How two charities hope to provide sick kids with life-saving oxygen

It was 2008 and Dr. Hamish Graham was volunteering for Doctors Without Borders in the Darfur region of Sudan to provide health care for about 30,000 people displaced by the country’s bloody civil war.

A 2-year-old girl arrived with a severe case of pneumonia — barely conscious, breathing hard and fast, and clearly in desperate need of oxygen.

But the clinic where Graham was stationed, in the small town of Nertiti, surrounded by the Jebel Marra volcanic mountains, was too remote to be supplied with tanks of the life-sustaining gas and there was only one small, portable oxygen concentrator on hand.

The girl was treated with oxygen and antibiotics but she kept getting sicker over the next several days, recalled Graham, who at the time was just three years out of medical school at Australia’s Monash University in Melbourne.

Meanwhile, other children arrived who also needed oxygen and a fatal decision had to be made.

“Unfortunately, deaths were not uncommon, and the demands from newly admitted patients were always priority,” Graham said.

The tragic incident — and others like it — had a profound effect on Graham, now 39 and a pediatrician and research fellow at Melbourne’s acclaimed Murdoch Children’s Research Institute.

The nonprofit institute was co-founded by the late Dame Elisabeth Murdoch,  the philanthropic mother of Rupert Murdoch, the founder and executive chairman of News Corp and chairman of The Post.

“My experiences in Darfur were the first time I was faced with the inability to provide basic health services to sick patients, and the first time I really felt what millions of health care workers feel every day – frustration, unfairness and often demotivation,” Graham said.

Fast forward to 2014 and Graham was working on an MCRI project, backed by nearly $6 million from the Bill & Melinda Gates Foundation, to increase the availability of medical oxygen at 12 hospitals in Nigeria and 38 in Papua New Guinea.

The funding paid for around 150 oxygen concentrators, which use minerals known as zeolites to remove nitrogen from the air through a process known as adsorption.

The money also bought about the same number of pulse oximeters, hand-held devices that measure the amount of oxygen in a patient’s blood by passing a beam of light through a fingertip or other extremity, as well as solar-power generators to run all the high-tech gear.

Around the same time, Jason Houdek was working as a senior technical adviser for the Clinton Foundation’s Clinton Health Access Initiative and was also focused on increasing access to medical oxygen in Africa.

One of his defining moments came in 2015, when he walked into a pediatric ward in a hospital in Kano, Nigeria.

“In the ward, a handful of oxygen cylinders and broken oxygen concentrators were scattered amid bed after bed of sick children struggling to breathe,” he said.

“And then the math slowly dawns on you: there’s one cylinder for every ten kids when really it should be something like one for every three or four, just judging by how many have clear difficulty breathing.”

CHAI’s efforts helped the government of Kajiado County, Kenya, centralize oxygen purchasing for about 100 health care centers in the increasingly urban region south of the capital Nairobi.

By negotiating a long-term deal with BOC Gas, a major producer, the per-unit price dropped about 70 percent and dozens of facilities suddenly had a reliable source of medical oxygen, Houdek said.

Now, Graham and Houdek hope to scale up their previous work to dramatically expand the availability of oxygen for the treatment of sick children in Nigeria, Kenya, Ethiopia, Uganda and India.

Graham and Houdek are the MCRI’s clinical lead and CHAI’s program manager, respectively, on a joint application for a $100 million grant from the charitable MacArthur Foundation, famed for its annual “genius grants.”

Their proposal is one of six finalists in the foundation’s second “100&Change” competition, which generated more than 750 applications to fund a single program that offers the promise of “real and measurable progress in solving a critical problem of our time.”

The first contest was won in 2017 by Sesame Workshop and the International Rescue Committee, based on their plan to educate and alleviate the “toxic stress” inflicted on children displaced throughout the Middle East by the decade-long Syrian civil war.

The current competition began in February 2019 and was narrowed to the top 100 proposals a year later.

It’s expected to conclude with the announcement of a winner in early April.

The other finalists include the National Geographic Society’s “Pristine Seas” program; a plan by Report for America to put 2,500 local reporters in more than 750 US newsrooms; and the World Mosquito Project’s proposal to use a naturally occurring bacteria to reduce the spread of dengue, Zika and other viruses by killing the insects that transmit them.

Although the MacArthur Foundation relied on nearly 300 outside experts to evaluate and rank the initial proposals, the finalists were chosen by its 11-member board, which will also select the winner.

It’s led by foundation president John Palfrey, former head of school at the prestigious Phillips Academy Andover in Massachusetts, and includes Harvard Law School professor and former dean Martha Minow, venture capital investor Paul Klingenstein and James Manyika, a senior partner at the McKinsey & Co. consulting firm and chairman of the McKinsey Global Institute.

The history of medical oxygen dates to 1771, when a German-Swedish pharmaceutical chemist, Carl Wilhelm Scheele, heated mercuric acid, silver carbonate, magnesium nitrate and other nitrate salts to produce what he initially called “fire air” due to its extreme flammability.

Cylinders to store oxygen for use during general anesthesia were developed in 1868 and the demonstrated ability of the gas to save lives was first recorded on March 6, 1885, at Pennsylvania’s York Hospital, where Dr. George Holtzapple used it to successfully treat a 16-year-old pneumonia patient, Frederick Gable.

Low blood oxygen, called “hypoxemia,” is a life-threatening ailment that’s also caused by premature birth, sepsis, malaria and other conditions.

It affects about 8 million people every year, about 90 percent of whom go undiagnosed, and increases the risk of death by 700 percent, leading to an estimated 900,000 fatalities annually, according to the MCRI and CHAI.

In severely affected countries, one in six children under age 5 who are admitted to hospitals suffers from hypoxemia, according to studies by the MCRI and CHAI, which also show that 90 percent of hospitals in sub-Saharan Africa don’t use pulse oximetry to measure oxygen levels and less than half of all pediatric wards even have access to oxygen.

“In places like Chicago, New York, or Melbourne, oxygen is available for whoever needs it because as far as the health worker is concerned, they just turn a dial and the oxygen comes out of the wall,” Houdek said.

But even in the US and other highly developed countries, taking the availability of medical oxygen for granted faded amid the coronavirus pandemic and the huge demand created by waves of sick patients who needed it to survive.

During a March 11 panel discussion hosted by former President Bill Clinton, Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, admitted he was “not really ever fully aware of the importance and the critical nature of a shortage of oxygen” until the virus struck.

“Right here in the United States, the medical oxygen shortages due to surges in hospitalizations that I first noticed in the spring of 2020 in New York City, New Jersey and Connecticut, then in Texas in the fall of 2020 and then in California in the Navajo Nation this past fall and current winter … impressed upon me how extraordinarily critical this asset is,” he said.

Clinton called the uneven distribution of medical oxygen “quite a health equity crisis.”
“If you live in a wealthy country, having too little oxygen in your blood is a problem doctors have the tools and training to treat,” he said.

“In other parts of the world, it can still be a death sentence.”

Data from studies in Nigeria, Papua New Guinea and Laos suggest that improving hospital oxygen systems can cut pneumonia deaths among children in half, Graham said.

A cost-effectiveness study involving the 38 hospitals in Papua New Guinea also put the price tag of preventing each pediatric death at $6,435, he said.

But the MCRI/CHAI proposal breaks with the traditional approach of most nongovernmental organizations and charities, which typically provide equipment and supplies, along with the training to use them, Houdek said.

“This work is focused on building lasting systems to reliably meet patient needs in the countries where we work and we’re focused on a comprehensive approach to improving access to medical oxygen,” he said.

Part of the plan involves working with governments and health care networks to consolidate purchasing and “negotiate discounted pricing and value-added, after-sales services from private-sector suppliers,” Houdek said.

“So, rather than, for example, purchasing $100 million worth of equipment that will last a few years and donating it to a couple hundred health facilities, we can use that same $100 million to mobilize public- and private-sector investments, reduce the cost of goods and services, and create lasting partnerships that will serve thousands of health facilities in perpetuity,” he said.

Additional reporting by Gabrielle Fonrouge