Fieldset
COVID-19: The four-tonne machine that could save lives in Burkina Faso

Just because it hasn’t been done before, doesn’t mean it can’t be done. That’s what logistics specialist Kim and her team discovered when planning for the pandemic in Burkina Faso…

Parts of the oxygen plant being loaded onto a truck in Burkina Faso

We weren’t sure it would fit on the plane. That’s how big it is.

I’m part of an MSF emergency team, which is made up of really experienced staff, and none of us had done this before.

But COVID-19 is a new disease. We’re learning new things about it all of the time. And that means new equipment and new ways of working for MSF.

Burkina Faso

I was in Burkina Faso, a country in West Africa, when the first cases of COVID-19 arrived.

It was March. At first, it was just a few, and then there was a spike. Members of the government, public figures were falling ill.

It would mean not only sourcing one of these machines, which we had never done before, but also transporting it around the world

I’m still in Burkina Faso now. The government closed the borders to prevent the spread of the pandemic, and my two-week visit has now lasted over two months.

I came here not because of COVID-19, but because of a different crisis. People are being forced to flee their homes to escape armed violence. When food is short in the summer, and the malaria season peaks, these people are going to be really vulnerable. So, I’d come to prepare, so we’d be ready to provide the best assistance possible later in the year.

But then COVID came.

Unprecedented

In Burkina Faso, the outbreak has been focussed in the cities. Bobo-Dioulasso, the country’s second city, has fewer medical facilities than the capital, Ouagadougou, so it looked like that would be where we could make the biggest impact when it comes to saving lives.

Our medical department made clear that every patient treated for severe COVID symptoms will need a large amount of medical-grade oxygen.

As a logistics team, we’re used to providing the equipment and supplies for some, limited oxygen therapy using small, portable concentrators. But such a large amount of oxygen, delivered to so many beds? That’s unprecedented for us.

The search

The medical department, along with our biomedical support staff, identified a potential solution. “Oxygen plants”: machines that can generate large amounts of oxygen that is then piped to patients’ bedsides.

It would mean not only sourcing one of these machines, which we had never done before, but also transporting it around the world. We’d need to find a building we could convert into a hospital, and install a sophisticated piping system in order to bring the oxygen to the patients.  

Whilst we’d been working with the team in France to get the oxygen centre delivered, our team on the ground in Bobo had also been busy

Meanwhile we learned that in Bobo, at the nearest hospital which had anything like the kind of oxygen capacity needed to respond to a large number of COVID-19 patients, one of the generators was broken.

I got the first technical specifications in early April, and 10 days later we had made the order.

The challenge

These things are larger than most aircraft doors in terms of height. And it being the first one that we’ve ever ordered, we didn’t have the final dimensions of the packaging. Without the packaging, we knew we’d need to find a larger aircraft. With the packaging on, we weren’t sure we’d be able to find any plane that could carry it.

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Construction underway on the building that would house the oxygen plant
Construction underway on the building that would house the oxygen plant

But a healthcare desert was opening up in Bobo. People were scared to go to the hospital where COVID-19 patients were being treated. We had to get the patients moved to a COVID-specific facility, and we had to make sure that facility could offer the right care.

The journey

We made an agreement with the factory. They would provide the machine with minimal amount of packaging, knowing that this would then be hauled across many different modes of transportation and many different countries, and that it should arrive safe and in one piece.

From the factory it travelled by road to our warehouse in Bordeaux. Then by plane to Morocco, and on to Ougadoudou, before arriving in Bobo with the help of a special crane truck – the only thing powerful enough to unload it.

The hospital

Whilst we’d been working with the team in France to get the oxygen centre delivered, our team on the ground in Bobo had also been busy.

As a humanitarian community, we don’t really know yet what will happen when it arrives in places like refugee camps

The Ministry of Health had identified a building for the COVID-19 patients. When we first visited we saw a very nicely constructed building, but inside the electricity wasn’t all working, the ventilation wasn’t working, there were cuts in the water supply at lot of the times. There was a lot of dust.

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The oxygen finally plant installed at the hospital in Bobo
The oxygen finally plant installed at the hospital in Bobo

We rehabilitated one wing within days in order to get the patients out of the main hospital.

But the number of patients in our facility was still relatively small. There was much more to do in order to get it ready to respond to a potential epidemic.

The government drilled a borehole in order to get water back up, and for the rest, our construction teams got to work. We built more toilets. We built a laundry room and a waste management area. We added a morgue, and we built a structure to house the oxygen plant itself.

We were thankful we didn’t have to build the road to the hospital itself, but if we’d needed to, we would have.

Epilogue

Again, this disease is new.

As a humanitarian community, we don’t really know yet what will happen when it arrives in places like refugee camps. Places where you can’t ask people not to sleep 20 to a shelter, because there are no other shelters for people to sleep in. You can’t close the markets, because there’s no refrigeration, so people have to buy food every day. Where there’s not enough water because of the dry season, so washing your hands is a luxury.

MSF is putting huge resources into preparing for COVID-19.

The emergency team in Paris has now sent two more oxygen plants to countries that have been hard hit by the disease. One has gone to Chad. Another to Haiti.

This isn’t the solution for every context. For the displaced people in the south of Burkina Faso, who are living in temporary, makeshift sites, or squeezed in with family, we’re going to have to find other ways to care for people, and to try to stop the spread of the disease. And at the same time, we’ll need to provide medical care for malnutrition and malaria and the other life-threatening health conditions people are facing.

Back in Bobo, the number of cases is still relatively low, so we’ve been able to get really prepared. Outreach teams are on the streets, helping to educate the community about COVID-19. The piping system is in place. Tomorrow we’ll turn on the oxygen centre for the first time.

Note: Kim has sent us an update since this piece was written – the oxygen plant is up and running and working perfectly!

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