Kenya battles oxygen crisis as demand grows

Breathing is one of those activities that majority of people take for granted, yet a couple of minutes without air – oxygen, to be more specific – will inevitably lead to the loss of life.

The deaths caused by the coronavirus disease, where patients suddenly could not get adequate oxygen in their lungs and had to rely on ventilators, helped to highlight the importance of medical oxygen.

But even before the Covid-19 pandemic, many Kenyans with underlying medical conditions owe their lives to oxygen therapy.

Take Ado Abdi, who suffered kidney failure a year ago, for example. She is regularly accompanied by her daughter, Asha Mohammud, from their home in Kabachia estate to the Rift Valley Provincial General Hospital for a four-hour dialysis session.

The mother and daughter then have to wait for Ado’s 11-litre portable oxygen cylinder to be refilled.

“My mother has been using 30 litres of oxygen weekly for the past one year. An oxygen refill is necessary to save her life,” says Asha. “Failure to have the oxygen causes shortness of breath and she could easily die.”

Ado has a 60-litre oxygen cylinder at home, and only uses the portable one when she is travelling. The medical oxygen is in great demand and the family has to book in advance to get their supply.

It costs Sh500 to refill the 11-litre cylinder and Sh2,500 for the bigger tank.

“We must have standby oxygen. We cannot risk my mother’s life,” says Asha, adding that in case of an emergency, the nearby medical facilities are closed at night.

Then there is the case of 83-year-old Benson Waciira who suffered from pancreatic and prostate cancer and is said to have died from a lack of oxygen.

His daughter Carolyne Wandia said he was reviewed by a doctor at home on April 2. The medic diagnosed that Waciira had shortness of breath.

Oxygen concentrators

“At the time, there was a shortage of oxygen concentrators and the few that were available were too expensive. Prices had shot up from around Sh30,000 to Sh120,000 while the cost of hiring one was between Sh25,000 and Sh30,000 up from Sh10,000.”

Wandia said they hired an ambulance that took nearly one hour to arrive. “We needed a vehicle with oxygen to take him to the hospital, but we waited for too long.”

By the time he arrived at Coptic Hospital, Waciira was gasping for breath. He died the next day.

It was, however, not the first time Waciira had required oxygen. Wandia said any time he suffered breathing difficulties, they would reach out to medical suppliers for oxygen. “Perhaps if my father had oxygen on time, he would have survived. He was in a lot of pain.”

Home oxygen therapy can help with many conditions such as asthma, chronic bronchitis, pneumonia, lung cancer and sleep apnea.

Children who contract sudden bouts of acute pneumonia also need oxygen. The disease ends up killing one in five children due to lack of oxygen in local health centres.

The shortage extends to public hospitals, where it is not uncommon to see several infants hooked up to one oxygen cylinder.

The coronavirus pandemic has seen a surge in the demand for oxygen in isolation centres, where patients with dangerously low blood-oxygen concentration struggle to breathe through damaged lungs.

In the last few weeks all available oxygen in counties has mostly been directed to the intensive care units, thus creating a shortage in other hospital units.

A patient with an underlying terminal illness uses at least 60 litres of oxygen daily. There are four sources of medical oxygen: oxygen concentrators, refillable cylinders, liquid oxygen generators and oxygen plants.

The Rift Valley Provincial General Hospital set up an oxygen plant in 2017, which produces nearly 1,800 litres of oxygen for the ICU and 10 surgical theatres.

“The maternity wing and 18 wards get piped oxygen to avoid wastage and inefficiency,” said Joseph Mburu, who is in charge of the plant. “The outpatient and emergency units have standby oxygen cylinders”.

The plant, which is one of the 70 in Kenya, is the main supplier of oxygen in Rift Valley and parts of central Kenya.

Makueni County also has a facility that produces 4,000 litres of oxygen daily. The oxygen is distributed to local hospitals, and the surplus sold to neighbouring counties.

Kanini Muthama suffers from asthma and has been going to Makueni County Referral Hospital for check-ups for the last three years.

“The oxygen eases my breathing after attending my clinics and I can stay for two to three months with the asthma under control,” she said.

Samson Kamau, a biomedical engineering technologist at the hospital, said the plant was bought for Sh15 million and its annual maintenance cost is Sh1.9 million.

Makueni Health Chief Officer Patrick Musyoki said the operational costs were low compared to what they used to spend in the past to buy oxygen.

“The hospital used 96 cylinders of oxygen at Sh400,000 daily, with monthly costs running up to Sh11.5 million. Patients would sometimes be referred to other hospitals due to lack of portable oxygen.”

In neighbouring Machakos County, the oxygen plant cost Sh20 million and it helped bring down costs from Sh1 million to Sh200,000 every month.

Machakos Level 5 Hospital Medical Superintendent Paul Nyamweya said they were still forced to buy oxygen because the plant only produces about eight litres a minute against a demand for 500 litres.