The second wave of the Covid-19 pandemic laid bare how grossly unequipped our healthcare systems were to handle the spike in the number of daily positive cases. While several factors were responsible for the damage, an easily preventable dimension of the disaster is deaths caused due to shortages of oxygen in hospitals, which could have been averted by heeding early warnings and taking prompt action to address an imminent oxygen crisis.
While much has been discussed about this all around, I would like to highlight experiments conducted by us in transport of liquid nitrogen, which went on to become a fool-proof delivery system and can be used as a reference when we are trying to avert such crisis during next round of covid pandemic.
This memory is from my early years of career, where I was involved more in selling things not at all related to milk or milk products and as varied as Liquid Nitrogen, Cattle-feed, Mineral Blocks, Chaff cutters, Salt, Tarpaulin, etc.
As a part of extension activities carried out by dairies, Artificial Insemination (AI) is performed on milch animals of farmers by getting supplies of high-quality semen from designated semen stations. This semen needs to be preserved at very low temperature in order to maintain its motility and effectiveness. Therefore, liquid nitrogen (around -230 degree Celsius) has been traditionally used for preservation of semen since many years now, being transported in cryogenic containers.
The system for distribution of semen was three-tiered as detailed below:
Both semen stations as well as individual District Unions used to procure their requirement of liquid nitrogen locally through traders or distributors. At that time, we had 3 semen stations (which later increased to 5) and 10 distribution centres (mostly District Unions but also a central place for distribution of semen to nearby Unions in case of smaller Unions).
All supply chain members were facing difficulties in sourcing liquid nitrogen with unavailability and exorbitant pricing being primary reasons and this was leading to compromise on quality of semen thereby providing lower conception rate and loss to farmers as well as everyone involved in the supply chain. In order to resolve this perennial issue, we made a plan of liquid nitrogen distribution as follows:
1. We decided to put up large (10,000 Lits) stationary liquid nitrogen tanks at all semen stations as well as distribution centres (akin to large oxygen tanks that we see today in many big hospitals).
2. Further, we purchased a big Liquid Nitrogen Road Tanker (27,000 Lits) for supplies to all these units.
3. We also purchased large cryogenic transport containers (50 Lits) for further distribution at village level.
4. We used to collect monthly requirement estimates from all the units in advance as per their regular requirement and prepared beats and route-map for distribution of nitrogen to these units.
5. Later, we negotiated directly with large liquid nitrogen producers like Inox & Linde for our annual requirements and locked rates for the year.
6. We had only one executive who got involved part-time in terms of confirming schedules and planning movement. Apart from that, we employed a dedicated driver and outsourced cleaner to man the liquid nitrogen tanker.
7. We took the cost of tanker & its maintenance on ourselves and sold liquid nitrogen to units on literally ex-factory basis.
By doing this, we achieved following:
1. Within first few months, we were able to bring down costs from exorbitantly high of Rs. 30-35 per litre to Rs. 12/Litre and that was further reduced to Rs. 8.5/Litre within 2 years (The rates are of those times and not relevant today but explains the vast difference in cost).
2. AI conception rates improved dramatically but more importantly, due to easier availability of nitrogen, the absolute no. of inseminations sky-rocketed in subsequent years and laid the foundation for more intensive breed improvement programmes.
3. We operated with best-in-class parameters, bringing down leakage rates in decimals, absolute cost of nitrogen per dose of AI to negligible.
4. As the requirements increased much more than what could be fulfilled by our own tanker, we than mapped the routes directly to manufacturers and negotiated even better rates of liquid nitrogen, delivered at units directly.
While this was made possible due to the system and culture in place at the organisation; I would like to specifically pay tribute to our past colleague Mr. CM Bhatt, who was the central pillar in this initiative and created such a fool-proof system. He unfortunately had an untimely demise.
While medical oxygen supply is much complex and life-saving in nature, creating a robust system of distribution on much larger scale per above template would definitely save more lives going forward.
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