The Africa Infrastructure Relief and Support (AIRS) project focuses on delivering stable medical oxygen and electricity to hospitals in Sierra Leone, the Gambia, and Liberia, empowering clinicians to provide effective lifesaving care.
Imagine a patient who desperately needs surgery. The patient is ready for surgery, the surgeon is ready to operate, then the power goes out. By the time electricity is restored, the patient has died. In many sub-Saharan African hospitals, unstable or nonexistent electrical infrastructure is a daily reality. “Frequent power outages disrupt healthcare, damage equipment, and severely affect patient care,” said Society of Critical Care Medicine (SCCM) President Lauren R. Sorce, PhD, RN, CPNP-AC/PC, FAAN, FCCM. “Night-shift nurses face uncertainty, oxygen delivery is inconsistent, and surgeries are often at risk of failure due to power loss. This instability increases patient morbidity and mortality, impacting care from childbirth to critical illness management.”
Beyond the need for consistent electricity, many hospitals in western Africa do not have reliable access to medical oxygen. There is no substitute for oxygen, which is needed in many medical settings, such as intensive care units, operating rooms, delivery rooms, and emergency transport.
SCCM has been providing fundamental critical care training in Africa for decades, but its impact has been limited by the lack of reliable electricity and medical oxygen. Thanks to a $5.5 million grant from Direct Relief, SCCM launched the Africa Infrastructure Relief and Support (AIRS) project in 2023 in collaboration with the Johns Hopkins Global Alliance of Perioperative Professionals (JHU-GAPP) and the Institute of Global Perioperative Care (IGCP). AIRS focuses on delivering stable medical oxygen and electricity to hospitals in Sierra Leone, the Gambia, and Liberia, empowering clinicians to provide effective lifesaving care.
Sierra Leone
Bo is the second largest city in Sierra Leone, and Bo Government Hospital is the city’s largest hospital. Its biggest need was a reliable source of power. Like many hospitals in the area, it relied for electricity on diesel generators, which are unreliable, expensive, and environmentally unsound.
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| Left to right: John Sampson, MD, IGPC; Dr. Jalikatu Mustapha, Deputy Minister of Health of Sierra Leone; and SCCM’s Mark Lenhart at the inspection of solar panel installation at Bo Government Hospital in Bo, Sierra Leone. |
The AIRS project delivered and installed solar energy panels outside the hospital to create a renewable energy source. In addition to powering clinical areas of the hospital, the solar panels will help the hospital end its dependence on diesel generators and correct energy challenges that limited the use of an existing oxygen-generating system.
“Renewable, resilient, and sustainable energy is crucial to hospitals in these countries as power outages are common and access to electricity can be limited,” said Mark Lenhart, SCCM’s manager of global health and donor development. “Hospitals regularly face poor power quality issues, which damage equipment. Without clean and green reliable power sources, hospitals cannot provide critical care to patients or operate essential medical equipment.”
Solar energy brought much-needed electrical reliability to the hospital. “The nursing staff were used to coming to work and not knowing whether the lights would work through the night,” said John B. Sampson, MD, associate professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine and chair of the AIRS project. “Now the nurses come to work at night and know they can actually continue pushing patients forward toward discharge. They can provide the necessary medical care throughout the night because they’re going to have electricity all night. We are also eager to discover healthcare delivery improvements that the hospital may make through the reallocation of funds that were previously used on diesel fuel, oil, and generator maintenance.”
The Gambia
Edward Francis Small Teaching Hospital in Banjul, the Gambia’s capital, is the largest hospital in the country and is three times the size of Bo Government Hospital in Sierra Leone. The AIRS project piped the entire hospital for oxygen delivery, medical air delivery, and wall suction at every bedside. The piping and accessories have all been installed, as well as an energy-efficient vacuum swing adsorption (VSA) oxygen plant and air compressors. Final steps and testing are expected to be completed at the end of December 2024.
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| Lauren A. Plante, MD, MPH (center) teaches intubation skills during the FCCS: OB course in the Gambia. |
In July 2024, SCCM held two training sessions in the Gambia: a Pediatric Fundamental Critical Care Support course led by SCCM members Mohan R. Mysore, MD, FAAP, FCCM, and Joram Nyandat, MD, MPH, and a Fundamental Critical Care Support: Obstetrics course led by Madian Yahya, MD, and SCCM member Lauren A. Plante, MD, MPH. These courses trained 60 learners to ensure their ability to provide high-quality care to critically ill and injured patients.
In August 2024, members of SCCM, Direct Relief, JHU-GAPP, and IGCP traveled to Sierra Leone and the Gambia to participate in the commissioning ceremonies for the project. In the Gambia, the AIRS team was greeted by the First Lady of the Republic of the Gambia, Her Excellency Madame Fatoumatta Bah-Barrow. “The first lady’s passion for the healthcare of her people was palpable,” said Dr. Sorce. “As we walked through the hospital campus, I imagined the impact of this new support—how many now would survive hypoxemic respiratory failure and other pathologies with a ready source of oxygen? Once again, I was struck by the impact of the project.”
Liberia
At the rural F.J. Grante Hospital in Greenville, Liberia, the AIRS project is working on producing solar power and building an oxygen-generating delivery system that includes an energy-efficient VSA oxygen plant, piping of oxygen to all clinical areas of the hospital, piping medical air to all clinical areas, and wall suction at every bedside. Liberia’s Ministry of Health helped coordinate the project, highlighting its importance for national healthcare security.
The hospital is in one of the most underserved and under-resourced areas of the country, said Dr. Sampson. “They aren’t on the electrical grid and can’t afford diesel-electric generators for 24 hours a day, and there’s no way to get oxygen except for expensive intermittent cylinders,” he said. “People were dying because of energy reasons and people were dying because of oxygen reasons.”
Construction and installation for solar energy are under way. Fortification of the land around the hospital with rocks to support solar panel installation is almost complete, and equipment is being moved to the hospital to prepare for the piping to begin. The work is scheduled to be completed by the end of December 2024.
Ensuring the Future of Reliable Electricity and Oxygen
To prepare for ongoing equipment maintenance in each region after installation is complete, several people identified by the project team are undergoing biomedical technician training to maintain and repair solar panels, maintain oxygen piping, and manage oxygen facilities.
Five people obtained solar training certification by undergoing online training through Solar Energy International on solar panel maintenance, in addition to hands-on training in Ghana. Eight people completed online training for oxygen delivery system maintenance and oxygen facility management certification. The technicians will undergo in-person training after the oxygen-generating system is completed in the Gambia and Liberia. The AIRS project team will also implement a train-the-trainer program to prepare the technicians to teach others and promote a culture of maintenance in West Africa.
SCCM has executed agreements with the installation companies in each location to maintain the equipment, support the trained technicians, and foster a smooth transition to the countries’ ministers of health and hospital leadership. The goal is to build a culture of maintenance and ensure that the installed equipment is maintained in good condition for years to come.
“Critical care can’t be practiced without oxygen and reliable energy,” said Dr. Sampson. “We’re empowering the doctors and nurses who are giving all aspects of care to use the knowledge and skills that they trained for to actually deliver care for their own patients.”
