Doctors and climate change: “you played at rapid sequence induction while my world burned”

I felt totally out of place in the Auckland Medical School student cafeteria amid the carefree faces, understated T shirts, and faded jeans. I had just arrived back from two years’ volunteering at Mother Teresa’s Home for the Dying in Kolkata and teaching during apartheid in South Africa, and I thought I couldn’t last long, certainly not five years. A young woman in a gaudy salwaar-kameez radiated non-conformity. I headed over. “Hi! What are you doing here?” I said.

We randomly pieced our lives together, drifting from my upbringing as a swotty kid in an Indian immigrant family in suburban Auckland, to hers as a kiwi in India and Nepal, diverting ourselves into a eulogy to Kolkata’s Lower Circular Road and its functional chaos, laughing about quirky rituals from my Cambridge undergraduate years, and yearning dreamily of summiting romantic South Island peaks like Aspiring and Stargazer.

Recognising in each other companions similarly attracted to the beautiful, violent, ugly, delightful, unjust, exciting world, we haphazardly lashed together a little life raft from these stories, aspirations, and values. Medical school began to feel safer, merely a survivable interlude.

“Developing world doctors then,” she concluded. “Preferably rural, ideally in the mountains . . . perhaps a Himalayan village. It’ll be a trip!”

Twenty five years on and we’re still negotiating the turbulent waters between global health and Western medicine. We started with electives in Amazonia and the Himalayas; house surgeon jobs in small town New Zealand; then public health and emergency medicine, strategically chosen to give us the skills needed in the developing world. After graduating, our first step out of the mainstream was to live in a Cambodian slum, and then we ran a Médecins Sans Frontières community malaria programme in guerrilla filled Colombian jungles.

We’ve worked on both sides of the world’s resource-need mismatch: as well paid locums in quiet rural hospitals and in voluntary community health in the trans-Himalaya. We’ve picked up New Zealanders by helicopter and we’ve sent Indian villagers away without lifesaving tuberculosis drugs. The disparity was inescapable for me as an expedition doctor for wealthy clients on Everest, but slightly subtler when we were awarded NZ$100 000 (£50 000, €61 000, $83 000) for a public health initiative to get New Zealand’s kids exercising. Despite the ethical dilemma, a funded “inspirational” expedition traversing the Mekong was irresistible.

We’ve gathered qualifications and learned skills along our way (for example, spinal anaesthesia, hysterectomies, caesareans, fasciotomies, recognising the myriad faces of tuberculosis)—and we’ve knocked off some of those South Island mountains.

At first my Hindi lexicon rippled with words like kaleja (liver) and dusth (diarrhoea), but I don’t see patients now, don’t insert chest drains, and don’t intubate. I’ve relinquished the stethoscope, learning instead another kind of auscultation. When I facilitate village meetings I try to elicit signs of community wellbeing, listening now, as I once did for murmurs, for words like samudai (community), lachilapan (resilience), and hasiya (marginalised).

In emergency medicine I faced technical challenges but conceptually simple problems (for example, a feverish kid with purpuric rash equals spinal fluid out, ceftriaxone in—quickly). But for a febrile world no standard procedures exist: climate change is socially and scientifically complex and morally nuanced. I survey parched fields alongside squinting farmers for whom diligent pujas (prayer) and assiduous tilling yield only frustration, and I sit on dirt floors while women tell me that their children migrated after consecutive floods, unable to say that it was my carbon that dragged their daughters into the Delhi sex trade.

Community based adaptation aims to facilitate grassroots responses to stresses on village livelihoods. Helping poor people find ways to drag themselves out of climate induced stress seems insignificant, but maybe, alongside others, my contribution can make a difference. At least my 13 year old can’t say when she’s 20, “You played at rapid sequence induction while my world burned.”

What is community? Why does equality matter? Is sustainable development possible? Does any man’s death diminish me? In these questions lies the answer to how seven billion people, genetically programmed for greed, can share one planet. Climate change makes the conundrum even harder, more personally entangling. In the blink of a plane flight and a cloud of carbon I move from overdeveloped New Zealand to Indian villages where children starve, from the world’s upper deck to its boiler room.

Our consumption on the top deck is supported by missile engineers, bankers, and, yes, doctors on—in global terms—obscene salaries. Meanwhile humanity’s biggest health problems lie hidden, for now, amid the grease and steam below. Rational economics, which apparently so efficiently partitions our planet’s resources, allocates almost nothing for human or environmental problems on the dingy lower decks, but dangles irresistible incentives in affluent areas with relatively minor problems. And thus ever more engine room doctors come to serve on the top deck. Their contracts come with “I won’t challenge global inequalities” clauses. Inequality, the force that drives global warming, drives this migration of human resources away from needs.

I have no answers. The interface between people and our environment is now my emergency room and my challenge as a human being. I have hope—not for an antidote specific to global warming—just irrational hope that I can contribute to changing the behaviour of an oil addicted world. Long ago the woman in the salwaar-kameez predicted a trip; we’re on an odyssey.