The 51 CPAP oxygen-delivery machines delivered by Gift of the Givers this week to health facilities in Makana will significantly boost their capacity to assist Covid patients. This comes as hospitals, clinics and the ambulance services brace for an anticipated rise in Covid cases when businesses and schools reopen.
The handover on Wednesday was part of a consignment of 900 CPAP machines for health facilities across the Eastern Cape, and 12 000 nationally. Continuous positive airway pressure (CPAP) is a non-invasive method of assisting patients in respiratory distress to breathe.
*A total of 20 000 CPAP machines have been produced in South Africa under the National Ventilator Project. Together with the Department of Trade and Industry, the Project called for proposals earlier in the year to design ventilators. The South African Radio Astronomy Observatory (SARAO) was appointed to manage the national effort to design, develop and produce the oxygen delivery machines to support the government’s response to the Covid-19 pandemic. The R250-million development and production project was funded by the Solidarity Fund.
Deputy Manager of Nursing at Settlers Hospital and acting CEO, Yvonne Ngesi, said the hospital was very grateful for the donation.
“I’m giving a huge thanks to Gift of the Givers,” Ngesi said. “From today, we won’t be short of machines. We’ll be able to provide every Covid patient with a machine now. Previously we had only two. This is really of huge assistance to us at the hospital – thank you very much.”
Acting station commander at the Makhanda Emergency Medical Services base, Zoleka Sandi, said the donation would boost their ability to support patients in respiratory distress on their way to hospital.
“This is going make a big difference for us,” Sandi said.
Gift of the Givers delivered a total of 30 CPAP machines to EMS for the Makana Subdistrict, to serve four ambulances in Makhanda, three in Port Alfred and one each in Alicedale, Alexandria and Bushmans.
In additional to the 12 units for Settlers Hospital, a total of 36 were delivered to Temba (3), Fort England (3), Settlers Day Hospital (3), Port Alfred Hospital (9), Marjorie Parrish Hospital in Port Alfred (6) and Nompumelelo Hospital in Peddie (12).
A health professional not present at the handover and who requested not to be named explained that in addition to its ease of use, the CPAP’s advantage is that it’s economical on oxygen compared to other oxygen delivery systems.
A normal oxygen cylinder attachment delivers 15 litres a minute. High-flow nasal cannulas (short tubes inserted in the nose) supply 60 litres a minute.
The CPAP unit, together with its attachment, allows anything between 10 and 30 litres a minute to be delivered.
“Most hospitals don’t have the capacity to supply high flow,” the source said. “These [CPAP] units are very significant for the kind of care we will be able to provide Covid patients.”
Ahead of the delivery to Eastern Cape health facilities, Gift of the Givers founder Dr Imtiaz Sooliman said, “We now have a truly South African oxygen delivery machine that suits our current needs: a machine that is essentially mechanical and not electronic, easy to use, practical and highly effective.
“At this critical point in dealing with the severity of the second Covid-19 wave, these CPAP machines couldn’t have come at a more opportune time,” Dr Sooliman said. ”A gigantic thank you to all who made this possible. Lives are going to be saved in numbers.”
When is breathing support necessary?
Respiratory failure is when it’s very difficult for you to breathe, or when not enough oxygen is getting into your blood. Doctors make decisions about how to treat this based on the oxygen saturation rate – measured using a pulse oximetry device (pulse oximeter) that clips on to your finger.
Normal is 95% to 100%. Anything below 93% is a sign of potential hypoxia – a condition that can cause serious and permanent damage to your kidneys, liver and other vital organs.
In pneumonia and other dyspnea (breathlessness) causing illnesses, that’s usually when doctors prescribe oxygen therapy.
With Covid-19, because the physiology of the disease is different, oxygen is used differently.
More about the South African designed CPAP ventilators
These ventilators were produced by the Council for Scientific and Industrial Research (CSIR) and the South African Ventilator Emergency Project (SAVE-P) – a consortium of companies. Production began in July 2020 and the final units were completed during November 2020.
The development, production and procurement cost for the 20 000 units were funded through a R250 million donation from the Solidarity Fund, at an average cost of R12 500 per unit. They were approved at the end of June by the South African Health Products Regulatory Authority following clinical testing at Charlotte Maxeke Johannesburg Academic Hospital on behalf of the SARAO. A further clinical trial was conducted at Chris Hani Baragwanath Hospital under the supervision of the National Department of Health.
* Source of details about the commissioning, testing, approval and manufacture of the CPAP machines from the Minister of Trade and Industry’s written reply to a parliamentary question. Read the full reply which includes further details here: http://www.thedtic.gov.za/wp-content/uploads/6th-q1738-1.pdf
Systems to support breathing
When someone with Covid has acute hypoxemic respiratory failure, medical staff can assist their breathing with high-flow nasal cannula (HFNC) therapy, Noninvasive Positive Pressure Ventilation or invasive mechanical ventilation
High-flow Nasal Cannula (HFNC)
Oxygen is heated and humidified before being delivered to a patient via two small prong-like tubes inserted in their nose and kept there with an elastic fastening around the back of their head.
Noninvasive Positive Pressure Ventilation
Noninvasive positive-pressure ventilation is mechanical ventilation for patients with respiratory failure without the requirement of an artificial airway. CPAP (continuous positive airway pressure) is one type; another type of noninvasive positive-pressure ventilation is BiPAP (bi-level positive airway pressure).
Invasive mechanical ventilation
Invasive mechanical ventilation means a machine is used to push air and oxygen into a patient’s lungs through a tube in their windpipe (this is known as intubation).
Is Settlers coping with Covid?
When Grocott’s Mail last visited Settlers Hospital, in early December, the situation was desperate, with very ill patients forced to wait on chairs as examination cubicles in Casualty quickly filled. Overloaded doctors and nurse struggled to attend to the tide of patients in severe respiratory distress, even as five or six ambulances at a time lined up outside, waiting to bring in their patients.
We wanted to know how the situation at the hospital is this week, and in an informal briefing, acting CEO Yvonne Ngesi confirmed the following:
- There has been a drastic change since the November/ December surge in cases.
- There were 20 Covid patients on Wednesday, attended to by one doctor who also assists in casualty.
- The medical ward, which had been emptied to accommodate the surge in Covid cases, has returned to being a general medical ward and on Wednesday had 19 patients. The three patients transferred from there to Temba have returned.
- Three new community service doctors have begun working at the hospital; however, the hospital needs at least another three doctors.
“Our numbers are down, but we are expecting the next big wave as schools reopen and people return to work,” said Ngesi.