From clatter of oxygen cylinders to noiseless flow at NHSL
Dr. Hector Weerasinghe
Oxygen has become the most used word among healthcare workers after the onset of the COVID-19 pandemic, especially now in neighbouring India battling a desperate shortage of oxygen.
The National Hospital of Sri Lanka (NHSL) in the heart of Colombo is the largest and best equipped Teaching Hospital in the country with a bed strength of nearly 4000. Flanked by 26 operating theatres, 28 Intensive Care Units (ICUs) and several Institutes including one for Cardiology housed in many buildings, it is circled and intersected with busy roads, always filled with hurried medical staff, ambulances with sirens blaring, trolleys carrying patients, distressed relatives and tired visitors. If one wondered why a truck loaded with cylinders was crawling across this melee, it was to ensure continuous and uninterrupted supply of essential medical oxygen for the patients treated in ICUs and those undergoing surgery in operating theatres.
A few years ago there were 6-7 jumbo oxygen cylinders hanging on walls outside these operating theatres and ICUs. When I made the morning strolls down the hospital corridors, my eyes always fell on these cylinders. Oxygen was taken through a copper tubing system fixed to these cylinders to the respective destinations – the oxygen outlet at the bedside of patients treated in ICUs and in operating theatres.
The hospital had a sufficient number of cylinders filled with oxygen. No sooner a cylinder was empty it was replaced with a refilled one. Every day workers collected empty cylinders, loaded them on a truck and transported them to the Oxygen Company in Mattakkuliya for refilling.
On certain days when oxygen consumption was high, this operation had to be doubled. The hospital had its own truck and specially trained skilled employees assigned for the task. Loading and unloading of these jumbo cylinders was a specialised job.
I noticed this operation during my afternoon inspection tour. In fact, the noise made in loading and unloading as well as dismounting and mounting cylinders on the walls and the sight itself, to say the least, was an eyesore. Once the truck returned, the refilled cylinders were immediately distributed among the theatres and ICUs. Needless to say this was a hectic operation.
There were tense situations when the truck did not return on time due to a breakdown, traffic congestion or an accident. Thoughts of the trucks being delayed gave me many sleepless nights. My official residence was in very close proximity to the Merchants Ward where many cylinders were unloaded. No sooner I heard the clattering sound, I would rush to the window to witness the unloading.
As Director of the country’s largest hospital, I was responsible for the overall smooth functioning of the hospital and its men, material and machinery. Ensuring the continuous and uninterrupted supply of oxygen for critically ill patients and those undergoing surgery was foremost among many tasks. Only a handful of staff knew the complexity of the ‘oxygen supply operation’ in the hospital. Others did not realise it as all the steps in this operation had been well taken care of, monitored and executed. It was a nightmare for me personally and all my predecessors.
Worrying over this cumbersome, complex manual operation, my mind was busy exploring and weighing alternatives. Listening to the clattering of cylinders and watching the swift movements of workers’ hands in the unloading operation in the middle of the night, with a cup of steaming cup of coffee in my hand, a thought struck my mind. I heard my own voice shouting over the clattering sound of falling cylinders; Hey! Man, be practical, instal a Liquid Oxygen Plant in the hospital premises itself.
Early next morning ignoring the supervision tour, I prepared a comprehensive proposal to the Ministry of Health with a clear justification of the investment. Having submitted the proposal followed by a few telephone calls, the Ministry responded by approving the proposal.
The proposal was to have a Liquid Oxygen Plant with the highest capacity for the hospital and another with lesser capacity for the Institute of Cardiology located a little away from the main hospital premises across the street.
A few moons later, a Liquid Oxygen Plant near Ward 13 and a separate smaller plant on the premises of the Institute of Cardiology rose to the sky. The copper pipelines were laid connecting all the operating theatres, Intensive Care Units and high dependency units which required continuous uninterrupted supply of oxygen. The project was completed within a few months giving me great relief.
It was in 2006 that the hospital installed the two oxygen plants. Since then we did not have to wait for the truck or bother about cylinders to have a permanent reliable source of oxygen supply for our patients. The company which installed the tanks attends to maintenance and repairs and regularly monitors the level of consumption and replenishes the tanks. The hospital staff need not intervene. After retirement today, I look back at my time as Director of NHSL and recall how the idea to instal a Liquid Oxygen Plant to ensure the continuous supply of oxygen to patients dawned on me 15 years ago, much before the ‘COVID-19 pandemic’ entered our vocabulary.
(The writer is a former Director – The National Hospital of Sri Lanka)