Oxygen demand, poor planning leave corona patients gasping

For the last week, India has hit the headlines with record-breaking infections and deaths.

It’s a country that donated 100,000 doses of coronavirus vaccine to Kenya in March.

The recent spike in deaths has been attributed to acute shortage of oxygen in hospitals in India as with many countries, where dozens of patients are dying due to lack of the essential gas.

A coronavirus patient requires oxygen ventilators because they cannot breathe naturally as the virus attacks the respiratory system.

In Kenya, on April 7, the Kenyatta National Hospital announced the scaling down of surgical procedures as an oxygen shortage hit the hospital.

KNH chief executive Evanson Kamuri said high oxygen-dependent units have faced rising demand.

“Over the last one year, the average consumption of oxygen has sharply risen from 4,000 liters to 8,000 liters per day due to an increase in the number of patients requiring ventilator support and critical care," he said in a statement.

In a press briefing last month, Health CS Mutahi Kagwe admitted to a shortage of oxygen in the country. “We have around 70 oxygen plants in Kenya. Most of these plants are in disrepair and we need to get them working very urgently," he said.

“We are going to standardise the kind of oxygen plants we have because as we speak, we can’t get spare parts for some of the plants that were built years ago, essentially because they came from sources that are suspect.”

PRODUCTION PROCESS

Just how does the oxygen find its way from the air to hospital wards?

The Star visited Hewatele Oxygen Production plant at Mama Lucy Hospital, Nairobi, to find out how the gas is tapped and processed before finding its way to a coronavirus patient’s bed.

From the atmospheric air, the raw material is trapped into an air compressor, where it undergoes compression to get rid of moisture. Then it is channelled to undergo cooling.

The air composition is 78 per cent nitrogen and 21 per cent oxygen, with other smaller gases taking the rest of the percentage.

The dried air is then channeled to a cold tower, where oil and other fractional impurities are removed.

After that, the air is channelled to an air receiver tank and then to the Pressure Swing Absorption unit, where separation of air takes place.

Here, under high pressure, a material called zeolite is used to trap nitrogen gas.

Upon lowering of pressure, nitrogen is released back to the air as waste as freed oxygen is then channelled into an oxygen receiver tank then to a compressor area, where it undergoes further pressurisation.

The plant operator John Obiero says the oxygen undergoes successive compression until a pressure of 2200 PSI is attained. Cylinders are filled at this point.

The filled cylinders are checked for weight using the weighing machine, purity of the gas using the oxygen analyser and pressure using the oxygen gauge.

“We then check for leakages using a soapy solution and seal the cylinders,” John Obiero says.

The cylinders are then taken to a designated area, awaiting collection and distribution to hospitals.

Obiero says how much to be extracted from the air depends on the size of the plant.

The bigger the plant, the bigger the volumes of oxygen it can extract.

The plant has operated for 13 years now.

INCREASED DEMAND

Plant administrator James Njeru said the plant has seen an increased demand for oxygen since the onset of the coronavirus pandemic.

The plant has a partnership with the Nairobi Metropolitan Service to supply oxygen to all government hospitals in Nairobi county.

While the plant supplied 70 cylinders to hospitals before the pandemic, the demand now has doubled to 140.

But the Hewatele plant is only able to produce 100 cylinders in a day.

“We have three shifts and our staff here now have to work day and night to try and meet the demand.”

Here at Mama Lucy Hospital, we used to supply them with 20 cylinders a day before the pandemic. Now they take up to 60,” Njeru says.

He says Mbagathi Hospital used to get 10 cylinders a day.

At another private hospital in Eastleigh, which depends on the plant for supply of oxygen, demand has gone up from 10 per day to 30.

“Kenya has been concentrating on the availability of masks and PPEs, but even if you have the ventilators and beds, the real driving force is oxygen and the government has not been keen on this,” Njeru says.

At MP Shah Hospital, the demand shot up from 20-30 cylinders a day to 100 in a day at the minimum, says head of Biomedical Engineering and Maintenance department Millicent Alooh.

Although the hospital has its own oxygen production plant as its second line of oxygen supply, it had to install a new standby oxygen tank to boost the management of coronavirus patients.

SYSTEMIC FAILURES

But why is the country gasping for oxygen, a free natural resource that’s turned rare and expensive?

Alooh says many plants in government hospitals have failed because the state has failed to employ biomedical engineers to maintain the available oxygen plants.

“You find that one biomedical engineer is running around critical care, ICU, HDU, theatre and that’s a lot of work. So not many hospitals have dedicated staff to monitor these plants,” she said, adding that most biomedical engineers in the country remain unemployed.

She said governments have been slow in purchasing spare parts, service kits and doing regular checks according to manufacturer’s recommendations.

Hospitals can acquire oxygen through the use of cylinders, oxygen tanks and production plants.

But both cylinders and tanks need to be refilled after depletion from production centres and brought to the hospital, making the option a long-time expensive affair.

“Having a production plant at the hospital is the only cheaper option and one that can effectively handle the high demand of oxygen hospitals are facing,” Alooh said.

She is also the current national secretary general of the Association of Medical Engineering of Kenya.

Early this month, Council of Governors Health Committee chairman Anyang’ Nyong’o said 42 out of 58 oxygen plants in the 47 counties are functional, hence the crisis of lack of medical oxygen to meet the increasing demand.

Experts say setting up of oxygen is an expensive affair. Benard Olayo, a Kenyan physician who founded Hewatele, said nevertheless, it is worthwhile in the long run.

“You need around Sh50 million for the plant machinery, Sh10 million for the construction of plant house and a standby generator for Sh5 million,” Olayo said.

Additionally, you need cylinders each going for Sh27,000 and a distribution truck. Most of these are imported from abroad.

He said cumulatively, you would require Sh100 million for one oxygen plant that can serve hospitals in two neighbouring counties.

“If the government invested in 10 such plants, the bulk of oxygen problems would be solved throughout the country,” he said.

Stakeholders have blamed wrong prioritisation in the health sector for the failure to set up oxygen infrastructure.

“We have lost so much money through corruption that would have been used to put up and repair oxygen plants, but now patients have to die or pay millions for oxygen which is freely in the air,” Stephen Auma, a human rights official from Muhuri, said.