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Hi, everyone. Can everyone hear us? Yes. Ok, great. Um So my name is Karen. Um I'm one of the anesthetic desk reps. Um And um today we have the um pleasure of um uh welcoming doctor Renny Kin um to uh present to us uh a paper on building sustainable and resilient surgical systems. Um a narrative review of opportunities to integrate climate change into National Surgical Planning in the Western Pacific region. Um Rennie is a surgeon and a researcher based in New Zealand and she's had over 10 years of experience in research, training, advocacy, policymaking in the areas of global health and climate change. Uh So without further ado I'm going to um pass over to Renie who will um present to us um her um very important paper. Great. Thanks so much Karen. Um I'm just gonna begin by sharing my slides. Hopefully this will work for everyone. Can you see my slides? Ok. Yes. Ok, excellent. I'll get started. Uh Thanks Karen for the introduction. My name is Renee Ching. I'm a general surgery registrar from a New Zealand. Um So warm greetings to everyone. Um uh is um our greeting in Maori. So today, I'll be presenting a paper that we published in LS of Western Pacific three years ago in 2022. And this is our building sustainable and resilient surgical systems opportunity to integrate climate change into National Surgical Planning. This paper was published in a Western Pacific regional journal, but the implications are not only limited to Western Pacific countries and is very relevant to your parts of the world as well. So behind every academic project, there is a personal story and my journey in climate change started 13 years ago when I was a youth delegate at the United Nations climate change negotiations there, I saw the negotiator from the Philippines. Yo in tears as Tai Haiyan ravaged his country during the conference, I traveled to LA a year later and spent summer volunteering and cooking school lunches and I could see the devastation from the typhoon on the ground. More than a year later at the conference, I had a taste first hand of the global injustice as Yo was ignored by negotiators from high income countries. The really scary thing is a decade later. We don't need to travel far to see the reality of climate change, climate change um has become a daily happening around us whether this is heat waves in Europe wildfires in Australia cyclones in the Pacific or recently in Auckland. We've had the worst flood in history about three years ago. As you can see people are kayaking down the street near where I live. And just in the last week, we've had three thunderstorms from extra tropical cyclones between Easter and ANZAC Day. The latest A PCC report has three key findings. Climate change is not just in the future is already a part of the reality around us and we will exceed 1 to 21 to 1.5 to 2 degrees of warming in the 21st century under all projected scenarios. And most importantly, every action counts because the impact of climate change is not on, not only on increasing averages but also extremes. With every additional increment of warming changes in extremes will be bigger. Therefore, every bit of mitigation in reducing um climate change and every bit of adaptation in minimizing the impact of climate change will count in producing a future that is as normal as possible. So the impetus of the paper I'm presenting today stemmed from my work with five Pacific Island countries in developing National Surgical plans. And this was during my research fellowship with a program in global Surgery and Social change at Harvard Medical School. During a stakeholder consultation meeting, a stakeholder pointed out the fact that climate change was missing from the Lancet Commission on Global Surgery. And there there was very little literature on the intersection between climate change and global surgery at that stage and even less literature on adaptation. As a part of this work, Ministries of Health in the Pacific asked how climate change could be integrated into surgical system design. And this really is a twofold process. Firstly, our surgical systems have to be sustainable. We have to mitigate and minimize our impact on climate change. And secondly, they also need to be resilient to the effect of climate change and adapt to the impact of climate change. And we realized our Pacific neighbors cannot do it alone because high income countries emit much more greenhouse gasses than low and middle income countries. In fact, one of the papers we looked at as a part of this review demonstrated that emissions from minimally invasive surgery in the United States alone is more than the total national emissions of some countries in the world. So therefore, we realized high income countries such as ours um and also the UK have the ability to make much more of an impact through adopting sustainable surgical practices and we have a responsibility to do so. So in conducting our narrative review, we framed it has been relevant to both high income countries and low and middle income countries across the Western Pacific region, we searched several scientific databases between July to September 2020 using a range of keywords and mesh terms that relate to climate change, greenhouse gasses and carbon footprint and also surgical anesthetic and obstetric care. We also performed the hand search of key gray literature and key policy papers through organizations such as the World Health Organization and the Intergovernmental Panel on climate change. We included all relevant papers and excluded papers that weren't published in English. We performed two levels of screening first by screening the abstracts and then by screening the full text of papers. And we performed narrative synthesis using the modified world Health organization building blocks framework, which is based on the six pillars of service delivery, workforce, information management, infrastructure, finance and governance, and I will present our findings according to this framework. So in terms of the first domain of infrastructure, we found that the operating theaters are among the most energy intensive parts of the health system. They are 3 to 6 times more energy intensive than the rest of the hospital. 30% of emissions associated with surgery with anesthesia excluded is from the built environment and this can be reduced by improving the energy efficiency of operating theaters through occupation based ventilation led light use and also renewable energy use. The second component of infrastructure is equipment and consumables and they contributed to 70% of emissions from surgery with anesthesia excluded and this can be reduced throughout the equipment life cycle. Firstly, starting with procurement, environmental preferable purchasing can select equipment based on their long term financial and environmental cost rather than the upfront cost. Secondly, the number of instruments in a surgical set can be rationalized to the minimum required. And thirdly proper segregation of biohazardous waste can reduce the amount requiring inc incineration. Lastly, reprocessing instruments have been found to have a significantly lower cost and carbon footprint than single use devices around the world. However, we found some variation, for example, in Australia, where electricity comes.