Very soon, Monggar Regional Referral Hospital (MRRH) will not have to bring in about 110 D-type filled oxygen cylinders on a weekly basis all the way from Phuentsholing. Nor will Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) need to bring around 200 D-type cylinders every two to three days, from the border town. And the reason behind this is the establishment of oxygen plants in the two hospitals.
In what is a giant lap and move for the first time, the Ministry of Health (MoH) has taken the bold and essential step, which would ensure reliable supply of medical oxygen for the two major hospitals in Bhutan. While the construction of a shed for the Pressure Swing Adsorption (PSA) generator plants has been successfully completed at MRRH, the shed for the JDWNRH is expected to be completed by the end of May, 2023.
Despite the government’s efforts to produce oxygen in Pasakha, Chhukha, there was still a high demand for oxygen in the referral hospitals, especially JDWNRH and MRRH. To overcome this issue, the government has taken the step in establishing its own oxygen plant units in these two hospitals.
Before, Bhutan used to import oxygen mainly from India.
According to the health minister, Lyonpo Dechen Wangmo, once the construction is complete, the installation of the equipment will be carried out by experts, scheduled for mid-June at MRRH, followed by JDWNRH.
“The shed for the JDWNRH is expected to be completed by the end of May 2023,” Lyonpo said.
Lyonpo also added that according to the project timeline, the fully functional PSA generator plants are anticipated to be operational by mid-July at both MRRH and JDWNRH, allowing for a reliable and uninterrupted supply of medical oxygen to meet the hospitals’ high demand.
“Currently, MRRH receives approximately 110 D-type filled oxygen cylinders on a weekly basis from Phuentsholing, while JDWNRH requires around 200 D-type cylinders every two to three days,” Lyonpo said, adding that by installing these oxygen plants, the hospitals aim to reduce costs and improve efficiency by refilling empty cylinders during periods of low demand and supplying to neighboring hospitals.
This move is a first of its kind in the country and is expected to benefit critical patients who rely heavily on oxygen. Lyonpo shared that the decision to construct the plants was driven by the hospitals’ high oxygen consumption and the logistical challenges associated with transporting oxygen cylinders from distant manufacturers.
However, the project faces challenges due to the limited local capacity for equipment installation, maintenance, and repair. As a result, the procurement and installation of the plants had to be tendered at an international level.
To address routine maintenance and repair needs, the current supplier will train the biomedical staff at both hospitals. Additionally, the WHO Country Office Bhutan has implemented a three-year annual maintenance contract (AMC) for the plants.
“The installation of oxygen generator plants at JDWNRH and MRRH serves as a pilot project, with valuable lessons expected to inform future installations at other major hospitals with high oxygen consumption,” the health minister said.
Additionally, World Health Organization (WHO) has played a significant role in supporting this initiative by providing funding for the procurement and installation of the necessary equipment.
“The costs associated with the procurement, installation, and training for JDWNRH is USD 408,919 (Nu 33mn) and MRRH is USD 339,765 (Nu 27mn).” Lyonpo said, adding that, the World Bank has also contributed to the project by funding the construction of the sheds.
“The costs incurred for constructing the sheds in JDWNRH is Nu 2.8 mn and MRRH is Nu 5.3 mn.
While discussing the significance of establishing PSA generator plants, Lyonpo emphasized the importance of these oxygen plants in ensuring uninterrupted health services for the people of Bhutan, given the vital need for medical oxygen gas.
As Bhutan strives to improve healthcare infrastructure and ensure the availability of critical resources, the successful implementation of these oxygen generator plants marks a significant step forward in safeguarding the health and well-being of the population.
According to the WHO, oxygen is a life-saving essential medicine with no substitution. Healthcare professionals use oxygen to treat respiratory illnesses like COVID-19 and pneumonia. Oxygen is also essential for surgery and trauma. Vulnerable groups like the elderly, pregnant women and newborns need oxygen therapy in regular basis.
Despite being an essential medicine, oxygen is a complex product. It needs to be produce by a medical device or Industrial plant. Oxygen also requires a whole system to safely reach patients.
Due to their complexity, access to oxygen meets many challenges on: availability, quality, affordability, management, supply, human resources capacity and safety.
Low levels of oxygen in the body tissues leads to Hypoxia. It causes symptoms like confusion, restlessness, difficulty breathing, rapid heart rate, and bluish skin. Many chronic heart and lung conditions can put one at risk for hypoxia, which can be life-threatening.
Meanwhile, the world witnessed and felt the importance of oxygen during the fight against Covid 19, India and many other countries faced a growing crisis of severe oxygen shortages which led to hundreds of people dying. A doctor in Somalia’s semi-autonomous region of Puntland told the BBC in June 2021 that between five and 10 of his Covid patients were dying because of a lack of oxygen almost every day, which would all have been prevented if there was adequate oxygen.
On May 3, 2021, Al Jazeera reported that 12 corona virus patients died at New Delhi’s Batra Hospital after it ran out of medical oxygen. Among the dead was head of the gastroenterology unit at the same hospital. Al Jazeera reported that the private hospital in southern Delhi was among several in the Indian capital and across India to sound an alarm over a crippling oxygen shortage as they struggle to cope with patients pouring in, needing ventilators and ICU beds.
Tshering Pelden from Thimphu