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Statement Oxgen Supply Somalia Dear Ladies and Gentleman, the Emergency Medical Association of Somalia is a non-profit and non-governmental institution, seeking to improve emergency healthcare in Somalia. It works under the umbrella of the East African Emergency Medicine Association and is supporting public education on emergency preparedness and help for acute emergencies, the improvement of a valuable EMS system in Somalia and the development of in hospital emergency care for all citizens of Somalia. We offer an internationally backed „Think Tank“ on emergency medicine and preparedness. Here for we bring together the experiences and visions of Somali healthcare professionals with the knowledge and foresight of internationally recognized experts. Statement on „Improving access to Oxygen in Somalia“ Exploring sustainable solutions and partnership to address oxygen shortages during Covid-19 and beyond SITUATION ANALYSIS The Somali health care system is chronically underfunded and is lacking material resources and sufficient staffing. The healthcare system of Somalia was once one of the best in Africa but has systematically been destroyed during civil war and political instability for decades. In recent years there has been some improvement on the situation for emergency healthcare, but never the less this development hasn’t been sustainable in wide parts. The access to sufficient emergency healthcare for Somali citizens can widely depend on their residential area and there financial resources. Especially in bigger cities there have been many hospitals opened in recent years. These hospital often are more run as a business than as public healthcare providers. The access to public healthcare facilities may also be limited if you don’t live in an urban center but in the rural countryside. 1, 2, 3 Urban Centers Many bigger cities in Somalia such as Baidoa, Kismaayo or of course Mogadishu are offering governmental run healthcare facilities of different size. Many of them are chronically underfunded and under-equipped. Basic emergency healthcare services are offered but often specialized treatment is not available due to shortages in material, equipment or staff. Hospitals in Somalia are actually never fit by the state of science and technology to treat infectious patients sufficiently. The access to emergency healthcare at hospitals is usually easier in urban centers because public transport is available and in some areas even ambulance services with various qualities are in place. Version 1.0 - 06.03.2021 Page 1 of 9 © Emergency Medical Association of Somali Rural Settings Especially in rural areas public healthcare facilities face even bigger obstacles to deliver sufficient and state of the art emergency healthcare to potential patients. The difficulties are mainly the same as described above, but are complicated by power shortages, general lack of access to electricity and clean water and the complete absence of specialized structures to treat critical ill or injured patients. 2 Public Health Care Facilities Public facilities are as described above mainly underfunded and often insufficient in the way of emergency treatment they can offer. Shortages of drugs and medical supplies are common and the access to state of the art medical equipment is limited. If machines break down they often can’t be repaired. Staff at public healthcare facilities often faces long periods of being not payed sufficiently due to public money shortages or mismanagement. Further more there is no sufficient training program for emergency care nursing or emergency physicians in place in Somalia right now. 3 Private Health Care Facilities Privately run hospitals and healthcare facilities are bringing the problem of accessibility due to financial resources of big parts of the Somali population. Further more in many cases the quality of healthcare provided there is only slightly better than in public facilities. There are positive tendencies in the improvement of care in some facilities but there are still many „black sheep“ in the herd of hospitals that need to be addressed. Generally the level of equipment, machinery and medical supplies is significantly higher in private health care facilities in Somalia. There is a better access to specialized treatments and interventions and the overall benefit for emergency patients is higher. Still there are big steps to go even in the private sector. Sufficient and well running emergency departments are widely not available and the intensive care treatment for serious ill or injured patients is simply in its children shoes at the moment. Reasons for that can be identified by the financial obstacles associated with the implementation of ICU facilities and the lack of staff resources with relevant background in the country. OXYGEN SITUATION The access and supply of medical oxygen has been a problem for an extended period of time now in Somalia. Hospitals and health care facilities in general have been facing oxygen shortages and accessibility problems for years. These problems have widely not improved over the last years. 4 Oxygen is supplied by bed-side oxygen tanks in most Somali healthcare facilities. This means that small or big oxygen cylinders (usually 10l size) are unsecured placed at the hospital bed or the place of treatment to support the patient with the insufflation of medical oxygen. This modus of operation begs several risks and difficulties. 6 Version 1.0 - 06.03.2021 Page 2 of 9 © Emergency Medical Association of Somali • Oxygen cylinders are not fitted with pressure alarms, if the cylinder runs empty this can be unnoticed and the patient can suffer oxygen shortages • Oxygen cylinders are widely used unsecured, if a full oxygen cylinder falls and the valve breaks it can cause severe injury or damage by flying around cylinders • A oxygen cylinder can only be used at one patient at a time. Often the access to necessary pressure reducers is limited, so even if there are enough oxygen cylinders at the facility this can be a limiting factor • Oxygen cylinders often don’t fit to ventilators or other oxygen relying medical machines Further more we have noticed over the years that the offered oxygen filled in cylinders does often not meet the medical requirements and is of bad quality at some times. Often cylinders are also not filled with the recommended pressures so that the amount of oxygen that can be delivered is limited. In some facilities home care oxygen concentrators are used in Somalia. These machines have usually been designed for the home care treatment of patients with chronically lung disease. They can offer oxygen flow rates between 1 and max. 6 liters/minute and need a continuous 220V electrical power supply to be operated. Home care oxygen concentrators with rechargeable batteries are not available on the market. So that the continuous supply of electric energy is a valuable size in the use of this devices. Generally the use of oxygen concentrators can bring benefits to Somali healthcare facilities. But there are also some relevant limitations that need to be addressed: • Oxygen will be only available as long electricity is available • Low oxygen flow rates, max. 6 liter/minute • Low pressure oxygen outlet, not useable for most respirators and other medical machinery • Only one patient can be treated with a concentrator at a time The access to repair of broken down oxygen concentrators in Somalia is limited. Often the machines can only be repaired abroad. Some healthcare facilities operate gas manifolding systems also known as „piped oxygen“. This system distributes oxygen from a central facility and cylinder storage room to patient beds. The benefit of a system like described above is that oxygen gets available at more patient beds, without the risk of oxygen cylinders at each patient bed. A further benefit is that medical devices like ventilators can be connected to the system. 7 RECENT DEVELOPMENTS The WHO has started improving access to oxygen for rural hospitals in Somalia. Just recently on the 29th March 2021 there was an official hand-over ceremony for solar power driven oxygen support for Galmudug. The Hanano hospital in Dhusamareb has been fitted with a solar power plant and home care oxygen concentrators to improve the access to oxygen treatments for patients there. 5 Version 1.0 - 06.03.2021 Page 3 of 9 © Emergency Medical Association of Somali Bigger hospitals in Mogadishu such as the Recep Tayip Erdogan Hospital (former Digfer) and the former Deva hospital have stationary full scale oxygen concentrators in place that are able to directly supply oxygen to the gas manifolding system. These concentrators are highly efficient and can be also used to fill oxygen into tanks or cylinders for further use. TREATMENT OF COVID-19 PATIENTS WITH MEDICAL OXYGEN Since over one year we are facing now a serious pandemic situation with the SARS CoV-2 Virus and the resulting COVID-19 Pandemic all over the world. Vaccination is one step to the reduce of infections and has shown more moderate or mild courses of illness. Never the less the treatment of patients with medical oxygen remains a central point in the fight against Covid in severe and critical cases. Mild cases: usually no treatment needed, symptoms like a normal cold or flue Moderate cases: usually no treatment needed, sometime reduce of oxygen saturation but no requirement for immediate oxygen treatment Severe Cases: immediate Oxygen treatment is necessary. Often in combination with nebulizer inhalation therapy, physical therapy, usual flow rates between 6-10 liter/minute. Covid-19 causes severe oxygenation problems by the infestation of lung structures.. Critical cases: Immediate high-flow oxygen therapy is necessary, usual flow rates between 10-15 liter/minute. mechanical ventilation and breathing support are necessary. Non invasive ventilation is necessary. Chart 1: Need for Oxygen treatment in Covid-19 due to severity of illness As you can see by this chart the treatment with oxygen is highly necessary and needs to be urgently addressed to safe lives.
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