WHAT YOUR HOSPITAL CAN DO TO COMBAT CLIMATE CHANGE

This week, global thinkers and authorities converge in Egypt for the 27th UN Conference on Climate Change (COP27). Dubbed the ‘COP for Africa’, this event comes amidst a year of climatic turmoil for the continent. Africa is dubbed the continent of extremes. And 2022 has had its fair share of extremes: from wild fires in Algeria to catastrophic floods in South Africa. Nigeria lost 600 people to their worst floods in a decade while Kenya continues to suffer the ravages of her worst drought in four decades. 

My journal, in conjunction with tens of other science journals,  released an editorial calling for more effort from the wealthy nations to protect the developing world from the ravages of the climate change. This is a follow up to an earlier editorial done in tandem with COP26. 

It becomes painful to watch the devastation occasioned by climate change especially considering this happens when Africa has only contributed to 3% of green house emissions since the industrial revolution. North America and Europe account for 62% of the emissions that leave our planet on the brink. While to the ordinary eye this looks like an environmentalist’s problem, it is actually every ones problem. It is right for all to think of ways in which we could be contributing to global warming and ways in which it affects us ( at the specific level). Most importantly, it is time to move to the granular level of asking, what can every one do to avert further global warming? 

Health is affected directly and indirectly by climate change. Indirect impacts of climate change on health include injury, mortality from natural calamities (floods, cyclone, drought), thermal injuries (heat waves and cold injuries), skin and eye damage from UV radiation (include skin cancer), respiratory problems from deranged air quality. Direct effects include malnutrition from drought, water borne diseases in floods, disruption of Human Resources for health through displacements by natural disasters like floods and fires as well as infrastructure breakdowns.  

Surgery, to go to the painful detail, is not left out of the conundrum. For instance, rising temperatures have been associated with rising prevalence of surgical site infection in temperate countries. That is besides rising climate related natural disasters like fires and storms which increase the burden of trauma and disrupt hospitals where surgical care can be provided. Remember, trauma (a small branch of surgery) accounts for more deaths than HIV/AIDS, Tuberculosis and Malaria combined. 

Research shows that operating rooms (theatres) account for up-to a third of the hospital waste and can be up to six times more energy intensive than the rest of the hospitals’ units. Theatres use a lot of disposable wastes (plastics, disposable gowns, gloves, etc). During my surgical training, I always looked with awe at the nice disposable gowns  as opposed to the recyclable green one. Yet the more disposable gowns the more plastic waste we generate, putting our planet under global warming pressure. It is time to rethink how we can tone down on this. What is the sense in saving a life while ruining a universe and putting thousands at risk? 

Some ways in which to improve our hospitals to be more environment friendly include supply chain adjustments, re-engineering our structures to be more green etc. 

MITIGATIONS

Recycling:

If you are a theatre practitioner, take a step to don the recyclable green gown and green cap today. It will be for a greener future. Let us go green in the OR for a greener planet. 

Supply chain: Go recyclable instead of disposable if possible. Minimize sets/equipment/ material used as much as possible. If you are a theatre practitioner, take a step to don the recyclable green gown and green cap today. It will be for a greener future. Let us go green in the OR for a greener planet. 

Pharmaceuticals:

Reduce use of anaesthetic gases. Some gases like Nitrous Oxide used in anaesthesia are worse than carbon dioxide in terms of Ozone layer depletion. Encourage your anaesthesia teams to opt for ‘total intravenous anaesthesia’ where applicable, do spinal anaesthesia and regional nerves blocks instead of general inhalational anaesthesia. 

Energy:

Use solar energy when possible. Air conditioners account for over 90% of energy use in some theatres. Set occupancy sensors that detect when no one is in the OR in case people forget to switch them off. Motion sensors for lighting will also help with wasted light. Do not switch on lights and heaters unless necessary. Though we cry, Africa is blessed to have most of its landmass have nearly equal nights and day. With majority of working hours being during the day. It means not all lights must be on as there is natural lighting with adequate engineering/architecture design. In trauma, we talk about ‘operating in the tropics’ to indicate that the air conditioners must be set to warm the room so that the trauma patient does not suffer hypothermia – a critical contributor to mortality in trauma. But what is the need of the air conditioner if the ambient temperature is 28 degree Celsius? Probably none.  

Governance and strategy: 

Set  core values and visions around environmental sustainability and carbon emission reduction. There is nothing as impactful as setting the pace from the top. We have learnt this from the Diversity Equity and Inclusion (DEI) conversation.

Funders and venture capitalists:

Ask facilities for their commitment to going green before doing business with them. Give an incentive for those with plans and strategies to go green as much as possible. Do it the same way and with the same enthusiasm with which you call for Diversity, Equity and Inclusion statements.  

I recently heard the Kenyan cabinet secretary for agriculture plead with the citizens to do anything, however minuscule, to avert the food shortages. ‘If you can plant a bunch of kales in your back yard, please do it’, he begged. I also join him in begging the players in health care sector, if you can do anything to slow the rising global temperatures, please do it. Use a recyclable head cap or gown, switch off heaters and lights if not needed, do more with less. It goes along way for our planet.