Malaysia leadership take on health and environment

Malaysia’s general elections on 5 May 2013 saw the existing government being re-elected, much to the chagrin of many who wanted a change in the government, seeking reformation and true democracy.

In the past, Malaysia’s development agenda was primarily driven by economic growth, with the government aiming to be a high-income country. New ministers have been appointed but we foresee that the development policies would remain the same with the Prime Minister pushing for the Economic Transformation Programme, launched on September 2010.

We fear of the price that has to be paid by us and the future generation in Malaysia’s pursuit to become a recognizable, developed nation of international standing. Is this what Malaysians really want? Is material wealth or living in a high-income country what we aim for in life? What about our health and well-being?

Rapid modernization and unsustainable development in the past have led to the exploitation and abuse of the environment in Malaysia. Hazardous industries pollute the air and water sources whilst forests are indiscriminately cleared for development or industrial agriculture, hence leaving the environment devastated.

In most cases, the destruction of the environment affects the livelihood and health of communities. Industrial chemicals, pollutants, pesticides, heavy metals are prevalent in our environment, bodies, food, air and water.

Environmental health problems in Malaysia are mostly attributed to atmospheric pollution, water pollution, climate change, waste management and disposal comprising of solid, toxic and hazardous waste.

Sadly, Malaysia's approaches to environmental management through policy and legal measures had not evolved from a mandate to afford the public with a right to clean air, water and a liveable environment. Rather, they emerge more out of a response to intolerable environmental conditions.

We do have substantial legal and policy initiatives that require proper consideration and action towards protecting the environment. However without a real commitment to strictly enforce laws and properly apply sound principles across the environmental landscape, Malaysia will continue to be at risk to pollution and the loss of its natural identity.

There is also a problem of general lack of transparency in decision-making and frequent high-handedness demonstrated towards the concerns of ordinary folk who dare to question development at the cost of health and the environment.

Although there are parts of the civil service who genuinely understand the practical common sense of integrating environment with development, sadly, the overriding perception among policy makers is that environmental concerns are an impediment to progress. Sometimes they even condemn communities opposing destructive projects as barriers to economic progress. This has forced many affected communities to seek international attention or legal redress.

Our angle of vision needs to shift from skyscrapers to observing what is happening closer to the ground in nature and in the everyday lives of Malaysians struggling with the consequences of development gone awry. At this more humble level await insights which question not just our quality of life but also the quality, nature and meaning of the journey towards modern development.

What is needed is a strong political will to address the issues of environmental health degradation and an environmentally and socially conscious public to push for concrete changes! For our own sake and the sake of our future generations, we must start to act responsibly before the momentum of irreversible changes overwhelms us.

(Partly extracted from paper jointly prepared by Sahabat Alam Malaysia & Consumers' Association of Penang)

Mageswari Sangaralingam currently works as Consultant for Sahabat Alam Malaysia (SAM) and Consumers' Association of Penang (CAP). HCWH-Asia partners with both SAM and CAP.

Global Green and Healthy Hospitals connects with Asian hospitals

The Global Green and Healthy Hospitals initiative is a network of hospitals and health organizations spanning over 3,500 hospitals in six continents. This network is composed of members who are committed to implementing GGHH’s ten interconnected goals. These goals are all geared towards reducing the environmental impact of health care, and promoting environmental health.

A vital part of GGHH’s platform is the sharing of case studies and best practices. The breakthroughs of one hospital, for example, can inspire another institution thousands of miles away. The network thrives on this free exchange of ideas, which is why it decided to create GGHH Connect, a site that combines social networking, content creation, and interaction.

We’re pretty excited about this, because the Health Care Without Harm and GGHH teams have been looking for ways to encourage members of our networks to interact in even better ways. While HCWH and GGHH already use Facebook and Twitter, we also wanted to give professionals another platform to engage.

Unlike Facebook and Twitter though, GGHH Connect is exclusively for members of GGHH. This means members can share and receive information in a safe, professional environment. Everyone can be assured of the credentials and expertise of each participant. This will tighten the global network of GGHH and create a climate more conducive to sharing information and breakthroughs.

The platform, which was developed by GGHH, Cisco Systems, and the Skoll Foundation, will enable all GGHH members to share and receive information, feedback, as well as work together to achieve their sustainability goals.

The Cisco-powered site is set to open on the fourth week of May. Right now, I’m working on spreading the word to hospitals and other potential members. If you’re interested on hopping onboard, I’d be happy to tell you more. Email me at Inigo@no-harm.org.

To learn more about the GGHH network as a whole, visit greenhospitals.net.

Iñigo de Paula is a Manila-based digital marketing consultant and freelance creative director. He is currently doing consultancy work for HCWH-Asia.

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.]

Wastewater management in healthcare

My 2nd year with Health Care Without Harm-Asia on its 10th year celebration.

There are 10 goals to achieve and hopefully more hospitals will be involved in the Global Green Healthy Hospital (GGHH) network. The Network sets out to support existing efforts around the world to promote greater sustainability and environmental health in the healthcare sector, and thereby to strengthen health systems globally.

One of GGHH goal is on Water. We know that water is crucial for all aspects of life but only 1% of all freshwater on Earth is available for human use. Wastewater management is essential for a most effective and sustainable future.

The Philippines is made up of over 7,000 islands, and has the longest total coastline in the world. Given this, many Filipinos rely on the ocean as a source of food. Eating seafood from, and actually consuming, contaminated water puts the person in grave risk.

This put emphasis on the need to protect the Philippine waters from contaminants. Small bodies of water such as rivers, streams, and waterfalls are also used for drinking, washing, and cooking. People relying on these may be harmed by the toxins present in the water.

Concern over the world's water supply is likewise increasing. Industrialization and urban development is often seen as a marker of progress, but these developments may also compromise the cleanliness and safety of water supplies. This concern is as relevant as ever, as freshwater demand for industrial applications will increase to 120 billion cubic meters by 2025. (Babu, 2008). An increase in industrialization brings an increased need for better waste management.

The Philippines had made several positive steps to protecting our waters. The Philippine Clean Water Act (2004) requires facilities to obtain a wastewater discharge permit.

Hospitals are also bound to this law. One hospital that sets a positive example is the Philippine Heart Center (PHC). Considered one of the top facilities for cardiovascular treatment, the hospital implements stringent waste water processing.

PHC has noted an increase in water consumption in line with the increase in patients. To process the wastewater produced, the hospital has introduced a Sewerage Treatment Plan (STP). The STP has its own staff to monitor smooth operations around the clock. The facilities also undergo a monthly examination of its water output by independent laboratories.

The STP project cost PHC a big sum of Php10.5 million (approx US$260,000). Although the return of investment (ROI) is not yet significant, PHC expects it in the coming years of operation.

The recycled water is being used to water ornamental plants in the hospital grounds and gardens, and for toilet flushing. As of now they are saving quite a lot in the water consumption because the areas for the ornamental plants and gardens are quite considerable.

The work in waste water treatment takes up time, knowledge, experience, lots of passion, and commitment. As Engr. Barzaga, engineer IV of PHC’s Mechanical Department shares, “For proper wastewater treatment facility to work properly, adequate manpower plus an experienced, knowledgeable, and passionate team should be working on the facility fulltime. As hospital people, it is not only their responsibility to comply with laws but also to make sure to keep the environment healthy for the surrounding communities.”

Setting-up wastewater treatment facilities is a huge investment, but it is the surest way to sustainability of water management and secure our water resources.

A healthier future needs urgent global action for smart investment to improve wastewater management. Wise investments will generate greater return.

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Joyce C. Lanuza, HCWH-Asia Admin/Finance Officer

Medical Waste Awareness at an All-time High in Nepal

A front-page news article in the Himalayan - one of Nepal's leading English language newspapers - reports the government warning that hospitals that do not treat their waste will lose their licences and be forced to shut down. A team lead by a representative from the Prime Minister's office visited three Kathmandu Hospitals in December and found that only one was treating their waste properly. That one hospital was Bir, where HECAF has created a sustainable waste management system with support from HCWH and the World Health Organisation. A short HECAF video about the progress at Bir, by filmmaker Russ Pariseau, can be seen here.

The Prime Minister and the Minister of Science and Technology also came to the Energy Week Workshop organised by the Alternative Energy Promotion Centre and visited HECAF's stall, where they were raising awareness about HCWH's Global Green and Healthy Hospital's, and the potential of biodigestion to treat waste and generate renewable energy in hospitals. Biodigestion is just one of the innovative technologies that are being piloted at Bir, and plans for other hospitals are under development.

Outside of the capital, the Chitwan District Public Health Office, a government institution responsible for Public Health, is also backing HECAF and HCWH's work. The District Public Health Officer is supporting our project to develop waste systems suitable for the small healthposts that so many of the rural population depend on. Suitable pilot facilities have already been identified and the next step will be to raise awareness with facility bosses across the region and field testing some of the priority technologies.

Health Care Without Harm has been working with strategic partners Healthcare Foundation Nepal (HECAF) since 2008 and the issue has never been hotter.

Ruth Stringer, HCWH International Science & Policy Coordinator