Gasping for air: High prices of medical oxygen force African doctors to choose which patient to treat
As Covid-19 spreads throughout Africa, a potentially deadly lack of oxygen is leaving patients gasping for breath. Many are having to go without this essential treatment.
The Linde Group refused to comment on any of the allegations but said they would “do everything possible to continue to reliably supply our customers”. While the majority of people with Covid-19 have mild symptoms, of all patients, 14% will need oxygen in hospital and 5% will need mechanical ventilation in intensive care. Yet, across countries including Nigeria, Kenya, Burkina Faso, Guinea, South Africa, South Sudan, Cameroon, Ethiopia and Tanzania, many hospitals and dedicated Covid-19 isolation centres have reported oxygen shortages.
Air Liquide told the Bureau: “The 88% margin claim is totally inaccurate and does not reflect the economic reality of our business in Africa or the competitive nature of the market.” One former gas company employee, who wanted to remain anonymous, characterised the discrepancy between the prices of medical and industrial oxygen as, in their opinion, “exploitation”.
Beatrice, 1, getting a checkup in Yola, Nigeria, where thousands of children died every year from pneumoniaBut even when oxygen is available, it has to be paid for – along with other hospital treatments. For children with pneumonia in Nigeria, the gas accounted for half the cost of an admission, said Dr Hamish Graham, a consultant paediatrician who researched improving oxygen access. “Oxygen was a really big driving force of catastrophic health expenditure for those families.
Patients that need oxygen have sometimes discharged themselves against medical advice because the costs get too high. Air Liquide and BOC have a history of pricing practices that have attracted criticism. In 2002, the European Commission fined them and five other gas companies for running a medical oxygen cartel in the Netherlands, which prompted other investigations across Europe. The companies held regular meetings to fix prices and agreed not to deal with each other’s customers for at least two months every year, which were concluded to have been in order to raise prices and keep them at the set level.
Exposing systemic failings through investigative journalism isn’t a quick fix. It takes time to uncover the evidence. It takes time to get people to notice. But when we take that time, we can get results. Help us do more.Over the years, smaller companies have tried to provide cheaper oxygen. Insiders say, however, that the multinational companies fight to maintain their market share.
One of Hewatele’s plants was built on the grounds of the Rift Valley General Hospital in Nakuru, Kenya’s fourth largest city. According to Dr John Murima, who was then the area’s medical superintendent, the hospital had previously suffered shortages. BOC orders, which had to be driven for 3 hours from Nairobi, often turned up short.
The companies also install tanks and piping when hospitals opt for liquid oxygen, the ex-employee added, and this infrastructure also stops hospitals from switching suppliers. Some hospitals report that oxygen companies have occasionally limited their oxygen supply. Usually, 35 cylinders were delivered every day to Yalgado Ouedraogo University Hospital in Burkina Faso, said Idrissa Ouedraogo, who is in charge of buying the hospital’s oxygen. But in March, Air Liquide said that the hospital could only order more cylinders if they had returned 60% of those already provided. But those cylinders were still in use.
That concentration is only possible with oxygen made cryogenically – where air is frozen so that the oxygen and nitrogen separate and liquid oxygen is formed. This is the method used at BOC’s African plants. The other two methods to make oxygen – the concentrators and pressure swing adsorption plants – produce concentrations of between 93% and 99%.Experts disputed the health federation’s reported stance. The World Health Organization defines medical oxygen as anything above 82%.
Concentrators are not a perfect solution. Electricity is not always available, and stories of patients dying during blackouts are common. They were not built for hot, dusty or humid conditions, so are prone to breaking down.
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