When Dr Shahirsha decided to introduce a centralised oxygen supply at Punalur Taluk Hospital in Kerala’s Kollam district in 2011, he was motivated by the need to remove the deep anxiety induced in patients by oxygen cylinders.

“Seriously ill patients had a mortal fear of these heavy-looking oxygen cylinders, which were rolled near their bed in times of emergency. A bedside cylinder was seen by many patients as a sign of sure death. We thought a centralised oxygen supply, by keeping the cylinders hidden in some underground cellar, would take away such a fear,” Dr Shahirsha, the superintendent of Punalur Taluk Hospital, told Onmanorama.

It is this patient-first approach, and not any new strategy to adapt to the COVID-19 situation, that has kept Punalur Taluk hospital battle-ready.

The centralised supply also relieved the nursing staff of the immense strain of wheeling these heavy cylinders from their storage space to the wards. Then, 10 years before when a Covid-like pandemic was not even thought probable, such centralised gas supply was found only in medical colleges and some district hospitals.

Boon for poor, newborns and nurses

Dr P K Jameela, who was then the Director of Health Service and now a member of the State’s expert committee on COVID-19, said Dr Shahirsha's was a thoughtful move. “It is mostly poor patients who visit taluk hospitals and I remember patients calling these oxygen cylinders 'maranapetti' (the death box). There were patients who even objected when an oxygen cylinder was brought near them,” Dr Jameela said.

“Such a centralised supply also ensured immediate oxygen care for poor patients suffering from respiratory or lung diseases, especially the asthmatics and those with COPD (Chronic Obstructive Pulmonary Disease) induced by smoking. Immediate oxygen care is crucial for newborns, too,” Dr Jameela said.

Nursing staff also could focus more on patient care as they didn't have to rush for cylinders in a moment of emergency and then, 45 minutes or an hour later, replace these heavy cylinders in a state of unbearable stress.

The oxygen supply was regular, constant and unlimited.

Centralised supply hits hospital's health

Nonetheless, this centralised system, even if it took away the terror patients felt about cylinders, did not do away with the need for cylinders. “It increased our demand for oxygen cylinders," Dr Shahirsha said. "We had to depend on private suppliers. This meant an additional four to six lakh rupees annually, which was more than what a taluk hospital with low user fees could bear," he said.

The hospital management under Dr Shahirsha then took a decision that was unheard of in the annals of not just Kerala's but the country's public health system: Install an oxygen generator plant.

Oxygen revolution

The plant became functional in the Punalur Taluk Hospital in 2013, two years after the centralised supply was installed. At that point, forget medical colleges, not even a tertiary care hospital run by the Centre like Sri Chitra Thirunal Institute of Medical Sciences and Technology (SCTIMST) had such a mechanism.

“I still remember the loud claps of our nursing staff when we announced during an internal meeting the decision to procure a generator for the hospital,” Dr Shahirsha said. “No one understands the suffering of patients more than them,” he said.

Not just the nurses, workers too were about to be spared of gruelling work. After the installation, they will not be called to unload filled cylinders, carry them long stretches to storage areas and then carry back and load empty ones onto transport trucks.

Conspiracy of private suppliers

But the path to the first-ever government hospital in the country with an oxygen generator was not an easy one for Punalur Taluk Hospital.

“Private oxygen suppliers were worried that they would go out of business if government hospitals were allowed such generators. Hoping to trouble us, they shot off RTI (Right to Information) queries asking whether we had called for tenders and had fixed the right price. Some big government hospitals, which were also planning to procure generators, backed out. But we gave clear answers, scotching any further questions,” Dr Shahirsha said.

This was a man for whom the entire Punalur town went on a hunger strike when he was transferred in 2014. He was quickly restored.

In fact, the Punalur Taluk Hospital got the generator from Germany installed at a huge discount. “Our provider installed the generator for just Rs 15 lakh when it would have actually cost over 25 lakh. For them, this was a huge opportunity and Punalur Taluk Hospital was the entry point,” the hospital superintendent said. The money was spent from the hospital's own funds and was recouped in just three years.

From 100 to 400 oxygen beds

It was a small generator that could generate 100 litres a minute, and could serve 100 beds. This was more than enough. Now, there are 85 COVID-19 patients under the hospital's care and the existing generator is not enough to meet all the requirements. “These days, in addition to the medical-grade oxygen we get from our generator, we also buy 25 cylinders daily,” Dr Shahirsha said.

The Kerala Government has rewarded the hospital for the visionary management style it has adopted under Dr Shahirsha. A benefit it had conferred only on medical colleges in these pandemic times, has been extended to Punalur Taluk Hospital, too.

The government has sanctioned two more oxygen generators for the hospital; one with a capacity to generate 200 litres of oxygen a minute and the other 270 litres a minute. They will be installed at a cost of Rs 50 lakh and Rs 82 lakh respectively, a total of Rs 1.32 crore. Unlike earlier, both these will be government funded, one from the Punalur Municipality's plan fund and the other from the Health Department's.

The two new generators, and the existing one together could then generate 570 litres a minute, good enough to serve at least 400 patients simultaneously.