By Goodluck Musinguzi
Eight years ago Mulago National Referral Hospital used to spend SHS 800 million buying oxygen per year until it installed its own 4 plants, with COVID19 pandemic the same hospital will have spent shs 10 billion on oxygen if they had not added new 4 plants.
Thank God that Ministry of Health had a 5 year National Scale Up of Medical Oxygen Implementing plan 2018-2022, aiming to increase availability and utilization of oxygen in higher level facilities.
Covid19 patients at Mulago hospital consume between 5 -40 liters of oxygen per minute. Those in critical condition are supported by 2000 liters of medical oxygen to live for another day.
Oxygen is a simple(essential) treatment that saves lives of every covid19 patient that has reached critical stage. Each patient has an Oxygen flow meter placed in the wall to tap medical oxygen. It supplies up to 15 liters of Oxygen per minute.
When a patient goes beyond 15 liters, a cylinder is fitted with other Oxygen flow meter to supplement the first one. Should the levels of the second Oxygen flow meter go passed 15 liters, a third cylinder is fixed to supply 60 liters per minute.
Such patients have their lungs affected by the virus spread by COVID19 pandemic.
Dr Diana Atwine, Permanent Secretary says Covid19 positive patients who reach hospital late have their lungs spoilt which means they will need much more oxygen to supplement their breathing.
Ministry of Health announced that Uganda had reached stage 4 of the viral disease. Community infections that are almost impossible to trace which puts the country at risk. 206 people have been recorded in Hospitals to have died of Covid19.
Dr Diana Atwine says the demand of medical oxygen has increased after Community infections rose beyond tracing. The newly installed 4 Oxygen plants have capacity to produce 2,999,520 liters per day.
Each Referral Hospital has a medical oxygen plant making it 14 plus other 3 added to Entebbe, Mbarara and Kayunga hospitals. Until 2012, there was no oxygen plan in Uganda. Government was buying from Nairobi or private companies in the country.
“The biggest challenge is ever increasing numbers that require oxygen .Let us observe sops to preserve life .Mulago is inelastic”, said Dr Diana Atwine.
The plants procured produces 3m liters of 100% oxygen per day .They are the best plant that can fill over 400 cylinders, each costing Ushs. 42,000 saving around Ugshs 17m. The output from all the 7 plants is worth over Shs 10bn per year. Isn’t that a good health investment for Uganda?
Mulago managers have since reported that besides the new plant producing over two million litres of oxygen daily, the hospital has three other oxygen units that distribute it to where it is required, at “optimal amounts and purity levels”.
“The newly installed four plants at the hospital makes it the largest in the country. It can generate 2,083 litres of oxygen per minute. In 24 hours, the plant can generate 2,999,520 litres of oxygen, which in normal circumstances can serve 900 patients. The four are part of the seven plants procured to meet the oxygen needs in the country,” Mulago’s executive director Dr Baterana Byarugaba said.
Mulago insists that besides the new oxygen plant, they also have an old plant that has capacity to produce 50 cubic metres of oxygen per hour that is now being used to reﬁ ll mobile oxygen cylinders.
High number of admissions
Byarugaba said Mulago has registered cumulative admission of 2,456 patients, with a total discharge of 2,137 and the current admission stands at 160, of these 95 severe cases in HDU, ﬁ ve in ICU and 60 in the general ward. The total fatalities currently stand at 150.
The cumulative admission into HDU and ICU is 605. Byarugaba said almost all patients are referred to the facility from other hospitals in critical condition, some arriving from ICUs of other hospitals with late stages of the disease.
“Most of the patients are referred when in critical condition with multi-organ failure,” he added.
The commissioner health services infrastructure, Eng. George Otim, said whereas the new plant directly supplies patients in need of oxygen while on their beds, the supply of the old plant has now been directed to reﬁlling mobile cylinders for the hospital and other public health facilities across the country.
“Previously, we have been depending on the old plant. This plant was enough for the hospital before, but with the outbreak of coronavirus, the plant had become incapacitated but works on the new one were expedited,” he said.
Otim said a patient takes 100 litres of oxygen per day. The plant is able to supply the required amount of oxygen in the ICU, heart institute, and other places. The oxygen is delivered to the user wards through pipes with its purity ranging between 93% and 100%.
Regional centres get plants
Dr Charles Olaro, the director clinical services, clariﬁed that all regional referral hospitals have a 15 millimetre cubic plant that generate 40 to 50 cylinders of oxygen per day.
He explained that Mbarara Hospital has two plants while Entebbe Hospital will have its plant installed by the end of the week. He, however, said the plant in Masaka Hospital has a broken cooling chamber and is under repair.
“All the regional referral hospitals have functioning oxygen plants and are meeting the oxygen needs,” he said.
Olaro said Yumbe and Kayunga hospitals will also be getting plant since it is a ministry policy for all upgraded regional hospitals have oxygen plants.
According to recent assessment by the health ministry, 3% of COVID-19 patients develop hypoxemia which means that they need oxygen.
Ninety-three percent of patients with hypoxemia have been managed with oxygen therapy and 16 % of them have been referred to Mulago Hospital.
Olaro said the National Medical Stores supplies oxygen to the rest of other health facilities across the country adding that it is not only COVID-19 patients who may need Oxygen.