On the importance of problem definition

I have written at length (more than thirty posts) on the issue of problem definition. I want to come back to this issue now, particularly because I was made to think about this during a wonderful discussion that I had yesterday.

I gave a presentation yesterday titled Why do we waste? An ethic of trash, waste, pollution and degradation to a group of mechanical engineering graduate students. (I had given this same presentation last semester to the Graham Doctoral Fellows.) In this presentation, I talk about the perceptions of trash, and whether trash is a natural outcome of "modernisation."

"Modernisation" has given us many, many things, including this keyboard I am using to type this blog, as well as pharmaceuticals and drugs. Various tensions are brought out when the issue of medicine is raised...always. The medical field is probably the most environmentally impactful field of all, with copious amounts of radioactive materials, chemicals, gloves, plastics, metals and paper used. A few of my medical school friends have mentioned this, too. We got involved in a discussion about whether there is "beneficial" trash and waste, i.e. the trash and waste that is produced in making a machine that detects cancer, or the trash and waste that goes into making drugs. This is of course a difficult issue, and one that people may come to loggerheads to. It all comes down to our ethic, whether we place humans at the center of our ethic (anthropocentric), or whether we place the environment and everything that constitutes it at the center of our ethic (biocentric, for example). If we say that humans are the most important thing, period, then it is not surprising that such an ethic will lead us down a path that may result in blowing apart a mountain or damming a river to save a human life. Would we drain an ocean to save a life? Where is it we draw the line? This question is overwhelming, and there is no answer to it. But, I believe it is important to think about, because the outcomes that result from our ethic have major implications.

When we think of medicine, we think of the human impacts of the endeavour. But just as with everything else we do nowadays, guided by anthropocentrism (and Western elitism), we undertake the endeavour at the potential expense of that which sustains us - the rivers, the land, and the air.

My medical waste

I have only superficially touched on the issue of medical waste, and the huge amounts of waste and trash that is generated through it, not to mention the amounts of resources that go into medical and pharmaceutical research, and how medicines and wastes are dealt with, whether used or not. Bryan and John, both medical students, mentioned to me independently the inherent contradictions between medicine the way it is currently practiced and sustainability. I have not needed any medical attention for a really long time now, not even a band-aid. My streak came to a crashing halt these past few days.

Act I
The time: Friday night/Saturday morning, two am
The place: My kitchen
The event: Environmental harm through medical waste
The people: Darshan, Matt, Ashlea, Alex

After a fun night out going to see Theo Katzman and Love Massive, and Hannah Winkler at The Ark followed by a good time at 8 Ball, Matt and I came home with hungry stomachs. Very few things are better than late night breakfast. I have enjoyed making hash browns of late, and with a couple eggs, who needs to go to Fleetwood Diner? I make us breakfast with some of my dad's wonderful mustard-marinated hot peppers on the side. We sat down at the dining table, and I wanted to turn on a lamp rather than keeping all of the kitchen lights on. It seemed like it wasn't plugged in, and so I ran my hand along the cord, and when it got close to the fridge, I felt a very clean, very deep cut through my ring finger on my right hand. I take a look at my finger, and blood is gushing out, but luckily, I was able to keep the top of that finger on and pressed. Turns out I almost took off the top of my finger (really) with the top of a tin can that was lying on the floor, held down by the fridge, right along the path of the cord. Alex came out with a band-aid, and we stemmed the flow of blood. The band-aid was not getting soaked, and so even though the cut was very deep, I didn't need stitches. Ashlea and Matt were queasy.

 

Interlude

Did I need a tetanus shot? I didn't remember the last time I got a shot of any kind. It is likely therefore that my last shot was in India, at least eight years ago.  By the next morning, everything seemed to have sealed up alright, and the band-aid and medical tape held my finger shut. My finger did not seem infected. The debate raged in my mind for a few hours. My dad said that I probably didn't need a shot if the cut wasn't infected by then, but he recommended getting one. But a shot?! What about the single-use needle and syringe? And what about those huge vials of vaccine from which they only use a small amount? I am sorry for all of this, Mother Earth. 

I waited a couple days, so I didn't have to go to the ER. UHS seemed like a much more low-key place...

Act II

The time: Tuesday morning, nine am

The place: Clinic 1A, University Health Services

The event: Further environmental harm through medical waste

The people: Secretary X, Dr. Y, Nurse Z, Darshan

I caved. I went to UHS, and set up a walk-in appointment. Out came a bundle of papers, and I filled in a sheet. They put the papers in a red folder, and put this little yellow zip tie kind of thing to ensure that no one tampered with the records. I trudged over to Clinic 1A, and handed the folder to the Secretary X, and she cut off the yellow zip tie and threw it away. (Heart sinks.) I wait to see Dr. Y, and take off the second band-aid I had put on since the cut. He takes a quick look (~5 seconds), and says the wound is healing well. He takes a band-aid, and puts it on, and hands me several more band-aids. I get up and see Nurse Z to get the shot. She makes me fill out a form stating the risks of the shot, and show her my upper arm. In goes the needle, and injected is the liquid with the syringe. She puts a little round band-aid on my arm after wiping the spot with a little bit of cotton. I don't ask for the needle or syringe, although I really should have.

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It is interesting how we've surrounded ourselves with essentially non-reusable objects that can cause such physical harm (e.g. concentrated sharp metals) such that getting hurt because of them warrants the use of more non-reusable objects.

Harming nature and creating trash in the name of medicine and health

Health is a concept I think about frequently: What does it mean to be healthy? What does it take to be healthy? How do other people influence one's health? How do nature and the environment influence health?


It is easy to look up the standard definition of health, written by say, the World Health Organisation (WHO): "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." What is striking about this definition is its anthropocentrism. What this definition implies is that health is contained within a human or a group of humans, and one is well when all is in sync within oneself and within a social group. When you ask someone what it means to be healthy, more likely than not they will reply that health ends with her. As long as she eat wells, mind absent of stress, and are surrounded by good people she can have a beer with, she is healthy. Unfortunately, we live in a continuous world (at least macroscopically). Air and water and nature begin where the human body ends, contained in its skin. Health includes our surroundings. It is not only that our environments influence our health, but we influence its "health," too, and consequently are influenced in return by it. Yet, because of how medicine is practiced in many places around the world, our conceptions of what it means to be healthy, and what it takes to be healthy, are firmly at odds with the natural world. Consequently, we cannot define health that ends merely in a healthful mind and healthful body.

According to the Environmental Protection Agency, medical waste (and trash) includes bandages, gloves, syringes, surgical instruments, culture dishes and glassware, etc. This list also includes "highly hazardous, mutagenic, teratogenic and carcinogenic chemicals, such as cytotoxic drugs used in cancer treatment and their metabolites," as well as nuclear wastes, and chemicals that aren't metabolised in our bodies.


The common perception of the problem of medical waste is not that waste itself is a problem, but how this waste can spread disease and harm other humans; indeed medical waste is thought of as a public health problem. Here's what the WHO says: "Health-care waste is a reservoir of potentially harmful micro-organisms which can infect hospital patients, health-care workers and the general public. Other potential infectious risks include the spread of, sometimes resistant, micro-organisms from health-care establishments into the environment...Wastes and by-products can also cause injuries, for example radiation burns or sharps-inflicted injuries; poisoning and pollution, whether through the release of pharmaceutical products, in particular, antibiotics and cytotoxic drugs, through the waste water or by toxic elements or compounds such as mercury or dioxins."


But the medical industry is a disposable industry. The value of the human life is worth more than the value of all it takes to produce the chemicals, plastics, metals, and elements to provide health - and we end up "disposing" these materials, either incinerating them, or landfilling them. Patient care generates, on average, 5 to 6 kg of waste per bed daily, or about 750 to 800 million pounds of waste annually in the United States. Of this, about 6% constitutes biomedical waste while the remainder consists of general waste, i.e., paper, plastics, and food (full text here).


Brian shared some thoughts with me a few days ago: Is avoiding the spread of disease fundamentally at odds with reducing waste? It just struck me when working on the ambulance: for the care of one patient, we create more waste than you do in a year. I'm not sure it has to be that way. We already autoclave and reuse a ton of equipment, but some seem impossible to circumvent. Gloves are a good example.


Can we be healthy in full harmony with nature?