4 minute read.

Sitting longer than 30-60 minutes at a time increases your risk of back pain, diabetes, and cardiovascular disease. It also decreases your learning ability and mental alertness.

You can take steps every 30 minutes to increase your physical health and mental clarity; literally, take steps every 30 minutes, at a minimum. For some reason, people aren’t doing this, despite extensive scientific evidence of the risks of sitting and the benefits of moderate motion throughout the day.

This is similar to smoking; for years, people ignored the scientific evidence that proved smoking’s hazards because it was socially acceptable. To help others, we could make sitting all day less socially acceptable, both in the workplace but especially in school classrooms where kids are forming habits that will impact them the rest of their lives.

This article summarizes the science behind getting off your behind, then gives steps anyone could take to improve their health can mental clarity and create a healthier culture for workplaces and classrooms.

Facts

The following statements summarize 18 research studies that, combined, followed 800,000 people for up to 30 years.

People who sit most of the day:

Twice as likely to develop diabetesTwice as likely to have a heart attack2.5 times more cardiovascular diseaseMore back pain

People who alternate sitting and standing:

More energyFewer headaches

Students allowed to move instead of sitting:

Less attention deficit More long-term learning and memory

Exercising once a day does not change the negative effects of sitting all day. Benefit comes from alternating sitting and standing throughout the day, with no more than 20 to 60 consecutive minutes of sitting.

Science

Our bodies and minds are more efficient when in motion because of blood flow, spine biomechanics, and blood sugar levels.

Blood Flow

Sitting puts pressure on our thighs and restricts blood flow, decreasing energy and accumulating toxic wastes. Leg muscles pump blood while walking and, to a lesser extent, while standing. Stand using proper posture, ensuring your knees aren’t locked.

Image from Stepit

Spine biomechanics

Sitting weakens back-muscles and changes orientation of spinal discs. When discs change orientation, nutrients are pumped out, disc height decreases, and pressure on bones increases. Together, this leads to degenerated discs and back pain. Similarly, poor posture leads to abnormal forces in the cervical spine (neck), causing headaches.

The effects of spine degeneration can take years to be felt, and are permanent. When you sit, which should not be for longer than 30 minutes, use the best posture for working on a computer.

Image from The Wave Seat

Blood sugar

Sitting after eating increases blood glucose levels, which can cause diabetes. To reduce your chances of diabetes, eat moderate portions, avoid sugars, and walk after eating.

Mental clarity

Our brains need blood flow and oxygen to be efficient, and throughout history, people have realized that mental clarity comes from standing while working.

Winston Churchill advocated using a stand-up desk.

Earnest Hemingway used a stand-up desk, later in life.

In the 1800’s, inventors and designers recognized the need for stand-up desks.

In the 1700’s, Thomas Jefferson designed his own standing desk.

2,600 years ago, The Buddha described the posture of a person wanting to increase mental clarity, saying [he] “sits down cross legged, holding his back erect…”

Sitting cross legged, with your back erect, negates many harmful effects of sitting. The Buddha also advocated eating moderate amounts and following the middle-way between extremes. The middle-way between sitting all day and standing all day, which is also harmful, is a sit-stand desk.

Sit-stand desks

Sit-stand desks include additions to your existing desk, desks designed to alternate between sitting and standing, and desks with treadmills or other forms of exercise. Examples include:

You can experiment with a standing desk by stacking boxes under your computer.

This improvised standing desk is from a Time magazine article, “How a DIY Standing Desk Changed My Life”

Experts

The risk of sitting all day has been emphasized by almost every major newspaper, scientific journal, and government agency.

Take these steps

To start:

Never sit for more than 30 minutes without moving.Eat moderately, avoid sugar, and walk after eating.

Advanced:

Practice being mindful of your breathing and mental clarity each day

Help others:

Arrange your workplace, classroom, or meeting room to allow both sitting and standing.

If you think this could help others, please share.

This is under revision… please don’t forward this version. For a current version, please see my iteration on Linkedin.

Early in 2018 I underwent surgery surrounded by medical devices that were made by companies for which I had consulted. As the staff connected to a device that would keep me breathing during surgery, I thought about my experiences helping companies become more innovative while reducing risk to patients. I wrote this article while recovering. To keep it fun I use 1980’s pop-culture to illustrate the most important points.

Background

Reducing medical device risk is a law in the United States and a standard internationally. The regulations define risk as the severity of harm and how likely it is to happen.

Risk = Severity X Probability

This is more than just a definition, it’s a systematic method of reducing risk that provides repeatable, inspectable methods known to reduce harm to patients and create new products. Unfortunately, this method is underutilized or misunderstood, which harms people and adds costs to companies. For example, 44% of medical device recalls could have been prevented by design-controls that included risk-reduction, and up to 250,000 people die each year from accidental deaths in the American healthcare system. But, when used properly, risk management creates safer products, opens new markets, and makes quality control more efficient.

Regulatory requirements

Medical device manufacturing is regulated in United States by 21 CFR 820, and internationally by ISO 13485. Both require risk analysis, but neither describes how to do it, so we use methods from from the International Standards Organization, ISO, which describes Risk Management in ISO 14971:2007. Additionally, selling medical devices in the European Union requires a supplemental standard, EN 2012 : ISO 14971. which requires, among other things, that risk be reduced “As Far As Possible” (AFAP), which is a stronger statement than ISO’s, “As Low As Reasonably Practicable” (ALARP), and implies that cost can not be an obstacle to reducing risk to people, property, or the environment. Including property and the environments in risk is unique to ISO; the Food and Drug Administration limits risk to patients and users.

EN 2012 : ISO 14971 satisfies risk requirements for all countries, and using it allows a abbreviated regulatory process in the United States. A FDA 510(k) submission can refer to EN 2012 rather than explain internal processes that may be questioned by the FDA.

Medical device companies must pass country-specific audits before they can sell products in that country. An exception is the Medical Device Single Audit Program, MDSAP, which is currently accepted by five countries, including the United States. The image below, from Australia’s MDSAP policy, illustrates that risk management should be fundamental to all areas of a company’s quality-control system, especially purchasing from suppliers, and that risk management begins with a company’s management team.

Hazardous situations

A key aspect of ISO 14971 is identifying potential hazardous situations that could lead to harm. Hazardous situations are often unforeseen, especially by a small group of people who are likely biased by their experiences, therefore identifying hazardous situations requires diverse team input and constant re-evaluation. A classic example is the 1986 Space Shuttle Challenger explosion, which stemmed from a small O-ring allowing gas to leak in a rare, but catastrophic series of events that led to a hazardous situation of a postponed launch, a cold launch day, and fuel leaking around the O-ring that was not rated to such a cold temperature. Some people knew of the risk, but, in 1986, systems weren’t in place to ensure risk was analyzed for all hazardous situations.

Risk analysis methods

After identifying potential hazardous situations and harms, risk analysis is conducted to quantify the severity and probability of each harm. Risk analysis must be documented in a systematic way so that your work can continue with a product’s life-cycle, and that assumptions can continuously be monitored and updated. The two most common methods for medical devices risk analysis are:

Other risk-analysis methods are less common to medical devices, but all should lead to similar results. Most use a table, or matrix, to illustrate Risk = Severity X Probability for different scenarios.

Probability is initially assumed based on similar products or scientific literature, and should be continuously updated with data from real-world use. For the matrix example shown, “catastrophic” and “high” risks would be unacceptable, and “moderate” risks would need to be reduced As Low as Reasonably Practicable or As Far As Possible. In the case of the space shuttle, an unlikely probability of a sequence of events leading to a hazardous situation would be balanced by the severity of failure.

To apply a risk analysis matrix for medical devices, each harm must be unambiguous. Harm is defined by ISO 14971, section 2.1, as “physical injury or damage to the health of people, or damage to property or the environment,” and must be unambiguous so that a “severity” number can be applied, monitored, and continuously re-evaluated.

Companies are required to maintain their risk analysis in a risk management file so that auditing organizations can see evidence of continuous improvement by constantly re-evaluating risk, which includes re-evaluating potential hazardous situations and harm that could result from those situations.

Risk Control

Both ISO 14971 and the EN 2012 supplement describe systematic methods of risk management. For example, they standardize how risk is solved by providing three priorities:

Improve the design to be risk-tolerantAdd safeguards to reduce exposure to riskLabels or instructions to educate or warn of risk

Most of us don’t read or follow instructions, so ISO doesn’t consider written warnings to be effective risk control. This partially explains the European Union’s supplement that cost can not be an obstacle to reducing risk, i.e. companies can not apply a warning label to justify not improving their product’s design. This concept is summarized by an image used for training companies, provided by Oriel STAT-A-MATRIX, a training and consulting organization:

Other forms of risk control can be included in manufacturing processes, inspections before shipping products, etc., but it’s important to emphasize that ISO standards clearly state that prioritization should be placed on design and safeguards, whichever is the current “state of the art.” State of the art means that if a solution is known, it should be implemented; if not, extensive justification should be documented for audits. And, per the European Union definition of reducing risk “As Far As Possible,” cost can not be justification for not implementing state of the art risk control.

Post-market surveillance

Risk analysis uses assumptions that must be constantly re-evaluated using real-world data. Your company’s post-market surveillance processes must be linked to your risk-management processes, ensuring real-world data is used to adjust assumptions in a closed-loop system of continuous improvement.

Definitions

The following definitions can help you search risk management regulations:

HARM – injury to people or property

HAZARD – something that can cause harm

HAZARDOUS SITUATION – a situation in which a hazard could cause harm

HAZARD ANALYSIS – a process for identifying hazards and hazardous situations

RISK – the severity of harm and the likelihood it will happen

RISK ANALYSIS – a process for estimating risks from hazard analysis

RISK CONTROL – actions taken to reduce risk for a product

RISK MANAGEMENT – a company’s official, systematic process for reducing risk

RISK MANAGEMENT PLAN – a plan before risk activities, required by law and standards

RISK MANAGEMENT FILE – a document tracing the location of all risk documents

RISK MANAGEMENT REPORT – a report summarizing all risk management activities for a product, and how it will be continuously improved.

Safer Products

Needle sticks:

Hospital caregivers were often exposed to used needles, increasing their risk of a skin puncture and exposure to diseases such as HIV and Hepatitis C. The first company to innovate a way to reduce this risk quickly dominated the market, and other companies scrambled to create their own designs. Now, patients all over the world benefit from multiple forms of risk reduction, ranging from different needle designs to user-friendly disposal containers.

New Markets

Automatic Electronic Defibrillators (AED’s):

In the past, a patient with a heart attack had to wait for trained paramedics to arrive with a cardiac defibrillator. Paramedics were trained to ensure a patient had a heart attack, as opposed to an illness with similar effects, because using a defibrillator on someone without a heart attack could harm them. Companies innovated defibrillators that reduced this risk by detecting a patient’s condition before allowing defibrillation, which allowed public defibrillators all over the world. This expanded market size, and improved public safety.

Improved Quality Control

Manufacturing processes:

The Sulzer orthopedic company recalled one of their hip implants because a manufacturing change introduced risks into their product. Their quality system did not have modern risk management methods, resulting in thousands of patients with failed hips, secondary surgeries, and permanent damage to their livelihood. A billion dollars went towards lawsuits, putting the world’s 4th largest implant manufacturer out of business. Modern risk management methods ensure that changes are reviewed by a risk management team, reducing errors before they become harmful and costly problems.

Resources

CONSULTING & TRAINING

MaetricsLNE G-MedMDI ConsultantsGreenlight Guru

AUDITING ORGANIZATIONS

Summary

Risk = Severity X Probability

Common risk-analysis methods are: requires a company’s quality system to be a risk-driven process.

Risky Business

I’m having fun with 80’s pop culture while sharing my belief in ; there’s no new information here.

was a 1983 film that springboarded into fame after he danced in his underwear, just like how my career began. (Just kidding.) In the film, a teenage Tom took risks, resulting in harm to his father’s Porsche sports car and their home. Like most movies in the 80’s, their problems were quickly solved with money and quirky but reliable friends.

Healthcare is Risky Business. In the real-world of medical devices, risk affects people’s lives and well-being, and can rarely be fixed with money. If you if they would rather have insurance money or be able to walk normally the rest of their lives, they would have prefered a less-risky hip replacement. Any heart-attack patient saved by a public defibrillator would be grateful for risk-reduction, and hospital workers all over the world are safer each day thanks to reduced risk of needle-sticks.

Our work can be more fulfilling knowing it makes the world a safer, healthier place. We can do our work more effectively by understanding Risk Management regulations that focus on patient safety.

Take a break from saving lives to watch Tom Cruise dance in his underwear, a risk that paid off.

3 minute read, or a 12 minute quiz, if you’re ready.

By January 2019, the Canadian government will require all companies selling medical devices in Canada to be certified under the Medical Device Single Audit Program (MDSAP). There are only a few circumstances in which this deadline can be extended.

If you’re familiar with MDSAP, this article quizzes your knowledge of key concepts. If it’s new to you, read how to prepare for MDSAP.

Background

MDSAP allows medical device companies to sell products in multiple countries with one audit. To help you prepare, I created a guide to MDSAP and this quiz.

If you can answer all questions in this quiz, you should be able to discuss three questions with anyone, at any level, in your company:

Is MDSAP right for your company?If so, are you ready for a MDSAP audit?If you’re not ready, what steps can you take to prepare?

QUIZ

MDSAP overview

How many countries are participating in MDSAP? List them.Is MDSAP mandatory for all participating countries?Does MDSAP add regulatory requirements beyond existing ISO 13485 and country-specific requirements?If your company doesn’t plan to sell products in one of the MDSAP countries, do you still have to comply with that country’s unique requirements to pass a MDSAP audit?

Canada

When will Canada require MDSAP for most companies?

Auditing Organizations and audit reports

What is an “Auditing Organization (AO)?”List two, fully-recognized AO’sIf an AO finds a score of 5, how long do they have to report that score to regulatory authorities?If your company receives a MDSAP score of 5, how long do you have to submit a corrective-action plan?How many tasks with scores of 4 result in the same action as one score of 5?If your company has no scores of 4 or 5, how long does an AO have to submit a report to participating countries?

Audit model

How many quality-system “processes” are identified by MDSAP? List them.

The image below is used by some regulatory agencies to summarize MDSAP processes and links. In your own words, explain the concepts this image is trying to convey.

Image thanks to Australia’s TGA

MDSAP grading

Use the MDSAP two-step grading system to answer the following questions.

Scoring matrix via Australia’s TGA

Repeat questions #1 and #2, replacing clause 5.5 with clause 7.3.Repeat question #3, this time as if a nonconforming product had shipped.

Are you ready?

Do you believe your company is ready to pass a MDSAP audit?If your company isn’t ready, what are two things you could do to start getting ready?List three consultants or consulting companies that provide MDSAP training or consulting.

Conclusion

MDSAP is straight-forward and transparent. To paraphrase The Buddha, there are no secrets “hidden in the closed fist of the teacher.” If you weren’t sure about portions of the quiz, see these key resources, which include links to consultants and trainers to help larger groups gain understanding of medical device quality systems and regulations.

Resources

OFFICIAL DOCUMENTS

Canada’s MDSAP updatesSearch “MDSAP” in the

CONSULTING OR TRAINING

AUDITING ORGANIZATIONS (AO’s)

Good Luck!

Please share this blog if you think other people could benefit from it.

6 minute read.

The Medical Device Single Audit Program (MDSAP) allows medical device companies to sell products in multiple countries with one audit. This article summarizes the MDSAP and helps your company prepare for it.

If you’re confident in your knowledge of MDSAP, consider taking a quiz to see if you’re prepared for MDSAP.

After you understand MDSAP, if you’d like to have fun learning how to improve your Quality System, consider reading “Van Halen, brown M&M’s, & the quality system audits”

BACKGROUND

Medical devices are regulated by governments in order to protect patient safety. For example, when the United States discovered that 44% of medical device recalls could be attributed to design flaws, the FDA began enforcing design controls.

Companies must comply with the regulatory requirements of each country in which they sell medical devices. Participating countries will accept MDSAP in lieu of individual audits. These countries, and their regulatory agencies, are:

The United States of America, FDA

MDSAP is a standardized way of auditing, ensuring repeatable audits regardless of the auditor. It doesn’t add any new regulations; it standardizes the audit process to emphasize risk-driven processes, which was already required by ISO 13485.

Currently, MDSAP is voluntary. Beginning in January 2019, Canada will require MDSAP. There are only a few circumstances in which this deadline can be extended.

Before continuing, it’s important to emphasize that MDSAP was driven by industry input, and is considered both practical and beneficial by the International Medical Device Regulators Forum, which archives the respected work of the Global Harmonization Task Force.

Most participants believe that MDSAP audits represent an improvement over previous audits. More importantly, MDSAP can increase patient safety while improving company efficiency.

Does MDSAP add requirements to existing quality systems? Why or why not?

MDSAP VS. PREVIOUS AUDITS

Previously, each country required an audit.

MDSAP allows one audit to be used for all participating countries. A company only needs to comply with countries in which they intend to sell products.

Previously, auditors were encouraged to review a company’s quality system as process but were allowed to audit components independently.

MDSAP audits are conducted as a “process,” ensuring each part of a quality system links to other parts for a seamless flow of information. This must be a close-loop process; the outputs of each process become the inputs of another process, with information cycling through a review by senior management to ensure continuous improvement of the entire system.

The most common links are Risk Management and Purchasing procedures; all decisions must be based on reducing Risk to a patient, and documented to provide evidence for auditors and metrics for management review.

Image thanks to Australia’s TGA

Previously, noncompliances were graded as “minor” or “major.”

MDSAP noncompliances are graded from 1 to 5 based on the potential impact to a patient, frequency of occurrences, and whether or not products were shipped with the noncompliance.

What is a “closed-loop process,” and how does it apply to a quality system for continuous improvement?

How do you make, and document, risk-driven decisions about suppliers?

Consider checking your understanding in these fun, but informative, articles:

PROCEDURE

MDSAP auditors grade companies using a list of approximately 92 “tasks,” provided in seven chapters of the MDSAP audit model. The tasks capture all clauses of ISO 13485:2016, plus country-specific requirements.

Audits are conducted through Auditing Organizations (AO) that are approved by Regulatory Authorities (RA) of participating countries. I list some AO’s at the end of this article.

An AO will conduct an initial audit, perform surveillance audits, then re-certify a company every three years. An initial audit begins with a review of documents before an on-site visit; subsequent audits are document reviews unless there’s a reason to conduct a special audit.

What are MDSAP “tasks?”

GRADING

Noncompliance for each MDSAP task is graded from 1 to 5, with 5 being the most adverse. Grading has two steps.

STEP 1: start with a score based on two factors:

Scoring matrix via Australia’s TGA

STEP 2: apply an escalation score, if applicable.

+1 if a process isn’t documented (vs. being inaccurate or incomplete)+1 if the company shipped a non-conforming product

The final MDSAP score for each task is the combination of Step 1 and Step 2 scores, but with a maximum score of “5.” Audit results will include the following information:

Step 1 scoreFinal scoreThe ISO clause, or country-specific addition, out of complianceExamples of company documents out of compliance

Audit reporting formats, plus a standard grading system, allow regulatory agencies to know exactly what happened during the audit. This also allows companies a clear, unambiguous path to correct non-compliances.

Auditing Organizations report a score of “5” or three scores of “4” to Regulatory Authorities within five business days. Otherwise, AO’s have 90 days to submit their report to all participating countries.

Look at Step 1 scoring. If you were preparing for an audit, which ISO 13485 clauses would you focus on, initially, if you did not have a lot of time? In other words, which clauses are “bang for your buck?”

STEPS TO PREPARE

Consider if consultants could help you train your company or assist preparing for MDSAPSchedule an audit with an Auditing Organization soon; there are only a few AO’s, so their schedules may be busy.

MORE TO MDSAP

An overview of the MDSAP won’t answer every question. Examples include how companies respond to noncompliances, how internal audits are utilized, etc.

But there are no surprises with the MDSAP. To paraphrase The Buddha, there are no secrets “hidden in the closed fist of a regulatory agency.” All documents used by Auditing Organizations are available, for free, online.

If you have the MDSAP audit model, are you fully prepared for what an auditor will ask? Why or why not?

RESOURCES

OFFICIAL DOCUMENTS

MDSAP audit modelThe United States FDA MDSAPAustralia’s TGA MDSAP

CONSULTING OR TRAINING

AUDITING ORGANIZATIONS (AO’s)

SUMMARY

Five countries are participating: USA, Japan, Australia, Brazil, CanadaCanada will require MDSAP by January 2019

Test your understanding by taking this MDSAP quiz.

Please Forward

If you think others would benefit, please “like” or forward this article.

6 minute read.

When you walk through a jungle, remember four things:

If you’re charged by a rhino, climb the nearest tree. If there are no trees, run in a zig-zag pattern and drop your backpack or a piece of clothing; rhinos have poor eyesight and use their sense of smell when charging.If you encounter a sloth-bear, stay still and don’t startle it. Gather in a group and bang sticks on the ground.If you cross paths with a tiger, maintain eye contact and back away, slowly.If charged by a wild elephant, run and pray.

That’s the training we received before hiking into the jungle for three days, where we stayed in villages surrounded by fences to keep out wildlife. Nepal’s national parks are some of the few places in the world where you can go on a walking safari. It’s a rare opportunity to get up-close with endangered species in their natural environment.

During Nepal’s civil war, their army, which guards national parks, was pulled away to fight for ten years, allowing poachers to decimate already-endangered animals. National parks are vital to the future of endangered species; approximately 300 of the world’s remaining 3,000 one-horned rhinoceroses are protected in Nepal’s Chitwan National Park.

Getting there

This was part of a multi-month backpacking trip through Nepal and India, where I arrived in Kathmandu without plans, hiked across the Himalaya Mountains and explored the kingdom of Mustang. After resting a few days, I took a bus from the foothills of the Himalayas to the jungles of Nepal.

To be affordable, public buses in Nepal allow people to sit on each others’ laps, stand, or cram several people into seats designed for two people. Buses are small; I’m taller than average Nepali people, and I had to pull my knees towards my chest to fit into the seat. It’s uncomfortable, especially for a six-hour ride across bumpy mountain roads. To have fun, I let kids play with my camera. In poor areas of the world, people in tourists’ photos have rarely seen a photo of themselves or used a camera; many of the photos in my blog were taken by kids I met while backpacking.

Welcome to the jungle

The town near Chitwan National Park, Sauraha, is separated from the park by a river. The people of Sauraha use Elephants like people in the rural United States use tractors, working in fields and riding into town.

Shop owners share old produce with the elephants: their trunks can lift 750 lbs using 150,000 muscles, yet tickle your hand when they’re sniffing for an apple.

There are few roads or infrastructure in this part of Nepal, and villages inside the national park are isolated and rustic. There are few roads, and during the rainy season roads become impassable even to jeeps, but elephants live here naturally and can cross rivers that jeeps can not. They carry wood to cook food, and products to trade in town. And, they’re safer than walking: each year, people are killed by bears, tigers, rhinos, and wild-elephants.

The villages were sheltered from development because, until recently, there was malaria in the area. Then, the civil war kept development away. Now, the lack of roads, schools, and hospitals keeps the area isolated, except for tourists coming through with much-needed money. A popular activity is touring the jungle on the backs of elephants. They’re intelligent, social animals, known to show compassion and mourn their dead. They resist being chained and made to carry people, and the methods used to keep them domesticated is inhumane. So, as much as I enjoy them, we could not justify supporting a decadent use of elephants. We hiked into the jungle, enjoying elephants in a more natural setting.

Canoe & hike

We left town in a canoe, early in the morning when a thick fog blocked view of shore. We could hear monkeys howling in trees, birds singing from shore, and crocodiles splashing in the water. Over the next three days, we alternated between wading through rivers and hiring dugout canoes for deep sections where crocodiles may be unseen; the week before we arrived, a soldier disappeared while on patrol, presumably killed by a crocodile.

At night, we’d sleep in villages that were surrounded by rustic fences to keep out wildlife. Both guides were born in the area, became trained in conservation, and now earn their living preserving wildlife and wilderness. To make this a sustainable social business requires tourists willing to make the journey.

Most of our time was spent hiking to and from villages, observing wildlife along the way. We saw seven one-horned rhinos, which is a treat because there are only 3,000 remaining in the world today. They’re known to “Charge!” when startled, especially when protecting young rhinos. The rest of the time, they’re content sitting in water, eating and farting between naps.

To me, this sounds like a wonderful world: everyone eats, swims, farts, and naps; don’t be aggressive, except to protect your children from harm.

We had a scary experience with one rhino, after we startled one while hiking through high grass. This one photo was taken just before we all ran, including our guides, after ensuring we were safe.

Nepal requires two guides for walking safaris, one in the front and one in the read, watching all directions and keeping count of tourists. One of our guides had scars on his arm from a sloth bear attack.

Guides are usually from local villages, and are well-educated about animal conservation. They are there to help tourists have authentic experiences; we protect what we cherish, and we cherish what we experience positively.

Seeing tigers require being still. Each morning, we’d sit silently for four hours, observing trails that led to watering holes. Mostly, we only saw wild hogs, which are intelligent enough to realize that they’re cute and we’re mostly harmless.

Back in town

Over the three days, I had become friends with our guide. Back in town, I stayed with his family, in a hut overlooking the river. He insisted on buying beers: a Nepali beer is 350 Rupees ($3.50 U.S.), he earned $15/day as a tour guide, which required a year of school. His family and I grilled food, played music, and discussed what to do about balancing nature conservation with infrastructure development and people’s need for employment. He chooses to not take tourists on elephants, even though that’s more lucrative. He also knows that every road helps villages have access to modern health and education, but takes away land from wildlife; all threats to humans stem from us encroaching on land used by these animals for thousands of years before we started building roads there.

Ultimately, animals will be saved when humans preserve their land; we can’t expect rural people to preserve land at the expense of their own well-being, especially when faced by decadence in other areas of the world. The future of conservation may require sustainable tourism based on socially-responsible businesses, and democracies where people choose where tax funding goes.

Nepal is new to democracy. The civil war ended recently, and they had their second elections, which I witnessed when backpacking in the Himalayas. Everyone hopes for the same, and when we help them have equitable health and education they can help preserve nature for all of us.

We didn’t solve the world’s problems, but had fun and enjoyed cold beers while playing music and grilling food over an open fire. Alcohol is detrimental to inflammation in our bodies (I have chronic inflammation), and can become a problem for many people, but at that moment, sharing a beer was the best choice I could have made. The day before, I had been charged by a one-horned rhinoceros and saved by the guy buying me a beer.

I travel by backpack to get to know people who live drastically different lives than we do. I believe this allows me to better appreciate my home in San Diego, California, which makes me happy. When you’re happy, you want to share, which is I work towards equitable education and healthcare for others.

The future

Preserving these beautiful animals requires people like you and me making it financially feasible for villagers to earn a living sustaining their wilderness. We can do this through responsible tourism, supporting animal-welfare organizations, and encouraging global programs that assist local entrepreneurs in creating sustainable businesses.

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