How to treat pneumonia when the power goes out

"Our [key performance indicator] is how many lives have we saved," Roger Rassool says. "You can't argue with it." (Credit: USAID/Flickr)

Blackouts in low and middle-income nations stop oxygen generators in their tracks, potentially leading to the death of children with pneumonia, the number one killer of children under five worldwide. Worse, many small health facilities have no access to electricity at all.

Pneumonia kills one child every 30 seconds. Even if a child suffering from severe pneumonia is on antibiotics, without a steady flow of purified oxygen their lungs struggle to cope and the condition often becomes fatal.

Researchers ,may have come up with some creative and low-cost ways to remove the nitrogen that makes up 78 percent of the air, leaving purified oxygen to go to the patient.

Where there is electricity, they build on existing oxygen concentrator technology by storing some of the oxygen locally at low pressure, ready to come instantly online and ensure a steady supply whenever the electricity fails.

“How do we build a low-cost air compressor that does not need reliable electricity?”

The solution for places with no electricity comes straight out of left field: a new approach to concentrators that uses a vacuum created by water running in a nearby stream or river.

The key with both solutions is their basis in solid physics—both represent absolutely the lowest possible energy cost, which translates into lower running costs and greater sustainability in resource-poor settings.

Providing oxygen in the smallest hospitals and health centers has the potential to reduce child pneumonia mortality rates in these settings by up to 30 percent.

Big problems in healthcare

Roger Rassool, an associated professor in the University of Melbourne physics department, and Jim Black, an associate professor from the Nossal Institute for Global Health, share a commitment to helping disadvantaged children. They were both at a symposium held at the Nossal Institute a couple of years ago.

Black, whose expertise is in health in low-income countries, recalls, “We brought speakers from the world of healthcare in low-income countries to an audience of engineers, physicists, and other ‘technical’ people. The clinicians outlined issues they considered important and which seemed to need technical solutions, in the hope that someone in the audience might have a novel solution.”

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Among the half-dozen speakers was a leading childhood pneumonia researcher mostly working in Papua New Guinea at the time.

“He explained how much potential there is to improve pneumonia outcomes by supplying oxygen in small health facilities, but pointed out that such health facilities have unreliable electricity supplies, so that standard oxygen concentrators may switch off at critical times, putting lives at risk during electricity blackouts.”

Even worse, they tend to burn out as a result of voltage fluctuations, giving them very short working lives. He asked the technical audience to find a cheap way to provide reliable electricity in remote settings.

Rassool and postdoctoral colleague Bryn Sobott were in the audience that day. “Being physicists they went right back to basics, looking at how concentrators work and what the actual energy requirements are,” Black says.

“They came back to me (as organizer of the symposium) and asked if the question is really about electricity—in fact what a concentrator needs is compressed air, so they re-phrased the question as: ‘How do we build a low-cost air compressor that does not need reliable electricity?’

“Re-imagining the problem in this way opened up a wide range of possibilities, and we worked through four or five really imaginative possibilities over the next couple of years. Yes, years—we were all working on this in our ‘spare time’ without a grant or other funding.”

Sucking out the nitrogen

Rassool says the breakthrough for him came when he realized the problem was not about power, but pressure.

“There was also a physics moment when we realized vacuum was pressure—a lack of pressure that could be used, by flipping the process to vacuum-based we could use the vacuum to suck the nitrogen out of the air.”

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The rigs are not small—one takes up about half a shipping container—and locals will have to be trained not only to use the equipment, but also to monitor patients’ blood oxygen levels to ensure it is working properly.

And the cost? “As low as possible,” says Black.

The team now has a prototype operating in Gippsland; Rassool has gone to Uganda for initial fieldwork and Black has been to Mozambique negotiating partnerships in preparation for trials.

Both consider it vital to work closely with local researchers and health workers in refining the designs and making sure they fit well into the health facility’s workflow.

Rough conditions and welcoming people

So what’s next? “So far we have been making contacts with locals and young people we can train up to run our systems. We are hoping to get working systems on the ground in November-December and a fully operational system in the New Year,” says Rassool.

The team has a sobering key performance indicator.

“Our KPI is how many lives have we saved,” Rassool says. “You can’t argue with it. It’s confronting mortality and trying to not get too personal with it.”

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He says working in places like Uganda can be hard. “You stand in these environments and say: ‘I can solve these problems.’ But there are hundreds of thousands of problems.”

There are rewards for this labor of love, too. “We have been inundated with warmth by the local communities there. They are so receptive. It is embracing and it keeps your spirits up.”

The team has received support from the Bill and Melinda Gates Foundation via its Grand Challenges Explorations Grants program and a grant from Grand Challenges Canada to prototype new technology, with a chance to receive $1 million more once it’s proven.

The ultimate aim is to establish a startup in Melbourne with strategic partnerships among the University of Melbourne, industry, and community, to form the manufacturing capability in Australia.

Source: Jonathan Porter for University of Melbourne