Building Treatment Capacity to Respond to COVID-19 within an Innovative Business Model
The UMOYA project was born during the COVID-19 pandemic and the realization that there is a large gap in South Africa (as in other developing countries) in the provision of respiratory care and treatment necessary during the COVID-19 pandemic. The desire to help alleviate this shortage of respiratory care and treatment led a core group of individuals to voluntarily use their diverse skills, experience, and capabilities to establish a collaborative network across South Africa. The initial gap was foreseen by our team’s doctors Craig Parker and Brendan Toy, who are based at the ICU and anaesthetic departments of state hospitals in the Eastern Cape. Their input, together with medical Professors and medical colleagues during design and testing was critical to our developing a viable solution.
The team consists of mechanical engineers, doctors, mechanical designers, systems engineering experts, and 3D printing experts. The proof of this team’s capability is the agile approach that has been able to rapidly iterate through multiple concepts and designs to come up with a working prototype within 2 weeks and a finalized design within 7 weeks.
Our assessment of the longer term was that we could only make a sustainable impact if we generated our own funds through our products and services. A donor funded organisation was not the future we wanted. Consequently, Umoya was constituted as a for-profit, social enterprise but one where our Memorandum of Incorporation dictates that 100% of our profits must be used for developing the business or donated to improving health care. We do not distribute dividends to shareholders.
The Umoya Journey
Umoya’s first goal was to address the gaps in respiratory therapy that we identified would be problematic during COVID-19 in South Africa and other low-resource environments. Initially we aligned ourselves with the National Ventilator Project which focused on the design and development of ventilators but as our design work progressed our doctors soon realised that good clinical outcomes could be achieved using simpler, more affordable designs.
Our philosophy was to design simple mechanical components that could be rapidly evaluated using 3D printing and subsequently taken to scale employing standard manufacturing processes. By combining these with readily available off-the-shelf components we could produce effective yet simple, robust and easy to use products which would be ideal for use in developing countries and communities.
Our thinking was driven by the current reality that not everyone has access to the best available health care during the times of a pandemic such as Covid-19. Tackling a global challenge of such magnitude is best achieved in small steps and producing a device such as the OxERATM which raises the ceiling of therapy offered by low resourced healthcare facilities is one such step.
By adopting a social enterprise model, we offer a different business approach which we hope can make an impact in the health care sector and beyond.
The story of Umoya
Interview with Discovery
Respiratory treatment in hospitals is administered on a continuum depending on level of treatment required by the patient. Generally, the simplest form is facemask oxygen or high-flow nasal cannula which has nozzles that are place in/below the nose directing oxygen into the nostrils.
More sophisticated treatments are non invasive ventilation treatments, namely Constant Positive Airway Pressure (CPAP) and Bi-level Positive Airway Pressure (BiPAP) with critically ill patients requiring intensive care Invasive Ventilator Treatment administered by accredited Intensive Care Unit (ICU) staff.
The goal is to treat hypoxia early and break the inflammatory cycle and lung damage which occurs. This gives the patient’s immune system time to fight the virus without having to also deal with hypoxia.
COVID-19 has resulted in a common scenario globally, where approximately 6% – 10% of people infected by the virus require respiratory support treatment. About two-thirds of these patients don’t recover from oxygen treatment alone and deteriorate to the point where they require ICU Invasive ventilator treatment.
UMOYA’s solutions are about bridging some of the gaps in current health care therapy and providing cost-effective alternatives to, but not replacing, costly and/or sophisticated technology. These solutions are cognisant of the infrastructure and staffing constraints typically available in low resource settings but still have broad appeal in all clinical facilities. At the outset of the coronavirus infections in South Africa we aimed to develop solutions that would reduce the load on the limited ICU facilities and could be used in field and district hospitals and reduce the number of patients requiring escalation to ICU in major centres.
We saw early on that oxygen supply would become one of the biggest requirements in treating Covid-19 patients and that oxygen availability in many hospitals and clinics was constrained. We brought oxygen supply and efficiency of use into our design thinking and into our work.
- OxERA™ device – high percentage O2 via accumulator bag with adjustable PEEP.
- Adjustable PEEP valves.
PRODUCTS UNDER DEVELOPMENT
- A range of accessories OxERA™ to enhance it’s use.
- Portable, robust oxygen generating systems.
- Empty oxygen cylinder alarm.
- Improved hospital beds.
CONSULTING SERVICES AND PROJECT MANAGEMENT
We offer a range of project management, training and consulting services focussed on finding solutions and removing barriers in the delivery of community health care. These include the development of new cost effective medical devices, products and the supply of oxygen.
Here are some completed projects:
Training of Health Care Workings in eSwathini (in partnership with Right to Care NPO)
Right to Care sourced a number of OxERA units for Swaziland and identified that training was needed to maximise their usefulness during the covid pandemic. A short course was compiled by Umoya and training took place by one of the Umoya Doctors over two days with a virtual session held one day and in person training held in ESwatini on the second day.
Valuable experience on using the OxERA device to manage patients was shared with attendees together with broader experience obtained in ICU with covid positive patients. Training covered assembly and use of the device as well as troubleshooting clinical scenarios around its use. Its broader use potential off-label on non-covid pneumonia patients was also highlighted with some interesting case examples.
Attendees left feeling empowered with the skills needed to maximise the effectiveness of the OxERA device in their clinical practice.
Thank you to Right to Care for making it possible.
The Design, Supply, Installation and On-going Support of a PSA Oxygen Generation Plant at Madwaleni Hospital, Eastern Cape
There are many hospitals in remote areas which provide a critical health care service to large and dispersed rural communities. Running these facilities presents many challenges, including the reliable supply of critical lifesaving consumables, one of which is oxygen. In these settings the supply of oxygen is often dependent on the delivery of costly oxygen cylinders, over long distances and often on poor roads. The Madwaleni Hospital in the Eastern Cape was one such hospital.
The Umoya team engaged with the Madwaleni Hospital management and the Eastern Cape Department of Health and established that there was real need for on-site generated oxygen, during the Covid crisis and beyond. The Umoya team established a funding and support relationship with Right to Care NPO (add website link) and USAID. Over a period of 5 months, between August and December 2021, the Umoya team managed the project which involved the design, construction delivery and commissioning of a containerised pressure swing adsorption (PSA) oxygen manufacturing plant, along with the training of the hospital staff in the operation of the plant and the safe use of oxygen.
The plant runs on a continuous basis, providing a stable supply of low-cost oxygen directly to the main ward and allows for the filling of cylinders for use in other wards and satellite clinics. Umoya monitors the plant remotely and manages the regular maintenance of the plant on behalf of Right to Care NPO. The facility is currently owned by Right to Care NPO
Data is being gathered to support the possible replication of the project at other rural hospitals.
The Umoya team is funding additional facilities at Madwaleni hospital to further improve the care of patients.