RAB 2023 - 24
Theme A: Climate justice in primary care Theme B: Complexity and generalism in primary careBreathless in a polluted world
As the cars roar loudly near my abode,
The thousands of them, on the motorway road,
I cough, splutter, panic, I scream out a wheeze,
I thought, “not again”, and suddenly, I could not breathe,
My mother ran towards me, screaming for assistance,
Next thing I know, I am fighting for my existence,
It lasted for minutes, but it felt like forever,
Why me, why can’t it be never,
But I knew it was where we lived, near the poisonous air,
We could not afford to move, it is simply unfair,
I wonder why we focus more, on the plastic straw,
Rather than the companies, who seem to be above the law,
The world leaders, as they slumber in their palaces,
Whilst my family works all day, for pennies, and calluses,
All those promises they make, they seem so empty,
Words with no meaning, they say so plenty,
I am enraged and exhausted, anxious and upset,
When those in power are flying again, with their private jet,
I worry for myself, I worry for my generation,
They deserve to know, all of our condemnation,
The floods, the hurricanes, the droughts, and cyclones,
They take so much away from us, leaving us with bones,
We call them natural disasters, but what is so natural about them,
Like the smog that surrounds me, as I battle my stubborn phlegm,
I could have been bones, but I am still here today,
It was that time again to go to the doctors, I had a lot to say,
I went to the GP, with tears in my eyes,
They must have saw my notes, they looked at me without surprise,
They let me rant and cry, they let me wail and shout,
I was aggrieved with the world, I had to let it all out,
I asked the doctor, will it happen once more,
As they were sorting my prescription, asking my closest store,
They tried to reassure me, but they could not guarantee,
Even they had no power, over our warmer land and sea,
Over the skies infested with dirty, dangerous gas,
We both want a cleaner world, but alas,
What will it take, for those in power to take action,
How many of us must perish, for their reaction,
No appointment or medication, can fully prevent another attack,
It is up to the richest, to put us on the right track,
We cannot do it all, our recycling bins have no meaning,
Unless corporations do the same, we need to convince them, for their intervening.
Breathless in a polluted world: Cian Patel
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The poem I created was to give the reader a first-person perspective of an asthma patient who lives close to a motorway and developed a severe asthma attack because of it. It recounts their thoughts and experiences of being exposed to excessive greenhouse gas, climate change as a whole, as well as highlighting the reality of the limitations of clinical medicine in primary care. My piece was primarily brought about by my recollections of the story of Ella Adoo-Kissi-Debrah, who lived in an area close to a major busy road in South London. She tragically died aged 9, and there was a ruling that stipulated air pollution as ‘a major causal factor’ in her death [1]. Ella’s death and the area she lived in I feel illuminates the wider socioeconomic inequalities those who live near busy roads in inner city regions may face, with many of those in inner cities being working class. I attempted to encapsulate this in my poem, as it refers to a young person whose family cannot afford to move from their home near the motorway. Additionally, although my poem depicts an extreme case, pollution is well-documented as a risk for asthma attacks [2].
Although I had some prior knowledge of this, it was shocking to hear the level of carbon dioxide emissions related to major corporations. Shockingly, just 57 companies involved in making fossil fuels ‘are directly linked to 80% of’ these emissions from 2016 to April 2024 [3]. I incorporated this in my poem, writing about the frustrations of the personification I concocted, where they relate the contributions of large businesses to their misfortune of having an asthma attack. This also angers myself, since I feel that climate change has such a huge impact on us all, whether that is via our health and wellbeing, or the overall ramifications it has on the planet. Although I believe we all have a role in the betterment of the Earth, there are many factors, including leadership and big businesses, that have a greater impact than just individual actions.
Despite the barriers we as individuals face in driving change, I do believe that primary care does have a role in climate justice. Climate change does affect patients’ health and wellbeing, sometimes on extreme levels. Patients, especially those who have worser outcomes due to social and economic circumstances, are becoming increasingly affected by man-made actions on the planet. Apart from pollution, I also mentioned about extreme weather events in the poem, which itself can be catastrophic for the healthcare of patients. This can extend onto those delivering healthcare, where on an individual level can be the wellness of an individual healthcare professional, including GPs, and to the wider system, where in the worst of cases, the destruction of hospitals, general practices and other centres from natural disasters that damage both access to, and delivery of healthcare.
The purpose of the first-person point of view was to convey the struggles individual patients may face due to pollution. In the GP setting, it is necessary to be able to empathise with patients. I feel that even though patients may have specific needs, in all cases, patients want someone to listen to them and to take them seriously, even if the GP is unable to help them directly at that moment in time. In the poem, I made sure to include this element as well, with the doctor not being able to provide full reassurance that the patient would never face another asthma attack.
A GP appointment usually lasts just a mere ten minutes, but a patient’s life is mostly outside the GP room, where they will be facing various challenges, including climate change. These are changes that GPs cannot do in the appointment setting, but I feel should be able to advocate for this outside. Unfortunately, I heard of a recent story of a former GP, Dr. Benn, having ‘had her medical licence suspended for five months’. She was part of a Just Stop Oil protest and conveyed that she wanted to ‘take action to protect life and health’ [4]. With vast evidence of climate change and worsening health, I personally found this decision concerning, as public health forms a large basis of current policy and decision making. From reflections during my time in a conference I attended as part of my medical educator elective, known as the GP educator day, I remember one of the speakers emphasising about presenting evidence to the government that can help drive change. This may be a direction that could be done in a collaborative way by many GPs and other healthcare professionals in relation to climate change and pollution. Raising the concerns for environmental issues and linking them to patient outcomes I feel will become more vital than ever if we are to both treat and prevent poor health outcomes for patients.
References
1. Marshall C. Air pollution death ruling: What comes next? BBC News [Internet]. 2020 Dec 17 [cited 2024 May 10]; Available from: https://www.bbc.co.uk/news/science-environment-55352247
2. NHS. Causes - Asthma [Internet]. NHS. 2019 [cited 2024 May 11]. Available from: https://www.nhs.uk/conditions/asthma/causes/
3. Watts J. Just 57 companies linked to 80% of greenhouse gas emissions since 2016. The Guardian [Internet]. 2024 Apr 3 [cited 2024 May 11]; Available from: https://www.theguardian.com/environment/2024/apr/04/just-57-companies-linked-to-80-of-greenhouse-gas-emissions-since-2016
4. Lawson E. Just Stop Oil doctor suspended for five months [Internet]. BBC News. 2024 [cited 2024 May 15]. Available from: https://www.bbc.co.uk/news/articles/c6pygw71w3go