Three years ago, just a few days after joining the GE Foundation, I was asked a simple question during a meeting. "David", my new boss asked, "I am curious. How do we get oxygen supplies in our hospitals here in the United States?" I stammered, turned a bit red, and sheepishly admitted that I had never actually thought about it. "I don't know. I just turn on the spigot on the wall." I have been in medicine for 30 plus years and it never occurred to me to ask.
This embarrassing moment was also a key moment of clarity for me, as I began to realize how much I took that easy access to free-flowing oxygen for granted. Outside of the developed world, oxygen in hospitals is a luxury. Since that moment, I, and my equally passionate colleagues, have been on a mission to eliminate the "oxygen deserts" across much of sub-Saharan Africa and other parts of the developing world. No person should die just because something so truly elemental is unavailable.
As I learned more, though, I found out that in fact, millions of people across the world are adversely affected by a lack of medical oxygen. Globally, over 800 women die each day due to preventable pregnancy-related and childbirth complications. An estimated 2500 children under age five die each day due to pneumonia. An estimated 30 million people are at risk of developing complications due to unsafe anesthesia. All of these conditions and adverse reactions are directly connected to lack of access to medical oxygen.
Indeed, without this vital, yet simple, drug that the WHO has listed as an essential medicine for the past three decades, millions die every year. The oxygen availability gap is colossal: while it is an ubiquitous drug in developed countries, 25% of health facilities in sub-Saharan Africa never have oxygen available, while 32% have an irregular supply. As a result, the use of the available oxygen is restricted to surgeries and a small number of very ill patients. In Kenya, 42% of children prescribed oxygen were unable to get it. According to the Kenya Demographic Health Survey (KDHS) 2014, the Infant Mortality Rate is 39 deaths per thousand while the Under 5 Mortality Rate (U5MR) is 52 deaths per thousand; chest infections are reported as the major contributor to these deaths--an issue that could be solved through a reliable supply of oxygen.
The specific issues that cause the prevalent lack of access are many: first, the distances between hospitals and the source of oxygen can be vast. Oxygen cylinders must be picked up at an oxygen generation plant in a major city and transported hundreds of kilometers. This adds delays and significant cost. Second, local alternatives to O2 cylinders (i.e. O2 concentrators) require a steady power source and are prone to maintenance issues. One in three concentrators recently sampled at Kenyan hospitals were broken or unusable. Third, oxygen is expensive when sold by the tank. In Uganda, oxygen is priced at $40 per cylinder and at $10 per liter in Kenya. This is 13 times the average US price. The cost is driven by the lack of competition and by the high cost of transportation. Finally, health workers require updated training on the benefits of oxygen as well as how, when, and how much oxygen to administer to patients in different scenarios. Given that access to oxygen is so sparse, health workers are not as familiar with its use as they could be.
Three years ago, after my uncomfortable moment, we partnered with UNICEF and Assist International with the aim to scale access to oxygen globally. This partnership led to sustainable solutions leveraging local social entrepreneurs who are now distributing needed quantities of oxygen regionally and saving many lives. The model developed is simple: build an oxygen plant at a district hospital in semi-rural or rural communities and generate enough oxygen to supply the host hospital itself and to fill tanks to distribute to local rural health clinics or dispensaries. Oxygen tanks are now just shipped a few kilometers to rural facilities with charges that are 30% less that the current monopolist suppliers. This enables these clinics access to an essential medicine that they could never afford or would never reach them. These hub-and-spoke programs also assure proper use by deploying experts to train health professionals on the optimal use of oxygen for the best possible patient care. In Kenya and Rwanda, oxygen plants supplied by GE Foundation provide reliable, low-cost medical oxygen to over 40 hospitals.
As this social enterprise model and others show, access to oxygen in the remotest parts of sub-Saharan Africa or anywhere truly can be achieved. As many work hard for better vaccines and new drugs to treat communicable diseases, and others tackle the challenges of global antimicrobial resistance, we simultaneously must insist that an essential medicine - the most basic of human needs - gets equal attention, advocacy and funding. No child should die gasping for breath while waiting for us to deliver the most basic of human physiologic needs. This can be done; this should be done; and it must be done now.