Latest / Becker’s Healthcare Podcast / Howard Maunus, MD - Fellow, Climate Health Organizing Fellowship, Cambridge Alliance and Harvard Medical School; Member, Carolina Advocates for Climate, Health, and Equity

Transcript

Howard Maunus, MD - Fellow, Climate Health Organizing Fellowship, Cambridge Alliance and Harvard Medical School; Member, Carolina Advocates for Climate, Health, and Equity · Becker’s Healthcare Podcast

• 0:00
  This is Scott Becker with the Beckers HealthCare
• 0:03
  podcast.
• 0:04
  I'm thrilled today to be joined by Howard
• 0:06
  doctor Howard Manes.
• 0:08
  And doctor Manes is gonna talk to us
• 0:09
  about
• 0:10
  some of his efforts, you know, particularly around
• 0:13
  the climate and so forth. And, doctor Manas,
• 0:15
  can you take a moment?
• 0:17
  And you've had this great career.
• 0:19
  Tell us about yourself.
• 0:22
  Talk about your effort in the organization
• 0:26
  that you're involved with with the Climate Health
• 0:29
  Organizing Fellowship,
• 0:32
  and and more. Tell us about what you're
• 0:34
  doing. Sure. Thanks, Scott.
• 0:36
  As you said, I'm Howard Manas. I'm a
• 0:38
  retired gastroenterologist,
• 0:40
  and I'm one of six health care professionals
• 0:42
  that recently completed the climate health organizing fellowship,
• 0:46
  which is offered through Harvard Medical School and
• 0:49
  the Cambridge Health Alliance.
• 0:51
  I was a gastroenterologist for over thirty years,
• 0:54
  probably did over 10,000
• 0:57
  endoscopies, and I came to appreciate,
• 1:00
  over time just the sheer volume of weights
• 1:03
  we generated with each procedure,
• 1:05
  especially involving the single use devices in the
• 1:08
  GI realm.
• 1:09
  So even though I cared a lot about
• 1:12
  the environment, I realized I was a big
• 1:14
  part of the problem.
• 1:15
  Every case I did contributed to just an
• 1:18
  enormous amount of waste. So that realization led
• 1:21
  me to,
• 1:23
  try to find some community,
• 1:26
  that was involved in healthcare sustainability.
• 1:29
  For the first year or so, I was
• 1:31
  more involved with trying to get
• 1:34
  climate in the health, climate and health in
• 1:37
  the curriculum at my medical school, which was
• 1:38
  Jefferson. And we we were actually successful,
• 1:42
  through a lot of maneuvering to get climate
• 1:45
  and health into the curriculum at Jefferson.
• 1:48
  And I thought, wow, this is easy. I
• 1:50
  I I I'm really good at this advocacy
• 1:52
  work.
• 1:53
  Then I got stuck, and
• 1:55
  that's when I learned about the fellowship.
• 1:58
  And,
• 2:00
  I decided how can we make inventory centers
• 2:03
  more operationally environmentally sustainable without asking anyone to
• 2:06
  sacrifice quality or margin.
• 2:09
  So I'll just keep going on and tell
• 2:11
  you about No. No. So So yeah. Tell
• 2:12
  us tell us. No. Stop for a second
• 2:14
  and tell us what are some of the
• 2:16
  things that you can do to improve the
• 2:18
  climate.
• 2:19
  And sometimes it feels so helpless because
• 2:21
  we do our small part here, but other
• 2:24
  parts of the world are growing, you know,
• 2:26
  so so crazily and so busily with fossil
• 2:29
  fuels and other types of things. And I'm
• 2:30
  not an anti fossil fuel person, but it
• 2:33
  seems sometimes that even though we try and
• 2:35
  change things,
• 2:36
  how do you how do you think about
• 2:38
  actually making a difference? Or do you go
• 2:40
  back to, I don't know if I can
• 2:41
  make a difference globally, so I'll make a
• 2:43
  difference locally.
• 2:44
  How do you think about that? Because it
• 2:46
  seems so frustrating.
• 2:47
  Yeah. That's frustrating, especially with such headwinds,
• 2:50
  at this point,
• 2:52
  in this country.
• 2:54
  So I think you have to start with
• 2:56
  what is your responsibility.
• 2:58
  I think that in health care,
• 3:00
  you have to understand that health care is
• 3:02
  responsible for about eight and a half percent
• 3:04
  of greenhouse gas emissions in United States. So
• 3:08
  I think you have to look internally,
• 3:10
  not only how you live, but also how
• 3:12
  you work. So
• 3:13
  I think that
• 3:15
  to answer the question, I looked at
• 3:18
  where I work and what I could do
• 3:20
  to not only
• 3:22
  reduce waste, but also try to make a
• 3:24
  difference in the bottom line for our center.
• 3:27
  So I hope that answers the question. I
• 3:30
  I I drive an electric vehicle. I'm not
• 3:31
  saying everyone should drive an electric vehicle.
• 3:34
  I'm just saying that
• 3:36
  when you realize that you're part of the
• 3:38
  problem
• 3:39
  and you realize that
• 3:42
  there are solutions,
• 3:43
  I think that's where you feel
• 3:45
  less helpless.
• 3:48
  And what are some of the solutions in
• 3:50
  the surgery center area? You spent a lot
• 3:52
  of time as a gastroenterologist,
• 3:54
  thirty years, phenomenal profession.
• 3:56
  You spent a lot of time in surgery
• 3:57
  centers. I know you've been to our meetings
• 3:59
  and spoken, I believe, and looking forward to
• 4:02
  having you do so again on the climate
• 4:03
  issues.
• 4:04
  But but what are some of these you
• 4:05
  can do in surgery centers to help, you
• 4:07
  know, improve your impact on the climate?
• 4:10
  Yeah. We we just completed or we're in
• 4:12
  the process of completing three pilot studies,
• 4:15
  through,
• 4:16
  trying to push forward this accreditation
• 4:19
  certification
• 4:20
  that we're working with several accreditation agencies on.
• 4:24
  So
• 4:24
  we just completed a
• 4:27
  a survey,
• 4:28
  at,
• 4:29
  ophthalmology center in Fairlawn, New Jersey.
• 4:32
  And,
• 4:33
  Andy Draper, who's
• 4:35
  from Scion sixties
• 4:37
  offering pro bono work with this. We just
• 4:40
  completed,
• 4:41
  a site visit at, Oregon Health System, which
• 4:44
  is a large academic center. And they have
• 4:46
  an ophthalmology center and then a multi specialty
• 4:49
  center. So when we started going through the
• 4:52
  pilots, we realized that the first low hanging
• 4:55
  fruit was just LED lights,
• 4:58
  which are an enormous,
• 5:00
  enormously easy solution,
• 5:02
  to try to reduce your energy costs and
• 5:05
  to reduce greenhouse gas emissions. So at Fairlawn,
• 5:08
  for example,
• 5:09
  they only had about 25%
• 5:11
  of their lights in LEDs.
• 5:13
  And at the KCI Institute in Portland, none
• 5:16
  of their lights were LEDs.
• 5:18
  So this is a really easy fix. And
• 5:20
  also, there's often
• 5:23
  state incentives to do this.
• 5:26
  For example, in New Jersey, there's a five
• 5:28
  year loan offer with, no interest. So we
• 5:31
  know that the return of investment
• 5:33
  on LED lighting is about eighteen months. So
• 5:36
  really this becomes kind of a free thing
• 5:38
  to do.
• 5:39
  We also realized at Fairlawn that their HVAC
• 5:42
  unit was eighteen years old and
• 5:45
  through state incentives,
• 5:46
  they could actually get a 30 to 35%
• 5:49
  reduction on the cost of a new HVAC
• 5:51
  unit. So these are very easy things to
• 5:53
  do. Now
• 5:55
  interestingly,
• 5:56
  at KC Eye Center in Portland and in
• 5:59
  the Center for Health and Healing,
• 6:01
  they had centrally
• 6:03
  central nitrous oxide, which was piped to their
• 6:05
  ORs.
• 6:06
  Nitrous oxide is a terrible agent, has a
• 6:09
  global warming potential 273
• 6:12
  times that of c o two, destroys the
• 6:14
  ozone layer. And when we talked to people,
• 6:16
  we realized that none of the anesthesiologists
• 6:18
  were using nitrous. None. Zero. No. Nobody had
• 6:21
  used it in several years.
• 6:23
  So we, in our assessment, said, hey. Listen.
• 6:26
  You should get rid of this central
• 6:28
  nitrous because it's just destroying the environment. You're
• 6:31
  paying for something that actually
• 6:34
  from the time it gets sent from the
• 6:36
  central unit to the OR,
• 6:37
  98 to 99% of the nitrous is lost.
• 6:40
  So it's just an incredibly
• 6:43
  ridiculous thing to use.
• 6:46
  One more thing just to add. At the
• 6:48
  KC Eye Institute, they throw away their bottles
• 6:52
  after twenty four hours. These are the eye
• 6:53
  drop bottles. If any of you have ever
• 6:56
  had cataract surgery, you know, you get two
• 6:58
  two drops before surgery and one after surgery.
• 7:02
  So they're roughly throwing away 3,000 to 4,500
• 7:06
  bottles a year
• 7:07
  before
• 7:08
  they've actually used the volume in the bottles.
• 7:11
  So this again is such an easy fix
• 7:13
  because there's no accreditation organization that says you
• 7:17
  have to discard bottles after twenty four hours.
• 7:19
  That's just, an internal,
• 7:22
  rule that they have. So this is another
• 7:24
  way
• 7:26
  of just trying to reduce the waste, trying
• 7:28
  to actually make sense in a surgery center,
• 7:31
  and trying to save money.
• 7:34
  Fantastic.
• 7:34
  And and and take a moment
• 7:37
  and and talk to us about
• 7:39
  you've had this fascinating career, great career,
• 7:42
  and now you've really taken to this.
• 7:45
  Advice for people that are sort of working
• 7:48
  through careers, trying to have impactful careers,
• 7:50
  and also trying to make pivots over time
• 7:52
  and and find that next thing that lights
• 7:54
  them up and excites them.
• 7:56
  Any advice for listeners there?
• 7:59
  Yeah. Sure. I think that
• 8:01
  often when physicians retire,
• 8:03
  and in my case, I kind of was
• 8:05
  forced to retire just because of a disability,
• 8:08
  they're lost.
• 8:09
  Medicine was a big
• 8:11
  part of their lives,
• 8:13
  and often it's a big part of, an
• 8:15
  individual's identity.
• 8:17
  So I think that finding community is so
• 8:20
  important
• 8:21
  in this realm. So if you're interested in
• 8:23
  sustainability, if you're interested in
• 8:26
  climate change, for example, then I think you
• 8:29
  try to find community. And there's just so
• 8:31
  many people that are passionate about this throughout
• 8:35
  the healthcare community.
• 8:37
  There's organizations
• 8:38
  that you can join. For example, I joined
• 8:40
  a local organization, Carolina Advocates for Climate Health
• 8:43
  Equity. These are full of healthcare professionals that
• 8:45
  have an interest in trying to make healthcare
• 8:48
  more sustainable.
• 8:49
  There is
• 8:51
  federal there's,
• 8:53
  state statewide
• 8:54
  and nationwide agencies that you can join. There's
• 8:57
  an organization called Practice Green Health and Healthcare
• 9:00
  Without Harm that has, an annual meeting coming
• 9:03
  up in Saint Louis called CleanMed.
• 9:05
  I met so many passionate people at these
• 9:08
  meetings,
• 9:09
  and really kick started our fellowship
• 9:13
  process by just
• 9:14
  networking with just amazing people who are doing
• 9:17
  incredible work all the way around the country.
• 9:20
  Thank you very, very much. Doctor Manish, what
• 9:22
  are people who are more about the work
• 9:24
  that you're doing and how can they connect
• 9:25
  with you?
• 9:27
  Yeah. They can connect with me, and I
• 9:29
  will go ahead and give you the my
• 9:31
  email address. But we our organization,
• 9:34
  which is the fellowship organization that we are
• 9:36
  in, ended in December.
• 9:38
  But we are continuing our work.
• 9:40
  All six of us are continuing on trying
• 9:43
  to
• 9:44
  gain this
• 9:45
  voluntary
• 9:46
  certification
• 9:47
  for ASC sustainability.
• 9:49
  We are currently working with
• 9:53
  ACHC to implement this and also have continued
• 9:55
  discussions with the joint commission,
• 9:58
  Quad a, AAA, AT, and DNV.
• 10:01
  We welcome anyone to
• 10:03
  to
• 10:04
  join us in in this
• 10:07
  venture,
• 10:08
  because we think it's a really important,
• 10:11
  aspect of trying to make health care more
• 10:13
  sustainable.
• 10:14
  Thank you so much. Doctor. Mattis, what a
• 10:16
  pleasure to visit with you. Congratulations on what
• 10:18
  you're doing. Good luck with the rest of
• 10:20
  the day. You are fantastic, and what you're
• 10:22
  doing is great. Thank you for joining us
• 10:24
  on the Becker's Healthcare Podcast. Appreciate it, Scott.
• 10:27
  Thank you very much.