At South Eastern Sydney Local Health District (SESLHD), we recognise the benefits of an environmentally sustainable healthcare system. Improving our environmental performance will have health and financial rewards for our community, as well as environmental advantages for the planet.
We have undertaken a greenhouse gas emissions assessment of our services and are developing a sustainability strategy. It recognises that half of the Australian health system’s carbon footprint is from hospitals and almost 20% is from pharmaceuticals.
Therefore, as well as energy and recycling, we will also be focussing on:
- Primary and community-based care
- The judicious use of resources, including pharmaceuticals
- Less waste and duplication
- Innovative, low-carbon models of care
Did you know that in Australia, the health system’s carbon footprint is 7% of our total national emissions – the same as the entire emissions of the state of South Australia? At SESLHD, we are strongly committed to the NSW Government’s target of net-zero carbon emissions by 2050.
The support and involvement of patients, staff and our community are welcome. Please contact us for information.
In a State first, the Kirketon Road Centre (KRC) is involved in a trial to dramatically scale back the amount of polypropylene syringe containers (FitPacks) distributed through their Needle & Syringe Program (NSP). Fitpacks are plastic containers used for the personal storage and transportation of syringes.
They also allow for the disposal of used syringes in a separate compartment. These plastic containers take 20 – 30 years to fully decompose and one of the KRC services in Darlinghurst dispenses around 27,000 FitPacks each year.
With the support of NSW Health and the KRC Consumer Participation Group, KRC has started a three month trial to replace FitPacks with discreet white cardboard boxes called FitKits.
“Prior to the trial commencing, KRC management and consumer representatives held a number of meetings to discuss the proposed changes,” Gary Gahan, Projects Manager, KRC said. “As a result, KRC staff and clients have produced a series of resources recommending alternate safe disposal options for clients.”
“During the trial period, we are surveying clients to assess their knowledge and attitudes to the transition to FitKits and to assess any changes in how they are disposing of their used injecting equipment. We are also conducting in-depth interviews with clients and carefully monitoring any changes to the disposal of equipment in public spaces.”
KRC hope they can reduce the reliance on plastic containers without impacting public amenity. If successful, the project will be extended across the entire District NSP and will provide evidence for NSW Health to consider a State wide-roll out.
KRC’s Waste Watchers Group and the KRC Consumer Participation Group have also implemented other environmental initiatives, including switching from single use Styrofoam cups to reusable melamine cups in client areas and the introduction of designated recycling bins. KRC is also addressing food wastage by partnering with services such OzHarvest and Second bite.
In another innovative sustainability practice at Calvary Health Care Kogarah, kitchen staff are putting aside sealed non-perishable food items that come back from patient rooms untouched and donating them to the St Vincent de Paul (Vinnies) night patrol.
Instead of being thrown into landfill, the food is separated and given a second chance to help people less fortunate. Collections are delivered weekly to Katrina Andrews from Vinnies.
The re-use of sealed non-perishable food items was initiated by Jodie Ellis, Head Dietetics and Speech Pathology at Calvary, who recognised the wasteful practice of blindly tipping returned food tray items into the general waste bins.
“As individuals and as a community, all we have has been given to us as a gift. It is our responsibility to manage these precious resources effectively now and for the future. We are responsible for our environment,” Ms Ellis said.
The Randwick Campus Redevelopment team recently hosted a Ride2Work Day community breakfast in the courtyard of the historic Edmund Blacket Building. With complimentary bike tune-ups, route planning advice as well as cycling prizes and giveaways, the event was well attended, attracting more than 120 cyclists from across the campus.
Liz Kookarkin, Communications and Engagement Officer, Randwick Campus Redevelopment, said her team members are always looking for fun and engaging ways to talk about their project and promote the benefits of active and sustainable travel.
“What better way to achieve both these objectives than by celebrating Ride2Work Day – Australia’s largest commuter riding and workplace cycling event,” Liz said.
“The community was keen to hear about the end-of-trip facilities planned for Prince of Wales Hospital’s new Acute Services Building and provide feedback about how campus cycling amenities can be improved.”
This event is one of a number of initiatives by the Randwick Campus Redevelopment team under the Randwick Hospitals Campus Green Travel Plan. The Green Travel Plan’s core objective is to grow travel and access choices for staff – specifically, it targets an eight per cent reduction in people driving to and from Randwick Hospitals Campus by the time the first stage of the redevelopment is completed in 2022.
Progressing the SESLHD Environmental Sustainability Plan 2019-2021, Ellie Black, Public Health Medicine Registrar, has joined Dr Kate Charlesworth, Environmental Sustainability Lead, for six months to complete a climate risk assessment plan.The plan will look at the risks and impacts for the health system, and in particular SESLHD, resulting from climate change.
“We’re trying to get an idea of the range of possible health impacts on our community - what are the most likely risks and what risks may be less likely, but potentially have severe consequences,” Ellie said.
"We will look at what we’ve already got in place to manage those risks, what’s missing and what we can do to manage and reduce those risks into the future.
"For example, from heat there can be heatstroke, dehydration and exacerbation of pre-existing chronic disease, like cardiovascular, respiratory and mental health problems."
A literature review has been completed and Ellie has identified two climate-related health impacts to focus on. These are: heat and air pollution.
Projections are vital and Ellie has met with SESLHD’s internal audit and data analytics teams. Crunching data from the Bureau of Meteorology and NSW Health is helping to estimate how increased heat will impact areas such as emergency department presentations and hospitalisations.
The District Finance group, situated in Sutherland Hospital (TSH), is implementing part of the South Eastern Sydney Local Health District (SESLHD) Environmental Sustainability Plan by setting up several waste initiatives in their office.
Sinisa Sikiric (Domestic Services Manager TSH) noticed how every desk had a general rubbish bin under it.
“We found we collected probably 70 per cent paper out of these bins. If the cleaners found a banana peel or an apple core, the whole lot would have to be thrown out due to contamination. We suggested to Kate Dobinson we remove the bins,” Sinisa said.
“We didn’t have a lot of resistance,” Kate (SESLHD Clinical Product Manager-Nurse Manager, Finance District Procurement) continued. “Nearly 40 bins have been removed from the office. We’re all in sedentary roles so there was the potential for us to move more.”
This initiative has seen a reduction in the use of plastic liners and the cleaners have to complete less manual handling. The paper recycling bins, which were placed in a centrally located area, need only to be emptied every 7 to ten days. Co-mingle and general waste bins are located in the kitchen.
“We are also not ordering any more disposable cups, plates or cutlery. Our staff are encouraged to bring their own,” Kate said. “We used a lot of foam cups. It’s just silly. I was guilty too, because you don’t think. You’d go to the kitchen, ‘oh I haven’t got my cup’, so you’d grab one.”
Sinisa mentioned that Domestic Services are looking to introduce these waste initiatives across all admin areas in Sutherland Hospital.
“We were getting two x 240 litre bins of general rubbish from Finance per week, now we’re getting half of it, or less,” he said. “It makes a huge difference to our financial bottom line as you pay to have the rubbish taken away.”
“People feel very passionate about waste. The health dollar is hard earned and needs to be respected. That brings it back down to people like ourselves who want to make the most of it,” Kate concluded.
(Pic: District Finance recycling team: Sinisa Sikiric, Debbie Gilbert, Jamie Wotherspoon, Robyn James & Kate Dobinson)
South Eastern Sydney Local Health District's Oral Health Service faced a dilemma recently when they converted all their patient dental records to electronic files. They were left with thousands of plastic binder clips.
Being environmentally minded, Katherine Peers, Community Dental Liaison Officer at the Special Needs Dental Service based at Mission Australia didn’t want to add more plastic waste to the environment by tossing away the clips.
“It felt like the kind of plastic that you could recycle,” Katherine said. “It was hard to find out what sort of plastic they were made from, but Avery said it was P5, which is an expensive kind of plastic that is heat resistant.”
Katherine went down several avenues to categorise the clips. Firstly, she spoke with internal contacts at Mission Australia and the Prince of Wales Hospital record department, who both took a few boxes to reuse them. Katherine knew of a glasses company called Dresden in Newtown who take plastic, melt it down and make brightly coloured frames. Unfortunately, they have been inundated and didn’t need more.
“After that, I put up a Facebook post on the ‘Inner West Paying it Forward’ group, and someone from the State Library responded. They took a two huge garbage bags for their records department, which was great.”
“From there, we started storing them. There’s an app called ‘scraps’ and I took a photo and a guy contacted me from China. He was going to offer us $1,000 for them. So I said that was fine, but you need to arrange transport. He never got back to me.”
Still left with a cupboard full of clips, Katherine took some to Reverse Garbage in Marrickville and she is giving them out to whoever wants them, including local community centres and NGO’s.
“If anyone has any great ideas, or knows someone who can use them, I’d love to hear from you. It can’t just be dental going digital. Think of all the clips SESLHD has. If you buy something, you’ve got to be responsible for its disposal as well.”
From replacing outdated lighting to installing new technology, Calvary Healthcare Kogarah is leading the way in environmental sustainability according to John Muscat, Corporate Services Manager and Sam Jeyakumar, Director of Corporate Operations at Calvary Healthcare.
“We changed 1,200 lights to energy efficient light emitting diodes (LEDs) across the hospital,” Sam said. “It cost $175,000 but they should pay for themselves within four years.”
In addition, with the help of Cannon, all 19 of the hospital’s printers are networked for "follow-me" printing, which has led to a decrease in wasted printing and shredders have also been installed on each floor, saving costs on the use of blue security bins.
“Whenever you go to print, you scan your ID and you can print from any printer,” John said. “All staff receive the monthly printing report and can keep an eye on their usage.”
Further, two new chiller systems, which are responsible for the hospital’s air conditioning, have been installed. They have replaced one 18-year-old chiller. The new technology allows water to compress and condense, generating heating as well as cooling. Since installation, Calvary has seen a substantial drop in both its gas and electricity bills.
Another development is the hospitals' lifts, which have been updated thanks to the help of their lift provider Otis.
“When the lifts are in a downward run, they act as a generator and put electricity back into the supply,” John said. “So there’s more efficiency.”
In an effort to keep Calvary's garden in shape, rainwater tanks that hold up to 60,000 litres have been installed. Gary Hancock, Gardener at the hospital, also successfully lobbied Georges River Council to plant trees on the nature strips around the hospital.
And finally, the hospital's café - The Street Canteen - has gone "green", by offering bamboo cutlery and a discount to staff bringing their own reusable cups.
"Other initiatives that the hospital is still working on include reducing food waste, recycling their metal and saving more energy by turning off unnecessary equipment. In regards to waste management performance, Calvary have been kicking goals, with costs and tonnes of waste both declining steadily over the last 12 months," John said.
John said the updates have been spurred on by great communication and education from our environmental champions, mainly from the Pastoral Care team.
Pic: Jenny Abellera from the Calvary Kogarah Street Canteen with some green initiatives
SESLHD has taken a significant step to recognise and act on climate risk, launching the SESLHD Environmental Sustainability Plan 2019 – 2021 on Friday, 21 June, at the Research and Education Centre, St George Hospital.
The Plan, officially presented by Tobi Wilson, Chief Executive, SESLHD, sets out an intentionally ambitious agenda to address the District’s climate risk and to take opportunities to simultaneously improve health, save money and save carbon.
“Health professionals and organisations have a responsibility to take an evidence-based approach to our services and to our models of care, so that we can provide the best possible patient care,” Mr Wilson said.
“Similarly, we have a responsibility – and an opportunity – to take an evidence-based approach to our climate risk.
“SESLHD has a significant carbon footprint: 185,000 tonnes CO2e – which is equivalent to the annual emissions of about 35,000 family cars.
“I am pleased to launch this SESLHD Environmental Sustainability Plan 2019-2021. We understand that it is ambitious, but we also understand that ambition is what is required to meet this challenge, and we look forward to working together to realise the many opportunities for SESLHD to improve health, save money and save carbon,” Tobi said.
Dr Kate Charlesworth, Environmental Sustainability Lead, SESLHD, said the Plan is the first in Australia to be guided by the Sustainable Development Assessment Tool (SDAT).
“The SDAT was developed by the National Health Service in England, and has a proven record of success. Between 2008 and 2018, the tool helped to reduce the carbon footprint of England’s healthcare sector by almost 20 per cent,” Dr Charlesworth said.
“Immediate tactics within the Plan will focus on reducing carbon, including waste and energy management.
“Looking forward, the Plan aims to set the District on a path to developing low-carbon models of healthcare. In this setting, as well as patient outcomes and cost, carbon will also be measured,” Dr Charlesworth said.
Pic: Mr Tobi Wilson, Chief Executive, SESLHD, Dr Kate Charlesworth, Environmental Sustainability Lead, SESLHD and Mr Tony Jackson, A/Director, Primary, Integrated and Community Health, SESLHD
Ged Hyde, Executive Manager, Uniting War Memorial Hospital (UWMH), Jane McGuire, Service Manager, Deputy Director of Nursing, UWMH and Dr Kate Charlesworth, Environmental Sustainability Lead, SESLHD recently attended a luncheon featuring former US Vice President, Mr Al Gore.
Mr Gore presented a series of sobering slides showing the devastating environmental, health, social and financial impacts of extreme weather that is becoming more frequent and severe as the climate crisis accelerates. He described the unconscionable failure of national governments to act appropriately and urgently on the climate crisis as frankly “insane”.
However the overall message was an extremely positive one, as he noted the ambitious actions underway at the sub-national level (governors, premiers, CEO’s), the remarkable innovations and community-driven movements around the world, and the extraordinary progress and plummeting prices in the renewable industry.
“At SESLHD we recognise the urgency in lowering our carbon footprint, both for the health of our community and the health of the planet, and so far we have taken many steps to do so,” Dr Charlesworth said. “We have just launched our new Environmental Sustainability Plan, which is a blueprint for our continued work across the District. We have also joined the Global Green Healthy Hospitals community.”
Mr Gore also welcomed and responded at length to questions from A/Prof Kylie Ward, CEO, Australian College of Nursing, about the power and potential of nurses to be climate leaders, and from Kate about climate change as an issue of health equity and a ‘fair transition’ to a low-carbon future.
The event was hosted by HESTA.
Pic: Jane McGuire (WMH), Kate Charlesworth (SESLHD), Mr Al Gore, A-Prof Kylie Ward (CEO Australia College of Nursing), Ged Hyde (WMH)
As part of its ongoing duty to improve the environmental sustainability of the district, South Eastern Sydney Local Health District has joined the Global Green and Healthy Hospital (GGHH) network. A green and healthy hospital is one that promotes public health by continuously reducing its environmental impact and ultimately eliminating its contribution to the burden of disease within the community.
Primary, Integrated and Community Health is overseeing the development of our Environmental Sustainability Plan 2019 – 2021. Greg Stewart, Director, Primary, Integrated and Community Health, said the overarching theme of the plan is the recognition of the connection between human health and the environment. It addresses how the district demonstrates this understanding through its governance, strategy and operations.
“It's important we join with health organisations around the world to reduce the environmental footprint of the health sector. With assistance from the GGHH network, we aim to reduce our carbon footprint, become more climate resilient, and exert leadership to help transition to a low carbon future,” Dr Stewart said.
The GGHH network has more than 1,160 members across 55 countries, representing the interests of over 36,000 hospitals and health centres. The GGHH has 10 interconnected sustainability goals for members to work towards, these are:
1. LEADERSHIP: Prioritise environmental health
2. CHEMICALS: Substitute harmful chemicals with safer alternatives
3. WASTE: Reduce, treat and safely dispose of healthcare waste
4. ENERGY: Implement energy efficiency and clean, renewable energy generation
5. WATER: Reduce hospital water consumption and supply potable water
6. TRANSPORTATION: Improve transportation strategies for patients and staff
7. FOOD: Purchase and serve sustainably grown, healthy food
8. PHARMACEUTICALS: Safely manage and dispose of pharmaceuticals
9. BUILDINGS: Support green and healthy hospital design and construction
10. PURCHASING: Buy safer and more sustainable products and materials
Each GGHH member is asked to focus initially on two to three areas. SESLHD will focus on leadership, waste and energy.
To support members in their efforts to implement initiatives and projects related to the 10 agenda goals and the Health Care Climate Challenge, GGHH offers access to innovative tools and resources, events, webinars, and more. For more information click here.
In order to support its local Environmental Sustainability Plan, Uniting War Memorial Hospital (UWMH) has become a member of Global Green and Healthy Hospitals (GGHH).
GGHH is an international network of hospitals, health care facilities, health systems, and health organisations dedicated to reducing their environmental footprint while promoting public and environmental health. Members pledge to work under the shared goal of reducing the environmental footprint of the health sector.
UWMH have pledged to work specifically towards the goals of
- Leadership – to prioritise environmental health as a strategic imperative
- Waste – to reduce, treat and safely dispose of healthcare waste
GGHH offers educational and interactive monthly webinars on topics ranging from the GGHH sustainability goals, to current events of interest and important research & publications.
UWMH’s Green Team consists of a range of staff members from executive, clinical, environmental services and administrative areas. It is exploring opportunities to address important environmental issues around the campus as well as engaging staff, clients and visitors in seeing the vital importance of environmentally sustainable healthcare. They are also considering how different models of care may have a reduced environmental impact.
Jane McGuire, Service Manager/Deputy Director of Nursing, UWMH, hopes that by having cross campus membership, initiatives will have good uptake and sustainability, overall achieving behavioural changes.
“UWMH is proud to be a leader within SESLHD in the establishment of sustainable modelling for current and future health service delivery. We recognise that there are finite resources to deliver healthcare to an ageing population and also for future generations to enjoy the world around us,” Ms McGuire said. “With the support of SESLHD Environmental Sustainability Lead, Dr Kate Charlesworth, and GGHH, we aim to identify opportunities to generate both environmental and financial capacity in existing services and to then re-invest back into smarter service delivery.”
UWMH launched their environmental plan during a hospital Work Health Safety barbeque in October 2018. In the future it will be incorporated into standard business practices. At the barbeque, staff members measured their individual carbon footprint, proposed green ideas, nominated themselves as champions and recycled household e-waste items.
More information on GGHH can be found here.
Pic: War Memorial Green Team left to right: Jill Hall, Julia Fisher, Annabel Kingsford, Jane Mcguire, Natsuho Takita, Marie Bradley, Gerard Hyde
Sutherland Hospital’s The Street Canteen and Prince of Wales’ Barker Street Canteen have announced they are going green. Each cafe has introduced paper straws and bags, as well as bamboo cutlery.
In addition, customers who bring along a reusable cup for their drink orders will receive a 20 cent discount on their purchase. These changes to the café operations mean that by mid-year plastic containers will be phased out.
Nora and Rouby Sidarous, owners of the cafés, said that by moving towards the use of more sustainable resources they hope to minimise their ecological footprint.
“It is estimated that three billion coffee cups are sold in Australia each year, and many of those aren’t recycled. Our café staff are hopeful that by offering a discount to customers who bring their own reusable coffee cup that we can help reduce landfill and likewise for our strategies to discourage the use of single-use plastic utensils,” Mr Sidarous said.
In an initiative to decrease waste and increase recycling, the St George Hospital Emergency Department (ED) has created team “Green Dragon”.
Staff understand the department creates a lot of waste and although some of it is necessary due to clinical single use, the team wants to make the department more environmentally friendly.
To date, a lot of the initiatives have been based around staff consumables, such as disposable coffee cups, plastic water bottles and cans. ED staff have embraced the initiative with the majority now using their own reusable cups and drink bottles.
Dr Kara Gray, Emergency Registrar, St George Hospital, explained that the team proposed the idea of purchasing branded reusable coffee cups. Due to the costs involved however, this option was not possible.
“Everyone would have ended up with the same cup, so we’ve been focusing more on encouraging people to bring their own reusable one,” Dr Gray said.
Also strategically placed around the ED are small Return and Earn bins for cans and bottles. These are collected in a large wheelie bin and taken to the Return and Earn recycling hub in Rockdale.
“We get the big wheelie bin filled approximately once a month and receive around $25 per time. It’s not a lot of money but it is lots of bottles. The first time we did it we ran a competition to see who could guess what refund we would get and used it to purchase a prize of a Keep Cup. In the future we’ll probably use the refunds for more recycling bins or other resources to help our cause.”
In an initiative lead by the Royal Hospital for Women's Domestic Services Department, a significant percentage of their PVC Intravenous (I/V) bags are now being diverted from landfill to recycling.
In collaboration with the Vinyl Council of Australia, Baxter Healthcare supports hospitals to recycle clean PVC after clinical use. This program is a cost efficient way to dispose of recyclable materials and reduces landfill.
All ward areas now have 50 litre tubs with appropriate labelling and an initial training program has been provided to each area by a member of the Baxter Healthcare team and Ms Patricia Orr, Manager, Domestic Services.
“Members of the waste management team within Domestic Services will regularly empty the ward bins and place the bags in one 240 litre bin for collection, Ms Orr said. “We will regularly audit the bins and provide follow up training as necessary.
Once recycled, Australian manufacturers will receive the granulated PVC to make hoses, safety mats and other products. Recycling PVC also results in reduced carbon emissions. Compared with incineration for clinical waste, recycling a PVC IV bag reduces CO2 emissions by 77%. When compared with general waste disposal, recycling a PVC IV bag results in a CO2 emissions reduction of up to 20%.
Currently, over 55 hospitals have signed up for the PVC Recycling In Hospitals program across Australia and New Zealand.
Waste management is a significant cost – both financial and environmental - to the District. As part of the ongoing environmental sustainability activity occurring across SESLHD, round tables and walk-throughs have been conducted at St George Hospital and the Randwick campus to discuss waste management.
SESLHD has recently become a member of Sustainability Advantage (SA) – a program within the NSW Office of Environment and Heritage which assists organisations across NSW to achieve better environmental practices. Richard Birdsey from SA and Robyn Pearson, a waste management consultant, sat down with a wide range of staff members to discuss current issues and projected outcomes for a waste management strategy, then took a tour of the key areas across each hospital.
Staff included representatives from Corporate Services, the Emergency Department, the Operating Theatres, the Kitchens, Maternity, Infection Control, pathology and domestic services. Many issues were discussed, including the importance of avoiding waste in the first place through more thoughtful procurement strategies. Other subjects included recycling, staff education and the need for appropriate, clear signage for staff, patients and visitors.
One example of the complexity of waste management in a hospital setting was the Operating Theatres at St George Hospital. Anaesthetics Fellow Marcus Kornmehl and Registrar Matthew Overton spoke about the 8 types of syringes used during procedures and the fact that 4 different bins are required for disposal.
“This creates a lot of confusion for staff members,” Mr Overton said.
Richard and Robyn were very impressed with the great work underway at St George and Randwick, and are keen to assist SESLHD with several initiatives. Robyn Pearson is writing the SESLHD Waste Management Plan (a Ministry of Health policy directive) looking for further opportunities to save money and save carbon within our waste management. She will consider the need for consistent systems, education and reinforcement. This will feed into the SESLHD sustainability action plan.
In summing up the visits, Richard Birdsey pointed out how the cost of waste is often hidden, and how important it is to remember that waste can be incredibly complex for what is considered such a simple thing. He emphasized the importance of the first step in the waste hierarchy: REDUCE.
“We buy our waste,” Mr Birdsey said. “Whilst recycling is important, we need to consider the whole supply chain to really address the waste issue.”
Pic: Izat Zayed & Zoran Markovski from St George Hospital waste management
As part of a major environmental sustainability project, lighting within Prince of Wales Hospital, The Royal Hospital for Women and The Sydney Children’s Hospital will be replaced with energy efficient LED lighting.
Roy Imperial, Electrician, Engineering Services said the lighting upgrade will benefit the campus in many different ways, including:
- A major reduction in energy consumption, saving money on campus power bills
- A decrease in replacing bulbs, freeing-up electricians for other more important projects
- Providing better illumination throughout the campus, creating a safer environment for staff, patients and visitors
- The new panels are sealed, providing a more hygienic environment (no moths or insects can collect in the lighting fixtures)
- A saving on the ongoing disposal of the old fluorescent tubes (normally $1 per tube)
- Reducing the campus’ carbon footprint.
“This project is well underway with street lighting, corridor lighting and several wards already receiving the upgrade,” Mr Imperial said. “It’s amazing to see the quality difference this lighting has made to the spaces we have changed already.”
Normal twin fluorescent tubes are rated at 72 watts, while the LED equivalent is only 30 watts. If a ward is using 100 fittings, use of LED fittings means there is a saving of 4,200watts per hour (or 4.2kwh).
In dollar terms, 4.2 kwh over 20 hours equals 84kwh - and 84kwh multiplied by $0.37 (the current price for electricity) equals a saving of $31 per day.
This project is a finalist in the ‘Safe and Healthy Workplace’ category at the 2018 SESLHD Improvement and Innovation Awards. Winners will be announced on July 19.
Pic: Frank Mallia, Garry Cooper, William Liu and Roy Imperial from Engineering Services in front of the newly arrived shipment.