‘As Much As We Can, As Fast As We Can:’ PIH Teams Racing to Boost Oxygen Supplies Amid Global Shortages

When Partners In Health opened a new oxygen plant at a Lesotho hospital in December, with potential uses including support for the pandemic response, tuberculosis patients, and a few targeted health facilities, clinicians almost immediately made a decision: 

Keep it running, non-stop. 

As a devastating second wave of COVID-19 struck the southern Africa nation in January, just weeks after the plant was installed, oxygen production quickly switched from new luxury to urgent, vital necessity. Dr. Melino Ndayizigiye, executive director of PIH in Lesotho, said every hospital in the country has contacted PIH, known locally as Bo-mphato Litsebeletsong Tsa Bophelo, to request medical oxygen. Concentrated, high-purity medical oxygen is vital for patients struggling to breathe normally.

“We decided to operate the plant day and night,” Ndayizigiye said. “However…we couldn’t meet demand.” 

Day-and-night production has continued at the plant, a retrofitted shipping container on the campus of PIH-supported Botsabelo Hospital in Maseru, Lesotho’s capital. The plant produces several hundred liters of concentrated oxygen per day. For comparison, bedside oxygen concentrators—wall-mounted units placed beside hospital beds—can dispense about 10 liters of medical oxygen per minute. While some patients may need just 5 liters per minute, people with severe breathing difficulties can need much more, making even bedside concentrators not optimal for all patients, and making oxygen plants very necessary.

Ndayizigiye said he’s hoping to upgrade to boost production even further and supply oxygen to more health facilities, and ideally, add more oxygen plants in rural parts of mountainous Lesotho.

The situation reflects both the dire global shortages of medical oxygen and the lifesaving race—of supply chain teams, maintenance technicians, clinical staff, and global health leaders—to provide oxygen where it’s needed most. Devastating impacts of shortages are tragically playing out in India and other countries where COVID-19 is surging, outpacing medical capacity and infrastructure, and filling hospitals to overflowing.

“Gasping for air and not being able to breathe have become the norm for impoverished people around the world struggling with COVID-19, and that is unacceptable,” Dr. Joia Mukherjee, PIH’s chief medical officer, said at a recent webinar about strengthening global supplies of medical oxygen. 

Forrest Shroyer, associate director of facilities on PIH’s clinical operations team, said PIH has focused on bedside concentrators, buying and shipping hundreds of them over the past year to supply hospitals and health facilities in Lesotho, Malawi, Peru, Haiti, Liberia, and Sierra Leone. 

“We are working to move as much as we can, as fast as we can to respond to the pandemic, and to use this opportunity to strengthen health systems,” said Jesse Greenspan, PIH’s director of supply chain and logistics. 

Those shipments have faced enormous obstacles during the pandemic. Seyfu Abebe, PIH supply chain manager, said lockdowns and global surges in demand led to limited availability of COVID-19-related goods, especially for poor countries, and resulting high prices. National export bans, shipping woes and decreased flights also have snarled PIH’s supply chain, for everything from gloves and facemasks to oxygen plants and equipment. 

“The global supply chain was broken in so many ways,” Abebe said of the past year. 

Nonetheless, PIH made more than 700 international shipments—including all goods—between March 2020 and March 2021, up from about 400 annual shipments in non-pandemic years.

Oxygen Systems, Not Just Tanks

Country-specific challenges arose, as well. Shroyer said major manufacturers of oxygen concentrators don’t offer products for Peru, for example, because of the country’s electrical specifications. PIH supply teams have had to find other partnerships to support Socios En Salud, as PIH is known in Peru. 

“We were working on advocacy campaigns to try and pressure suppliers to see if they could make some for us,” Shroyer said. “We’ve really tried to push from every angle possible to get these concentrators to Peru.”

Meanwhile, oxygen demand in the country has been skyrocketing. Dr. Leonid Lecca, executive director of Socios En Salud, said in April that Peru’s consumption had reached 200 tons of oxygen—300% of levels before COVID-19—amid the nation’s second wave of the pandemic. 

Socios En Salud has made expanding the availability of medical oxygen a priority during its pandemic response. Lecca said that while “there is still a long road ahead of us to reduce the oxygen gap,” his team also is working on a new program to deliver oxygen directly to homes, to support COVID-19 patients receiving care in isolation.

Other signs of progress are emerging, as well—a PIH-ordered oxygen plant similar to Lesotho’s recently arrived in Malawi, where it’s been installed at a PIH-supported facility in rural Neno District.

And every new oxygen concentrator or plant is a long-term investment in the health system it serves, long beyond COVID-19. PIH buys recommended spare parts for every concentrator, while supporting maintenance and trained technicians around the world to keep the equipment running.

Because medical oxygen, of course, is about far more than COVID-19. Treatment of pneumonia, traumatic injuries and heart problems, for example, all require oxygen, as do safe childbirths and simple surgical procedures.

And because oxygen equipment and supplies must be tailored to their specific health facility, environment, and even climate—humidity in tropical regions, for example, can require additional ventilation and air dryers to maintain oxygen infrastructure—supplying oxygen is about far more than tanks and nozzles; it’s about building strong systems for its use.

Mukherjee noted that oxygen development in rural Liberia was rooted in the Ebola response more than five years ago, and since then, has served the country through outbreaks of measles and Lassa fever, as well. She noted that the key trifecta of saving lives—airway, breathing, and circulation (ABC)—makes oxygen a universal need.

“As we think about strengthening health systems, that ABC is always in our mind,” she said.

It’s in patients’ minds, too. Dr. Shada Rouhani, PIH senior adviser for clinical operations, said patients, of course, are not thinking about global supply chain disruptions or equipment maintenance when they arrive at a health facility. Having oxygen ready in that moment can be the difference between life and death.

“All they can think about it is, ‘I can’t breathe,’” Rouhani said. “For critical illness, time matters, and minutes matter.”