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Health leaders share reflections from the fires, ruins and front-lines, with some pointed messages

From the health front-lines of the bushfire and climate emergency, there are many stories and lessons to share.

Thanks to the seven people below who spoke with Croakey’s Melissa Sweet about their personal and professional reflections from this catastrophic season.

1. In the line of fire

Amanda Adrian has had a wide-ranging career in health, from working in operating theatres to senior executive roles at NSW Health and elsewhere. As well as being president of the Climate and Health Alliance, she is president of the Carwoola Rural Fire Brigade, which covers a rural area of NSW in the hills between Bungendore and Queanbeyan, a short drive from Canberra.

Adrian joined the brigade to help manage her own anxiety and learn more about bushfire preparation, and is now one of two call-out coordinators. She has been spending four to six hours a day on this voluntary role since late November.

“So all those skills I learnt managing busy trauma operating theatres many years ago, I’m now using to put fire crews on trucks. Since 25 November, we have had one or two crews out every single day,” she says. Adrian’s husband is also regularly on the firetruck.

Adrian has observed the physical and mental health toll on the fireys, and sees them showing signs of the trauma of dealing constantly with community members in distress.

She says:

The community liaison stuff, we’ve all been dealing with members of the community who lost their properties after the last fire, also just dealing with people on the crews who are going out every day and seeing people losing their property, that has an impact.

The other point I’d make is that firefighting is inherently physically dangerous, the burns you get, the trips and falls from when you can’t see clearly. A number of people from our team have been admitted to hospital, for relatively minor things at this stage.”

Adrian also sees the impact on the wider social determinants of health from the drought, lost housing, environmental degradation and widespread loss. Health systems are not set up to accurately record the incidence of climate-related presentations, she says, whether these be from flooding, fire, drought or lack of water.

Adrian despairs at the Government’s lack of engagement with the climate crisis.

“I can’t tell you how many times I’ve banged on [Health Minister] Greg Hunt’s door,” she says. “We can’t get through his door; we have met with Greens, Labor, the crossbenchers. They are all talking the same language but that message isn’t getting to the other side.”

Adrian thought the bushfire crisis and drought would have been enough to prompt the unified, multilateral response that is desperately needed, but says “I’m not seeing that”.

Instead, all of the issues were being addressed in silos – water, energy etc – rather than being seen as part of a whole, she says.

Adrian poses this question to Minister Hunt and Chief Medical Officer Professor Brendan Murphy: “What will you say to your grandchildren?” about their efforts to prevent an apocalyptic future.


2. Support primary care

Dr Tim Leeuwenburg recently tweeted the photograph below of the burnt ruins of what was once his home on Kangaroo Island, off the mainland of South Australia.

Leeuwenburg says Kangaroo Island has lost 56 houses, numerous farming properties, much of its tourism infrastructure, and an estimated 25,000 koalas and other wildlife, with further fire danger forecast for the coming days.

Thousands of livestock have been euthanised. “The paddocks were alive with gunshots on the weekend in the aftermath. It’s something I’d rather not talk about,” he says.

Leeuwenburg envisages a long hard road for rebuild and recovery efforts on Kangaroo Island, given that the builders were already so busy before the fires that there were three-year waits for building to start.

The impact of the fires on the local economy will be devastating, he says, “so we want tourists to come to Kangaroo Island and other communities and spend your money; if you’re looking for things to do, donate money and visit, and bear in mind that this will be marathon, not a sprint.”

Leeuwenburg calls on Health Minister Greg Hunt to invest in supporting primary care specialists in bushfire affected communities, including through special bushfire rebates. He says:

Long after the media and the ADF [Australian Defence Force] and the emergency responders have moved on, these rural communities are going to be hurting for a long, long time.

As primary care specialists, we’re going to be the people who walk the path with our patients.

But we’re also hurting; many of us have lost houses; many of our staff have been affected; many of us will be bulkbilling in businesses that were already frankly marginal; we’re going to be seeing a lot of psychological pathology but also the huge economic impacts on these communities.

Primary care is going to step into the breach. Good primary care is invisible; it’s hard gritty stuff. We’re going to spend 45 minutes to an hour counselling farmers preventing them from suicide but the [political and funding] attention is on helicopters and hospitals.

We need the Government to step up and recognise the primary care role. We’re going to need some help.”

Leeuwenburg, who is currently taking a break from general practice to care for his ill father, has not been personally involved in medical response efforts to date, but has heard of many concerns elsewhere, including of local GPs being sidelined by emergency response efforts.

He has been a longstanding advocate for primary care practitioners to be incorporated into emergency systems, whether bushfire disasters or more common emergencies such as traffic accidents (as reported in this 2017 article at Croakey).

Indeed, on 7 January, the Rural Doctors Association of Australia called for the establishment of a national emergency responder network involving primary care, and Leeuwenburg has been involved in bringing standardised training and equipment to Australia via the Sandpiper Trust.


3. It’s a national crisis, where is the plan?

Janine Mohamed, a Narrunga Kaurna woman and chair of Croakey Health Media, writes:

I haven’t been directly affected by the bushfire crisis, but I have been immersed in it, via social media and through most of my circle of friends being affected, one way or another. I have also been worried about my children living in Canberra with the worst air pollution in the world, and knowing my daughter’s lungs and eyes were hurting.

I have been disappointed by the poor national leadership in the response to the bushfires crisis, with the Prime Minister putting the blame back onto communities and dismissing peoples’ concerns about his lack of leadership and support. We want leaders who listen and who commit to change, who have the foresight to walk through the fire and refashion themselves, rather than just walking around it.

I have also been disappointed by the lack of mainstream media news coverage of how Aboriginal communities are being affected. We know they are going to be most affected. The crisis response tends to be one-size; we need a targeted response for our most vulnerable people. I think of our kids in care displaced once again by these fires. In Victoria, we know the highest number of kids in care; I feel for them in this compounding trauma. And for the families that care for them.

I would like to see the Government acknowledge climate change and how it affects peoples’ health and is putting a strain on the health system. We are not doing enough preventative work; we don’t have enough GPs in rural areas, and guess where the fires are happening!

We also need to see greater investment in fire services and in research, for example, to develop a better understanding of the health impacts of bushfire smoke exposure.

We also need a COAG response, and for health ministers to understand the impacts on social and emotional wellbeing. People are going to be depressed, traumatised for a long time. The destruction of our sacred sites, our Country, our ecosystems, flora and fauna is devastating for our cultural determinants of health.

As with any pandemic or public health emergency, we need a plan, we need to have foresight and resources ready, particularly for our most vulnerable. We should be responding as if it was a pandemic. It is a national crisis.

I would also like to see more engagement with and respect for our cultural land management practices of caring for Country, including through cultural burning.


4. A defining time, but how will we respond?

The bushfire crisis is a defining time for Australia, for the health sector and for researchers such as himself, says Professor Guy Marks, a respiratory physician, epidemiologist, public health physician at UNSW, and a chief investigator at the Centre for Air pollution, energy and health Research (CAR).

“We need to respond to not just this event that’s happened now but to what it means for the future of our country and our planet,” he says.

“It is a national disaster and I’m not sure that anybody has come to grips with the scale of the disaster, what are the impacts and how to deal with them.

“The irony is that Australia is better equipped to deal with this than many of the poor countries in the world that are going to have to deal with it too. If we’re struggling to deal with it, how are countries in the Pacific, in Africa, in Asia, in South-East Asia, how are they going to deal with it?

“We need to not only deal with it in our own country but work out how to deal with it around the rest of the world.”

Recently, Guy Marks has been receiving many requests from friends in Vietnam for information about how to donate to support the bushfire crisis in Australia.

This only exacerbates his anger at Australia’s political leadership and their failure to act on climate.

“I am so angry with our political leadership. That is the dominant emotion that I have at the moment. I can’t get away from an overwhelming sense of anger of what led us to this position,” he says.

Marks says the bushfire emergency was predicted. “Anybody who had eyes to see knew this was going to happen. And yet nobody was prepared to take any of the sorts of actions that were required to mitigate it, and now we need to deal with adaptation.”

He urged Health Minister Greg Hunt to show leadership and convene a group of experts on public health responses to disasters and emergencies to scope out the public health response to this disaster.

“Leadership is saying, ‘this is a national emergency, I am the Federal Minister for Health, I have some responsibility for helping to broker a national response’,” Marks says.

CAR recently released a fact sheet, Bushfire smoke: what are the health impacts and what can we do to minimise exposure?, which says that tackling climate change is crucial to minimise health effects of bushfire smoke

Marks says, however, that there are many unknowns about the health impacts of the current bushfire smoke exposure, and that more research is needed, using routinely available data as well as data collection.

“People have been asking people like me, ‘what should we do about it?’,” Marks says.

“We haven’t been able to give very strong advice as the advice is not necessarily applicable to prolonged exposures like this. For example, advice to avoid strenuous activity and stay indoors is useful if it’s a transient episode but not if it goes on for months, as it has been.”

Marks says he and colleagues in the field need to come together to develop more systematic responses to prolonged bushfire smoke exposure.

“Much more effort has been put into measuring the impact of urban traffic-related air pollution; whether it’s the same as smoke remains to be seen,” he says.


5. Global shock

Professor Nick Talley, a senior clinician, researcher and Editor in Chief of The Medical Journal of Australia, has been contacted by many colleagues and friends from around the world about the bushfire crisis.

“The shock of Australia seems to have been internationally felt,” he says. “People are viscerally feeling this elsewhere. I think that will be a bit of a lesson.”

Speaking in a personal capacity, Talley says he expects the bushfire emergency will be a catalyst for change, and that the Government will have to listen to the advice of experts:

Anyone sensible would realise there has to be action. If they want to continue to be supported in government, across both federal and state, they are going to have to deal with this in the most appropriate way. I think we will see all sorts of actions.

If people aren’t prepared to do something in this situation, then we really are in trouble.”

Talley adds that we can expect further such emergencies to arise, given climate projections, and that it is vital lessons are learnt from the current emergency, where there has been some lack of coordination in the health response and less than optimal preparation.

Living on acreage outside of Newcastle, Talley has personal experience of the anxieties of the season.

While not directly affected by fire, his family has been anxious knowing that if anything arose, their local RFS was so stretched, “we wouldn’t have a lot of support if anything had happened. We’ve certainly been anxious, the family. We feel absolutely terrible about what’s happened around the country.”

(Read the article here).


6. Mental health concerns

Dr Simon Judkins recently spent some days in the besieged northern Victorian town of Mallacoota as a field emergency officer dealing with some of the acute presentations.

However, the more significant and ongoing health concerns will be around mental health, he says.

This is a life changing event for many people; many have lost their livelihoods and their communities. What people have to face to rebuild their lives is going to be enormous.

Once all the bells and whistles move out, we need to ensure we have a long term plan for the mental health care of families.

There is no doubt there will be a lot of people with issues around PTSD, anxiety and depression, so we need to ensure robust systems are in place including resourcing GPs in the area.

The GPs working in those areas also need assistance; they’ve been stalwarts and have been leaders in communities and need to ensure they have support and can get relief when they need a break.”

Like Dr Tim Leeuenburg (see above), Judkins said a critical lesson was the importance of ensuring GPs are an integral part of disaster responses, bringing their deep community knowledge and connections.

Judkins also called on Greg Hunt and the Federal Government to acknowledge this as a national climate health disaster and to develop a national health and climate plan that addresses climate change’s impacts on everything from bushfires to food and water supplies, diseases and mental health.


7. More of the same: “just not tenable”

Like many people who work in Canberra, Leanne Wells has been affected by smoke haze, bushfire disruption and non-stop immersion in the news media’s coverage of the bushfire crisis. It’s hardly been a restful start to a New Year.

Wells, CEO of the Consumers Health Forum of Australia, has called for Minister Greg Hunt to convene an urgent roundtable meeting with the Climate and Health Alliance and other experts to develop a plan for action on climate and health.

It needs to be an implementation plan, rather than a policy document, that can be systematically deployed in future “so that we are on the front foot with all measures, early intervention,  mental health and social and primary care responses”, she says.

Will this Government ever take such action, given their longstanding resistance to climate action?

“I think they’ve got to concede there is a problem, we are seeing some shifts,” says Wells. “It’s incumbent on affected communities and organisations like us to continue to press that point and demand action. I can’t see how they are going to be able to get away with more of the same, it’s just not tenable.”

Wells is also calling on the Government to be proactive in ensuring there are resources and services to deal with the massive mental health impacts of the bushfires.

“Now is not the time to put up any more barriers. Mental health services are going to be so critical; they’re not on the ground quickly enough.”

Wells also says there is a need for greater clarity in public health messaging around smoke and air pollution, as consumers have heard confusing and mixed messaging about the effectiveness of the P2 face masks.

While health officers had finally released a joint statement on this subject, it had not been widely disseminated, and a comprehensive education and dissemination strategy was needed, she said.

Croakey’s requests for phone interviews with Health Minister Greg Hunt and Chief Medical Officer Professor Brendan Murphy were declined, but written questions will be put to them arising from these interviews and other articles.

Click here to see Croakey’s coverage of the 2019-2020 climate bushfire crisis.

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