On Feb. 5, minutes after she gave birth to her eighth child at the Hanaano General Hospital in Dusamareb, Somalia, 37-year-old Zahra's* heart sank. Her doctor explained her baby had birth asphyxia, which meant she was having difficulties in breathing. She had an oxygen rate of less than 40 per cent, compared with the required levels of 90 per cent or above.
"I cried and was worried when I saw my child very ill," said Zahra. "I believed she would die."
Immediately, the baby was admitted to the maternity ward, where doctors rushed to offer her medical oxygen using one of the three solar-powered oxygen machines that had just been installed at the hospital.
"Now I am very happy—I saw the situation of my child improving and saw her receive oxygen for 24 hours a day, as needed. I am really grateful to the hospital team and the World Health Organization," said Zahra.
Mohamed Abdi, the hospital director at Hanaano General Hospital, couldn't hide his gratitude toward the supporting partners. Zahra's baby was special to him because she was the first person to use the solar-powered oxygen, which more than doubled Zahra's baby's oxygen saturation levels to 94 per cent.
"I was responsible for laying the first brick in the Hanaano Hospital," said Abdi. "Since then, this is the first time I have seen how one timely investment can save lives. Last year, sadly, more than 180 patients died in the hospital due to the lack of oxygen. Many of them were children. This system will save many lives."
A global intervention with Canadian roots
The life-saving intervention is a collaboration between the World Health Organization (WHO), Grand Challenges Canada (GCC)—a Canadian not-for-profit organization, primarily funded by the Government of Canada, that invests in innovations to address critical global health, humanitarian and Indigenous community challenges in Canada and low-resource countries—and a team led by Michael Hawkes, associate professor in the Department of Pediatrics at the University of Alberta.
Hawkes and his team first conceived of the idea of solar-powered oxygen in 2013 as a way to help prevent the 900,000 pneumonia deaths that occur in children around the world each year— mainly in Africa and Asia. Childhood pneumonia is the leading cause of death in children under five in the world today, with most deaths occurring in low- and middle-income countries. Oxygen is essential therapy for childhood pneumonia but is not always available in lower-income or remote settings globally. The COVID-19 pandemic has also dramatically increased the worldwide demand for oxygen, for adults as well as children.
Traditionally, clinicians in such settings rely on purchased, one-time-use compressed oxygen cylinders or oxygen concentrators that can be plugged into an outlet but need consistent power. In his work, Hawkes found neither could consistently be relied on, with dire consequences.
"We were running into this problem in Uganda treating patients who were dependent on oxygen and the power went out, and we would see them die within minutes," said Hawkes, who is also a member of the Women and Children's Health Research Institute and a Stollery Science Lab Distinguished Researcher. "These areas often have two or three electricity outages per week that can last an hour or two at a time. It's frequent. So we came up with solar-powered oxygen as a solution to fill that gap in oxygen therapy."
By 2016, Hawkes' team (in collaboration with Global Health Uganda) had set up its first solar-powered oxygen systems at two hospitals in Uganda for testing. After first verifying they were consistently reliable and as safe and effective as conventional methods of providing oxygen, the team has since been rapidly expanding the project to 20 hospital sites in Uganda. With the success of the efforts in Uganda and the additional challenges brought on by the COVID-19 pandemic, WHO worked with Hawkes and Grand Challenges Canada to pilot the project in Somalia.
"When the first laboratory-confirmed case of COVID-19 was reported in March 2020 in Somalia and the outbreak was raging across the country, none of the public sector hospitals in Somalia had medical oxygen available," said Mamunur Malik, WHO representative for Somalia. "Driven by the dire need for pure, high-grade medical oxygen, we realized we had to act fast to save lives—and we did it with the support of our partners."
Saving lives through freely available resources
According to Hawkes, each system costs about US$12,000 to set up, including locally procured solar panels, batteries and oxygen concentrators, along with the training needed to properly use and monitor them.
The systems are designed to capture enough solar energy during the daytime to last through the night, and some cloudy days as well. According to Hawkes, solar power is consistently reliable, and any gaps in availability due to cloudy days have proven to be insignificant compared with the problems with grid power in lower-income and remote settings internationally.
Since first testing the system in Uganda, data over the past several years show the solar-powered oxygen system is saving lives, Hawkes noted. Before the system was implemented, about 5.5 per cent of children admitted to hospital would die. After it was implemented, mortality rates dropped to 3.2 per cent—a 35 per cent drop.
"Saving lives by using freely available resources such as the sun and air is ingenious," said Grand Challenges Canada's co-chief executive officer Karlee Silver, noting that GCC has been a supporter of the project from the start, enabling Hawkes' team to scale up the project in Uganda and connecting it to WHO in Somalia. According to Silver, GCC grants for the work were provided using funds from the Government of Canada, most recently through Global Affairs Canada.
"We take it for granted, but oxygen is an essential medicine used to care for patients at all levels of the health-care system," added Silver. "COVID-19 has made the delivery of oxygen even more urgent. We know how important this work is and are excited to be part of this global partnership that is having a tangible impact."
Adapting the system for local needs
Hanaano General Hospital's solar-powered oxygen system was installed in January. Team members who had worked on the previous project in Uganda travelled to the area to provide training and support.
Three portable concentrators were set up in the hospital, with four possible locations for their use—the pediatrics ward, operating theatre, emergency department and maternity ward. According to Hawkes, initially he had trepidation about setting up the system for use in the operating theatre.
"I'll be honest with you—as a pediatrician, I was kind of hemming and hawing about that. But of course, you want to listen to the local asks," he said. "So we did what they asked, and of course, they know what they're talking about. Next thing you know, conflict broke out in the region and they were using it in the operating theatre for wounded soldiers."
Since the three solar-powered oxygen stations were installed, between Feb. 8 and March 30, 45 patients with different medical conditions received medical oxygen from the stations. Among them, 30 were children (13 with pneumonia and 17 with birth asphyxia) and 15 were adults (six with gunshot wounds, one with heart failure, two with stroke and six with acute respiratory disease due to COVID-19). Overall, 42 of those 45 patients survived.
