The U.S. health care industry could learn a lot from India’s doctors
They're delivering top-notch care while producing minimal waste.
We know climate change is bad for our health. But we know much less about the carbon cost of the care needed to heal the sick and injured. In fact, the medical industry produces plenty of waste from treatments, tossing disposable gowns, caps, booties, gloves and blankets, in addition to using loads of energy to drive machines needed in diagnosis and surgery. And that’s not even talking anesthesia, which is a greenhouse gas much more potent than carbon dioxide. The health care sector accounts for 10 percent of carbon pollution in the United States, according to one study.
“Surgery is one of the most resource- and cost-intensive areas of medicine, so anything we can do to reduce the footprint here will help reduce our overall emissions,” said Cassandra Thiel, assistant professor in the departments of population health and ophthalmology at NYU Langone Health. “Unfortunately, the way we practice medicine today has a negative impact on our environment and, in turn, human health.”
She and her colleagues decided to examine the problem of health industry emissions to see if they could find greener approaches. They studied cataract surgeries performed in a health care center in India, the Avravind Eye Care System, which is seen as a model for its low cost and excellent results. “Part of the way Aravind reduced their costs was to invest in reusable surgical supplies and to develop their surgical process in a way that ensured its speed and safety,” Thiel said. “Their surgical outcomes are on a par with — and in some metrics, better than — U.S. facilities.”
Because the United States and other developed nations rely largely on single-use materials in surgery, “we wanted to examine whether a different approach, where surgical supplies are mostly reused, could make a bigger impact on reducing emissions, but we had to look outside of the Western world to find a strong example,” she said. Their paper appears in the Journal of Cataract and Refractive Surgery, and also includes researchers from the University of Maryland Medical Center and Aravind.
Cataracts, a leading cause of blindness, occur frequently among the aging and involve a clouding of the lens of the eye. Having cataracts is like trying to look through a frosty window. Cataracts make it harder to read, to drive a car — especially at night — and to see many things clearly. Surgery to remove them is one of the most commonly performed procedures in the world.
“We spend more than $6.8 billion annually here in the U.S. just on cataract surgeries, and, as the world’s population ages, the number of cataract procedures should also increase — meaning the cost and environmental footprint of cataract care will likely also increase,” Thiel said. “Cataract surgery in the U.S., like most other surgeries, is conducted in an energy-intensive operating room with a large number of disposable supplies. Making a small change … can make a big difference.”
From November 2014 through February 2015, the researchers analyzed surgical materials, energy and waste from cataract surgery at Aravind, calculating greenhouse gas emissions, as well as those related to ozone depletion, water and air pollution. They then compared them to those of the United Kingdom, the focus of an earlier study, and found that Aravind was responsible for just 4 percent of the emissions of a comparable U.K. operation.
“India currently performs over seven million cataract surgeries a year,” Thiel said. “If all were done with the U.K.’s process, they would emit nearly one million metric tons of greenhouse gases. If all were conducted with Aravind’s process, they would emit about 40,000 metric tons of greenhouse gasses. This difference is equivalent to removing over 230,000 passenger vehicles from the road.”
Aravind’s strategy includes shorter surgery duration, better reuse of surgical gowns, caps, booties and blankets, multiuse pharmaceuticals, and more efficient sterilization of stainless steel instruments so they can be reused the same day, according to the study.
“Aravind has standardized their process so everyone does the same thing, every time — it resembles an assembly line,” which cuts surgery time, Thiel said. “Aravind’s surgeons only do what surgeons are trained to do — the surgery. Mid-level ophthalmic professionals handle all the pre- and post-operative work the day of surgery, thus optimizing the surgeon’s time.” In contrast, most surgeons in American hospitals visit with patients in the pre-operative room, prepare the patient’s surgical site, and help clean up the patient after the surgery, she said.
Also, Aravind has designed processes to ensure that recycled supplies are properly sterilized for each case, she said. Moreover, “at Aravind, eye drops used in surgery are administered to multiple patients until the bottle is empty,” she said. “In the U.S., because the vials are branded as single-use, the amount remaining after they administer a few drops is thrown out.” She said many of these practices will work for any procedure. It’s not clear, however, how quickly they would be accepted, if at all. Even more important, our healthcare system relies on single-use disposable items for a good reason. They lessen the risk of hospital-acquired infections, which continue to pose a problem.
“Of course, with any surgery there is always the risk of infection,” Thiel said. “Some of [Aravind’s] practices may present a higher risk due to the potential for human-caused error. While we will likely not adopt all of Aravind’s practices — such as glove reuse — surgical-grade reusable gowns, drapes and caps are readily available [from] standard medical supply companies. With proper treatment protocols and good design, these items should present no greater risk than single-use supplies.”
Most medical staff already dislike the amount of waste generated by their procedures, she said. “Reducing waste in the healthcare system is mostly enacting the principles we learned in school,” she said. “Reduce, reuse and recycle — and in that order.”
Marlene Cimons writes for Nexus Media, a syndicated newswire covering climate, energy, policy, art and culture.