Frugal Innovation for Global Surgery

Limited or inconsistent access to necessary resources creates many challenges for delivering quality medical care in low- and middle-income countries. These include funding and revenue, skilled clinical and allied health professionals, administrative expertise, reliable community infrastructure (eg water, electricity), functioning capital equipment and sufficient surgical supplies. Despite these challenges, some surgical care providers manage to provide cost effective, high quality care, offering lessons not only for other low- and middle-income countries but also for high-income countries that are working towards increasing value-based care. Examples would be how to optimise the consumption of resources, and reduce the environmental and public health burden of surgical care.

Owing to the liberal utilisation of capital equipment and single-use supplies, surgical care in high-income countries is increasingly recognised as a significant source of greenhouse gases and other environmental impacts that adversely affect human health. Regulations require many potentially reusable supplies and drugs to be discarded after single use. Supply manufacturers may label drugs or products as single-use to increase profit, reduce liability or facilitate regulatory approval. Many high-income countries struggle to increase the value of care while maximising quality and outcomes, and minimising cost and resource use.

For most high-income countries, cataract surgery is the highest volume and most expensive surgical procedure (in aggregate) in all of medicine. Studies analysing global cataract care found few differences in outcomes, such as surgical infection, despite large differences in carbon footprint and cost.2 A single cataract procedure in the UK emits an estimated 180kg CO2e (carbon dioxide equivalents) whereas the same surgery with similar outcomes in India emits only 6kg CO2e, 5% of that in the UK.

Source: Steyn, A., et al. “Frugal innovation for global surgery: leveraging lessons from low-and middle-income countries to optimise resource use and promote value-based care.” The Bulletin of the Royal College of Surgeons of England 102.5 (2020): 198-200. [open access]

Does Health Promotion Harm the Environment?

“Health promotion involves social and environmental interventions designed to benefit and protect health. It often harmfully impacts the environment through air and water pollution, medical waste, greenhouse gas emissions, and other externalities. We consider potential conflicts between health promotion and environmental protection and why and how the healthcare industry might promote health while protecting environments.

After probing conflicts between promoting health and protecting the environment we highlight the essential role that environmental resources play in health and healthcare to show that environmental protection is a form of health promotion. We then explore relationships between three radical forms of health promotion and the environment: (1) lowering the human birth rate; (2) transforming the food system; and (3) genetically modifying mosquitos.

We conclude that healthcare and other industries and their institutions and leaders have responsibilities to re-consider and modify their priorities, policies, and practices.”

Read more (open access): Cheryl C. Macpherson, Elise Smith & Travis N. Rieder (2020) Does Health Promotion Harm the Environment?, The New Bioethics, DOI: 10.1080/20502877.2020.1767918

Copper Kills Superbugs

In China, it was called “qi,” the symbol for health. In Egypt it was called “ankh,” the symbol for eternal life. For the Phoenicians, the reference was synonymous with Aphrodite—the goddess of love and beauty.

These ancient civilizations were referring to copper, a material that cultures across the globe have recognized as vital to our health for more than 5,o00 years. When influenzas, bacteria like E. coli, superbugs like MRSA, or even coronaviruses land on most hard surfaces, they can live for up to four to five days. But when they land on copper, and copper alloys like brass, they die within minutes. “We’ve seen viruses just blow apart,” says Bill Keevil, professor of environmental healthcare at the University of Southampton. “They land on copper and it just degrades them.”

Read more: Copper kills coronavirus. Why aren’t our surfaces covered in it?

Low-Cost Breathing Ventilators

The high price of machine ventilators forces many hospitals in the poorest regions of the world to rely on a simple solution known as an Ambu Bag that requires constant manual pressure in order to get oxygen to the lungs.The Umbulizer is a mechanically powered version of the Ambu Bag.

More info & on-going efforts to design low-cost (incl. DIY/3d-printed) ventilators:

Biological Pest Control: Bat Towers

At the turn of the twentieth century, Dr. Charles A. Campbell, a physician and former city bacteriologist in San Antonio, Texas, began the first experiments with attracting bats to artificial roosts. Although he had the highest regard for bats, the motive behind his experiments was not that he thought bats needed homes. The real reason was to find a way to control a disease that caused millions of deaths throughout the world each year: malaria. In his native Texas, mosquitoes and disease rendered countless acres of fertile land uninhabitable, and Campbell, who treated victims of malaria, knew the suffering it caused. [Read more…]

Non-Electric Hearing Aids Outperform Modern Devices

Most people with hearing problems are not using hearing aids, mainly because the electronic devices often do not provide enough benefit. Research shows that non-electric hearing aids from earlier centuries are performing significantly better.

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