Too little too late
When the inter-ministerial Covid-19 Crisis Management Center (CCMC) finally reacted, it was too late. Its arbitrary quota system for every hospital proved disastrous.
“The quota resulted in hard-hit hospitals being undersupplied and safer hospitals being unnecessarily saturated with cylinders,” explains Roop Jyoti, former chairman of Grande City Hospital, suggesting the problems lay in supply chain management rather than oxygen production.
Faced with mounting criticism for bungling the oxygen quotas, the Health Ministry resorted to micromanaging, and ordered suppliers to only send filled cylinders to hospitals that had its recommendation letter.
The result was catastrophic, many hospitals were either forced to refuse service or they asked families of patients to bring their own full cylinders.
In a notice posted in mid-May, Kathmandu’s Om Hospital said: ‘Under the capping made by the government on oxygen supply, we are unable to take admissions despite our willingness to provide service. We have enough manpower such as doctors and nurses to take care of patients but not enough oxygen supply.’
Families with Covid-19 patients hoarded full cylinders at home, and desperate ones rushed to the gates of oxygen factories to buy the life-saving gas. Municipalities, especially in areas with spare capacity, prevented the transport of oxygen beyond district borders.
Most of Nepal’s oxygen plants are in central and eastern Nepal. The Morang-Sunsari industrial corridor alone had five large oxygen factories with surplus capacity, but these were prevented from sending supplies to hospitals in Kathmandu and other areas with shortages.
Lack of training in oxygen flow management and ventilator use did not help matters. Makeshift local isolation centres with non-medical staff were using full flow to treat patients with mild symptoms. Hoarding and black marketing was rampant, and while large hospitals ran out of oxygen supply, local isolation centres had one cylinder per patient.
In Grande International Hospital, there was a 30% drop in oxygen demand when doctors were more judicious in oxygen use. Still, the shortage was serious enough for some doctors to ration oxygen even for their most serious patients. Others had to make the difficult choice between continuing to put patients who had little chance of survival on oxygen, or to give it to those who would immediately recover with oxygen.
Even before the pandemic, government oversight on cylinders was non-existent with no standardisation or regulation in place regarding colour coding, pressure, price rates and deposits on oxygen cylinders.
“I used to get desperate calls at 3am from families of patients desperate for oxygen. We were able to call up spare capacity during the second wave, especially in the east of the country, but the shortage of cylinders for refilling did create a temporary shortage,” says Gaurav Sharda of the Nepal Oxygen Industries Association (NOIA).