Science Friday - Greenhouse Gases From Anesthesia | Fighting Militarization In The Mariana Islands

Episode Date: October 1, 2024

Emissions from anesthesia are one of the largest sources of greenhouse gases from hospitals. This anesthesiologist wants to change that. And, a cultural anthropologist discusses the Mariana Islands’ long history of colonization and why demilitarization matters for climate progress.A Major Source Of Greenhouse Gases In Hospitals? AnesthesiaDid you know that some of the gases used in anesthesia are strong greenhouse gases? A few years ago, Seattle Children’s Hospital analyzed its carbon footprint and found that the gases used in anesthesia made up about 7% of the hospital’s total emissions, right behind emissions from heating and power and those from commuting.Faced with this problem, Dr. Elizabeth Hansen, a pediatric anesthesiologist at Seattle Children’s, took matters into her own hands and slashed the operating room’s emissions. She now helps other hospitals do the same with Project Spruce.Guest host Anna Rothschild talks with Dr. Hansen about how and why she took on the problem.Militarization And Environmental Injustice In The Mariana IslandsLet’s take a trip to the Northern Mariana Islands, a string of islands in the Pacific just north of Guam. The islands were sites of major battles during World War II and were captured by the United States in 1944. The US established a military presence across the territory—including building the world’s largest air force base at the time, on an island called Tinian.The US military never left, and in the 1980s, the Northern Mariana Islands became a US territory. A few years ago, the Pentagon proposed building a bombing range on an island called Pagan, but residents of the islands pushed back.Dr. Isa Arriola is a cultural anthropologist at Concordia University in Montreal and co-founder of the organization Our Common Wealth 670, based in Saipan, the capital of the Northern Mariana Islands. She’s fought back against the militarization of her home islands, and she talks with guest host Anna Rothschild about how the military presence has affected the people and environment of the Marianas, and why demilitarization needs to be part of climate action.Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Climate solutions can be found anywhere, including in the operating room. I'm really proud when I hear my kids talking about what I do and how when I take care of kids at the hospital, I'm also helping to take care of the planet. It's Tuesday, October 1st, and you're listening to Science Friday. I'm sci-fri producer, Russia, or Reedy. Did you know that some of the gases used in anesthesia are really strong greenhouse gases? An anesthesiologist in Seattle is helping colleagues slash their car. urban footprints in the operating room. We'll hear from her later as part of our Climate Week conversations. But first, how demilitarization is part of a just climate future. Here's guest

host Anna Rothschild. Let's take a trip to the northern Mariana Islands, a string of islands in the Pacific just north of Guam. The islands were sites of major battles during World War II, and were captured by the U.S. in 1944. The U.S. established a military presence, across across the territory, including building the world's largest air force base at the time, on an island called Tinian. And the U.S. military never left. In the 80s, the northern Mariana Islands became a U.S. territory. A few years ago, the Pentagon proposed building a bombing range on one of the islands,

Poggin, but the residents of the island pushed back. Joining me to discuss the military's environmental impact on the islands and around the world is Dr. Issa Ariola, a cultural anthropologist at Concordia University in Montreal, and co-founder of the organization Our Commonwealth 670. She's speaking to me from Saipan, capital of the Northern Mariana Islands. Welcome to Science Friday. Halfadain, thank you for having me today. Oh, it's our pleasure.

So how has the military's presence on the islands affected both people and the environment? So, you know, in the post-war era, you're seeing, a lot of continued buildup of military presence in the region, right, to combat, which was at the time, Japan. And, you know, it's been a bit quiet for a while, but what you're seeing now is a ramping up of a lot of militarization, what we call hyper-militarization, as a response to what the U.S. sees as a Chinese threat in the Western Pacific, right? So what we're seeing is that, While the environment was devastated during the war, we're now seeing a remilitarization of the islands, especially Tinian, where a divert airfield, for example, is being built, a fuel pipeline over the only potable source of water.

And we're seeing a lot of land clearing, and this is interfering with our people's ability to make our own sovereign decisions about our land. As we said, the U.S. military uses land across the Mariana's, but in 2013, the military proposed a plan to use the island of Pagan for training. How did residents push back? Till 2013, it had never been proposed to use the island of Poggin, which is a northern island in the northern Mariana Islands. So this provoked a very intense resistance in the community because there were people who had grown up there and who were raised on that island and had actually moved. when a volcano erupted in the 70s. And so the way that the military was kind of framing it was like it was this almost uninhabited

island that could be used for military training. The community was just incensed. There were all these women-led organizations that came out and stepped up to say, you know, we can't have this. People were really active in getting commenting campaigns for the environmental impact statement that was slated to use the island of Pagan for live, fire training, right? So these were really intense environmentally destructive practices that were happening. And what ended up happening was almost 30,000 comments were submitted for that environmental

impact statement. And up until that time, it was really unprecedented to have that amount of comments. As a result, the military came back and they said, you know what, we're going to take Pagan off the table. But again, I want to point out that even though that really is considered a community win. The military had no business using Pagan to begin with. It was nothing we ever really agreed on, and it was something that was released in an environmental impact statement to our surprise, really, as a community. What kind of work does your organization, our Commonwealth 670 do? So we do a lot of research, awareness raising about the process of militarization and the way that it's connected to not only our own self-determination, but indigenous sovereignty. We also want to connect.

and work to change the narrative around the security discourse that we are so often used to hearing out here, which is there is no other way you must have this level of militarization to protect yourself from threats from China, from threats from North Korea, and so on. We are the quote unquote, and I really don't like this phrase, but we are the quote unquote tip of the spear. We are considered a kind of westernmost border of the United States in its fight. And so we're seeing a lot of that playing out on the ground right now. Yeah, there's sort of a strange irony here, right?

Because I think a lot of people equate the military with safety, as you said. But at the same time, the world's militaries contribute almost 6% of global greenhouse gas emissions. And the U.S. military is, you know, the biggest contributor of them all, which globally can actually make more unsafe? I think what we're seeing is that the United States military or the Pentagon is really weaponizing environmental stewardship to its advantage. And we always have to ask the question of, to what end, right? Is it to sustain the earth? Is it to sustain the livelihood of the communities in which you're working with? Or is it to complete your defense goals? You're having the Department of the Navy call itself the stewards of the environment, right, on indigenous territory,

where the indigenous people are really the original swords of that environment, right? And all of this is happening, all for the broader nation state. And we're kind of left asking, where do we fit into all of this, right? Like, where should we stand? You've advocated for demilitarization more broadly beyond your islands. How does demilitarization intersect with climate justice? And what would you like to see happen? Well, when you have an area that's highly militarized,

you also see an uptick in environmental exemptions, right? So there's a very real problem here when we're talking about militarization and the environment and environmental stewardship. And that is that if anything is considered, quote unquote, paramount interest of the United States, under the Pentagon, that area can be used for almost anything, right, from live fire training to bombing, et cetera. And so the Pentagon is able to skirt a lot of environmental regulation by using that provision, right? So a lot of this is a question of land desecration too, especially

over indigenous territory, right? Two-thirds of Tinian is already leased by the Pentagon, for example. And Tinian was once the island that housed the atomic bombs that were done. later dropped on Hiroshima and Nagasaki and we're seeing a remilitarization of that island. They're now turning it into a divert airfield or a base, basically, apparently in case Guam gets attacked, right? You know, there's also the question of water contamination I mentioned earlier, right, that so many of these military pipelines go over really sacred and important sources of water in our community, which are not, they're finite, you know.

And so we have very little environmental oversight for what happens when something leaks, for example, right? We don't have any security over who will clean it up and how long will you clean it up. And so the environment becomes a kind of afterthought in the process of all of this, right, rather than the first thing that should be taken into account. To wrap up, what does the future of the climate movement look like to you? I think it's indigenous led. I think it's women led. I think this is the history that we've been given, and these are the players that have consistently stood up to argue that, you know, the land is the most central thing in this conversation and we can't keep prioritizing bombs and bullets over what we put in our bodies, over what we teach our children, over the sanctity and importance of our cultural transmission. I think that's where I see it being. That's where I see the conversations leading towards.

and I'm proud to be part of that. That's beautiful. Issa, thank you so much for talking with me. Cizuos Mawesi, thank you for having me. Dr. Issa Aariola is a cultural anthropologist at Concordia University in Montreal and co-founder of Our Commonwealth 670, based in Saipan, northern Mariana Islands. A few years ago, Seattle Children's Hospital analyzed its carbon footprint and found that the gases used in anesthesia made up about 7% of the whole hospital's total emissions,

right behind emissions from heating and power and those from commuting. Faced with this problem, pediatric anesthesiologist Dr. Elizabeth Hansen took matters into her own hands and slashed the operating room's emissions. Dr. Hansen, welcome to Science Friday. Thank you so much. I'm so delighted to be here with you. Well, I am delighted to be speaking with you. So what was your reaction when you learned that 7% of your hospital's emissions were from the gases you use every day? Well, as an environmentalist and someone who had been spending sleepless nights worrying about the climate crisis and the future of planetary health,

I was pretty shocked and upset to hear that the medications and gases that I used to take care of my patients every day were contributing to the problem. Right. I mean, why does anesthesia have some? such a large carbon footprint? Well, a lot of the medications that we use are inhaled anesthetics, including ones you may have heard of like nitrous oxide or laughing gas, but also volatile anesthetics like siva fluorine and des fluorine. And all of these gases are potent greenhouse gases, as you mentioned. So we compare greenhouse gases using a metric called global warming potential 100, which is the ability of a gas to warm the planet over a hundred-year time horizon. And the anesthesia gases that we use range in their global warming potentials from about 300 for nitrous oxide up to 2,540 for des fluorine.

Wow, that's huge. Absolutely. The good news is there are lots of evidence-based practices that we can implement to reduce the impact of our inhaled anesthetics, including avoiding use of these really high-impact agents like nitrous oxide and does fluorine in favor of lower. impact agents like syphylphlorine or even using IV anesthesia medications that have a much, much lower impact. Yeah, talk a little bit more about that. Can you tell us about like all of the changes that you started making to really lower your your carbon footprint? Yeah, so there are some really excellent evidence-based recommendations coming from the leaders in this field and the ASA,

including using lower impact agents like sivofloreen, avoiding use of nitrous oxide and des fluorine, those higher impact agents, using low fresh gas flows, which allows us to be more efficient with our use of anesthesia gases so that we waste less of them while still delivering an adequate amount to our patients and using IV alternatives when clinically appropriate. Okay, so first you opted to use anesthetics that are less greenhouse gassy, and sometimes you use IV anesthesia instead of gas. And when you do use gas, you are now administering it more efficiently so that you waste less. But I guess I'm wondering why that administration was so inefficient in the first place. Yeah, so a couple of reasons. One is that in pediatric anesthesia,

we often have kids breathe anesthesia gases to go off to sleep with a mask. And we used to use really high fresh gas flows for that. We realized that we didn't need to use high fresh gas flows and that there was really no difference when we lowered our fresh gas flows in terms of the experience of the patient and how quickly they fell asleep. So we were able to reduce our fresh gas flows and save a lot of anesthesia gases that way. The other reason is something we discovered, along with others around the world who've discovered the same thing, that the method that we use to deliver nitrous oxide to our operating rooms through a centrally piped system is notoriously leaky. So because of the design and the way that we deliver nitrous oxide throughout the hospital, we were actually wasting about 90%

of the nitrous oxide that we purchased before it even got to patients for use. Wow. How did you make these changes while also making sure your patients were safe? So we made a lot of changes as a group. I have to give a lot of credit to our leadership at Seattle Children's Hospital at the hospital level and in my department of pediatric anesthesia, as well as every single person in my anesthesia group who really took what I had to say to heart. So we implemented the evidence-based practices that I talked about. And then we also used a system to track our emissions, not just the annual purchasing data, which is how we learned about 7% of our total hospital emissions coming from anesthesia gases, but individually tracking so that we could all see, every single person in our department could see the carbon footprint or carbon equivalent footprint of our anesthesia delivery for all of the cases that we gave anesthesia to in the operating rooms. And so allowing folks to see the impact of their choices really drove behavior changes. So for example, I would send out a report every month to our entire group outlining the

recommendation about changes that we should make to our anesthesia delivery, stories from the lowest emitters in the group so that they could share the techniques that they had been honing and perfecting and celebrating the successes that we had that allowed us to make a tenfold reduction in our carbon emissions from anesthesia gases in the operating rooms. That's amazing. Thank you. I'm really proud of our group and really impressed with everyone's dedication to this project. When we talk about climate solutions, the medical field gets left out a lot of the time. What are some other solutions in medicine that you're excited about?

You said this exactly right. I mean, the health care community as a whole gets a pass for our carbon footprint, but we shouldn't. global health care is responsible for about four and a half percent of global emissions. So there are a lot of things that we can do. And many of them are things that other industries are doing. So decarbonizing our energy and our buildings and working with folks who design greener buildings to make our health care facilities more green. Others are medication swaps. So I learned that meter dose inhalers for medications like albuterol can have propellants in them that are really, potent greenhouse gases, but there are dry powder inhaler alternatives that have a much lower carbon footprint. So that's another area of an easy medication swap that can have a big impact. What's your proudest moment from this whole process? Well, I have a couple things to say for that.

So one is what we've achieved a Seattle Children's Hospital hasn't stopped in Seattle. I had colleagues around the world in pediatric anesthesia who wanted to do the same thing. And so we joined together to create a consortium called Project Spruce. We had nine founding institutions that have already achieved a 50% reduction in their emissions from inhaled anesthetics during the first year of this consortium's existence. And we have new institutions that have joined and are on their way to the same goal. And then on a personal note, I'm really proud when I hear my kids talking about what I do and how when I take care of kids at the hospital, I'm also helping to take care of the planet. Oh, I love that. That's so sweet. They must be so proud of you. Thank you. Well, Dr. Hansen, thank you so much for joining me. Thank you so much for having me. Dr. Elizabeth Hanson is a pediatric anesthesiologist at Seattle Children's Hospital in Washington.

That's it for today. Lots of folks help make this show happen, including Kathleen Davis. Diana Plasker. Beth Ramney. Danielle Johnson. Santiago Flores. On tomorrow's episode, how emergency departments can better serve teens who are struggling with mental health issues.

Join us. I'm SciFrag producer, Rasha Aridi.