At the Rain Tree Clinic (RTC), electricity is only on from 6:00 pm to 9:00 pm.
In case of emergency, when a patient needs to use the oxygen concentrator, the diesel generators will also be turned on. But the engineering technician will have to keep a close eye on the generators to make sure they don’t overheat after 3-4 hours of usage and fail.
While travelling in the area, Raykaw, RTC Medical Director, can tell if an emergency is ongoing if the clinic lights are on past 9:00 pm in the pitch-black jungle.
Not having constant electricity when taking care of patients can be quite stressful for our staff and students. Saw Moo Kler Taw, Year 4 Physician Assistant student, remembers a patient case:
“Saw Kler Mu Htoo (3-month-old baby) from Ler Sue Kho (K5) village was the latest victim of the measles outbreak and was brought to us at the clinic by his parents. His face was pale in color when he first arrived, he was also fast breathing, head nodding, nasal flaring, chest indrawing, in short, he was very sick and tired.
After the first check up, we immediately gave him oxygen. We checked the vital signs every 2 hours. His mother told us that he had a fever with rash from the last 4 days. He was not the first one with measles; his mother and two sisters also had measles because of the outbreak in their village. Basically, he had measles’ complication with severe pneumonia. He was admitted to our inpatient department (IPD), where he stayed with us for 9 days.
It was a very busy case for us as we had to run the generator every 2 hours for 4 days to give oxygen with the machine. We were worried as well. What if the generator breaks down?”
Being able to provide oxygen to patients can sometimes be the difference between life or death. Dr. Mitch, EMA Program Director, explains the medical importance of having electricity to power the oxygen concentrator:
“The single biggest killer of children under 5, both in the world and in Karen State, is pneumonia. Pneumonia is an infection in the small air sacs of the lungs. Most cases are easily treated with antibiotics that are readily available.
In severe cases, however, the lung’s ability to absorb oxygen is affected. The problem in these severe cases is that the patient can die from hypoxemia before the day or two it takes for antibiotics to start to work. Usually, supplemental oxygen can bridge the gap and give the body enough time for the medicine to impact the infection.
In remote rural areas, we can get oxygen in two ways. We can carry in compressed oxygen in steel tanks. These are heavy and often only available in larger cities. Furthermore, they only hold enough oxygen to treat a patient for a few hours. Considering the difficult nature of travel in Karen State, carrying in enough compressed oxygen for every patient with severe pneumonia is simply not practical. A second way to get oxygen into these remote areas is by using an oxygen concentrator. This machine concentrates oxygen from the air and can provide a constant supply of oxygen.
However, it requires a continuous electricity supply. Many clinics and small hospitals in remote areas are not connected to the national power grid, necessitating the use of alternative energy sources. Although we have tried generating electricity from small hydropower plants in local rivers, rainy season often turns relatively calm rivers into raging torrents, destroying everything in its wake. Because of the cloud cover, solar power also becomes significantly less effective during the rainy season. In our experience, the most effective arrangement has been a combination of solar panels backed up by a small diesel generator. The solar panels charge a bank of batteries which run an inverter to produce 220volts of ac current. This in turn runs the oxygen concentrator. When the solar panels can’t keep up with the demand, a small diesel generator can help keep the batteries charged. This kind of local power grid can also run other technology that is needed to provide quality healthcare: medical laboratory equipment, refrigeration for vaccines, communication devices and computers. The simple fact is that many lives will depend on these remote clinics having a good power supply.”
Another dangerous issue the Rain Tree Clinic has been facing is a rabies outbreak. Rabid dogs have been roaming around near-by villages, and people in this area have not been vaccinated. There is no treatment for rabies, the safest way to survive is to get vaccinated or to receive shots as soon as you get bitten. A few months ago, RTC lost their very first patient, a two-year old girl who passed away from rabies.
To be able to stock vaccines, the clinic needs to have a ‘cold chain’. It isn’t feasible to run the generator 24/7 to supply electricity to a refrigerator. Therefore, the clinic is not able to keep life saving vaccines on hand for patients.