In his first interview after recovering from coronavirus disease (Covid-19), UK Prime Minister Boris Johnson remembered gasping for air when his life hung in the balance.
“I was going through litres and litres of oxygen,” he told The Sun on May 3. “It was hard to believe that in just a few days my health had deteriorated to this extent.”
Johnson recounted that when “the bloody indicators kept in the wrong direction”, he realised there was no cure for the fast-spreading Covid-19 discovered in China six months ago.
If a highly developed healthcare system struggled to treat its leader, what about Malawi’s overwhelmed health facilities grappling with massive staff vacancies, low funding and a high disease burden?
Johnson’s difficult moment highlights the importance of medical oxygen in the fight against Covid-related deaths.
Dr Samson Mndolo, director of Queen Elizabeth Central Hospital (QECH) in Blantyre, describes oxygen as the only proven lifesaver for severe Covid-19 patients.
He said: “Oxygen treats almost every critical patient, even those who have lost blood in an accident or during childbirth. It is also used for people with all sorts of infections. Oxygen is what keeps the body alive.”
The Southern Region’s largest referral hospital uses oxygen worth K25 million to K30 million a month, according to Mndolo. This takes between K360 million and K400 million yearly from the healthcare budget.
However, in May, just a month after Malawi confirmed the first of its 1224 coronavirus cases, the hospital’s oxygen bill shot to K40 million a month to fill more oxygen cylinders in readiness for the spiking pandemic.
“Even minus Covid-19, oxygen worth K30 million a month wasn’t enough mainly for our intensive care unit and the theatres, the biggest consumers of oxygen. For the wards, we used to supplement with concentrators,” said Mndolo.
But now, the hospital can use the oxygen budget for other essential medical services as it has its oxygen plant which will generate a million litres per day to over 100 patients in need of the lifesaver.
The extra oxygen will be filled in gas cylinders to be supplied to other district hospitals in the Southern Region such as Thyolo and Chiradzulu.
The plant, installed by the Malawi-Liverpool Wellcome Trust (MLW) using a £2.1 million (almost K2.1 billion) grant from the London-based Wellcome Trust, was commissioned two weeks ago.
MLW deputy director Professor Henry Mwandumba calls it a “phenomenal investment” that will benefit the country’s constrained health system beyond the coronavirus pandemic that has claimed 14 lives in Malawi.
The contribution from the clinical research institution comes at a time the country is recording over 100 cases a day, mostly returnees from South Africa.
Mwandumba explained: “We realise that we have to invest in cost-effective opportunities. Of course, there are so many drugs being trialled, but none of those is proven to be beneficial.
“So we decided that if we are going to invest, we should [invest] in something that will save lives.”
The plant comprises cylinders which trap air from the atmosphere and purifies it into oxygen for medical use.
“The purified oxygen is now suitable for patients admitted to different wards. It will be transferred to them through pipework that has been installed,” said Mwandumba.
The system also replenishes 80 cylinders to be used in places without direct oxygen supply, including the outpatient department as well as Thyolo and Chiradzulu district hospitals.
For Mndolo, the oxygen plant could not have come at a better time than now.
The hospital that once treated mild coronavirus cases, who were mostly self-isolating at home, now admits patients with severe conditions requiring oxygen.
He said: “In the last 72 hours [from June 19], we have admitted two patients who are getting oxygen. One is at our hospital’s special ward for healthcare workers diagnosed with coronavirus and the other patient is at Blantyre Emergency Treatment Unit located at Kameza.
“Health workers requiring oxygen are being put within the hospital’s premises because they are at greater risk.”
The oxygen plant is also handy for conditions requiring surgery, survivors of road accidents and pregnant women undergoing Caesarean section.
Mndolo stated: “When Covid just came, the thinking was that we should have a separate theatre for patients requiring surgery, but what if it stays with us for the next five to 10 years or we have other scenarios of Covid patients needing surgery?
“Since we might still have Covid-19 cases coming to QECH with other illnesses, we are redesigning our facilities to incorporate a theatre where they will be assisted.”
Dr Charles Mwansambo, chief of health services in the Ministry of Health, said plans are underway to establish similar oxygen plants at Mzuzu, Zomba and Kamuzu central hospitals.
He says: “Frontline healthcare workers are doing a lot to save people’s lives in this outbreak. We are doing whatever possible to complement their efforts.
“MLW has done a commendable job and we want to emulate its gesture. Currently, work is in progress in Lilongwe and then we will move to the other hospitals.”