He has studied the environmental impact of health services. Did you already have this awareness when you were in the hospital? Do you think most people have it?
It had some of the things we all see when we work in hospitals, but it’s something that I ended up discovering when I retired. I think the majority of the population doesn’t have it, but medical professionals have become more aware. About a month ago the Portuguese Congress of Cardiology took place and several responsible doctors came to talk to me saying that in fact it is necessary to change culture and habits. There are several dimensions in the approach to this problem which imply a change of organization and behavior and there are things which turn out to be very counter-intuitive even in the life of institutions. I usually give an example: Type I and II waste goes in black bags and Type III hazardous waste goes in white bags. Whoever determined this does not realize that black is related to death and white is related to life.
One of the decrees which, according to her, should be modified is precisely the law of 1996 which determines the different types of waste.
Yeah. We know that around 40% of hospital waste comes from operating theatres. We currently have a prehistoric law, which considers that everything that comes out of an operating theater is hazardous waste, even when it comes to papers and textiles that are never in contact with patients. This is a huge amount of material which, by law, cannot be recycled or reused and must go to incineration. And the collection must be carried out by special operators, who charge hospitals 80 cents per kilo. Therefore, in addition to being a crime in environmental terms, it causes enormous damage to hospitals.
What type of material are you referring to?
Textiles that wrap material boxes, for example, that are needed during surgery. Everything is packed in the operating room. There is cleaner paper in an operating room than outside. There has already been an attempt to change this decree, the General Directorate of Health had made a project, but in the meantime nothing has changed.
I was in a hospital recently and noticed that the nurse, when she needed a tub, ended up opening a bag just to get the container out. Is the rest lost?
This is one of the issues that contributes to a huge waste of prepackaged kits. They’re a way for institutions to make bulk purchases, but they end up being hugely wasteful.
Another thing he doesn’t talk about much is food. We see for example that the boards are the same for adults and children. For example, does the bread you don’t eat that has already been in the infirmary go in the trash?
What we know from some analyzes that have been done there is that 12% of the food served in hospitals is wasted, for various reasons. Probably will. What I argue is that it should be possible to separate food that has been affected from food that remains packaged, and the latter can be donated to social institutions. But overall, it’s estimated that every hospital bed produces five to six kilograms of waste.
Basically, the effort that has been made outside of hospitals. Because the impact of the health sector in terms of consumption and environmental footprint, does it end up being out of step with the movement that has taken place “outside”?
We are completely out of step and, in Portugal in particular, completely out of step with what is being done in more developed countries. The case of the reprocessing of single-use devices is another example. There is an experience of 20 years in several countries. In Germany, 28 university hospitals are already reprocessing single-use devices. And there is a curious aspect: the definition of whether they are single-use or not is given by the original manufacturers and not by the regulators. I came to see, I don’t know if it’s still like that today, catalogs in which the same product was for single use in one place and not another. São João Hospital was a pioneer, there were results – in a single device, a saving of 500,000 euros in five years – and for a year everything was stopped once again under the direction of ‘Infarmed.
Works with a reprocessing company. I usually talk about conflict of interest. Have you heard any reviews about this?
I tried to make sure that in Portugal there are people who are interested in it. I have to say that I have spoken with big names about big fortunes and innovations. They were very nice but no one showed up. I decided the only way was for me to move on. I set up a nano-company, because I knew that the one that did quality reprocessing was a German company called Vanguard. I am not their representative, I am an influencer, I do not do business with hospitals. Now, I always declare it. I have a conflict of interest with great pride, because I’m doing a good thing. And I did it because in Portugal, after endless contacts, nobody wanted to do it and I thought it was mandatory for it to start happening. I know that in Portugal people are still accused lightly, but that’s the mentality of a backward country.
He estimates that, in reprocessing alone, hospitals could save 60 million euros per year. On what kind of devices?
Single-use devices used for example in surgery, such as scissors or catheters, duly reconditioned.
Some time ago, Pr. José Fragata said that when they undergo a heart transplant and take out a defibrillator, sometimes placed a short time ago, 35,000 euros are wasted.
And it’s true, but we’re still not talking about reusing implantable devices. I think we are going to go in this direction, but we are now talking about perfectly reusable devices, as is already the case in many countries.
It’s not just about washing.
No, they must be certified remanufactured and sterilized. This can be done in hospitals or outsourced to reprocessing companies.
Are there blockages from home industries?
In the United States, the original industries, which resisted, are already buying up reprocessing companies themselves. This was, for example, the case of Johnson & Johnson. The same ones who said it was for one use have already started selling both originals and restatements. Of course, this affects many interests.
He recently denounced that in Portugal, these activities have been stopped for a year since the entry into force of the regulation on medical devices. Find an explanation?
I prefer not to comment. It’s so incomprehensible that everyone draws their own conclusions.
Are there not, for example, fears in the face of problems such as hospital infections?
That was never the problem. Worldwide experience of more than 20 years, and that of the Hospital de S João for 10 years, shows that this risk does not exist.
Do you think this battle could be your greatest legacy than the first heart transplant in 1986, at Santa Cruz Hospital?
I’m sure it’s a much bigger brand. I feel like what I’m doing now is similar, in terms of social change and integration, to what happened then. When I had the heart transplant, it was almost forbidden to talk about a transplant in Portugal. A colleague of his had written an award-winning book called The transplant scandal. He insinuated that the transplants were carried out only for financial interests and that the organs, in this case the kidneys, were removed only for interest. He even suggested that in some cases organs were removed while people were still alive. At the time, there was no clear definition of brain death, there were no mechanisms for anyone who did not wish to have their organs removed to declare it.
There was no national non-donor registry.
The only way would be for people to have a signed statement in their pocket, but the organs were taken from young people and people weren’t going to clubs with statements. There would be no medical progress in Portugal without the Calouste Gulbenkian Foundation and at the time I remember going to talk to Dr. Reimão Pinto [Diretor do Serviço de Saúde e Proteção Social da Fundação Calouste Gulbenkian entre 1963 e 1995] telling him that it was essential to change the law, because we had to move forward with social peace. He told me: “It is forbidden to start talking about laws. If you do, you won’t get a heart transplant and kidney transplants will stop. We are back. Get the heart transplant and we’ll change the law later.” I’m sure these themes we’re talking about will come up sooner or later. They’re so correct, so obvious, already made in the most advanced countries, that it’s going to take it’s happening here. And that’s why I say that this cause of mine is more important for my country than the heart transplant, which will be done sooner or later. Santa Marta was also advancing. Of course, it was a big step for Portuguese medicine, but this one has more consequences.
Where do you think the inertia comes from?
I don’t know if it’s a lack of attention or knowledge. I spoke to all the officials for several years. The people are all very nice, but apart from a few exceptions, nothing happens.