Ruby was 90 when she was admitted into the busy Melbourne emergency department in that horrendous summer of 2009 that smashed heat and disaster toll records.
She told hospital staff her walker had got caught on the edge of the carpet and she had fallen “like a sack of spuds” in the red-brick home where she lived alone. Her husband had died 10 years before. They were mad Kangaroos footy fans, and she’d dressed him for his funeral in a three-piece suit, topped with the club beanie. “He was a rat,” she said. “A Rat of Tobruk.”
Outside the hospital, Melbourne was sizzling and its soaring temperatures were set to ignite the Black Saturday bushfires, Australia’s worst.
Emergency physician Dr Simon Judkins was concerned about releasing Ruby into those conditions, but she had recovered well from the fall, was keen to go home, and assured him she had airconditioning and attentive neighbours.
He later wrote about her in a book of stories about emergency medicine, sharing their conversation that day. In it, he described how she had been found unconscious, four days later, on the floor in her home, near the airconditioner that had “packed it in” on day three.
“When I met Ruby for the second time, she was unconscious with a temperature of 40.2 degrees. Her tongue was dry, her lips cracked, her body shrivelled and cooked. She was small, frail and dying. Her kidneys had stopped working, her heart was struggling to pump the syrup around in her veins. Acid had built up in her body.“It looks like climate change has almost become the Voldemort of health impact research and policy – it shall not be named.”
“I don’t know if she had fallen over and injured herself or just collapsed. Either way, it didn’t matter. Ruby’s life was ending.”
That summer when Ruby died is mostly remembered for Black Saturday, which, said the subsequent royal commission, “wrote itself into Victoria’s history with record-breaking weather conditions and bushfires of a scale and ferocity that tested human endurance”.
The fires killed 173 people. But the heatwave also inflicted a terrible toll, with Ruby among an estimated 374 lives lost.
Judkins worries that deaths such as Ruby’s, even when they come in massive waves, don’t spark alarm and action in the same way as Black Saturday, or even a freeway accident killing a number of young people.
He believes that’s because of where they strike, mostly in poorly ventilated private homes or boarding houses, scattered across a city or town, not seen as part of one disaster. And because of the victims – mainly elderly people or those with chronic or mental health issues, typically without the financial resources to ward off what is increasingly being identified as the impacts of climate change.
Judkins is president-elect of the Australasian College for Emergency Medicine (ACEM) and a member of Doctors for the Environment Australia, a small group of doctors and medical students with a focus on the health threats of climate change.
At their national conference last month, Oxfam Australia CEO Helen Szoke urged the medical profession to be more vocal on climate change, saying doctors are able to “speak differently to power” than others in civil society. There is trust and respect that they speak from an evidence base for a greater good, she said.
That reputation was put to the test the same week when Australian Medical Association president Dr Michael Gannon spoke out about the closure of Victoria’s Hazelwood power station. Critics complained that the timing and context of his call to also consider the health impact of lost jobs and energy insecurity downplayed the health risks of coal-fired power stations and undermined evidence on the health impacts of climate change.
For many, it came as no surprise. Gannon campaigned last year for the presidency on a conservative agenda, saying the AMA had become too vocal on issues such as asylum seekers. He promised to “build bridges” with the federal government. But his Hazelwood comments were for some a bridge too far, particularly with the government heading for big decisions on the Adani Carmichael coalmine.
Not surprisingly the sharpest rebuke came from Gannon’s election rival, former AMA vice-president Dr Stephen Parnis, who led the organisation’s 2015 climate change and health policy review.
Parnis is also an emergency physician and was AMA Victoria president in 2014 when the fire at the Hazelwood mine burned for 45 days and sent choking smoke and ash over the nearby town of Morwell, triggering evacuations and significant health issues. He accused Gannon of a “wilful distortion” of the AMA’s climate health policy and said his comments “sounded like a press release from the minister for energy’s office”. Others threatened to quit the AMA in disgust.
Gannon has taken a conciliatory approach, meeting quickly with Doctors for the Environment Australia and publishing a lengthy explanation that regretted any suggestion he was more concerned about job losses at Hazelwood than the global impacts of climate change or transition to renewable energy sources. “Nothing could be further from the truth,” he said.
But the row again highlighted the politicisation of climate change in Australia and hinted at why we still have no national strategy on climate change health issues.
The World Health Organisation is clear, declaring climate change “the defining issue” for this century. The WHO’s director-general, Dr Margaret Chan, has described it as “the fifth horseman” of the apocalypse, a new threat riding across the public health landscape.
The health risks posed for Australia have been catalogued by the Climate and Health Alliance (CAHA), a coalition of health and social policy groups that has developed a framework for a national strategy on climate, health and wellbeing in the absence of government or departmental leadership.
At the top of the list of risks are increasing frequency and ferocity of extreme weather events such as heatwaves, floods and storms such as cyclone Debbie. A warmer climate and changing rainfall patterns will increase the range and prevalence of food, water and vector-borne diseases. The evidence also warns of mental health impacts, worsening allergies and asthma, disrupted food and water supplies, and health issues for people who work in the outdoors or respond to escalating disasters.
Groups such as CAHA say a big struggle on climate change has been to persuade people that it’s not just an environmental issue, and that the health urgency is personal and immediate.
That’s where Dr Bastian Seidel sees a role for GPs as “climate witnesses”. Seidel moved to Tasmania a decade ago from Germany and was recently elected president of the Royal Australian College of General Practitioners, Australia’s largest medical organisation.
He says not a day goes by in his rural Huon Valley practice that he doesn’t hear about a climate change impact for his patients. Seasons are now pretty much unpredictable. He sees cherry farmers struggling to get crops out at Christmas, graziers dealing with prolonged drought, salmon producers worried about unseasonably hot weather. Hayfever cases now seem to go all year round.
The trouble is, he says, that not enough questions are being asked – by politicians, the media, public service, and also the medical profession – about what is causing these shifts and what health services need to do about them.
Seidel points to the recent thunderstorm asthma outbreak in Victoria that resulted in nine deaths and overwhelmed services – Victoria’s health minister Jill Hennessy likened it to 150 bombs going off in different places at once. While the government’s report into the event briefly acknowledges the influence of climate change on key conditions, Seidel says there was barely any scrutiny of its role.
“It looks like climate change has almost become the Voldemort of health impact research and policy – it shall not be named,” he says.
Seidel says GPs have to be bold enough to nominate climate change as a cause of illness and to campaign to have health policies “blueprinted” against climate change effects.
A priority example, he says, is the federal government’s Closing the Gap report. While many Aboriginal and Torres Strait Islander people and communities are at heightened risk from climate change, he says the term is only mentioned once in the 2017 report – in reference to the number of Indigenous employees at the Climate Change Authority.
While others may still shy away from the debate, Simon Judkins sees speaking out on climate change as a growing professional responsibility based on two core principles of healthcare: that prevention is better than cure, and that doctors have a duty of care for patients such as Ruby and others most immediately susceptible to climate change effects.
“Obviously there is the science to support, and we are scientists,” he said. “But we also need to advocate for the people we look after. The people who are going to be most affected by climate change are those who need a very robust public health system and GP support system because they can’t buy their way out of this. We do have a voice that is hopefully respected and I don’t think we use that voice enough in this space.”