily solvable problem (pun intended) of electricity supply, the beautiful concentrators will always remain white elephants standing in the way between life and death for many innocent children. I have severally witnessed many trainings of health workers happening but I wonder whether such resources are not merely going to waste. What’s the training for when conditions are not being met for hypoxaemic children to receive appropriate, uninterrupted oxygen therapy for as long as is necessary to save their lives, as recommended by the WHO? May be we should buy more Oxygen cylinders instead because they do not require electricity to function.
At the second hospital where nine concentrators are non-functional probably in need of easy fixes, I was told that they do not have access to biomedical engineers and technicians. As I prepared to leave The Daily Monitor in 2009, one of my last articles highlighted the non-availability of biomedical engineers in Uganda and how hospital stores and Ministry of Health regional workshops were fast turning into museums for medical equipment. A few months later Kyambogo University started a program in Biomedical Engineering. Makerere University followed. The pioneer cohorts of these programmes finished but many remain on the streets, unemployed.
To this, I say that with a little tweak in our priorities, these solvable problem can be fixed in our hospitals. And many preventable deaths would be avoided!
*The author, Kakaire Ayub Kirunda, is communication for development specialist working at Makerere University School of Public Health.