Operating for the earth and humanity: urging greener global surgical solutions


Surgery is a crucial medical intervention that saves lives and improves health outcomes for millions worldwide. It is a necessary component of modern healthcare, and access to surgery is necessary for many people to receive life-saving treatment. However, despite its importance, surgical systems have been identified as a significant contributor to carbon dioxide emissions, contributing to climate change. The unsustainable and inefficient practices employed in high-income countries (HICs), such as excessive energy consumption, unsustainable waste generation, and emissions of greenhouse gases such as anesthetic agents, profoundly impact the environment. These practices, therefore, undermine the very goals of surgery, which is to heal people and improve their lives.

Access to surgical and anesthesia care in low- and middle-income countries (LMICs) remains limited, leading to preventable disabilities and high mortality rates. Moreover, although LMICs contribute the least to CO2 emissions compared to HICs, the effects of climate change are felt disproportionately by LMICs, where natural disasters often necessitate the availability of efficient and effective surgical systems. For instance, injured people may need surgical intervention when a natural disaster strikes. Hence, the effects of climate change also burden already stretched surgical systems in LMICS. If the surgical system is not adequately equipped and staffed with effective systems (e.g., blood, supply chain, referrals) to handle the increased demand, many lives will be lost.

To address this surgical problem, many governments in LMICs have taken significant steps by focusing mainly on education, infrastructure, equipment, and policy development. Many, like Zambia, Tanzania, Ethiopia, Pakistan, Nigeria, and Madagascar, among others, have developed and begun implementing National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs) to increase access to safe, timely, and affordable surgical and anesthesia care. NSOAPs help countries to identify gaps in their surgical systems, establish priorities for improvement, and set up targets for achieving those goals. These plans are critical for improving access and quality of surgical care. However, while these efforts are commendable, LMICs must refrain from replicating the unsustainable and inefficient practices in HICs’ health systems, particularly those that contribute to global climate change. Instead, they must leverage their position to be innovative and consider climate-friendly surgical systems as they scale up their surgical services from the ground up. The Tanzanian NSOAP, for example, aims to upgrade existing health facilities with the necessary infrastructure, equipment, and supplies needed for safe surgical services by upgrading operating theatres. In upgrading these facilities, the Tanzanian Ministry of Health should consciously consider how the structural and operational designs of these facilities will impact climate change and ensure that these facilities can withstand climate change’s short- and long-term effects. For example, solar energy sources may be considered in place of fuel backup generators. Also, hospitals could implement energy-efficient surgical instruments, adopt waste management systems that minimize pollution, and promote renewable energy sources in surgical facilities. All facility and national-based policies should approach surgical systems strengthening with such conscientious considerations of climate change and sustainability.

Investment in research and innovation and surgical providers advocating for more sustainable surgical systems is needed. Climate change presents a business opportunity for entrepreneurs. Governments and investors should support researchers and entrepreneurs to identify innovative and contextual solutions to surgical challenges.

Such an approach can yield long-term benefits beyond environmental sustainability, such as better health outcomes, reduced morbidity and mortality, and more efficient resource utilization. A shift towards renewable energy sources would reduce carbon emissions and decrease energy costs, thus freeing up resources for other healthcare needs.

Recently, some HICs started implementing sustainable surgical care practices. For example, some surgical teams are exploring low-carbon anesthesia techniques. These efforts by HICs should be encouraged. Nevertheless, HICs, the leaders in global CO2 emissions, have an ethical duty to help mitigate the effects of climate change felt mostly in LMICs who contribute the least to global CO2 emissions. Therefore, HICs should justly and equitably support LMICs in increasing access to safe and sustainable surgical care by sharing best practices, providing technical assistance, and assisting in accessing renewable energy sources and implementing energy-efficient technologies. This collaboration can help build a global network of sustainable surgical care providers, ensuring patients worldwide receive safe and high-quality surgical care while minimizing the environmental impact of surgical care.

In conclusion, surgical and anesthesia care is critical to modern healthcare. However, it is important to recognize the impact of surgical systems on the environment and take proactive steps to address it and prepare for climate change’s short-term and long-term impacts. By investing in sustainable and climate-friendly surgical systems, governments and surgical care providers in LMICs can provide essential surgical care to their populations while contributing to global efforts to combat climate change. HICs also have an ethical obligation to assist LMICs in these endeavors. The result will be a more sustainable and equitable healthcare system that benefits everyone, now and in the future.


About the authors:

Yvan Zolo is a Global Surgery Fellow at the University of Cape Town with a Doctor of Medicine degree from the University of Buea. He is the founder and CEO of SurgiFinder, an NGO that aims to improve access to sustainable, safe, and affordable surgical care in low- and middle-income countries through research, education, advocacy, policy, innovation, and implementation.

Desmond T. Jumbam is a global surgery research and health systems consultant, serving as the Director of Health Policy and Advocacy at Operation Smile and the president and co-founder of the Jumbam Family Foundation. He has a bachelor’s degree in biological sciences and a master’s degree in global health, and his research interests include global surgery, health financing, health systems strengthening, and decolonizing global health.

Competing interests: None

Handling Editor: Neha Faruqui

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