SCCM Pod-518: Achieving Sustainable Healthcare in Africa

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The Society of Critical Care Medicine’s (SCCM) new global health project, Africa Infrastructure Relief and Support (AIRS), will ensure the availability of medical oxygen to patients in the Gambia, Liberia, and Sierra Leone, made possible by a $5.5 million grant from Direct Relief and in collaboration with the Johns Hopkins Global Alliance of Perioperative Professionals (GAPP) and the Institute of Global Perioperative Care (IGPC).

Host Samantha Gambles Farr, MSN, AG-ACNP, FNP-C, CCRN, RNFA, is joined by John B. Sampson, MD, executive director of GAPP and a critical care anesthesiologist at Johns Hopkins University, to discuss the AIRS project. AIRS tackles challenges such as energy shortages and outdated infrastructure to tailor solutions to each country. AIRS prioritizes sustainability and capacity building to empower local communities and address global health disparities. Listeners are urged to support AIRS by raising awareness, advocating for sustainable healthcare, and exploring collaboration and funding opportunities.

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Transcript:

Dr. Gambles Farr: Hello and welcome to the 2024 Society of Critical Care Medicine Podcast. I’m your host, Samantha Gambles Farr. Today I’m joined by John B. Sampson to discuss the SCCM Global Health AIRS program. Today we’ll be describing breathing new air into global health and where this initiative currently is today. Dr. Sampson, along with a team of clinicians, technicians, and SCCM staff, has worked closely with African governments and medical communities abroad in each country to bring oxygen to those most in need.

Dr. Sampson is a critical care anesthesiologist at John Hopkins University and director of the John Hopkins Global Alliance of Perioperative Professionals. He is also the founding president of the Institute of Global Perioperative Care. His global health engagement began as a medical student visiting Nigeria in 1989. Since that time, Dr. Sampson has engaged in the work in numerous countries, founded IGPC, and established numerous international Society of Critical Care Medicine courses in Africa and Asia.

Dr. Sampson has an interest in bridging the medical and cultural divide between America and Africa through education, training, technology, and historical forums. Through his work, he has introduced dozens of physicians, students, and others to Africa in a manner that has altered their perceptions, careers, and interests. Dr. Sampson currently focuses on improving access to anesthesia and critical care through training as well as access to sustainable oxygen and renewable energy in Africa through the SCCM Africa Infrastructure Relief and Support project, commonly known as the AIRS project. It is my immense pleasure to have you here today, Dr. Sampson. Before we get started, do you have any disclosures?

Dr. Sampson: Thank you. I have no disclosures to make.

Dr. Gambles Farr: Thank you very much. It’s been a busy year. It’s been a year since the AIRS project was officially launched in 2023 at Congress in San Francisco, and we felt it would be important to catch up with you and see exactly where the project is and what you see happening in the near future. I guess my main question surrounds where you think the project is right now. If you had three things for the audience to really take home from where the project is right now, what would those three things be?

Dr. Sampson: Number one, the environments, the countries that we’re working in. Some of those countries did not have any hospital in the entire country that had a sustainable oxygen supply, including their tertiary and teaching hospitals, up until 2020. So delivery of care was very difficult for the healthcare providers there.

Number two, some of the facilities that we’re working with were so energy constrained because of being off of the electrical grid and relying on diesel generators that they only kept the lights on half of the day so that they could save money from diesel energy.

Number three, the addition of oxygen access in a continuous and sustainable way, 24 hours a day, and energy for those countries that needed it 24 hours a day for their hospital facility would be transformative for the practice of medicine, transformative for training of new physicians, transformative for patient care and survivability of everyone from infants and newborns, pregnant women having babies, all the way through to critical care medicine, and allow for the advancement of healthcare in those environments, as well as giving the doctors and nurses we were working with exposure to research and coauthorship and papers to verify and document the progress that they’re making.

Dr. Gambles Farr: The interdisciplinary approach that is needed to pull off a project like this, when most people think about an initiative like this, they just think of it from the healthcare perspective. But for you, you’re talking about enacting change not only in the healthcare system but in the way that they provide climate protection for themselves and ensuring resources are going to the right avenues, such as healthcare and not being utilized in transporting oxygen. Can you discuss a little bit more about that?

Dr. Sampson: If we start with the multidisciplinary issue, then we start with the identification that we have to understand the environments we’re working in. And in the environments we’re working in, the multidisciplinary cadres, the categories of multidisciplinary people, are different. If you don’t have sustainable oxygen, one cadre that you don’t have is respiratory therapists. Why would there be a respiratory therapist if there’s no consistency of oxygen flow? On the other hand, you have a new cadre, the oxygen attendant. For example, in the Gambia, the oxygen attendant is of a very critical and pivotal role in terms of his position.

When any of the medical wards or even the operating room is going to start their day, they actually probably start their day by looking at what is the status of the two large oxygen cylinders on their unit. Will they have enough for the day? Do they need to contact the oxygen attendant, who they actually call the oxygen man, and find out what the hospital’s oxygen status is, and what the facility where they get the oxygen from, whether they are capable of replenishing the oxygen, or if they’re out of oxygen, of supplying oxygen to them. The oxygen attendant will also coordinate the delivery of a cylinder to them.

That is a role that we wouldn’t even think of having in our system, because we think of oxygen as being something that’s in unlimited supply, simply coming from the wall. They have no such assumption because there is no infrastructure for having anything coming from the wall. They are getting oxygen from cylinders that are trucked in. These are huge, heavy cylinders that weigh a considerable amount. There are oxygen attendants who get hernias, literally trying to simply transport those oxygen tanks. Those oxygen cylinders are so large and heavy that they literally damage the floors of the hospital itself, as well as consuming diesel energy in terms of both compressing the oxygen, 2200 pounds per square inch, as well as transporting the oxygen in a fleet of trucks that need to be also maintained.

So that whole system can have great benefit from having oxygen generation on site that is then piped to all clinical locations, which is what we’re doing. As a fringe benefit, because we’re working with our Ghanaian brothers and sisters in terms of implementing this project in lower-resource countries than Ghana, the Ghanaian brothers and sisters informed us that they could add extra value to the project by adding additional piping for medical air to blend the oxygen to the right concentration, and additional equipment for wall suction, instead of having unstable portable suctions in the operating room or in other areas. Just like we do here, they will plug it into a wall. It is exciting to even think about the changes in the way that people practice medicine after these infrastructure projects are executed.

Dr. Gambles Farr: When you live in a system that is resource rich like the U.S., like we do, you take a lot of things for granted. I know I had heard you telling one story about one facility or one hospital that had the oxygen, I believe, and had not turned on their oxygen for two years, had not functionally had oxygen for two years because of systematic issues that they were having. Can you describe some of those things, even if they have the tanks there available, some of the issues that hospitals like that undergo?

Dr. Sampson: Okay. Let’s just imagine that you are a college student on a fixed income, okay?

Dr. Gambles Farr: We can all relate to that.

Dr. Sampson: I am a rich uncle, and I’m going to gift you a wonderful car. I could gift you a Volkswagen Rabbit that is very energy efficient and doesn’t cost much energy to zip around from one place to the other. But I want to gift you something else. I’m going to gift you a nice, big, safe Hummer. But you have a very meager amount of financial resources and you’re so happy to get the Hummer because everybody’s looking at the Hummer. But in the first week of using your Hummer, you realize that, I can’t fill this tank up.

Dr. Gambles Farr: Can’t afford it.

Dr. Sampson: I can’t maintain this Hummer. That’s the situation, is that there are many entities, global entities, that are installing oxygen-generating plants at hospitals, and those hospitals are so happy. Just like as a college student, you are so happy to take that car. And the fact that it’s a Hummer, you’re even more happy, until it comes time to fill up the tank, and you realize that you can’t afford it.

So what are you going to do? You’re going to park the Hummer somewhere, and you’re not going to use it, because it takes too much to run it. So that’s what will happen. They’ll spend hundreds of thousands of dollars in just one facility for an oxygen-generating plant. They’re not going to pipe the oxygen from the plant to the parts of the hospital. They’ll say, no, that’s more expensive. We’re just going to fill cylinders, which the stress of filling cylinders increases the maintenance requirements of the plant.

Also, filling cylinders, compressing the oxygen to 2200 pounds per square inch, requires a lot more energy, but it’s a cheaper way to start up. So you’re going to start it cheap. You’re going to have a nice oxygen plant, and then you can’t afford to fill up those cylinders. You can’t afford to run the plant, and then you’re trying to figure out how you’re going to juggle this.

So the way that we’re looking at it is that we’re going to pick the most energy-efficient method of making the same amount of oxygen, with the same quality of oxygen, and deliver it not by trucks, but pipe it to every area of the hospital that’s needed, so that their ongoing energy needs are much less, less than a third of the amount, not including the fact that we’re not trucking it around.

Because sometimes it’s not global partners. In this case, the case that you’re describing, a private hospital was very proactive and purchased a very beautiful oxygen plant from Turkey. It’s an international plant, so it’s actually manufactured in China, sold by Turkey. But when they turned that thing on, they realized that they would have to pay more money for diesel generators to create electricity for the oxygen plant than they were previously spending in purchasing oxygen in cylinders. And since this was a business situation, this is a private hospital we’re talking about that we visited, then they decided, we’re going to leave that oxygen plant off, just like you would have left the Hummer parked in one location. So that’s what happened.

Because we went and visited them, we have an international, pan-African solar partner that has offices in the Congo and in Togo, and we paired them with our pan-African solar partner. They made a private partnership deal, and that solar partner is, right now, as a fringe benefit from our project, working to install a solar facility specifically tailored for their oxygen plant, so that their oxygen plant will be actually powered by solar.

Dr. Gambles Farr: That’s amazing. I love the analogy of the Hummer, because that really puts it in real time of how you can, even having the resource, not have the ability to actually enact the change because of the additional layer of lack of access to resources. It doesn’t matter if you have this beautiful car, like you said, the beautiful oxygen tanks there. If you cannot get the oxygen from the tank to the patient, what good is it? This is what makes this program so unique, because most people are just thinking that this is just about taking oxygen tanks. And it’s so much more than that.

Dr. Sampson: Exactly. Now there’s another thing about that Hummer. Because I learned that you could actually be driving on a road in Texas, in your nice Volkswagen Rabbit or electric vehicle, and a big old pickup truck or maybe a Hummer will come around and he’ll rev up his engine and he’ll do something that’s called blowing coal, which means that he’ll rev up the engine so that there’s a huge plume of black exhaust, rich with carbon dioxide, to blow at you for his own enjoyment.

Well, the interesting thing is that the analogy flows through that as well because, if you have a gas-guzzling oxygen plant, then for every liter of diesel energy that you add to fuel that plant, then you are also creating an additional load of carbon dioxide. In addition, if you haven’t piped the oxygen and you’re running a bunch of diesel trucks back and forth, then you’re also creating an additional load of carbon dioxide. Then, if all of your oxygen has to be delivered by compressing it at 2200 pounds per square inch because there’s no piping system to deliver it at 50 pounds per square inch through the tubing, then you are also creating an additional CO2 product.

Now the frustrating thing about it is that sometimes, sometimes, when we communicate this to various people in the international community, then they say, so what? I guess that goes to the fact that some people believe that conserving carbon dioxide output and conserving the climate for some people is a so-what. But we hope that we can somehow get the message through that, when you’re talking about the environment, every bit counts.

I mean, if you are just polluting, one person throwing something on the floor, it counts. Okay? One person using something that just produces tons of CO2 out, it counts. And from an economic standpoint, a country that is picking renewable energy and clean technologies, they can literally get money in terms of international carbon units, so for them, it also counts. But we are really working to get the word out to the international community that has stakeholders relating to oxygen to think about this. Because right now, just doesn’t seem like they’re thinking about it.

Dr. Gambles Farr: But I think that there’s another aspect to that. If they’re not thinking about it, we know that, in areas that have lack of access, don’t have equity, we know that those areas suffer from environmental strains that other areas don’t. Those are the areas, not specifically saying that in the Gambia and in those areas that they necessarily have power plants and things like that. We also understand that that’s another component of having communities that don’t have access and don’t have money. They put these things that are not kind to the environment, that have real implications on health for the people living in those areas, so I think not paying attention to that footprint, it may not matter now, but we don’t know what it’s going to do down the line, right?

Dr. Sampson: In addition to that, there’s something that we all share and that is the atmosphere. So, ultimately, whatever happens anywhere in the world, it all contributes to the carbon dioxide in the atmosphere, and it is the cumulative amount that’s going in the atmosphere that affects global warming and climate change.

Dr. Gambles Farr: Can you describe exactly how many hospitals or how many entities are actually being worked on right now as far as the entire plan that you have in place? I know we’re in the Gambia and I know that we’re in Liberia, correct? Do you know how many facilities are up and actually running? Do you have a number or a list?

Dr. Sampson: We’re about maybe halfway through the project, and our current implementee projects are in the Gambia, Liberia, and Sierra Leone, with Ghana participating as an implementer. In other words, we are working with our Ghanaian partners to help the lower-resource countries to implement. There’s a south-south connection that is going to pay off in the end in terms of sustainability and in terms of education as they help to educate the lower-resource countries in how their biomedical techs can maintain these facilities.

We have a biomedical tech training program as another multidisciplinary feature that is key to the sustainability of this project over the long term. In each of those countries, we consulted with the national stakeholders of the country to work with them so that they could identify which facilities would be best in keeping with their national health priorities.

Now with the Gambia, they were almost so elated that they were in disbelief that this project could even exist. With decades and decades and decades of the entire existence of their country, the homeland of the famous Kunta Kinte, that there had never been anyone to come and create oxygen-generating plants. During the time that we were working with them, an international initiative spurred by COVID did come and create three oxygen plants without the piping, without an energy-efficient solution, and without paying attention to some of the things we discussed.

So what they told us, they said, we want you to provide this unique solution of oxygen to our most important and only tertiary referral hospital in the country, our only training hospital that trains doctors, nurses, and all healthcare providers in the country, which is in the capital, which is the Edward Francis Smalls Teaching Hospital in Banjul, the Gambia. So that’s where we focused in on. The hospital has never had oxygen, so there’s no piping infrastructure at all in the hospital.

The minister of health of the Gambia had just recently told me that when he was chair of surgery just a couple years ago in that same hospital, he was left with half of a cylinder of oxygen as the only oxygen for the entire institution. When they could, they would actually purchase industrial oxygen, not for human consumption, from an oxygen company that makes oxygen for welding and building. That is the level of desperation. They will also purchase oxygen at three to four times the cost of the oxygen from neighboring Senegal and have it trucked across the border to the great financial benefit of middlemen to the facilities, with all of those dollars being spent going away from patient care just to make ends meet as much as possible with oxygen.

They also had what’s called bedside oxygen concentrators, about two in each unit, that when you plug it into the wall, it can convert five liters per minute of room air into about 93% oxygen. However, whenever there’s a power failure, even a brief power failure, that oxygen concentrator turns off, and if you are dependent on oxygen for your life, then you don’t have it. If you need more than five liters per minute of oxygen, then you don’t have enough. If you need oxygen for mechanical ventilation for critical care medicine, then you can forget it with the oxygen concentrators. You need an oxygen cylinder, and if the oxygen cylinders are dry, then either you’re going to cancel all surgeries for the day and you’re going to say prayers for your ICU patients. Will the oxygen cylinders last long enough before you get replenished, before those ventilators turn off?

Dr. Gambles Farr: Which is why a lot of people say the COVID pandemic shed light on this. It did in a way, but in a way that most people did not expect, because the response to the COVID pandemic was, let’s send ventilators to these places. But the ventilators weren’t any good because they had no oxygen.

Dr. Sampson: They had no oxygen. The ventilators had no oxygen. The idea, at least when I initially heard it, the idea that, let’s say, a car company like Ford or a vacuum cleaner company like Dyson is going to suddenly make a ventilator that has the safety features that ventilator companies that professionally make ventilators have tried to develop over many, many decades is also faulty, as well as the sustainability of those ventilators, because once COVID is over, all of the effort to maintain those ventilators or even spare parts is gone.

We actually have to pray that now that it’s not a COVID pandemic, will the international community now, without the urgency of COVID, now turn their back on this ongoing, continuous disaster of trying to give healthcare facilities, hospital facilities, without reliable oxygen and allow the deaths and disability of infants, premature babies, pregnant women, people with asthma, COPD patients, pneumonia patients, trauma patients, stroke patients, or heart attack patients, allow them to continue to die because there’s not something like COVID to press on them to do that?

Will they just look at this as a temporary fad that we’re going to build some oxygen facilities, some oxygen-generating plants for some of the hospitals for a period of time, and then turn our back on that, go back to the old way of just like, we’re only going to support temporary medical missions? Or will they see the wisdom that they need to continue the effort to help healthcare facilities, hospitals, to continue to give so that their doctors and their nurses could actually use the knowledge and skills that they developed during medical school and training in their hospital, that their doctors and nurses could actually provide modern medicine in their hospital without dreaming about coming to the United States or England, that their hospitals actually have something for them to work with?

Dr. Gambles Farr: And for the people that they serve.

Dr. Sampson: Yes.

Dr. Gambles Farr: In talking about that, we heard during the opening lecture, we had the former surgeon general here talking about health equity, not equality, and himself suffering from asthma as a young child and telling some of his story as well. Hearing everything that you just said about the international community keeping itself accountable for this process that we have started and not stopping because it’s no longer a pandemic and we can take our foot off of the gas somewhat. Can you talk about how the past 100% has predicted where we are right now, as far as the history of these areas and the things that they have endured over time that presents them directly where they are right now?

Dr. Sampson: Okay. In terms of global equity, I will basically reflect on the name of our organization at Johns Hopkins University, which is the implementing arm of the Society of Critical Care Medicine project. The organization that we created within Johns Hopkins is a multidisciplinary organization as well as one that reaches out to work with people in other institutions. In other words, it’s an alliance. It’s the Global Alliance of Perioperative Professionals, abbreviated GAPP, with the tag name of Closing the Gap on Global Health Equity.

So now we go to global health equity and we have, unfortunately, the father of global health suddenly passed away last year, Paul Farmer. But in his final book that he wrote right before he passed away, he actually focuses even on the same geographic region that these different hospitals are in, and he actually talks about the fact that the hospital systems were not built to serve the people living there. They were built to serve the needs of the colonial infrastructure. When the colonial entities left, they left with an infrastructure that wasn’t designed to serve the people because it was designed for the survivability of the colonists who also would be leaving the country as soon as they could once they’re stabilized.

Now you can have the wealthy do that instead of the colonists, but the healthcare systems are not designed for the survivability of the people. Now what Paul Farmer says is that there is a difference in terms of how we look at the value of human life of different populations. He uses, as an example of this, the Ebola epidemic and the handling of the Ebola epidemic. The fact that Sierra Leone, one of the countries that we’re doing this project in, basically had a world-renowned virologist who was from their country, in Sierra Leone, who was so world renowned that international entities had developed an entire virology center around him.

Being a virologist with a virology center, he encountered Ebola early on. But the international Western partners that were responding to the Ebola epidemic chose not to evacuate him to get Western care, not to give him access to IV infusions, to fluid resuscitation, to mechanical ventilation, to dialysis, or any other stuff that he may need in order to survive the Ebola infection that he had. Those things that would be available to any American or European who got Ebola, they would be evacuated so they could get those things.

They said no. He is Sierra Leonean, so he should get the standard of care of any other Sierra Leonean, regardless of the fact that he is literally a national treasure. He was a unique individual. He did not survive. There were other unique individuals who were also denied evacuation, did not survive because they were not American, they were not Western.

The actual care that was given were the people who were being treated by the heroic Westerners who did go down heroically to help with the Ebola epidemic, were they actually providing Western-level care? Were they providing any of the services that anyone who is evacuated out got? What we’re proposing is a different way of looking at this. It shouldn’t be that if you live in one community or if you live in another community, this community has a high value of life and this community has a low value of life, that we’re just going to do temporary measures to temporarily give surgical care, temporarily give medical care, and just leave for this community.

But this community, it’s important that we install the infrastructure and make sure that it can sustainably be provided for healthcare delivery with the population. This is a way of strengthening the healthcare systems in Sierra Leone and Liberia and the Gambia.

Dr. Gambles Farr: It’s almost the adage of, if you give a man a fish, he’ll only eat for one day. But if you teach him how to fish, he can feed himself. It’s the same thought process behind the oxygen, setting up the oxygen, making it sustainable, making it environmentally safe, making sure that they have the infrastructure that they need so that when we decide to take our foot off the pedal, for lack of a better comparison, they are self-sustained themselves, that they can do it themselves and they’re not dependent on other countries to help them but they’re able to do it themselves.

Dr. Sampson: Exactly, right.

Dr. Gambles Farr: That is the goal and, in doing that, I guess my next question is, with everything that we’ve talked about, I know that there are so many people in the Society who are extremely grateful for your vision and your leadership and really shining a light because there are times that people, if you don’t know the environment, you don’t know those problems.

However, when those problems are brought to you in the way that you have brought them to us in the Society, people want to be of service and they want to be in alliance with closing that gap of global health equity. How can someone help right now? Is there anything that anyone in the Society needs to do in order to support the initiative moving forward and making sure that it stays consistent and that we stay accountable?

Dr. Sampson: Let me address that in two ways. First, I think it might be useful just to update where the three different country projects are, and then from there, address how people can help in the accountability part. The Gambia project is at the level where the biomedical tech training program is almost completed, at which point the biomedical techs will take a very intense online training program with iPads that have a data plan where each person can actually study that program and take the program on their own time while they’re at home. They will then, having completed that program, take hands-on training from the installers and the training program company that we’re working with to actually, in a hands-on way, learn how to maintain oxygen-generating facilities.

They will then repeat that training program, more as a teacher point of view, from the ones who are the star teachers, and they will do that until they can demonstrate that they can actually teach as well as understand the program, that they can actually teach it to others. This is tailored to the unique technology, vacuum swing absorption, that we’re using for this particular project because, since it’s a unique technology, there hasn’t been a program like this for this technology that was developed.

From a physician standpoint, we right now have a team in the Gambia that is making sure that the doctors and the nurses and any other ancillary healthcare providers are up to date on just the basics of the recognition and treatment of hypoxic patients and how to access the wall devices for oxygen, medical air, and suctioning that we are installing as a new infrastructure feature in their hospitals.

In addition to that, the Ghana installation team is about three-quarters of the way finished with installing piping that will take the oxygen to every single clinical location in an entire 700-bed hospital, while in about two weeks, the actual oxygen generation plant will arrive. They will install that, connect it to the piping, connect it to the electricity with the assistance of the biomedical techs who are learning about maintenance, and then the flow of the oxygen will start with about a three-year maintenance program as a redundant thing on top of the biomedical techs who are doing this.

That’s the level of The Gambia project. The Gambia project does not have a solar component because, being in the capital, their electrical grid is relatively stable and, though they occasionally have power outages, those power outages are relatively short and will not affect the delivery of oxygen from our equipment.

In Sierra Leone, there are some other initiatives to develop oxygen resources, but they lack the energy resources to maintain those. In the second largest city in Sierra Leone, we are installing a solar system to provide renewable energy to every clinical location and therefore decrease the load of their diesel generators and therefore bring more diesel dollars into the healthcare system. Diesel dollars to healthcare dollars is our motto.

In Liberia, the Ministry of Health of Liberia chose for us not to do a project in the second-largest city or the largest city or the capital, but they chose to actually address one of their most underserved areas of Liberia, an area that is called the Mississippi of Liberia because it was originally settled by African-American freed slaves who left a plantation in Mississippi and reconnected to Liberia in this particular area. So it has that connection to the United States, but it is in a remote area that is a day’s journey away from the capital and is not connected to the electrical grid. They leave the energy off half of the day every day because of the cost of energizing their diesel generators.

What we’re doing there is a 100-bed hospital. We’re providing oxygen that’s piped to all clinical locations like the Gambia, though a smaller system, and we’re providing medical air like the Gambia and wall suction like the Gambia, but we’re also, very importantly, installing a solar farm that can provide all clinical areas of the entire hospital, not just the oxygen generation plant, but the entire hospital’s clinical areas will have continuous electricity that is stored in batteries that can continue all through the night every day and therefore transform their energy situation. Their equipment is accumulating in Liberia and the solar installer is actually already installing the panels. Theirs is going to be finishing shortly after the Gambia project is finished. That’s the current status of the project right now.

We are really concerned that, we have historically seen the patterns of different medical fads and excitements that have happened in different locations, and we’re concerned that the international donor community, will they continue to do these meaningful healthcare-strengthening things that give doctors and nurses value to their work, that help save lives of everyone from newborn babies to elderly patients within a hospital and allow the delivery of general medical care as well as critical care medicine?

I think one of the most valuable things that anyone can do is to help lobby to anyone that is a potential stakeholder, from the United States to the World Bank or the WHO, that they should continue to do this type of work, that this is an ongoing disaster every day in the lives of people who live in locations where their literal hospital doesn’t have oxygen to take care of their asthma when they have an asthma attack, doesn’t have oxygen to take care of pneumonia when they have pneumonia. The basic service of expecting oxygen at the hospital is not something that they can rely on. That lobbying and that advocacy is something that I think is probably one of the most important things that anyone can do to help with this type of work.

Dr. Gambles Farr: Dr. Sampson, thank you so much. Everything that you said was so poignant and just reminds me why I got into healthcare, why we do the things that we do. No one, like you said, should die as a result of such a simple illness as asthma simply because they don’t have oxygen. We would find that completely absurd in the United States. To think that that same thought process is not carried throughout the world baffles me.

Dr. Sampson: I agree 100%.

Dr. Gambles Farr: Well, you guys have tuned into another SCCM Podcast. It was a good one, with Dr. Sampson giving us an amazing update on the AIRS project, breathing new air into life. We are enthused, we are encouraged, and we are proud to stand by you and lobby with you and for the people we are trying to serve, touch, and ensure that they have access and equity in all things as it relates to healthcare. Dr. Sampson, thank you so much for joining us. I really appreciate it. We look forward to the next update, and you are moving at speed of light over there. We appreciate you.

Dr. Sampson: Thank you.

Dr. Gambles Farr: You’re welcome. Tune in next time for the next SCCM Podcast. This is your host, Samantha Gambles Farr, signing off.

Announcer: Samantha Gambles Farr, MSN, AG-ACNP, FNP-C, CCRN, RNFA, is a nurse practitioner intensivist at University of California San Diego Health in the Department of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery at the University of California San Diego Health. She also serves as adjunct faculty at University of San Diego Hahn School of Nursing and Health Science in its nurse practitioner program.

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