Navajo Nation's Monument Valley Park, Arizona.
Elmer Guy and Nonabah Lane.
Credits: Navajo Technical University, left, and Diana Levine
Nonabah Lane: The COVID pandemic is really highlighting a lot of ways in which we are lacking, and that's especially true here in our tribal community, because the first thing you need to even address where we are in this science and technology space is the internet. There's a considerable gap between the haves and the have-nots in terms of internet. The Navajo Nation is roughly the size of West Virginia, but we don't have anywhere near the broadband and internet access that other "states" this size would have. Some of the more glaring reasons for this go back to historical policies, lack of funding for infrastructure on tribal lands, and current rights-of-way issues, and a lot of it has to do with the fact that larger corporations aren't as willing to take risks in doing business on a tribal trust land. When you don't have the internet, you don't have access to information, you don't have access to what is going on in the world or science or technology, and you can't keep up with work or school.
Dr. Elmer Guy: That's right. In this pandemic, as we're being forced to go online, I see school buses parked outside for students who don't have internet at home. The buses are equipped with Wi-Fi, so if students can find a way to get to where those buses are parked, they can get on and do their homework. But only then.
Internet has long been an issue, and the Navajo Nation's telecommunications department created a cyber task force that we at Navajo Technical University (NTU) are members of. One of the things we recently did was to petition the FCC for special temporary authority of an EBS [Educational Broadband Services] 2.5-GHz spectrum that was available but not being used. So now we have that and we're using it to set up hot spots for students to connect. We're also working with the four internet-service companies: Cellular One, Navajo Tribal Utility Authority, Sacred Wind, and Frontier. As Nonabah was saying, the Navajo Nation is quite large and has five agencies. NTU is in the eastern agency, but Navajo Tribal Utility Authority doesn't have a footprint here, so we partnered with Sacred Wind as well as Frontier to broaden our bandwidth.
We've also been collaborating with the Navajo Cyber Team on developing a Navajo Nation broadband policy, and we're almost done with that. The Navajo Nation received some CARES [Coronavirus Aid, Relief, and Economic Security] funding, and part of that is being used to address broadband. One of the things we're trying to do is see if tribal colleges can qualify for E-Rates [educational rates], since schools are eligible for E-Rates. And so some of the schools are getting connected.
What's also happening is that the Navajo Nation is trying to expand water lines to families so that they have water to wash their hands during this pandemic. We're recommending that if they're going to dig for the water lines, they might as well lay down conduits, too, so that later we will be able to install fiber as well. We happen to specialize in wireless technology here at NTU, and that is making a significant impact. In the past, it used to be about point-to-point, and when you're trying to serve a community in the valley, you'd have to find a water tank or something high and then get down and into that community from there. But with newer technology, they can bend now into those valleys. We keep reminding the state that they need to address rural communities. We've reached out to congressional members to push them to address broadband issues with Indian communities, and there are a couple of bills out now addressing that.
Of course, there are other things we're looking at in terms of scientific priorities: artificial intelligence, robotics, and climate change. We're in a high-desert environment, and the sand dunes are increasing because of overgrazing and other factors. Water sources are limited, and air pollution doesn't really help, so robotics could be promising. For example, we're looking at the water-filtering systems for wells so that both animals and humans have access to safe water. We're beginning to see the reach of technology in places like grocery stores, where people can check themselves out without the need for cashiers. So we try to look ahead and project what kinds of jobs will and will not be needed on the Navajo Nation, then have our faculty think about ways of adjusting the curriculum to stay in line with where the world is headed.
"One of the biggest challenges for us is how we make sure there's a connection between the students who want to go into science and how they can continue to contribute to Navajo communities—to their parents' and grandparents' way of life."
NL: Since we're talking about the internet and A.I., I think one of the key issues that isn't addressed in tribal communities is data: data security, privacy, and, ultimately, ownership. It's such a gray area. Take this pandemic, for instance, and the numbers and the data that's being collected: who's taking all of this information out of our communities and who's accounting for it? It's an important component being extracted seemingly covertly. Our tribal communities don't necessarily understand how valuable it is to keep that data within our communities.
I know there are various data holders who are not Navajo who have studied Navajo people and our environment, from soil samples to diabetes rates, and it's just not information we fully have access to as a population—our own information. It's critical to get everyone on the same page and to understand the importance of that.
There's a water project I'm working on that came out of the Gold King Mine waste-water spill of 2015, which was a major environmental catastrophe in New Mexico that affected the run-off from the San Juan Mountains. The water contamination really hurt agriculture, especially Navajo farmers on the San Juan River. We still feel it, even if the pandemic has kind of overshadowed it, and before the pandemic, my organization, Navajo Ethno-Agriculture, adopted a lot of the hard-science data that was taken by the University of Arizona. We've been working with New Mexico State University in continuing to collect and share data with the community in order to build back confidence with Navajo consumers about our farm produce. We have an ongoing partnership with New Mexico State University where they come out and do soil testing, and Navajo Preparatory School students are developing a curriculum around this as well. The point is to get easy-to-use, low-cost technology so that farmers can do this testing on their own and not have to wait for and rely on a university or the government agencies to come out and test it. This initiative would not have been possible without the support of the MIT Solve Indigenous Communities Fellowship.
Of course, you're always going to have the people in the community who don't believe in science and don't believe that the water is, in fact, okay, but it's essential that we have that scientific data. It's about empowering farmers to be able to relay that message as well—and finding a bridge between our longstanding traditions and modern science. A lot of the farming among the Navajo is deeply traditional to this region, and, as a culture, we're focused on the traditional aspects of the food. That's really why we felt like it was important to be proactive about this—because if you lose one more generation of farmers who don't produce these heritage foods, it's not just your food, it's your whole culture and way of life—your heritage—that could be gone. So it's important to preserve that tradition, but also alongside Western science—and data is critical.
EG: Nonabah is right about tradition, and I think one of the biggest challenges for us is how we make sure there's a connection between the students who want to go into science and how they can continue to contribute to Navajo communities—to their parents' and grandparents' way of life. A lot of the time, you have to create those opportunities. For example, we're trying to develop an environmental laboratory at one of our sites in Chinle, Arizona, where we want to be able to test the water, soil, air, uranium, etc. We have people who can run that facility mainly to help with the uranium mine clean-up. There are over 500 abandoned uranium mines, and what might usually happen is that funds would become available and outside entities would get those grants and they'd come in and do the work. Then, as soon as the grant is up, they leave and everything disappears, but the problem remains. It's these kinds of situations where we say, Why can't we do that ourselves? And the only way is to train and prepare engineers ourselves, from our community.
A lot of our students intern with the U.S. Army and Air Force Research Labs Faculty Fellowship or with Boeing or NASA, and, when they graduate, those groups grab them for themselves. So I keep asking the Navajo Nation where they are in all of this. A lot of times we are the ones who create the barriers that only end up hurting us. When the Navajo Nation puts out job vacancies, they require candidates to have so many years of experience, and our students don't qualify. There is a tremendous need for our graduates, but everybody except the Navajo Nation ends up hiring them.
NL: As Dr. Guy says, creating opportunity is so important. My family's non-profit organization, Navajo Ethno-Agriculture, actually came about for that particular reason. We had people coming in and doing workshops and telling us how we should plant and do this or that. It was absurd—how can you come from Washington State and tell us how to plant when you don't know what native crops have been planted in our home region for centuries? And so, because of my family's background in the sciences and the traditional upbringing we all share, we built this program ourselves. We incorporate the science into our program, and we encourage students to pursue a career in science, while trying to create those job opportunities for them here. I find that more than 75% of the Navajo students I interact with—whether in high school or college—want to come back home. They just don't have the work or career opportunities to do so.
EG: NTU also has a partnership with the Navajo Nation's economic department, and we run their business incubator program. We encourage people to go into businesses here on Navajo. One of the challenges is that, even though the Navajo Nation may be the size of West Virginia, we don't own the land. So you have to deal with leases or homesite land-use permits, and it's daunting. We streamline that process and help people put together business plans, set up payroll taxes, figure out marketing strategies, and so forth.
One of the challenges is resistance, and that's something you have to deal with. For example, when I was pushing my faculty to develop an engineering degree, no one could understand why. So I told them about the national goal—that the United States has set a goal for itself that by the year 2026 or whenever, it wants to have 100,000 engineers. But what about the Navajo Nation's goals? We don't have a goal, but we should, and you have to push people to get there. Eventually everyone sees the benefits of these kinds of decisions.
NL: I also believe we have to encourage the entrepreneurial mindset: If something doesn't exist here already, then ask yourself what's needed and create it. This is our community, and we can make that change. I'm really biased toward starting your own thing because that's what I do. Before COVID-19 hit, I was developing a water lab that would stand closer to the Southern Ute Reservation so that it could be at the opening to the tributaries that run into the Colorado River and downstream to the tribes. I wanted that specific site because it would allow us to monitor the water that's a priority for tribes—because everyone else already has their own resources. And all of the water scientists involved were Navajo. If people like us don't take the initiative for these kinds of projects, the absolute wrong person is going to do it, without understanding the community.
EG: Whether it's the environment or water or some other scientific need, it's important that we remember to develop the smaller steps necessary for achieving any goal. For example, if we need veterinarians, then we have to ask what the steps are to get us to that point. A veterinary or medical school probably won't happen at NTU, but we could begin by identifying and building the steps needed to get there. We did this by starting a veterinary technician program and then added an animal science degree and then a biology degree, which is designed somewhat as a pre-medical degree, so that students can go into either medicine or veterinary science. We know we can't always make a leap right away, but we can build the pathways that get us there.
NL: For everything we've been discussing, I think it's really important to understand that we're not talking for the whole of the Navajo Nation; the Navajo Nation is large, and its culture is regional. There are different priorities in different communities. Where I live, we have abundant water around us, so that is not a need, but if you go 100 miles south, there's no water infrastructure whatsoever. And there are other issues, from coal and oil and gas extraction, to the uranium issue, which are regional. Some people live close to large health facilities while rural communities only have access to a clinic. NTU is resource-abundant in terms of having that academic outlet for students while people on the other side of the reservation may not have that. I'm always very clear about this. I may be speaking from a tribal nation, I may be speaking from experience, but I'm not speaking for the Navajo Nation as a whole, and I'm not speaking for tribal communities as a whole. Yes, we are a community, and we can expose a greater picture in our area of expertise, but there are definitely different areas that have individual needs.
Still, I do believe in the promise of what the future can hold for us in terms of both science and tradition. The two can complement each other and are not at odds, even though we tend to think of sustainability in scientific terms. And yes, science can help us achieve sustainability through things like solar tech, health innovations, and natural sciences. But I'm talking about sustainability overall and of the Earth: sustainability of water, energy, and agriculture, but also of human capacity and Navajo culture.
[Editor's Note: To read other articles in this special magazine issue, visit the beautifully designed e-reader version.]
In the U.S., hospitals generate an estimated 6,000 tons of waste per day. A few clinics are leading the way in transitioning to clean energy sources.
She decided to research alternatives for plastic in the medical sector and learned that cups could be reused and easily disinfected. All dentists routinely disinfect their tools anyway and, Stroetzel reasoned, it wouldn’t be too hard to extend that practice to cups.
It's a good example for how often plastic is used unnecessarily in medical practice, she says. The health care sector is the fifth biggest source of pollution and trash in industrialized countries. In the U.S., hospitals generate an estimated 6,000 tons of waste per day, including an average of 400 grams of plastic per patient per day, and this sector produces 8.5 percent of greenhouse gas emissions nationwide.
“Sustainable alternatives exist,” Stroetzel says, “but you have to painstakingly look for them; they are often not offered by the big manufacturers, and all of this takes way too much time [that] medical staff simply does not have during their hectic days.”
When Stroetzel spoke with medical staff in Germany, she found they were often frustrated by all of this waste, especially as they took care to avoid single-use plastic at home. Doctors in other countries share this frustration. In a recent poll, nine out of ten doctors in Germany said they’re aware of the urgency to find sustainable solutions in the health industry but don’t know how to achieve this goal.
After a year of researching more sustainable alternatives, Stroetzel founded a social enterprise startup called POP, short for Practice Without Plastic, together with IT expert Nicolai Niethe, to offer well-researched solutions. “Sustainable alternatives exist,” she says, “but you have to painstakingly look for them; they are often not offered by the big manufacturers, and all of this takes way too much time [that] medical staff simply does not have during their hectic days.”
In addition to reusable dentist cups, other good options for the heath care sector include washable N95 face masks and gloves made from nitrile, which waste less water and energy in their production. But Stroetzel admits that truly making a medical facility more sustainable is a complex task. “This includes negotiating with manufacturers who often package medical materials in double and triple layers of extra plastic.”
While initiatives such as Stroetzel’s provide much needed information, other experts reason that a wholesale rethinking of healthcare is needed. Voluntary action won’t be enough, and government should set the right example. Kari Nadeau, a Stanford physician who has spent 30 years researching the effects of environmental pollution on the immune system, and Kenneth Kizer, the former undersecretary for health in the U.S. Department of Veterans Affairs, wrote in JAMA last year that the medical industry and federal agencies that provide health care should be required to measure and make public their carbon footprints. “Government health systems do not disclose these data (and very rarely do private health care organizations), unlike more than 90% of the Standard & Poor’s top 500 companies and many nongovernment entities," they explained. "This could constitute a substantial step toward better equipping health professionals to confront climate change and other planetary health problems.”
Compared to the U.K., the U.S. healthcare industry lags behind in terms of measuring and managing its carbon footprint, and hospitals are the second highest energy user of any sector in the U.S.
Kizer and Nadeau look to the U.K. National Health Service (NHS), which created a Sustainable Development Unit in 2008 and began that year to conduct assessments of the NHS’s carbon footprint. The NHS also identified its biggest culprits: Of the 2019 footprint, with emissions totaling 25 megatons of carbon dioxide equivalent, 62 percent came from the supply chain, 24 percent from the direct delivery of care, 10 percent from staff commute and patient and visitor travel, and 4 percent from private health and care services commissioned by the NHS. From 1990 to 2019, the NHS has reduced its emission of carbon dioxide equivalents by 26 percent, mostly due to the switch to renewable energy for heat and power. Meanwhile, the NHS has encouraged health clinics in the U.K. to install wind generators or photovoltaics that convert light to electricity -- relatively quick ways to decarbonize buildings in the health sector.
Compared to the U.K., the U.S. healthcare industry lags behind in terms of measuring and managing its carbon footprint, and hospitals are the second highest energy user of any sector in the U.S. “We are already seeing patients with symptoms from climate change, such as worsened respiratory symptoms from increased wildfires and poor air quality in California,” write Thomas B. Newman, a pediatrist at the University of California, San Francisco, and UCSF clinical research coordinator Daisy Valdivieso. “Because of the enormous health threat posed by climate change, health professionals should mobilize support for climate mitigation and adaptation efforts.” They believe “the most direct place to start is to approach the low-lying fruit: reducing healthcare waste and overuse.”
In addition to resulting in waste, the plastic in hospitals ultimately harms patients, who may be even more vulnerable to the effects due to their health conditions. Microplastics have been detected in most humans, and on average, a human ingests five grams of microplastic per week. Newman and Valdivieso refer to the American Board of Internal Medicine's Choosing Wisely program as one of many initiatives that identify and publicize options for “safely doing less” as a strategy to reduce unnecessary healthcare practices, and in turn, reduce cost, resource use, and ultimately reduce medical harm.
A few U.S. clinics are pioneers in transitioning to clean energy sources. In Wisconsin, the nonprofit Gundersen Health network became the first hospital to cut its reliance on petroleum by switching to locally produced green energy in 2015, and it saved $1.2 million per year in the process. Kaiser Permanente eliminated its 800,000 ton carbon footprint through energy efficiency and purchasing carbon offsets, reaching a balance between carbon emissions and removing carbon from the atmosphere in 2020, the first U.S. health system to do so.
Cleveland Clinic has pledged to join Kaiser in becoming carbon neutral by 2027. Realizing that 80 percent of its 2008 carbon emissions came from electricity consumption, the Clinic started switching to renewable energy and installing solar panels, and it has invested in researching recyclable products and packaging. The Clinic’s sustainability report outlines several strategies for producing less waste, such as reusing cases for sterilizing instruments, cutting back on materials that can’t be recycled, and putting pressure on vendors to reduce product packaging.
The Charité Berlin, Europe’s biggest university hospital, has also announced its goal to become carbon neutral. Its sustainability managers have begun to identify the biggest carbon culprits in its operations. “We’ve already reduced CO2 emissions by 21 percent since 2016,” says Simon Batt-Nauerz, the director of infrastructure and sustainability.
The hospital still emits 100,000 tons of CO2 every year, as much as a city with 10,000 residents, but it’s making progress through ride share and bicycle programs for its staff of 20,000 employees, who can get their bikes repaired for free in one of the Charité-operated bike workshops. Another program targets doctors’ and nurses’ scrubs, which cause more than 200 tons of CO2 during manufacturing and cleaning. The staff is currently testing lighter, more sustainable scrubs made from recycled cellulose that is grown regionally and requires 80 percent less land use and 30 percent less water.
The Charité hospital in Berlin still emits 100,000 tons of CO2 every year, but it’s making progress through ride share and bicycle programs for its staff of 20,000 employees.
Wiebke Peitz | Specific to Charité
Anesthesiologist Susanne Koch spearheads sustainability efforts in anesthesiology at the Charité. She says that up to a third of hospital waste comes from surgery rooms. To reduce medical waste, she recommends what she calls the 5 Rs: Reduce, Reuse, Recycle, Rethink, Research. “In medicine, people don’t question the use of plastic because of safety concerns,” she says. “Nobody wants to be sued because something is reused. However, it is possible to reduce plastic and other materials safely.”
For instance, she says, typical surgery kits are single-use and contain more supplies than are actually needed, and the entire kit is routinely thrown out after the surgery. “Up to 20 percent of materials in a surgery room aren’t used but will be discarded,” Koch says. One solution could be smaller kits, she explains, and another would be to recycle the plastic. Another example is breathing tubes. “When they became scarce during the pandemic, studies showed that they can be used seven days instead of 24 hours without increased bacteria load when we change the filters regularly,” Koch says, and wonders, “What else can we reuse?”
In the Netherlands, TU Delft researchers Tim Horeman and Bart van Straten designed a method to melt down the blue polypropylene wrapping paper that keeps medical instruments sterile, so that the material can be turned it into new medical devices. Currently, more than a million kilos of the blue paper are used in Dutch hospitals every year. A growing number of Dutch hospitals are adopting this approach.
Another common practice that’s ripe for improvement is the use of a certain plastic, called PVC, in hospital equipment such as blood bags, tubes and masks. Because of its toxic components, PVC is almost never recycled in the U.S., but University of Michigan researchers Danielle Fagnani and Anne McNeil have discovered a chemical process that can break it down into material that could be incorporated back into production. This could be a step toward a circular economy “that accounts for resource inputs and emissions throughout a product’s life cycle, including extraction of raw materials, manufacturing, transport, use and reuse, and disposal,” as medical experts have proposed. “It’s a failure of humanity to have created these amazing materials which have improved our lives in many ways, but at the same time to be so shortsighted that we didn’t think about what to do with the waste,” McNeil said in a press release.
Susanne Koch puts it more succinctly: “What’s the point if we save patients while killing the planet?”