A true story of our health system


By Dr John Locke

The piercing persistent ring of the phone shattered the tranquil of the brief pre-dawn sleep. I concluded that it was not the Suhoor (heda) alarm having already let it ring a few times.

“Doctor, bed X’s condition has changed.”


“Please remind me again, what’s her name and the admitting diagnosis? “, I blearily mumbled to the nurse. “And secondly is she really alive or dead?” I asked the admittedly cynical question because believe it or not, I’ve been called numerous times about patients’ ‘changed condition’ only to find that the patient was actually taking their final breaths or already dead. But I digress as that’s a story for another day.

On the ward I found the patient gasping for breath. Her blood oxygen level was dangerously low and she urgently needed oxygen amongst other things. But life-saving oxygen first and foremost.

The nurse tiredly shook her head. The only oxygen sources on the ward, the portable cylinder and the concentrator were being used for two patients at that very moment. In effect there was no oxygen available for this patient. 4:15 am, no oxygen in the hospital. The hospital only had limited oxygen supply in the form of portable cylinders and oxygen concentrators. The word portable is a misnomer as there is nothing portable about them; each cylinder is the height of an adult male and heavy. Not to mention expensive. Oxygen concentrators are machines the size of a small suitcase and basically extract oxygen from the air using electrical power.  They are also expensive to purchase, run and maintain, and our hospital only had 3 working concentrators. The remaining two are owned by the maternity/gynae department and paediatrics department. Borrowing from those two wards was out of the question. As we pondered this quandary, her sister who had been by her bedside all night pleadingly stared at me……

This oxygen shortage experience I just related happens with wretched regularity the length and breadth of the national health system, and I speak with the conviction of a health care practitioner on the front lines of care. I am not interested in massaging the facts or delivering some ‘maslaha’/spin about how plans are afoot to address this situation as healthcare practitioners have been hearing such platitudes for ages with no progress. The painful catastrophic reality is that patients i.e. your relatives, my relatives, our relatives, die daily due to a shortage of oxygen in our health system and the situation shows no signs or fierce urgency to improve.

Consider the following:
1.    There is no overarching national framework or strategy to supply oxygen to the major health centers or public hospitals, or if there is, it is only on paper i.e. the perennial ‘being worked on’.
2.    The international standard is for individual hospitals to have their own oxygen plants on sight or at the very least a central Government-owned manufacturing plant that supplies oxygen to the peripheral health facilities. Each patient bed ideally should have piped oxygen on demand from the on-site plant.
3.    As such major hospitals and health centers (public and private) have to source/buy their oxygen cylinders from private oxygen manufacturers like Banjul Oxygen Ltd, which is hideously expensive and unsustainable.
4.    Our apex referral Hospital EFSTH (Edward Francis Small Teaching Hospital) at one point was allegedly spending 800,000 Dalasis monthly on oxygen purchases alone.

Oxygen is classified as a drug and it goes without saying that it is among the most elemental and fundamental in any health care system. It is critical in life support systems i.e. emergencies and surgeries.

Across the myriad issues facing the Gambian health system, there is a disheartening continuation even widening of that disconnect between the daily experience of those on the front-lines (i.e health care workers) and the policy/decision makers ‘at the top’ especially how the former can guide what needs to urgently addressed to deliver good patient care.

A sustainable long-term solution to the oxygen issue would be a good start.