A conversation with Dr. Barigye on oxygen provision and how FREO2 can keep the oxygen flowing.

In the Western Region of Uganda lies the Mbarara Regional Referral Hospital (MRRH), home of some of the best health professionals and educators in the region and referral hospital for the districts of Mbarara, Bushenyi, Ntungamo, Kiruhura, Ibanda, and Isingiro. Despite being located in the second largest city in Uganda, when the FREO2 team arrived at MRRH in 2016, the hospital was grappling with a low supply of an essential medicine: oxygen.

It was here that the FREO2 team were unexpectedly reunited with an alumnus of the University of Melbourne, Dr. Celestine Barigye. Dr. Barigye is the Director of MRRH and was previously the Personal Assistant to the Honorable Minister of Health in Uganda, Dr. Ruhakana Rugunda. Before receiving a scholarship to undertake a Masters in Public Health at the UoM, he practised as a doctor for over a decade, working on the frontlines of Uganda’s health system in emergency care.

FREO2 Uganda intern Cathybert Ainembabazi recently sat down with Dr. Barigye to discuss the oxygen access crises in Uganda, the impact of the COVID-19 pandemic and how FREO2 Foundation can help…

Dr. Barigye, can you tell us about some of the challenges you have observed in oxygen provision in Uganda?

Oxygen provision is one of the biggest challenges in Uganda. When I first arrived here at MRRH, we were only using oxygen cylinders which we had to ration to those patients we thought really needed it. It was so sad because many would go without oxygen because the oxygen cylinders would often run out. Then in 2015 there was a report from a medical ward which showed that many people were dying of single organ failure, due to a lack of oxygen.

In response I enquired with the Ministry of Health, and MRRH became the first hospital in Uganda to get an oxygen plant in 2016. During its installation, a team from Australia called FREO2 came to learn about the oxygen situation at MRRH. I told them about the key challenge with the oxygen plant, it required constant energy supply, so when the national grid turned off, we would lose oxygen which is vital for the survival of many patients.

To my surprise, the FREO2 team said they had come up with a solution! That’s how I learned that FREO2 systems reduce oxygen cylinder use by running off a concentrator while the power is on and when the power shuts out it uses the cylinders, so that the children can survive during a power outage.

In your opinion, why is access to oxygen so essential for pediatric health?

Children are so vulnerable when they are not able to have their lungs functioning. When they are born you really need to support them to help their lungs get acclimated to higher levels of oxygen, so they can breathe. Still in Uganda we have too high rates of neonatal deaths. Many children die before the age of 28 days. For many of these babies it is because they have an infection in the chest and they need medical oxygen treatment which is hard to find.

According to the Ministry of Health, pneumonia accounts for 10% of deaths in children under 5 in Uganda, with at least 25 Ugandan children losing their lives to pneumonia every day. How have you personally seen pneumonia impact the lives of Ugandans?

Pneumonia used to be so bad here in Uganda, but over the years we have had some interventions including vaccines and better access to oxygen. Measles also was causing pneumonia-like symptoms which required oxygen, and vaccines have reduced this burden. Other illnesses that can cause a patient to be immunocompromised like HIV or malnourishment have also improved over the years.

Critical care generally has not been a big priority because generally public health focuses on prevention efforts like vaccination. I think for us COVID was a wake up call – what do we do for illnesses that cannot be prevented? We need better human resources, infrastructure and treatment. Slowly at MRRH we hope to be there soon.

How has the COVID-19 pandemic impacted your work at MRRH?

The pandemic has impacted us both positively and negatively. Positively we are more at work, therefore the doctors have been really focused on improving care and seeing patient needs holistically. We have also improved our resources to include rapid diagnostic tests and PCR, and of course the new investment in oxygen has been really positive. Negatively, of course the impact on our economy and the loss of so many lives. We have lost two doctors at MRRH, one resident and one specialist. Since the pandemic started, we have lost about 256 lives which is still much less than I’ve seen in other countries and regions.

As you know, FREO2 works to improve access to oxygen at the under-resourced periphery of health services to keep the oxygen flowing, even when the power goes out. What has been the impact of having FREO2 systems in MRRH?

FREO2 systems are currently installed in our pediatric wards at MRRH and the impact is great! We have had lots of survival. The real benefit of FREO2 systems is that golden time when the electricity goes off and the system continues the flow of oxygen, to me that is the most important. I really think the impact has been so great that I can see FREO2 systems installed in every ICU bed at MRRH, which would significantly reduce mortality.

What is your dream for the future of MRRH and what role does oxygen play in this future?

The dream is to create centres of excellence. We have 24 specialised areas across our centres and our big dream is to handle critical care. We’d like to become the national referral hospital. Oxygen is so important to this dream, if we can have more FREO2 systems to bridge that gap when the power goes out. To sustain life at MRRH, we need to be prepared for these emergencies. FREO2 can continue to help us raise the bar for survival rates, because every life matters.