Empowering local healthcare staff

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Mme Ngome Vivian, recently trained NCC instructor, returned to her health facility and delivered training on the oxygen concentrator

The Neonatal Care Course is a short, stand alone course on the care of the newborn baby in the first 28 days of life but the ripple effects of the training are far-reaching. NICHE believes that training local instructors leads to this sort of – hopefully long lasting – empowerment. Many oxygen concentrators are abandoned or broken because they are poorly maintained or not fully understood. Here, Vivian is teaching staff at Nkoabang Baptist Health Centre how to look after this vital piece of equipment.

Nkoabang Baptist Health Centre, 15 miles outside of Yaoundé, Cameroon

The transcript below is Vivian’s WhatsApp message to Grace in Cameroon, delighted that a baby’s oxygen saturations came up so demonstrably after she had overhauled the concentrator and got it working again:

[5:00 pm, 25/05/2022] NDZE GRACE BONGBAN: Greetings to everyone in the house above is my first presentation on oxygen concentrator to the staff body in Nkoabang Baptist health center infact i really thank Ma Grace and Daddy Justin Fombe for the knowledge I have rescued a patient’s life today we had a patient whose saturation stood at 88 just from cleaning changing distilled water, positioning and ventilation saturation is now 91 dear colleagues let’s pass this knowledge to safe lives on another positive note i emphasized on the need for a projector and we bought one to facilitate teaching
[5:00 pm, 25/05/2022] NDZE GRACE BONGBAN: Also did a presentation to MCH Staff today on convulsion and there was a lot of learning
[5:00 pm, 25/05/2022] NDZE GRACE BONGBAN: We keep on putting our knowledge into practice and results will be visible

The oxygen concentrator

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In the UK, oxygen is piped to our wards and surgical theatres.  Resuscitaires (for neonatal resuscitation) take air and O2 cylinders in case babies are delivered in areas where there is no piped O2.  But really we only use cylinders nowadays in hospitals in the UK for teaching purposes – most resuscitation teaching rooms don’t have piped oxygen.

The hospital we are in currently in Liberia runs its electricity entirely on generators and only has running water for a few hours a day so it is unlikely to have piped oxygen any time soon.  Oxygen has to be concentrated from air.  We have a session on the O2 concentrator on day 2 of the Newborn Care Course and it gives the UK instructors’ a chance to take a break and hand over to the local instructors who are absolute whizzes on how these things work and, more importantly, how to maintain them.  It is always one of the most popular workshops in the course; many neonatal nurses have one in the corner of their unit but it often doesn’t work because no one knows how to clean the filters, change the water etc.  This demonstration can bring 4 or 5 defunct O2 concentrators back to life in one fell swoop!

Here is Kola explaining all about the O2 concentrator in ways which even I could understand for the first time ever. The last photos are of homemade CPAP which he has made from a bottle of mineral water and some oxygen tubing attached to the O2 concentrator. CPAP ensures pressure in the baby’s nose all the time he/she is breathing out as well as in. This prevents the lungs collapsing right down and effectively treats respiratory distress syndrome in the premature babies.

This is one of the most popular demonstrations of the whole course. Most of the learners have seen one but in many places, it sits broken in the corner of their unit.  This session on maintenance will bring most of those defunct units back to life.  Kola is somewhere in the middle of this crowd!

Kola enthusiastically dismantling the oxygen concentrator, urging his learners to clean the back regularly with a toothbrush and change the filters.

Making CPAP from an O2 concentrator, bottle of mineral water, nasal prongs and some O2 tubing.

An oxygen concentrator can turn 21% from the air into 70 -90% O2 depending a bit on climatic conditions.  WHO has put together a FAQ sheet for people who want to know more at https://www.newbornwhocc.org/ONTOP-DATA/Equipment-PDF/Oxygen-concetrator/FAQ-Oxygen-concentrator.pdf.   Kola’s unit, courtesy of MCAI funding, has an O2 splitter which means that 3 babies can receive oxygen from the one concentrator.  They rely on electricity to work so health facilities should keep some back up cylinders as well.