Green Nephrology

Author: Karim Moutchou

Medical Student, Fez Faculty of Medicine and Pharmacy

Editor: Yuki Senoo

The advance of new medical techniques made hospitals more energy dependent than ever. An extent of hospitals’ contribution to climate change and pollution is hard to estimate as it varies widely from one country to another. However, we know now that in Brazil hospitals consume 10% of the total energy produced by the country. In the United States of America, healthcare buildings are the second most energy-intensive commercial sector buildings. Furthermore, NHS (National Health Service in the United Kingdom) estimated the percentage of CO2 emissions from hospitals at 25% among all sectors combined.

This numbers put the “do no harm” part of the Hippocratic Oath in a danger zone as we see hospitals participating in causing to climate change and CO2 emissions.

This sad fact about hospitals is discussed rarely in medical schools or between doctors in their private talks and international gatherings. The sense of a need to solve problem is not recognized so strong yet even though the World Health Organization has commented that “The health sector is one of the most trusted and respected sections of society and it is also one of the largest employers and consumers of energy. This presents both a responsibility and an opportunity to be an ‘early mover’ to achieve climate-neutrality in its own operations, and to demonstrate that this can go hand-in-hand with improved effectiveness and cost savings.”

We have enough evidence suggesting that an environment friendly hospital is not only better for our planet but also for the patients and the country’s economy. Studies have shown that for every dollar a country spends on renewable energy in hospitals the national economy saves 20 dollars in exchange.

This change should be initiated from doctors/medical students and should include everyone related to the healthcare field from politicians to patients.

In the Faculty of Medicine of Fez, students and professors of nephrology started an ambitious project to promote green hospitals in Alghassani hospital. This peripheral medical structure in Fez has a dialysis center called “ISAAD Center” attached to it.

The project called “Green Nephrology” is aimed to reduce the waste of natural resources in the processes of dialysis. More specifically, it is aiming to reduce the amount of wasted water, while creating a friendly environment for patients and their families.

Most of the patients who visit the dialysis center in Alghassani hospital normally have social and financial difficulties. As it is a public hospital, the majority of people are supported by government’s free healthcare program dedicated for the poor people who does not have stable jobs.

The project begun when the researchers realized that each patient consume more than 300 liter per week for dialysis and this continues for life-time if not treated by kidney transplant (a surgery that is still very rare in Morocco). Therefore, they came up with the idea to purify the used water clean enough to make it usable for other purposes rather than just being thrown to the sewage.

The hospital is named after “AlGhassani”, who was a famous doctor who worked really closely on medicinal plants and wrote a book about them.

This is because the one of researcher suggested the idea of creating a garden irrigated by the purified water and the goal of the project was to create a garden with the same plants mentioned in Dr. AlGassani’s book.

In order to make it work, a lot of participants and parties got together to brainstorm and work to develop the project. Medical students, doctors, professors, engineers, biochemists, deans and even the local secretary of health all pitched in.

In order to re-use this wasted water in an appropriate manner, a plumbing system was constructed behind the center; the storage tank is equipped with pump that permits the control of the usage of the water.

Repeated studies confirmed that the microbiological and biochemical compositions of the used water after exiting the filtration system are within the limits recommended by the World Health Organization for water used for botanic activities.

The social goal from the project was to create a delightful place for patients and their families as they have to spend at least 10 hours per week in the hospital. This system of using wasted water for plantation around hospital is now the subject of multiple studies conducted in the faculty of science of Fez who are recording its evolution on the short and the long term.

And to make the experience more educational, a mobile app was created to teach visitors more about every plant mentioned in AlGhassani’s book. All they have to do is to scan the QR code next to each plant to get the information on their phones.

The budget was relatively affordable as most of the activities and the material came from voluntary actions from the different parties involved. The rest of the expenses were covered by donation. The students also participated by organizing a Gala party with Moroccan music to gather money by selling tickets and donations.

The project was presented in both COP 22 (Conference of parties, post Paris agreement) and COY 11 (Conference of Youth, the equivalent of COP for young climate activists). It was appreciated by attendees regardless of whether they were nephrologists, dentists, nurses or non-medical activists but who were interested in starting similar actions in their communities or hospitals,

“Green Nephrology” is an example of how green climate friendly hospitals can work even in developing countries, the fight for a better planet is our responsibility as humans, and doctors should be on the frontline leading this movement.