Nikili V Rochill
Kohima
It is a horrifying nightmare to behold. Across India, even in the most developed of States, a shortage of medical oxygen in hospitals continues to claim the lives of people who would have otherwise survived. Contrary to what people think, oxygen and medical oxygen are not the same. So what is medical oxygen, and why are hospitals running short on it? What does this mean for Nagaland?
The air that we normally breathe in comprises of a mixture of various gases namely, 21% of oxygen, 78% nitrogen, and small amounts of other gases. This air is processed in Oxygen manufacturing plants to produce oxygen of different grades for industrial and medical use. Medical grade oxygen used in Indian hospitals, comprises of minimum 90% oxygen with 5% nitrogen and 5% argon. On April 12, 2021 the Central Health Ministry stated that the medical oxygen consumed was 3842 MT per day. In India 7287 metric tonnes (MT) of liquid oxygen is produced per day, of which 2500 MT is used for industrial purposes. This means that there is only 4600 MT remaining for medical use.
So why is there a national shortage?
Firstly, the number of active cases in India has almost doubled from 12,64,000 on April 12, to 21,57,000 on April 21. This means that the daily requirement of oxygen can be conservatively estimated to have increased to more than 6000 MT/day, while supply remains fixed at 4600 MT. There are currently 384 active cases in Nagaland, as of April 23.
Secondly, in the second wave there are more hospitalized Covid patients reporting shortness of breath, and requiring supplemental oxygen during treatment as compared to the first wave from 2020.
Thirdly, transport of Medical Oxygen to different parts of India poses a huge problem. Liquid Oxygen is transported in cryogenic tankers, and there simply aren’t enough in India as almost all hospitals face a shortage. Additionally bad roads, make many areas inaccessible or extremely expensive (as prices increase to cover vehicle repair costs). In Nagaland itself, it is reported that one trip to remote towns in Eastern Nagaland with a tanker carrying around 60,000 liters of medical oxygen cylinders costs an astonishing Rs. 80,000 due to the condition of the bad roads. This means that there are hospitals which cannot restock on medical oxygen due to financial constraints. Repairing the roads and improving connectivity among cities would resolve this issue.
Fourthly, there is a lack of awareness amongst local hospitals on the amount of oxygen consumed per patient. According to Dr Kamna Kakkar, senior resident, Department of Pulmonary and Critical Care Medicine at PGIMS Rohtak, a single patient on high flow nasal cannula (HFNC) uses over 86,000 litres of oxygen per day. To give an example, District hospitals in Nagaland are said to roughly have a storage of 100,000 litres of medical oxygen on average. Moderate cases require 6000-7000 litres a day, however, a single emergency could wipe out hospital reserves within 3-4 days.
Fifthly, there is improper storage of medical oxygen. Currently, there are three types of types of storage of medical oxygen in hospitals - Oxygen Cylinders, Liquid Oxygen, and Oxygen Concentrators. Oxygen Cylinders are often used in small towns as they are readily available. Many cylinders (often Type J Cylinders with a capacity of 6800 litres) are often stored together and rigged to a pipeline to supply oxygen. Liquid Oxygen is stored in Vacuum Insulated Evaporators which can hold large amounts of liquid oxygen. It is often used in large hospitals. Oxygen Concentrators are electrically operated medical devices which purify raw air to produce medical oxygen. It is highly useful for hospitals which face issues transporting cylinders, and suitable for many hospitals in Nagaland. Eg., It is used in African countries where road access is difficult. A setback of oxygen concentrators is that its maximum flow output may be insufficient in high oxygen consumption instances.
The main source of medical oxygen is called the primary supply of the hospital. However, most hospitals do not have a secondary supply, located at a separate location, in case there is a failure of the primary supply or an accident. Additionally, most hospitals do not have an alarm system in place to detect leaks and mishaps. A single leak can cost lives, as seen in the Nashik tragedy where 22 people died due to oxygen shortage caused by a leak. Lastly, hospital staff must be trained to handle instances of failure of primary supply, and a switch over to the secondary supply. These are requisites, which hospitals in Nagaland desperately need to implement.
In conclusion, I’d like to add that it was recently reported that the Nagaland State Government plans to complete constructing Oxygen Plants in 11 District hospitals by May. This is an emergency measure that must be completed efficiently and adequately at the earliest to save the lives of our people before we are faced with more fatalities.
