In the realm of healthcare, few resources are as indispensable as medical oxygen. From battling the perils of Covid-19 to aiding the treatment of respiratory ailments and childbirth complications, oxygen stands as a cornerstone of modern medicine.
In few places is this significance more apparent than in South Africa, a country marked by both the persistent burden of respiratory disease and the urgency brought forth by the Covid-19 pandemic.
South Africa’s healthcare landscape is marked by a complex interplay of factors that make it particularly vulnerable to the impact of diseases requiring oxygen therapy.
With a population beset by a high prevalence of respiratory illnesses aside from Covid-19, such as chronic obstructive pulmonary disease (COPD), asthma and pneumonia, the demand for medical oxygen has never been more acute.
According to a study published in the South African Medical Journal, Ravensmead in Cape Town has the highest prevalence of COPD among 47 towns and cities globally (19%), and South Africa the highest incidence of COPD among 24 countries surveyed.
Moreover, the country’s alarming burden of communicable diseases, compounded by the ever-present threat of emerging pathogens, heightens the need for a robust and accessible oxygen infrastructure.
The stark reality of the Covid-19 pandemic further magnified the country’s vulnerability. As the virus wreaked havoc on global healthcare systems, it exposed the fragility of medical oxygen supply chains in resource-constrained regions.
The sudden surge in severe respiratory cases due to the virus strained the existing healthcare infrastructure, spotlighting the critical importance of oxygen in treating patients with acute respiratory distress.
The situation was particularly dire in South Africa, where both the prevalence of respiratory illnesses and the rapid spread of the virus converged to create a perfect storm.
At the forefront of addressing this challenge is O2Africa, an organisation that has embarked on a journey to transform medical oxygen production and distribution.
By enabling onsite oxygen generation through pressure swing adsorption (PSA) technology, O2Africa aims to ensure there is a constant supply of medical-grade oxygen to hospitals, which is used to support the treatment of patients.
Having recently joined the Every Breath Counts (EBC) coalition, the company has begun to make inroads into multiple organisations and global health nonprofits such as Build Health International (BHI), CHAI (Clinton Health Access Initiative), and Assist International.
“There’s a lot of opportunity and potential in some of the stuff we’re doing, especially with the NGO’s operating across Africa,” said David Kempe, Commercial Director of O2Africa, who spoke to gasworld.
Building a name is important in the South African medical oxygen industry which is traditionally dominated by companies such as Afrox, Air Liquide and Air Products.
Although the company sees opportunities in rural communities and smaller hospitals and clinics across the country, Kempe highlights the advantages of using the company’s expertise in PSA over bulk liquid oxygen and traditional distribution – an industry vulnerable to the unpredictability of transport-related logistical challenges.
“The price of getting it there and cylinder rental coupled with the time it takes to get there, it’s a serious issue,” he explained.
When it comes to PSA systems, Kempe emphasises the advantage that O2Africa has by being ‘a South African company on the ground and close to the African market.
Many PSAs sold to hospitals in the country and across the continent are from international companies, which tends to result in plants not being serviced or maintained on a regular basis, leading to breakdowns and a drop in production capacity.
We’re not scared of a crisis, we’re used to it…
By operating in South Africa, the company – although relatively small – believes that it holds an advantage over larger firms that may be detached from the continent itself and the challenges it presents.
“People are starting to get attracted to the idea that we’re on the continent and we know what Africa is like,” said Kempe. “We’re not scared of a crisis, we’re used to it and we actually have got to get out there and get it done ourselves, which is what we’re trying to achieve.”
“From a PSA perspective and from an oxygen and nitrogen production space in South Africa, there’s no real companies on the ground here that do it, that’s why we started.”
Disrupting an industry
The impact of the Covid-19 pandemic exposed the underlying inequities in access to medical oxygen in low- and middle-income countries (LMICs), prompting the Access to Medicine Foundation to analyse the efforts of some of the world’s largest gas companies to ensure that oxygen reaches the people who need it.
Having analysed six major gas companies that also produce medical liquid oxygen (Air Liquide, Air Products, Linde, Messer, Nippon Sanso Holdings Corporation and SOL Group), the report revealed that some of these companies demonstrated ‘agile’ approaches to increase supply during the pandemic.
Despite this, the report suggested that efforts were limited in geographic reach, prompting AMF to outline six priority areas for action to sustainably scale up access to medical liquid oxygen in LMICs.
According to O2Africa, this may provide opportunities for smaller companies such as itself to take advantage of ongoing backlog issues and disrupt the larger, more established companies.
“I think the problem that the medical industry and even the steel industry faces is that the amount they are consuming on a daily to monthly basis isn’t always consistent,” said Kempe.
“So tomorrow there’s a surge, they need excess and then they ask for it. But for those big guys to go produce that, they don’t have an order. They don’t know how long it’s going to take them, they’ve got 400 other customers to serve.”
“I think that is the backlog issue as it is, and that is where I think we can make a difference in disrupting them.”
One of the advantages of O2Africa’s PSA technology is its ability to cater for a wide range of demands. Its Ambition Range of PSA technologies offers a capacity of 100 litres per minute and is ideal for smaller operations, while the Accelerator Range is equipped with an output of 300 litres per minute and its Advantage Range is capable of delivering up to 2,650 litres per minute.
“If someone wanted 400l/min system , we wouldn’t sell them the 400l/minsystem, we’d sell them 600, so you could scale the 300 to 600 and still hold the same spare parts, without the overburden of excess stock for multiple bespoke solutions” revealed Kempe.
By standardising its PSA systems, the company makes it possible for buyers to simplify the maintenance process.
This was explained by Luke Jamieson, Technical Director at O2Africa, who said that the decision to standardise its technology was based on his experience in seeing companies with a huge range of different PSAs.
“With so many different sizes of them, the complexity increases and that’s why we have standardised three; the maintenance on all sizes is exactly the same.”
“So whether someone needs 85 or 100 or 90 and we standardise on that size for maintenance purposes, you’ll have the same air compressor, you’ll have the same oxygen compressor, you’ll have the same PSA and we can hold a sustainable amount of spares, reducing lead times and ensuring continued production.
The company is not just fulfilling a need in the medical space, however. South Africa is home to the largest reserves of Platinum-group metal (PGMs) such as manganese, chromite and gold in the world.
Oxygen plays a key role in the highly complex process of gold extraction. Having been retrieved from the ground during the mining process, gold-bearing ore is broken down into small pieces before being processed inside a large spinning metal drum that contains heavy steel balls.
The ore is crushed further down into a slurry or fine powdery substance before water is added to thicken the slurry and form a paste which is processed through various leaching tanks to separate the gold from the rock using a chemical solvent – a mixture of cyanide and oxygen.
Sparging oxygen inside leach tanks and flotation cells makes sure that the gas is evenly dispersed and reaches all compounds inside.
The company’s PSA plants enable mines to ensure a consistent supply of oxygen for gold extraction, but also to ventilate mines for the workers.
Oxygen is also used in the steel sector, an industry that contributes to about 1.5% of GDP in South Africa and produces approximately 6.5m tonnes of crude steel per year.
PSA technology has also made significant inroads into sectors like aquaculture, where it plays a pivotal role in ensuring optimal oxygen levels for aquatic life.
“We’re busy doing work for an aquaculture farm in Botswana,” revealed Kempe. “We’re helping service some of their plants at the moment and we partnered with a company that installs water treatment plants across South Africa and they typically use liquid oxygen for the creation of Ozone. PSA offers a sustainable and more affordable alternative”
Challenges going forward
When asked about the main challenges and opportunities for the industry, Kempe highlighted the ongoing load shedding issue in South Africa. Also known as rolling blackouts, load shedding is a controlled and temporary electricity supply interruption implemented by the South African utility company Eskom.
The measure is designed to prevent the entire power grid from collapsing due to an imbalance between electricity supply and demand. This practice has been a recurring issue in the country for several years and it often leads to scheduled power outages across different areas of the country.
Load shedding is seen as necessary because Eskom faces various challenges in generating and distributing electricity, including ageing power plants, insufficient maintenance, financial constraints and mismanagement.
The causes have been attributed to inadequate investment in power infrastructure, high demand for electricity and a lack of diversity in the energy mix.
Corruption and mismanagement within Eskom have exacerbated the problem by affecting the utility’s financial stability and ability to maintain and upgrade its facilities.
The frequency of power outages in South Africa have caused concerns for both manufacturers and consumers of oxygen generating equipment.
Kempe explained that the main challenges the company faces around load shedding surround “How you design your systems around building back up while at the same time delivering a constant supply, so that when the electricity is off, you still get a backup of oxygen that can continue to supply your capacity needs wherever you are.”
To ensure a reliable supply of oxygen, the company is also in talks with multiple organisations about their innovative remote monitoring and preventative maintenance solution.
“Operating in Africa brings a whole set of challenges but where companies see an opportunity and can be agile, while minimising risk, it becomes a lot easier. Our goal at O2Africa is to empower our clients by giving them sustainable solutions and total control over their oxygen or nitrogen supply,” said Kempe.