The first time we stepped into an operating theater in the United States as medical students, we were shocked by the sheer amount of waste produced from just one surgery. In fact, health care is responsible for nearly 10% of total carbon emissions in the United States, contributing approximately 5 million tons annually. Thirty percent of that waste comes from operating rooms, much of it due to disposable gowns, drapes, instruments, and plastic packaging.
As we continued with our medical training, we grew used to the idea that high-quality care inevitably produces high waste. But reading several published articles on the resource efficiency of hospitals in India forced us to question that assumption. How were they providing thousands of surgeries a day with a fraction of the waste — and no compromise in safety?
As part of our summer research project in medical school, we traveled to India to study the sustainability practices of the hospitals there. What we discovered challenged the belief that sustainability and modern medicine must be at odds and offered a glimpse into how health care everywhere could operate differently.
We first visited LV Prasad Eye Institute, located in Banjara Hills, Hyderabad. In the aftermath of monsoon rain, it took us nearly two hours in traffic to reach the hospital. Rising above the driveway stood a gleaming white hospital, its terraced roofs lined with solar panels that shimmered in the afternoon sun, quietly fueling an urban hospital in one of India’s busiest cities. During a tour of the facility, their chief sustainability officer told us that since 2021, LV Prasad cut back on 2,400 tons of CO2 emissions, which is the carbon footprint of 12,500 Indian homes.
Inside the hospital, we walked past glass doors to reach a modestly sized, well-lit room with half a dozen monitors. This was the hospital’s tele-ophthalmology hub.
One patient’s photos and clinical notes flashed onto the screens; a rural technician had just examined a farmer complaining of red, itchy eyes. An ophthalmologist resident in Hyderabad reviewed the images, spoke with the patient via a telehealth platform, and prescribed medication for conjunctivitis. There are nearly 200 LV Prasad-operated primary vision centers that provide basic eye exams in remote villages across South India. Their robust telehealth and mobile health van networks then connect these patients to secondary district-level centers and tertiary centers as necessary to ensure patients get exactly the right level of care, while minimizing cost, travel, and carbon emissions. The executive director emphasized that financial and environmental sustainability go hand in hand.
Next on our trip was Pondicherry, a historic beach town and former French colony in South India. We had heard much of the city as children watching “Life of Pi,” but never imagined we would visit, much less for health care-related work. Beyond its central role in the Oscar-winning film, Pondicherry is known within India for housing one of the country’s best ophthalmological institutes, the Aravind Eye Hospital.
Aravind has served as a global model for health care sustainability for decades. It has mastered the pipeline of using reusable surgical gowns, autoclaving its surgical instruments after each procedure, and diligently sorting waste into three well-defined bins: biohazard, recyclables, and compost. Crucially, staff receive thorough training on proper waste segregation, ensuring items go into the correct bin.
This stands in stark contrast to many U.S. operating rooms, where despite having an array of disposal categories — red bag, sharps, pharmaceuticals, blue wrap recycling, and e-waste — much surgical waste ends up in biohazard bins by default, often because staff lack clear guidance on sorting. The result: unnecessary incineration of recyclable materials and a far larger environmental footprint.
And the difference in waste volume speaks for itself: Aravind generates only 0.25 to 0.5 kilograms of waste per phacoemulsification, compared to more than 4 kg per case in many U.S. operating rooms. Despite these sustainable practices and the fact that the average surgeon at Aravind performs nearly four times as many procedures per day as their American counterparts, Aravind has similarly low infection and complication rates as the U.S. and U.K.
These weren’t isolated examples. Across multiple Indian hospitals, we saw consistent patterns: renewable energy infrastructure, reusable materials, streamlined waste management, and innovative use of technology to reduce patient travel. In the practice of global health, much emphasis is placed on how Western high-income nations can support low- and middle-income countries through funding, training, and infrastructure development. But our travels repeatedly made clear that the relationship must be bidirectional. Though we likely saw hospitals at their best, given the purpose of our visit, it was clear: The United States and peer nations have much to learn from India about optimizing care delivery sustainably.
The lessons are practical and actionable. Hospitals like Aravind have shown that reusable surgical gowns, linens, and drapes can maintain infection control standards while dramatically reducing waste. Their meticulous waste sorting systems make sustainable practices easier for staff to follow. LV Prasad’s robust tele-ophthalmology networks demonstrate how technology can reduce unnecessary patient travel and resource use while expanding access to care.
But implementation requires systemic change, not just individual effort. In the U.S., the FDA must update regulations to permit safe reuse of supposedly single-use devices when evidence supports it. Hospital purchasing decisions need to prioritize sustainability alongside cost and quality. Medical education should train the next generation of physicians to consider environmental impact as a core component of quality care, not an afterthought. Health care leaders have already called for designating carbon footprint as a secondary endpoint in randomized controlled trials, enabling physicians to choose treatment options that are both effective and sustainable.
The economic incentives align: Sustainable practices often reduce costs, as LV Prasad’s CEO shared with us. Hospital executives and vertically integrated delivery systems stand to benefit financially from waste reduction, creating natural allies in countering resistance from device manufacturers invested in single-use products.
Standing in those Indian operating rooms, watching surgeons perform procedure after procedure with minimal waste and excellent outcomes, we realized that “high-quality care” and “high waste” are not synonymous. American health care has pioneered countless medical innovations. Now it’s time to learn from others about doing more with less — not because resources are scarce, but because our planet demands it.
Srinidhi Polkampally is a third-year medical student at Stanford School of Medicine. Bhav Jain is a third-year medical student at Stanford School of Medicine.
