‘We have come so far’: Getting oxygen into local hospitals in Uganda

I joined CHAI in 2009, after working for a large immigration law firm. Although it was a significant change in my career, I hoped what I had heard about CHAI was true: it was an organization making a difference, in a way that was sustainable and supportive of the governments it worked with.

As part of the Human Resources department for five years, I watched CHAI grow and was inspired by my colleagues and our programs. I joined the Essential Medicines team on what I thought would be a temporary basis, but fell in love with the work and have continued in this role for almost six years. As a Director for the global Essential Medicines program, I work on strategy development, implementation, and program evaluation. Watching the work unfold firsthand is one of my greatest joys, but also hardest challenges.

On a recent trip to Uganda, I had the opportunity to visit several hospitals. In the pediatric ward at the first hospital there were three children receiving oxygen therapy, including a small boy hooked up to an oxygen cylinder. His mother sat close by, holding a small baby that she was nursing. You could see the worry on her face as the doctor hooked up an IV solution, hanging the bag from the window nearby. The boy was breathing slowly, as the oxygen gave his body a chance to fight and absorb the antibiotics. I felt a sigh of relief that he was probably going to make it.

In the other corner, two children were connected to an oxygen concentrator, which requires regular maintenance and
a power source. When we checked the oxygen purity on the concentrator, it was so low it might as well have been ambient air. The concentrators were broken. The nurses thought they were saving the children, but they were dying in front of us. One child was breathing fast, a likely indicator of pneumonia. The other child was breathing so slowly, I wasn’t sure he was still alive. Upon realizing that the concentrator was failing, the hospital technician removed it. Now the children had nothing.

After quick assessment of the situation, health workers connected these two children to oxygen cylinders that were available in the room. I soon saw the fast breathing child start to slow down, but I feared it might be too late for the other child. Making it even scarier, there were no pulse oximeters in the facility. If you have ever gone to an emergency room in a high-resource setting, this is the first thing they stick on your finger to check the level of oxygen in your blood. Without this tool, it is hard to monitor oxygen use. Instead, staff must carefully watch clinical signs and symptoms to know when to stop the oxygen therapy. This can be extremely difficult even for a trained clinician.

As a mother to two young boys, I often find myself watching my children breathe and taking in this privilege. I realize there is another mother somewhere watching her child take their last breath. The CHAI approach seeks transformative change, amidst what might seem to be overwhelming need and obstacles that many have considered insurmountable. Hand-in-hand with the government and our partners, we overcome these barriers to save lives.

And we have come so far. At the facility I visited, they have the option to give a child oxygen therapy — something that didn’t exist not long ago — because there is a plant onsite producing oxygen cylinders. CHAI has worked diligently alongside the government of Uganda to build plants at all of the regional referral hospitals and we are working to develop distribution strategies to reach the lower level hospitals. We are helping to get pulse oximeters and oxygen analyzers in place and routinely used. There is more work to do, but we’ve already made immense progress.

In my ten years at CHAI, I have seen many facets of our organization. The people that I work with have inspired and challenged me, and this has been such a privilege. What I hoped for when I accepted a job at CHAI has proven to be true: our values are lived and the results are real and sustainable. It has been more than I could have imagined.