Doctor-engineer who created Covid-19 lifeline for rural areas recognised by WHO, peers

Dr Craig Parker’s oxygen device, the OxERA, saved hundreds of lives during Covid-19, particularly around the rural Eastern Cape. Now the device has earned a global nod by being listed in the World Health Organisation’s 2022 Compendium under “innovative health technologies for low-resource settings”.

A brochure describes OxERA as an “all-in-one device using an oxygen accumulator bag, an anaesthetic mask and an adjustable mechanical peep valve (a spring-loaded valve which the patient exhales against) that is cost-effective and oxygen efficient”.

The device requires an oxygen source, but uses less oxygen than traditional ventilators and is simpler to operate.

With a background spanning both mechanical engineering and medicine, Parker pioneered the idea for OxERA in March 2020.

Building solutions

Practising as an anaesthetist at East London’s Frere Hospital — a tertiary government hospital — he says: “I had been in the UK visiting my grandmother for her 100th birthday. The UK was then collapsing and imploding with Covid. I realised that if they were not coping, then goodness, we were in trouble. And I felt ventilators were not going to fix our problem. To have somebody ventilated, you need a ventilator. You also need an ICU-trained [Intensive Care Unit] nurse and space in an ICU. You need ICU-trained doctors. So I came back and I put a call out on Facebook for anyone who wanted to join me to try build a solution.”

Quickly, a group assembled in East London.

“I called in some of my mining buddies. We had De Beers loan us two engineers at one point,” says Parker. “A colleague at Frere was helping me with some of the ICU stuff, Dr Brendan Toy. We were tossing ideas around, building prototypes, testing them. I think it’s the hardest I’ve ever worked — like 18 hours a day.”

Eventually, their hard work paid off, and they had a prototype.

In the throes of lockdown that year — with up to 50 Covid-19 patients being admitted to Frere Hospital daily — Parker and his colleagues successfully used the device, preventing lung collapse and saving lives.

Up the coast at Madwaleni District Hospital, overlooking the Xhora River — where oxygen had to be ferried in by bakkie over two hours via rutted roads from Mthatha — desperate doctors welcomed the device too.

“It was challenging,” says Parker. “The device was still a prototype we were testing, but healthcare workers were desperate and finding them useful and they were saving lives. So we were just making them and donating them to those who asked.”

Their most exciting feedback was from Zimbabwe.

“Zimbabwe compared to SA was so much worse,” says Parker. “Really, if you were anything beyond mildly ill there, it was a death sentence. They had no hope of big bulk oxygen supplies that could support high-flow nasal oxygen solutions. They didn’t have equipment or the skills to ventilate patients. And so they used OxERA devices a lot, through an NGO there called Kufema.”

Daily realities

Dressed in doctors’ scrubs, Parker makes big gestures with his hands while putting his points across. He is speaking to Spotlight after a long day administering anaesthesia at Frere Hospital.

One patient, a 78-year-old woman, did not respond well to the anaesthetic for her hip-replacement surgery and had to be resuscitated.

“So many patients needing hip replacements are elderly patients who fall and break a hip,” says Parker. “So they’re usually quite sick and frail. You know, they don’t tolerate an anaesthetic very well. You need a good, healthy heart to handle a spinal anaesthetic well.

“One of my ladies today, a 78-year-old, quite a frail old lady — I mean, at one point she, you know, we had to resuscitate her. It’s quite stressful. I mean, she is somebody’s granny, and she’s a sweet old lady who wants to hopefully make it through the operation. We managed to sort her out, but ja, it was a bit of a scramble.”

Born in Harare in Zimbabwe, Parker’s father died in the Zimbabwean civil war in 1974, when Parker was two years old. “My father was a teacher at a technikon, but he’d trained as a field medic, as a paramedic for the army,” says Parker. “He was killed in a medical evacuation. At night, the plane crashed on take-off and my dad and the patient they were transporting and the pilots were all killed.”

In 1981, Parker’s mother moved to SA, where she took a job as a laboratory technician at the University of KwaZulu-Natal (UKZN) in Pietermaritzburg.

In 1993, Parker completed a BSc in Mechanical Engineering at UKZN, after which he worked in mines in SA and Zambia. For a while, Parker, his wife Catherine, a nurse, and their two children lived in the Zambian copper belt town of Chingola. His distaste for what he describes as the “rich getting richer” ethos of mining started to wear him down.

A ‘midlife crisis’ and a Leatherman

In 2011, aged 39, a “midlife crisis” saw Parker rethink his career. The following year, he enrolled in medical school at the University of the Witwatersrand.

“So there was lots of soul searching,” he says. “I read a little book called The Dream Giver, which speaks about the dream that God puts in your heart. And I said, 'Well, Lord, I’m the one you forgot. I’m the one you left out!' And over about a week of wrestling with this, medicine dropped into my heart and the minute it did, it just felt so right.”

Practically, he says this felt “ridiculously impossible” — financially and time-wise. But with his wife Catherine’s support, he made changes.

“We had to save like mad, sell the cars and buy little runaround cars,” he recalls. “There were a few miracles in terms of getting accepted at university — well, first getting rejected, then accepted.

“White-knuckle stuff towards the end — I was only able to graduate because the medical school actually paid my fees. Everything was maxed out. I’d sold my house, but I hadn’t been paid yet. When I graduated, the certificate still said ‘Degree, not awarded: fees outstanding’. You know, it had been printed before they settled the fees.”

A two-year internship at Frere Hospital followed. Then a year of community service at Victoria Hospital in Dikeni, in the rural Eastern Cape, where Parker “used [his] Leatherman to fix things as much as his stethoscope”.

Back at Frere Hospital, he worked in paediatric surgery and then in anaesthetics.

Ubuntu in the Eastern Cape

On healthcare challenges in the Eastern Cape, he says: “So it’s a very challenging province because it’s a province that for so long was neglected, for decades really. And then once democracy came, it sort of continued along that trend. Where politicians seemed to be voted in just because they were in the favourite party, but no-one’s being held to account. And so we top the lists of poverty, of everything negative really. It’s quite difficult to reinvent that.”

He points out the galvanising effect of disaster. “But one thing is, it’s quite a homogeneous province. So it’s mainly Xhosa-speaking people and there’s a great sense of unity. [And] among that disaster and crisis, a sense of we’re all in it together. And I think that really shone through if you think of Covid.

“I guess ubuntu is probably stronger in the Eastern Cape than anywhere else. There were some people, the darker it got, the brighter those stars shine.”

Democratising healthcare technology

In December 2020, the SA Health Products Regulatory Authority approved the OxERA device for emergency use. It is being manufactured and distributed by Gabler Medical in Cape Town, through a “social enterprise model” company called Umoya, which sees all profit ploughed back into the project.

Parker says they want to set a precedent in democratising healthcare technology. “Our original plan was to create a design that was open-source so that anyone could [3D] print their own unit. But that’s not how the medical device world works. We realised that there is regulation for a reason. So we set up and registered a company called Umoya, a social enterprise. Now, this is not something that is well known in SA yet. What it means is that your business is not set up for a traditional capitalist objective but a social objective.

“Usually, companies exist to create shareholder value. [With] our product, the profits go straight back into the company. We think this is a new, sustainable model for medical devices in the developing world because of the massively growing gap between fancy new stuff that’s revolutionising health care, but which is completely out of reach for the majority of people who need it.”

Rural Doctor of the Year

Earlier this month at the Rural Health Conference in Oudtshoorn, Parker received the Rural Doctor of the Year Award for 2022, a title bestowed annually by the Rural Doctors Association of Southern Africa (RuDASA).

RuDASA said in a statement: “Dr Parker’s leadership, knowledge and understanding of engineering, clinical and social fields was instrumental in the development of the OxERA product. He continues to provide leadership at Umoya, as they have been asked to assist with a number of other innovations to improve health care, specifically in resource-constrained environments.”

During the interview, Parker’s sentences have a self-deprecating bent. “Perhaps I am an average engineer, and an average doctor,” he says. “But this combination of skills is quite unique, and they were hugely beneficial during Covid-19.”

— For more detail on the device, see this video on the Discovery website.

This article was first published by Spotlight