Healthcare contributes to a significant amount of emissions and waste. According to a report by Healthcare without Harm, it accounted for 3.4% of Singapore’s emissions. In terms of annual healthcare carbon emissions per person, Singapore ranks just behind the US at 1.6 tCO2e per capita. This is significantly much more than countries such as the UK and France, both of which delivers a good standard of care with much less emissions – 0.7 and 0.5 tCO2e per capita. This highlights the need and opportunity for us to do more with less.

To highlight these issues and tackle the problem at hand, the Singapore Society of Anaesthesiologists organised the inaugural Singapore Healthcare Sustainability Symposium on 1st March 2024, in conjunction with the College of Anaesthesiologists, the new Centre for Sustainable Medicine (CoSM), Changi General Hospital, National University Hospital, along with industry partners Molnlycke and Juniper Biologics. This is the first such symposium of its kind to bring together healthcare professionals from all 3 clusters to talk about healthcare sustainability.

So how do we go about addressing these challenges given that climate change is such a huge topic? The day started with A/Prof Eugene Liu highlighting carbon hotspots to find the areas where biggest gains can be made. This was followed by Dr Tim Yang who kindly shared his experiences of climate change overseas whilst back on holiday visiting family in Singapore. The issue of infection prevention is always a topic of contention when it comes to sustainability and reusables and concerns regarding these were thoroughly addressed by Dr Somani Jyoti and Dr Jo-Anne Yeo.

It is estimated that 20-25% of healthcare interventions in Singapore are what we term as low-value care – this may include investigations or treatment which provide no or minimal benefit to the overall care of a patient. A/Prof Diarmuid Murphy shares the work that his team at NUH are working on to identify these interventions to save both costs and carbon. Dr Lowell then outlined what surgeons can do on a dayily basis to reduce their impact on the environment, and Dr Amanda Zain, deputy director of CoSM, shared her work on the switch to environmentally-friendly inhalers as well as what CoSM will be working on in the years ahead.

We all know that operating theatres are one of the most energy intensive areas of the hospital which also generates the most amount of waste. This is closely followed by endoscopy suites according to Dr Nicholas Tee, who has been working in his hospital to highlight these issues. Dr Oon Zhihao shared with us how simple interventions can make a substantial impact with his involvement in a quality improvement project that looked to reduce the need for routine blood tests in cataract surgery. A/Prof Koduri Sreekanth presented ideas and efforts to make dialysis greener, and we were then treated online to a talk by Martin Nguyen from Australia who started “Medical Pantry”, a project to find avenues for unwanted medical equipment that might still hold some value in other countries, and the principles of doing so ethically.

Of emerging concern is the topic of microplastics, and Dr Chris Lim shared with us his research into his field with devices that are used in ocular medicine. Desflurane has seen a steady and remarkable decline in its use over the last few years, but the value of it has been brought into question in recent conferences and publications. Dr Michelle Tan has done substantial work to understand the science behind it, and addressed these in her talk to the audience. Dr Prit Singh presented ways that pain medicine can be more sustainable if we take into account the principles of the 3Rs, and to end the day, what better topic than learning how to orchestrate a more natural death for some of our ICU patients.

The day was well attended; a total of 165 participants turned up, and interestingly, individuals from sectors outside of healthcare were in attendance too. Healthcare need not be a problem, it can be part of the solution as well. As we navigate our way in this space, it is important we leave no stone unturned… Because every little bit helps, and there is no planet B.

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