Topic for Today: Chemicals

Looking towards the front part of the conference room, the projector has presentations on cue and the lecturers are reviewing their notes. At least 40 people in uniforms are waiting. It was announced that the topic for today is chemicals.

Could this be a déjà vu of my days in high school, sitting in my Chemistry class? The dreamlike sequence was: We were being told that matter is anything that occupies space and has mass. We were shown examples of matter in three different phases: the water in the beaker as liquid, the spoon as solid, and the released air from a balloon as gas. The next days became a tedious memorization of the periodic table of elements. I was happy with my easy codes Al for aluminum, Au for gold and Au for silver. But the rest of the elements are tongue-twisters and where they are found in the periodic table is an unsolved crossword puzzle for me.

Snap back to reality. It is a work day in March 2013 and I am at St. Paul Hospital Tuguegarao preparing for the afternoon’s forum on chemicals in health care. I sit among the hospital staff in different uniforms representing their work areas. The slides for presentation, the scribbled notes, and what the people will be hearing are all about chemicals.

What was taught is applied chemistry, but not another science subject though. The forum focused on how chemicals are being used in a health care set-up and its effects on people. The opening slide showed the vicious cycle of chemicals with text “the risks of hospital chemicals” which stirred the interests of nurses, midwives, medical technologists, housekeeping staff and others in the audience.

Ruth Stringer, International Science and Policy Coordinator of Health Care Without Harm gave a run-down of hazardous chemicals found in hospitals. Ingredients of disinfectants may include glutaraldehyde, triclosan, ethylene oxide, sodium hypochlorite, and silver. Intravenous bags, tubings, catheters and other plastic medical supplies may contain polyvinyl chloride (PVC), di(2-ethylhexyl)phthalate (DEPH), and bisphenol A (BPA). Formaldehyde is another chemical that laboratories use for preservation of specimen to study.

The quicksilver mercury, which is encased in old types of thermometers and sphygmomanometers, is neurotoxin. No less than the Philippine Department of Health has prescribed year 2010 for the complete phase-out of these medical devices. However, some dental clinics still have not shifted from mercury dental amalgams to the composite resin fillings.

The list could go on and a three-hour forum would not be enough to give details for every chemical. Hence, the speaker picked glutaraldehyde to discuss since most of the hospital staff can identify with it. Using some sense organs as science tool will surmise that glutaraldehyde is a colorless pungent liquid. Its primary purpose in hospitals is for cold sterilization of surgical instrument and scopes. Some hospital also uses glutaraldehyde formulations for infection control procedures.

Glutaraldehyde is a respiratory irritant and linked to occupational asthma and asthma-like symptoms such as throat and nose irritations, sneezing, breathing difficulty, and wheezing. Other health concerns with glutaraldehyde are hand stains, rash and dermatitis from direct skin contact with the liquid while its inhalation can also cause headaches, nausea and eye irritations.

The irony is that hospital workers themselves are at high risk to health hazards of glutaraldehyde. These are the doctors, nurses, and other hospital staff who work in areas with glutaraldehyde exposures like the operating room, endoscopy unit, gastroenterology and cardiology departments, dialysis unit, intensive care unit, and sterilization room. Patients who are supposed to be taken cared in these special areas are also at risk.

The other speaker, Michael Ravago, President of Philippine Society of Endoscopy Nurses and Assistants validated the issues and concerns on glutaraldehyde. Being a nurse supervisor assigned to the endoscopy unit of a tertiary private hospital in Metro Manila, he shared their experience with glutaraldehyde. Aside from reported staff illnesses from chemical exposure, patients also forwarded complaints about the strong irritating smell inside the unit. Soon after, they began to observe discoloration and damage at the distal end of the scope.

The general sentiment of the participants during the open forum is how to minimize the negative effects of toxic chemicals considering that they have to deal with these until alternatives are available. The speakers offered recommendations:

• Wearing appropriate personal protective equipment;

• Improving ventilation system in work areas;

• Using disinfectants wisely. Regular good cleaning is enough for some application;

• Choosing non-chemical and least toxic disinfection where possible;

• Requiring full disclosure of product ingredients from suppliers; and

• Setting-up a green purchasing policy

The forum ended like a usual class wrap-up. Participants get up from their seats. A group buzzes about the day’s inputs, some exchange opinions and afterthoughts, while some went to the speakers to ask more questions.

The topic for the day has been well discussed. But there is still homework for HCWH-Asia’s Safer Chemicals campaign. The goal is to pilot two hospitals for chemical substitution and management. Research is underway for the feasibility of introducing chemical products with lesser harm for the people and the environment.

Library work (I mean, surfing the internet at this day and age) will be online searching for materials related to glutaraldehyde, tabbing and bookmarking different web sites, downloading pdf files of product literatures, clicking on the http links to material safety data sheets, and all the other cursor works that did not come in handy when I had my Chemistry class.

The work continues beyond the day’s topic.

Note:

Health Care Without Harm-Asia is currently cooperating with KEMI (Swedish Chemicals Agency) and SAICM (Strategic Approach to International Chemicals Management) for the campaign on “Chemical Substitution and Management in the Health Care Sector”. The project aims to (1) identify the hazardous chemicals used in health care, (2) introduce safer alternatives, and (3) document case studies from two pilot hospitals in the Philippines. This experience will later on be used for broader dissemination and for future policy recommendations on chemicals management.

Ayeth Enrile, SAICM Project Coordinator, Safer Chemicals Campaign, HCWH-Asia

Winning the elections

Now that the Philippine national elections is less than a month away, campaign jingles are heard from every street corner. After hearing most for several straight days, you start wishing that the elections will be over soon.

But not soon enough. Not until you have voted for candidates who support your cause or causes.

Health Care Without Harm-Asia always pushes for a greener and healthier health care system. So we need leaders who can look us straight in the eye and passionately declare, yes I am for green and healthy health care.

There are 10 criteria, following the 10 goals of the Global Green and Healthy Hospitals .

1. Priority: environmental health. There’s no more denying that environment and health are two sides of one coin. You cannot protect and save the environment without looking at the health care sector, same way you cannot go on focusing on the health of the people without looking at the health of the environment. We need leaders who see and acknowledge this connection. We want them to work on these issues.

2. Support for substitution of hazardous chemicals. Sadly, several chemicals used in the health care are not safe for our health. But the good news is, there are alternatives. We’d go for leaders who can see this happen during his term.

3. Anti-incinerator. Anti-burn. Yes, we do not like to burn our wastes, be it health care or regular household wastes. We want them to uphold the law in banning incineration of wastes.

4. Energy-efficient. We want those who support energy efficiency and renewable energy generation. But it should be energy efficiency in its truest sense. Not the fancy names that some would use to appear green and clean.

5. With the summer heat, we’d vote for candidates who see the wisdom behind water conservation, recycling and treatment.

6. We’d like those who support transport strategies that reduce climate footprint.

7. And those that buy local and organic food.

8. We’d also like someone who will pledge to policies on safe management and disposal of pharmaceuticals.

9. With the budget allocated to elected officials, we’d go for those who would support green and healthy building design and construction.

10. And those who’d push for purchasing safe and more sustainable products and materials.

These are just the first ten. There are plenty more. We’re not asking too much. The reality is, if we don’t keep our standards high enough, we’d have to put up with the same old leaders that we had for a long time.

So we say, set the examples. Go Green and Healthy Honorables! May you be truly green and healthy!

Vote wisely.

Sonia G. Astudillo, HCWH-Asia Communications & Press Campaigner

What does Climate Change Have to Do With Health Care?

In the last six months, we have witnessed Superstorm Sandy flooding New York City, New Jersey and surrounding areas, a massive Midwest drought impacting 40% of the US corn crop, and unprecedented air pollution from burning fossil fuels that forced Chinese authorities to tell Beijing residents to stay in their homes. When we think about climate change, we are no longer thinking about polar bears stranded on melting ice caps. Climate chaos has come home and its impacts are being felt all around the world.

What health scientists are telling us is that climate change will bring increased asthma, more virulent allergens, medical emergencies from heat stress, the spread of water- and vector-borne diseases and increased severe weather events. The Lancet, Britain’s premier health journal, calls climate change “the biggest global health threat of the 21st century.”

Given these dire warnings, one would expect that the healthcare sector would be prepared for the coming public health storm. Nothing could be further from the truth. When Hurricane Katrina hit New Orleans, the hospitals were completely flooded along with everyone else. But because they all had their electrical equipment as well as their back-up generators in the basement, , they lost all power. And because none of the windows in the hospital were operable, hospital staff had to break all the windows in the hospitals’ upper floors to get air into the facility.

Five years later during Hurricane Sandy, a similar story occurred. Both Bellevue Hospital and New York Langone Medical Center had to be evacuated because all their electrical systems were in the basement. At NYU Langone, millions of dollars of medical research specimens were destroyed because of lack of consistent refrigeration. It took Bellevue more than ten weeks to clean up the mess and reopen its doors to patients.

We are learning the hard way that the healthcare sector’s understanding and ability to respond to climate change is still in a primitive stage of development.

What, then, should the role of healthcare be in dealing with climate change?

First, hospitals need to focus on preparedness and resilience in their design and operations so they can be critical players in responding to extreme weather events, rather than being one of the victims. Spaulding Rehabilitation Hospital in Boston is one example of a hospital that has taken the reality of climate change to heart. The hospital, which is scheduled to open in April 2013, employs on-site power generation, operable windows to provide natural ventilation and has put all the mechanical/electrical equipment on the roof of the facility. These innovations are part of the overall business strategy of Partners Healthcare (Spaulding’s owner) which has added climate change to its top “business risks” category.

The second critical role for health care should be to model the transition to a post-fossil fuel economy. In the U.S., health care represents 18% of the entire GDP, and is likely to increase to more than 20% when health care reform is in full swing. In other industrialized countries, health care represents 10% of the economy. Given its enormous economic clout and its healing mission, health care is well positioned to “model” the transition away from our addiction to fossil fuels, which not only contributes to global climate change but also has local pollution and public health impacts. Reliance on coal, for example, contributes dramatically to increased asthma and respiratory diseases while fracking for natural gas contaminates local groundwater and vents toxic chemicals into the community air. Health care has a mission-related imperative to lower its own extensive carbon footprint and lead the effort to a secure and sustainable energy economy.

Reducing hospital dependence on fossil fuel energy through conservation efforts improves resilience – the less energy that hospitals require, the longer they can operate during and after extreme weather events. An alternative source of power independent from the electrical grid also helps in weather emergencies; while all hospitals have diesel generators, much of this infrastructure has proven to be vulnerable and inadequate for prolonged grid outages.

During Sandy, hospitals that had on-site power generation continued to provide critical care to their patients, and offered safe haven for those hospital patients that were evacuated from flooded areas. Known as co-generation (or Combined Heat and Power), this technology not only dramatically improves the hospital’s energy efficiency and saves money, but it also turns out to be a critical climate resiliency strategy. Kiowa County Hospital, destroyed by a massive category 5 tornado in 2007 that damaged 95 percent of the town of Greensburg, Kansas, has been reconstructed with a 100 percent renewable wind energy system. According to FEMA, renewable energy infrastructure has performed well in extreme weather events, demonstrating that sustainable design and increased resilience go hand in hand.

The third central role of the health care sector is in education and advocacy around climate change policy. Health care professionals, especially doctors and nurses, enjoy an unprecedented role as positive messengers for health in society. As we begin to calculate the enormous health care and social costs of climate change, health care professionals are in a position to educate their patients about the public health impacts of climate change and help prepare them for these impacts, and also become potent spokespersons for policies at all levels of government that would rein in climate change. As Margaret Chan, director general of the World Health Organization, has stated, “the health sector must add its voice – loud and clear – and fight to place health issues at the center of the climate agenda. We have compelling reasons for doing so. Climate change will affect, in profoundly adverse ways, some of the most fundamental determinants of health: food, air, and water.”

Climate change will bring us many more heat waves, hurricanes and droughts in the years to come. We need to engage the health care sector in climate change mitigation so they can help communities be prepared to weather these crises and help lead us to a healthier and more sustainable future. Who else is going to play this role?

Gary Cohen, Co-founder and President, Health Care Without Harm

[This article was published as part of a special series for World Health Day and in advance of the 2013 Skoll World Forum. Watch the live stream on April 10-12.]