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The Dark Side of Surgery: The Life-Threatening Problem You're Not Hearing About

Flawed and Poor-Quality Surgical Instruments Place Patients at Risk

introduction

The BBC documentary, “Surgery’s Dirty Secrets,” which originally aired in 2011, investigates the sources of surgical tools, and highlights flaws in British safety regulations.

If you’re like most, you probably assume that surgical instruments are made to the very highest, exacting standards. The reality of where and how these tools are made is downright shocking.  

According to BBC reporter Samantha Poling, who spent a year investigating this topic, there are significant problems in the industry — problems that can, and have, caused severe illness and death.

An estimated 30 million operations are carried out in British hospitals each year. In order to perform, surgeons need the right tools for the job, and these tools must be made to exact specifications and be of the highest quality.

Poorly made or non-functioning surgical tools can mean the difference between a successful surgery and the loss of a limb or organ, or death of the patient.

For example, for each fraction of a second a surgical assistant is struggling with a poorly functioning arterial clamp, the patient is losing blood, compromising the success of the surgery.

Lethal Infections Spread by Surgical Tools

In 2009, Dorothy Brown underwent heart surgery at Nottingham City Hospital. While the operation was a success, she contracted an antibiotic-resistant infection that nearly claimed her life. Ten other patients operated on by Brown’s surgeon around the same time contracted the same lethal infection.

Five of them subsequently died. In the U.S., the Food and Drug Administration (FDA) reports at least 1,000 incidences where poor-quality surgical instruments have caused harm each year.

A confidential report obtained by Poling reveals the two most likely causes of the mass infection at Nottingham City Hospital were either airborne bacteria or micropunctures in the surgeon’s gloves. As a result of the internal investigation, surgeons must now wear thicker gloves or double-up on regular gloves. 

But what would repeatedly cause micropunctures in the surgeon’s gloves in the first place? According to experts, the most likely cause is poor-quality surgical instruments.

While few medical professionals were willing to go on record with the BBC, Tom Brophy, a lead technologist with Barts Health NHS (National Health Service) Trust, did. Deeply concerned about what he’s been seeing, he has started collecting evidence showing just how defective some surgical tools are.

Most of these defects cannot be seen with the naked eye, but under magnification, jagged edges and poor-quality construction becomes readily evident. Common problems reported by Brophy include:

·         Fractured and re-welded instruments, which can harbor and spread bacteria

·         Sharp, protruding guide pins on forceps that can lacerate gloves

·         Sharp burs and metal fragments that can break off, lacerating gloves and/or pose an infection risk if deposited inside the patient

·         Corrosion and pitted metals that can pose an infection risk

·         Faulty screw heads

1 in 5 Surgical Instruments Is Flawed

According to Brophy, 1 in 5 instruments, or about 20 percent of all instruments he receives, are rejected due to flaws that place patients’ health at risk. He even reports receiving used equipment where blood and dried tissue could pose an infection risk.

These tools are somehow recycled and passed off as brand new — something that simply should not occur. Yet it’s happening. Poorly constructed instruments also should not enter the surgical suite, yet they do with frightening frequency. How is all of this possible?

In the U.K., manufacturers and suppliers of surgical instruments must be registered with the Medicines and Healthcare Products Regulatory Agency (MHRA), and there are over 900 manufacturers registered.

In December 2010, following mounting complaints about shoddy quality, the agency issued a warning to all manufacturers saying steps must be implemented to ensure that all instruments are “fit for purpose.”

However, the responsibility for ensuring that quality standards are actually met still rests with the manufacturers, not the MHRA or any separate quality control agency. The suppliers are not even required to inspect the products received from the manufacturer before reselling them to a hospital.

In all, there are 180 health trusts and boards in the U.K., but Barts is the only health trust that actually employs a technologist to inspect all the instruments before they’re used in surgery.

Disturbingly, when Brophy sent back rejected instruments to an Asian supplier, he was told that the instruments were sent out to another U.K. hospital that accepted them without issue. “Well, of course they’re going to accept them,” Brophy says, “because they haven’t checked them.”

Where Are Surgical Tools Made?

Thoughts of Swiss-made precision come to mind when considering how surgical tools are made, but two-thirds of the world’s surgical instruments are actually manufactured in Sialkot, located in the northern Punjab area of Pakistan.

Seventy percent of the 900 surgical tool manufacturers registered with the MHRA are based there.

Some of these manufacturers appear to be doing a decent job, including Hilbro, which is one of the largest manufacturers. Each instrument is at least visually inspected with a magnifying glass before being sent out. Others operate under far more questionable circumstances.

Regal Medical Instruments, a small manufacturer in Sialkot that sends their wares to two small-scale suppliers in the U.K., offers a wholly different view of the industry. The facility is so dark you can barely see, and metal dust fills the air. Surgical instruments lie scattered in piles on the floor.

In their quality assurance department, employees visually inspect each instrument before stamping it with the requisite “CE” quality stamp required by the MHRA, but no magnifying glass is used. This means most defects caught by Brophy — who uses a microscope — will never ever be caught.

Then there’s “the ramshackle side to the industry,” to use Poling’s words. In this part of town, workers toil away at their grindstones in tiny dust-filled shacks with open sewers flowing past their doorways. According to Poling, larger, respectable companies frequently outsource work to these workers in order to meet demand.

In all, there are more than 3,000 of these “outsourcing units” in Sialkot, and these workers make less than $2.50 per day. According to some of the workers, both Hilbro and Regal Medical regularly buy surgical instruments from them.

‘Made in Germany’ — Not Quite!

Remarkably, the maker’s mark on these Pakistani-made tools will often say “Made in Germany.” As explained by Poling:

“Under EU law, the instruments made in these backstreets can be stamped with another country’s name so long as that country helps substantially transform the product. So, as the forged steel they’re working with here comes from Germany, the whole thing can be stamped ‘Made in Germany,’ and German instruments sell for much more than those stamped ‘Made in Pakistan.’”

Making matters worse, British suppliers rarely conduct quality inspections of their Pakistani manufacturers’ facilities. Part of the problem is the constant risk of terror attacks in Pakistan. It’s a dangerous area, and carrying out inspections in person is risky. Poling also found evidence suggesting the Pakistani surgical tool industry may be using child labor.

The MHRA declined meeting with Poling, but provided her with a statement saying they have “no evidence that non-compliant instruments are being supplied to the NHS.” Meanwhile, Brophy inspected the 19 instrument samples collected by Poling during her Pakistani trip, where she visited over 100 different instrument manufacturing facilities. Twelve of the 19 samples failed his inspection.

Poling even unearthed illegal activities during her investigation. While legal loopholes allow for a Pakistani manufacturer to label his goods as “Made in Germany” if the steel used is from Germany, it is illegal to use Pakistani or French steel, for example, and mark it as being German-made.

Undercover footage, in which she poses as a supplier of surgical instruments, shows two U.K. representatives of Regal Medical Instruments offering to sell her tools made with Pakistani steel stamped “Made in Germany,” so that she would then be able to resell them at an inflated price. According to the Pakistani representatives, they are already selling mid-priced French steel instruments to suppliers that bear the German mark, per the suppliers’ requests.

you can heal your life only if you heal your mind

     Doctors have pondered the connection between our mental and physical health for centuries. Until the 1800s, most believed that emotions were linked to disease and advised patients to visit spas or seaside resorts when they were ill. Gradually emotions lost favor as other causes of illness, such as bacteria or toxins, emerged, and new treatments such as antibiotics cured illness after illness.More recently, scientists have speculated that even behavioral disorders, such as autism, have a biological basis. At the same time, they have been rediscovering the links between stress and health. Today, we accept that there is a powerful mind-body connection through which emotional, mental, social, spiritual, and behavioral factors can directly affect our health.If you look at the so-called Blue Zones around the globe, such as Okinawa, Japan, and Ikaria, Greece—places with unusually high concentrations of healthy older people, first identified by explorer and traveler Dan Buettner—you find that ill health isn’t the norm. Yet, most of us share a culturally-supported belief that disease and infirmity are inevitable as we age. What our culture doesn’t teach us is that diseases don’t just appear out of nowhere. They are the final result of a process that takes time to develop. And it is well-documented that every disease has a mental, emotional, and spiritual or energetic aspect. So it makes perfect sense that your emotions and beliefs can reverse disease and create vibrant health.The most common diseases of aging today—heart disease, arthritis, cancer, dementia, and diabetes—start with chronically high levels of the stress hormone cortisol.  Stress and a diet high in refined sugar are the leading causes of the top degenerative diseases that you have been programmed to believe you will succumb to as you age. In addition, education and awareness about any disease can distort your view. If you really want to become educated and aware where your health is concerned, here’s what to you really need to know: The body is a marvelous creation designed by the Creator to be in a continual state of regeneration and repair. If you listen to your body’s messages and heed them, you can very often prevent disease or reverse it long before it becomes established.So, rather than worrying about your family history and your genes, and then stressing out and spending your time looking for symptoms and having endless tests for the rest of your life, you can actually reverse the aging process by focusing on the causes of health These include pleasure, exalted emotions, and righteous anger—most of which are not taught in our culture. No matter your age, no one is completely free of health threats. Everyone’s body has cancerous cells and microorganisms that could cause illness if not kept in check. But, despite what you have probably learned, it is actually the fear of those pathogens that will depress your immune system and make it more likely that you will get sick, not the mere presence of them.When you make choices that strengthen your immune system—such as finding things to feel joyful about, or believing you are not destined to suffer from disease as you age —your body becomes better able to surround, weaken, and kill pathogens.Here are some of my tips for growing older without aging:

ü  Don’t Fear Your Genes! Your genes are just a blueprint, not a destiny. Scientists now know that we have more control over how our genes express than most believe and that gene expression is strongly influenced by beliefs and emotions as well as by your lifestyle choices. Don’t accept the disease that runs in your family rather see it as opportunity to make a difference. You must not suffer that disease.

ü  Feel and Express Your Emotions.  Exalted emotions – joy, fun, pleasure – change your hormones by increasing DHEA, your life force hormone.  So, think of this as a prescription to go have fun and enjoy every minute of your life.  Similarly, the worst thing you can do for your health is hold on to anger, fear, and sadness.  If you have these feeling, it’s important to feel them fully then release them. When you alleviate emotional stressors you are improving your health and signaling those potentially harmful genes not to express genes for disease.
 ü  Get A Good Night’s Sleep.  Getting enough sleep has amazing health benefits.  It’s been shown to lower blood pressure and help you lose weight.  Sleep also helps you digest extra stress hormones from your day. One way to help readjust your inner clock is to take melatonin, a naturally occurring substance that promotes deep sleep. Another way to do this is to have what Dr. Lipman calls "an electronic sundown." Turn off all TV's, computers, and blackberries by 10:00 p.m. at the latest.
 ü  Change Your Beliefs. It’s estimated that 80 percent of all illnesses begin in the mind. Metaphysical healer Edgar Cayce said, “The spirit is the life, the mind is the builder, the physical is the result.” In other words, work with Spirit to design the house (your health) and let your thoughts, beliefs, and emotions serve to build it. You can’t change your genes, but you can change your inherited emotional patterns. Here’s a prayer to inspire you: “Divine Beloved, please change me into someone who completely trusts my body and my genes.”
 ü  Don’t Fear Your Test Scores. Numbers on a diagnostic test can be helpful indicators of a condition that needs to be addressed, but don’t give them too much weight that they worry you. Your thoughts and beliefs have a far bigger impact on your health than your medical test scores do. In fact, when a patient is told bad news, it’s often the news itself and the stress hormone reaction to it that hastens the progress of the disease.
 ü  Carry out some regular checkups.  There are certain tests that truly can assist you in creating better health. Here’s what I recommend: Get a Fasting blood sugar test. Your fasting blood sugar should be no higher than 85 mg/dl. One hour after a meal, your blood sugar should go no higher than 120 mg/ dl. Also test your vitamin D levels. Be sure to get a 25(OH)D blood test (not a 1,25(OH)2D test.) It’s the 25(OH)D that will tell you how much vitamin D is in your blood. This can be done through your doctor or an online lab. Your level should be 40–80 ng/ml—and it will usually take at least 5,000 IU of vitamin D a day to get it there and keep it there. Finally, be sure that your blood pressure is around 120/70, give or take a few points either way.

MALNUTRITION KILLS OVER 2000 DAILY IN NIGERIA

   Mr Ubah Nnaemeka, the Project Officer, Civil Society Scaling-up Nutrition in Nigeria (CS-SUNN), on Tuesday said malnutrition accounts for the death of 2,300 Nigerian children daily.

Nnaemeka made this known on Tuesday in Ilorin at a two-day Advocacy Skills and Strategic training organised for members of the organisation in Kwara.

Quoting the National Demographic and Health Survey of 2013, he also said that only 17 per cent of mothers in Nigeria breastfeed their children.

He listed three indicators of malnutrition as over-nutrition, under-nutrition and micro-nutrient deficiency.

According to him, if nothing positive is done to stem the rate; there is possibility that malnutrition may claim more lives of children.

He said that globally, out of a population of seven billion, no fewer than two billion were suffering from micro-nutrient malnutrition.

“Out of the five billion adult worldwide, nearly two billion are overweight or obese with one in every 12 person having type II diabetes,” Nnaemeka said.

He said that malnutrition has the ability of sapping intelligence from childhood and by extension, compromising the future of Nigerian leaders.

The project officer said at present, Nigeria accounts for 11 per cent of the total global under-five deaths, with 37 per cent of children under the age of five stunted.

Earlier, Dr Uthman Mubashir, the Chairman, CS-SUNN Local Working Group, said that the organisation was concerned with the nutrition of women and children.

He described malnutrition as a collective problem that needs collective response from all stakeholders.

Mubashir called for a strong voice by policy makers to create the desired change in the country in respect of malnutrition.

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