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This article was first published on Thursday, May 23, 2024
Introduction by Croakey: Amid criticisms over the Federal Government’s missed opportunity to address the climate health emergency in last week’s Budget, specialist emergency physician Dr Mark de Souza has urged health professionals to speak out on issues that affect health.
Below, Marie McInerney reports from the annual Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) conference on initiatives to green hospitals in the Northern Territory, where the conference was held.
Marie McInerney reports:
A leading Darwin physician has called on health professionals to do their due diligence on policies that they know will impact badly on health, including the Federal Government’s renewed commitment to gas extraction, in the face of the urgent need to address the climate crisis.
Royal Darwin Hospital specialist emergency physician Dr Mark de Souza, the NT representative of the Doctors for the Environment Sustainable Healthcare SIG (special interest group), has also criticised “undemocratic” moves by some health authorities to stop doctors, nurses and other health professionals from speaking out on important issues that affect health.
There had been clear efforts to do so on last year’s Voice referendum and with “other politically charged issues”, including the health impacts of fracking and of gas processing from the proposed Middle Arm precinct on Darwin Harbour, he said.
De Souza spoke at the #ASMIRT2024 conference in Darwin, on Larrakia Country, about the Royal Darwin Hospital Greening Project – a grassroots, volunteer led project, dubbed ‘guerrilla gardening’ – which saw him nominated as Northern Territory Local Hero in this year’s Australian of the Year Awards.
He opened his presentation with a graphic slide of northern Australia coloured in sizzling red, taken from a Climate Council website mapping the impact on local jurisdictions across Australia of a dangerously warming world.
“We are at the forefront of climate change in the Northern Territory,” he said, detailing predictions that the number of “extremely hot” days will, under worst case scenarios, more than treble by 2050 to 179 days per year, versus 47 on average now.
As importantly, overnight lows will be much higher than 24 degrees, which means people and buildings will not be able to shed heat, he said.
The health system will struggle to deal with that and climate health modelling shows it will be socio-economically disadvantaged people who suffer most, he said.
“If you have energy insecurity, or you’re in public housing without air-conditioning or shade from eaves, you are not going to cool down your premises.”
De Souza, who chairs the Sustainable Healthcare Committee (Top End Region), which advises NT Health on opportunities for sustainability in healthcare, said the disruption of climate change is already apparent in healthcare in the NT.
Grim reality
Research has shown that healthcare professionals are contemplating leaving already under-served rural and regional areas because it is too hot, while increasing incidents of flooding and cyclones are displacing Aboriginal and Torres Strait Islander communities, adding to the already heavy demand on Darwin’s hospitals and to the high rate of Indigenous homelessness already in the city.
“That is the grim reality of Northern Australia and, while adaptation is really important, we should not give up on mitigation of our emissions,” he said.
De Souza told the audience of medical imaging and radiotherapy professionals that he hoped they would leave the conference “looking at the world in different ways” and thinking about what action they could take on the big issues affecting health — climate change, the biodiversity crisis, and Indigenous rights – because change would not come without a groundswell of demand from the community.
“That’s why I want you to consider your own role,” he said, later telling Croakey that health professionals “need to be doing our due diligence: engaging respectfully in debate that we are well equipped for”.
The Greening Project at Royal Darwin Hospital was, he said, “a story of taking action, and I hope when you leave this conference…[it] will make you reconsider what your role is as a healthcare provider, as a radiographer or radiologist – what will be your action in the world going forward?”
De Souza’s comments came amid national criticism of the Federal Government’s Future Gas Strategy, which committed Australia to “new sources of gas supply”, despite evidence that fossil fuels are the primary cause of global warming, and in the lead up to the Federal Budget where climate health was missing in action, with, as one critic said, “not one cent…earmarked for the climate health emergency”.
He told Croakey at the conference that decisions taken to embrace new gas projects are “flouting” climate science.
“As a citizen, as a public health expert, and a public health provider, I’m really concerned that the health service may really suffer from some of the decisions that are being taken today because it’s going to put more work on healthcare services to deliver care and it’s going to create more burden of disease by exacerbating climate change,” he said.
De Souza was speaking in an #ASMIRT2024 session on Healthcare, Environment and Sustainability, which focused on climate health, waste, and the need for climate-adapted restorative spaces in healthcare settings, for the wellbeing of patients and staff.
Also presenting to the session were Renae McBrien, a radiologist who is steering sustainability efforts at Brisbane’s Royal Children’s Hospital, which last year eliminated more than a million pieces of plastic from its operations, and specialist anaesthetist Dr Brian Spain, co-director of surgery and critical care at Royal Darwin Hospital, who talked about the impact of health infrastructure on staff and on healing.
More on each of those presentations below, and you can watch this video interview with Spain and De Souza.
Inappropriate design
“You’d wonder why you would build a building like that in the tropics,” Dr Brian Spain told the session.
He was showing a slide of the Royal Darwin Hospital – “a big concrete tower that was completely counter to the way any First Nation people would want to be accommodated” – that, incredibly, was modelled on hospitals in Canberra and Calgary in Canada, reportedly right down to eaves for when it’s snowing.
However, since the 1970s when it was built, health systems have increasingly identified the connection between the work environment and staff wellbeing, as well as the impact on patients and their capacity to heal, he said.
As a result, the new Palmerston Regional Hospital, 20 kilometres from Darwin, has been designed in consultation with Aboriginal people from across the NT, a low rise building amid tropical savannah, with a big sense of space, plus outdoor gardens and areas for smoking ceremonies – much more attractive for all patients, “but particularly our First Nations patients”, Spain said.
Palmerston Hospital has air-conditioning but some lounge rooms are left open to the elements, with wire mesh around them to keep the insects out, for patients who want to be exposed to the local environment, to the heat and humidity. Some people hate how cold it is in the Royal Darwin Hospital, he said.
“We know there’s better engagement in healthcare if people can come to an environment where they feel cared for and welcomed and where they enjoy coming to receive the treatment. They are more likely to engage in and complete the healthcare journey,” he said.
Providing culturally safe health environments in Darwin is, de Souza said, critical, particularly given that Aboriginal and Torres Strait Islander people make up 30 percent of the NT population and, “due to the social determinants of health”, 70 percent of Royal Darwin Hospital’s inpatients, increasing to 90 percent for renal patients.
Many leave hospital before treatment is complete for a range of reasons, some of which were explored at another session on Indigenous health at the conference.
“That’s really concerning for us when we’re here to deliver equitable care to all people”, he said.
Transformation
De Souza described how the Greening Project is transforming the grounds of the Royal Darwin Hospital, as has been detailed in previous Croakey stories here and here.
The ‘before’ pictures were truly grim, from a precinct which the project reported was prone to the urban heat island effect due to a lack of tree canopies and so much paving that surface temperatures could exceed 51 degrees Celsius.
“You certainly wouldn’t take a restorative break outside this doorway,” he said. One hospital visitor had described walking from the carpark to the hospital as being “like an SAS training exercise”.
Led by an army of volunteers and working closely with Larrakia Elder Aunty Bilawara Lee and other knowledge holders, in two-and-a-half years the project has created 16 “biodiversity corridors”, planted more than 1,200 native trees, including 157 different species, and attracted “stacks of bird life”, de Souza said.
Thermal imaging data taken periodically over the project has shown a reduction in land surface temperature of up to 32 degrees Celsius compared to the surrounding paved surfaces.
The project was launched in response to COVID-19-related exhaustion and low morale of front-line healthcare workers, staffing shortages, hospital overcrowding, and workplace aggression, as de Souza and Lee wrote in the International Journal of Environmental Research and Public Health.
It was a period of time marked by a rise in patient complaints, particularly about long wait times and a lack of privacy imposed by ‘double bunking’ in cubicles, and critical incidents, which included assaults of staff.
The article warned that rising heat conditions will place an additional burden on the NT’s health services, which are already struggling to manage operational demands.
Describing the approach as “psychological first aid”, de Souza said providing patients and staff with access to biophilic healthcare settings – connecting people and the natural world within built environments – reduces the need for pain medications, can shorten surgical recovery time, increases staff retention and makes people happier.
The Greening Project is part of the bigger H3 Project (Healthy Patients, Workforce and Environment), which explores nature-based interventions via biophilic design in the NT health sector. The aim is to strengthen the resilience and responsiveness of health infrastructure and workforce in a climate-altered future.
Last year the H3 team spearheaded a campaign that saw NT Health last year appoint its first ever Director of Sustainability Action.
De Souza said Indigenous cultural safety, climate adaptation, biodiversity preservation, and promotion of wellbeing are the four pillars by which the project engages with public infrastructure.
Aboriginal and Torres Strait Islander patients have known about biophilia all along, he said, telling the session that, as an Elder and healer, Aunty Bilawara Lee has said she will support any project that allows Larrakia people to carry out their ancient roles of caring for visitors to their Country who are ill and to access traditional medicines and bush tucker.
War against waste
Renae McBrien can rattle off damning statistics related to waste in the health sector at high speed, including that healthcare is responsible for seven percent of the carbon footprint in Australia, with 50 percent of that footprint coming out of hospitals and 50 percent of hospitals’ footprint coming out of operating theatres.
But the one that bothers her most is that “30 percent of every piece of plastic on this planet is generated because of healthcare”.
Plastic is not the devil, she said; the problem is with single use, especially when 67 percent of plastic that comes out of hospitals is in fact recyclable or compostable.
McBrien is the Sustainability Consultant for Children’s Health Queensland, whose work on implementing the Queensland Children’s Hospital’s environmental sustainability plan has featured on the ABC’s War on Waste series.
That work has generated its own impressive big statistics – annually moving over 500,000 kilograms of waste out of landfill and into resource recovery, and removing more than one million pieces of unnecessary single use plastic, a 44 percent diversion rate, not too far off the 67 percent target.
She has launched multiple initiatives across the hospital and community to get there, including an effective ‘bin strategy’, removing bins that are not required, putting them in different locations “so you have to think about the bin”, and seeking to educate staff around issues like how much pharmaceutical waste gets into waterways.
As a result, hospital regulated waste has dropped from 22 tonnes per month to 10 tonnes, saving $64,000 a year.
Circular economy
Other initiatives include:
- Reducing food waste by diverting nearly 22,000 kilograms (85 percent) of all food waste on site, auditing meals to determine what children are not eating, and delivering around 560 kilograms of food to OzHarvest: “anything that that is non perishable and has been to a non-infectious patient would never go in the bin”.
- Hosting a monthly ‘medical market’ where different units of the hospital can swap excess items that might be nearing their expiry dates. This is about redistribution and stock accountability, she said, saying expired consumables are an “unknown black hole in health”.
- Offering the many cardboard boxes that come into the hospital to hospital staff who are moving house. “It’s a game changer,” she said. “I move about five staff members a week. That’s something you can do tomorrow,” she told delegates.
- Building ‘circular economy’ partnerships outside the hospital, including with Substation 33, which dismantles and reuses electrical waste, and builds new job skills.
- Donating superseded but fully functioning equipment, ranging from crutches to a heart lung fusion machine, to Timor Leste, Papua New Guinea and Fiji.
Together these initiatives have delivered $1.2 million in cost savings and generated $307,000 income in a year — reducing environmental impact while improving the financial bottom line.
It’s a strategy that she says has won the support of her Chief Financial Officer. “This is not about begging [hospital administration] for the dollars. This is about showing them the dollars,” she said.
It’s also translatable across Australian health services, she said, urging delegates to go back to work with at least one thing they were determined to “make change about”.
Health professionals have a shared huge responsibility to look after the planet. Not doing so will only cause more emergencies and admissions, she said.
“If your hospital does not have an environmental sustainability plan, or a sustainability lead, start the campaign, because this is where it starts,” she said, warning that governance is critical.
“You need to have dedicated roles like mine inside a hospital that drives this, [ensuring] that it’s not volunteer based. We need people who are actually funded to ensure that this is part of your clinical practice.”
From X/Twitter
See this thread for Marie McInerney’s coverage of the healthcare and sustainability session.
Bookmark this link to follow Croakey Conference News Service coverage, check the conference news on X/Twitter at #ASMIRT2024 and via this X/Twitter list of presenters and participants.
