An Environmental Scientist and an Educator Highlight Navajo Efforts to Balance Tradition with Scientific Priorities
This article is part of the magazine, "The Future of Science In America: The Election Issue," co-published by LeapsMag, the Aspen Institute Science & Society Program, and GOOD.
The global pandemic has made it impossible to ignore the stark disparities that exist within American communities. In the past months, journalists and public health experts have reminded us how longstanding systemic health and social inequities have put many people from racial and ethnic minority groups at increased risk of getting sick and dying from COVID-19. Still, the national dialogue noticeably lacks a general awareness of Indigenous people's needs and priorities, especially in the scientific realm.
To learn more about some of the issues facing often-overlooked Indigenous tribal communities, we sought the perspectives of two members of the Navajo Nation: Nonabah Lane, Director of Development of New Mexico Projects at Navajo Power and the founder of Navajo Ethno-Agriculture, a farm that teaches Navajo culture through traditional farming and bilingual education; and Elmer Guy, Ph.D., president of Navajo Technical University, the first university to be established forty years ago on the Navajo Nation that today stands as a premier institution of higher education focusing on a balance between science and technology and traditional culture.
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.
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Telehealth offers a vast improvement in access and convenience to all sorts of medical services, and online therapy for mental health is one of the most promising case studies for telehealth. With many online therapy options available, you can choose whatever works best for you. Yet many people are hesitant about using online therapy. Even if they do give it a try, they often don’t know how to make the most effective use of this treatment modality.
Why do so many feel uncertain about online therapy? A major reason stems from its novelty. Humans are creatures of habit, prone to falling for what behavioral scientists like myself call the status quo bias, a predisposition to stick to traditional practices and behaviors. Many people reject innovative solutions even when they would be helpful. Thus, while teletherapy was available long before the pandemic, and might have fit the needs of many potential clients, relatively few took advantage of this option.
Even when we do try new methodologies, we often don’t do so effectively, because we cling to the same approaches that worked in previous situations. Scientists call this behavior functional fixedness. It’s kind of like the saying about the hammer-nail syndrome: “when you have a hammer, everything looks like a nail.”
These two mental blindspots, the status quo bias and functional fixedness, impact decision making in many areas of life. Fortunately, recent research has shown effective and pragmatic strategies to defeat these dangerous errors in judgment. The nine tips below will help you make the best decisions to get effective online therapy, based on the latest research.
For instance, a 2014 study in the Journal of Affective Disorders reported that online treatment proved just as effective as face-to-face treatment for depression. A 2018 study, published in Journal of Psychological Disorders, found that online cognitive behavioral therapy, or CBT, was just as effective as face-to-face treatment for major depression, panic disorder, social anxiety disorder, and generalized anxiety disorder. And a 2014 study in Behaviour Research and Therapy discovered that online CBT proved effective in treating anxiety disorders, and helped lower costs of treatment.
During the forced teletherapy of COVID, therapists worried that those with serious mental health conditions would be less likely to convert to teletherapy. Yet research published in Counselling Psychology Quarterly has helped to alleviate that concern. It found that those with schizophrenia, bipolar disorder, severe depression, PTSD, and even suicidality converted to teletherapy at about the same rate as those with less severe mental health challenges.
Yet teletherapy may not be for everyone. For example, adolescents had the most varied response to teletherapy, according to a 2020 study in Family Process. Some adapted quickly and easily, while others found it awkward and anxiety-inducing. On the whole, children with trauma respond worse to online therapy, per a 2020 study in Child Abuse & Neglect. The treatment of mental health issues can sometimes require in-person interactions, such as the use of eye movement desensitization and reprocessing to treat post-traumatic stress disorder. And according to a 2020 study from the Journal of Humanistic Psychology, online therapy may not be as effective for those suffering from loneliness.
Online therapy is much more accessible than in-person therapy for those with a decent internet connection, webcam, mic, and digital skills. You don’t have to commute to your therapist’s office, wasting money and time. You can take much less medical leave from work, saving you money and hassle with your boss. If you live in a sparsely populated area, online therapy could allow you to access many specialized kinds of therapy that isn’t accessible locally.
Online options are much quicker compared to the long waiting lines for in-person therapy. You also have much more convenient scheduling options. And you won’t have to worry about running into someone you know in the waiting room. Online therapy is easier to conceal from others and reduces stigma. Many patients may feel more comfortable and open to sharing in the privacy and comfort of their own home.
You can use a variety of communication tools suited to your needs at any given time. Video can be used to start a relationship with a therapist and have more intense and nuanced discussions, but can be draining, especially for those with social anxiety. Voice-only may work well for less intense discussions. Email offers a useful option for long-form, well-thought-out messages. Texting is useful for quick, real-time questions, answers, and reinforcement.
Plus, online therapy is often cheaper than in-person therapy. In the midst of COVID, many insurance providers have decided to cover online therapy.
One weakness is the requirement for appropriate technology and skills to engage in online therapy. Another is the difficulty of forming a close therapeutic relationship with your therapist. You won’t be able to communicate non-verbals as fully and the therapist will not be able to read you as well, requiring you to be more deliberate in how you express yourself.
Another important issue is that online therapy is subject to less government oversight compared to the in-person approach, which is regulated in each state, providing a baseline of quality control. As a result, you have to do more research on the providers that offer online therapy to make sure they’re reputable, use only licensed therapists, and have a clear and transparent pay structure.
Figure out what kind of goals you want to achieve. Consider how, within the context of your goals, you can leverage the benefits of online therapy while addressing the weaknesses. Write down and commit to achieving your goals. Remember, you need to be your own advocate, especially in the less regulated space of online therapy, so focus on being proactive in achieving your goals.
Because online therapy can occur at various times of day through videos calls, emails and text, it might feel more open-ended and less organized, which can have advantages and disadvantages. One way you can give it more structure is to ground these interactions in the story of your self-improvement. Our minds perceive the world through narratives. Create a story of how you’ll get from where you are to where you want to go, meaning your goals.
A good template to use is the Hero’s Journey. Start the narrative with where you are, and what caused you to seek therapy. Write about the obstacles you will need to overcome, and the kind of help from a therapist that you’ll need in the process. Then, describe the final end state: how will you be better off after this journey, including what you will have learned.
Especially in online therapy, you need to be on top of things. Too many people let the therapist manage the treatment plan. As you pursue your hero’s journey, another way to organize for success is to take notes on your progress, and reevaluate how you’re doing every month with your therapist.
Since it’s more difficult to be confident about the quality of service providers in an online setting, you should identify in advance the traits of your desired therapist. Every Hero’s Journey involves a mentor figure who guides the protagonist through this journey. So who’s your ideal mentor? Write out their top 10 characteristics, from most to least important.
For example, you might want someone who is:
- Good listener
That’s my list. Depending on what challenge you’re facing and your personality and preferences, you should make your own. Then, when you are matched with a therapist, evaluate how well they fit your ideal list.
When you first match with a therapist, try to fail fast. That means, instead of focusing on getting treatment, focus on figuring out if the therapist is a good match based on the traits you identified above. That will enable you to move on quickly if they’re not, and it’s very much worth it to figure that out early.
Tell them your goals, your story, and your vision of your ideal mentor. Ask them whether they think they are a match, and what kind of a treatment plan they would suggest based on the information you provided. And observe them yourself in your initial interactions, focusing on whether they’re a good match. Often, you’ll find that your initial vision of your ideal mentor is incomplete, and you’ll learn through doing therapy what kind of a therapist is the best fit for you.
This small subgoal should be sufficient to be meaningful and impactful for improving your mental health, but not a big stretch for you to achieve. This subgoal should be a tool for you to use to evaluate whether the therapist is indeed a good fit for you. It will also help you evaluate whether the treatment plan makes sense, or whether it needs to be revised.
As you approach the end of your planned work and you see you’re reaching your goals, talk to the therapist about how to wrap up rather than letting things drag on for too long. You don’t want to become dependent on therapy: it’s meant to be a temporary intervention. Some less scrupulous therapists will insist that therapy should never end and we should all stay in therapy forever, and you want to avoid falling for this line. When you reach your goals, end your therapy, unless you discover a serious new reason to continue it. Still, it may be wise to set up occasional check-ins once every three to six months to make sure you’re staying on the right track.
This is part 2 of a three part series on a new generation of doctors leading the charge to make the health care industry more sustainable - for the benefit of their patients and the planet. Read part 1 here.
After graduating from her studies as an engineer, Nora Stroetzel ticked off the top item on her bucket list and traveled the world for a year. She loved remote places like the Indonesian rain forest she reached only by hiking for several days on foot, mountain villages in the Himalayas, and diving at reefs that were only accessible by local fishing boats.
“But no matter how far from civilization I ventured, one thing was already there: plastic,” Stroetzel says. “Plastic that would stay there for centuries, on 12,000 foot peaks and on beaches several hundred miles from the nearest city.” She saw “wild orangutans that could be lured by rustling plastic and hermit crabs that used plastic lids as dwellings instead of shells.”
While traveling she started volunteering for beach cleanups and helped build a recycling station in Indonesia. But the pivotal moment for her came after she returned to her hometown Kiel in Germany. “At the dentist, they gave me a plastic cup to rinse my mouth. I used it for maybe ten seconds before it was tossed out,” Stroetzel says. “That made me really angry.”
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?”