Pandemic and the political economy of oxygen supply

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Too little, too late

When the Covid-19 Interministerial Crisis Management Center (CCMC) finally reacted, it was too late. Its system of arbitrary quotas for each hospital has proved disastrous.

“The quota resulted in under-supplying hard-hit hospitals and safer hospitals unnecessarily saturated with bottles,” says Roop Jyoti, former president of Grande City Hospital, suggesting that the problems lay in managing the supply chain instead. than in the production of oxygen.

Faced with mounting criticism for messing up oxygen quotas, the health ministry resorted to micromanaging and ordered providers to only send filled cylinders to hospitals that had their letter of recommendation.

The result was catastrophic, with many hospitals either being forced to refuse service or having patients’ families bring their own full bottles.

In a notice published in mid-May, Om Hospital in Kathmandu said: “Under the government’s cap on oxygen supply, we cannot accept admissions despite our willingness to provide services. . We have enough manpower, like doctors and nurses, to take care of the patients, but not enough oxygen. ‘

Families with Covid-19 patients piled up full bottles at home, and the desperate rushed to the gates of oxygen factories to buy the life-saving gas. Municipalities, especially in areas with spare capacity, have prevented the transport of oxygen across district borders.

Most of Nepal’s oxygen factories are located in central and eastern Nepal. The Morang-Sunsari industrial corridor alone had five large oxygen factories with excess capacity, but these were unable to send supplies to hospitals in Kathmandu and other areas in short supply.

The lack of training in oxygen flow management and ventilator use didn’t help matters. Makeshift local isolation centers with non-medical staff were using the full flow to treat patients with mild symptoms. Hoarding and black marketing were rampant, and while large hospitals ran out of oxygen, local isolation centers had one bottle per patient.

At the Grand Hôpital International, there was a 30% drop in oxygen demand as doctors were more judicious in the use of oxygen. Yet the shortage was severe enough that some doctors were rationing oxygen for even their most severe patients. Others had to make the difficult choice between continuing to put oxygen on patients who had little chance of survival, or giving it to those who would immediately recover on oxygen.

Even before the pandemic, government oversight on cylinders was non-existent with no standardization or regulations in place regarding color coding, pressure, tariffs and deposits on oxygen cylinders.

“I used to get desperate calls at 3 a.m. from families of patients who were in desperate need of oxygen. We were able to draw on spare capacity during the second wave, especially in the east of the country, but the shortage of cylinders for filling created a temporary shortage, ”explains Gaurav Sharda of the Nepal Oxygen Industries Association (NOIA ).

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