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Manipur CM, N. Biren Singh at the inauguration of an oxygen plant

More Than Generation of Oxygen, Manipur Government Needs to Take Immediate Steps Toward Better Oxygen Access

Amidst the surge of COVID-19 in Manipur, the State Government has been rushing to install as many oxygen plants as in every districts of Manipur in a major step towards strengthening the healthcare infrastructure and to ensure adequate supply of medical oxygen throughout the state.

Recently oxygen plants have been inaugurated by Chief Minister Nongthombam Biren at Jawaharlal Nehru Institute of Medical Sciences (JNIMS) in Imphal East district and other three in Chandel, Ukhrul and Senapati districts,

CM Biren inaugurated PSA oxygen plant with 1,000 LPM capacity.

Manipur Chief Minister Nongthombam Biren on August 10 inaugurated another Pressure Swing Absorption (PSA) oxygen plant with 1,000 LPM capacity at the Jawaharlal Nehru Institute of Medical Sciences (JNIMS) in Imphal East district. Inaugurating the PSA plant, CM Biren expressed hope that the PSA oxygen plant will further strengthen the oxygen producing capacity in the state.

It may be mentioned that Manipur Chief Minister Nongthombam Biren on May 28 inaugurated another 10 KL Liquid Medical Oxygen Cryogenic Tank at Jawaharlal Nehru Institute of Medical Sciences (JNIMS), Porompat, Imphal.

Moreover, on the same day of the inauguration 1,000 LPM capacity PSA Oxygen Plant at JNIMS on August 10, Chief Minister Nongthombam Biren Singh inaugurated a 20 KL Liquid Medical Oxygen (LMO) Plant installed at Veterinary Complex, Porompat. In the occasion, the Chief Minister informed that the LMO Plant inaugurated was the first state-owned and largest among such plants in the Northeast.

The 20 KL Liquid Medical Oxygen Cryogenic Storage Tank inaugurated on August 10 has the storage capacity of 2,600 D-type oxygen cylinders and refilling capacity of 40 D-type cylinders per minute while the PSA plant inaugurated at JNIMS has a capacity of producing 1000 litres of oxygen per minute (LPM).

Moreover, Chief Minister Nongthombam Biren inaugurated PSA Oxygen Plants in Chandel, Ukhrul and Senapati districts on August 9 to boost the medical oxygen infrastructure in the state.

At Chandel district hospital, Nongthombam Biren said that the government is working tirelessly for the welfare of the people and to save precious lives during this pandemic. Mentioning that the government would install Oxygen plants in all the districts of the state, he announced that each of the PSA plants inaugurated at Chandel, Senapati and Ukhrul districts would produce 1,000 litres of oxygen per minute (LPM). Around 200 D-type oxygen cylinders could be refilled daily at each PSA plant, he said. He further said that another 5,000 LPM PSA Oxygen plant under PM CARES Fund would be installed in Chandel district very soon.

Later, the Chief Minister went to Ukhrul and Senapati by helicopter to dedicate the PSA Oxygen plants to the public. Reports said during his visit to Ukhrul district, he expressed his satisfaction to learn about the successful child delivery cases of five COVID-19 positive pregnant women in the district and also appreciated the doctors and nurses for their sincere service.  He also instructed the concerned officials to provide 45 more oxygen cylinders to the Ukhrul district hospital to increase its number to 100 from earlier 55 cylinders.

After inaugurating the oxygen plant at the Senapati district hospital, he said that the plant would have the capacity to refill 200 D-type cylinders every day. Another oxygen plant with a refilling capacity of 100 D-type cylinders would also come up in the district under PM CARES Fund, he added.

It may be mentioned that the 15th Finance Commission had sanctioned for the installation of eight PSA oxygen plants in the state i.e. two PSA plants at JNIMS, Imphal and one each at Chandel, Ukhrul, Senapati, Tamenglong, Churachandpur and Kangpokpi district. Of the eight PSA plants, the ones at Tamenglong, Churachandpur and Kangpokpi are yet to be inaugurated.

Earlier, Regional Institute of medical Sciences (RIMS) has added capacity to produce up to 350,000 litres of medical oxygen daily, when its shortage has taken lives of many COVID-19 patients across the country, swept by the second wave of the disease. RIMS began oxygen production on April 24 at its manufacturing unit at Lamphelpat.

The director of RIMS, Prof. A. Santa said, “We have started to produce D-type oxygen (in Jumbo cylinders) since April 24 onwards.” Each Jumbo cylinder contains around 7,000 litres of oxygen and according to Santa, RIMS was producing enough oxygen daily from the atmosphere to fill up 40-50 such jumbo cylinders with the help of five Pressure Swing Absorption (PSA) Oxygen Generator Plants, installed recently to deal with any medical emergency in the landlocked state. “Each of these five generators can produce around 10 jumbo cylinders daily,” reports quoting Santa added.

Besides public hospitals, amongst private hospitals SHIJA Hospital also started producing oxygen to meet the requirements in the fight of COVID-19 in Manipur.

Notably, until the beginning of the second wave of COVID-19 pandemic Manipur had only two private oxygen plants and few cylinders and Manipur faced many hardships to procure oxygen cylinders and medical oxygen from outside the state.

Now, Chief Minister Nongthombam Biren is enthusiastically hopeful that the oxygen plants installed in various parts of Manipur and procured sufficient numbers of oxygen cylinders can meet the oxygen requirement in the state. He further informed that the government had decided to recruit manpower and train them with expert knowledge for operating the newly installed oxygen plants in the state.

However, the shortage of oxygen or mismanagement in public hospitals of Manipur are reflected in the High Court of Manipur orders of the PIL No. 26 of 2021 between Mr. Naresh Maimom represented by learned counsel Mr. Serto T. Kom Vs. Union of India; and Others represented by Mr. S. Suresh, learned ASG, for the Union of India; Mr. Lenin Hijam, learned Additional Advocate General, Manipur, for the State authorities; and Mr. M. Devananda, learned counsel, for RIMS, Imphal.

In this regard, the division bench of the Manipur High Court comprising Chief Justice Sanjay Kumar and Justice Kh Nobin on June 2 directed RIMS to approach the Audit Sub-Group of Medical Oxygen for securing required oxygen supplies, in terms of office memorandum dated May 19, issued by the special secretary (Health and Family Welfare).

The Division Bench of Chief Justice Sanjay Kumar and Justice Kh Nobin Singh said, “It would be necessary for the state to demonstrate the steps already taken, in terms of the demands raised for medical supplies and facilities, medicines and infrastructure; the steps taken to meet such demands; and also the plan for the future, in terms of the perceived demands that may arise for medical supplies and facilities, medicines and infrastructure and the steps that need to be put in place to meet such future demands, so that the state is not caught unprepared in meeting the challenges of another wave of this pandemic.”

The bench has asked the State Government to indicate the steps taken by it to put in place a “long-term plan” for meeting future challenges during the COVID-19 pandemic.

Many experts say even if enough oxygen is produced what is more important and crucial is the supply of oxygen properly to the patients.

In a research paper, Medical oxygen supply during COVID-19: A study with specific reference to State of Andhra Pradesh, India by Srinivas Bikkina, Vijaya Kittu Manda, and U.V. Adinarayana Rao concluded, “The Covid-19 increased the problems to heart patient that related with the many other factors. On the other hand, all the infected people may cured by sufficient facilities. In these facilities, oxygen is a technology-dependent medicine and requires effective teamwork between healthcare workers, technicians, and managers. Improving oxygen systems is an achievable priority for hospitals in LMICs. This paper proposes practical steps to support significant and sustainable improvements in hospital oxygen systems during the COVID-19 pandemic. Hospital administration and policymakers can derive learnings from this paper to take immediate steps toward better oxygen access to patients.

However, biomedical engineers and hospital technicians are frequently left out of decision-making processes citing, often citing lack of maintenance budgets or system support. Training, provision of tools and spare parts, and more robust maintenance and transport systems can enable repair and optimization of existing oxygen equipment and supply chains. Installation of simple piping and individual flowmeters can improve safety (allowing individual titration of flow), efficiency (sharing a single oxygen source between multiple patients), and infection control (by keeping sources farther from patient areas). Including technicians alongside health care workers in multidisciplinary teams can help transform a problem-driven “oxygen headache” into focused oxygen solutions. We have created practical resources to assist biomedical engineers/technicians in building and maintaining reliable, user-friendly oxygen systems using oxygen concentrators, cylinders, flowmeters instruments/accessories, and simple piping. Improving patient outcomes always hinges on doing the basics well. The COVID-19 pandemic offers the opportunity to refocus efforts on the basics of acute care, knowing that improvements in oxygen (and infection control, triage, laboratory testing, amongst others) will benefit patients both now and in the future.”

Therefore, more than generation of oxygen, Manipur Government needs to take immediate steps toward better oxygen access to patients.

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