Out of the Box is a new column at Croakey from emergency medicine specialist Dr Simon Judkins that will explore climate-related issues through a health lens.
In his first column, Judkins reflects on the year that was, and his hopes for 2021.
Simon Judkins writes:
We heard a lot about “thoughts and prayers…” in 2020. It was a year that we will never be able to really ever put behind. So much suffering, so much sadness, stress, angst and pain.
On the first day of 2020, while having a lunch with family and friends, discussing a virus in Wuhan and bushfires in NSW and Victoria, I received a phone call asking me to pack my things and head to Mallacoota the next day. The town, as we all know, had been surrounded by fire and there was no way out.
My role was to provide emergency care for the holidaymakers, the town residents and the emergency workers who had selflessly volunteered to help. Fortunately, the physical needs were manageable, but it was clear that the mental health needs were going to provide the biggest challenges.
I was only there for a few days and found it stressful. But I had an escape, a way out…many others continue to live in those fire affected areas and suffer the long-term anguish left by the worst bushfire this country has ever seen.
The ongoing homelessness, the dislocation, the uncertainty regarding employment and the lack of action on climate policy and risk mitigation all adds into the ongoing suffering in these communities.
A short time later, with COVID looming and building, I took up a role as the Director of the Emergency Department in one of Melbourne’s major hospitals and was to step up and lead a team to manage the response to COVID-19.
For the better part of 2020, I spent many long hours in my ED, working with a team of incredible nurses, doctors, clerks and orderlies who came to work each and every day, committed to their work, their colleagues and their community, to ensure that we were able to provide emergency care to everyone who needed us.
I also worked across a few aged care facilities, with the health department and other bodies, experiencing the depth and breadth of our COVID response.
The work my team did in my ED was nothing short of inspiring; it was selfless, but it was mentally and physically exhausting. This was repeated across so many areas of healthcare – in aged care facilities, hospital wards, ICUs and in the back of ambulances, by GPs and volunteers, going above and beyond.
The empathy, the compassion, the collaboration and care rose to a level that I don’t think I’ve seen before. Despite the ongoing concerns regarding personal protective equipment (PPE), the risk of exposure and personal health, staff still turned up day-in, day-out. Care 24/7…
Our communities, in the main, pulled together. People followed the rules, they did what was asked; they followed the steps set out by the state’s leaders and medical experts.
Communities stepped up to support those less well off, those who needed extra supports. People did what was required for the greater good; it wasn’t about what was best for “me”, it was about what was best for “us”.
The good was incredibly good…
But the bad has been incredibly bad. When compassion, empathy and a common goal to preserve humanity, care for the weak and the vulnerable, driven by evidence, by expertise, by medical science and a desire to ensure the safety of all, sees so much good happen, it has been heart-breaking to see the opposite across our country and many others.
While I won’t go into what we have seen in the US which, like they have throughout history, provided the best-of-the best and the worst-of-the worst, we have seen enough in the Australian context to paint a very clear picture of what I, and I hope you also, do not what to see as we move into 2021.
So much inequity
We have seen inequity deepen. Our uber-rich are richer, taking advantage of the opportunities the pandemic offered up to ensure their mega-wealthy businesses post larger profits and pay less taxes; we are still waiting to see the “trickle-down” effect, with employees seeing their lot improve. And profitable companies took advantage of government subsidies meant for struggling organisations and small businesses, not those making huge profits and paying their CEO bonuses.
We have seen the absolute inhumanity and disdain for refugees and their health from this government. The plight of the Biloela family on Christmas Island deserves national and international condemnation and a special place in Australian history. The lock up of 60 people in the Mantra Hotel in Preston for a year adds to the international shame file, notwithstanding the recent releases of some. In stark contrast, we saw Behrouz Boochani given refugee status in 2020 in New Zealand after we punished him on Manus Island for so long.
We see those who lost their homes in Mallacoota, Cabargo and other parts of the country still living in tents and caravans, while Hillsong church, with a bank balance in the hundreds of millions and a leader whose net worth is well over $10 million, seems to have a special place in the hearts and minds of some of politicians. Anthony Pratt’s company gets $10 million from the Bushfire Recovery Funds for his undamaged papermills, governments waste millions of dollars on airport land acquisitions and politicians spend thousands on travel, meals and other self-indulgences.
In the meantime, where I work, I see more and more people unable to get medical care in their communities, particularly those with mental health needs, and turn to overcrowded emergency departments, spending days in an under-resourced, stretched system.
Reading the Productivity Commission’s report from its inquiry into mental health, which suggests that no-one should be discharged out of hospital into homelessness, I am ashamed to think that, in a wealthy country like Australia, that this needs to be offered up as a recommendation. It should be a standard of care, but it’s not, and it happens with regularity across the country.
Children with tragic histories of abuse and neglect are ever present in our EDs. We see them moved from one place to another, suffering from the traumas they have endured, but seemingly unable to get any ongoing stability in their lives in a dysfunctional and stretched system.
I’ve been working long enough to see some of these kids grow into adults, mentally scarred, unable to manage life…homeless and uncared for. Many others don’t make it to adulthood.
The #BlackLivesMatter movement came to our shores, highlighting the long-standing truth that Indigenous Australians continue to suffer as a result of systemic racism across multiple sectors, including justice and health. Health systems and health practitioners need to do so much more to address this. Despite the widespread acknowledgement that inequity exists, the bias and overt discrimination exists, the healthcare and justice gap rise.
Meanwhile, reports have shown that no or minimal tax is paid by the top 10 fossil fuel and mining companies that dig up Australia and make billions of dollars in profits, while employing only a small number of Australians despite propagating the illusion that they employ tens of thousands. At the same time, they also get very substantial financial supports from us (yes, you and me). But it’s not limited to our mining conglomerates.
Regional Australia is suffering, and this suffering may well get worse. Climate change is impacting incomes and livelihoods, the sustainability of future generations living in the vast expanses of regional and rural Australia, trying to survive through record heat waves, droughts and storms. Bushfire smoke has strangled our cities and costs many lives.
Again, it’s the less fortunate, those with chronic illness, and mental health needs who are affected the most.
The ongoing health impacts of climate change, the bushfires and heatwaves will ensure that the health divide, the health inequities will continue to widen and will never close, unless drastic changes are made.
Sadly, our Federal Government’s response is to ignore the devastating health impacts of climate change and we are increasingly becoming an international laggard in the battle to reduce the impacts of climate change. Unfortunately, the Labor opposition can’t seem to get its act together to take leadership and ride the bandwagon of a global change into the next election. An interesting and worrying state of affairs.
Our youth, I’m afraid, are at risk of losing hope. Our leadership on these challenges, particularly the sustainability and habitability of the planet, which will impact today’s young adults and teens more than our political “leaders”, has been missing for a long time.
So, 2021 needs to be dramatically different.
2021 needs hope, direction and certainty. 2021 needs to be a year of empathy, compassion and humanity.
2021 doesn’t need thoughts and prayers; 2021 needs a palpable change across all levels of leadership to embrace humanity and caring. No more marketing, pandering to those who can buy your support. No more denial of human rights and humanity. 2021 needs action on a large scale.
In 2021, as a clinician, I will focus on compassion, understanding and gratitude, while striving to improve the care for the communities I work in and the patients I see. As a colleague, I will support the people I work with to be the best they can be, give them support and recognise them for the work they do and what they bring.
As an advocate for change in healthcare, I will focus on continuing to argue for equity and access to healthcare, for prevention of disease, for a system which is fair for all, which puts people and patients over profits.
And, as a contributor to the public discourse through becoming a member of the Croakey team, I will endeavour to bring a new perspective on how the issues outlined above impact the individuals and communities I work in and hopefully, contribute to some meaningful, sustainable change.
But my main focus will be on the biggest threat to global health that we all face…the impacts of a changing climate, a warming and changing world, and how this almost incomprehensibly enormous challenge will continue to impact our health, our lives and those of our children. And, importantly, what we can do to influence our Government to recognise the need to change our course and our future.
Looking forward to working with you…
• Follow Dr Simon Judkins on Twitter: @JudkinsSimon