President's Message: Exploring SCCM: Breathing Life Into West Africa

The Society of Critical Care Medicine (SCCM) has long been involved in multiple efforts to bring critical care relief and volunteerism to areas of need affected by low resources, disaster, or war. One of the most notable efforts during the past decade has been to bring reliable and sustained medical oxygen and electrical power to hospitals lacking these resources.

The World Health Organization notes that oxygen is an essential inpatient medication without substitute for treating patients with respiratory illnesses, such as pneumonia and chronic obstructive pulmonary disease, and to support anesthesia, surgical, and intensive care unit (ICU) care. Lack of access to oxygen leads to increased morbidity and mortality in vulnerable populations such as neonatal, pregnant, and elderly patients.¹ 

In 2020 and 2021, it became evident from the COVID-19 pandemic that many hospitals throughout West Africa lacked access to consistent medical oxygen and, in some countries such as The Gambia, no hospitals had oxygen delivery systems beyond oxygen concentrators and purchased oxygen cylinders. In low-resource regions, including many areas of Africa, lack of oxygen supply is directly connected with lack of reliable electrical power supply. 

In 2023, SCCM launched the global health initiative Africa Infrastructure Relief and Support (AIRS). This project began after discussions with government officials and healthcare professionals from The Gambia, Liberia, and Sierra Leone about how to address the dire and ongoing lack of reliable oxygen supply at healthcare facilities. Funded by a $5.5 million grant from Direct Relief, SCCM partnered with the Johns Hopkins University Global Alliance of Perioperative Professionals and the Institute of Global Perioperative Care (IGPC). Direct Relief’s investment in the AIRS project represents its single largest investment in oxygen delivery availability to date, building on its efforts in recent years to equip healthcare professionals across 65 countries with oxygen generation plants, ventilators, and oxygen concentrators. AIRS sought to develop solar energy systems to power medical oxygen delivery systems in hospitals in The Gambia, Liberia, and Sierra Leone.

“For most of us working in a hospital in the western world, we expect that we will immediately get 100% medical-grade oxygen through a face mask, cannula, or ventilator by pressing a knob on the wall,” said John Sampson, MD, chair of the SCCM AIRS project and associate professor in anesthesiology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. “This is not the case in The Gambia, which, until last year, did not have any oxygen delivery systems and relied on oxygen cylinders.” The use of oxygen concentrators and imported oxygen cylinders left patients vulnerable and resulted in most of a hospital’s monthly revenue being used to purchase oxygen while still having insufficient amounts to safely care for operative and critically ill patients.

The installation of oxygen generation capability in these hospitals was no simple task, requiring careful planning and engineering for each site.  The AIRS team used a highly energy-efficient oxygen generation technology, piping oxygen to each patient’s bedside with a monitored gas delivery system, piping medical air along with the oxygen so that adjustments can be made for the percentage of oxygen administered, and using the infrastructure of piping to allow hospital-wide wall-based suction at every bedside.

Profoundly interconnected with oxygen supply in hospitals is continuous and reliable energy systems to power everything, such as lighting, sterilizing, cooking, cleaning, and monitoring systems. In many low-resource areas, electrical power is not consistently available around the clock, even for a hospital that may be the only one for miles. Often these hospitals use diesel generators to produce electricity that lasts only as long as fuel is available. Unreliable power supply directly results in deaths of patients who are undergoing surgery, supported on ventilators, or reliant on other powered equipment that fails in the middle of treatment and may not restart for days.

In Sierra Leone, the priority was energy stabilization. Persistent power failures interrupted oxygen generation and all other technological aspects of care in the Bo Government Hospital. The AIRS team organized the construction of a solar energy delivery system to relieve the hospital from its dependence on diesel generators. The new solar energy system provides uninterrupted power to all critical clinical areas of the hospital, including the ICU, neonatal unit, operating rooms, emergency department, labor and delivery area, and some of the pediatric and general care wards. 

Dr. Sampson said, “The Bo Government Hospital nursing staff were used to coming to work and not knowing whether the lights would work throughout the night or not. Now the nurses come to work at night and know they can actually continue pushing patients forward toward discharge. They can provide necessary medical care throughout the night because they're going to have electricity all night.”

The 700-bed Edward Francis Small Teaching Hospital in Banjul, The Gambia’s largest teaching and tertiary hospital, was founded in 1853.  Before the AIRS project, the Edward Francis Small Teaching Hospital spent more than 50% of its annual budget on oxygen cylinders, which constrained all other essential functions, including medications, staff salaries, and technology upgrades, while rationing electricity in the hospital for nearly half of every day.  

The Gambian Ministry of Health requested that oxygenation at Edward Francis Small Teaching Hospital be the focus of the AIRS project because of the hospital’s importance to the region. The AIRS team installed two large vacuum swing adsorption (VSA) oxygen generation plants that provide oxygen using approximately one-third of the energy required for traditional oxygen plants that use pressure swing adsorption (PSA). The AIRS team piped the entire hospital for oxygen delivery, including medical air delivery and wall suction at every bedside. The plants are fully operational and, with the piping and gas monitoring system, form an oxygen delivery system, providing oxygen in every patient room.

The electrical grid in Liberia has long been severely unstable, making a dependable and renewable energy program absolutely necessary to render benefits for any oxygen-producing program. Furthermore, certain rural parts of southern Liberia often become isolated from the capital during the rainy season due to poor road conditions. 

The 100-bed F.J. Grante Hospital in the rural south of Greenville is not connected to the national energy grid and has never had access to sufficient oxygen or energy to meet clinical demand and has had to ration both resources, often at the cost of patient survival. Hospital policy dictated that electricity could not be maintained for a full 24-hour period unless a patient’s family or somebody else subsidized that day’s generator cost. The hospital’s remote location limited the delivery of oxygen cylinders, and bedside concentrators could function only when electricity was on. In December 2024, the AIRS team installed a solar energy system accompanied by a VSA oxygen generation plant in F.J. Grante Hospital. Solar panels and batteries were installed and are now 100% operational. 

Bringing clean, consistent, and sustainable oxygen delivery systems and solar energy systems to key hospitals in The Gambia, Liberia, and Sierra Leone has brought greatly needed infrastructure support. Another benefit AIRS provided was education and ongoing training. In collaboration with Safe Surgery Initiative biomedical trainers, the AIRS team trained hospital-based biomedical technicians on how to manage VSA oxygen delivery systems with both hands-on and online components of training as well as maintenance of solar energy delivery systems and oxygen delivery systems, including maintaining oxygen piping, air compressors, and oxygen boosters. 

The AIRS team identified local technicians to be trained online in coordination with Solar Energy International before traveling to Ghana for hands-on solar training and certification from an SCCM partner. With this in-depth training of workers who will operate and maintain oxygen generating systems, SCCM fully expects these systems to contribute to lifesaving health system strengthening for many years to come.

To further support West African clinicians, SCCM and its partners at Johns Hopkins University organized refreshers on the recognition and treatment of hypoxic patients at project hospitals. SCCM offered complimentary membership as well as Fundamental Critical Care Support (FCCS) training for healthcare professionals in the three project countries. 

In July 2024 and March 2025, SCCM held multiple FCCS courses in The Gambia, Liberia, and Sierra Leone, including the core FCCS, FCCS: Pediatrics, and FCCS: Obstetrics. More than 100 learners were trained, equipping them with knowledge and skills to provide high-quality care to critically ill and injured patients.

SCCM continues to seek further improvements in sustainable energy production, oxygen generation, and other support for hospitals in the region through the AIRS project. Anyone who wishes to support this effort is invited to connect with me or SCCM Chief Philanthropy Officer Mark Lenhart with any questions or comments.


References

1. World Health Organization. Oxygen. Accessed September 8, 2025. https://www.who.int/health-topics/oxygen#tab=tab_1