Monday, September 26, 2011


I lost the little adapter that enables me to plug in my I phone directly to a wall outlet. As I knew I was going to be in the hospital all night and would probably need to charge my phone, I headed off to the mega mall to get a new adapter which I found no problem.

Here is the charger above. Not a great photo and I should have put a ruler or something next to it but most of you can figure out how big it is.

Here above is the charger before I took it out of it packaging and below is the packaging which I recycled.

This kind of reminds me of a clip from Curb Your Enthusiasm.

I handled this in a more mature fashion than Larry did but why does everything we buy now have to come in a hard to remove plastic case which is often 2-3 times bigger than what we bought. The worse case was the USB stick I bought at Costco that came encased in a plastic cases that was 30 cm long and 20 cm wide. I suppose that one reason for packaging a small item in a large package is to prevent shop-lifting. There are other approaches like for example hiring more staff.

Just Friday I was looking at the large garbage can in the Pain Clinic. I typically fill this to the rim by the end of a clinic. I trained using reusable epidural trays and I never want to go back to that (on the other hand the reused needles were so blunt it was impossible to get a wet tap) but do we really need all this packaging. I have a number of patients with intrathecal pumps who come in every 1-2 months for a refill. The kit we used to fill the pump comes in a box 20 by 20 cm. This holds a 22 gauge needle, a filter, a 60 cc syringe and a narrow bore tubing I use to empty the pump and refill it. It also comes with an instruction manual in multiple languages that is the size of a small paperback novel. All the packaging and literature goes straight to the garbage.

Another anaesthesiologist told me how in their hospital the German company that makes pedicle screws used in back surgery had been bought by an American company with the result that the size of the packaging actually tripled in size. Germany many years ago forced companies to reduce the size of their packaging. Just about all our surgical equipment comes in elaborate plastic cases. Some of them are quite useful. You see them around the OR used to store things. Nurses bring them home sometimes; I have brought home the odd piece of OR plastic. Most of them go straight to the garbage from where they are trucked to the incinerator. No recycler will touch them, they could have some nasty bug on them. Which reminds me, when I came to the CofE they had an incinerator in the building that burned all their medical waste. Drapes, syringes, needles all went into the same bag, somebody took them downstairs and they were burned, heating the building in the winter we were lead to believe. That was of course too good to be true and now by government edict all medical waste has to be separated and trucked 200 km south to a waste disposable facility owned by some well connected people.

A Ugandan doctor who visited our OR years ago was appalled at how much we threw out. In Ecuador we bagged our garbage to be disposed of by the hospital but realized that the local OR nurses went through it looking for things they could re-use. We started separating our garbage to help them out.

In my first job a senior staff member religiously scoured the garbage for things he could re-use. Periodically an award in his name was issued for a particularily creative re-use of what would otherwise be medical waste. For example tubing used in opthamology was re-used as ETCO2 tubing. (I wonder how many prions were transferred).

There was an article in the recent Medical Post which I am ashamed to admit I read ( it was in the lounge and I was bored okay?) This outlined the large amount of waste particularily with orthopedic cases and the environmental cost. We are big offenders in anaesthesia and maybe we should be taking the lead in this.

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