The Infrastructure to Breathe
Medical Oxygen is one of the strongest tools we have to fight COVID-19 and other respiratory illnesses. Yet too often, countries like Peru lack the infrastructure to support it.
As COVID-19 cases continue to climb globally, many countries are facing critical oxygen shortages, resulting in drastic changes to how care is delivered. In recent weeks, Los Angeles County officials advised paramedics to administer the “minimum amount of oxygen necessary” to patients in need. In Nigeria, the air force has been deployed to manufacture an emergency oxygen supply. In Brazil, a local public health researcher told Al Jazeera, “It’s chaos. Seven people died from asphyxiation in Amazonas on Tuesday alone.”
The lack of access to medical oxygen in the face of surging COVID-19 cases is catastrophic for many communities, but the shortcomings in preparedness are sadly not surprising, given the deficiencies in medical oxygen infrastructure that have long been a reality in low-, middle- and high- income countries alike.
Peru, for example, is an upper middle-income country that has experienced rapid economic and developmental growth over the past fifteen years, but it has been one of the hardest hit nations in South America, with more than 1,158,337 million positive cases of COVID-19 and 41,538 deaths to date. Last summer, an exponential increase in COVID-19 cases in the region sparked a surge in the demand for supplemental oxygen to treat those suffering respiratory distress as a result of the virus. The owner of OxiRomero Group, a Peruvian company dedicated to the distribution of oxygen, told the BBC that they were filling about 200 oxygen cylinders a day, “a hundred times more than what we used to do before the pandemic.” On the heels of this unprecedented demand came unprecedented supply shortages.
With hospitals and clinics out of oxygen, private vendors exorbitantly inflated prices for oxygen cylinders and refills: before the pandemic, one cubic meter of oxygen cost around $5.50; now, it’s risen to an average of $14, with some vendors selling oxygen for as much as $175 per cubic meter. One woman, fearing for her son’s life, used Facebook to buy an eight cubic meter cylinder for $1,300. In some cases, existing oxygen infrastructure was broken or inaccessible. One hospital in Tumbes, Peru had an oxygen plant for years, but was unable to use it because an electronic key card was stolen, rendering the plant inoperable and forcing workers to drive five hours to the closest Peruvian plant or import oxygen from Ecuador to supply the hospital. In San Martín, the oxygen plant at Tarapoto Hospital was abandoned in 2018 after it malfunctioned and produced gas with a concentration too low for use. As a result, they, too, began contracting for oxygen and left the plant unused.
This pressure on the Peruvian health sector has highlighted the structural limitations in its health infrastructure, systemic deficits that left communities woefully under-equipped and unprepared to confront the scale of the challenges presented by COVID-19.
Modernizing and expanding oxygen infrastructure in Peru — and similar countries — is critically important, not only in the fight against COVID-19, but to increasing long-term capacity for oxygen therapy in response to a range of deadly diseases. Before the onset of the pandemic, in 2019, pneumonia claimed the lives of 2.5 million people and was the leading global cause of death for children — conditions that could be significantly improved with more equitable oxygen delivery.
That’s where Build Health International (BHI) stepped in. BHI has been working alongside international partners, local officials, and healthcare providers to expand sustainable, high-quality healthcare infrastructure in Peru.
Beginning in October 2020, BHI partnered with Socios en Salud, Partners in Health’s Peru arm, to develop an assessment of oxygen delivery capacity in northern Lima. This includes examining existing oxygen supply and infrastructure, discovering where and from whom the facilities have been sourcing their oxygen, and mapping out cost assessments. BHI has led on consulting on the infrastructure, while SeS has taken charge of the medical components. The final report will give the Peruvian government and other key development actors a more detailed picture of the current oxygen situation in northern Lima, along with recommendations on how to best allocate resources to support operations in the region.
BHI and SeS are also working on plans to conduct the same type of assessment in six other regions all across the country, providing much needed data and specific recommendations tailored to the different contexts and realities of Peru’s diverse healthcare landscape and geography.
An Uncertain Future
The steps that Peru has taken to address oxygen infrastructure challenges since the onset of the pandemic have helped to diminish the gap between oxygen demand and its supply; however, much more work is needed to ensure that its citizens have access to the resources they need during this pandemic and beyond.
BHI’s Director of Engineering, Omar Hernandez, has been deeply involved in BHI’s work in northern Lima and acknowledges that, while oxygen infrastructure has improved, a lot of work still remains. During BHI’s evaluation of oxygen infrastructure in several health facilities in northern Lima, they’ve identified many cases where hospitals have installed oxygen fittings in parts of the hospital that were not designed to be intensive care units. Additionally, in some facilities, oxygen cylinders have been left standing in corridors and in storage without proper safety restraints and some of the cylinders have exceeded their inspection expiration dates. “Our focus has been on survival and getting more sources of oxygen,” says Hernandez, “but there is still work to be done to ensure oxygen access is sustainable in the long term”.
Getting the Work Done
Early in the pandemic, United Nations Secretary-General António Guterres noted that COVID-19 has been likened to an x-ray, “revealing fractures in the fragile skeleton of our societies, and [laying] bare risks we have ignored for decades.” Now, with drastic oxygen shortages spanning from Nigeria to Brazil, Lebanon to Malawi, and Los Angeles to Peru, these fractures have never been so clear.
By laying bare these issues, however, the COVID-19 pandemic has also given us an opportunity to prioritize funding and construction of oxygen infrastructure, actions that must be taken immediately to prevent further loss and health system collapse. And BHI is deeply engaged in advancing these solutions in Peru and around the world: in May, BHI released an open-concept “Ox-Box” design, a cost-effective, rapidly-deployable solution addressing the two biggest barriers to oxygen delivery: cost and unreliable electricity. In December, BHI and Partners in Health worked together to open the first ever oxygen plant in Lesotho. In January, the Tuck School of Business, in partnership with BHI, published a comprehensive business model for sustainable oxygen delivery to supply all of Southern Haiti.
As the global health community looks to end COVID-19 and build greater resilience in the face of other infectious disease, it is imperative that we not only recognize that oxygen access is a key piece to the puzzle, but also take collective and swift action to make quality, robust, and sustainable oxygen infrastructure accessible in every community.
Pedro Castro is Build Health International’s Research and Development Intern, supporting our mission by collecting qualitative and quantitative data and providing our team with study reports and presentations. He is a senior at Dartmouth College pursuing a passion for Neuroscience and Global Health.
