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 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), refueled every 3-5 months. While this gives us 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, 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 installation
of the solar power, the efficiency and functionality of our operating room has
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 the surgical services will be discussed
at COP29 and a new hope will prevail around the globe.
Dr. Amos Muzuka is a Pediatric
Anesthesiologist at Mbeya Zonal Referral Hospital in Tanzania.
Notes to the editor
- The Solar Surgery system ensures reliable power for medical equipment during surgeries, addressing frequent power cuts.
- Initiative boosts patient safety and surgical outcomes, and reduces carbon emissions.
- Partnership aims to upgrade more than 30 pediatric theatres across Africa by 2025.
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