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“When COVID hit our district, we realized that we had a serious oxygen problem,” says Dr. Jenny Nash, a family physician who covers the rural Amathole District in the Eastern Cape, South Africa’s poorest province. “Our oxygen demand increased tenfold — and so did everyone else’s.” In August 2020, bulk tanks were installed at Butterworth, the largest hospital in the district. But this was not the gamechanger Nash had hoped it would be. Doctors often talk about the oxygen escalation ladder, she explains. At the bottom of the ladder are things like nasal prongs and face masks that don’t require much oxygen but can only deliver low concentrations of oxygen. At the top of the ladder are high-flow nasal oxygen, BiPap and CPap machines, and ventilators. These can deliver very high oxygen concentrations, but they require an enormous amount of oxygen. | In our district, things definitely would have been worse without it … People would have died unnecessarily. - Dr. Jenny Nash | This is all very well in rich countries when there isn’t a pandemic. But even once bulk tanks had been installed at Butterworth Hospital, insufficient reticulation made it difficult to have more than two or three patients on high-flow nasal oxygen at the same time. Relief came from an unlikely source when Craig Parker, a doctor from a neighboring district, sent Nash and her team some prototypes of a device he and some colleagues had designed together. Parker claimed that the OxERA (Oxygen Efficient Respiratory Aid) was the missing rung on the oxygen escalation ladder: a device capable of delivering high oxygen concentrations without using vast quantities of oxygen. Desperate, Nash and her team started using the OxERA on COVID-19 patients — with remarkable results. “Patients really responded to it,” says Nash. “And because it required so little oxygen, we could use it on everyone who needed it.” The fact that you could “train a nurse to use it in 30 minutes,” as Nash puts it, sealed the deal. Of course, some patients did still die after using the OxERA. But Nash is convinced that “in our district, things definitely would have been worse without it … People would have died unnecessarily.” |
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In early 2020, as COVID-19 wreaked havoc in Italy and the U.K., Parker watched in horror. If first-world nations with highly trained doctors, state-of-the-art equipment and abundant oxygen supplies couldn’t cope, what would happen when COVID-19 came to the Global South? “I could see we were going to have a massive oxygen problem,” he remembers. “And I decided to do something about it.” Before long he’d assembled a remote team of around 10 doctors, engineers and others with 3D-printing capacity to attempt to find a solution. Parker’s group was by no means the only one that set out to mitigate this looming calamity. Emergency ventilator projects were ten to the dozen in the early days of the pandemic. But his unique resume put him on the inside track to find a workable solution. After high school, Parker qualified as a mechanical engineer. He spent almost two decades working on mines in South Africa and Zambia. Over time, his disillusionment with the “rich getting richer” ethos of mining grew until, in 2011, things came to a head. Some might call what happened a midlife crisis, and others a religious awakening. Either way, at the age of 39, Parker made the “crazy” decision to train as a medical doctor. After selling his cars and house to make it happen, Parker graduated in 2015 and moved to the Eastern Cape with the goal of helping those who needed it most. | I could see we were going to have a massive oxygen problem. And I decided to do something about it. - OxERA creator Dr. Craig Parker | Little did he know that COVID-19 would present him with an opportunity to save lives across the region — and, pending FDA approval, the entire world. After lots of thought and consultation, the team Parker put together in March 2020 decided that a blower-based BiPap (bilevel positive airway) system was the way to go. A core group of five or six people moved mountains to complete a working prototype by the middle of the year. While working on the BiPap machine, Parker also made a much smaller, cheaper and simpler system in his home workshop: OxERA 1.0. Everyone in the team, which was now officially known as Umoya, expected the BiPap to be more effective than the OxERA. But when the two were put to the test, the OxERA was the clear winner. While both devices were very oxygen efficient, only the OxERA was effective at treating severe pneumonia, and it didn’t even require electricity to work (it’s controlled by the patient’s breathing and the oxygen source). “It was a massive win for scalability,” recalls Parker. “The BiPap system would have been really expensive to produce.” |
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While the OxERA is fairly simple to make and very easy to use, it is by no means simplistic. It’s so successful because of two key design features: — A tight-fitting anesthetic mask (as opposed to a regular oxygen mask) means that very little oxygen goes to waste. — A PEEP (Positive End Expiratory Pressure) valve allows patients to breathe out against a variable resistance. As Nash explains, “the PEEP ensures that when a patient breathes out, their lungs don’t collapse. This makes breathing much easier.” | It would be really useful in ambulances, when bulk oxygen is unavailable. And even for taking patients who are on high-flow nasal oxygen out of their wards for X-rays or other procedures. - OxERA creator Dr. Craig Parker | PEEP valves are not especially complicated or expensive, but they are usually only found in high-end machines like ventilators. Their inclusion in the OxERA was revolutionary, says Nash, who found that — thanks to the support provided by the PEEP — the device could sometimes even be effective in treating COVID-19 patients when not connected to oxygen at all. While the benefits for developing nations and low-resource environments are obvious, Parker has also spoken to doctors in rich nations who are excited to add the OxERA to their arsenal. “It would be really useful in ambulances, when bulk oxygen is unavailable,” he explains. “And even for taking patients who are on high-flow nasal oxygen out of their wards for X-rays or other procedures.” Nash is also keen to point out that its applications extend far beyond COVID-19. “We’ve had great success using it to treat pregnant women with pulmonary edema. And it even seems to help with PCP pneumonia,” a serious infection that’s common in HIV patients. |
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Shortly after Nash and her team used the first OxERA prototypes in the rural Eastern Cape, Parker was contacted by Juliet le Breton from under-resourced Zimbabwe. When COVID-19 hit, she founded a social enterprise (she called it Kufema, meaning “to breathe” in Shona) in the hopes of designing and producing an open-source ventilator. “We very quickly realized ventilators weren’t the answer. But we didn’t know what we did need,” remembers Le Breton. “Until we heard about the OxERA.” | I’ll never forget the first time I got a message saying: ‘Your device saved a life last night.’ - Kufema founder Juliet le Breton | Parker was born in Zimbabwe, so he has a soft spot for the place and a deep awareness of the challenges facing healthcare providers there. Since receiving their first batch of OxERAs in September 2020, Kufema has leveraged its contacts with local municipalities to distribute 231 units to all 10 provinces of Zimbabwe. “The OxERA was incredible,” says Le Breton. “I’ll never forget the first time I got a message saying: ‘Your device saved a life last night.’ And it was by no means the last.” The data Kufema has been able to gather from providers around Zimbabwe shows that the OxERA achieved a 59% recovery rate — quite something when you consider that in most communities in Zimbabwe it was mainly used on people in severe breathing distress. “Of course there were sad stories,” she adds. “But without the OxERA there would only have been sad stories.” Nash tells a similar story about the rollout in South Africa’s Eastern Cape. Within months, “hundreds” of OxERAs were in use at almost every healthcare facility in the district. “As the pandemic progressed, we became really aggressive in how we used oxygen. We found giving patients the OxERA within 30 minutes of admission to be really effective,” she explains, before adding: “We should have them at every clinic in South Africa. And it would be wonderful if they could spread around the world.” On that note, Umoya has already teamed up with Gabler Medical in Cape Town to mass produce the OxERA. Thus far, Gabler has sold around 13,000 units at an average price of $80 — although governments and NGOs typically pay less than this. Regulatory challenges mean the OxERA hasn’t yet made it much further than southern Africa, but Gabler is in the process of getting U.S. Food & Drug Administration approval for the device. If all goes according to plan, this should be in place by early 2023. |
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