By Ilona Hamilton
The leading cause of children’s deaths worldwide is surprising. Pneumonia kills nearly 1 million children under five each year, many of whom are in Africa. Find out how FREO2, a Melbourne based foundation, is supporting remote health centres without reliable electricity to provide oxygen, a life-saving treatment for children with pneumonia or newborns with trouble breathing.
MBARARA, UGANDA – Many Australian parents have felt distressed when their young children have struggled to breathe. Juliet, a Ugandan mother of two, was similarly scared when her six month old boy Francis became sick in May 2018. “I felt sad,” she says, “He had a cough and a fever.”
Juliet took Francis to the Toto (Children’s) Ward at the Mbarara Hospital in south-eastern Uganda. The ward is typically bustling, filled with babies wrapped tightly against their mother’s backs using colourful engozi (sarongs).
The doctors suspected pneumonia or sepsis, also potentially caused by pneumonia. Pneumonia is an infection of the lungs that limits the supply of oxygen to the body’s cells and prevents them from doing their job properly. What this looked like was small Francis lying limp in a bed, almost breathless.
Oxygen, antibiotics, and new vaccines are in the armoury of effective treatments, usually employed successfully for Australians. Yet according to the World Health Organization (WHO), pneumonia is still the leading cause of death for children under five worldwide, most of them in South Asia and Sub-Saharan Africa.
Francis was lucky. He was the first child in the country to be connected to the FREO2 system, an Australian invention that has found a way to store and deliver oxygen, with or without electricity.
When the lights go out, oxygen stops too
Hospitals and rural health centres in Uganda often lack oxygen, listed by the WHO as an essential medicine. “They do not have a stable supply of electricity, which makes it very difficult for them to be able to rely on equipment that requires electricity,” explains Moses Ntaro, the Assistant Director of the Community Education Program at Mbarara University of Science and Technology.
This equipment requiring electricity could be a large onsite oxygen plant, with moving parts prone to fail, or oxygen cylinders that are expensive, logistical nightmares. In the three weeks before Francis received oxygen therapy, a much needed oxygen cylinder delivery had not appeared.
Sheillah Bagayana is the Technical Lead of FREO2 Uganda and a Biomedical Engineer. “I always knew that oxygen was a challenge but I had not experienced how bad it was,” she says, “It was my first week as engineer in charge of the oxygen plant, we had a period where the plant was down. There was nothing we could do. In the morning I noticed the children’s ward was almost empty. When I talked to the nurse in charge she said, yeah your machine is down and most of the children passed on last night. It was a wake up call. That is why I focus my efforts on oxygen.”
Dr Elias Kumbakumba, the busy Head Paediatrician at the Mbarara Hospital speaks of the unmet need for oxygen, “On a daily basis we have an average of 15-20 children who need oxygen in this ward alone,” he says. “Many of them are pre-term newborns but there are others who are critically ill from acute infectious diseases.”
The innovative power of water
Five years before Francis was sick, a group of physicists, engineers, and medical experts in Australia began thinking about access to oxygen. One of the group, Roger Rassool, an Associate Professor of Physics at the University of Melbourne, was shocked, “To know that it [oxygen] is in the air all around us and yet there are children dying from the lack of this medicine.”
This realisation was key to the team flipping the problem from being about getting more electricity. “The oxygen is already there,” points out Jim Black, Honorary Associate Professor at the Nossal Institute for Global Health, “If you look at it with fresh eyes, it [the problem] is how we get the air concentrated into oxygen.”
They eventually landed on the power of water.
The FREO2 LPOS system, developed with Ugandan support, uses a small machine called an oxygen concentrator to remove most nitrogen from the surrounding air, leaving almost pure oxygen. It is then stored in a large bag. When the electricity goes out, gravity fed water from above automatically pushes the oxygen in the bag through pipes to the ward. The height the water travels is carefully calculated to ensure the right pressure for patients.
Three days after receiving oxygen, Francis is sitting up in bed and laughing. Juliet reflected, “I felt happier once he was connected to the oxygen.” When asked about her hopes for his future Juliet says, “I would like Francis to be a teacher, or maybe, a doctor.”