As COP29 kicks off, it is exciting to see conversations about climate change innovation and investment that is going into preserving the environment. I would like to advocate for investment in solar-powered operating rooms that ensure safer surgery for children.
We had scheduled a 5-year-old child for Adenotonsillectomy, a common pediatric procedure where adenoids and tonsils are removed. This common procedure helps treat children with recurrent throat infections or sleep-disordered breathing. It was a day like any other in the room with a normal surgical team. As the procedure was going on, at around 3pm, the power went off. The hospital has a well-functioning backup generator but as fate would have it, on that day the generator did not turn on immediately.
There was eerie silence waiting for the backup generator to kick in followed by frustrated murmurs with the surgical team anxious and scared because for 5 minutes the room was in total darkness. This being a surgery in a patient airway, it was a critical and defining moment for the survival of the child. Mobile phones were used to illuminate the surgical site at least for the surgeon to press hard the gauze in the oral cavity to arrest the bleeding. We were lucky that the electricity came back after the most stressful 5 minutes that felt like a lifetime.
We may have been lucky that day, but what happens when power stays off for hours? What happens when a generator is faulty? We are lucky that no patient has lost their life in the operating room because of the lack of lighting. This is because when the light goes off the immediate action is to make sure the patient is continued supported by oxygenation and ventilation and hemodynamics are well taken care of. Patient safety becomes the focus of everyone in the room making sure that Basic Life Support is well provided using the supportive means we have in the OR.
In many low-resource settings, the race to save lives clashes with the environment as there is unreliable power, resulting in the use of backup generators that rely on fossil fuels- culprits of greenhouse gas emissions. Our hospital, for instance, has 7 automated generators which supply different parts of the hospital when power goes off. The one supplying our operating rooms can accommodate 300-litres of diesel costing close to 1,000,000Tsh (400 USD), refuelled every 3-5 months. While this gives us a relatively stable electricity supply, the use of diesel has a ripple effect on the overall costs of running a hospital.
When two children’s charities- Kids Operating Room (KidsOR) and Smile Train did their pilot study in 2023 to assess the need for a solar-powered theatre, it was a critical moment when there was a serious shortage of electricity supply across the country. The hospital was equally being faced by power outages.
In their pilot study titled Solar Surgery, they surveyed hospitals in 4 countries- Nigeria, the Democratic Republic of Congo, Tanzania and Zimbabwe. Of the 4 sites, the Democratic Republic of Congo had the longest average outage time of 176.7 minutes and lost the most amount of time to power outages during the trial. Tanzania fared better but still lost significant time during the trial to power outages.
This prompted the charities to set up solar-powered theatres in early 2024. The unit comprises solar panels and a battery that can hold energy for up to six hours without being charged. After the installation of the solar power, the efficiency and functionality of our operating room have significantly improved. The surgical teams can comfortably perform surgeries during the day and at night without any fear of working in darkness. This helps us reduce reliance on the generators because the solar battery seamlessly kicks in.
Smile Train and KidsOR have demonstrated that with the right investment and strategic collaborations, it is possible to tap into solar energy to improve surgical infrastructure. I am calling upon policymakers to make use of solar energy affordable and accessible to reduce reliance on fossil fuels. My profession is delicate because children rely on machines to breathe during a surgical procedure.
For their safety and those of many people in need of safe surgery, I hope that the agenda of climate change in relationship to strengthening surgical services will be discussed at COP29 and a new hope will prevail around the globe.
Dr Amos Muzuka is a Pediatric Anaesthesiologist at Mbeya Zonal Referral Hospital in Tanzania
