Good morning, my name is John Sampson, I'm a faculty member, associate professor at Johns Hopkins University and also the director and sort of like the architect of the AIRS program, Johns Hopkins Society of Critical Care Medicine AIRS program, Africa Infrastructure Relief and Support Program. What's the right side? Oh, left side. Got it. I'm a Mac person. All right. So I'm going to give you an overview of the AIRS program. We're going to talk a little bit about the need for increased oxygen access and how it impedes critical care medicine and medicine in general, how you make oxygen, and then what are the unique aspects of this particular Society of Critical Care Medicine program that are unique beyond any other organization that's installing oxygen programs that we've met so far. The program is focused on the Gambia, Liberia, and Sierra Leone, all three West African countries. First of all, in terms of oxygen needs, the hospitals that we are working in basically had no suitable oxygen supply. They were using oxygen cylinders and oxygen concentrators. An oxygen concentrator, many people in the United States are not necessarily familiar with, you plug it in the wall and basically it takes room air in, it's got a sieve that attracts the nitrogen from the room air, allowing oxygen or at least 93 to 95 percent oxygen to be pushed out of it. Oxygen concentrators work on the same principle as the type of technology that we're using on an industrial scale for hospitals for oxygen delivery. Obviously something like an anesthesia machine is of little use without oxygen. The tank you see in the back is a type of oxygen tanks or cylinders that they use in these environments. These cylinders are heavy, trouble, they're difficult to transport. There's a patient safety issue in terms of them falling over. Imagine these in a neonatal unit as well. They're unreliable in terms of always having oxygen and there's a lot of cost involved with utilizing these tanks. The oxygen concentrators also have issues. The oxygen concentrators which really were developed for care here in the United States but are used internationally are limited usually to about five liters per minute. Some have higher amounts. Whenever there's a power failure, your oxygen concentrator goes out. These environments are prone for power failures. What we're doing is we're actually installing oxygen generating facilities that utilize large industrial level equipment to use that same technology I just described, make the oxygen and then push it through pipelines that we have to now install because these are locations that have never had oxygen and that delivers oxygen throughout the entire hospital. The Minister of Health of the Gambia last week met with me and described his situation in 2017 before he was Minister of Health when he was Chief of Surgery at the largest teaching hospital and tertiary hospital in the Gambia. He basically said that up until 2020 there was no hospital in the Gambia that had an oxygen delivery supply system. He was down to his last one half of a cylinder of oxygen for the entire hospital. It's interesting because sometimes when we talk about situations in disaster areas, places that have had war or natural disasters, we talk about their system being brought to its knees and being brought to a situation that these places have to live in all throughout the year. So while medical missions and other short-term interventions have helped to treat patients, over the years no intervention has addressed this limitation to the people living in these environments delivering healthcare themselves. So healthcare without oxygen. The COVID pandemic brought attention to this need and basically brought enough attention to bring donors and there also are international efforts by the World Bank and others to deliver oxygen generating plants to places in Latin America, Asia, and Africa. But there are some challenges and the challenges relate to the overall goal. Is the goal just to build an oxygen generation plant or is it to have a comprehensive package that includes both piping it to all of the locations, that includes training the biomedical techs to maintain it, and training the healthcare providers in order to use it the best. And now also how do you use that most. And I recommend anyone who's interested to read this book Fees, Refuse, and Diamonds by Paul Farmer because it describes the very countries that we are doing this project in and how the colonialism basically left them with an infrastructure that is broken resulting in the problems that we're discussing right now. So basically we put together a coalition of organizations that includes Johns Hopkins University Global Alliance of Paraoperative Professionals, which is the group that I created at Johns Hopkins. Direct Relief, which is the funder of this, which was responding to the COVID pandemic. The Diaspora Africa Forum, which is a diplomatic entity that represents all people in the African Diaspora internationally outside of Africa. And they represent those people to Africa. And the Gambia Ministry of Health and the Office of the Presidency of the Gambia. This is one of our heroes for this because she helps to make it happen. This is the First Lady of the Gambia. And before she was First Lady, she would literally go to the hospital and hold the hands of infants that were questionable in their survival because of oxygen and other issues and pray that they survive the night. That is the level of compassion of her heart. So she is intimately involved and wants to be all updates in terms of what's happening with our project. And that helps that type of support at the highest level helps this project to go through smoothly. So this is just, we had a diplomatic mission and this is actually a picture from that diplomatic mission where we actually brought leadership from SCCM, leadership from the African continent at the West African region. And we actually met with all of the different government entities that we will interface with to make sure that they fully agree, fully cooperate, fully collaborate, and support the life-saving work that we're doing in these key hospitals in the Gambia, Liberia, and Sierra Leone. Okay. And here you can actually see some of the output. Some of these pictures were just from a couple weeks ago. I just returned from Gambia last week and you can see those copper pipes. They're literally going to every clinical location and the entire hospital of a 700 bed teaching hospital in the Gambia. So in other words, not only could you not do critical care reliably because you could have a patient on a ventilator, you could have a patient on CPAP, BiPAP, high flow or regular flow, and then tomorrow, maybe there's no oxygen supply, it runs out because they have to get it from another hospital. And before 2020, their source of oxygen was often Banjul Gas Company, which was an industrial oxygen company, which made oxygen for welding and building. So this was oxygen not meant for human consumption and that was their oxygen source and the purity of it was down to probably around 80%. So some of the places that get oxygen generating facilities have them break down. On the right, that's the oxygen generating plant that was built in Sierra Leone by a company, Noverre is a French company. Basically, it never worked for a single drop of oxygen because there was one item that was needed that was missing and they could never get that last item to install from the company. And so literally it's just used, the shed, the place is just used to throw trash. And then the left, you see a burnt out circuitry, which is another issue that was a donation as well for a hospital in that region. And so you also have energy problems. This is a ship that's anchored off the coast of Freetown, Sierra Leone, because the energy grid is so unstable that this Turkish ship sells electricity by burning crude off the coast, worsening our environment, carbon dioxide, and also causing strain for the hospital as well. So on the right, you see an example of one of the oxygen generating plants that we're actually installing. This is a 500 liter per minute plant, and we'll have two of those at the Edward Francis Teaching Hospital in Banjul, Gambia, and that's some of the shipments where it's being installed. Finally, what we found by participating in Africa Climate Week in September of this year, where we took an SCCM and Johns Hopkins, an international team to do a workshop at Africa Climate Week, we found that there were hospitals in Kenya and other places where they had gotten oxygen generating facilities, but whereas those oxygen generating facilities did not have the ability to afford the amount of energy that it would take to power the oxygen generating facility. One hospital right here on the left has had their oxygen generating facility off for two years because of that expense. So because of that, we're using an alternate technology for creating oxygen called vacuum swing adsorption, and it's the most energy efficient by 30% than any other technology for producing oxygen, making it more affordable, and then on top of that, we solarize the generation of the oxygen in sometimes the entire hospital. In this case, we actually did hook up. The brother is actually at the front of the table. He's the CEO, young CEO of this private hospital system, and right now, our team is actually installing a solar system that's not part of this project. He actually purchased that solar system from our group so that he could power his oxygen generating plant. So the next thing is sustainability. This thing won't make any difference if everything breaks down right as soon as we create it, so we have created a customized biomedical tech training system for the specific technology that we're using, which there wasn't already a training system established because we're using a more unique technology, and so this consists of both an online training and hands-on training for both the Liberian and the Gambian biomedical techs, and an iterative process where they actually, after they take the course, they retake the course, and then they start teaching the course to each other, and on the fourth time of teaching it, then the objective is for them to reach competency not only as implementers of maintenance but also as teachers of maintenance as well. And so our best practices are, first, if we can identify how much money is being used on diesel generators, right, to power oxygen generation, and diesel generators to power a hospital, and then convert those diesel dollars into healthcare dollars, then we are bringing, well, that's our slogan, diesel dollars into healthcare dollars by using the most energy-efficient form of oxygen generation. Next, if we can then take even the fact that we still have to use energy even if it's the most energy-efficient form, and then provide a solar answer to that, then now we've created more diesel dollars to healthcare dollars. And then finally, if we can pipe that oxygen to all of the locations of the hospital instead of using all of the increased energy for putting that in cylinders at high pressure and then transporting those cylinders all over the place, we've actually increased the efficiency of the hospital as well as bringing even more diesel dollars into healthcare dollars. And so these are just some of the companies that we're collaborating with to execute this relatively complicated project. And I don't want to take any time from our other partners. I think I've gone over most of it. Let me just summarize by saying that our project is clearly an infrastructure development project for critical need. I don't think anybody here thinks that hospitals can deliver adequate care without reliable oxygen access. It's the most fundamental thing. All of the fancy critical care stuff won't work if you don't have oxygen and if you don't have energy. But at the same time, we want to establish and publish on the need. So separate from this project, we have separate grants that are funding a number of different research studies, both quantitative and qualitative, to basically establish and confirm the impact that this project will have that we'll publish. Thank you.

oxygen infrastructure

West Africa

solar power

medical care

sustainability